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President Barack Obama listens to comments while meeting with healthcare stakeholders in the Roosevelt Room at White House May 11, 2009. At right is Health and Human Services Secretary Kathleen Sebelius. (Official White House Photo by Pete Souza)
President Obama and Kathleen Sebelius at a 2009 meeting with health care stakeholders. It got better.
The bulk of the most popular stuff of the Affordable Care act hasn't gone into effect yet, but the regulations for it have been finalized, so insurance companies will have plenty of time to get used to the fact that there are going to be real limits on how much they can screw you starting next year.

Those new regulations hit the five key consumer protections:

  • Guaranteed Availability
    Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
  • Fair Health Insurance Premiums
    Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography. Basing premiums on other factors will be illegal. The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
  • Guaranteed Renewability
    Health insurance companies will no longer refuse to renew coverage because an individual or an employee has become sick. You may renew your coverage at your option.
  • Single Risk Pool
    Health insurance companies will no longer be able to charge higher premiums to higher cost enrollees by moving them into separate risk pools. Insurers are required to maintain a single state-wide risk pool for the individual market and single state-wide risk pool for the small group market.
  • Catastrophic Plans
    Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market. Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.
This is the stuff that's going to make Obamacare no longer a dirty word. It's also the stuff that's going to lessen opposition to a larger federal government role in all of our health care, a good starting point to the much larger, systemic reforms that are still going to have to happen to fix health care in America.

Originally posted to Joan McCarter on Fri Feb 22, 2013 at 01:13 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (118+ / 0-)

    "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

    by Joan McCarter on Fri Feb 22, 2013 at 01:13:37 PM PST

  •  time is on Obamacare's side... (45+ / 0-)

    ...as is evidenced by all of those frothing-out-the-mouth Republican Tea Bagger governors who absolutely hated and detested everything about it two years ago, including the expansion of Medicaid coverage and creation of exchanges. And now...not so much. One radical, right-wing extremist rabid Republican governor after another is suddenly...changing their minds.

    To my way of thinking, time is on Obamacare's side. When citizens of those states with governors who are obstinately failing to enjoin the benefits of Medicare expansion and state health exchanges discover that they are being left behind the rest of the country...more and more of these rabid, right-wing, Tea Partying, right-wing Republican governors will suddently...have a change of heart.

    And, as you've pointed out, as more and more of the benefits of Obamacare are realized, the less and less the objections will be.

    •  My thinking, exactly. n/t (10+ / 0-)

      It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

      by karmsy on Fri Feb 22, 2013 at 02:01:37 PM PST

      [ Parent ]

    •  All except Scott Walker. (11+ / 0-)

      He's ideologically committed to taking Wisconsin down.

    •  Maybe, on the access issues. (5+ / 0-)
      Recommended by:
      3goldens, shaharazade, ferg, Vatexia, wdrath

      Unfortunately the cost of hc that has already spiraled out of control as experienced by today's insureds will continue to spin upward. The newly insured are likely to have mixed reactions where the subsidized will be in much better shape and the healthy newly insured unsubsidized will be in the same boat full of holes the rest of the county is in.

      California's ACA state exchange will be better than today for low income residents (as low as $100/mon) and the same or worse for higher income residents (up to over $1200/month).

      Access will be achieved and the basic insurance reforms have to be popular. Republicans have nothing.

      But time has run out on the cost control issue and that's the main issue for 80% of the country.

      •  evidence shows that Obamacare's already (1+ / 0-)
        Recommended by:
        doroma

        helped to keep rising health care costs down.

        •  There have been areas of lower cost increases... (1+ / 0-)
          Recommended by:
          wdrath

          ...notably Medicare where reductions may be as high as 15% and partially attributed to ACA. Premiums will continue to rise and only partially blamed on ACA. However the overall cost to non Medicare is expected to continue rising.

        •  Read Steven Brill in Time (1+ / 0-)
          Recommended by:
          wdrath

          Before further fluffing.

