BatFFP has a good question and the short answer is that she’s screwed:
Long story sorta short: I get super-cheap insurance through my job. It’s well under the 9.5% of my income that would make me eligible to get subsidized insurance on the exchange…
work also gives me the option to buy it for the Spousal Unit — at $800 a month. My Insurance + SU’s = 25% of my monthly paycheck, which would leave us homeless. Whoops!
I have heard the following contradictory things: 1) because MY insurance costs are less than 9.5%, the whole Fam Unit is ineligible for subsidies; 2) I HAVE to buy insurance for SU through my work or pay the no-insurance penalty and leave SU without coverage; 3) because Me + SU = more than 9.5%, there are all sorts of fun subsidies available for SU to enjoy.
No subsidies would be a real bummer, especially as there is a Mini Spousal Unit on the way….
The short answer is #1 — the long answer is below the fold:
New York Times from January 2013:
In deciding whether an employer’s health plan is affordable, the Internal Revenue Service said it would look at the cost of coverage only for an individual employee, not for a family. Family coverage might be prohibitively expensive, but federal subsidies would not be available to help buy insurance for children in the family.
This is an administrative fuck up that is reversible as it is a matter of rule making and not the underlying law.
For people who are in this situation where they get decent single coverage at a reasonable price through work but can’t cover their families cheaply, they’re getting screwed in an effort to keep the 10 year CBO score down.
BatFFP situation is not horrendous. Her husband can get a solid Silver plan that is unsubsidized for under $300 a month, and her soon to be mini-me can probably be covered through CHIP for either no premium or a nominal premium. But this patchwork quilt of reasonable coverage is not a situation that everyone who has affordable employed individual coverage but unreasonable family coverage can assemble.
This is an area that any Democrat who is running in 2016 should campaign on to fix.
Villago Delenda Est
This is unspeakably bone headed. Who is responsible for this? Obama? Congress? The parasites of the health “insurance” industry?
henqiguai
@Villago Delenda Est (#1):
Bet it’s the result of the compromises (and screwups) resulting from trying to put together something that makes sense *and* could get through what passed for Congress back when the legislation was being put together.
Richard Mayhew
@Villago Delenda Est: Read the NY Times article — IRS regulation, so therefore Obama administrative ruling.
I think the intent behind the narrow rule was to avoid a back-door mandate on employers for family coverage and keep the CBO score low.
Villago Delenda Est
@Richard Mayhew:
What does that MEAN?
Fuck this shit. Single payer NOW.
daveNYC
@Villago Delenda Est: And a pony.
cmorenc
The GOP will work this both ways:
1) As an example of how the ACA screws people with its unfixably poor design;
2) By working in every way possible to frustrate any attempts to legislatively fix problems with the ACA, except to repeal the whole thing.
Faux Nooze is all on continual full-court-press propaganda mode to discredit the ACA, breaking off only to cover stuff like the commuter train wreck in New York or the recklessness of the administration’s dealings with Iran or…Bengazi! Sniping at the ACA seems to be Carl Rove’s full-time job at Faux these days.
PurpleGirl
These work arounds also happened before the ACA. A coworker whose wife was a graduate student had set this up: He got his insurance from the job, his wife got hers through her college, and their two children got covered by way CHIP. Otherwise, to have covered everyone under his office insurance would have eaten up most of his pay.
Ben Cisco
Sounds jacked up. I believe the formula for a fix = fewer Republicans in Congress.
Pen
My wife and I are dealing with this now. She can get crappy (but adequate) insurance for herself through work but as soon as we look at covering the entire family it’s a third of her pay every check. Not happening. But, because it’s offered, we’re not eligible for the ACA exchanges and living in bloody fucking Wisconsin, we have some of the highest unsubsidized rates in the nation and buying an unsubsidized plan would leave us, at best, in the same position as just going the work family route.
So, that the end of the day, I’m still uninsured and there’s not a fuck all I can do about it. Fun times.
danielx
@Pen:
Minor grammar fix:
Fixed.
Though I feel your pain. How’s life in Scott Walker’s Ayn Rand fairy land otherwise?
Matt McIrvin
@cmorenc: Erick Erickson recently contradicted himself in adjacent sentences on that subject: he insisted that the ACA was unfixably broken and that therefore Republicans had to deny Democrats the opportunity to fix it. Why deny them the opportunity if it’s impossible anyway?
