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So, instead of pushing for a bill that would attempt to reign in medical costs like say, a public option or maybe medicare buy ins, we enact a health insurance reform bill.

The Administration has released data today to show what a folly this law will become. It turns out that costs of medical procedures are completely arbitrary and in many cases inflated by the health care facility to get higher payments from insurance companies.

Just read this article on HuffPo. I don't even know how to begin to express the exasperation I'm feeling.

Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences

The charges are the prices hospitals establish themselves for the services they provide. Although Medicare and Medicaid don't base their payment rates on these figures, private health insurance companies typically do, which means they usually pay more for the same health care than the government does. That translates into higher premiums for people with insurance. And uninsured people are expected to pay the full list price or a discount from that number, which tends to mean they pay more than anyone else.

When a hospital doesn't get paid as much as it wants from one source, it tries to make up the difference in other ways, such as billing so-called self-pay patients -- almost always the uninsured -- for the full list price of a service, said Robert Huckman, a health care expert at Harvard Business School. Even when hospitals agree to huge discounts for patients who can't pay the bill, those discounts are taken from inflated prices much higher than those the government or private insurance companies pay, he said.

So I can already hear the proponents, "but more people will be insured so they'll pay less". Less than what? An exhorbitant price pulled out of thin air? What the hell does that do to stop the arbitrarily inflated prices charged to both insurance covered patients and the non-insured? Notice, they both pay more than medicare and medicaid patients.

Frustrated beyond belief.


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Comment Preferences

  •  if you can do better, then give it a go (8+ / 0-)

    -You want to change the system, run for office.

    by Deep Texan on Wed May 08, 2013 at 07:16:01 AM PDT

    •  That's the point. You can't do better if you don't (1+ / 0-)
      Recommended by:

      attack the costs. And when they are arbitrarily inflated to get a higher payout from insurance companies then by forcing everyone to be insured you are just spreading the pain. Premiums will continue to rise it's just that more folks get to shell them out.

      •  maybe you didn't read the link? (1+ / 0-)

        -You want to change the system, run for office.

        by Deep Texan on Wed May 08, 2013 at 07:26:02 AM PDT

        [ Parent ]

      •  jec - it's really "attack the price" (4+ / 0-)
        Recommended by:
        jec, greenbell, myboo, virginislandsguy

        One of the biggest problems we have in discussing health care economics is that people keep using the word cost when they really mean price. The amount a hospital charges for a service is the price and we have no understanding of how that price actually relates to the true cost of delivering the medical service. While the price the hospital charges is a cost to Medicare or private insurance it may not have any real basis as it relates to the actual cost.

        One of the giant gaps in data we have is what does it actually cost to deliver the care? That data would help us understand why our healthcare costs are 2X others in the G8 with much poorer outcomes. I have my suspicions, but none of us has any facts. This is a place where the federal government could provide some real help.

        "let's talk about that"

        by VClib on Wed May 08, 2013 at 07:49:21 AM PDT

        [ Parent ]

        •  Agree. I had trouble using the word cost when (1+ / 0-)
          Recommended by:

          writing this but it is the cost to the payer. This just reinforces what many were saying before ACA was passed, that it wouldn't do anything to curb costs. The astounding thing is that the Administration had this factual evidence of the price gouging going on and did nothing to address it. I suspect that if this data had been released prior to the bills passage there would have been significant changes made to ACA.

          •  I think the challenge is that having price data (1+ / 0-)
            Recommended by:

            is only half of the information you need to negotiate or develop good policy. I know many healthcare providers, with very good cost accounting systems, who provide service to Medicare patients at an actual loss, even on a marginal cost basis. The way they stay in business is to charge insurance and private pay patients more to make up the shortfall. There are very few healthcare providers who can serve the Medicaid market at a profit which is why when the ACA dramatically expands the number of Medicaid patients they will find it very difficult to find primary care physicians who will serve them. The trend is for a growing number of physicians to not take new Medicare or Medicaid patients so the pool of providers is shrinking just as the patient pool is expanding. It will be a challenge.

            "let's talk about that"

            by VClib on Wed May 08, 2013 at 08:22:06 AM PDT

            [ Parent ]

            •  If all interested parties were privy to the (1+ / 0-)
              Recommended by:

              price data before enacting the law, it may have made a difference.