          •  Shame: The Bitter Pill (1+ / 0-)
            Recommended by:
            wdrath

            Bitter Pill: Why Medical Bills are killing us

            When I asked MD Anderson to comment on the charges on Recchi’s bill, the cancer center released a written statement that said in part, “The issues related to health care finance are complex for patients, health care providers, payers and government entities alike … MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.”

            The hospital’s hard-nosed approach pays off. Although it is officially a nonprofit unit of the University of Texas, MD Anderson has revenue that exceeds the cost of the world-class care it provides by so much that its operating profit for the fiscal year 2010, the most recent annual report it filed with the U.S. Department of Health and Human Services, was $531 million. That’s a profit margin of 26% on revenue of $2.05 billion, an astounding result for such a service-intensive enterprise.1

            The president of MD Anderson is paid like someone running a prosperous business. Ronald DePinho’s total compensation last year was $1,845,000. That does not count outside earnings derived from a much publicized waiver he received from the university that, according to the Houston Chronicle, allows him to maintain unspecified “financial ties with his three principal pharmaceutical companies.”

            Shame
            As soon as you delve into the policy wonkery in cases like this, you are submitting to a conspiracy by the powerful against the many. The greater the sphere of disagreeable things that are “complicated”, the more it is possible to construct intricate and inscrutable bureaucracies to “arbitrate”. There will be think-tanks and policy papers, funded by people who are well-meaning (in a narrow, idiotically un-self-aware way) but very rich and powerful. The conclusions of which will be earnest and carefully researched but confined to a window not very upsetting to the very rich and powerful. Undoing the ability of plutocrat hospital “CEOs”, or bankers or lobbyists or whatever, to continue the sort of ass-rape to which their lifestyles have grown accustomed will not be on the table. A good society depends on an active public, first and foremost. A society that has allowed the predations of the powerful to become purely private matters mediated via “markets”, courts, academies, and bureaucracies, that has delegated “activism” to a mostly protected professional class, is nothing more than a herd hoping that today it is somebody else who will be slaughtered.

            Is that who we are?

  •  It's also gonna make (33+ / 0-)

    the distance between the Rs (particularly governors) and the people even wider.

    People want this - not just us liberals. People want to have health care - not just access to it, but actual real care. I dare a single Gov or legislature (looking at you, Kasich and Ohio) to tell the people who elect them that, 'No, you can't have health care under this plan. Because, Jesus or Socialism or whatever.'

    Can we start the fight for single payer now? Pretty please?

    The only thing harder than speaking truth to power is speaking truth to stupid.

    by themis on Fri Feb 22, 2013 at 01:26:32 PM PST

  •  Existing policies (10+ / 0-)

    Will premiums on existing individual policies conform or will one need a new policy to reap the benefit?

    Will the price on a policy now be definite before applying or can they still advertize hokey estimates?

    ------
    Ideology is when you have the answers before you know the questions.
    It is what grows into empty spaces where intelligence has died.

    by Alden on Fri Feb 22, 2013 at 01:36:39 PM PST

    •  That's a good question. Seems like it would (2+ / 0-)
      Recommended by:
      themis, glorificus

      be at enrollment time at the end of the year for the following year.  That is what happens for us, at least, though hubby works for a corporation.

    •  And could you clarify this statement, Joan? (2+ / 0-)
      Recommended by:
      3goldens, glorificus
      ...small employers will only be allowed to vary premiums based on age...
      What is the target age, and how will it affect the cost of their coverage?
      •  It's a Friday doc dump (1+ / 0-)
        Recommended by:
        splashoil

        We'll have to wait til next week, most likely, before the consumer advocacy groups sift through it to learn the details.

        I'll be watching to see what Kaiser Family Foundation says, among others.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Fri Feb 22, 2013 at 04:51:01 PM PST

        [ Parent ]

    •  Aw crap (0+ / 0-)

      Did a lick of real work for a change and ended up missing the deadline for reccing responders.  At first I thought I had lost my mojo.  Sure feels like it sometimes.

