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I have known Opal for five years. In that time, her health has gone from not too good to pretty bad, but she is hanging in there. Or rather, she was hanging in there.  Now, she's hanging by a thread. Who am I? No one. Just a family physician at a county clinic for the uninsured in Texas, one of the 24 states that refused the Medicaid expansion. Our governor did everything he could to make the ACA rollout a failure. But nevertheless, Opal’s husband works, and he makes just enough to qualify for care under the Affordable Care Act. Great, right? Having some insurance is always better than having no insurance, right?

Like many urban areas, my county funds a public clinic for the uninsured. We pay for necessary medications, surgeries. We do screening colonoscopies. We do mammograms and immunizations. If you have a heart attack, you can get your coronary artery stented. If you get cancer, you can get your chemo. No deductible, no caps, no pre-existing conditions exclusions and while there are some medication copayments, you can get them waived. We don’t want to see anyone die for lack of $5. Medicaid type health care, more or less, but with a higher income cap.

The Medicaid expansion would have taken over the cost of running the clinic. Since Rick Perry thinks he has a shot at becoming Vice President, he said “No” to billions of dollars. Therefore, taxpayers in our state's urban areas will continue to face double taxation---once to pay for health care for our own poor, once to pay for health care for the poor in the lucky 26 states that took the expansion. Tax payers in rural areas will continue to see their hospitals close and their doctors flee----but this is not about them. This is about Opal.

Opal and her husband were told that the ACA’s cheapest plan would allow its members to keep seeing their county doctors and getting the care they are used to receiving through the county.  They were relieved. The cheap plan only cost them pennies a month out of pocket. The next cheapest plan would have cost them $100 a month---and people who live with chronic illness don’t have that much cash lying around. Once they signed on the dotted line, Opal and her husband learned the truth. Opal now had insurance that had an enormous deductible.  Her insurance would cover care only if it was prescribed by a tiny handful of providers---anyone who believes that HMO provider directories are accurate has obviously never dealt with an HMO. Anyone who believes that the people who sign you up for an HMO tell the truth has never encountered an HMO rep. They are paid for one thing---your signature.

Opal needed her medication. Her medication cost $500. Opal did not have $500. Opal had not met her deductible. Her $5000 deductible.  Opal had a heart attack. Opal went back to the county hospital. She is getting care again with her county doctors.  Too bad it was that last little bit of her heart that she could not afford to lose. I wish you could hear the fluid in Opal’s lungs when she breathes. I wish you could see the fear in her eyes as she faces her mortality.

You can make some things right, after they get messed up, but you can’t put back dead myocardium or restore a dead kidney or replace infarcted brain. Yes, I love my party. Yes, I want to see it do well in the elections this fall and in 2016. But I am not going to keep my mouth shut and watch Opal and people like her get sick and die, because the ACA has as many holes in it as the god damned Titanic, and the GOP and the SCOTUS and the Tea Party are exploiting every last one of them.

So, if you want to go back to circling the wagons around the ACA, insisting that everything is just fine, go right ahead. You can even accuse me of not being a Family Physician and of not working with the chronically ill and uninsured.  But if you try to accuse me of being a Bad Democrat, of not supporting the President,  because I won’t keep my mouth shut, I have to ask:

What kind of Democrat would ask another Democrat to keep quiet about the suffering of the chronically ill? No Democrat, that’s who. The only folks who hate the chronically ill are the bean counters of the private health insurance industry. And they will do whatever it takes to make sure that sick folks who make the mistake of signing up for their insurance plans get the hell back off---assuming that they don’t die first. And that is no exaggeration. Though Opal’s name has been changed, for reasons of patient confidentiality. The fluid filled lungs, her fear, my anger---they are all real.

Originally posted to McCamy Taylor on Sun Apr 13, 2014 at 08:54 PM PDT.

Also republished by Obamacare Saves Lives and Progressive Policy Zone.

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  •  Tip Jar (228+ / 0-)
    Recommended by:
    doh1304, VClib, WisePiper, elfling, fToRrEeEsSt, deepeco, worldlotus, terabytes, markthshark, allie4fairness, librarisingnsf, Idaho Guy, rsmpdx, Mokurai, Nannyberry, Lujane, notrouble, AaronInSanDiego, Cadillac64, blueoasis, alypse1, jacey, chimene, Jim P, tegrat, YucatanMan, Grey Fedora, schumann, jgilhousen, limpidglass, jadt65, lotlizard, WisVoter, Villanova Rhodes, camlbacker, MartyM, cap76, orestes1963, dkmich, cassandraX, radarlady, Ezekiel in Exile, Book of Hearts, GeorgeXVIII, Vetwife, YaNevaNo, FrY10cK, ban nock, Skyye, tommymet, rapala, JDWolverton, joedemocrat, political mutt, deben, cv lurking gf, RFK Lives, ChuckChuckerson, on the cusp, Lonely Texan, Involuntary Exile, musicsleuth, VPofKarma, annetteboardman, rivercard, nancyjones, Shockwave, psnyder, Phoebe Loosinhouse, marina, Alice Olson, Pescadero Bill, pixxer, Thinking Fella, karmsy, freesia, Sylv, FindingMyVoice, gizmo59, dagolfnut, rbaillie, Lefty Ladig, poligirl, temptxan, felix19, tgypsy, greenbastard, stringer bell, Byron from Denver, JoanMar, TracieLynn, Catte Nappe, Joe Bacon, ColoTim, triv33, Pluto, unfangus, gooderservice, kareylou, Trevin, MusicFarmer, dansk47, One Pissed Off Liberal, quagmiremonkey, Choco8, commonmass, claude, Occulus, wonmug, Rogneid, leonard145b, George3, vahana, Willa Rogers, mslat27, Preston S, badger, RUNDOWN, allenjo, m00finsan, Pat K California, angel d, PhilJD, albrt, LaEscapee, greengemini, clarknyc, dance you monster, tardis10, Wolf10, MufsMom, Jarrayy, JayBat, weneedahero, Sun Tzu, poco, shari, Aureas2, old wobbly, congenitalefty, dradams, Terre, sentinalnode, AdamSelene, Observerinvancouver, lissablack, Lefty Coaster, rhutcheson, dewley notid, annecros, soarbird, eeff, priceman, Sean Robertson, 3goldens, Jim R, kharma, democracy inaction, gloriana, No Exit, AoT, mollyd, ItsaMathJoke, TheMomCat, oldliberal, where4art, Prinny Squad, bfitzinAR, gabjoh, lgmcp, JVolvo, SuWho, Sunspots, atana, JayRaye, markdd, mikejay611, DeadHead, TKO333, Bluesee, Born in NOLA, CoolOnion, Simplify, enhydra lutris, brentut5, Gardener in PA, zerelda, Knucklehead, dksbook, mrkvica, deeproots, kfunk937, yoduuuh do or do not, MKinTN, aliasalias, slowbutsure, SixSixSix, Chaddiwicker, Persiflage, crose, 1BQ, ridemybike, Angie in WA State, dmhlt 66, xynz, spooks51, Senor Unoball, sk4p, psychodrew, liberaldemdave, Mayfly, smrichmond, Robynhood too, cyberKosFan, Greyhound, fugwb, Catskill Julie, Yohannon, Heiuan, movie buff, cai, denise b, Cassiodorus, SpecialKinFlag, BusyinCA, beverlywoods, blue91, magnetics

    "A dog starved at his master's gate/Predicts the ruin of the state" Blake

    by McCamy Taylor on Sun Apr 13, 2014 at 08:54:36 PM PDT

  •  That is a sad reality of the partisan divide... (43+ / 0-)

    arguing its terrible on one side and its great on the other.

    What we need is 'These are its real flaws and these are workable solutions for them'

    Join the DeRevolution: We are not trying to take the country, we are trying to take the country back. Get the money out of politics with public financed campaigns so 'Of the People, By the People and For the People' rings true again.

    by fToRrEeEsSt on Sun Apr 13, 2014 at 09:16:45 PM PDT

    •  We were told it was a starter home in 2010 (34+ / 0-)

      By 2013, supporting it "as is" became a party litmus test.  I don't even see anyone proposing to add a sun porch out back--forget about moving to a bigger house.  The president certainly didn't do so in the 2012 campaign, and I don't see any Dem candidates doing so thus far this cycle.

      Yes, I know, VT hopes to implement single-payer in 2017--it if can get the federal waiver and if it can come up w/ a funding mechanism.  Has the putative Dem front-runner taken a position on whether she will grant such a waiver if she's elected?  Are people going to make that a litmus test for supporting her campaign?  

      Maybe a devout 3d Wayer will grant a waiver that many of her biggest financial backers will despise.  Maybe VT will come up w/ the 59% increase over current tax revenue to fund single payer.  Maybe success in a state w/ 620,000 residents will lead other states will follow suit in ensuing years.

      That's a lot of "ifs."  For now, we have a system whose framework, as per its Senate patron, was drafted by an insurance exec.  It's better than the previous status quo, but it's not something to make a litmus test.

      Some men see things as they are and ask why. I dream of things that never were and ask why not?

      by RFK Lives on Mon Apr 14, 2014 at 06:20:20 AM PDT

      [ Parent ]

      •  No one is saying 'as is'. (34+ / 0-)

        Absolutely NO ONE.  What we need isto counteract the damage that started in 2010 in state and federal legislatures.  We are saying NOT to run from ACA but to champion it as the biggest step toward access to health care for all Americans in our history.  If we continue to feed into how 'bad' it is, then the bad guys win.  And if they win in 2014, this country is doomed.  

        We can say that we want to improve it, fix it, find its weaknesses and make it better  The President says that ALL THE TIME.  But we must FIRST say how important a step it is, how this is more comprehensive a progressive achievement than Medicare was at is inception (it was just hospitalization, you  know.  It got 'fixed' decades later).  

        The frame we use can encourage people to vote.  The frame of this diary and this comment discourages people.  I only wish Jerry Falwell had taken his ball and gone home when he didn't get repeal of Roe v. Wade in the 1980's.  Instead, they kept working and working and taking each little rightward move as a huge achievement.  And we can't take a huge achievement and call it that?  

        •  What changes did president campaign for in 2012? (22+ / 0-)

          I sure as hell didn't hear him run on, say, pushing for a PO in his 2d term.   If you're halfway serious about improving the bill, you lay out substantive improvements during your re-election campaign and then claim a mandate.  Even if you don't achieve them in your 2d term, you keep the dialogue going.  That didn't happen.

          When did you last even hear a Dem mention the PO?  It's not even in the discussion anymore.  It was a compromise position for us, and now it's disappeared like EFCA, reforming NAFTA, and a lot of other hopes that were raised in 2008.

          You didn't answer the question about HRC's position on the VT single-payer waiver.  She said the following about single-payer in 2008:

          I never seriously considered a single payer system. ... I think that, you know, there's too many bells and whistles that Americans want that would not be available." Besides, "Talking about single payer really is a conversation ender for most Americans, because then they become very nervous about socialized medicine and all the rest of this."
          Has she changed her position since then?

          Some men see things as they are and ask why. I dream of things that never were and ask why not?

          by RFK Lives on Mon Apr 14, 2014 at 07:51:02 AM PDT

          [ Parent ]

        •  EVERYONE is saying "as is" (9+ / 0-)

          Show me ONE prominent Democratic politician who is saying that the ACA is just a starting point and still needs a lot of work. ONE.

          I'll save you the trouble. There aren't any. This is the exact bill that the Democratic leadership wanted, and they won't make any changes that will hurt the insurance companies' bottom line.

          So long as the Democratic party occupies the left side of the political spectrum in this country, without a complete replacement of the party leadership (which won't happen), we aren't going to get any improvements on the ACA for AT LEAST a generation.

          •  No: "Fix it don't Nix it" and (5+ / 0-)

            "Mend it don't end it" are catch phrases I've heard from a number of Democrats on Sunday talk shows. A lot of Dems acknowledge that it has areas that need to be improved.

            Some people fight fire with fire. Professionals use water.

            by Happy Days on Mon Apr 14, 2014 at 10:37:52 AM PDT

            [ Parent ]

            •  Examples? (2+ / 0-)
              Recommended by:
              RFK Lives, JVolvo

              I'm genuinely curious. Who has been saying this?

              •  As I noted below.... (1+ / 0-)
                Recommended by:
                etherealfire

                there is legislation proposed by Democrats to change the ACA already in play. I am not sure why you are unaware of this proposed legislation but it completely contradicts your argument.

                Six Senate Democrats Thursday unveiled proposals to make changes in the Affordable Care Act, the health care law under fire from conservatives and Republicans. Two senators, Mary Landrieu, D-La., and Mark Begich, D-Alaska, are considered among the most vulnerable Senate Democrats this year as they face tough re-election efforts. Joining them in proposing new ideas for the health care law are Sens. Heidi Heitkamp, D-N.D., Mark Warner, D-Va., Angus King, Ind.-Maine and Joe Manchin, D-W.Va.

                Expanded Consumer Choice Act (S. 1729) (Sens. Begich, Heitkamp, Landrieu, Warner, Manchin, King...Provides a new lower cost, high-deductible option called the Copper Plan, in addition to the existing Platinum, Gold, Silver, and Bronze options in the marketplace that would give consumers more control over their own coverage, spur competition, and, most importantly, increase affordability. The new Copper Plan would meet the essential benefits laid out by the Affordable Care Act

                Increased Competition for Consumers Act (S. 1333) (Sens. Begich, Heitkamp, Landrieu, Warner, Manchin...Restores startup funds for new consumer-driven health insurance cooperatives, now operating in 23 states. This will allow families to have more options to access health coverage beyond traditional insurance companies, infusing state marketplaces with more competition to reduce average premiums. These nonprofit health care co-ops are already offering good options for thousands of consumers in states like Louisiana and Maine.

                It's the Central Limit Theorem, Stupid!

                by smartdemmg on Mon Apr 14, 2014 at 02:21:27 PM PDT

                [ Parent ]

            •  Exactly. n/t (2+ / 0-)
              Recommended by:
              Shawn87, etherealfire

              Visit http://theuptake.org/ for Minnesota news as it happens.

              by Phoenix Woman on Mon Apr 14, 2014 at 11:03:40 AM PDT

              [ Parent ]

          •  No. That simply is not true. (8+ / 0-)

            You are simply wrong. There is legislation being promoted by Democratic senators to modify the ACA as we speak.

            Show me ONE prominent Democratic politician who is saying that the ACA is just a starting point and still needs a lot of work. ONE.
            Six Senate Democrats Thursday unveiled proposals to make changes in the Affordable Care Act, the health care law under fire from conservatives and Republicans. Two senators, Mary Landrieu, D-La., and Mark Begich, D-Alaska, are considered among the most vulnerable Senate Democrats this year as they face tough re-election efforts.

            Joining them in proposing new ideas for the health care law are Sens. Heidi Heitkamp, D-N.D., Mark Warner, D-Va., Angus King, Ind.-Maine and Joe Manchin, D-W.Va.

            Expanded Consumer Choice Act (S. 1729) (Sens. Begich, Heitkamp, Landrieu, Warner, Manchin, King...Provides a new lower cost, high-deductible option called the Copper Plan, in addition to the existing Platinum, Gold, Silver, and Bronze options in the marketplace that would give consumers more control over their own coverage, spur competition, and, most importantly, increase affordability. The new Copper Plan would meet the essential benefits laid out by the Affordable Care Act

            Increased Competition for Consumers Act (S. 1333) (Sens. Begich, Heitkamp, Landrieu, Warner, Manchin...Restores startup funds for new consumer-driven health insurance cooperatives, now operating in 23 states. This will allow families to have more options to access health coverage beyond traditional insurance companies, infusing state marketplaces with more competition to reduce average premiums. These nonprofit health care co-ops are already offering good options for thousands of consumers in states like Louisiana and Maine.

            Commonsense Competition and Access to Health Insurance.... Increases consumer choice by directing state insurance regulators to develop models for states to sell health insurance across state lines. These multi-state models will help us discern the benefits and challenges of selling health insurance in this manner, and determine if it is a means to increasing choice and competition among plans – potentially driving down costs while maintaining quality and value

            Read more here: http://www.mcclatchydc.com/...

            It's the Central Limit Theorem, Stupid!

            by smartdemmg on Mon Apr 14, 2014 at 10:46:39 AM PDT

            [ Parent ]

      •  Of all the Front Pagers here who pushed the (2+ / 0-)
        Recommended by:
        JayRaye, denise b

        "Pass it and fix it" four years ago, how many have devoted even one post to proposals to fix it?

        I know of three.  I may have missed others, I probably only see about half of what hits the front page.

        "High deductibles kill low income patients." FishOutOfWater

        by JesseCW on Mon Apr 14, 2014 at 02:02:28 PM PDT

        [ Parent ]

    •  What You're Describing (11+ / 0-)

      Is the position of the staunchest supporters of PPACA I know--myself included:

      What we need is 'These are its real flaws and these are workable solutions for them'
      The notion that anybody here is suggesting or defending this as the single perfect cure-all to health care reform in this country isn't just a joke--it's a lie.  And I cannot fathom the motives of the people who keep repeating it.
      •  Nice straw man wanna try again? nt (0+ / 0-)

        Join the DeRevolution: We are not trying to take the country, we are trying to take the country back. Get the money out of politics with public financed campaigns so 'Of the People, By the People and For the People' rings true again.

        by fToRrEeEsSt on Mon Apr 14, 2014 at 10:19:35 AM PDT

        [ Parent ]

        •  So to whom is the diarist referring when... (2+ / 0-)
          Recommended by:
          etherealfire, Kevskos

          ...the diarist mentions, in the header and in the diary itself, people who are "circling the wagons" around the ACA?

          Visit http://theuptake.org/ for Minnesota news as it happens.

          by Phoenix Woman on Mon Apr 14, 2014 at 10:51:28 AM PDT

          [ Parent ]

          •  Please you responded to me... (0+ / 0-)

            All I said is both the right and the left are missing the point it is neither terrible nor great, but an imperfect law good enough to try and improve.

            Most would call that reasonable politics, but we have traveled so far from reasonable politics it looks alien to most.

            Please point out anybody in power trying to clearly define its flaws and suggest solutions? Anyone?

            Join the DeRevolution: We are not trying to take the country, we are trying to take the country back. Get the money out of politics with public financed campaigns so 'Of the People, By the People and For the People' rings true again.

            by fToRrEeEsSt on Mon Apr 14, 2014 at 11:03:41 AM PDT

            [ Parent ]

            •  Over the last year (3+ / 0-)
              Recommended by:
              poco, geordie, etherealfire

              or so the House had over 50 votes to essentially repeal the ACA.  Most of the effort on the Dem side has been put in to just RETAINing the law.  Several efforts have been put forth by Democrats to improve the law, but they have never even made it to the floor of the House, let alone come up for a vote.

              Until we control the House, or have a more reasonable group of Republicans in the House we will not be able to make any substantial improvements to the ACA.

              The Supremes on the right wing should bear some blame for ruling against Medicaid expansion and allowing it to be voluntary.  The individual state Republicans who voted against Medicaid expansion should bear the rest of the blame.

