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serewit posted:Does the Medicaid expansion have any mechanism or instruction to the states to make the actual process for applying easier? In my state, it's an absolute nightmare trying to find out if you qualify, and the language is incredibly unclear on the myriad of websites that you need to jump through to even figure out if you qualify. There will be one application to rule them all. Every state must accept the Centers for Medicare and Medicaid Services (CMS) application form. It will be available primarily on Healthcare.gov, but also as a printed form. It applies to the Marketplaces, Medicaid, and CHIP. It's still in draft form and open to public comments. Interestingly enough, the strongest complaint so far is that it is compliant with the motor voter law, and asks if you want to register to vote. I expect CMS has a watchful eye out for a O'Keefe vs. ACORN style sting. YouTube video Written form Stupid Edit: The executive branch no longer calls them Exchanges. They are now Marketplaces.
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Apr 3, 2013 05:37
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Harik posted:This one in specific is one of those incredibly dumb cliffs congress is so fond of. It quite literally places a hiring wall at 99 employees (49?). Huge businesses get good group rate discounts, small startups say 'gently caress healthcare' and pay nothing, so it's a squeeze only on a few specific size businesses. There's a work around for that. Those businesses can insure themselves and avoid all those troublesome federal standards. They just need to pay for their employee's health expenses consistent with their state standards for health insurance. Wait, you can't get a good deal on prices? Just contract with your local What do you mean you're not incorporated in Delaware? What's wrong with you? It costs like, five bucks. And 45 cents postage. Anyway, the "price club" will take care of all the administrative hassles and employee health expenses over a few thousand dollars as long as you pay your
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Apr 3, 2013 10:38
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Sarion posted: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. There are health care providers that run exclusively on Medicare funds. Medicare has a huge advantage in that it provides cash flow. They pay on time, in full. Private insurance pays late, in part. And while bill collection companies and credit agencies are happy to go after private individuals and small businesses, they are very reluctant to deal with Blue Cross or Humana. The military health care budget, for example, is limited to Medicare reimbursement (so they say) and has much better health outcomes than private medical centers. And ask a military retiree to choose between TRICARE, VA, and insurance , and they'll pick TRICARE just about every time. Sarion posted: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. For some reason, Congress hasn't been willing to increase funding for ACA activities since 2010. So like the BHP, SHOP was dropped as a "nice to have, but not essential." Small business will get some sort of SHOP support in the states willing to do a little extra to support robust heatlh exchanges. Sarion posted: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. OPM defined plans for federal employees (who work in all states and territories) can be made available if the local plans and insurance departments can't get their act together. Interestingly, OPM has more experience with private health insurance than DHHS/CMS.
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Apr 5, 2013 04:47
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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. Perry is an rear end clown; people in the medical industry and large counties are already giving the state lawmakers a huge earful over it; they will cave eventually - those dollars are too important to the state economy. Mississippi Health Insurance Commissioner Mike Chaney (a dyed in the wool Republican) with remarkable foresight, had a bill passed through the Mississippi legislature making him the exclusive decision maker on whether to set up a state based exchange. He felt strongly that the federal government should not come in and tell Mississippi how to handle its healthcare. He made as much progress, and more than most, creating a healthcare marketplace that treated well the interests of the insurance companies and consumers. Ultimately, HHS decided that Mississippi Governor Phil Bryant could still trash the program and denied the application. Mike Chaney felt betrayed and said the decision was political. He's right. Left alone, he would have made it work. And HHS bureaucrats sincerely tried to help him make it work. But HHS and the White House thought that Republican operatives would bypass him, get their claws into it, wreck it, and hold it up as a failure of ObamaCare. So they cut loose MississippiOne. It was the smart decision, but it doesn't feel right. So anyway, about Dallas getting their own little health care marketplace or Texas swallowing a conservative idea implemented by a democratic president: 
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May 10, 2013 02:19
