I was amazed that Obamacare ever passed at all, and (though I have no special knowledge) here, I suspect that most people won’t notice a change at all, aside from people who are helped a lot by it. Polls don’t mean much on issues like this: if 60% of people “disapprove of it” but are mostly oblivious to it, and 10% of people are helped enormously by it and are locked down as loyal Democrats for life as a result, that’s a political win.
That said, I do agree with many of the critiques of it. Two of my favorite younger writers — Elias Isquith and (conservative) Josh Barro — both write that Obamacare was weakened by the need to appease everyone. Isquith argues (correctly in my view) that it gave too much away to private insurers, Barro argues (also correctly in my view) that the “you can keep your plan” provisions will lead to market distortions. It’s quite possible that, in both cases, there was no way to get the bill passed without introducing these weaknesses.
WereBear
Quite possible? Um; no one weakens their dream bill for chuckles.
Art of compromise in action. If you can point to one piece of legislation that was constructed solely based on what made the most sense, I will wear a jelly roll on my head for you. All day.
aimai
I don’t understand the harping on the “you can keep your plan” provisions–but I admit I’m not reading the linked posts. Basically under the old system you never had the slightest control over your health care costs, your insurer, or your employer’s decisions about health insurance so you NEVER had the “right” to “keep” any plan. You didn’t have the right to your job, to your pension agreements, or to your health care. You certainly didn’t have the right to prevent your insurer from dragging their feet, refusing to cover something, raising your rates, or creating a high deductible plan and getting your employer to choose it.
Under the old system you had no rights whatsoever, whether you were employed by a big employer or self employed or unemployed. So I don’t get the hand wringing over that.
different-church-lady
Ain’t that how democracy goes.
Hill Dweller
The Republicans’ filibusters have made every piece of legislation worse during Obama’s presidency.
CarolDuhart2
I think that this plan was probably the best we can get. Considering that Clinton’s attempt went down in flames, I’m amazed that we got this through at all. Even more I’m amazed that it happened despite the tantrums of the Tea Party, up and including attempted intimidation of Congress people.
I’ll admit I’m biased now. Obamacare got me a free mammogram and pap smear, has helped keep my medical costs down, and last year, before my health insurance expired, when I hit the donut hole, my meds were without a copay.
aimai
I don’t get why Barros thinks that obamacare “distorts” the market while all other plans, somehow, don’t. There’s no such thing as an undistorted market–each of the plans he outlines which, you know, don’t exist and don’t solve the problems that Obamacare was designed to solve like THE UNINSURED, have their own “distorting” effect. First among the major distortions is employer based health care which, of course, distorts the labor market by tying workers to an employer who is defintionally hostile to the health interests of its employees and their families.
Baud
@Hill Dweller:
The plan would have been slightly stronger had Scott Brown not won. Because of him, the Democrats were stuck with the Senate bill and whatever changes they could get with reconciliation. Had Coakley won, the House and Senate bills would have gone through conference committee and Pelosi would have had a stronger hand.
MattF
Note current item on Krugman’s blog about winger dishonesty wrt Obamacare. Forbes columnist Avik Roy makes ridiculous and fraudulent comparisons, gets nailed by both Krug and Ezra Klein. Of course, this doesn’t matter– Forbes is the magazine that supplies talking points for people who don’t know what they are talking about. Still, know thy enemies, etc.
Ol Froth
One of my wingnut friends insists his homeowners insurance went up 33% because of “Obamacare.” I tried pointing out that while I’m sure his rates went up, it was because of Hurricane Sandy, and NOT the ACA. Tilting at windmills, it seems.
Steve in Sacto
I’m directly affected and early signs here in CA look good. Wife and I have sucky $3,500 deductible individual insurance and have been notified of cancellation effective 1/14, so we’re eligible for CA Exchange plans. If the announced rates hold, it looks like we’ll be paying about 20% less for a much better plan. We may be eligible for some subsidies, which will increase our savings.
Contracted provider networks in the Exchange plans are significantly smaller (at this time anyway), so that’s a concern, as I expect a lot of complaining about “not able to keep my doctor under Obamacare.” Hopefully more providers will be contracted by 1/14.
While all this looks good at first blush, we’re both over 50 and would much prefer the ability to buy into Medicare, which would be a win for everyone. Private insurers would lose some of their least healthy population, Medicare would gain a healthier population and an influx of funding. So fuck you very much Joe Lieberman…
Violet
I’ve noticed changes and not for the better for me. I’m lucky to have health insurance through an employer. Employer is large and the health insurance is very good. From my perspective, nothing has changed with the insurance company or policy that has been offered by the employer. However, changes are evident:
1. Flexible Spending Account maximum is now $2500/year. Used to be twice that. That’s a federally allowed maximum and is a change due to Obamacare. Seems like a way to screw the little guy since you can’t roll that money over year to year anyway–it’s use it or lose it, so it’s not exactly a massive tax shelter.
2. Premium costs have gone up. I know Obamacare will slow their rise, but they have increased significantly so far.
3. When I call the health insurance company, they now ask me if this is the first time I’ve called on this issue. If I say yes, I get put through to the next step. If I say no, they ask me how many times I’ve called. I understand they need to show how much money they spend on patient care and admin costs are not patient care, so I get the impression they’re trying to get a handle on how much time is wasted on calls. This is new this year. (Also, not a negative thing, but just a curiosity.)
4. Costs to me have gone up considerably. Example 1: My Endocrinologist used to cost me about $20 to visit. They now cost me $45. Same doctor, same visit. My costs are now more than double. That’s a change from 2012. Example 2: The ultrasound of my thyroid that my Endocrinologist requested I get cost me zero out of pocket in 2011. Same doctor, same in-network facility, same procedure this year cost me $104 out of pocket. These are specific examples, but I’ve noticed these increases with in-network and out-of-network doctors I’ve seen this year. These are not isolated incidences.
I’m very, very glad Obamacare passed and more people are going to have access to doctors and health insurance. I know I’m extremely lucky to have the insurance I do have. No complaints from me. These are just changes I’ve noticed. I can imagine that others are noticing similar changes and it could make the lucky folks who have health insurance less happy about Obamacare, if they determine or are told the changes are due to that.
WereBear
I went from $250 deductible, paying 80% after that, to a larger deductible (which my company helps with) and 100% after that.
This is HUGE. Ever paid 20% of even a simple procedure at the current inflated rates? I have.
Mnemosyne
@Violet:
If your endocrinologist went up from $20 to $45 per visit, it sounds like your insurance changed the copay — you should probably check the fine print on your current policy. The ultrasound also sounds like it may have been a coverage change by your insurance company.
Violet
@Violet:
Let me be clear that the employer offers tiered options for health insurance. My tier has remained the same. The policy has changed, but there is nothing the employees can do about that change. So by “nothing has changed” I meant that my tier option is the same as it has been for several years. The policy details change year to year, and never for the better (ie, more covered, lower premium, less out of pocket.) The only positive change I’ve seen is that the lifetime maximum has gone away. That’s a fantastic change and one due to Obamacare, but unless someone is close to hitting the previous maximum, it’s somewhat invisible to them. No complaints though. It’s an excellent change. I was speaking more from a day to day, visiting your doctors perspective.
WereBear
@Ol Froth: I know someone who blames everything on Obama; even when it was Bush.
Very typical. Facts mean nothing. They just know.
Bob, for example...
@aimai: Excellent point. Few had health insurance security that extended past the pleasure of their employer. Most were only one pink slip away from being one of the “10%”.
For those most disappointed in Obamacare, focus on the fact that the big issue is now behind us. The only way Americans will be without health care insurance is if they decide they want to go it on their own. (And I’ll bet those folks are largely extinct in a generation.)
From here on the issue will be how to make that insurance as affordable as possible. That will certainly involve reducing the cost of health care. And it might mean moving to single payer if the present approach fails.
The discussion will not be about kicking the sick out of the system or taking coverage away from those least able to pay something.
Violet
@Mnemosyne: As I said in my update, what I was trying to say is that I’m at the same tier of insurance plan offered by the company. The policies change year to year and there’s nothing the employee can do about that. It’s the same helpless feeling of just waiting for the health insurance info so show up during open enrollment so you can see how much more you pay this year.
Yes, the co-pays have changed and the out of pocket has changed, etc. That sort of thing happens every year and there is nothing an employee can do about it. These are changes from 2012 to 2013. They are not beneficial to me. Not that I’m complaining. Just noting how it looks from my perspective.
Bob, for example...
@Violet:
Take a look at the provisions in Obamacare. There’s a lot in it dealing with the quality and cost of health care. Lots aimed at keeping us all healthier and reducing costs.
Fred Fnord
Wow. I think that’s ridiculously optimistic.
Every rate increase that every single person in the country sees in the next ten years is going to be blamed on it loudly, by every piece of media that exists in this country. That is what people are going to think, when they think of Obamacare.
WereBear
One of the most exciting things about Obamacare is how it will shift care more towards what actually works.
Oh, what? You thought that is what modern medicine does? Don’t we all wish.
Getting pharma and insurance companies out of deciding what care we get? Priceless.
James E. Powell
@MattF:
Forbes is the magazine that supplies talking points for people who don’t know what they are talking about.
On the contrary, Forbes supplies talking points for people who know exactly what they are talking about and exactly what they are doing. It is propaganda: they are not being persuaded, they are being told what to say.
Mnemosyne
@Violet:
Okay, but it sounded like you were attributing those copay changes to the insurance changes that were mandated by Obamacare, but I’m pretty sure those changes were made by your employer and the insurance company and don’t have anything to do with the new regulations from Obamacare.
IIRC, my insurance hasn’t changed at all as far as my copays, etc., but my paycheck deduction for insurance has gone up by about $10 per week. Also, I’m guessing that we can no longer put the $300 we can get for having a “healthy lifestyle” (getting a physical, low blood pressure, and in-range BMI) straight into our FSA accounts because of Obamacare rules, which is very irritating.
Mnemosyne
@Violet:
Also, looking at my coverage online, the copay to see a specialist may have gone up to $50, but I haven’t had to see a specialist in a while, so I’m not sure if that’s how it’s always been or if it’s a post-Obamacare change.
aimai
@Violet: What makes you think “Obamacare” affected the cost to you of your endocrinologist visit?
We have health care through my DH’s california employer. Because it makes financial sense for the employer we have a really high deductible plan and the employer kicks in a fairly large amount of money into a health savings account that we end up using to pay for the things that fall under the deductible. That’s nice, and all, but even so it turns out the plan they signed us up for (and of course we had no choice in plan coverage at all) pays for various things every other year. So, yeah, last year our once-a-year checkup was covered entirely, this year its not covered at all. Nothing to do with Obamacare. Same visit, same doctor, same time of year–the plan has all these hidden minefields in it.
jeffreyw
The flaws are intentional. It was passed only because of them, in much the same way the Emperor inflicted a mortal wound on the Russel Crowe character before he would face him in the arena. The invisible hand at work in modern America.
aimai
@Violet: One of the biggest changes due to Obamacare isn’t going to be visible to you at all–its the rule on how much the insurance company has to pay of your premium dollars to actually giving care. You are still going to be charged money to be insured, but the money you are paying actually has to go to proviiding more health care to the people who are being insured. Totally invisible to you? Sure, but very, very, important.
Another thing that we are all getting that, again, won’t be evident, is the lifetime caps and the increased focus on wellness. Yes, you aren’t going to notice it for a while or until you discover that its important to you or someone you know. But that’s a fact of the nature of health insurance generally–that when you need it most is when you find out what, in fact, you’ve got. And if you are lucky you never need the provisions that were most fought over.
