Why I’m Jealous of My Dog’s Insurance
March 26, 2014 5:07 AM Subscribe
But we were shocked at what we confronted. The least expensive premium for a couple like us in our 40s would be about $620 a month. And because our household adjusted gross income is likely to be over the $62,040 cutoff this year, it’s doubtful we’ll end up with a subsidy to help offset that price increase.
If you are shocked that it would cost 620 dollars to insure two middle aged adults, then you're really easily shocked.
It’s as if we just bought a new car that we will never see and that we can never pay off.
Except that you can use that car (insurance) when you get sick. You're not only easily shocked, you are bad at analogies.
The author isn't a dog either, so if he had his dog's health insurance, it wouldn't do him any good, because he is not a dog.
posted by MisantropicPainforest at 5:22 AM on March 26, 2014 [15 favorites]
If you are shocked that it would cost 620 dollars to insure two middle aged adults, then you're really easily shocked.
It’s as if we just bought a new car that we will never see and that we can never pay off.
Except that you can use that car (insurance) when you get sick. You're not only easily shocked, you are bad at analogies.
The author isn't a dog either, so if he had his dog's health insurance, it wouldn't do him any good, because he is not a dog.
posted by MisantropicPainforest at 5:22 AM on March 26, 2014 [15 favorites]
I noticed that prices for services at my local veterinaries really started ballooning around the same time pamphlets for animal health insurance started appearing on the counters. It's similar to what I observed years ago with dentists as soon as things like CareCredit arrived in those offices.
And, really NYT? I've used only 5 of my 10 "free" monthly articles, but you won't let me read this one unless I now register?
posted by Thorzdad at 5:27 AM on March 26, 2014 [1 favorite]
And, really NYT? I've used only 5 of my 10 "free" monthly articles, but you won't let me read this one unless I now register?
posted by Thorzdad at 5:27 AM on March 26, 2014 [1 favorite]
The author isn't a dog either, so if he had his dog's health insurance, it wouldn't do him any good, because he is not a dog.
Maybe he could get a doctor's note saying "This patient is as sick as a dog."
posted by GenjiandProust at 5:30 AM on March 26, 2014 [14 favorites]
Maybe he could get a doctor's note saying "This patient is as sick as a dog."
posted by GenjiandProust at 5:30 AM on March 26, 2014 [14 favorites]
The author is also failing to mention is that almost all pet insurance is a reimbursement payment. If my dog needs a 2k surgery, I have to pay the cash up front to the vet and submit forms for reimbursement in a few months. I hope he's got a couple of hundred thousand on hand for the up front costs of any procedure when he goes on fido's plan.
posted by cmfletcher at 5:34 AM on March 26, 2014 [7 favorites]
posted by cmfletcher at 5:34 AM on March 26, 2014 [7 favorites]
Yes, the new plan has more coverage, including pediatric vision. But we don’t have children, and I’d trade coverage for things like substance abuse treatment and mental health in return for lower premiums.
Am I the only one reading this as an implication that middle-aged childless couples are immune to substance abuse and mental health problems?
posted by Tomorrowful at 6:03 AM on March 26, 2014 [15 favorites]
Am I the only one reading this as an implication that middle-aged childless couples are immune to substance abuse and mental health problems?
posted by Tomorrowful at 6:03 AM on March 26, 2014 [15 favorites]
comes after the author discusses his expensive asthma treatments. I don't have asthma; would he be sympathetic to folks like me if we opted out of asthma coverage and raised his premiums?
This (along with basic human dignity) is why I, who is childless, am delighted to help pay for all the costs that go along with pregnancies and births, not to mention helping to pay for schools. People's willful ignorance and shortsightedness are constantly a surprise, and shame on the Times for publishing this.
posted by Dip Flash at 6:05 AM on March 26, 2014 [43 favorites]
This (along with basic human dignity) is why I, who is childless, am delighted to help pay for all the costs that go along with pregnancies and births, not to mention helping to pay for schools. People's willful ignorance and shortsightedness are constantly a surprise, and shame on the Times for publishing this.
posted by Dip Flash at 6:05 AM on March 26, 2014 [43 favorites]
I hope he's got a couple of hundred thousand on hand for the up front costs of any procedure when he goes on fido's plan.
Fortunately, all of these pet insurance plans include a one person death panel who can always decide to pay a hundred bucks and put fido down.
posted by three blind mice at 6:08 AM on March 26, 2014 [20 favorites]
Fortunately, all of these pet insurance plans include a one person death panel who can always decide to pay a hundred bucks and put fido down.
posted by three blind mice at 6:08 AM on March 26, 2014 [20 favorites]
At this point, I think any article about health care that's not pushing for single payer is just trolling.
posted by Bulgaroktonos at 6:22 AM on March 26, 2014 [24 favorites]
posted by Bulgaroktonos at 6:22 AM on March 26, 2014 [24 favorites]
I do find myself thinking that Rachel Ray's dog entrees look enticing though.
posted by srboisvert at 6:25 AM on March 26, 2014
posted by srboisvert at 6:25 AM on March 26, 2014
Something's not right here.
He says:
Previously, our family deductible totaled $13,600 for outpatient care and $6,600 for hospital care (with a maximum combined out-of-pocket cost of $13,600). Under our new plan, we have a deductible of $10,000 (and an out-of-pocket maximum of $12,700).
Under ACA, the maximum out-of-pocket allowed is $6,250 per family member and $12,500 for the whole family. He's in the California exchange, but the terms under the State exchanges cannot be worse than ACA.
He says his prior premium was $263 under a plan that likely did not meet the minimum standards of ACA. We don't know how bad this plan was, but I can only imagine. That is dirt cheap and you can bet the actuaries at BlueCross weren't offering insurance plans that grossed $3,000 a year unless there were MASSIVE gaps in coverage.
He goes on:
I tried frantically to find a medical facility that would take our new Covered California Anthem Blue Cross bronze plan. When I did, they said it would be three weeks before I could see a doctor.
He is implying here that he tried frantically to find a medical provider who would accept his BlueCross plan. His plan is the most widely supported in the state (see link). If there was a problem getting an appointment it was because suddenly a lot of people have insurance and can see a doctor, rather than take their usually mild asthma to the ER.
He is being misleading or willfully ignorant.
posted by SugarFreeGum at 6:28 AM on March 26, 2014 [30 favorites]
He says:
Previously, our family deductible totaled $13,600 for outpatient care and $6,600 for hospital care (with a maximum combined out-of-pocket cost of $13,600). Under our new plan, we have a deductible of $10,000 (and an out-of-pocket maximum of $12,700).
Under ACA, the maximum out-of-pocket allowed is $6,250 per family member and $12,500 for the whole family. He's in the California exchange, but the terms under the State exchanges cannot be worse than ACA.
He says his prior premium was $263 under a plan that likely did not meet the minimum standards of ACA. We don't know how bad this plan was, but I can only imagine. That is dirt cheap and you can bet the actuaries at BlueCross weren't offering insurance plans that grossed $3,000 a year unless there were MASSIVE gaps in coverage.
He goes on:
I tried frantically to find a medical facility that would take our new Covered California Anthem Blue Cross bronze plan. When I did, they said it would be three weeks before I could see a doctor.
He is implying here that he tried frantically to find a medical provider who would accept his BlueCross plan. His plan is the most widely supported in the state (see link). If there was a problem getting an appointment it was because suddenly a lot of people have insurance and can see a doctor, rather than take their usually mild asthma to the ER.
He is being misleading or willfully ignorant.
posted by SugarFreeGum at 6:28 AM on March 26, 2014 [30 favorites]
$620 a month for two people is pretty good.
posted by shakespeherian at 6:31 AM on March 26, 2014 [6 favorites]
posted by shakespeherian at 6:31 AM on March 26, 2014 [6 favorites]
Fortunately, all of these pet insurance plans include a one person death panel who can always decide to pay a hundred bucks and put fido down.
He also left out the compulsory neutering.
posted by GenjiandProust at 6:35 AM on March 26, 2014 [4 favorites]
He also left out the compulsory neutering.
posted by GenjiandProust at 6:35 AM on March 26, 2014 [4 favorites]
$620 a month is what I make these days, and 1/2 my gross monthly pay when I lived in the US.
posted by jb at 6:39 AM on March 26, 2014 [3 favorites]
posted by jb at 6:39 AM on March 26, 2014 [3 favorites]
I got my dog from the the SPCA as an older dog. His insurance doesn't cover anything the insurer sees as a pre-existing condition, which is basically most of what ails him, so none of the considerably over 1,000 I've spent on him since the 8 months I've had him is covered. Basically it's just emergency insurance in case he gets something new and hideously expensive -so just like many people on health insurance before reform.
posted by lesbiassparrow at 6:39 AM on March 26, 2014 [1 favorite]
posted by lesbiassparrow at 6:39 AM on March 26, 2014 [1 favorite]
$620 a month is what I make these days, and 1/2 my gross monthly pay when I lived in the US.
I'm not sure what point you're trying to make but if you were making $14,880 a year, your insurance would be heavily subsidized if not free, and even then you'd only be paying for a single person of insurance, not two as the $620 is for.
posted by griphus at 6:42 AM on March 26, 2014 [18 favorites]
I'm not sure what point you're trying to make but if you were making $14,880 a year, your insurance would be heavily subsidized if not free, and even then you'd only be paying for a single person of insurance, not two as the $620 is for.
posted by griphus at 6:42 AM on March 26, 2014 [18 favorites]
As me to the list of people questioning how insane this pricing is. In 2002 I was paying $120 a month for coverage for myself, a then-32 year old single male. This KFF piece comments than since that year premiums have risen 97%. So that doesn't quite get us to their current premium on a linerar progression, though that was for a younger person.
Para too long, didn't read: $620 as a premium more or less tracks with rising costs so the ACA likely irrelevant other than not allowing them to buy a plan that wouldn't ever actually pay out.
When I did, they said it would be three weeks before I could see a doctor.
Where has this person been getting care that this wasn't the case before? I can't get in to see my GP in less time that that and that's been true for over a decade.
posted by phearlez at 6:43 AM on March 26, 2014 [3 favorites]
Para too long, didn't read: $620 as a premium more or less tracks with rising costs so the ACA likely irrelevant other than not allowing them to buy a plan that wouldn't ever actually pay out.
When I did, they said it would be three weeks before I could see a doctor.
