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US News (AEI analysts):

There has been considerable controversy in recent months about whether the Affordable Care Act is causing employers to shift towards a part-time workforce. For example, in a recent television interview on NBC's "Meet the Press," television journalist Maria Bartiromo suggested that as a result of Obamacare, we are becoming "something of a part-time employment country." In addition, a recent article in Forbes points to anecdotal evidence that a number of employers, including restaurants and universities, have been replacing full-time workers with part-time ones. This shift towards part-time work is occurring, they argue, because the ACA requires large employers to offer health insurance to full-time workers (defined as those who put in 30 hours a week or more) starting in 2015.

But this anecdotal evidence isn't borne out in the data for the labor force as a whole. In fact, there's very little evidence to suggest that ACA has led to an increase in part-time work thus far. However, research on a state-level employer insurance mandate suggests that it could well have such an effect in the future.

There's been some controversy about a new study from OR on Medicaid (Harold Pollack).  Small as it was, expanding medicaid in 2008 led to increased ER usage.  However, that was then and this is now.  Sarah Kliff explains:
Officials out in Oregon don't dispute the results -- but they do argue that the study doesn't offer a great picture of what's happening out there right now. The Science study looks at a 2008 expansion. A lot has changed in the past five years. In fact, over the past two years, Oregon has actually seen a decline in Medicaid emergency department visits this past year -- and attributes that to big changes the state has made to how it delivers care to Medicaid patients.
With ACA, it's complicated, there are costs and benefits, winners and losers... but you've heard me say that before.

More on the OR Medicaid study from Austin Frakt and from Adrianna McIntyre.

Brookings:

David Wessel, senior fellow and director of the new Hutchins Center on Fiscal and Monetary Policy at Brookings, told Fox News that the middle class not doing better is one of the most surprising things he's learned from covering the economy for 25 years at the Wall Street Journal.
We didn't expect the gap between winners and losers in the economy to widen as much as it has. ... For a variety of reasons The growth that we have had has gone disproportionally to the people at the top, and the people in the middle have not had much of it.
Asked whether this challenges the "theory of trickle down economics," Wessel replied "Yes, it certainly does. It's not trickling down ... almost every measure of inequality has widened since about the end of the 1970s."
Brian Beutler:
On the contrary, if there’s one story I wish I’d been on hand to watch unfold in real time, it’s the “Duck Dynasty” debate. If you write about politics for a living, and you were bored by the “Duck Dynasty” story, or wrote it off like you might write off a gaffe or some other creation of the outrage industry, you’re in the wrong line of work. Phil Robertson’s comments about gay and black people and social welfare — and the way they pierced public consciousness — explain more about our country’s political culture than almost anything else that happened all year.
and Brian Beutler:
After spending three months effusing sympathy for people who’ve had their insurance plans canceled, Republicans can’t really continue to support repeal while ignoring the (2 million? 6 million? 9 million?) who would lose their coverage as a result. But the GOP lacks a consensus replacement for Obamacare, and the plans that caucuses within the party do support don’t do anything for the new beneficiaries, and fall well short of Obamacare’s coverage expansion in the long run.

They’ve walked into a cul-de-sac planting mines behind themselves along the way.

Josh Marshall gets the same twitter feeds I get:
Now, as I said up at the top, there are a lot of Obamacare dead-enders out there who just blow a gasket when they make first contact with these numbers. The first claim is that Medicaid expansion somehow doesn't count. Or it doesn't count if a 24 year old is now covered under their parents policy because well that happened a while ago or well, something.

The best dead-ender argument is that well, maybe these people who've signed up for subsidized private insurance policies won't end up paying their premiums. When the arguments get down to this level you know you're dealing with a deep and intense form of denial. I mean, what if all these people change their mind next month and decide they don't want the coverage after all? What if Obamacare is so bad they all die in the Spring? What if Spartacus had an airplane? If you really, really are hoping for bad news you can come up with anything to keep hope, as it were, alive.

And then finally, these numbers are just more administration lies.

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Comment Preferences

  •  infidels are deserving of your enmity, not your em (6+ / 0-)

    is what I call this post in which  I examine this column by Charles M. Blow containing those words

    "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

    by teacherken on Sat Jan 04, 2014 at 04:32:29 AM PST

    •  deserving of your enmity not your empathy (5+ / 0-)

      sorry, not awake yet

      "We didn't set out to save the world; we set out to wonder how other people are doing and to reflect on how our actions affect other people's hearts." - Pema Chodron

      by teacherken on Sat Jan 04, 2014 at 04:33:09 AM PST

      [ Parent ]

      •  ER Visits and Obamacare aka ACA...the TRUTH (5+ / 0-)

        1.  Until new recipients of Medicaid realize that they can see a GP and/or NP (nurse practitioner for those of you not in the health field), they will fall back onto the ER for routine visits that could be handled in a routine outpatient setting.

        2.  Many if not most ER's have associated walk-in clinics, and after triage, many folks who come to the ER are sent there.  It is unclear from the Oregon study if this was done.  

        3.  People on Medicaid have legitimate reasons to use the ER.

        4.  The greater use of Nurse Practitioners for primary care delivery is both patient-centric and cost effective.  NP's are highly skilled in the delivery of primary care, have excellent training, and can be trained and put into practice faster and at a lower cost than physicians.  We should be expanding the use of NP's across the country.

        5.  We should expand the number of publicly funded urgent care centers, which are NOT ER's, for 24 hour non-emergent health care delivery.

        •  It would help the population used to using the ER (1+ / 0-)
          Recommended by:
          Tackle

          for their medical care if the hospital to which the ER is attached would help the patients learn about and enroll in Medicaid - actually assign workers to handle this task.  Doing so would be a huge help to the patients and also help the hospital actually get paid for the care they render through the ER.

          "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

          by SueDe on Sat Jan 04, 2014 at 08:39:31 AM PST

          [ Parent ]

  •  Hardball last night...some GOP apologist said that (12+ / 0-)

    republicans DO have alternatives to the ACA but the media is covering them.......whereupon I switched to Duck Dynasty....;-)

    •  the media is NOT covering them. (6+ / 0-)
      •  The GOP "plan" is as hard to find (12+ / 0-)

        and unicorns and leprechauns...

        Filibuster reform, 2013 - woulda, coulda, shoulda.

        by bear83 on Sat Jan 04, 2014 at 05:32:20 AM PST

        [ Parent ]

      •  The media has covered the Republican (13+ / 0-)

        health insurance plan for years - since the days of their working against Hillarycare.  It's the same plan it's always been, except the first step now is the complete repeal of Obamacare:
        *  Allows individuals to buy insurance plans across state lines
        *  Tort reform
        *  Allows individuals to deduct health care costs from income taxes
        *  Allows individuals to put more money into Health Savings Accounts
        *  "Bolsters" state high-risk pools for those with pre-existing conditions
        *  Forbids federal funding of abortions.