Ted & Hellen
Obamacare is the weakest, most milquetoast version of faux healthcare insurance change that could also insure more money for corporate insurance companies; a natural fit for Obama.
Mnemosyne
@aimai:
I think Violet is saying more that she hasn’t seen any direct benefit from Obamacare yet, not that it increased her copays. I was a little confused at first, too.
I have gotten to see a direct benefit already — when I pick up my BCP at the pharmacy, my copay is $0. Thanks, Obamacare!
Mnemosyne
Aargh! Can someone please release me from moderation for the crime of using the name of the type of store where I pick up my birth control?!
PeakVT
…. Obamacare was weakened by the need to appease everyone.
It was weakened by needing to appease the 52nd-60th most conservative Democrats.
Roger Moore
@Violet:
Ah, so nothing changed in the sense that insurance costs have continued to go up faster than inflation, so your coverage has continued to erode a little bit every year. This is an important point in understanding why some people hate and will continue to hate Obamacare. Insurance sucks, and as long as costs keep spiraling out of control, it will suck a little bit more all the time. Somebody who hates Obamacare can unfairly blame that constant decline in coverage on Obamacare, rather than acknowledging that this is part of a long-term trend that Obamacare was designed, but has not yet had a chance, to solve.
Ted & Hellen
@Mnemosyne:
My god, what sort of cretinous, disfigured monster do you pay to have some vile form of sexual congress with you?
Pity the poor soul…
Higgs Boson's Mate
Am I the only one who believes that it’s time for a certain commenter to go?
Luna Sea
Anybody here work for or know people who work for really small companies (under 50-100 employees)? I’m curious if companies are changing work hours to keep under the threshold where insurance is required, and/or limiting their number of full-time employees in order to avoid providing coverage. I worry that people having their hours cut back will make them blame Obamacare rather than their employers.
Also, I’m not sure where small employers are getting their info or advice — if they’re being told by a lot of wingnut financial planners how to either play the system or make it fail. My employer is basically telling everyone it’s Obama’s fault the company can’t grow because of the onerous costs, regulations, etc. I’m not an expert on the healthcare act, but neither are the people advising her.
As for me, I’m hoping I can quit the place and contract with them instead, get my own insurance through the exchanges, assuming my state doesn’t screw that up.
SatanicPanic
I only like my plan because my employer pays for most of it. On the private market I wouldn’t like my plan because I would never have the option to buy one, having a pre-existing condition and all.
Ruckus
@Violet:
Last job I had that had health insurance(left in 2005) had up until 2004, very good insurance. Coverage – best I’ve ever heard of, copay – zero, deductible – $200/yr. December of 2003 we had a company meeting and they told us that the insurance co would no longer write this policy even though our co said they would pay any price. We went to less coverage, copay – $20/visit, $1000 deductible and increased rates on the order of 20%, which was our out of pocket increase. This was all the insurance company, ACA was not even a glint in Obama’s eye then.
IOW I’m not sure I’d blame ACA for all of that. And yes there probably are people who will not have the same level of insurance after 1/14, you and I have already seen that.
Baud
@Luna Sea:
It’s a perennial grift in a lot of industries — to blame their decisions on the government. Every once in a while it’s accurate or partially accurate, but the average person isn’t going to try to sort it out.
Roger Moore
@Roger Moore:
Hmm. That didn’t come out quite right. In case it’s not clear, I don’t think Violet is an anti-Obamacare dead-ender. I’m just saying that somebody who is a dead-ender could take the pattern of facts she’s describing (i.e. insurance sucks worse every year) and claim that it’s Obamacare’s fault rather than recognizing it as the continuation of a long-term trend.
Ted & Hellen
@Higgs Boson’s Mate:
Am I the only one who believes that it’s time for a certain commenter to go?
I agree. Phlegmnospleen should stop coming here.
gene108
@Violet:
Is you plan fully-insured or self-insured?
There are going to be more compliance requirements/costs for fully insured group plans under Obamacare.
EDIT: Depending on state law, things which an employer sponsored plan may have been not required to cover (varies from state to state) they will now have to cover, such as infertility treatments, so these added costs get priced into the plan. Also, the reason FSA limits are reduced and you can no longer by OTC meds with an HSA account is to increase the tax base available for paying for Obamacare, with the least direct impact on people.
Fully-insured plans the employer pays a premium and the insurance deals with all costs.
Self-insured plans the employer pays for claims up-to some predetermined level, after which the insurance covers claims. The upside for the employer is in a year with few claims, they get to keep the money not spent for paying claims. The downside, depending on how the plan is structured, is if claims are high the employer potentially ends up paying more than a fully insured plan.
Ruckus
@Higgs Boson’s Mate:
No. Your Honor I second the motion.
? Martin
Understand that most of what Obamacare has done so far is expand access, rather than contain costs. The big cost containment is yet to happen. This was something of a political miscalculation by the left. Liberals demanded expansion over cost containment and the right were happy to trade that for delayed implementation of the containment provisions. The benefits of expansion would fall on Obama’s supporters so nothing would be gained, but flat or rising costs for several years would buy the GOP a window to try and repeal it with skeptics and detractors.
The big cost containment moves are the mandate (and the regulation that surrounds it) and IPAB and similar measures. The mandate hits next year and the IPAB benefits in 2015. It’s going to take 5 years yet before we see savings across the board.
MomSense
Ok–I just had to click on the ‘top secret’ link. I only managed 30 seconds of viewing but Obama is taking our guns so that we can’t resist tyranny. The tyranny is that in the next natural disaster FEMA could take your food stockpiles and give them to other people.
Yes, you heard that right. Obama wants to come to your house and take your 10 year supply of shitty canned food.
I hope Tunch gets a nice can of tuna every time I click on one of those links.
Violet
@Bob for example,
I know that Obamacare has done good things. If you read my comment, you’ll see that I am very glad it passed. My point is, I’ve seen changes and they are not beneficial changes for me. I’m quite certain things have changed, but I don’t see them. I’m very sure I’m not alone in that. So when DougJ at the top said
I’m disagreeing with that. How and why the changes happened are not always clear to people. It’s very easy to blame Obamacare. I’m not necessarily doing that–some things are as a result of it, some are not. But the changes I’ve seen are not positive ones.
rikyrah
as someone who has a chronic disease that runs in the family….I’m thankful for Obamacare. I don’t have it yet, but in case it comes to me, I don’t have to worry about pre-existing conditions
Violet
@Mnemosyne:
For the average person, it’s hard to parse out. Why did the policy change? Were these Obamacare mandates or something else? What did the insurance company change (increase prices, etc.) to get in before the 2014 deadline? I can’t find that out because I can’t see the policy–that’s owned by the employer and short of hiring a lawyer (and then probably losing the job) the employee can’t have access to the fine print. So all I, and others see, is the increases. We aren’t sure why. The employer did tell us some of the changes were mandated because of Obamacare (they used the correct name for the law, though).
Baud
@MomSense:
Obama will have to pry my Spam from my cold dead hands.
Baud
@MomSense:
Obama will have to pry my Spam from my cold dead hands.
belieber
“The only thing that matters is what Greenwald thinks about it.”
Wrong way bipolar man…Cole
evap
I have reasonable health care through my employer and since my employer (a university) runs a major healthcare operation (hospitals, clinics, cancer center, etc.) I have access to very good health care should I need it. The main changes I have noticed for me are that my mammograms and anti-cholesterol drugs are now free. The co-pays and cost of insurance have gone up a bit, but that probably would have happened anyway.
On the other hand, my daughter graduated from college last May and didn’t find a job until October. Until then, she stayed on my insurance. Back when the supremes were looking at the health care bill, I asked someone high up at my workplace if they would allow my daughter to stay on my insurance if Obamacare was thrown out. His response: “We aren’t going to do anything we don’t have to do.” Thank you, President Obama, for making it possible for my daughter to have insurance while unemployed.
FlipYrWhig
@Higgs Boson’s Mate: I figure eventually the already evident rampant and irreversible putrefaction of soul and mind afflicting a certain commenter will run its course, kill off its host, and thereby solve the problem.
The prophet Nostradumbass
Without Obamacare, I wouldn’t have coverage of any kind, nobody would insure me.
Firebert
If only Kucinich would’ve won, so he could have his space alien buddies give us their wondrous and magical healthcare technology.
gene108
@PeakVT:
It was weakened because Ted Kennedy had fucking brain cancer and what work he would’ve done on it got shuffled to Max Baucus, who wasn’t ready for it, which is why he didn’t get a bill out of his committee before the August 2009 recess.
The House had a plan put together. Dodd had a plan out of committee. The Democrats were ready, set, go to take a victory lap during the August 2009 recess, where they could focus on healthcare reform as being a big legislative accomplishment and how Americans would no longer be a pink slip away from not having insurance.
And then, there was nothing…but angry people shouting at them about keeping the government out of their Medicare…
Violet
@aimai:
Re-read what I wrote. I did not say that. I’m saying that I’ve noticed changed in 2013 and I do not know why they have changed. There was a lot of wording in the open enrollment info at the end of 2012 explaining that many changes were due to the PPACA. Exactly what has changed due to it, I can’t remember offhand and would have to go back and look at the info to be sure.
However, I’ve noticed that things have changed. Costs to me have gone up. I do know (playing average person here) that Obamacare is going into effect. Employer tells me some changes are due to PPACA’s regulations. Therefore, it’s not a huge leap to blame Obamacare for the increases to the out of pocket. It’s definitely correct to blame Obamacare for the lowering of the FSA maximum amount–that’s due to the PPACA.
When DougJ says people won’t notice, I’m saying people will and have noticed. They have noticed changes. They may not be sure exactly who to blame for the changes, but they’ve noticed changes. Obamacare is certainly convenient to blame and in some cases it’s correctly responsible for some less than good changes (FSA for example).
Ruckus
@? Martin:
And yet we have seen posts on this here blog about costs that have already dropped due to ACA. Here in CA the exchange pricing seems to be a lot lower, at least to me. And I’ve been in the individual market as my post up thread indicates, until I qualified for the VA just last year.
Another little aside, I used to own a small business(6-10 employees) that purchased HC ins for all it’s employees. HC ins was the number one problem as a business owner. Every year I had to have discussions about what policy to purchase and what they covered, in detail. I just didn’t have the time to do the work required to make intelligent decisions because I would be doing nothing else. So I took what sounded good and was priced reasonable. It was a shitty way to do an important part of my job but my time was more valuable elsewhere. I don’t know that anyone ever suffered due to this but that was the point of the insurance cos, sell the least policy for the most profit.
the Conster
@MomSense:
Not that any bit of fact would get in the way of believing that Obama does nothing but sit around all day waiting for any and every opportunity to take away some fat toothless cracker’s guns and cheez whiz, but is there anything they cite to to buttress that claim? Oh never mind, I crack myself up sometimes.
jl
@aimai:
” Barros thinks that obamacare “distorts” the market ”
The market design or health insurance is flawed in the U.S., and it is just churning chaos.
The story of the commenter in the thread who’s company would pay a much higher price but could not even get an offer shows that.
Before anyone talks about a competitive market being distorted there has to be a competitive market, and for there to be a competitive market, there has to be a stable equilibrium. There is very good reason to believe that there is no stable equilibrium in the current health insurance market. Why, because a lot of reasons:
long run production processes and short run (in fact, an annual schedule for lots of companies and organizations) contracting,
asymmetric information about health states of people who demand care,
asymmetric information about relative costs and benefits of given bundle of care delivered at a certain time between insurer, medical provider and insured,
ability of insurers to cherry pick, cream skim, whatever you want to call it.