            •  I think you're right on medicaid (1+ / 0-)
              Recommended by:

              Other than a lot of screaming and hand wringing, there isn't a lot of evidence that providers are dropping medicare on a widespread basis. Because it's still profitable. Hospitals in particular do face serious challenges with some of the new rules, where payment is at least in part, theoretically based on quality of care, but in practice doesn't necessarily accomplish that goal. Yet at least so far, i've seen no widespread evidence of hospitals declining to treat medicare patients.

              •  Kane - I agree (0+ / 0-)

                I have not seen any hospitals who won't take Medicare. My comment should have been more specific. We are seeing an expanded number of primary care physicians who won't take Medicare patients, including mine who has had that policy for five years. With some exceptions he will keep long term patients who turn 65.

                "let's talk about that"

                by VClib on Wed May 08, 2013 at 08:45:43 AM PDT

                [ Parent ]

                •  That policy is rare (1+ / 0-)
                  Recommended by:

                  There's been a lot of talk about physicians declining medicare patients. Outside of Texas, there's been very little evidence it's happening on any widespread basis. Not never, just very rare. Specialists have survived very well on medicare reimbursement rates, despite their moaning. The effect of the lower reimbursements on primary care physicians is much greater,  yet despite all the talk, threats and surveys of future plans, when new medicare patients call,  they're still accepting these patients.

      •  The Affordable Care Act by Year (4+ / 0-)

        The Affordable Care Act


        2010: A new Patient’s Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans.
        See More 2010 Changes.

        2011: People with Medicare can get key preventive services for free, and also receive a 50% discount on brand-name drugs in the Medicare “donut hole.”
        See More 2011 Changes.

        For many or most generic drugs you pay $4 and elderly poor people may pay as little as $1 under the extra help provisions of Medicare
        2012: Accountable Care Organizations and other programs help doctors and health care providers work together to deliver better care.
        See More 2012 Changes.
        Free Care allows doctors and Hospitals to pass on the costs of universal comprehensive Hospital healthcare for people without insurance or medicare to a single payer, the government.
        2013: Open enrollment in the Health Insurance Marketplace begins on October 1st.
        See More 2013 Changes.

        2014: All Americans will have access to affordable health insurance options. The Marketplace will allow individuals and small businesses to compare health plans on a level playing field. Middle and low-income families will get tax credits that cover a significant portion of the cost of coverage. And the Medicaid program will be expanded to cover more low-income Americans. All together, these reforms mean that millions of people who were previously uninsured will gain coverage, thanks to the Affordable Care Act.
        See More 2014 Changes.

        I have been the recipient of those changes this year and as a result the Hospital Free Care paid something like $40,000 worth of my wife's cancer treatment bills saving her life without bankrupting us.

        Live Free or Die --- Investigate, Incarcerate

        by rktect on Wed May 08, 2013 at 09:05:31 AM PDT

        [ Parent ]

  •  I read that WaPo (17+ / 0-)

    article -- and maybe I'm just stupid -- but what I got out of it is that there's a lot of hospitals fucking people over.  This system has been going on forever.  How is it ACA is responsible?    

    " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Wed May 08, 2013 at 07:20:36 AM PDT

    •  How does ACA do anything to fix it? (1+ / 0-)
      Recommended by:
      •  ACA doesn't address procedure costs and (10+ / 0-)

        it never claimed to do so.

        This game of high charges from the provider and then they accept a much lower amount from the insurer is a game that has been going on for a long time.

        It goes way back as a means the "free market" used to get everyone to buy an insurance product.  It's like a "member" discount if you belong to an insurance "club".

        However, since Reagan moved the healthcare system from a not for profit model to a profit allowed model the price list between the no insurance price and the insurance price has grown.  And since a lot of people can no longer afford the monthly membership cost of hc "insurance" many must go without because the list prices are so high.

        Can we do better, yes, but we will need to elect a much better Congress to make progress on this front.  

        As for ACA, it's a step in the right direction and will get many more people in the system and bring down the monthly cost of insurance millions.

        I personally will benefit greatly by finally being able to get a good policy that actually covers stuff at a greatly reduced price.  For me, I can't wait for ACA Exchange policies to be available.

