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Quick Note: There’s a lot of information here, but I still have more to add. I just wanted to go ahead and get the bulk of it posted. In 2010 President Obama signed into law the Patient Protection and Affordable Care Act, more commonly referred to as Obamacare. In the three years since, Ground Rules * The thread is about PPACA. As a result it will be natural for there to be some (maybe a lot) of discussion regarding the Washington wheeling and dealing that went on to pass the law. That is fine. This thread is not for debating whether Obama is a right-wing plant trying to sell us out to corporations or a realistic centrist playing Nth dimensional chess against a useless Congress. * The thread is about PPACA. As a result it will be natural for there to be some (maybe a lot) of discussion about how PPACA compares to Single-Payer and other true UHC systems. That is fine. This thread is not for debating whether we will all die without Medicare For All versus the Free Market saving us all with it’s invisible embrace. * This thread is about PPACA. If you want to rant about how the American Healthcare system is poo poo and has hosed you over royal, we want to hear about it. In this thread. * All things PPACA related are fair game. What it did to help you personally, or hurt you. What you like about it; things that are flawed with it. New regulations from the Department of HHS as a result of it. News about your state’s implementation of it (or refusal to implement it). Court challenges to it. Questions about how it will impact you. Promises Obama kept, and those he broke. If it is PPACA related, feel free to post it here. I will try to update the OP to fix mistakes people find (it’s a huge complex law, I’m sure my summary of it will be lacking), adding interesting news, and useful links. Obamacare: A Brief History of America’s Wink and a Nod to Socialism For nearly a century, American politics has had an on-again, off-again relationship with the idea of establishing a system of universal health care. But for a long time, nothing was done about it. In the 60’s Washington got its poo poo together long enough to create Medicare and Medicaid to help the elderly and the horrifically poor. Subsequent years saw changes to both programs, but for the vast majority of Americans, including those who were merely “extremely poor”, there was no help. In the 1970’s President Nixon proposed reforms to the American Healthcare system that would have established subsidies to assist anyone whose employer did not provide insurance; as well as regulating health insurance to guarantee a minimum level of coverage for everyone. His proposal failed to become legislation. In the 1990’s President Clinton attempted his own reforms. In response to Clinton’s proposal, Republicans pushed for their own proposal. It was based on a 1989 report by the Heritage Foundation, and called for creating a health insurance marketplace to make plans more competitive, offer Americans more choices, assistance for those who had trouble affording it, and a requirement that all Americans buy health insurance. Both Clinton’s and the Republicans’ proposals went nowhere. Then in 2009 Obama began his own push for health care reforms, and after most of a year it was passed into law on March 23rd, 2010. PPACA would provide subsidies for people unable to afford insurance, regulate insurance plans to require minimum levels of coverage, create a marketplace for insurance plans to encourage competition and increase choice, and requires that all Americans purchase health insurance. Obama may have given birth to PPACA, but if so then that bastion of socialist thought, the Heritage Foundation, was the father; and noted Communist sympathizer, Richard Nixon, the grandfather. PPACA is not the monstrous, unreadable, mountain of paper, legislative nightmare that its opponents made it out to be during the 2009-2010 debates. That being said, it is large and complex. In the following sections I’ve tried my best to explain the important parts. First, starting with a broad overview look at the key components of the law. Then a second section listing some of the good and bad effects of the law. Lastly, a look at more minor changes brought about by the law. For example, an increase in the grant money to nursing students, and programs to help new doctors pay off med school loans. These are not significant enough to be included in the other sections, but still changes people might like to know about. This is by no means to be considered comprehensive. As discussion occurs I can update these sections to fix mistakes and to add new information if it seems important or interesting. The Core of PPACA PPACA does a ton of stuff, but I wanted to cover the major, key parts in one place to help people understand the basics of how it works. Since this is just an overview, I’ve tried to keep it succinct. There is more details about how much of this works later on if you wish to know more. It’s easiest for me to break down the law into five areas: Taxes, Expanded Coverage, The Mandate(s), Regulations, and Medicare. Taxes There are a number of revenue sources, big and small, introduced in PPACA to help fund it. 1) Increased the Medicare tax on wealthy (over $200K/$250K) by 0.9%; started in 2013. 2) 10% Tax on Tanning booths, already in effect. 3) Annual Fees on Insurance Companies, and Brand Name drug Manufacturers and Importers. 4) Annual Fees on certain Medical Device manufacturers/importers. 5) Lower limits to how much people can contribute to FSA's, and restricts their usage. 6) 3.8% tax on capital gains; this tax can be applied to certain home sales. There's some limits on this tax though, you have to have an income over $200k and only the gains above $500,000 are taxed. That means if you buy a house for $1M and sell it for $1.4M, no tax. Sell it for $1.6M, and $100,000 of the profit you made is taxed at 3.8%. This tax is a big one for chain emails that scream about everyone having to pay 3.8% of their home's value if they sell it; which is nowhere close to accurate. 7) Tax on certain "Cadillac" plans provided by employers. But this doesn't go into effect until 2018, and to be honest, I wouldn't be surprised to see it stripped out of the law in 2017. It’s very unpopular with labor unions. 8) Fees on people who don't carry insurance (More on that below). Expanded Coverage This is the part of the bill that actually helps more people get insurance coverage. Or make the insurance they already have more affordable. It accomplishes this through an expansion of Medicaid and two different types of "Exchanges". Everything in this section begins in 2014. 1) Medicaid is being expanded to cover everyone under a federal poverty level of 133%. However, States are not required to expand coverage, so this may not be an option everywhere as originally envisioned. 2) Individual Insurance Exchanges. These are "virtual marketplaces", run at the State level, where people can pick and choose from a bunch of different insurance plans. These plans are then subsidized by the Federal Government to help make them easily affordable. The poorer you are, the bigger subsidy you get. 3) Small Business Exchanges. These work pretty much the same as above, but are targeted to small businesses buying small group plans for employees. It offers them more options, guaranteed/regulated coverage requirements, and subsidies. The Mandate(s) There are actually two Mandates in PPACA, though most people only talk about the first one: 1) Individual Mandate. Starting in 2014, if you don't carry insurance you get fined. Sort of. If you're too poor, there's an exemption. If the cheapest available plan is more than 8% of your income, you’re also exempted. There are exemptions for certain religious groups too; think Amish, not Muslim (loving chain e-mails). 