The young are being told it is the baby boomers soaking all the Trusts......the middle-class are being told it is the poor that are causing their rates to go up in order to insure the poor---who are getting almost nothing for the insuring......the unions are seeing their union plans take a hit as another way to make the unions look useless to workers.
Now that the ACA is rolling out people are beginning to see the effects of this reform on their ability to access care. They may not have been able to access these health system websites but they are reading social media and research that shouts out what is being seen. REMEMBER, THE AFFORDABLE CARE ACT IS A MIRROR IMAGE OF BANK REFORM FROM BILL CLINTON----IT IS ONLY ABOUT CONSOLIDATION THE HEALTH INDUSTRY INTO GLOBAL SYSTEMS LIKE THE FINANCIAL SECTOR AND WALL STREET TO MAXIMIZE CORPORATE PROFIT. As with all global businesses they will prey on the poor, sick, and elderly, not care for them.
This is what we are seeing:
The Bronze Plans that will be what 80% of Americans will sign to because the costs are too great are said to have more in them but the costs of premium will be all most people will be able to afford as co-pays and deductibles are prohibitive. 70% of health care costs adds up to a substantial bill and we know each health incident can be tens of thousands.
The idea was to get people out of emergency rooms and private offices so health profits can increase and indeed, that is what is happening. Hospitals will now transport a patient to a facility that handles what insurance level you can afford and that may mean no quality care or specialist. I told the story of the MedStar in my neighborhood setting a severely broken bone and ankle sprain without ever taking an XRAY because they thought the patient was uninsured. The patient was told to go elsewhere for followup. MedStar is listed as a non-profit paying no taxes even as it now has a for-profit structure. This is the kind of health care that is given in third world clinics and it often leaves that patient with permanent physical challenges just to save the cost of an XRAY.
This is the level of coverage most people will have as they choose not to go to the hospital because the deductibles are so high. AS YOU CAN READ FROM THE RESEARCH, THE PEOPLE MOST AFFECTED NEGATIVELY IN COST WILL BE THOSE WITH CATASTROPHIC PLANS -----GENERALLY THE YOUNG WHO DON'T EXPECT HEALTH PROBLEMS AND THE CHRONICALLY ILL WHO WILL FALL INTO THESE HIGH-DEDUCTIBLES/CO-PAY CATEGORIES. Hey-----they said the insurance company would offer the insurance plan for pre-existing conditions----they didn't say anyone would be able to afford to seek care!
The Silver and Gold Plans increase the premium for lower co-pays so all around the idea was to limit the most costly patients by making access too expensive. If you can pay $600-800 a month for health insurance you will get what Americans have gotten for several decades. THE POINT BEING THE COST IS TOO HIGH AND THIS REFORM NOT ONLY DOES NOT ADDRESS THIS BUT MAKES COSTS HIGHER.
Look at Medicare to see a continuing problem for seniors. Medigap vs Medicare Advantage. If you didn't know better would you think Medicare Advantage is closest to Medicare? OF COURSE YOU WOULD! Yet, Medicare Advantage is the private health insurance. Now, if you wanted to get people off a public plan and into yours what would you do? GIVE THEM A SWEETENER LIKE A CREDIT CARD GIVES A LOW INTEREST RATE UNTIL IT SOARS! That is what Advantage is all about and it does it because of what you see below----if you sign up for Medigap and then leave it to go to Advantage you will not be able to come back to Medigap because of 'pre-existing' health restrictions. NOTICE THE REFORM DID NOT REMOVE THIS PRE-EXISTING HEALTH RESTRICTION AND THIS IS THE AGE THESE CONDITIONS SOAR. So, many people leave Medigap to Advantage for a sweetener and then find they are stuck with this private plan that then acts like a credit card in soaking you for cost! THEY ARE DELIBERATELY LURING PEOPLE FROM THE PUBLIC PLAN AND LEAVING THEM NO WAY TO GET BACK. Keep in mind that the deductible is already 80% and these few years the cuts to Medicare has raised co-pays and deductibles. They are doing the same to entitlements as they remove the health protection in old age for those not able to pay higher premiums-----MAXIMIZING PROFITS ON THE BACK OF SENIORS AND WORKING CLASS AND POOR. Remember who paid all the payroll taxes that fund the Trusts for just this? THESE SAME PEOPLE NOW NOT ACCESSING THE CARE!
For those thinking that democrats tried to end Advantage or other things like public option----look at your own state to see what they did with their health systems----private systems that maximize profit in all neo-liberal states.