        How many stories can the media air when the Republican "plan" hasn't changed in thirty years?

        "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

        by SueDe on Sat Jan 04, 2014 at 05:39:48 AM PST

        [ Parent ]

        •  So true! (8+ / 0-)

          Maybe we're more attuned to it because we live in red states?
          John McCain was big on the health savings account which is great when you have a job where you make enough money to put some money away every month.

          Your beliefs don't make you a better person. Your behavior does.

          by skohayes on Sat Jan 04, 2014 at 05:45:36 AM PST

          [ Parent ]

          •  and get cheated ... (2+ / 0-)
            Recommended by:
            SueDe, skohayes

            We had one of those HCAs that mysteriously billed us for a charge that neither the medical center nor we found to be correct. We were out of town when the supposed 'charge' occurred, saw no medical professionals and then medical center combed their records and found none. They sent a letter to that effect to the HMA people, who still demanded $264.00 from us or they would go to collection. We paid. Not only that, they made us xerox and mail to Georgia from California, copies of all our medical bills... Scam city.

            As for using the ER. If the people are insured, the ER people are getting PAID, so they don't have to raise rates on the rest of us to cover their unpaid costs. But no mention of this in the study ...

        •  First step: repeal Obamacare. Final step... (12+ / 0-)

          repeal  Medicare and Medicaid.

          There's no such thing as a free market!

          by Albanius on Sat Jan 04, 2014 at 06:34:00 AM PST

          [ Parent ]

        •  I'm all for Obama care even though... (0+ / 0-)

          I expect my insurance premiums to increase substantially (I'll know for sure next month). However, some of the things you list are attractive to me, i.e., numbers 1, 3, 4, & 5.

          As with every issue I see good and bad ideas from each side of the political divide. It's too bad we can't take the best of both.

          I'm not paranoid or anything. Everyone just thinks I am.

          by Jim Riggs on Sat Jan 04, 2014 at 07:44:45 AM PST

          [ Parent ]

          •  Buy insurance across state lines....... (4+ / 0-)

            so that you can buy worthless insurance policies issued in Alabama and Mississippi?  

            Really?

            That is going to help ANYONE?

            And while SOME aspects of tort reform may be needed, don't kid yourself:

                   a.  It isn't going to lower the cost of health care delivery by any meaningful amount.
                   b.  It is only reasonable IF it is coupled with REAL sanctions against the bad apples practicing medicine (and having served on a medical review board in a progressive state, believe me, there are a significant number of HORRIBLE doctors out there who need retraining and/or prohibitions against practicing medicine).

            •  I live in MD and my doctor, (0+ / 0-)

              who I have had for over 20 years, is in Pennsylvania. I also own a company in PA and have offered health insurance, which I also am on, to all employees since I started it 17 years ago. If I wanted to see a doctor in MD they wouldn't be in the network. It's an Aetna PPO with $40 co-pays, which the employees chose. It wouldn't have been my choice. There are other reasons to support health insurance across state lines besides buying cheap policies.

              Totally agree on tort reform. Btw, it's #2. I said 1, 3, 4, 5.

              I'm not paranoid or anything. Everyone just thinks I am.

              by Jim Riggs on Sat Jan 04, 2014 at 08:59:23 AM PST

              [ Parent ]

              •  That speaks to an altogether different issue (3+ / 0-)
                Recommended by:
                Aquarius40, TheMeansAreTheEnd, Tackle

                has NOTHING to do with the idea of buying insurance across state lines in the way the GOP has proposed.  

                We have similar issues here where I live because of the fact that so many people live on the CT side of the line and work in the NY side of the line.  Your insurance should cover you regardless of whether you are being treated in the state you live in or the state you bought your insurance in otherwise nobody would be able to leave the state lest they get sick.  That's just stupid.  You're talking more specifically about in network and out of network issues.  I'm not even sure how allowing insurance companies to sell across state lines would improve this since it would hand insurance companies more power to dictate who is in network and who isn't.  It would exacerbate the problems not make them better.

                Again, I'll reiterate what I said before, these issues with in network and so on would ALL be eliminated if we had a basic single payer heath care system that was funded by our taxes the same way other countries have.  Why anyone would support a system that would essentially keep the same shit we have only on steroids when the alternative would end all these issues is beyond me.  

                This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

                by DisNoir36 on Sat Jan 04, 2014 at 09:09:31 AM PST

                [ Parent ]

                •  I think single-payer might be a good thing. (0+ / 0-)

                  But I'd have to see what my premiums would be.

                  I'm not paranoid or anything. Everyone just thinks I am.

                  by Jim Riggs on Sat Jan 04, 2014 at 10:01:00 AM PST

                  [ Parent ]

                  •  You wouldn't have premiums (2+ / 0-)
                    Recommended by:
                    Tackle, Jim Riggs

                    That's the point.  A single payer government run program would be funded by our taxes.  

                    Since there is no profit motive or shareholders to satisfy the costs would be significantly less.  Private insurers are being dragged tooth and nail to use 80% of the premiums they collect on paying for healthcare.  That means for every dollar they get from you in premiums, they're using only 80 cents to actually pay for your healthcare.  The other 20 cents are being used to pay shareholders dividends, to pay their executives lucrative payouts and so on.  That's a new requirement under the ACA.  Prior to the ACA private insurers were using as little as 60% of your premiums to actually pay for your insurance.  That's why they used every means legally possible to avoid paying providers.  The less they paid out the more they were able to keep in their pockets.

                    A Medicare type system only has a 3% - 5% overhead.  That means out of every dollar you pay into the system via taxes 95 to 97 cents go to pay for your healthcare.

                    Do the math.  If you visit the ER and have a $2,000 medical bill, that means you will have to pay $2,100 in taxes to pay for that bill and overhead.  With a private insurer you'd have to pay $2,400 in premiums for the same service because the extra $300 goes to shareholders and exec pay.  This is a very simplistic example and omits out alot in the equation but it should give you a basic idea how it works.  

                    Other factors like the fact that the govt would have tremendous negotiating leverage over providers to reduce costs and they could implement policies which would reduce other costs and you can begin to understand how a Medicare type system will be far cheaper than the system we have today.  Not to mention the fact that We the People have the ultimate power in choosing who runs our healthcare as oppose to allowing private insurers to make the decisions.  After all we are the govt.  

                    I guess what I'm saying is that your 'premiums' or rather what you're paying for healthcare would be far less under a Medicare for All type system than what they are now.    

