With the Democratic National Convention starting today in Chicago, we can expect a lot of talk this week – and right up until we vote on November 5 – about the Affordable Care Act, or “Obamacare” as Republicans and their allies have called it from day one.
I guess I'm the only contrarian here. Here are the facts about the ACA:
- It wasn't necessary to redesign health insurance. Also, the "Metal" Levels just created confusion. Today, plans that are labeled "Gold" look and feel like "Silver" plans. This just increased the cost of health insurance.
- The Summary of Benefits and Coverage requirement is confusing at best.
- Age weighted premiums for small group health plans. For an average plan, the premium for a 60 year old is 3 times that of a 30 year old. All other things being equal, employers would be incentivized to hire younger workers over older ones for those who have the same qualifications.
- The law could have been written to do only 2 things: a.) provide an online portal where individuals would register, input their info and receive a determination on how much of a subsidy they would qualify for. The portal would then provide a control number in which they would provide to the health insurer to apply the subsidy to the premium. b.) that all policies are guarantee issue.
- With respect to the Marketplace, the government spent $30 billion for a website that crashed and was prone to hacking. Jeff Bezos offered to create the portal for 1/10th that amount.
- Its popularity stems from the fact that people like free stuff. Take away the subsidies and popularity plumets.
- The original legislation didn't contain cost sharing subsidies to Silver level plans. This was added by the Obama Admin through HHS and subsequently declared unconstitutional. The Administration asked insurers to provide the cost sharing subsidies and they complied, adding about 18% premium for Marketplace over non-Marketplace Silver level plans.
- Today, many, who do not qualify for a premium subsidy, go to the Marketplace and purchase a Silver plan, not knowing the same plan off Marketplace is 18% cheaper.
- Obama sold the ACA by claiming families would save $2,500, and would be able to keep existing plan and their doctors. The reality, the cost for a family increased by more than $2,500 per year in the 3rd year. Many doctors were not in the narrow provider networks. Although many insurers allowed their subscribers to keep their plan for a few years, they forced everyone with individual plans into ACA plans. Blue Cross Blue Shield of MI informed both individual subscribers and small group clients they would be forced into ACA plans no later than January 1, 2014. They were the only health insurer in Michigan to do so.
- With the advent of the ACA, there are now fewer than a handful of health insurers in each state. Prior to the ACA, Michigan had no fewer than 30 health insurers. Today there are only 5 health insurers that offer fully insured plans.
- The ACA has resulted in consolidation of health care providers. The distortions include dominant hospital systems through the purchase of individual medical practices and other hospitals in metropolitan areas around the country. Health insurers, like UHC, are now the biggest employer of doctors.
- Medical Loss Ratio - requiring health insurers to pay out in claims 20% of collected premiums. This created the above distortion. It's similar to the government telling businesses what their profit margin will be. Harris just outlined this in a recent speech about all businesses.
I could go on and on. This was all predicted BEFORE passage of the ACA. When the ACA was passed it was a shell. That's why Nancy Pelosi said "we have to pass it to see what's in it". The American public didn't see what was in it for another 3 years, with the final language appearing in 2013. Other than guarantee issue and premium/cost sharing subsidies, the ACA is a train wreck!
You are not the only contrarian here. ACA is the biggest and most deviously disguised gift of pro-corporate-welfare that has ever been passed over on a purposefully misled and misinformed public.
Well said! Each increase in premium subsidies correlates with an increase in premiums. Free college tuition will only increase college tuition. The $25,000 government down payment that Harris is promoting for first time home buyers will increase homes prices by $25,000. The more government subsidizes or regulates something the higher the price of that item or service. I defy anyone reading this to cite an example where the cost of an item or service has gone down when the government becomes involved. Please don't use the IRA Rx drug price negotiation as an example. If drug companies don't come to agreement with Medicare they will pay a high excise tax. This is coercion not negotiation.