Barro is talking nonsense.
Higgs Boson's Mate
@FlipYrWhig:
Good points. I am just frustrated because Cleek’s trusty Pie Filter hasn’t worked since the site upgrade.
Baud
@Higgs Boson’s Mate:
I don’t use the pie filter but I think there is a new version.
Violet
@aimai:
Please read what I’ve written because I’ve addressed both these issues:
This has been visible to me, I believe, in the company asking me how many times I’ve had to call them about an issue. They’re trying to make sure they’re streamlining their services because of this new requirement. Them asking this question is new in 2013. I mentioned this above.
I mentioned this in a follow up comment. I’m aware of this change and, as I said, think is a fantastic change. As I said, the lifetime cap change is not something the average person is aware of until or unless they bump up against it. It’s not something most people will see. It is a great change and will benefit everyone who needs it for sure.
The focus on wellness is evident as well with the bribing by the employer/insurance company to get you to have your annual physical and fill out some online questionnaire about your health so you save money on your monthly premium. This got much more stringent during open enrollment 2012. It’s an evident change to me and to others. (And a right pain in the ass if you have to do all the work to make sure they get your paperwork. Spent the better part of a week chasing it from my doctor to the insurer, etc.)
jl
Hate to repeat myself, since I think I’ve made this comment three or four times. What is happened in the U.S. health insurance market is similar to what happened in a number of poorly regulated insurance markets in the past, except in very slow motion.
The most dramatic example was life insurance in the U.S. from late 18th through mid 19th century. Insurers went bankrupt when they tried to cherry pick, they could not control the decisions of their policy holders to cash out policies when financial conditions made it advantages for them to pull out of the risk pool. Life insurance had a bad reputation as a shady kind of scheme.
But, in mid 19th century, a sensible set of regulations were established the allowed some kind of market equilibrium to exist. I don’t see how health insurance is much different.
Property and disaster insurance has similar problems that have not been solved, But you have big federal programs that can step into the breach, and property unlike one’s life is replaceable, so there is a difference.
Ruckus
@Higgs Boson’s Mate:
I’m on firefox and had to go to tools, add ons and delete the old one first. Then install the new one. Of course I now have to re-pie people I had in the filter but it does work.
Violet
@Roger Moore:
Yes, I believe you are correct. It’s easy to “blame Obamacare” for things that were happening anyway. It’s also very, very hard for the average person to see how Obamacare is benefiting them in this regard. How can they tell that Obamacare prevents costs from going up as fast? It’s not evident in how the average person interacts with the health care system. The average person with insurance has copays and percentages and deductibles. How do people know or find out that Obamacare made that better and not worse, especially if their own personal out of pocket expenses are higher this year?
Higgs Boson's Mate
@Ruckus:
Thanks. I was using Chrome so I’ll try the setup with FF.
the Conster
On Maher last night, I actually liked the comment by the woman from CAP, who just shook her head at the absurd claim by that toolbag Poulos that offering consumers choice and price transparency through competition of private insurers in the exchanges is “nightmarish” and Stalinist (?!), and she said that if conservatives were smart (!!) they should embrace Obamacare and say that they won. She’s right, but the resistance to what was a conservative initiative not that long ago because of ODS means we’ll eventually end up with a public option. I don’t think Poulos was bright enough to see how conservatives are kicking themselves in their own junk.
Redshift
My only complaint is that it’s characterized as “you can keep your current insurance” when it’s actually “your employer decides if you keep your current insurance.” I understand why it was done that way, but there are any number of crappy insurers I’ve had chosen for me over the years, and I’d much prefer to be able to at least see if I can get a better deal on the exchanges.
Of course, unless I get a new job before then, I may get to be one of the early-adopter guinea pigs in October. Does anyone know if anything’s changing with COBRA? Since I haven’t heard anything, I’m assuming it will still exist, but since its main purpose was to allow you to continue to be part of a group, it seems like it will be much less necessary. It’ll be interesting to see how the rates compare between COBRA and the exchange.
Brother Machine Gun of Desirable Mindfulness (fka AWS)
@Higgs Boson’s Mate: I have installed the new Chrome filter. It works, but you have to re-add people. I’m glad when they show their ass, because then I can put them in.
? Martin
@Ruckus: Yeah, up until now it’s been a very mixed bag. The prophet Nostradumbass is clearly coming out ahead. Cadillac plan holders will come out worse – I’m in CA with such a plan and a worse off, but its still an excellent plan, and the costs are still quite modest. And CA has done a lot more with the rope provided by Obamacare than most states (due in no small part to shoving all of the Republicans out of office and giving Dems 2/3). But if you’re in Texas, it’s a lot less likely that you’re better off at this stage. That’s just a function of who is running your state, really.
It’s interesting to see how this second round is playing out. AB 880 is advancing which would require large employers Walmart in CA who dump their employees onto Medicaid to pay for it. So the piece that other states used to resist Medicaid expansion is something that CA is doubling down on, and which will erase a weak point in Obamacare within the state. And depending on how employers react to it, it could provide an additional incentive for the state to go single payer.
And CA did quite a good job on the exchange. The plans look pretty balanced and are priced reasonably. There’s enough there for the non-profits to make it work, and not enough to keep the for-profits participating. That’s a good sign.
Davis X. Machina
@aimai: I don’t understand the harping on the “you can keep your plan” provisions
Polling going back to the 1993-94 fiasco showed that if people thought they weren’t going to keep their plans, reform, any reform died on the spot.
An irrational fear of change kills a bill just as dead as a rational one.
Ruckus
@Higgs Boson’s Mate:
Don’t remember if Chrome has a similar add on tool but you might try that if possible if you like Chrome better.
Violet
@Roger Moore:
That’s exactly how I took it. As I said above, I’m a huge fan of Obamacare. It’s not perfect, but it’s the best we could have got at the time in the circumstances and I’m thrilled we have it. Now we need to improve it. I lobbied my representatives and even other representatives near me to get it passed. I’m so happy it’s here. I just see that things have changed for me and I see it’s very easy to blame Obamacare and very hard to find out the truth because many of the changes are not so easy to uncover–like slowing of cost increases.
The Other Chuck
@Higgs Boson’s Mate: Time for my weekly or so plug: Balloon Juice Troll-B-Gone. Looks best with Better Balloon Juice.
It works with Greasemonkey on FF and with Tampermonkey on Chrome (I use it regularly on both). No idea about other browsers userscript support, but it’s pretty generic JS so I don’t see any reason it shouldn’t.
(Just noticed there’s a harmless bug that duplicates the block links immediately after blocking someone, so there’ll probably be an update that fixes that sometime next week)
ruemara
hmph. Early last year, I was the perfect customer for an insurer; healthy, well managed, mild chronic condition. Late last year, I became Queen of the Emergency Room and Empress of Nosebleedistan. Without just the basic provisions that went into effect, the onerous cost of my regular medication would have become the crippling costs of my new spectrum of medication. Pills that were $10 with copay went down to $3. I am truly grateful for even these minor improvements. I am all the more grateful that people with serious medica conditions will be able to have some healthcoverage. It’s an awful world without medical care and the costs for out of pocket medical. And I should know, I’m still stuck under over $2k worth of bills and I had insurance. No. Nobody deserves this nonsense.
gene108
@? Martin:
Yet to everyone’s surprise, both with my anecdotal experience with my small-medium sized employer and based on actual numbers and facts and stuff the cost curve is getting bent, taking a last couple of shots, before lying down as close to flat as possible.
The real issue is will Obamacare get any credit or will “liberal” contrarians in the media refuse to give Obamacare explicit credit, while right-wing rags turn out pieces about how Obamacare is going to bankrupt the universe?
Something is happening. It’d be interesting to see how much can be traced back to Obamacare.
trollhattan
@Steve in Sacto:
Have hope. Bog only knows how much costs would have risen by now had there been no bill–the state has already enforced the provision on minimum percentage of revenues to be spent on healthcare.
Republicans would like us to return to the Eden of annual double-digit premium and co-pay increases. Those were good times.
Ruckus
@the Conster:
I don’t think Poulos was bright enough to see how conservatives are kicking themselves in their own junk.
Conservatives aren’t bright enough to see they are doing this with every issue. Of course they will inflict a lot of pain on others in the meantime but it is likely if we survive the self destruction we will be a better nation.
Redshift
@Violet:
I agree, but I think the result of that will be that people who don’t like Obama will blame Obamacare for what’s happening, and the people who like him or are indifferent will not be strongly persuaded. The important thing is that it isn’t going to produce the groundswell of outrage that Republicans are hoping for. (We’ll still have to deal with our usual problems with midterms, but not any kind of wave.)
Higgs Boson's Mate
Thanks, gang. I’d tried Cleek’s script and I think that Google made changes to Chrome that break how Tamper Monkey works. I just lit up FF, installed the necessaries and it’s hearty helping of pie for for someone.
Brother Machine Gun of Desirable Mindfulness (fka AWS)
To add to the discussion, I have a state-employee plan that saw a double-digit percentage health care increase this year which ate away the paltry raise we had wrangled in our last contract negotiations. Couple that with an attack on pensions where they want an additional 2 percent from employees who have paid the entire time the state has been fucking us over, and I’ll end up making less than I was before.
Fuck you, conservatards.
Violet
@ruemara:
My Endocrinologist requires I take a brand name thyroid medication. My out of pocket costs for it have increased significantly this year. Someone the other day who has Kaiser in CA said Kaiser wouldn’t cover any non-generic medications. So for them I’m guessing the costs would be even higher.
Tonal (visible) Crow
@Ol Froth:
His argument is classic bullshit propaganda: throw out whatever seems to work politically, whether it’s true, false, unknown, or unknowable. Republicans long ago substituted bullshit for every other form of argument, consequences to the culture be damned. It’s now gotten so bad that many people seemingly can’t understand or won’t accept any valid form of argument. They choose their conclusion, then stick to it no matter what.
This is one reason I read more science than politics these days: (most) scientists respect the valid forms of argument, and are willing to change their minds if shown enough contrary data.
? Martin
@gene108:
Something big is happening. And most of it is due to Obamacare, but the benefits aren’t going to be felt by us for a little while. The biggest benefit is to Medicare and Medicaid (by design). For example, Obamacare cut payments to hospitals with poor outcomes because poor outcomes used to previously make them more money. So, we directly lowered that cost (cut payments), and then indirectly lowered it more by improving outcomes and not having to pay a 2nd time or for more costly follow-up care. You and I don’t see that benefit though. Medicare/Medicaid does. Insurers will by extension (because they were also paying the indirect costs) and that will trickle down eventually, but mostly that will go to pay for the expansion of coverage for a while.
And as I noted above it’s enabling the states to help out as well. It provides a new framework for them to build on, and while not all states are doing that, enough are.
aimai
@Violet:
Yeah, employers have always lied to employees. I heard my college professor sister-in-law tell me, very seriously, that her college increased the costs to everyone of health care by explaining to them that they were “so educated” that they “used more health care” than they “should” or normal people “would” so rates had to go up.
Rates have been going up for years, without any explanation at all. Why would all rates going up in the future be attributable to Obamacare? I mean, I get that some people are going to be told a lot of shit, and some people (like the guy upthread who told a commenter that his house insurance went up because of Obamacare) but why opt into it by throwing every rate increase or co-pay increase that you have seen into the mix?
Again: you have never had any right to anything under your employer’s health care plan–Obamacare has increased your right to access some kind of plan under all circumstances, even unemployment or even when (or especially when) your employer drops health care coverage entirely. But its not a miracle worker. It couldn’t make employers care enough to cut into their own profits in order to ensure the health care of their workers. Given high enough unemployment there is no worker currently employed who matters enough to any employer that they want to keep paying for health care costs. They are going to nickle and dime you to death but that has nothing to do with Obamacare.
