If you like your health insurance, you can ... um ...

Great Debates
1

Well, it’s been slightly over a year since the official launch of Affordable Care Act, better known as Obamacare. In April, liberals from the President on downwards crowed about the 8 million people who had enrolled in plans on the exchanges. Then in September we learned that the 8 million figure was untrue, and that the real figure was 7.3 million. Then in November we learned that the 7.3 million figure was also untrue, and that the real figure was 6.97 million. And since then, Obama and his friends have been crowing quite a bit less about the numbers. Meanwhile the government has also tried to lower expectations for how many people will be enrolled during 2015.

That wasn’t the only news to hit the presses during in the past year. There was also this funny fact. Originally we were supposed to be able to shop for insurance for the 2015 year starting in October of 2014. The administration then changed its mind and decided that we shouldn’t be allowed to purchase insurance, or even see the prices being offered, until November 15. This new date was conveniently located after the midterm elections, and a few cynics suggested this may not have been a coincidence. The President knew that once people saw the prices on the exchanges, they weren’t going to experience good feelings towards the Democrats.

Turns out he has reason to worry. Premiums were going up. Some supporters of the law tried to describe the increases as small. That’s relative, of course, an increase of 6% may sound small to some, but for a family that pays $10,000 for insurance it equals $600, which could be brutal for some folks. Moreover the price increases are highly uneven. In some states, premiums have actually fallen a bit. In other states, they’re rising much faster than average.

But at least those purchasing insurance on the exchanges have generous federal subsidies to assist them, right? Well, about that: because of the way that subsidies are calculated, most people may find themselves receiving a smaller subsidy this year than they did last year, even as prices rise.

Meanwhile, we shouldn’t think that only those in the individual market are facing trouble. For those who get their insurance through their employer, deductibles are soaring. It’s particularly bad for those employed by small businesses.

Given all that, it’s probably not too surprising that public support for the law is at an all-time low. It’s probably also not too surprising that in the last election, the Republicans mentioned the ACA constantly while Democrats mostly tried to avoid mentioning it at all. It’s probably also not too surprising that a large percentage of voters think that health care is a “very important” topic. Given all that, simply insisting that the ACA is working probably won’t be a winning strategy for the Democrats going forward. Instead they’ll need to acknowledge that the problems voters have with the law are real.

2

Still don’t have any better ideas on how to increase health care coverage, huh?

3

Ravenman, your post does not appear to offer anything substantial in response to my OP. I’ve started other threads about how we might increase insurance coverage or lower costs, such as allowing everyone to purchase catastrophic coverage or making more drugs available over-the-counter. Right now, however, the ACA governs the entire health care industry, so any realistic discussion has to begin with how we address the problems created by the ACA.

4

I think even the most die-hard supporters have acknowledged since day 1 that this thing’s going to need tweaking, fixing and improving. Unfortunately, there’s a vocal population in Congress unwilling to do any-fucking-thing besides choke out the word “Repeal” over and over and over. No tweak. No fix. No improvement. Just repeal. Repeal. Re-fucking-peal.

So what is it you want to discuss now that hasn’t already been discussed ad nauseum for five-plus years?

5

IIRC, Obama himself used the word ‘tweaking’ when describing the changes that needed to be made. I recall in one of his speeches he said it wasn’t perfect and that it would require some tweaking. He needed to hear what was wrong and that they would keep fixing it.
I mean, they’re building it from the ground up. It just plain didn’t exist not that long ago, you can’t expect it to be 100% perfect right off the bat.

I thought it was funny when everyone jumped down Obama’s throat that first day when the servers crashed. Yup, let’s cancel the whole thing because the servers can’t handle millions of people trying to sign up at the same time. Also, everyone should throw out their XBoxes and Playstations too since literally the same thing happens every Christmas morning.

6

It doesn’t govern my heath insurance. As a fed, my health insurance is governed by FEHB. Many say had ACA been modeled after FEHB it would have been a better plan.

7

ITR, what is your position? All you’ve done is list a bunch of problem with the ACA. Do you want it repealed?

8

I think what ITR is trying to say is that we should work towards a universal single payer system like most of the rest of the civilized world. Maybe we should even extend it to illegals since, yanno, they are human and get sick too. Then we’d achieve the twin aims of functionality and morality, where the ACA is merely moral and sort of functional.

9

Ah, very well; I agree with him 100%.

10

Well, there have been a number of tweaks made already. Yet as we see, the law remains quite unpopular with the American people. Perhaps the tweaks themselves need to be tweaked.