Where has this person been getting care that this wasn't the case before? I can't get in to see my GP in less time that that and that's been true for over a decade.
posted by phearlez at 6:43 AM on March 26, 2014 [3 favorites]
Heh. I JUST signed up my new puppy for health insurance (Healthy Paws) yesterday.
posted by Windigo at 6:48 AM on March 26, 2014
posted by Windigo at 6:48 AM on March 26, 2014
> People's willful ignorance and shortsightedness are constantly a surprise
That must be nice.
posted by The Card Cheat at 6:49 AM on March 26, 2014 [8 favorites]
That must be nice.
posted by The Card Cheat at 6:49 AM on March 26, 2014 [8 favorites]
Under ACA, the maximum out-of-pocket allowed is $6,250 per family member
Does that include premiums?
posted by MisantropicPainforest at 6:51 AM on March 26, 2014
Does that include premiums?
posted by MisantropicPainforest at 6:51 AM on March 26, 2014
Speaking of Dogs and the ACA, Bob Laszewski had a long post over at his Health Care Policy and Marketplace Review earlier this month entitled "Obamacare: The Uninsured Are Not Signing Up Because the Dogs Don't Like It" which is worth the read. In a recent post, he thinks that if Wellpoint's recent predictions of double digit rate increases for 2015 hold true, the ACA is going to enter a death spiral. More and more I think that Marcia Angell was right about its prospects.
posted by Auden at 6:56 AM on March 26, 2014
posted by Auden at 6:56 AM on March 26, 2014
First, we were notified that we would be kicked out of our existing $263-a-month Anthem Blue Cross plan because it didn’t meet the minimum standards of the new law.
This is just another way of saying "We were paying $263 a month for something they lyingly called 'health insurance' that can actually be summarized as 'fuck-all.'"
posted by ROU_Xenophobe at 6:59 AM on March 26, 2014 [22 favorites]
This is just another way of saying "We were paying $263 a month for something they lyingly called 'health insurance' that can actually be summarized as 'fuck-all.'"
posted by ROU_Xenophobe at 6:59 AM on March 26, 2014 [22 favorites]
Also, was the NYT running articles like this when the income tax became a thing?
"Yes, the income tax has helps build civil infrastructure, including funding things like schools. But we don’t have children, and I’d trade funding the construction of rehabilitation clinics and psychiatric hospitals in return for less taxes."
posted by griphus at 7:02 AM on March 26, 2014 [6 favorites]
"Yes, the income tax has helps build civil infrastructure, including funding things like schools. But we don’t have children, and I’d trade funding the construction of rehabilitation clinics and psychiatric hospitals in return for less taxes."
posted by griphus at 7:02 AM on March 26, 2014 [6 favorites]
I wish every time the Republicans tried to kill this bill over the past 3 years the Democrats would have countered with a bill to make Medicare for all. This has always been the problem in this country - both parties only support the corporation and no one represents the individual. How else can one explain how an overwhelming percentage of Americans support universal health care, gun control and climate change legislation yet nothing gets down. We need a revolution in this country. What the fuck happened to Occupy?
posted by any major dude at 7:06 AM on March 26, 2014 [10 favorites]
posted by any major dude at 7:06 AM on March 26, 2014 [10 favorites]
the author discusses his expensive asthma treatments
To be fair, a few years ago treating occasional asthma cost $9 for a generic inhaler -- rather than a $300 trip to the doctor's office and a $60 CFC-free patent-encumbered inhaler.
We wouldn't be so picky about what's on our plans if simple things like this cost less.
posted by RobotVoodooPower at 7:06 AM on March 26, 2014 [2 favorites]
To be fair, a few years ago treating occasional asthma cost $9 for a generic inhaler -- rather than a $300 trip to the doctor's office and a $60 CFC-free patent-encumbered inhaler.
We wouldn't be so picky about what's on our plans if simple things like this cost less.
posted by RobotVoodooPower at 7:06 AM on March 26, 2014 [2 favorites]
Where has this person been getting care that this wasn't the case before? I can't get in to see my GP in less time that that and that's been true for over a decade.
I've always wondered where to find this pre-ACA utopia where you could see a PCP or GP or gyno for a check-up with less than at least 3 weeks notice. My OB/GYN is backed up 2 months at a minimum for annual exams. My PCP/internist is right around 3 weeks. For acute cases their office either has me wait in their waiting room all day for a 5-minute break between patients, or they send me to urgent care.
I gotta suspect that people complaining about post-ACA appointment wait times just haven't been to a doctor in a long time.
posted by muddgirl at 7:06 AM on March 26, 2014 [11 favorites]
I've always wondered where to find this pre-ACA utopia where you could see a PCP or GP or gyno for a check-up with less than at least 3 weeks notice. My OB/GYN is backed up 2 months at a minimum for annual exams. My PCP/internist is right around 3 weeks. For acute cases their office either has me wait in their waiting room all day for a 5-minute break between patients, or they send me to urgent care.
I gotta suspect that people complaining about post-ACA appointment wait times just haven't been to a doctor in a long time.
posted by muddgirl at 7:06 AM on March 26, 2014 [11 favorites]
My OB/GYN is backed up 2 months at a minimum for annual exams. My PCP/internist is right around 3 weeks.
Why don't you schedule your annual exam for next year every time you go in for one? Then you have no wait, ever.
posted by roomthreeseventeen at 7:09 AM on March 26, 2014 [1 favorite]
Why don't you schedule your annual exam for next year every time you go in for one? Then you have no wait, ever.
posted by roomthreeseventeen at 7:09 AM on March 26, 2014 [1 favorite]
Jesus christ, I had no idea people were waiting so long to see doctors. What does that sort of thing depend on? Population density relative to the number of doctors?
posted by griphus at 7:09 AM on March 26, 2014 [1 favorite]
posted by griphus at 7:09 AM on March 26, 2014 [1 favorite]
I'm not sure what point you're trying to make but if you were making $14,880 a year, your insurance would be heavily subsidized if not free
Unless you fall into the Medicaid gap engineered by Chief Justice Roberts and the GOP governors.
posted by TedW at 7:12 AM on March 26, 2014
Unless you fall into the Medicaid gap engineered by Chief Justice Roberts and the GOP governors.
posted by TedW at 7:12 AM on March 26, 2014
And, really NYT? I've used only 5 of my 10 "free" monthly articles, but you won't let me read this one unless I now register?
It's some sort of javascript junk; I did 'view source' and the full article was there. Also showed up fine when I turned on my "force incognito" plugin in Chrome for the NYT domain.
Going back to the article - If he really wants dog insurance he should have picked Kaiser and their HMO type coverage, as it tracks better. He'll be restricted to a limited set of practitioners, just like pet insurance usually is. Based on the location of his businesses he's got several Kaiser providers just a few miles south of him.
Of course if he wants dog insurance he's not really interested in ACA reforms; my dog, as a parvo survivor, can't get insurance. It's a pre-existing condition of the type the ACA now won't let insurers use to exclude you.
The pre-existing part that is; they couldn't exclude you for having a dog virus before either.
Dog insurance also has lifetime caps which are no longer allowable under ACA. He vaguely hand-waves about this $10,000 deductible and it keeping them from being bankrupted but that's not really accurate. I suspect that a couple earning $60,000 a year in California wouldn't necessarily file bankruptcy if they had a $35,000 debt, but would certainly radically alter the course of the next decade of their life. A minor hospitalization could run up that $30,000. A major one could easily hit that lifetime cap.
I'm presuming he's not prepared to put his spouse to sleep once s/he hits that cap. I also would bet he'd want hir to have all sorts of access to prosthetics and other things pet insurance isn't going to cover. Like, say, the prescription medication for asthma. I've got $20 that says his pet insurance isn't covering monthly heartworm meds, which I'm paying about $100 a year for for my pooch.
posted by phearlez at 7:14 AM on March 26, 2014 [5 favorites]
It's some sort of javascript junk; I did 'view source' and the full article was there. Also showed up fine when I turned on my "force incognito" plugin in Chrome for the NYT domain.
Going back to the article - If he really wants dog insurance he should have picked Kaiser and their HMO type coverage, as it tracks better. He'll be restricted to a limited set of practitioners, just like pet insurance usually is. Based on the location of his businesses he's got several Kaiser providers just a few miles south of him.
Of course if he wants dog insurance he's not really interested in ACA reforms; my dog, as a parvo survivor, can't get insurance. It's a pre-existing condition of the type the ACA now won't let insurers use to exclude you.
The pre-existing part that is; they couldn't exclude you for having a dog virus before either.
Dog insurance also has lifetime caps which are no longer allowable under ACA. He vaguely hand-waves about this $10,000 deductible and it keeping them from being bankrupted but that's not really accurate. I suspect that a couple earning $60,000 a year in California wouldn't necessarily file bankruptcy if they had a $35,000 debt, but would certainly radically alter the course of the next decade of their life. A minor hospitalization could run up that $30,000. A major one could easily hit that lifetime cap.
I'm presuming he's not prepared to put his spouse to sleep once s/he hits that cap. I also would bet he'd want hir to have all sorts of access to prosthetics and other things pet insurance isn't going to cover. Like, say, the prescription medication for asthma. I've got $20 that says his pet insurance isn't covering monthly heartworm meds, which I'm paying about $100 a year for for my pooch.
posted by phearlez at 7:14 AM on March 26, 2014 [5 favorites]
Actually I think pet insurance is a great comparison. Veterinary medicine is pretty darn close to where human medicine was 40 or so years ago. Sure your dog isn't getting open heart surgery or a bone marrow transplant, but he can get tons of different procedures and some really innovative diagnostic techniques including MRIs. A lot of people in this country would be better off with dog insurance than with no insurance.
So why is human insurance more expensive? Everyone in the chain is paid a lot more money, a few people have chronic illnesses that may cost a huge amount over time, and some of the newest procedures are inherently insanely expensive.
posted by miyabo at 7:18 AM on March 26, 2014 [1 favorite]
So why is human insurance more expensive? Everyone in the chain is paid a lot more money, a few people have chronic illnesses that may cost a huge amount over time, and some of the newest procedures are inherently insanely expensive.
posted by miyabo at 7:18 AM on March 26, 2014 [1 favorite]
Why don't you schedule your annual exam for next year every time you go in for one? Then you have no wait, ever.
Sure, as long as you never move or change to an insurance your doctor doesn't accept. Furthermore, I can't successfully predict my schedule a year out (can any working person?), so when I do make an appointment in advance so there's no wait, invariably I will be out of town on that day and have to re-schedule a few weeks prior, and now we're back to the original problem.
posted by muddgirl at 7:21 AM on March 26, 2014 [3 favorites]
Sure, as long as you never move or change to an insurance your doctor doesn't accept. Furthermore, I can't successfully predict my schedule a year out (can any working person?), so when I do make an appointment in advance so there's no wait, invariably I will be out of town on that day and have to re-schedule a few weeks prior, and now we're back to the original problem.
posted by muddgirl at 7:21 AM on March 26, 2014 [3 favorites]
Our old policy and our new Covered California policy were both with Anthem Blue Cross, so a representative there told us to use our old ID cards for our visits since our new cards hadn’t arrived yet. We were covered, he assured us. At the medical center, we gave our ID cards to the receptionist, who accepted them as valid, and went in to see our regular doctors. But later we found out that they were not in our new network’s plan.
If a hospital or doctor's office assured me that I was covered, and they were wrong, I would challenge the bill. Health care billing is so byzantine that civilians cannot be expected to figure it out. It's my understanding that the ACA makes efforts to address this.
