From Nels New Day:
Health Care on the Chopping Block?
Just a couple of days after Sen. Mitch McConnell (R-KY) and Rep. John Boehner (R-OH) became leaders of the 114th Congress, they declared open season on health care for the poor and middle class. Their starting salvo was announced in a Wall Street Journal op-ed in which they began with eliminating benefits for workers employed fewer than 40 hours a week. In typical GOP-speak, they said that this change would provide employees with “more hours and better pay.” In 2013, 43.8 percent of all workers, 60.9 million people, were employed at 40 hours or more. The question is whether members of Congress would lose their insurance if health care guidelines change. The people wanting the increase in hours worked to get health care, congressional legislators, work about two days each week. They seem to be saying that they would work harder if they didn’t get health care unless they worked five days a week.
Conservatives have been jumping with joy ever since Jonathan Gruber, self-proclaimed architect of the Affordable Care Act, proclaimedthat it was the “stupidity of the American voter” that allowed the bill to become a law. Far from being an “architect,” Gruber served as a consultant to produce cost estimates of provisions and giving technical advice based on his overseeing similar reforms in Massachusetts. According to Gruber, Democrats kept the Congressional Budget Office from scoring the mandate as a tax and hide the provision that young and healthy beneficiaries would subsidize premiums for the sick.
Scoring the mandate as a “tax” would not have changed the estimate of increasing revenue by $4 billion in 2016 and approximately $5 billion per year for the next eight years. There was also no lack of transparency about everyone, healthy or sick, paying into the insurance, and the media incessantly covered this fact. AP reporter Erica Werner clearly explained that premiums varied only on age, geographic area, and tobacco use. The president told AARP in 2009 before the law was passed:
“[Y]ou get the healthy and the young people alongside the not-so-healthy and the older people. But we’re all kind of spreading our risk, because each of us don’t know at any given time what might happen.”
Gruber also complained that the law does little or nothing to control health care costs. Yet four years after the act passed, projections for health care in 2019 is $500 billion less than projected at the time that it passed. As costs increase in many other areas, a study of 48 urban areas shows an average 0.2 decrease in the “silver” plans. Costs seem to be all over the place from an increase of 28 percent in Anchorage (AK) to a reduction of 24 percent in Jackson (MS). At the same time, the government paid $104 billion less in 2014 subsidies than originally predicted. The country has seven million more people than insured before ACA, the government pays less than predicted, and the rise in healthcare costs has dramatically slowed.
Gruber has apologized for his statements, saying that they were just “off the cuff” at academic conferences. It may not be enough to save the millions of dollars that he was scheduled to make. Eight states hired Gruber to help design their health exchanges after he banked nearly $400,000 in 2009 through contracts with the Department of Health and Human Services. He and a few colleagues had state contracts for $1.6 million over seven years from Michigan ($481,000), Minnesota ($329,000), Vermont ($400,000) and Wisconsin ($400,000). He also advised Colorado, Connecticut, Maine and West Virginia.
Because of ACA’s requirement that insurers must spend at least 80 percent of premium costs on medical care, 6.8 million families are getting average rebates of $80 totaling almost $2 billion. That’s one reason premiums are being lowered. Subsidies are the other reason. If the Supreme Court denies these subsidies in states without state exchanges, people can see their insurance premiums increase by about 75 percent.
As people line up to register for health care this week, the U.S. Supreme Court may join the conservatives in Congress to kill off the law—and many people at the same time. Paul Krugman called the lawsuit to be argued this year as death by typo. The Supreme Court is set to determine if the word “state” in one sentence of the 2200-page law means that poor people won’t receive subsidies in the states that don’t have their own government-run marketplace. Krugman wrote:
“Judges who support this cruel absurdity aren’t stupid; they know what they’re doing. What they are, instead, is corrupt, willing to pervert the law to serve political masters.”
Over two decades ago, the conservatives supported single-payer health insurance, but that was before the Democrats accepted the idea. When Congress started working on the plan in the president’s early years, the Democrats attempted to mollify the GOP by incorporating their ideas into the law. After the GOP pushed the Democratic legislators in a corner, the law received only one GOP vote, a representative. Current problems show that single-payer health care would be the best for almost all the people in the United States.
Megan Rothbauer’s $50,000 bill is one example of why the U.S. needs a single-payer plan. Up-to-date on her insurance payments, the Wisconsin woman went into cardiac arrest and was unconscious when she was rushed to a hospital. The place where the ambulance took Rothbauer, 30, didn’t take her insurance although one three blocks away did. Unfortunately, she wasn’t able to tell them where they should take her. Without the Affordable Care Act, she would have owed another $100,000. A single-payer plan would have kept her from the possibly of becoming destitute, but Rothbauer is now facing bankruptcy. Blue Cross Blue Shield stated that the fault is with the hospital. The hospital stated that they could have charged her more but didn’t. Medical experts indicate that this is a common situation.