                    This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

                    by DisNoir36 on Sat Jan 04, 2014 at 10:24:14 AM PST

                    [ Parent ]

                    •  Sounds good but I don't believe it. (0+ / 0-)

                      I was under the impression that my costs under the ACA wouldn't go up significantly but I was wrong. And I have very good coverage, which used to cost around $7,000/yr.

                      I bought into Obamacare completely and it may yet prove to be a good thing. But I'll be a much tougher sell the next time politicians come pushing the next great health care plan.

                      I'm not paranoid or anything. Everyone just thinks I am.

                      by Jim Riggs on Sat Jan 04, 2014 at 01:41:24 PM PST

                      [ Parent ]

                      •  Well sorry Jim (0+ / 0-)

                        I don't know your particular circumstance but it's hard to argue with the results from a system that is in place in just about every other industrialized nation and costs significantly less than the system we have.  I don't like the ACA for many reasons but it IS better than the bullshit system we had, even if just a bit better.  At the very least we are heading in the right direction and with some tinkering hopefully we will improve upon it until it gets significantly better.  What we cannot do is go back and the GOP with their crap ideas represent a step back.  They're the ones who fucked up our healthcare system in the first place.  Their Medicare D has cost us trillions in additional and unnecessary spending.  Medicare Advantage is a big we kiss to private insurers and is another huge source of extra and unnecessary costs.  The ACA was their idea in the first place, which is why it sucks big hairy elephant balls.  But if we use that as a starting point we can end up with something resembling the liberal idea.  

                        This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

                        by DisNoir36 on Sun Jan 05, 2014 at 01:09:37 PM PST

                        [ Parent ]

          •  Only problem is (2+ / 0-)
            Recommended by:
            Aquarius40, TopCat

            #1, #3, #4 and #5 do nothing to help insure more people and they're all fucked up ideas.  

            Infact #1 would only lead to a patchwork of state laws governing health insurance and 50 insurance commissioners who would enforce/not enforce them.  That would inevitably lead to a race to the bottom exactly like the credit card companies where insurance companies would race to states with the least onerous laws and more easily corruptible insurance commissioners.  The end result would be insurance companies would be free to do what they wanted to when they wanted to.  Pre-existing conditions would return with gusto, caps and rescission would be the name of the game.  The same way credit card companies can now charge any interest rate they want despite certain state usury laws prohibiting them form charging say above 15%, insurance companies would be unburdened of any state law they didn't agree with.  They'd get around it by simply relocating to a state with minimal or no laws, a weak commissioner with no desire or power to enforce the laws or worse a corrupted commissioner and they would sell insurance across state lines with the laws of the state they relocated in being the ones they would have to follow.

            Anyone who says they support insurance companies across state lines is woefully ignorant of what that actually means and is only repeating a great sounding talking point or they are a shill for the insurance companies and stand to benefit from this proposal.  PLAIN AND SIMPLE.  

            #3 and #4 are simply giveaways to the rich who can both afford high cost plans and be able to put more money away into HSA's and would thus benefit more from being able to deduct them from their taxes.  The HSA is nothing more than a tax shelter the same way the IRA's have become.  It's nice for the average person but even better for someone like Romney who has millions tucked away in them sheltered nicely from taxes.  We would need neither of these if we simply had a basic single payer heath care system that was funded by our taxes the same way other countries have.

            #5 is basically admitting that you want pre-existing conditions to return.  Under Obamacare they no longer exist.  I don't even know why anyone would support this. It's basically admitting you want to go back to the old system prior to Obamacare.

            This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

            by DisNoir36 on Sat Jan 04, 2014 at 08:01:45 AM PST

            [ Parent ]

            •  As I said, I'm all for Obama care. (0+ / 0-)

              I believe all of these things could have been addressed and melded into the ACA if the Republicans hadn't been such dickheads.

              There must be millions of people in this country who live in one state and work and/or have healthcare in another.

              If HSAs are "nice for the average person" why couldn't the law have been designed with them in mind? Other than the dickhead thing. IMO if Democrats keep saying that everyone who thinks they pay too much in taxes is evil it's going to bite them in the ass one day.

              Obamacare is better than what we had but it could have been much better for everyone.

              I'm not paranoid or anything. Everyone just thinks I am.

              by Jim Riggs on Sat Jan 04, 2014 at 09:16:57 AM PST

              [ Parent ]

              •  HSA's are pointless (0+ / 0-)

                if there is a basic single payer heath care system that was funded by our taxes the same way other countries have.  What would you use HSA's for?  Extra care?  It would simply be a vehicle for the rich to shelter money under the guise that they need it for care not provided and paid for by the system in place.  

                Obamacare would have been better if we got rid of insurance companies altogether and just had Medicare for all.  All the issues you raise would at that point have been moot.    

                As for the people working in one state and live in another, selling insurance across state lines does nothing to help people in those situations, even if there is a problem.  As I said elsewhere, giving insurance companies the power to choose which state they want to do business out of and then sell insurance outside of that state will only exacerbate our problems with the system not improve it.  Free of burdensome regulations they would probably even be free to charge more of people who work in one state and live in another.  I don't understand how allowing insurance companies to sell across state lines will help and supporter of this proposal have never given any reasonable explanation how it will.

                This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

                by DisNoir36 on Sat Jan 04, 2014 at 10:09:33 AM PST

                [ Parent ]

    •  OH yeah. (7+ / 0-)

      They covered it a lot (I read your correction, no fear, I am leading up to a joke, hang on)...

      Alan Grayson:

      GOP Health Plan.

      1. Don't get sick.

      2. If you do get sick, die quickly.

      Yep. Covered A LOT.

      :)

      Ugh. --UB.

      "Daddy, every time a bell rings, a Randian Libertaria­n picks up his Pan Am tickets for the Libertaria­n Paradise of West Dakota!"

      by unclebucky on Sat Jan 04, 2014 at 06:04:43 AM PST

      [ Parent ]

    •  The GOP Plan: stay well or die, loser (6+ / 0-)

      Happy just to be alive

      by exlrrp on Sat Jan 04, 2014 at 06:13:43 AM PST

      [ Parent ]

  •  Thanks for this morning's APR, Greg! (19+ / 0-)

    ACA implementation has proceeded quite smoothly in states that created their own exchanges, hasn't it?  And as for companies switching full- time jobs to part- time to avoid paying for health care insurance, we heard that before ACA was implemented. That's one of the reasons ACA was passed.

    "Religion is what keeps the poor from murdering the rich."--Napoleon

    by Diana in NoVa on Sat Jan 04, 2014 at 04:43:38 AM PST

    •  and again, (10+ / 0-)

      employers getting out of the health insurance game is NOTHING but good.  