Ruckus
@Brother Machine Gun of Desirable Mindfulness (fka AWS):
Fuck you, conservatards.
A well and good mantra if there ever was one.
Violet
@Redshift:
I’m a huge, huge fan of Obamacare. I called and lobbied and even visited offices in person to persuade them to vote for it. However, I was disappointed when the FSA stuff came out, that the annual maximum was cut so much. I get that it’s part of getting tax money to pay for it, but it’s a small thing that not that many people used (average amount was $1,400/year that people put into it before the lowering of the max), and so the people it really hurts are people with chronic conditions who depended on that tax break to help pay for their higher medical costs. They could easily have left the maximum at $5,000 and seriously, not that many people would have gone that high on it because the data showed the average contribution was only $1,400. I can’t believe the tax savings from it were so high that it was worth the bad PR. Lots of people were ticked off about it when they discovered that provision.
? Martin
@Violet:
That’s slightly incorrect. Kaiser will cover non-generics, but the policy costs more. Many employers switched from the ‘cover anything’ plan to the ‘cover generics’ plan.
Understand that insurers will insure anything that the state allows them. They’d be more than happy to write a policy that would cover weekly hand jobs if they could. If there are things that the ‘insurer won’t cover’ that’s a function either of the state laws preventing it, or your employer specifying it as part of your plan, or you choosing a plan that doesn’t cover it. There’s some rounding of the corners as the insurers package things that sell, so small businesses don’t have infinite flexility on the plans they can buy into – they have to pick off of the menu, but large employers can get a custom plan with no problem.
I have close family members whose job it is to negotiate those plans. At dinner once a friend of ours commented that it was wrong for the insurer to cover penîs pills but not birth control. “I negotiated that plan, and we offered up the cost to cover certain forms of birth control in the initial talks and the company rejected that immediately, but the company board of directors insisted on the penîs pills being covered. I tried to talk them out of it several times as they were asking for cuts in other areas, but they wouldn’t budge on it.”
Turns out birth control coverage isn’t that important in the benefits plan when recruiting talent but penîs pills are.
Violet
@aimai:
That’s just ridiculous. Employers are liars for sure. I learned a long time ago that the HR department is there to defend the interests of the company. They are not there to help the employees. Not one bit.
I am going to play average, mildly-informed person here. The answer is, because Obamacare is now the law. It was supposed to control costs. If rates are going up and costs to me are going up, then it must be the fault of Obamacare.
Ruckus
@Violet:
Sometimes the outcome of having to compromise with shitty people is shitty outcomes. From your own posting it doesn’t seem like this affects too many people. So it sucks for you but as you point out it can make things better for most without hurting too many. Which as you well know and fought hard for was the whole point. Make it better for almost all, even though some will suffer not a lot. It sucks to be one of the ones who suffer but I always think of it as AWS said up thread – Fuck you, conservatards. Blame them for this, not Obama.
ETA per your post at 87, You are not one of the average misinformed people. I get your point that these are the people who will blame Obama for this but you are better than this.
Violet
@? Martin:
Okay, sure. But the plan the person has is Kaiser. To them, Kaiser won’t cover any non-generics. If it’s an employer plan, then the employee is helpless to change it–the employer picks the plan as always. And that’s the plan you get. That person’s reality is, they have Kaiser and Kaiser won’t cover generics. And honestly, there’s not much they can do about it if it’s an employer plan. They can’t exactly call up Kaiser and say, “Hey, I need to add non-generic medication coverage to my plan. I’ll pay an extra $20/month.” That’s not an option for an employer plan.
Tonal (visible) Crow
@Davis X. Machina:
Change that to
and I’ll agree. A rational fear can sometimes be argued, an irrational one is the domain of the gut and thus often impervious to argument.
aimai
@Violet: This strikes me as rather a solipsistic reading of this provision. Could it be that not as many people as you think are affected by it? Could it be that most people, even with chronic health conditions, aren’t even eligible for FSAs? Or that FSA’s are a total boondoggle that were really being used to cover up basically inadequate plans? I’d really like to see the numbers on this. It is also the case that a whole lot of people think that making something tax deductible is a really great idea when, in fact, it is meaningful only to a very small number of people who make enough to have care about lowering their tax burden. Basically, when you are talking about creating a carve out for (some) people: people with chronic conditions + people who are employed + people who make enough money to worry about lowering their taxes + people who are paying for medical care using FSAs you are starting to talk about a vanishingly small number of people or people who are finding coverage through other parts of the system.
? Martin
@Violet:
And that’s not an unfair answer. The problem with this sort of thing is that Obamacare is specifically designed to make things worse for some people. It just is. Much of the problem with the US healthcare system isn’t that we put too much money into it, it’s that we dump huge money in for the benefit of a few, and then fuck over most of the rest. It’s an unequal system. Obamacare sets to equal it out to a large degree, and that means that people with great plans are going to get screwed. But they’re also the people that have the means to pay for what they lose. And some people won’t see that they gain in other areas. Unions have been trading wages for benefits for decades. The only way to get the wages back is to get the benefits balanced a bit the other way. I don’t think they’ll come out better (probably not worse) on the benefits, but they may well come out better on wages. I lot of those workers won’t credit the wage improvement to Obamacare though.
Stella B.
@Redshift: We’re newly retired on COBRA. It looks like we will be saving $200/month after the first of the year, but with a bigger deductible.
Violet
@Ruckus: I don’t blame Obama at all. I am not upset about the law nor how it is affecting me. Although I do wish the FSA contribution max was still higher like it was. As I’ve said, I’m thrilled we got Obamacare and know it was the best we could do at the time. Now we have to improve it. I know so many needy people will be helped and I know that I could easily be one of those people needing coverage and I’m so lucky not to be in those shoes. I am so happy that it’ll be in place should I need it and for those who will need it.
I really just wanted to address what I thought was DougJ’s rather throwaway observation that “most people won’t notice a change at all.” I disagree with that. I’ve outlined changes I’ve noticed (not all for the better) and I’ve imagined how those changes might be perceived by either low-info people or kind of middle of the road voters–thought Obamacare was a good idea, “but why are costs still going up? I thought it was supposed to control costs.”
I’m happy to pay my share and so happy that Obama got this done. And yeah, fuck you, conservatards. A mantra to live by.
SiubhanDuinne
This is O/T, but Jean Stapleton has died at age 90.
RIP Edith, you dingbat.
Violet
@Ruckus: Not sure what you meant by that. I think you are misreading what I wrote.
James E. Powell
@The Other Chuck:
Not sure what was supposed to happen when I downloaded from your link, but other than watching the icons jump up and down on the desktop, nothing happened.
Redshift
@Violet:
This is another one that Republicans have been setting up for a long time — it was supposed to keep costs from going up, right? So unless rates stay the same or go down, it’s a failure!
Never mind that no such thing was promised, and arguably the sales job was made harder because of the strenuous effort to keep to the honest “it will keep price increases lower,” which isn’t as appealing. It’s especially frustrating because for Republican policies (like their tax cuts), they just lie about what they’re going to do (like create jobs), and then when they don’t do that, they lie and claim they really did. But that’s the price we pay for actually caring about making things work.
geg6
@SiubhanDuinne:
Awwww, I loved her. Just loved her. Edith is one of the greatest characters to ever grace television.
AAAAAAAARRRRRRCHIE! (screamed in a screechy NY accent)
Meanwhile, we need an open thread. I’m working on a cooking frenzy for tonight and tomorrow. And I think John Cole would like what I’m making for dinner tomorrow.
James E. Powell
@Ruckus:
Conservatives aren’t bright enough to see they are doing this with every issue. Of course they will inflict a lot of pain on others in the meantime but it is likely if we survive the self destruction we will be a better nation.
Conservatives are bright enough to know that nothing close to majority of the country will support, or even tolerate, the consequences of their policies. They are bright enough to know that they have to disconnect policies from outcomes in the minds of the electorate. They are bright enough to know that confusing issues works for them, that fanning the flames of bigotry and fear is the only way they can win. And they do win, nearly every time.
Violet
@aimai:
Absolutely. I could easily be wrong. Anecdotally, it’s the thing that people have bitched about the most that I’ve heard. The plural of anecdote is not data, I know. People are used to costs going up, so it isn’t a surprise. The FSA max being lowered that much seemed to surprise, and anger, people.
Brother Machine Gun of Desirable Mindfulness (fka AWS)
I think Violet has repeatedly proven she’s not the enemy here. It sucks, but it is what it is (re: helping some while hurting others).
A Humble Lurker
@Ted & Hellen: Well we can’t all patrol the preschools.
Ruckus
@Violet:
@Violet:
I don’t think I’m mis-reading you unless everyone else is also. I hear you that you fought hard for the ACA. I hear that you are ecstatic that it passed, even in the form it is. But as many have been trying to tell you, you sound like you are complaining about it. As many have explained(most far better than I) these are the “costs” of a compromise bill. I’ll bet aimai is correct that very few are affected by the FSA compromise. You have to be in a small sub set of employed, insured, high enough paying to even hit the new FSA limit, as you yourself pointed out. And tax credits are always a crappy way to prioritize and make policy. They are like coupons or must buy 2 at the regular price at the supermarket, most don’t use them so there is no redemption cost. FSA is the same. Look at the instructions for your 1040 and all the possible deductions. A minister gets one, why? Railroad workers get one, why? Tax credits sound good but effect few at the cost of many. FSA is but one example.
Violet
@? Martin:
Yep. And at this point in my life, I’m probably one of those people. I could easily not be this lucky and be one of the people who needs it and so I’m thrilled it’s in place…or getting in place.
I think this is an important point. In order to make more health care available, some people are going to have some things be more expensive or harder to access or whatever. Some changes for some people won’t be beneficial. And the ones who are most likely to have that happen are those who have it really good right now (like me).
I think it’s wrong to suggest that such people won’t notice changes, as DougJ did in the initial post. People will see changes. Those of us who are strong supporters of Obamacare would be better off having good, strong, reasonable and positive explanations for why those changes are important and necessary so we can counter misinformation that’s out there. I think the responses to the changes that I’m suggesting that the average somewhat-informed person might have are quite realistic (having heard some of them myself in real life), and we’d be better off being ready to provide good information rather than just saying, “that’s not the fault of Obamacare”.
burnspbesq
As a participant in the individual insurance market in California, 1/1/14 can’t come soon enough for me.
? Martin
@Violet: So why blame Kaiser instead of the employer? They’re making a choice here of who is at fault.
Look, I said it was slightly incorrect. I agree with you on the reality to the individual. It might even be the reality to the employer if they had to choose from a menu that didn’t include non-generic coverage. We don’t know.