Even knowing what hospital is in a network doesn’t always help. When probate attorney Jeffrey Craig Hopper was smashed in the face with a baseball while coaching Little League in Austin (TX), his wife made sure she took Hopper to a hospital that is part of their insurance network. The ER doctor sent the couple a bill for more than $700; he could do this because he was outside the approved network of physicians. Again, this is fairly common: in more than half of Humana’s Texas hospitals, none of the ER doctors is within Humana’s network. The same situation goes for almost half the Texas hospitals with United Healthcare insurance and about a fifth of Blue Cross-accepting hospitals. Preparing for the next emergency, Jennifer Hopper couldn’t find even five doctors who would take their insurance at hospitals her plan uses in Austin.
For the fifth consecutive year, the United States, the richest nation in the world, ranked last in industrialized nation’s health care systems. The only industrialized nation without universal health care, the U.S. has the highest percentage of U.S. residents not seeking necessary medical care because they can’t afford it. Thirty-seven percent of Americans said they didn’t fill a prescription, visit a doctor, or get recommended medical care because they worried about the cost compared to only four percent of people in the United Kingdom.
The United States has the highest infant mortality and deaths possibly preventable with access to effective health care. It’s also at the bottom of “efficiency” because of the time and money spent dealing with insurance administration, lack of communication among health care providers, and duplicative medical testing. In “equity,” the 39 percent of adults with below-average incomes in the U.S. who could not visit doctors because of costs puts the U.S. also at the bottom, compared with the less than one in ten who have the problem in the UK, Sweden, Canada, and Norway. People in the U.S spent $8,508 per person on healthcare in 2011 compared to $3,406 per person in the UK, but the higher cost of health care in the U.S. doesn’t equate to better care.
The data that put the United States last was collected before ACA went into effect. Even if the Supreme Court destroys “Obamacare,” the nation many have a brief shining time of health care for residents in Democratically-controlled states. Even so, six million of the poorest residents lack health care if GOP states refuse to expand Medicaid. A negative Supreme Court decision could triple or quadruple that number.
In Oregon, Monica Wehby, the GOP candidate who just lost to Sen. Jeff Merkley, wants to be boss of the Oregon Health Authority. The day after the election, she called newly re-elected Democratic Gov. John Kitzhaber to ask for the job. The agency runs the state’s Medicaid program for 300,000 low-income Oregonians and may also administer Cover Oregon, the health insurance exchange, which Wehby wants to destroy. Her campaign slogan was “Keep Your Doctor. Change Your Senator.” Before she ran for the senate, she starred in a 2009 nationwide commercial warning about the plan’s dangers. The job would also give her a serious hit in salary: in 2013, she made $861,479 as a pediatric neurosurgeon for Legacy Health Systems, and the previous OHA director made $173,000. She says that she just wants to “stay involved.”
One question in the Supreme Court argument about ACA is whether the business-friendly justices will go against the money-makers in the insurance and health industries. They’re making more money, and they like it.
As in the past couple of years, the Supreme Court is addressing voting rights, health care, and possibly marriage equality. Millions of people will be waiting until their pronouncements next June.
Thank you Nels New Day.
You’re invited to join open enrollment this Friday, November 14th, 2014. Open enrollment period for the health insurance marketplaces under the Affordable Care Act is from November 14th, 2014 until February 15th, 2015.
The White House • 1600 Pennsylvania Ave NW • Washington, DC 20500 • 202-456-1111
2015 Open Enrollment
The Open Enrollment period for 2015 coverage is November 15, 2014 to February 15, 2015.
If you haven’t enrolled in coverage by then, you generally can’t buy Marketplace health coverage for 2015 until the next Open Enrollment period for coverage the following year.
If you’re enrolled in a 2014 Marketplace plan, your benefit year ends December 31, 2014. To continue health coverage in 2015, you can renew your current health plan or choose a new health plan through the Marketplace during the 2015 Open Enrollment period.
If you don’t have health coverage during 2015, you may have to pay a fee. The fee in 2015 is higher than it was in 2014 — 2% of your income or $325 per adult/$162.50 per child, whichever is more.
Enrollment and coverage start dates
During Open Enrollment, if you enroll:
- Between the 1st and 15th days of the month, your coverage starts the first day of the next month.
- Between the 16th and the last day of the month, your coverage starts the first day of the second following month. So if you enroll on January 16, your coverage starts on March 1.
You may buy Marketplace insurance outside Open Enrollment only if you qualify for aSpecial Enrollment Period due to a qualifying life event such as marriage, birth or adoption of a child, or loss of other health coverage. Learn more about how you qualify for a Special Enrollment Period.
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) any time. There is no limited enrollment period for these programs. You can apply any time. If you’re qualified, you can enroll immediately.
If you own or operate a small business, you can start offering coverage to your employees at any time.
The state Health Insurance Marketplaces will open on Saturday Nov. 15 and stay open through Feb. 15, 2015. As was the case the first time around last year, if you buy insurance on your own, this will be your only chance to enroll in or change your plan until next year (with a few exceptions, such as if you lose other coverage midyear).
