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Like many progressives I was deeply disappointed we did not get universal healthcare. But after diving into the basic elements of the Affordable Care Act soon to become law on Jan 1, 2014, I believe the case can be made that what we're about to get is a vast improvement over what we currently have, in terms of both what is covered and how much it will cost you. There have been many articles here and elsewhere with important bits and pieces of the new law. We thought it would helpful if we could introduce a more organized, nuts and bolts overview this week, following up in future posts by drilling down to specific points of interest such as out-of-pocket cost, how you will choose and enroll in a policy, and providing a platform for the kind of ongoing discussion DailyKos is almost perfectly designed to host.

The Affordable Care Act, AKA Obamacare, is essentially a three layer-cake, meaning a three-way interface between the 1) the Health and Human Services department of the federal government (HHS) which will oversee 2) online exchanges created by the states where 3) people can compare policies and even enroll in one. For a brief over view of these three elements and a hypothetical rate calculator, please join me below.

The HHS does two main things of interest here: It provides a minimum threshold those policies must meet in terms of what they cover, and a maximum threshold those policies will cost anyone out of pocket who enrolls in them. On the former, you've probably heard the policy cannot exclude or penalize for a preexisting condition and cannot have lifetime caps for the insurance company. They have annual caps of a sort, but they're to protect the consumer, not the insurance company bottom line.

Individual states only have to do one thing of note here: create and maintain a mega-website where residents of that state can find details on various insurance policies listed. This portion of the ACA is typically handled by that state's insurance regulation department. The exchange is where you will actually shop and compare policy features and choose the one best for you. You can see what one of the landing pages of the exchange for New Mexico may end up looking like here, when it's up and running.

The policies from private insurance companies come in various shapes and sizes, but all must meet the HHS-state mandated requirements. One important thing to understand right away, the out pocket premium cost for lower income people is not affected by age or preexisting conditions, it's a function of income and tobacco use. Tell your friends who are thinking about enrolling, if they want to save a big chunk of money, now is a good time to stop smoking. As you earn more, your age does become a factor, but the rates are still a big improvement and are calibrated to remain affordable for all tax brackets. Anyone earning less than federal poverty wages will be covered under the Medicaid expansion side of the Act, which we will cover in future posts.

The Kaiser Family Foundation has a great tool here, which has been rendered partially embeddable below, that you can use to generate hypothetical premiums and other costs. Keep in mind this is only a hypothetical illustration, the actual rates may vary, but it's a great place to get an idea of how this will work (Note that submitting data into the tool will take you offsite to the Foundation page to render results, and you will need to reload the page before putting in new parameters to get an accurate result, and there are some bugs or blank spots for some parameters). Read on, and you'll see we have already worked out a couple of hypothetical rates using it.

Assuming one person, no children on policy, 51-years-old, making just over the single person poverty rate of about $12,000 a year. As a non-smoker the total premium as calculated by the tool would be $5,629, but the out of pocket premium paid by the insured would only be $240 a year or $20 a month. Which equals two percent of household income and covers four percent of the overall premium.

The ACA covers the rest of that $5,629 with a tax credit. The tax credit is advance-able, which means the premium is reduced to $20 a month or $240 a year from the get-go. Again, keep in mind these will be real policies, often referred to in three increasing levels of coverage as Bronze or Silver or Gold plans, with copays for in and out of network providers, and there can be no riders for lifetime caps or preexisting conditions.

In most cases, the cap you're going to care about is the one that can save you a fortune and may save your life; the cap on how much you have to pay out of pocket in a given year, i.e., the annual cap. A typical out-of-pocket annual cap would be about $1,500 to $5,000 a year for a single person. They won’t pay more than that for the entire year, even if they suffer a major injury or illness requiring hundreds of thousands of dollars worth of treatment. Estimated rates and caps for specific permutations of adults and kids covered can be generated using the same subsidy calculator, be sure and read the info posted below the summary of premium cost.

Here's one way to save money right off the bat. Play around with numbers in the subsidy calculator and you'll soon notice, if that 51 year old smokes, their out-of-pocket portion rises to $3,054 (about $251/month), which equals 25.45 percent of household income and covers 36 percent of the overall increased premium of $8,443. That’s still a great deal for the smoking 51-year-old compared to what’s out there in the private market now. But $251 a month will be a commitment for someone making 12K or $1000/month. A premium of $20 a month ($240 a year) for the 51-year-old who quits smoking on the other hand, is so low it seems almost surreal. It also means a whole bunch of people from all political corners are going to sign for this once they realize that simple fact.

In summary: the Affordable Care Act is is a massive undertaking by civil servants at the federal and state level, compliance officers and auditors from the insurance industry level, and developers and page designers in IT, all geared to bring comprehensive, affordable health insurance coverage to millions who are not currently insured, and to dramatically lower premiums for millions more who are insured. For the purposes of simplicity it can be thought of as a three-layer cake: 1) your cost and your benefits of coverage on an approved policy offered under Obamacare is regulated by the HHS; 2) people looking for affordable health insurance will go their state's website, called an exchange; 3) where they can compare features and enroll in listed policies.

Policies are more affordable overall, they are required to provide specific benefits such as birth control and preventative care, they cannot have riders for preexisting conditions, and they come with an annual cap to protect the insured against catastrophic injury or illness. The already affordable out-of-pocket premiums are subsidized for lower income earners, and those who earn less than federal poverty rates will be covered at little or no cost under the Medicaid expansion side of the ACA.

In future posts, we'll be writing about features of the policies, how some states are trying to impede access to healthcare in much the same way they are impeding access to voting, the Medicaid expansion side of the Act, showing screen shots of what exchanges might look like, and giving you the hard info and community support you might find useful for enrolling yourself or others. On the latter, this is one of those subjects where wonky info from experts and anecdotes from patients, up to longish comments and well researched diaries here or elsewhere, would be quite welcome. If you can learn the basics well enough to help friends and family navigate this system when it becomes available, help them enroll and get them covered, you will be doing a lot of good for them, good for their families, and good for the nation. It will make you feel good, too.

I believe that effort could be where community sites like Daily Kos shine brighter than ever. And be prepared to be hit in the gut emotionally as ACA-day draws near. When people begin to understand how affordable this insurance will be, and find they and their loved ones are finally able to get decent medical care after years or decades of medical neglect, misery will be reduced, in some cases lives will be saved, and some folks may break down in tears from the emotional relief.

Real relief is now in site for millions of uninsured and under-insured Americans. Make no mistake, this is a Big. Fucking. Deal.



Based on the post above, where should you first direct friends and family who are interested in learning about and/or enrolling in Obamacare?

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Comment Preferences

  •  Any plan that requires tens of millions of people (5+ / 0-)

    to buy private insurance is not a step forward.  Yes, there are some goodies - important goodies for some people - but the prize goes to the insurers.  The ACA is not a step toward single payer, which is the only thing that makes sense.

    The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

    by accumbens on Sun Sep 01, 2013 at 03:27:40 PM PDT

    •  No. It's a BFD for lots of people. (46+ / 0-)

      DarkSyde is right for the reasons he explained.

      Single payer was pie in the sky in 2009-10 when the ACA was enacted. It's even more so with the current congress.

      The best hope for single payer will be on a state-by-state basis beginning with a public option on the exchanges with which private insurers are unable to compete.

      •  You are RIGHT RIGHT RIGHT (13+ / 0-)

        Private health insurers can't be defeated in any setting that resembles a boxing ring.  Their resources are too vast.  If they can fritter away $300 billion in unnecessary paper-shuffling overhead annually (and stick premium payers with the bill) they can always come up with the scratch to flood Fox Noise and AM douchebag radio with ads against any effort to kill them off.

        The way they will die is the way old houses die in ghost towns, as the termites of sensible health reform legislation continues to undermine them a few bites a day, until the whole rotten structure falls to dust.

        The ACA is a mess, full of all kinds of problems that sometimes make acquiring health care harder.  But its most important function is setting things up for further legislation toward single-payer.

        I'm not sixty-two—I'm fifty-twelve!

        by Pragmatus on Sun Sep 01, 2013 at 04:27:17 PM PDT

        [ Parent ]

        •  I still haven't heard a real response to (2+ / 0-)
          Recommended by:
          cocinero, BradMajors

          my question posted on several ocassions.  

          1.   If the insurance companies are now guaranteed a regulated income based on a percentage of total payouts for healthcare services,

          2.  What is in place to prevent them from simply not negotiating down the cost of services from health care providers, thereby allowing them to recevie a higher income.


          3.  In the case of nearly unlimited government subsidies in a rapidly growing cost environment, why wouldn't they do this?

          •  There is an 80/20 ratio that they must stick to (3+ / 0-)
            Recommended by:
            VPofKarma, RiveroftheWest, denise b

            In other words, 80% of the premium dollar must go for paying for healthcare. Anything left beyond the 20% in costs they are allowed is refunded to the policy holder.

            No, you can't fix stupid. You OUTNUMBER stupid. -Wildthumb, 1/10/2013

            by newinfluence on Sun Sep 01, 2013 at 05:23:00 PM PDT

            [ Parent ]

            •  The insurers are expert at playing the game and (1+ / 0-)
              Recommended by:

              they are already finding ways to fudge costs into that 80%.  Plus, with loads more customers they can afford some erosion in their margins.  

              The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

              by accumbens on Sun Sep 01, 2013 at 06:02:22 PM PDT

              [ Parent ]

          •  That's a good question. (2+ / 0-)
            Recommended by:
            worldlotus, kareylou

            The answer may be competition. Insurance companies that do not negotiate down costs will have to charge higher premiums to cover the cost. That will make them less competitive on the exchanges or when seeking contracts from employers.

          •  Your first premise is not clear. (1+ / 0-)
            Recommended by:
            tb mare
            If the insurance companies are now guaranteed a regulated income based on a percentage of total payouts for healthcare services,
            I've never answered your "question" because I don't have a clue what you are referring to in your premise.  I have a fairly good understanding of ACA and I hold a state insurance license (although I've never sold insurance) which required me to take a test every 7 years for 21 years.  If I don't know what you are referring to in your premise, I'm sure many others don't either.  

            I have seen people in other diaries attempt to answer your question.  

            Are you asking the question because you are seeking information, or are you asking the question because you are trying to make a point?  If you are trying to make a point, I don't get it.

            We are all in this together.

            by htowngenie on Sun Sep 01, 2013 at 06:35:06 PM PDT

            [ Parent ]

          •  Answered you in another thread but (6+ / 0-)

            I'll repeat here.  

            Lets take a hypothetical case:

            If under an insurance policy the insurance company pays 70% of a hospital stay that cost $10,000, they pay $7,000, and the patient picks up the remaining 30% or $3,000.  The profit to the insurance company (if any) is the income from the premiums of the entire risk pool minus the $7,000 paid on the hospital stay.  

            If the the cost of the hospital stay goes up to $15,000 due to rising costs, the insurance company still pays 70% but now the payout from the insurance company is higher at $10,500 ($3,500 more than above) and the cost to the patient is higher at $4,500.  However, the premium income from the risk pool is unchanged.  

            In the scenario above if you want to apply the 80/20 rule, the income from premiums on the $10,000 hospital stay is the same as the income from premiums on the $15,000 hospital stay.  It's the expenses that have gone up $5,000.  

            For simplicities sake, let's say that the original payout of $7,000 represented all claims for this hypothetical insurance company and it equalled 80% of the premiums they had collected that year.  That means the company received $8,750 in premiums in the year and spent 80% of that premium income on legitimate health care and kept the difference as profit, or $1,750.

            Now apply the effect of a health care cost increase to the insurance company of the hospital stay going up to $15,000.  The expenses have now gone from $7,000 to $10,500, a difference of $3,500 in increased expenses.  But the income from premiums has remained the same at $8,750.  Now the insurance company has a loss of $1,780 for the year.  They've spent more than 100% of their income on legitimate health care expenses because of the rising cost of healthcare.

            At this point, the insurance company has several choices, 1) make an adjustment to the premiums to all people in the risk pool to cover the rising cost or 2) add healthier people to the risk pool to mitigate claim payouts or 3) put pressure on health care providers to keep costs in line, or 4) a combination of the three.  

            If they raise premiums, consumers will have a choice to pick another insurance carrier who offers lower rates for the same coverage.  There might be room for a slight increase, but not much.  Real competition means that other insurance companies who may have healthier clients can lower their premiums making competition even fiercer.  It's more likely that insurance companies would choose to add greater numbers of healthier people to their risk pool to mitigate the risk.  Thus, the reason why insurance companies are now actively marketing to young invincibles.  That's why putting an individual mandate in ACA was so critical (although that's now on hold).  And insurance companies will put pressure on providers to keep costs level because it is in their best interest to do so.

            You will also notice that prior to ACA, health insurance companies had no incentive to add greater numbers of healthier people to their risk pool and no incentive to pressure health care companies to keep costs down.  They had pretty much one tool to make a profit...raise premiums.  

            ACA has leveled the playing field and caused market forces to make a closed market into an open market.  In may not be perfect, but it is way more fair than previously.

            I hope this answers your question.  

            We are all in this together.

            by htowngenie on Sun Sep 01, 2013 at 10:51:02 PM PDT

            [ Parent ]

            •  Thanks so much for this explanation. (1+ / 0-)
              Recommended by:

              I hope you will stay connected to this diary series, or even that you will do some diaries yourself. Cogent, digestible information here is so valuable.

              Thanks again!