        Congressional elections have consequences!

        by Cordyc on Wed May 08, 2013 at 07:49:57 AM PDT

        [ Parent ]

        •  ACA just reinforced the for profit model we're (1+ / 0-)
          Recommended by:

          now living with. This was the opportunity to start reversing course.

          As for ACA, it's a step in the right direction and will get many more people in the system and bring down the monthly cost of insurance millions.
          I'm still unclear as to what is meant by it's a step in the right direction and I certainly see no evidence of it bringing down monthly insurance costs. Quite the opposite.
          •  ACA is a lot different than what you think (1+ / 0-)
            Recommended by:

            For one thing the Insurance companies are no longer calling the shots, since 2010 there have been many new consumer protections.

            When I hear Consumer Protection I hear Elizabeth Warren getting President Obama's ear back even before the Consumer Protection Agency was begun.



                Putting Information for Consumers Online. The law provides for where consumers can compare health insurance coverage options and pick the coverage that works for them. Effective July 1, 2010.
                Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions. The health care law includes new rules to prevent insurance companies from denying coverage to children under the age of 19 due to a pre-existing condition. Effective for health plan years beginning on or after September 23, 2010 for new plans and existing group plans.  
                Prohibiting Insurance Companies from Rescinding Coverage. In the past, insurance companies could search for an error, or other technical mistake, on a customer’s application and use this error to deny payment for services when he or she got sick. The health care law makes this illegal. After media reports cited incidents of breast cancer patients losing coverage, insurance companies agreed to end this practice immediately. Effective for health plan years beginning on or after September 23, 2010.
                Eliminating Lifetime Limits on Insurance Coverage. Under the law, insurance companies will be prohibited from imposing lifetime dollar limits on essential benefits, like hospital stays. Effective for health plan years beginning on or after September 23, 2010.
                Regulating Annual Limits on Insurance Coverage. Under the law, insurance companies’ use of annual dollar limits on the amount of insurance coverage a patient may receive will be restricted for new plans in the individual market and all group plans. In 2014, the use of annual dollar limits on essential benefits like hospital stays will be banned for new plans in the individual market and all group plans. Effective for health plan years beginning on or after September 23, 2010.
                Appealing Insurance Company Decisions. The law provides consumers with a way to appeal coverage determinations or claims to their insurance company, and establishes an external review process. Effective for new plans beginning on or after September 23, 2010.
                Establishing Consumer Assistance Programs in the States. Under the law, states that apply receive federal grants to help set up or expand independent offices to help consumers navigate the private health insurance system. These programs help consumers file complaints and appeals; enroll in health coverage; and get educated about their rights and responsibilities in group health plans or individual health insurance policies. The programs will also collect data on the types of problems consumers have, and file reports with the U.S. Department of Health and Human Services to identify trouble spots that need further oversight. Grants Awarded October 2010. Learn more about Consumer Assistance Programs.


                Providing Small Business Health Insurance Tax Credits. Up to 4 million small businesses are eligible for tax credits to help them provide insurance benefits to their workers. The first phase of this provision provides a credit worth up to 35% of the employer’s contribution to the employees’ health insurance. Small non-profit organizations may receive up to a 25% credit. Effective now.
                Offering Relief for 4 Million Seniors Who Hit the Medicare Prescription Drug “Donut Hole.” An estimated four million seniors will reach the gap in Medicare prescription drug coverage known as the “donut hole” this year. Each eligible senior will receive a one-time, tax free $250 rebate check. First checks mailed in June, 2010, and will continue monthly throughout 2010 as seniors hit the coverage gap. Learn more about the "donut hole" and Medicare.
                Providing Free Preventive Care. All new plans must cover certain preventive services such as mammograms and colonoscopies without charging a deductible, co-pay or coinsurance. Effective for health plan years beginning on or after September 23, 2010. Learn more about preventive care benefits. See the full list of covered preventive services.
                Preventing Disease and Illness. A new $15 billion Prevention and Public Health Fund will invest in proven prevention and public health programs that can help keep Americans healthy – from smoking cessation to combating obesity. Funding begins in 2010. See prevention funding and grants in your state.
                Cracking Down on Health Care Fraud. Current efforts to fight fraud have returned more than $2.5 billion to the Medicare Trust Fund in fiscal year 2009 alone. The new law invests new resources and requires new screening procedures for health care providers to boost these efforts and reduce fraud and waste in Medicare, Medicaid, and CHIP. Many provisions effective now. Fact Sheet: New Tools to Fight Fraud.