But it goes to a set of assumptions that led a lot of liberals to see insurers as the cost villains over the care providers. And that’s mostly not the case. In this specific situation, the insurer is containing costs in a reasonable way for most people. Most people could switch to generics with no consequence, and the savings across the board are significant, and the only loser is pharma. But, as you note, some people get caught out. Now, if pharma wasn’t so busy lining the pockets of doctors, and doctors could be relied on to prescribe generics and achieve the same outcome (which I believe will happen down the road here a bit) then we’ll likely see the insurers change. And Obamacare does a lot to promote generics, so this may naturally balance out. My point is that liberals are too eager to create villains in this mess rather than understand the real dynamics of the market. And that’s led them to push for some bad things and make some bad compromises. Large employers have a lot more say in what’s in your plan than most people are willing to acknowledge. No point putting all the blame on the insurer.
sherparick
Let’s see, you needed 60 votes to get Obamacare through the Senate, and then after the Scott Brown catastrophe, they had to basically adopt that Senate bill with certain house amendments to avoid the filibuster rule after Mitch McConnell got his 41 blocking votes. With Joe LIeberman and Chris Dodd firmly defending the insurance companies of Hartford, Conneticut, I would like to understand how a “better” AHCA could have become law? Me, if you made me dictator for a day, then I would give you “Medicare for All” and private health insurance would just be a supplement, but unfortunately you don’t have me as your dictator for a day. And laws have to pass Congress and the Republicans, who reflect a very destructive coalition of plutocrats who want to create a Randian feudal Bladerunner dystopia and a large faction of unhappy, resentful, white people who think all changes are bad for them and done for the “freeloading” browns and blahs, actually controls what comes out of that institution. That we have the AHCA and that it is working as well as it is, is a major miracle.
Elizabelle
@SiubhanDuinne:
Cling peaches!
MomSense
@gene108:
No, Ted Kennedy got an excellent bill through the HELP committee of the Senate. Teddy wasn’t on the Finance committee. The problem was always going to be the Senate Finance committee in part because they had to deal with the budget aspects of the bill. Also, too Senate Finance tends to be the sticking point for all of the safety net legislation.
It was the Senate Finance committee that didn’t want to include non-whites in Social Security back in FDRs day.
I don’t know if you read all four versions to come out of the Congress but the HELP version was very similar to both House versions.
Higgs Boson's Mate
@SiubhanDuinne:
RIP, Ms. Stapleton. You made us laugh and look at ourselves while you did it.
? Martin
@Violet: Actually to be most fair to DougJs observation: most people come out way ahead, but nobody cares about them because they’re poor or latino or whatever. Most People That Matter™ will be negatively affected by this. That would be the Tom Friedmans, David Brooks of the world who each individually count for at least a million of the little poor brown folks.
SiubhanDuinne
@geg6:
“Tire rims and anthrax again??”
I loved Edith Bunker too, and even apart from that iconic role, Stapleton was a wonderful entertainer (did you know she was in the chorus of the original Broadway production of Damn Yankees?)
The Raven on the Hill
So many people who currently have no health insurance will be mandated to buy it under the PPACA. I think, oh, they might just notice. I suspect the complaints will be audible from Mars, even from people who actually benefit. For people who don’t…
I have a friend, an artist in her 20s, who is just scraping on her thrift store day job. The PPACA requires that she buy into her employer’s health care plan, which will take $45/mo. out of her skimpy biweekly paychecks. People in their 20s in this tough job market are really going to feel it.
To the bigger picture, the funding provided by the PPACA is creepy-variable. There are nasty marginal “tax” rates in three places. One group affected will be the working poor like my artist friend—just a bit too well off to qualify for Medicaid, and not well enough off to easily afford even the low price of insurance at her level. Another is going to be people just over the 400% of federal poverty level, where the tax credit gives out—middle income, but not comfortably so. And yet another is going to be people with very good employer insurance, who will arbitrarily be hit by the tax on very good plans.
It’s going to be a huge mess. Pass the popcorn.
Ruckus
@James E. Powell:
Beg to differ.
CA is a prime example of they don’t win all the time with their bullshit. But it is never a fast process and there will be much disaster along the way. Remember 2 steps forward one step back? This is like 1 1/8 forward, 1 back. Takes a long time and progress is slow and some days you lose. For example I’ll bet it won’t be a lot better in my lifetime. But if you are 40 or less maybe yours will be better. There is a tipping point to most everything. Politics is no exception. Conservatives are reaching theirs. Not tomorrow, probably not the day after but they are getting there. Limpballs and Dreck will die and so will their audience. Yes there will be younger idiots getting older but not as many will be conservative. It’s always nice when kids fight the idiocy of their parents.
Violet
@Ruckus:
I don’t think “everyone else” has been mis-reading me. People have had a vigorous discussion around an interesting and important issue. Some people have agreed with some of my points. Some have not.
I’ve repeatedly said I’m not unhappy with changes I’ve seen. I have, however, countered DougJ’s statement that people won’t notice changes. I’ve seen them. A lot of other people I’ve talked to have seen them. I think it’s wrong to suggest people won’t notice them. Some changes have been positive for people, some not so much. But people have noticed changes.
As a policy I think that the FSA is silly. But then a ton of things in our tax code are really dumb, as you pointed out. However, as a personal cost to people, it was an obvious way for individuals to save a little money and make their out-of-pocket expenses seem kind of invisible. Some people even get debit cards that they use to pay co-pays straight out of their FSA so they don’t really “see” the money. It’s deducted out of their paycheck before they ever see it. Now if they have to pay that money themselves it seems big because they aren’t used to it.
MomSense
@the Conster:
I don’t know if they had any “facts” because I couldn’t stand to watch more than 30 seconds. They showed a giant food storage area that would make my local food pantry envious and said something like “you may think you have a decades worth of food stores for your family’s survival but (cue scary sound effects)”
I’m thinking really a decade worth of food stored? Who has time or space for that? Does someone say “gosh my underground bunker is bare–I only have 5 years of food”
@Baud:
I had a ballet teacher who loved Spam because the Americans handed it out at the end of WWII and she was a starving little girl at the time. She always kept Spam and Hershey’s bars in her cupboard.
? Martin
@Ruckus:
I don’t think she is. I think she’s just noting for the record that some people will complain about ACA and will have valid personal reasons for doing so. That’s worth noting. Nobody likes to be in the minority group getting screwed over by something that was promised to make things better, but it’s usually inevitable that such a group exists.
Nobody knows in this case how large that group is, but she’s saying that it comprises as least one non-exceptional individual (her), and that we should fully expect there to be a non-trivial number of other non-exceptional individuals who come out worse off. And its important to not dismiss these groups because:
1) I’d be willing to bet they are every bit as influential (even if small in number) as the people that will be helped massively by this.
2) Just acknowledging that there are rough edges in the law that are making things worse for some can go a long way to ameliorating them. The issue of the generics is a valid one. There’s 5 prescriptions in my household. 4 were able to switch to generics (at absurdly low cost) and the 5th absolutely cannot. We’ve tried repeatedly. It happens, and we shouldn’t fuck over the people that are forced to take a name brand for reasons out of their control. So, we work out a solution to that. There’s going to be a lot of nipping and tucking to ACA over the next 10 years. This is a place where I think it’s very warranted.
Violet
@? Martin:
I don’t know why they said that. I was only reporting what the person said. I can’t even remember who it was. Just struck me because I do have this medication that is brand name and I’m glad my policy covers some (less this year, though). Yes, the person is making a choice of who to blame. They should probably blame their employer for choosing that policy. Although the employer also has to balance the costs for all employees. Presumably the employer thought this was a good compromise? I generally think employers are out for making the upper management rich at the expense of everyone else. I don’t know if that’s the case in that specific case, because I don’t even remember who specifically said it here.
Violet
@? Martin:
Thank you. That was my point. I’m not complaining because I understand how it all works. Others in my shoes might complain. Pointing out that their wrong to complain won’t really win them over. Explaining how things work might work better.
Mnemosyne
@Redshift:
I don’t know if any more COBRA changes will be forthcoming, but IIRC it was originally created so people would not lose health insurance after losing a job, but also (and more importantly) so that the insurer for your new job couldn’t dick you around and claim they didn’t have to cover any pre-existing conditions you might have because you were new to their insurance.
@? Martin:
I was the Kaiser complainer in the original thread. It makes sense that the change was generated by the Giant Evil Corporation’s deal with Kaiser, because the GEC has also switched its prescription coverage with its other plans so you have to pay an extra $300 for a name-brand prescription even if you have a clinical reason for needing the name brand. My boss had an allergic reaction to one of the ingredients in the generic of one of her drugs and can’t take the generic without, y’know, potentially dying of anaphylactic shock, but it doesn’t matter — she has to pay that $300 premium anyway. It really sucks.
Violet
@? Martin: Yes, you are correct. However, taken that way, if poor and brown people notice a big positive change and then middle class people with jobs and good insurance and rich folks notice a negative change, isn’t that most people noticing a change? I still stand by my statement that most people will notice some kind of a change. I think DougJ is wrong with his assessment there.
Anna Granfors
…erm…where are Doug J’s post title lyrics from…? I think he’s finally stumped me…
NO! WAITAMINNIT! I know…Lou Reed’s mid-70’s magnum opus, “Metal Machine Music”! (And if you’ve never heard the quadrophonic mix, you’ve missed a treat!)*
Which is actually a way to wish Lou a speedy recovery from his recent liver transplant. (His own liver must’ve either resembled a diseased raisin or something out of Lovecraft.) I can’t honestly say I’ve loved any of his latter-day music, but a world that never had the Velvet Underground would’ve been a far poorer place.
*The joke: “Metal Machine Music”, for those of you lucky enough to have never heard it, was a 2 LP set of nothing but white noise, designed by the crafty bugger to get out of his contract with RCA Records. Just bloody awful, and simulaneously, the most hilariously brilliant thing he ever did. (And there really WAS a quadrophonic mix, too!)
Ruckus
@The Raven on the Hill:
Have you looked at the credits and benefits or just that she is mandated to do something. If she is working part time at a thrift store she should qualify for an offset that will mean she will pay nothing and have health care. And that is better for her and for us. We will pay less collectively and she will have health care insurance. Unlike my sister who was in a similar boat and didn’t know she had breast cancer until too late. She died. She didn’t go broke, she died. Had the ACA been in place 12 years ago she would most likely have been able to get regular checkups and her cancer found soon enough. But she died. Yes cancer killed her. But so did our heath care system.
The Raven on the Hill
Digby is also on this:
http://digbysblog.blogspot.com/2013/06/obamacare-implementation-its-all-about.html
SiubhanDuinne
@Elizabelle:
In heavy syrup!!
? Martin
@The Raven on the Hill:
These last two are mostly bullshit.
400% of federal poverty is $48K for a household of one, and $96K for a family of 4. I make way the fuck less than $96K supporting my family of 4 and live in one of the most expensive places in the country. If you’re making $96K and you aren’t comfortable, you just fucking fail at managing your finances or have unreasonable expectations. Same for the $48K individual, is about the median household income for this country. And don’t give me the ‘single in Manhattan’ bullshit. I commuted from the island. Nobody is forcing you to live in Rachel and Monica’s loft.
And on the Cadillac plan. The tax isn’t on you – it’s on your employer. Yeah, your plan may get a bit worse, but boo fucking hoo. I have one of those plans, and it’s gotten worse as my employer has brought it under the cap. I now have to pay $10 for any prescription instead of $5. And I have a $10 copay for any visit or outpatient treatment instead of $0, and a $50 copay for any inpatient instead of $0. Yeah, it’s intolerable…
And the ‘not qualifying for medicaid’ isn’t the fault of Obamacare, but of your state. Take it up with them – they set the rules.
Violet
@Mnemosyne: Sheesh, that really sucks. I’m so sorry. I know I have to take the brand name thyroid medication. As Martin said, I tried generic and it didn’t work. I can’t take the chance and my Endocrinologist is adamant. I would hate to be in your shoes with that. I can imagine a bunch of other people would find that a big financial burden as well. Ugh. I hope stuff like that gets ironed out.
The Raven on the Hill
@Ruckus: Aaagh, er, kraw! No, I looked at the numbers. She’s right on the edge: she can either: (1) buy insurance from her employer for $45 every two weeks, (2) (depending on her income level, which I don’t know exactly) buy insurance on the exchange for $75/mo, or (3) pay a tax penalty.