620/month to cover 2 adults with decent coverage? And those 2 adults make 60K/year? I'm fine with that.
posted by theora55 at 7:23 AM on March 26, 2014 [1 favorite]
If a hospital or doctor's office assured me that I was covered, and they were wrong, I would challenge the bill. Health care billing is so byzantine that civilians cannot be expected to figure it out. It's my understanding that the ACA makes efforts to address this.
620/month to cover 2 adults with decent coverage? And those 2 adults make 60K/year? I'm fine with that.
posted by theora55 at 7:23 AM on March 26, 2014 [1 favorite]
I like how he waves away the preexisting conditions issue like it's meaningless. My dog has health insurance, but because he had food allergies that manifest as gastric upsetV when he was younger, all coverage of gastrointestinal issues is waived in his plan.
Ask me how useful an instance policy for a Labrador that refuses to pay out for any trouble involving his digestive tract can possibly be. Dog insurance is a total scam as fast as I'm concerned.
posted by town of cats at 7:24 AM on March 26, 2014 [4 favorites]
Ask me how useful an instance policy for a Labrador that refuses to pay out for any trouble involving his digestive tract can possibly be. Dog insurance is a total scam as fast as I'm concerned.
posted by town of cats at 7:24 AM on March 26, 2014 [4 favorites]
I'm not complaining about wait times, BTW. I'm wondering where people are living where they weren't waiting for their PCP. Texas is not a state generally considered to have a higher-than-usual doctor shortage, and while I can't find statistics on the city level my city seems to have quite a few doctors per capita.
Jesus christ, I had no idea people were waiting so long to see doctors. What does that sort of thing depend on? Population density relative to the number of doctors?
I don't have to wait a long time to see any doctor. I have to wait a relatively long time to schedule a non-urgent appointment with a specific PCP that knows my medical history.
posted by muddgirl at 7:27 AM on March 26, 2014 [1 favorite]
Jesus christ, I had no idea people were waiting so long to see doctors. What does that sort of thing depend on? Population density relative to the number of doctors?
I don't have to wait a long time to see any doctor. I have to wait a relatively long time to schedule a non-urgent appointment with a specific PCP that knows my medical history.
posted by muddgirl at 7:27 AM on March 26, 2014 [1 favorite]
NYC here. I can almost always call my PCP and get a same day appointment.
posted by roomthreeseventeen at 7:29 AM on March 26, 2014
posted by roomthreeseventeen at 7:29 AM on March 26, 2014
But we were shocked at what we confronted. The least expensive premium for a couple like us in our 40s would be about $620 a month.
Oh I see, you thought that the affects of the ACA on this enormous economic system to be instantaneous.
I mean, maybe the ACA will help, maybe it won't but it will take some time before we really see the affects.
posted by VTX at 7:31 AM on March 26, 2014 [1 favorite]
Oh I see, you thought that the affects of the ACA on this enormous economic system to be instantaneous.
I mean, maybe the ACA will help, maybe it won't but it will take some time before we really see the affects.
posted by VTX at 7:31 AM on March 26, 2014 [1 favorite]
I'm wondering where people are living where they weren't waiting for their PCP.
I'm in Brooklyn, albeit in a neighborhood packed to the brim with old people so there's medical offices on literally every block. I can generally see my PCP no more than 2-3 days out.
Now I am terrified to move anywhere else. Moreso, anyway.
posted by griphus at 7:31 AM on March 26, 2014 [1 favorite]
I'm in Brooklyn, albeit in a neighborhood packed to the brim with old people so there's medical offices on literally every block. I can generally see my PCP no more than 2-3 days out.
Now I am terrified to move anywhere else. Moreso, anyway.
posted by griphus at 7:31 AM on March 26, 2014 [1 favorite]
I pay $0/month for better coverage than the author, and I'd wager that I pay less in general for the services I receive. Ask me how! No need to be jealous of your dog when there are dozens of other countries and their citizens you can be jealous of.
posted by blue_beetle at 7:34 AM on March 26, 2014 [12 favorites]
posted by blue_beetle at 7:34 AM on March 26, 2014 [12 favorites]
Well, my Canadian friends have longer waits than anyone in this thread, so the comparison is just noise, considering the U.S. is never going to move to single payer.
posted by roomthreeseventeen at 7:36 AM on March 26, 2014 [1 favorite]
posted by roomthreeseventeen at 7:36 AM on March 26, 2014 [1 favorite]
Jesus christ, I had no idea people were waiting so long to see doctors. What does that sort of thing depend on? Population density relative to the number of doctors?
It's really area-dependent. I'm in the greater Boston area, and I can get in to see my PCP or one of the NP/PAs on her team same-day (most days), and if I have an issue that needs a specialist I generally can get in within 2 weeks (faster if it's urgent).
Meanwhile, up in Maine, my friends and relatives are waiting two weeks plus for PA/NP/PCP appointments and sometimes up to six months for a specialist, even if their issues are serious. In some cases there are only a few of that type of specialist in the state, and good luck if one of them doesn't take your insurance. Some of them end up coming down to Boston (a 5+ hour drive). They're lucky to have that option; people in other rural low-access states may not.
This also leads to other inequities: I pay (around) $9 for a Rapid Strep at my practice, where they have weekend and holiday coverage with same-day appointments; my relatives have told me that they pay $150 for the same test at an Urgent Care, which is the only place they can get an appointment without waiting (which of course you don't want to do with strep).
Wait times here in MA definitely got longer for things like routine physicals after RomneyCare came in, but overall, our wait times are minimal compared to a lot of other areas.
posted by pie ninja at 7:38 AM on March 26, 2014 [1 favorite]
It's really area-dependent. I'm in the greater Boston area, and I can get in to see my PCP or one of the NP/PAs on her team same-day (most days), and if I have an issue that needs a specialist I generally can get in within 2 weeks (faster if it's urgent).
Meanwhile, up in Maine, my friends and relatives are waiting two weeks plus for PA/NP/PCP appointments and sometimes up to six months for a specialist, even if their issues are serious. In some cases there are only a few of that type of specialist in the state, and good luck if one of them doesn't take your insurance. Some of them end up coming down to Boston (a 5+ hour drive). They're lucky to have that option; people in other rural low-access states may not.
This also leads to other inequities: I pay (around) $9 for a Rapid Strep at my practice, where they have weekend and holiday coverage with same-day appointments; my relatives have told me that they pay $150 for the same test at an Urgent Care, which is the only place they can get an appointment without waiting (which of course you don't want to do with strep).
Wait times here in MA definitely got longer for things like routine physicals after RomneyCare came in, but overall, our wait times are minimal compared to a lot of other areas.
posted by pie ninja at 7:38 AM on March 26, 2014 [1 favorite]
This is just another way of saying "We were paying $263 a month for something they lyingly called 'health insurance' that can actually be summarized as 'fuck-all.'"
For someone without kids, the previous insurance might have been just fine. A lot of people without kids are getting hosed due to the maternity provisions of the ACA.
posted by Kadin2048 at 7:38 AM on March 26, 2014
For someone without kids, the previous insurance might have been just fine. A lot of people without kids are getting hosed due to the maternity provisions of the ACA.
posted by Kadin2048 at 7:38 AM on March 26, 2014
I'm wondering where people are living where they weren't waiting for their PCP.
I live in the Midwest and can get an appointment to see my PCP in about a week, same day if it's urgent. They keep some appointments open for people who wake up with horrible coughs or fevers or whatever. For specialists, the wait is longer, more along the lines of 2-3 weeks.
The wait for dermatology, however, is much longer. 3-4 months on average. And 14 years ago when we were getting comprehensive testing for our then three-year-old, it was a 6 month wait for a pediatric psychiatrist.
posted by cooker girl at 7:39 AM on March 26, 2014
I live in the Midwest and can get an appointment to see my PCP in about a week, same day if it's urgent. They keep some appointments open for people who wake up with horrible coughs or fevers or whatever. For specialists, the wait is longer, more along the lines of 2-3 weeks.
The wait for dermatology, however, is much longer. 3-4 months on average. And 14 years ago when we were getting comprehensive testing for our then three-year-old, it was a 6 month wait for a pediatric psychiatrist.
posted by cooker girl at 7:39 AM on March 26, 2014
I haven't noticed any ACA difference in New York City yet.
posted by roomthreeseventeen at 7:39 AM on March 26, 2014
posted by roomthreeseventeen at 7:39 AM on March 26, 2014
For someone without kids, the previous insurance might have been just fine
Until they actually needed it, then those earlier 'catastrophic' plants would have just denied their claims and not pay out any money. Thats the thing about insurance, its a waste until you actually need it.
posted by MisantropicPainforest at 7:46 AM on March 26, 2014 [8 favorites]
Until they actually needed it, then those earlier 'catastrophic' plants would have just denied their claims and not pay out any money. Thats the thing about insurance, its a waste until you actually need it.
posted by MisantropicPainforest at 7:46 AM on March 26, 2014 [8 favorites]
Worst bit of writing I've ever seen. Well, maybe not worst, but this is the fucking NYT! The only real comparison he makes is with the deductibles, but I'm guessing at $230 a month, there were a lot of things that weren't covered and that the total coverage limits were pretty low. ACA-compliant plans have no limits and cover just about everything. His idea that if he left off substance abuse coverage it would have a major impact is the kind of idiotic thinking that allows the anti-ACA crowd to get away with out-and-out bullshit. I'm pretty upset the NYT would print such a mess of an opinion piece.
posted by Mental Wimp at 7:48 AM on March 26, 2014 [3 favorites]
posted by Mental Wimp at 7:48 AM on March 26, 2014 [3 favorites]
We gambled on low-coverage, low-cost insurance for my incredibly healthy husband for one year, and IMO we lost. Sure, we saved a lot of money in insurance premiums for one year, but there are a lot of health problems (tumors, for example) that don't care how many miles you run in a week or how low your blood pressure is.
With our dogs, we could choose whether or not to treat a tumor. We could choose a lower-cost, less-effective treatment. We can choose palliative care until it is time to euthenize them. As animal welfare and animal rights becomes a more widespread cultural phenomenon and as people start making more and more expensive decisions for their pets health care, it's likely that insurance will become more widespread and will require more regulations to limit predatory companies. Perhaps one day we'll even have a Pet Affordable Care Act. But at this point comparing human insurance to pet insurance ignores the fact humans and pets are legally treated in completely different ways at every step of the health care process.
posted by muddgirl at 8:04 AM on March 26, 2014
With our dogs, we could choose whether or not to treat a tumor. We could choose a lower-cost, less-effective treatment. We can choose palliative care until it is time to euthenize them. As animal welfare and animal rights becomes a more widespread cultural phenomenon and as people start making more and more expensive decisions for their pets health care, it's likely that insurance will become more widespread and will require more regulations to limit predatory companies. Perhaps one day we'll even have a Pet Affordable Care Act. But at this point comparing human insurance to pet insurance ignores the fact humans and pets are legally treated in completely different ways at every step of the health care process.
posted by muddgirl at 8:04 AM on March 26, 2014
My wife and I are comperable in age and income to the author of the piece, and we also don't have children. Before ACA, we were paying $440/month for health insurance. When we were sold the health insurance in 2009, we were told it had a $5,000 deductible, after which the insurance would kick in at 100% payment. After the ACA changed reporting standards and insisted on trasparency in yearly out-of-pocket expenses, our deductible was listed at $30,000 a year. I went to the ER last year. It turned out to be nothing. My bills from three hours in the ER came out to $4,900. The insurance paid jack shit. Zero. Nothing. Nada.
