Need help explaining the health care law

[caraher]

Some of my badly-informed acquaintances on FB are in a tizzy over the Supreme Court upholding the health care law. Among those not completely blinded by the worst RW ravings the chief concern is how the currently-uninsured with low incomes are going to afford being "forced" to pay for insurance.

A typical remark: "Makes a lot of sense doesnt it? Force people who can't afford health insurance to buy health insurance or pay a penalty. We are sooo screwed!!!!"

What would you say to the sincere low-information person worried about making ends meet who sees this as another thing they can't squeeze into an already-overstretched budget?

[donco]

1. My understanding

is that they can still get Medicaid without a penalty.

[frazzled]

2. Tell them families earning up to $88,200 will qualify for credits to help buy it

These subsidies are the biggest part of the ACA. And yet everyone ignores them. The poorer you are, the more of a subsidy you get, but even people earning up to $88K for a family of four will get some kind of subsidy.

Sliding-scale premium credits will be available to people with incomes up to 400 percent of poverty who purchase health plans through the exchanges. The credits will be tied to the silver plan and will cap premium contributions for individuals and families to about 3 percent of income at just over 133 percent of poverty ($14,404 for a single adult or $29,327 for a family of four) and gradually increase to 9.5 percent at 300 percent to 400 percent of poverty ($43,320 for a single person and $88,200 for a family of four) (Exhibit 1).

In addition, cost-sharing credits and lower annual out-of-pocket limits will limit cost-sharing for low- and middle-income individuals and families. Credits will limit cost-sharing such that the costs covered by the silver plan (70 percent of costs covered) will increase to 94 percent for those with incomes up to 150 percent of poverty, 87 percent up to 200 percent of poverty, and 73 percent up to 250 percent of poverty (Exhibit 1). In addition, out-of-pocket expenses will be capped for families earning between 100 percent and 400 percent of poverty from $1,983 for individuals and $3,967 for families up to $3,967 for individuals and $7,933 for families.


http://www.spotlightonpoverty.org/exclusivecommentary.aspx?id=ba21673c-b1ac-44b7-8f76-50e856cdb9b5

[caraher]

9. Thanks!

Good info

[Igel]

13. And that's the law's Achilles' heel.

The gamble is that the reduction in costs will at least compensate for the increase in expenses.

It's unlikely that this will be the case--it's not how it worked in MA--but the assumptions were imposed on the CBO.

If it's not the case, there are alternatives. Increased deficits; increased taxes; decreased subsidies.

[frazzled]

18. Let me set straight a few things you've said

The bill is expected to reduce expenses (not increase them) and has definitely been analyzed by the nonpartisan Congressional Budget Office to REDUCE the deficit by some $1.3 trillion over the next decade.

The reason Mass. did not lower expenses is because they only focused on coverage when they passed their bill, vowing to tackle the cost part of the equation later. (They're starting to do that now). By contrast, the ACA tackled coverage AND costs at the same time. So you can't compare this federal bill with the MA one on that count.

The only problem for increased deficits and costs to citizens would have been had we done nothing about healthcare.

[Hoyt]

4. Tell them to look up the word "subsidies." Then, there's Medicaid. Next have them check "dumbass."

[leftstreet]

5. 'Democrats taxing the middle class and subsidizing the poor'

That's what the GOP will say and that's what people will hear. Same as it ever was

Obama and the Democrats did a shitty job of explaining this

[Hoyt]

8. To be fair to Dems, it's difficult explaining anything to birthers, flatearthers, callous bigots,etc

[treestar]

23. Exactly and these are people who don't listen anyway

They put their hands over their ears.

[truedelphi]

6. Well, I would say their concerns are valid.

The ACA does force insurance companies to take you on as an insured, if you have a previously existing condition. But nothing the ACA did allows the premiums to have to be reasonable.

Nothing. So in my case, the insurance premiums are so outrageous, and not affordable, over $ 1,400 a month. So I can either give up renting a place to live or feeding myself, in order to have health insurance.

I could go to the California state setup for people like me, with just above minimal income. (and it's called PCIP or PIIP or some such.)

But even so, I have to pay some $ 1,100 a month and then consider this: there is a $ 2,500 deductible. And also co pays for both procedures, visits, and drugs. Most people over 55 are in this same boat with my household, unless they work for a corporation that pays their insurance.

Also the ACA did nothing to allow citizens here to start seeing drugs imported from Canada or elsewhere so the drug costs are manageable.

But now that the Unsupreme Court has ruled in its favor, there will have to be an extensive bureaucracy set up to see to it that everyone out there comply.

