Healthcare Changes : Restarting the discussion with a few more ground rules.

Mods,
I wonder if we can delete the offtopic posts in this thread. Or maybe we can voluntarily take them out... This thread is getting very interesting and useful, but it was certainly digressed by the TV talk. I have removed my OT posts.

Tony

"Thus, in my opinion, you should only go on th exchange if you know you will qualify for a subsidy."

And also...

"My concern is that the news media is pointing everyone to the exchange, when many people will be better served by going directly to the insurance company for coverage. They would also be getting their applications processed now."

JNF,
Thank you much I can tell you have done a lot of this. Your information is great. It's a shame that the only use for the state exchanges will be to get subsidy. That's not what the public perception is. And the media is missing the mark as well. I figured there may be some folks that are paying privately today that may benefit from the exchanges but more and more that does not appear to be the case. Medicaid os receiving a lot of applications lately and that's to avoid ever paying for healthcare.

When the dust settles, and through reflection, we will see the benefits of the ACA. But for now, they are not reporting the enrollment numbers and I assume that is because they are not favorable from a public perception stand point.

Tony

John the exchanges were always meant to be attractive for the people who qualify for the subsidized coverage plans. My understanding is that individuals with low, non existent or even moderate incomes should qualify for a tax credit. I think they have access to this right away, monthly so they can apply it to mitigate their monthly premiums. This wasn't written for many of us. Plans will vary significantly across States, also because in some States they are working hard to curtail the law, and I think it will take quite some time to understand the coverage and the cost of all of the available options. And I might be out of the loop, but I thought Americans had until March 31st to figure it out.

Tony, in my opinion the exchanges have been oversold for the wrong reasons. Plus they were and are being sold as a one-stop shopping site that won't let you shop/browse until you have entered all your payment information. No other commercial shopping system does that. The health insurance shopping systems already exsisted for some 20 years but the media and administration have ignored them.

In a couple of states that report some initial success with their exchanges (California and Washington) some 85% of the registrants have been funnelled to Medicaid due to income. This shows there is interest in coverage at the low end of income, but these people are not buying insurance so will not count towards the 7.5 million healthy young people needed. Plus it indicates to me that these are the low income probably sicker people who are more likely to use the health care system. Their cost will, according to the law, be met from the reductions in Medicare. We will have to see what the reality becomes.

John, I am guessing there will be a section on the tax return or a worksheet for those that want to claim or reconcile a subsidy. I haven't seen the 2014 income tax form draft, but will ask my CPA what she has heard.

As to doctors refusing to accept exchange purchased plans, I don't know how they will know. The person will have an insurance card from a company (just like now) that the doc will use to verify coverage, deductible, etc. (just like now). I think this is either a red herring concern, initial operational ignorance, or concern that an exchange purchased plan will have the payment limitations of Medicaid.

Plan B? I won't say what first comes to mind or the thread risks being locked. Many have said this is among the most significant legislation ever passed. The initial actions indicate that the administration will do whatever it takes to make it operational. It will be up to congress to change the law. I have lived by the addage that Plan B is to do everything possible to make Plan A work and live up to expectations. I think we are seeing that with the initial modifications the administration has already made, most of which have not been widely reported. Certainly the current issues with most every exchange indicates that there will need to be a lot of corrective actions made on the fly. We will see how that goes. Aside from the exchanges not working near promised effeciency, it appears the biggest potential problem is the "death spiral" effect on the insurance companies. If companies can not be profitable selling individual coverage under the PPACA they simply will not offer the coverage. There are many counties in the country where only one company entered the individual market due to profitability/solvency concerns. If the "death spiral" becomes real look for qualifying insurance companies to become more like regulated utilities to keep them viable so people can have commercial insurance. Absent that, government based single payor will likely come to the forefront.

DavidG, great summary. People have until March 31 to use the exchanges and that will likely be extended due to the current problems. As to the requirement to have insurance, that starts January 1, 2014. A person can only go three months without coverage and then the individual mandate tax is assessed unless one can qualify for the numerous waivers available. If we get close to March 31, 2014 and people still can not effectively use the exchanges to get the subsidies, there may have to be some relaxation of the tax for those people. However for those not qualifying for the sibsidies that can use all the other purchasing options currently available and operational, I don't see an exception to the mandate tax. Such an action will, most likely, begin a new round of legal challenges.

Makes one wonder why the government didn't simply license the software from ehealthinsurance.com.