              And yes, let us keep working to improve the law and elect more and better Democrats to office on all levels..

              •  So thats a nobody ty nt (0+ / 0-)

                Join the DeRevolution: We are not trying to take the country, we are trying to take the country back. Get the money out of politics with public financed campaigns so 'Of the People, By the People and For the People' rings true again.

                by fToRrEeEsSt on Mon Apr 14, 2014 at 12:36:12 PM PDT

                [ Parent ]

                •  Hardly, I just haven't (1+ / 0-)
                  Recommended by:
                  fToRrEeEsSt

                  kept track of all the bills that have been developed but never made it to the floor...

                  •  Well to be honest I do have to admit such, (0+ / 0-)

                    bills have been drafted, but show me any diaries to get us to back them or moves on the part of the collective Dems to get such legislation through.

                    Its not that nobody is trying (even my posts could be regarded as trying), but that there is no strong movement within either party to actually do it.

                    Join the DeRevolution: We are not trying to take the country, we are trying to take the country back. Get the money out of politics with public financed campaigns so 'Of the People, By the People and For the People' rings true again.

                    by fToRrEeEsSt on Mon Apr 14, 2014 at 01:05:05 PM PDT

                    [ Parent ]

        •  I Don't Think You Know What a Strawman Is (0+ / 0-)

          You said all we hear on one side is it's great, and all we hear on the other side is it's terrible.

          I just told you explicitly that--even among it's biggest fans--our position is "There are real flaws that need workable solutions."

          Where are the people who are saying everything about it is only great?  That was your claim.  Those were your words.

  •  You have said it--she would have been covered (113+ / 0-)

    by Medicaid. Cast thine aspersions there. If you stay here long enough, you will see a regular Florida Death Count from the lack of a Medicaid expansion by their governor. It's not the fault of the ACA, imperfect as it is, it's not the fault of Democrats.

    It's the fault of those who are actively sabotaging the law to make as many people die as they possibly can.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White -6.00, -5.18

    by zenbassoon on Sun Apr 13, 2014 at 09:18:05 PM PDT

  •  There is still a great deal of work to do, no (60+ / 0-)

    question.

    Thanks for sharing your story, and for all you do.

    I think where we are is better than where we were. I think the failure of states to expand medicaid is an impressive bit of evil and I hope the people of those states will rise up and insist that their lawmakers make it right.

    And I hope that once we get the Republicans to accept that the ACA is here to stay that we can get to work on quite a few needed fixes, and that this will happen sooner rather than later.

    No question: a high deductible medical plan, a chronic condition, and a low income is not a good place to be, and never has been.

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

    by elfling on Sun Apr 13, 2014 at 09:20:14 PM PDT

  •  Take heart, McCamy Taylor, (24+ / 0-)

    and be of good cheer. Legions of liberals swore, if we'd all just back off our criticisms of the extremely flawed ACA and support its passage, the very next priority would be to pressure our elected officials to fix its myriad problems. (Those of us who argued its passage would mark the end of serious health care reform efforts for years to come were told we didn't understand politics.)

    Please reassure Opal that there's only three years remaining before states can begin to institute single payer systems, and that Texas will likely get on board with that within the next decade or so.

    Rupert Murdoch to Fortune Magazine, 4/10/14: "I could live with Hillary as President." I don't doubt that for a second.

    by WisePiper on Sun Apr 13, 2014 at 09:25:11 PM PDT

    •  You aren't helping (24+ / 0-)

      by casting snarky aspersions while Opal may very well be dying.

      It's true. You understand neither politics nor how to be human.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sun Apr 13, 2014 at 10:11:02 PM PDT

      [ Parent ]

    •  Texas on board with single payer in a decade? (39+ / 0-)

      Do you measure decades the way those who believe in the six day creation of Earth but also know the universe is 13+ billion years old measure the days of creation - i.e., a decade could actually be eons?

      Every anti-ACA person who claims that those of us who support the law see it as flawless is setting up the flimsiest of a strawman.  We know the ACA was a product of a dysfunctional congress and that our fondest dreams of single payer or public option were just that - fond dreams - given the likes of Ben Nelson and Joe Lieberman, and that once Scott Brown was elected we had the narrowest of time frames within which to get something passed.

      And if you think we would have something better today, after the elections of 2010, I have a bridge to sell you.

      •  You're pedaling the same sorry excuse that's (28+ / 0-)

        always trotted out to defend the indefensible.

        The first rule of effective politics is to strike while the iron is hottest. The second is to never, NEVER negotiate with yourself, while laboring under the ridiculously naive assumption that your opponent will reward your sporting gesture by pre-conceding elements of their own wish list.

        The PPACA passed under the terms of a simple majority budget resolution. All those absurd "compromises" offered up to get a filibuster proof majority ultimately proved unnecessary.

        Health care delivery had reached a crisis point. The public was demanding something be done. If a far stronger ACA, including the promised public option, could not pass in that session, it assuredly would have passed in the next - the crisis was not going to resolve itself.

        Premature passage of this deeply flawed health insurance reform legislation took all the pressure off, and ensured that health care reform will not be revisited for many years into the future.

        An analogous situation is the effort to raise the minimum wage. Depressed purchasing power among those at the bottom end of the economic pyramid has become a crisis - a crisis that is driving the demand for reform. So what the fuck does our brilliant President propose? Ten freaking ten per hour. In the vast majority of this nation's urban and suburban areas $10.10 per hour is not a living wage. Fifteen is the bare minimum needed to keep your head above water and maintain food and domicile security.

        Do you think $10.10/hr is going to be easier to pass than $15/hr. Here's a clue - it won't be.  Hell, $7.26/hr would generate the same resistance and faux outrage from the Republicans and their "job creator" constituents.

        On major issues like health care delivery and the minimum wage (as well as with many others) you're lucky to get ONE bite of the apple every generation. Fuck it up at your peril.

        Passage of a $10.10/hr minimum is guaranteed to lock tens of millions of Americans into an impoverished wage slave existence for many, many years.

        Don't lecture me about politics - you haven't got a fucking clue. Sell your bridge to some other sucker who doesn't understand the concept of counter-productive pressure release.

        Rupert Murdoch to Fortune Magazine, 4/10/14: "I could live with Hillary as President." I don't doubt that for a second.

        by WisePiper on Sun Apr 13, 2014 at 11:35:00 PM PDT

        [ Parent ]

        •  Good lord. Between your nasty attitude (12+ / 0-)

          and your belief that the President fight the unwinnable - and potentially disastrous - battles, you're quite the addition to this site.  I know it takes all kinds to make the world go round, but it's unfortunate it's taking all kinds to keep this site going.  It used to consist of intelligent, thoughtful sharing of information; now it consists of posts like yours.  Ugh.  

        •  *rolls eyes* You appear to be one (37+ / 0-)

          of those locked into some sort of spiral of anger because we didn't get what YOU KNOW TO BE THE TRUTH.   It never occurs to people like you - not once - that the alternative to what we were able to achieve is NOTHING.

          "The public was demanding something be done. If a far stronger ACA, including the promised public option, could not pass in that session, it assuredly would have passed in the next - the crisis was not going to resolve itself."

          WHA???  You know for a fact that the public option would have passed in the next session?   Assuredly?  That statement alone proves no one should be listening to you.  You also state that the public was demanding somehting be done. It was. It's called the ACA and support for it is going up. The 2012 election was, in part, about the ACA. He won re-election.  

          "Passage of a $10.10/hr minimum is guaranteed to lock tens of millions of Americans into an impoverished wage slave existence for many, many years."

          Again, wha?  How does $10.10 "lock tens of millions of Americans into an impoverished wage slave existence for many, many years" more than $7.25 except in so far as you know everything and you have the best strategy ever?

          Stay angry, stay in delusion.

          •  Heh, wouldn't have written my reply, (4+ / 0-)
            Recommended by:
            Cedwyn, duhban, Shawn87, Denver11

            if I had seen yours...

          •  The entire Dem approach was weak & flawed (16+ / 0-)

            from day one.

            What should have been done--as I argued over and over at the time, though not on this site--was very different. The acute insurance crisis involved rescission of policies, pre-existing condition exclusions and all the other amoral profit-driven insurance industry abuses chronicled in Michael Moore's "Sicko." There was a broad national consensus that that stuff had to change, not somewhere down the road but right away. A stand-alone bill enforcing those popular reforms would've passed easily; I guarantee you it would've had some Republican support.

            Once that was in place the Democrats, including-but-not-limited-to President Obama, Harry Reid, Nancy Pelosi and the rest of the Party leadership, would've been free to stump the country advocating Single Payer as the real future of American healthcare; crucially, this would have been Single Payer branded as Medicare-for-All, because almost all Americans--certainly a solid majority--understand how successful Medicare has been. Even the reddest of red states are full of aging parents and grandparents.

            Now, I don't guarantee that Medicare-for-All would ultimately have passed into law. But, with the "Sicko" reforms already in place and the immediate crisis alleviated, the Dems would've been in a far stronger position to use Medicare-for-All as a starting place to hammer out a compromise national insurance plan that would've been stronger and helped more people than the weak and overly-complex ACA.

            An enormous historical opportunity missed. Whether this failure was primarily the result of political cowardice or more the outcome of a venal defense of the economic "health" of the insurance industry, I don't know and honestly don't much care.

            Fascism in the mirror is nearer than it appears.

            by PhilJD on Mon Apr 14, 2014 at 09:39:59 AM PDT

            [ Parent ]

            •  That isn't compelling to say the least. (2+ / 0-)
              Recommended by:
              Aquarius40, Denver11
              The acute insurance crisis involved rescission of policies, pre-existing condition exclusions and all the other amoral profit-driven insurance industry abuses chronicled in Michael Moore's "Sicko." There was a broad national consensus that that stuff had to change, not somewhere down the road but right away. A stand-alone bill enforcing those popular reforms would've passed easily; I guarantee you it would've had some Republican support.
              "A consensus that that stuff had to change" just leaves out, "change to what?"  You assume there would be Republican support to cause insurance companies to allow all the benefits that ended up in the ACA with regard to insurance companies but without a mandate to buy insurance.  Because the problem was "acute".  Where does that suddenly cowed and concerned republican come from?  1972?

              Any thinking person would argue that such reforms would bankrupt the insurance companies and cause people to be unhealthy as people waited to become sick before they signed up.  I guess the assumption is that everyone would simply be surprised by that outcome and then would have no choice but to call on the government through taxes pay for it.  It's more realistic that people can see more than one step down the road and that they would have to want the government through taxes to pay for health care first.

              I guess if I were to assume that republicans were to somehow allow the imposition of a reform that would put private insurers out of business, yeah, I'd also see the dems has being in a stronger position to negotiate a national single payer program.  I could also assume that all the republicans are caught strangling hoboes down at the railyard and see dems in a stronger position too.

              And:  

              because almost all Americans--certainly a solid majority--understand how successful Medicare has been. Even the reddest of red states are full of aging parents and grandparents.
              The House just passed another budget ending Medicare as we know it.  That's how far we are from extending it; there's a constant call for eliminating it.

              The dossier on my DKos activities during the Bush administration will be presented on February 3, 2014, with an appendix consisting an adjudication, dated "a long time ago", that I am Wrong.

              by Inland on Mon Apr 14, 2014 at 01:01:43 PM PDT

              [ Parent ]

              •  The two Maine Senators would've voted for (4+ / 0-)
                Recommended by:
                JesseCW, LaEscapee, TheMomCat, Cassiodorus

                the limited reforms I outlined. Probably Scott Brown as well, maybe even our our esteemed Mark Kirk. Maybe one or two others.

                More than enough, even if we use the bogus 60 vote threshold.

                Fascism in the mirror is nearer than it appears.

                by PhilJD on Mon Apr 14, 2014 at 02:13:35 PM PDT

                [ Parent ]

                •  No, they wouldn't have. (1+ / 0-)
                  Recommended by:
                  Denver11

                  Not leaving funding out of the equation, and there's no reason to believe they would go with public financing.

                  You may see the value in a catastrophic end of private insurance as a means to force public financing.  But there's no evidence any legislator does, or that they would somehow stumble into it by mistake.

                  In the meantime, 24 states refuse basically FREE single payer financing, the House votes again to change medicare as we know it.  I like to think of that as evidence of resistance, not proof that the resistance could have been overcome if we had just bluffed our way through it.

                  The dossier on my DKos activities during the Bush administration will be presented on February 3, 2014, with an appendix consisting an adjudication, dated "a long time ago", that I am Wrong.

                  by Inland on Mon Apr 14, 2014 at 02:50:21 PM PDT

                  [ Parent ]

          •  Making it personal. Attributing base motive. (3+ / 0-)
            Recommended by:
            JVolvo, TheMomCat, denise b

            and just a little borderline ad hominum-ing

            Always classy
            Always PERSUASIVE.

          •  No, the problem is (3+ / 0-)
            Recommended by:
            TheMomCat, WisePiper, denise b

            We never even talked about single payer and "the public option" was only ever a pipe dream, half heartedly advanced to keep the coalition together. This isn't "the best we could do". It was the only thing we tried.

            "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 Mon Apr 14, 2014 at 01:20:40 PM PDT

            [ Parent ]

            •  Wrong. I actually attended an Obama speech (0+ / 0-)

              in Raleigh NC, of all places, where he touted support for the public option.  It was not then, and still is not now, a passable option, as much as we clap for it.  At some point in time when the R party gets over its hate-fest for all things Obama, Ds and Rs MIGHT be able to cobble together a coalition to support and pass such an option, but it just isn't in the cards right now.

        •  Holy cow are you wrong about politics (15+ / 0-)

          Don't mean to be nasty but if you're telling folks they "haven't got a fucking clue"...

          "If a far stronger ACA, including the promised public option, could not pass in that session, it assuredly would have passed in the next - the crisis was not going to resolve itself."

          I find it hard to believe that anyone would actually think that... That if the ACA hadn't been passed, this country would have gone BACK to health care reform, and it would be STRONGER??  And would that be before or after Republicans won the house in '10?  Do you follow politics at all?

          "Do you think $10.10/hr is going to be easier to pass than $15/hr. Here's a clue - it won't be."

          Yes, it would be.  15/hr would be by far the highest the min wage would be in HISTORY, in real dollars.  10.10 would be, adjusted for inflation, the highest since the '60s.  10.10 is realistic and makes sense, 15 would be BAD for the economy.

        •  I'd almost tip this comment (9+ / 0-)

          for the perspective it offers. But your personal insults are unhelpful. Why resort to them? When you tell somebody with a view different from yours, conscientiously arrived-at, that they "haven't got a fucking clue," you serve to discredit yourself.

          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 Mon Apr 14, 2014 at 07:18:49 AM PDT

          [ Parent ]

          •  Well, I appreciate the almost-rec. (14+ / 0-)

            Perhaps the tone of my comment was overly angry, but its genesis was the smug condescension of the poster I was responding to - the guy implying I'm so naive about politics I'd be a willing purchaser of the bridge he's selling.

            In truth, I AM angry. I'm angry that after five years of witnessing this President pre-concede negotiating points on every issue, large and small, there are still so many in our community here who think whatever got achieved is the best that could have been achieved.

            And I made the analogy with the minimum wage because, once again, we're supporting a policy that, once enacted, drastically takes the wind out of the sails of real reform.

            I'm angry that so many of us here believe that a sub-poverty level wage of $10.10 per hour is actually going to be easier to pass than a barely sufficient $15 minimum wage. How can anyone have paid attention these past five years and NOT understand that, with the current crop of Republicans, it's not the cost of the reform that matters, but the very reform itself.

            Rupert Murdoch to Fortune Magazine, 4/10/14: "I could live with Hillary as President." I don't doubt that for a second.

            by WisePiper on Mon Apr 14, 2014 at 08:31:22 AM PDT

            [ Parent ]

            •  THIS I will tip: (6+ / 0-)
              In truth, I AM angry. I'm angry that after five years of witnessing this President pre-concede negotiating points on every issue, large and small, there are still so many in our community here who think whatever got achieved is the best that could have been achieved.
              It's an entirely reasonable criticism of this president, and one I often make variants of myself. In the face of perfectly avoidable human misery, damn it, the pace of change IS glacial.

              But I couldn't disagree with you more passionately here:

              And I made the analogy with the minimum wage because, once again, we're supporting a policy that, once enacted, drastically takes the wind out of the sails of real reform.
              Since Ronald Reagan's inauguration, nationally, the Republicans have been cleaning our clocks. For decades, they've made great progress advancing their legislative aims and getting their candidates elected, at federal and state levels. Why? Different people make different arguments, and probably, they're all right in whatever measure. But here's something that's not discussed too much. The Republicans understand playing for the long term. In a given contest, they can take a 10% or 20% win, and get up again, and work with that, and the next time, the outcome is 40% of what they wanted. And so on. Us, if a given outcome isn't 100% if what we wanted on the first go, we go all to pieces. It's a "failure." We have no sense of perspective, and this, as much as any single factor, forever kicks our asses.

              So, no, I don't believe any progressive fervor has diminished with the inauguration of the ACA, or with the impending success of the minimum-wage hike. On the contrary. I see these part-victories as encouraging us and stoking our fires.

              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 Mon Apr 14, 2014 at 09:30:35 AM PDT

              [ Parent ]

              •  Not one of the GOP's successes in recent decades (10+ / 0-)

                would've been possible without at least tacit enabling by equally-venal Democrats. Many of the Thug "advances" were actively abetted by Democrats.

                Fascism in the mirror is nearer than it appears.

                by PhilJD on Mon Apr 14, 2014 at 10:05:21 AM PDT

                [ Parent ]

                •  You are describing another (2+ / 0-)
                  Recommended by:
                  PhilJD, Shawn87

                  manifestation of progressive defeatism, other than the lack of ability to play for the long term I pointed to above. There's this sad, codependent go-along-to-get-along attitude where Republican aims are concerned.

                  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 Mon Apr 14, 2014 at 10:37:49 AM PDT

                  [ Parent ]

              •  While I think you're mistaken, (4+ / 0-)
                Recommended by:
                karmsy, JVolvo, TheMomCat, jhancock

                I applaud your commitment to continued pressure.

                Honestly though, can you really imagine that, after all the energy and capital expended to enact major policy initiatives like health insurance reform or a minimum wage increase, those same issues would be revisited in the foreseeable future?

                I contend that there comes an opportune time to capitalize on the public's demand for change. How we respond in those times is critical. After-the-fact tweaking is all well and good, but there's no substitute for getting it right the first time.

                The New Deal programs and the Great Society programs were improved upon substantially over the course of years following their enactment. That was only possible because both parties, despite their very different philosophies, were committed to achieving what's best for America. We live in a very different world now.