And don't forget - one way that the ACA programs should help pay for themselves is that penalties will be established such that anyone "opting out of getting health insurance will pay close to 700 bucks a year. The GAO has stated some 54 billions of dollars of penalties will occur between 2012 and 2022. Which is another way of saying tha those whose income is just a niche above the standards for help from the government will be paying a penalty.

And again, the ACA did nothing about preventing health insurers from offering their executives over 500 millions of dollars a year.

[Southerner]

10. ACA does a lot to raise the price of the product...

...and then forces us to buy it.

[caraher]

11. I agree that there's a lot wrong with the Heritage Foundation solution we're stuck with

I'm a single-payer guy all the way. But this is the beginning of at least some sanity - attacking the "pre-existing condition" problem, mandating at least some fraction of an insurer's spending actually goes to health care, etc. With any luck we'll look back on this some day as a first step toward a real solution...

[Ms. Toad]

19. Some of what you have said is not accurate.

Your premium, once the ACA is completely implemented, cannot be based on your health. You cannot be charged more because you have a pre-existing condition. That is one of the major insurance reforms because currently you can be charged more, or denied insurance outright.

The high risk pools under the ACA (the insurance which is currently available for the people with pre-existing conditions who cannot currently obtain insurance) are far less than $1400 you quoted for open market insurance, or the $1100 you quoted for the PCIP plan. The pools are not for people with low income - they are for anyone with a pre-existing condition who cannot obtain insurance. In California, the maximum cost is $557/month. There is a $1500 deductible, but you would make that up in savings over the $1400 insurance you quoted in 2 months on the plan. This is just a stop-gap measure to protect people like you, and the price (for everyone) should drop even more once everyone is in the pools.

Which ties into my second point - the law limits the amount of money which can be charged for premiums but not spent on medical care. That does not directly limit the pay to executives or lower the average premium, but it does indirectly because the total of all that overhead cannot exceed a certain percentage of the amount spent on care. Because of the this provision of the ACA, it effectively lowered premiums because of the estimated mandatory rebate of approximately $1.3 billion dollars of premiums by August, because they spent too much on administration and not enough on medical care.

I am not arguing that the plan is perfect. It is far from it, but there is a lot of misinformation out there about the positive parts of the plan, many of which have not even kicked in yet.

[truedelphi]

20. That is not what the newspapers that covered the pre-exisiting

condition situation discovered when they interviewed families in California who were insuring a disabled child.

Also one of my pre-existing conditions is my age - and Obama himself said that the insurers needed a free market basis for their product and would need to charge old people more

Also, if you are a two person household the amount for the premium under the California program is 2 x $ 557 a month (the amount you mention) which equals
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ONE THOUSAND AND ELEVEN DOLLARS for my household

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That amount is totally do-able for myself and my spouse, as soon as we figure out how ourselves and the four cats would co-exist in our van.

[Ms. Toad]

21. Newspapers are often inaccurate.

A level playing field, with respect to pre-exsisting conditions is one of the main achievements of the ACA. Once fully implemented (in 2014), you cannot be charged more because you have a pre-existing medical condition. I don't know the circumstances of the families being interviewed, or whether they were discussing pre passage, partial implementation, or after full implementation, but I have a disabled child and that is one of the parts of the legislation I paid most attention to because that without it there is little hope of obtaining medical care for her.

Here's a summary from a government site: "Uninsured people with pre-existing conditions in every state now have access to coverage through the new, temporary Pre-existing Condition Insurance Plan. This serves as a bridge until 2014, when insurance companies can no longer deny or limit coverage or charge higher premiums to anyone because of a preexisting condition. " http://www.healthcare.gov/blog/2011/01/preexisting.html

Age (itself) is not a pre-existing medical condition. It is one of the few factors which can increase your premium (smoking being another). ACA does limit the multiplier for age to either 4 or 5 x the lowest premium . Insurance companies previously had free reign and the surcharge has been around 7x the lowest.

The stop gap measure for pre-existing conditions is not fantastic. It is way better than it was before the ACA - and once fully implemented it will be affordable. Many individuals with low income will be entitled to coverage at no charge, and even more will be entitled to subsidies to cover part of the cost and a portion of the deductible and co-pays. I would have preferred single payer. I would have preferred immediate implementation. But I'm not about to toss the baby out with the bathwater just because the baby is disabled.