It’s kind of like the way that, back in the late Cold War days, the super-hawks in the West claimed to be down on Communism, but also seemed to be the only people who actually believed the Soviet system worked, because otherwise there was no reason to be so scared of it.
Pen
@danielx: yah, I know. That’s what I get for trying to comment on BJ with a tablet. Not only are errors common at 6am, but the FYWP comment editor breaks after you fix one word and you have to save and try again. I gave up after a couple corrections and said “screw it, they can figure it out”.
Betty Cracker
My family is in a similar situation: I’m self-employed, and we get our insurance thru hubby’s work for ourselves and our sprog. Hubby’s employer picks up almost all of the cost of HIS coverage, but we get hosed on family coverage.
I understand why ACA coverage had to be such an absurdly Byzantine, Rube Goldberg contraption: It’s the half a loaf that’s better than none, and despite what many doomsayers say, it does represent a massive transfer of wealth downward (mostly via Medicaid expansion), which lord knows is desperately needed.
But yeah, the whole healthcare finance system in this country still sucks big green gators, and coverage is only a part of that suckitude. There are structural changes ACA will hopefully effect that will address some of that, but I still think our best hope is that people get used to the notion that the government has a hand in ensuring that everyone gets coverage, and then they get fed up with this tottering structure and say feck it — Medicare for all.
Raven
And if you suck like a gator ….
Villago Delenda Est
@Pen:
This is fucking INSANE.
WereBear
This has always been a rip-off of the childless couple too; the Family Plan is very expensive to simply add a partner to.
I recognize it’s designed to cover children who are already expensive enough. I’m just pointing out that something this screwed up will take a while to unscrew.
Pen
@Villago Delenda Est: welcome to the land of Walker. I grew up bragging that we gave the nation Bob Lafollette but now, with Walker, we’re right back to McCarthy. As soon as I’m done with my whole “go back to college to get a better career” stage we’re moving out west or just across the river to MN. It’s aggravating as hell to have friends 15 minutes away in MN talking about how awesome everything is while my state is hell bent on being run by Birchers.
Villago Delenda Est
You know, I just don’t understand this crap.
This is so, and Betty nailed it with this word, byzantine. It’s beyond stupid that if you are covered by some pathetic little health plan, it costs a small fortune to cover your family as well.
This rule needs to be changed. Without any delay, so that (and I don’t care if it’s an employer mandate, I want this fixed) families can qualify for subsidies.
This country has the WORST health care provisioning system on this planet. It is an absolute disgrace that in a country so wealthy that anyone is denied health care for these reasons. I don’t care if we have to tax the 1% at 99% of their income to finance it.
SiubhanDuinne
Holy fuck, I have to go off-topic for a minute to share something I just heard on the local (Atlanta) NPR news. Rep. Austin Scott (R-BecauseWhatElseWouldHeBe) talking about food stamps and the ag bill, said “We’ve all had the experience of being in line at the grocery store behind a person who uses their SNAP card and then pays for the rest of their food with a roll of $100 bills.” Slight paraphrase because I wasn’t taking it down, but for sure the “we’ve all experienced” and the “roll of $100 bills” are word for word. It’s too early for me to be SMH so violently.
Betty Cracker
@SiubhanDuinne: I heard that too. God, I hate these people. I really, really do. What kind of depraved motherfucker do you have to be to make up lies about SNAP recipients in one breath while weeping bitter tears over the prospect of a billionaire having to pay a nickel more in taxes in the other? Fucking sociopaths. They better hope no alien invaders ever appoint me queen of the planet, because the first thing I’d do is have them ground up into paste and fed to the hogs.
Betty Cracker
@Raven: That thing that goes around? It also comes around. But I won’t gloat when it does. I’m classy that way! ;-)
MomSense
@SiubhanDuinne:
Fuck Rep. Austin Scott! I hope you weren’t driving because that could have caused some anger-veering off the road.
Just for the record, I have never ever had the experience of someone pulling out a roll of $100 bills after paying for some of their items with a SNAP card.
