cronewitch
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Post by cronewitch on Jun 28, 2012 12:28:34 GMT -5
I haven't read the bill but my boss said our insurance is too good and we will need to reduce coverage or pay a penalty. I like our current company policy we pay a 30 co pay but get about $500 in free services a year like mammograms or lab test, the we pay a $3,000 copay so we are inventivised to not waste services. I just had a blood draw to check vitamin D level and had to sign saying I knew it wasn't covered so will cost me 85.05 and have spent around $1K so far this year on health care with good coverage. I will only used needed services because it is costing me money but not so much I won't get what I need.
I don't really like having young adults covered by parents until 26 that will cost insurance companies money they pass on to employers. Currently when a kid is done with college we can drop the parent plan from family to single or married saving hundreds a month. At 26 they should have been on their own long enough to pay for themselves or get a job with coverage. How does it work when the adult child is married and has children yet still covered by parents? Are the grandchildren covered too? My coworker was 18 when she had her oldest and her parents covered her baby for a year but then she was expected to grow up and get a job, would this mean her parents had to cover her son until he was 8?
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shanendoah
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Post by shanendoah on Jun 28, 2012 12:28:37 GMT -5
For those of you who don't know- Medicare already has regulations in place that require people to meet specific criteria in order to get some treatments- including dialysis. These criteria have been in place for YEARS. There is nothing in the healthcare law that has said anything about changing the criteria the Center for Medicare Services uses to determine who qualifies for what treatment. A person who needs dialysis is still going to get dialysis.
As another note ALL insurance companies currently review claims based on criteria. HMOs/MCOs review before the service is received. Other insurance reviews it after. But they all review it (at least the really high cost stuff). And they all have the right to deny coverage based on Medical Necessity and efficacy of the treatment. This happens NOW. This is not a change. This is not new. No one who qualifies for care NOW is suddenly going to be denied care.
In addition, the Pre-Existing Conditions (PEC) clauses have already gone into effect, just like the clauses that expanded how long young adults could remain on their parents' policies. But again, something people who don't work in healthcare don't really know- if you have employer sponsored insurance, you already aren't denied for PEC. PEC pretty much only comes up when you are looking at individual and family plans. In addition, managing PEC is a PITA to insurance companies. It costs as much or more to investigate and to fight and to track and administer PEC policies as it does to just pay for PECs. (I've actually been the analyst responsible for putting some of these numbers together, so while I can't provide you the specifics, I've done the math myself.) Many insurance companies were already looking at moving away from PEC clauses since they not only are a pain to administer and often don't break even, they cost the company quite a bit in terms of public relations, as well.
And Romney's campaign poster didn't just say "Repeal" - it said "Repeal and Replace". If the Republicans can come up with a better way to help make sure all Americans have access to affordable health care, I'm fine with that. Refine, revise, even replace, as long as you make it better. But it does need to be better- not just better than the current state, but better than the ACA. Everyone deserves affordable healthcare. As someone else said, breathing is a necessity. We shouldn't limit who gets to continue doing so based on their financial status.
And, as a bone to the Republicans, I'm reading opinions that state by upholding it as a Tax, and not part of the Commerce Clause, John Roberts actually handed the Republicans a longer term major win by limiting the power of Congress to act via the Commerce Clause.
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justme
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Post by justme on Jun 28, 2012 12:31:14 GMT -5
Isn't it the YM credo, or maybe it was just someone like Phil, that the really wealthy have enough money to self insure? I mean, realisitically, if I make $10M and don't feel like buying health insurance, the only way paying $100k in a tax would incentivize me is whether I could get insurance the would get me out of the fine for less than the fine. And that would only be under the notion of saving money.
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justme
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Post by justme on Jun 28, 2012 12:33:40 GMT -5
He's against it now because it is politically expedient. par for the course with him, actually. if anyone expects otherwise, they will be sadly disappointed if he is elected. Because Obama never does anything politically expedient.
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Rocky Mtn Saver
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Post by Rocky Mtn Saver on Jun 28, 2012 12:36:11 GMT -5
Isn't it the YM credo, or maybe it was just someone like Phil, that the really wealthy have enough money to self insure? I mean, realisitically, if I make $10M and don't feel like buying health insurance, the only way paying $100k in a tax would incentivize me is whether I could get insurance the would get me out of the fine for less than the fine. And that would only be under the notion of saving money. In order to make the whole thing work and hopefully reduce costs, the health care system needs as many people as possible in the pool to share the costs. This was the point of the individual mandate. So I understand why it's necessary to make a sufficient penalty part of the process. High income people who really don't want to participate can just pay a portion of those pooled costs in the form of a tax and self-insure all they want.
