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View Diary: Woman in debunked Obamacare horror story finally speaks ... to Fox News (232 comments)

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  •  I wouldn't necessarily say (18+ / 0-)

    mismanaged finances.  I think it is more of a budget issue.  You might be able to absorb $500-$600 in cost per month but if the cost in January is $1000, in the short term, it matters less if that the cost in May is $200.  With time you can plan out costs - so if she hits limits early in the year then she would be able to then set aside money for the reminder of the year to pay for the next year but that first year can be painful in terms of finances.

    "I'm not left wing because i'm ideological, or passionate, or angry. I'm left wing because I'm informed." - Mikesco

    by newfie on Mon Feb 24, 2014 at 09:24:11 AM PST

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    •  Payment schedules (26+ / 0-)

      Can sometimes be negotiated - especially if the care provider knows you have reliable insurance.

    •  This is the big missed point (5+ / 0-)
      Recommended by:
      QuelleC, newfie, Smoh, jfromga, DonMahoney

      And I am very glad you brought it up.  I had a similar reaction to a piece last week that simply compared annual numbers to "prove" that someone's health insurance was just as good as it used to be.

      MOST AMERICANS DO NOT LIVE ON AN ANNUAL BUDGET.

      Very many Americans live either paycheck to paycheck or with very little cushion for an extra expense.  And, hey!  That's the point of insurance!  To reduce the risk of an unforseen extra expense (to the extent that doesn't apply to cancer treatment, that's an indictment of the concept of mandating health insurance to provide health care - but that's the ACA).  But, as it turns out, with the growing popularity of high deductible plans, you purchase insurance but still bear all of the initial risk for health expenses.

      Just a quick recap, you pay the health insurance company every single month (premiums - perhaps subsidized, perhaps not), and after you pay a bunch of money to your providers (the deductible), afterwards the insurance company start chipping in (coinsurance).  Once you're bled dry for the year (annual individal/family limit), the insurance company will pick up the rest of the tab for the year.  Rinse and repeat in the new year, until and unless you hit a lifetime cap.

      The administration/talking points reaction to this just shows me how out of touch the 11th dimensional chess players continue to be.  First they bet the bank on a Republican plan that mandated you purchase insurance from health insurance companies, some of the most unpopular companies in America.  Then, they turn up their nose at people saying "I can't afford this!" by referring to annual expenditures.  That only makes sense in a world  where you have significant surplus income or large savings.  Reality check: average American savings are net negative.  

      As to the suggestion about working out a payment plan with the providers, that's a viable solution, but again, it's asking the patient to wrestle with the providers - isn't that what they bought health insurance for?  So they wouldn't have to do all that?  

      •  Insurance providers are not your advocate (5+ / 0-)

        with medical providers. The key remains reducing the cost of healthcare. Obamacare takes steps in that direction. It is preferable to what came before. Likewise, having medical insurance is preferable to not having it.

        •  Reducing the cost of healthcare for whom? (4+ / 0-)
          Recommended by:
          deh55, Skanner, Rita5018, k88dad

          This is always the sticking point when my insurance points out that they have "reduced the cost" by paying less so that I have to pay more or worse still, paying the provider less "by contract" and putting our rural non-profit hospital in jeopardy, extending back to how we will have to travel two hours northeast to the next hospital in all kinds of weather.

          Single payer, private provider would have, in fact, lowered costs by negotiation of a large group of patients/the government with the providers.  Well, of course that just smacks of unions and can't be tolerated.  So we got what we have and there we are, better--but not perfect yet.

      •  So what was her previous situation? (10+ / 0-)

        That's the big missing factor in this story.  Where did she get this fantastic policy that had no co-pays and didn't require her to do any budgeting over the course of a year?  

        I think the poor woman is just upset about the fact that she has to do things a bit differently than she used to.  But that is the essence of change.  We would never change anything if we there was a prohibition on anyone anywhere having to make some adjustments in their way of doing things.  

        •  Probably co-pays (2+ / 0-)
          Recommended by:
          Lance Bearer, GrandmaTess

          It's not hard to extrapolate from the information we're given.  She probably used to pay a set premium, with a set co-pay for each doctor's visit.  She could predict her doctor visits, so she could predict her costs.  And if she had to go the ER, well, there's a higher co-pay for that, but still (probably) a reasonable amount.