Education, highways, libraries, fire protection, police protection, child protective services, military protection, parks, Social Security and traditional Medicare for starters. The original GI Bill returned $7 just in increased tax revenues alone for every $1 dollar we invested (and we included a living stipend so students would not have to work and go to school). That's a great return. It created a lot of professional accountants, engineers. etc., most of whom otherwise would have spent their lives trapped in low-earning laborer jobs and paying much lower taxes. If everyone had the same equal opportunity for free public education beyond high school, the cost of private schools might go up but the cost of public schools most likely would not. If we all schools were private and run like we do healthcare, tens of millions of our children would have to go without any education at all. Some things are captive market products about which people have no freedom to choose whether they want to purchase them or not. Those kinds of "have to have" things need to be provided as not-for-profit public services (provided by well-paid public servants with great benefits) for the good of our whole. Other products we have the freedom to choose whether we want to purchase or not. Those kinds free market goods and services work perfectly fine using free market rules. Here in the United States we do not seem to be able to tell which are which. Public education and healthcare are two of the best investments any society can make in its people and its future. Our leaders on both sides are allowing our people to be run over roughshod by powerful moneyed interests.
I wish that were true but it's not. The original bill was essentially the former Republican plan but passed without one single Republican vote. Democratic leaders knew before t was passed that (at best) the way ACA was originally designed would leave tens of millions completely uninsured plus tens of millions more dangerously under insured. According to CBO (not me) the fact that some Republican states refused to expand Medicaid added one uninsured person for every nine people who were left uninsured by Rombamacare. For every two people who gained some sort of coverage, three other people were left behind without anything at all. We need healthcare justice and equality (some call it "Medicare") for all and we needed it generations ago already. We're being scammed by powerful moneyed interests and the political leaders who allow themselves to be corrupted by their money (which is almost all of them) into working against the good of our whole.
Rebecca, you couldn't be more wrong. The ACA was one of the major platforms of Obama when running to win is first term. The reason why there wasn't one Republican vote in favor was because the Democrats told the Republicans to "BUT OUT!" This was a Democrat initiative from the very beginning! It started with Hillary Clinton's "secret" Health Care Taskforce. An investigative attorney uncovered negotiations being held behind closed doors, much to the chagrin of the American public.
Regarding Medicaid expansion, that was a totally different part of the bill. the biggest reason why some states refused expansion was that there was no guarantee the federal government would continue to subsidize 80% of the cost of expansion indefinitely. It was written that federal subsidies would gradually be reduced, leaving the states to cover the cost. This of course would break state budgets even more then the are now.
Lastly, you mention we are being scammed by big money interests. This is the only part of you response that is true. This why ever imposing government mandates, regulations and laws create distortions that are exploited by both politicians and business. Many times these ambiguities are built into legislation allowing exploitation.
At about 7:40 into this, Zeke Emanuel explains that Obamacare IS the Republican plan, that Democrats embraced it so then Republicans didn't like it so much anymore.
The only thing more hypocritical than Republicans being against their own bass-ackward, horribly regressive healthcare non-reform plan just because Obama and Democrats passed it (ironically without one single Republican vote) instead of them...are people who think they are progressives but who support and defend the most horribly regressive healthcare policy on our planet for the exact same reason.
I understand ACA was Obama's baby. You don't understand that it used to be the Republican plan. Everyone who knows very much about the issue knows that much.
Erica, seriously? Please inform us as to how the Republicans have prevented implementation? With the exception of the coverage mandate (which was challenged legally and overturned by SCOTUS), there is nothing the Republicans have done successfully to impede the ACA. In fact, premium subsidies are the highest since implementation!
Almost forgot about the cost sharing subsidy2, which was challenged by Republicans. As previously stated, this was not included in the originally passed ACA bill. The Obama administration added through HHS fiat. Is was also declared unconstitutional and struck down. Only by special agreement with participating health insurers was it resurrected in exchange for higher premiums on Marketplace Silver Level plans.
Be a Hero has been working for several years to realize Ady Barkan's dream of quality health care for everyone on the road to Medicare for All. We have been trying to teach people about these Medicare Avantage plans that the insurance cmpanies market so heavily. They are taking trillions every year from the Medicare Trust Fund to ostensibly treat people, then refuse their authorizations for care ("Deny") , delay care unnceessarily ("Delay"), and refuse to pay the hospitals, driving them out of business ("Don't pay"). They also kill about 10,000 [people a year while making their execs into billionaires on our Medicare tax dollars. To learn more, go to info@beaherofund.org and join our campaign to Reclaim Medicare fromCorporate Greed.