When we went to sign up for ACA, we found a new plan that we liked with a $2,000 deductible and a $9,000 out-of-pocket maximum for $480. Then we found out that our primary care physician wasn't in the network for that plan, but for $500/month we could get an identical plan that included our primary care physician's network. We were disappointed that our premium was going up by $60 a month, but were ultimately OK with it because of the vastly improved coverage. Then we got our renewal notice on our old plan. The shit insurance that we had before was going up to $580/month.
The ACA is an attempt to prop up a failed model for delivering health care, but it's better than nothing, and it has helped me and my family considerably.
Also, this guy's DOG has fucking health insurance and he's bitching about not having enough money? Fuck that.
posted by vibrotronica at 8:07 AM on March 26, 2014 [22 favorites]
When we went to sign up for ACA, we found a new plan that we liked with a $2,000 deductible and a $9,000 out-of-pocket maximum for $480. Then we found out that our primary care physician wasn't in the network for that plan, but for $500/month we could get an identical plan that included our primary care physician's network. We were disappointed that our premium was going up by $60 a month, but were ultimately OK with it because of the vastly improved coverage. Then we got our renewal notice on our old plan. The shit insurance that we had before was going up to $580/month.
The ACA is an attempt to prop up a failed model for delivering health care, but it's better than nothing, and it has helped me and my family considerably.
Also, this guy's DOG has fucking health insurance and he's bitching about not having enough money? Fuck that.
posted by vibrotronica at 8:07 AM on March 26, 2014 [22 favorites]
The ACA is an attempt to prop up a failed model for delivering health care, but it's better than nothing, and it has helped me and my family considerably.
When ACA kicked in, our workplace insurance went to shit. Like, there's a medicine I take that cost me $20/mo before and it went up to $70. Other stuff got considerably worse as well. So my boss canned the workplace insurance -- we're a small shop: 3 employees total -- and said he'd pay the equivalent amount of our workplace insurance cost toward my ACA plan premium, which I don't get a subsidy for because I make too much money (which I have no gripe with, honestly.)
So now I pay ~$80/mo for drastically better insurance that I got to pick, rather than had thrust upon me by virtue of what my boss thought was best for him. I could've picked a cheaper plan and either pocketed the difference or had it covered totally, but a totally healthy friend of mine got cancer recently (in remission, thank god) and watching her deal with her HMO -- she was on a cheapo plan for the obvious reasons -- before she was able to get on her husband's insurance was fucking terrifying.
Meanwhile, a few years ago I got offered a job and decided to actually read through the insurance paperwork, which I assume isn't something they expected a 25-year-old guy to bother with. The plan had a maximum lifetime payout. As in, if I had incurred more than $10K of medical expenses in my life, I'd be on the hook for them. I suspect this author's $263/mo plan was roughly along the same lines.
posted by griphus at 8:18 AM on March 26, 2014 [10 favorites]
When ACA kicked in, our workplace insurance went to shit. Like, there's a medicine I take that cost me $20/mo before and it went up to $70. Other stuff got considerably worse as well. So my boss canned the workplace insurance -- we're a small shop: 3 employees total -- and said he'd pay the equivalent amount of our workplace insurance cost toward my ACA plan premium, which I don't get a subsidy for because I make too much money (which I have no gripe with, honestly.)
So now I pay ~$80/mo for drastically better insurance that I got to pick, rather than had thrust upon me by virtue of what my boss thought was best for him. I could've picked a cheaper plan and either pocketed the difference or had it covered totally, but a totally healthy friend of mine got cancer recently (in remission, thank god) and watching her deal with her HMO -- she was on a cheapo plan for the obvious reasons -- before she was able to get on her husband's insurance was fucking terrifying.
Meanwhile, a few years ago I got offered a job and decided to actually read through the insurance paperwork, which I assume isn't something they expected a 25-year-old guy to bother with. The plan had a maximum lifetime payout. As in, if I had incurred more than $10K of medical expenses in my life, I'd be on the hook for them. I suspect this author's $263/mo plan was roughly along the same lines.
posted by griphus at 8:18 AM on March 26, 2014 [10 favorites]
This writer's attitude seems to be that since he and his wife are perfectly healthy they shouldn't be required to pay money to cover anybody's possible medical care, because they are not people like me, who unpredictably went from healthy to terminally ill with cancer. That's because they are morally superior, obviously.
Oh no! They pay more for their more extensive coverage and GASP! have to change their PCP! How tragic.
posted by miss tea at 8:22 AM on March 26, 2014 [6 favorites]
Oh no! They pay more for their more extensive coverage and GASP! have to change their PCP! How tragic.
posted by miss tea at 8:22 AM on March 26, 2014 [6 favorites]
My well-insured cat licks her butthole in his general direction. Because if her human momma didn't have the ACA, her human momma wouldn't be around to provide food and general spoiling (and pay the pet insurance premiums).
posted by like_a_friend at 8:44 AM on March 26, 2014 [1 favorite]
posted by like_a_friend at 8:44 AM on March 26, 2014 [1 favorite]
I'm jealous of my dog's work/life balance. Dude's job is to pee outside the house. That's it.
posted by 2bucksplus at 8:56 AM on March 26, 2014 [15 favorites]
posted by 2bucksplus at 8:56 AM on March 26, 2014 [15 favorites]
It really shouldn't surprise me that a Times op-ed is this intellectually lazy, but it does.
This is the equivalent of saying "My car gets 30 miles per gallon. Why can't it be more like my scooter, which gets 100 miles per gallon and costs one fourth as much?" Which is not a compelling question because the answer is obvious: clear trade-offs have been made in the areas of cargo space, passenger space, and comfort.
Likewise, it's obvious why human insurance can't be more like pet insurance; the reasons have already been stated in this thread. So the article isn't asking "how can we change our current health insurance system to be more like pet insurance?" — it's asking "man, wouldn't it be really great if health insurance functioned just like it does now, except cheaper and with lower waiting times?"
It's a gripe, and not even a good one.
posted by savetheclocktower at 8:56 AM on March 26, 2014 [2 favorites]
This is the equivalent of saying "My car gets 30 miles per gallon. Why can't it be more like my scooter, which gets 100 miles per gallon and costs one fourth as much?" Which is not a compelling question because the answer is obvious: clear trade-offs have been made in the areas of cargo space, passenger space, and comfort.
Likewise, it's obvious why human insurance can't be more like pet insurance; the reasons have already been stated in this thread. So the article isn't asking "how can we change our current health insurance system to be more like pet insurance?" — it's asking "man, wouldn't it be really great if health insurance functioned just like it does now, except cheaper and with lower waiting times?"
It's a gripe, and not even a good one.
posted by savetheclocktower at 8:56 AM on March 26, 2014 [2 favorites]
First, we were notified that we would be kicked out of our existing $263-a-month Anthem Blue Cross plan because it didn’t meet the minimum standards of the new law.
This is just another way of saying "We were paying $263 a month for something they lyingly called 'health insurance' that can actually be summarized as 'fuck-all.'"
posted by ROU_Xenophobe at 9:59 AM on March 26 [8 favorites +] [!]
There's a lot of presumption here that their old plan sucked. Maybe it did, but based on facts, their total maximum out of pocket expenses then were about the same as the "new and improved" ACA acceptable plan. So please please stop with the Insurance companies were ripping you off and now the ACA is here to save you... That's just plain BS. I live in Massachusetts, home of Romneycare, which had over 98% of residents covered. Then comes the ACA, and guess what even Romneycare plans were cancelled and called inadequate. Now they cost more, have higher co-pays, and more expensive drug plans, and offer less (no adult dental), and because of the CGI frakking up the Web site people can't sign up. ( I've been waiting since October for a simple renewal.)
posted by Gungho at 9:14 AM on March 26, 2014 [2 favorites]
This is just another way of saying "We were paying $263 a month for something they lyingly called 'health insurance' that can actually be summarized as 'fuck-all.'"
posted by ROU_Xenophobe at 9:59 AM on March 26 [8 favorites +] [!]
There's a lot of presumption here that their old plan sucked. Maybe it did, but based on facts, their total maximum out of pocket expenses then were about the same as the "new and improved" ACA acceptable plan. So please please stop with the Insurance companies were ripping you off and now the ACA is here to save you... That's just plain BS. I live in Massachusetts, home of Romneycare, which had over 98% of residents covered. Then comes the ACA, and guess what even Romneycare plans were cancelled and called inadequate. Now they cost more, have higher co-pays, and more expensive drug plans, and offer less (no adult dental), and because of the CGI frakking up the Web site people can't sign up. ( I've been waiting since October for a simple renewal.)
posted by Gungho at 9:14 AM on March 26, 2014 [2 favorites]
I, for one, would prefer an insurance plan that isn't predicated on being transported to my doctor in a cramped plastic-and-metal box, but maybe that's just me.
posted by Tomorrowful at 9:27 AM on March 26, 2014
posted by Tomorrowful at 9:27 AM on March 26, 2014
Then comes the ACA, and guess what even Romneycare plans were cancelled and called inadequate.
How many were cancelled?
posted by MisantropicPainforest at 9:32 AM on March 26, 2014
How many were cancelled?
posted by MisantropicPainforest at 9:32 AM on March 26, 2014
MoonOrb, at my most cynical, that's the system we have prior to ACA coverage, and may still have to some extent. If you don't have coverage for a liver transplant/ heart valve replacement, you'll get care for symptoms, and you'll die of liver/heart disease. The change can at the convenience store for the local child who needs a non-covered procedure? That's the moral equivalent of putting the dog down instead of paying for expensive surgery. Only that child won't be humanely put to sleep, that child will suffer as the illness progresses to its conclusion. I'm not saying the child should be euthanized, I'm saying I'm really scared that we'll lose Obamacare because it's not the perfect plan for every person, as they perceive it.
posted by theora55 at 9:32 AM on March 26, 2014 [2 favorites]
posted by theora55 at 9:32 AM on March 26, 2014 [2 favorites]
I'm unemployed and ill, and had to choose between COBRA and Obamacare. Easy, huh? Obamacare + subsidy. But my state didn't extend Medicaid (because Governor LePage is a nasty, teapartying jerk) so I may end up ineligible for Obamacare, unable to get Medicaid, and screwed because I can't go back in time and get the COBRA. So, yeah, there are big problems that remain, but it's So Much Better, and it seems like it's still in danger of being taken away.
posted by theora55 at 9:37 AM on March 26, 2014 [1 favorite]
posted by theora55 at 9:37 AM on March 26, 2014 [1 favorite]
I'm not sure what point you're trying to make
My point is that $600/month is a huge amount of money.