“More of the cost responsibility is being shifted to patients, and more to patients with serious chronic illness,” Mr. Mendelson said, noting that the silver plans, the second cheapest, are intended to cover only about 70 percent of a patient’s medical costs.
News Analysis ‘Affordable Care’ or a Rip-Off?
Tim Lahan By ELISABETH ROSENTHAL Published: September 28, 2013
As Americans begin signing up this week to buy insurance, they will begin to test the legislation’s tantalizing promise to make health financially viable. Will the policies deliver care at manageable prices, or will “affordable” seem like a hollow promotion?
That probably depends a lot on patients’ needs, where they live and — importantly — their preconceptions of what health insurance is supposed to do, experts say. The insurance marketplaces, or exchanges, will sell four different levels of plan — bronze, silver, gold and platinum — with the more expensive plans offering the most extensive benefits. And while premiums for the low-end plans may be relatively cheap, they still require significant out-of-pocket payments, in the form of co-payments and deductibles that could add up to more than $6,000 a year.
“The perception of cost will vary a lot,” said Dan Mendelson, the chief executive of the consulting firm Avalere Health and a former associate director for health at the federal Office of Management and Budget.
Mr. Mendelson predicted that the plans would be welcomed by people who had wanted to be insured but couldn’t obtain or afford insurance because of pre-existing conditions, for example, and for low-income earners who would qualify for heavy subsidies for premiums. “For some people it will be free, and that is a pretty good value,” he said.
But the required outlays might seem like a lot of cash to healthy families who previously did without insurance. And they could be downright shocking to patients who last had insurance a decade ago, when health plans tended to require little if any patient payments.
“More of the cost responsibility is being shifted to patients, and more to patients with serious chronic illness,” Mr. Mendelson said, noting that the silver plans, the second cheapest, are intended to cover only about 70 percent of a patient’s medical costs. “This is different from the concept of insurance we’ve been carrying around for a long time. So people who sign up for insurance thinking all will be covered are in for some surprises.”
Elisabeth Benjamin, vice president for health initiatives at the Community Service Society of New York, says that — perceptions aside — the exchange plans she has vetted in New York State provide consumers a good deal. For a number of years, the group has operated a hot line to help patients troubleshoot their medical bills; 45 percent of callers are uninsured.
“The premium prices are reasonable — for some people we’re talking about as much as my cable bill,” she said. “Yes, there are high co-pays, but there’s also a cap,” she added. “We now have people come to us owing $50,000 or $150,000. So if the worst-case scenario is you pay $5,500, you won’t go bankrupt over that.”
Health experts also point out that the larger patient payments required under policies developed for the Affordable Care Act are increasingly a feature of private health care insurance as well.
“We are going through a period of revolution in what health insurance is, from more comprehensive to less comprehensive,” said Drew Altman, president of the Henry J. Kaiser Family Foundation. In 2006, he said, only about half of employer-provided insurance plans had any deductibles; now 78 percent do.
Insurers impose co-payments and deductibles as an alternative to raising premiums, which are often more tightly regulated. But many health economists approve of the practice because even a small co-pay can push patients to price shop for cheaper care, studies show.
The goal of the new legislation is to make sure everyone has decent health insurance, but that ideal will come at a cost for many Americans. Even though the White House celebrated the fact that premiums released this week by the exchanges in 36 states proved lower than anticipated, those premiums vary tremendously depending on where you live, your age and which plan you choose. For example, the monthly premium for a low-end silver plan for a 40-year-old runs about $300 in many places, but as high as nearly $700 in parts of New York. And monthly premiums are more than $600 for 60-year-olds in some states, although a few states, like New York, charge the same rate regardless of age.
And perhaps more important, all of the plans have significant deductibles and co-payments. Silver plans often do not kick in until the patient has spent $2,000; many states require patients to cover 20 percent of hospital costs and some drugs — although that cost-sharing is capped at $6,350 per individual, or $12,700 per family, and effectively less for low-income patients.
The Affordable Care Act also includes tens of millions of dollars in spending for patient navigators, who will help patients choose the plan that best suits their needs, and their pocketbooks.
Still, a $2,000 deductible is high compared with plans provided by employers, where the average annual deductible is $1,135, Dr. Altman said.
For those who balk at the new bills, it is useful to remember that those high co-payments are largely a function of the uniquely high price of medical services in the United States — everything from drugs to scans to operating room time.