Since you are so aware and in a position to observe this day to day, would you be inersted in joining Be a Hero? We are truly garssroots but with great leadership that prepares good handouts, helps us meet with our legislators, conducts teach-ins about MNedicare (Dis)Advantage. etc. Follow the link above or email me. I can send you all kinds of literature and invite you to our monthly member meeting and facebook page.
ACA does to Americans under age 65 what Medicare Disadvantage does to Americans age 65 and over, except Disadvantage offers a public option and Rombamacare does not.
Unfortunately, that "public option," after 65 isn't available to a whole lot of elderly if you are poor--Medigap policies can also be expensive and you will need it for cover that 20% Traditional Medicare won't cover, and/or you miss the 'magic window" for signing up--then you're subjected to underwriting and lots of rejection!!
Yes, but...If we had the full funding of the Medicare Trust Fund, we could make those changes to traditional Medicare. My husband and I have applied for financial aid through our insurance company so we have few medical expenses. That may be the best option for them. Too many people get Med Adv plans to save money, then discover that they aren't getting care and can't get out. Go here to watch Rob Wolpa's story: https://docs.google.com/document/d/1MaGXcWrdtdFrc7NLuvCX4Kzp1uKViiYC85Di38fbsk8/edit
Medicare Advantage are for-profit plans that often don't offer anything but denials, delays and don't pays. They take public funds but that is all and they kill real people. The very idea of a public option of any kind is abhorrent to them. Call one of them ask about their denial rate and you will see that they don't want you to know. The ACA doesn't include a public option as we were led to believe it would, but it does offer lower medical costs and portability to many.
I was one of the first people in the country to use it. Based in NY, they rolled it out quickly. My monthly cost went up significantly from what I had before that as part of the Freelancers Union, but I was happy that other people's costs went down, because collective. But what people don't realize is if you get a subsidy and then start making more money, you have you pay that subsidy back.
FF several years and I started my own business. If you don't quality for subsidies, NYS has the highest rates, with the fewest options among the states. What Obama wanted was the Swiss model where it's required for everyone to have insurance, which helps to keep costs down. I lived in Switzerland so I know it works. What republicans "allowed" was not the Swiss model.
I'm paying a FORTUNE for health insurance every month (+ deductible) before I even step into a doctor's office. And we allow these insurance companies to require prior authorizations, denials, etc. I live with three chronic diseases (genetics suck) and have to fight ALL the time for medicines, one of which insurance companies are now all declining to cover.
This just isn't sustainable and moreover an ethnical and morale failure of our electeds on both sides of the aisle.
Something just occurred to me. Telling Democratic voters that forcing everyone to have to purchase and subsidize private health insurance corporations is a "step toward single payer (M4A)" is a lot like telling Republican voters that tax cuts for the wealthy trickle down. Ouch.
I so agree. In fact, I'm just surprised that the ACA--privatized Healthcare, is helping any American at all. I'm no longer in that group--I'm 68 but no matter what age, healthcare insurance in US is just a corrupt racket.
Expect a Firehose of Obamacare Misinformation From Bad Actors, Insurance Industry Operatives <------- Insurance Industry Operatives? I'm pretty sure that is the group who will most vehemently defend the ACA. The vast majority of insurance company profits these days are via government plans. No one has benefited more than they have. (Maybe you mean that they will pretend to be against it- reverse psychology type thing.)
I guess I'm the only contrarian here. Here are the facts about the ACA:
- It wasn't necessary to redesign health insurance. Also, the "Metal" Levels just created confusion. Today, plans that are labeled "Gold" look and feel like "Silver" plans. This just increased the cost of health insurance.
- The Summary of Benefits and Coverage requirement is confusing at best.
- Age weighted premiums for small group health plans. For an average plan, the premium for a 60 year old is 3 times that of a 30 year old. All other things being equal, employers would be incentivized to hire younger workers over older ones for those who have the same qualifications.
