Bison Bud

We are all aware of the "Affordable Care Act" also known as Obama Care and whether or not it gets taken down or modified/improved in some way is going to be a big issue during the next Presidency. Now that the mandate and associated tax penalty has been removed (which didn't work anyway) I think we can now focus on the real problems with this program. Frankly, I think the word "Affordable" pretty much says it all and I'd like to present my personal experience to illustrate the irony of this statement as follows:

A few years back, I had to leave my job due to multiple issues that have left me disabled and in a lot of pain.
While working, my employer provided my wife and I with excellent health insurance and at a cost to me of less than $300.00/month deducted from my paychecks and that covered us both. When this company coverage expired due to my disability, we both went on Cobra coverage, where we could extend our original coverage at our costs since my employer would no longer kick in payments. This coverage was not cheap and we paid right around $1,200.00/month to keep it, but again we were able to keep the excellent coverage. When I turned 65, I moved on to Medicare coverage, but still had to provide for my wife. As it turned out, they allowed us to continue her on the Cobra coverage without me until she too could go on Medicare, which we accepted. Her monthly cost for this coverage was just shy of $600.00/month.

Anyway, it was at this point that we looked into Obama Care as an option for her coverage. Turns out she qualified for a subsidy payment of around $900.00/month, but had to pay $1,200.00/month to get this coverage and then wait to get the subsidy on her taxes. The coverage offered was also far less then we had on the company insurance, with much higher deductibles, higher co-pays, rediculously high maximum yearly costs, and much increased out of pocket costs all around. We also checked with all our doctors and only one of them would even take this coverage!

This brings me back to the irony of using "Affordable" in the name of this program. First off, they require the participant to pay all the premiums up front, which for just about anyone working for an hourly wage is a real burden at $1,200.00/month and that's just for one individual, I have no idea what it might cost to insure an entire family. Then there's the reduced coverage at increased cost. If we could get individual Cobra coverage with a much better policy for $600.00/month, then why does Obama Care coverage cost twice that for less coverage?

At least in my opinion, Obama Care as written is just a license to steal for the insurance industry and as written was supposed to be mandatory! Although they intended to increase competition with the State Insurance Exchanges, this apparently didn't work either. In fact, most of the insurance companies have now pulled out of the Exchanges since primarily the younger folks decided to take the tax penalty rather than pay so much for their health insurance and the insurance folks needed them to balance out the cost of covering us older folks.

Anyway, I don't know what the real solution might be, but unless they can reduce the personal costs of this insurance, there is virtually no plan that is really going to work. While I realize that the insurance companies have to make money to exist, I've got a feeling that their profit margins are sky high and something needs to give. It wouldn't hurt to cut expenses at the treatment level either and I think it's a crime that any doctor can refuse to accept your insurance. They should be required to take any and all insurance coverages from legitimate sources rather than be so damned picky about it. We also need to get rid of the two price system that exists, where the doctor bills an inflated amount to get what he wants or needs after the insurance discount is applied. It's even worse if the insurance doesn't pay, because they then expect the patient to pay this inflated price! I guess I've rambled on enough, but hope it's food for thought for someone out there. Frankly, Healthcare is going to be a huge issue as we move forward and it's time to do some sensible and realistic thinking on how we can get a handle on the costs involved! God bless us all.

dennis2146 Loc: Eastern Idaho

I have to say I have heard the same complaints from others though I never had to sign on to Obamacare. I had my own health insurance or the VA to turn to if needed.

Maybe you can answer some questions for me or verify some things I have heard but don't know for sure.

Did hospitals and other medical personnel raise their prices because of Obamacare?

I believe that insurance companies do not specifically charge the government at the end of the year for those who used Obamacare but instead charge the government some untold number of dollars and the government simply pays that bill. I hope you understand that question. Basically is each persons medical care tallied OR does the government just pay wh**ever the insurance company says the government owes. THAT in itself is a good s**m for insurance companies to make money.

But having said that, I have heard that insurance companies dropped out of the plan because they were not making money. Didn't at least one insurance company bill the government a few years ago saying the government owed them millions of dollars?

As you can tell I am not up on Obamacare nor did I ever look into it. I never could have afforded the premiums and absolutely objected to the government ORDERING me to have insurance.

Dennis

sippyjug104 Loc: Missouri

Oh how your post has struck one of my most sensitive nerves..! There is an intentional political misdirection with the use of the term "Affordable Healthcare Act" when it truly should be referred to as "Affordable Health Insurance Act" which of course it is far from affordable as well as far from being good compared to the competitive marketplace which is no surprise anytime government attempts to control something in their monopoly ways.

