Plan B Forum

Of the many unintended consequences in Healthcare Reform (aka Obamacare), here are a couple more that have come to light recently. Used to be that many small employers who couldn't afford to provide health insurance would provide an allocation of pre-tax money for employees to use on medical expenses, including buying their own insurance policy. That option is now gone thanks to the rule that an employer has to provide a plan that meets certain criteria or not provide a plan at all. That's right, the government just mandated that employers stop giving employees a the little bit of help the can afford with employee medical costs.

Next up we will see many employers dropping the option to add a spouse to the employer's coverage. Many employers pay for the employee's insurance coverage and offer the alternative for the employee to add his/her spouse and children to the group plan (group coverage generally being less costly than individual coverage). However, many middle-income and below taxpayers will be eligible to get a government subsidy for obtaining coverage on the "exchange" which might make coverage for the household cheaper than getting covered on the spouse's employer's plan. They can only get the exchange subsidy, though, if they are not eligible for other coverage. Since the spouse is eligible for her husband's employer's plan, she would not get the subsidy. As a result, many employers will start to design their health plan to exclude the option to add a spouse so that those lower-income level employees can have their spouse go on the exchange at less cost. Well, that's less cost to the spouse and her family, but more cost for us taxpayers. End result being we, as a society, pay more for the spouse's coverage not just because of increased public spending, but also because the overall cost would be less with the group.

So there are two more examples of what happens when you have centralized planning with the pointy-headed types putting together a plan that rewrites how a major sector of the economy is going to work. Or maybe there is genius to the idiocy -- design something that makes the already complicated system completely dysfunctional so that you can sell single-payer as the only viable alternative.

Maybe you could just join the rest of the first world.

What happens with the current system is so bad that it had to be changed.

Most people are 1 serious illness or injury away from bankruptcy. If you do not have health insurance and you get a treatable form of cancer you will die from it. Cancer treatment is not an emergency and no one is required to provide it.

The ACA insures more people, prevents exclusion for pre-existing conditions, and collects premiums from more people who are young and healthy (albeit small). All are improvements and are evolutionary changes to a better system than we had before. Single-payer is a better and cheaper system and this is an evolutionary step towards that.

Employer-provided HI was already being stripped to nothing. And 60% of bankruptcies were caused by health costs: more than 750,000 people a year. Driving people into bankruptcy increases the costs of welfare and makes their health and their families health even worse which escalates societal costs reduces their children's chance of getting a good education.


yrs,
rubato

Long Run wrote:Of the many unintended consequences in Healthcare Reform (aka Obamacare), here are a couple more that have come to light recently. Used to be that many small employers who couldn't afford to provide health insurance would provide an allocation of pre-tax money for employees to use on medical expenses, including buying their own insurance policy. That option is now gone thanks to the rule that an employer has to provide a plan that meets certain criteria or not provide a plan at all. That's right, the government just mandated that employers stop giving employees a the little bit of help the can afford with employee medical costs.

Liz's employer used to offer that...and yep, they now have to drop it.

Next up we will see many employers dropping the option to add a spouse to the employer's coverage. Many employers pay for the employee's insurance coverage and offer the alternative for the employee to add his/her spouse and children to the group plan (group coverage generally being less costly than individual coverage). However, many middle-income and below taxpayers will be eligible to get a government subsidy for obtaining coverage on the "exchange" which might make coverage for the household cheaper than getting covered on the spouse's employer's plan. They can only get the exchange subsidy, though, if they are not eligible for other coverage. Since the spouse is eligible for her husband's employer's plan, she would not get the subsidy. As a result, many employers will start to design their health plan to exclude the option to add a spouse so that those lower-income level employees can have their spouse go on the exchange at less cost. Well, that's less cost to the spouse and her family, but more cost for us taxpayers. End result being we, as a society, pay more for the spouse's coverage not just because of increased public spending, but also because the overall cost would be less with the group.

She's covered on my plan at least through the end of the year...if my plan drops spouse coverage, I truly think we'll be TOTALLY fucked.

So there are two more examples of what happens when you have centralized planning with the pointy-headed types putting together a plan that rewrites how a major sector of the economy is going to work. Or maybe there is genius to the idiocy -- design something that makes the already complicated system completely dysfunctional so that you can sell single-payer as the only viable alternative.

Obamacare is failing, because it was INTENDED to fail, for just that reason.

