As any good ole insurance salesmen would say, we have a policy that will look great on you! Especially an affordable health insurance policy courtesy of Obamacare. If you want a great intro into the kinds of basics policies that will be available for millions of uninsured or under-insured Americans beginning in October, this
superb post by Joan is a must read.
Keep in mind that coverage does not go into effect for those who enroll between now and the end of the year until Jan 1, 2014, at the earliest; you have at least until the end of March, 2014, to enroll this time around; if you are covered under employee insurance already this will have no effect on you; and for many on COBRA, Obamacare will probably be more affordable. There are two big components of the Affordable Care Act: the affordability part, and what the insurance companies offering qualifying policies are required to provide and restricted from doing. Below we'll talk a little bit about the latter. For bonus points we'll start off with watching Rachel Maddow tear the right a new one!
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That's the hype and hypocrisy, the craven lengths to which the right will go to sabotage the ACA. It's clever ... and dishonest as hell, the people who really seem to dream about getting their version of government all up in your vaginas are the social conservatives and their libertarian allies—a strange political marriage indeed. But it makes a deeper point that I actually agree with: if you don't want medical care, you probably shouldn't worry much about health insurance. Policies offered under Obamacare do have to offer basic preventative care and that includes the option for physical exams of all kinds.
The policies offered under Obamacare that will soon be listed on the Health Insurance Exchanges (HIX) come in four basic flavors: bronze, silver, gold, and platinum. Each flavor has a different formula for deductibles and copays. A deductible is how much you pay percentage wise out of a given amount charged for a specific service. A copay is a flat fee you pay out-of-pocket for specific visit to a specific doctor or a specific script filled at a local pharmacy. The table looks like this:
- Bronze: The insurance company pays 60 percent of costs, you pay 40.
- Silver: The insurer pays 70 percent, you pay 30.
- Gold: The insurer pays pays 80 percent, you pay 20.
- Platinum: The insurer pays 90 percent, you pay 10.
It doesn't matter if you have the "best" insurance in the world if that insurance company can weasel out when you need it most. Most large insurers had become experts at statistics and underwriting years ago. Over the last decade they came to realize one of the easiest way to increase earnings year over year was to limit paid claims, and viola, the bag of tricks got bigger and nastier. They had a huge advantage going in: most modern healthcare plans are protected under ERISA, the retirement security act that originally had nothing to do with protecting insurance company profits.
That protection made it extremely difficult to punish insurance companies for denying coverage. If you could prove they dragged their feet for a procedure, you might get that procedure covered. But winning compensation for pain, suffering, or needless death was well nigh impossible. It's no wonder insurance companies exploited this loophole to screw people out of benefits left and right. And since medical treatment is so often time sensitive, they ended up hurting and killing a lot of people in the process. Obamacare eases this by requiring any insurance company offering coverage under the ACA to adhere to several basic rules. Here are a few of the ones most likely to help you and your family:
- The policy must cover pre-existing conditions.
- There is an annual cap to benefit you; you can't pay more than that cap, a cap for a given year and another for your entire life, even if you're so sick or so injured it takes a lot of healthcare services to treat you.
- The policy must cover a comprehensive list of preventative tests and services at no charge—no copay to the insured—and there's an additional list for women's services that have been ignored or excluded in the past, like breast cancer screening and birth control/hormone replacement therapy.
- Last but not least, the insurance can't arbitrarily drop you or arbitrarily raise your rates when you get sick or hurt—they cannot pull bullshit shenanigans like saying your misspelled your address on your forms. And all companies/policies must spend at least 80 percent of customer premiums on healthcare. If they don't, you get a rebate check mailed or electronically deposited.
Naturally, the usual suspects sided with a small sliver of the one percent of business owners who want to control your genitalia instead of the 99 percent of the people whose labor enriches them. Of course you can have the health insurance, for things like car wrecks or lightning strikes, without having to take advantage of the preventative care or other required benefits offered, if that's what you want. It's hard to see how that would be getting your money's worth, but it's your call.
The truth is the pre-existing and no-cancel riders by themselves will save a ton of people's lives and a ton of money for taxpayers. Including people like me; last winter I had a severe heart attack and, even though it was treatable, even though I've since lost all kinds of weight and am on the verge of even being a little bit buff, I would never, ever be able to get a private policy that covers future cardiopulmonary issues without the requirements of Obamacare. Multiply me times about 100 million people, as at least half of all men, women, and children in America will be in that same life-threatening boat sooner or later, and you get the idea.
Kill Obamacare and you kill people, lots of people that wouldn't have otherwise died, you might kill me. I've already found that's an effective talking point shutdown the next time Uncle Bob goes into full tea party mode over the holiday dinner table.