Healthcare is the receiving of health services. Health Insurance is helping offset costs if and when they occur based on prepaying an established amount based on several factors and pooling those prepayments to cover portions of the costs of those filing claims. For example, I've had automobile insurance which I have paid into for over 50-years and NEVER had a claim. Let's call that Affordable Auto Insurance Act (just as a comparison)

Now, what this Act did do was to place an enormous burden on the doctors and hospitals that had to change their means and methods of filing claims for treating patients. Here's a case in point:

"As Obama Care is being implemented, another “wonderful” burdensome item is being added to the reform of the American Medical industry: the shift to the international medical codes.

In conjunction with Obama Care, every American citizen under international codes to link us to this new, wonderful “international” system. This the International Classification of Diseases (IDC) is part of the part of the “medical coding” under (WHO) the World Health Organization. This basically gives our health information to the United Nations.

As of October 1, 2014 the ICD 9 coding used has an additional 86,000 codes. ICD-10-PCS (Procedure Code System) “mandated” medical coding will add 68,105 codes. There will be 155,000 medical codes for medical professionals to learn and peruse for each patient. According to the Center for Medicare and Medicate (CMS.gov) is being undertaken under revisions mandated by the Health Insurance Portability Accountability Act (HIPAA)."

Many of these are so obscure that only a political committee could even conceive them:

W16.221A Fall in (into) bucket of water causing drowning and submersion, initial encounter
W16.221D Fall in (into) bucket of water causing drowning and submersion, subsequent encounter
W16.221S Fall in (into) bucket of water causing drowning and submersion, sequela
W62.0XXA Contact with nonvenomous frogs, initial encounter
V95.40XA Unspecified spacecraft accident injuring occupant, initial encounter
W61.11Xa Bitten by macaw, initial encounter
W61.11XD Bitten by macaw, subsequent encounter
W61.11XS Bitten by macaw, sequela
W61.62XA Struck by duck, initial encounter
W61.62XD Struck by duck, subsequent encounter
W61.62XS Struck by duck, sequela
V98.2XXA Accident to, on or involving ice yacht, initial encounter
R46.1 Bizarre personal appearance
R46.0 Very low level of personal hygiene
Z63.1 Problems in relationship with in-laws
A66.8 Latent yaws
Z62.1 Parental overprotection
Z62.6 Inappropriate (excessive) parental pressure
T71.231D Asphyxiation due to being trapped in a (discarded) refrigerator, accidental, subsequent encounter
Z99.89 Dependence on other enabling machines and devices
Y93.C1 Activity, computer keyboarding
A81.81 Kuru (This is a disease most often found in cannibals).
AND...Wait for it....
V91.07 Burn due to water-skies on fire

Frank T Loc: New York, NY

What the original post proves beyond a shadow of a doubt is that your health insurance should not be tied to your employment.
If every other democracy in the world can provide healthcare to their citizens, then why can't we?

Triple G

Yet, everything and everyone have assimilated very well over time and the ACA is very popular.

Where will 29 million get healthcare if ACA is ended and where will over 1 million people find new jobs?

https://www.epi.org/aca-obamacare-repeal-impact/

https://www.kff.org/interactive/kff-health-tracking-poll-the-publics-views-on-the-aca/

sippyjug104 Loc: Missouri

Triple G, I'm not debating the need...the dire need for healthcare. There are elderly who are homebound, those that are infermed, mentally ill, drug addicted that have no support means to even SEE a doctor and the list goes on and on.

Healthcare to me would be to have neighborhood clinics like a "Doc-in-a-Box", healthcare workers who regularly visit homebound people in need. Care for the mentally ill that have been turned out on the streets, neighborhood drug treatment programs in conjunction to heavy prosecution of the drug dealers and less prosecution of the drug addicted.

To me...THESE are the things that our taxpayer money should support. The Federal Government has no business in the Insurance Business where lobbyist and special interest groups have the power of influence.

My view is that "Healthcare" starts in the communities for that's were the people are. The Federal Government should incentivise the formation of medical clinics and in-home caregivers.

Here's my case in point Number One; Did one ever wonder why 75% of the A******n Clinics which receive Federal Tax Dollars are located in minority communities? Would it not therefore make sense that the Federal Government do the same for healthcare clinics that serve all people within those communities?

Case in point Number Two; Why would there be tens of thousands of homeless people camped in cardboard boxes and blue traps living in the filth, garbage, rodent infested, drug needles and feces which is a breeding ground for some of the worst communicable diseases in history yet there are none or very few medical outreach to these people in dire need and to save others from the effect of potential outbreaks?

But hey...as long as my insurance prices are reduced then I'm happy for I really don't personally know who those other people are anyway.

An Ace is an Ace and a Spade is a Spade and Healthcare and Health Insurance are truly quite different in my understanding of the two.