- The law could have been written to do only 2 things: a.) provide an online portal where individuals would register, input their info and receive a determination on how much of a subsidy they would qualify for. The portal would then provide a control number in which they would provide to the health insurer to apply the subsidy to the premium. b.) that all policies are guarantee issue.
- With respect to the Marketplace, the government spent $30 billion for a website that crashed and was prone to hacking. Jeff Bezos offered to create the portal for 1/10th that amount.
- Its popularity stems from the fact that people like free stuff. Take away the subsidies and popularity plumets.
- The original legislation didn't contain cost sharing subsidies to Silver level plans. This was added by the Obama Admin through HHS and subsequently declared unconstitutional. The Administration asked insurers to provide the cost sharing subsidies and they complied, adding about 18% premium for Marketplace over non-Marketplace Silver level plans.
- Today, many, who do not qualify for a premium subsidy, go to the Marketplace and purchase a Silver plan, not knowing the same plan off Marketplace is 18% cheaper.
- Obama sold the ACA by claiming families would save $2,500, and would be able to keep existing plan and their doctors. The reality, the cost for a family increased by more than $2,500 per year in the 3rd year. Many doctors were not in the narrow provider networks. Although many insurers allowed their subscribers to keep their plan for a few years, they forced everyone with individual plans into ACA plans. Blue Cross Blue Shield of MI informed both individual subscribers and small group clients they would be forced into ACA plans no later than January 1, 2014. They were the only health insurer in Michigan to do so.
- With the advent of the ACA, there are now fewer than a handful of health insurers in each state. Prior to the ACA, Michigan had no fewer than 30 health insurers. Today there are only 5 health insurers that offer fully insured plans.
- The ACA has resulted in consolidation of health care providers. The distortions include dominant hospital systems through the purchase of individual medical practices and other hospitals in metropolitan areas around the country. Health insurers, like UHC, are now the biggest employer of doctors.
- Medical Loss Ratio - requiring health insurers to pay out in claims 20% of collected premiums. This created the above distortion. It's similar to the government telling businesses what their profit margin will be. Harris just outlined this in a recent speech about all businesses.
I could go on and on. This was all predicted BEFORE passage of the ACA. When the ACA was passed it was a shell. That's why Nancy Pelosi said "we have to pass it to see what's in it". The American public didn't see what was in it for another 3 years, with the final language appearing in 2013. Other than guarantee issue and premium/cost sharing subsidies, the ACA is a train wreck!
You are not the only contrarian here. ACA is the biggest and most deviously disguised gift of pro-corporate-welfare that has ever been passed over on a purposefully misled and misinformed public.
Well said! Each increase in premium subsidies correlates with an increase in premiums. Free college tuition will only increase college tuition. The $25,000 government down payment that Harris is promoting for first time home buyers will increase homes prices by $25,000. The more government subsidizes or regulates something the higher the price of that item or service. I defy anyone reading this to cite an example where the cost of an item or service has gone down when the government becomes involved. Please don't use the IRA Rx drug price negotiation as an example. If drug companies don't come to agreement with Medicare they will pay a high excise tax. This is coercion not negotiation.
Education, highways, libraries, fire protection, police protection, child protective services, military protection, parks, Social Security and traditional Medicare for starters. The original GI Bill returned $7 just in increased tax revenues alone for every $1 dollar we invested (and we included a living stipend so students would not have to work and go to school). That's a great return. It created a lot of professional accountants, engineers. etc., most of whom otherwise would have spent their lives trapped in low-earning laborer jobs and paying much lower taxes. If everyone had the same equal opportunity for free public education beyond high school, the cost of private schools might go up but the cost of public schools most likely would not. If we all schools were private and run like we do healthcare, tens of millions of our children would have to go without any education at all. Some things are captive market products about which people have no freedom to choose whether they want to purchase them or not. Those kinds of "have to have" things need to be provided as not-for-profit public services (provided by well-paid public servants with great benefits) for the good of our whole. Other products we have the freedom to choose whether we want to purchase or not. Those kinds free market goods and services work perfectly fine using free market rules. Here in the United States we do not seem to be able to tell which are which. Public education and healthcare are two of the best investments any society can make in its people and its future. Our leaders on both sides are allowing our people to be run over roughshod by powerful moneyed interests.
