What is your ongoing opinion of the Affordable Care Act? (Title Edited)

[Typo_Knig]

@adaher

No insurance means you still have emergency room access. Medicaid has to do better than that, and by everything I’ve seen, it does not. Ever seen a lobby at a doctors’ office where they take Medicaid?

ER care has been discussed extensively, please try to keep up. It is the most expensive health care delivery method. It is hideously inefficient. It is ineffective for chronic conditions. You want patients to manage diabetes, asthma, high blood pressure, etc. well enough so they avoid ER visits. That means regular visits to a doctor’s office, plus appropriate medications, monitoring, rehab, an other treatments that are not emergencies.

When candidate Mitt Romney made the same argument, he was roundly criticized for speaking an untruth. One of the people who provided rebuttals was Governor Mitt Romney - back when he was advocating the Massachusetts health plan.

adaher your statements show more about your acceptance of discredited criticisms of PPACA than about the law itself, its implementation, or the reality of health care delivery in the US in 2013.

[GIGObuster]

@adaher

I recognize that Medicaid in theory should be better and might even be better health care delivery than having no insurance. But it’s not so much better that it indisputably improves health outcomes.

No evidence for that, and I already cited the Families USA report that cites the CBO extensively. About what happens when many people do not have insurance.

@adaher

For an investment costing in the hundreds of billions of dollars, don’t the taxpayers deserve evidence that it actually accomplishes something?

Yeah, tell the one that has many old relatives and knows many poor families that my eyes are lying to me. It does accomplish a lot.

[elfkin477]

@Fear_Itself

The Biggest Study Yet of Obamacare Premiums Indicates Insurance Will Be Cheaper Than Expected
An Early Look at Premiums and Insurer Participation in Health Insurance Marketplaces, 2014 [Kaiser Family Foundation study]

Or, you know, they could increase by an average of 24%.

[GIGObuster]

@elfkin477

Or, you know, they could increase by an average of 24%.

Or, they could then get so much “helpful” feedback that the maker of the article had to do a few butt covering updates so far.

UPDATE 1: After we published our map, the office of Gov. Paul LePage (R., Maine) reached out to us to correct our pre-ACA Maine data. It turns out that a number of significant reforms enacted by the Maine legislature from 2011 to 2013 drove down the price of individually-purchased health insurance in Maine. The results of those reforms started to show up on the Maine insurance market on July 1; our examination of Maine pre-ACA rates had taken place in late June. The updated results, which we independently verified, are incorporated into the interactive map.

These changes have had a significant, albeit temporary, effect on the Maine insurance market; previously, the average price of a Maine individual-market policy was $1,228 a month; today, it’s only $316 a month: a 74 percent drop. Obamacare drives the average back up to $366 a month; the average rate increase is 14 percent. I will examine Maine’s 2011-13 reforms in a separate article.

2011-2013, uh, it is like if the politicians in Maine were reacting to the 2010 law and they wanted to be ready.

What I do see is a huge point being missed by Forbes, no matter how you cut it, that 74 percent difference is a demonstration of how inefficient the previous system was/is to prevent specially job lock.

And simple logic should tell you that a lot of jobs never existed thanks to many individuals that saw the numbers and decided not to go to business on their own. In other policies the extra expense also means that many companies (specially small ones) are not hiring a few more employees not because of Obamacare, but because the already insane health care cost for each employee means that a few workers that could had been hired before are not because of the irrational cost that very little competition has gotten us in the current system.

[NonaSequitur]

We’ll have to wait a bit to before we can declare whether the ACA is a success or not. I’m not too optimistic. But I hope to be proven wrong.

However, I’d like to pass on a good Columbia Journalism Review post on the logistics of signing up for insurance through the exchanges. The article is geared towards journalists, but there’s some good stuff for the average consumer.link

For starters, it’s best to think of buying insurance in the exchanges as a four-step process that includes several key decision points. Forget all that extraneous stuff that is the focus of too many stories—the politics of Obamacare, the prognostications about premiums, the latest academic study. Audiences care little about that as they face the daunting challenge of selecting coverage.