            •  Thanks for this (0+ / 0-)

              I also provided an answer that I will replicate here:

              it kind of does answer my question, I say kind of because

              1. As far as I know the individual mandate is still scheduled to take effect in 2014
               2.  insurance companies were ALWAYS interested in adding healthier people to their pools since these premiums were almost complete profit.
               3.  If the medical care goes up for all insurance companies (who all use the same service providers) then the rates will all go up together as a form of defacto collusion.
               4.  If the example you use has a company that was scheduled to provide a refund for 10% of their total premiums due to reduced payout, then they would want to allow prices to go up so that they can keep a portion of that payout in future cycles. .


              •  Your discussion points addressed. (2+ / 0-)
                Recommended by:
                RiveroftheWest, newinfluence

                1) You are right, the individual mandate is not on hold, but the penalties are.  For the first year for individuals, the penalty is $95 or 1% of income, whichever is greater.  The penalty goes up for the next two years and reaches $695 or 2.5% of income.  Many young healthy people will choose to pay the penalty the first year.  This is not really a mandate, it's an opt scheme.  In order to make PPACA a success, we have to convince young healthy people to sign up.  The subsidies help in this regard.  As they age and inevitably face their own health care needs, more and more young healthy people will make the decision on their own.  It is incumbent on those of us who want PPACA to be a success to reach out to this segment and help them in their decision making process.  

                2) Yes, insurance companies have always wanted young healthy people as policy holders because that would increase their profits by spreading the risk.  However, as mentioned in #1, young healthy people tend not to buy insurance.  The young healthy person is a golden unicorn in the private insurance world, few and far between.  Describing this as "no incentive" was a bad choice of words on my part.  PPACA is handing them a whole bunch of golden unicorns they couldn't find before.  They desperately want a piece of that segment of the population.

                3) You get no argument from me that insurance companies and the healthcare delivery system are in bed together.  That started decades ago when insurance companies realized that if they couldn't make money off premiums they could attempt to reduce costs.  It's the same model as socialized medicine really - it controls costs by owning the clinic, owning the hospital, and hiring the health care employees.  Unfortunately, because the US continues to view regulation as something harmful to business, no laws were in place when the insurance companies realized they could offset losses from premium income by manipulating the price of health care and earning profits on the health delivery system.  Thus the $99 aspirin for an insured individual.  They got away with it because there is no accountability in the system, no regulation.  The consumers (the insured) don't care how much things cost, they only care that their co-pay is low and their premiums are low.  My 91 year old mother in law still believes her blood pressure medicine costs 64 cents because that's what is on her express pay. She doesn't ask and most others don't either.  PPACA addresses that by capping premiums to a percentage of income  and addressing profits with the 80/20 rule.  People have a responsibility to ask questions of their health care costs and we as a society need to educate them about that.  

                4) The hypothetical scenario I gave you previously did not provide a situation where the 80/20 rule would kick in.  

                So let's examine such a scenario.  To do this we use the same scenario as before - an insurance policy purchased on an exchange that pays 70% of the $10,000 hospital bill with the patient paying 30% of the $10,000 hospital bill.  We've already accepted the fact that even when you change the amount of the bill, the amount of income from premiums remains the same.  Only the profit or loss changes when the hospital bill changes.  

                To simplify the scenario we need to have administrative costs be zero, although we know in real life this does not happen.  We also need to have income from investments or other lines of business be zero, although this too is not the case in real life.

                Now say the hospital cut costs and the bill reduces to $5000.  The insurance company portion would now be $3500 and the patient would pay $1500.  

                Let's assume that insurance premium income is $10,000.  This is a good year for the insurance company, they've taken in $6,500 more in premiums than what they paid out in claims, ($3,500).  They end up with profit of $6,500.  

                Note that if this was private insurance purchased outside of exchanges, the insurance company would be able to spend this $6,500 profit any way they choose including executive bonuses, lobbying for insurance rules that screw consumers and paying for membership in ALEC, or returning part of the profit to stockholders in the form of dividends. Nothing in PPACA would change for private insurance.  

                But our scenario is an exchange purchased insurance pool and must meet the 80/20 rule, which states that at least 80% of premiums must be used for health care expenses or be refunded to the policy holders.  Premium income is $10,000, health care expenses are $3,500.  Healthcare expenses should be at least 80% of income or $8,000.  But actual healthcare expenses are $4,500 less. The insurance company has three choices basically, 1) refund the excess to policy holders in the form of premium rebates or 2) spend the excess on administrative needs like raises for staff, capital improvements like buildings or computer systems, etc or 3) a combination of the two.  

                I hope this addresses your discussion points and I hope I got my basic math right (I've been retired since 2007 and haven't had much need for math in a while. :)  

                I believe we have a moral duty to help the 30 million people who will gain access to affordable health care through PPACA.  Is it perfect?  No.  Nothing ever is.  But I can't say no to 30 million people because I would prefer perfection.  I hope you agree.

                We are all in this together.

                by htowngenie on Mon Sep 02, 2013 at 06:27:39 PM PDT

                [ Parent ]

                •  ok yes I got all of that (0+ / 0-)

                  very good.

                  the thing is the other side that I am talking about.

                  instead of negotiating down the prices, what if the prices go up?

                  starting with your example toward the bottom

                  premium income is $10,000, health care expenses are 3,500, target health care expenses are 8,000 but are 4,500 less the insurance company refunds the left over 4,500 and keeps a profit of 2,000.

                  or they would but what they realize is that if they allow the costs to go up then

                  the premium incomes go up (because the costs went up, they raised their rates--since the majority of new enrollees are relying on massive government subsidies this is a good thing and increases the amount of dollars coming in)

                  and the premium income goes to 15,000.  since costs went up then they get to have a higher percentage kept as remainder profit = $3,000.  

                  So higher provider costs equals increased premium costs = increased subsidies = increased nominal dollars kept as 20% of total premium buyins.

          •  The ACA contains measures, (1+ / 0-)
            Recommended by:

            not yet fully implemented, to permit honest cost and outcomes comparisons between insurance and health-care providers, and to support evidence-based medicine. Insurance companies that do not negotiate costs down have to compete (the magic word) with those that do.

            Kaiser is one of the best sources for analysis of such issues, because they have done so much of it in their own medical facilities. Henry Kaiser started Kaiser Health because he worked out that it was cheaper to keep workers healthy than to pay the losses from them getting sick or injured, such as interruptions to contract work done under deadlines. We need to think about creating such incentives for industry generally.

            Ceterem censeo, gerrymandra delenda est

            by Mokurai on Mon Sep 02, 2013 at 07:27:57 AM PDT

            [ Parent ]

      •  Naysayers will soon be fighting against a massive (5+ / 0-)

        groundswell of approval. This is absolutely a BFD!

        •  Yep, 30 million new customers for the health (0+ / 0-)

          insurers is definitely a BFD for them.  If anyone thinks that not enough inertia to stymie anything like single payer for generations, I've got some chained COLA to sell them.

          The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

          by accumbens on Sun Sep 01, 2013 at 06:07:13 PM PDT

          [ Parent ]

      •  It always pays to settle for less when the (0+ / 0-)

        private insurers wrote the law.  If this isn't good for insurers, then why are their stocks going gangbusters?  This is a huge give away.  Yes, many people will benefit, but it locks in private health insurers' control  for generations and anyone thinking it's a step toward single payer is kidding themselves.  The insurers are ready to pop the corks on the champagne.

        The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

        by accumbens on Sun Sep 01, 2013 at 06:15:39 PM PDT

        [ Parent ]

        •  What do you care most about? (1+ / 0-)
          Recommended by:

          ...getting people good health coverage or screwing the insurance companies?  

          Personally, I don't give a damn if the insurance companies make a profit and their stocks go up as long as every American can buy good health coverage that they can't lose.  

          Your attitude is the mirror image of the Republicans who care only about sabotaging a program identified with President Obama.

          As for single payer, I'd love to see that too, but anyone who thinks it was ever politically possible in the U.S. has been smoking too much of that stuff they just legalized in Colorado.  

          •  If you're ok with private insurers running the (0+ / 0-)

            show, then I guess it's good.  Basically, we made a deal.  The people get health insurance, the quality of which remains to be seen, in return for continued control by the insurers.  And it's a deal that will last many generations.

            The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

            by accumbens on Mon Sep 02, 2013 at 08:46:35 AM PDT

            [ Parent ]

        •  This turns out not to be the case (0+ / 0-)

          The Swiss health care system has been based on private insurance. The Swiss just voted for Single Payer. The Republican Party is on a path to irrelevance, after which we can take up the issue again and do it much better.

          Medicare Equality!

          Ceterem censeo, gerrymandra delenda est

          by Mokurai on Mon Sep 02, 2013 at 07:31:29 AM PDT

          [ Parent ]

          •  The Swiss have a population of 7.5 million of (0+ / 0-)

            largely well-to-do people.  The comparison with the Swiss is a red herring and, in fact, their costs for health insurance are among the highest, albeit much reduced compared with ours.  Furthermore and more to the point:

            Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.

            Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.

            The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

            by accumbens on Mon Sep 02, 2013 at 08:40:16 AM PDT

            [ Parent ]

    •  Wrong again hamster breath! (22+ / 0-)

      This is a big step forward. The ACA may save my life. I am 56 and haven't had insurance for five years...I am likely diabetic (have many symptoms) but generally can't afford to see any physician. I am desperately waiting four more months so I can start getting my symptoms checked out and get medical care and treatment if needed. I just had a bad episode with a kidney stone and am several thousand dollars in debt just for an ER visit and CT scan. I had shingles about a year and a half ago-once again went to the ER and have several thousand additional dollars in debt for that visit and necessary follow up. I work at a minimum wage job and have had trouble finding higher paying work here in SW MO (reddest of red areas). I live here because I have been caring for my mother full time when not working at my low wage, no benefits job. So please don't tell me how getting (even) private insurance is no big deal. The silver ACA plan is estimated to cost me about $60.00 a month-that I can afford- not the hundreds more monthly for any health insurance-- if I could even qualify with my various pre-exsiting conditions.

      •  I didn't read past "hamster breath." Whatever (2+ / 0-)
        Recommended by:
        DarkSyde, denise b

        your argument is, I've discounted it  - and you - to zero.  Thanks for your valuable input.

        The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

        by accumbens on Sun Sep 01, 2013 at 06:04:23 PM PDT

        [ Parent ]

        •  No sense of humor? (5+ / 0-)

          I am not making an argument for you to agree or disagree with in this case. I am reflecting on the topic with a combination of humor and and personal experience. This is my life, not some ivory tower where these things are debated. Thanks for the very sensitive response.

        •  You (7+ / 0-)

          should have read, although I understand the objection; the comment went to note that it could be a matter of life and death for them.

        •  Really accumbens if you want to help (3+ / 0-)
          Recommended by:
          edwardssl, jdld, tb mare

          you must write more into your comments.  I don't understand what your beef is.  Are you personally hurt by the ACA?  Do you think others are going to be hurt by the ACA?  What's the deal that makes you comment negatively on every pro ACA diary?  

          We are all in this together.

          by htowngenie on Sun Sep 01, 2013 at 06:39:17 PM PDT

          [ Parent ]

          •  It's simple. I agree that the ACA will help many (1+ / 0-)
            Recommended by:

            people.  The problem is it helps the health insurers even more by assuring their control over health insurance and, to a large extent, health care.  In the long term, that will hurt people for a very long time both through their control of people's lives and through damage to the economy.  Even worse, the debate didn't even instruct people about the benefits of single payer because Obama, in his attempt to mollify the insurers, didn't even allow the point of view represented.  

            People underestimate the skill of the insurers to work the system - they are better at that than at providing insurance.  Lots of folks here think the government/Obama/the people won, but in time it will be the same old story because the insurers are in control and with even more customers will wield more power. The inertia for change has been weakened considerably as a result.   I think people should be worried not celebrating (unless they bought stock in the health insurers).  They have less, not more, control over the costs of their health insurance.

            The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

            by accumbens on Sun Sep 01, 2013 at 09:24:04 PM PDT

            [ Parent ]

            •  I don't think an uninsured person would (9+ / 0-)

              agree with your position.  They are now able to get insurance.  How can you say the following to 30 million people previously uninsured people.  

              They have less, not more, control over the costs of their health insurance.
              Prior to ACA, the 30 million had NO control over the costs of insurance because they didn't have any insurance.  

              We are all in this together.

              by htowngenie on Sun Sep 01, 2013 at 10:21:48 PM PDT

              [ Parent ]

              •  The get insurance - how good remains to be seen - (1+ / 0-)
                Recommended by:
                Brooke In Seattle

                but they have no control over it - the private insurers do.

                The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

                by accumbens on Mon Sep 02, 2013 at 06:06:43 AM PDT

                [ Parent ]

                •  No, HHS has control (1+ / 0-)
                  Recommended by:

                  over what levels of coverage they have to provide, the law controls their margins for overhead and profit, and the exchange operators (states or HHS) control competition.

                  Ceterem censeo, gerrymandra delenda est

                  by Mokurai on Mon Sep 02, 2013 at 07:41:14 AM PDT

                  [ Parent ]

                  •  That's the whole point (1+ / 0-)
                    Recommended by:

                    Private health insurance is now a regulated commodity, and one that will come under increasing political scrutiny.  This is the sea change about the ACA.  People are going to become educated about health insurance and the companies won't be able to play the kinds of games they did in the past.  

                    Maybe single payer will come some day, but it will be a long road and this is a crucial first step.  

                    •  I think it's naive to believe that the insurers (0+ / 0-)

                      are under control.  That's my opinion.  I think people are kidding themselves to think so.  The ACA casts a central role for insurers in concrete for generations.  