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esquilax posted:I believe it is the case that if the spouse files separately and they are not claimed as a dependent, then they don't count as a "related individual" and I think they can go on the exchange by themselves. At this point though I need to clarify that IANAL and there are a lot of loopholes like that that seem to be allowed by regulations but may not actually be. The administrative rules for Navigators came out in the Federal Register. It basically says to get a Navigator grant, Navigators need to be trained and cannot take pay from people selling health insurance. No details on the content of training in there. Presumably, CMS is still writing the training, because CMS is still writing some of the final regulations. By an oversight, the PPACA says employer coverage is affordable as long as the employee's (not family's) premiums are not over 9.5% of household income. Which screws married couples filing jointly, especially when both partners are working. The law also says that the source of income information is the IRS, unless the taxpayer tells the IRS not to share that information. In that case, the verifiers must collect that information solely from the applicant. That clause is not meant to be a loophole, but meant for someone to provide more accurate information that the IRS must have. I assume. Whatever someone wants to say is most accurate is on them. But at least in the first few years, no one's going to have any time to check up on people opting out of the IRS transmission. But most of all, filing status controls whether you are married or not. You could just crunch the numbers and find out if the subsidy means that filling separately for 2013 gives more tax advantages than filing jointly. Which I expect will be the case when at least one person in the marrage would qualify for a subsidy.
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May 29, 2013 04:49
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Unfortunately, no one is looking to make any tweaks to the ACA. Or any other real law for that matter. Edit: I can't tell years apart anymore.
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May 30, 2013 02:38
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EugeneJ posted:Question - If I get one of the state-sponsored Healthy NY plans offered from private insurers, can I drop it to either get a plan through the exchange or a work-sponsored plan at the end of the year? Does that 'qualifying event' bullshit disappear at the end of 2013? http://www.dfs.ny.gov/healthyny/hny_ind_sole_change.htm Looks like it depends on the insurer, but some at least let you drop the plan with a month's notice. That probably means you can drop it after any month. But it might mean you have to give notice a month in advance of a renewal period. Send an e-mail to the program to pin them down on this before sending in an application.
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Jun 1, 2013 17:04
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mugrim posted:I thought if anyone had any questions about the advocacy or what was happening in state I would be a decent resource. Yes. Given how massive the health care industry is in Texas, how they hell did they not threaten/bribe the Republicans into taking the Medicaid expansion? Honestly, they contribute tons of money, have tremendous clout, and have lost money on the uninsured since forever.
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Jun 3, 2013 03:39
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Here's a summary posted Friday on how the health insurance marketplaces are going. http://www.whitehouse.gov/sites/default/files/docs/competition_memo_5-30-13.pdf For the people who have been keeping up, there aren't any hard data/surprises until page 4. First, the Multi-State plans (say, weren't there some people saying we should buy across state lines instead of passing the ACA?) are going to be in at least 31 of the marketplaces. Maybe more depending on what OPM can pull together in the next four months. The Multi-State plans are essentially tweaked versions of the health plans OPM negotiates for federal employees. Second, there is a new tier of health plan besides the metal ones. It's called "Catastrophic" and listed before Bronze. This is the first I've heard about it, and I haven't found any other details on it anywhere. So I can't tell if it will be available in all the marketplaces or even what the actuarial value would be. I'm not sure why they're keeping quiet about them. What could be wrong about the catastophic health insurance plans Obamacare provides. 
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Jun 5, 2013 01:35
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Aeka 2.0 posted:I got an email from Moveon.org stating that California WalMart employees are getting cut enough to be put on Medical as a loophole to avoid the mandate. There is a senate bill that is trying to close this loophole. So I ask the obvious, why weren't these large corporate entities pushing for single payer so they could have washed their hands of the whole thing all together without undercutting the buying power of Americal? They don't like change. They don't want to have to deal with a whole new tax structure/workman’s comp system/qualification regs. It also leaves the door open to government employees (rather than other private companies) meddling in their business processes.