And, yes, for a small minority of young people this is going to be a lifesaver. But most people age 20-40 are healthy, and for the working poor, in that age group it’s going to hurt like hell. It may even make their health worse: poverty itself leads to health problems.
Violet
@Ruckus: I’m so sorry about your sister. That kind of story is exactly why the PPACA is so, so important. Hopefully when it gets fully implemented those kinds of stories will be few and far between. That kind of thing just shouldn’t happen.
Violet
@? Martin:
That cracked me up. So true. And seriously, they never could have realistically afforded that place on what they made. No way.
Higgs Boson's Mate
Employer-provided health was something that became big during WWII. For political and economic reasons the Roosevelt administration signed off on it. It has more than sixty years’ worth of momentum and cash. Moving away from it isn’t going to be easy and there are plenty of obstacles in the way. Anyone else remember Weepin’ Joe Lieberman reverse his stance on Medicare buy-in for instance? The ACA is barely good and far from great. It’s a start and that’s all it is. What it becomes from here is up to Congress. I am not optimistic.
Kay
@? Martin:
I don’t buy the 400% either. The only people who make that much and don’t have employer-provided health insurance are self-employed people.
We were that family. 2 adults, 2 kids, both self-employed, 100k. We paid 950 a month for what was essentially a catastrophic policy and that was 10 years ago. We would have happily grabbed a real policy with no out of pocket for preventive care at 700 a month.
? Martin
@Violet:
Only if we’re willing to acknowledge the poor and minorities as actually being people. That’s not widely agreed upon.
Ruckus
One of the things that I detest in discussions like this is that we complain that things cost too much without looking at wages. But as was pointed out here on BJ not too long ago, if the minimum wage had kept up with inflation it would be $22/ hour. The federal is $7.25. What do you think life would be like in this country if the minimum was was even close to $22? Would we be able to afford health care insurance? Food? Rent? $22/hr would be approx $44,000/yr.
? Martin
@Violet:
Trivia that only I would remember, because I’m a freak.
They actually addressed that in one of the first episodes. It was Monica’s grandmother’s place that she inherited – rent controlled. That’s a very important detail.
Violet
@? Martin:
Is it your understanding that these increases are as a result of Obamacare? Those are the types of increases I was outlining in my initial comment–my out of pocket costs are much higher this year.
Mnemosyne
@The Raven on the Hill:
I worked crappy minimum wage jobs, too, but I always got the crappy insurance that was offered because I didn’t want to end up like my co-worker who was bright yellow with jaundice but didn’t have any health insurance, so he had to scrape up the cash to see a doctor. Turned out he had a large tumor on his liver, so he had to quit working in order to qualify for Medicaid so he could try and get the state to pay for his surgery and chemotherapy. Assuming it was even operable, of course.
I was glad I had the crappy insurance when I landed in the hospital overnight with abdominal pain that made them think I was going to need an emergency appendectomy. Fortunately, it subsided, but I still managed to generate a hospital bill of $15,000. How is your friend planning to pay a sum like that from her $15K a year job? (I assume she makes over $14K, because that’s 133% of the poverty level at which she would qualify for Medicaid coverage. If she makes less than $14K, then you’re talking bullshit.)
MomSense
@Kay:
$1,600 a month for us. When you are in the self-insured market you are totally screwed. Every year the premiums increases are highest in this category as well.
Here in Maine the Republican legislature and LePage deregulated the health insurance industry which has led to huge increases in premiums–because there is no recourse now. We used to be able to fight rate increases and the State had to approve them but we are now at the mercy of the insurance companies. If LePage continues to block Medicaid expansion it will mean no end to the suffering.
Ruckus
@The Raven on the Hill:
The devil is in the details. As Martin pointed out $48K is not bad money for a single person. I am one and I live on far, far less and I live in CA. Now it would be nice to have a place like Rachel and Monica, that would be far better than where I live now but all things considered it is not a bad place. I’d like to be able to live in a better neighborhood but the people are friendly and although it looks like there would be high crime, there isn’t.
Violet
@Ruckus: Agreed, they’re all intertwined. I honestly can’t imagine if the minimum wage was $22/hr. How would that even work with NAFTA and all our stuff being made in China and so forth. I guess if we taxed the hell out of anything that wasn’t made where worker standards were at a certain level, then that might help. I don’t know.
And the system is so fucked up that health insurance is tied to full time employment. If there’s just one thing that Obamacare has done/will do, it’s to begin to untangle that mess. I just want to buy my health insurance like I buy car insurance or whatever. The car insurance people don’t force me to buy it from my employer or tell me I’m SOL because I’m self-employed or only work four part-time jobs. It’s just the dumbest system.
Mnemosyne
@Ruckus:
When we were fresh out of college, my best friend got an apartment in Inglewood where she was literally the only white person on her block. She was totally comfortable because it was a pretty low-crime neighborhood and she had grown up in a pretty rough Detroit neighborhood, so she was used to being the only white person around. She said she always felt very safe because everyone in the neighborhood knew who she was (“That’s the white girl who lives at 1232, apartment D.”)
Violet
@? Martin: I did not know that! How did Chandler and Joey afford the place across the hall? Wasn’t Joey an unemployed actor for a lot of the show?
Mnemosyne
@Violet:
Joey was mostly unemployed, but Chandler had a good (high-paying) job, as did Ross. It was an interesting source of tension throughout the show, who had a good job at any specific time.
Ruckus
@Violet:
Yes it is the dumbest system. The employee doesn’t know the actual cost, unless the employer is actually open and honest with them. The employee has no say in what gets covered or more importantly, not covered. As I pointed out somewhere above I used to purchase health care insurance for my employees. What a fucking nightmare. I had to depend on my agent, who was a nice, smart guy but I’ll bet he didn’t really know the ins and outs of the policies he sold. They are complicated for a reason, they have many clauses for a reason, each ins company sells many competing policies with overlapping details for a reason. That is so they can sell you less than you think you are getting at a price that is higher than you should pay. The ACA brings that out a little bit into the open and regulates a lot of the details. This will help more than many understand.
Kay
@MomSense:
I’ve traversed the whole health insurance landscape over my working life. I had no insurance, then I had my husband’s county insurance, then he had my federal insurance, then we bought insurance, now we have his STATE insurance, because he does a permanent part-time contract job with the state :)
There’s another part that gets lost in this. You are actually earning your employer-provided health insurance. It’s part of your pay package. It’s not “free”.
So, if you’re self-employed and making 48k, they could not put you in a better position than the person who gets insurance through work, because that’s not fair. You have to pay because the person who gets it through work IS ALSO paying.
It has to be EQUITABLE as to employer-provided and self-employed. They couldn’t set this up so people who are uninsured got a better deal than people who get insurance through an employee.
Violet
@Ruckus: I know it’s going to be a great change. It’s only a start, but you have to start somewhere. Any sunlight that can be shone on it and any uncoupling of health insurance from employment is a good thing, imho.
Also, I’m all for regulating the hell out of the health insurance companies. I think they should be like not-for-profit utilities. They do their job, people work there and make a living, but no CEOs get golden parachutes and fly around in personal private jets, to their company-paid-for Aspen retreat. That kind of thing is fucked up and bullshit.
Mnemosyne
@Kay:
I find it kind of interesting that the Giant Evil Corporation I work for will not permit its employees to be completely uninsured. You either have to prove that you’re covered by a spouse’s insurance or you get signed onto a crappy insurance plan that doesn’t require a payroll deduction. Even part-timers have insurance available to them.
I’m assuming that the cost of having uninsured employees out sick or injured ended up being higher than the cost of just offering some form of insurance to everyone.
Violet
@Mnemosyne: Wow, that’s interesting. How long has that been going on? Is that since the law passed or has it been like that for awhile? (Assuming you’ve worked there long enough to have some idea.)
Ruckus
@Mnemosyne:
I got injured at a customers job site 25 yrs ago and he took me to the nearest workers comp clinic. In Compton. The intake person went and got the hand doc. He looked and said he could fix it and what it would take and did I want him to fix it. BTW he was black and about 55-60. I asked him if he could do it. Yes. My next question was why wouldn’t I want him to then. He looked at me like I was just a little off. I don’t think he was used to white people treating him like the professional man he was. Hand works fine.
aimai
@Davis X. Machina: No, I get why Obama had to say it, I just don’t understand why people lost their minds over it. If what you thought was so scary was “big gubmint in my healthcare” then you ought to have enough brain cells to grasp that since you had not right to “keep your health care plan or your doctor before” only MASSIVE government intervention would guarantee you that right after. I mean, I get why Obama said it and I grasp just how indescribably stupid people are about health care and insurance–I argued with a ton of people who had absolutely no idea where their insurance premium money went, what the relationship was between their being able to buy into a group plan and the health care they actually got, and everything else in between but I still shake my head and marvel at the stupidity both of the general populace and the pundits who pretend to speak for them.
Mnemosyne
@Violet:
I think it’s been that way for a few years, but it seems to have preceded Obamacare by a very short margin, so I suspect they put it in place on the assumption that Obamacare or something like it was going to be passed. There were rumblings about getting universal healthcare passed in California even before Obama was elected, so it may have been in response to that.
Debbie(aussie)
Another fine example of US attempting to reinvent the wheel.
Violet
@Mnemosyne: Yeah, you’re in CA, right? That may have something to do with it. I wonder if they ran the numbers and realized it was cheaper for everyone to be insured and so just made a condition of employment. Fewer sick people at work infecting others, healthier workforce overall, etc. It’s really common sense that that’s how it works. It’s kind of mind-boggling that anyone would want it any other way.
Ruckus
@Violet:
That kind of thing is fucked up and bullshit.
At the very least.
I mean I don’t have my jet pack, how’s that work?
Violet
@Ruckus: And where’s my flying car?
Jax6655
@Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet: @Violet:
Epic threadjack, Violet. My hat is off to you. Enabled by those who are sincerely trying to explain something to you that you absolutely don’t want to understand. BJ’ers are intelligent folk. If you’ve been misunderstood this many times by 3/4 of this thread, maybe you need to stop digging.
Or maybe you just need some pie?
#stealthtroll
Kay
Self-employed people do this a lot with health insurance (and other employer-provided benefits) and it doesn’t make sense.
If you’re clearing 50k self-employed and you’re not buying health insurance and your neighbor is clearing 50k working
for someone else but has employer-provided health insurance, your neighbor would make more than 50k without the insurance.
Your neighbor is paying for her health insurance. It’s not a gift from her employer. Why shouldn’t the self-employed 50k person pay a comparable amount on an exchange?
Everyone is paying, one way or another.
Ruckus
@Mnemosyne:
Do they self insure? That might be an explanation. Their lawyers may have told them they could be financially responsible if they do and don’t make sure everyone gets at least the minimum coverage.
OTOH I seem to recall that at one point either a state or federal law was that if a company bought health insurance it had to be the same for all employees, workers and management. Sounds like that has been gone for some time.
aimai
@Violet:
Ok, I get that this is what you are arguing but the fault lies not in Obamacare but in your apparent inability to just say, straight out, to your whining friends (for example, on the FSA thing) “Who the fuck told you that you were the only person in the world who needs health care, or that your health care costs wouldn’t go up as you age or as your insurance company decides to fuck you over? If you cared about lowering your health care costs and incerasing your health care access over what a private market would do were you calling your Republican representatives and demanding full National Health Care? If not, STFU already about how sad you are because things are changing. Things have always changed. You were bound to get the short end of the stick at some point if nothing was done. Now at least the government is committed to trying to get you and everyone else health care. If you don’t like the way it was done the time to fight over the details was a few years ago when the Dems were begging for help from the voters.”