      Please don't dominate the rap, Jack, if you got nothin' new to say - Grateful Dead

      by Cedwyn on Sat Jan 04, 2014 at 05:00:33 AM PST

      [ Parent ]

      •  Cedwyn (4+ / 0-)

        It is not good if employees think that ACA is the reason they are losing employee sponsored health care. Remember, this was not supposed to interfere with the 85% who receive coverage from work.

        I know a lot of us think that employees getting dumped onto the exchanges will lead to single payer, but it could just as easily lead to more unjustified hatred of ACA.

        Being forced to buy Obamacare is not the same as liking it.

        •  Who cares what they think now (2+ / 0-)
          Recommended by:
          Aquarius40, Cedwyn

          if the end result is that they will have more freedom to move from job to job being unburdened by the fact that they may lose those benefits.  Sooner or later they will realize how much better off they are as a result of the ACA.  

          We really have to stop fearing what some people who watch FOX might think and just do what is right regardless of what they may think.

          This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

          by DisNoir36 on Sat Jan 04, 2014 at 08:05:04 AM PST

          [ Parent ]

          •  Come on!! (0+ / 0-)

            If you really think its just Fox viewers, you should leave DKos for a few minutes and check out other progressive sites. This is a real issue. It has nothing to do with fear. It has to do with not losing the Senate and not having the power fix the flaws in ACA. And it is flawed.

            •  Nothing to do with fear (1+ / 0-)
              Recommended by:
              Aquarius40

              EVERYTHING to do with ignorance which is being fueled by FOX and other right wing leaning groups.  Even progressives are prone to buying the RW BS if they hear it enough and never bother to debunk it.  

              We're not gonna lose the Senate unless we allow it to happen.  This loser chicken little mentality that we have to worry what others may think isn't gonna help up keep the Senate.  

              This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

              by DisNoir36 on Sat Jan 04, 2014 at 09:12:26 AM PST

              [ Parent ]

    •  CT has already hit their march 31 target (6+ / 0-)
      Recommended by:
      DRo, skohayes, annieli, eyo, gchaucer2, rl en france

      which isn't a target (just an estimate by CBO).

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Jan 04, 2014 at 05:22:15 AM PST

      [ Parent ]

      •  A question... (2+ / 0-)
        Recommended by:
        LI Mike, rl en france

        Do you know how the law applies to to emergency medical centers that have sprung up? I took my mom to one once and another time I went (for minor problem). In both cases we were covered by medicare for the total cost.  I have since switched to an advantage plan, so I don't know what would happen now.  I was wondering about the new laws as I was pleased with my interactions. If it's a holiday or long weekend it's nice to not have to wait it out to get a Rx and stop a problem from getting worse.

        Be the change you want to see in the world. -Gandhi

        by DRo on Sat Jan 04, 2014 at 05:47:28 AM PST

        [ Parent ]

      •  To be fair (0+ / 0-)

        our goal in CT was pretty low.  That's because CT started their effort to insure more people earlier.  We have a great program for children and pregnant/new mothers called Husky and CT had a state run insurance plan which was based on income for people like me who could not otherwise get insurance because of pre-existing conditions.  It was called Charter Oak.  As a result CT had a lower percentage of uninsured people than other states in the country before the ACA rollout.

        This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

        by DisNoir36 on Sat Jan 04, 2014 at 08:09:59 AM PST

        [ Parent ]

    •  Some states are smooth.. (5+ / 0-)

      some states have performed terribly - i.e. Minnesota & Oregon specifically.. and I believe Hawaii and Maryland have had pretty rough rollouts as well.  California also had problems initially.

      There's only about 15 states that did their own exchange so far.

      As far as part-time employment being attributed to ACA, we'll know more as the deadline for employer mandate gets closer, I think.

      At my own company, we have a part-time college intern who makes his own hours.  He has been told under no circumstances can he work more than 25 hours because of benefit mandates.

      •  Many minimum wage employers (5+ / 0-)

        keep a majority of their workers part time so as not to have to pay benefits, or give days off.

        Your beliefs don't make you a better person. Your behavior does.

        by skohayes on Sat Jan 04, 2014 at 05:54:50 AM PST

        [ Parent ]

      •  that's been true forever (9+ / 0-)

        preACA. bennies are expensive, and employers have always, always done this.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Jan 04, 2014 at 06:14:25 AM PST

        [ Parent ]

      •  At least heads rolled in Oregon (5+ / 0-)

        The Cover Oregon  website was worse than the national one---AFAIK its still not working.
        But they've been using good old paper and pen forms to do it, sending state workers all over the state to register people. I think about 140K people have registered now.
        But unlike the federal website, the two heads of this mess "retired for medical reasons." You know, the "wanted to spend more time with the family" thing. But  AFAIK no one's been held responsible for the federal mess---no one ever is.

        Happy just to be alive

        by exlrrp on Sat Jan 04, 2014 at 06:20:20 AM PST

        [ Parent ]

        •  Merely anecdotal, but a lot of us here in OR sent (0+ / 0-)

          in the initial paperwork/application before the deadline to get coverage in January and we're still waiting to hear back from the State which specific plans we can choose from the exchanges.  That should have been all chosen, enrolled and in place by now.  

          We have all received some sort of notification that our paperwork has been received; that it is being processed; you have been accepted...but no specifics.  Please wait.  It's coming.  

          Meanwhile, in my own situation, the state program we used to be part of, FHIAP, subsidized 90% of my husband's employer-provided insurance. It stopped January 1 because Cover Oregon was supposed to take its place.  It hasn't yet.  So we are seeing mr. koosah bring home big old whopping paychecks for $36.00 after the insurance is paid for, with no reimbursement now.  We used to get a reimbursement check for about $400.00 from the FHIAP subsidy program.

          Because insurance is paid a month ahead, this started in December.  We haven't had reimbursement for the employer insurance since November, but we also hadn't heard whether we were going to get anything from Cover Oregon either.  If we knew which program/plan we were in, we could have told mr. koosah's employer to adjust his payroll deductions and stop buying the expensive crap for koosah kid and me.  But we have to have insurance...just in case.  

          Just this week we received a letter AT LAST informing us that koosah kid and I would most likely be in the new OHP (expanded medicaid) program.  Still no details.  Still no cards.  Still nothing for sure.  And nothing on mr. koosah's future.  

          So we're continuing to pay out-of-pocket for the expensive crappy employer insurance...and hope our creditors will be understanding when we tell them we can't pay our bills with $36.00 of take-home pay.    