Median household income in the US is about $50,000 (Wikipedia). Gross is then about $4166 per month -- and $600 is 15% of that. Let's say that you have a $5000 deductible (which is what's being quoted with these plans), and now you have 25% of your gross income going to healthcare. That's more than many people spend on housing; definitely more than most spend on food -- and (as Elizabeth Warren has shown) the costs are going up yearly.
The marginal income tax rate for someone making $50,000 in Canada is only 22% federal and something like 10% Provincial - and aside from a small premium in Ontario, this covers all doctors visits and hospitalisation (Not drugs, dental or vision care - that's another issue), as well as education, social services, the military, etc.
this is why it boggles Canadians - and Brits and lots of other people - why Americans don't have single payer healthcare. Americans are being bled to death by the cost of basic healthcare, and they aren't even getting the health outcomes to justify it. Yeah, the poor may be covered by a program (limited, second class, with massive gaps) but working people are shelling out so much money.
Also: don't use anecdotal evidence re wait-times in Canada. There is research if you are interested - and from what I can remember from working for a scientist who studied wait times, they aren't substantially different except for specific procedures (hip, knee replacement) -- and Canada is improving those (thus the fact that she had a grant to study them).
But to repeat: $600 is a lot of money. If you don't think so, perhaps your income is substantially above the median. But a lot of people - half even - have incomes at or below the median.
posted by jb at 9:41 AM on March 26, 2014 [7 favorites]
My point is that $600/month is a huge amount of money.
Median household income in the US is about $50,000 (Wikipedia). Gross is then about $4166 per month -- and $600 is 15% of that. Let's say that you have a $5000 deductible (which is what's being quoted with these plans), and now you have 25% of your gross income going to healthcare. That's more than many people spend on housing; definitely more than most spend on food -- and (as Elizabeth Warren has shown) the costs are going up yearly.
The marginal income tax rate for someone making $50,000 in Canada is only 22% federal and something like 10% Provincial - and aside from a small premium in Ontario, this covers all doctors visits and hospitalisation (Not drugs, dental or vision care - that's another issue), as well as education, social services, the military, etc.
this is why it boggles Canadians - and Brits and lots of other people - why Americans don't have single payer healthcare. Americans are being bled to death by the cost of basic healthcare, and they aren't even getting the health outcomes to justify it. Yeah, the poor may be covered by a program (limited, second class, with massive gaps) but working people are shelling out so much money.
Also: don't use anecdotal evidence re wait-times in Canada. There is research if you are interested - and from what I can remember from working for a scientist who studied wait times, they aren't substantially different except for specific procedures (hip, knee replacement) -- and Canada is improving those (thus the fact that she had a grant to study them).
But to repeat: $600 is a lot of money. If you don't think so, perhaps your income is substantially above the median. But a lot of people - half even - have incomes at or below the median.
posted by jb at 9:41 AM on March 26, 2014 [7 favorites]
Then comes the ACA, and guess what even Romneycare plans were cancelled and called inadequate.
How many were cancelled?
posted by MisantropicPainforest at 12:32 PM on March 26 [+] [!]
About 105,000 plans were cancelled.
posted by Gungho at 9:43 AM on March 26, 2014
How many were cancelled?
posted by MisantropicPainforest at 12:32 PM on March 26 [+] [!]
About 105,000 plans were cancelled.
posted by Gungho at 9:43 AM on March 26, 2014
Its a lot of money but $600 to cover two adults in their 40s in the US is what one would expect to pay. No one should be shocked.
posted by MisantropicPainforest at 9:44 AM on March 26, 2014
posted by MisantropicPainforest at 9:44 AM on March 26, 2014
And why were they cancelled? Because they didn't provide the requisite coverage, right? Or where their other reasons?
posted by MisantropicPainforest at 9:47 AM on March 26, 2014
posted by MisantropicPainforest at 9:47 AM on March 26, 2014
jb, 620/month is real money. However, comparing it to median income is not valid, as the cost would be different if they made the median. Their income is given in the article as
our household adjusted gross income is likely to be over the $62,040 cutoff this year
When I initially read the article, I read it as them making 62K, now I see that their income is over 62K. The highest their cost would be is 12% of their pre-tax income, to cover 2 people.
posted by theora55 at 9:51 AM on March 26, 2014 [3 favorites]
our household adjusted gross income is likely to be over the $62,040 cutoff this year
When I initially read the article, I read it as them making 62K, now I see that their income is over 62K. The highest their cost would be is 12% of their pre-tax income, to cover 2 people.
posted by theora55 at 9:51 AM on March 26, 2014 [3 favorites]
And, sure, single-payer would be miles better. But ACA wasn't easy to get passed, and is being fought hard, and bitterly. Single payer wasn't going to happen. I'm mildly hopeful that the parts of ACA that address the huge cost of health care in the US will be effective. Incidentally, know what sector of the economy is really consistently, really profitable? Healthcare.
posted by theora55 at 9:57 AM on March 26, 2014
posted by theora55 at 9:57 AM on March 26, 2014
I don't understand the subsidies.
How much would a household making $50,000 end up paying under the ACA? Is that the same if they are in a state which has refused to expand Medicaid?
posted by jb at 10:04 AM on March 26, 2014
How much would a household making $50,000 end up paying under the ACA? Is that the same if they are in a state which has refused to expand Medicaid?
posted by jb at 10:04 AM on March 26, 2014
And how old are they?
posted by MisantropicPainforest at 10:14 AM on March 26, 2014
posted by MisantropicPainforest at 10:14 AM on March 26, 2014
There's a lot of presumption here that their old plan sucked. Maybe it did
There is no maybe about it; two adults in their 40s cannot get reasonable health insurance for $263 a month. It is actuarially impossible. I was paying more than that as a single adult in my late 20s for good coverage.
I have criticized aspects of the ACA as anyone who reads metafilter regularly knows. But this article is not a reasonable criticism. It is yet more NYT concern trolling of the "WONT SOMEBODY PLEASE THINK OF THE WELL-OFF MANHATTANITES???" variety.
posted by Justinian at 10:22 AM on March 26, 2014 [5 favorites]
There is no maybe about it; two adults in their 40s cannot get reasonable health insurance for $263 a month. It is actuarially impossible. I was paying more than that as a single adult in my late 20s for good coverage.
I have criticized aspects of the ACA as anyone who reads metafilter regularly knows. But this article is not a reasonable criticism. It is yet more NYT concern trolling of the "WONT SOMEBODY PLEASE THINK OF THE WELL-OFF MANHATTANITES???" variety.
posted by Justinian at 10:22 AM on March 26, 2014 [5 favorites]
jb - you can use the subsidy calculator at the kaiser foundation website.
I did a quick example on US State Average, 50k, 2 adult household
Results:
Maximum % of income you have to pay for the premium, if eligible for a subsidy: 9.5%
Health Insurance premium in 2014 (for a silver plan, before tax credit): $5,070 per year
You could receive a government tax credit subsidy of up to: $320 per year
(which covers 6% of the overall premium)
Amount you pay for the premium: $4,750 per year
(which equals 9.5% of your household income and covers 94% of the overall premium)
For what it's worth - that is the maximum cost for a silver plan. There are cheaper "bronze" plans which have higher out of pocket and lower deductible levels.
posted by PissOnYourParade at 10:28 AM on March 26, 2014
I did a quick example on US State Average, 50k, 2 adult household
Results:
Maximum % of income you have to pay for the premium, if eligible for a subsidy: 9.5%
Health Insurance premium in 2014 (for a silver plan, before tax credit): $5,070 per year
You could receive a government tax credit subsidy of up to: $320 per year
(which covers 6% of the overall premium)
Amount you pay for the premium: $4,750 per year
(which equals 9.5% of your household income and covers 94% of the overall premium)
For what it's worth - that is the maximum cost for a silver plan. There are cheaper "bronze" plans which have higher out of pocket and lower deductible levels.
posted by PissOnYourParade at 10:28 AM on March 26, 2014
Based on the KFF calculator, it looks like they'd be paying $400/mo for a Silver plan. Medicaid expansion doesn't apply because they're far above the Medicaid cutoff.
On preview: what POYP said.
posted by griphus at 10:30 AM on March 26, 2014
On preview: what POYP said.
posted by griphus at 10:30 AM on March 26, 2014
There's a lot of presumption here that their old plan sucked.
It would be impossible for a plan that cost a couple $263 a month to be actuarially sound and not suck donkey balls dressed with sputum and hate.
posted by ROU_Xenophobe at 10:34 AM on March 26, 2014 [3 favorites]
It would be impossible for a plan that cost a couple $263 a month to be actuarially sound and not suck donkey balls dressed with sputum and hate.
posted by ROU_Xenophobe at 10:34 AM on March 26, 2014 [3 favorites]
Yeah I'm not about to make the argument that the ACA is a cure-all, but if $263/mo for two people covered anything save for checkup PCP visits and generic drugs (both with co-pay probably), I'd be really, really surprised.
posted by griphus at 10:38 AM on March 26, 2014
posted by griphus at 10:38 AM on March 26, 2014
I'm in the guy's demographic. I think my wife's plan costs went up, and maybe mine went up a little bit, but it more than pays for itself with the vastly better coverage I get now. I was paying over $300 additional per month for a prescription which was formerly not covered, and is now $25.
ACA is not a panacea, but it's damn better than what went on before, unless you formerly received some sort of Cadillac plan and your employer is now being a whiny ass.
Pet insurance is generally at least $100 per month, and the coverage is fairly abysmal for that amount of money, in my opinion. You'd be better off banking it into a special account--or better yet, spend it on better quality dog food and underwriting shared outdoor adventures.
By age 14, your pet would have about $15K in the slush fund if you did that. If you decide that your 14-year-old dog with invasive, painful cancer--who just wants to go to doggie heaven already--should maybe exit this world gracefully rather than be kept around because you cannot cope with that, you have still have your money, rather than the soulless hucksters selling the insurance.
posted by maxwelton at 10:54 AM on March 26, 2014 [5 favorites]
ACA is not a panacea, but it's damn better than what went on before, unless you formerly received some sort of Cadillac plan and your employer is now being a whiny ass.
Pet insurance is generally at least $100 per month, and the coverage is fairly abysmal for that amount of money, in my opinion. You'd be better off banking it into a special account--or better yet, spend it on better quality dog food and underwriting shared outdoor adventures.
