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PeteMoss

Obamacare - Epic Failure

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I don't understand why the insurance company that underwrites your policies aren't subject to the quality standards set forth by Obamacare specifically the ten "healthcare rights" and the 80/20 rule. ie Does your insurance already cover preexisting conditions? (if that's asking too much info, it's ok) Secondly, if nothing changes for you and you're happy, that's great. I'm glad some people get to retain their right to be left alone. I'm glad some people will be able to operate within the healthcare system without being manipulated to comply with mandated health directives.

thanks Ginger. I didn't sign up for any of obamacare coverage so thats probally why I don't have to abide by their rules because I have my own insurance. I don't have any pre-existing issues,so I don't know about that.I don't go to the doctor much so there are no records of any pre existing issues anyhow for me. Yes i'm very happy. We pay 20 copay for the doctor, 5 to 25 copay for p.scribsitons. My son had two operations a few years his appendix burst and he got some gran green in there also. The total bill was 65000 he was in ten days and our bill was 100.00 total. They paid for everything.

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Go to the this whitehouse website. Click on New York. NOTHING. The words hint at good things in 36 states, but they don't tell you which 36 states, you have to guess. But hey the site will be updated:

 

"Use the map below to explore a summary of the choices and premiums expected in those 36 states. Final, complete information about all the plans in each state Marketplace will be available via HealthCare.gov on October 1."

 

Notice they don't say which October 1.

 

http://www.whitehouse.gov/healthreform/map

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Go to the this whitehouse website. Click on New York. NOTHING. The words hint at good things in 36 states, but they don't tell you which 36 states, you have to guess. But hey the site will be updated:

 

"Use the map below to explore a summary of the choices and premiums expected in those 36 states. Final, complete information about all the plans in each state Marketplace will be available via HealthCare.gov on October 1."

 

Notice they don't say which October 1.

 

http://www.whitehouse.gov/healthreform/map

The reason the website does not have NYS on it is because New York chose to set up their own exchange, you can find exchange rates on the new york state run health exchange site.

 

Is there anything specific you're wondering about the exchanges here in the state? I'll toss some information out and see if it helps clarify anything and if you want to ask for more information I'll try and answer on what I know. I'm not an expert by any means but I've navigated some of the waters for my parents and friends, trying to make sure that people I know are adequately prepared, I'm good at navigating this stuff typically.

 

Here's some basic information, I'm going to use a 25 year old person single household making 25k a year for calculations and if you want a specific scenario let me know:

 

All Values are after subsidies:

BRONZE: American Progressive 105$ a month premium. CDPHP 172$, Excellus Blue Cross 85, MVP 61

SILVER: (same order as above) 195, 247, 185, 159

GOLD: 264, 338, 257, 246

PLATINUM: 329, 421, 341, 338

 

In addition because this person is under 30 I'll include catastrophic: 335, 410, 345, 170 (No tax credit in NYS because Catastrophic is NOT tax subsidized here)

 

Depending on my conditions would depend on how I chose. I'd choose Bronze if I were relatively healthy, take the MVP and pay out 15 dollars a week, that'd get me cheaper copays on prescriptions (10 dollars generic), doctor visits at 50% covered, a few free preventative care visits a year (3 I believe), and cover me if anything big went down. (Deductible would be around 3k for the year, max out of pocket 6.3k) - Everything in the MVP plan is at 50% covered typically. So anything huge came down (broken leg, arm, random hospitialization) I'd be relatively covered.

 

Honestly if I thought I could afford it and had ANY sort of medical problem I'd skip silver and jump to gold. The deductible for gold is like 600 a year. They cover a lot of things and the coinsurances are relatively cheap, 60 dollar MRI's etc.

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LA:

 

Thanks for the info. The whitehouse.gov website should have linked people to the NYS site. Secondly, the WH site has not been updated.

 

I went to the NYS website and I can't see a way to view costs unless I register. That makes no sense.

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LA:

 

Thanks for the info. The whitehouse.gov website should have linked people to the NYS site. Secondly, the WH site has not been updated.

 

I went to the NYS website and I can't see a way to view costs unless I register. That makes no sense.

 

I agree they should do a better job with giving out the information, it's one of my criticisms of the process and a very fair one when people bring it up. The NYS site is actually decent

 

http://www.healthbenefitexchange.ny.gov/resources

 

This page has a rate estimator on it that's pretty accurate, it's an excel file though. But it's essentially a plug and play calculator.