We're boned.

http://pullquote.com/pq/gxSMVf

This kind of obstructionism has been seen before. After the Supreme Court’s ruling in Brown v. Board of Education, in 1954, Virginia shut down schools in Charlottesville, Norfolk, and Warren County rather than accept black children in white schools. When the courts forced the schools to open, the governor followed a number of other Southern states in instituting hurdles such as “pupil placement” reviews, “freedom of choice” plans that provided nothing of the sort, and incessant legal delays. While in some states meaningful progress occurred rapidly, in others it took many years. We face a similar situation with health-care reform. - www.newyorker.com

Here is another fun one having to do with the Exchange plans (assuming they overcome their huge technical failures and can start enrolling people). Under current law if you want to be covered in a new health plan without excluding your pre-existing condition, you have to start in your new plan within 63 days of losing coverage in your old plan. (Otherwise you have to serve out a waiting period of 6 to 12 months). This is a way that health plans protect themselves financially from being an attractor for people who just got sick or injured. The ACA eliminates the ability of a plan to protect itself from this adverse selection by not allowing pre-existing condition exclusions, even if the new enrollee has not had coverage.

However, back to the Exchange plans, guess what? A person without current health coverage (including those who are gaming the system and now have a medical condition, aka pre-existing condition) cannot sign up for an Exchange plan except during open enrollment each year. The government is protecting the Exchange plans from the exact thing private plans were vilified for -- protecting themselves from adverse selection. I think we won't need to eat spinach for at least a few more years since we will be well supplied with ACA irony for some time to come.

Uhh the enrollment period is the same as it current;y is for most insurance save ofr certain live events hired/fired/ married have child etc. enrollment is once a year.

I believe that the deferment of the budget/debt fight until after the first of the year will prove very wise for Republicans who are fighting full implementation of ACA. By that time, the tens of millions of employed Americans who are not really paying attention now will have seen their first paycheck of the year, seen how much their premiums have increased and/or their coverage has deteriorated, and will be PISSED OFF.

I get my health insurance through my wife's employer (she pays a monthly charge because I could get it from my employer). Our Out-of-Pocket deductible will go from $1,000/year max to $9,000/year max. But it's not so bad because she will be eligible for an $800 credit of some kind. I think that balances out, right?

In Democrat-speak, we are not "harmed" by the implementation of ACA, but it will cost our household a couple thousand dollars more, if my medical interactions remain at the same level as in the past 4-5 years.

The law was sold on a pack of lies, which I don't need to repeat here. The entire thrust of it is to get as many additional people dependent on Government largesse as possible, knowing that they will be perpetually in the Democrats' debt. But politically, many times more people wil be negatively impacted by ACA than will be helped; I daresay, every gainfully-employed American who posts here will be negatively impacted when everything is considered.

All the R's have to do is keep reminding gainfully-employed Americans of the source of their pain.

They won't have to remind those who have been shifted to part-time, or lost their jobs entirely due to ACA.

Right, just like what happened in Massachusetts under Romneycare.

Oh, wait...

Gob wrote:Maybe you could just join the rest of the first world.

In Louisiana we have state owned hospital system that any citizen of Louisiana can use and pay according to their income. The poor pay nothing and everyone else pays on a sliding scale according to their income. Some people in Louisiana won’t use the system because they still consider it the charity hospital. When I had my operation done I used it because I wanted to support the system. My mother said to me why are you here this is the charity hospital; you have insurance. That is the problem with the state owned system, more people with insurance need to use it, rather than seeing as beneath them, if they don’t it will go defunct.

THURSDAY, OCT 17, 2013 06:44 AM CDT

Right-wing nuts nab new way to sabotage Obamacare
Remember how the shutdown deal only gave the GOP "small" concessions? One low-profile component could prove costly
BY DAVID DAYEN

The final deal to avert a breach of the debt limit and end the government shutdown included what has been described as a “small concession” to Republicans: tightening the income verification measures for customers on the Obamacare insurance exchanges to qualify for subsidies. But considering the hurdles associated with this step – and the enormous IT problems we’ve already seen with the exchanges – the concession may not be small at all.

As one prominent health care expert tells Salon, the impact could contribute to an attempted sabotage of the law by those who want to see it repealed. Rather than letting the health care law survive “unscathed,” the income verification piece could trigger a new round of headaches for Obamacare, and this time, Republicans – and the country – will be paying attention.

Conservatives have been grumbling for months that Obamacare invites fraud, by using an “honor system” to verify the income levels that determine subsidy amounts on the exchanges. Just last month, House Republicans passed the No Subsidies Without Verification Act 235-191, with all of their members voting in favor. The bill prohibits any subsidies from being distributed until the Inspector General of the Department of Health and Human Services (HHS) certifies that a system of income verification is operational.

HHS did say back in July that they would rely on “self-attestation” to determine the initial subsidy level, with sample audits to verify information. But later, HHS announced the sample size would equal 100% of the population, and that they would test self-reporting against sources like past tax filings and Social Security data. While they haven’t officially changed the regulation, income verification tests are included in the exchange’s data hubs. So you can say that the Republican measure just forces compliance with spelling out the regulations for a full verification regime.