          What you're brushing off as "make some adjustments" means that she may be paying thousands of dollars during the first month of coverage (until she hits a deductible), whereas before she may have paid just a single small co-pay.  In other words, what's at stake here is the very nature of high-deductible policies - which may be the only affordable option for many people, and are therefore de facto mandated by the ACA.  iIstead of tackling that issue, we're treating it like  some dumb partisan argument (no matter how untenable the argument, we must be right and they must be wrong!)

          This is a bad change.  Up-front deductible policies are a worse outcome for people that actually use their policies.  If our best defense is that at the end of the year they end up paying the same amount or equivalent, then our best defense for these policies is not a defense at all.  So why defend it?  Why defend paying insurance companies just so you can earn the right to get health care coverage?

          •  copays (1+ / 0-)
            Recommended by:
            Rita5018

            Maybe it depends on the policy you pick, but under my new policy, I am paying copays and I did NOT have to reach my deductible($3000) first. Sheeshka was basically right with her reply.

          •  co-pays versus deductibles (0+ / 0-)

            Not sure, but on prior policies I have seen, the co-pay is fixed and  is paid for each type of visit.  The deductible then is paid on a pro rated amount per claim, but I have now seen on the healthcare.gov web site policies that clearly say all deductible dollars has to be paid first -- or at least that is way they appear to be set up.  

            That has stopped at least a couple of people I know from buying because they simply could never meet the deductible in normal circumstances and think the insurance is too expensive even with a subsidy.  

            I realize they are overlooking the possibility of a major illness or accident, but they really don't have the money but make too much to get much of a subsidy, so I could understand their decision to take the risk.

             

      •  Deductibles and co-pays are reduced for low income (2+ / 0-)
        Recommended by:
        jfromga, acornweb

        People making under 250% FPL have reduced deductibles and co-pays as well as premium subsidies.  That's with a sliver plan. If you want a 'cover it all' plan, that's available in the gold and platnium plans. No deductible, and low co-pay for name brand drugs. Gold/platnium plans cost $500-$600/mo for a 44yr old in CA. about what she is paying.

      •  meeting out of pockets (2+ / 0-)
        Recommended by:
        acornweb, eatapeach

        up front can be hard for most people.  Nevertheless, for the vast majority of people, they will have less debt after a serious illness with the new system.  I don't think we've heard the whole truth about this woman's insurance situation yet.

      •  Wrong---you don't have to fulfill Out Of Pocket.. (5+ / 0-)

        ..yearly max before the insurance kicks in...this is the BIG LIE the Rethugs want you to believe! You are comparing health insurance to car insurance where there is a deductible for every accident/event.  That is NOT how health insurance works.  OCare requires routine office visits, tests and prescriptions to be available for a simple copay. And each of the co-pays gets credited against the Out of Pocket annual maximum. Stop perpetuating the LIE! Even before OCare, under a decent plan, you could get plenty of healthcare without ever reaching your yearly Out of Pocket. Under OCare, it is even better as it is mandatory.  Again--YOU DO NOT HAVE TO FULFILL THE ANNUAL OUT OF POCKET MAXIMUM BEFORE HEALTH CARE BENEFITS AND PAYMENTS TO PROVIDERS BEGIN.

        •  I didn't say that (1+ / 0-)
          Recommended by:
          GrandmaTess

          You should look again at what I wrote, in my discussion of  high deductible plans. I never said you had to pay the out of pocket maximum before health care payments to providers begin - I said you had to pay your deductible first.    Wellness visits are a nice perk and all, but I generally want to see a doctor when I'm sick, not when I'm well - and since the insurance company is pricing that "free" cost into the premium, it's still the health insurance customer paying.

          Health insurance companies would also say that while you're paying the deductible, you still get the benefit of using the rate the insurance company negotiated with the provider, as opposed to the rate the provider charges an uninsured patient.  How providers/insurance companies get away with charging an insured man $10 and an uninsured man $100 for the exact same service, I really don't know, but that's the system we have.