                      If the insurers have demonstrated anything it's that they know how to game the regulations.  That's what they're expert at.  And now with millions more customers it's even easier for them to hold a gun to the government's head.  They just have to scream "you're going to put us out of business" like they've done for years and the government will cave.  And it will just be easier for them if it's a Republican government they're dealing with.

                      Time will tell, of course, but I'm not so optimistic.

                      The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

                      by accumbens on Mon Sep 02, 2013 at 08:27:25 AM PDT

                      [ Parent ]

                  •  If people really believed the government controls (0+ / 0-)

                    their profits and margins, the insurer's stocks would be in the tank, not hitting new highs.  When you give them 30 million new customers, an erosion in margins is just not too big a deal.  Plus, they are already finding ways to skirt the 20% limit on overhead.  

                    The insurers will make out like bandits.  Why else didn't they raise a huge stink about the ACA beyond their usual complaining?  Maybe it had something to do with the fact that they helped write the law.  Nobody wanting single payer helped write it - they didn't even let them at the table.  

                    The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. Bertrand Russell

                    by accumbens on Mon Sep 02, 2013 at 08:33:14 AM PDT

                    [ Parent ]

                  •  If HHS really had control (0+ / 0-)

                    there wouldn't be millions of us who will remain uninsured after this goes into effect. They would have allowed ALL of us to be covered with a waiver.

                    Congress didn't write this bill with the lowest end of society in mind; they aimed it right at the middle.

                    Great, for those in the middle and upper end. Bad for those who fall between the gaps at the lower end.

                    "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

                    by Brooke In Seattle on Mon Sep 02, 2013 at 09:10:02 AM PDT

                    [ Parent ]

                    •  I know you think your one in the gap, (1+ / 0-)
                      Recommended by:

                      but really "millions" might be overstating it.  We won't know for sure until Oct 1.  Lots of caving in going on with Republican governors as we speak.  Jan Brewer caved.  Others will too as the deadline approaches.  

                      We are all in this together.

                      by htowngenie on Tue Sep 03, 2013 at 07:21:14 AM PDT

                      [ Parent ]

            •  While you are correct up to a point (0+ / 0-)

              that the Senators from The Hartford CT and Mutual of Omaha NE, among others, sold us out to the insurance industry, the ACA in fact does more to rein in the industry than we have ever seen. No exclusions for pre-existing conditions; no lifetime caps; no dropping policyholders just because they get sick (with nitpicky pretenses of irregularities on applications, where they were happy to take your money all those years); and the 80/20 rule (which admittedly should be 90/10 or better). In addition, there are measures to enforce honest competition, which will act to bring down premiums and expenses, and improve care hugely.

              We traded them a shot at 30 million new customers for that.

              So you are simply wrong that this was a pure giveaway.

              Ceterem censeo, gerrymandra delenda est

              by Mokurai on Mon Sep 02, 2013 at 07:39:34 AM PDT

              [ Parent ]

      •  You had me as "SW MO" (5+ / 0-)

        I really feel for you and your health situation and am so happy you may soon find the relief you need.  SW MO is beautiful but the politics are ugly.  I lived there for 10 years and got back to Texas as soon as I could.  And people here on DKos love to bash Texas, but is heaven compared to SW MO the birthplace of Dred Scott and the Baldknobbers.

        We are all in this together.

        by htowngenie on Sun Sep 01, 2013 at 06:42:03 PM PDT

        [ Parent ]

        •  Some of us stand up for Texas (0+ / 0-)

          especially Battleground Texas, which now has 3,000 volunteers working to turn Texas Blue. I have written several diaries against South-bashing and in favor of supporting embattled Southern Kossacks, and celebrating the achievements of Southern Progressives. I'm against the racist culture of entitlement in much of the South and among some groups elsewhere, but entirely in favor of Southern virtues. Especially pie. ^_^

          I did my Peace Corps training in Nashville TN in 1966, at the height of the Civil Rights Movement. We learned about local politics as part of our cross-cultural training. Weird and wonderful.

          PS I miss Molly Ivins. She's still right about Gov. Goodhair.

          Ceterem censeo, gerrymandra delenda est

          by Mokurai on Mon Sep 02, 2013 at 07:49:42 AM PDT

          [ Parent ]

  •  Weirdly enough... (13+ / 0-)

    ...Obamacare may be working heavily to my DISadvantage, but I'm one of the great exceptions to the rule.

    After a bout with a nearly fatal illness (precipitated, in no small part, due to a percentage-based coinsurance "junk" student insurance policy) I made damn sure to get on a health care plan that does NOT include any percentage-based coinsurance.  Never again.  Currently, I'm paying $600/mo COBRA to stay on University of Michigan's plan.  My last hospital stay at UM?  Cost me $30.  Total.  My $3000 or so in drugs a month?  I pay about $40 in copays.

    And yet, the state exchanges  all seem to have percentage-based co-insurance, right up to the Platinum Level.  I may get a much better deal on premiums, but the total cost may well go up disastrously for me the first time I end up in a hospital, and get handed a $5000 bill (for example).

    So I may end up paying substantially more to keep myself alive were I to go on the exchanges.  But then, I've occupied a privileged position for several years - health insurance with high monthly premiums, but nearly total coverage for my chronic care, with a minimum of co-pays and no co-insurance anywhere.

    All that being said, I'm still happy that Obamacare exists, and I'll fight to the death (maybe even my own death) to keep it around.

    •  I thought the out of pocket was fixed and that (3+ / 0-)
      Recommended by:
      ArchTeryx, PSzymeczek, Lujane

      the only percentage in the picture is the 9.5% price point that you need to exceed if you wish to participate in the exchange when another option is open to you.

      "Don't Bet Against Us" - President Barack Obama

      by MRA NY on Sun Sep 01, 2013 at 03:54:34 PM PDT

      [ Parent ]

      •  Out of pocket for *premiums* is fixed. (5+ / 0-)

        For co-pays, it's entirely dependent on the level of coverage.  If I get a Bronze plan in, say, California, I'd have almost total premium subsidy, but I'd be hit with a $6000 bill from the hospital within a few weeks from discharge, even for a minor ailment.  And that $6000 would not vary, whether I made $15,000 a year or $150,000.

        Now, Medicaid is a whole different ball of wax, but if you're in a refusenik state you get the worst of ALL worlds: you pay 100% premiums AND the full cost of the co-insurance...or you go naked and pay the penalty.

        •  yeah, penalty for me. nt (1+ / 0-)
          Recommended by:

          "Don't Bet Against Us" - President Barack Obama

          by MRA NY on Sun Sep 01, 2013 at 04:17:19 PM PDT

          [ Parent ]

        •  I just ran the calculations for our son (6+ / 0-)

          He's 24 and making $10.00 an hour, no benefits at a job where hours have been getting cut.

          "If your state does not expand Medicaid
          You will not be eligible for subsidies in the exchanges because your income is below 100% of the federal poverty level."  

           He's on our insurance for a little while longer- for which we are grateful- but when he ages out, it's not going to be pretty.  Seems like he won't qualify for subsidies and insurance will run about 3K, a hefty chunk out of his meager salary.

          Medications will be God-knows-what.   I checked the pharmacy we currently use and they are $1600 a month.  I know we can get a better deal at Costco.

          It might mean all his income will go to his health care.   He'll have a roof over his head- we have the room at our house, but I worry about people falling through a gap.

          Reason, observation, and experience; the holy trinity of science. Robert Green Ingersoll

          by offred on Sun Sep 01, 2013 at 04:23:49 PM PDT

          [ Parent ]

          •  situations like yours should cause a stir (4+ / 0-)
            Recommended by:
            VPofKarma, myboo, htowngenie, davehouck

            in those states not expanding Medicaid, when people are confronted over and over again with the "you will not be eligible because of your state's obstruction to Medicaid expansion." Caseworkers will be telling them that what is available elsewhere isn't available to them.

            I bet many of those state's will come around fairly quickly, and Obamacare will become the albatross around the obstructionists' necks, instead of Obama, if they don't.

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

            by Sherri in TX on Sun Sep 01, 2013 at 04:46:02 PM PDT

            [ Parent ]

            •  nope (0+ / 0-)

              The states are not doing any "obstruction".  The states don't want to pay for medicare expansion and the feds don't want to pay for it either.

              don't drone me, bro

              by BradMajors on Sun Sep 01, 2013 at 06:22:46 PM PDT

              [ Parent ]

              •  The FEDS are paying for it. (0+ / 0-)

                that's why they are offering Expanded Medicare - the Feds pay for it for the first few years, then the state takes over.  It's a wedge built into ACA to make non-compliant states (think Texas and Michigan and Arizona) roll over and accept the Feds money.  Four red states with Republican governors have already done it.  Why even Jan Brewer in Arizona has done it.  

                The wedge is putting pressure on the Republican governors to accept Expanded Medicare.  The pressure will come from the millions who will go without care because their state didn't take the Expanded Medicare money.  Rick Perry is already starting to break by asking HHS to provide coverage for those with mental illness.  He'll be asking for other groups as soon as those groups or their advocates start putting pressure on him.  

                Expanded Medicare was designed to be a political wedge - designed to make Republicans acquiesce.  

                We are all in this together.

                by htowngenie on Sun Sep 01, 2013 at 11:47:15 PM PDT

                [ Parent ]

          •  got an extra room (2+ / 0-)
            Recommended by:
            nio, GayHillbilly

            for a 54 year old woman? I'm quiet, clean, only the occasional toga party. 100% of my income now goes toward health care and I have been paying my rent out of savings. Now I find that I'm one of those people you are worried about.

            To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

            by kareylou on Sun Sep 01, 2013 at 06:38:55 PM PDT

            [ Parent ]

            •  Wait til Oct 1 to worry. (2+ / 0-)
              Recommended by:
              1Nic Ven, tb mare

              These posts are intended to make you worry.  If you think the GOP has a lock on Chicken Little, you are wrong.  People right here are playing games with your well being.  The sky is not falling.  If you have problems after Oct 1st, by all means tell somebody here at DKos, because they are all in all a very helpful bunch.  But until then, please don't worry because of a few posts from naysayers.  

              We are all in this together.

              by htowngenie on Sun Sep 01, 2013 at 11:51:30 PM PDT

              [ Parent ]

              •  If someone could point out to me (1+ / 0-)
                Recommended by:

                A reading of the law that gave me hope I would be covered I would be less worried. But it appears that because of my extraordinary medical expenses my AGI is below poverty line. That means as a childless woman living in VA I seem not to be covered.
                I just sold my lovely townhouse of 12 years because my medical expenses were twice my Mortgage. I am renting a small room in someone else's home. My beloved pianos with which I have supported myself for 25 years are on Craigslist. I'm already worried and oct 1 can only change that if my health care becomes something close to affordable.

                To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

                by kareylou on Tue Sep 03, 2013 at 03:27:39 AM PDT

                [ Parent ]

                •  I feel you and understand it's hard to not worry. (1+ / 0-)
                  Recommended by:

                  I admit there will be gaps, but I am hoping that the numbers of people affected will be small and the gaps will be quickly recognized and addressed.  Of course, that answer doesn't help you if you fall in the gap. And it doesn't relieve your worry now.

                  But did you notice that your medical expenses are not part of AGI?  AGI is on the first page of 1040A before itemized deductions.  I pray this information will help you.  Or maybe I am misunderstanding your situation because I don't have the complete numbers picture.  If you want, you can send me a Kos mail and I can try to help alleviate some of your worries, but please don't include any personal identifying information.  

                  We are all in this together.

                  by htowngenie on Tue Sep 03, 2013 at 06:14:48 AM PDT

                  [ Parent ]

          •  We (5+ / 0-)

            will be researching and writing about the Medicaid expansion sire of the act in future posts. We wanted to get a framework out there to refer back to.

          •  Good luck (2+ / 0-)
            Recommended by:
            kareylou, jdld

            I'm sorry to hear that your son will be off your insurance fairly soon, but without much prospect of finding affordable insurance when he turns 26.

            One good thing about this situation is that it involves someone like you, offred, who will be very skillful at calling elected people responsible for this travesty and pointing out how much it will cost you, the parents, and your son; and how seriously annoyed you are; and why a minimum of three votes in the next election are not going the callee's way.

            And you aren't the kind of person who will be bamboozled by the likes of those people.

            Which doesn't mean that I like the idea it is happening to your family. It is just completely rotten, through and through.

        •  I'm not sure I understand ArchTeryx. (1+ / 0-)
          Recommended by:

          Are you saying that in a hypothetical bronze plan there is agreement that the insurance company will pay 70% of a hospital stay and you pay the 30%?  

          Not sure I have all parts of the equation.  

          Could you go up to a silver plan to make it more affordable for you?

          Of course, CoveredCalifornia is already online and you can actually see the plan choices and how that affects your premium and your subsidy.  But I thought you were in Michigan?

          We are all in this together.

          by htowngenie on Sun Sep 01, 2013 at 06:56:25 PM PDT

          [ Parent ]

          •  I am in Michigan, yes. (0+ / 0-)

            I'm going on the state exchanges already put up - Covered California, Kynect, and so on.  That's a limited dataset, but the results are very discouraging.

            Keep in mind that right now, I pay almost no co-pays for something really expensive like a hospital state, and what co-pays there are are fixed, not percentage based co-insurance.