               

          "In matters of style, swim with the current; in matters of principle stand like a rock." Attributed to T. Jefferson

          by koosah on Sat Jan 04, 2014 at 08:11:01 AM PST

          [ Parent ]

    •  I think Oregon has had problems. (1+ / 0-)
      Recommended by:
      koosah

      But given that state's commitment to quality, affordable medical care, I'm certain they'll work it out.

  •  I remember when Gillespie was announced as the (9+ / 0-)

    savior of the Romney campaign.....then he disappeared.....now he's back......prolly needs a new boat...

    http://www.politico.com/...

    •  It's the Remaking of the RINO (9+ / 0-)

      Watch Gillespie turn into a Teabag Hero.
      Here in Kansas, however, we have a good Democratic candidate for governor running against Brownback, and moderate Republicans are endorsing him over Brownback. Including my former hometown State Senator. The Democratic candidate, Paul Davis, actually is leading in some polling.
      It's amazing.

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Sat Jan 04, 2014 at 05:59:37 AM PST

      [ Parent ]

      •  Go Kansas! (6+ / 0-)

        Happy progress.

        Here in Kansas, however, we have a good Democratic candidate for governor running against Brownback, and moderate Republicans are endorsing him over Brownback. Including my former hometown State Senator. The Democratic candidate, Paul Davis, actually is leading in some polling.

        In any endeavour it is a fact that you have to succeed with the people who are willing to participate. -- Fitch Williams

        by eyo on Sat Jan 04, 2014 at 06:10:54 AM PST

        [ Parent ]

        •  I know! (7+ / 0-)

          I moved here from the east coast the year Sebelius was elected, and it was a fairly good time for Kansas, she did some great investing in wind energy, and in our schools.
          Brownback has slashed education funding (in order to pay for huge cuts to business income taxes, of course) to the point that a case is now before our state supreme court that asserts that Brownback's cuts violate the state constitution.

          The Kansas Families for Education PAC broke with tradition Friday, giving an endorsement nearly a year before the gubernatorial election to Democrat Paul Davis.

          The education PAC usually issues endorsements in July, but said it was endorsing Davis, the House minority leader, prior to the 2014 session because of the importance of this year's race to public education.

          “This race is the most critical election ever for the future of public education in Kansas,” said Kathy Cook, KFE PAC board member.

          Davis also scored an endorsement from the Kansas National Education Association, the state's largest teachers' union and a major political donor.

          http://cjonline.com/...

          Your beliefs don't make you a better person. Your behavior does.

          by skohayes on Sat Jan 04, 2014 at 06:15:52 AM PST

          [ Parent ]

    •  Oh good god. Gillespie? (1+ / 0-)
      Recommended by:
      Aquarius40

      I hope the fucker gets trounced.  Some of the quotes in the article are really telling when it comes to how far the GOP has veered to the right and off the cliff.

      McWaters said Warner has not been the “bipartisan radical centrist” that the former governor promised to be when he cruised to victory in 2008.

      “I like Mark Warner,” he said. “I consider him a friend. But a bad vote’s a bad vote. I don’t care how nice they are or how affable. The policies of this president that he has aggressively supported were the wrong policies for America.”

      Warner has been a classic DLC Third Way centrist.  A thorn on our side on so many issues.  Yet that's not centrist enough for these VA assholes.  I guess when you're to the right of Genghis Khan and your idea of a moderate is Ronald Reagan there isn't much of a center and that person is someone who is a few fries short of a Happy Meal like maybe Ken Kookinelli.  Good job VA GOP.  Look how well that worked for you in the last election.  

      Thankfully we may not even have to worry about Gillespie as they will pick the nominee in a convention much like the one that chose EW Jackson over saner and more electable alternatives.  

      Even if Ed Gillespie, who has no experience as a candidate does get the nomination, he'll have to tea bag which will make him unelectable especially compared to a Warner who is a skilled politician with tons of cash.  They seem to think because the Kook only lost by a few % to an underqualified and unappealing Dem that they can run the same playbook against Mark Warner.  They're gonna get their asses kicked.

      This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

      by DisNoir36 on Sat Jan 04, 2014 at 08:24:30 AM PST

      [ Parent ]

  •  Another dead-ender (13+ / 0-)

    argument I keep hearing is that doctors are quitting en masse because of Obamacare. When pressed my mom who was parroting the Fox talking point admitted she only knew of one...except the guy was actually 75 and retiring. But he still hates Obama(care). Is it such a burden to take patients who now have private insurance? Seems to me it would mean an influx of business for physicians.

    •  and the 75-year-old was a technophobe (12+ / 0-)

      What really drove him out of business (other than being old enough to retire and play more golf) was the Bush Administration's rules requiring electronic medical record-keeping. It had nothing to do with the ACA. But of course Fox wasn't going to name Bush as the enemy.

      •  Yes.. I heard that story.. (7+ / 0-)

        Electronic record-keeping IS a hassle for medical personnel.  Nurses and docs spend a LOT more time with me typing things into a computer than they used to.

        But having those electronic records also reduces time when you go to see the next doc or specialist who has access to them.

        All in all, it's a good thing. But, an arduous task for a small medical practice.

        •  that pushes small ones to join (6+ / 0-)

          larger networks, another pressure that exists independent of ACA.

          "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

          by Greg Dworkin on Sat Jan 04, 2014 at 06:15:32 AM PST

          [ Parent ]

          •  which drives cost up, IIRC. (3+ / 0-)

            there was an interesting study about a year ago the thesis of which was that prices go down when there are fewer insurance companies and more medical providers, and costs go up in the reverse situation.  insurance and doctors are on opposite sides of the table, and each tries to exploit negotiating power to drive costs up or down.

            if that thesis is right, and we're worse off with more competition among insurers and less among health care providers.

            •  except that small groups uniting don't give you (4+ / 0-)

              less providers. The provider number doesn't change. it might even go up if each little group can united now afford to hire someone else.

               it potentially gives you better hours (more coverage compared to solo groups) and less overhead.

              Not always true, of course. But your initial equation is flawed.

              "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

              by Greg Dworkin on Sat Jan 04, 2014 at 06:34:04 AM PST

              [ Parent ]

              •  When small groups join large groups (0+ / 0-)

                the power of providers to increase prices and therefore insurance premiums goes up.  

                While insurance companies can pressure providers to accept lower prices as a condition of being in their network, the insurance company needs enough providers in the right places to serve their customers.

                The most important way to protect the environment is not to have more than one child.

                by nextstep on Sat Jan 04, 2014 at 11:57:06 AM PST

                [ Parent ]

            •  also the idea that a doc office here (7+ / 0-)

              and one across the street will be in competition and therefore drive down prices is also flawed.

              never worked that way, prices are set by a wider market and reimbursement rates from insurance companies.