      ------
      Ideology is when you have the answers before you know the questions.
      It is what grows into empty spaces where intelligence has died.

      by Alden on Sat Feb 23, 2013 at 09:10:12 PM PST

      [ Parent ]

  •  It's a step in the right direction, but we need (14+ / 0-)

    to continue to move FORWARD to make sure everyone has affordable access to affordable preventative, necessary and emergency care.

    I see what you did there.

    by GoGoGoEverton on Fri Feb 22, 2013 at 01:38:10 PM PST

  •  It's also going to raise premiums for everyone... (11+ / 0-)

    I'm not against that, but the biggest single change brought on by the ACA is going to be higher premiums for those of us who have been in more favored brackets based on age, medical history, employment, etc.

    With up to 30 million more people insured, including many with significant health issues, total health care spending is going to rise, and many of the new enrollees aren't going to be sharing much, if any, of the increased total cost.

    So I hope I don't hear too many liberals screaming about their insurance premiums going up - we'll be getting enough of that from the right, won't we?

    Here is a link to the Time magazine cover story about hospital costs. It's engrossing, and by far the best analysis of this critical topic.

    TIME story about hospital costs

    It does occur to me that getting more people on insurance - even though it is private - will all by itself significantly improve the dire situation detailed in the Time story. The fewer people who are victims of the 'chargemaster' (those who have no insurance), the better, especially because it means the insurance companies have more clout when negotiating with the hospitals because they have more insureds.

    But let's not forget the real solution:

    Medicare for All!!!

    Cheers.

    Against stupidity the gods themselves contend in vain. Friedrich Schiller

    by databob on Fri Feb 22, 2013 at 01:45:22 PM PST

    •  I haven't screamed about my taxes going up (4+ / 0-)

      each year, won't scream about my insurance premiums rising if it's for a good cause, either.

      "So, please stay where you are. Don't move and don't panic. Don't take off your shoes! Jobs is on the way."

      by wader on Fri Feb 22, 2013 at 01:49:10 PM PST

      [ Parent ]

    •  it will start to rob (9+ / 0-)

      the hospitals of one of the arguments for a chargemaster that multiplies the cost of medicines, supplies, etc. by 100-400%,  with fewer uninsureds (through private insurance or expanded medicaid though they have to accept less for a medicaid patient just as with Medicare),   as they can'tcontinue to justify the charges on uninsured patients if they lose on so few patients.   Pressure will come from the insurers and the goverment to bring prices in line.  

      •  It will also rob the federal treasury (3+ / 0-)
        Recommended by:
        themis, Willa Rogers, alwaysquestion

        Because ACA provides tax credits to help cover the cost of insurance premiums, the continuing rise in those premiums will begin to make a substantial drain on the treasury.

        If you think the howling about deficits is bad now, wait until you see the deficit rise with all the tax credits under ACA.   Our leaders will be forced to choose between placing real cost controls on insurance companies or force more of the costs onto an unwilling public.  They've already begun some of the latter with recent rules changes in ACA.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Fri Feb 22, 2013 at 02:56:30 PM PST

        [ Parent ]

        •  A lot of that is paid for... (3+ / 0-)
          Recommended by:
          themis, alwaysquestion, glorificus

          it didn't get nearly the press I thought it would, but in addition to raising the capital gains tax from 15% to 20% at the beginning of this year, there is an additional surtax of 3.9% on capital gains in ACA. That's going to raise a good chunk of money.

          And, believe it or not, Mitt Romney's 13% tax rate is long gone! He'll now be paying at least 23.9%, and probably even a couple percent more because the fiscal cliff deal also contained a cut in the charitable contribution deduction that will hit people like 'poor' Mitt pretty hard.

          'Poor Mitt', indeed!!!

          If you have links to the tax credits and especially stats on what they will cost, please share.