                Providing Access to Insurance for Uninsured Americans with Pre-Existing Conditions. The Pre-Existing Condition Insurance Plan provides new coverage options to individuals who have been uninsured for at least six months because of a pre-existing condition. States have the option of running this program in their state. If a state chooses not to do so, a plan will be established by the Department of Health and Human Services in that state. National program effective July 1, 2010.
                Extending Coverage for Young Adults. Under the law, young adults will be allowed to stay on their parents’ plan until they turn 26 years old (in the case of existing group health plans, this right does not apply if the young adult is offered insurance at work). Check with your insurance company or employer to see if you qualify. Effective for health plan years beginning on or after September 23.
                Expanding Coverage for Early Retirees. Too often, Americans who retire without employer-sponsored insurance and before they are eligible for Medicare see their life savings disappear because of high rates in the individual market. To preserve employer coverage for early retirees until more affordable coverage is available through the new Exchanges by 2014, the new law creates a $5 billion program to provide needed financial help for employment-based plans to continue to provide valuable coverage to people who retire between the ages of 55 and 65, as well as their spouses and dependents. Applications for employers to participate in the program available June 1, 2010. For more information on the Early Retiree Reinsurance Program, visit
                Rebuilding the Primary Care Workforce. To strengthen the availability of primary care, there are new incentives in the law to expand the number of primary care doctors, nurses and physician assistants. These include funding for scholarships and loan repayments for primary care doctors and nurses working in underserved areas. Doctors and nurses receiving payments made under any state loan repayment or loan forgiveness program intended to increase the availability of health care services in underserved or health professional shortage areas will not have to pay taxes on those payments. Effective 2010 .
                Holding Insurance Companies Accountable for Unreasonable Rate Hikes. The law allows states that have, or plan to implement, measures that require insurance companies to justify their premium increases will be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium exchanges may not be able to participate in the new health insurance Exchanges in 2014. Grants awarded beginning in 2010.
                Allowing States to Cover More People on Medicaid. States will be able to receive  federal matching funds for covering some additional low-income individuals and families under Medicaid for whom federal funds were not previously available. This will make it easier for states that choose to do so to cover more of their residents. Effective April 1, 2010. Learn more about Medicaid.
                Increasing Payments for Rural Health Care Providers. Today, 68% of medically underserved communities across the nation are in rural areas. These communities often have trouble attracting and retaining medical professionals. The law provides increased payment to rural health care providers to help them continue to serve their communities. Effective 2010. Learn more about Rural Americans and the Affordable Care Act.
                Strengthening Community Health Centers. The law includes new funding to support the construction of and expand services at community health centers, allowing these centers to serve some 20 million new patients across the country. Effective 2010.

            Between 2010 and 2012 Primary Care and Community Health Centers were given more funding and their role was expanded to make affordable healthcare both more comprehensive and more universal.

            Hospitals and doctors now have more say in the treatments they prescribe and consequently unnecessary testing and labs are being eliminated. Because of the mandates unnecessary medical equipment company subsidies, denials of coverage sue to pre-existing conditions and limits on reimbursements go away and as a result the affordable care Act is rapidly making healthcare affordable for 50 million people who couldn't afford it previously.

            In particular affordable medications, phlebotomy and access to doctors has been radically increased.



                Offering Prescription Drug Discounts. Seniors who reach the coverage gap will receive a 50% discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. Effective January 1, 2011. Download a brochure to learn more (PDF - 1 MB)
                Providing Free Preventive Care for Seniors. The law provides certain free preventive services, such as annual wellness visits and personalized prevention plans for seniors on Medicare.  Effective January 1, 2011. Learn more about preventive services under Medicare.
                Improving Health Care Quality and Efficiency.  The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care to patients. These methods are expected to improve the quality of care, and reduce the rate of growth in health care costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Additionally, by January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including by these programs. Effective no later than January 1, 2011. Learn more about the Center for Medicare & Medicaid Innovation.
                Improving Care for Seniors After They Leave the Hospital. The Community Care Transitions Program will help high risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities. Effective January 1, 2011.