              "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

              by Greg Dworkin on Sat Jan 04, 2014 at 06:36:41 AM PST

              [ Parent ]

            •  Yeah that's flawed (1+ / 0-)
              Recommended by:
              Aquarius40

              In CT for example there aren't less providers.  If anything there are more and more of them.  There's tons of new doctors and specialists moving into my area with medical offices being built, filled and then more being built.  The only caveat is that they are all part of a larger network that covers the western part of the state and includes 3 regional hospitals.

              If your theory is correct and insurance companies and medical providers are on opposite sides of the negotiating table then that would seem to suggest that large regional networks with many providers all under one umbrella would have a distinct advantage over insurance companies when it comes to negotiating.  

              This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

              by DisNoir36 on Sat Jan 04, 2014 at 08:40:32 AM PST

              [ Parent ]

              •  It goes both ways (0+ / 0-)

                A major insurer pulling out of a large network can be devastating to the network.

                They have had some of these pissing matches here in Illinois where, for instance, Blue Cross pulls out of one of these networks.  A thousand offices no longer accepting Blue Cross means tens of thousands of patients looking for new doctors.

                •  I'm in CT (0+ / 0-)

                  one of the global capitals of insurance.  Somehow I can't imagine an insurance company pulling out of a state they're in and abandoning a network as large as the one in Western CT.  If they do then maybe the alternative would be to create a state run single payer plan which completely bypasses the need for private insurance companies.  After 2017 that will be a viable option.  

                  This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

                  by DisNoir36 on Sat Jan 04, 2014 at 10:02:18 AM PST

                  [ Parent ]

                  •  what did happen in CT (0+ / 0-)

                    is one of the big players pulled the plug on the Children's Hospital because specialty care >> community care prices.

                    eventually got fixed.

                    http://articles.courant.com/...

                    and

                    CCMC-Anthem Resolve Contract Dispute
                    Claims for Anthem members from April 16, the day the contract expired, to June 11 will be paid under the member’s in-network benefits.
                    Good example of how you don't need ACA to have disruption in the system.

                    "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

                    by Greg Dworkin on Sat Jan 04, 2014 at 10:18:25 AM PST

                    [ Parent ]

  •  Might I note that (23+ / 0-)

    "Obamacare" doesn't "cause" employers to cut hours and make more people "part time" -- asshole employers are using it as an excuse for a practice that has been well under way for a long time.

    Don't blame the law; blame those who abuse it.

    •  I do know of some that are ACA related (9+ / 0-)

      The state colleges and URI have limited adjunct classes to 2 per semester rather than 3, out of fears that 3 would be considered "FT." That has a real impact on people trying to piece together enough work to equal a decent income. My college (where normal load is over 3) is still treating 3 as PT, but some of my colleagues teach in multiple places and I trust their reporting.

      The way they count "FT" for teachers is, apparently, based solely on "contact hours" (classroom + required office hours), so there's no way any of us would be considered FT -- same is true of all K-12 teachers, actually. It's an area that really needs tweaking.

      OTH, I discovered that I could get much cheaper and equivalent coverage through the exchange than what my college offers to adjuncts. So I don't care how they classify me. Frankly it doesn't make sense to ask low-wage employers to cough up $20,000 a year for health insurance on a person/family who's only making minimum wage, and who is eligible either for Medicaid or for heavily subsidized exchange coverage. I'd much rather have them pay a living wage and let people get their own insurance.

    •  Thank you for saying this (7+ / 0-)
      -- asshole employers are using it as an excuse for a practice that has been well under way for a long time.
      It's not abuse, it's exploiting a newly-owned resource. ;)
      It's how to win the race to the bottom.

      In any endeavour it is a fact that you have to succeed with the people who are willing to participate. -- Fitch Williams

      by eyo on Sat Jan 04, 2014 at 05:47:14 AM PST

      [ Parent ]

    •  Exactly! (7+ / 0-)

      How many of you want to bet that Hobby Lobby had insurance that covered contraceptives before the ACA was passed?

      Your beliefs don't make you a better person. Your behavior does.

      by skohayes on Sat Jan 04, 2014 at 06:02:49 AM PST

      [ Parent ]

    •  So true! (5+ / 0-)

      When my daughter worked for Cheesecake Factory, they had really good benefits for those working at least 25 hours a week.  When the economy crashed in 2008, the first thing they did was to cut everyone to 22 - 24 hours a week and hire more people.  I'd get these frantic calls from my daughter that she had gotten a bill for her full premium that she couldn't pay.   This was before Obama was even elected!

      “It is the job of the artist to think outside the boundaries of permissible thought and dare say things that no one else will say."—Howard Zinn

      by musiclady on Sat Jan 04, 2014 at 07:02:49 AM PST

      [ Parent ]

  •  Wingnut on the radio last night...'Boehner is a (11+ / 0-)

    great guy but an awful Speaker of the House.....What we need is a true conservative like Louie Gohmert as Speaker.'

    Oh Please Oh Please Oh Please!!!

  •  I highly rec Austin Frakt link on Oregon Medicaid (8+ / 0-)
    It may also be the case that the ED is less interested in the “whole patient,” treating just the symptoms as presented. Some consumers may view this as an advantage.
    His list of why unhealthy poor people who've not had access might go to Emergency first, reminds us that there is a large human behavior component. Their website is one of few trying to approach American health care from a scientific perspective and seeking improvements across the system.
    •  it's a great series and so is this link from there (6+ / 0-)

      to another great site, this by Harold Pollack.

      Medicaid – and what having it means to ERs

      Three-year study of low-income adults produces some heartening and not-so-heartening findings about impact of Medicaid enrollment

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Jan 04, 2014 at 05:24:47 AM PST

      [ Parent ]

    •  and since you liked the austin frakt piece (4+ / 0-)
      MT @DemFromCT: Patients are smarter than we are. http://t.co/...
      @afrakt

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Jan 04, 2014 at 06:17:01 AM PST

      [ Parent ]

    •  I think a surge is understandable (1+ / 0-)
      Recommended by:
      rl en france

      I mean all these people weren't insured before, when they got it they decided to do something about their health problems.
      they were saying on the news last night here in OR that the results were inconclusive

      Happy just to be alive

      by exlrrp on Sat Jan 04, 2014 at 06:23:35 AM PST

      [ Parent ]

      •  see the sarah kliff piece (3+ / 0-)

        the Oregon data is now 5 years old. She has an update.

        "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

        by Greg Dworkin on Sat Jan 04, 2014 at 06:31:04 AM PST

        [ Parent ]

        •  did you see this 2013 study (2+ / 0-)
          Recommended by:
          Heart of the Rockies, mikeVA

          from RAND?  

