Congresswoman Cathy McMorris Rodgers (R-Washington) had a great idea to document just how horrible Obamacare has been for Americans: She went to her Facebook page , posted a chart that doesn't merely lie about the ACA but also makes no logical sense (a bullet point list of lies would at least look sensible, but a
She probably knew she'd get these (to her) horror stories, but thought there would be a residue of good stories she could use, from good honest Americans who all misspell the same three words the same way. Her error was not realizing that in such a public forum, people can actually see what's being said. Apparently that's something they don't teach in Republican School.
While I am one of those that believe ACA has been a success thus far, I am wondering where the horror stories are regarding high deductibles.
The Facebook replies talk of American's finally getting covered, but what good is being covered when that $350 office visit falls under their $7,000 annual deductible? To me that's as good as not being covered at all, yet I haven't read any stories about this anywhere.
Marc Jordan: You need to get educated about how health insurance works. A doctor may start out charging $350, but that's not how it ends up. If he accepts the insurance, he has to take the plan-negotiated rate and write off the rest, a steep deduction from the "sticker price." Next, the insurance company picks up and pays its assigned share (60%, 70%, 80%, or 90%, depending on whether the plan is "bronze," "silver," "gold," or "platinum," as they're called under ACA. So that's another steep reduction. Finally, the patient pays only the designated remaining percentage under his/her plan.
You apparently believe that your hypothetical patient has to pay the full $350, and insurance coverage only kicks in when the annual deductible limit is reached. Nothing could be further from the truth. Don't spend your time spreading ignorance. Do some research and learn the facts.
I for one can give a "horror story" for the ACA, but I am going to say right now that I am not for or against it, nor am I anti Obama or anything else people will gleefully slap onto anything I say in order for it to fit into their own personal opinions of any of it. This is simply what it has meant for me.
I had a PPO that, while it was not a comprehensive policy it did cover 100% of hospitalization, labs and radiology, surgeries (both in and out patient) along with home care provisions after a $3,500 deductible had been met. I also had prescription drug coverage with a $10/30 co-pay on medications. I was allowed one doctor visit a year, anything above that I paid for out of pocket, which was only $55 to see an internal medicine doctor and $80 to see my cardiologist. Not a big deal since I only saw my PCP twice a year and my cardiologist three times a year as my conditions were stable and well managed. All in all the policy I had was more a major medical coverage plan with prescription drug benefits. Then along came the ACA and suddenly this policy did not meet the governments minimum requirements for coverage so it was terminated. After nearly six months of dealing with signing up, re-signing up and eventually having to get a health care advocate to deal with it for me because the website was either constantly crashing, losing my account or altering information such as changing gender or suddenly there were 240 people in my household (that was the most amusing glitch), it was just a hassle to try and simply get signed up.
Then came the sticker shock. I was paying $189 a month for the plan that I had....granted I had that plan since I was 19 (I'm now 40) and the rates have gone up steadily as I've aged, but I nearly had a heart attack when the ACA gave me my choices of plans. Interestingly enough I qualified for Medicaid with my state or, I could pick from one of a total of six plans they had for me. The lowest cost plan of the group would have me paying $1673 a month, with the highest cost plan being over $2200 a month. Where they expect me to come up with that kind of cash, a house payment, property taxes, car insurance, house insurance, food, utilities and any other standard cost of living fees is beyond me. So, my choice was Medicaid.
Now that I was forced to Medicaid, I have a choice of five doctors who accept Medicaid and who are accepting new patients. The average wait time for an appointment is 3-5 months as opposed to 2-3 days with my former doctor. My health has spiraled downward and resulted in two hospital stays lasting over five days each in ICU because the new doctor and cardiologist have no idea how to treat my conditions, constantly screw with medication because they wont file for pre-authorization of medications I was taking that Medicaid wont otherwise pay for. Mind you that previously I had not been in the hospital since 2001, now I frequent the ER and have had two extended stays in the hospital....and guess what, the feds and tax payers are footing my bill now because none of this costs me a cent. Everything is 100% free.
What have I done, well I decided the hell with this and I am just going to play the system. I found one doctor who takes Medicaid who is a "yes man" doctor. If I come in with suggestions from other doctors, he will do them. So, I have started seeing my old PCP and old cardiologist as a cash pay patient...still $55 and $80, have gotten back on the medications I was on prior (though, two of them I order from India as Medicaid refused to pay for them for any reason and its 1/3 the cost of buying them in the States). So now I just see my old doctors, have my "yes man" doctor order the tests the other doctors want and let Medicaid and tax payers foot the bill.
If the feds wont let me have health care plans and coverage that is affordable, give me a choice of doctors who aren't one step above med school drop outs and prescription coverage of all medications like I had before, then that's fine. I'll let them pick up the tab for me.