However, there’s another part to this, the simplest and easiest way to ensure that everyone receives the proper subsidy level. It’s called the Internal Revenue Service. Every American sends in a tax return annually showing their exact income level, subject to routine verification by a large government agency. Under Obamacare, the IRS can claw back excess subsidies after the fact, something frequent conservative critic Avik Roy acknowledged in July. He added that “the IRS’ record of impartiality is, shall we say, contested,” and that people in poverty who don’t file tax returns “would probably not be subject” to clawbacks (weasel word alert!). Roy is relying on the discredited IRS scandal here to suggest that the agency wouldn’t do their job when Obamacare recipients (read: Democrats) are involved. But he also takes a very curious stance for a conservative: that the IRS, far from being a group of jack-booted thugs who will stop at nothing to take your money at the barrel of a gun, is simply too lazy to do its job!

“You have to wonder, why isn’t clawback enough,” Paul Starr, Princeton professor and author of Remedy and Reaction, about the legislative fight over Obamacare, told Salon. “This seems to me another form of sabotage.”

Starr’s perspective is borne by the early experience of the exchanges. The federal exchange, which is the Obamacare portal for customers in 34 states, has performed very badly in the opening weeks. Even supporters of the law like the Washington Post’s Ezra Klein has called the rollout a disaster. Not only have potential customers been unable to register for the program after 20 or 30 attempts, those few who have been successful aren’t having their data transferred to insurance companies properly.

“Things are worse behind the curtain than in front of it,” according to health care writer Bob Laszlewski, describing how the system is enrolling and unenrolling customers seemingly at random. If HHS can’t approve subsidies until the Inspector General decides income verification is operational, that would definitely delay subsidies – nothing is operational about the federal exchanges right now. (Subsequent reports about the deal suggest that Health and Human Services Secretary Kathleen Sebelius, and not the Inspector General, would do the certification. But it’s not clear what would have to be tweaked in the process.)

And you have to question whether income verification would ever be operational, and if that’s contributing to the major delays on the exchange website. Accurate, real-time income verification has been a cherished goal for members of the financial services industry for many years; they use this data to determine eligibility for loans of all types. Needless to say, big banks and financial services firms have massive resources relative to the federal government. And they haven’t been able to nail electronic income verification yet; they mostly ask people to mail or fax in forms proving income, rather than submit them through the Web (which leads to losing forms and multiple queries for data and all the rest).

Most of the information you can scrape from payroll or Social Security data would be 6-18 months out of date, especially for the types of part-time workers, freelancers, “unbanked” individuals and self-employed persons who comprise the primary group signing up for Obamacare. Demanding real-time income verification would require technology that doesn’t even exist for the financial sector, and to get it right would add significantly to the already burdensome delays in acquiring insurance coverage on the exchanges. It would also expand costs for IT development exponentially, achieving the neat trick of making Obamacare more costly and more ineffective at the same time.

As noted before, there’s an already existing method of income verification, through the IRS, that stands ready to handle any potential misreporting through clawbacks. In fact, the IRS will have to verify income anyway; people simply don’t have perfect information about their future income, especially part-timers and freelancers and the self-employed. This is how many means-tested programs like Medicare and Medicaid work, and despite the cries of conservatives, fraud in those programs mostly come from health care providers bilking the government rather than individual subscribers.

Instead of using a time-tested process that works (and would work better if Republicans weren’t so dedicated to defunding the IRS), the GOP wants to add this kludgey extra step to an already strained online exchange. The clear goal here is to make it harder to enroll or collapse the insurance exchanges entirely, along with creating the impression that Obamacare customers are automatically freeloaders and cheats, which aligns with conservative demonization of other government programs.

So far, the woes of the insurance exchanges have played in the background of the news, far behind the government shutdown and possible debt limit breach. By embarking on a white-whale quest to defund Obamacare, Tea Party Republicans have ignored the huge PR value of the exchange disaster. Indeed, many people logically assume that the problems with the exchanges are due to the shutdown (they aren’t). The Administration has basically gotten a lifeline on the bad rollout, thanks to the GOP focusing attention elsewhere. That could change with this deal, and the added hurdle of income verification.

Obviously, verifying the income of applicants to determine their proper level of subsidy is critical to Obamacare running smoothly. But there are plenty of ways to do this, particularly through the agency best equipped to verify income. Asking the federal government to perform an impossible technical feat through a shaky online portal is a recipe for further disaster. Senate Democrats made this concession to Republicans in their fiscal deal; House conservatives are well-positioned to exploit it.

David Dayen is a contributing writer for Salon. Follow him on Twitter at @ddayen.

http://www.salon.com/2013/10/17/right_w ... obamacare/

People who have never used enterprise software (like SAP) might be excused for being ignorant and hyperbolic in describing the Obamacare HI exchanges two weeks into its first trials a "disaster". But you would think even a few of them would recall Windows8 ? An ongoing disaster by a company who is supposed to specialise in software applications unlike the Federal government.