          The Evolving Role of Emergency Departments in the United States

          • Between 2003 and 2009, inpatient admissions to U.S. hospitals grew at a slower rate than the population overall. However, nearly all of the growth in admissions was due to a 17 percent increase in unscheduled inpatient admissions from EDs. This growth in ED
          admissions more than offset a 10 percent decrease in admissions from doctors’ offices and other outpatient settings. This pattern suggests that office-based physicians are directing to EDs some of the patients they previously admitted to the hospital.
          •  In addition to serving as an increasingly important portal of hospital admissions, EDs support primary care practices by performing complex diagnostic workups and handling overflow, after-hours, and weekend demand for care. Almost all of the physicians we interviewed—specialist and primary care alike—confirmed that office-based physicians increasingly rely on EDs to evaluate complex patients with potentially serious problems, rather than managing these patient themselves.
          •  absolutely true (0+ / 0-)

            and ACEP and other ER specialists have pointed this out for years. Especially true after hours if there is no alternative.

            But in that time frame (and the preceding years), "elective" admissions have dropped. No more overnights for tonsillectomy, or even same days. So naturally, % from ER, the portal, has gone up somewhat. All blends together.

            "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

            by Greg Dworkin on Sat Jan 04, 2014 at 07:26:06 AM PST

            [ Parent ]

  •  Fake AAA securities from housing bubble crashed (3+ / 0-)
    Recommended by:
    Stude Dude, skohayes, rl en france

    the economy in late 2007 which increased less pay for more hours and less hours for many....no? Vat es dis blame it on da kids with asthma getting rescue breathers bullshit??

  •  As a former hospital admin at a safety net (8+ / 0-)

    Hospital I can report that changing health access behaviors is daunting.  If takes work to break the habit of ER use, but it can be done and it looks like OR is doing it. Good for them.

    At our hospital, our ER visit was 2x the cost of a clinic visit. So you can see that by getting patients to the proper setting is key for pt's health, cost and effectively health care delivery. (Note - only 2x as much because we had some high cost specialty clinics.)

    •  yes and what people do at first (10+ / 0-)

      is not what people do once they get into the system, internalize it and get directed elsewhere. See the problem, fix the problem.

      But Frakt is right that consumers are acting in their best interest (example: off hours use).

      When I was just starting as an intern, I had a pt come see me in the ER for a minor 5 week problem at 2 am. When I gave them a bit of a hard time for showing up at 2 am and not during the day, they just looked at me and said "you must be new. Ever see the wait time at 10 am?"

      Lesson learned, quickly. Patients are smarter than we are.

      "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" — Upton Sinclair

      by Greg Dworkin on Sat Jan 04, 2014 at 05:34:53 AM PST

      [ Parent ]

      •  There obviously is some balance... (3+ / 0-)

        ...between setting up non-emergency options with more "off peak" hours and resigning ourselves to the fact that the ER is going to ALWAYS bear the burden of dealing with runny noses and moderately high fevers (I am intentionally exaggerating here) at 2 AM. It's going to take time to build the capacity and social awareness to have a near optimal match between resources and predictable, baseline need.

        Change does not roll in on the wheels of inevitability, but comes through continuous struggle. --Martin Luther King Jr.

        by Egalitare on Sat Jan 04, 2014 at 06:40:43 AM PST

        [ Parent ]

  •  Oh, it trickles down, alright (8+ / 0-)

    but recycled champagne doesn't have quite the same bouquet.

    I live under the bridge to the 21st Century.

    by Crashing Vor on Sat Jan 04, 2014 at 05:31:17 AM PST

  •  A few other bits and pieces. Justice Roberts and (6+ / 0-)

    his Christmas Carol: "Courts reap what they sow."

    With a link to [this article] Milbank notes:

    The chief justice invoked both Scrooge’s ghosts and George Bailey’s guardian angel in the first sentence of his annual report on the federal judiciary, released on New Year’s Eve, in which he begged for more money for the courts. “Both ‘A Christmas Carol’ and ‘It’s a Wonderful Life’ have happy endings,” he wrote. “We are encouraged that the story of funding for the Federal Judiciary — though perhaps not as gripping a tale — will too.”
    notes
    But his conservative majority has made the Roberts Court the most pro-business court since the 1930s, and he and his fellow justices have done a great deal to expand the rights of the wealthy and the powerful — most notably by allowing them to spend unlimited sums to purchase lawmakers and to sway elections. The wealthy and corporate interests have responded by buying a Congress determined to shrink government and to weaken its reach — including that of the courts.

    Typical Republican mentality too. Cut, cut, cut but not for me!

    Two stories demonstrate a fact many of our citizens are just, if even that, learning. The ability of a "superpower" or even several to actually change a culture or culture driven events other than certain erupting symptoms is very limited. Fallujah is back in the news and U.N. peacekeepers at record levels are not stopping brutal African wars.

    Too many people still thing "we" have the power and influence to control events. Some is based on a rosy view of post World War II successes but even that view ignores reality. Much of the turmoil that the bipolar world's giants used in proxy fights was the result of failures. While the U.K. and U.S. in a burst of relative wisdom recognized colonial days were over others did not and tried to use force to control alien cultures. The Dutch, people we now see as quite liberal, insisted on trying to return to Batavia, now Jakarta, and resume control of a by no means "enlightened" colonial domination. Same with France in Vietnam. Even the wiser approach had major problems as anyone looking into the partition of British India will know from the trains of death and bloody separation into what are now nuclear armed enemy states.

    There is a place and necessity for intervening force, but reaching for that remedy has mostly been a badly timed and misplaced option rather than well timed and very limited option. It almost never works to change a cultural, religious or ethnic "problem" and usually makes those worse. Too damned often it has been all that as a result of our earlier misuse as in post war decisions to support repressive regimes in Iran and elsewhere in attempting to control cultural, ethnic and religious driven events.

    The only foes that threaten America are the enemies at home, and those are ignorance, superstition, and incompetence. [Elbert Hubbard]

    by pelagicray on Sat Jan 04, 2014 at 05:31:52 AM PST

  •  People near the poverty line (11+ / 0-)

    who have never had insurance coverage have been using the ER for their medical needs for years, and as soon as the ACA becomes law, they are expected to change all their previous habits, apply for Medicaid, and find a doctor.  This will all take place, but it takes some time.

    There will be dozens of stories like this about how the ACA is not working and is causing problems that didn't exist before in parts of the health care delivery system.  Yes, people's habits will have to change; they will need to learn to navigate the new system and take care of their medical needs in a different and unfamiliar way.  And that takes time.  Meanwhile, opponents of the ACA will have fodder for more outrage.