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Fri Feb 22, 2013 at 03:07:03 PM PST

          [ Parent ]

          •  It would have been paid for if (2+ / 0-)
            Recommended by:
            Willa Rogers, alwaysquestion

            ACA had been developed in a way that handles real cost control.  Those forecasts were developed before the rules were written and so many other aspects of ACA changed.

            I'll have to dig around here, but the gist of it is that insurance premiums are still rising at astronomical rates.  Many of them have figured out how to work around the medical loss ratio restrictions written into ACA.

            So far, the Obama administration has addressed the problem by cutting the number of people eligible for tax credits to help pay for premiums.  That may be like sticking a finger in the dyke, though.  It's going to get much worse.

            I predict Obama will try to keep the whole thing afloat until he leaves office in a few years, after which time it will become a full blown crisis.

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Fri Feb 22, 2013 at 03:16:59 PM PST

            [ Parent ]

          •  Link to NYT on the latest ACA cost-shifting (0+ / 0-)

            Federal Rule Limits Aid to Families Who Can’t Afford Employers’ Health Coverage

            I must admit it was pretty damn clever of the WH to issue this as an IRS rule to allow them to take the blame.  

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Fri Feb 22, 2013 at 03:24:04 PM PST

            [ Parent ]

            •  Thanks for the info (0+ / 0-)

              I agree that ACA is less than it should have been.... by a long shot. Unfortunately, it was the best that could be achieved at the time with the obvious opposition.

              It's quite possible that ACA may fail due to its weaknesses, or due to other factors like the doctor shortage.

              But hey, it's all we've got!

              As for the tax credit limit, that's a bummer, and I hate to see people in need shunted aside, but I don't think these people - who don't have health insurance right now, and won't have to pay the Roberts 'tax' - are any worse off than they are right now, are they? (Please let me know if my analysis is wrong)

              So maybe the way to look at it is the 'lifeboat' view: if the ship's not sinking immediately, but we can't get everyone to shore on the lifeboat on one trip, then some folks will have to stay behind until we can get the rest to shore and come back.

              If unpleasant exclusions like this are what it takes to (hopefully) make ACA work, then these people can be added later. I don't like it any more than you do, but we can't 'save' everybody in one trip.

              Cheers.

              Against stupidity the gods themselves contend in vain. Friedrich Schiller

              by databob on Fri Feb 22, 2013 at 03:38:34 PM PST

              [ Parent ]

              •  I agree (0+ / 0-)

                The Medicaid expansion alone was worth the effort, provided it becomes a reality as promised.    We'll have to wait and see, I fear there will be more tinkering with the eligibility for that one before it's rolled out in 2014.  They may add age and other restrictions.  

                I have a hard time predicting what changes they'll make, I don't have the criminally sociopathic creativity necessary to devise those kinds of changes.

                Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

                by Betty Pinson on Fri Feb 22, 2013 at 03:43:08 PM PST

                [ Parent ]

              •  Except that this issue won't be revisited again (0+ / 0-)

                for another generation.  Perhaps your grandkids may live to see it fixed.

                You have watched Faux News, now lose 2d10 SAN.

                by Throw The Bums Out on Fri Feb 22, 2013 at 11:36:10 PM PST

                [ Parent ]

        •  Congressional Budget Office analyzed PPACA (0+ / 0-)

          They put some numbers on its effects on the deficit.

          You won't believe me if I tell you, but it should be easy to look up.

          Freedom isn't free. Patriots pay taxes.

          by Dogs are fuzzy on Fri Feb 22, 2013 at 09:29:14 PM PST

          [ Parent ]

    •  Cost controls on the insurance side (5+ / 0-)

      are terribly inadequate, almost non-existent.  The system, as its been designed through rule-making for ACA, is unsustainable for more than a few years.

      ACA will not last long in its current configuration. There have been too many loopholes carved into it that will result in very high costs to consumers and the federal government.  

      The next step will have to be single payer - in the form of Medicare or Medicaid for all.  