                Introducing New Innovations to Bring Down Costs. The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund.  The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high-quality care. Administrative funding becomes available October 1, 2011. Learn more about strengthening Medicare.


                Increasing Access to Services at Home and in the Community. The Community First Choice Option allows states to offer home and community based services to disabled individuals through Medicaid rather than institutional care in nursing homes. Effective beginning October 1, 2011.

            At least 85% of every health insurance dollar must be spent on health care and improving quality

                Bringing Down Health Care Premiums. To ensure premium dollars are spent primarily on health care, the law generally requires that at least 85% of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80% of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals, because their administrative costs or profits are too high, they must provide rebates to consumers. Effective January 1, 2011. Fact Sheet: Getting Your Money's Worth on Health Insurance.
                Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage. Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Traditional Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77% of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The law levels the playing field by gradually eliminating this discrepancy.  People enrolled in a Medicare Advantage plan will still receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care. Effective January 1, 2011. Learn more about Medicare and the Affordable Care Act.

            In 2012 the focus was on improving quality and lowering costs by allowing doctors and hospitals to replace insurance companies in determining what treatment patients should be receiving


                Linking Payment to Quality Outcomes. The law establishes a hospital Value-Based Purchasing program (VBP) in Traditional Medicare. This program offers financial incentives to hospitals to improve the quality of care. Hospital performance is required to be publicly reported, beginning with measures relating to heart attacks, heart failure, pneumonia, surgical care, health-care associated infections, and patients’ perception of care. Effective for payments for discharges occurring on or after October 1, 2012.
                Encouraging Integrated Health Systems. The new law provides incentives for physicians to join together to form “Accountable Care Organizations.” These groups allow doctors to better coordinate patient care and improve the quality, help prevent disease and illness and reduce unnecessary hospital admissions. If Accountable Care Organizations provide high quality care and reduce costs to the health care system, they can keep some of the money that they have helped save. Effective January 1, 2012. Fact Sheet: Improving Care Coordination for People with Medicare. .
                Reducing Paperwork and Administrative Costs. Health care remains one of the few industries that relies on paper records. The new law will institute a series of changes to standardize billing and requires health plans to begin adopting and implementing rules for the secure, confidential, electronic exchange of health information. Using electronic health records will reduce paperwork and administrative burdens, cut costs, reduce medical errors and most importantly, improve the quality of care. First regulation effective October 1, 2012. Learn how the law improves the health care system for providers, professionals, and patients.
                Understanding and Fighting Health Disparities. To help understand and reduce persistent health disparities, the law requires any ongoing or new federal health program to collect and report racial, ethnic and language data. The Secretary of Health and Human Services will use this data to help identify and reduce disparities. Effective March 2012.


                Providing New, Voluntary Options for Long-Term Care Insurance. The law creates a voluntary long-term care insurance program – called CLASS -- to provide cash benefits to adults who become disabled.  Note: On October 14, 2011, Secretary Sebelius transmitted a report and letter to Congress stating that the Department does not see a viable path forward for CLASS implementation at this time. View a copy of the CLASS report. Read about the original CLASS proposal.

            This year a lot of the focus is on preventative care with Community Heal Centers taking the lead in lowering costs.


                Improving Preventive Health Coverage. To expand the number of Americans receiving preventive care, the law provides new funding to state Medicaid programs that choose to cover preventive services for patients at little or no cost. Effective January 1, 2013. Learn more about the law and preventive care.
                Expanding Authority to Bundle Payments. The law establishes a national pilot program to encourage hospitals, doctors, and other providers to work together to improve the coordination and quality of patient care.  Under payment “bundling,” hospitals, doctors, and providers are paid a flat rate for an episode of care rather than the current fragmented system where each service or test or bundles of items or services are billed separately to Medicare.  For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment that provides incentives to deliver health care services more efficiently while maintaining or improving quality of care.  It aligns the incentives of those delivering care, and savings are shared between providers and the Medicare program. Effective no later than January 1, 2013.