                Rupert Murdoch to Fortune Magazine, 4/10/14: "I could live with Hillary as President." I don't doubt that for a second.

                by WisePiper on Mon Apr 14, 2014 at 10:12:00 AM PDT

                [ Parent ]

            •  Well, he DID get the Sequester. So there's that. (0+ / 0-)

              Clive is the man! Woooo! HAHAHAHAHA! Teh martyr weeps tonight...

              by JVolvo on Mon Apr 14, 2014 at 11:45:05 AM PDT

              [ Parent ]

            •  asdf (0+ / 0-)

              Taking steps help. Sadly, much of America is pretty damn ignorant. I don't blame them. Beaten down with the day to day drudgery of trying to survive (I understand the beaten down aspect of things, as I experience it, I just don't have cable and am a compulsive reader). Makes it easy to be preyed upon by all the damn hucksters out there.

              But, trying to double the minimum wage would not work. You would have too many people freak out out over fear of losing their jobs. So, instead, we can try to push forward a small, meager increase. And hope it can go through. Or that republicans choke on their opposition to such a small, pitiful increase, get more Democrats in office, and still push through the small increase.

              Hell, push through $7.26/hr. Then, when the world doesn't end, you will find a larger portion of the populace being willing to consider further improvements. It won't stop a significant portion (around 27%) of the populace from enjoying being lied too, but it is a step in the right direction. Ultimately we can't persuade everyone to our side, but, the more we can show that Republican policies are absurd and not beneficial to the US, the better off we as a party and we as a country will be.

        •  Then we would have had nothing. (11+ / 0-)

          Nothing.

          Well, of course, you would have had the satisfaction of saying, "We may not have health insurance, but at least I can say we fought to get everything I wanted, or accepted nothing at all!  So we have nothing at all.  I WIN!".

          Geezus.

          btw, I've yet to find one single person who can define the "Public Option", other than to give some vague idea of a concept.

          Give me a complete detail of the "Public Option" that Congress was willing to consider and pass.  How would it work and under which circumstances?  Who would qualify? Details please, and links.  Keep in mind, Pelosi passed a public option that only covered a couple of million people under strict circumstances.  So what "Public Option" plan are you talking about?  Does such an actual public option plan proposal even exist?

          •  You are peddling that same fallacy (6+ / 0-)

            that the only choices were the ACA or nothing. Despite what the Democrats would like everyone to believe, it's simply not true.

            The Democrats could have passed anything they wanted, up to and including Medicare for all. They had the power to do it. The reason we got the ACA is because it's the exact bill that the Democratic leadership wanted, not because nothing else could have been passed.

            And that's a simple fact.

            •  You're misstating history. There was no consensus (3+ / 0-)
              Recommended by:
              edwardssl, poco, Shawn87

              among "Democrats".

              "Because I am a river to my people."

              by lordcopper on Mon Apr 14, 2014 at 11:21:40 AM PDT

              [ Parent ]

            •  No, that's not a simple fact, no matter how much (3+ / 0-)
              Recommended by:
              poco, Aquarius40, jhancock

              you want everyone to believe it.

              We had many more bluedogs at that time (Lieberman, Bayh, Lincoln, Nelson, Baucus, etc) blocking what we really wanted to get done on health care. In addition, Al Franken's swearing in was delayed months because of the recount, after which the Dems only had a few short months of 60 Dems in the Senate before Scott Brown's election pushed us back to 59.

              We could NOT get past the 60 votes we needed to move the legislation forward.  And you know it.

              •  Yes it is a simple fact (2+ / 0-)
                Recommended by:
                TheMomCat, WisePiper

                The Democrats could have done away with the filibuster at any time with 51 votes. And you know it.

                •  As you will recall (0+ / 0-)

                  (or maybe you don't want to), Senate Dems couldn't even get the public option out of committee to become part of the legislation, due to obstruction of the repubs and the blue dogs.

                  You SHOULD know that.

                  •  The public option didn't get out of committee (0+ / 0-)

                    because DEMOCRATS blocked it.

                    The Democrats had a majority on the committee, just as they did in the full Senate. They could have passed anything they wanted to. We could have had Medicare for all if only the Democrats had voted for it.

                    •  Well duh, I said all along that bluedogs helped (0+ / 0-)

                      block it.

                      Thanks for acknowledging that fact.

                      You accused Dem leadership of blocking it.  Per the article I linked to, that's a demonstrably false statement.

                      The Senate Finance Committee on Tuesday rejected two amendments to include a government-run public health insurance option in the only compromise health care bill so far.

                      The amendments by Democratic Sens. Jay Rockefeller of West Virginia and Charles Schumer of New York were opposed by all 10 Republicans on the committee and a few Democrats, including committee Chairman Sen. Max Baucus of Montana.

                      The White House responded to Tuesday's actions with spokesman Reid Cherlin repeating both President Barack Obama's support for a public option -- and also his willingness to consider other proposals.
                      •  Blue Dogs are still Democrats (0+ / 0-)

                        Try as you might, you can't blame this one on Republicans.

                        The Democrats had the power to pass anything they wanted. We got the ACA instead of Medicare for all because that was what the Democrats wanted.

                        Not the Republicans. The Democrats.

                        •  The fact that the vast majority of Dems (1+ / 0-)
                          Recommended by:
                          sviscusi

                          wanted what we wanted, while none of the repubs did, makes no difference to you whatsoever.

                          The Dems did not have the power to "do whatever they wanted".  That is a line of unadulterated bullshit.

                          But you've already decided that you're going to believe what you want to believe in advance.

                          Which makes this conversation an exercise in futility.  And since I have more important and constructive things to do with my time and energy, I'll just mosey along now.

                          Have a nice day.

        •  And your plan for getting Lieberman's vote was? (11+ / 0-)

          Yeah, I didn't think so.

          It's all well and good to be self-righteous, but we didn't have 60 at the time. We had 57 plus a couple persuadables, plus Lieberman.

          If it had been delayed do you think all the lobbyist money pouring in would have made the bill better? Do you think waiting until 2010 when the R's predictably (off-cycle following a wave election) made gains would have been better?

          If we followed the path your indignation dictates we'd be right back in 1998 again, with no reform and people like your friend stuck with junk insurance that would screw her on the front and back end.

          We can do better than the ACA, but it's a first step and it will lead to a better healthcare system here.

          "Emancipate yourself from mental slavery. None but us can free our minds." - Bob Marley

          by nightsweat on Mon Apr 14, 2014 at 09:29:48 AM PDT

          [ Parent ]

        •  So it's Obama's fault that TX GOP Gov is a jerk? (5+ / 0-)

          Because the reason Opal is in this predicament is because she lives in a state whose Republican governor won't allow Medicaid expansion, as the diarist states right in the very first paragraph of this diary.

          Visit http://theuptake.org/ for Minnesota news as it happens.

          by Phoenix Woman on Mon Apr 14, 2014 at 11:09:39 AM PDT

          [ Parent ]

        •  it assuredly would have passed in the next session (0+ / 0-)

          Hmm ... I don't need my own witnesses and testimony to prove the idiocy of your argument, I'll just use your own words.

          If resistance was the modus for the Rs, then how in the hell were we supposed to move forward with a Republican congress after 2010?  I suppose you can argue that without the ACA, there wouldn't have been a 2010 R takeover of the House, but that is a pretty tenuous argument, since the recession was still lingering and the Senate still couldn't pass the necessary stimulus to really get us moving.

          Nope - while we can debate the finer points of how the ACA was pushed and passed, just remember that it was the limitations of the Democratic Senate and Democratic Blue Dogs that defined the limits of what could be done, in the context of a united R resistance.

    •  "within a decade" probably won't do Opal any good. (3+ / 0-)
      Recommended by:
      WisePiper, PhilJD, TheMomCat

      "The long memory is the most radical idea in this country." Utah Phillips 1935 - 2008

      by Grey Fedora on Sun Apr 13, 2014 at 11:59:02 PM PDT

      [ Parent ]

    •  the end of reform? (1+ / 0-)
      Recommended by:
      Shawn87
      Those of us who argued its passage would mark the end of serious health care reform efforts for years to come were told we didn't understand politics.
      I guess I missed all of that serious health care reform that had been going on prior to the ACA that has now ended.
    •  TX gov nixes Medicare expansion, ACA's to blame. (2+ / 0-)
      Recommended by:
      Shawn87, Aquarius40

      Gotcha.

      Visit http://theuptake.org/ for Minnesota news as it happens.

      by Phoenix Woman on Mon Apr 14, 2014 at 11:06:40 AM PDT

      [ Parent ]

  •  That's not how we roll (53+ / 0-)

    telling people that our issue is more important than theirs, so just shut up. No, we want to hear you loud and clear, and we want to magnify your voice. We would like to invite Opal here, and any others you know in similar trouble, or similarly trying to help. If that works for them.

    It is Republicans who just need to shut up and allow us to save tens of thousands of lives each year, and many more fortunes, and the ability of many more to avoid becoming disabled and unable to work or otherwise contribute to our society.

    Who gave you that notion, that they think you should just shut up? I need to have a word with any such person, and bring a few others with me.

    I write the ACA Signups Diaries, which I took over from Kossack brainwrap, where we celebrate the millions who now have coverage of various kinds, and discuss how to apply that information to electoral and other political strategies. We do not circle the wagons. We also go on quite regularly about the millions more who did not get the coverage they need, whether from a broken Web site, or from a lying insurance company, or from a broken Republican Party standing athwart history shouting, "Die!", to paraphrase Bill Buckley. We talk about how to take back Congress and various statehouses this fall. We talk about how to embarrass and pressure Red state governors and others who are standing in the way.

    I am also the second member of the Obamacare Saves Lives group after JoanMar. There we celebrate lives, fortunes, and sanities saved by providing affordable care, individually and by the millions, and the political actions aimed at saving many more. And we also go on at great length about lives not saved because of Republican intransigence. (I am republishing this Diary to the group as soon as I finish this comment, and I will send people your way from the ACA Signups Diary tomorrow.)

    Now, what else do you need us to do? That's not snark. How can Kossacks help fix Texas, besides joining Battleground Texas and working to turn Texas Blue in some future election, or assisting the Wendy Davis campaign? Can we help you help Opal and others with other such problems right now? Can we spread the word to someplace else that would help? You tell us.

    Back off, man. I'm a logician.—GOPBusters™

    by Mokurai on Sun Apr 13, 2014 at 09:34:45 PM PDT

    •  I also felt that I was told to shut up (2+ / 0-)
      Recommended by:
      blueoasis, JayRaye

      when I asked for help with a real problem that I describe below.  Senate aides and people at HHS agreed that the problem exists, but they were not helpful.  They were not even sure just what the rules are.  The rules vary state by state, but they are not available in any accessible format on the state websites.

    •  Please ask Washington to step in. (41+ / 0-)

      I believe that the WH promised to use its regulatory power to make sure that insurance exchange plans lived up to the law. From what I am seeing and hearing, this is not happening. Maybe because there is so much fraud or chaos they can not be everywhere at once.  For one thing, I think that there is a minimum number of local providers that have to be on an insurance plan before the plan can call itself an ACA Insurance Plan. The plans are printing provider lists--but they do not ask the doctors. They just include names. So, when the patients start calling they find out that the lists are inaccurate.  This used to happen sometimes with the old HMOs (insurance would put your name on a list if they sent you a contract even if you tore it up) but it is happening a LOT right now. And it is next to impossible for providers to find out if members are covered and what is covered and where and what deductibles are. I am guessing that Washington is mailing the checks to someone, so they have a right to demand accountability, the same way that Medicare demands accountability. Medicare is all over providers who commit fraud. HHS should be all over insurers who are not meeting the law. They could start by demanding lists of people who have signed up and then interviewing new enrollees to see what they were told at signup and what their real experiences have been. Another idea would be a 1-800 hot line for insurance issues. Impose stiff fines on insurers the way they impose stiff fines on providers who rip off Medicare.

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Sun Apr 13, 2014 at 10:50:45 PM PDT

      [ Parent ]

      •  I just want to ask (3+ / 0-)
        Recommended by:
        Cedwyn, MT Spaces, duhban

        about Medicaid and spend downs. In our state even before the ACA if you were faced with a bill you could not pay you could apply for help from Medicaid for a one time payment. You pay a percentage and Medicaid picks up the rest, it's called a spend down.

        Is that not possible in this case?

        My niece and her husband were faced with having to hospitalize their son in a psychiatric unit for over a month. Both of them made good money but nothing close to what they needed for that bill. Medicaid picked up the bill and set up a payment structure for them to pay their smaller portion of it.

        Again, this has nothing to do with ACA this was twenty years ago, nothing like this is Texas?

        Some humans ain't human some people ain't kind. They lie through their teeth with their head up their behind. You open up their hearts and here's what you'll find - Some humans ain't human some people ain't kind. John Prine

        by high uintas on Mon Apr 14, 2014 at 08:00:19 AM PDT

        [ Parent ]

  •  Haven't heard anyone say "everything is just fine" (53+ / 0-)

    now. No one. What people are saying is that the ACA has helped millions of people get access to healthcare and to be relieved of the stress of being uninsured. This is true. No one has said all is perfect now or there is no need to do anything more. No one has said that anyone should "keep quiet" about those needs either. You're just making that up, I think. Wonder why.

    The fact remains, the republicans are actively trying to undo the progress that has been made, rather than doing more. Democrats have to fight to protect the gains made and continue to push for more at the same time.

  •  ACA has a big problem for Medicaid recipients (25+ / 0-)

    There is another serious problem with ACA.  Low-income and unemployed people between the ages of 55 and 64 have to reimburse Medicaid for services they receive. Section 1917 of the Social Security Act, and federal regulations at 42 C.F.R. 435.700, et seq. says that people over 54 may have to pay 100% for all community-based services and prescriptions if a state chooses to take their assets. States can put a lien on the home while the Medicaid recipient is still alive.  If the home is sold before the Medicaid recipient's death the state can presumably take the money from the sale.  States can probably choose to grab the savings and most other assets from people who have been laid off.

    This is a partial descripton from medicaid .gov:

    State Medicaid programs must recover certain Medicaid benefits paid on behalf of a Medicaid enrollee. For individuals age 55 or older, states are required to seek recovery of payments from the individual's estate for nursing facility services, home and community-based services, and related hospital and prescription drug services. States have the option to recover payments for all other Medicaid services provided to these individuals, except Medicare cost-sharing paid on behalf of Medicare Savings Program beneficiaries.
    Most people who are 54 and younger get Medicaid for free or with token copayments. People under 55 who make a little more than the poverty level get Obamacare subsidies to help pay the premiums. Only people between the ages of 55 and 64 cannot really benefit from Obamacare in states that expanded Medicaid. Unemployed homeowners over 54 who are affected by this may have problems relocating to find new jobs. A lien placed on savings and other assets could make it impossible to pay rent and other expenses. The existence of inaccessible assets could prevent people from getting some other types of aid.

    I have called HHS and  Congressional offices. The rules do not seem to be clear to any of them. I was told that it is up to each state to decide what to do. Much of my information about the application of Medicaid liens came from a HHS memo dated Feb 21, 2014:
    This memo says:SMDL #14-001 ACA #29
    RE: Application of Liens, Adjustments and Recoveries, Transfer-of-Asset Rules and Post-Eligibility Income Rules to MAGI Individuals

    This is an excerpt with the parts that concern me most put in boldface by me:

    Under section 1917(b)(1)(B), states must also seek recovery, for Medicaid beneficiaries who were 55 years old and older when they received medical assistance, from the estates of such individuals for amounts at least equal to medical assistance paid on their behalf for nursing facility services, home and community based services (HCBS), and related hospital and prescription drug services, or, at state option, for any other items and services under the state plan (with the exception of Medicare cost-sharing). . . . .
    MAGI individuals who were 55 years old or older when they received medical assistance are therefore not exempt from the estate recovery provision in section 1917(b)(1)(B), although all of the estate recovery limitations and exceptions described in other parts of section 1917(b), including those described in section 1917(b)(2), and the exception in situations of undue hardship described in section 1917(b)(3)(A), apply.
    Due to the potential barrier to enrollment that future estate recovery may create for some individuals, CMS intends to thoroughly explore options and to use any available authorities to eliminate recovery of Medicaid benefits consisting of items or services other than long term care and related services in the case of individuals who are determined eligible for Medicaid benefits using the MAGI methodology.
    In the meantime, states have some existing authority to limit the scope of recovery for Medicaid beneficiaries. They may limit recovery based on the eligibility categories in which the beneficiaries are enrolled; for example, a state may limit estate recovery to the services under section 1917(b)(1)(B)(i) for people enrolled in the new adult group – that is those relating to LTSS.
    http://www.medicaid.gov/....

    States may limit the recovery of money spent on Medicaid recipients, but they are not required to do so.  It would be a very good idea to repair this problem as soon as possible.  The Republicans could use this as an actual, truthful criticism of ACA next fall if state laws are not changed to protect Medicaid recipients from having to reimburse states for all medical care that is not related to nursing home care.

    •  That was all true before the ACA (27+ / 0-)

      Add it to the long list of things Republicans wouldn't let us fix last time.

      Back off, man. I'm a logician.—GOPBusters™

      by Mokurai on Sun Apr 13, 2014 at 10:14:26 PM PDT

      [ Parent ]

      •  Medicaid had a means test of $2000 in many states (14+ / 0-)

        although it is $3000 in NJ.  Before ACA people were not put on Medicaid if they had any real assets other than a car, a house, and burial insurance.  ACA eliminates the asset test and is based only on income.  

        People who sign up for insurance through the exchanges may be moved to Medicaid if their income decreases enough.  People who are unemployed or have low incomes have to accept Medicaid or pay the fine for being uninsured.  

        Many people between the ages of 55 and 64 have been laid off and are living on their savings.  Others have only been able to get crummy, part-time jobs that barely allow them to get by.  Grabbing their savings may force renters into homelessness.  Homeowners may be using their savings to make their mortgage payments.  

        States are not required to do this, but ACA allows it.  States are not even providing adequate information to people who may by affected by this.  

          •  No. Before ACA the person's home was their (5+ / 0-)

            only real asset.   A lien could be put on the house during their lifetime.  If they wished to sell the house the state had to be reimbursed for Medicaid expenses before the house could be sold.  Clearly the states can put liens on assets before the person dies.  

            It does not seem to be clear to HHS if liquid assets can be confiscated before the death of the Medicaid recipient or if they can just be tied up with a lien until the person dies.  If there is a lien freezing a bank account is still useless for paying rent.

            States do not have to do this but they can.  

            •  A lien on a property does not freeze funds in a (12+ / 0-)

              bank account. And the estate recovery is just that -- estate, which implies that the recipient is deceased.

              •  State can prevent sale of the property during the (3+ / 0-)
                Recommended by:
                terabytes, Shockwave, Cassiodorus

                lifetime of the Medicaid recipient.  The lien can be placed during the lifetime of the Medicaid recipient for people over 54.  

                Obamacare decides to put people into Medicaid based on their income--without looking at their savings.  Before Obamacare Medicaid recipients could only have very limited assets according to the following government website:
                 http://aspe.hhs.gov/...

                Recipients may own $2,000 in general savings ($3,000 for a couple), limited amounts of life insurance, burial funds, household and personal effects, and certain other types of assets. Medicaid rules generally mirror those of the Supplemental Security Income program (SSI). SSI rules on assets ("resources") are available in the Code of Federal Regulations, Title 20, Part 416, Subpart L
                at:

                http://www.ssa.gov/....