Here’s what you need to know to get ready.
You can window shop ahead of time
HealthCare.gov, which handles shopping for 37 states (look up your state on this interactive map) started a window shopping function over the weekend. We recommend you use it. Without logging into it or creating an account, you can put in info about your household size and income, get a quick estimate of your 2015 subsidy (if any), and start shopping and comparing plans. But you won’t be able to buy a plan for real until Nov. 15.
We played with the window shopping tool a bit and were impressed—especially in comparison to 2014. Back then, in order to see the health plans available in your state, you had to create an account, get your identity verified, and fill out an application that was 76 screens long.
This time around, the plan preview feature is chock-full of helpful explanations that appear just when you need them. For instance, when it’s time to enter your household income, you’ll see a link to click to explain how to count that income if you’re not sure.
You can see the plans within a couple of screens, and then you can filter them by multiple factors, such as the name of the insurer, the size of the deductible, and the monthly premium. And if you see a plan you like, you can save or e-mail to yourself a link that will take you straight back there on your next visit.
Many of the state-run marketplaces also allow window shopping. As of today, they included California, Colorado, Connecticut, the District of Columbia, Idaho, Maryland, Rhode Island, and Washington. We couldn’t find plan previews on the Massachusetts, Minnesota, or New York sites, and the marketplaces in Hawaii, Kentucky, and Vermont were down for maintenance.
Collect these documents and info
You’re going to need them to fill out your application.
- Your most recent income tax return.
- Social Security number and birth dates for everyone in your household who’s going to be buying insurance with you. (If you’re confused about this, just collect info for everyone who is on your household’s tax return with you.)
- If you’re self-employed or didn’t file taxes last year, whatever information you have on your income and business expenses.
- Log in and password for your marketplace account, if you already have one.
If you want your insurance to start on Jan. 1, you have to sign up for a plan by Dec. 15
You can sign up later, but if you don’t have insurance now, you’ll be waiting another month or two for it to start. And if you do have insurance now that you’d like to replace with something else, you’ll be automatically re-enrolled in your existing plan if you don’t change to another one by Dec. 15. You can still switch out if you do it by Feb. 15 but you’ll be stuck with your old plan until at least February or March.
If you want a plan that has specific doctors in it, do some advance research
Many marketplace plans have smaller doctor and hospital networks than people expected. If you found yourself in a plan that your favorite doctors didn’t take, now’s the time to fix that. The fastest way to get this done is to call the doctor’s billing office and ask what marketplace plans it accepts.
Tell your uninsured friends about open enrollment
Nine out of 10 uninsured Americans don’t know open enrollment is coming up, according to a recent poll by the Kaiser Family Foundation. And more than half of them have no idea that financial help with insurance is available if they have low and moderate incomes. Do them a favor and let them know.
To find out how to apply for, select, and use health insurance, including Medicare, visit our main health insurance page.
Got a question about your health insurance, retirement portfolio, or anything else finance-related? Drop us a line: YFmoneymailbag@yahoo.com. Yahoo Finance is answering your money questions on Tumblr!
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The Absurd New Supreme Court Case That Could Kill Obamacare (w/ Ian Millhiser)
Published on Nov 12, 2014
Ian Millhiser of the Center For American Progress and author of the forthcoming book Injustices: The Supreme Court’s History of Comforting the Comfortable and Afflicting the Afflicted, explains the insane legal reasoning behind the Halbig V King case, why even a “textualist approach”, how the insurance market works, is precedent irrelevant when it comes to Obamacare? Will Roberts go with the four far right wing Justices and the horrifying human costs of overturning Obamacare.
Filed under: "BARACK" The Vote, 2014 Mid Term Elections, Abortion Rights, Abuse To Women, Abuse/Domestic Violence/VAWA, Affordable Health Care Act, Barack's Blog, Breaking News, Business, Campaign Ads, Causes, Congress, Court Room/Legal, Daily White House Schedule, Democrats/Democratic, Economy, Education, Event, Finance, Good News, Health, Information & Links, Interview, Medicare/Medicaid/Social Security, Mental Health, News, ObamaCares (AHCA), Politics, POTUS Obama, Race, Racism, Stories, The White House, The White House Daily Snapshot, Thoughts Opinions & Ideas, Videos, Women's Causes, World News | Tagged: Affordable Care Act, Allstate, Associated Press, Barack Obama, Centers for Medicare and Medicaid Services, Education, health costs, Health insurance, Health insurance exchange, Jonathan Gruber, Jonathan Gruber (economist), Kansas, Massachusetts Institute of Technology, Medicaid, Monica Wehby, Patient Protection and Affordable Care Act, Population growth, Poverty, State Children's Health Insurance Program, Supreme Court, Supreme Court of the United States, The New York Times, The Patient Protection and Affordable Care Act, The Topeka Capital-Journal, Topeka, United States | 2 Comments »