 

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Main Criticisms which I think are fair:

1) The current structure of the plans and subsidies do not help those who pay for insurance through work but pay quite a bit due to paying for family plans.

2) The federal site is darn slow, and buggy as crap.

3) There isn't enough transparency in being able to view rates and plans without signing up. It's possible to find these rates on other sites in some cases but it's very hard to navigate and find them on the government sites.

4) I don't think they're giving adequate information to people signing up for plans, without a good grasp of insurance (which can be very confusing) some people are going to be in the wrong plans for their needs.

5) Plan rates vary too much based on regions, better equalization should have been applied. I understand the reason for it, but I dislike it, it's going to make consumers feel like they're getting hosed in some cases.

 

-------------

 

I think these things can be ironed out though. I am hard pressed to label the current situation as an epic failure yet. I think the big determination is going to be a couple years down the line.

 

1) Does the plan meet CBO projections?

2) Do they fix some of the coverage gaps for middle class tax payers?

3) How do the insurance companies fair after the injection of high risk/cost people into the pools, have we adequately covered the bases with low risk people being in the pools? This is going to really matter because of the 80/20 or 85/15 rules. If these plans lower cost and you start seeing people getting a refund on premimums later on you're going to have a very happy base of people. If these plans continually rise in prices based on low estimates from the initial estimators you're going to see a weird combination of things happening in the insurance markets. You may see companies opting out and competition dying out as one plan manages to offer the lowest rates constantly with decent coverage and you'll end up with a single company dominating the markets for these exchanges. For example right now MVP or American Progressive seems to have the cost advantage across all markets in NYS BUT did they go to low and will need to dramatically raise costs? Or did they go low as a strategy to lure people in, having the largest base of people and being able to drive CDPHP out as the highest cost.

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I don't understand why the insurance company that underwrites your policies aren't subject to the quality standards set forth by Obamacare specifically the ten "healthcare rights" and the 80/20 rule. ie Does your insurance already cover preexisting conditions? (if that's asking too much info, it's ok) Secondly, if nothing changes for you and you're happy, that's great. I'm glad some people get to retain their right to be left alone. I'm glad some people will be able to operate within the healthcare system without being manipulated to comply with mandated health directives.

 

CC's employer more than likely filed to grandfather the plan back in 2010 after PPACA was passed (or they were granted a waiver). Employers were allowed to file for grandfather status as a means to keep their current plan design "as is", and thus exempt from complying with the mandates of the law. If they did this then they are not allowed to make significant changes to the plan which will jeopardize their grandfathered status.

 

http://www.kaiserhealthnews.org/stories/2012/december/17/grandfathered-plans-faq.aspx

 

 

Secondly, the employer mandate has been delayed until 1/1/2015 for employers with 50+ employees.

 

Since the plan is negotiated by the union, it will potentially be subject to compliance at renewal, if it is NOT granfathered.

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CC's employer more than likely filed to grandfather the plan back in 2010 after PPACA was passed (or they were granted a waiver). Employers were allowed to file for grandfather status as a means to keep their current plan design "as is", and thus exempt from complying with the mandates of the law. If they did this then they are not allowed to make significant changes to the plan which will jeopardize their grandfathered status.

 

http://www.kaiserhealthnews.org/stories/2012/december/17/grandfathered-plans-faq.aspx

 

 

Secondly, the employer mandate has been delayed until 1/1/2015 for employers with 50+ employees.

 

Since the plan is negotiated by the union, it will potentially be subject to compliance at renewal, if it is NOT granfathered.

my coverage is through NYS and my plan covers everything at very little or no cost. So I would expect our plan to fully comply with the mandates.Its even better than they want people to have and with very little or no out of pocket expense.So why would the ACA want any changes to my coverage?

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As of today. 10/29/2013, the whitehouse website still says you can keep your insurance:

 

"For those Americans who already have health insurance, the only changes you will see under the law are new benefits, better protections from insurance company abuses, and more value for every dollar you spend on health care. If you like your plan you can keep it and you don’t have to change a thing due to the health care law."

 

The lies continue.

 

http://www.whitehouse.gov/healthreform/healthcare-overview

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As of today. 10/29/2013, the whitehouse website still says you can keep your insurance:

 

"For those Americans who already have health insurance, the only changes you will see under the law are new benefits, better protections from insurance company abuses, and more value for every dollar you spend on health care. If you like your plan you can keep it and you don’t have to change a thing due to the health care law."

 

The lies continue.

 

http://www.whitehouse.gov/healthreform/healthcare-overview

PeteE if you don't want insurance,just pay the fine. I have not talked to one person I know that their health insurance has changed since the ACA. Alot of barking going on out there,but no biting.