          •  re copays (4+ / 0-)

            I just replied to your comment yesterday before I saw this one....it may be dependant on the policy chosen, but I DID NOT have to pay my$3000 deductible first to get my copays.
            I've seen similar comments to yours many times and its not necessarily true

          •  Do notice, though, that she has said nothing (2+ / 0-)
            Recommended by:
            eatapeach, kfunk937

            anywhere about there being a DEDUCTIBLE with her new insurance...nor, apparently, is there one...just an 80/20 copay.  

            Which means that she is paying 20% of her incurred charges only up to the maximum of $6,350 a year.  Which means she's ultimately paying no more than $2 this year than last year under her old insurance.

            Ah!  But she did say she had "low out-of-pocket expenses" on her old plan...in addition to her premiums  And this is important to remember.  

            Why?  Because her insurance premiums last were twice as expensive as her new plan...plus she had those additional out-of-pocket expenses.  

            So, instead of her costs being $2 a year more this year(a whole 17 cents a month), they will actually be LOWER this year by whatever her last year's out-of-pocket expenses were less that $2 :-)  This will give her more money to pay off the $6,350 sooner...and leave her some left over.  

            She needs to understand that it is simply NOT necessary to come up with the entire 20% of any given charge at once.  She can set up payment plans.  People do it all the time.  

            She also needs to understand the meaning of the word "cap".  Understand that once she gets, in total, to $6,350, her insurance company will pay 100%.  

            Considering the type and cost of chemo medication she is taking...even if it isn't the one she used to be on (there are 18 more options)...she's actually already met that cap and won't get any more new bills for the rest of the year.  So I hope that she gets interviewed again a month from now and asked about that.  Asked about how much she's having to pay in new charges each month.  By then, she'll know the answer is $0.  Ah, but will she tell us?

            •  That is all true (0+ / 0-)

              Which is why I tried to steer away from this person's policy in particular and discuss high-deductible plans in general.  I don't know this woman's policy.  She's apparently married to a Republican operative, and it's very likely she's arguing in bad-faith.  I do wish the media would do more fact-checking on "Obama ruined my great health care!" and I know that most of these stories don't add up.  

              Having said all that, I stand by my concerns regarding high deductible plans - having one myself through my employer, I'm familiar with their advantages and disadvantages, but it may come as a big shock to many customers first getting this type of plan.   I think we should be prepared to accept that on its own terms, instead of looking at it through a partisan prism.

          •  Wong again---the deductible is the same as the... (2+ / 0-)
            Recommended by:
            salliezoo, eatapeach

            ..."out of pocket"...and "co-pays" are indeed "out of pocket" which go towards the annual Out of Pocket cap.  This is what you said "What you're brushing off as "make some adjustments" means that she may be paying thousands of dollars during the first month of coverage (until she hits a deductible), whereas before she may have paid just a single small co-pay"...and you are wrong...and this wrongness is confusing people and scaring them....just what the Repugs want.  Again, you do NOT have to fully satisfy "deductibles" before you get benefits under Ocare.  

    •  Yeah, this (17+ / 0-)

      The monthly out of pocket costs aren't as predictable. But the $500+ she's saving in premiums should help alleviate that, and as DButch says, payment schedules, too.

      The disruption in her insurance has to be difficult and upsetting. It would be for anyone. That I have sympathy for. But it ends at her turning herself into a Koch brothers tool and forwarding their lies.

      "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

      by Joan McCarter on Mon Feb 24, 2014 at 10:16:22 AM PST

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      •  All part of the bargain when (8+ / 0-)

        you can't have a national conversation about how to move to a universal healthcare platform - be it in the form of universal financing (aka private insurance) or universal healthcare (aka socialized medicine).  Instead we have the nonsense we have.  And it goes across the board on nearly everything.

        "I'm not left wing because i'm ideological, or passionate, or angry. I'm left wing because I'm informed." - Mikesco

        by newfie on Mon Feb 24, 2014 at 10:22:51 AM PST

        [ Parent ]

      •  And I would think that if (4+ / 0-)
        Recommended by:
        JerryNA, nachtwulf, Lefty Ladig, jfromga

        She wanted to pay more in monthly premiums, there's a good chance that there's a gold or platinum plan that would have no deductible. I can't imagine the kick ass ACA plan she could get for $800/month....

