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  •  The big fail is #4 (4+ / 0-)

    while the ACA is designed to ensure that most of the working uninsured will be able to afford their premiums after the subsidy, the fact is that high deductibles threaten to limit access to healthcare. And regarding #1 and #3, narrow networks on many lower-cost plans may limit quality and availability. People who are just above the subsidy limit are getting "sticker shock," while the majority of people with employer provided insurance will blame the ACA if their rates go up, regardless of whether it has anything to do with the ACA.

    Although people point to the Massachusetts system as a "success" story, the fact is that healthcare there is not more affordable by any stretch, though thanks to the above-average education levels and income of the citizens of that state, most of them can afford the high costs associated with universal private insurance (they already had 92% of people insured before the mandate went into effect). It's not going to work that way in the rest of the country.

    "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

    by Alice in Florida on Fri Dec 27, 2013 at 10:14:44 PM PST

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    •  agree that implementation & cost reduction (2+ / 0-)
      Recommended by:
      wdrath, True North

      Will be the driver of acceptance by the population. As use of the marketplace becomes easier and more dependable, and people get past the first few months of finding out how doctors and hospitals are going to work with ACA, republicans will find it much harder to keep beating the drum.

      There is still much uncertainty about what will happen January 1, if it goes fairly smooth, and the world doesn't end as republicans have predicted, I think their credibility will start to be questioned. If the story is nobody's insurance was accepted, or they couldn't pay deductibles, then the dems will have a hard year.

      Today's problems are yesterday's solutions. Don Beck

      by Sherri in TX on Sat Dec 28, 2013 at 03:34:41 AM PST

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    •  Thanks, Alice. Let's continue the conversation. (5+ / 0-)

      First, HealthCare in America is very, very expensive, far too expensive, and it will take a far stronger political coalition to deal with the cost of HealthCare itself.  "Obamacare" helped a little with some costs of HealthCare, but it deals mostly with health insurance.  The PPACA coalition did what it could with what it had, but it's our job as voters and citizens to improve it going forward.  Some of the flaws weren't fixed because the Voters failed in the MA special election in 2010 and the 2010 midterms.  

      If we think the subsidies need to be extended, we need to work for the politicians who will help to fix that problem and against those who want to retain, extend and exploit any actual, perceived or fictitious problems.

      Second, all of the standards need to be understood in relation to the failed health insurance system before ACA.  It's okay to compare ACA to Perfection as a motivator towards future improvements, but we can't allow the forces of negativity to lead us towards resignation and defeat.

      The Affordable standard (#4) doesn't mean that ACA suddenly made healthcare and health insurance inexpensive, it means that the expense is now within reach even for those who are older or unhealthy.  

      High-quality (#1) means that every policy has to provide real coverage not the unrestricted junk insurance that was previously allowed.

      Unlimited (#3) means that there are no annual or lifetime limits.  

      I'm in Massachusetts.  Regardless of the starting point, MA is a true success story and the standards have been strongly established.   It will take time to fully establish the standards countrywide, but the politicians can't do it without the voters.  

      Finally, why so negative?  It's good not to be satisfied, but why buy into so many of the RighTea talking points.  Izzy Stone had far greater opposition but never gave up the fight; neither can we.  We're far closer to total victory.  Keep up the fight for Perfection, but appreciate and shout about the lesser victories along the way.

      •  I agree - I really don't understand the negativity (3+ / 0-)
        Recommended by:
        divineorder, wdrath, worldlotus

        I was, without question, opposed to the ACA initially because I wanted single payor.  I continue to be disappointed that we didn't receive something better, but to accept that this is at least a small step in the right direction, and we need to focus on making it better, not whining about it and undermining the little we obtained.

        Yes, the deductibles are depressingly high, especially since the mandates aren't that helpful for people on the cusp.  Eg.  My niece, who's gross income is expected to be a mere $27,000 next year faces a monthly premium of over $200 a month, after the small credit she receives, and her deductible will be $4,000, plus she'll have some co-pays.  That means she will end up spending $6400 plus out of the about $21,000 after tax income on healthcare, leaving her with about $1300 a month for evey thing else.

        On the other hand, without the ACA, she'd not have been diagnosed with an illness that, with treatment, will not have a major impact on her life, but that without treatment would have led to her developing lupus in short order, because she'd not have had insurance and not been able to afford the medical care that finally provided her with that diagnosis.  She was able to obtain that through her mother, since she's under 26.  And now, without the ACA, she'd not be able to get insurance at all because of this pre existing condition.

        So, it's a mixed blessing.  It probably saved her life - certainly saved her many, many thousands of dollars in medical expenses she'd have incurred had it developed into lupus.  But it's still at a higher cost than she can truly afford.

        I'd like to see the higher credits for the lower income people, with lower deductibles and copays available to them as well.  If somehow, medical expenses could be limited to a percentage of income for lower income people.  But I'm hoping that's an improvement that will be made as time goes on, but we need to take a positive approach when trying to make these improvements, not these silly attacks talking as though the ACA itself is a total failure.

        •  If she has an illness, she is better off (1+ / 0-)
          Recommended by:

          going with the low deductible you get at the high premium plans.

          My son in the same  position got a platinum plan with just a $1,000 deductible, but that costs him $167 a month, the high end for 29 yr olds in his state/county. Bottom line he will save over $3,000 in routine annual meds needs.