By age 14, your pet would have about $15K in the slush fund if you did that. If you decide that your 14-year-old dog with invasive, painful cancer--who just wants to go to doggie heaven already--should maybe exit this world gracefully rather than be kept around because you cannot cope with that, you have still have your money, rather than the soulless hucksters selling the insurance.
posted by maxwelton at 10:54 AM on March 26, 2014 [5 favorites]
Also: How is it legal for a governor to deny his constituents medical care because he doesn't like the President? In the other direction, how is it legal to tie medicare benefits to something outside the control of the people who they're ultimately intended to cover?
"State's Rights" is such a stupid, stupid concept.
posted by maxwelton at 10:59 AM on March 26, 2014 [4 favorites]
"State's Rights" is such a stupid, stupid concept.
posted by maxwelton at 10:59 AM on March 26, 2014 [4 favorites]
> In the other direction, how is it legal to tie medicare benefits to something outside the control of the people who they're ultimately intended to cover?
This is the direction in which we have to consider it, because Medicaid has been a state-by-state program from the start, as opposed to Medicare which has always been exclusively federal.
I'm not entirely sure why this is — maybe the federal government didn't want to pay the entire cost of Medicaid and wanted states to chip in. Unlike old age, poverty is a condition that is influenced by state policy, so perhaps the federal government wanted to give states incentive to decrease the number of poor people in their state (by making them less poor through policy, rather than driving them out of the state entirely).
But because Medicaid is a voluntary program, the Supreme Court said that the ACA couldn't force states to adopt the Medicaid expansion. (They found that the ACA's stipulated consequences for a state refusing the expansion were coercive, so they struck them down.) All this did was turn the Medicaid expansion into a "you'd have to be an idiot to refuse free money" thing, but unfortunately half our state governors are either idiots or feel that they're under the thumb of idiots.
> "State's Rights" is such a stupid, stupid concept.
Yes. Yes, it is.
posted by savetheclocktower at 11:44 AM on March 26, 2014
This is the direction in which we have to consider it, because Medicaid has been a state-by-state program from the start, as opposed to Medicare which has always been exclusively federal.
I'm not entirely sure why this is — maybe the federal government didn't want to pay the entire cost of Medicaid and wanted states to chip in. Unlike old age, poverty is a condition that is influenced by state policy, so perhaps the federal government wanted to give states incentive to decrease the number of poor people in their state (by making them less poor through policy, rather than driving them out of the state entirely).
But because Medicaid is a voluntary program, the Supreme Court said that the ACA couldn't force states to adopt the Medicaid expansion. (They found that the ACA's stipulated consequences for a state refusing the expansion were coercive, so they struck them down.) All this did was turn the Medicaid expansion into a "you'd have to be an idiot to refuse free money" thing, but unfortunately half our state governors are either idiots or feel that they're under the thumb of idiots.
> "State's Rights" is such a stupid, stupid concept.
Yes. Yes, it is.
posted by savetheclocktower at 11:44 AM on March 26, 2014
Hmm, $263 per month is roughly what my wife and I paid in health insurance all through her terminal illness, covering everything from dialysis to two years of hospital care, with very little additional cost. But that was done in Holland with the government not just mandating insurance, but also its coverage.
posted by MartinWisse at 12:14 PM on March 26, 2014
posted by MartinWisse at 12:14 PM on March 26, 2014
Then comes the ACA, and guess what even Romneycare plans were cancelled and called inadequate
Just to be clear, any plan that was actually cancelled because of ACA was changed by the insurance company since ACA was enacted with their full realization that this would mean it would have to be cancelled. In that case, it is not really attributable to the ACA, but rather to the venal insurance company who changed it (probably to increase its profits).
posted by Mental Wimp at 12:22 PM on March 26, 2014 [1 favorite]
Just to be clear, any plan that was actually cancelled because of ACA was changed by the insurance company since ACA was enacted with their full realization that this would mean it would have to be cancelled. In that case, it is not really attributable to the ACA, but rather to the venal insurance company who changed it (probably to increase its profits).
posted by Mental Wimp at 12:22 PM on March 26, 2014 [1 favorite]
I've had pet insurance. Once your pets reach a certain age, they stop covering illness and only cover injuries. I don't think he'd be fine with health insurance that only covers injuries once he's a bit older than he is now.
posted by Jacqueline at 12:23 PM on March 26, 2014
posted by Jacqueline at 12:23 PM on March 26, 2014
Of course, before OBUMMER!care, health costs would reliably go down every year. We'd gather around our email every December and wait to hear from HR that, yes, not only do we get to keep our coverage, but it's actually getting better for less money. And that they'd be taking care of the paperwork for us. We never had problems finding an in-network provider or had to switch doctors and we always knew exactly what we were going to pay, even for prescriptions! Once, a company I worked at had an employee with a seriously ill child and the insurance company recognized that we were all helping a fellow employee through a tough time and cut all of our premiums as a thank you.
posted by stet at 5:03 PM on March 26, 2014 [10 favorites]
posted by stet at 5:03 PM on March 26, 2014 [10 favorites]
On reflection, that's one of those rants I should have deleted instead of posting. Oh well.
posted by stet at 5:04 PM on March 26, 2014 [1 favorite]
posted by stet at 5:04 PM on March 26, 2014 [1 favorite]
Well, my Canadian friends have longer waits than anyone in this thread, so the comparison is just noise, considering the U.S. is never going to move to single payer.
posted by roomthreeseventeen at 9:36 AM on March 26
Do they? My friends and family in Nova Scotia never have to wait for anything where it would affect the outcome. The long wait times all seem to be for stuff like knee surgery to fix an injury they sustained three decades before and never bothered to have fixed.
posted by joannemerriam at 11:32 AM on March 27, 2014
posted by roomthreeseventeen at 9:36 AM on March 26
Do they? My friends and family in Nova Scotia never have to wait for anything where it would affect the outcome. The long wait times all seem to be for stuff like knee surgery to fix an injury they sustained three decades before and never bothered to have fixed.
posted by joannemerriam at 11:32 AM on March 27, 2014
Then comes the ACA, and guess what even Romneycare plans were cancelled and called inadequate
Just to be clear, any plan that was actually cancelled because of ACA was changed by the insurance company since ACA was enacted with their full realization that this would mean it would have to be cancelled. In that case, it is not really attributable to the ACA, but rather to the venal insurance company who changed it (probably to increase its profits).
posted by Mental Wimp at 3:22 PM on March 26 [1 favorite +] [!]
Ah so that's where all the Kool-Aid went. You drank it all. IIRC We were told "If you like your plan you can keep it." We were told that several times. UNTIL the reality set in and the ACA required so many changes that for all intents and purposes the old plans went bye-bye. So I guess Romneycare was offering those "junk plans" I hear so much about... Then Obama et al come out saying "That's not what i said, I said you could keep it until it changed." I cry SHENANIGANS! They knew all along that a vast vast majority of plans would have to at least be modified to conform to the ACA. The reality is they were cancelled. And really shame on them for thinking we would just swallow that line of utter BS along with all the kool-aid. This so-called reform has so badly altered the existing insurance structure that in some areas of the country the only option is ONE plan. So much for better coverage and competitive rates. That went along with the $2500.00 reduction and the Easter Bunny.
posted by Gungho at 12:05 PM on March 27, 2014
Just to be clear, any plan that was actually cancelled because of ACA was changed by the insurance company since ACA was enacted with their full realization that this would mean it would have to be cancelled. In that case, it is not really attributable to the ACA, but rather to the venal insurance company who changed it (probably to increase its profits).
posted by Mental Wimp at 3:22 PM on March 26 [1 favorite +] [!]
Ah so that's where all the Kool-Aid went. You drank it all. IIRC We were told "If you like your plan you can keep it." We were told that several times. UNTIL the reality set in and the ACA required so many changes that for all intents and purposes the old plans went bye-bye. So I guess Romneycare was offering those "junk plans" I hear so much about... Then Obama et al come out saying "That's not what i said, I said you could keep it until it changed." I cry SHENANIGANS! They knew all along that a vast vast majority of plans would have to at least be modified to conform to the ACA. The reality is they were cancelled. And really shame on them for thinking we would just swallow that line of utter BS along with all the kool-aid. This so-called reform has so badly altered the existing insurance structure that in some areas of the country the only option is ONE plan. So much for better coverage and competitive rates. That went along with the $2500.00 reduction and the Easter Bunny.
posted by Gungho at 12:05 PM on March 27, 2014
So much for better coverage and competitive rates.
But, many many people are experiencing better coverage (or, actual coverage) and better rates.
posted by MisantropicPainforest at 12:08 PM on March 27, 2014
But, many many people are experiencing better coverage (or, actual coverage) and better rates.
posted by MisantropicPainforest at 12:08 PM on March 27, 2014
They knew all along that a vast vast majority of plans would have to at least be modified to conform to the ACA. The reality is they were cancelled.
This is factually untrue. The vast majority of plans, as intended, slowly modified their coverage to meet ACA requirements or met the rules required for grandfathered plans (like my plan is). The number of people with individual plans potentially affected by the new rules was less than 4% of all Americans.
Yes, it's true that not all cancelled plans were substandard. It's true that some plans that people liked were cancelled and Obama should have been much more careful with his promises. But that doesn't make it acceptable to catastrophize a relatively small number of cases into some kind of nation-wide epidemic.
posted by muddgirl at 12:18 PM on March 27, 2014 [1 favorite]
This is factually untrue. The vast majority of plans, as intended, slowly modified their coverage to meet ACA requirements or met the rules required for grandfathered plans (like my plan is). The number of people with individual plans potentially affected by the new rules was less than 4% of all Americans.
Yes, it's true that not all cancelled plans were substandard. It's true that some plans that people liked were cancelled and Obama should have been much more careful with his promises. But that doesn't make it acceptable to catastrophize a relatively small number of cases into some kind of nation-wide epidemic.
posted by muddgirl at 12:18 PM on March 27, 2014 [1 favorite]
and many many and more to come are having their rates increased, plans changed, employer contribution dropped. somehow these are treated as if they don't exist, or aren't real problems. or that they should be done as a sacrifice for the cause. Please tell that to someone whose plan is gone, and costs have doubled.
posted by Gungho at 12:22 PM on March 27, 2014
posted by Gungho at 12:22 PM on March 27, 2014
and many many and more to come are having their rates increased, plans changed, employer contribution dropped.
So, like health insurance in this country as it as always been?
posted by MisantropicPainforest at 12:32 PM on March 27, 2014
So, like health insurance in this country as it as always been?
posted by MisantropicPainforest at 12:32 PM on March 27, 2014
UNTIL the reality set in and the ACA required so many changes that for all intents and purposes the old plans went bye-bye.