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Fri Feb 22, 2013 at 02:52:20 PM PST

      [ Parent ]

    •  Rec'd for te TIME story. (2+ / 0-)
      Recommended by:
      alwaysquestion, Losty

      Bitter Pill: Why Medical Bills Are Killing Us

      I just finished reading it.

      The author's recommendations (after a long, comprehensive analysis of the problem):

      We should tighten antitrust laws related to hospitals to keep them from becoming so dominant in a region that insurance companies are helpless in negotiating prices with them.
      [W]e should tax hospital profits at 75% and have a tax surcharge on all nondoctor hospital salaries that exceed, say, $750,000. ...If we recouped 75% of all hospital profits (from nonprofit as well as for-profit institutions), that would save over $80 billion a year.
      We should outlaw the chargemaster. [W]hy not require that [bills] be rewritten to reflect a process that considers actual and thoroughly transparent costs?
      There's more. Amend patent laws to limit how drug companies can exploit the market.

      Enact medical malpractice reform.

      Allow Medicare to negotiate prices with drug companies, use comparative effectiveness research to set prices, and use competitive bidding for durable medical equipment.

    •  It would happen in single-payor too. (0+ / 0-)

      In terms of we paying more now for care we probably won't need.

      I see what you did there.

      by GoGoGoEverton on Fri Feb 22, 2013 at 03:42:33 PM PST

      [ Parent ]

  •  First I've heard of the (4+ / 0-)

    catastrophic plans. I really like that idea because it takes care of the "I don't need insurance, I'm young and healthy" objection. Even those people get into wrecks, develop serious illnesses, etc. They can buy coverage for just those types of situations and take their chances on the rest. Love it!!

    •  I'd like to see those plans supplied by Medicaid. (4+ / 0-)
      Recommended by:
      themis, alwaysquestion, shaharazade, ferg

      by opening up Medicaid to buy in if you are between 200% and 500% of the povertyline. It would expand Medicaid's base, provide revenue and bring in healthier people. And it would destigmatize Medicaid, upgrade what it provides.

      If I ran this circus, things would be DIFFERENT!

      by CwV on Fri Feb 22, 2013 at 02:09:18 PM PST

      [ Parent ]

      •  open Medicaid up to anyone who wants it (0+ / 0-)

        Eliminate the whole qualifying paperwork nonsense.

        Granted, few richer people would buy into it. But if Bill Gates paid his Medicaid premium, I'd be happy to let him enroll.

  •  "Nearly all"? (4+ / 0-)
    Nearly all health insurance companies
    Who's excluded?

    The scene on November 6, midnight: Barack Obama holds up newspaper reading "Romney defeats Obama" as he heads to give his second term acceptance speech.

    by alkatt on Fri Feb 22, 2013 at 01:57:20 PM PST

    •  CMS words it differently.... (2+ / 0-)
      Recommended by:
      alwaysquestion, OleHippieChick

      Centers for Medicaid and Medicare Services is the government agency that actually writes these rules, and their website words the paragraph on guaranteed availablility like this:

      Health insurance issuers will be prohibited from denying coverage to people because of a pre-existing condition or any other health factor.   All policies in the individual market will be guaranteed available and will be offered during open enrollment periods.  All policies in the group market will be available continuously year-round.  In addition, individuals will have special enrollment opportunities in the individual market when they experience certain significant life changes, similar to those in the group market today.
      CMS Insurance Rule

      I'm going to sniff around to see if I can find the text of the rule, because I'm curious.... and because it's Friday afternoon and I'm not interested in doing any more work!

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Fri Feb 22, 2013 at 02:15:12 PM PST

      [ Parent ]

    •  Would that have anything to do with religion? n/t (0+ / 0-)
    •  Here is the actual rule... (1+ / 0-)
      Recommended by:
      alwaysquestion

      CMS Insurance Rule Text

      The applicable section starts on page 38.

      As close as I can tell, 'nearly all' deals with 'closed products' and policies sold through 'associations'. I quit trying to penetrate the government-ese in the document when I got a headache.