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shanendoah
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Post by shanendoah on Jun 28, 2012 12:36:22 GMT -5
Crone: Kids can only still be covered by their parents' plan while they are unmarried, without dependents, and in school. It is not blanket coverage until age 26. It's coverage for kids who take a little longer to graduate, or who go on to graduate school. It covers the young people who are most likely not to have any coverage at all. They are one of the smallest risk groups for insurers (much more likely to have one time injuries than chronic illnesses, etc as a whole). A 22 year old who gets married is no longer eligible for coverage on their parents' plan. A 19 year old who has a child of their own is no longer eligible for coverage on their parents' plan (unless they give the child up for adoption, therefore maintaining their status as not having dependents). If their parents become guardians of the grandchild, then yes, the kid and grandkid are still covered, but that's becuase the grandparents decided to be legally responsible for the grandchild. A 23 year old who has graduated from college and is working full time is not eligible for coverage under their parents' plan.
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shanendoah
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Post by shanendoah on Jun 28, 2012 12:37:56 GMT -5
All politicians act in politically expedient ways. It's what happens when you have a professional class of politicians.
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Sum Dum Gai
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Post by Sum Dum Gai on Jun 28, 2012 12:39:22 GMT -5
Don't they teach logical thinking in colleges anymore? There are like ten people on this thread talking about how companies are going to drop coverage because the fine is cheaper. Let's think about that for a second. Right now they can offer coverage which costs a lot, or not which costs nothing. After this law goes into effect they can offer coverage which costs a lot, or not, which costs a little.
If all these companies were only worried about the bottom line none of them would offer coverage now, which wouldn't cost them a single cent. After the law they'd have to pay a fine for dropping coverage. Put on your logical thinking cap for two seconds here, why in the sam hell would a company wait until after this law goes into effect to drop coverage? It doesn't make a lick of sense. If they were that greedy you wouldn't have coverage now. You never would have had employer coverage in the first place.
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Sharon
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Post by Sharon on Jun 28, 2012 12:41:23 GMT -5
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Sum Dum Gai
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Post by Sum Dum Gai on Jun 28, 2012 12:46:01 GMT -5
I highly doubt that they would actually drop the rates, at the most they would keep the rates the same and pocket even more money. They aren't allowed too. That's part of the law. Health insurance companies have to spend at least 80% of the premiums they take in on treatment. Their entire overhead, salaries, marketing, compliance, etc, etc, and their profits have to come out of the remaining 20%. The fine if they're found to be outside those limits is huge. This thing has only been public for like two years. I'll give you pass for apparently not looking up a single article on the topic yet. Geez.
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movingforward
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Post by movingforward on Jun 28, 2012 12:47:02 GMT -5
Don't they teach logical thinking in colleges anymore? There are like ten people on this thread talking about how companies are going to drop coverage because the fine is cheaper. Let's think about that for a second. Right now they can offer coverage which costs a lot, or not which costs nothing. After this law goes into effect they can offer coverage which costs a lot, or not, which costs a little. If all these companies were only worried about the bottom line none of them would offer coverage now, which wouldn't cost them a single cent. After the law they'd have to pay a fine for dropping coverage. Put on your logical thinking cap for two seconds here, why in the sam hell would a company wait until after this law goes into effect to drop coverage? It doesn't make a lick of sense. If they were that greedy you wouldn't have coverage now. You never would have had employer coverage in the first place. Well, that is my thought exactly but some people are like chicken little and think the sky is falling which is exactly what politicians and the media love. Both political parties (one in particular) often uses fear to invoke irrational thoughts against the other party in order to get votes.
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justme
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Post by justme on Jun 28, 2012 12:47:29 GMT -5
I looked into it when craziness was going on at work and I might be laid off due to contract issues. At 25 I could go back on my parents insurance even if I wasn't living with them or going to school.
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NomoreDramaQ1015
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Post by NomoreDramaQ1015 on Jun 28, 2012 12:50:12 GMT -5
Don't they teach logical thinking in colleges anymoreWhere have you been? I thought it has been established is that all colleges do is brainwash young people into believing the liberal agenda.
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shanendoah
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Post by shanendoah on Jun 28, 2012 12:51:18 GMT -5
And again- a lot is based on state law. In my state, no health insurance company is allowed to be a for profit entity. All health insurance providers must maintain not for profit status. However, depending on how many lives they cover, health insurance companies are also required to maintain massive reserves, so when reserves are listed, it often seems likes the companies' have too much money, but the levels of their reserves are mandated by law.
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Deleted
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Post by Deleted on Jun 28, 2012 12:52:36 GMT -5
Don't they teach logical thinking in colleges anymoreWhere have you been? I thought it has been established is that all colleges do is brainwash young people into believing the liberal agenda. DEATH TO THE PROLETARIAT!!!!
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Sum Dum Gai
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Post by Sum Dum Gai on Jun 28, 2012 12:54:03 GMT -5
Where have you been? I thought it has been established is that all colleges do is brainwash young people into believing the liberal agenda. Now that you mention it I do remember hearing that a lot. I wouldn't know since I never really went. It does make you wonder though if college is only good for brainwashing kids with the liberal agenda why is YM so hell bent on making sure everyone goes? Hmmm... those commies!