                Increasing Medicaid Payments for Primary Care Doctors. As Medicaid programs and providers prepare to cover more patients in 2014, the Act requires states to pay primary care physicians no less than 100% of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Effective January 1, 2013. Learn how the law supports and strengthens primary care providers.
                Open Enrollment in the Health Insurance Marketplace Begins. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. Effective October 1, 2013. Find out how you can get a break on costs in the Marketplace.

            From  2014 to 2015 Affordable Health Care will focus on new consumer protections that limit some of the more egrigious practices of insurance companies in the past.


                Prohibiting Discrimination Due to Pre-Existing Conditions or Gender. The law implements strong reforms that prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, the law eliminates the ability of insurance companies to charge higher rates due to gender or health status. Effective January 1, 2014. Learn more about protecting Americans with pre-existing conditions.
                Eliminating Annual Limits on Insurance Coverage. The law prohibits new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive. Effective January 1, 2014. Learn how the law will phase out annual limits by 2014.
                Ensuring Coverage for Individuals Participating in Clinical Trials. Insurers will be prohibited from dropping or limiting coverage because an individual chooses to participate in a clinical trial.  Applies to all clinical trials that treat cancer or other life-threatening diseases. Effective January 1, 2014.

            The number of people covered increases while deductibles, coinsurance costs, and copayments go down

                Making Care More Affordable. Tax credits to make it easier for the middle class to afford insurance will become available for people with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. (In 2010, 400% of the poverty line comes out to about $43,000 for an individual or $88,000 for a family of four.) The tax credit is advanceable, so it can lower your premium payments each month, rather than making you wait for tax time. It’s also refundable, so even moderate-income families can receive the full benefit of the credit. These individuals may also qualify for reduced cost-sharing (copayments, co-insurance, and deductibles). Effective January 1, 2014. Learn how the law will make care more affordable in 2014.
                Establishing the Health Insurance Marketplace. Starting in 2014 if your employer doesn’t offer insurance, you will be able to buy it directly in the Health Insurance Marketplace. Individuals and small businesses can buy affordable and qualified health benefit plans in this new transparent and competitive insurance marketplace. The Marketplace will offer you a choice of health plans that meet certain benefits and cost standards. Starting in 2014, Members of Congress will be getting their health care insurance through the Marketplace, and you will be able buy your insurance through Marketplace too. Learn more about the Health Insurance Marketplace.
                Simple comparison of two coverage options
                Increasing the Small Business Tax Credit. The law implements the second phase of the small business tax credit for qualified small businesses and small non-profit organizations. In this phase, the credit is up to 50% of the employer’s contribution to provide health insurance for employees.  There is also up to a 35% credit for small non-profit organizations.  Effective January 1, 2014. Learn more about the small business tax credit.


                Increasing Access to Medicaid. Americans who earn less than 133% of the poverty level (approximately $14,000 for an individual and $29,000 for a family of four) will be eligible to enroll in Medicaid. States will receive 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years. Effective January 1, 2014. Learn more about Medicaid.
                Promoting Individual Responsibility. Under the law, most individuals who can afford it will be required to obtain basic health insurance coverage or pay a fee to help offset the costs of caring for uninsured Americans.  If affordable coverage is not available to an individual, he or she will be eligible for an exemption. Effective January 1, 2014. Learn more about individual responsibility and the law.



                Paying Physicians Based on Value Not Volume. A new provision will tie physician payments to the quality of care they provide. Physicians will see their payments modified so that those who provide higher value care will receive higher payments than those who provide lower quality care. Effective January 1, 2015.

            Live Free or Die --- Investigate, Incarcerate

            by rktect on Wed May 08, 2013 at 09:41:20 AM PDT

            [ Parent ]

    •  what? what? (0+ / 0-)

      it's billed as better than slice bread.

      ACA is short for AFFORDABLE, or am I wrong about that?

      hospitals should be reverted to NOT FOR PROFIT... as should health insurance.

      that woulda been a start.

    •  Maybe your just not a patient (1+ / 0-)
      Recommended by:

      So far this year my wife's treatment has racked up maybe $40,000 in bills. She was uninsured and about three months short of being eligible for Medicare when we started three months ago so the Hospitals Free Care payed all the bills thus far. After this its 80 % Medicare and the rest Maine Care (Medicaid)

      The Hospitals may be able to do this with Free Care because under the the Affordable Care Act provisions which are already in place it may be getting a tax break.