                Obamacare removed the asset limit in states that expanded Medicaid.  Homeowners did have an exemption on their house:

                The home retains an exemption from estate recovery only if the recipient is survived by a spouse, a minor or disabled child or, in limited instances, certain siblings or adult children living in the home. In all other cases, the deceased recipient's equity interest in the home may be subject to estate recovery.
                The homeowner exemption would not apply to savings and similar assets.  I called HHS and asked about liens and possible asset confiscation under Obamacare, but they said it would be up to each state to decide what to do.
                There does not seem to be any information available about "pre-death" liens on savings and the new effects of Obamacare.  This was not really an issue when Medicaid recipients could have almost no assets other than their homes.  
                See the footnote about TEFTRA at http://aspe.hhs.gov/... :
                TEFRA or “pre-death” liens are permitted under section 1917(a) of the Social Security Act. Detailed Federal guidance is in Sections 3810.A.1. and F. of the State Medicaid Manual.

                It is not clear if it is relevant, but disabled people who win legal settlements may have to pay for Medicaid care as well.

                •  It might be helpful to cite the language (19+ / 0-)

                  on which you rely.

                  Sec. 1917. [42 U.S.C. 1396p] (a)(1) No lien may be imposed against the property of any individual prior to his death on account of medical assistance paid or to be paid on his behalf under the State plan, except

                  (A) pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of such individual, or

                  (B) in the case of the real property of an individual

                  (i) who is an inpatient in a nursing facility, intermediate care facility for the mentally retarded, or other medical institution, if such individual is required, as a condition of receiving services in such institution under the State plan, to spend for costs of medical care all but a minimal amount of his income required for personal needs, and

                  (ii) with respect to whom the State determines, after notice and opportunity for a hearing (in accordance with procedures established by the State), that he cannot reasonably be expected to be discharged from the medical institution and to return home, except as provided in paragraph (2). [para 2 does not apply here]

                  No lien except on real property means no lien -- not on bank accounts, not on IRAs, not on jewelry. Pre-death: real property. Post-death: the estate as defined by state probate laws, including bank accounts, etc. (There are also some annuity-related provisions in longterm care situations, but they're not liens.)

                  As my mother used to say, you're borrowing trouble.

                  Find me a single state law or regulation to the contrary -- imposing without court order a pre-death Medicaid lien on personal property for services properly provided or paid for -- and that would advance the discussion, and perhaps change my view. I haven't read every state's laws to see if they're complying with sec. 1917, or tried to figure out whether they've found a loophole in it. (HHS refusing to give you a legal opinion on state law is irrelevant to this analysis. I'd expect nothing different.)

                  Until then, you're fear mongering.

                  BTW, Medicaid liens don't prevent the sale of property. They just direct where some or all proceeds go. And the lien is dissolved if the person returns to the home after a nursing home stay, even if Medicaid paid for the nursing home.

                  •  Fearmongering? This has trashed my life. (1+ / 0-)
                    Recommended by:
                    Cassiodorus

                    Six weeks age I had planned to move to a blue state.  My car is still loaded and everything is in storage.  Then I read about the Medicaid liens while I was waiting for the weather to clear.  Now I am living in a rented room trying to decide what to do.  Not that any of you care.

                    If the discussion you quoted about the estate recovery limitation had been the first thing I had read I would not have been worried about this.  However I called HHS and state agencies to try to find out what the rules are.  Many of the people I talked to had never heard of Medicaid liens or estate recovery.  Several people told me that if a house is sold the money for Medicaid has to be paid back to the state at the time of the sale.  They thought that all other property had to be sold to reimburse the state as the medical expenses were incurred.    

                    Some of them implied that people who lose their jobs are a bunch of deadbeats who should pay the state back when they are generously allowed to have medical care.  Apparently they feel that Obamacare subsidies are for honest, hardworking people and Medicaid is for lazy, poor moochers.  Never mind that most of us who have been laid off earned our savings by working.  There are plenty of bureaucrats and politicians who feel that liens on the property of moochers are a good idea and prompt confiscation of the property would be even better.  Even if they grab assets in violation of federal rules it will be almost impossible to get the money back.  There are also several conflicting versions of the HHS rules.  The states all seem to have their own version of the rules.

                    I kept detailed notes of my calls and downloaded hundreds of pages of documents.  I meant to write a diary and ask people to help correct this problem before the fall elections.  It is clear that there are too many Obamacare fundamentalists here.  This is not a football game between a blue team and a red team.  This is my life.  This was Opal's life.

                  •  many states have expanded recovery beyond probate (0+ / 0-)

                    and will seek to recover upon a Medicaid recipient's death from any asset, not just probate estate assets - life insurance, jointly owned property, etc.

                    If you act out of anger, the best part of your brain fails to function. - the Dalai Lama

                    by beverlywoods on Wed Apr 16, 2014 at 04:14:49 AM PDT

                    [ Parent ]

                •  if you have significant (0+ / 0-)

                  assets and savings and very little income, you can still liquidate something or borrow against it and use the money to buy regular insurance, no one can force you to take medicaid.

                  If you want to keep all your assets and get subsidized medical care on Medicaid,  then you are arguing against the basis of Medicaid as it has always been,  you couldn't qualify if you had significant assets in the past.  

                  •  So the poorest people have to pay for all care (0+ / 0-)

                    In the state where I live a 60-year-old woman who makes $12,000 per year gets about $8,000 in Obamacare subsidy to buy insurance.  http://kff.org/...

                    The same woman will get nothing if she only makes 11,000 per year.  If Medicaid is expanded she may have to pay the state back for every bit of medical she gets.  This will be up to the state.  Apparently a lot of you think this is fine.

                  •  Isn't it a little absurd (0+ / 0-)

                    now that we're subsidizing people with a just a little more income than those on Medicaid, and not looking at their assets at all, and not trying to take back their assets, to be doing this to people who are even poorer?

                    The entire structure of the ACA should have generated a viewpoint shift on Medicaid recipients. It makes no sense to single them out when so many other people are getting subsidized care now.

                    •  if you want medicaid revamped (0+ / 0-)

                      because it has always taken what few assets the poorest people had,  and what assets middle class people had if they entered long term care,  then fine, lets talk about that.

                      The long term care rules are what are in play, not a simple doctor visit.  To take something away, that means that the person acutally had substantial assets of some sort or another, which most poor people don't have.    Look at who owns houses,  it pretty much isn't people making ten to twenty thousand dollars a years unless they are older people who have the house, but now can't work and don't have substantial income.   They won't take a house as long as that person is alive, or if a spouse survives, they don't take it from the spouse, if a parent has a disabled child living at home, they won't take it from the child either.   So what we are saying, if you need care that will cost $50-60  thousand or more a year,  you can't leave your house to your kids and let the government pay your bills at the nursing home.  That is harsh, but it isn't harsh in the way the diarist is portraying it.

                      Right now I am spending down all my mom's assets as she is no longer able to take care of herself.  I didn't try to hide them or move them to my name years ago so that she could immediately go on medicaid.  Others may feel differently, in fact I know they do, I get calls all the time about moving assets so the kids get the house/money while medicaid pays for the nursing home.

                      If we could go to national single payer, cradle to grave, all conditions, we could avoid this.   But right now, this really isn't a huge problem.  No one is forced out of their home while alive.  The issue is the amount of money they live to their kids.

        •  You are not representing the situation accurately. (24+ / 0-)

          We've been over this many times here. I refer you to, among others, the diaries of kossack beverlywoods.

          There is a genuine fairness issue that it would be nice to fix, but you are misrepresenting it in nature and scope. Sorry I don't have to go over it yet again, but you can read prior diaries to get the gist of the facts and arguments.

          Meanwhile, if you are advising anyone over 54 to go without any insurance rather than go on Medicaid, you are doing them no favor. That puts their assets at much higher risk than potential estate recovery, and while they are still alive. On the other hand, anyone who can afford a private plan or adjust their income to become eligible for subsidies might be well advised to do so rather than go on Medicaid. But it varies greatly by state and personal circumstance.

        •  It is a feature of our system that public (2+ / 0-)
          Recommended by:
          Shockwave, Shawn87

          corporations (governmental organizations) are directed by positive directions -- what they may or must do.
          The Cons like being prohibitive, so they keep pushing laws which seek to restrict agents of government (e.g. DADT). But, there's a good practical reason for not trying to direct with negatives. Prohibitions don't work, if only because they are easy to evade. It simply isn't possible to enumerate all the permuations of things we don't want to happen.
          "You must do this and that and nothing else" is a simple directive. Only what's mentioned is authorized.

          Individual behavior, on the other hand, is presumed to be good (the adjunct to innocent until guilt is proven), so no directives in the law are called for. Even our participation in government as citizens is entirely optional (jury service can be excused for cause and taxes don't have to be paid, if the currency isn't used). This is not to say individuals won't do bad; only that one-off crime can't be stopped and the best we can hope for is to prevent repetition by the same person (bad actors are not deterred by another's bad experience).  We can afford to assume the individual does good until he does bad because the amount of bad one person can do is limited (unless he's got weaponry he shouldn't have). That's not the case with associations or non-governmental corporations. Which is why it is inappropriate to consider them as individual persons and why they should be regulated via their charters with duties and obligations at the outset. That they are not is the fault of the legislative bodies (mostly in states) which refuse to set appropriate standards and regulations and deny the executive mechanisms to enforce them.
          ALEC is well named in identifying the weak link and then aiming to break it for the advantage of corporate entities which resist any form of restraint.

          http://hannah.smith-family.com

          by hannah on Mon Apr 14, 2014 at 01:07:16 AM PDT

          [ Parent ]

      •  "Republicans wouldn't let us." (2+ / 0-)
        Recommended by:
        Shockwave, JVolvo

        Let's see: how many R votes were contributed to the passage of the ACA?

        Wasn't it a big, fat ZERO?

        In what sense does, "Republicans wouldn't let us" apply?

        The ACA was a D bill, passed by Ds and signed by a D President.  Don't go laying the blame at the foot of the Rs.  The Ds managed to fuck this up all by themselves.

    •  I think you are misunderstanding this a bit (6+ / 0-)
      Recommended by:
      otto, Cedwyn, high uintas, Alice Olson, poco, askew

      I'm opposed to means testing for health care at all but the nursing home/protection of assets thing is a bit different. We are actually facing this issue with a Great Aunt. We are paying a fortune to keep her in her home rather than asking medicaid to pay for nursing home care.  Technically that will leave her assets (house, car, stuff) untouchable after her death but the truth is that those things wouldn't cover the costs we are paying.  If we weren't there, paying for her nursing care, and she went into a nursing home why should her assets, after her death, not reimburse the taxpayers? I'm not sure why her children, if any, who did not pay for her care when they could should receive the assets?  Its a post death clawback from an estate that no longer benefits the sick person at all but is being inherited.

      •  Here's what I think. (4+ / 0-)
        Recommended by:
        marina, splashy, poco, middleagedhousewife

        We already have a problem with social mobility in the US.

        When  persons assets go to end of life care rather than to the relatives then that is another factor in declining social mobility.

        That money could go to providing an education or a house for the next generation.

        However I keep hearing this coming up like it's due to the ACA when it's really not.

        I don't really hear anybody proposing any legislation to fix it,  just using it as an excues to diss the ACA so they must mostly be republican shills.

        Personally I'd like to see the estate tax increased, the capital gains tax increased and the clawback provisions banned.

        •  Inequality grows (1+ / 0-)
          Recommended by:
          mrkvica

          When only a few in society are able to pass on the fruit of their lives' labors.

          And some of those few never have to labor at all.
          While others are broken.

          •  Yes, sure, but... (2+ / 0-)
            Recommended by:
            poco, askew

            Yes, sure, but the law applies to middle class people who have assets in the first place. Its unclear to me why a middle class person with a house and two cars should be able to be fully funded in a medicare/medicaid nursing home while their educated and affluent children then inherit the house.  This law obviously doesn't apply to the truly indigent since they have no assets.

            We have a lovely neighbor, 97 years old. She's sitting in her family house which is worth at least a cool million.  She'd be better off selling that house and living like a queen in assisted living but she is hanging on to it for her daughter. OK, that's all very well and good. But that's her decision about her care. If she went into a nursing home and took money and a space from someone who had no kids and no assets how would it be fair for her daughter to take the house and pay nothing towards her mother's care?

            •  If she lived in many countries in the developed (1+ / 0-)
              Recommended by:
              aliasalias

              world, this question wouldn't even exist.  Why is it that in the US and even here at duos we can't all seem to get the concept of health care as a human right?

              The good we secure for ourselves is precarious and uncertain, is floating in mid-air, until it is secured for all of us and incorporated into our common life. Jane Addams

              by Alice Olson on Mon Apr 14, 2014 at 09:40:59 AM PDT

              [ Parent ]

              •  You don't know what you are talking about (1+ / 0-)
                Recommended by:
                poco

                There are in fact uncovered expenses in even countries with the NHS or single payer style coverage.  And yes, people have to pay for it out of pocket or with their assets. Not all of them but some of them. I have a friend who works for a "cancer charity" in the UK. They pay for stuff for people struggling with cancer that are not covered by the NHS.

      •  That's an interesting conundrum (0+ / 0-)

        It is natural that people would attempt to protect their inheritance by using Medicaid.  

        Streichholzschächtelchen

        by otto on Mon Apr 14, 2014 at 07:18:18 AM PDT

        [ Parent ]

    •  Happened to my gramm (2+ / 0-)
      Recommended by:
      Cedwyn, Alice Olson

      Long before the ACA, my gramma was well aware of this when it came to Medicaid.  

      Streichholzschächtelchen

      by otto on Mon Apr 14, 2014 at 07:13:33 AM PDT

      [ Parent ]

    •  Another problem I've heard little about here (0+ / 0-)

      is that the Medicaid "costs" that can be recovered in estate recovery can include the costs of administering the program in states that have outsourced that.

      The cost of simply determining eligibility and supplying someone with a Medicaid card can, according to the companies, run hundreds a month.

      So if you get Medicaid between the ages of 55 and 64 and get no health care whatsoever, your state might still recover tens of thousands from your estate when you die.

      Furthermore, people who try to buy ACA plans but have too low income, or who enroll in other low-income programs like food stamps, may be auto-enrolled in Medicaid.

      Personally, I think that the wisest choice for someone eligible for Medicaid would be to take it -- your heirs would rather have you alive than your money -- but I find it horrifying that people don't know these facts.

      © cai Visit 350.org to join the fight against global warming.

      by cai on Mon Apr 14, 2014 at 05:34:00 PM PDT

      [ Parent ]

  •  Who claimed it was perfect? Straw-men don't count. (46+ / 0-)

    Medicare was passed in 1965, it needs a yearly Doc fix and the ACA added 7 years of solvency to it. Look - women and minorities can tell you that historically, 'one size has never fit all.'

    What kind of Democrat would ask another Democrat to keep quiet about the suffering of the chronically ill?

    Who asked that?......I need names.

    What kind of Democrat would ask tens of thousands of people yearly to 'die quietly' (as oppose to Republicans' DIE Quickly plan) while we wait for the Great Liberal Awakening to sweep the nation and we all get single payer?
    Some people can't afford to wait. This law, SCHIP,SSI, Medicare, Medicaid can all use a 'fix' of some sort but they're all we have until we don't.

    But hey, Republicans just voted to replace Medicare with Ryan 'could give a' care -- so there's that to look forward to.

  •  I really appreciate (11+ / 0-)

    what you are saying in this post but a question kept coming up in my mind. . .

    what would opal's experience be like without the ACA?

    And I realize that you are simply stating the obvious, that the ACA was intentionally sabotaged by the corporatist supreme court, that it was intentionally written for lobbyists to begin with, that a public option could have circumvented the refusal to expand medicare and actually work to reduce overall costs.

    The ACA will not be able to function much longer if costs are not reigned in, and we all know that the economy is not serving 80% of the population.  

    Still I sure appreciate what you are doing and what you are saying in this post.  There needs to be real, vibrant critique of current business as usual,

    this goes for climate change, economics, health care, unions, agrigulture, basically all aspects of our modern society.  It all has to change or it is all going to get flushed and recreated via massive social revolt.

    Be the change that you want to see in the world

    by New Minas on Sun Apr 13, 2014 at 10:12:15 PM PDT

    •  I'm pretty sure he's saying she would have (17+ / 0-)

      gotten free health care from the county-funded public clinic.

      •  Temporarily. (14+ / 0-)

        The county funded public clinic system was not working in Texas any more than it was working in the rest of the country. I read a long article by another Texas doctor about just how bad the prognosis was for her patients near Galveston, how ruthlessly the local hospitals were pruning indigent patients, how little treatment was available to them prior to the ACA.  

        Here's a representative sample:

        St. Vincent’s is the primary care provider for more than 2,000 patients across Southeast Texas. Our catchment area is a strip of coastal plain strung with barrier islands. Drive inland and you start to see live oaks; go toward the coast and the oil refineries loom up over neighborhoods. The most polluting refinery in the nation is here, in Texas City. Our patients are factory workers, laborers, laid-off healthcare workers, the people behind the counters of seafood restaurants.

        Most of our patients come from Galveston and Brazoria counties, but some drive two hours from Port Arthur or over from Orange, near the Texas-Louisiana border, to get to us. That’s how hard it is to see a doctor in Southeast Texas: People take a day off work to drive two hours to a student-run clinic that can only provide basic care.

        The clinic is overseen by faculty physicians—UTMB docs—who see every patient along with us students and prescribe medications. These doctors are volunteers. We are not a UTMB clinic, but we depend on UTMB, which is twenty blocks from St. Vincent’s, for training our student volunteers, for liability insurance and for running our blood tests and other labs. UTMB has given us grants, including one that helped us get our electronic medical records system, and funds a nurse-managed day clinic for the uninsured at St. Vincent’s House.

        But UTMB is no longer the state-subsidized charity hospital it used to be. The changes began before Hurricane Ike in 2008. But after the storm, UTMB administrators drastically cut charity care and moved clinics to the mainland, where there are more paying patients. The old motto “Here for the Health of Texas” was replaced by “Working together to work wonders.” Among those wonders are a new surgical tower and a plan to capitalize on Galveston’s semi-tropical charm by attracting wealthy healthcare tourists from abroad. Medical care for the poor is not, apparently, among the wonders. Whereas UTMB accepted 77 percent of charity referrals in 2005, it was only taking 9 percent in 2011.

        •  An important point (8+ / 0-)

          The diarist seems to suggest that the "free" medical system that Opal relied upon was working.  As described, preventative care, all the way up to several significant medical procedures were handed out free of charge and this has now changed due to ACA. This just doesnt ring true.  At least in my city, the free clinic is over subscribed, and treatment is minimal - as is their funding.

          Is the diarist really saying that Texas didnt need ACA because of all that free health care it was handing out?  If so, why would the ACA change this? Or is Opal being punished by Texas for having the audacity to have an ACA policy?