I'm not alone in this. I know hundreds of friends, coworkers, business associates and professionals who have opted to just pay the fine and not have any insurance coverage because they don't want to deal with the nightmare that it inflicts, and in many cases doctors, labs and other medical facilities are willing to cut you steep discounts (often lower than co-pays for procedures) if you pay with cash.
So while yes, it may have given coverage to millions without any...it's also lowered the standard of care below that of a third world country in the process.
Howard, you may not believe me but I've been working in the health insurance industry for the past 30 years and know how it works quite well as I'm responsible for negotiating provider contracts. I am well aware that the $350 billed charge is reduced by (on average) 1/3 of that, called the "Allowed" amount in industry terms. Add to the mix concepts such as RBRVS and local adjustment schemes and you get to the final amount that the plan will pay the provider.
Now then, my point was that when Mr. X goes to the doctor and the doctor bills the carrier for the encounter (it's not called a "visit" in insurance speak), the physician will bill the usual and customary amount of $350 of which, as you said, expect to get about 1/3 of that, or about $116.00. The patient is responsible for that $116 until he fulfills his deductible.
My question is, there are a lot of American's that find themselves with a serious ailment and will need to seek treatment which will cost tens of thousands. My point is, how many of them could afford to layout the first $7,500?
Also, you need a lesson on the different plans. The 60,70 80% applies to how much the plan will pay towards the claim once you satisfy the deductible. For example, if the negotiated amount for a $300 visit is reduced to $100, the plan will pay (for example) 70% or $70. You as the patient will be responsible for paying the provider the remaining $30. I can't believe how wrong you got this part of the equation. Let me reiterate, the health plan will not pay one red cent until you meet the $7500 deductible. Not one penny.
I find it almost laughable that you don't know how deductibles work, and you are calling me "ignorant".
Finally, I don't expect you to reply to this since it shows just how uneducated you are on the matter, but it made me feel better getting it off my chest.
While your story is comprehensive, some things don't make sense to me. You said that you were on a PPO and that hospitalization was covered 100%. By it's very nature of a PPO vs HMO, PPO's do not cover anything at 100%, it's typically a 70/30 or 80/20 arrangement. So that statement has me perplexed.
Next you said that the plan offered under ACA was going to cost $1,673 a month, but in your next breath you said you qualified for Medicaid, I assume due to income. My question here is why you didn't qualify for a subsidy which would have brought the $1,673 premium down to approx $200 a month.
Read more carefully and your questions would have been answered. The PPO plan pays 100% -after- a $3500 deductible was met.
"I had a PPO that, while it was not a comprehensive policy it did cover 100% of hospitalization, labs and radiology, surgeries (both in and out patient) along with home care provisions after a $3,500 deductible had been met."
As I also said, this was a more a major medical plan, which is not a standard PPO health insurance plan, they work a lot differently than your standard health care plan in that they really only cover major medical and not all of your typical outpatient office visits, outpatient labs and other exams. I got this plan back in 1997 when they offered the addition of prescription coverage for an extra fee a month (the newer plans didn't have any provisions for that)
As far as a Medicaid vs. normal plan with a subsidy, when I applied it gave me two choices, the high premium traditional plans or "you may qualify for Medicaid with your state" plan. After seeing the costs of the plans I went to my states website and I did qualify for Medicaid based on # of people in the house and income of the household. But because it was such a nightmare, I decided to go through the sign up agents that were offered at no cost, so I could wade through all the red tape and nonsense. After seeing two different health insurance agents, if I was to take a ACA paid plan, the very best I would be paying out of pocket (after subsidies) was still upwards of $800 a month for the ACA nonsense. Even having my CPA do my taxes this year, I would have ended up in a huge hole due to the ACA BS and "dance around" laws (as the CPA called them) that negated a lot of the benefits of the subsidies anyways.
DM. With respect, that still doesn't make sense. My wife and I have an income of around $30,000 and don't qualify for medicaid -- which would be, I think, below $20,000 in California (but haven't checked). Still, our subsidized premiums for a Silver Plan is $107/month. This vs. the $1,100/month I was paying for a high deductible pre-ACA plan two years ago. Also, it defies logic that you know "hundreds" of people who are just going to pay the fine. You must live in a particularly unrepresentative area. Most have health insurance through work. Those that don't have signed up for ACA policies in the millions. Basically, I don't believe that. Finally, I just don't see where your "red tape" nonsense comes from. The web interface worked fine for me, no crashes, and it was really straightforward. Enter number in household under policy; enter ages; enter income. It spits out plans and prices. It's really not that hard. If you qualify for medicare, your premiums shouldn't be that high.
I think you need to drop those agents and try again.
Is that what they mean when they talk about "alternate energy sources"?
And if he can't find one, he's under orders to write one himself.
No wonder Final Cut Pro sells so well.
Our shitty governor in Maine, as well.