            I had a 90%/10% plan in grad school, and the end result of that was very nearly bankruptcy, followed by my death due to being unable to get the surgery I needed.  10% of a $100,000 surgical bill - payable in advance - still was enough to exclude me from health care, and $6000 total out of pocket isn't very much better.

        •  I think there may be a misunderstanding here. (2+ / 0-)
          Recommended by:
          tb mare, MRA NY

          When I went to CoveredCalifornia it has a maximum out of pocket on nearly every plan - $6250 on the bronze plan.  You have lots of copays and a deductible of $2000.  Once your copays reach $4250, the plan pays 100%.  

          Did you base your $6000 bill on the CoveredCalifornia website because that is one of the only websites available yet, or are you planning on moving there?  

          In Michigan, you won't know the plans and premiums offered until Oct 1st.

          We are all in this together.

          by htowngenie on Sun Sep 01, 2013 at 11:38:04 PM PDT

          [ Parent ]

          •  Essentially, yes. (0+ / 0-)

            I was looking at state exchanges: Kynect, Covered California, etc.  The out of pocket maxes are pretty staggering up to Gold, and ALL of them were quite a bit more then I pay out of pocket for a hospital stay now, under UM's insurance plan.

            But you are right - until the federal exchanges go on line, I won't know for sure if the exchange plans will be worse then what I am paying for now.  It's just that the data available to me is pretty discouraging.

          •  I thought (1+ / 0-)
            Recommended by:

            the out-of-pocket maximums for exchange plans were set by the law. No?

      •  Yes, there is an annual cap on out-of-pocket (1+ / 0-)
        Recommended by:

        expenses. The various plan levels in the exchanges specify a percentage of shared cost up to a certain limit, and 100% coverage past that point, except for drugs in 2013. Preventive care is to be provided with no deductibles and no co-pay. Non-exchange plans are not bound by these restrictions. From United Healthcare:

        What are the out-of-pocket maximum limits under the ACA?

            The ACA establishes limits on out-of-pocket maximums for non-grandfathered plans in the Individual, Small Group and Large Group markets. As with the deductible limits, the out-of-pocket limits will apply to the plan on the first day of the first plan year beginning on or after January 1, 2014. Out-of-pocket maximums may not exceed the limitations imposed on HSA-qualified high-deductible health plans ($6,350/single, $12,700/family for 2014)…This requirement does not apply to grandfathered plans.

        Kaiser is one of the best sources for this kind of information.

        Federal Rule Allows Higher Out-Of-Pocket Spending For One Year

        The following is a typical example of the poorly-worded and confusing explanations often being made, but it is possible to work out that it means what I said above if you already know that.

        Reform Law Will Require New Plans to Cover Preventive Care and Limit Out-of-Pocket Expenses

        The reform law will reduce the out-of-pocket spending limits by setting up a tiered system of health care plans—which will be offered through health care exchanges and to individuals and the small group market (those with 100 or fewer employees). These plans will be categorized as bronze, silver, gold and platinum plans. The benefits paid and out-of-pocket expenses for the plans will take effect in 2014 as follows:
        • Bronze plans will cover 60 percent of the costs for health care services and treatment and will limit out-of-pocket expenses to the annual deposit level for an HSA [Health Savings Account] ($5,950 for individuals and $11,900 for families).
        • Silver plans will cover 70 percent of health service costs with the HSA out-of-pocket limit.
        • Gold plans will cover 80 percent of health service costs with the HSA out-of-pocket limit.
        • Platinum plans will cover 90 percent of health service costs with the HSA out-of-pocket limit.
        (Note the discrepancy on HSA limits in these two sources. Even the supposed experts get confused. I do not know which is correct. HSAs are part of Medicare law, but are not explained on the site. If anybody knows of a proper source for this information, please let us know.)

        So if you are on a Bronze plan and your 40% share is $5,950, that means your covered expenses were $14,875, excluding preventive care. Above that, you pay nothing.

        That's nearly $500/month in the worst case. It would not actually affordable for a minimum-wage worker with a chronic but not disabling condition and no access to Medicaid, except that in such cases the ACA provides for reimbursement for copays.

        Young Adults and Low-Cost Health Insurance

        The ACA, also called Obamacare, provides tax credits to help make insurance more affordable to those with incomes that are lower than 400 percent of the federal poverty level ($45,960 per person in 2013); people who earn up to 250 percent of the federal poverty level ($28,725 for individuals) can get subsidies to cover out-of-pocket medical expenses like co-payments.
        Does that help?

        Now, if we had a functioning economy with real jobs at above minimum wage, people would leave states that refuse to expand Medicaid or create their own exchanges. They would leave right-to-work states in significant numbers, too. It has happened before.

        Ceterem censeo, gerrymandra delenda est

        by Mokurai on Mon Sep 02, 2013 at 09:10:25 AM PDT

        [ Parent ]

        •  You seem well-informed and I'm confused. (1+ / 0-)
          Recommended by:

          Is there a simple answer to my question?

          Say I pick the plan that covers 80% of hospitalization and either my husband or I are hospitalized, let's imagine the bill is $100,000. Will we pay $20,000 or will we pay the maximum out-of-pocket, $5000 or whatever it is, but no doubt less than $20K, right? In other words, does 20% patient share mean 20% up to your max out-of-pocket or 20% period?

    •  I hope the concept of "in network" still (1+ / 0-)
      Recommended by:

      exists on these policies, and pays 100% and out of network pays the percentage as most policies do now.

      Otherwise, a whole new business will open up for supplemental insurance to pay the difference, much like medicare.

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

      by Sherri in TX on Sun Sep 01, 2013 at 04:40:12 PM PDT

      [ Parent ]

    •  Is the range of your options available yet? (2+ / 0-)
      Recommended by:
      DarkSyde, worldlotus

      I'm really sorry that you are facing the possibility of worse insurance coverage. I'm no expert on ACA. I live in Canada, but I follow the ACA news with interest. This is what I've learned from others.

      As I understand it (and, as always, stand to be corrected by the real experts), each level represents an actuarial standard: e.g., that it will cover 70% of the costs for a whole bunch of people. Individuals and families may find their mileage varies, with much more than 70% of their costs covered. Or less, I suppose.

      Insurers can come up with various combinations of high, medium, low co-pays, deductibles, and so forth.

      People seeking insurance can see which combo works best for them.

      Someone in your situation might want the very best coverage available, the Platinum one. I hope that the subsidies help to offset whatever downside there is to your choice.

      •  Yeah. I'll be looking at Platinum. (1+ / 0-)
        Recommended by:
        True North

        The thing that concerns me is that NO option may be without percentage-based co-insurance.  It was a 90% plan that damn near killed me, and drove me within a hair's breadth of bankruptcy.  10% of a $100,000 hospital bill is still more then enough to destroy you if you're a grad student, and the lifesaving surgery I was lined up for required me to prove I could pay the co-pays before they scheduled it.

        •  There might be some limits (1+ / 0-)
          Recommended by:

          ArchTeryxm, I came across some information somewhere that said that one bit of data the insurers will provide is the maximum amount a person has to pay in a year. The example given was around $5,000, which is still a lot on top of premiums. However, in all those combinations that insurers will offer, maybe there will be a range on the maximum out-of-pocket expenses.

          It will still raise the cost of insurance, and can be a tremendous burden to the insured.

          Still, I can see why that open-ended percentage business is so much worse. People get insurance partly out of fear of some catastrophic event--but how are fears allayed if an insured person can still go bankrupt paying a percentage of extraordinarily high costs?

          I'm sorry I can't point you to a source. I came across this in reading about ACA, somewhere, and I haven't had any luck finding the reference again.

          •  Don't worry too much. (0+ / 0-)

            After the mess of dealing with Ohio State's insurance (and the illness that it no small part exacerbated)  I've become old hat at this.  When the federal exchange info comes out, I'll be looking very closely at premiums vs. co-pays of the plans.

            As I've said upthread, I'm lucky.  Obamacare is a huge improvement to many folks' plans.  It may be a downgrade for me ONLY because I've fought like a tiger to get employed in places offering the best insurance possible.  All my choices post-graduation have been about health insurance and virtually nothing else.

        •  I could be wrong (2+ / 0-)
          Recommended by:
          ArchTeryx, RiveroftheWest

          but it looks to me as though there's a $4k out-of-pocket maximum for a platinum individual plan.

    •  The other aspect of this is that if you're on a (2+ / 0-)
      Recommended by:
      worldlotus, ArchTeryx

      COBRA, your eligibility for that COBRA runs out after eighteen months of being on it.  So it doesn't really matter how good it is, if it's not something you can get after a relatively short time.

      •  True, but... (0+ / 0-)

        ...I've just started on COBRA.  This would be Month 2 - which leaves 16 months to find a job.  By the time I run out of COBRA, my unemployment will have long ago ceased, and I'll be forced to leave the state and go on Medicaid elsewhere anyway.

        COBRA vs. Exchanges is for the short term.  For the long term, unless I am extremely lucky in a job search, it's Medicaid or death.

    •  Michigan has no information yet. (2+ / 0-)
      Recommended by:
      tb mare, ArchTeryx

      I don't understand where you are getting your information to base your $6000 loss scenario on.  Do you have access to the plans and premiums that will be offered in Michigan?  What website or calculator tool did you use to come up with this scenario?

      Re: Health Insurance Marketplace in Michigan

      If you live in Michigan, you’ll use this website,, to apply for coverage, compare plans, and enroll. You can apply as early as October 1, 2013

      We are all in this together.

      by htowngenie on Sun Sep 01, 2013 at 11:25:39 PM PDT

      [ Parent ]

      •  From existing state exchanges. (0+ / 0-)

        Covered California, Kynect, and so on.  The presence of percentage-based co-insurance on those exchanges is extremely discouraging to me, considering that a 90% coverage plan both nearly bankrupted me and almost led directly to my death.

        But you are right - until Oct. 1st, I won't know for sure if the federal exchanges are following in the path of the state exchanges that have been put up so far.

  •  The problem is (6+ / 0-)

    That for profit insurance companies and big pharma are still in charge. Couple that with the courts allowing red states to opt out of cooperating with the new law and this is going to be nothing short of disastrous for many working poor and families already living close to the edge. I hope I'm wrong but I don't believe I am. I'm afraid that the President just became too focused on getting a law, any law that he allowed the whole thing to be written by a handful of blue dog Senators who were trying to protect their patrons and retirement prospects. I think that in places like New England and California that it will be a boon but many, many others are going to suffer gravely because this leaves the people who are trying to maximize their own monetary gain in charge of the entire system. For the working poor, this system is going to make their lives much more difficult, I'm afraid.

    "Given the choice between a Republican and someone who acts like a Republican, people will vote for a real Republican every time." Harry Truman

    by MargaretPOA on Sun Sep 01, 2013 at 03:31:23 PM PDT

  •  This is incorrect: (14+ / 0-)
    Anyone earning less than federal poverty wages will be covered under the Medicaid expansion side of the Act,
    considering the 20+ states that are not doing the expansion.  in those states (one of which I'm in), those making below poverty level or unemployed (like me) are left out in the cold.

    nope, no insurance for me yet.

    "Don't Bet Against Us" - President Barack Obama

    by MRA NY on Sun Sep 01, 2013 at 03:33:15 PM PDT

    •  Would have been but for Scotus & Repubs (5+ / 0-)
      Recommended by:
      MRA NY, FindingMyVoice, Lujane, VPofKarma, jdld

      Scotus gave states the option of opting out & many red states took that option to snub Obama.

      look for my eSci diary series Thursday evening.

      by FishOutofWater on Sun Sep 01, 2013 at 03:45:23 PM PDT

      [ Parent ]

    •  who put the Repugs in charge in those states? (4+ / 0-)
      Recommended by:
      VPofKarma, DarkSyde, GayHillbilly, jdld

      I wouldn't want those heartless bastards in charge of my ability to get affordable care or anything else for that matter.  When implementation of the ACA proves its worthiness,  perhaps those tinmen will be finally voted out of office so that every citizen in every state will have the same access to health care.

    •  You (6+ / 0-)

      are correct, it is at best an oversimplification for the reason you state MRA. I hope to have better info on the expansion side for those in recalcitrant states. It may turn out that some states successfully impede access to healthcare for their most vulnerable, struggling residents for some period of time. But if they do, I am going to do what I can to pressure those lawmakers, and make them pay politically and morally, until they either give or are invited to leave office by weary voters.

    •  If you live in a refusenik state (2+ / 0-)
      Recommended by:
      tb mare, RiveroftheWest

      and live below the poverty line, you can still get coverage from the exchanges.

      You report your estimated income level. Since no one knows for sure what they'll make (who knows, a lottery ticket could be a winner!), just estimate your income ABOVE the minimum required to get into the exchange.

      You will have coverage at least. What happens at the end of the year is anyone's guess. But if the choice is worrying about dying or being optimistic on future income, chose optimism.

      In an insane society, the sane man would appear insane

      by TampaCPA on Sun Sep 01, 2013 at 09:03:51 PM PDT

      [ Parent ]

    •  Sounds like you probably qualify for regular (1+ / 0-)
      Recommended by:

      Medicaid.  Expanded Medicaid was designed for the working poor.  You are not working, but you are poor by definition of lack of annual income, correct?  Each state has different rules.  Check your State Medicaid website to see if you qualify for Regular Medicaid.  

      Even in Texas where I live they offer Medicaid to indigent people including people who are unemployed for long periods.  It's based on annual income, current income, and prospects for income.  