2) Business Mandate. Businesses over a certain size will be mandated to provide insurance or pay a fine per employee beyond the first 50. However, they have another option. The business can give their employee a voucher to use to pick their own plan from the Exchange; if they do this they don't get fined. Regulations There's a ton of new regulations; some are in effect already, some start later, some still have to be defined by HHS. Generally they only apply to new plans, including plans that will be in the Exchanges in 2014. Some older plans have been "Grandfathered" in and can avoid the new regulations, though this ends in 2018. Here’s a list of some of the most significant changes: 1) 100% covered (No deductible, co-pay, co-insurance, nothing) preventative care: Vaccines, annual checkups, etc. 2) No more Lifetime or Annual Coverage Maximums. 3) Out of Pocket Maximums capped around $12000 for families, $6000 for individuals in 2014; with a formula to increase slightly each year or so. 4) Can't drop policies of people who get sick. 5) Better claims appeals process 6) Insurance companies must have a 85% or 80% Medical-loss-ratio or higher (varies by type of insurance). If they don't, they have to provide their customers a rebate. Essentially it's saying 85% of the money insurance collects from Premiums has to be spent on medical care. Only 15% is for administration and profit. 7) FSA's, HRA's, and HSA's can't be used for a lot of over-the-counter stuff anymore. 8) 100% coverage for a lot of Women's Services: Contraception, screenings, breast feeding equipment/assistance, domestic abuse, etc. 9) Can't charge different rates for Men vs. Women 10) Can't charge sick people higher rates 11) Can charge different rates based on age, but the difference between the youngest and oldest is limited to 300%. Currently it's not uncommon to see age based costs to differ by 500% to 1000%. Medicare Various changes to Medicare include... 1) Reductions in future increases in payments to certain types of hospitals. (This is a big part of that "$700B cut" from Medicare argument thrown around during elections). 2) Reductions in how much the Government pays to private insurance companies for Medicare Advantage plans. (Another big part of the dreaded $700B in “cuts”). 3) Pilot program to pay doctors for curing a patient, rather than paying per service. For example, paying $X for a "broken leg", instead of paying for every individual test, every pain pill, etc. (Another part of the $700B cuts). 4) New payment rules that pay hospitals less if they have bad results (like if they have a lot of patients who end up getting secondary infections while in the hospital), and pay providers a small bonus if they improve. (More of that $700B). 5) An independent advisory board tasked with finding ways to make Medicare more cost effective. This board has taken a lot of flack from Republicans because they think it sounds scary and getting rid of it would be a "legislative win". Ultimately though, the board's recommendations can be blocked by Congress, and they are extremely limited in what they can offer as ideas. It probably won't matter in the long run if the board is disbanded or not because they are likely too restrained to find much savings anyways. (Another, small, part of that $700B). 6) Closed the Medicare Prescription Plan "Donut Hole". 7) Free visits to the doctor to discuss End-Of-Life options, like Hospice care, and Living Wills, with a doctor and family members, once every 5 years. More often if health is deteriorating. (These are Sarah Palin’s dreaded Death Panels). Sarion fucked around with this message at 16:34 on Mar 24, 2013 |
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If you still want more in-depth details about what is changing, then keep reading! The Good Medicaid Expansion Right now Medicaid coverage eligibility varies from state to state; but as an adult who is neither elderly or disabled or pregnant, getting on Medicaid is next to impossible even if you're poor. Most poor families can get their children covered due to CHIP, but not the parents. PPACA changes this, now the whole family will be covered. Anyone under 133% of the Federal Poverty Level will be eligible for Medicaid, even if you’re completely healthy, single, with no kids. The only requirement required will be a measure of income. Currently, Medicaid funding is split between the Federal Government and the States. Ideally it’s a 50/50 split, realistically it’s more like 60/40. However, the people who will qualify under the new rules will be covered 100% by the Federal Government until 2017. After that, the Federal money will scale back slightly, though they will continue to provide 90% of the funding with no expiration date. Unfortunately, due to a Supreme Court ruling last year, the states are not required to expand Medicaid. Considering the billions of dollars of Federal money that will enter their state economies, most states are still expected to go ahead with it. Some, like Washington, are even setting the income level higher than 133%. However, other, more spiteful states, like South Carolina, are refusing. I’ll discuss this in more detail later. This is actually where many, if not most, of the newly covered people will come from; not private insurance. Medicaid Reimbursement Increases One problem with Medicaid is that it can be difficult to find doctors who accept it because it often pays out significantly less than Medicare (which usually pays less than Private Insurance plans). The help with that, Medicaid reimbursement rates have been set to match Medicare’s rates. On average, this will increase Medicaid payouts by 73%; though it (like most poo poo in this country) varies wildly from state to state. The downside? The increase is only for 2013 and 2014. In 2015 all those rates drop back to their original rates. Personally, I think this may have been a budget trick pulled by Democrats to keep the overall cost of PPACA low. After two years of paying Medicare level rates, Congress will likely extend the rates rather than allow Medicaid rates drop by ~50% in 2015 when millions of Americans will be relying on doctors accepting Medicaid. If this cost had been included in the original bill it would have hurt the CBO rating. But it’s possible they’re really just that stupid and think that the temporary increase will get doctors to take Medicaid and then not care when the reimbursements plummet. Insurance Exchanges The Exchanges are virtual marketplaces, where many different insurance plans are offered. They all have to provide information about their plans in simple to understand language, with a standardized form so that they can be easily compared side-by-side. Most of this will be on a website, though I suppose there will be other means of selecting a plan for people without internet access. In theory, each state will run their own Exchange, but they’re not required to do so. States that don’t wish to have their own will use one run by the Federal Government instead. Every plan on the Exchange must meet the coverage requirements in PPACA, and the states may set the requirements for plans on their Exchange to be higher if they wish it. Plans will be rated as either Bronze, Silver, Gold, or Platinum plans. There’s not currently anything that spells out what kinds of plans are at each level, it’s dependant upon the cost sharing of the plan. Plans that take more of the cost burden are rated higher, and will likely have a higher premium. But one way to think about the difference between the ratings is like this: Bronze - Lowest premiums, meets the bare minimum requirements. High Deductible plans. [60% actuarial value] Silver - Low deductible with co-insurance plans. [70% actuarial value] Gold - Co-Pay plans [80% actuarial value] Platinum - Gold plans with additional benefits (Dental, Vision, Life Insurance, etc). [90% actuarial value] The subsidies a person or family receive is then based on the second cheapest Silver plan. It is also based on their income compared to the Federal Poverty Level. For example, a young family of four has an income of $59,000 and the second cheapest Silver plan costs around $11,000. Because they make ~250% of the