Question about the topic of this thread. Since this is an IRS ruling, is this a situation where a Taxpayer Advocate could be asked to help? It seems like the ruling is causing a consequence that is not intended.
gene108
The 9.5% cost for the employee is not a bad compromise, in my opinion. It gives employers an incentive to limit their cost shifting onto employees, while not pushing so hard on employers to pick up everything that they say “fuck it, it’s cheaper to pay a penalty than offer insurance”.
Contrary to popular belief, the ACA has not unshackled employees from employer based coverage. The way the law is written it basically doubles down on employers offering coverage to employees. If your employees waive coverage, the employer has to have proof the employee has alternate coverage (probably a part of the waiver form, where the employee states “declining coverage, have through spouse’s insurance”) or face the possibility of penalties for having too many uninsured employees.
Pushing too hard on employers really can create the “dooms day” scenario Republicans have been looking for, where employers start dropping coverage and opting for the penalty. Considering most Americans get their medical coverage through their employers, pushing this relationship too hard for employers really can create the sort of situation that will completely unravel this attempt at expanding access to health care.
Given the crap that’s been written about 5% or so of policies being dropped, having employers say “fuck it” and take the penalty will just kill what support this law still has.
lou
This existed before ACA. Colleagues at our small office who wanted to cover their families through our insurance plan would have to pay $800 a month. I would have thought ACA would have taken care of that problem too.
Matt McIrvin
@lou: It existed before ACA, but the problem is that the ACA doesn’t take it into account in the rule for subsidy eligibility.
gene108
@WereBear:
That really depends on how many tiers your employer has opted for with the insurance provider.
You can do single, single+spouse, single+child, and full family, so the expected added costs of a full family are not shouldered by those without a full family.
Pen
@Matt McIrvin: It takes it into account, it’s just that as of now it doesn’t care. The questions are: how much do you and your spouse make, and do you or your spouse have insurance offered through work. Answer too high on the first OR say yes to the second and no subsidies for you, by design. I wouldn’t be surprised if people are getting divorced to get around this, to be honest.
WereBear
@gene108: Yes, in some places, you can. I work for a tiny non-profit, and we can’t.
Just another example of how health insurance is designed to make money, not help people stay healthy.
beltane
@gene108: My husband’s employer offers employee+spouse (which is what we are on) separately from employee+family. Our income level is such that the children are on Medicaid. My oldest son just turned 18 and will have to do without until his college provided plan kicks in for the fall ’14 semester.
gogol's wife
@SiubhanDuinne:
This is also OT, because I just saw your last night message that you are a fellow Hvorostovsky freak. Have you seen this? The concert on Red Square with Netrebko. I love it despite the fact that it’s probably some kind of Putin love-fest. Moscow looks ravishing in this film:
youtube.com/watch?v=92lx_7x-H1U
Aimai
@MomSense: makes you wish for a twitter storm of rebuttal. I dont tweet but i think someone should creat # OHNOGOP or SADLY,NOGOP as the place for rebuttals.
Belafon
I’m going to blame Republicans. Had they not decided to play the “oh my god, a black man has been elected, therefore we either fight or change” game, a few of them would have acted rationally, and this corner of the law could have been taken care of. As it stands, the law had to get past a few conservative Democrats who get to balance budgets when Democrats re in control.
The law was designed to minimize the number of companies dumping people onto the exchanges, so you ended up with rules like this one.
Rob Patterson
This is not an administration screw-up, this is the way the law is written. The premium tax credit provision (Section 36B of the Code) refers specifically to the cost of self-only coverage.
Aimai
@lou: i think one issue, IIRC, was that they were trying to force each employer to cover tbeir own workers and not have married couples choosing to cover as a family under one employer and saving the other employer coverage costs. It was something stupid like that.
John
@beltane: I’m sure you have already looked into how to get insurance for your son. So, you may already have this info, but here is something I found useful: A Young Adult’s Guide To New Health Insurance Choices. Seems like at least a catastrophic plan or even Medicaid (if your state is expanding) might be options until college.
John
beltane
@John: Thanks, John. I will look into those. Fortunately, we live in Vermont which is not only expanding Medicaid but working towards getting single payer in place by 2017. I’m fairly confident that something can be done to keep him from falling through the cracks.
Roger Moore
@Ben Cisco:
That would fix a lot of things.
