I don't intend to be insensitive, but I always wonder why some people don't have any health insurance. In many cases it is because they just don't have the funds. Others, I can't imagine why not.

(07-26-2013 06:48 PM)WeatherfordOwl Wrote:  I don't intend to be insensitive, but I always wonder why some people don't have any health insurance. In many cases it is because they just don't have the funds. Others, I can't imagine why not.

It is pricey if you aren't covered by work and have to buy a private policy. Plus if you have a checkered medical history it is even worse. I still get dinged on our private policy for having tumors in 1951 and 1977. If you are trying to cover a family it becomes a trade off for some folks.

(07-26-2013 06:56 PM)Tiki Owl Wrote:  

(07-26-2013 06:48 PM)WeatherfordOwl Wrote:  I don't intend to be insensitive, but I always wonder why some people don't have any health insurance. In many cases it is because they just don't have the funds. Others, I can't imagine why not.

It is pricey if you aren't covered by work and have to buy a private policy. Plus if you have a checkered medical history it is even worse. I still get dinged on our private policy for having tumors in 1951 and 1977. If you are trying to cover a family it becomes a trade off for some folks.

It becomes a tadeoff for MOST folks who are not either wealthy or covered through their employer. Individual insurance can run as high as $1,000/month, and family coverage as high as $2,500+/mo. That's quite a bill for a household earning even $75,000 per year (with 20+% going to taxes); let alone for those earning $50,000 or less. And the unfortunate reality is that it is VERY difficult for those making uner $50,000/yr to even get accepted/approved for coverage under a private policy.

(07-26-2013 07:23 PM)waltgreenberg Wrote:  

(07-26-2013 06:56 PM)Tiki Owl Wrote:  

(07-26-2013 06:48 PM)WeatherfordOwl Wrote:  I don't intend to be insensitive, but I always wonder why some people don't have any health insurance. In many cases it is because they just don't have the funds. Others, I can't imagine why not.

It is pricey if you aren't covered by work and have to buy a private policy. Plus if you have a checkered medical history it is even worse. I still get dinged on our private policy for having tumors in 1951 and 1977. If you are trying to cover a family it becomes a trade off for some folks.

It becomes a tadeoff for MOST folks who are not either wealthy or covered through their employer. Individual insurance can run as high as $1,000/month, and family coverage as high as $2,500+/mo. That's quite a bill for a household earning even $75,000 per year (with 20+% going to taxes); let alone for those earning $50,000 or less. And the unfortunate reality is that it is VERY difficult for those making uner $50,000/yr to even get accepted/approved for coverage under a private policy.

Texas has a high risk coverage through BCBS for those who cannot get private coverage. it ran me, just me,about $700 a month for a $5k deductible policy.

Ladies and gentlemen..As of Oct 1, 2013, insurance exchanges will be set up to provide people with an avenue to buy insurance if they are not covered by their employer's plan, or are not covered by Medicare or Medicaid. Three tiers of coverage will be provided as mandated by the ACA. Insurance companies will submit their plans and premiums (and be chosen by the exchanges). It will (supposedly) be accessed via the internet, be transparent..as to differences in coverage between the tiers, premium differences, etc., and have a graduated subsidy (up to a level of $88,000 for a family of four..I think) available to defray premium costs. As of 2014, I think, pre-existing conditions will be covered..as well as an end to yearly and life-time limits on coverage. And (again,... supposedly) this coverage is to be provided without a significant increase in premiums for those benefits.
The fly in the ointment, of course, is that our governor (brain dead..or a genius..take your pick ) has refused to set up the exchanges to be run by Texas. Supposedly (again!) the feds will set them up for Texas. ALSO, the governor has refused to expand Medicaid in Texas (as mandated by the ACA)...the Supreme Court said sates could do this. So, coverage in Texas for our poorest people who do not already have Medicaid will continue to be provided by YOU the tax payers in places like Dallas, Houston, San Antonio, Midland, etc where there are publicly supported hospitals and ERs that must see these patients..at a tremendously higher cost compared to seeing them in a physician's clinic.
Oh, and by the way, did I mention that as of 2014, you are REQUIRED, as a U.S. citizen (there are a very few exceptions) to have health insurance???!!! And that aspect will be enforced, supposedly (again!!!), by those friendly folks at the IRS. The penalty for not having health insurance will gradually increase over three years to a figure in the neighborhood of 2% of your yearly income.
One wonders where those people who are so poor that they can't afford health insurance, and would be included in a new expanded Texas Medicaid.. will get the $ to pay the fine for not having coverage. 'Guess they can ask that question to the Governor or the President.
Have a nice day.