In a country where even minor medical procedures cost two or three times more than elsewhere in the developed world, cost-sharing is far more likely to be a burden. A healthy 60-year-old in California with a chronic condition like asthma who needs little more than asthma medicine and an outpatient hernia operation could easily pay $7,000 in premiums plus a $2,250 deductible plus $3,000 for the 20 percent hospital co-pay. When my husband recently developed a blood clot in his leg after a bicycling injury, the generic heparin shots to treat the condition cost $1,400 at the pharmacy. Though the medicine is nothing new, our insurer considered it a specialty drug because of its price. Under some states’ silver plans, that would require a 50 percent, or $700, co-pay before getting this potentially lifesaving treatment.
Does that seem affordable, or not?
Elisabeth Rosenthal is a reporter for The New York Times who is writing a series about the cost of health care, “Paying Till It Hurts.”
Below you see groups in Maryland that are working for Universal Care because they know that most people will not be able to access health care and as Sharfstein, the Wall Street policy writer for Maryland states----it is simply about the insurance status. This is to guarantee profits for hospitals that used to have to take everyone as a public service!
This hits the poor the hardest even as neo-liberals are trying to paint it as an aid to the poor---but it hits the middle-class as hard as they lose their private coverage and public plans are thrown into these systems!
Group marches for health care for all Participants rally to promote single-payer system
October 26, 2013|By Andrea K. Walker, The Baltimore Sun
The federal Affordable Care Act is expected to provide access to medical coverage to hundreds of thousands of Maryland's uninsured, but one group said that doesn't go far enough.
The group, Healthcare is a Human Right-Maryland, led a rally Saturday in Baltimore to push for single-payer coverage similar to that in countries such as Canada and Sweden, where the government runs most of the health system and there are no insurance companies.
The health reforms widely known as Obamacare require most people to get insurance. The uninsured will be able to buy from private insurers on a state exchange. Low-income people will qualify for plans under expanded Medicaid.
Healthcare is a Human Right-Maryland said that while health reform will expand coverage to many of Maryland's 800,000 uninsured, many people still won't qualify, including immigrants in the country illegally who can't get insurance under the law.
Others still won't be able to afford adequate coverage or coverage at all, members of the group say. Health reform creates a tiered system where people who have more money can buy better plans, the group said. For example, people who buy insurance on a state exchange in Maryland can choose between bronze, silver and gold plans. The bronze plans have less costly premiums but higher deductibles.
"Although the Affordable Care Act has helped some people get insurance, it doesn't solve the problem," said Roxanna Harlow, a member of the organization's Carroll County chapter.
Maryland Health Secretary Dr. Joshua M. Sharfstein said he agrees that the ultimate goal is for everyone to be insured. But he said the access Marylanders will have to insurance under reform shouldn't be underestimated.
Obamacare will also create a system that focuses on preventive care and keeping people out of the hospital. This will help create a healthier population and curb health care costs, he said.
"I think we're engaged in the task at hand right now, which is making progress in the areas that we can," he said. "We can help a lot of people through what we're working on now," he said.
Harlow was one of many who shared their experiences of living without insurance during Saturday's rally. When she left a full-time job to start an education nonprofit, Harlow said, she didn't make enough to pay for insurance. Under Obamacare, she will qualify for Medicaid. But she said that is only because Maryland chose to expand Medicaid under reform. The law gives states the choice to opt out of Medicaid expansion, which many states chose to do. Because of this, many people will remain uninsured.
In addition to Medicaid expansion, federal subsidies will also be offered to help people who fall under certain incomes pay for insurance.
That won't help everyone, those at the rally said. They believe that under health reform, deductibles, co-pays and other out-of-pocket medical expenses will continue to keep health coverage out of reach for some. They also say people will still be in danger of falling into debt or medical bankruptcy because of health costs they can't afford.
Raquel Rojas Rojas knows what it's like to incur exorbitant medical fees. She didn't have health insurance when she recently contracted pneumonia and landed in the hospital for two days. It cost her $12,000, and she said she feels that she'll be paying that off for the rest of her life.
Rojas now has a job as a cook at a restaurant that provides health benefits, but she said she knows many others who don't have insurance and have gotten stuck with hefty medical bills.
"As someone who has been uninsured, I really understand the importance of fighting for this," she said.
Rojas and a large group marched from Highlandtown to the Canton waterfront and the offices of CareFirst BlueCross BlueShield.
Healthcare is a Human Right-Maryland believes that insurance companies such as CareFirst cause many of the problems with access to coverage. CareFirst officials could not be reached for comment Saturday.
Margaret Flowers was a pediatrician until 2007, when she said she became fed up with the insurance industry. She said insurers don't pay for much-needed tests and drugs. She also had a hard time getting paid for services, she said.
"The system is not about health," she said. "It is about profit. I decided I would quit and fight for health care."
