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"Affordable" Care Act - Yeah, Right.

I looked up the rates for a relative today. She makes about 13,000, live in Oklahoma and is 49 years old. Occasionally she goes to the doctor but sometimes does not because she doesn't want to pay. I was thinking she would be getting care for next to free. She has to pay over $100 a month in order to have the ability to go to the doctor for $35 or $55 for a specialists. I am guessing for a specialists she has to get a referral so really it would cost $90. Prescriptions are $20 for generic or up to a $100 for preferred non generic.

I had thought she was the type of person being helped by the law but it doesn't look like it to me. Before she paid nothing per month and usually got an appointment for $60. I know she will have hospitalization but even that would break her before she meets the deductible. Previously if she had to be hospitalized she would not have been denied.
 
eeyore1954 said:
I looked up the rates for a relative today. She makes about 13,000, live in Oklahoma and is 49 years old. Occasionally she goes to the doctor but sometimes does not because she doesn't want to pay. I was thinking she would be getting care for next to free. She has to pay over $100 a month in order to have the ability to go to the doctor for $35 or $55 for a specialists. I am guessing for a specialists she has to get a referral so really it would cost $90. Prescriptions are $20 for generic or up to a $100 for preferred non generic.

I had thought she was the type of person being helped by the law but it doesn't look like it to me. Before she paid nothing per month and usually got an appointment for $60. I know she will have hospitalization but even that would break her before she meets the deductible. Previously if she had to be hospitalized she would not have been denied.
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I suggest that you have your relative call the exchange and speak with a Navigator. At $13,000 she's at 113% FPL. She should qualify for Medicaid, if OK did the expanded Medicaid. If they didn't, then I don't know where that leaves her. If she made just a wee bit more, she would qualify for the Exchange, and should receive a substantial subsidy. She would also qualify for a cost-share reduction on the Silver plans- the copays she would pay would be lower than what is listed in the plan design, but a significant amount. Her monthly premium might be a little higher than if she got a Bronze plan, but her cost at the point of service would be significantly less. The overall out-of-pocket exposure would be much lower.
 
Oklahoma did expand Medicare coverage. Although maybe it was a little more because she did get a credit. I did it on value penguin not the OK site because I just wanted to inform her about her options not sign up.

What is the cost share reduction? I will look it up .
 
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eeyore1954 said:
I looked up the rates for a relative today. She makes about 13,000, live in Oklahoma and is 49 years old. Occasionally she goes to the doctor but sometimes does not because she doesn't want to pay. I was thinking she would be getting care for next to free. She has to pay over $100 a month in order to have the ability to go to the doctor for $35 or $55 for a specialists. I am guessing for a specialists she has to get a referral so really it would cost $90. Prescriptions are $20 for generic or up to a $100 for preferred non generic.

I had thought she was the type of person being helped by the law but it doesn't look like it to me. Before she paid nothing per month and usually got an appointment for $60. I know she will have hospitalization but even that would break her before she meets the deductible. Previously if she had to be hospitalized she would not have been denied.
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The problem for your relative is that Oklahoma rejected Medicaid expansion for political reasons. It's not a problem with the law, it's a problem with right wing domination of Oklahoma politics.
 
eeyore1954 said:
Back when it was done I don't recall anyone supporting it.
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The Heritage Foundation link is from 2006 (or, at least, it is currently dated 2006). If that doesn't count as supporting it back when it was done, I don't understand what you're looking for.
 
eeyore1954 said:
Oklahoma did expand Medicare coverage. Although maybe it was a little more because she did get a credit. I did it on value penguin not the OK site because I just wanted to inform her about her options not sign up.

What is the cost share reduction? I will look it up .
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The reductions vary by carrier, and I'm not sure how your exchange will present it. You know the metallic levels correspond to actuarial values, right? Actuarial value, if you don't already know, is the portion of incurred costs that the insurer is expected to pay in aggregate (your experience may differ). So to make a Bronze plan, we put together a benefit design, that on average has the patient paying 40% of the expected costs at the time of service, and the insurer paying 60%. The Silver is 70% insurer paid, the Gold is 80%, and the rare Platinum is 90%.

The Cost-share reduction alters this relationship, but it is ONLY available on silver plans. If your income is between 200% and 250% of Federal Poverty Level (FPL) then your cost shares are such that the insurer pays 73% of the expected costs instead of 70%. For incomes between 150% and 200% FPL, the insurer pays 87% (nearly platinum). And for incomes between 133% and 150%, the insurer pays 94% - which means much lower cost-shares than Platinum.

For your relative, she should qualify for Medicaid... which usually has no cost sharing, or extremely low cost sharing on some select services that are very price elastic and prone to overutilization.
 
Emily Cat said:
The reductions vary by carrier, and I'm not sure how your exchange will present it. You know the metallic levels correspond to actuarial values, right? Actuarial value, if you don't already know, is the portion of incurred costs that the insurer is expected to pay in aggregate (your experience may differ). So to make a Bronze plan, we put together a benefit design, that on average has the patient paying 40% of the expected costs at the time of service, and the insurer paying 60%. The Silver is 70% insurer paid, the Gold is 80%, and the rare Platinum is 90%.