STEP 1 The health insurance buying cycle: A good way to think about shopping for exchange coverage, Benjamin suggests, is a cycle with four phases.

Initial enrollment. From October 1 though the end of March 2014, the 24 or so million Americans eligible for exchange coverage can sign up online at HealthCare.gov or with the help of specially trained navigators. That includes people already in the individual market and those who are newcomers. Those who have employer coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan are not eligible. People who are sick and have lots of preexisting conditions will be able to get coverage in the exchanges, and that is a pretty big deal for those now shut out of the insurance market. When first enrolling, consumers will need household information, residency status, employment information, and, of course, income details, which will determine eligibility for subsidies to help pay premiums that for many families will not be cheap.

Mid-year enrollment changes. Families change, incomes go up or down, people move, eligibility for subsidies comes and goes. Although the law says there is only one open enrollment period each year, insurance companies and states may allow special enrollment periods for certain qualifying events. Failing to sign up for insurance during open enrollment, later getting sick, and then needing insurance is not one of them. Someone taking this risk is out of luck until the next open enrollment period, which may be months away. Beginning in 2015, open enrollment will start October 1 and end December 31.

Reconciling with Uncle Sam. Just because at sign-up time the computer spits out a number—the subsidy you are entitled to when you present information about your income—doesn’t mean that’s the subsidy you’ll eventually get for the year. If your income goes up during the year, the subsidy you’ve received might be too much, and you’ll have to repay it in your tax bill—in effect, turning the subsidy into a loan. It works the other way, too. If your income decreases, you might find yourself with a welcome tax credit. Of course, this could mean disputes with the IRS. The reason for all this: the infamous clawback provision. Soon after Obamacare became law, the business community complained mightily about some tax reporting requirements intended to raise about $22 million to help finance the subsidies. Congress let businesses off the hook, but needed a way to restore the lost revenue, and they got it from people—you guessed it—who buy in the exchanges.

Subsequent open enrollment periods—or, starting all over again. Insurers usually write coverage for one year. Don’t be surprised, though, if at the time of the next open enrollment you need to change insurers. The one selected this year may no longer be selling in your area a year from now, or some new companies may be sitting it out for this first go-around (many of the big household names in the business are) and will suddenly decide they can make money in this market after all. Or your income could change, meaning your subsidy might be higher or lower. Maybe you’ll want a plan that has a larger selection of docs. Or, maybe your current providers will drop out of the network or be dropped by insurers. In other words, getting and staying covered will hardly be a straightforward affair. There’s nothing seamless about obtaining insurance.

STEP 2 The mechanics: You’ll need an email account to make the process work, and navigators can help people without accounts create one. Next comes a lot of fill-in-the blank stuff—household information, residency, immigration status, and household income. Government computers verify the information and let customers know whether they are eligible for exchange coverage or for public insurance like Medicaid. Some states will allow people to sign up for Medicaid through the exchange; others will send them to state or local Medicaid offices. People with employer-provided insurance may still need to visit the exchange to see if they’re eligible for exchange coverage (they may be, if their share of the premium for employer coverage is more than 9.5 percent of their income).

[Anise]

I am paying insane prices every month for a horrible policy that covers virtually nothing and has literally NO PROVIDER AT ALL in their network in this state. The deductible is $10,000. I had no other options because of a “pre-existing condition” that predated getting the policy. This act is the difference between making it and not making it for me.

If everyone had to get their own individual health insurance instead of being lucky enough to get it through an employer, every single complaint about this health care act would instantly stop. Nobody knows what hell it is until they’ve had to do it. And literally 50% of the population has what insurance companies consider a “pre-existing condition”, including nearly 25% of all 18-34 year olds. It doesn’t take much.) In my worst moments, I just want to wish that on everyone who complains. But I can’t. I can’t really hope that my worst enemy could ever be in the position I’ve been in.