It's because the republicans wouldn't allow it to be implemented the way it was intended.
I wish that were true but it's not. The original bill was essentially the former Republican plan but passed without one single Republican vote. Democratic leaders knew before t was passed that (at best) the way ACA was originally designed would leave tens of millions completely uninsured plus tens of millions more dangerously under insured. According to CBO (not me) the fact that some Republican states refused to expand Medicaid added one uninsured person for every nine people who were left uninsured by Rombamacare. For every two people who gained some sort of coverage, three other people were left behind without anything at all. We need healthcare justice and equality (some call it "Medicare") for all and we needed it generations ago already. We're being scammed by powerful moneyed interests and the political leaders who allow themselves to be corrupted by their money (which is almost all of them) into working against the good of our whole.
Rebecca, you couldn't be more wrong. The ACA was one of the major platforms of Obama when running to win is first term. The reason why there wasn't one Republican vote in favor was because the Democrats told the Republicans to "BUT OUT!" This was a Democrat initiative from the very beginning! It started with Hillary Clinton's "secret" Health Care Taskforce. An investigative attorney uncovered negotiations being held behind closed doors, much to the chagrin of the American public.
Regarding Medicaid expansion, that was a totally different part of the bill. the biggest reason why some states refused expansion was that there was no guarantee the federal government would continue to subsidize 80% of the cost of expansion indefinitely. It was written that federal subsidies would gradually be reduced, leaving the states to cover the cost. This of course would break state budgets even more then the are now.
Lastly, you mention we are being scammed by big money interests. This is the only part of you response that is true. This why ever imposing government mandates, regulations and laws create distortions that are exploited by both politicians and business. Many times these ambiguities are built into legislation allowing exploitation.
At about 7:40 into this, Zeke Emanuel explains that Obamacare IS the Republican plan, that Democrats embraced it so then Republicans didn't like it so much anymore.
The only thing more hypocritical than Republicans being against their own bass-ackward, horribly regressive healthcare non-reform plan just because Obama and Democrats passed it (ironically without one single Republican vote) instead of them...are people who think they are progressives but who support and defend the most horribly regressive healthcare policy on our planet for the exact same reason.
http://www.c-span.org/video/?318033-4/washington-journal-affordable-health-care-act
Of course Zeke would claim it was a Republican. He's a hardcore Democrat! Talk about misinformation.
I understand ACA was Obama's baby. You don't understand that it used to be the Republican plan. Everyone who knows very much about the issue knows that much.
Erica, seriously? Please inform us as to how the Republicans have prevented implementation? With the exception of the coverage mandate (which was challenged legally and overturned by SCOTUS), there is nothing the Republicans have done successfully to impede the ACA. In fact, premium subsidies are the highest since implementation!
Almost forgot about the cost sharing subsidy2, which was challenged by Republicans. As previously stated, this was not included in the originally passed ACA bill. The Obama administration added through HHS fiat. Is was also declared unconstitutional and struck down. Only by special agreement with participating health insurers was it resurrected in exchange for higher premiums on Marketplace Silver Level plans.
Be a Hero has been working for several years to realize Ady Barkan's dream of quality health care for everyone on the road to Medicare for All. We have been trying to teach people about these Medicare Avantage plans that the insurance cmpanies market so heavily. They are taking trillions every year from the Medicare Trust Fund to ostensibly treat people, then refuse their authorizations for care ("Deny") , delay care unnceessarily ("Delay"), and refuse to pay the hospitals, driving them out of business ("Don't pay"). They also kill about 10,000 [people a year while making their execs into billionaires on our Medicare tax dollars. To learn more, go to info@beaherofund.org and join our campaign to Reclaim Medicare fromCorporate Greed.
Medicaid too. Same situation: take over the taxpayer money, deny basic care (refuse to pay $7 laboratory A1C tests, $40 doctor visit etc)
Since you are so aware and in a position to observe this day to day, would you be inersted in joining Be a Hero? We are truly garssroots but with great leadership that prepares good handouts, helps us meet with our legislators, conducts teach-ins about MNedicare (Dis)Advantage. etc. Follow the link above or email me. I can send you all kinds of literature and invite you to our monthly member meeting and facebook page.