Sergio Espana, the statewide organizer for Healthcare is a Human Right-Maryland, said he hopes the rally brings more attention to the need for a better health care system.
"What we have now is not enough," he said.
Here is an example of where unions have compromised themselves. They behave as corporations when they create things like insurance systems for their members and when they allow labor pensions be invested in projects or with financial vehicles that prey on people and their union members. When I talk with Federal employees about fighting in courts the pension fraud they say we have 401Ks which are probably invested in corporations maximizing profits off of low wages and undocumented workers that are fleeced.
Below we see the only way these health insurance corporations are made to pay for this health reform is through this individual tax on policies. We all know that placing taxes on all industries is the only way to recover massive fraud so if you have a union as an insurance provider then that explains why it supported the ACA rather than Universal Care. THESE CONFLICTS RUN THROUGHOUT UNIONS AND WE NEED TO REFORM THESE.
THIS IS WHAT CORRUPTS OUR LABOR MOVEMENT AND WE NEED UNIONS TO CLEAN SHOP AND RETURN TO THE WORK OF PROTECTING ALL LABOR!
The second issue is having the Republicans supporting issues that are democratic while the neo-liberals work to prey on people. This is an example of how both parties are captured and they are simply playing good cop bad cop tag team. NEO-CONS AND NEO-LIBERALS ARE BOTH WORKING FOR WEALTH AND PROFIT SO NEO-LIBERALS ARE KILLING ALL OF LABOR AND JUSTICE.
Don't allow neo-liberals to play these games. Run and vote for labor and justice!
Here's a tax increase Republican lawmakers support
By STEPHEN OHLEMACHER 4 hours ago
But GOP senators balked when Democrats proposed delaying a new temporary fee on everyone covered by health insurance.
So employers, insurance companies and other health plan sponsors are in line to pay $63 a person next year for everyone who has coverage. The temporary fee covers all workers, spouses and dependents covered by health insurance.
Senate Majority Leader Harry Reid, D-Nev., proposed delaying the fee in recent budget talks with Senate Republican leader Mitch McConnell of Kentucky. McConnell and other Republican senators objected; the fee was left intact.
GOP senators complained the delay was basically a favor for labor unions, traditional Democratic allies that oppose the new fee.
"It's beyond ironic that the mantra from the president and the Democrats has been, 'There can't be any changes to Obamacare. After all, it's the law of the land,'" said Sen. Pat Toomey, R-Pa. "And then big labor comes along and wants a change and, lo and behold, there's got to be a change."
But also opposing the fee are large employers, traditional Republican allies, even though in many cases the fee probably will be passed on to workers.
"It's a sizable expense. For some of my employers it's millions of dollars a year and we don't get anything from it," said Gretchen Young, senior vice president for health policy at the ERISA Industry Committee, a group that represents large employers on benefits issues. "It's definitely not solely a union issue."
View gallery."Graphic shows several examples of how health coverage might change for different people; 6c x 10 inc …Sen. Ben Cardin, D-Md., said the proposed delay was meant to balance Republican demands for other changes to the health law. Republicans in Congress have been attacking the law since it was passed in 2010, and earlier this month, they forced a partial government shutdown over Obama's refusal to negotiate changes.
Cardin said he didn't want any changes in the law to be part of the deal for reopening the government and extending the country's ability to borrow. In the end, the only change was an income verification procedure for people applying for tax credits to help them purchase health insurance.
The temporary fee on people with health insurance is designed to raise $25 billion over the next three years.
The money will provide a cushion for insurers from the initial hard-to-predict costs of covering previously uninsured people with medical problems. Under the law, insurers will be forbidden, effective Jan. 1, 2014, to turn away applicants who are ill.
Insurance companies hit by unexpectedly high costs for insuring people with medical conditions will be able to tap the fund, which will be administered by the Department of Health and Human Services. The fund will mainly benefit companies participating in state-based health insurance exchanges.
The fee will total $12 billion in 2014, $8 billion in 2015 and $5 billion in 2016. That means the per-head assessment would be smaller each year, around $40 in 2015 instead of $63.
It is being assessed on all "major medical" insurance plans, including those provided by employers and those purchased individually by consumers. About 150 million workers, spouses and dependents are covered under employer-sponsored health plans.
Large employers will pay the fee directly. That's because major companies are usually self-insured, with the health insurance company that workers deal with basically acting as an agent administering the plan.
View gallery."Health and Human Services Secretary Kathleen Sebelius, left, talks with Dr. Norma Parra, right, afte …Unions that operate multi-employer health plans also will pay the fee. More than 20 million union workers and family members are covered by such plans.