      We are all in this together.

      by htowngenie on Mon Sep 02, 2013 at 12:00:55 AM PDT

      [ Parent ]

      •  No, I am incorrect on this. (2+ / 0-)
        Recommended by:
        jdld, RiveroftheWest

        To qualigy for Regular Medicaid you have to fall into a special category, pregnant, disabled, single parent of young children, elderly, etc.  Not knowing your status or residence, I can't tell you that you might would be a longshot.  

        We are all in this together.

        by htowngenie on Mon Sep 02, 2013 at 01:00:55 AM PDT

        [ Parent ]

  •  What if my state (7+ / 0-)

    (and yours, btw) doesn't do an exchange?

  •  What I received from the VA: (15+ / 0-)
    What are my VA health care benefits?

    As an enrolled Veteran, you have:

    • Medical care rated among the best in the U.S.
    • No enrollment fee, monthly premiums, or deductibles.  Most Veterans have no out-of-pocket costs.  Some  veterans many have to pay small copayments for healt care or prescription drugs.
    • More than 1400 places available for you to get your care.  This means your coverages goes with you if you travel or move
    • Met the new requirement to have health care coverage.
    Who knew that a commitment I made to my country 40 years ago would pay dividends today?  Just goes to show ya, you never know.

    P.S. I've said here before that y'all are missing the boat.  Medicare for all would be nice.  But the VA Healthcare model for everyone would solve this country's health care issues in a N.Y. minute (at less cost than Medicare for all, or even the ACA).  We have socialized medicine in the United States, and it works -- very well, mostly -- for millions:


    UID: 14791 Join Date: 7/7/2004 Status: Lifetime member Mojo: nearly infinite Any questions?

    by Richard Cranium on Sun Sep 01, 2013 at 03:46:27 PM PDT

    •  My husband (1+ / 0-)
      Recommended by:

      spent nine years in the Army Reserve, but does not qualify for VA healthcare.  I was active-duty for two years, so I do, with perhaps a small co-pay.   If we get just coverage for my husband, it's $1,800 a year after the subsidy, which we can't afford.    He currently goes to a Community Health Clinic at $30 a pop, which is manageable, if he only has to go once a month.  But if he has to be hospitalized, we're screwed.

      You can't keep a mighty tree alive (much less expect it to thrive) by only spritzing the fine leaves at its tippy-top. The fate of the whole tree depends on nurturing the grassroots. - Jim Hightower

      by PSzymeczek on Sun Sep 01, 2013 at 04:13:33 PM PDT

      [ Parent ]

  •  Thanks for this (8+ / 0-)

    ..looking forward to future posts on Obamacare.

  •  I would never argue (8+ / 0-)

    that the ACA is not a great leap over the previous status quo. If. If it were to be implemented, executed, and maintained as designed in good faith.

    That' s a big if considering the GOP we have, rather than the one we might wish existed.

    Just looking at the State website responsibility, not too much heavy lifting, but important for consumers of the program as a vital source of information for State residents... do I trust that a Scott Walker, that freak from Maine, or the Medicare fraudster Governor of Florida, or their Teahadi stooges and minions, are going to do their jobs and provide the information accurately and concisely? Or use the responsibility to inform their state residents as a weapon. To deliberately confuse and manipulate people inside their States to increase confusion and doubt and string out the roll-out as another theatre in their war on Healthcare reform.

    The more I see of the ACA, the more I see of all it's parts, the more I marvel at how much it is dependent on good faith good government to work properly and effectively.

    The more gears turning, the more places to shove a shoe and break the machine.

    The GOP, institutionally, the whole ball of wax, is completely controlled by the most bad faith-fueled force for gumming up functioning government, on all levels from town councils to the highest State and Congressional offices of leadership at the State and Federal level, I am concerned that the promise of the program depends on good faith good government where very little exists.

    The ACA, I believe, will never stop being under assault in some way. The GOP doesn't own it, even though it is their policy really, and the Democrats do. Since the GOP has shown very little willingness to put people's needs ahead of winning, why would I think otherwise.

    I don't think those concerns are hyperbolic or overplayed. Five minutes of watching Jim DeMint's Heritage Foundation "resident scholars" or American Enterprise Institute "in-house healthcare industry experts" opining on C-Span or on Fox News about how the healthcare reform regime that they helped design in past days can be resisted or hamstrung in many ways doesn't give me a lot of faith that it isn't going to be constantly sabotaged on the state and federal level.

    Then, the Movement Conservative Right, after sabotaging a Movement Conservative policy regime, the most free-market driven reform regime they were ever going to get, then turns around and says "liberalism has failed" so we cannot have further, and more actually liberal policy added by way of reforming the reform.

    At every turn, non-Conservatives have been expecting, Waiting for Godot style, the Movement Conservative Right to stop acting as an agent of chaos for personal gain for the greater good and their own longterm benefit.

    Being offered and then taking free Federal money, massive amounts of it, and having to be begged to do it in some cases, like free money and tons of it were a burden to be born, doesn't make me confident we are in for any good faith on the Right any time soon.

    This program needs good faith, and it needs it from some of the most blatantly bad faith actors at all levels of governance. I haven't heard a lot about how to deal with this reality going forward.  

    I am a Loco-Foco. I am from the Elizabeth Warren wing of the Democratic Party.

    by LeftHandedMan on Sun Sep 01, 2013 at 03:56:55 PM PDT

    •  Thank you for this diary (7+ / 0-)

      and the information it contains.

      As somebody who lives in a state with a Teahadi pandering Governor with Presidential ambitions, Nevada and Brian Sandoval, I'm going to need it. Every roll-out delay, setback, or punt to the Federal government has been due to his need to keep himself viable for a national race in the GOP. I can only imagine what it must be like in a dark Red State with an out-and-out crazy in the corner office and no Democrats in the House or Senate to default to for good governance.  

      I am a Loco-Foco. I am from the Elizabeth Warren wing of the Democratic Party.

      by LeftHandedMan on Sun Sep 01, 2013 at 04:01:53 PM PDT

      [ Parent ]

    •  Yep. Obstructionism is the name of the game. (9+ / 0-)
      The more I see of the ACA, the more I see of all it's parts, the more I marvel at how much it is dependent on good faith good government to work properly and effectively.
      I, for one don't want to let the bastards get away with it.

      In the time it took Adam Lanza to reload, eleven children escaped. What if...

      by Sixty Something on Sun Sep 01, 2013 at 04:20:13 PM PDT

      [ Parent ]

    •  Good Faith needed here on this thread, too (7+ / 0-)

      We have obstructionist here who are acting just like the Republicans you mention.  

      Single payer was put on the table when Obama first got elected and got no support in the senate, it was a dead issue, an issue I wanted more than anything when Obama got elected.  I got over it.  But many of our "more and better Democrats" here on DKos are still angry about it and have resorted to GOP like tactics to get there message across.  You can substitute single payer sour grapes supporters in your sentence for "GOP":

      Since the GOP has shown very little willingness to put people's needs ahead of winning
      Every time I see a single payer sour grapes poster here, I want to say "get over it!"  So many people are going to benefit from ACA, how can you humanely say "forget you, I didn't get what I wanted," which is basically what one poster did upthread referring to a real person as a "zero".  That doesn't sound like a better Democrat to me.    

      To the Single Payer Sour Grapes posters:

      To all the people who post individual cases of concern here:
      If you have an individual case that is damaged by ACA, by all means post it here and the good folk at Daily Kos will try to help you. But we can't help you if you do not reveal the state where you live.  Many of the concern posts have been disingenuous and have included premium rates that are unpublished yet.  If someone asks you "what state are you in" they are actually listening to your concern and trying to help you.  If you don't respond, it is assumed that you didn't really want help to begin with.

      And some of the individual scenarios reported are conveniently just on the cusp of being helped by ACA.  The son story upthread is a good example.  Now I am not questioning the veracity of the basic story, however, had the son made $1000 more, rather $12,000 a year instead of $11,000, he would have received subsidies even in states that have refused the expansion of Medicaid.  The poster did not provide enough detail to be able to respond adequately and everyone else piled on about how horrible Obamacare was to leave the son in the dust.  But, we don't really know that yet, now do we?

      October 1st is the date when the information is going to be released for the vast majority of us.  It's like the Grand Opening of a store.  In the store we all hope to find variety and good prices.  We will have 3 months to bitch about the bad merchandise after we see what's in the store or crow about the great deals we find.  

      If during that 3 months you are still concerned, post your problem here at DKos and people here will reach out to you.  But until then, unless you live where an exchange is already open, there is no need to disclose your personal scenario and express your concern.  

      If you have a beef about ACA because you wanted single payer, say so.  It will make it easier for us who want the ACA to be a success to dedicate our time more efficiently by just ignoring you and moving on to people who really need our help.        

      We are all in this together.

      by htowngenie on Sun Sep 01, 2013 at 08:23:28 PM PDT

      [ Parent ]

      •  Nice threadjack (0+ / 0-)

        Go write your own dKos suxors Diary. The rest of us have work to do, which includes dealing with the ACA as it is and with planning to improve it. We also have to explain from time to time why we don't have a better law.

        Ceterem censeo, gerrymandra delenda est

        by Mokurai on Mon Sep 02, 2013 at 09:20:48 AM PDT

        [ Parent ]

        •  Not a threadjack (0+ / 0-)

          it's on topic (ACA), it's about this thread and it's commenters.  I never implied that Dkos sucks and that commenters suck.  I said the anti-ACA commenters have resorted to tactics that do them no credit, strawman arguments, disingenuous concern, etc.  

          One of my main points is that we won't know until Oct 1st.  Basically, we can't "work with "ACA as it is or plan to improve it" until we see the numbers of people and cases that produce actual harm.  I am not convinced that the cases repeated here on DKos are actual harm.  That doesn't mean I don't believe those cases won't pop up after Oct 1.  I hope they will be few in number and easily rectified.  In the meantime, I do know that 30 million people will get access to affordable healthcare due to the passage of ACA.  

          Your profile says you are a philosopher, a Courtesy Kossack, and a Buddhist.  I had to look at your profile to find that out about you because nothing in your comment above suggests those beliefs or affiliations.  It was unkind, untrue, and not pertinent.


          We are all in this together.

          by htowngenie on Mon Sep 02, 2013 at 09:49:27 AM PDT

          [ Parent ]

  •  I choose trick question (3+ / 0-)
    Recommended by:
    on the cusp, Bensdad, kareylou

    I'm half shit faced !
    There are no open threads today so a person can just have fun post a picture talk about the weather while they get shit faced!

    I'll put money on: I've already read about this subject & my mind is crammed full of it !


    I always forget to take a picture before I start !



  •  Other. (4+ / 0-)
    Recommended by:
    eeff, PSzymeczek, Orinoco, VPofKarma

    As a veteran how do I make sure that I continue to collect the health care I paid for.

    •  Vote for Democrats. They are less likely to (4+ / 0-)

      screw veteran's your benefits.

      In the time it took Adam Lanza to reload, eleven children escaped. What if...

      by Sixty Something on Sun Sep 01, 2013 at 04:22:25 PM PDT

      [ Parent ]

    •  Enroll at your closest VA facility (2+ / 0-)
      Recommended by:
      VPofKarma, htowngenie

      The VA will work with your existing medical providers and your existing health insurance company.

      I'm not entirely sure that's what you meant by "collecting the health care you paid for", since, with our health insurance model, you don't pay for care, you pay for insurance. If you don't use any health care while you are covered, you don't get a refund.

      If you are a veteran, and you are not enrolled at the VA, get your butt down there immediately and sign up. Bring your DD214 when you go, the long form that says what kind of discharge you got. If you can't find your DD214, go anyway, they have contacts with the services' archives to help retrieve those documents.

      If you are already enrolled, your VA health care benefits meet the standards of the ACA (and then some), so you're good to go.

      "The problems of incompetent, corrupt, corporatist government are incompetence, corruption and corporatism, not government." Jerome a Paris

      by Orinoco on Sun Sep 01, 2013 at 04:38:43 PM PDT

      [ Parent ]

  •  The "navigators" will play a key role... (7+ / 0-) the enrollment" process.

    California seems to be leading the way.

    But 30 to 50 thousand navigators have to be trained and this is a challenge to say the least.  These navigators have to recommend to the 5.5 million people in California who don't have health insurance today but qualify for Obamacare.  Mostly Latinos and poor people who will have to understand which of 10 or more possible plans within the platinum, gold, silver and bronze level they should get given their income, expenses, medical conditions, etc.  I envision a complex decision flowchart.  I talked to some fron liners in Covered California yesterday and they told me that the navigators are being trained.  I want to get some more clarity about all this.  Some Latino non profits who are being asked to participate are not happy.

    Here is the 1st TV ad;

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Sun Sep 01, 2013 at 04:02:42 PM PDT

  •  After this has been running (4+ / 0-)

    a year or two, certain reactionary governors will look over at Blue States, and they will feel so stupid.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Sun Sep 01, 2013 at 04:07:21 PM PDT

    •  I'm afraid I have to disagree. (1+ / 0-)
      Recommended by:

      They will look over at blue states, see the disparity, and blame it all on the greed of the people who have it slightly less crappy than they do.

      Rather, they'll tell the people in their states that they suffer because of the greed of people who have it slightly less crappy than they do. Just like they did with public vs private sector workers, and every other example of shifting the blame for the failures of their ideas.

      The problem with going with your gut as opposed to your head is that the former is so often full of shit. - Randy Chestnut

      by lotusmaglite on Sun Sep 01, 2013 at 04:15:15 PM PDT

      [ Parent ]

  •  Thanks so much for the diary, Darksyde! (10+ / 0-)

    I am in the pre-existing condition insurance plan which ends in January.  I think my premiums will be reduced a little.
    I am only 3 yrs, 8 months from Medicaire.
    Somehow, I will do this.