Federal Poverty Level, they are expected to pay 8.05% of their income towards the premium, and the subsidy picks up the rest. As a result they would pay $4600 and the government would pay the remaining $6400. However, if they wanted to they could apply this $6400 subsidy to any other plan on the Exchange. So they could choose the cheapest Bronze plan, apply that $6400 subsidy, and then pay whatever remains. Or pick a more expensive Platinum plan and apply the $6400 to that. Out of Pocket Subsidies Less often discussed than the premium subsidies, but related, are subsidies to reduce the Out-of-Pocket costs for low income families. The way this works is that there is a maximum limit for everyone: $6000 individual and $12500 family in 2014. But depending on your income, the government will pick up some of those out-of-pocket costs. So the family of four from the last example would only have an out of pocket maximum of $6250 for the whole family. The government would then pay the other $6250 of out of pocket costs if they occurred. While the premium subsidies will be paid directly to the insurance providers, it’s currently unclear how these subsidies will work. Or at least I haven’t found an official explanation. Do families have to pay the cost, and get reimbursed? Does the government pay the insurance company to cover the cost? Does the government pay the health care provider in place of the patient?  SHOP Exchanges These Exchanges are similar to the Exchanges for individuals, but they sell small group insurance plans to small businesses. And the government helps to subsidize these plans as well. Medicare Advantage Payment Reductions Medicare Advantage (Medicare Part C) is a program that allows seniors to choose from private insurance plans, rather than using the Federal Medicare plan. The idea behind this is the fallacy that private companies can always provide better results for lower costs than the government. However, the plan also provides a 15% bonus to the insurance companies. So, if the average cost to the government per Medicare recipient is $10,000, the government pays Medicare Advantage plans $11,500. Plus the plans are typically more expensive for the recipients than normal Medicare. So the government pays more, seniors pay more, and insurance companies profit. PPACA eliminates the 15% bonus - Medicare Advantage plans will now be paid the same as it costs to cover the average Medicare recipient for that year. This is a large chunk of the “Medicare Cuts” Republicans have been bringing up in the past two elections. Closes Medicare “Donut Hole” Medicare Part D was introduced during the Bush administration as a way to help seniors pay for prescription drugs. However, it had a weird coverage plan: $0 - $295 -> Patient pays 100% (Deductible) $295 - $2700 -> Medicare pays 75%, Patient pays 25% $2700 - $6154 -> Patient pays 100% (Donut Hole) Over $6154 -> Medicare pays 95%, Patient pays 5% PPACA closes the coverage gap. As of this year, Seniors only pay 50% for name brand drugs (79% for generics). This will eventually shrink between now and 2020, at which point they will pay 25%, eliminating the hole completely. Mandatory Coverage Regulations All plans will now have to cover a list of conditions and procedures. PPACA itself simply lays out broad categories (like Maternity Care) that they all must cover. The Department of Health and Human Services then decides what falls under each category. There are also limits set on out-of-pocket costs, no annual coverage limits and other regulations. I listed most of them above so I won’t list them all again here. The goal here is to eliminate the problem of millions of Americans being “Underinsured”. Abolishment of Pre-existing Conditions This is a pretty significant reform, but doesn’t take much to explain. In 2014, insurance plans cannot deny you coverage based on any health problems you may already have. The one kink in this is that they don’t have to cover anything that occurs in the first 30 days you’re on the plan. So calling up and buying insurance right after you break your legs, but before you go to the hospital isn’t going to do you any immediate good. It will have to cover any follow ups related to the broken legs that occur more than 30 days later, however. Contraceptive Coverage Another part of the Mandatory Coverage, but one I felt deserves its own discussion. All plans are now required to cover contraceptives at 100%. There’s not really much more to say here, the benefits of giving nearly all women access to free birth control should be obvious. Coverage of dependents up to 26 years old Dependents may now stay on their parents’/guardians’ health insurance plans until they are 26. This has been in effect for a few years now. If you’re under 26, you can remain on your parents plan even if: - You don’t live with them - You are married (but spouse/children are not covered) - You are not financially dependent upon them - You are eligible for insurance through your employer or school The only exception for this is certain “Grandfathered” group plans, but this exemption ends in 2014. State Exchange Waivers In 2017, the DHHS will begin providing waivers to states who do not wish to run an Exchange or Medicaid. They will be required to have some other state-wide plan in place to provide their residents with healthcare. The most obvious example of this is the state of Vermont which recently passed a law to create a statewide single-payer plan for all residents. In 2017, when they will likely receive the waiver, they will be able to redirect the funds spent on the Exchange and Medicaid to their state’s single payer plan instead. Business Mandate Much like the Individual Mandate, there is also a requirement that businesses with more than 50 full time equivalent employees provide them with health insurance. Full time equivalent means that the business takes the number of hours worked by all employees in a month, divides it by 130 (~30 hours a week) and that’s the number of “full time equivalent” employees they have. So simply hiring part time workers does not avoid the mandate, though there are problems with part time workers (discussed further below). The insurance plan must provide minimum essential coverage defined by PPACA, must provide a minimum value of 60% cost coverage, and the employee’s portion of the premium must be less than 9.5%. If a business does not provide this, they are taxed. There are two scenarios. In the first, they do not provide any insurance at all. If this happens, the tax is $2000 per full time employee, but the first 30 employees are excluded. The second scenario is where they do provide insurance, but some employees still buy on the Exchanges and get a subsidy. In this case, the tax is $3000 per employee that receives a subsidy, or $2000 per full time employee minus 30 employees; whichever is less. And these rules apply to non-profits as well as for-profit businesses. If you’re interested in more details about the Business Mandate, the IRS issued it’s Rules regarding how it interprets this portion of PPACA and you can read them here. The Not-So-Public Public Options While the Public Option (a government run plan sold on the Exchanges) did not survive to the final legislation, I am fairly certain a weaker option was included in its place. The DHHS will select two insurance plans which will be made available in all states, one of which must be a non-profit plan. I am having trouble finding information about this at the moment though, so take this with a grain of salt until I can find more info. Here is a New York Times article about this part of PPACA. It's actually the Office of Personnel Management that is overseeing these plans, not DHHS. The question now seems to be whether or not these plans were bargained away as part of the tax deal at the start of 2013. The Bad Individual Mandate I’m sure most people have heard about this by now. Starting in 2014, if you do not have health insurance that meets standards set by PPACA you will have to pay a fine/tax. The penalty