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Jun 14, 2013 04:01
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There's a bright, shiny new healthcare.gov! For now, the site uses a simple algorithm to tell you generally if you are going to use your employer's plan, the There's some interesting features in the blog section though. There's a live chat box that I haven't tried yet. So the official website is finally getting started and has been up since Friday. I find it interesting that after years of the most heated, mind-bending, virulent rhetoric with demagogues pushing their audiences to express their  on this issue in every way possible, the comments section has exactly one entry. An "Attaboy!" Probably done by someone who works there trying trying to make a coworker feel good. Goes to show that no one is really interested in what the government is actually doing to get the PPACA up and running.
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Jun 25, 2013 02:36
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It's starting to sound like one of those "Sign up now and get the first month free!" deals.
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Jul 7, 2013 16:46
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Amused to Death posted:Question! If your employer offers health care insurance, can you buy insurance on the exchanges paying for it fully out of pocket? Answer: Yes, as long as you are a citizen or legal resident, and not in jail at the time of enrollment, you can buy insurance on the exchanges regardless of whether you qualify for a subsidy. You also have the opportunity to try to prove your employer is a piece of poo poo who won't offer decent healthcare. It's covered in section 1312 of the ACA.
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Sep 4, 2013 06:09
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Sundae posted:Okay... ridiculous question, but I've noticed that I tend to run into ridiculous situations. If your plan doesn't cover a family member, then you can buy a plan on the marketplace (exchange) and get a subsidy. In fact, family members can usually get a subsidy for a marketplace plan even when your employer offers a family plan. You will need to put your policy number in the application and the marketplace enrollers will check it out. A crappy sounding plan like yours shouldn't disqualify you from any subsidies. If you do get turned down, call the appeal number on the application. This goes more smoothly if you claim them as dependents for tax purposes too, but that's not required. You can put them on a subsidized family plan as long as someone else isn't already putting them on a subsidized plan. If they are on one, the application should just switch them to the plan you want.
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Sep 17, 2013 03:38
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Nonsense posted:Would health insurance companies be able to raise their prices high enough to get people angry enough to affect the law? Health insurance companies will have a hard time jacking up rates quickly. Their biggest problem is the rule that no more than 20% of gross income can be attributable to administrative costs and profits. After posting rates like this, they are going to have to claim losses to justify jacking up rates. And that will kill their stock prices. But keep in mind, insurance companies are one of the few industries still comfortable playing the long con. They will be content compounding percentages, subverting regulatory bodies to create exceptions, and gathering in increasing profits year after year instead of trying to cash in all at once. In the end, what they pull in will be hard to tease out of the overall growing gap between the rich and the poor. They resent propaganda like that map, because it can only draw attention to what they are doing. I'm far more worried about what the rates will be 10 years from now rather than next year.
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Sep 26, 2013 05:20
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Indigofreak posted:I've only seen them jack of the pricing if you compare old lowest price to new lowest price. Those plans are radically different though in what they offer. Like my plan has completely changed. Yes, the price goes up overall. Have the prices of the same plan gone up? I may have missed the graphs of that. I purposely spent 8 years working in military health care, because I wanted to work in socialized healthcare and did not want to spend my career wrestling with insurance companies over reimbursement rates. I had an inkling something had changed whenever I walked into a civilian hospital and saw the décor laid out like an investment bank. But Brill's article really astounded me on how the center of power in healthcare had switched from insurance companies to providers. Change over such a short time frame causes a huge problem for people studying an industry. When people wait five years to turn in bills, much less write them off, or to validate other data, you can't make declarative statements about what's wrong right now with the healthcare system. When the PPACA of 2008 was passed, it used data from 2003. That's the only data people could defend, and it said insurance companies ruled the roost. Now there's a huge disconnect, because most of the law addresses health insurance. Health insurance is the lesser problem now. The half assed fix to health insurance is showing benefits, but only because the system was so broken before. Unfortunately, the marketplaces only fix very little. (Universal Health Care carries $5,000 deductibles per year? Seriously?  )The PPACA did include health care improvement provisions, but they were mostly afterthoughts. Still the Accountable Care Organizations give incentives to reduce costs, and the Medicare readmission penalties are a stick against hospitals providing lousy care. Unfortunately several efforts to re-focus health reform on providers were sabotaged. The whole Independent Payment Advisory Board = Death Panel fiasco was the most obvious one. HHS also turned in several legislative proposals that died, because Republicans took a stand of repeal or nothing. Another big defeat was the Senate refusing to consider Dr. Berwick as CMS Administrator. Just because he said Britain's NHS achieved better heath care outcomes at a cheaper price than the US system, and maybe we could learn something from them. Of course, he lost some popularity helping author the To Err Is Human report that pissed off every physician in the country who wasn't a medical school professor.