They run all aspects of the health care economy- Medicaid Tricare Medicare ACA and employer plans.
ACA does to Americans under age 65 what Medicare Disadvantage does to Americans age 65 and over, except Disadvantage offers a public option and Rombamacare does not.
Unfortunately, that "public option," after 65 isn't available to a whole lot of elderly if you are poor--Medigap policies can also be expensive and you will need it for cover that 20% Traditional Medicare won't cover, and/or you miss the 'magic window" for signing up--then you're subjected to underwriting and lots of rejection!!
Yes, but...If we had the full funding of the Medicare Trust Fund, we could make those changes to traditional Medicare. My husband and I have applied for financial aid through our insurance company so we have few medical expenses. That may be the best option for them. Too many people get Med Adv plans to save money, then discover that they aren't getting care and can't get out. Go here to watch Rob Wolpa's story: https://docs.google.com/document/d/1MaGXcWrdtdFrc7NLuvCX4Kzp1uKViiYC85Di38fbsk8/edit
Medicare Advantage are for-profit plans that often don't offer anything but denials, delays and don't pays. They take public funds but that is all and they kill real people. The very idea of a public option of any kind is abhorrent to them. Call one of them ask about their denial rate and you will see that they don't want you to know. The ACA doesn't include a public option as we were led to believe it would, but it does offer lower medical costs and portability to many.
I was one of the first people in the country to use it. Based in NY, they rolled it out quickly. My monthly cost went up significantly from what I had before that as part of the Freelancers Union, but I was happy that other people's costs went down, because collective. But what people don't realize is if you get a subsidy and then start making more money, you have you pay that subsidy back.
FF several years and I started my own business. If you don't quality for subsidies, NYS has the highest rates, with the fewest options among the states. What Obama wanted was the Swiss model where it's required for everyone to have insurance, which helps to keep costs down. I lived in Switzerland so I know it works. What republicans "allowed" was not the Swiss model.
I'm paying a FORTUNE for health insurance every month (+ deductible) before I even step into a doctor's office. And we allow these insurance companies to require prior authorizations, denials, etc. I live with three chronic diseases (genetics suck) and have to fight ALL the time for medicines, one of which insurance companies are now all declining to cover.
This just isn't sustainable and moreover an ethnical and morale failure of our electeds on both sides of the aisle.
Something just occurred to me. Telling Democratic voters that forcing everyone to have to purchase and subsidize private health insurance corporations is a "step toward single payer (M4A)" is a lot like telling Republican voters that tax cuts for the wealthy trickle down. Ouch.
I so agree. In fact, I'm just surprised that the ACA--privatized Healthcare, is helping any American at all. I'm no longer in that group--I'm 68 but no matter what age, healthcare insurance in US is just a corrupt racket.
Expect a Firehose of Obamacare Misinformation From Bad Actors, Insurance Industry Operatives <------- Insurance Industry Operatives? I'm pretty sure that is the group who will most vehemently defend the ACA. The vast majority of insurance company profits these days are via government plans. No one has benefited more than they have. (Maybe you mean that they will pretend to be against it- reverse psychology type thing.)
! also ! ins should cover
naturopathy !
p
erfect intricacy of the body
& of the planet...
provided me with health
...& a $47,000 cc oop debt
well care is a right..
not a privilege
affirmation on the walls
of free clinics
in the late 60's ...70's
& remains true
( truth being
infinite )
...wdnt need much health ins
if we prevented dis-ease
in the 1st place...!
western " medicine " 💊
attempts to " fix " the broken
client ( no patience
with patients )...
...tackle the sugar king
korporate klamp on
processed krap !
...tackle the farm bill
get the egg folks out of...
the korporale kill
of billions of enslaved sentient hens suffering..,
in battery cages... to be slammed against a wall...
by 16-year-old employee
of a slaughterhousek
...breeding abuse
This sounds like it's going to be fascinating and well worth sharing widely.
Excited to hear more.
Oh thank you so much for highlighting these points! To paraphrase our president, this is still a big f*cking deal! Onward and upward!