If you are looking to prevent a medical catastrophe from completely wiping you out, you can get short term insurance until the ACA completely kicks in. Short term policies cost very little - a few hundred a year (and have high deductibles). They aren't intended to cover routine care - just to kick in so that you don't lose all of your assets because you had a catastrophic illness. (They do not cover pre-existing conditions, but you won't be denied coverage because you have one.

[truedelphi]

22. Well maybe this will help you figure out the cricumstances of the

People interviewed by the SF Chronicle about paying for health insurance including a disabled child - they are not living in 2014.

Nor are any of the rest of us. And most people do not understand what is in the 2,700 pages of the ACA.

Also although twenty years ago, I would have agreed with you that a policy that covered catastrophic situations was a good way to go. But that was back in the day when cancer and cancer treatments were considered to be a catastrophic situation and they were covered procedures.

Today, the only part of cancer treatments covered by most catastrophic insurance companies happens to be for the care given when a person is an in patient at a hospital.

And so yes, if I have to get a breast whacked of because of breast cancer, my one and a half day (And that would be a rare and extra long stay) hospital stay will be covered. But all the radiation and chemo won't be, as it is done on an out patient basis.

So with a catastrophic health insurance policy I have to hope that when catastrophe hits, it's in the form of being hit by a truck rather than cancer.

This discussion brings me to my other point I'd like to hammer home - regardless of all the in's and the out's of the piece of crap legislation, the fact remains -we are forced to buy mandates from companies that are in collusion with the Big Hospital Chains. We pay more than any other nation pays, per capita, and we pay for a much more inferior product.

I ave been in the trenches regarding this.On many occasions, I have been hired to take care of people who are tossed out of the hospital a mere 18 hours after going in. They fasted the night before, they went under anesthesia, and then had a body part amputated, and now after 18 hours, they are being sent home to deal with the aftermath.

I'll cite two different cases where I did private, in home nursing assistant work. One was a lady in her mid sixties who was a Kaiser patient. Kaiser chopped off her leg at the knee. This due to poor circulation. (In may nations of the world, this wouldn't even happen - acupuncture treatment possesses the ability to restore circulation to people with bad circulation.) And get this - Kaiser gave her Tylenol for her pain. Tylenol!

The family spent much of the next ten days attempting to find some doctor who would prescribe morphine for the woman. (This would have been standard patient care item back in the fifties and sixties for such a procedure.) They finally managed to find a doctor who did this for the patient.


Second case that I had that deeply disturbed me, a nurse called me up and asked me to go to her home and make it ready for her arrival by taxi cab on a particular afternoon. Surgery was planned for the early morning hours of that day. She felt I would be needed for at least three days to help her with not only getting her her meals, lite housekeeping and all that, but also to do dressing and wound care.

When she arrived at the house, I was amazed at her condition. Her bandages covering where the surgical team had removed her right breast and much of the underarm lymph nodes was already in need of being changed from all the discharging fluids.

How any hospital with any type of decency could send someone home in that type of situation, still woozy from the anesthetics, still dripping discharge fluids, I have no idea. But this was the prominent hospital int he area, not a County or charity hospital.

And the insurance companies had gotten the hospital to release people undergoing this type of surgery. (This is one reason why so many of our best doctors quit doing medicine in the nineties - they couldn't participate in being part of a system that is run by big insurers, rather than by established medical protocols.)

She immediately instructed me in how to go about changing her bandages. She also gave me the hospital booklets on wound care. So I got a very quick mini course in post surgical care.

By the third day, she was getting better, and we started talking about how I could now go home. And maybe come back every other day or so for the next week. With the understanding I would return to help if there was any crisis.

What was most amazing about all this is that she had told the hospital that she planned on having help -and several people inn the hospital told her - "Naw, you'll do fine on your own."

Really? Too drowsy to stand upright without feeling faint? In too much pain to deliberately move the arm and use it to bandage herself? How can people think this is okay?

She said she believed that most patients ended up believing the discharge staff. But since she was a nurse, and had a tremendous understanding of the effects of anesthesia and of lymph node removal, she knew better.

But most people could very well end up going home and getting an infection because they wouldn't be able to cope with everything they needed to do.

[Ms. Toad]

25. You won't get any argument from me that the bill still leaves far too many people

without access to health care. I know way too much, way too personally.

But the ACA does dramatically change thing for a lot of people, including my own family. My daughter now has the ability to continue her education because she can go to school part time (all her health allows) because she no longer has to be in school full time to stay on my plan. She is that disabled child in the article, except that I have an employer who provides insurance. Her care costs ~$50,000 every year, and in the year she needs a transplant it will cost between half and 3/4 of a million dollars. And, in 2014, she will almost certainly receive health insurance for free because of the ACA.