Clocknut, thanks for the cautions. I had hoped I was participating in the spirit of the current thread in addressing DavidG's concerns for a co-worker. I will be more carefull in my commentary, but allow me a few comments in response to your post.

I have added disclaimers that I am not an expert in the same way many, including some moderators, have added disclaimers indicating they are not medical professionals. I don't believe that makes the discussion theoretical. I have also just referenced two informative articles, without indicating whether they were either positive or negative (from whose viewpoint?), giving factual information. But you indicate if an article were to be informative but in some people's views negative, it would not be appropriate. And why isolate Fox News? That is confusing to me.

As far as the theoritical, please excuse me in my discussion with JohnT regarding a plan B. That is theoretical and I appologize for expressing an opinion. But, as to when to use an exchange, the issues the insurance comapanies face based on challenges to get coverage, how to get subsidies, etc., those aren't theoretical.

As to whether we should explain the PPACA, we explain veterans benefits, agent orange disability, medicare payments, health insurance coverage for proton therapy and Provenge, etc. in much the same way. Are you suggesting those patient-to-patient experience and knowledge sharing discussions be off limits?

Please understand that my comments and questions for you are not meant to be cynical. Since you referenced me, I assume the position of defending my discussions. I do want to be able to contribute in a positive acceptable way and appreciate the information and experiences I have received from others.

JNF, thanks for the reply, and as usual you make a lot of good points.  And, to reiterate, the amount of thought you've given to these topics and the time you've devoted is obvious and appreciated.

I guess all I'm really saying, and this is after watching the congressional hearings this morning, so much of what's in the law, what the consequences are going to be, how many are going to be helped and how many "hurt,"......some things are known, and many are not and will only be revealed as we go along.

I'll butt back out of the conversation.  I shouldn't have mentioned you by name.  It just seems to me that when Peter D. says in his guidelines that participants' responses must explain the benefits, there's a sort of implicit exclusion of explaining any negative aspects, because those comments then seem to be judged as "political."

My apologies to you.

Mel,
it's hard to disagree with the intentions of the law, but the best intentions sometimes lead to very bad outcomes, think Viet Nam and Iraq. I'm having a very tough time with the credibility issues associated with the law. Cost of $900 bil which is now 1.6 tril, no change in anyone's plan and an average savings of $2500 on insurance premiums and being able to keep your doctor are just a few major issues that we were sold on and have proven not to be accurate. The end result will also still have 15 million still uninsured. I feel we have been mislead intentionally just to get something passed and this leads me to question other benefits that have been promised.
The web site will be fixed eventually, but having installed over 100 systems I know by far the largest cause of system failures is not the programming, but the management policies driving development and implementation. The system development and implementation is a direct reflection on management's ability to manage complex issues and is also a direct reflection of how other areas are also managed. This is why I have both a credibility and confidence gap in the new law. It has nothing to do with the intentions of the law.

Clock,

The way I structured the rules here does lead to a mildly pro-ACA flavor to the discussion. Very little is known for sure about how it will actually perform when fully implemented. We can talk, quite factually, about the letter of the law -- all five reams of it -- but to do so unskeptically -- to take it at face value -- is to ignore the near certainly of unintended consequences. Von Moltke the Elder said that no plan of battle survives contact with the enemy, and similarly, no complex legislation survives enactment unchanged.

The initial discussion, about 3D televisions and Sandra Bullock's callipygousity, stemmed, I thought, from the condition that, limited to known facts about the ACA and how they apply to us as a group, we simply don't have much to say.

But then some members who have given the subject a lot of study started to post insightful information that might provide a background, at least, in which real concrete advice could be understood. Yes, I noticed that it was a bit theoretical, and yes, it pushed the boundaries I set around the discussion. But it seemed polite, and a few skeptical notes were sounded to give some balance, and I decided it was acceptable. So I think the thread is OK, for now.

All,

Clock has a point. The problem of the ACA is not ours to solve. We've described some background about the act and now it's time to try to get back to the topic, which is mostly how the ACA will affect cancer patients, or more generally, people with disqualifying pre-existing conditions.

Question:
Can you buy a family policy through the exchange or is it just for individual policies?

John T, you can buy a family policy on the insurance exchange. You have to provide information on the # of adults and children and their ages.

Folks,
Take a look at the site. It will answer some questions. The first tabs are for individuals and families. The second small businesses.

healthcare.gov

It's working right now but that's subjective. It has not been reliable.

Tony