She probably knew she'd get these (to her) horror stories, but thought there would be a residue of good stories she could use, from good honest Americans who all misspell the same three words the same way. Her error was not realizing that in such a public forum, people can actually see what's being said. Apparently that's something they don't teach in Republican School.
(Sorry: Skool)
While I am one of those that believe ACA has been a success thus far, I am wondering where the horror stories are regarding high deductibles.
The Facebook replies talk of American's finally getting covered, but what good is being covered when that $350 office visit falls under their $7,000 annual deductible? To me that's as good as not being covered at all, yet I haven't read any stories about this anywhere.
That was so funny to see those MULTIPLE reports of those Kentuckians who swore that Kentucky Connect was "ten thousand times better than ObamaCare."
We all have had to deal with it now and half the country wants it repealed.
Marc Jordan: You need to get educated about how health insurance works. A doctor may start out charging $350, but that's not how it ends up. If he accepts the insurance, he has to take the plan-negotiated rate and write off the rest, a steep deduction from the "sticker price." Next, the insurance company picks up and pays its assigned share (60%, 70%, 80%, or 90%, depending on whether the plan is "bronze," "silver," "gold," or "platinum," as they're called under ACA. So that's another steep reduction. Finally, the patient pays only the designated remaining percentage under his/her plan.
You apparently believe that your hypothetical patient has to pay the full $350, and insurance coverage only kicks in when the annual deductible limit is reached. Nothing could be further from the truth. Don't spend your time spreading ignorance. Do some research and learn the facts.
I for one can give a "horror story" for the ACA, but I am going to say right now that I am not for or against it, nor am I anti Obama or anything else people will gleefully slap onto anything I say in order for it to fit into their own personal opinions of any of it. This is simply what it has meant for me.
I had a PPO that, while it was not a comprehensive policy it did cover 100% of hospitalization, labs and radiology, surgeries (both in and out patient) along with home care provisions after a $3,500 deductible had been met. I also had prescription drug coverage with a $10/30 co-pay on medications. I was allowed one doctor visit a year, anything above that I paid for out of pocket, which was only $55 to see an internal medicine doctor and $80 to see my cardiologist. Not a big deal since I only saw my PCP twice a year and my cardiologist three times a year as my conditions were stable and well managed. All in all the policy I had was more a major medical coverage plan with prescription drug benefits. Then along came the ACA and suddenly this policy did not meet the governments minimum requirements for coverage so it was terminated. After nearly six months of dealing with signing up, re-signing up and eventually having to get a health care advocate to deal with it for me because the website was either constantly crashing, losing my account or altering information such as changing gender or suddenly there were 240 people in my household (that was the most amusing glitch), it was just a hassle to try and simply get signed up.
Then came the sticker shock. I was paying $189 a month for the plan that I had....granted I had that plan since I was 19 (I'm now 40) and the rates have gone up steadily as I've aged, but I nearly had a heart attack when the ACA gave me my choices of plans. Interestingly enough I qualified for Medicaid with my state or, I could pick from one of a total of six plans they had for me. The lowest cost plan of the group would have me paying $1673 a month, with the highest cost plan being over $2200 a month. Where they expect me to come up with that kind of cash, a house payment, property taxes, car insurance, house insurance, food, utilities and any other standard cost of living fees is beyond me. So, my choice was Medicaid.
Now that I was forced to Medicaid, I have a choice of five doctors who accept Medicaid and who are accepting new patients. The average wait time for an appointment is 3-5 months as opposed to 2-3 days with my former doctor. My health has spiraled downward and resulted in two hospital stays lasting over five days each in ICU because the new doctor and cardiologist have no idea how to treat my conditions, constantly screw with medication because they wont file for pre-authorization of medications I was taking that Medicaid wont otherwise pay for. Mind you that previously I had not been in the hospital since 2001, now I frequent the ER and have had two extended stays in the hospital....and guess what, the feds and tax payers are footing my bill now because none of this costs me a cent. Everything is 100% free.
What have I done, well I decided the hell with this and I am just going to play the system. I found one doctor who takes Medicaid who is a "yes man" doctor. If I come in with suggestions from other doctors, he will do them. So, I have started seeing my old PCP and old cardiologist as a cash pay patient...still $55 and $80, have gotten back on the medications I was on prior (though, two of them I order from India as Medicaid refused to pay for them for any reason and its 1/3 the cost of buying them in the States). So now I just see my old doctors, have my "yes man" doctor order the tests the other doctors want and let Medicaid and tax payers foot the bill.
If the feds wont let me have health care plans and coverage that is affordable, give me a choice of doctors who aren't one step above med school drop outs and prescription coverage of all medications like I had before, then that's fine. I'll let them pick up the tab for me.