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Sep 26, 2013 07:32
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DP, but what the hell.Bizarro Kanyon posted:Under the PPACA, what happens if a family of four (2 adults, 2 kids and one on the way)has the father who receives insurance through his school which covers him and his wife (and one on the way), but the other two kids are on high deductible insurance plans(the family received a letter stating that their kids insurance does not "meet standards of PPACA")? If the insurance policies for the kids do not meet the standards, you can use the marketplace and qualify for subsidies/tax credits for them. That letter is more than enough proof. Indigofreak posted:I've checked further into my situation. I can't get subsidies. If your work offers health care, you pretty much are forced to go with that(provided you qualify for your work's.) So I wonder if they will just have to put the entire family on the the fathers work plan. Your situation is a little more complicated. When your employer offers family coverage, and you accept it, and it qualifies as affordable, your family does not qualify for subsidies/tax credits. When your employer offers family coverage, and you accept it, and it does not qualify as affordable, your family does qualify for subsidies/tax credits. When your employer offers family coverage, and you only accept self coverage, your family might qualify for subsidies/tax credits. (This hasn't been tested yet. Wait and see if someone else makes this work first.) The controlling information on whether your policy qualifies is your policy number and what it covers. Don't assume what your employer/insurance company told you about affordability and qualification is correct. This is all new, and I can't say things will work out the way they should. But you have until March 31st to get on the exchanges. Make an application next week using your current policy. If you don't like the answer, call the number for appeals. If you still don't like the answer, ask what you need to change about your insurance to qualify for subsidies/tax credits. Then re apply.
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Sep 26, 2013 08:32
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morrisirrom posted:So my wife's job's healthcare runs from Oct 1 this year til Sep 30 2014. Is it possible to still sign up for ACA starting Jan 2014 and dropping her existing plan then? There does not seem to be verbiage in her healthcare docs stating we cannot drop coverage. It would save us @ $240 a month. If you are counting on subsidies/tax credits, you can't drop employer sponsored coverage to get them. You can buy a marketplace plan right now regardless of your employer plan if it's cheaper even without the subsidies. You just need to make sure you aren't locked in to your current plan.
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Oct 5, 2013 21:00
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Ravenfood posted:So, for various reasons that aren't important, I need to sign up for short-term health insurance. Beyond noting that they basically offer only catastrophic coverage and are not sufficient to prevent me from having to pay the ACA fee, is there anything I need to know before I start diving into that market? I know pretty much nothing about them and wouldn't know how/where to look for ones to see how reputable they are. The basic starting point is healthcare.gov. The application process is supposed to flag any life circumstances that qualify you for any support or aid. You could get one on one counseling on the best way to approach your application. You need to look for healthcare navigators or enrollment assisters. Who exactly you go to depends on where you live. Healthcare.gov or search engine results will help you find out. Navigators help you put together the best application possible and explain the differences between plans. They are not allowed to work for insurance companies and can be volunteers, so they are usually neutral. Generally speaking, if you are in the position where you need healthcare now, you are probably in the position where you can sign up for any plan now instead of waiting for open season to open up a month from now.