Ruckus
@Debbie(aussie):
Hey at least it’s a hexagon now, and not a triangle.
MomSense
@Kay:
Oh I understand that it has to be equitable. I do think that when we have access to the Federal Exchange in 2014 we have a chance at better rates.
ObamaCare requires employers to provide employees with the cost of their health care plan. I think that is fantastic since most people have no idea how much it costs their companies to provide insurance–nor did they realize how much it had been increasing over the last 10 years or so.
Violet
@aimai:
How do you know what I did or didn’t say to anyone about the PPACA? How do you know if these people I mentioned are friends of mine?
Ruckus
@Kay:
What you are really saying is that an employed person at 50k with health insurance is actually making more than a self employed person at 50k. They are actually making more than that if you factor in FICA of which half is paid by the employer or all by self employed. Of course that holds down wages a bit as well.
Kay
@Mnemosyne:
I think the worst part of employer-provided insurance is, employers ( and dopes in media) managed to convince people it is a GIFT rather than part of a pay package.
So you have self-employed people thinking insurance should free, because then they will be on equal footing with people who have insurance thrust Giant Evil Corporation.
Self employed people don’t have employer provided health insurance. That is true. But they’re also not paying for it, and YOU ARE.
We talked about this with birth control. The idiots in media were saying employers “paid for” birth control coverage. Really? Because I thought people earned insurance as part of compensation.
It’s crazy however they’ve framed this.
Violet
@MomSense:
I think this is great, too. People will know how much they pay at work. They can then ask their insurance agent how much it would cost on the open market and will have a much better idea of how much they’re paying, what they’re getting and whether or not it’s a good deal. Right now it’s utterly murky. People are just desperately hoping for a full time job to get “good insurance”. That really means “any health insurance at all”, because for a lot of people that’s the only affordable option.
Kay
@MomSense: @MomSense:
People are tuned into the equity issue because I get cranky questions on it.
If there’s a 25 year old here who clears 25k but has employer provided health insurance, he wants to know if the uninsured 25 year old who also clears 25k but doesn’t have health insurance gets it free on an exchange with a subsidy.
Because that’s inequitable. He’s right. That’s not fair.
Ruckus
@Ruckus:
Some rough numbers.
Self employed, no HC 50k FICA $7650 =$42350
Employed HC 50k FICA $3825 plus HC(500/month for discussion) = $52175 and no taxes on that 6k insurance.
Violet
@Kay: You are absolutely right that it’s not fair. Will people be able to refuse their employer health insurance plans and buy it on the open market and get a subsidy for it? Will that be possible? The question will certainly come up.
mclaren
The big problems with the ACA aren’t market distortions or the kowtowing to private insurers. The two killer problems with the ACA are
[1] No cost controls on the underlying cost of medical care;
[2] The people who really need the ACA can’t get it, because if you’re less than 150% of the poverty line and you can’t afford to pay for unaffordable private health insurance whose premiums are guaranteed to rise infinitely forever, you get dumped on state medicaid — but the states are slashing medicaid right and left because medicaid is destroying their budgets and causing a Niagara falls gusher of red ink as medical costs rise without limit, and states are also upping medicaid requirements to the point where nowadays if you own a car or anything of value, or if you have any kind of job, you’re not eligible for medicaid.
As more and more people get laid off and drop out of the workforce but still own a car and a laptop and have a bank account, they’ll fall between the cracks, not eligible for medicaid but unable to afford private insurance.
ACA has no solution to this problem.
As a result the ACA is the “underwear gnome” plan for fixing America’s broken health care system
Step 1: pass the ACA without imposing cost controls and require people to buy unaffordable private health insurance guaranteed to rise in cost without limit;
Step 2: ???
Step 3: Health care reform!
Doesn’t work.
Kay
@
Ruckus:
Right. But I don’t really get the FICA complaint from self-employed people either, honestly, and I am self-employed.
You are your own employer. That’s what self employed means. You’re complaining because you have to pay yourself what an employer would pay?
I feel like saying “start at the dictionary. Start over”
SELF-employed :)
Gian
@evap:
I just don’t understand the hostility to keeping recent college grads on insurance. I mean actuarial table wise aren’t they some of the best premium payment to cost of care customers?
Odie Hugh Manatee
@aimai:
My wife and daughter work for such a company (Kroger affiliate). IMO, their ‘insurance’ is designed to not be usable as affording it leaves you little money to be able to use it. The terms are so bad that employees can spend as much as one third of their earnings before they get to where the insurance kicks in. The company they work for had excellent coverage until Kroger bought them out. The downhill slide began right afterward. The employer-backed insurance is the reason.
Combine that with shitty pay (some positions are minimum wage only, no raise no matter how long you work there), loads of part timers and few full timers, work hours/days that change every week, departments that are understaffed, employees from all non-food departments having to spend time every work day straightening up the food aisles, deliberate shortage of cashiers and dragging people in from other departments to make up the shortage (and not comping them the pay differential that regular cashiers get) and on top of that they are expected to get their regular job done and have to waste time getting bitched at because they couldn’t, makes for one shitty workplace.
Ted & Hellen
@Higgs Boson’s Mate:
YAY
Baud
@Kay:
Employers these days think of salary as a gift.
Ruckus
@Kay:
Oh I understand I have been either self employed or worked for my own corporation where I did the payroll for most of my working life. I’m just pointing out that a lot of employed people don’t seem to know that their employer pays the same into FICA that they do. It is a benefit in that the money goes out the door but not out of their check. Just like HC goes out the door but not out of their check. Using your example as I show means an employed person has a lot more take home pay than a self employed at the same gross. Just enhancing what you said and what it looks like.
Kay
@Violet:
No, it will be equitable in that situation ( if it works right)
The 25 year old will have to stay on his employers health plan if the plan meets two conditions.
The plan has to qualify (be comparable to an exchange plan) and it has to be “affordable” (% of income)
If my 25 year old’s employer-provided plan doesn’t meet those conditions he gets a subsidy and goes to the exchange.
But it will.meet those conditions, because if it doesn’t his ( large) employer has to pay a penalty.
So it’s equitable as to those two people. One is paying for health insurance as part of compensation and the other is paying cash, but the plans are comparable and the price is comparable.
Equity between insured and soon-to-be-insured is really important. Not so.much for uninsured, who had nothing so won’t feel unfairly treated, but for INSURED.
Mnemosyne
@Ruckus:
I’m pretty sure we don’t self-insure — my insurance is Cigna, and before that it was Kaiser. The baseline crappy insurance may be self-insurance, but the GEC is really giant (branches on every continent except Antarctica) so they can get a better deal than most employers just by virtue of being so huge.
@Kay:
That’s what’s frustrating to me when trying to talk to people about PPACA — my employer pays part of my insurance as part of my compensation, plus I pay a portion through weekly payroll deductions, plus I have co-pays, but somehow I’m getting “free healthcare” if I don’t have a co-pay on a particular prescription?!
Violet
@Kay: Thanks for the clarification.
Yeah, as I’ve pointed out in this thread, currently insured people are seeing changes. Some of those changes are not positive to them, or appear not to be, and some of those changes are as a result of Obamacare. If it looks like currently uninsured people are going to get a better deal while currently insured people “pay for them to have health insurance” (because that’s how it can and very likely will be framed by our pathetic media), that is not going to go over well. Making sure it’s fair and equitable for the currently insured people is important to making it a success.
Ruckus
@Mnemosyne:
Either way is possible but with such a giant, GEC they may save money by self insuring the basic plan and have it administered by Cigna and then purchasing re-insurance for the upper end and catastrophic events. Many large corps do this with all kinds of insurance, they work the odds. Sometimes it works, sometimes they lose. But they have to be big to even get in the market.
Kay
@Ruckus:
Sorry. You probably know more about than I do because we have an employee who does the whole thing.
She pays all of us, really.
She must never ever leave :)
It just drives me crazy with self-employed people. I used to hear it at the Post Office because small business people use the PO a lot.
“I don’t have a retirement plan like you do because I’m SELF EMPLOYED”
Well, they don’t take any money out of your check for it either, then, so we’re even.
mclaren
@Higgs Boson’s Mate:
Yes, it’s a tragedy that you’re unable to maintain total epistemic closure, as the Republican party does. You actually have to get bombarded with horrible unthinkable different points of view.
ZOMG! Terror! Madness! Call out the national guard!
If you want to see how the Democrat party can destroy itself, take a look at the epistemic closure of the Republicans. Cocooned within their sealed bubble of incestuous self-confirming discourse, they need never face any criticism from anyone who disagrees of them…a royal road to craziness, folly, and collapse.
Kay
@Violet:
His equity question is different than yours, though.
His I can answer. It’s simple. “Will I be on the same footing as an uninsured person on the exchange if I get employer-provided insurance?”
Yes, if it works right. Those two 25 year olds will pay a comparable amount for the same “qualified” insurance.
Yours is “will what I have stay the same as compared to before?”
I don’t know the answer to that.
mclaren
@Kay:
The FICA tax is one of the most regressive taxes out there, and self-employed people typically make significantly less money and get a lot fewer benefits than people who work for giant corporations. So the FICA tax requirements for self-employed people is brutal and a double hit. It’s not only a regressive tax that hits hardest those least able to afford it (which is exactly the opposite of what we want in our tax system), it also sucks badly-needed money out of the pockets of self-employed people who are already getting vampired for vast sums to pay for their own health insurance, etc.
Add to that the fact that most or all of the income of the wealthiest Americans gets classified as capital gains and thus requires America’s wealthiest parasites to pay zero FICA tax on their vast ill-gotten gains, and you may be able to intuit why FICA tax for the self-employed is so grotesquely unfair and so economically unwise.
What we need to have, if America is serious about encouraging entrepeneurs, is a tax break that’s the equivalent of the Earned Income Credit but for self-employed people.
But that would be truly progressive policy, so we can’t expect a neocon in sheep’s clothing like Barack Obama to propose it.
mclaren
@Gian:
It’s not about money or making profit, it’s about making as many people suffer as possible.
Once you understand that America is a sick twisted nation that glories in cruelty and despises joy and imagination and enthusiasm, you can easily predict the policies of our elected officials. Whatever causes the greatest amount of agony to the largest number of people — that’s the policy American government will put in place, and those are the policies that the American people will applaud until their hands are raw.
The next step of Shithole America’s collapsing medical system will probably be to pass a law requiring people to be tortured whenever they get sick. “He’s got diabetes…get out the red hot pokers and the chainsaw!” That law will pass by a supermajority and it’ll receive 80% approval ratings from the American population.
Violet
@Kay:
Where did I ask that question? I don’t think that was my question.
mclaren
@Kay:
No, no, no, utterly wrong. Your claim that “we’re even” is so totally crazy and so bizarrely false it’s hard to find words in the English language to describe how nutty and utterly false your statement is.
Let’s take it slowly, one step at a time:
[1] If you’re a public employee and money gets taken out of your check every month to pay for your pension, you are nonetheless guaranteed a pension. Even if the stock market tanks, even if we get a massive global financial meltdown…you are still guaranteed a pension. If you’re a public employee, the government invests your monthly payment and the government takes all the risk. If those investments go to zero, guess what? The government is still obliged to give a pension — for life. Until you die. In that case, the government makes up for that loss by taxing other people. You don’t lose your lifetime pension. You’re in clover, forever, with a guaranteed lifetime pension.