Short term insurance is not limited to hospital coverage - so it would cover chemo and radiation, not just the hospital stay. Depending on what you purchase, it covers all medical care once (likely with some copays) after you hit your deductible, and 100% after you hit your out of pocket maximum. Just like any other insurance policy. I used them during a period when no one would insure me, just to make sure that a medical catastrophe did not wipe us out. Here's one website which is pretty easy to navigate if you are looking for stop-gap options: http://www.ehealthinsurance.com/short-term-health-insurance

I'm not trying to convince you the system is perfect. It isn't even good. But there are some options available now , and there will be more options available under ACA for more people with pre-existing conditions than there have been anytime in my lifetime, (and will be far more in 2014).

[EC]

27. The way I understand it

they have to be reasonable to be allowed on the exchanges and they cannot raise prices without approval and reasons for increases.

[Iggo]

7. When my co-workers started bemoaning ObamaCare this morning...

...I just told them "It used to be called RomneyCare", and that shut them up.

Not the best explanation, but good enough for the likes of them.

[Nay]

17. Ha! That's what I did, too, today at work! It did shut everyone up! nt

[mzmolly]

12. Actually, Larry O'Donnell explained it best.

See here: http://www.democraticunderground.com/101737103

[Igel]

14. I'd tell them to wait until 12/13 before getting an answer.

By then we might know.

The bill was around 3k pages long. Good luck summarizing that for a low-information person. By that token, we're *all* low-information people. We know what others have found it expedient to tell us and what made it through our particular biases.

Crucially, even at 3k pages much of the law--possibly most of the law--was left unwritten. Congress couldn't agree on a lot of the important details so they left it to bureaucrats (call them "officials" if you want, but this is going to breed a huge bureaucracy). The (R) figured that it wasn't worth hassling over, the thing would be repealed or tossed out by the courts. (D) Senators figured that they'd be all around happier if they just let Obama appointees--whether confirmed by the Senate or not--fill in the gaps.

Grosso modo, sure: If you make X amount of money you get a partial subsidy; if you don't make X amount, you can opt out; if you make under Y amount, you get free care. There'll be exchanges, revisions, changes, and updates. Nobody knows how they'll work--we just know how individuals interpret bits and pieces of the law--and some of the individuals are even lawyers!

[chowder66]

15. My take (this is general and broad - so go lightly)

The penalty is like it’s own insurance, by pitching in via requirement…. it helps keep society more healthy and thus keeps healthcare expenses down overall.
So when a person who chooses the penalty over the actual insurance they are a) actually paying for insurance to a lesser degree - if they get sick there will be a pool to draw from financially that will not alter the current insurance subscribers premiums….and b) helping to keep the costs down so when they do decided to choose to purchase a plan - it is more affordable because they contributed to it.
If for some incredible reason they never need to see a doctor for anything in their lifetime then they will have paid into the system to help their family members, descendents, friends, neighbors, etc because they contributed to something that benefits society for a good reason. Health and well being.

____________________________.

When efficiency is in place, technology is utilized and everything is streamlined the steps to move to universal or national health care are much much shorter and the benefits will reach the majority who will support to move this direction and it will be massive. It is possible that we can attain this sooner rather than later. Especially since many of the mechanisms that need to be in place are going to or are being put in place right now.

http://www.who.int/health_financing/pb_1.pdf

[socialaidem]

16. A good thing for seniors

Found this interesting post about how ACA will help seniors, could help with your responses to people on fbook!

http://www.dailykos.com/story/2012/06/28/1104087/-Court-Ruling-Means-Seniors-Can-Keep-New-Medicare-Benefits

[Tennessee Gal]

24. Links put together to help explain:

The Requirement to Buy Coverage Under the Affordable Care Act
http://healthreform.kff.org/the-basics/Requirement-to-buy-coverage-flowchart.aspx

How health insurance mandate will work

http://money.cnn.com/2012/06/29/pf/taxes/health_insurance_mandate/

Health Reform Subsidy Calculator

http://healthreform.kff.org/SubsidyCalculator.aspx

What does the Supreme Court's health-care ruling mean for me?

http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/

[PoliticAverse]

26. Send them to this online calculator...

http://www.washingtonpost.com/wp-srv/special/politics/what-health-bill-means-for-you/

[DrewFlorida]

28. This link should help you.

Hi,
Here is a link to Reddit (explainlikeimfive).

This page lays out all of the main points and explains them briefly yet concisely.

http://www.reddit.com/tb/vbkfm

[caraher]

29. thanks! <nt>