BAtFFP
Thanks again for the info — all I can say is thank god we live in Seattle, where insurance options are excellent. I think a combination of the silver plan for the Spouse + CHIP for the Mini Spouse will be our best bet for now, until I can find a better job. And yes, sadly, at least one person has suggested a paper divorce if things get too tight. We’re not gonna go that route, but I know people who have.
This sounds like a faaaaaaabulous time to start calling my two senators a lot. Also thank god for Patty Murray.
GHayduke (formerly lojasmo)
@Pen:
Jebus, what are you in Lacrosse? Move to Winona and commute.
Roger Moore
@Matt McIrvin:
I would blame it on cognitive dissonance, but that assumes Erick Erickovich Erickov is capable of cognition.
Roger Moore
@MomSense:
I don’t think I’ve ever seen anyone pull out a roll of $100 bills. The only time I can ever remember seeing somebody with more than a few hundreds is when they got a bunch of cash to buy something from Craig’s List. ETA: And if poor people really do have a bunch of cash, it’s probably because they can’t get a bank account and have no safe place to keep cash other than their person.
NCSteve
@Betty Cracker: Why in the world would you grind them up into paste first, Queen Betty? Just toss the cocksuckers into the pen with their hands and feet bound and let the hogs do the rest.
Pen
@GHayduke (formerly lojasmo): close, but one phrase: “in-state tuition”. If that weren’t a factor we’d be in winona within the month. With the Walker administration playing funny games over tuition reciprocity we don’t dare move to MN until after both my wife and I have finished our degrees. Luckily she’s done and I’ve got 3 years left, so once I’m done we’re gone.
Cervantes
@Betty Cracker: No self-respecting hog would eat them.
slippy
@SiubhanDuinne:
Oh, we’ve all had the experience of a right-tard Congressman making up a fabulous fucking lie to advance his people-hating agenda, too.
Kropadope
Fixed.
MikeJ
@slippy: Funny how everything is seen as evidence of fraud when the program is designed to help poor people and nothing counts as evidence of fraud if the money is going to “defense” contractors.
Cervantes
@slippy: Here’s hoping the Congressman has to use a SNAP card, and soon-ish.
The Fat Kate Middleton
Our son just learned he’s about to be in a similar situation. He’s covered by his employer’s plan, his two kids are on federal children’s health insurance, and mom (who is unemployed due to disability) is on Medicaid. He was told he’ll be receiving a raise of $3000 come spring, which means his kids can no longer be covered by fed insurance – and he’ll have to pay an extra $7200 per year for their coverage. We consulted our state’s exchange on line, and found he will not qualify for subsidies, as you’ve all noted here, and he’s still absorbing the news. He’s awfully good with his money, but this may mean he’ll have to look for a second job,. even though he’s already nearly overwhelmed with duties relating to wife’s illness and a special needs child.
Cervantes
@Rob Patterson: Others can look at Section 36B (etc.) here.
RaflW
@Pen: I was curious, since I have family in WI, and took a look at Anthem Blue Cross WI for a hypothetical 48 y.o. male and two young kids living in Menomonee Falls.
A not all that crappy $2,500 deductible plan appears to be available ~$485/mo. (Opting for $5,000 deductible gets it to $397/mo).
I am not saying this is the solution for you, neither of those premiums may be affordable, and where you live premiums could of course differ a lot.
But at least now with guaranteed issue, it is possible to get some level of bankruptcy-avoidant insurance, and under ACA, preventive care is covered. The above plan even gives 3 sick visits per year per person at $35 copay, before deductible (if I’m reading it right).
Anyway, what I’m suggesting is that because of ACA and the exchanges, insurers are now offering decent plans ($2.5K deductible is what passes for decent in 2014, IMO) outside the Exchanges, so there’s no income test, no question of spousal coverage.
Again, your particular situation, Pen, may mean my hypothetical is useless. If so I’m certainly sorry. But in my own search to replace my expensive individual plan in MN, I’m finding the best plan is a Blue Cross open access plan not offered on the exchange.
beltane
@The Fat Kate Middleton: That is just disgraceful. What state does your son live in?
The Fat Kate Middleton
@beltane: Iowa … which is another story in itself regarding Obamacare.