The Cost-share reduction alters this relationship, but it is ONLY available on silver plans. If your income is between 200% and 250% of Federal Poverty Level (FPL) then your cost shares are such that the insurer pays 73% of the expected costs instead of 70%. For incomes between 150% and 200% FPL, the insurer pays 87% (nearly platinum). And for incomes between 133% and 150%, the insurer pays 94% - which means much lower cost-shares than Platinum.

For your relative, she should qualify for Medicaid... which usually has no cost sharing, or extremely low cost sharing on some select services that are very price elastic and prone to overutilization.
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What is the best bang for the buck? Silver?
 
Upchurch said:
The Heritage Foundation link is from 2006 (or, at least, it is currently dated 2006). If that doesn't count as supporting it back when it was done, I don't understand what you're looking for.
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I am looking for conservative politicians who said they were in favor of it. Was it ever seriously considered in any other state?
 
Emily Cat said:
The reductions vary by carrier, and I'm not sure how your exchange will present it. You know the metallic levels correspond to actuarial values, right? Actuarial value, if you don't already know, is the portion of incurred costs that the insurer is expected to pay in aggregate (your experience may differ). So to make a Bronze plan, we put together a benefit design, that on average has the patient paying 40% of the expected costs at the time of service, and the insurer paying 60%. The Silver is 70% insurer paid, the Gold is 80%, and the rare Platinum is 90%.

The Cost-share reduction alters this relationship, but it is ONLY available on silver plans. If your income is between 200% and 250% of Federal Poverty Level (FPL) then your cost shares are such that the insurer pays 73% of the expected costs instead of 70%. For incomes between 150% and 200% FPL, the insurer pays 87% (nearly platinum). And for incomes between 133% and 150%, the insurer pays 94% - which means much lower cost-shares than Platinum.

For your relative, she should qualify for Medicaid... which usually has no cost sharing, or extremely low cost sharing on some select services that are very price elastic and prone to overutilization.
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Thank you
 
Neally said:
And fortunately they aren't forced by the federal government to get it. And they can chose what level of minimal coverage they want. Not so with Obamacare.
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Don't move the goal posts. The government does, in fact, make you purchase car insurance if you want to operate a car. Likewise, the government does make you purchase health insurance if you want to operate a human body.



eta: whoops. mis-remembered the conversation. Edited to adjust
 
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Upchurch said:
Don't move the goal posts. The government does, in fact, make you purchase car insurance if you want to operate a car. Likewise, the government does make you purchase health insurance if you want to operate a human body.
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Don't falsely claim I moved the goal posts.

Your quote, "Not everyone wants car insurance when they buy a car, either."

You never used the term "government" let alone "federal government".

Furthermore not every state government requires insurance. This "well the government requires you to have car insurance, therefore there's nothing wrong with the federal government requiring health insurance..." is such a tired and lame rationalization for Obamacare anyway.
 
Fudbucker said:
What is the best bang for the buck? Silver?
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If you're under 200% FPL, then I would say the Silver is the best bang for the buck.

If you're between 200% and 400%, then it depends on your medical needs. If you're very healthy, then the Bronze is the best bang, if you're very ill, then a Gold (actually a Platinum if there's one available) is probably the better choice.

If you're over 400%, then there's no subsidy, so it comes down to budget versus need.
 
Upchurch said:
The Heritage Foundation link is from 2006 (or, at least, it is currently dated 2006). If that doesn't count as supporting it back when it was done, I don't understand what you're looking for.
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A vote for PPACA from a republican congressperson in DC would count as support.

White Papers asserting conclusions and recommendations are nice I do agree, but often imo provide viewpoints subject to further discussion. ymmv

http://www.investopedia.com/terms/w/whitepaper.asp

Definition of 'White Paper'
An informational document issued by a company to promote or highlight the features of a solution, product or service. White papers are sales and marketing documents used to entice or persuade potential customers to learn more about or purchase a particular product, service, technology or methodology. White papers are designed to be used as a marketing tool before a sale, and not as a user manual or other technical document developed to provide support to the user after making a purchase.
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Upchurch said:
How about Jim DeMint (R-SC), circa February 2008? He says "over 20 states now that are trying to copy what he did".
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Yes that is an example. Although that was when he knew Romney was running and RomneyCare would be held against Romney .
 
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Neally said:
Don't falsely claim I moved the goal posts.

Your quote, "Not everyone wants car insurance when they buy a car, either."

You never used the term "government" let alone "federal government".

Furthermore not every state government requires insurance. This "well the government requires you to have car insurance, therefore there's nothing wrong with the federal government requiring health insurance..." is such a tired and lame rationalization for Obamacare anyway.
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At a quick Google, only one state does not require it and that was only recently. The analogy is still valid. Government can and does require the purchase of insurance for lots of things whether or not the purchaser wants to buy it. This is neither unprecedented nor unusual.
 
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