11

Largely at the implementation level, not at its core. The Republicans wouldn’t allow any real fixes to take place because that would mean helping the devil.

And now the very people who want it repealed are suing the president because they can’t actually repeal it, so they are trying to force him to implement it faster, despite their hatred of it.

You can’t make this shit up. There’s nothing to discuss that hasn’t been already discussed. But I don’t think you really started this thread to debate anything new, but rather itemize ways the law isn’t working properly and show that public opinion of it is low. Everyone already knows this, supporters and opponents alike.

So the questions should be: What are Republicans going to actually do about it now that they’re in control of Congress? I don’t mean lawsuits and meaningless votes to repeal. I mean what are they going to do to actually improve healthcare in America?

RESOLVED: Republicans in Congress and in statehouses across the US of A will do nothing, besides file lawsuits and take meaningless votes to repeal, the financial well-being and health of millions of human beings be damned.

12

Hi, ITR champion! One reason that annual rises in health premiums are still at about the same levels as they were pre-ACA is the lack of the individual mandate. Do you understand why that mandate would lower premiums? Do you support faster adoption of that rule?

Perhaps you have the same keyboard problem I have where typing is lost during some Windo$e alerts. I proofread and go back and restore the deleted keystrokes. In this case your “GOP-led sabotage of” got eaten between "“by” and “the ACA”.

I don’t see a smiley-face here. Is this really what you’re trying to say, ITR ?

13

Fwiw, ‘tweaking’ the NHS is a never ending process. It’s been tweaked every year by every Gov since 1948 - that’s how you find improvements (you measure the change, right?). Healthcare is never a finished deal and is generally two steps forward, one step back.

Tweaking is how you get to sub 10% GDP with entire population coverage.

What else does the OP think you do?

14

So, what changes do you think are necessary to achieve the enrollment projections that you criticized in the first paragraph of your OP?

15

The OP falsely states that the 8 million number was “untrue.” From the OP’s own source, a Politico article entitled “7.3 million in Obamacare plans, beats CBO forecast”: “The figure — which is the number who had signed up and paid as of mid-August — is a drop from the 8 million who had chosen plans but not necessarily paid by mid-April.”

From the Christian Science Monitor article that the OP links to: “After all, 6.97 million for first-year enrollment is pretty much 7 million if you round up, as most analysts would have. Also, the CBO had actually lowered its enrollment projection to 6 million because of the problems encountered by HealthCare.gov in its opening weeks, according to Charles Gaba, a writer who closely follows Obamacare enrollment at his ACASignups.net blog.

Furthermore, it would have represented a perfectly reasonable attrition rate, says Mr. Gaba. “On a policy effectiveness level, this means … not much at all,” he writes.”

In summary, from the source material provided by the OP, the OP makes false statements about the fact that Obamacare enrollment did exceed 8 million, and then dramatically overstates the implications of the difference between the enrollment number of 6.97 million versus the number of health care plus the number of dental-only enrollment. Again, as the CS Monitor stated, the actual enrollment numbers represent a “perfectly reasonable attrition rate”, and this issue “means not much at all.”

Why does the OP offer such an overblown and misrepresentative perspective on his own cites? He appears to play fast and loose with the facts.

16

Question - is a 5% average price increase on health care plans abnormal? In fact, to quote this guy:

[QUOTE=Rick Ungar]
When was the last time we saw insurance premiums experience an annual increase of less than 5 percent? I cannot remember such a time and doubt that you can either.
[/QUOTE]

Huh. Now, maybe I’m just reading into things, but the implication I’m getting from the OP is that this 5% figure is supposed to be a lot. Like, something we should worry about. That seems, to put it nicely, a little bit disingenuous. In fact, from 1999 to 2009, health care premiums went up 131%. That’s an average of 13% per year, for those who have trouble with math. That’s… quite a bit more than 5%. Like, more than double. Closer to triple, really, if you want to be stingy about it. Why would the president be worried about premium increases that are 2.6 times less than the 10-year average over the period before he got elected? Answer: because right-wing hucksters are playing up that 5% as though it was the end of the fucking world, and as if health care costs were perfectly stablebefore Obamacare came along. Hell, even your own cite admits, further down, “Double-digit premium increases were common for people buying their own insurance before the passage of President Barack Obama’s health care law.” Why paint this 5% rise as some huge deal?