        •  I thought of the very same article, (2+ / 0-)
          Recommended by:
          poco, jhancock

          and linked to it below, before I noticed this comment.

          I wonder how many low-income Texans were covered by free clinics like those described in this diary, and how many were not covered, like the people on Galveston Island described in the article.

          •  The OP is talking about a county hospital (5+ / 0-)

            while the article I linked to is talking about a community clinic attached to a hospital.  So its true that in the one the OP is talking about actual surgical procedures, rather than diagnostics and palliative care only, could be performed.

            But as the article I linked to shows hospitals are not continuing the practice of taking indigent/charity patients.  And without the payments from insurers for covered care new hospitals are not going to take on new patients.  Especially in rural areas.

            There are many underserved areas of the country.  Especially rural and poverty stricken areas. Areas without enough primary care physicians, and without enough hospitals or clinics.  No single health care approach--not Medicare for all, not various other things, was going to build hospitals in those areas.  The ACA tries to leverage the buying power of all the people brought into the system and the work of the insurance company actuaries to figure out where the sickest people will be, and where the greatest demand will be, on the already existing doctors/hospitals.  All of this "narrow network" and "broad network" stuff and the competing insurance plans are ways of trying to manage the demand and match up needy people with providers in a cost efficient way.

            Its impossible to tell what is happening with the OP's county hospital but one thing you can say for sure: prior to the ACA it wasn't going to stand still, because the taxpayer base that was paying for that free care wasn't standing still.  

            •  I wonder how many patients were turned away (1+ / 0-)
              Recommended by:
              poco

              last year from the OP's county hospital. In the Galveston Island situation in the article, the doctor reported that only 9% of charity cases who applied to be treated at the local county hospital were treated. That's not 0%; some people who needed care got it. But a lot of people who needed care didn't get it.

              Pre-ACA, was the OP's county hospital taking 100% of the low-income cases? Or were a lot of people turned away, people that the OP doesn't know about because they never saw her?

      •  He didn't say (1+ / 0-)
        Recommended by:
        poco

        why the ACA was a reason that she WOULDN'T STILL get help from that clininc.  If a person has insurance, but is below the income limit that wouldn't prevent them from receiving the same care that they would get before.

        Be the change that you want to see in the world

        by New Minas on Mon Apr 14, 2014 at 09:32:28 AM PDT

        [ Parent ]

  •  Sorry to hear about Opal's plight (49+ / 0-)

    and it is a terrible shame that Texas did not expand Medicaid and that the SCOTUS threw out the part of the law that would've made it mandatory.

    But I have a question:  it appears that based on the facts you've given, Opal and her husband have a very low income.  I gathered that from your suggestion that Opal might've qualified for Medicaid if Texas had expanded it, and the statement that Opal's husband made just enough to get help under the ACA, which would indicate he makes just above 133% of FPL ($15,521).

    Yet if those facts are correct, Opal and her husband actually would've qualified for an enhanced silver plan that has a $500 deductible per individual that drugs aren't subject to, has no copay at all for generic medications, and a $50 copay for brand names.  Also, the two lowest premiums could range from $6 to $28.  

    Again, assuming I have the facts right, Opal and her husband must've opted for the bronze plan with its $5000 deductible when they could've gotten a much better enhanced silver plan (which as I've detailed above has a $500 deductible with no drug deductible) for as low as $6 a month.  Either they somehow didn't know about it or whoever signed them up screwed up in not advising them of this.

    In helping folks sign up for Covered California, I've always made sure that middle-aged and/or chronically ill folks avoid the bronze plans, and if they're low income, made sure they're aware of the enhanced silver plans that are designed to have low or no deductibles, low copays, and low premiums to accommodate folks of low income.  These plans are more generous in California than Texas, but Texas does still have them and, assuming I've got the facts right here, Opal was tragically not made aware of them as it might've saved her from this calamity.

    Sorry again to hear about Opal.  If you can, and if it applies, please advise her of the better options she may have available to her as I've tried to outline.  

    "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

    by puakev on Sun Apr 13, 2014 at 10:27:09 PM PDT

    •  Very true....the bronze option was an inexcusable (19+ / 0-)

      blunder on someone's part.   The enhanced Silver option for low income persons is the unsung sweet spot of the ACA

      We are the principled ones, remember? We don't get to use the black hats' tricks even when it would benefit us. Political Compass: -6.88, -6.41

      by bmcphail on Sun Apr 13, 2014 at 10:34:47 PM PDT

      [ Parent ]

    •  California is lucky. My patients all say the same (14+ / 0-)

      thing. It was either go with the "pennies per month" plan that has the $5000 deductible or pay over $100 a month for a plan with a $500 deductible. And I am not exaggerating when I say that our patients are desperately poor and sick as only the chronically sick and uninsured can be in this country. They choose between food and meds every day. And if you do not make that payment, the insurance drops you like a hot potato---and expects to get its money back for anything it spent on you.

      California took the Medicaid expansion and California made good faith efforts to set up decent ACA Insurance exchanges. So, I can believe that things are better there. In Texas, our governor actually threw up barriers to keep people from signing up for ACA. Who knows how much of this mess is his fault?

      Sigh. I guess what I really want is some kind of 21st century emancipation proclamation that says that the poor and sick folks of the so called "red" states don't have to be hostage to the political ambitions of Tea Party Politicians. I was living in Alabama when ended segregation. Can we end health care inequality? Do states really have a "right" to let their poor folks die?

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Sun Apr 13, 2014 at 11:03:43 PM PDT

      [ Parent ]

      •  But it appears there were enhanced silver plans (23+ / 0-)

        available that are cheaper than the $100 a month/$500 deductible plan you mention.  I found ones for $6 and $28 in a rural Texas county.  It appears Opal could've gotten one of those plans for not a terrible amount more than the bronze plan she got.  That she didn't is very tragic.  What I wonder is whether it was due to error on her own part or her husband's or whether a navigator messed up.

        "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

        by puakev on Sun Apr 13, 2014 at 11:12:24 PM PDT

        [ Parent ]

      •  It's time to (12+ / 0-)

        get everyone in Texas that needs Medicaid expansion to vote. Opal has my sympathies and I would never ask her to shut up because she is the one that can help make the changes that are necessary. That is by making sure as many people as possible hear her story.

        But laying it at the feet of the largest expansion of coverage since Medicare itself isn't going to help. This is the fault of every single republican who has done everything in their power to make it fail.

        Unless you think we should dismantle it and try again. Opal's grandchildren will be the ones working on getting something passed and if history is any guide it will be worse than what we have now.

        Most of the people taking a hard line against us are firmly convinced that they are the last defenders of civilization... The last stronghold of mother, God, home and apple pie and they're full of shit! David Crosby, Journey Thru the Past.

        by Mike S on Sun Apr 13, 2014 at 11:18:54 PM PDT

        [ Parent ]

      •  No doubt she should not have signed up for (1+ / 0-)
        Recommended by:
        tardis10

        the Bronze plan, though. It is useless to her.

        My calculations agree with McCamy: say her income was $13K/year, just under 138% of poverty. In an expansion state like California, she would have been eligible for Medicaid.

        In Texas, she is eligible for a subsidy. But she still has to pay 9.5% of her income, about $100/month, for a Silver plan with the reduced deductibles and copays.

        Now, clearly she would have been better off with Silver. The Bronze plan is completely useless to her, because she can't afford the deductible. No honest navigator would have steered her to that pointless plan. But if she also doesn't have $100/month for the Silver premium (and this is a very poor woman) she is out of luck.

        •  Because of the way the subsidies work (0+ / 0-)

          platinum or gold level coverage can be purchased by some for the price if the silver plans, in order to get that subsidy you have to get at least a silver plan.

          You also would have to buy the plan on the exchange. It's hard to tell from the few facts given in the diary, but it sounds like this plan what bought from an HMO.

          •  For someone like her, Silver is the way to go (0+ / 0-)

            Silver has the extra subsidies for deductibles, copays, coinsurance.

            I'm pretty sure Opal bought the plan on the exchange. That's how she got it so cheap. But Rick Perry deliberately made it harder for people to get help selecting the right plan for them, by making it difficult for navigators to navigate.

            She seems to have been taken advantage of by some fasting-talking HMO salesperson who steered her to a plan that just doesn't work for her. If she'd bought Silver, she would have had to have come up with $1000/year, which for her would have been a lot of money... but much less money than the $5000 deductible she saddled herself with. It's crazy for a woman like Opal, a woman with heart disease who knows she will need medical care and plenty of it, to go for a high deductible.

      •  Did you, (0+ / 0-)

        or the clinic you work for, ever consider or attempt to help these patients find the best plan?

        Something as simple of a sign stating that "if you make less than x, you qualify for an enhanced subsidy silver plan" seems like it would have worked wonders.

    •  It is too late for Opal to change plans. (2+ / 0-)
      Recommended by:
      YucatanMan, terabytes

      The insurance companies have been complete weasels about this whole thing where I live.  People who signed up in October and paid in December did not get insurance cards until February.  I know a diabetic who used to be on a program to get free insulin, but now she has to meet a $500 deductible.  This is difficult for her because she is just getting by with a part time job.  The insurance companies had seminars to explain how to sign up through the exchanges.  The insurance guys probably did not have the interests of the customers as their first priority.

      People over 54 are better off not being put on Medicaid if they have any assets.  They will have to pay for their medical care anyway if they get sick.  If Medicaid is privatized and resembles an HMO people over 54 have to pay the premiums even if they do not use any medical services.  If they use more than the premiums cover that month they have pay for whatever medical services they do use.  Nobody has been properly warned about this by the states.

      •  All but a few states already use managed care (6+ / 0-)

        plans by which Medicaid recipients are enrolled in a private plan which received a fixed monthly premium from the state.  Something like 60% of Medicaid recipients are enrolled in these kind of plans.  I'm totally against doing nationwide what Arkansas is doing by making poor people pay premiums, but in a sense Medicaid is already "privatized" in that it works mainly through private insurers.  

        "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

        by puakev on Mon Apr 14, 2014 at 12:16:11 AM PDT

        [ Parent ]

        •  There's still the Medicaid claw back for people (2+ / 0-)
          Recommended by:
          puakev, freesia

          55 or over. Not all states have it but mine does. They don't' bother for bills under a few thousand but if I rack up tens of thousands of bills they'll take it out of my wife when I croak.

          “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

          by ban nock on Mon Apr 14, 2014 at 05:23:24 AM PDT

          [ Parent ]

    •  This is why Navigators were sent out (1+ / 0-)
      Recommended by:
      puakev

      and banned in TX.

      We want to build cyber magicians!

      by VelvetElvis on Mon Apr 14, 2014 at 03:20:16 PM PDT

      [ Parent ]

  •  Thank you for this reminder that, even (8+ / 0-)

    with the ACA launched, our work toward universal coverage is far from complete.

    It is encouraging that, to-date, the percentage of uninsured people has dropped a few percentage points, and will likely drop a few more as enrollment following the extension of the first open-enrollment period.

    But even if the number of uninsured drops this year by, say 12M, or even 15M, starting from a peak of 48M, that leaves 33-36M uninsured.

    Then there is the problem of the underinsured, such as Opal.

    In their article, The Affordable Care Act: Keeping Our Eyes on the Ball, Commonwealth Fund president David Blumenthal, M.D., and vice president Sara Collins, Ph.D. identify reducing the number of uninsured as one of four criteria for evaluation the success of ACA.

    Is the number of people who are underinsured falling?

    Many people who have health insurance are considered underinsured because they have high out-of-pocket costs, not including premiums, relative to their incomes. The Commonwealth Fund Biennial Health Insurance Survey tracks this measure. In 2012, an estimated 30 million people ages 19 to 64 were underinsured. Analysis by The Commonwealth Fund has estimated that by providing more comprehensive benefits with greater cost protection, the Affordable Care Act has the potential to lower this number by 70 percent, or by about 20 million people, over the next decade. Next year, as people with inadequate health benefits in both individual and employer-based plans gain more comprehensive coverage and start to get health care under their new policies, we should begin to see reductions in the number of people who are underinsured. CBO has not estimated the impact of the law on the numbers of underinsured. In our view, reducing the number of people who are underinsured by about 5 million people in 2014 would constitute a significant success for the law.

    Clearly, our job is not done until we have moved the numbers of both uninsured and underinsured to very near zero.

    We need to keep ourselves honest and keep the pressure on our elected officials to rapidly reduce both numbers.

    Thanks for reminding us of this.

    I can't help it. I love the state of Texas. It's a harmless perversion. - Molly Ivins

    by rsmpdx on Sun Apr 13, 2014 at 10:37:30 PM PDT

  •  The ACA isn't actually at fault here. (38+ / 0-)

    At least not as I read the diary.

    I think the diarist doesn't understand that the ACA was intended to create nationwide Medicaid expansion.  The only reason we don't have it is the Supreme Court; it's not a defect in the statute itself.

    So if the Medicaid expansion would have ensured that the diarist's clinic stayed open, and if the clinic would have treated Opal despite her having a high-deductible policy, then the fault lies not with the ACA, but with the boneheaded Texas Republicans who refused the Medicaid expansion.

    I could be wrong here, because the facts of the diary don't make all of this clear.  

    "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

    by FogCityJohn on Sun Apr 13, 2014 at 10:51:03 PM PDT

    •  It sounds like Opal and her husband made a little (0+ / 0-)

      too much for Medicaid.  The exchanges have an income cutoff to decide who gets Medicaid and who gets insurance subsidies.  Since they got the insurance subsidy they were no longer eligible for the free clinic.  Opal would not have been eligible for Medicaid even if it had become available in TX.  

      It sounds like she could have gotten better insurance for $100 a month, but that is $1200 per year.  Maybe that does not sound like much to you, but if they are living on $16K to $20K per year that is a lot of money.  If she could not afford a $500 prescription, how could she pay the premiums.  

      The Republicans are being utterly evil about this, but that does not make ACA less messed up.

        •  Opal and her husband made too much to be put (1+ / 0-)
          Recommended by:
          kareylou

          on Medicaid even if it were available in TX.  If someone is above a specific income cutoff they are put into the insurance exchanges to buy insurance.  If they are not too far above the income cutoff they get government subsidies to help pay for the insurance.

          People only go on Medicaid if their income is below the cutoff for their family size.

          The Kaiser Family Foundation has explanations and so does the healthcare.gov website.  

          •  If Medicaid wasn't expanded in Texas, it doesn't (11+ / 0-)

            matter how little they make. They wouldn't have been eligible. However, diarist stated that the husband earned just enough to qualify for ACA, which means that the income is just over 100% of poverty level. Since expanded Medicaid includes up to 133% of poverty level, they would have been eligible for Medicaid in that scenario.

            •  Huh? (1+ / 0-)
              Recommended by:
              nancyjones

              If he qualified for a subsidy, he wouldn't have qualified for even expanded Medicaid.

              If he qualified for expanded Medicaid (even if his state did not expand), he wouldn't qualify for a subsidy.

            •  No. If Opal and her husband were at an income (1+ / 0-)
              Recommended by:
              kareylou

              level where they qualified for subsidies under an ACA plan then their income was not low enough to qualify for Medicaid or expanded Medicaid had Texas accepted it.

              The people who lost out when Texas and other states did not accept the expanded Medicaid were those who fell

              between
              100% and 133% poverty levels.  From reading the diary Opal and her husband were above 133% poverty level and therefore were put into the exchange - something that would have happened even if Texas had accepted the expansion.
              •  No, that's not the case. ACA is available to (3+ / 0-)
                Recommended by:
                Cedwyn, poco, guyeda

                anyone over 100% of the poverty level.

                • If you live in a State that has agreed to expand Medicaid, and your household income is up to 138% of the relevant FPL you probably qualify for Medicaid. In State's that don't expand Medicaid the threshold is between 100%-133% although many more restrictions apply to eligibility aside from income.
                http://obamacarefacts.com/...
                •  Just for the sake of clarity... (1+ / 0-)
                  Recommended by:
                  guyeda

                  If someone lives in a state that did not expand Medicaid eligibility and makes between 100-138% of the FPL, they may qualify for subsidies.

                  If someone lives in a state that DID expand Medicaid and makes the same, they do not qualify for subsidies.

                  If someone lives in a state that did NOT expand Medicaid AND makes LESS THAN 100% but also does not meet that state's qualifications, they do not qualify for subsidies.

                  http://kff.org/...

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

                  by newinfluence on Mon Apr 14, 2014 at 05:16:43 PM PDT

                  [ Parent ]

      •  Actually, in doing a little more research (8+ / 0-)

        it appers the diarist is from Tarrant County, Texas (based on her one of her previous diaries).  In Tarrant County there is an enhanced Silver plan that costs $0 - yes, $0 - and another that costs $28.  That is for a household of 2 that has an income of $16,000.

        In other words, there were better plans that were less than $100, in fact there was one that cost nothing.

        "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

        by puakev on Mon Apr 14, 2014 at 09:59:49 AM PDT

        [ Parent ]

      •  This is where the facts are unclear: (2+ / 0-)
        Recommended by:
        poco, jhancock
        Since they got the insurance subsidy they were no longer eligible for the free clinic.
        This depends upon the clinic's policies. If the clinic treats only people who are completely uninsured or on Medicaid, then you're right. If, however, the clinic also treats low-income people whose costs are not covered by the insurance they have (in other words, the underinsured), then perhaps Opal might have received care there.

        As I mentioned in my original comment, the facts aren't entirely clear from the diary, and the diarist hasn't responded to clarify them.

        "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

        by FogCityJohn on Mon Apr 14, 2014 at 01:23:07 PM PDT

        [ Parent ]

  •  I think everyone who knew something about (8+ / 0-)

    the ACA knew it was a start, it was imperfect, it was going to require a reform process in each state.
    That's what I heard.
    The problem is, we need to get rid of the gop and get them out of the way, and the ones that are left must start working for their citizens in order to fully realize the promise of the ACA.
    So there will be stories like Opal's and other stories of people who were saved by the ACA.

    We have to get the gop out of the way.

    You can't make this stuff up.

    by David54 on Sun Apr 13, 2014 at 11:10:41 PM PDT

    •  I said it from day one (0+ / 0-)

      No matter what was proposed, the GOP was going to call it socialized medicine, so why not go for socialized medicine?

      What we ended up with was the result of trying to please Republicans like Grassly who still wouldn't vote for the damn thing.  There's also Lieberman et all who blocked even a public option.

      We want to build cyber magicians!

      by VelvetElvis on Mon Apr 14, 2014 at 03:26:41 PM PDT

      [ Parent ]

  •  Please Encourage Opal To Reapply..... (7+ / 0-)

    for the silver enhanced plan.  She could plead hardship or that she was given incorrect information due to the rollout.

    When you don't have it, a $100 premium seems impossible to round up, but so does a $5000 deductible.  

    If Texas had expanded medicare under the ACA, Opal & her husband would be fine.   Call Perry's office & lay it where it belongs......on his doorstep.  What does he have to say for himself?  How is he going to help his constituent?