Matt McIrvin
@The Fat Kate Middleton: Can he turn down the raise?
You know, Republicans constantly trumpet an innumerate scare story about how if you make more money you end up taking less home because you get into a higher tax bracket. It only makes sense if you don’t understand how marginal tax rates work… yet they generally ignore the fact that perverse incentives like this really DO exist when it comes to means-testing for assistance for low-income people. (Or if they take note of it, it’s just part of an effort to remove the assistance entirely.)
Apparently the means-testing in the ACA is no exception. Why don’t these things always taper off gradually?
The Fat Kate Middleton
Regarding turning down the raise: he works for a local school district, and has been told he may not do so.
beltane
@Matt McIrvin: Just yesterday Atrios pointed out that marginal tax rates are much, much harder on the working class than on millionaires.
Matt McIrvin
@beltane: Krugman’s waxed eloquent on it as well, IIRC.
Richard Mayhew
@The Fat Kate Middleton:
Something is not adding up regarding CHIP and Medicaid eligibility for your daughter in law — could you take a look at the Iowa CHIP website to see if a $3000 raise bumps them from free CHIP to cheap CHIP as that could make sense if mom is MA eligible:
hawk-i.org/en_US/costs.html
Something is not adding up right here — as Iowa is expanding its Medicaid program (although it is reducing its Adult Basic/not quite Medicaid for the working poor program)
Rob Patterson
Cervantes — Thanks. I guess the self-only language is actually in Section 5000A, here (it is cross-referenced in Section 36B), but the point is, the IRS can’t fix this. The law would have to be changed.
The Fat Kate Middleton
@Richard Mayhew: The kids are currently on “cheap CHIP” ($40/mo,), but once his raise kicks in their family income will be exactly $350 over the limit noted on the webpage. He certainly needs to explore how mom’s MA eligibility and disability income figure in – I will urge him to do that. I really know nothing about how all that works … thanks for the reminder.
Aimai
@The Fat Kate Middleton: cant he turn down the raise?
Cervantes
@Rob Patterson: Right.
Just Some Fuckhead, Thought Leader
@Belafon: I blame health care providers. Yes, health insurance companies are skimmers, but they’ve been limited in how much they can skim and how hard they can fuck you for a dollar. The overwhelming bulk of your health insurance dollars go right into the fat wallets of health care providers. They are paid too much damned money to perform a public good, from nurses and doctors right on up through hospital administrators. I know someone who did a charity benefit for a children’s hospital every year for the last dozen years. She eventually landed a very nice job in the payroll department of said hospital. When she saw the criminally obscene amounts of money that doctors are making on the backs of sick and dying children and their bankrupted families, she found another job and no longer does charity benefits for them. What she raised in a charity event was a rounding error on a doctor’s paycheck. She was out there begging for money to buy incubators for babies while these amoral fucks were living millionaire lifestyles.
We aren’t going to make a dent in the healthcare problems of this country until we break up the AMA cartel and burst The Healthcare Bubble.
Aimai
@The Fat Kate Middleton: sorry. Just saw you answeed this up above.
The Fat Kate Middleton
@Aimai: He’s been told he cannot – but I’ve suggested he talk with the district’s business manager and see if something can’t be worked out.
Pen
@RaflW: Thanks for the info RaflW, that’s about what we’d found on our own. As is my wife’s degree is in population dynamics and statistical probability analysis (i.e. insurance) so we aren’t looking at the situation blind. Unfortunately there’s no way we could swing an additional $600/mo, which is the best we could find unsubsidized. The Walker administration did this on purpose, and for that reason alone I get nearly violently argumentative with anyone who tries to tell me that the republicans give a damn about small businesses or working families.
This argument got so bad this year that my family Thanksgiving gathering was effectively cut in half. The GOP bulk of the family did the usual gathering up north and everyone else (pretty much just my parents and brothers & their families) stayed down at my place and watch the game, ate a ton of food, and then switched over to video games and Pacific Rim with 30m left in the Packer game because it was either that or watch father throw the remote at the TV. Not one word of politics or religion was spoken the entire time; it was glorious.
Cliff in NH
@The Fat Kate Middleton:
just lose 350 in the market, and his taxable income is less, bingo.