This isn't even wrong. The law, which I have read, contains a clause that grandfathered in existing policies. The catch was that they had to be in force at the time the law went into effect. You can bet you ass the insurance companies knew these rules as a) they had an army of lobbyist helping to write the bills, and b) they had an army of employees looking to see what opportunities and costs would arise from its implementation. They knew that if they changed the policies after ACA went into effect that they would have to cancel them and sell a newer policy that was ACA compliant. They went ahead and changed those policies in the interim specifically so they could tell their clients that they had to cancel their policy to comply with ACA, and then turned around and sold them an ACA policy at a higher price than the junk policy the client had been paying for. If you think I'm wrong and have something other than insults that addresses my misperception I would like to see it.
posted by Mental Wimp at 3:28 PM on March 27, 2014 [2 favorites]
This isn't even wrong. The law, which I have read, contains a clause that grandfathered in existing policies. The catch was that they had to be in force at the time the law went into effect. You can bet you ass the insurance companies knew these rules as a) they had an army of lobbyist helping to write the bills, and b) they had an army of employees looking to see what opportunities and costs would arise from its implementation. They knew that if they changed the policies after ACA went into effect that they would have to cancel them and sell a newer policy that was ACA compliant. They went ahead and changed those policies in the interim specifically so they could tell their clients that they had to cancel their policy to comply with ACA, and then turned around and sold them an ACA policy at a higher price than the junk policy the client had been paying for. If you think I'm wrong and have something other than insults that addresses my misperception I would like to see it.
posted by Mental Wimp at 3:28 PM on March 27, 2014 [2 favorites]
If you create economic incentives for insurance companies to move you to the new plans you can hardly blame the insurance companies for following those economic incentives. Hell, they have a duty to their shareholders to do exactly that.
posted by Justinian at 6:07 PM on March 27, 2014
posted by Justinian at 6:07 PM on March 27, 2014
Is Obamacare repeal fatigue setting in?
"Only 18 percent want to repeal the law and not replace it, while all of 11 percent want to repeal and replace it with a GOP alternative — a grand total of 29 percent. Meanwhile, 49 percent want to keep the law and improve it, and another 10 percent want to keep it as is — a total of 59 percent.
Among indys, that keep/improve versus repeal/replace spread is 52-31. Republicans are all alone here, with their spread at 31-58.
That overall keep-versus-repeal spread has improved for the law since February (when it was 56-31), and even more so since December and October, suggesting a clear trend.
Virtually every one of them — the Medicaid expansion; the preexisting conditions piece; subsidies for low income people’s coverage – has overwhelming majority support, and all of those are even backed by a majority of Republicans. The big exception: The individual mandate."
posted by MisantropicPainforest at 5:52 AM on March 28, 2014 [1 favorite]
"Only 18 percent want to repeal the law and not replace it, while all of 11 percent want to repeal and replace it with a GOP alternative — a grand total of 29 percent. Meanwhile, 49 percent want to keep the law and improve it, and another 10 percent want to keep it as is — a total of 59 percent.
Among indys, that keep/improve versus repeal/replace spread is 52-31. Republicans are all alone here, with their spread at 31-58.
That overall keep-versus-repeal spread has improved for the law since February (when it was 56-31), and even more so since December and October, suggesting a clear trend.
Virtually every one of them — the Medicaid expansion; the preexisting conditions piece; subsidies for low income people’s coverage – has overwhelming majority support, and all of those are even backed by a majority of Republicans. The big exception: The individual mandate."
posted by MisantropicPainforest at 5:52 AM on March 28, 2014 [1 favorite]
If you create economic incentives for insurance companies to move you to the new plans you can hardly blame the insurance companies for following those economic incentives. Hell, they have a duty to their shareholders to do exactly that.
Very true. And independent of ACA.
posted by Mental Wimp at 7:19 AM on March 28, 2014
Very true. And independent of ACA.
posted by Mental Wimp at 7:19 AM on March 28, 2014
They went ahead and changed those policies in the interim specifically so they could tell their clients that they had to cancel their policy to comply with ACA, and then turned around and sold them an ACA policy at a higher price than the junk policy the client had been paying for. If you think I'm wrong and have something other than insults that addresses my misperception I would like to see it.
The only problem with this theory is that the ACA sets a cap on profits as related to plan expenditures. An insurance company could indeed set up a plan - within the ACA guidelines - that made more money than the 20% (IIRC) cap, but once a year goes by and the discrepancy is revealed they'd just have to refund it. So there's no real value in setting up such plans.
Now, if you want to contend that there were strategic plan cancellations for marketing/perception value? I suppose I might buy that. We certainly saw every damned thing in the universe blamed on the regulations that capped exchange fees and cut down on banks soaking consumers on ATM/CC charges, far out of sync with the actual costs. I could believe that insurance companies figured they'd make some PR hay out of the inevitable.
posted by phearlez at 12:08 PM on March 28, 2014
The only problem with this theory is that the ACA sets a cap on profits as related to plan expenditures. An insurance company could indeed set up a plan - within the ACA guidelines - that made more money than the 20% (IIRC) cap, but once a year goes by and the discrepancy is revealed they'd just have to refund it. So there's no real value in setting up such plans.
Now, if you want to contend that there were strategic plan cancellations for marketing/perception value? I suppose I might buy that. We certainly saw every damned thing in the universe blamed on the regulations that capped exchange fees and cut down on banks soaking consumers on ATM/CC charges, far out of sync with the actual costs. I could believe that insurance companies figured they'd make some PR hay out of the inevitable.
posted by phearlez at 12:08 PM on March 28, 2014
So there's no real value in setting up such plans.
There was in the short term. And note that the cap is on all profits, not on individual plans.
posted by Mental Wimp at 12:52 PM on March 28, 2014
There was in the short term. And note that the cap is on all profits, not on individual plans.
posted by Mental Wimp at 12:52 PM on March 28, 2014
They went ahead and changed those policies in the interim specifically so they could tell their clients that they had to cancel their policy to comply with ACA, and then turned around and sold them an ACA policy at a higher price than the junk policy the client had been paying for. If you think I'm wrong and have something other than insults that addresses my misperception I would like to see it.
posted by Mental Wimp at 6:28 PM on March 27 [2 favorites +] [!]
What more can I offer as an example than personal experience. I was purchasing a plan through the Massachusetts Connector because my employer did not offer a plan that qualified. I took on 100% of the cost simply to be compliant with Massachusetts law. As soon as the ACA takes hold The MA Connector cancelled 105,000 people and required them to re-apply for new plans that qualified under ACA rules. There was no offer of "grandfathering, even after Obama caved and allowed insurers to grandfather people if they wanted to. You are making a very broad assumption that the evil insurance companies changed the plans because they could, not because, as is the truth, because they HAD to. I can assure you that under Romneycare the plan I was buying, and the other 104,999 people were buying was not "junk".
So how does/did the affect me? I have been waiting since October 2013 for a determination if I qualify. Qualify? For what? I am paying 100% because my employer has no plan. If/when this is determined I will be paying a higher premium for WORSE coverage than before the ACA. How so is it worse? Well for one there is the higher premium, but premiums do rise from time to time, but IIRC I was told the ACA would save me money. Then there's the higher office visit, emergency room, and hospital visit co-pays, then there's the more expensive perscriptions, and the elimination of emergency oral surgery coverage for wisdom teeth. The new ACA compliant plan has none. Of course if I want what was previously included i can purchase a separate dental plan for...wait for it...more money....and that's only the stuff on the surface. So please step away from the kool-aid and learn what this so-called Affordable Care Act is doing to the middle class who liked their plan and thought we could keep it.
So where am I now? Still waiting, not being billed, being sent an "emergency" coverage letter every few weeks, wondering, if needed, will the ambulance see my letter and accept it, will my doctor accept it? Who do they bill? In MA we have 9 or 10 insurance company options. Who is paying for these "emergency coverage" letters? And the Ma Connector Web site, built by CGI is a massive failure. CGI has been fired, weeks ago, and no one seems to know if it can be fixed, or just trashed to start all over again.
In a nutshell, while the idea of the ACA is great, and I love it and welcome it, the salesmanship, lies, failures and continuing ineptness, make me wonder if it was worth spending nearly 2 billion dollars and counting to ensure that 7 million out of the 48 million eligible have coverage, and that perhaps a less drastic plan could have been implemented.
posted by Gungho at 7:38 AM on March 30, 2014
posted by Mental Wimp at 6:28 PM on March 27 [2 favorites +] [!]
What more can I offer as an example than personal experience. I was purchasing a plan through the Massachusetts Connector because my employer did not offer a plan that qualified. I took on 100% of the cost simply to be compliant with Massachusetts law. As soon as the ACA takes hold The MA Connector cancelled 105,000 people and required them to re-apply for new plans that qualified under ACA rules. There was no offer of "grandfathering, even after Obama caved and allowed insurers to grandfather people if they wanted to. You are making a very broad assumption that the evil insurance companies changed the plans because they could, not because, as is the truth, because they HAD to. I can assure you that under Romneycare the plan I was buying, and the other 104,999 people were buying was not "junk".
So how does/did the affect me? I have been waiting since October 2013 for a determination if I qualify. Qualify? For what? I am paying 100% because my employer has no plan. If/when this is determined I will be paying a higher premium for WORSE coverage than before the ACA. How so is it worse? Well for one there is the higher premium, but premiums do rise from time to time, but IIRC I was told the ACA would save me money. Then there's the higher office visit, emergency room, and hospital visit co-pays, then there's the more expensive perscriptions, and the elimination of emergency oral surgery coverage for wisdom teeth. The new ACA compliant plan has none. Of course if I want what was previously included i can purchase a separate dental plan for...wait for it...more money....and that's only the stuff on the surface. So please step away from the kool-aid and learn what this so-called Affordable Care Act is doing to the middle class who liked their plan and thought we could keep it.
So where am I now? Still waiting, not being billed, being sent an "emergency" coverage letter every few weeks, wondering, if needed, will the ambulance see my letter and accept it, will my doctor accept it? Who do they bill? In MA we have 9 or 10 insurance company options. Who is paying for these "emergency coverage" letters? And the Ma Connector Web site, built by CGI is a massive failure. CGI has been fired, weeks ago, and no one seems to know if it can be fixed, or just trashed to start all over again.
In a nutshell, while the idea of the ACA is great, and I love it and welcome it, the salesmanship, lies, failures and continuing ineptness, make me wonder if it was worth spending nearly 2 billion dollars and counting to ensure that 7 million out of the 48 million eligible have coverage, and that perhaps a less drastic plan could have been implemented.
posted by Gungho at 7:38 AM on March 30, 2014
The MA Connector cancelled 105,000 people and required them to re-apply for new plans that qualified under ACA rules.
So this was a Massachusetts decision? I don't know how you can blame ACA (or Obama) for that.
...grandfathering, even after Obama caved and allowed insurers to grandfather people if they wanted to...
You don't say when you purchased your MA Connector plan, but if it was since the signing of ACA, then it didn't originally qualify for grandfathering. This website explains the grandfathering rules as encoded in the law.
I know it is easy to blame all problems with health insurance on ACA, but just about every problem I've heard is based on a decision made by someone outside of the federal government in full knowledge of the implications and not a direct result of ACA.
posted by Mental Wimp at 4:10 PM on March 30, 2014
So this was a Massachusetts decision? I don't know how you can blame ACA (or Obama) for that.