is assessed per person. So if two family members have insurance, but three don’t the penalty is applied based on three people. In 2014 the penalty is relatively small, but increases in 2015 and 2016: 2014 - $95 per person, up to $285 for a family OR 1% of income -- whichever is higher 2014 - $325 per person, up to $975 for a family OR 2% of income -- whichever is higher 2014 - $695 per person, up to $2085 for a family OR 2.5% of income -- whichever is higher There is also a fixed cap on the penalty, even for the percentage based penalty. The penalty cannot be higher than the cost of the cheapest Bronze plan available. Also, the penalty for children under 18 is only half of the amount listed above. Also, the penalty is applied monthly. So if you have insurance for 7 months, and no insurance for 5 months, you pay 5/12ths of the penalty listed above. And if you are uninsured for 3 months or less, the penalty is waived. And incase that wasn’t enough to wrap your mind around, there are also several exemptions to the mandate: - If you make less than 100% FPL. - If the cheapest plan available is more than 8% of your income after any subsidies you may qualify for. Even if it’s an employer plan. - Certain religious groups who do not participate in the healthcare system, such as the Amish. - Also, Native Americans, incarcerated individuals, people visiting on business, and illegal aliens are exempt. Cadillac Insurance Tax Starting in 2018 insurance plans that are expensive will be taxed. The tax is 40% of the cost of the plan above the threshold. For individual plans the threshold is $10,200, and $27,500 for family plans. So if a family plan costs $30,000 a year, the tax would be 40% of $2500 -- $1000 in tax. The tax is paid by the insurance provider, not the insured. However, the expectation is for some portion of the cost to be passed to the customer. There are also exemptions for plans for people over 55, and people in high risk professions. Generally, unions are less than thrilled with this provision. As are big businesses that provide expensive benefits. So I wouldn’t be surprised to see a push to eliminate this in 2017. Medicare Payment Reductions To help lower overall costs, and free up money for PPACA, changes were made to some of the formulas for calculating payments that Medicare makes to hospitals and other providers. The change is designed to allow the payments to continue to increase, just at a slower rate than they would have otherwise. The fear here is that it may cause some healthcare providers to decide they don’t want to accept Medicare anymore. However, I also think that we’d see Congress block these reductions if that becomes an issue. But it’s still an area that could end up being bad, or no big deal. Hard to say at this point. Waivers and Grandfather Plans Currently things are really confusing because there are all these new regulations to help improve insurance coverage; but at the same time the government is handing out waivers and grandfather exemptions to plans and companies like candy on Halloween. As a result, companies like McDonalds are still giving their employees lovely mini-med plans that come nowhere close to meeting the currently in place regulations. The expectation is that most of these will run out in 2014 or soon after, but it makes it confusing because it means benefits are in place for some people, but not for others. Preventative Care Becomes Diagnostic Care PPACA requires that preventative care is covered 100%. However, some of these procedures can suddenly cost money without a patient’s knowledge. For example, a routine colonoscopy at 50 should be covered 100% by insurance. But if the doctor finds something wrong, it ceases to be “preventative” and becomes “diagnostic”, which means the insurance company does not have to cover it 100%. If you’re healthy, it’s free; if they find bad news, you get to pay for it! Yay! Single People Pay More Than Families An oddity of the way subsidies are calculated is that it’s possible for someone to pay more for insurance if they’re alone than if they are paying for an entire family. For example, if you’re single and make $45,000 a year, you may pay up to $4,275 for your own insurance. But a co-worker with a family of four making the same pay would pay $2,672 a year for their entire family. Great news for families, but really weird and doesn’t seem to make much sense that covering one person costs more than covering a family. In reality, the family plan is more expensive; it’s just that the subsidy for the single person is nearly nonexistent, but for the family it’s about $10,000 a year. The Ugly The Obamacare Cliff This is any issue I haven’t really seen mentioned in the news much; perhaps because it will only affect a small number of people. But it is pretty bad. Like most American social safety nets, Congress stupidly included a hard cap at 400% FPL for benefits, rather than simply allowing benefits to slowly decrease to nothing. For many people this is a non-issue because as they get closer to 400% FPL, their expected insurance costs will be less than the 9.5% required for subsidies. However, there are people for whom this is not true. The most obvious example are people in their late 50’s to early 60’s who don’t yet qualify for Medicare, live in an expensive area, but make more than 400% FPL ($46,000). For someone in this situation, the expected health insurance plan cost is $12,206 a year; but they don’t qualify for any subsidy. At $46,000 a year, they would receive a subsidy worth $7,800 a year; but if they made an extra $50 for the entire year, the entire subsidy vanishes and they’re left choosing between paying $12000+ for insurance or no coverage. The good news is that since insurance would cost them more than 25% of their income, they’re exempt from the mandate. Kind of like how getting punched in the face is better than being kicked in the balls. Optional Medicaid Expansion/People under 100% FPL barred from the Exchanges In the Supreme Court Case last year, the Supreme Court ruled that the means by which PPACA tried to encourage the states to expand Medicaid was effectively extortion (don’t think they used that term), and illegal. PPACA proposed that they could expand Medicaid, or choose not to expand Medicaid. But if the states did not expand Medicaid, they would lose ALL Medicaid funding. The SCOTUS ruled that the Feds still had to provide the current agreed upon Medicaid funding so long as the state continued to meet the original requirements for that funding. As a result, some states are choosing to not expand Medicaid; effectively cutting off their nose to spite Obama. But it actually gets worse. For people between 100% FPL and 133%, PPACA allows them to choose either Medicaid or use the Exchanges and pay 2% income with the rest subsidized. So for people in states like South Carolina who are between 100% and 133% FPL, they can still get insurance on the Exchanges. But PPACA expressly states, over and over again, that the Exchanges are for people over 100% FPL. Which means that people who are below that point, but live in states who don’t expand are out of luck. They are excluded from the mandate though. Ball-kick meet face-punch. Encourages Part-time jobs While the business mandate requiring that companies share in the expense of providing health insurance for their employees is pretty much a good thing, there is a weird wrinkle in this portion of the law. The rules for calculating whether or not a business is required to provide insurance includes part-time workers. However, the portion of the law that is used to calculate the penalty for not providing insurance does not include part time workers. As a result, a business with 100 part time employees and 25 full time employees is required to provide insurance, but their penalty for not doing so is $0. Now, you may be wondering what the gently caress they were thinking. I have no idea  Lack of Cost Controls One of the benefits mentioned earlier was that plans will now have to spend at least 85% (or 