Matt McIrvin
@Pen: I was struck by a quote from a Wyoming TV ad I heard about: it apparently mentions that Wyoming has the highest exchange-plan premiums in the country, and then intones that the people of Wyoming have no use for this big-government Obamacare.
It’s a real one-two punch: sabotage the system and then get the people to reject the sabotaged version. That’s the kind of thing that gets me despairing about the system’s long-term prospects. It’s too easy to mess up on purpose and blame afterward.
Pen
@Just Some Fuckhead, Thought Leader: When I was still working with my former employer I had an extremely nice family benefits package. 4 years ago my wife and I had a son born 3-months early, and by the end of it all the bill my insurance paid for my wife and son came out just over a million dollars. Should it have been expensive? Probably, the care they both received was top-notch and they’d both be dead without it.
Should it have cost nearly a million dollars? Well, when you see that they were charging over a $100 every time the heart monitor was checked, $200 for a new pack of gauze every day, and other similar costs its no wonder the price went through the roof in a hurry. $13k a day for 77 days (which is what it came out to) is ridiculous. It’s no wonder most of the area doctors live in some of the most expensive communities in the area.
Yatsuno
@BAtFFP:
Her office is 15 floors above mine. I can leave both her and Maria a nice letter at any time. Since this is an IRS rule it might be something for both of them to question the new IRS head about, though for whatever reason his appointment is dragging.
slippy
@Matt McIrvin:
Well, all that is doing is kicking the can down the road. The system-that-was was doomed, and I think most intelligent people knew it. It’s not going to matter what supposedly principled idiots think, we won’t have a healthcare system at all if it is not sustainable, and a system that can’t actually take care of people’s health but manages to take all our fucking money anyway, is a system that can’t be sustained.
All your reported ad reminds me is that most especially Republicans but in general people can be really, really fucking stupid and hold multiple contradicting beliefs without ever realizing that you can’t, actually, have it both ways. One of those ways will give eventually.
Another Holocene Human
So the Dems brought back the marriage penalty? In what universe is this a sane policy? I know we’ll be running on Medicaid expansion but come on, this sucks. Especially with employers dropping spousal coverage altogether in many cases.
Another Holocene Human
@Richard Mayhew:
IRS has been a bunch of cheapskate skinflints the last few years. Dunno which president or philosophy to blame or both.
IRS released a public rule saying police officer’s uniforms and scrubs–but not police detective’s suits–were still a non-taxable fringe benefit, but the IRS office told us that bus driver’s uniforms are a taxable fringe benefit. Because there is just no daylight between cop uniform and bus driver uniform. This is so obvious people! How could we not see this!
I talked to some other labor people and they were jawboning about people abusing tool allowances to buy stuff for their personal business… I mean, great. Not exactly the same sitch, is it?
It’s like if they can’t raise taxes they’ll nickle and dime working families, much like our big corporation loving, ordinary citizen fee-ing state governments.
This shit is lame.
Another Holocene Human
@SiubhanDuinne: Because poor people never, ever have all of their money in cash at the beginning of the month.
Yes, it is shocking. Think how easy it would be to lose that money or get robbed and get your utilities cut off and go begging for food for the rest of the month and have to get rides off scary people because you can’t make bus fare, etc.
Another Holocene Human
@Pen:
As soon as they figure it out, they will. People have done that with Medicaid for years.
Another Holocene Human
@BAtFFP: Marriage only makes money sense when you have assets of significance that need to be passed between spouses. You know, houses, cash, that kind of stuff. Cars.
The problem is that we don’t have decent domestic partnership laws, which means that you end up being legal strangers which can be scary. Especially with children involved. Although het couples are on the receiving end of less of the scary than other couples. However, I do recall with clarity the kind of shit that went on during the 1990s towards unmarried het couples. Some even got “married–but not legally”.
Another Holocene Human
@The Fat Kate Middleton: If he’s hourly can he go on unpaid FMLA leaves? (This will require draining his PTO, probably, but if he has a sick wife that’s happened already.) I have coworkers who used this method to keep their benefits for their children.
@The Fat Kate Middleton:
$350 is less than a week’s pay for him, isn’t it? So he wouldn’t have to lose much time.
liberal
@Just Some Fuckhead, Thought Leader: agreed. The biggest problem is the health care system itself.