I know people who have had it much worse than I have. I knew a couple who lost everything they had ever worked for because the husband got sick and had no health insurance… they had been college professors, and they were headed for being homeless the last I heard.
It’s all an academic armchair argument until you’ve had to fight the insurance companies trying to casually destroy your life. And then you know.

[adaher]

I agree that the law is a huge help to people like you. the problem is that the law was sold to the public as helping each and every one of them, not as compassion for our neighbor. The president appealed to our self-interest rather than our generosity.

[jasg]

@adaher

I agree that the law is a huge help to people like you. the problem is that the law was sold to the public as helping each and every one of them, not as compassion for our neighbor. The president appealed to our self-interest rather than our generosity.

Any of us could be in Aniise’s shoes in an eyeblink.

[Fear_Itself]

Don’t you think laws should be repealed through the constitutional legislative process, rather than coercion by the minority that will damage the economy and hurt millions of people? If attaching amendments to a continuing resolution to keep the government from shutting down is appropriate, how should House Republicans respond if the Senate attached an amendment for a federal assault weapons ban, or repeal of the Bush tax cuts? Is that how we makes laws now, through coercion not compromise?

[adaher]

@jasg

Any of us could be in Aniise’s shoes in an eyeblink.

Absolutely. That would be an honest way to sell the law. A dishonest way to sell the law would be to claim that everyone will benefit regardless of their situation.

So what happens now is that since people were promised that the law would make insurance cheaper for them, theyll be less likely to participate if that’s not true. the law wasn’t sold as charity, so citizens aren’t going to see it as their responsibility to participate if it’s not in their self-interest.

[GIGObuster]

@adaher

Absolutely. That would be an honest way to sell the law. A dishonest way to sell the law would be to claim that everyone will benefit regardless of their situation.

Having more freedom to start your own business and to find mechanisms to reduce prices with more competition does benefit all.

@adaher

So what happens now is that since people were promised that the law would make insurance cheaper for them, theyll be less likely to participate if that’s not true. the law wasn’t sold as charity, so citizens aren’t going to see it as their responsibility to participate if it’s not in their self-interest.

As Massachusetts showed, the FUD reported so far is really silly.

[ZebraShaSha]

I mean, anecdotes can be done to death. I’m a vegan, straight edge, non-smoking 25 year old in the prime of my health. I looked into healthcare about a year ago and could only find a $5k deductible for $120/month. Being underemployed (despite a degree and several speciality skills), I decided to simply take my chances, and maybe wait for Obamacare.

Over the weekend, I developed some gastrointestinal illness which showed all the signs of appendicitis, including a sharp pain in my lower right abdomen - you know, the One Thing you don’t want to fuck with, because if it ruptures, you’re fucked. So I waited, and waited, and tried sleeping it off, but decided to just bite the bullet and go to the ER. I’d figure out how to pay for it later, or something.

After 4 hours in the ER – which came out to $2.3K – they determined my appendix was fine. And released me. I’m still in pain, still have the symptoms, but hey, clean appendix!

The kicker is that if you look back at the insurance policy I could have enrolled in, with the $5k deductible, I’d still be on the hook for the $2.3K, but I’d have sunk $1.2k in a policy for a year I couldn’t really use.

…

My solution? Move to Europe, until America gets single payer. I’ve watched in my own (working class) family how time and again the healthcare system fucked us. My dad is a delivery driver for a major company, but through an interesting corporate trick he’s a “contracted service” aka self-employed. My mom is a decorated, dedicated elementary school teacher and she’s in one of the few states without a teacher’s union and her healthcare sucks. So in their mid-60s, I’ve seen both of them have teeth rot out of their faces, and all sorts of crazy shit go untreated, and crazy stuff like my dad needing a hip-replacement (remember, he delivers packages for a living) for over a year but without the money, choosing to, er, walk it off.

In short, fuck this country.

[Gyrate]

@adaher

Absolutely. That would be an honest way to sell the law. A dishonest way to sell the law would be to claim that everyone will benefit regardless of their situation.