  •  confused (3+ / 0-)
    Recommended by:
    Onomastic, Sylv, jhancock

    why couldn't she go back to your free clinic?
    Her husband lost his insurance as it was that they could afford and they were bumped to plans they can't?

    My cousin in NH is in their boat but not ill yet. He's 58 in a blue collar job with various ortho injuries, high cholesterol and a terrible diet. Ticking time bomb without insurance because he makes too much for expanded medicaid (slightly) but can't pay for the plan With subsidies as it's $200 bucks a month. One thing I know, my cousin has a 2BR appt for one person, can't part with his "stuff". He might save that much moving to smaller digs. So, he's not as tight as many I think. I wonder how many people who "can't afford" their new plans are like my cousin Rich. On the other  hand, I'm sure looking at the numbers many are like your unfortunate patient.

    Yet as some certainly have said here, patients like yours represent only 1% or less, iirc from what I read, of people. Oh no, sorry. Those are more like people like my cousin.

    I hope your lense is biased because you see a certain demographic in your role that would have more people like Opal than the general public. I hope that the percentage of people like Opal is small. I feel bad she did it alone and didn't go through a navigator. Maybe that wold have helped.

    The ACA is about broad numbers. And few, unlike what you say, think it is perfect. What many of us think is OVERALL it will save more lives than not having it. What is that statistic? I think 20-40K people die per year. ACA intends to make that  number go down and if it does it is successful.

    I wonder if you believe that the ACA will bring those numbers down and if you do you think it is moral to basically innadvertantly change who will die so the Opals die instead., to be exceedingly blunt.

    My hope, ours, is that the ACA is a foot in the door to lead to better thinks. Eventually to single payer. We had to try something. Surely you see that what happens to Opal is not the intent.

    That doesn't help Opal though. So sorry this is happening to her.

  •  Wait, you blame the ACA and not Rick Perry? (26+ / 0-)

    You are looking at this through a very odd lens.

    We have people in Virginia right now facing the same issues because Virginia's previous governor and legislature did not accept the Medicare expansion. They're the ones I blame for the suffering in Virginia, not the ACA. That's why I am doing all I can to support our new Democratic governor who called the legislature back into special session to try to get them to accept the expansion.

  •  Good diary and it is encouraging to (4+ / 0-)
    Recommended by:
    freesia, tardis10, aliasalias, JayRaye

    see physicans give their own analysis on the ACA.  I find it states like Florida and Texas, it has had little effect for the poor because of the expansion denials.  I too think instead of bashing or cheerleading, the people in Washington need to get priorties straight.   They are clueless.   We as democrats need to demand and I mean demand.. the fixes implemented as per our rights for the " to care for the general welfare" and according to this report...
    Half of our income taxes go to the military for war and only a small amount goes to help our most vulnerable including the veteran.

    http://money.cnn.com/...

    Enjoy your writing and thanks for caring !!!  Wish I could find a doc like you.

    We the People have to make a difference and the Change.....Just do it ! Be part of helping us build a veteran community online. United Veterans of America

    by Vetwife on Mon Apr 14, 2014 at 04:55:49 AM PDT

  •  You are blaming ACA . . . (18+ / 0-)

    and not the insurance company? So they were told one thing before they signed and then given something different? Everything should have been made perfectly clear, doctors in their plan, deductibles etc etc etc. This should have come as no surprise . So either these people did not pay attention or they were lied to by the insurance company.

    This is not the fault of ACA they have been defrauded and have recourse and if they have no recourse that is the fault of Texas.

    or

    There is a great deal of you story that is incorrect.

    Frankly, I’m getting more than a little tired of hearing from angry America. I’m also less than fond of knee-jerk America. And when you combine the two with the Internet, you too often get stupid America, which is really annoying.

    by jsfox on Mon Apr 14, 2014 at 04:58:22 AM PDT

  •  Thanks Doc (2+ / 0-)
    Recommended by:
    FishOutofWater, DaveDC

    I'm sorry about Opal. She has a tough row to hoe.

    I have a friend that started a clinic in urban Dallas sometime after the Vietnam war when he went to university on the GI bill and became some sort of Nurse Practitioner, now they have doctors and everything, but they do deal with a lot of dying people. My friend is finally retired, I think that kind of work takes a lot out of you.

    I haven't looked into the plans available via the ACA in a while since we're on Medicaid. I was intent on somehow fudging our income such that we'd be ineligible for Medicaid and could get private insurance which is less prone to arbitrary cancellation the way our state Medicaid is. I should pay more attention and read up on things before jumping.

    Thanks for doing the work you do, and I'm sorry about Opal.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Mon Apr 14, 2014 at 05:20:14 AM PDT

  •  I'm a big supporter of the ACA and (1+ / 0-)
    Recommended by:
    kareylou

    I hope this diary stays on the rec list for a while. Thank you for posting it.

    Tar sands, fracking and deep water drilling are expensive. Crude oil price exceeded $100/bbl in 2008 where it still hovers. NH₃ based fertilizer feeds an estimated ⅓ of the world with the Haber-Bosch process using natural gas as a feedstock.

    by FrY10cK on Mon Apr 14, 2014 at 05:23:20 AM PDT

    •  Why? (0+ / 0-)

      There are some glaring issues with the diary, the least of which is that the diarist isn't answering any of the issues or corrections brought up in the comments.

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

      by newinfluence on Mon Apr 14, 2014 at 05:26:55 PM PDT

      [ Parent ]

  •  Thank You (4+ / 0-)
    Recommended by:
    freesia, Choco8, kareylou, JayRaye

    for this diary, the flaws need to be expressed openly and balanced.

    While the ACA takes a similar financial toll on us, essentially leaving of with a new bill each month and nothing left for the 5,000 deductible nor god forbid a huge unknown 40%, (which I will take no chance on by even going to a hospital), I am truly much more fortunate than Opal.

    I will send all prayers of healing and hope for Opal. It is terribly, irresponsible of any government, in my opinion to not give it's people an opportunity to include it's costs, ie: property tax, insurances, care for elderly parents, etc in determining payment.

    NOw, before anyone gets down about my attitude, let me be VERY clear, I am ever thankful that we have even the ACA, I am soo thankful for those that now CAN see a doctor, no pre-exsting and on and on, all the good.

    I just think we need to openly and loudly express the serious and sometimes fatal downsides, or flaws, and we need to do it NOW. What better time, to pressure our government with the truth, and hope that will start a competition for them to open their logical intelligence and fix the flaws NOW.

    Before more and more find them in the heartbreaking situation that Opal is in now! My heart is filled and I send my best.

    Keep speaking the truths in balance.  

  •  More people covered... (0+ / 0-)

    for the trade off of less quality of care for everyone...population management...

    "I know the meaning of life. It doesn't help me a bit."

    by dss on Mon Apr 14, 2014 at 05:41:12 AM PDT

  •  Sorry to Hear About Opal (14+ / 0-)

    Could you connect some dots for me though, there's something here I don't get?

    Like many urban areas, my county funds a public clinic for the uninsured. We pay for necessary medications, surgeries. We do screening colonoscopies. We do mammograms and immunizations. If you have a heart attack, you can get your coronary artery stented. If you get cancer, you can get your chemo. No deductible, no caps, no pre-existing conditions exclusions and while there are some medication copayments, you can get them waived. We don’t want to see anyone die for lack of $5. Medicaid type health care, more or less, but with a higher income cap.

    The Medicaid expansion would have taken over the cost of running the clinic.

    Exactly how did the ACA cause the free clinic to close?  You're saying the medicaid expansion would have paid for it, and Rick Perry vetoed it.  Was there language in the ACA that said: "Every county operating a free clinic must close their clinic once the ACA is implemented?" or possibly "Any county that has a free clinic will only be able to fund that clinic with medicaid expansion money, and if the governor of the state vetoes medicaid expansion, they must close it."

    We have had several (probably more than a dozen) people come here and post complete lies about "true stories of the ACA," but this doesn't sound like one to me.  This sounds like a legitimate shortcoming of a program that pretty much everyone acknowledges is better than what we had, but far from perfect.

    •  Annnnnd I Just Realized (8+ / 0-)

      That you actually ARE one of the "several to a dozen" people who came on here and posted complete falsehoods about the ACA.... claiming that there was only one plan available in the entire DFW area and only 3 PCP's accepted it or some other made-up nonsense.

      The ACA is completely flawed legislation.  There is no question.  It won't cover enough people.  It will cost too much for the people it does cover, because it doesn't do enough to bring health care costs down.

      It is probably that nothing short of single payer will remedy this, and we can all hope that--as we work to improve PPACA--we will also move closer to single payer.

      That's not "circling the wagons," but it doesn't mean I don't think you're full of it.

    •  Remember that the ACA took away (2+ / 0-)
      Recommended by:
      TooFolkGR, ybruti

      certain subsidies for care for low-income people, on the grounds that they would now be covered by Medicaid.

      •  The Diarist Specifically States (1+ / 0-)
        Recommended by:
        askew
        Like many urban areas, my county funds a public clinic for the uninsured. We pay for necessary medications, surgeries. We do screening colonoscopies. We do mammograms and immunizations. If you have a heart attack, you can get your coronary artery stented. If you get cancer, you can get your chemo. No deductible, no caps, no pre-existing conditions exclusions and while there are some medication copayments, you can get them waived. We don’t want to see anyone die for lack of $5. Medicaid type health care, more or less, but with a higher income cap.

        Emphasis mine.

        If the county was paying for it, and the people who took advantage of the clinic weren't required to pay any money at all, I don't see how subsidies factor into it.  If they don't want anybody to die for "lack of $5," why are they open to letting people die for a lack of $500?

        •  I meant, (1+ / 0-)
          Recommended by:
          TooFolkGR

          the ACA took away subsidies from the federal government directly to the hospitals and care providers, to provide care to the indigent.

          The OP's county funded a public clinic for the uninsured. But where did the county get the money to fund the public clinic? Did the county get the money from the federal government?

          •  I Don't Know (0+ / 0-)

            And I'm not making assumptions... I'm responding directly to the diary and asking the diarist a question about it.

            •  The ACA removed some payments (0+ / 0-)

              from the federal government to the states to provide care for poor people. The OP's county hospital may not have been funded by those payments (though I think it likely that it was) but in any case, it's indisputable that some poor people are now not going to get care, when previously they were getting care, due to provisions of the ACA and to the intransigence of Republican governors.

  •  While I feel for Opal I think this is flawed logic (10+ / 0-)

    Had the ACA not become law from my reading Opal would be facing the exact same issues when it comes to coverage.  On top of that her husband wouldn't have a health insurance plan at all.  

    Is the law perfect?  Not by any means but it is a start. Just like when Social Security was first passed by FDR it was a start.  Just like when Medicare was first passed by LBJ it was a start.  For example it took 40 years for Medicare to cover prescription drugs and then it took another 7 from the passage of prescription drug coverage for the doughnut hole to start closing.  

    The only thing we can do is work to make sure it is improved so that tragedies like Opal's become more rare.

    •  Let me add that celebrating ACA successes (11+ / 0-)

      Is absolutely NOT  the same thing as thinking the work is done.  Both can be true.  Celebrating that there have been millions who have gotten the life saving coverage they need while understanding there is still a lot more work to do.  Still the successes along the way need to be celebrated in order to steel ourselves for the continued fight.  

    •  Outstanding point (0+ / 0-)

      Opal is depending on a free health care ride - you know - the ones Paul Ryan is going to do away with.  And her husband would have been out of luck. What if he had a medical emergency?  Had ACA been implemented as it was designed would this have happened? No it isnt perfect, but it is a start toward covering everyone. But it will take more work until the Opals are covered correctly.

  •  So your complaint is that your patient (15+ / 0-)

    So your complaint is that your patient was lied to by an insurance agent and that is the fault of the ACA? I get that you are upset, and rightly so, but you are really letting emotion cloud your reason if you think this is a problem with the ACA rather than with, in descending order,

    Texas
    Texas's Governor
    Texas's Attorney General (the person who in a sane state would be responsible for enforcing laws relating to truth in advertising)
    The HMO

    Prior to the passage of the ACA there were millions of Opals around the country. Now lots of them are getting the care they deserve. Opal isn't because she lives in Texas. That is not the fault of the ACA and complaining about the ACA rather than the defalcations of your own State and the HMO in your state is just besides the point.

  •  While I appreciate your frustration... (15+ / 0-)

    This:

    "So, if you want to go back to circling the wagons around the ACA, insisting that everything is just fine, go right ahead"

    couldn't be further from the truth for ANYONE I know who supports ACA.

    Insurance companies are gaming the system (there shouldn't be 80 plans to choose from, designed by actuaries and marketing folks to make the least worthy ones seem like the best option). You shouldn't have to have a juris doctorate to understand a freaking insurance policy, nor should you need an accounting degree to figure out which is the best plan for you.

    And that's just the insurance side. Should we talk about the pharmaceutical companies, who continue to rip off the American public with $450 inhalers Canadians can buy for $7?

    Should we talk about hospital groups that bilk their clients for many times more than others, in the name of the almighty dollar?

    Should we talk about doctors who charge preposterous rates for simple procedures and 15 minutes of time, justifying it by pointing to the costs of medical schools, which control the flow and number to keep mini-monopolies among specialists? (Heck, should we talk about the huge subsidies those medical schools get from Medicare?).

    ACA is a start. Next target HAS TO BE Republican Governors and legislatures who refused Medicaid expansion.

    Baby steps and we'll get there. Frustrating baby steps, I agree.

  •  health insurance does not equal health care (4+ / 0-)
    Recommended by:
    Shockwave, freesia, tardis10, JayRaye

    I think that many people often confuse the two.  Just because you have insurance, it doesn't mean that you will actually get the care you need...even on decent plans.  For the lowest level (ie, cheapest) ACA plans, there are still huge financial hurdles for many people to use them.  So, the monthly premium is subsidized, but does that matter if they don't have the cash for co-pays, deductibles, or to cover the other 40% that the insurance does not?  The private insurance companies still rake in the HUGE subsidies while the patient still doesn't get the needed care.

    I went into science for the money and the sex. Imagine my surprise.

    by Mote Dai on Mon Apr 14, 2014 at 06:19:44 AM PDT

  •  Okay you have spoken. (2+ / 0-)
    Recommended by:
    Cedwyn, etherealfire

    So now what.

  •  Whoa. (9+ / 0-)

    I sense 'troll'.  

    Someone 'told' her that there would be no deductible and then an enormous deductible just 'showed up?'  Don't know who the 'someone' was, but deductibles, co-pays are clearly stated.  Did she go to some private broker?  Did she go to a navigator provided by ACA?  Did she ask for the details of her policy in writing before signing up?  

    All of this is some nefarious fault of ACA?  

    I checked all of my meds and doctors on all of the policies before signing up for a policy.  I knew what I was getting into.  Yes, I am comfortable with a computer and spent months comparing policies.  ACA (and Obama in general) depends way too much on the internet for absolutely everything.  That being said, the information I needed to choose a plan was available to me.  And I made sure I understood my policy to the best of my ability before I signed up.  

    Bernie Sanders fought for an received funding for community clinics, or things would be even worse than they are now.  

    Needless deaths are the fault of the heartless GOP that won't allow Americans to join the 21st century, just so they can hurt Obama.  I was almost one of those deaths, but because of ACA I could go to the ER for pneumonia this winter.  

    I want Medicare for All.  I was incensed that that miserable little twit, Joe Lieberman, canned Medicare for 50 or 55 above, which would have been a big ol' step in the right direction.  

    This diary seems to say that since ACA isn't close to perfect, it's BAD.  We could have said, NOTHING UNTIL IT'S PERFECT and had NOTHING.  I am 63 years old, self-employed, no coverage for my asthma, a shitty policy for years until I couldn't even afford that.  I am getting health care right now that was unavailable to me before ACA.  It ain't perfect by a long shot but  it was a monumental step in the right direction for millions of Americans.  

    I suspect this diary is meant to feed into the left's 'if it ain't perfect I'm not voting" meme.  We can do what Republicans do - we can vote in large numbers and undo the damage done to this country, starting with Richard Nixon and on steroids with Reagan.  We can accept anything that moves us in the right direction and VOTE and work to get others to VOTE.  Or we can decry everything that isn't perfect, and ignore a major step in getting access to health care to Americans under the most poisonous political climate I've witnesses in my 63 years on this planet.  

  •  It's sad (7+ / 0-)

    This is a very sad story.  

    I'm curious as to the target here.  Are you attempting to get Democrats to support you in forcing Texas to accept the Medicaid expansion?  

    That would be excellent.  

    When I look back at what you wrote during the Bush admin, you are putting the responsibility for spreading misinformation on the backs of the Insurance companies.  You mentioned that the insurance companies spread propaganda, for instance.  

    I can understand that you would have multiple places to point your ire, but it is interesting that you are very clearly aware of the damage that an insurance company can do.  And, you are aware that the medicaid expansion was rejected after the Supreme court said that states weren't required to accept it.  

    What is the action you are thinking would work?  

    Streichholzschächtelchen

    by otto on Mon Apr 14, 2014 at 06:47:48 AM PDT

  •  you are right (13+ / 0-)

    your county decided not to help people and that's the ACA's fault.  Any insurance excludes you, when they could take an assignment of any insurance and cover the rest.  But that doesn't fit your narrative does it?

    And the ACA, it didn't make medicaid expansion optional, the Supreme Court did that.  But that's the ACA's fault too, isn't it?

    And the Democrats, who can't do a thing in the House, should have already fixed this law, right?

    Losing people to the American Health Care System is a shame.   Tens of thousands died every year before the ACA, thousands will still die,  it isn't right.  But you have no solution, you're a doctor,  have you been lobbying your medical associates to demand change?  Have you gone to the county to demand a better charity system?  Or was your county only too glad to cut back the number of people they help?  Have you started a charity to cover the difference for these people. It's the new thing since government can't help people.

    I'll vote for Democrats in my deep red district, not one will get to Congress to change things.   What is wrong with the ACA is not a Democratic problem, its an American problem.  Stop blaming the people that tried to make things better, and do something about the obstructionists that want to destroy any semblance of public health care.

  •  How would this story be different (6+ / 0-)

    if Texas had the medicaid expansion?

    How much of this is ACA, and how much is Texas and the Supreme court majority?

    I'm pretty sure nobody imagined the Supremes would make medicare optional without killing the law entirely.

    •  I don't think this particular story would be any (3+ / 0-)
      Recommended by:
      kareylou, Choco8, tardis10

      different. If Opal qualified for an exchange policy then she would not have qualified for Medicaid. It's one or the other, based on income.

      Opel is one of the working poor for whom the ACA provided insurance, but not actual coverage. She is the complete epitome of the design flaw in the ACA that affects only the working poor. They can afford the premiums, aided by subsidy, but they cannot afford the co-pays and deductibles.

      “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

      by Phoebe Loosinhouse on Mon Apr 14, 2014 at 07:28:06 AM PDT

      [ Parent ]

    •  The patient would qualify for Medicaid, probably (0+ / 0-)

      In expansion states, people under 138% of FPL qualify for Medicaid. In non-expansion states, people above 100% of FPL qualify for insurance. I'm guessing Opal is in the 100-138% FPL group.