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justme
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Post by justme on Jun 28, 2012 12:54:47 GMT -5
I highly doubt that they would actually drop the rates, at the most they would keep the rates the same and pocket even more money. They aren't allowed too. That's part of the law. Health insurance companies have to spend at least 80% of the premiums they take in on treatment. Their entire overhead, salaries, marketing, compliance, etc, etc, and their profits have to come out of the remaining 20%. The fine if they're found to be outside those limits is huge. This thing has only been public for like two years. I'll give you pass for apparently not looking up a single article on the topic yet. Geez. Do you know what the current overhead is for health insurance companies? I've only seen things that speak to their profits, which is around 3%. It'd be interesting to find out how much their over head is right now and if they're grossly over 20% it'll be interesting to see what effect having to meet that 20% will have.
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shanendoah
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Post by shanendoah on Jun 28, 2012 12:55:11 GMT -5
My company must have done the original expansion of coverage based on the grandfather laws. My bad.
However, it is pretty clear that a if a 22 year old has a child of their own, they are not eligible to be on their parents' plan.
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Sharon
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Post by Sharon on Jun 28, 2012 12:57:01 GMT -5
Actually the 22 year old can be on their parents plan the grandchild can not. We have encountered this situation.
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Sum Dum Gai
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Post by Sum Dum Gai on Jun 28, 2012 12:59:40 GMT -5
Do you know what the current overhead is for health insurance companies? I've only seen things that speak to their profits, which is around 3%. The only thing I remember from the Wall St Journal article on it was these health insurance company executive crying because there was no way they could meet that without huge cuts to their advertising budget which would cripple their business. I never did quite get the logic. Stop spending so much money on advertising, and you'd be able to lower rates while still keeping your profits the same, which would bring in customers without you spending a fortune chasing them. Seemed pretty simple to me, but I'm sure it's more complex than that and I'm just too stupid to grasp it all.
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Peace Of Mind
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[font color="#8f2520"]~ Drinks Well With Others ~[/font]
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Post by Peace Of Mind on Jun 28, 2012 13:02:32 GMT -5
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chiver78
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Post by chiver78 on Jun 28, 2012 13:06:27 GMT -5
par for the course with him, actually. if anyone expects otherwise, they will be sadly disappointed if he is elected. Because Obama never does anything politically expedient. did I make a claim about Obama in any way? I don't see anything about him in my post. do not put words in my mouth. I'm just pointing out to those that think Romney will save the day that he is more likely to change his mind as the wind blows like he did here in MA. sent from my electronic distraction
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Rocky Mtn Saver
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Post by Rocky Mtn Saver on Jun 28, 2012 13:06:35 GMT -5
Agreed that the penalties aren't designed to be prohibitive or overly-burdening. 1% to (eventually) 2.5% of income isn't designed to bankrupt people, but rather to incentivize.
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Deleted
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Post by Deleted on Jun 28, 2012 13:10:17 GMT -5
Wow. P&M is being so civil about this ruling, and YM is havingthe heated exchange. Everything is surprising me today.
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Poptart
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Post by Poptart on Jun 28, 2012 13:10:31 GMT -5
As the daughter of a woman who died of cancer, and who did not get proper treatment because she could not afford it and as a sister to a young woman with a serious medical condition, one that has led to months spent in hospital rooms I'm all for Obamacare. One of the things that has always scared me is what would happen to her as an adult, would she even be able to get health care or would she be rejected because of her past medical history? And if she did get coverage would she be able to afford it? I'm glad that at least now she has a shot at getting coverage!
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movingforward
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Post by movingforward on Jun 28, 2012 13:12:25 GMT -5
I believe the basis of the law is more about allowing those who need & want health insurance to have access to it rather than punishing those who don't. I don't think it is a perfect law but you have to start somewhere...
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Rocky Mtn Saver
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Post by Rocky Mtn Saver on Jun 28, 2012 13:13:30 GMT -5
I believe the basis of the law is more about allowing those who need & want health insurance to have access to it rather than punishing those who don't. I don't think it is a perfect law but you have to start somewhere... Agreed!
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Deleted
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Post by Deleted on Jun 28, 2012 13:19:15 GMT -5
They've been doing this for decades (cigarette and alcohol tax). They also have the power to lower your taxes if you do something they DO like (have kids, buy a house). This is nothing new. This is funny as I've never paid a cigarette tax in my life. Of course the government hasn't mandated that I buy cigarettes. Is that coming?
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Deleted
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Post by Deleted on Jun 28, 2012 13:20:21 GMT -5
I don't see it as that different from car insurance. I am required to carry car insurance but as long as I don't hit anyone/thing then there really isn't a penalty if I DON'T carry it, but once I do hit someone then all hell is going to break loose. I know lonewolf has brought this up, but if you didn't have a car would you still purchase car insurance? I doubt it.
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chiver78
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Post by chiver78 on Jun 28, 2012 13:22:39 GMT -5
I believe the basis of the law is more about allowing those who need & want health insurance to have access to it rather than punishing those who don't. I don't think it is a perfect law but you have to start somewhere... very well said! as I said somewhere else, it's not perfect but it's a step in the right direction.
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