    •  That is odd ... (1+ / 0-)
      Recommended by:

      I, too, am in the PCIP. And I'm about the same age as you to boot. But from what I've researched at the Covered California website, it's looking like the PCIP is a DEAL that the insurance exchanges won't come close to replicating.

      When CA was administering the PCIP up until last July, I paid $530/month for health insurance. (Now that it's been turned over to the Feds, it's an even better deal: $505/month.) I'm subject to a $1500 deductible, and $25 copays for doctor visits.

      Unfortunately, it looks like the ACA insurance exchange choices in my county won't even come close to that. The cheapest policy I could get is $549/month, but the copays range from $60 for a doctor visit to $300 for an emergency room visit. To get the kind of copay I get with the PCIP, I'd have to go to the Platinum level: $978/month for the cheapest policy!

      Sigh. Oh, well. I'm sure I'll work something out. But PCIP saved my bacon. Wish the exchanges had an option to just continue with it ...

      "Long term: first the rich get mean, then the poor get mean, and the rest is history." My brother Rob.

      by Pat K California on Sun Sep 01, 2013 at 04:57:57 PM PDT

      [ Parent ]

  •  A "vast improvement" or nothing. (3+ / 0-)
    Recommended by:
    DarkSyde, HappyMichBlogger, edwardssl

    Hmmm. What do I choose? This is really hard.

    "They come, they come To build a wall between us We know they won't win."--Crowded House, "Don't Dream It's Over."

    by Wildthumb on Sun Sep 01, 2013 at 04:20:56 PM PDT

  •  Don't forget (9+ / 0-)

    No matter your state, whether you'll have a state-based exchange, a federal exchange or a hybrid, it's a good starting point and it's easy to use.

    •  I (3+ / 0-)

      need to learn more about that, fast.

      •  I chose "none of the above" (4+ / 0-)

        because you didn't have on your poll.

        We are all in this together.

        by htowngenie on Sun Sep 01, 2013 at 08:35:36 PM PDT

        [ Parent ]

        •  I (3+ / 0-)
          Recommended by:
          worldlotus, tb mare, RiveroftheWest

          mainly put the poll in there to generate discussion. I imagine one could find some info at all those places, and in some cases find no info at all those places. If I had to start with one, though, I'd look for an exchange, or info on what to do if your state is run by a Governor Crazy Pants and has no exchange. That's where you should be able to put in parameters like income and number of insured, see if you even qualify, and in some cases get an actual quote.

          The comment you wrote higher up is spot on imo.

          So, this isn't directed to anyone in particular: there's no reason to be limiting any viewpoints outside of trolls and spammers -- they suck of course :)

          Those who need help will want to not be afraid to ask for it, and it's understandable some who fall into weird gaps or live in state's dragging their feet may feel deeply despondent and frustrated. They should be!

          So, those who offer help must be patient, read their comment not as anonymous diatribe, but as if it were posed by someone in your life you care about. This goes both ways.

  •  I have and will stick with Kaiser Advantage, (1+ / 0-)
    Recommended by:

    but I'm super privileged (CSRS + FEHBP), for as long as I can. I have acquaintances who are likely to get hammered by this, however.

    That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

    by enhydra lutris on Sun Sep 01, 2013 at 04:32:31 PM PDT

  •  I have an uncommon interest in this game. (6+ / 0-)

    My daughter in NYC, is seriously considering moving from NYC to NC after this last year of her child in preschool.

    She has been a New Yorker for the last 20 years but finds being able to raise a child in a tiny one person apartment no longer a viable option for a single parent, with no financial support from the father.

    Personally, I am scared that she will be making a decision between continuing life in NY with good health coverage, or life in NC, with the party here doing everything in their power to destroy health care for people in NC.  There are a lot of people in this position.

    Sooner or later, businesses are going to have to confront the issue of whether they can attract people to our state, given the approach the Governor and the Art Pope financed  State House has taken to ObamaCare.

    In the time it took Adam Lanza to reload, eleven children escaped. What if...

    by Sixty Something on Sun Sep 01, 2013 at 04:38:07 PM PDT

    •  As (10+ / 0-)

      far as NC vs NY, I think and I plan to use as an analogy in later posts, those folks above and below who are worried uncooperative are going to bitch and moan and fuck this up every way they can are absolutely right. Those state governors and state ledges will indeed do exactly that. Appealing to their ethics and sense of decency is not going to work, they can only be defeated.

      The analogy I plan to rely on is voter suppression. There are states where our brothers and sisters from all ideologies and no ideologies are being systematically disenfranchised at the ballot box. It happens that this has made voting an act of rebellion, the repressers have just about singlehandedly made voting cool. Something we could have never done on our own, and it may be blowing up in the usual suspects' faces now.

      I don't know how this will turn out, but those who have fought back against voter suppression offer one possible tactic we can use to force the issue: help your friends an family navigate the obstacles erected, wait in line as long as necessary, cast your vote despite those obstacles, and win anyway. We might be able to do something similar here, help our community navigate the obstacles and even start getting some of them signed up. Then we shame those who aren't playing ball right out of office.

      •   I do hope that voter suppression will blow up (3+ / 0-)

        in my governor's face and all the others who use it.  

        The GOP game plan is supress student vote, supress minority vote, supress the poor vote in that order, aka anyone likely to vote Democratic.

        I do hope the courts will do something about this but after the SCOTUS, striking down part of the Voting Rights Act, I'm not at all sure this will happen.

        Thank you for your response.

        In the time it took Adam Lanza to reload, eleven children escaped. What if...

        by Sixty Something on Sun Sep 01, 2013 at 07:40:00 PM PDT

        [ Parent ]

    •  Hope she finds a good option (3+ / 0-)
      Recommended by:
      kareylou, tb mare, RiveroftheWest

      Is she considering any other state than NC and NY? Or maybe some part of New York that isn't as expensive as New York City?

      It is depressing what those red states are doing to their residents.

      I sure hope she finds a good alternative in one of the good states, where she can do the work she loves and have a better quality of life--and insurance.

      In the meantime, perhaps you should call your elected people--the ones responsible for this mess--and tell them that you are discouraging family members from moving to North Carolina because of the abysmal health insurance situation they've created.

    •  You make a good point (3+ / 0-)
      Recommended by:
      rsmpdx, RiveroftheWest, Mokurai

      about being able to attract people to your state.

      Somewhere recently I was reading that the Chamber of Commerce in Charlotte had asked in an open letter to the paper that all the voter suppression be stopped (well they didn't call it voter suppression but you know what they meant), that it was bad for business and they had invested a ton of money trying to lure business to NC.  That was very interesting.  

      We are all in this together.

      by htowngenie on Sun Sep 01, 2013 at 08:41:04 PM PDT

      [ Parent ]

  •  What about retirees? (2+ / 0-)
    Recommended by:
    rl en france, RiveroftheWest

    disability retirement from the Feds (OPM), with BC/BS primary, Medicare secondary.

    All the calculators seem to address current workers.

    Total premium payments are roughly 10% of yearly gross income.

    Will anything change?

    (-7.62,-7.33) Carbon footprint 11.3 metric tons. l'Enfer, c'est les autres.

    by argomd on Sun Sep 01, 2013 at 04:42:26 PM PDT

    •  The (4+ / 0-)

      calculator definitely has some gaps, for example, if you use zero people enrolled vs one enrolled, it changes some results. Alas, it's the best we/they could develop and have partially embeddable this weekend. I hope to have more accurate tools soon and even have an idea how we could create our own, someone like Jotter might probably write what I have in mind. That guy does good work. If he can't maybe he or someone else here knows someone who can.

    •  As far as I know ACA will not affect (2+ / 0-)
      Recommended by:
      rsmpdx, RiveroftheWest

      your situation (you are over 65 right?).  However, I have a question for you.  Shouldn't your Medicare be primary and your BC/BS secondary?

      The only thing that might change for you is that the pool of insured people is getting bigger - spreading the risk may actually reduce your premiums on your BC/BS policy.

      10% of income is pretty high for a secondary policy.  Is your math correct on that?  I could understand if you had no retirement, but it sounds like you do have some sort of retirement income.

      Anyway, your question doesn't provide enough info for anyone here to answer your question adequately.  Your Medicare helpline should be of assistance though.

      We are all in this together.

      by htowngenie on Sun Sep 01, 2013 at 08:46:05 PM PDT

      [ Parent ]

      •  Thanks. Details are as I stated. (1+ / 0-)
        Recommended by:

        Don't know what pertinent info I could have provided that I didn't, but here's a bit more to answer your questions:  disability retirement (62yo); BC/BS primary, Medicare secondary (until official SS retirement age of 66, at which time it reverses); retirement income ~$40k/y; premiums for both total just under 10% of gross annual income.  No, the Medicare helpline has not been able to clarify, nor has congresscritter's office.

        Stroke aside, my ability to do arithmetic remains reasonably good, given my Ph.D. in physics.  I've spent several years living with these numbers.  

        (-7.62,-7.33) Carbon footprint 11.3 metric tons. l'Enfer, c'est les autres.

        by argomd on Mon Sep 02, 2013 at 07:10:05 AM PDT

        [ Parent ]

  •  If a person lives in FloriDUH, (1+ / 0-)
    Recommended by:

     If a person lives in FloriDUH, has no money for healthcare,
     can she still sign up on the "national exchange" get healthcare subsidized bt Govt even though they live in FloriDUH??

    looking for answers...
    she only makes like $1,000 a year on odd jobs,

    or do we need the medicaid expansion which Floriduh will not do?

    "You can't think and surf at the same time" Yogi Surfdog

    by surfdog on Sun Sep 01, 2013 at 04:42:31 PM PDT

  •  My insurance will be more expensive.... (4+ / 0-)

    .....under Obamacare. Using the calculator, I will be paying about $200 per month than I am paying now. That may be because my income keeps me from getting a subsidy. Also, I am older but not eligible yet for Medicare.

    On the plus side, I will get prescription medical coverage and of course they cannot deny me for a preexisting condition so I will be able to choose from either of two providers in my area.

    The prescription drug coverage doesn't help me much economically as I only have one prescription (for allergies) and it only costs me $35 per month.  So, I will be losing about $165 per month if the calculations hold true.

    If you hate government, don't run for office in that government.

    by Bensdad on Sun Sep 01, 2013 at 04:54:36 PM PDT

    •  Yup, same here ... (5+ / 0-)

      I, too, make too much to get a subsidy (which is fine). Right now I'm in the temporary Pre-Existing Condition Insurance Program set up by the Feds to tide us folks with pre-existing conditions over until the full ACA takes effect. What a deal that has been! I've absolutely loved it. It IS, in effect, single payer insurance. Now that I'm faced with being thrown back on the tender mercies of the private insurers, things don't look quite so rosy. The offered policies are much more expensive from where I stand.

      Not that I would wish to get rid of the ACA, mind you. I just yearn for the day when single payer will be a reality.

      "Long term: first the rich get mean, then the poor get mean, and the rest is history." My brother Rob.

      by Pat K California on Sun Sep 01, 2013 at 05:11:16 PM PDT

      [ Parent ]

      •  I need (3+ / 0-)

        to understand situations like this better, feel free to email me at darksydothemoon .. domain is aohell :)

      •  I understand making too much to get a subsidy (2+ / 0-)
        Recommended by:
        Pat K California, RiveroftheWest

        but not making enough to get a subsidy? you can't make this stuff up.

        To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

        by kareylou on Sun Sep 01, 2013 at 07:30:08 PM PDT

        [ Parent ]

        •  thus the offering of EXPANDED MEDICAID (3+ / 0-)

          If you don't make enough to get a subsidy, you may qualify for Regular Medicaid through your states Medicaid office, if you make too much for Regular Medicaid, then the FEDS have offered the states Expanded Medicaid for the working poor.  If your state chose not to offer Expanded Medicaid, you may still qualify for a subsidy (check  If you don't, you fall in a crack, but it's a narrow crack designed to put pressure on the non-compliant states (usually red states or those with a Republican governor)to accept the FED money.  Four thoroughly red states have accepted the Expanded Medicaid recently, including Jan Brewer in Arizona.  They will all cave before too long.  

          We are all in this together.

          by htowngenie on Mon Sep 02, 2013 at 12:08:58 AM PDT

          [ Parent ]

          •  I live in Virginia (1+ / 0-)
            Recommended by:

            So no Medicaid for me. We simply must defeat cuccinelli this fall.
            Seems to me that falling down a narrow crack would hurt worse than falling down a wide one. Would that your sig line was true. We're not all in this together when many spend sleepless nights worrying about how they will get treatment for life-threatening illness without becoming homeless. That can't be good for one's health

            To keep our faces turned toward change, and behave as free spirits in the presence of fate--that is strength undefeatable. (Helen Keller)

            by kareylou on Tue Sep 03, 2013 at 03:15:43 AM PDT

            [ Parent ]

  •  another quick example: I am 50, single, make ~26K (13+ / 0-)

    and it looks like I'll pay about $180/month on the exchange.  Haven't had health insurance for 4 years and couldn't begin to afford it (or qualify) without ACA.

    This is a good diary.  

  •  Thanks for this diary (8+ / 0-)

    I'm 100% committed to getting the word out about the ACA.  I've been talking it up all along, and it's great to have resources to back my enthusiasm.