  •  Please tell us... (27+ / 0-)

    ...Opal's location (preferably by ZIP Code) and her particular insurance plan.

    The last time you diaried on an ACA failing--HMOs, deductibles and an alleged dearth of PCPs--you refused to provide that information, and you didn't respond to people who went digging and provided information that seemed to rebut your argument.

    Then, you wrote a diary about "ototoxic" eardrops you were prescribed, but refused to identify the drug in question, even when asked.

    Now, here's another diary short on verifiable information...you'll understand if I'm a wee bit skeptical, yes?

    Yes, there are people who need more help than the ACA currently provides. No, the ACA is not perfect--it will never be perfect. I don't think anyone here denies either of those points.

    However, I think your opinions would be a bit more credible if you were more forthcoming with information that readers could use to verify your statements.

    The word "parent" is supposed to be a VERB, people...

    by wesmorgan1 on Mon Apr 14, 2014 at 07:05:10 AM PDT

  •  Some commentary in this venue (1+ / 0-)
    Recommended by:
    Pat K California

    that's critical of the ACA is so much clueless purity trolling.

    Not this.

    Tipped and recommended.

    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 Mon Apr 14, 2014 at 07:08:52 AM PDT

    •  When I have a problem (3+ / 0-)

      Let's say that I'm having a problem with someone who is completely opposed to what I want.  

      If that's the case, and appealing to that individual will do nothing, then I will attempt to get in touch with someone who will hear me.

      Nobody can actually convince Rick Perry to do anything, so the only real constituency to yell at is the Democrats.

      Streichholzschächtelchen

      by otto on Mon Apr 14, 2014 at 07:21:57 AM PDT

      [ Parent ]

      •  Interesting point. (4+ / 0-)

        Above, I was striking back at a nameless contributor at this site who's rather notorious for pronouncing part-wins for progressives as "failures." Drives me batty.

        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 Mon Apr 14, 2014 at 07:24:38 AM PDT

        [ Parent ]

      •  That's a big problem at daily kos. (5+ / 0-)

        Yelling at democrats because they are in the room, and letting Perry's intransigence win him a free pass.

        Of course, in a democracy, it's not Perry who has to be convinced, but voters.  Voters who read diaries that blame democrats and not Perry don't realize that the whole point is to yell at the people who will listen, and actually blame democrats for things that should be placed at the feet of republicans.  

        The dossier on my DKos activities during the Bush administration will be presented on February 3, 2014, with an appendix consisting an adjudication, dated "a long time ago", that I am Wrong.

        by Inland on Mon Apr 14, 2014 at 09:28:56 AM PDT

        [ Parent ]

  •  This diary is sad, and horribly misguided. Your (15+ / 0-)

    efforts would be better served arguing for further expansion of medical services, rather than attacking the most significant advancement in public health since Medicare.  As a matter of fact, it was this very attitude that put the ACA in it current hole (public polling) in the first place.

    "Because I am a river to my people."

    by lordcopper on Mon Apr 14, 2014 at 07:11:58 AM PDT

  •  Umwut? (11+ / 0-)

    Rick Perry and the Texas Republicans refuse to implement the ACA, and you write a diary criticizing the ACA?

    No wonder you're so defensive. Your argument is nonsense.

    Art is the handmaid of human good.

    by joe from Lowell on Mon Apr 14, 2014 at 07:23:21 AM PDT

    •  I read it mostly as a criticism of insurance. (2+ / 0-)
      Recommended by:
      kareylou, Choco8

      And yes, maybe the ACA should have reformed health insurance more than it did. There is nothing wrong with recognizing that.

       Since the ACA was just the first step, maybe the second step should be eliminating deductibles for people with income below a certain point. There is no reason to ask people that live paycheck-to-paycheck to pay a premium every month that only gets them through the door of the doctors office.

      •  It's not (2+ / 0-)
        Recommended by:
        joe from Lowell, etherealfire

        The diarist knows how to write critically of insurance.  The diarist has done this in the past.  

        When Bush was president, the diarist wrote about heath insurance propaganda.  

        This diary is about rank and file democrats.  That's who it is directed towards. It's not directed towards health insurance.  

        Streichholzschächtelchen

        by otto on Mon Apr 14, 2014 at 09:19:17 AM PDT

        [ Parent ]

        •  I agree? (2+ / 0-)
          Recommended by:
          greenbastard, otto

           It seems that the greater point is that maybe we shouldn't be so celebratory and/or smug about the ACA since the insurance industry that it relies on is still pretty damn bad.

           Maybe we shouldn't "circle the wagons" as tightly if it means we are ignoring the very real shortcomings of the ACA, which I think some people definitely are doing.

          I think that we need to put down the "Team Blue" pennants and start demanding the next step of improvements and reforms, because they are needed desperately.

          •  We won a victory: let's mourn! (5+ / 0-)

            Heaven forbid that anyone feel glad that progress has been made, because Lord knows that only a properly beaten down movement, disciplined to avoid even the suggestion of a sense of accomplishment, can be an effective political force.

            Art is the handmaid of human good.

            by joe from Lowell on Mon Apr 14, 2014 at 10:57:26 AM PDT

            [ Parent ]

            •  It was sold to us as the first step. (0+ / 0-)

              The ACA is NOT a walk-off home run. We shouldn't pretend that it is.

               It is a good first step. Now let's get start working hard on the second step, because we are doing America a great disservice if we stop here.  

              •  Have you ever been to a baseball game? (2+ / 0-)
                Recommended by:
                poco, Aquarius40

                Guess what happens when your team hits a single?

                You applaud.

                This leap you're making from "People celebrating the ACA" to "People thinking the ACA is the end all and be all of health care reform" exists nowhere but in your imagination.

                I mean, look at the thread. Find me someone who is arguing that the ACA is the ideal end of health care reform.

                Art is the handmaid of human good.

                by joe from Lowell on Mon Apr 14, 2014 at 11:54:28 AM PDT

                [ Parent ]

                •  I don't see applause for people hitting singles. (1+ / 0-)
                  Recommended by:
                  aliasalias

                  I see us bunting and barely getting to first, then part of the crowd (you?) going absolutely apeshit as if we just hit a bottom of the 9th grand slam to win the World Series.

                  I'm just saying that I expect the runner to try and make it to second base, because that is how the game is supposed to be played and that is what we were sold  when we bought our tickets.  

                  We need less back-slapping and more real work with regards to healthcare reform. It's only pragmatic to point out that there is a LONG way to go still, and we had better get started on it sooner rather than later because people's lives literally depend on it.

                  •  Could you quote some of that "absolutely apeshit?" (2+ / 0-)
                    Recommended by:
                    Aquarius40, poco

                    I notice you keep making assertions like this, about people allegedly lauding the ACA as the be-all and end-all of health care reform, without any holes to fill.

                    I also notice that you don't ever provide any examples, either in the diary or in response to the comments.

                    And I further notice that any applause whatsoever about the ACA causes you to bring down the STOP BEING HAPPPY hammer.

                    So, until you can actually back up your assertion that people are "going absolutely apeshit," I'm not inclined to give your criticism a whole lot of credit.

                    But by all means, change my mind. Show me the ape shit.

                    Art is the handmaid of human good.

                    by joe from Lowell on Mon Apr 14, 2014 at 12:47:55 PM PDT

                    [ Parent ]

                    •  We have both seen (1+ / 0-)
                      Recommended by:
                      aliasalias

                      people equate the passage of the ACA to the passage of Medicare and Social Security on this site (and I'd be willing to bet probably even in this comment thread). If that isn't "going apeshit" then I don't know what is.

                       Pretending that a few reforms that prevent that absolute worst insurance company malfeasance (and that we had to basically bribe the insurance companies to get)  is equally as important as Social Security is just insane to me. It's that mentality that I am reacting to.

                      Maybe you haven't specifically made this equivalence though, so I apologize if that is the case.

                      I'm not "bringing down the STOP BEING HAPPY hammer", I'm simply saying definitively WE ARE NOT DONE YET, KEEP YOUR FOOT ON THE GAS PEDAL.

                       I see a whole lot of celebrating and absolutely zero planning for step two. It's as if some of us have already accepted that this is all we are going to get. I'm not OK with that and I'd hope that you aren't either.

                      •  Social Security originally excluded black people. (2+ / 0-)
                        Recommended by:
                        Aquarius40, poco

                        Medicare didn't cover prescription drugs for the first forty years of its existence.

                        People are comparing the ACA to two other large scale social welfare that needed to be improved upon and expanded?

                        Sounds about right to me. I'm still not seeing the ape shit.

                        And NO, you are NOT just saying "keep your foot on the gas pedal." You aren't just saying "Don't stop now." You keep denouncing the ACA and telling people to stop defending it.

                        No, we're not going to do that. We're going to do the same thing the Democrats did with Social Security and Medicare - defend and celebrate them, even as we work to improve them.

                        Art is the handmaid of human good.

                        by joe from Lowell on Mon Apr 14, 2014 at 01:33:33 PM PDT

                        [ Parent ]

                        •  Now you are the one projecting. (0+ / 0-)

                          I'm not denouncing the ACA, and in fact I have gone out of my way in several posts to say that I am grateful for it and that it does improve the lives of many Americans. If you treat it as a first step then it isn't too bad.

                          I'm CERTAINLY not saying to stop defending it; I'm saying be real about it. Be honest. The ACA doesn't go nearly far enough. It doesn't fix the problem. Saying that out loud doesn't make you a teabagger or a purity troll.

                           What the ACA actually IS is a package of modest but desperately needed reforms tied to (what can only be honestly described as) a corporate welfare bill for the insurance industry. It's a foot in the door. It's a first, tiny, baby step. It's a good way to get the ball rolling.

                          What it IS NOT is anything even approaching the scope of Social Security, even on day one of SS's existence. Social Security isn't forcing you to buy 401ks from under-regulated (and politically influential) finance companies.

                          I wouldn't compare the ACA to large scale social programs like Social Security or Medicaid. That's just crazy.

                          •  No, you aren't denouncing the ACA. (0+ / 0-)

                            You call it out as the problem, and condemn the people who passed it for doing so, but in a positive, supportive way.

                            Look, if I've convinced you to defend the ACA, stop attacking it, and stop attacking the people who defend it, great.

                            But don't pretend that wasn't what you were doing.

                            Art is the handmaid of human good.

                            by joe from Lowell on Mon Apr 14, 2014 at 02:35:06 PM PDT

                            [ Parent ]

          •  I think we need to waive our team blue pennants... (1+ / 0-)
            Recommended by:
            Aquarius40

            as we start demanding the next step.

            After all, Team Blue are the ones who delivered this victory, and Team Blue are the ones who will deliver the next victory.

            Art is the handmaid of human good.

            by joe from Lowell on Mon Apr 14, 2014 at 10:58:42 AM PDT

            [ Parent ]

            •  I'd probably be OK with that plan. (0+ / 0-)

               But I think that waving the pennant too hard without also recognizing the very real shortcomings of the ACA is just moving that (incredibly necessary) second step even farther away.

               If we don't keep the pressure up, our elected representatives will be all too willing to rest on their laurels.

              The "Team Blue" management won't lift a finger to deliver anything if we don't force them to.  

              •  There's a rousing cheer. "Shortcomings!" (1+ / 0-)
                Recommended by:
                Aquarius40

                What is up with obsession of yours, demanding that calls for the next step be phrases as criticisms of the ACA?

                Was SCHIP or Medicare drug coverage sold as fixing the "shortcomings" of a flawed Medicare/Medicaid system? Or were they sold as awesome things in and of themselves, that fixed problems that people faced?

                Injecting criticism of health care reform into the movement for health care reform is worse than pointless; it's self-destructive, and serves only to help the people opposed to health care reform.

                Your obsession with injecting criticism of Obamacare into the call for the next bite at the apple has nothing to do with advancing health care reform.

                Art is the handmaid of human good.

                by joe from Lowell on Mon Apr 14, 2014 at 11:59:00 AM PDT

                [ Parent ]

                •  I'm not "injecting criticism"; (0+ / 0-)

                  I'm grateful for the good parts of the ACA, I think it was a good start, and I am excited to see what the next step is.

                   I have no doubt that there will be a next step. Whether that happens in our lifetime or not is what I am concerned about, and I'm not too blinded by party loyalty to see that our reaction to the ACA is largely what will determine that.

                  So if you are perfectly happy with the current post-ACA healthcare system then go ahead and cheer and ask for nothing else. I plan to try to hold our elected representatives to their promises, for the good of the people that have fallen through the cracks (there are tens of millions of them).

                  •  Now you're deliberately bullshitting. (1+ / 0-)
                    Recommended by:
                    poco
                    Me: I think we need to waive our team blue pennants... (0+ / 0-)
                    as we start demanding the next step.
                    You:
                    So if you are perfectly happy with the current post-ACA healthcare system then go ahead and cheer and ask for nothing else.
                    You are making up things to argue against. That's not what someone with a legitimate position has to do.

                    Art is the handmaid of human good.

                    by joe from Lowell on Mon Apr 14, 2014 at 12:49:58 PM PDT

                    [ Parent ]

                    •  I hear a lot of cheering from you (0+ / 0-)

                      but nothing about the next step. What would you suggest?

                      •  First, finish this step. Win the fight over ACA. (2+ / 0-)
                        Recommended by:
                        KMc, poco

                        We have the anti-health-care-reform forces on the ropes. The ACA is working, and the attacks they've been launching for the past five years are fizzling. We need to rout them, to make opposition to the Democrats' health care reform agenda into a huge political loser.

                        Doing that will make health care reform a popular issue again, put the Democrats into a stronger institutional position, and clear the way for the next bite at the apple.

                        As far as what that next bite should be, I'd like to see the state-level single payer efforts take root, a push for a public option in the exchanges, and a push to get the holdout states to take the Medicaid expansion.

                        But those are the spoils of victory. First, we have to win that next victory.

                        Art is the handmaid of human good.

                        by joe from Lowell on Mon Apr 14, 2014 at 01:11:27 PM PDT

                        [ Parent ]

          •  I tend to think we can differentiate (0+ / 0-)

            It's not that challenging to differentiate.    

            Streichholzschächtelchen

            by otto on Mon Apr 14, 2014 at 11:40:39 AM PDT

            [ Parent ]

    •  As I read it (2+ / 0-)
      Recommended by:
      greengemini, etherealfire

      If Opal and her husband qualified for an ACA plan, they probably wouldn't have qualified for Medicaid, even if Texas had accepted the expansion. In this instance, it seems Opal is fortunate enough to live in a county that already had an alternative, and her enrollment in an ACA plan would interfere with that. What would be Opals situation in some other county, without such a program, is a different story that diarist omitted to mention.

      “Texas is a so-called red state, but you’ve got 10 million Democrats here in Texas. And …, there are a whole lot of people here in Texas who need us, and who need us to fight for them.” President Obama

      by Catte Nappe on Mon Apr 14, 2014 at 07:58:20 AM PDT

      [ Parent ]

  •  Single payer is the final destination (9+ / 0-)

    Obamacare is the best that could come out of an increasingly dysfunctional DC where political polarization is the worst since the Civil War.  Progressive states can do much better.

     photo b80a2441-25b2-4674-a969-f62600aef8a1_zps0df8272b.png

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

    by Shockwave on Mon Apr 14, 2014 at 07:36:39 AM PDT

    •  Too late for me, I'm afraid. (2+ / 0-)
      Recommended by:
      Shockwave, Prinny Squad

      In 2017 I will finally qualify for Medicare. In the meantime, I will be stuck paying $956/month for health insurance because of my age and the fact that I don't qualify for a subsidy.

      Sometimes yu' just can't win ...

      "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 Mon Apr 14, 2014 at 09:18:55 AM PDT

      [ Parent ]

      •  Many of the single payer activists I know... (6+ / 0-)

        ...are on Medicare.  They use the term "improved Medicare for all".  The movement in California will become more visible after November.

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

        by Shockwave on Mon Apr 14, 2014 at 09:23:36 AM PDT

        [ Parent ]

        •  I think Medicare for All is the best title. (1+ / 0-)
          Recommended by:
          JayRaye

          Single Payer is an unattractive name that some pundits and talk show hosts have turned into a scary phantom of sorts. It's also, objectively, kind of a stupid name that doesn't really convey what it's doing.

          However, the concept is great, and popular.

          Medicare for All (Medicare is loved) is a better way to explain it to non-political people.

          I mean if there is a movement to make Single Payer a positive term, that's fine, it just seems an unnecessary hurdle. And Single Payer is not as excellent a term as Obamacare (Obama cares for you, that's easy to make positive).

          Just sayin'.

    •  LMAO! (2+ / 0-)
      Recommended by:
      aliasalias, Shockwave

      You mean like renewing long term unemployment benefits after the Democrats agreed to remove it from the continuing resolution? I'd be tempted to laugh at this absurd fantasy but it's far too real and ugly to find any humor in it. My problem isn't that we don't HAVE single payer, I could have lived with that if we had fought for it. My problem is that we never even TALKED about single payer. Single payer is the only real solution but I would have felt a whole lot better about this whole thing if it had even been discussed by people nominally representing US. Instead we only ever fellated the insurance companies.

      "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 Mon Apr 14, 2014 at 01:29:04 PM PDT

      [ Parent ]

      •  It will come state by state (0+ / 0-)

        Some states have very active single payer movements.  I agree that DC is dysfunctional and Obamacare was the only thing we could get there even with both houses with Democratic majorities.

        Enough laughing, lets get to work.

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

        by Shockwave on Mon Apr 14, 2014 at 03:50:47 PM PDT

        [ Parent ]

  •  The problem is that health insurance still sucks. (5+ / 0-)

    Yes, having health insurance is still FAR better than not having it, and the ACA helps more people get coverage and that is definitely a good thing.  The reforms in the ACA made a real improvement in the lives of many Americans.

    That doesn't change the fact that health insurance is still under-regulated and VERY expensive considering what most people actually get out of it.

    We need to be very careful now; the ACA has married the health insurance industry to the Democratic Party brand, and any shenanigans by the health insurance industry will reflect badly on the party. We need to continuously improve the ACA instead of resting on our laurels.

  •  high deductible insurance sucks (4+ / 0-)
    Recommended by:
    TJ, kareylou, Prinny Squad, aliasalias

    it's just true

    Growth for the sake of growth is the ideology of the cancer cell. --Edward Abbey

    by greenbastard on Mon Apr 14, 2014 at 07:39:53 AM PDT

  •  Put the Blame where it belongs (10+ / 0-)

    This is on the GOPers who refused the medicaid expansion

  •  BUT... (2+ / 0-)
    Recommended by:
    greengemini, joe from Lowell

    Every major new law such as this has had to have adjustments etc. so that it works the best it can.  This is true - no matter how well intentioned the original bill.  Trouble is that this is not possible with the current state of the GOP.

  •  I understand the diarist's (4+ / 0-)
    Recommended by:
    greengemini, wonmug, elmo, closerange

    frustration, or should I say, rage?