...grandfathering, even after Obama caved and allowed insurers to grandfather people if they wanted to...
You don't say when you purchased your MA Connector plan, but if it was since the signing of ACA, then it didn't originally qualify for grandfathering. This website explains the grandfathering rules as encoded in the law.
I know it is easy to blame all problems with health insurance on ACA, but just about every problem I've heard is based on a decision made by someone outside of the federal government in full knowledge of the implications and not a direct result of ACA.
posted by Mental Wimp at 4:10 PM on March 30, 2014
Gungho: perhaps a less drastic plan could have been implemented.
The least drastic method to reduce the number of uninsured would have been to simply pump more money into our existing single-payer programs -- Medicare, Medicaid, Tricare, etc. In a different universe with a different system of government, I'm certain Democrats would have been happy to simply lower the Medicare eligibility age and provide more funds for state Medicaid programs. However, there's this thing called "Congress" which has these people called "Republicans" who had to be courted while the legislation was being crafted. (None of them voted for it, of course, but the legislation would have died long before the Democrats ever got their brief period of a 60-vote supermajority had they not at least tried to get GOP votes.)
So, yeah, blame the executive branch for the website clusterfuck and the regrettable "you can keep your plan" utterances and what-not -- but the design of the ACA is what you get out of Congress as presently-constituted. Even at a local maximum of Democratic control, this is what they could get.
posted by tonycpsu at 8:18 AM on March 31, 2014
The least drastic method to reduce the number of uninsured would have been to simply pump more money into our existing single-payer programs -- Medicare, Medicaid, Tricare, etc. In a different universe with a different system of government, I'm certain Democrats would have been happy to simply lower the Medicare eligibility age and provide more funds for state Medicaid programs. However, there's this thing called "Congress" which has these people called "Republicans" who had to be courted while the legislation was being crafted. (None of them voted for it, of course, but the legislation would have died long before the Democrats ever got their brief period of a 60-vote supermajority had they not at least tried to get GOP votes.)
So, yeah, blame the executive branch for the website clusterfuck and the regrettable "you can keep your plan" utterances and what-not -- but the design of the ACA is what you get out of Congress as presently-constituted. Even at a local maximum of Democratic control, this is what they could get.
posted by tonycpsu at 8:18 AM on March 31, 2014
Obamacare Sign-Ups on Track to Hit 7 Million on Final Day
No word on how many dogs they've signed up.
posted by tonycpsu at 9:47 PM on March 31, 2014
No word on how many dogs they've signed up.
posted by tonycpsu at 9:47 PM on March 31, 2014
Awesome Fox News Graph about enrollment. Now that's some great work on the Y axis!
posted by Justinian at 3:21 PM on April 1, 2014 [1 favorite]
posted by Justinian at 3:21 PM on April 1, 2014 [1 favorite]
The MA Connector cancelled 105,000 people and required them to re-apply for new plans that qualified under ACA rules.
So this was a Massachusetts decision? I don't know how you can blame ACA (or Obama) for that.
I don't think Massachusetts had any choice in the matter. According to the ACA some of the Commonwealth Choice plans did not match the minimum requirements under the ACA, and some were changed to eliminate certain coverages no longer required by the ACA.
posted by Gungho at 12:16 PM on April 2, 2014
So this was a Massachusetts decision? I don't know how you can blame ACA (or Obama) for that.
I don't think Massachusetts had any choice in the matter. According to the ACA some of the Commonwealth Choice plans did not match the minimum requirements under the ACA, and some were changed to eliminate certain coverages no longer required by the ACA.
posted by Gungho at 12:16 PM on April 2, 2014
I don't think Massachusetts had any choice in the matter. According to the ACA some of the Commonwealth Choice plans did not match the minimum requirements under the ACA, and some were changed to eliminate certain coverages no longer required by the ACA.
But they would have been grandfathered in unless they were changed since the passage of the act, right? So it was Massachusetts' decision to make those changes that they knew would require canceling them and making new ones. Or am I missing something in the law?
posted by Mental Wimp at 1:25 PM on April 2, 2014
But they would have been grandfathered in unless they were changed since the passage of the act, right? So it was Massachusetts' decision to make those changes that they knew would require canceling them and making new ones. Or am I missing something in the law?
posted by Mental Wimp at 1:25 PM on April 2, 2014
You are missing the point that the ACA required different coverages than MA thus forcing the changes. It was only later, after the outrage of cancelled plans welled up that Obama waves his magic wand and allowed insurers to revert to previous plans, for one year, IF they wanted to. It was around this same time that he fell back on his promise of "If you like your plan you can keep it." by "amending" it to mean people could keep plans as long as the plan complied with all the new regulations.
posted by Gungho at 5:28 AM on April 5, 2014
posted by Gungho at 5:28 AM on April 5, 2014
That's not correct. If you sold someone a plan before the ACA, you could keep selling that plan to them so long as you didn't fuck with it. Including noncompliant plans.
posted by ROU_Xenophobe at 6:26 AM on April 5, 2014
posted by ROU_Xenophobe at 6:26 AM on April 5, 2014
You are missing the point that the ACA required different coverages than MA thus forcing the changes.
You keep ignoring the grandfather clause for some reason. Not sure why.
posted by Mental Wimp at 9:54 AM on April 5, 2014
You keep ignoring the grandfather clause for some reason. Not sure why.
posted by Mental Wimp at 9:54 AM on April 5, 2014
You keep ignoring the grandfather clause for some reason. Not sure why.
posted by Mental Wimp at 12:54 PM on April 5 [+] [!]
"A grandfathered plan is any policy in existence before March 23, 2010, when the ACA became law. Grandfathered plans must eliminate lifetime benefit caps, offer coverage to dependent children over age 26 and eliminate pre-existing condition exclusions in 2014, but they are exempt from most other ACA reforms."
The act of making these changes effectively changes the plans. (Quantum Healthcare?), has increased costs, and in many cases increased deductibles and out of pocket expenses. So how can one keep things the same if they have to change them?
posted by Gungho at 1:56 PM on April 7, 2014
posted by Mental Wimp at 12:54 PM on April 5 [+] [!]
"A grandfathered plan is any policy in existence before March 23, 2010, when the ACA became law. Grandfathered plans must eliminate lifetime benefit caps, offer coverage to dependent children over age 26 and eliminate pre-existing condition exclusions in 2014, but they are exempt from most other ACA reforms."
The act of making these changes effectively changes the plans. (Quantum Healthcare?), has increased costs, and in many cases increased deductibles and out of pocket expenses. So how can one keep things the same if they have to change them?
posted by Gungho at 1:56 PM on April 7, 2014
The act of making these changes effectively changes the plans. (Quantum Healthcare?), has increased costs, and in many cases increased deductibles and out of pocket expenses. So how can one keep things the same if they have to change them?
No, you're biting your own tail here. The ACA would have allowed Massachusetts to grandfather their existing plans, they just needed to include coverage up to 26 and eliminate lifetime caps. It explicitly exempts them from all other reforms. Why do you think that the grandfathering clause doesn't grandfather them?
As far as increased costs, nearly every plan premium I know about went up every year until 2010, so I'm not quite sure why you blame ACA for increases after that. My own very large employer plan has gone up inexorably, although it has slowed since 2010.
posted by Mental Wimp at 2:37 PM on April 7, 2014 [1 favorite]
No, you're biting your own tail here. The ACA would have allowed Massachusetts to grandfather their existing plans, they just needed to include coverage up to 26 and eliminate lifetime caps. It explicitly exempts them from all other reforms. Why do you think that the grandfathering clause doesn't grandfather them?
As far as increased costs, nearly every plan premium I know about went up every year until 2010, so I'm not quite sure why you blame ACA for increases after that. My own very large employer plan has gone up inexorably, although it has slowed since 2010.
posted by Mental Wimp at 2:37 PM on April 7, 2014 [1 favorite]
The ACA would have allowed Massachusetts to grandfather their existing plans, they just needed to include coverage up to 26 and eliminate lifetime caps. It explicitly exempts them from all other reforms. Why do you think that the grandfathering clause doesn't grandfather them?
My final comment, because we are obviously fundamentally diametrically and even color-wheel opposites on this. The plans changed. Even the "grandfathered" plans changed. This caused Massachusetts Connector to cancel 105,000 plans and require people to apply for new plans. Please don't piss on my back and tell me it is raining. They changed plans. They cancelled plans, they put the blame solely on the ACA.
posted by Gungho at 8:29 AM on April 8, 2014
My final comment, because we are obviously fundamentally diametrically and even color-wheel opposites on this. The plans changed. Even the "grandfathered" plans changed. This caused Massachusetts Connector to cancel 105,000 plans and require people to apply for new plans. Please don't piss on my back and tell me it is raining. They changed plans. They cancelled plans, they put the blame solely on the ACA.
posted by Gungho at 8:29 AM on April 8, 2014
Well, if you want feel the golden shower of the insurance companies (in this case, apparently, Massachusetts) and claim someone else is pissing on you, that's your prerogative, but the language you quoted proves that the ones doing the pissing are the insurers, not ACA. Sounds to me like you have a vendetta that you will carry out regardless of evidence; again, your prerogative. Just don't pretend you have the truth on your side.
posted by Mental Wimp at 9:26 AM on April 8, 2014 [1 favorite]
posted by Mental Wimp at 9:26 AM on April 8, 2014 [1 favorite]
Truthiness.
In MA The state approves all insurance offerings. So there goes your theory of "Big Bad insurance Companies". How can you, with an apparent straight face, claim that because the ACA required changes to all policies, then allowed some policies to be grandfathered AS LONG AS THEY INCLUDED THE CHANGES that nothing changed? A changed yet grandfathered policy is still changed. Whether grandfathered or not a policy that has to be altered to include ACA requirements has been changed, and in many cases the costs associated will change too.
I bet you fell for that new improved 12 ounce "pound" of coffee too.
posted by Gungho at 1:35 PM on April 8, 2014
In MA The state approves all insurance offerings. So there goes your theory of "Big Bad insurance Companies". How can you, with an apparent straight face, claim that because the ACA required changes to all policies, then allowed some policies to be grandfathered AS LONG AS THEY INCLUDED THE CHANGES that nothing changed? A changed yet grandfathered policy is still changed. Whether grandfathered or not a policy that has to be altered to include ACA requirements has been changed, and in many cases the costs associated will change too.
I bet you fell for that new improved 12 ounce "pound" of coffee too.
posted by Gungho at 1:35 PM on April 8, 2014
I repeat, the golden shower of the insurance companies (in this case, apparently, Massachusetts).
posted by Mental Wimp at 9:42 AM on April 9, 2014
posted by Mental Wimp at 9:42 AM on April 9, 2014
« Older WHERE'S ITS SCROTUM?! | Patatap! Newer »
This thread has been archived and is closed to new comments
posted by HuronBob at 5:16 AM on March 26, 2014 [2 favorites]