  •  Question (5+ / 0-)

    Does anyone know if people who work minimum wage in states whose governors refused Medicaid expansion will be able to sign up on the exchange?  I have a cousin, female, age 30 or thereabouts who lives in Louisiana where this is the case.  I'd like to help her get enrolled, if she's allowed to.

    •  Not (5+ / 0-)

      yet, but at some point this month I hope to be able to write a useful post on exactly that topic. We will almost certainly need diaries from various states as time goes by. I was thinking if some folks find they have a facility for their state or others like it, diarists could "adopt a state[s]" and become the virtual community organizer for that group of states on specific issues like expansion or exchanges, etc.

      This will take a commitment, it will take organization, but I think we have the crowd-source resources to do it well.

    •  Suggestion for you (3+ / 0-)

      Go to

      Enter all the data about her that you know in the section where it asks about state, age, income.

      See what comes up. That will give you a rough idea of what the situation may be.

      More detailed information will be needed to get the full picture, but you can start there.

  •  Sorry (2+ / 0-)
    Recommended by:
    DarkSyde, RiveroftheWest

    I posted my question above as soon as I finished reading the post.  Now that I've started reading the comments I see that my question has already been answered.  

  •  I wonder about retired workers (1+ / 0-)
    Recommended by:

    who are still too young to be qualified for Medicare.  How is their income counted if they are withdrawing from an IRA or 401k for purposes of the exchange and subsidies?

    Democrats give you the Bill of Rights; Republicans sell you a bill of goods!

    by barbwires on Sun Sep 01, 2013 at 05:52:00 PM PDT

    •  barbwires, this is answered on (4+ / 0-)

      site re retirees that are not yet old enough for Medicare.

      Income is also addressed under the Q&A as well as the definition of employment etal.  Lots of different subjects are addressed under the Q/A.

      The calculator gives an estimate only-the actual plan choices & premiums won't be on the site until Oct 1.

      I had some confusion/misconceptions cleared up by going to the site last night.  Our situation is unique in that we are currently on COBRA , currently self employed and (still) several years away from Medicare.

      Strangely, when I crunched different numbers, the possibility for a subsidy showed up even at the 78K range.  Not sure why....

      My state is one that opted out & is fighting Obamacare.  The site informed me that I would enroll at the federal site ( after I entered my state (GA).  

      Those who live in states that opted out of medicaid expansion & who would have qualified for medicaid will not be fined if I am understanding the site info correctly.

      Retirees not yet medicare eligible:

      The most important thing for everyone to know is:
      1) Open enrollment is Oct 1 2013
      2)Coverage is effective Jan 1 2014
      3)Open enrollment ends March 31 2014

      Once open enrollment closes, ya cannot enroll unless there is a major life event.  And if one gets insurance that is effective PRIOR to 1/1/14 through this site (or any other site) it will NOT be ACA/Obamacare insurance with all the protections & goodies


      •  Question (1+ / 0-)
        Recommended by:

        say you're on COBRA, but your premiums under ACA would be lower, can you switch, or does COBRA qualify as employer insurance meaning you are not eligible? If the latter, would not paying a COBRA premium kick you out and then qualify you for ACA? All assuming low to moderately low income?

        •  Keep in mind that you can only stay on COBRA (2+ / 0-)
          Recommended by:
          worldlotus, RiveroftheWest

          for a limited time.  It's eighteen months in most cases.  In a few cases it's three years.  (Unless it's different in different states?  Does anyone know if it differs by state?)  

        •  Re COBRA: (4+ / 0-)
          Recommended by:
          tb mare, RiveroftheWest, barbwires, jdld

          If I am understanding the above link, you can keep it or enroll in ACA.  

          Since the (ex) employer does not pay anything for COBRA (you foot the entire premium),  it is not considered employer insurance.   At least that is how I am reading/understanding it.

          My big concern was coordinating coverage before our COBRA runs out so that there was no gap in insurance..

          But it looks like we will be ok if we enroll before open enrollment ends.  I think our COBRA coverage is for 18 months & our 1 year mark is either in Feb or March 2014.

          Not sure if COBRA is a state or an employer thing.  All I know is that it has to be offered if an employee was on the company insurance & terminates employment.

          I won't know until they have all the plans & pricing options available, but it is thus far looking like we won't be saving any money if we choose a similar plan to what we currently have thru COBRA.

           If we had not had a major medical event, I probably wouldn't try to replace exactly what we have & we'd probably save some on premiums.

          But because of the medical fubar event the potential for future costly medical interventions are too great for us to consider a plan that pays less.  

          I had a real awakening in the past year about the horrific cost involved in just about every aspect of unexpected medical care.  I almost passed out seeing a recent MRI statement-for about 15K!!!!!

          Imagine having several of those suckers in the space of 6 months...on top of hospitalizations, surgeries, labs, CAT scans etc.  And managing to live well over 50 years without any issues other than little things a primary doc could tend to.  

          Jeebus, I am still in sticker shock but so very awakened.  If we had not had the insurance the employer provided, we'd be bankrupt (and probably dead).

          And since this happened, all I can think about is all those without insurance.  Haunted me in the hospital & as I recover.  

          I am so very glad to see your diary (& others) & hope that they will be replayed - with bullets about the 3 major things for everyone to remember-from now until March 31st.  And I hope everyone who reads these diaries sends them to everyone they know.

          Thank you.

          •  Thanks (1+ / 0-)
            Recommended by:

            On that statement you might have seen two rates, the one it would cost if you paid cash at the point of delivery, and the one your insurance company paid after pre-negotiating. Those numbers are typically widely divergent.  Say for example, $15k vs 7k.

            My crude understanding is one way the ACA saves huge bucks for taxpayers is by getting the preferred rate for services like an MRI on lower earning pax who otherwise would have no insurance and therefore cannot cover any of it, services which currently get charged full boat in some places to the tax base. Which exposes the hollow claims about deficits by the usual scolds; the more people who are signed up, and especially the more who are low income, the greater those kinds of savings will be. By impeding access to the most vulnerable residents, the same people who scold us about debt are directly piling on truckloads of debt to their states and communities.

    •  It's income for ACA (1+ / 0-)
      Recommended by:

      from the PPACA:
      Household income.--
                          ``(A) Household income.--The term `household income'
                      means, with respect to any taxpayer, an amount equal to
                      the sum of--
                                ``(i) the modified gross income of the
                            taxpayer, plus
                                ``(ii) the aggregate modified gross incomes of
                            all other individuals who--
                                          ``(I) were taken into account in
                                      determining the taxpayer's family size
                                      under paragraph (1), and
                                          ``(II) were required to file a
                                      return of tax imposed by section 1 for
       the taxable year.
                          ``(B) Modified gross income.--The term `modified
                      gross income' means gross income--

                                ``(i) decreased by the amount of any deduction
                            allowable under paragraph (1), (3), (4), or (10)
                            of section 62(a),
                                ``(ii) increased by the amount of interest
                            received or accrued during the taxable year which
                            is exempt from tax imposed by this chapter

      We are all in this together.

      by htowngenie on Mon Sep 02, 2013 at 12:25:16 AM PDT

      [ Parent ]

  •  Great in theory... (2+ / 0-)
    Recommended by:
    DarkSyde, worldlotus

    In the abstract, the system the ACA sets up could be seen as pretty close to the system they have in France.  That system is essentially the same, in practice, as single payer.  Insurance is provided through privately-owned companies, but they all stick so close to what is effectively one good, non-exploitative, insurance plan, that it might as well be single payer.  It's cheap and it's good insurance that doesn't screw the consumer.

    Maybe if we had instituted the ACA 50 years ago, we would now have something like the French system.  Health care insurance 50 years ago was a pretty tame, non-exploitative business.  It is easy to visualize the Blue Cross/Blue Shield of 50 years ago, or the Kaiser Permanente of 50 years ago, settling quietly into acceptance of a system that didn't allow them to ruthlessly exploit providers and patients, because they had no history of ever operating that way, no history of ever operating as anything other than in a tame, non-exploitative way.

    It is not at all clear, and seems to me quite unlikely, that the insurers of 2013 will settle into a tame, low profit margin business model.  For one thing, they have had 30 years to settle into the moral accommodations you have to make to exploit death and disease for profit.  More importantly, the great Managed Care Revolution let payers take over provider organizations, and vice versa.  It created the cartels that are the reason that we pay 3 times for crappy medical care what other countries pay for good quality.

    The exchanges will only bring down costs, or even hold them at sustainable levels, if these cartels are broken.  Nothing, at all, in the ACA is directed towards breaking cartels.  But if we don't do that, break the cartels, we leave control over prices in their hands.  They will not allow the ACA to turn them into low-profit margin, tame, operations.

    It's actually probably too late at this point for even Single Payer.  The big providers are so well organized, so aggregated into cartels, that they would have to be dissolved to allow even Single Payer to work.  The only thing that work for the US, at this point, would be a national health system.

    But we didn't do either a NHI or an NHS, because we have absolutely no will to destroy the cartels.  So sure, the ACA may bend that cost curve down for a bit, and might prevent the worst abuses of denial of care, for a time.  But the great Managed Care revolution did no less, reduced costs for a while, until the insurers and providers figured out how to get around it.  It just drove them into tighter cooperation, into their present cartels.  The ACA will have no more enduring beneficial effects than Managed Care.

    No reform will have any chance of working until and unless we destroy the cartel that the insurers and big providers now form.

    The states must be abolished.

    by gtomkins on Sun Sep 01, 2013 at 06:00:56 PM PDT

    •  Agree. In the early 80s, we happened to have (2+ / 0-)
      Recommended by:
      gtomkins, RiveroftheWest

      health insurance provided through a French owned company.  It covered everything imaginable with low deductibles, 90/10, 100% employer paid premiums.  

      Then the company was sold to a USA entity.

      Never again had comparable insurance....until a couple of years ago.  "Cadillac" insurance with the employer paying 1/2 of the premiums for 2.

       Ahem, total monthly premiums of over 1k a month.....

      •  Another way to compare prices (1+ / 0-)
        Recommended by:

        If I understand you correctly, what you're telling me is that your out of pocket is 1k/month, but you only pay 1/2, so your coverage actually costs you and your employer 2k/month, 24k/year.  From what I've heard and read, your out of pocket of 12k/year means you're doing a lot better than most of us, and even if you had to pay the whole 24k/year, there would still be plenty of us worse off than you.

        I suggested in my post that we should compare costs in the US to those in other countries where the health care you get for your money is at least as good as in the US.  Of course you can't compare costs directly from country to country without adjustment, because there are inherent differences, and many of those adjustments are imponderable.  If France and the US had differences of 10%, or even 30% in medical costs, maybe you could chalk that up to such imponderable differences in their overall economies.  But such costs are 200% greater in the US.  Nothing explains a difference of that size but monopoly pricing.

        Another cost comparison we could make, and not have to leave the US, is between your 1k/month to cover your medical needs (spottily, inconsistently) between now and age 65, and what you pay for Medicare, the single payer system that covers the medical expenses you will generate beyond 65 years of age, and is less spotty in its coverage.  Someone who earns 70k/year pays about 1k/year for Medicare, compared to that 12k/year you pay out of pocket for your pre-65 care.  

        And no, the reason for the disparity, the reason you pay >10 times more for your care up until you reach 65 than for your care as a 65+ year-old, is NOT that you generate more need for medical care before you reach age 65.  At one point, Americans were generating >50% of their lifetime medical expenses in the last 2 weeks of their lives, much less the last 20 years.  We have probably gotten a bit better at not doing too much to people who have clearly terminal conditions, but we still clearly generate most of our medical expenses past age 65.

        So, even a single payer system, Medicare, that has to pay providers often inflated prices for medical services, still manages to bring it in for < one tenth what the private industry charges for coverage of less need for medical care.

        The states must be abolished.

        by gtomkins on Mon Sep 02, 2013 at 07:39:56 AM PDT

        [ Parent ]

  •  Male, 30's currently in PCIP (7+ / 0-)

    Will go from $320 to $300 before subsidies. $120 after subsidies. I will save $200/mo. In my pocket. Obamacare is a BFD for a lot of people.

    A family member will be able to retire in the gap between 62 and 65 because of Obamacare. That is one more job for a young person who desperately needs it.

    I've been informing myself about Obamacare for a long time now, since I have skin in the game. Being in a position of understanding it at a basic level has allowed me to intelligently interface with and help people who are very, very confused right now. The right wingers are especially confused. I literally cannot wait until they are impacted by it and finally see what it is all about. There are going to be heads exploding.

    I've been pessimistic about our chances in 2014, but Obamacare could be our ace in the pocket.

  •  Thank you (4+ / 0-)
    Recommended by:
    DarkSyde, worldlotus, htowngenie, jdld

    Kaiser's subsidy tool that you mention really drives home how much I, at least, will benefit from ACA aka ObamaCare.

    Really appreciate this diary!

    •  Isn't (7+ / 0-)

      that surreal? Some will fall into bullshit gaps, others will be impeded by their state, but even at this early juncture, the savings for free lancers and those making low to medium low wages with no healthcare option, are more affordbale than i've ever seen in my adult life.

      The more of those folks who benefit as is, the more we can get signed up, the more grassroots inside lobbyists we will have working for our side, at every dinner table and water cooler around the nation, to leverage that success until everyone has healthcare.

      This has real potential, at every level, just on the cynical side, it's hard to imagine a cleaner, more decent political win than that produced by immediately, dramatically reducing needless suffering and even, in some cases, saving lives.