      Most of the comments dealing with guaranteed issue had to do with open enrollment periods and measures to combat cheating (waiting to get sick before getting insurance) and the 'adverse selection' effect that causes..... adverse selection is the reason for the individual mandate: if people can wait until they get sick, only people with health problems will get insurance right away, driving costs way up.

      Of course, the 'fine' - oh, excuse me Chief Justice Roberts!!@! um, TAX - in the first year is going to be $95 (for the whole year), so that isn't going to drive a whole lot of people into getting insurance, is it?

      Cheers.

      Against stupidity the gods themselves contend in vain. Friedrich Schiller

      by databob on Fri Feb 22, 2013 at 02:44:42 PM PST

      [ Parent ]

      •  Americans? (0+ / 0-)
        Guaranteed Availability
        Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
        I tried reading the fine print but could not tell if insurance companies have to (a) offer plans to green card holders, other visa holders and undocumented immigrants as well, and if so (b) do they have to offer it on the same terms as Americans citizens?

        Any help appreciated ... obviously, I have friends and relatives that would benefit (or not).

  •  We'll need to read the fine print (5+ / 0-)

    There seem to be a couple of loopholes

    Guaranteed Availability
        Nearly all health insurance companies offering coverage to individuals and employers will be required to sell health insurance policies to all consumers. No one can be denied health insurance because they have or had an illness.
    What's the definition of "nearly all"?  As originally touted during passage of ACA, these regs were supposed to apply to all insurance companies with the exception of employers who are self-insured.

       

    Fair Health Insurance Premiums
        Health insurance companies offering coverage to individuals and small employers will only be allowed to vary premiums based on age, tobacco use, family size, and geography.  Basing premiums on other factors will be illegal.  The factors that are no longer permitted in 2014 include health status, past insurance claims, gender, occupation, how long an individual has held a policy, or size of the small employer.
    This regulation was supposed to apply to all insurance companies, with the exception of the self-insured employers. What about insurance plans covering large employers? What defines a small employer?

     

      Catastrophic Plans
        Young adults and people for whom coverage would otherwise be unaffordable will have access to a catastrophic plan in the individual market.  Catastrophic plans generally will have lower premiums, protect against high out-of-pocket costs, and cover recommended preventive services without cost sharing.
    These are the groups that cause the most concern - the ones who are earning above 133% of FPL, are uninsured but can't afford the premiums in the state exchanges.   Do these nifty catastrophic plans have to follow the same regulations as above regarding renewal, rating, etc.?   This is where most middle to lower income American workers will end up and where many will die.

    Don't be surprised when many voters end up being unhappy with ACA, when their health care and insurance costs continue to rise and become unaffordable.  We Democrats will have to explain this mess somehow.

    Single payer health care is inevitable - Medicare for All.

    Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

    by Betty Pinson on Fri Feb 22, 2013 at 02:09:53 PM PST

    •  Agreed (1+ / 0-)
      Recommended by:
      alwaysquestion

      There seems to be quite a gulf between the policy and the actual implementation. There seem to be many negative consequences coming out of the implementation that ultimately I think people will not be happy with in the end.

      For example, it seems that while you may have coverage, there seems to be increased financial incentives for your doctor not to want to see you. In cases where you have conditions that will ultimately be costly or difficult to treat which will count against the person providing the care. Also, the people that will be providing care will likely not be the same people you are seeing now, due to cost reasons. So while access to care is there, it is seeming like it will be quite different care.

      Hard to tell at this point if these are intended or unintended consequences of the system.

      "I know the meaning of life. It doesn't help me a bit."

      by dss on Fri Feb 22, 2013 at 02:20:39 PM PST

      [ Parent ]

      •  When you hire insurance co. execs to write them (2+ / 0-)
        Recommended by:
        dss, 3goldens

        The rules come out much differently than the product that was advertised to the public.

        Thanks, Obama & Sebelius.

        Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

        by Betty Pinson on Fri Feb 22, 2013 at 02:32:54 PM PST

        [ Parent ]

        •  I don't see insurance execs in the rule.... (0+ / 0-)

          I posted the link to it just above, and while it is not easy reading, it looks like fairly straightforward comments and responses.

          IMHO, having CMS (Centers for Medicare and Medicaid Services) write these rules is a great idea - these folks literally wrote the book on efficient single-payer health care, and I don't see much, if any, insurance industry influence in their outfit.

          Look at it this way: if the hospitals and insurance companies had much sway over Medicare & Medicaid, they would be far less efficient than they are.

          Cheers.

          Against stupidity the gods themselves contend in vain. Friedrich Schiller

          by databob on Fri Feb 22, 2013 at 02:49:18 PM PST

          [ Parent ]

          •  Liz Fowler (5+ / 0-)

            She's a former VP from WellPoint who went to work for Max Baucus as his committee was writing the health care reform bill for the Senate.

            After passage of ACA, she went to work for Obama's administration as deputy director of the Office of Consumer Information and Oversight at the U.S. Department of Health and Human Services.   There she oversaw the process of rulemaking for ACA.

            She recently returned the private sector to cash in, taking a position as a senior officer in Johnson & Johnson's Government Affairs & Policy Group.

            Link

            Another link from the Guardian

            More amazingly still, when the Obama White House needed someone to oversee implementation of Obamacare after the bill passed, it chose . . . Liz Fowler. That the White House would put a former health insurance industry executive in charge of implementation of its new massive health care law was roundly condemned by good government groups as at least a violation of the "spirit" of governing ethics rules and even "gross", but those objections were, of course, brushed aside by the White House. She then became Special Assistant to the President for Healthcare and Economic Policy at the National Economic Council.

            Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

            by Betty Pinson on Fri Feb 22, 2013 at 03:11:02 PM PST

            [ Parent ]

            •  I think this will take time and the wrinkles (0+ / 0-)

              will iron out over time.  I am sometimes very conflicted on Obama's appointment choices, but think in the end that the public will demand more fine tuning after time shows the obvious fixes.

              Having said that, I am one of those impatient people and want single payer now.
               

            •  I'm conflicted on this one... (1+ / 0-)
              Recommended by:
              worldlotus

              I don't like the revolving door, but there's really no good solution for it, short of slavery, perhaps.

              Liz Fowler, with a Johns Hopkins PH.D. in Public Health and a law degree, is bound to be a power player in the public health arena.

              Accepting that some of ACA is a bailout for private insurance, I'm still having a hard time putting the blame on Liz Fowler. I'd need to know more about her, including her views on the subject.

              Blaming Liz Fowler for killing the public option - as the guy in the video insinuates -  seems a bit over the top. That was a far larger issue, as Max Baucus pointed out in the video.

              I guess we'll have to see how the ACA plays out, with fingers crossed.

              If only the people who are working so hard to destroy it had some reasonable alternative in mind.

              Cheers.

              Against stupidity the gods themselves contend in vain. Friedrich Schiller

              by databob on Fri Feb 22, 2013 at 03:56:30 PM PST

              [ Parent ]

  •  My gov., Terry Branstad, (0+ / 0-)

    met this afternoon with Kathleen Sebelius. He has been resisting accepting Medicaid expansion. Branstad has an inadequate program called "IowaCare" that he thinks can substitute for Medicaid. It cannot. I hope Sec'y Sebelius can disenthrall him from that fantasy. Branstad has a press conference scheduled for Tuesday. I hope he caves in on this.

  •  Reminder of context: Insurance is getting (3+ / 0-)
    Recommended by:
    OleHippieChick, 3goldens, worldlotus

    in the door; the actual health care is what's through the door. In the US, walking through the door finds you standing in a crumbling building.

    We'll not be "revisiting health care," because we've only visited insurance access the last few years.

    We still need the quality of care conversation, and correction, and urgently so.