        These people cannot be reasoned with. It's like arguing with a brainwashed fundie - facts don't matter. It's all about emotion - fear and hatred - with them.

        Money should be treated like any other controlled substance; if you can't use it responsibly then you don't get to use it.

        by La Gitane on Mon Feb 24, 2014 at 11:26:49 AM PST

        [ Parent ]

        •  Cost of ACE coverage! (0+ / 0-)

          I call BS!  I'm a senior on a limited income, but since I work part time, my "copay" is ridiculous for premiums, and I'm terrified to see what my additional out-of-pocket expenses will be!  I've had 4 strokes, so I don't have the option of just doing without - but the new plan terrifies me, as it punishes me for working by taking everything I earn.  Try to remember the ACA was based on a republican plan to funnel money to insurance companies, NOT to bring in universal health care (a la most developed countries!  Don't know why Obama wants to support insurance companies, who are more than happy to kill off the aged, sick, and poor!  My daughter simply cannot afford any of the offered plans, so her four kids will lose the care they had through the Indian health service.  The ACA is disgusting - you have to be completely in poverty to afford it -it is a killer for the working poor!  We need the public option to make this a useful program!

          •  I'm not sure what your situation is (1+ / 0-)
            Recommended by:
            MaryAskew

            But with four kids, if your daughter makes between $15K and $90K she is eligible for subsidies and cost assistance. I have no doubt she can find several plans that may even be close to zero. Below $15k, if you're in a state that expanded Medicaid then she's eligible for that - for free. But with four kids, she should be eligible even without the expansion, at least for the kids.

            For you, if you're on Medicare then I'm not familiar how that works. While I agree that single payer definitely would have been better, I don't know of anyone (other than people who got caught in the Medicaid hole) who can't get their premiums down close to zero. The subsidies are there for people who make up to four times the poverty rate.

            Please see if you can get some help in your state to help you find a solution. I'm sure there is one.

            Money should be treated like any other controlled substance; if you can't use it responsibly then you don't get to use it.

            by La Gitane on Tue Feb 25, 2014 at 07:01:51 PM PST

            [ Parent ]

        •  In both cases it's all about what they "believe" (4+ / 0-)
          Recommended by:
          La Gitane, eatapeach, MaryAskew, Rita5018

          not about facts.  I had a woman tell me that I couldn't tell her she was wrong about Pres. Obama's birth certificate because that was her BELIEF and it is a free country and she's free to BELIEVE whatever she likes.  huh?? Freedom gives one permission to scrap and ignore the facts of a matter?

          It gets weirder and weirder in right wing LaLa Land.

      •  Monthly costs were (5+ / 0-)

        just as unpredictable with her old insurance, only now she has a $500 cushion.  It's too bad she's so scared of change, and worse that Fox is exploiting her.

        I'm in a FaceBook group with others that share my disease that causes chronic pain.  There are 3 - 4 people that I've offered to walk through ACA sign-ups because they have a "block".  The block is that they've been fed Right Wing Bullshit.  They are uninsured and going without much needed care that would significantly increase their quality of life.  
        Damn the GOP for making healthcare political!

        Reach out your hand if your cup be empty, If your cup is full may it be again

        by VPofKarma on Mon Feb 24, 2014 at 12:15:25 PM PST

        [ Parent ]

        •  She probably did not have a long experience (2+ / 0-)
          Recommended by:
          VPofKarma, jfromga

          of how her old insurance handled leukemia, so she's imagining a rosy scenario that wasn't at all what it would have been.

          Fry, don't be a hero! It's not covered by our health plan!

          by elfling on Mon Feb 24, 2014 at 12:48:54 PM PST

          [ Parent ]

        •  i think this hits closer to the mark: (3+ / 0-)
          Recommended by:
          jfromga, VPofKarma, acornweb

          "It's too bad she's so scared of change"

          even if change is an improvement, it's still different than what you're accustomed to. that can be very scary, especially for someone in her position, dealing with a long-term, debilitating disease. I understand the ire of people watching this commercial, being pretty certain what she's saying isn't actually true. it's a pity someone didn't sit down with her, and show her, on paper, how she's benefiting from this change. it may have helped set her mind a little more at ease.

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