      I should be careful what I say here because I'm sure that if the Republicans had actually read the act they would be aghast that even though its another tax break, this one  helps poor people survive.

      In Maine LePage has been doing everything he can to cut Maine Care (Medicaid) payments to Hospitals for Free Care but we managed to put a democratic legislature back in place so what he wants doesn't matter much anymore and he will be gone after this next election.

      The tax break may be for costs which are more than a bit on the high side, but for the most part elderly retired poor people with cancer and other chronic diseases that need that Free care to stay alive can be forgiven if they consider it in practice to be acting like part of the single payer public option

      Live Free or Die --- Investigate, Incarcerate

      by rktect on Wed May 08, 2013 at 08:53:52 AM PDT

      [ Parent ]

  •  this healthcare law (5+ / 0-)
    Recommended by:
    pfiore8, jec, coffeetalk, Kickemout, Losty

    is giving me an ulcer. I was a huge proponent of ACA. But I think we are about to get pummeled by the law of unintended consequences.

    I've taken my bumper sticker off. I can't defend it any more.  

    I'm afraid that my signature won't match the mood of my comment.

    by heybuddy on Wed May 08, 2013 at 07:26:39 AM PDT

    •  There were bound to be unintended (3+ / 0-)
      Recommended by:
      VClib, Losty, FG

      consequences of any overhaul this massive.  Unfortunately, many of the unintended consequences were foreseeable if people had taken the time to really look at what they were doing.  

      •  Keep in mind the Admin had this information (0+ / 0-)

        while pushing the bill. Information that none of us had. That's the facepalm to me. How was the bill going to address the gouging going on by hospitals?

        •  For me, the big unintended consequences (4+ / 0-)
          Recommended by:
          VClib, jec, FG, nextstep

          come from the rules regarding what employees are covered.

          Really, if you have a rule saying, that if you have 49 full time employees you don't have to cover any, and if you have 50 full time employees, you have to cover them all, what do you THINK employers are going to do?

          And if you have a rule that says if an employee works 29 hours, you don't have to cover them, but if they work 30 hours you do, what do you THINK employers are going to do?

          •  Exactly. (1+ / 0-)
            Recommended by:

            And it is that easy to understand, which makes it that much more embarrassing for me. This isn't complex economic concepts like derivatives or whatnot, I've got high school dropouts explaining to me how stupid this is using your exact words.

            I'm afraid that my signature won't match the mood of my comment.

            by heybuddy on Wed May 08, 2013 at 08:33:55 AM PDT

            [ Parent ]

        •  I kept thinking that (1+ / 0-)
          Recommended by:

          the shortfalls in the system would create a demand for single payer and we would transition to that. I thought the healthcare itself would be cumbersome and cause that demand.

          Instead, I think we are looking at an economic catastrophe here. This is kitchen table economics - people losing 25% of their income to get below 30 hours, scrambling to find a second part time job, losing all discretionary spending money, and they're bitching about it to anyone who will listen. And these are democrats, not cons.

          I worry that the ACA will cost us 2014 and maybe even 2016.

          I'm afraid that my signature won't match the mood of my comment.

          by heybuddy on Wed May 08, 2013 at 08:03:16 AM PDT

          [ Parent ]

        •  It Wasn't! (0+ / 0-)
          How was the bill going to address the gouging going on by hospitals?
          The bill had no chance of being passed if it overreached on cutting too many corporate (hospital systems) costs (i.e., profits).

          Can you say Joe Lieberman? And, another factor, the delay caused by recounts in the Minnesota Senate race which kept Al Franken from being seated for a while?

          "Treat others as you would like them to treat you." -St. Luke 6: 31 (NEB) Christians are given a tough assignment here: Love the people you don't even like...

          by paz3 on Wed May 08, 2013 at 11:49:37 AM PDT

          [ Parent ]

      •  I fell for it hard. (0+ / 0-)

        And I took a lot of flack for it, and now I'm getting a steady stream of "i told you so's." I officially stopped defending it a while ago, but my friends pretty much see it as my personal bill.

        I think we may have shot one of our feet clear off the leg. My clients are far more interested in their jobs and their income than the perks they are getting from the ACA.