    We live in a nation where doctors destroy health; lawyers, justice; universities, knowledge; governments, freedom; the press, information; religion, morals; and our banks destroy the economy. -- Chris Hedges

    by Jim P on Fri Feb 22, 2013 at 03:41:29 PM PST

  •  asdf (0+ / 0-)

    Thank goodness, because I don't know how much longer we can live with this high deductible, no coverage plan.

    Weathering Michigan's recessions since the '70s.

    by jennifree2bme on Fri Feb 22, 2013 at 03:50:38 PM PST

  •  as with Social Security and Medicare (2+ / 0-)
    Recommended by:
    worldlotus, vernonbc

    in a decade this will be a 'touch only if you want to commit political sucide' program

    and with luck the experiments in Montana and Vermont will lead to even better national programs

    In the time that I have been given,
    I am what I am

    by duhban on Fri Feb 22, 2013 at 04:22:10 PM PST

  •  Employer won't pay (0+ / 0-)

    I'm work as a adjunct instructor at a community college in Tennessee.   Pay is horrible with no benefits, but I have to eat something. I commute between two rural campuses. Been doing this for 4 years.  I was told earlier in the  year that I was on the list for a full-time job.   A couple of weeks ago, I had a long talk with one of the campus coordinators.  As much as they would love to hire me for a full-time position, the Tennessee Board of Regents doesn't want to have to pay for health care benefits.  So as long as I'm less than 30 hours a week, Tennessee is happy.

  •  Maybe yes, maybe no (0+ / 0-)

    The hatred runs deep. I have a friend who is claiming that he can't get tests his doctors want because the company he's associated with (through Medicare, i presume) is associated with HHS and won't pay for the blood tests.

    He's fairly convinced that he's being held hostage by a "death panel."

    Gonna be a long time before Obamacare wins over many, many Americans, whatever the perks. They've got this idea that all was GREAT! before it, that insurance premiums weren't rising and that anyone who needed any medicine had no problem getting it.

  •  Love the single risk pools. (1+ / 0-)
    Recommended by:
    the oklahoma kid

    A good step toward single payor. Yay!

    Hey, Republicans, the whole world is watching.

    by TAH from SLC on Fri Feb 22, 2013 at 04:51:50 PM PST

  •  Another side of the coin. (0+ / 0-)
    This is the stuff that's going to make Obamacare no longer a dirty word.
    Of course this will be true for those whose premiums go down, those with pre-existing conditions who are not currently insured due to availability or very high premiums or exclusions, and those who are not now insured because they can't afford it but now, with the subsidies, will be able to.

    There is obviously another side of the coin though. Some people's premiums (or contributions in the case of group plans) will almost certainly go up. Some of these people will understand that it's for the greater good, but some will decide that Obamacare is a dirty word even though they didn't think so previously. The important question for politicians is: "Will those who benefit outnumber those who pay more?" My guess is that the absolute number of those who will pay more will be outnumber those who will pay less. Although the aggregate cost increase for "the many" may not be much more than the aggregate cost decrease for "the few", each person gets only one vote. If, for every 10 people who see a decrease in rates, 100 see an increase of $75 a month, it won't be a happy time in about three years.

    There are, of course, some mitigating factors. Obviously some people who are low risk will just drop their insurance and pay the penalty -- assured that they can get insurance if they get diagnosed with something that will be expensive and insurance is cheaper than paying for it (or than declaring bankruptcy to escape it). Although this will push up the cost of insurance for others, those who do this will likely be happy as they are saving a lot of money.

    It will be interesting, I'm stocking up on popcorn.

  •  We should hearken back to Ted Kennedy (0+ / 0-)

    Who, at least in spirit, made Obama make healthcare reform his top priority. No monument can beat a person's legacy measured in lives saved.

  •  Now the real stuff goes into effect (0+ / 0-)

    Excellent.  Its been a long and hard wait but now the good stuff will go into effect.  We'll see why this was worth fighting for.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

    by noofsh on Sat Feb 23, 2013 at 05:40:15 AM PST

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