Market failures are so pervasive that the only way to have a rational system is to socialize it.
different-church-lady
@SiubhanDuinne: You know what we’ve actually all experienced? We’ve all experienced stores refusing to take $100 bills, because so many of them are counterfeit. So this particular fellow is smoking crack if he sees cashiers taking them on a daily basis.
I am, in fact, so certain of this that I am about to take a small pile of the brand spanking new fresh-from-the-bank high tech counterfeit-proof ugly juice stain and all $100s (friend repaid a debt in cash) to my bank and convert them down to $20s, because I know perfectly well none of the stores around here will take them.
Roger Moore
@Pen:
I’m willing to bet that if you looked closely, the amount the insurance actually paid was a lot less than a million dollars. A contemporary hospital bill should be seen at best as a negotiating position and at worst a complete fantasy. The hospital bills whatever it thinks/hopes it can get away with, the insurance company allows whatever they’ve negotiated for that treatment, and the rest disappears into the ether. If the patient doesn’t have insurance, the hospital recovers what it can and presumably writes the rest off on its taxes. I wouldn’t be surprised to hear that even the largest hospitals can go years between times when they actually collect the entire amount on any bill for more than trivial of services.
The Fat Kate Middleton
@Another Holocene Human: He’s not hourly, but I’ll mention it to him. Thanks.
The Fat Kate Middleton
@Roger Moore:
I learned this when I went in to order new tubes and face mask for my CPAP machine. The invoice for the mask alone – a piece of molded plastic – was $400.00. When I questioned this (even though I didn’t have to pay for it), they explained that what they hoped to actually get was $200 (still ridiculous), but that meant they had to submit the $500 bill.
The Fat Kate Middleton
@The Fat Kate Middleton: Oops: “…submit the $400 bill.”
gratuitous
The short answer is that complex legislation like the Affordable Care Act always and that means always has problems just like this. It’s like Body Heat, when Mickey Rourke quotes William Hurt’s lawyerly words back to him: In any crime there’s 50 ways to screw up; if you think of 25 of them, you’re a genius. And you ain’t no genius.
Similarly, in writing legislation for 300 million people, there are about 10 million potential gaps. If Congress thinks of 25 of them while drafting it, they’re freakin’ geniuses, and I’m not looking for a Mensa meeting to break out anytime soon in the House. These are the sorts of things that get fixed along the way (or not), as unanticipated problems occur. Fixing them, however, depends on the majority party in the House (our good friends the Republicans) actually giving a tin shit and wanting the legislation to work. Which they don’t.
So, in answer to the question of why these problems occurred in the first place, I’d say they were pretty much unavoidable. Why these problems will persist and not be addressed, then we have our culprits: The House GOP.
Rob Patterson
@Richard Mayhew: Again, the NY Times article is wrong. This is not the IRS’/Obama administration’s doing; it’s the way the law (the ACA) is written. See #33, 50 and 59.
Just so the blame goes where it belongs . . .
Also – what gratuitous said.
Another Holocene Human
@The Fat Kate Middleton: If you want to really blow a gasket, shop around for CPAP parts on eBay.
I really, really hope the medical device tax stays in place. They have been getting over for wayyyyy too long.
Pen
@Roger Moore: no, that was the amount that my insurance paid out. 3 months in neonatal ICU and an unscheduled extreme high risk preeclampsia emergency hospital stay and c-section don’t come cheap.
fuckwit
@MomSense: WELFARE QUEENS IN NEW CADILLLACS! Jeebus, don’t you know the dog whistles? That one’s been around since Saint Reagan.
fuckwit
@The Fat Kate Middleton: At that point, I’d say “keep the raise, I’d rather work off the books for someone else on the side”. Really, if you’re poor especially, there’s no way to go except to become a scofflaw and hide income and assets.
The horrible thing about means testing is it’s a way to viciously fuck over not only the poor, but anyone who is trying to or is about to succeed climbing into the middle class. As soon as you get there, they fuck you over and push you back down again.
It’s like Rethugs are standing on every ledge, to step on the fingers of any poor folk who manage to reach it, and send you spiraling back down again.
I fucking hate means testing. It’s a way to enforce a rigid class heirarchy in the USA. It shouldn’t exist.