80% in some cases) of the money collected from premiums on paying for medical care. This is known as a medical-loss-ratio. Unfortunately, there are very few cost control measures in PPACA. As a result, insurance plans can simply offer to pay providers more money, raise premiums on customers, collect larger revenue, and grow the 15% that they get to keep. In theory the states are supposed to be on guard against this; plans that increase prices too steeply year after year may be removed from the Exchanges. Unfortunately, this relies on having an insurance commissioner with real powers. In some states this is the case, in other states the best you can hope for is a strongly worded letter of disapproval. Similarly, the competition provided by the Exchanges are expected to keep plans from jumping in prices too much. Whether or not this works remains to be seen. Abortion Bans There is a clause related to abortion coverage in PPACA. It states that every state’s Exchange must provide at least one plan that does NOT cover abortion. However, there is no related clause which states they must provide at least one plan which does cover abortions. As a result, some states will likely exclude abortion coverage from their Exchanges. This may have legal impacts, but I’m not a legal expert, so I’m not sure what kind of legal challenges individuals could bring against a state that did this. Sarion fucked around with this message at 13:19 on May 12, 2013 |
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Mar 24, 2013 03:22
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Details of minor reforms <Going to fill this in later> Useful Links! PPACA & Reconciliation Text PPACA Implementation Timeline State-by-State Implementation Progress State-by-State Medicaid Expansion Map Kaiser Subsidy Calculator The Council of Insurance Agents & Brokers Health Care Reform FAQ - Useful information from an employer's point of view, rather than the employee's. Are You In A "Grandfathered" Health Plan? - DHHS document providing details about Grandfathered Plans. Health Care Reform and Service Members, Veterans, and their Families - How PPACA effects things like VA benefits, TRICARE, etc. California's Health Plan Definitions - Example of what to expect from Bronze, Silver, Gold, and Platinum plans Comparison chart of Bronze/Silver/Gold/Platinum Plans in California Health Plan/Subsidy Calculator for California  PPACA in the News! Nothing here yet, but I’m sure there will be some soon. As more and more of the rules and regulations are hammered out by the Executive branch, progress towards the Exchanges occurs, and various legal challenges move forward, I’ll post news articles here. Sarion fucked around with this message at 16:35 on May 10, 2013 |
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Mar 24, 2013 03:22
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gently caress, I need insurance; how do I sign up? I'll expand this as more information becomes available; but for now here are the forms used to sign up: Individual Form Family Form Sarion fucked around with this message at 16:44 on May 10, 2013 |
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Mar 24, 2013 03:22
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Dolash posted:So I see a lot of this stuff kicks off in 2014. Would that day one of 2014, or what? (I might have missed it if you posted it) Yes, pretty much everything that starts in 2014 will kick in January 1st, 2014. That being said, the Exchanges should start up around the end of the year so people can start signing up for insurance plans which will then start January 1st, 2014. Neophyte posted:[Tell] me about mental health care coverage in PPACA. Yes, mental health services is one of the broad areas that all plans must now cover. As for the specific services, that's something the Department of Health and Human Services will have to decide. I'm not sure if they've released a list of mental health services yet, I'll see if I can find anything. edit: So far it looks like they're trying to make the coverage under each area resemble what's offered by good, large-group insurance plans. But I'll keep looking to see if there's a more concrete requirement. quote:Will they be able to play games like limiting the number of office visits or requiring pre-authorizations for everything? This would likely fall under the DHHS regulations; but my guess is that in most cases they'll be able to limit the number of office visits they'll cover and pre-auths are still a thing 
Sarion fucked around with this message at 05:42 on Mar 24, 2013 |
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Mar 24, 2013 05:20
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LP97S posted:[Tell] Is there any groups or congresspersons who are advocating for a more comprehensive UHC such as Medicare for all or something like the rest of the world? Any word on capping insurance profits as a secondary route? Yes. The current bill for this is HR 676. It was sponsored by Rep. John Conyers JR, and has 41 co-sponsors. Unfortunately it is unlikely to go anywhere; but such a group does exist. ReV VAdAUL posted:Thank you for such an excellent op. While I understand implementing the PPACA is a huge and complex task, I am curious why no sweetener came into effect immediately given significant Democrat losses in 2012 could've sunk the plan entirely. There were, though I don't think I made it clear in the OP. A number of regulations went into effect prior to 2014, some beginning as early as September 2010. Here's a list of some of them off the top of my head: 1) Dependents stay on parents' plan till 26 2) Pre-existing conditions abolished for children under 18 3) 100% Contraceptive coverage (this one started late last year, so there may still be plans without it) 4) Medicare Donut Hole started to close 5) Tax credits to assist small businesses in purchasing insurance 6) Additional funding for state run High Risk Insurance Pools to cover people with pre-existing conditions (I meant to include something about this in the OP, I'll go back and add it) 7) Prohibits lifetime benefit limits You can see more, a lot more, here: http://healthreform.kff.org/timeline.aspx?source=QL Going to add that link to the OP.
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Mar 24, 2013 13:48
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Invisible Handjob posted:So Medicaid qualification will be income based only? My fiancee and I have a pretty large savings we managed to accrue before, but now we both work pretty menial part time jobs making poo poo money. We should still qualify despite any savings or assets right? Yes, income qualifications only. But Amused to Death is right, you may not be in a state that is expanding. However, for two people 100% FPL is $15,510. So if you make more than this you should be able to participate on the Exchanges, even if your state does not expand Medicaid. If you make between $15,510 and $20,600 you guys would be expected to pay 2% of your income ($25-35 a month for both of you), with the government subsidizing the rest. This may actually be a better option than Medicaid depending on your situation.
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Mar 24, 2013 18:40
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De Nomolos posted:So say a state like Pennsylvania elects a Democratic governor and/or legislature next year. Could they still get in on this? Yes. They can choose to expand their Medicaid program at any point and will qualify for the federal funding to help support it. Mo_Steel posted:Thanks for the fantastic OP, solid information without being a billion pages long. As a potentially useful link I'd like to suggest The Council of Insurance Agents & Brokers Health Care Reform FAQ; The Council is an association of insurance administrators and brokers and the FAQs go into a decent amount of detail on a variety of mostly employer questions. For example: Thanks, this is a great link. I'll add it to the OP tomorrow when I'm not heading to bed.