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sounds to me from reading and listening to many other sources the policies that are costing people more is because the ones they had were total crap as far as the coverage they provided if any coupled with very high co payments that those insured couldn't pay anyway. So basically those policies are worthless and wouldn't pay nothing anyhow. EX. my brother in law had surgery 4 months ago and because he didn't stay overnight they said it was outpatient and would not pay any of it. Now he knows why his insurance was so cheap. He nows owes 34,000 thousand bucks and they garnish his wages 500.00 a month. this is why the ACA won't allow these garbage coverage policies in, they are just that garbage people paid for that pay out nothing when its needed.So thats a good thing.

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You can't be that dumb.

He thinks we are dumb also.

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You can't be that dumb.

whats so dumb? the policies I talked about are total shit. I told you what happened to my brother in law. thats not insurance thats a rip off, period. Its dumb to have that worthless coverage. why would anyone pay for something like that? piece of mine maybe untill its time to collect,then holy shit I owe what??? thats DUMB

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Your brother-in-law took a gamble and went with cheap insurance. He lost.

He obviously did not read his policy or check on his coverage.

 

I find your story very hard to believe. I find you very hard to believe.

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You can't be serious trying to justify the 300% average increase in Health Care Plans by saying "the old plan sucked and this one is worth the money".

 

1. Prove it.

2. Your brother in law keeping his doctors??

 

You advocates live in a world of "everyone should get healthcare, have the job they want, and just plain be Happy". Who is going to pay for it all?

If people don't work and don't pay taxes, what makes you think they are going to purchase Health Care Plans??

 

The Smothers Brothers designed the website and now we are paying to have it done correctly.

It is a bad joke anymore.

 

When ABC news is reporting it is failing, you know it is failing. You don't have watch FOX for that one kids.

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Aetna CEO: Why insurance will be costing more

All due to obamacare

 

http://www.cnbc.com/id/101153188

 

 

I wonder if his $5 million a year salary is passed on to consumers as well... oh wait, of course it is.

 

He's the CEO of an insurance company, of course he will say anything to deflect any sort of blame. What were their excuses when they were raising rates on an annual basis before the ACA?

 

Aetna saw a rise in 3Q earnings this year, they also acquired another health insurance company for $6.9 billion in May. And their CEO claims they have $1 billion in costs from the AVA to pass on to consumers, their investor forecast states that it's really $600 million. So where's that extra $400 million coming from?

 

Oh and they expect profits to go even higher within the coming year.

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Guest The Devils Advocate

The CEO of Aetna Inc., Mark T. Bertolini, had a 2012 pay package that more than tripled — nearly quadrupled — his compensation the year before, according to documents filed Friday with the U.S. Securities and Exchange Commission.

 

Bertolini was compensated a total of $36.36 million last year, not including $11.1 million in stock awards which vest later and are based on the company’s performance.

The bulk of Bertolini’s pay last year was $34.23 million in value from stocks vested and options exercised in 2012. He also received a $977,159 salary, $892,800 in non-equity incentives and $256,971 in “other compensation.” This does not include an increase of $33,584 in his pension value.

 

In 2011, Bertolini was compensated $9.7 million, not including $7.3 million in stock awards.

 

http://courantblogs.com/ct-insurance/aetna-ceo-mark-bertolinis-pay-more-than-tripled-last-year/

 

 

 

Gotta pay for those perks somehow.......

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Aetna CEO: Why insurance will be costing more

All due to obamacare

 

http://www.cnbc.com/id/101153188

 

I didn't have to read that to know that it's a piece of biased BS.

The CEO of an insurance company gets the opportunity to raise costs and blame it on someone else?

 

And you believe him?

 

 

Really?

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Looking through that article it reveals some interesting things...

 

I am currently insured through my workplace, with Excellus Blue Cross/Blue Shield. That article uses Cleveland Clinic as an example, well if you go to the Cleveand Clinic list of Accepted Insurance, guess what... NO Excellus Blue Cross/Blue Shield. So I couldn't go there.

 

My wife works for UHS, we were thinking of going through her workplace for health insurance. All of our doctors are currently affiliated with Lourdes, if we went to the UHS sponsored plan, we would be out of network and would have to pay out of pocket for EVERYTHING offered through our current doctors. This is not a result of the ACA, just businesses cutting costs.

 

So why is this ok, but the Cleveland Clinic not accepting insurance from people living in California, or even locally not ok?

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