Greowl:

best summary of the issues around the affordable care act I have read.

One byproduct of the ACA is that we have received roughly a $500 refund the past two years since our insurer failed to direct 80% of the premiums paid by policyholders to patient care.

(07-26-2013 07:23 PM)waltgreenberg Wrote:  It is pricey if you aren't covered by work and have to buy a private policy. Plus if you have a checkered medical history it is even worse. I still get dinged on our private policy for having tumors in 1951 and 1977. If you are trying to cover a family it becomes a trade off for some folks.

It becomes a tadeoff for MOST folks who are not either wealthy or covered through their employer. Individual insurance can run as high as $1,000/month, and family coverage as high as $2,500+/mo. That's quite a bill for a household earning even $75,000 per year (with 20+% going to taxes); let alone for those earning $50,000 or less. And the unfortunate reality is that it is VERY difficult for those making uner $50,000/yr to even get accepted/approved for coverage under a private policy.
[/quote]

So then, barring a layoff, or me being forced to go part time at my work, I guess I will be working until the day I die just to pay my health insurance premiums!

(07-26-2013 06:56 PM)Tiki Owl Wrote:  

(07-26-2013 06:48 PM)WeatherfordOwl Wrote:  I don't intend to be insensitive, but I always wonder why some people don't have any health insurance. In many cases it is because they just don't have the funds. Others, I can't imagine why not.

It is pricey if you aren't covered by work and have to buy a private policy. Plus if you have a checkered medical history it is even worse. I still get dinged on our private policy for having tumors in 1951 and 1977. If you are trying to cover a family it becomes a trade off for some folks.

Putting politics aside, the goal of health care reform was supposed to correct the problems of the individual health insurance market.

Elimination of the pre-existing condition exclusion clauses is the crown jewel of the affordable care act.

No matter what side of the political divide one is on, beginning January 1st, we all benefit as insurance companies will not be able to deny insurance, require underwriting review, or charge higher premiums if one has a pre-existing condition.

One will be able to enroll in an individual policy beginning January 1st, either through an insurance agent/agency, or through a health care exchange. Depending on state, the exchange will be operated by the state or by the federal government. All of the policies sold will be private insurance.

With the implementation of Medicare, the highest cost/highest risk patients were removed from the private insurance market improving the risk pool for the private insurance companies.

Unfortunately, that coincided with the dramatic increase in the group insurance enrollment. This was a natural development of the custom of health insurance being an employment benefit. One effect of this was the destruction of the individual insurance market as group insurance tended to "cherry-pick" a healthier population at discounted rates.

Small groups and individuals did not have a large enough risk pool to allow affordable insurance.

Health care financing has now been so politicized that workable solutions are nearly impossible to even discuss.

- I personally think all insurance should be individual.
- The risk pool for an insurance company should be the the entire pool of all customers insured.
- The employer health benefit of health insurance should change from the selection and purchase of insurance for their employees (or union members) to providing an allowance for the employee to purchase insurance with.

(07-26-2013 06:56 PM)Tiki Owl Wrote:  

(07-26-2013 06:48 PM)WeatherfordOwl Wrote:  I don't intend to be insensitive, but I always wonder why some people don't have any health insurance. In many cases it is because they just don't have the funds. Others, I can't imagine why not.

It is pricey if you aren't covered by work and have to buy a private policy. Plus if you have a checkered medical history it is even worse. I still get dinged on our private policy for having tumors in 1951 and 1977. If you are trying to cover a family it becomes a trade off for some folks.

If you can even get a company to write for you. My pre-existing conditions consisted of asthma which I had as a teen and which have not bothered me or required treatment since (and which even then was fully controlled and never caused more than wheezing) and the typical 30-35 year-old low back pain caused by degenerative disc disease (LBP has a lifetime prevalence of about 80% and an annual prevalence of about 5%) for which I had one cortisone shot and took pain relievers and muscle relaxants for a while.

I called all five companies offering individual plans in the Austin area at the time and not a single one would write a policy for me without a rider excluding coverage of all anatomical and disease processes related to the spine. For any price.

[/quote]
I called all five companies offering individual plans in the Austin area at the time and not a single one would write a policy for me without a rider excluding coverage of all anatomical and disease processes related to the spine. For any price.
[/quote]

This changes January 1st.

The exchanges are supposed to be up and running October 1st.