Ah well,it is the same people who derailed school integration.


Why are they trying to destroy the only system which will provide affordable healthcare for full-time workers making <= $20,000 / year? Why are the trying to bring back the Health Care exclusion for people with pre-existing conditions?

How will the world be better if none of the people with diabetes or high blood pressure or MS or Lupus or Leukemia can get affordable care?


yrs,
rubato

http://www.washingtonpost.com/blogs/won ... obamacare/

At least 185,000 people have applied for Obamacare

By Sarah Kliff, Published: October 16 at 3:55 pmE-mail the writer

Information on health law enrollment has begun trickling out from state insurance marketplaces. Now we've started tabulating it in the table below:

With one application per family or houshold the actual number affected is much larger.


yrs,
rubato

Scooter wrote:Right, just like what happened in Massachusetts under Romneycare.

Oh, wait...

Oh how reality bites some of them in the ass. As a Massachusetts resident, I can testify that my health insurance premiums have stayed stable for about the last 3 years. I also know for a fact that costs for client municipalities --- who provide insurance for wide numbers of individuals -- have stayed fairly stable as well. Same in my own town. And yes, I've seen the actual budget numbers. Plus, as I've mentioned before, those budgets are required to be balanced -- no borrowing allowed (other than bonding for certain capital projects, and bond payments generally come out of the annual budget).

Meanwhile, the Massachusetts economy is percolating along, and we still have the best public schools in the nation, as well as the best-educated work force in the nation.

Stop the fear mongering. It won't be perfect at the inception, what program is -- but its far better than where we were.

liberty wrote: In Louisiana we have state owned hospital system that any citizen of Louisiana can use and pay according to their income. The poor pay nothing and everyone else pays on a sliding scale according to their income. Some people in Louisiana won’t use the system because they still consider it the charity hospital. When I had my operation done I used it because I wanted to support the system. My mother said to me why are you here this is the charity hospital; you have insurance. That is the problem with the state owned system, more people with insurance need to use it, rather than seeing as beneath them, if they don’t it will go defunct.

Most counties (maybe all, I don't know) in California have one hospital run by that county that anyone can use and pay according to their income. It takes people without health insurance and patients are given an application for Medi-Cal (aka Medicaid in all other states). If they don't qualify for Medi-Cal, they can work out a payment plan.

Not only that, but any hospital in the U.S. (with few exceptions) must by law (EMTALA) take in someone who has an emergency. If the person doesn't qualify for Medicaid, most hospitals will accept only what a person can afford since the alternative is getting nothing or selling the debt to a collection agency.

ACA changes the income rules for Medi-Cal and allows more people to qualify and those who don't will qualify for health care based on their income and family size.

There are good things about ACA. Obama and others have said from the beginning that changes can be made after we see what works and what doesn't work. I don't understand why most republicans aren't coming up with ideas to improve on ACA instead of attempting to destroy it.

Or maybe I do know why. It's because Obama wanted it...

Guin
Is Romney-Care a public option, or is it setup in partnership with insurance companies underwriting the policies?
Is it mandatory?

And it would be nice if the feds had the same "budget must be balanced" laws, but we know they do not and will borrow all they nee to fund whatever they want.

Come on oldr, the federal government has many legitimate reasons to incur debt for funding budget items. imagine what would have happened if we had to fight WW2 without undertaking the massive debt the government did--we'd all be speaking Japanese (or German) today. I agree funding recurring expenses by debt is ridiculous, but I would not want to see our government saddled with a requirement to pay all current budget items by current receipts.

oldr_n_wsr wrote:Guin
Is Romney-Care a public option, or is it setup in partnership with insurance companies underwriting the policies?
Is it mandatory?

And it would be nice if the feds had the same "budget must be balanced" laws, but we know they do not and will borrow all they nee to fund whatever they want.

In short Romneycare is Obamacare something republicans heralded as a great success until a democrat got behind it.

Joe Guy wrote:
There are good things about ACA. Obama and others have said from the beginning that changes can be made after we see what works and what doesn't work. I don't understand why most republicans aren't coming up with ideas to improve on ACA instead of attempting to destroy it.

Or maybe I do know why. It's because Obama wanted it...

Or the other view is that there are so many problems that go to the very heart of the ACA, not the least of which is its unwieldy complexity and regulatory burden. This is the main reason the roll out has been a disaster in most places. Add all the dysfunction and disincentives caused by the law, as well as the complete lack of effort to control health care increases (in fact the law as designed would clearly increase health costs substantially, as is being borne out by the high cost of the new plans), and it is reasonable to say the law should be revoked in total. Then take the few good ideas that are in the law (e.g., coverage for adult children to age 26 on the parent's health plan), and rebuild a sensible law from there.