These unions and large employers argue that they shouldn't have to pay the fee because they won't benefit from the fund.
The AFL-CIO passed a resolution at its convention this year calling for the fee to be repealed. Large employers are fighting the fee, too. But, Young noted, the political atmosphere in Congress, especially when it comes to the health care law, will make it difficult to win any changes.
"The Affordable Care Act is now kind of a third rail," said Young, referring to the law's formal name. "If it wasn't before, it is even more so now."
With Medigap, once you sign up for a plan upon first joining Medicare, it can be hard to switch plans later because outside of when you first enroll, Medigap plans can turn you down or charge you extra if you have pre-existing conditions. (Note that this is not changing with the new health law, because the law does not apply to "supplemental" plans like Medigap.)
If you look more closely you will see that this Medicare Advantage is designed to get people out of the public plan and into the private one. Even the name makes you believe it is the public one. Look closely as this industry tries to lure you away from the public Medigap with sweeteners that will be offset by huge costs----which is the point. When Obama and neo-liberals shouted that pre-existing conditions would be covered they failed to mention that Medigap -----the public supplement plan will not.
The Affordable Care Act is a disaster for health care access for most people and the pols pitching it are neo-liberals running as democrats. RUN AND VOTE FOR LABOR AND JUSTICE!
Is Medicare Advantage the same as Medigap?
October 15, 2013 8:30 PM
Q. Is Medicare Advantage the same as Medigap?
A. This is probably the most common question I get from people about Medicare. And it's especially common now, with Medicare open enrollment starting today and running through December 7. The answer: No. They are in no way, shape, or form the same thing, and confusing them can in some circumstances lead to tears.
Medigap plans, also called Medicare supplements, are a way for you to fill in some of the holes in Medicare Part A (hospitals) and Medicare Part B (doctors and other outpatient treatments). Those two together are often called "Original Medicare." In Original Medicare, your medical providers send bills for your care to the government, and the government pays, minus deductibles and coinsurance that you're responsible for paying out of your own pocket. Medigap plans cover all or most of those out-of-pocket costs, which can be substantial if you need a lot of health care. You can sign up for Medigap plans when you first enroll in Medicare. Here's our advice on how to find and price a Medigap plan.
Medicare Advantage plans are simply a different way for you to get your Medicare Part A and B benefits. Instead of getting them directly through Medicare, you get them instead through private insurance companies. You'll have a private insurance card, your providers will bill the insurance company, not Medicare, and if you owe anything out of pocket, the bill will come from the insurance company, not Medicare. To find a Medicare Advantage plan, use Medicare.gov's Medicare Plan Finder. Also check the rankings of Medicare Advantage plans from the National Committee for Quality Assurance (NCQA) on our website. Note that if you have Medicare Advantage you can not buy a Medigap plan to cover out-of-pocket expenses. In fact, if you have a Medicare Advantage plan, it is against the law for an insurance company to sell you a Medigap plan.
Health reform countdown: We are doing an article a day on the new health care law until Jan. 1, 2014, when it takes full effect. (Read the previous posts in the series.) To get health insurance advice tailored to your situation, use our Health Law Helper.
Here are some important things to know about Medicare Advantage vs. Medigap.
Enrollment: You can switch Medicare Advantage plans every year at open enrollment. With Medigap, once you sign up for a plan upupon first joining Medicare, it can be hard to switch plans later because outside of when you first enroll, Medigap plans can turn you down or charge you extra if you have pre-existing conditions. (Note that this is not changing with the new health law, because the law does not apply to "supplemental" plans like Medigap.)
Premiums: Medicare Advantage plans charge the same premium to everyone. Medigap premiums can vary greatly depending on the age at which you bought the plan, how long you have had it, and the state of your health.
Providers: Medicare Advantage plans cover care only from providers in their networks. If you go to an out-of-network provider, you can get stuck with a big bill, like the reader who once sent me an indignant email demanding to know why Medicare had stopped covering cataract surgery. It hadn't, of course; the reader had made the very expensive mistake of not realizing she had a network-restricted Medicare Advantage plan. If you stay in Original Medicare, you can go to any provider that accepts Medicare (which is practically all of them), and your Medigap plan will automatically pay all or most of whatever original Medicare did not, depending on the specific type of Medigap plan you hae.
In the next few weeks we'll be discussing some of the ins and outs of Medicare Advantage and Medigap. Which you will never mix up again, right?
Got a question for our health insurance expert? Ask it here. It helps if you include the state you live in.
— Nancy Metcalf