Beyond that, yeah, basically what everyone else said. The ACA isn’t perfect, and the president himself made it clear that it needed tweaking and fixing. But we can’t do that, can we? Not when republicans are completely unwilling to even consider anything that doesn’t come down to “repeal” or “destroy”.

17

6-7 or 8 million insured is a lot of people. This is a good thing. In the past, these folks just neglected their health issues until it became an expensive crisis and then you and I (the insured) subsidized the cost of their care through our higher premiums.

I live in a city of about 3 million. That is a lot of people.

I have private insurance through my employer. My rates went down this year. I also had my private insurance refuse to pay some of my medical bills this year.

I have two family members who have health insurance for the first time in many years thanks to "Obamacare.’ They and I are greatly relieved that they have insurance now and can make some progress toward their chronic and long-standing health issues that they were unable to address in the past. Both complained that their rates went up a bit this year, but insurance rates have risen every year since forever for everyone, and they groused but paid.

I don’t see your complaint that rates weren’t available until November as a ‘real’ complaint. This is how it is done everywhere. My company starts its annual enrollment in November, too.

I’ve seen a couple of interesting things at work this year (I’m a nurse).

For example, even though I’m in Texas and we did not accept the Medicaid expansion, I have seen a large increase in the number of Medicaid covered patients at work. We have been so busy that our unit has been completely full and we have had patients wait-listed to get a room on a couple of occasions this fall. I’ve been at my job almost 20 years and have never seen that before. This has been a boon to many hospital staff as the company has been paying bonuses to staff to pick up extra shifts. But, to me, the real boon is to our patients who may not have been able to get care. I’m glad they can come in.

And, in my field, Medicaid is often awesome insurance. For example, If I life-flight or ground transport a woman from far away and she has her baby prematurely, Medicaid will put her up in a local hotel and give her 3 meal vouchers a day so she can be near her baby. Your private insurance would never pay for something like that. You might think this is unnecessary or unnecessarily expensive, but there are many very good reasons why we need this mom nearby.

Another thing I have seen this year is the dreaded ‘anchor baby’ issue. These foreign women contract with various hospitals or birthing centers (but not my facility- we only get these patients when things go wrong at the place they have contracted with) and they get some incredible rates to deliver at these places- $3500 for a vaginal delivery (that also includes a week at the extended stay hotel up the street) or $5500 for a c/s. There are usually some additional expenses.

It is not illegal to have your baby here and many choose to do so to gain dual citizenship for their children even though this gamble takes about 20+ years to pay off if it pays off at all.

Most countries require these women to prove ‘ties’ to their home country- jobs, family, banking, etc. If they plan to deliver here, they must show their contract and proof that they have the money to pay the contract. The thing most don’t plan for is the complications and complications in child birth can become very expensive very quickly.

The babies will get Medicaid because they are citizens. If the mothers take Medicaid to pay their bills and become a ‘burden’ to the US taxpayer, then they can then never reenter the US once they leave. That means that if their children do decide to claim their US citizenship 20 years from now, the mom will not benefit- she cannot visit or have her potential US citizen child gain citizenship for her.

The real health insurance question here is the cost. How can our facilities offer a cash price of $3500 for a vaginal delivery when the usual charge to a private insurance company is about $30,000? My facility recently offered a cash paying patient an 86% (you read that right- 86%) discount. Would your private insurance go to bat for you and get that rate? Absolutely not because your rate also includes huge profits and enough to cover all those uninsured.

I had a minor surgery on my finger last March or so. I had 4 stitches and the surgeon billed my insurance $20,800. Insurance ‘allowed’ $8,000. The true value of my surgery was probably more like $800.

And that’s where the real disparity is- the unevenness of the system.

My insurance cost about $18,000 a year and I can’t get a $2000 bill covered, but I am paying for hotels and deep discounts for others.

18

…expect Democrats to try desperately to change the subject whenever the matter comes up.

Fortunately, the tactic did not win them the last election, so they will have to try something else or remain irrelevant to the national discussion.

Regards,
Shodan

19

Case closed.

20

I agree with Shodan here! Where Democrats campaigned by trying to change the subject away from the successes of Obamacare, they lost. They will need to try a different strategy next time. Perhaps they will learn to tout their successes in domestic policy (like Obamacare), in regards to the economy, and in terms of foreign policy instead of changing the subject.

However, I disagree with Shodan that there’s much risk of them becoming irrelevant to the national discussion. As of the moment, they are quite likely to win the next presidental election, and their congressional electoral map is quite favorable.