[2] But if you’re self-employed, you have to take that monthly chunk out of your paycheck and invest it yourself to get a pension. And the little investor has essentially no chance to get ahead. You have zero chance of making enough off your investments to afford a pension. And if you run into a global financial meltdown and you lose your life savings?
Too bad! You live homeless! You get no pension! Nothing. Zero. Zilch. Diddly Nada. Bupkiss.
Now do you grasp the difference, Kay?
Ruckus
@Kay:
Well, they don’t take any money out of your check for it either, then, so we’re even.
Exactly.
The point about FICA wasn’t for the self employed but for the employed who don’t understand that the employer has to pay the other half. Just like they don’t usually know how much their HC actually costs. They know what they get(OK until they need it), they know how much comes out of their check, they know the copay. They usually don’t know the other side. The actual benefit side. That’s why the numbers. To take have the same paycheck the self employed have to make a larger gross. Given the above example it would be about 12-15K more. Of course there may be some tax credits that make up for some of the difference but it is dishonest to have this be a benefit and not have people know this. Just like it is dishonest to treat that 25 yr old with or without ins the same. Our tax system is byzantine for several reasons and one of them is tax offsets or credits that the working people for the most part don’t know about make the system less fair as it’s the upper end/businesses that mostly gets to use them or even know about them.
Kay
@Violet:
Well, you didn’t but that’s how I read it.
What people are asking me is will someone just like them get “free” insurance while they have to pay for their employer-provided insurance.
That seems simpler than your question, which I read as “will I pay more than what I have been paying?”
Ruckus
@Kay:
You also don’t work a mind numbing job, listening to complaints all day long from people who are pissed that they have to spend any of their precious time at the post office and spend $.44 for a stamp to mail a letter anywhere in the country all the while getting paid not a significant amount of money.
And given our current job structure in this country, how many jobs fit that description with just a few words changed?
Violet
@Kay: Not sure which question you are referring to. I was asking about the example you gave–and you answered that question. This one:
My observation of where it could go wrong and be a PR nightmare is if the currently-employed person thinks they’re paying for their plan (payroll deductions for premiums) and the other person buys it on an exchange but gets it subsidized so it’s “free”. That’s bad PR because it looks like one of them is getting the same thing for free, plus the one who is stuck with the employer’s plan “is paying for” the other person’s insurance via subsidies (tax money).
Edit: The question was, if that’s the case, can the employed person go on the exchange and get the cheaper plan. You answered that.
But there’s a solution for that, assuming it all works as it should. So it’s not a problem.
I wasn’t asking if my personal plan will stay unchanged. Not sure if other people would ask that question. I haven’t talked to anyone who thinks their plans don’t change from year to year, or expects them too.
Kay
@mclaren: @mclaren:
Oh, mclaren, you don’t have to scream at me. I know the difference between a pension and a 401k. I didn’t even have a pension at the postal service. I had a Thrift Savings Plan, which is like a 401k.
I agree with you about pensions versus stock plans. If you want to make a point about it, just make it. You don’t have to do this big elaborate smackdown. It’s just unneccesary.
There’s probably no one on this site that doesn’t agree with you about pensions versus stock plans. It’s not radical.
mclaren
@Steve in Sacto:
You’re not thinking clearly. You need to learn some high school math.
With an inflation rate of circa 2% and a year-over-year increase in underlying medical costs of around 7% per annum, this means your health insurance premiums have to rise by at least 5% per year to make up for basic cost increases in underlying cost of medical care. By the rule of 72 this means that your health insurance premium will double every 15 years.
But of course it’s really much worse than that since wages are now stagnant and have actually declined slightly since 1970 when we account for inflation — whereas medical costs are skyrocketing at a startling rate.
The ACA is not a solution. It’s yet another example of Obama kicking the can down the road, as he has done with Guantanamo Bay, with Bush’s Global War on Terror, with our insane Republican house of representatives’ threats to default the U.S. government, with congressional filibusters, with refusal by Republicans to appoint Obama’s nominess…and so on.
Obama never tries for an actual solution if he can sweep the basic problem under the rug.
Kay
@Violet:
Thanks. I think all the questions are valid, but the “I have to pay, why do they get it free?” keeps coming up here.
I’m sure it will come up for Medicaid, so it’s coming one way or another. People here accept Medicaid for kids, but selling them on adults is harder, because they don’t make THAT much more than Mediciad recipients.
mclaren
@Ruckus:
If your current job is mind-numbing, depend upon it — you will be replaced by a computer/robot/algorithm/data-mining of a giant database within the next 5 years.
Welcome to America’s wonderful jobless future. This is why Obamacare really matters. More and more people in America are getting dumped out of work into unemployment/underemployement/frantic failed efforts to start their own business as automation increasingly replaces not just human brawn, but human brains.
But I’m just exaggerating, right? More wild nonsense, right?
Wrong.
“The end of labor: how to protect workers from the rise of the robots,” The Atlantic magazine, 14 January 2013.
Violet
@Kay: Periods of adjustment are often challenging. I think 2014 is going to be a real challenge as the provisions truly kick in. There will be kicking and screaming by people who don’t want to pay but have to. People with insurance will see others “getting it for free” and that won’t go over well. I hope there is a good PR campaign all ready to go, because I think educating people about what they get out of Obamacare might really help. Has to drown out the idiots on TV, though. Not sure that’s gonna happen.
mclaren
@Kay:
If people keep whining “why do they get it free?” about health insurance, tell them the only people in America who can get health insurance for free are homeless people with less than $3000 of assets. That’s the medicaid cutoff in most states — some states, like Texas, are even more brutal.
Even an impoverished student who owns a car and a has fleabag studio apartment full of furniture has more than 3K of assets, so that impoverished student doesn’t qualify for medicaid.
Do you have a part-time job at Wal-Mart at starvation wages? Sorry! You don’t qualify for medicaid because you own a car! More than $3000 in assets! If you’re sick, go away and die outside the hospital Emergency Room’s waiting area so you don’t interfere with foot traffic.
It’s easy to get free health insurance in America. Give away everything you own and become homeless. (Oh, yes, or get sentenced to prison.)
Short of that, there is no free health insurance. Not in this country. Tell ’em that.
Kay
@Violet: @Violet:
I saw in The Hill that Democrats in the House are setting up local staffers as info people on PPACA. It was last week.
So they do have a plan, such as it is.
I think they’ve done a poor job so far, but I don’t have anything this big to compare it to, so.maybe the other large programs were like this, too.
Ruckus
@Kay:
Medicare was. I expect nothing less from this. And medicare was only as small add on to SS payments. This will be a bigger issue only because it will affect people to a greater degree. But I think the positive noise of so many getting health care insurance they don’t have now may drown out the complaints of the rest. I expect to hear the words selfish cocksuckers uttered a lot over the next couple of years.
Then I expect that things will settle down and the popularity will end all but the most extreme bullshit in 2-4 years. If this comes even close to working I believe the current republican party will shrivel up to almost nothing. It has benefits that most people will be able to recognize positively once they see it work and the health care industry gets itself together to provide the actual care with the insurance provided.
mclaren
@Mnemosyne:
BZZZT! WRONG.
It’s a PR move by that Giant Evil Corporation you work for. The crappy insurance plan they force people to enroll in has a deductible so high and a cutoff so low that anyone who gets sick will lose their house and their car and their lifetime savings and all their possessions and the Giant Evil Corporation doesn’t care — they just want to be able to say, “Oh, look, we’re not evil! See? We even pay for ALL our employees to have health insurance!”
And before you screech that it’s impossible for someone who has health insurance to lose their life savings and their home and their car and everything else, bear in mind that more than 60% of the bankruptcies in America are filed by people who already have health insurance and are caused by serious illness.
Unless you have very good insurance, it’s worthless. You’re still going to lose everything and wind up sunk deep in hopeless debt and homeless and bereft of everything up to and including clothes and food and enough money in the bank to pay for electricity.
The Giant Evil Corporation you work for is offering that crappy worthless insurance to its employees for the same reason Obama makes a big show of supporting gay marriage. It’s PR to cover up the vicious policies they support and the incredible social damage they wreak.
mclaren
@Ruckus:
The devil is in the details, as always.
If those 15 million people “getting health care insurance they don’t have now” get put into health insurance exchanges with very little competition and prices that are not lower than health insurance premiums for self-employed people now, that won’t be an improvement. But we don’t know how exchanges are gong to work out: they’re too new. Early news doesn’t look good. Few companies offering insurance in the exchanges, not much competition. Time will tell.
If most of the 15 million people “getting health care insurance they don’t have now” wind up dumped into state medicaid programs, the states will go broke and we’ll have a nationwide state fiscal crisis the likes of which you’ve never imagined. Or the states will find ways to raise medicaid eligibility requirements as TX has, with the result that hose millions of people don’t actually have access to health care. Once again it’s not clear which way this one will go.
Middle class people look like they’re seeing some rate relief on health insurance in states with very large health insurance exchanges, like California. It remains to be seen whether that rate relief will do anything more than temporarily stave off the exponential increase in underlying health care costs. Once again, it’s not clear which way this one will go. The example of Massaschusetts is not encouraging. MA has seen health care costs rising faster than in the rest of the country, and the state just pass a law requiring state-mandated caps on health care cost increases. That’s the backdoor to single-payer government cost control. So MA is a state to watch as we go forward.
Source: “Romneycare in Massachusetts: Six Years Later,” ABC News, 21 June 2012.
Earlier the article describes the MA Romneycare system as “working well.” How the highest health insurance premiums in America combined with a double-digit health care cost increase that will double total health care spending over the next 7 years constitutes a “reform” that is “working well” seems to be a puzzle that would require a cryptologist to decipher. Cost increases that force the MA state legislature to pass a law that slaps price controls on the cost of medical care in the state doesn’t sound like the system has been successful in controlling health care costs.
But maybe I’m missing something. After all, as various name-calling venom-spitting commenters have pointed out, I’m mentally ill and need institutionalization. Those of us who suffer from severe mental illness have cognitive deficits that prevent us from seeing what’s obvious to the rest of you, I suppose.
pluege
obama sucks – period
Since he had to use abnormal legislative processes, i.e., ZERO republican support and a budget gimmick to get it passed, at least he could have gotten something decent passed. Instead he pushed through a complex putrid mess sop to the private insurance industry trying to appease unappeasable republicans – a bill which we will agonize over for decades.
obama sucks – period
Ruckus
@pluege:
You sir are an idiot.
LAC
@Ted & Hellen: you are the most fucking annoying pieces of shit to float to the surface on a regular basis. The cost of accessing the corporatist media structure bullshit blah blah …using big words today, are we?
LAC
@mclaren: I hear Syria is great this time of year, you black hole of ceaseless emo.
Ms Mott
The global family entertainment behemoth that I work for is telling all the employees that the huge budget cuts and layoffs are because of Obamacare.
The Raven on the Hill
Reviewing this, I’m surprised by the objections on a number of points. It seems to me that there are many arguments over the reality of evident outcomes. Also, there seem to be some people who are positively gleeful that some groups are going to be harmed—why?
1. Private insurance plans vary. If the insurance available on the exchanges is better than some private plans, well, what has changed?
2. The exchanges are going to work differently in different states. There will be some winners and some losers. Even worse, the states that refuse to expand Medicaid will hammer the poor.
3. Some fraction of the working poor are going to be hit hard by this, especially in states that don’t implement the Medicaid expansion.
4. The plan will penalize some middle income people, and some union employees who fought hard for good insurance—their employers will fight hard to reduce their insurance. I am oh-so-unimpressed with the arguments that say the people who get this deserve it.
5. Individually, win or lose, we may be sure that the insurance companies will do well out of this plan.
Croak!