        I'm afraid that my signature won't match the mood of my comment.

        by heybuddy on Wed May 08, 2013 at 07:50:22 AM PDT

        [ Parent ]

  •  Couple of big leaps: (8+ / 0-)

    First, that the insurance companies "typically" pay the "sticker" price of the various surgeries

    Second, that the insurance companies who pay the sticker price price somehow pass the additional cost on in premiums to their insureds.

    It seems to me that the only way to believe that is to believe that insurance companies are as in the dark on prices as we are, preventing rational pricing.

    But at any rate, none of us are in the dark because comps are now published. Thanks, Obama Administration!

    "We're now in one of those periods when the reality of intense pressure on the middle class diverges from long-held assumptions of how the American bargain should work" --James Fallows

    by Inland on Wed May 08, 2013 at 07:36:44 AM PDT

    •  No big leaps. Insurance companies don't pay the (1+ / 0-)
      Recommended by:

      sticker price. They pay a percentage of an inflated sticker price. And yes, insurance companies will pass on additional costs as premiums.

      •  If they don't pay the sticker price (3+ / 0-)
        Recommended by:
        Deep Texan, Gary Norton, FG

        why would anyone believe they have additional costs to pass on?  Or that they could pass them on, since people buy insurance based on cost?

        "We're now in one of those periods when the reality of intense pressure on the middle class diverges from long-held assumptions of how the American bargain should work" --James Fallows

        by Inland on Wed May 08, 2013 at 07:49:09 AM PDT

        [ Parent ]

      •  They also don't pay full price for out of network (0+ / 0-)

        services. That is an even worse problem IMO. The made-up prices hospitals charge are mitigated by the fact that insured patients typically don't pay that: the hospital gets the price the insurance company has negotiated and the patient is off the hook if it is a covered service.

        But what if you go to a doctor that is out of network (many reasons you might do that, including that specialists in some areas tend not to join networks). Now the insurance pays based on what they consider "reasonable and customary" fees, minus deductibles and co-insurance. Which means that patients are reimbursed by their insurance much, much less than the doctor is charging.

  •  Here's another shocking article from Time: (2+ / 0-)
    Recommended by:
    Losty, high uintas

    "Bitter Pill: Why Medical Bills Are Killing Us"

    Save this article while you can.  Time has put this behind a paywall.

  •  ACA Is Not Perfect But More People Will Get (3+ / 0-)
    Recommended by:
    Deep Texan, Gary Norton, davehouck

    healthcare and that is the main goal.  Private health insurance companies are on their way out.  It is only a matter of time.  When big CEOs cannot squeeze any more money out of their turnips they will abandon ship and private health insurance companies will go down the drain.  The government will have to step in and do something.  

    "Don't Let Them Catch You With Your Eyes Closed"

    by rssrai on Wed May 08, 2013 at 07:51:36 AM PDT

    •  I used to say that. (0+ / 0-)

      But then I realized that the insurance companies support the ACA. The law forces everyone to buy from them! There's no abandoning ship - it's going to rain money on them!

      Meanwhile, the law has said to employers: any person who works for you more than 30 hours will cost you a lot more money. And employers have logically responded by cutting hours to under 30 and hiring more part timers to bridge the gap.

      You and me, and i don't spare myself from this, we were caught with our eyes closed, big time.

      I'm afraid that my signature won't match the mood of my comment.

      by heybuddy on Wed May 08, 2013 at 08:22:47 AM PDT

      [ Parent ]

  •  Look at it this way. The final bill only passed (2+ / 0-)
    Recommended by:
    myboo, serendipityisabitch

    with only 51 or 52 votes without the public option in it. And even that had to be passed under special rules not requiring 60 votes. Only 42 Dems would have voted for it with the public option in it. And about 5 or 6 blue dog Dems voted against the final bill (even without the public option in it).

    What we got, a ACA bill that will give congress a right by law they didn't have before, to reform health care from that day forward. If you can tell me how they could have passed  ACA with the public option in it, let us know. Remember, the Medicaid part of the bill was meant to lower cost. So the problem is and always have been republican obstruction and blue dog Dems. Most of the states with republican governors and legislatures are fighting against Medicaid.

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