          Did she thoroughly check her platinum plan options? If you are going to burn through a deductible fast, mifght as well hit it early in the year so the insurer pays from then.

          (Also, why is she not getting a subsidy?? It is there up till $45,090 income)

      •  It's personal (2+ / 0-)
        Recommended by:
        divineorder, wdrath

        I recognize that the ACA is going to be (at least if it works as designed) a very good deal for young people in entry-level jobs and others who find themselves earning in the range of 2xFPL. And it makes health insurance available to people with chronic conditions who couldn't get it at all before--if someone would have had to pay thousands every month to stay alive, it will be great to only have to pay $800 or so.

        The biggest hole in the ACA is not Obama's fault--it was a huge shock when the Supreme Court decide to ignore decades of precedent in terms of the federal government being able to set rules for federally-funded programs. The goal of the ACA to ensure access to healthcare has been dealt a huge blow by the failure to extend Medicaid, which will reportedly leave as many as 7 million poor adults with nothing.

        As for the personal part--I'm one of those whose income falls just above the 4xFPL limit. I realize that I am more fortunate than with lower incomes, in that I can more easily afford food, clothing, shelter, etc., and I'm not like those right wingers who are jealous those with less--I don't enjoy paying taxes, but it sure beats the heck out of living hand to mouth all year and getting a couple of thousand in the spring that goes straight into paying back loans or buying a shitbox (car) that runs to replace the one that doesn't.

        I had hopes of being able to find a plan in the range of $350-400 a month. Not expecting much for that, but it was what I saw on a chart for the high-risk pool (created by the ACA to provide coverage until 2013, vastly undersubscribed from what I heard). Instead, the lowest-cost plan available is $450, has a $6,350 deductible, is limited to my home county and maybe a handful of doctors that doesn't include mine. If I want to keep my doctor I have to go up in price--to at least $500 if I want a plan that might cover me if I'm away from this county for a couple of months. And still with a deductible over $5,000.

        Of course, that's life in the USA these days.

        Regarding "perfection"--it's really sad when Canada is the definition of perfection. I mean, they're nice and all, but not perfect, and their health insurance system (like those of, I think, every country in Europe) isn't perfect either, it's just not a clusterfuck like ours.

        The ultimate irony of the ACA is that its problems are not really due to Republicans, being that not a single one of them voted for it or contributed to it in any way. It was Democrats--specifically a certain handful of Senators who shall remain nameless--who cut out the public option, the one thing that could have forced prices down. The proposal to allow a Medicare buy-in for those over 55 would have been a boon to most of those now bitching and moaning about their insurance being cancelled--many are self-employed older people whose premiums have gone up instead of down--if they could have gotten on Medicare their premiums would probably have been so much lower they could have bought supplementals and still had money left over.

        Hopefully things will calm down, most people will realize that they're either better off or unaffected--the big difference between now and 2010 is that the law will actually be in operation rather than a big nebulous bugaboo that anyone could make up stories about, as it has mostly been since it was enacted.

        "All governments lie, but disaster lies in wait for countries whose officials smoke the same hashish they give out." --I.F. Stone

        by Alice in Florida on Sat Dec 28, 2013 at 08:51:11 AM PST

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        •  Very interesting comments, thanks! FWIW ACA (0+ / 0-)

          related news on the PNHP Articles of Interestpage :

          Articles of Interest

          These articles highlight many of the health care related stories in the news–ranging from single-payer op-eds by PNHP members to reports by newspapers on corporate health care.


            Americans are paying for health care with more than money
              Posted on Friday, December 27, 2013
              By Philip Caper, M.D. | Bangor Daily News
              Americans now spend close to $3 trillion a year for health care, around 18 percent of our GDP. That works out to almost $9,000 per person in Maine, almost twice as much per person as the average for other wealthy nations that provide health care for all their people. ... As one Canadian conference participant put it, “It breaks my heart to see Americans destroying your schools, libraries and public safety to pay for health care.” It breaks my heart, too. We can do a lot better.
            'Sticker shock' over Obamacare bolsters single-payer argument
              Posted on Friday, December 27, 2013
              By Jon Queally | Common Dreams
              As the political uproar surrounding the Affordable Care Act has played out over recent months, one single fact remains: the private insurance model—on which the law widely known as Obamacare is based—is more complicated, more expensive, and provides less coverage than a simple, "everybody in/nobody out," single-payer model that almost every other advanced country in the world enjoys.
            Simple solution — single payer
              Posted on Friday, December 27, 2013
              By Rochelle Dworet, M.D. | Health Policy Solutions
              So the Affordable Care Act is finally being implemented, even online. Our state has its own exchange, which seems to run better than the national model. The people in the states that implemented their own exchanges are all busy heaping accolades on each other. However, the real question is, “Where is the single-payer solution that would save hundreds of millions of dollars and lives?”

          Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

          by divineorder on Sat Dec 28, 2013 at 10:35:37 AM PST

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    •  I am thinking the next step after implementation (0+ / 0-)

      and as time goes on, is working to lower these deductible amounts which are quite high. I think that is one of the tweaks that will need to be made in the future.

      As I think ACA is just the first step. I think improvements will need to be made and one of the big ones will be lowering these very high deductibles that will still keep some people from seeing a doctor as much as recommended by physicials.

      Keystone Liberals on Twitter @ KeystoneLibs , Join PA Liberals at

      by wishingwell on Sun Dec 29, 2013 at 06:23:40 PM PST

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