  •  50% penalty for smoking is crazy. (4+ / 0-)

    And there are no subsidies to help with the penalty.  That's going to price a LOT of lower income people out of the ACA.  Smoking and age are the only things you can be penalized for, it seems.  They don't ask if you use meth or weigh 300 pounds or are an alcoholic or get your kicks skydiving.

    I've been touting this law, but just learned about this nasty detail, which will make insurance unaffordable for thousands.  I thought this law was to put everyone in a pool and end discrimination.  I thought the point was to get as much participation as possible.

    •  Here's the story - (2+ / 0-)
      Recommended by:
      worldlotus, GayHillbilly

      Vermont and Massachusetts and D.C. have passed laws prohibiting insurance companies from penalizing smokers.  

      •  Not sure I trust a news report from KY (0+ / 0-)

        on the smoking issue.  It's such a loaded issue there and everyone has an angle - even the news stations and news papers.  

        ACA is a federal law - all insurance policies offered through ACA must meet the requirements of the federal law.  

        If Vermont, Massachusetts and DC have passed laws prohibiting insurance companies from penalizing smokers, it applies only to private insurance and group insurance offered in the state outside of the exchanges.  If you are a smoker, it may be worth looking at private insurance for this very reason.  Basically, the Federal govt (because of that requirement to promote the general welfare of it's citizenry) wants people to quit.  

        We are all in this together.

        by htowngenie on Mon Sep 02, 2013 at 12:48:01 AM PDT

        [ Parent ]

        •  There are plenty of other stories out there (1+ / 0-)
          Recommended by:

          on the smoking penalty.  Federal law allows a 50 percent penalty for smoking.  Period.  States can pass laws to prevent the penalty from being charged, but the default position of federal law is that it's permitted.  Just google it if you don't believe me or any Kentucky news source, but  WAVE is a perfectly good news organization.

    •  I'm (2+ / 0-)
      Recommended by:
      worldlotus, RiveroftheWest

      worried about that, too.

    •  It might make thousands QUIT smoking! (1+ / 0-)
      Recommended by:

      Joins GUS (Giving Up Smoking) here on DKos for helpful tips and friends to back you up as you try to quit.  

      We are all in this together.

      by htowngenie on Mon Sep 02, 2013 at 12:36:25 AM PDT

      [ Parent ]

      •  Not every one wants to stop smoking (0+ / 0-)

        My husband is a bastard when he stops and we could not stay married if he stopped smoking. He stopped for 2 years and I was ready to divorce him. He has no health problems (they always take his blood pressure 3 or 4 times because it's low) and hasn't seen a doctor in 15 years (no need). So why should we be penalized?

        Soldiers and veterans are the reason we are able to argue about issues and to live in a free country. Let's not let their blood be wasted. Remember all gave some and some gave all. Honor their sacrifices.

        by Somegaveall on Tue Sep 03, 2013 at 03:12:16 PM PDT

        [ Parent ]

    •  'Smoking and age are the only things you can be (0+ / 0-)

      penalized for, it seems.'

      "only" penalizes for age and smoking?? It should not have penalized for anything. The age penalty is huge and will keep insurance unaffordable for those no longer young and in the middle class, which ACA shamefully does nothing to help. The already struggling middle class can afford to continue to pay through the nose through health insurance, 20% or more of their income - no problem! according to Obama.

      "It depends what the meaning of 'is', is"
      Platform of the Neo-Democratic Party
      Speaking out of one side of their mouth for the little guy, their nominal constituency, and the other for the plutocracy, their real constituency.

      by Sanctimonious on Mon Sep 02, 2013 at 08:00:50 AM PDT

      [ Parent ]

      •  If (1+ / 0-)
        Recommended by:

        you look at quotes in the private market now, they are way, way more expensive and they do have the usual games played with riders and other crap, there is a massive age differential and they don't cover preexisting conditions which is an incalculable cost for and back door way to charge more for age. Policies covering what the AC will cover are hard to find at any price. Such lavish plans are almost exclusively the purview of senior exec comp packages.

        The key parameter in affordable health insurance is the affordability part. We don't suffer from a lack of health insurance in this country, we suffer because so many are priced out of what is available and because preexisting conditions and lifetime caps are/were all the rage.

        So income has to be a big factor, it has to be the defining factor. It doesn't matter if a policy is great if it costs $3000/month. Few can afford that. OTOH $50/month is so affordable that millions can do it. I believe it is therefore self evident, to the point that denying it would be irrational, to say that what we're about to get is a vast improvement for millions of people in terms of what they now have and what it now covers.

      •  That's because this whole thing is (0+ / 0-)

        neither affordable nor caring.

        There is some talk that the PTB's know this will fail and then they will be able to put in the single payer they wanted in the first place. In the meantime we're the ones that suffer.


        Soldiers and veterans are the reason we are able to argue about issues and to live in a free country. Let's not let their blood be wasted. Remember all gave some and some gave all. Honor their sacrifices.

        by Somegaveall on Tue Sep 03, 2013 at 03:09:49 PM PDT

        [ Parent ]

  •  We can still kill the bill! (6+ / 0-)

    There are a couple hundred Representatives in the House ready to help us if we just forget party and reach across the aisle. In so great a cause, one cannot be choosy about where your allies come from.

    And then, in another twenty years -- that's how long it's been since  the Clinton health care was killed before it was even brought to the floor-- we can have real health care reform.

    There will, of course, be some level of unnecessary sickness, and avoidable pain and suffering, and perhaps even preventable deaths in the meantime.

    But if we explain to these people carefully what's at stake, and how terrible the ACA is, I'm sure they'll understand that their sacrifice is absolutely essential to having a better system a couple of decades down the road.

    Perhaps we could have some sort of memorial for them -- on the National Mall, something tasteful, not too big or showy, like the WWII memorial.

    Or a commemorative postage stamp, if there's still a USPS when we finally get our NHS/USA.

    But either way, we will remember them when the great day comes -- and that will cushion the blow.

    "Politics is not the art of the possible.
    It consists in choosing between the disastrous and the unpalatable" J.K. Galbraith

    by Davis X Machina on Sun Sep 01, 2013 at 09:07:10 PM PDT

  •  DarkSyde, (2+ / 0-)
    Recommended by:
    DarkSyde, RiveroftheWest

    Please include a definition of regular Medicaid vs. Expanded Medicaid in your future diary.  It's obvious from this thread that people don't know they are two different things.  

    We are all in this together.

    by htowngenie on Mon Sep 02, 2013 at 12:03:45 AM PDT

  •  Hmm... (2+ / 0-)
    Recommended by:
    DarkSyde, RiveroftheWest

    Of course, a person who makes $12k/yr is likely not going to be able to cover a thousand-dollar deductible, so how are they going to even get to the part where they enjoy the benefit of being insured? For many people, $1000 may as well be $200,000, because "out of reach" is an absolute term.

    •  If (3+ / 0-)
      Recommended by:
      manyamile, RiveroftheWest, jdld

      they suffer a serious injury or illness, if they need a lot of treatment, then they'll owe a thousand bucks and have to work out a payment plan or take a credit hit, instead of owing say 60k or more for the rest of their lives and being turned away for followup & preventative care as well as a home loan or car note due to horrendous credit and possible bankruptcy. Which one of those categories would you rather be in?

      •  You're assuming (1+ / 0-)
        Recommended by:

        that everybody has credit to "take a hit" on, or will be eligible for working out payment details.

        I've worked with a lot of people who had fallen through the cracks of our healthcare system. These have not been solutions for them in the past - you have to actually have some money in order for anybody to let you owe them money, isn't that ironic? (Not to mention "bankruptcy." That's a middle-class option.) Now, there may be other facets to this thing that will help the truly poor - all I noted was that I haven't seen them yet. I am still hoping that it is an even better improvement than I realize.

        •  Well (2+ / 0-)
          Recommended by:
          manyamile, RiveroftheWest

          which group you rather be in? The one who owes a grand and gets follow up care, or the one who owes 200k and gets turned away for future check ups and preventative care because they have no insurance? Or maybe can't get treated at all?

          The idea that a grand and 200k are equally out of reach for low income earners is puzzling to say the least. I'll make about 18k this year, and I know I can work out payment on a couple grand or more out of pocket costs because I had a heart attack at the end of last year and did exactly that. But 200k would have been utterly out of reach for me and providers would have known it was out of my reach.

          •  I'm not talking about (0+ / 0-)

            people who make $18k/yr and are reading the Daily Kos.

            It's amazing, how many assumptions people make about possible solutions... then you talk to the ones who are actually there and realize that their world is an entirely different place than the one in which those solutions were devised. Look up the causes behind what social scientists call the "cycle of poverty." The fact that you can only ever deal and plan with the cash you have in your hand is a huge part of what keeps the lowest class from improving their lot - the rest of us don't even realize that we count on some form of credit, at some point. We take it for granted.

            And maybe there is a legal requirement that doctors have to work out payments for the deductible. If so, then there also needs to be a public service/education push - because a lot of people simply won't seek medical treatment when they are sick because they have already learned that nobody is going to "work with them" for the cost.

        •  People in those circumstances are supposed to get (1+ / 0-)
          Recommended by:

          Expanded Medicaid. You may blame SCOTUS for making it possible for Red State legislatures and governors to refuse Medicaid Expansion. But we will get there someday. And eventually to Single Payer.

          Ceterem censeo, gerrymandra delenda est

          by Mokurai on Mon Sep 02, 2013 at 04:44:16 PM PDT

          [ Parent ]

  •  Question, oh informed one ... (2+ / 0-)
    Recommended by:
    DarkSyde, RiveroftheWest

    I've been self employed since '91. Never been individually covered in all that time. Though my kids are now grown, back in the day I traded chickens (well, IT services) for medical/dental/chiro care. Though there were stretches of crazy hardship, everyone got what they needed, and the burden was never too great.

    Now that I'm (finally!) happily successful, the subsidy calculator tells me I'm 856% above poverty level, and that my premium will be 7.82% of household income: $7690 per year, just to cover myself (58, non-smoker).

    Does the ACA obligate me to pay this amount?


    Calling atheism a religion is like calling not collecting stamps a hobby.

    by DavidHeart on Mon Sep 02, 2013 at 09:43:56 AM PDT

    •  I (2+ / 0-)
      Recommended by:
      DavidHeart, RiveroftheWest

      dunno how the obligation or penalty works yet.

      But compare $7690 a year and 856% of poverty to what we have now; I make barely over poverty, if I were terminated and had to go on COBRA it would be about $700/month on me or go naked, more than the premium you mentioned, and it would consume over half any unemployment I would get. A private policy out there as of now would cost even more and would not cover preexisting conditions. Even if I got a massive five-fold raise to 856% of poverty, and had to pay $7690, I would still be better off than on COBRA and way, way better off than on a currently existing private policy.

    •  trading doesn't do it (1+ / 0-)
      Recommended by:

      for one thing, in my rural area, the closest doc will see you, do nothing, then refer you to a specialist in the you would have to make a trade with the doc, the specialist, the lab, etc. etc.

      for another, for self employed the BIG  difference will be , which line of your tax return is your income for these purposes.
      i am a schedule C self employed person.. the past few years even my gross income get me close to poverty line, but my taxable income is horribly lower than that.

      right now i am similar age, nonsmoker and have the cheapest policy i can find,  but it covers nothng really and has a $10,000 deductible.
      it will sure be interesting to see how it all pans out.
       also  in my state ,for the last few years , single adults have been blocked from state med assistance so there has been no safety net whatsoever.
      the only thing my GOP has done right is not oppose  the health care act and she went ahead and agreed to restore medicaid to adults without children.

  •  I went to (1+ / 0-)
    Recommended by:

    entered my state (Indiana), and since we have a republican guv who hasn't set up exchanges, I will use as my exchange.  Easy to set up an account (I used a new yahoo email addy that will only be used at the exchange website).

    "Detective, if ignorance was a drug, you'd be high all the time." Sam Tyler, 'Life on Mars'

    by Kokomo for Obama on Mon Sep 02, 2013 at 10:57:10 AM PDT

  •  error in this paagraph (2+ / 0-)
    Recommended by:
    DarkSyde, RiveroftheWest

    you wrote

    "Here's one way to save money right off the bat. Play around with numbers in the subsidy calculator and you'll soon notice, if that 51 year old smokes, their out-of-pocket portion rises to $3,054 (about $251/yr), which equals 25.45 percent of household income ...."

    I think you meant to say $251 per MONTH (you later allude to this, but at first it is confusing)

  •  income for self employed (1+ / 0-)
    Recommended by:

    looks like you use  a 'modified adjusted gross income, MAGI which starts with the adjusted gross income then makes a few adjustments to the AGI
    adjusted gross income is
    Line 4 on form 1040EZ
    Line 21 on Form 1040A
    Line 37 on Form 1040

     then you need to refer to the FAQ on the kaiser site or fed site, etc to see if your MAGI is different than your AGI. mine wasn't.

  •  We will not be signing up (0+ / 0-)

    My husband smokes. If he doesn't smoke he's a bastard to live with. He has NO health problems (low blood pressure, etc) yet we will be forced to spend MONEY we do not have on health care we will not use. We do not go to doctors. Instead we use acupuncture and other treatments not covered in this healthcare system.  We will simply pay the penalty as it's cheaper. Those of us who do not use medical doctors should be able to opt out and choose a health savings plan instead.

    Soldiers and veterans are the reason we are able to argue about issues and to live in a free country. Let's not let their blood be wasted. Remember all gave some and some gave all. Honor their sacrifices.

    by Somegaveall on Tue Sep 03, 2013 at 03:03:00 PM PDT

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