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Oct 14, 2014 23:23
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The high deductible plans really suck. I really wish they weren't allowed. Avoid them if you can. If they're all that's out there, milk the fully covered preventive services as much as you can. Health insurance agents can help you find the best plan for you and and do so quickly. Personally, I just don't consider them truly neutral, so I don't usually suggest them.
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Oct 15, 2014 00:31
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I recommend against reporting future income high enough to qualify for the subsidies unless you really think you will earn close to that. Eventually you must report actual income and future subsidies could be reduced to make up for overpayments. Republican congressmen intend to watch administration enforcement of this very closely. There really is no way around the gap created by making the Medicaid expansion optional. Your state government is 100% screwing you, because a majority of the legislators want to see Obamacare fail more than they want to increase revenue and promote the health of their state. This is happening because too few people either know, care or believe that this is actually happening. On the topic of health insurance profits, I want to point out that insurance companies have revenue streams other than premiums. They are required to keep a large capital reserve in order to cover potentially catastrophic volumes of claims. But they are allowed to invest this capital. I would expect that right now investments are contributing more to insurance company profits than premiums are. That wouldn't stop them from maximizing premium revenue, oh no. Cost shifting is something only consumers, providers, and governments should have to put up with.
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Nov 26, 2014 00:53
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Qu Appelle posted:Insurance An exchange is not supposed to enroll you in Medicaid and a subsidized silver plan at the same time. That would be a glitch. Probably because your job situation changed so rapidly. That sucks BTW. Although it is possible that BCBS wrote a plan for you independently. Go back to your broker with that new card or go to the marketplace. Explain that you are already have Medicaid, and don't want another plan. If you run into any trouble, the WA insurance commissioner can help out.
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Apr 24, 2015 16:25
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Welp. This health care reform thing is still kind of a work in progress.
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Apr 24, 2015 21:06
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Oh, I think Republicans are finally getting on board and cooperating. Their Senate leadership just gave the OK for a bill that will preserve the marketplace tax credits for everyone! Until 2017.
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Apr 29, 2015 15:03
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Well, two out of three ain't bad.
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Aug 13, 2015 19:59
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Reik posted:Hold on to your butts. Oh hey, look, they copied and pasted an article from last April and added one year to all the dates. esquilax posted:Some other recent news: United had the highest priced plans on the markets. They are getting out because they couldn't sell any plans. Other folks will put more plans up for approval.
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Apr 28, 2016 04:58
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This is also the first year after the risk corridors were gutted. Risk corridors were like reinsurance where companies pay into a pot and anyone with really sick clients drew from the pot. Corridors were different in that you had to have really really sick clients, and the federal government would kick in too. Well republicans called that a bailout and said the market had to stand on its own. They repealed the government contributions in the last budget throwdown. So that's one of the things contributing to the extra sharp increase this year. Oh, it wiped out most of the co-ops too. They couldn't maintain minimum cash reserves after paying out. They took on a lot of sick people at very low prices.
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Oct 25, 2016 14:32
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baquerd posted:Bringing them into the ACA pool is a very tricky problem for employers and employees. I think perhaps the best and most straight-forward way to go about it would be to simply restrict all employer provided plans to those available on the ACA. That's not going to work unless you rewrite the ACA into a straight-up single payer system.
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Nov 1, 2016 20:36
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EugeneJ posted:Wouldn't it end up just like car insurance where the red states have less requirements as to what kind of policies you buy, while the blue states require any policy you buy to have a minimum amount of coverage  Get a discount for $1,000,000 lifetime cap backed by a Medicaid fund to tap into in case you bankrupt yourself after you have to liquidate all your assets to pay for medical costs? You make some great life decisions.
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Nov 4, 2016 01:19
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