I'm not alone in this. I know hundreds of friends, coworkers, business associates and professionals who have opted to just pay the fine and not have any insurance coverage because they don't want to deal with the nightmare that it inflicts, and in many cases doctors, labs and other medical facilities are willing to cut you steep discounts (often lower than co-pays for procedures) if you pay with cash.
So while yes, it may have given coverage to millions without any...it's also lowered the standard of care below that of a third world country in the process.
This isn't about making anyone's life better. It is about politics and failed ideas.
ACA or Obamacare or what not, have made things better.
Howard, you may not believe me but I've been working in the health insurance industry for the past 30 years and know how it works quite well as I'm responsible for negotiating provider contracts. I am well aware that the $350 billed charge is reduced by (on average) 1/3 of that, called the "Allowed" amount in industry terms. Add to the mix concepts such as RBRVS and local adjustment schemes and you get to the final amount that the plan will pay the provider.
Now then, my point was that when Mr. X goes to the doctor and the doctor bills the carrier for the encounter (it's not called a "visit" in insurance speak), the physician will bill the usual and customary amount of $350 of which, as you said, expect to get about 1/3 of that, or about $116.00. The patient is responsible for that $116 until he fulfills his deductible.
My question is, there are a lot of American's that find themselves with a serious ailment and will need to seek treatment which will cost tens of thousands. My point is, how many of them could afford to layout the first $7,500?
Also, you need a lesson on the different plans. The 60,70 80% applies to how much the plan will pay towards the claim once you satisfy the deductible. For example, if the negotiated amount for a $300 visit is reduced to $100, the plan will pay (for example) 70% or $70. You as the patient will be responsible for paying the provider the remaining $30. I can't believe how wrong you got this part of the equation. Let me reiterate, the health plan will not pay one red cent until you meet the $7500 deductible. Not one penny.
I find it almost laughable that you don't know how deductibles work, and you are calling me "ignorant".
Finally, I don't expect you to reply to this since it shows just how uneducated you are on the matter, but it made me feel better getting it off my chest.
While your story is comprehensive, some things don't make sense to me. You said that you were on a PPO and that hospitalization was covered 100%. By it's very nature of a PPO vs HMO, PPO's do not cover anything at 100%, it's typically a 70/30 or 80/20 arrangement. So that statement has me perplexed.
Next you said that the plan offered under ACA was going to cost $1,673 a month, but in your next breath you said you qualified for Medicaid, I assume due to income. My question here is why you didn't qualify for a subsidy which would have brought the $1,673 premium down to approx $200 a month.
Read more carefully and your questions would have been answered. The PPO plan pays 100% -after- a $3500 deductible was met.
"I had a PPO that, while it was not a comprehensive policy it did cover 100% of hospitalization, labs and radiology, surgeries (both in and out patient) along with home care provisions after a $3,500 deductible had been met."
As I also said, this was a more a major medical plan, which is not a standard PPO health insurance plan, they work a lot differently than your standard health care plan in that they really only cover major medical and not all of your typical outpatient office visits, outpatient labs and other exams. I got this plan back in 1997 when they offered the addition of prescription coverage for an extra fee a month (the newer plans didn't have any provisions for that)
As far as a Medicaid vs. normal plan with a subsidy, when I applied it gave me two choices, the high premium traditional plans or "you may qualify for Medicaid with your state" plan. After seeing the costs of the plans I went to my states website and I did qualify for Medicaid based on # of people in the house and income of the household. But because it was such a nightmare, I decided to go through the sign up agents that were offered at no cost, so I could wade through all the red tape and nonsense. After seeing two different health insurance agents, if I was to take a ACA paid plan, the very best I would be paying out of pocket (after subsidies) was still upwards of $800 a month for the ACA nonsense. Even having my CPA do my taxes this year, I would have ended up in a huge hole due to the ACA BS and "dance around" laws (as the CPA called them) that negated a lot of the benefits of the subsidies anyways.
I loved this! Brilliant, son, just brilliant!! I laughed so hard I woke up my girlfriend AND both the dogs. :-)
DM. With respect, that still doesn't make sense. My wife and I have an income of around $30,000 and don't qualify for medicaid -- which would be, I think, below $20,000 in California (but haven't checked). Still, our subsidized premiums for a Silver Plan is $107/month. This vs. the $1,100/month I was paying for a high deductible pre-ACA plan two years ago. Also, it defies logic that you know "hundreds" of people who are just going to pay the fine. You must live in a particularly unrepresentative area. Most have health insurance through work. Those that don't have signed up for ACA policies in the millions. Basically, I don't believe that. Finally, I just don't see where your "red tape" nonsense comes from. The web interface worked fine for me, no crashes, and it was really straightforward. Enter number in household under policy; enter ages; enter income. It spits out plans and prices. It's really not that hard. If you qualify for medicare, your premiums shouldn't be that high.
I think you need to drop those agents and try again.