Triple G

I agree with your care vs insurance distinction. I grew up in a community “health plan” with doctor’s office doing 95% of the care and other 5% at community hospital and people paid according to resources. It worked for a town of 1,000 back in the 1950’s and 1960’s. That concept is no longer feasible. The closest might be a Kaiser
integrated capitated health plan, but that removes choice which the USA consumer demands.

https://healthy.kaiserpermanente.org/static/health/en-us/pdfs/cal/ca_how_providers_are_paid.pdf

sippyjug104 Loc: Missouri

Triple G, I suspect that there are many of us that can agree on what healthcare is and what insurance is. Providing healthcare is very, very complex and buying insurance should not be made difficult or overly complex.

I strongly oppose the Federal Government being in the healthcare business. If the C****-** p******c has demonstrated anything, it is that there is no situation so severe that government can't make it worse. Government's recent crimes are legion: standing in the way of testing; complicating efforts to acquire protective equipment; imposing authoritarian and uniform lockdown rules across very different populations; and enforcing those rules in dangerous and ill-considered ways.

I do strongly support incentivising for what gets rewarded gets repeated and because the Federal Government (or Local and State for that matter) have NO means of production. They can only collect the people's money and buy what it needs or wants and therein lays many of the problems due to special interests and lobbyists.

Incentivising is akin to "Build it and they will come!"

One of the major factors of the cost of health insurance is the need to recover litigation from medical lawsuits and as anyone who has ever been in business knows oh so well is that every penny spent in the business has to be passed on to the customer at a profit.

The medical field is in great need of liability litigation reform....however....many, many politicians are lawyers and they will protect their own and pander to those that contribute to their e******n campaigns.

Triple G

There is so much that needs to done in healthcare; tort reform, medical error reductions, etc. Medicare and Medicaid have worked well for many for years and those entities plus public health, CDC, NIH, etc. we’re not made political or partisan until C***d.

Bison Bud

Dennis,

I am far from an expert on Obamacare and shared my personal experience hoping to stimulate some discussion on it's problems and possible improvements. While I don't believe that Doctor's raised their prices directly due to Obamacare it has to be a factor in the ongoing increases in overall costs. You also bring up a good point in how the insurance companies get paid the government subsidies. Whether or not they get paid a yearly lump sum or by the individual claim is unknown to me. However, I will say that making the patient pay the full premiums up front is not helping many obtain coverage. If the patients could only pay their portion and the subsidies then be paid directly to the insurer, then many more people could afford to buy coverage. The difference in my example would be $300.00/month verses $1,200.00/month and it's a no-brainer as to which would be more "Affordable." It baffles me as to why it was set up that way from the start, especially if they are really trying to help folks get coverage. In any case, there are changes coming and I sure hope our leaders make more sensible decisions this time around.

sippyjug104 Loc: Missouri

Triple G, now we are unified in our beliefs that there is much, very much, that needs to be done to improve our healthcare services. Obviously "cost" will be a major factor as well as how the cost will be covered.

Simply as an observer I believe that providing lower insurance costs to be what should be the easiest to accomplish. After all, that's strictly money and money has a solution (up to a point...not the National Debt).

Find out what is driving the costs and then come up with ways and means of reducing them. One would be to allow insurance to be purchased regardless of the State to open it up to competition. Tort reform that raises medical provider's expense is another. Immigration incentives for doctors and healthcare workers to provide more and to relieve the stress and pressures on those providing hands-on care. No Intern should be required to work long hours. Investments into medical equipment that provides diagnosis to more patients to help treat issues at earlier stages.

I see this the same as I do the Federal Government helping to build the Interstate Highways. The Government does not get into the construction business yet they provide the opportunities and incentives and funding and competitive bids for services. A case in point is that there is a reward system for contractors that beat the contract deadlines and that come up with cost saving ideas.

Bison Bud

If I'm not mistaken, Obama funded the changeover to computer medical records long before the Affordable Care Act was even sent to Congress. I'm pretty sure that the changeover to international codes was a big part of this mandated change to electronic records. However, I do admit that you make a good point about the difference in health care and health insurance and I too think the use of the word "Healthcare" was an intentional misdirection.

RixPix Loc: Miami, Florida

The odd thing is that the ACA worked and continues to work in every state that expanded its Medicaid system as outlined in the act.

Only the Republican led states like Florida that refused to adopt the full measure of the act had problems. It wasn’t the act itself but the lack of Republican support that caused the majority of the issues regarding premiums.

soba1 Loc: Somewhere In So Ca

Thanks for sharing

btbg

Because our Constitution limits the powers of the federal government and Health Care is not one of the powers granted to the federal government.

The ACA and any other kind of nationalized health care is clearly unconstitutional.