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Mar 25, 2013 05:38
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mastershakeman posted:From what my aunt's been saying, her hospital loses money on the Medicaid patients and will possibly lose money on Medicare ones, as the rates they're allowed to bill doesn't cover their overhead. That's her worry, and I've heard other anecdotes as well. It doesn't make much sense to me that hospitals wouldn't be able to find cost savings somewhere, but they'll probably do so by laying off staff. I think my mom's worry is that in the meantime some hospitals might flat out refuse Medicare patients, as I've read that some refuse Medicaid ones for the same reasons. Basically this, but not due to sequester, just due to Medicare limits: http://www.washingtonpost.com/blogs...-the-sequester/ It's a bit complicated, hospitals have a lot if fixed costs and a lot of various revenues. So, if for example, a hospital turns away a Medicare/Medicaid patient because they will be reimbursed less for an MRI than they would by a private plan, have they "saved money"? No, because they already had to pay for the MRI and they still have to pay the nurses and technicians regardless of whether they saw anyone or not. So their best bet is to make sure they're completely booked with people, even if some of those people don't pay as much as other people. Kind of like a hotel that takes on customers for a fraction of the normal price because empty rooms generate no revenue. It's possible that if all patients paid the Medicare rate, that hospitals could not afford to function as they do now. But this is a silly hypothetical because we aren't likely to see Medicare-For-All any time soon; and even if we did Congress would almost certainly step in and make sure Medicare rates were set high enough to ensure that hospitals didn't start closing their doors. And the same could be said here, really. If it turns out that hospitals refuse Medicare and Medicaid patients, Congress will likely act. In fact, PPACA already increased Medicaid to match Medicare reimbursements for 2013 and 2014; and I kind of expect this to be extended like a "Medicaid Doc-Fix" going forward. Though it's not guaranteed. quote:And speaking of exchanges, I just saw an article stating that exchanges wouldn't have more than one plan on them until 2015 (a year delay). I'm not sure how true this is or its ramifications, though. http://www.nytimes.com/2013/04/02/us/politics/option-for-small-business-health-plan-delayed.html?_r=0 An interesting article, thanks for posting this. Though to be clear, this article is referring to the SHOP exchanges where small businesses will purchase insurance for their employees. The Exchanges intended to sell to individuals do not seem to be effected by this. I suppose one possible fallout of this is that small businesses will just say "gently caress it" and let their employees use the individual Exchanges and the SHOP Exchanges may end up being dead on arrival. But its really hard to say right now if this will matter much in the long run. EugeneJ posted:Are the premiums you pay to an exchange going to be deducted from your wages, or will you have to pay a third party? I believe you'll setup payment through the Exchange. Most likely, what kind of options there will be (pay online, monthly auto-pay, paycheck deduction) will depend on how each state sets up their Exchange. oilcheck my rear end posted:Isn't there a federal non-profit option or some such if the state refuses to run its own exchange? If the states refuse to run its own exchange the Federal government will run one for them. I also think ALL Exchanges will be required to include two insurance plans sold throughout the entire country, chosen by the DHHS, one of which must be a non-profit plan. So you're kind of combining two different ideas. Also, I'm not 100% certain about the second part (national, non-profit plan). I remember reading about it, but I haven't found anything recently that I can point to as a definitive source on the issue. Sarion fucked around with this message at 02:59 on Apr 5, 2013 |
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Apr 5, 2013 02:57
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Sorry, I've been out of it lately. Got promoted recently, during an extremely busy part of our project and been swamped with trying to adjust to the new responsibilities. So I've pretty much been MIA from the forums for a while. There's been a lot of good info provided recently that I'm going to try to add to the OP soon, as well as finish cleaning it up and adding in some information I got via emails from people.
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May 9, 2013 13:51
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Veritas posted:I really hate to be the guy trying to defend against anecdotes, but my younger brother just posted the following on his Facebook (he's basically the #2 of a relatively successful small business in Texas): My take on that letter is that he raises some good issues with PPACA, but I doubt we'd agree on why they're a problem. I'm in the camp with some of the other people here who think employer-based insurance is a bad idea in general. I blame it for a lot of the mentality in the US that says "health insurance is a perk for having a good job". There may have been a time that was true, but getting healthcare without health insurance isn't feasible anymore. I'd much rather see the means for paying for healthcare detached from employment. Also, it seems counter to part of what PPACA is trying to accomplish. If the goal is to drive down costs via a free market approach in which customers can pick and choose their insurance plan, why are we trying to push employers to make that choice for them? It seems like it would make more sense to get rid of employer based plans, have everyone pick from the Exchanges, subsidize everyone based on income/family size, and pay for those subsidies with progressive taxes on individuals' incomes and businesses' profits. I doubt your brother would agree with what I want, but the "criticize Obama's major achievement" pleasure response may overwhelm the "this smells like socialism" response in his brain. Who knows? Another problem his screed raises is a big problem with how Congress does all kinds of things: hard, fixed points. If you're on one side you benefit/get penalized and on the other nothing happens. This is a really stupid way to do things, but they do it all the time, especially with social benefits like TANF or the Obamacare subsidizes or business mandate penalties. If they want to penalize businesses for not providing their workers with insurance, the penalties should be assessed by total labor-hours worked in a month, not "full time employee head count". That way the penalty naturally grows or shrinks with the business, rather than creating these stupid, arbitrary limits that businesses try to stay under. I mean, why is it 50 employees instead of 60 employees? Because 50 feels nicer, it's a nice round number that's exactly half of 100, so it seems good. Its totally arbitrary, there's no research saying 50 employees is a magic number. I suspect your brother feels that the answer to this is for government to stay out of business regulation entirely, where as I take more of a view that if the government is going to interfere with business it should do so in an intelligent manner. However, all of that being said, this reads like an emotional "gently caress you" letter. There's obviously some reason the business currently hires salaried employees instead of part-timers, so they are going to take some measure of pain to switch everyone to part-time workers. Is that business cost worth the benefits of avoiding the relatively mild penalties inflicted by Obamacare? For some businesses it almost certainly is, but for others its not. But I feel pretty confident that your brother hasn't sat down to assess this decision for the company he works at. This is all about saying, "look at me, I'm smarter than Barack HUSSIEN Obama, and I'm not scared to rub it in the world's face". His point about splitting the company into smaller companies each less than 50 employees really drives this home for me. First, I'm pretty sure such a plan won't work. I seem to remember reading that the rules are that all businesses owned by the same person/partnership/legal entity get added together for determining the employee count. So the only way splitting the company would work was if the current owner was willing to let other people own parts of his business without him having any control or direct benefit. But I could be wrong, and I don't have time to track down the rules governing that at the moment. But if I am wrong it only gets dumber. Because if they can split into a bunch of sub-50 employee businesses, all of those business are exempt from the business mandate and have no reason at all to limit their employees to being part-time. Sarion fucked around with this message at 15:09 on May 9, 2013 |
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May 9, 2013 15:05
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Ender.uNF posted:I know Dallas asked HHS if they could opt in to the Medicaid expansion and bypass the state government. I assume that went nowhere but we can dream. Unfortunately, it probably did go nowhere. As Medicaid is a joint Federal-State program, I don't think the Federal government could legally expand Medicaid in just Dallas without Congress making a change to Medicaid via legislation. But I could be wrong, so if you find out any more about where this went I would be interested to know about it. LeeMajors posted:Is there a list of the grandfathered plans? I'm on a State Health Plan with BCBS and they won't cover preventative healthcare unless you are obese, have diabetes or a heart condition. Or are a minor dependent. I couldn't find a list, but here's a document put out by the DHHS about Grandfathered plans: http://cciio.cms.gov/resources/files/are_you_in_a_grandfathered_health_plan_04072011.pdf It sounds like you are on a grandfathered plan; but they're required to disclose it in the plan materials they provide. So if you have a copy of the materials that sent out last year, or if you can pull up a copy online, or get a copy from work, it should say in them that they are grandfathered.