    The problem is that I have no idea how to fix the problems of the ACA unless we get a majority in the House and a filibuster-proof majority in the Senate, and elect Democratic governors and Democratic legislative majorities in state legislatures that are currently refusing Medicaid expansion.  The Republicans have been in a rage since they failed to steal the presidential election in 2008, and they want as many Opals as possible to die in order to punish the American people for having the temerity not to let them install their candidate.  We voted for Obama twice and we must suffer for it by watching our family members, friends, patients and even fellow humans we don't know die as a result of our being so uppity as to elect the candidate of our choice.  How dare we peons think we have the right to do that?

    As someone said last week, the refusal to expand Medicaid is "awesome in its evilness."  

  •  Pretty much defines the reason (3+ / 0-)
    Recommended by:
    Choco8, greengemini, tardis10

    that so many wanted a public option, so that there would be at least one safe choice with good coverage.

  •  your anger is misdirected (16+ / 0-)

    About this:

    So, if you want to go back to circling the wagons around the ACA, insisting that everything is just fine, go right ahead.

    That's not happening.  The vast majority of people here at DK know there are flaws in ACA and want to make it better.  The reason there is a push to get behind ACA right now is due to elections 7 short months away.  It's that simple.

    Now if you want to conflate the political goals - we as Dems want to try to elect more Dems, run on what ACA has accomplished so far and push for improving ACA - with the idea that it makes us insensitive to the suffering of others, you're delusional.

    Your anger is misdirected.  Your anger should be at the @$$holes in your own state that rejected the Medicaid expansion.  Your anger should be at the insurance regulators in your own state who aren't doing their job to make sure that insurance companies meet some realistic guidelines for meaningful coverage.

    Outside of that, yes, there are some policies that are unaffordable for some people who just barely qualify for ACA.  ACA accomplished some outstanding things.  Simply the one feature of retiring the phrase "pre-existing conditions" improves life for 50-100 million people.  But the sad reality is that doesn't help so much for people who can't afford the coverage at the lowest end.

    So look around where you live.  Texans are killing Texans.  It's the opposition of Republicans largely from red states that opposed moving single payer forward.  Put your anger to work in a more productive way and you can help push for improvement.

    I'm not liberal. I'm actually just anti-evil, OK? - Elon James White

    by Satya1 on Mon Apr 14, 2014 at 08:25:32 AM PDT

  •  You can see what the deductible is before you (4+ / 0-)

    "sign on the dotted line". Can you give some proof you have the facts right?

  •  Some areas in Texas never had free clinics (5+ / 0-)

    that were able to do treatments for serious diseases.

    For example, check out this doctor on Galveston Island. She runs a free clinic, which is the only health care available for many patients. But it can't treat serious diseases like cancer, and the local hospitals won't take her patients, so they die.

  •  Why would she buy from an HMO rep, when subsidies (7+ / 0-)

    are generally available only for plans sold on the exchange? How was she unable to see what the deductible would be until she "signed on the dotted line"? If she bought it on the exchange she would have seen the deductible before she signed.

  •  Is it the fault of the ACA that (12+ / 0-)

    Texas refused Medicaid expansion?  Hell no.

    Of course the ACA isn't perfect.  The issue with narrow provider networks is a genuine problem that needs to be fixed, for example.  But it was, I believe, the best that had any hope of passing during that window when the Democrats had a functional majority in the Senate.

    And yes, the GOP wants to exploit -- and expand -- every hole that it can find.  But they're not going to use those to improve the ACA.  They're going to use them to try to destroy the ACA -- and any hope of universal health care.

  •  Finally ... (5+ / 0-)

    ... someone who is willing to write about the ACA's warts!

    I tell you, it's been depressing reading all of the "bowl of cherries" accounts, especially when my own experience with the ACA hasn't been a great one.

    Back when I signed up in November, NO ONE could tell me if my doctors were covered or not. But I needed insurance by January 1st, so I chose Anthem Blue Cross which was the least expensive option in my over 60 age range.

    Then on March 28th I learned that the Covered California Anthem Blue Cross plan would NOT be accepted by half of my doctors AND my local hospital. Because that was three days before the open enrollment period ended, I couldn't get near Covered California. They were so overwhelmed that I couldn't even get put on hold over the phone ... I simply got dropped every time I called. And the website was no better.

    So I spent the next four hours solid on the phone talking directly with various insurance companies until I found the one PPO that the local hospital would accept in my area ... Health Net. Thank got they took me ... in fact, they processed my application and approved me within 3 days. Five days later I had my new insurance card in hand.

    Unfortunately, the cost is going to be pretty horrendous ... $956/month for a Silver level plan. So much for affordable. This is what has been happening to us 60-somethings who don't qualify for subsidies. No bowl of cherries for us ...

    "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 Mon Apr 14, 2014 at 09:14:34 AM PDT

  •  This is tragic. The holes (0+ / 0-)

    in the ACA that might have been plugged by a public option or better yet, an actual DEMOCRATIC plan will lead to more and more needless deaths. What kind of a country allows this?  Rhetorical question.

    The thing about democracy, beloveds, is that it is not neat, orderly, or quiet. It requires a certain relish for confusion. Molly Ivins

    by MufsMom on Mon Apr 14, 2014 at 09:15:25 AM PDT

  •  If you'd read these facts, that'd be great. (6+ / 0-)
  •  There is another problem (0+ / 0-)

    and it is this:

    We are proud of the Medicaid expansion.

    In fact, Medicaid in most states is every bit as junk as the insurance plans that the ACA abolished. Few providers can afford to accept Medicaid's awful reimbursements, and when you add managed care on top of that....

  •  ACA is Liz Fowler's creation not the Democratic (2+ / 0-)
    Recommended by:
    TheMomCat, JayRaye

    Party's. And Liz Fowler works for the insurance industry.

    "If Wall Street paid a tax on every “game” they run, we would get enough revenue to run the government on." ~ Will Rogers

    by Lefty Coaster on Mon Apr 14, 2014 at 10:01:07 AM PDT

  •  Your frustration is heartwrenching and (8+ / 0-)

    totally understandable.  

    However, from this distance, I don't see a lot of attempts by the Dems to claim the ACA is just fine.  A typical stance seems to be that, just like Social Security and Medicare Part D at their inception, changes are needed as the glitches become apparent.  The House has to co-operate with the Senate and the administration to make a lot of the required improvements.  The President is doing what he can but there's a limit to executive orders.  

    The ACA, for all its many flaws, is better than the old system.  If any improvements are to be made they'll have to wait until the Dems take back the House and red states start turning blue.  

    GOTV!  Yeah, baby!

    We must, indeed, all hang together, or assuredly we shall all hang separately. B. Franklin

    by Observerinvancouver on Mon Apr 14, 2014 at 10:02:15 AM PDT

  •  In Tarrant County, Texas (17+ / 0-)

    which is where the diarist is from, there is one enhanced silver plan that costs nothing - $0 - a month (a Blue Advantage Silver HMO.  This is, of course, assuming what the diarist is saying is truthful, that Opal and her husband make just enough to qualify for ACA premium assistance.

    It is tragic what happened to Opal, but can we stop blaming the ACA for this?  It appears that either Opal and her husband made a mistake or someone misled them in choosing the bronze plan when they could've gotten a much better silver plan with a low deductible and low copays (none for generic meds) and for zero dollars a month in premiums.

    That is, unless you're out to rip on the ACA whatever the facts may be.

    "Those who have wrought great changes in the world never succeeded by gaining over chiefs; but always by exciting the multitude." - Martin Van Buren

    by puakev on Mon Apr 14, 2014 at 10:06:24 AM PDT

  •  It looks like a standard deductable (3+ / 0-)
    Recommended by:
    poco, Phoenix Woman, joe from Lowell

    I think mine is $5000.00. It doesn't make it right, but 5 grand out of pocket is a lot better than 250,000.00 or whatever a serious incident like this would cost. They won't go bankrupt over the 5 thousand.

    I'm sympathetic to her cause. But the main problem is of course the Rick Perry issue.

    A true craftsman will meticulously construct the apparatus of his own demise.

    by onionjim on Mon Apr 14, 2014 at 10:37:20 AM PDT

  •  I don't know the facts exactly (6+ / 0-)

    But if Perry and his party had not stonewalled on the ACA would Opal have better alternatives?

    Over time the refusenik states are going to have divergent health and social outcomes than  the states that have jumped in and implemented the ACA. Kentucky will be an interesting case in point as it started with some of the worst health stats.

    the future begins

    by zozie on Mon Apr 14, 2014 at 10:44:19 AM PDT

  •  Help with medication expenses (0+ / 0-)

    Should be available for patients like Opal.  This help was available before the ACA and that has not changed.  Locally we have something called HEART USA that helps people access free or reduced cost prescriptions by finding pharmaceutical programs run by the drug companies,  filling out paperwork, assisting the person's doctor with paperwork, and helping when it is time for a refill.  To qualify you need to be low income and have no insurance which covers your meds, which sounds like was the case for Opal.

  •  From McCamy Taylor's Dem. Underground blog (7+ / 0-)
    Not Sick Enough
    Posted by McCamy Taylor in General Discussion
    Thu Dec 08th 2011, 08:19 PM
    Earlene had a bachelor’s degree. She did white collar office work all her life. At 50, she suffered a stroke which left her paralyzed----on her left side. She was confined to a wheelchair and needed assistance to go to the bathroom or cut her food or bathe herself. She was in and out of the hospital with infections. When sitting up in her wheelchair, her blood pressure would become dangerously low. But, because she could still speak and use her right hand---her typing hand---the Social Security Administration decided that she was healthy enough to work. She died without ever collecting a penny of the SSI she had paid into all her life. She died without ever qualifying for Medicare. It has gotten to be a joke. A sick joke, like a Gaham Wilson cartoon.
    Again, we have a sketchy, vague on details but, high on heart wrenching emotional appeals, critique on the inhumane and uncaring practices of govt. bureaucracy.

    SSA, ACA those cruel heartless bastards!! Of course, the more helpful account would  seek to identify the regulatory glitches that led to this tragic outcome, rather than just ranting against a program that has helped many, many citizens.

    Per this diary, after having read and re-read it, I still can't quite get why blame is placed on the ACA rather than the state of Texas who said no to Medicaid expansion. or the HMO agents who clearly gave Opal bad info.
     

  •  Another reason among too many that we need (4+ / 0-)

    proper universal healthcare, not just health insurance improvements.

    If we do not continue to push for health care, this will continue to repeat itself.

    The ACA is an improvement, not the ideal.

  •  In the many countries that already have Obamacare (9+ / 0-)

    .. it works pretty well.  In Switzerland for example.

    No, it is not as affordable as socialized medicine, nor as fair nor as efficient.

    But its a hell of a start.

    Once we stabilize ACA and bake it into the American consciousness, the tweaking of the fairness can begin.

    In the meantime given the conservative congress that produced ACA (by that I mean the democrats) it was the best that could possibly have been achieved.

  •  Righteous rant! (2+ / 0-)
    Recommended by:
    aliasalias, JayRaye

    And one I fully support. I had a friend named Carl who wasn't insured, nor would he have been eligible even if Texas had accepted Medicaid expansion because he was, (yes, was) single, male and childless. When he was diagnosed with lung cancer, it was already stage four but the original tumor was small and treatable. It was metastasis that killed him. He could have gotten treatment had he been getting regular care. Now he's gone and the world, (whether you know it or not), is a bleaker place for his absence.

    Obamacare, (the ACA) is a joke. I submit that the holes are much larger and more numerous than those in the Titanic. It's doing some of the things it was supposed to by covering more Americans but until there is a plan to cover the Carl's and the Opal's, it's almost useless. Until my premiums stop going up 20 percent a year, it's unsuccessful and not doing me a bit of good. The insurance companies are why healthcare costs are so high so the solution shouldn't have been codifying their role into law but rather regulating the crap out of them or just eliminating them altogether.

    This is why I'm not a Democrat officially. The party is too pro business right wing and it's members seem to find partisanship more important than policy. They'll support legislation or candidates based on the letter beside the name first before any other consideration. Considerations like the fact that this legislation was written by the Heritage Foundation and the fact that the only reason Republicans hate it is the very same shallow reason that Democrats love it: because Obama and the Democrats can claim a "victory". Some of the same people circling those wagons drew all kinds of "lines in the sand" over single payer, then over the "public option" and so forth. Then they watched as each of those lines were leapt over and they continued to cheer and still do to this day.  Yes, Obamacare is a "victory" but it's a pyrrhic victory at best. Ask Carl. Ask Opal. Cheering for Republican written legislation because a nominal Democrat has his name on it isn't any different than when Republicans defend adulterers just because they are Republican.

    Recommended highly.

    "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 Mon Apr 14, 2014 at 01:04:04 PM PDT

  •  McCamy, not sure why (5+ / 0-)

    you are taking shots at the Kos community for "circling the wagons around the ACA".  What I see is the community celebrating making the situation better, not thinking that the situation is now perfect and not in need of further improvements.

    I'm not sure who around here asked you to keep quiet about the suffering chronically ill - I certainly wouldn't!!  But I do have to ask you what you would like to accomplish by highlighting gaps in medical coverage just before the midterm elections.  It's a sad fact of our current political environment that precious little will get done between now and next January.  Almost everything that happens in DC between now and then will be simple posturing for the elections.  Highlighting the gaps in ACA (as well as mixing them in with the gaps in coverage that have always existed) will do more harm that good to the folks who are fighting for making things better.

    I understand your need to vent about a horrible, nightmarish situation and I fully support that.  I want to fix them too.  If you were around here during the long, long time that the ACA was being debated in the Senate and House, you would know that the majority of the folks would have preferred Single Payer (Medicare for All) or the Public Option.  We all want health care coverage to be a right.  

    Our next window to make it better is January.  Please let us circle our wagons until the time is right to sound the advance.

    Clearly, what has happened is that the use of the word Gestapo has clouded my message.
    - Maine Gov. Paul LePage

    by clinging to hope on Mon Apr 14, 2014 at 01:31:52 PM PDT

  •  The perils of co-opting the plans of the Right (0+ / 0-)

    They are shit ideas designed to make things worse, not better.

    Hillary does not have the benefit of a glib tongue.

    by The Dead Man on Mon Apr 14, 2014 at 01:52:50 PM PDT

  •  yes the ACA can be tweaked but not in a good way (2+ / 0-)
    Recommended by:
    Patango, JayRaye

    http://thinkprogress.org/...
    Obama Makes Surprise Reversal On Obamacare

    The Obama administration announced on Monday that it would be reversing scheduled reductions to the Medicare Advantage program, dealing a huge victory to private insurers and the bipartisan group of lawmakers who advocated for maintaining the higher reimbursement rates that President Obama claimed only padded company profits.
    The Affordable Care Act is supposed to reduce excess payments to private insurers participating in Medicare Advantage, saving the government $156 billion over a decade. The effort to bring Medicare Advantage in line with traditional Medicare began in 2012, and payment reductions were scheduled to take place each year until 2017. But 2015 is the second year that the Center for Medicare and Medicaid Services (CMS) has cancelled the scheduled cuts following political pressure. Instead, insurers will see a slight increase in payments.
    (emphasis mine)

    without the ants the rainforest dies

    by aliasalias on Mon Apr 14, 2014 at 02:34:43 PM PDT

  •  We circle the wagons (7+ / 0-)

    because Republicans are still doing their level best to repeal the ACA and replace it with ...nothing.

    Far more people would be much worse off under that scenario.

  •  For $50 I got a silver plan with a $500 (4+ / 0-)

    out of pocket limit for medications.  I met that the first month.

    I agree that the cheapest bronze plans are crap but somebody making $20k a year can get a really good deal on a decent plan.

    We want to build cyber magicians!

    by VelvetElvis on Mon Apr 14, 2014 at 03:04:00 PM PDT

    •  And I can raise you a single mother (1+ / 0-)
      Recommended by:
      JayRaye

      who has already had a quadruple bypass at age 50 who takes all her heart medications but can not fill her hydrocodone---the pain pill that helps with the chest arthritis from when they opened up her ribs--most months, because she needs to spend that $5 copayment on the kid's food.

      I once saw a man having angina who did not have a penny in his pocket. No a cent even for aspirin. We send people to the hospital all the time because they can not buy the simplest preventive medication. If a doctor tries to give one of these patients money, it is considered unethical and they get reported.

      $50 is like a mountain to some people. I honestly had no idea how bad some people have it in this country until I started working with the chronically ill. They get to choose whether to breathe or eat.

      "A dog starved at his master's gate/Predicts the ruin of the state" Blake

      by McCamy Taylor on Mon Apr 14, 2014 at 04:31:17 PM PDT

      [ Parent ]

  •  Doctors don't "blame" the appendix. (2+ / 0-)
    Recommended by:
    DeadHead, JayRaye

    If it gets infected, they take it out. They don't "blame" the sugar. If it gets high, they try to get it down.

    There is no "blame" here. There is just here. Some of what's here is pretty good. Some of what is here can be made better.

    "A dog starved at his master's gate/Predicts the ruin of the state" Blake

    by McCamy Taylor on Mon Apr 14, 2014 at 04:34:54 PM PDT

    •  Doctors blame the people who favor appendicitis (2+ / 0-)
      Recommended by:
      bluenick, howarddream

      if your diary is any indication.  You're far more interested in setting up and knocking down the strawmen of nonexistent STFU and claimants that the ACA is perfect than you are in actually looking at the ACA or Opal's finances, because I get the impression you don't know much about either.

      The dossier on my DKos activities during the Bush administration will be presented on February 3, 2014, with an appendix consisting an adjudication, dated "a long time ago", that I am Wrong.

      by Inland on Mon Apr 14, 2014 at 07:12:31 PM PDT

      [ Parent ]

  •  A Helpful Diary to Clear Up Some Confusion (1+ / 0-)
    Recommended by:
    howarddream

    Found here.

    Seems as if Opal might have had better options if Perry and his ilk hadn't tried to make navigators hard to access.

    I'm a "right-wing freak show," or at least that's what one nobody on DKOS seems to think.

    by kefauver on Mon Apr 14, 2014 at 06:57:40 PM PDT

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

    But for some reason this diary reads more like a fictional story the Koch Brothers would tell through AFP. Mccamy are you actually doctor or a fiction writer? Nothing wrong with writing fiction, I just hope it wasn't written to deceive. This story is just a little to perfect at tugging on heart strings when in actuality opal would have qualified for an enhanced silver play with lower patient cost shares and free prescriptions if she was jus barely able to qualify for a subsidy.

  •  Sounds Like Opal Needed a Navigator. (1+ / 0-)
    Recommended by:
    bluenick
    Once they signed on the dotted line, Opal and her husband learned the truth. Opal now had insurance that had an enormous deductible.
    Why did she and her husband go through an HMO rep instead?

    Also, you would think a "free clinic" would be interested in educating lower income patients about their best options regarding healthcare coverage.

    Yes, there are holes in the ACA, but there are a few holes in this diary as well.

    I miss Speaker Pelosi :^(

    by howarddream on Tue Apr 15, 2014 at 07:10:42 AM PDT

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