    If Democrats can keep control of the Senate, even if they can't quite manage taking back the House, most of these stories will be moot and problems with the law will be ironed out by the next presidential election.

    "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

    by SueDe on Sat Jan 04, 2014 at 05:58:17 AM PST

    •  You are right that it will take time (6+ / 0-)

      Let's put this in perspective.  The Massachusetts health care law needed about 4 years to really work well.  Now we have a similar model at the national level.  One note, there is an ultimate bail-out in the Massachusetts law.  If someone can't find affordable insurance in the private market there is a public state option.  I think that ultimately ACA will need a public option.

      "The real wealth of a nation consists of the contributions of its people and nature." -- Riane Eisler

      by noofsh on Sat Jan 04, 2014 at 06:36:42 AM PST

      [ Parent ]

      •  Whether the ACA will eventually need a (0+ / 0-)

        public option is a certainty, as you said.  Just being released from the mandate if you can't afford private market insurance still leaves you without insurance.  Maybe if the Democrats take over congress again...but maybe not.  They would have to prohibit the filibuster be used in the case of legislation, which is not too promising since, when the ACA was being formed, they held both ends of the capitol then.

        "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

        by SueDe on Sat Jan 04, 2014 at 04:01:53 PM PST

        [ Parent ]

  •  Single Payer Universal would remove the problem... (4+ / 0-)

    Employers no longer take part in health care. They do have to pay a living wage and full timers are a better investment than part timers.

    I don't see the problem. Oh yeah.... racists complaining that they don't want to pay for __'s health care.

    Meh. Randian Libertarians.
    Meh. southernISTs.
    Meh. GOP/TPer party members who can't read.

    Ugh. --UB.

    "Daddy, every time a bell rings, a Randian Libertaria­n picks up his Pan Am tickets for the Libertaria­n Paradise of West Dakota!"

    by unclebucky on Sat Jan 04, 2014 at 06:01:54 AM PST

  •  Republican Crocodile Tears Over the APA (2+ / 0-)

    reveal their contempt for the electorate. Their whole approach is based on the premise that voters are stupid, really stupid, and won't notice that: (a) while they complain about people having to shift coverage from substandard health plans to plans that comply with the APA (spun as "losing your plan"), they (b) don't give a rat's ass whether anyone (except maybe themselves and their own families) has any heath insurance coverage whatsoever, revealed in the facts they propose no serious alternative to the APA and turn down Medicaid expansion.

  •  The C Word (1+ / 2-)
    Recommended by:
    JuliathePoet
    Hidden by:
    scamperdo, tytalus

    On NBC's "Meet the Press," television journalist Maria Bartiromo suggested that as a result of Obamacare, she has been turned into an even bigger Republican Twat. Size matters.

  •  Maddow (3+ / 0-)

    There have been two diaries written about her show from last night.

    I wonder if she'll got thrown under the bus by higher corporate powers? I wonder if journalists will circle their wagons around her to protect one fo their own? I wonder if this leads to nothing rally happening?

    I am hoping that Koch or ALEC associations become toxic for uncoming elections. I wonder if digging into those people could expose a potential Watergate of our times?

    BTW, earlier this morning I was sore at myself for not buying Apple stock back in the summer of '97. I saw about 17 ways that it could suceed. I saw one way it could fail. That one way spooked me away.

    "If this Studebaker had anymore Atomic Space-Age Style, you'd have to be an astronaut with a geiger counter!"

    by Stude Dude on Sat Jan 04, 2014 at 06:28:00 AM PST

  •  I'd expect that a good many people will still rely (2+ / 0-)

    on the ER for a bit as those without insurance tend not to have a PCP. When you are making an appointment as a new patient you generally have a weeks to months wait for your first visit (and that's here in my area where doctors are plentiful) so for any condition that has been worrying you might head to the ER as soon as it becomes possible. For most plans, your out of pocket cost is less for a doctor's visit than the ER so folks will get sorted out. I also expect that the drop-in non-emergency care groups will see an upswing in business.

    Where are we going and what am I doing in this handbasket?

    by gelfling545 on Sat Jan 04, 2014 at 06:30:37 AM PST

  •  There is a shift to part time employees in general (3+ / 0-)

    This is all part of the problem of a workplace where workers have no power ... be it small or large business.

    It's simple:

    1) We need national health care.  Ultimately, I believe we will need to create a public option in the exchange.

    2) We need more employee owned business (cooperatives).

    In the meantime, I will not let the antics of business dictate our health care policy through threats.  If they really are going to create more part time workers roll the dice.  If the health care insurance industry is going to keep raising rates roll the dice.  There are answers to all of these actions which will basically make these entities obsolete.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Riane Eisler

    by noofsh on Sat Jan 04, 2014 at 06:32:19 AM PST

  •  Study was a snap shot of limited outpatient option (1+ / 0-)
    Recommended by:
    Greg Dworkin

    The hospital days and charges tell the tale. They appear small, a likely indicator to procedures done in outpatient settings today. We've had in five years great expansion of these ambulatory, primary care, outreach like centers. At the time of the study what you had was a new set of patients with no primary or usual place of care entering hospital, some in strategically rural locations, referral systems.

  •  ACA policies discourage ER visits (0+ / 0-)

    unless it's a true emergency. Deductibles for ER visits on ACA plans that I've seen are $300-500. They wave the deductible if you are actually admitted into the hospital for a true emergency. This discourages people from using the ER for minor ailments. This will help to drive down health care costs for everyone.

  •  I'll pay my premium as soon as I get a bill. (0+ / 0-)

    Dec 3 - enrolled
    Dec 27 - insurer didn't yet have me in their system, so I had to get my Assemblyman's office to intervene
    Dec 31 - insurer finally gets me in their system.
    Jan 2 - no bill, but they expect payment by 1/6.
       How the hell can I pay if I don't know where to send payment?
      Are they deliberately trying to stall enrollees' effective date  by not sending out bills on time?

    My Karma just ran over your Dogma

    by FoundingFatherDAR on Sat Jan 04, 2014 at 09:04:01 AM PST

  •  ACA and part-time work (0+ / 0-)

    The ACA by itself will not result in less full-time work. The whole proposition strikes me as false because employment status depends on an array of factors, most prominently the health of the economy.

    A full-employment, growth economy won't have as many part-time jobs regardless of the cost of health insurance (which, for practical purposes, largely passed on to employees anyway). On the other hand, if there's no discernible decrease in full-time work now, one has to wonder when there would be.

    "There is no room for injustice anywhere in the American mansion." Lyndon Johnson

    by pkgoode on Sat Jan 04, 2014 at 01:22:20 PM PST

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