The fact that it mitigates the problems that arise should that “eyeblink” occur means that it benefits everyone.

If you thought that people were saying that Obama would be going around handing out lollipops to everyone today, you need to recalibrate your strawman.

[adaher]

That’s not the benefit he sold to us. He said it would help each of us directly, not society. We would all see our rates go down. None of us would lose our insurance, and we’d all get to keep our doctor.

This sales job was intentional, because even appealing directly to our self-interest wasn’t enough. Appealing to the interest of our selves that might be if we are unfortunate probably focus grouped very poorly.

[Bridget_Burke]

@adaher

…Appealing to the interest of our selves that might be if we are unfortunate probably focus grouped very poorly.

Boy, that’s some tortured syntax.

I’ve got quite good insurance where I work; it’s not going to change, since BCBS doesn’t want to go out of business. But I know quite well what no insurance (or crap insurance) can do to people. Obamacare is far from perfect but it’s a start.

It’s starting today–a guy from my local CBS station was visiting a lady ready to log in & get insurance first thing. A self-employed African-American lady, she was glad to show him all the information at the website.

Meanwhile, the dog-in-the-manger, racist (or racist pandering) idiot Republicans have shut down the government & are risking the world’s economy. They’ve covered themselves in something other than glory…

This is the Election forum, isn’t it? It’s a bad day for the Republicans.

[Gyrate]

@adaher

Appealing to the interest of our selves that might be if we are unfortunate probably focus grouped very poorly.

@Bridget_Burke

Boy, that’s some tortured syntax.

It took me a few times but I’m grudgingly impressed that that sentence actually scans at all.

Parsing aside, it does speak to the “temporarily embarrassed millionaires” mindset of many Americans. We do tend to think that the worst can never happen to us, and that one day we’ll be part of the 1% if only we wait long enough.

Which says nothing at all about whether Obamacare will benefit everyone. In fact, it looks like the goalposts have moved from “It won’t benefit everyone” to “It may benefit everyone but everyone won’t see it that way”. Which is not surprising at all.

[Omg_a_Black_Conservative]

It’s interesting that you would mention “moving the goalposts”.

“No one will see a rise in their premiums” has now become “Some will see a rise in their premiums, but it’s for the greater good!”.

“No one will be forced to give up their preexisting coverage” has now become “Some people may be forced to give up their preexisting coverage, but it’s for the greater good!”.

“There will be no cost increase due to Obamacare” has now become “There might be a small increase in costs, but not a bad as it would have been without the law!”.

And so on and so forth.

It’s like you guys and gals have a memory span which lasts less than a year. Democrats have abandoned virtually every last argument they initially made in defense of Obamacare. But instead on relying on the facts, you rely on feel good, anecdotal evidence which “proves” the need for Obamacare. Even though it doesn’t.

Just because you stand on a train track with your eyes closed and ears plugged doesn’t mean an oncoming train won’t hit you.

[Fear_Itself]

It is interesting you conflate Obamacare canceling people’s policies with employer’s canceling people’s policies, then blaming Obamacare.

[Omg_a_Black_Conservative]

So let me make sure I understand your “argument”.

The fact that Obamacare drives the cost of some/many/most preexisting insurance plans up, in some/many/most cases making them simply unfeasible for an employer to continue to offer, is NOT the fault of Obamacare, but rather the employer who can no longer afford to offer those insurance plans because of Obamacare?

That makes zero fucking sense, dude.

[GIGObuster]

@Omg_a_Black_Conservative

So let me make sure I understand your “argument”.

The fact that Obamacare drives the cost of some/many/most preexisting insurance plans up, in some/many/most cases making them simply unfeasible for an employer to continue to offer, is NOT the fault of Obamacare, but rather the employer who can no longer afford to offer those insurance plans because of Obamacare?

That makes zero fucking sense, dude.

It is because you ignore the fact that costs were increasing, Obamacare or not.