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May 10, 2013 15:57
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Sir Tonk posted:Found this thing on how PPACA will effect vets, if anyone is interested: Thanks. I think someone asked about this earlier and I forgot to answer them. And I've added that link to the OP along with a bunch of the other links people have posted here recently. Such as Willa's post with the application forms, and Dr. Gaius Baltar's links to California's plan definitions/calculator. Also, I have a better understanding of how the minimum requirements of coverage are determined now, so when I get a chance I'll improve that section of the OP and include links to the California plans there to use as examples of what people can expect.
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May 10, 2013 16:41
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Avalanche posted:I'm a broke grad student with a lovely high deductible plan through Anthem. I am well below the poverty level needed for Medicaid, but right now I cannot apply due to college students being banned from Medicaid. My state is expanding Medicaid coverage. Will I be able to get Medicaid next year? Or am I screwed for 1) Being a student and 2) Already having health insurance? Under the new expanded Medicaid rules, the only thing that matters is income level. If you make less than 135% FPL, you can get medicaid. No more rules about students or requiring women to be pregnant or any of that crap. You're poor, you qualify.
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May 11, 2013 21:59
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Willa Rogers posted:What about college-aged dependents; does that influence whether the student is covered under parental plans or eligible for independent coverage? Do you mean, if you're under 26 and could be on your parents' plan, are you disqualified from Medicaid under the new expansion? I am pretty sure the answer is that it doesn't matter, but it might be worth double checking. Edit: I've looked around and can't find anything definite either way. Everything I find says the only factor is income (133%, not 135%, oops), nothing mentions any exceptions to this. Also, everything I've read makes it sound like you can stay on your parents' plan if you wish, but nothing says you have to use it. If you want to use Medicaid, employer-provided insurance, or buy it on the Exchanges with a subsidy you can. At least that's what I've been led to believe. If anyone can find something that spells this out either way it would be good to have since I suspect a fair number of the people on SA fall into the "adults under 26" category. PC LOAD LETTER posted:IIRC this is supposed to change in 2014. It was supposed to happen this year but was pushed back after complaints by small/rural hospitals but in 2014 smaller rural-ish hospitals will get reimbursed less than they used to by Medicare. Not sure about Medicaid but that doesn't really matter. Little to no money is made for hospitals off of Medicaid patients. Rural health care is a big problem, I think it is in all (large) countries, too. Of course it's made that much worse by America's for-profit-private-insurance system. Unfortunately it's an area that I think didn't get enough attention in PPACA; though there are some improvements in there. In any case, the things you touched on that I wanted to add to were the reduced payments and medicaid payments. I assume you're referring to the Disproportionate Share Hospital bonus currently paid to hospitals that see above average numbers of Medicare (and Medicaid?) patients. Under PPACA this bonus money paid to these hospitals will continue to increase year to year, it's just set to be a smaller increase than it used to be. So they shouldn't actually be getting paid less than they are now. And for this year and next, Medicaid payments have been increased to match Medicare payments. And I hope, but for now it's all hope, that Congress will feel compelled to extend the Medicaid payment increase rather than cut back payments to doctors a year after (tens of ?) millions of Americans join Medicaid. Sarion fucked around with this message at 00:21 on May 12, 2013 |
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May 12, 2013 00:13
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esquilax posted:Dependents cannot get a subsidy on the exchange if they have access to affordable coverage through an employer. Note that 'affordable' coverage is a technical term and can actually be quite unaffordable to dependents, since affordability is only based on the cost for 'Employee Only' coverage, and not for 'Family' coverage. Sorry, I didn't meant to imply you can just use whatever you wanted. I meant that you're not required to stay on your parent's plan. If you qualify for other forms of insurance you can choose to take those instead of your parent's plan. But you still have to meet the requirements for them, so if you can get "affordable" insurance through your employer, you wouldn't qualify for subsidies. Though you could still get a plan on the Exchange without a subsidy if you really, really wanted to.
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May 12, 2013 12:40
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Willa Rogers posted:Nope; the non-profit option was bargained away as part of this year's tax deal. Well gently caress I missed this apparently, though it would explain why I haven't been able to dig up any details on the non-profit plan. I'll try to get the OP updated with this info soon.PC LOAD LETTER posted:I don't know the actual part of the law that applies or the details on how much less they're getting paid exactly. There seems to be conflicting stories from the media on just what is to blame exactly and I can't figure out which are correct. Some stories blame the PPACA and some mention its due to deficit cutting measures but it does seem to be a real thing. My understanding is that almost no one knows exactly how things will work out (media story estimates range from a ~20-33% cut in revenue which I've been told is about right but that is a big spread...) but they know they'll be getting less money from that patient base and eventually from the private insurance base too over time. This is something that I was told by several different billers that I deal with and/or have in my family who work in various different private practice and bigger hospitals. Ahh, now I know what you're talking about. This has to do with the Medicare SGR. The SGR formula was a formula created in the late 90's to help slow the growth of Medicare costs; but someone didn't check their math and now the formula results in cuts to Medicare every year. Congress avoids this by passing a law saying "we're going to ignore the SGR for the next 3 months, 9 months, 2 years, whatever" rather than growing a pair and just writing the god drat thing out of the law. They've been passing these patchwork avoidance laws (usually referred to as a "Doc Fix" in the media) for about a decade now. The latest one avoided cuts to physicians, but "deficit hawks" pushed for paying for it by allowing a portion of the hospital cuts to occur over the next decade. Here's an article about it: http://www.mdnews.com/news/2013_01/doc-fix-extended-through-2013.aspx It doesn't have to do with PPACA directly, except that they could have fixed the SGR as part of the law but didn't.