Insurance companies that write individual policies sold directly, outside of the exchanges, will have to offer policies without pre-existing clauses and without lifetime limits. I have been told by at least one company that rates will be available by November 1st.

Oh, believe me, I know when my insurable fortunes will change. I'm good for the short term, because I'm back in school (and thus can get insurance through the school's student policy). And good for the long term once Jan 1 rolls around.

OK, so insurance will be readily available. But will health care? And will it remain so?

Judging from what I read about the ACA in this thread, it is difficult to make a case against it. I really have to wonder why the President and the Congress had to ram it though so quickly that no one had time to even read the bill. Or why noone could know what was in it without passing it first. (Could it be that the bill was only a notional set of ideas yet to be fully "fleshed out"?) And even then they had to go behind closed doors and barter with various congress men and women to get their votes, and still had to use some strange procedural methods to get it passed at literally the eleventh hour. That process is what really concerns me, and it is not limited to just the ACA.

(09-19-2013 10:57 PM)WeatherfordOwl Wrote:  Judging from what I read about the ACA in this thread, it is difficult to make a case against it. I really have to wonder why the President and the Congress had to ram it though so quickly that no one had time to even read the bill. Or why noone could know what was in it without passing it first. (Could it be that the bill was only a notional set of ideas yet to be fully "fleshed out"?) And even then they had to go behind closed doors and barter with various congress men and women to get their votes, and still had to use some strange procedural methods to get it passed at literally the eleventh hour. That process is what really concerns me, and it is not limited to just the ACA.

First, here is what I see as the substantive case against Obamacare. We are going to increase demand by covering an additional 30 million people. At the same time, we are going to control costs by paying docs and other providers less to do more. That cannot help but reduce the number and quality of providers. So we are reducing supply at the same time we are increasing demand. The end result will inevitably be delays, queues, and poor quality. From an economic perspective, I do not see how any other result is possible. If anyone wants to make the case for Obamacare, please explain how we dodge this bullet. Better yet, identify a single situation in all recorded history where this approach has worked.

Second, I agree with you regarding the procedural argument against it. Anything that requires this level of secrecy and gaming the system to get through is questionable for that reason alone. I think your characterization as a set of ideas to be fleshed out is an accurate one, and the agencies charged with filling it out are encountering extreme difficulties doing so. Moreover, leaving it up to the agencies to fill in the blanks means we get a health care system designed by lobbyists.

(09-20-2013 06:09 AM)Owl 69/70/75 Wrote:  First, here is what I see as the substantive case against Obamacare. We are going to increase demand by covering an additional 30 million people. At the same time, we are going to control costs by paying docs and other providers less to do more. That cannot help but reduce the number and quality of providers. So we are reducing supply at the same time we are increasing demand. The end result will inevitably be delays, queues, and poor quality. From an economic perspective, I do not see how any other result is possible. If anyone wants to make the case for Obamacare, please explain how we dodge this bullet. Better yet, identify a single situation in all recorded history where this approach has worked.

+1.

I just said that I could not make a case against the ACA, judging from what I read on this thread. But you have corrected that situation with your above reply.

This is my (evolving) perspective from a provider.

The ACA's primary goal is to provide health insurance for the 30 million people that don't have it now. Around 80-90% of the program's funds go to that goal.

Many people who have jobs now but can't afford insurance will be able to afford some sort of coverage because their premiums will be supported with sliding scale subsidies. That's good, but it doesn't eliminate the problem of high deductibles and significant out of pocket expenses for these patients.

A huge number of patients will now receive their health care through an expansion of Medicaid. In almost all states that means reimbursement to providers at rates of half, or less, of Medicare rates ( and those rates are low...and dropping). In addition, many states (including Texas) have thrown up onerous roadblocks to access reimbursement in the Meicaid system. It's not unusual for one of my staff to be on the phone (on hold!!) for 30-45 minutes to get approval for a procedure that MIGHT reimburse $150. In the past, our Medicaid patients have made up 5% of our total practice. Next year it has the potential to triple.

We are a private practice group of 7 surgeons. We are the only surgeons providing trauma and acute care emergency services to our 400 bed community hospital. And we don't refuse anybody at the hospital for those services. Never have. And never will.

However, with the prospect of significant declines in the quality of reimbursement in Medicaid and high deductible or "bare bones" insurance policies, I feel certain we will STOP seeing Medicaid patients in the office..and limit the number of Medicare and low reimbursement insurance patients we see.

Where will these patients go? To the ERs, "doc in the box" caregivers, and high volume and (in my opinion) lower quality providers.