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May 12, 2013 12:56
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Willa Rogers posted:Nope; the non-profit option was bargained away as part of this year's tax deal. From what I was able to find here, the tax deal bargained away the remaining funding for loans to help non-profit plans to get off the ground. But that's different from the national plan being operated by the Office of Personnel Management. Here's an article about what I'm talking about : http://www.nytimes.com/2012/10/28/health/us-to-sponsor-health-insurance-plans-nationwide.html?_r=0 Maybe this was cut out during the tax deal as well, but I haven't be able to find anything confirming that.
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May 12, 2013 13:12
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Iron Tusk posted:They also like it because they can use it to lie about future cost projections, and goose budget numbers lower than they'll really be. Yeah, I think this is the bigger reason, though I don't honestly know much about Congress vs. AMA. The CBO projects budgets and bills based on "current law" and the current law says that in a year Medicare payments are going to be slashed 25-30%, and then cut another 1-3% a year, every year, for the next 10 years. So when they do a ten year projection that involves Medicare, the projected outlays are way lower than they really will be (because everyone knows Congress is going to pass another short term patch on those cuts). But any attempt to fix it will inevitably "add to the deficit" by the nature of how it's calculated; when in reality a permanent fix may actually be cheaper that continuing to pass these short term patches for the next decade which is what is likely to happen. There was originally a push in PPACA to fix the SGR, but it was dropped to get better CBO numbers so to help bolster the "PPACA reduces the deficit" argument.
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May 18, 2013 22:25
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Typical Pubbie posted:Every horrible thing having to do with governance in this country can be linked to our right-wing obsession with the deficit. Not entirely true. There's lots of horrible things that go on in the name of "defense" or "security" and as soon as those are brought up deficits cease to matter. Deficits only matter when you're trying to keep poor people alive. If you're trying to kill them, no cost is too great. 
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May 19, 2013 02:35
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karthun posted:Reminder, the Army is mothballing brand new M1's because there is no where to put them and the Army is not allowed to cut procurement because of Congress. Congress is exactly who we're talking about.
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May 19, 2013 03:26
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One thing I didn't notice mentioned is that the subsidies are based on the second cheapest Silver plan. As a result, a single 34 year old making $20,000 a year should be able to get that lovely Bronze plan for close to $30/mo once the subsidy is applied. And then their out of pocket costs would also be subsidized to $2250 a year. For someone who currently has no insurance, a plan like that ($30/mo premium, $2250 oopm) is a vast improvement. Unfortunately it breaks down the further up your income goes, until you eventually reach Willa's scenario which is at a  level of stupid.And for comparing plan costs, I think the best way is to use a best/worst case range. Best case being only the premium, worst case being premium + max out of pocket. So the plan I described above would have a cost of $360-$2610. evilweasel posted:Jan Brewer, the governor of Arizona, is actually vetoing every single law the legislature passes until they agree to the medicaid expansion. This is hilariously awesome. I can't stand Brewer but I can get behind this. Any idea what the motivation for this is? Why is she so vehemently supportive of the expansion when most other Republican Governors are opposed or lukewarm in their support? edit: Also, Kaiser has significantly improved their subsidy calculator, so if you haven't checked it out recently its worth a look. Sarion fucked around with this message at 23:35 on May 25, 2013 |
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May 25, 2013 23:23
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Ardennes posted:Yeah one of the very many issues with the PPACA is that there is significant cut off between 400% over the poverty line and 401%. Someone making $46000 dollars a dear would get $1,000 in subsidies for $5,370 dollar silver plan (still pretty pathetic all things considered), while even that subsidy evaporates when you hit that line. Yeah, it really fucks older people the hardest though, people who are at an age where they're starting to need a lot of care but are too young for Medicare. Someone in their late 50's or early 60's is looking at a Silver plan that costs ~$12,000 with an ~$8,000 subsidy. Let's say this year they get their subsidy, but they end up making $20 too much in December. Now when their tax returns come around they have to pay back that $8,000 subsidy because they earned $20 too much. AND they lose their subsidy for the following year, even though that year they may end up making less money which means they should have qualified. The system works!
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May 26, 2013 14:53
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Konstantin posted:What state do you live in? The Medicaid expansion covers families up to 133% of FPL, so you would be covered under that if your state opted in. If it isn't in a covered state, if nobody in your family will have employer sponsored coverage you can get insurance from the exchange, with a premium cap of 2% of household income. This isn't entirely true. The 2% premium cap is expressly applied to people/families who make over 100% FPL. From what I read, it sounds like dpbjinc's household makes less than 100% FPL for a household their size. This means their only choices are to get insurance at full price (plus the smoker penalty) or Medicaid. And since it's Oklahoma, the odds are poor on the Medicaid front There's two glaring gaps of coverage in PPACA, one for the very poor (in anti-Medicaid States) and one for the "slightly too middle class" at the other end of the spectrum.
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May 26, 2013 18:13
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dpbjinc posted:Edit: Does the tobacco surcharge apply to electronic cigarettes? I don't think I could get my father to stop smoking, but if I got him to switch, would those still count as tobacco use? I've never seen them mentioned anywhere, I think it's always just "tobacco use". But the FDA has issued health risk warnings for e-cigarettes so it seems kind of iffy at best.
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May 26, 2013 18:17
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LorneReams posted:I was reading about the way deductibles work, and looking over my insurance, for new policies, deductibles are prorated from quarter of enrollment (Jan 100%, April 75%, July 50% ,October 25%)....this isn't the case for all because that seems like bullshit that would be illegal somehow. That seems like a good thing, unless I am misunderstanding something.
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Jun 2, 2013 16:04
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Malmesbury Monster posted:That's a fair point, and one I hadn't considered. He's definitely a walking health risk and god knows he needs to drop a (couple) hundred pounds anyway. It just didn't make sense to me that the PPACA would remove pre-existing conditions as a grounds to deny someone insurance, but allow them to functionally deny insurance by making it prohibitively expensive, particularly when there's a lot of language in the act about promoting wellness programs. You're correct, they can't do that. The issue though is that part of PPACA is not in effect for another 6 months. Right now they can refuse to cover him due to his weight, or set the premiums so insanely high that they are unaffordable. Next January the plan they offer him will be the same cost as anyone else who is his age and lives in the same area. A 600lbs man with AIDs who is 33 years old will get the same plans/premiums as a 33 year old, 140 lbs woman who lives next door. There is a penalty if he smokes, but that's the only health issue they can use to determine costs.
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Jun 7, 2013 17:31
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