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Photograph of Health insurance policy.
Bad news for the "burn your fake Obamacare card" crowd—health insurance under the new law is going to be really affordable. The most comprehensive review yet of proposed health insurance premium rates under the law shows that they'll be more affordable even than the Congressional Budget Office predicted.

The Kaiser Family Foundation surveyed 17 states and found lower than expected rates, as affordable as $62 a month for a 25 year-old New Yorker with a $25,000 income, to almost nothing for the same person in Vermont. They looked at both the bare-bones "Bronze" plans and the next level "Silver" plans, and found rates completely in line with current premiums and often lower, when subsidies are factored in.

“There’s obviously intense interest in what the choices are going to look like for consumers and what they’re going to have to pay in 2014,” Larry Levitt, a senior vice president at Menlo Park, California-based Kaiser, said in a phone interview. “For the most part insurers seem to find this market attractive and they’re pricing accordingly.” [...]

The lowest monthly premium for a 40-year-old in the 17 states surveyed by Kaiser would be $146 in Baltimore. If that 40-year-old had an annual income of $29,000, government subsidies would reduce the monthly cost to $111, according to the report from the nonprofit health-research group. [...]

For $214 a month, the same Baltimore 40-year-old may upgrade to a “silver” plan that covers about 70 percent of medical costs and reduced out-of-pocket expenses. A $35 monthly subsidy would discount the premium to $179.
The highest premiums in the Kaiser survey are in Vermont and New York, where the states require insurers to charge the same amount to people of all ages. That helps older people, who get a break on their premiums, at the expense of younger people, who pay more.

The whole idea behind the health insurance exchanges was that competition in the marketplace would do what it's always done, force companies to provide their best price to consumers. Early reports out of Oregon and California hinted at this trend. With more and more states reporting rates as October 1, the target date for the launch of the nation's insurance shopping spree nears, the trend is bearing out.

But Republicans should find some solace in the news. It does, after all, demonstrate that the market is operating just like it's supposed to. Capitalism lives, and the health insurance companies sure aren't bemoaning the fact that they'll have lots of new customers as of January 1.

Originally posted to Joan McCarter on Thu Sep 05, 2013 at 08:18 AM PDT.

Also republished by Maryland Kos and Daily Kos.

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Comment Preferences

  •  Tip Jar (46+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Thu Sep 05, 2013 at 08:18:42 AM PDT

  •  Just got our Kaiser renewal paperwork (25+ / 0-)

    yesterday, in fact. Self-employed, I provide medical coverage for my wife and I. For the first time in umpteen years, the premium did not go up by 10-25%. It actually stayed within a dollar or two, and the coverage stayed the same.

    So something good is very definitely going on out there. If there was any rationale whatsoever for them to increase the premiums, I believe that they would. There's no one to stop them, after all...

    •  This is a key point as well - (12+ / 0-)

      Obama Admin needs to show trendlines over the last 15 years, and not allow companies and Republicans to blame Obamacare for any and all increases.  Illustrate how they've been going up drastically each year and would have went up more without Obamacare if past trendlines were kept up.  

      “I will be far more aggressive in my reporting from now. I am going to publish many more documents. I have many more documents on England’s spy system. I think they will be sorry for what they did.” -G.Greenwald

      by Jacoby Jonze on Thu Sep 05, 2013 at 08:53:48 AM PDT

      [ Parent ]

    •  Our insurance went up 50% over the last (3+ / 0-)
      Recommended by:
      True North, mwh191, PSzymeczek

      two years.  My suspicion is that our insurance company pushed rates up ahead of 2014 just because it could.

      My insurance is catastrophic coverage that won't even be available after Jan 1.  We are very concerned about rates for the available coverage and hope to be pleasantly surprised.

      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

      by dinotrac on Thu Sep 05, 2013 at 09:24:25 AM PDT

      [ Parent ]

      •  I hope you'll be pleasantly surprised. (1+ / 0-)
        Recommended by:

        Here in New York state, our rates for policies available through the Affordable Care Act exchange have been posted.  Across the board, the premiums are about 50% of what they had been on the individual market in past years, with better coverage and protections for patients and policy holders.  Most New Yorkers I talk to are pleasantly surprised, and we're very happy that our state is implementing the Affordable Care Act as intended.  

        •  New York is a special case, though. (0+ / 0-)

          If I remember correctly, insurance companies in New York were not allowed to deny coverage of existing conditions without any mechanism to prevent abuse of the fact.

          Still, even a small decrease would be good news.  I'm more worried about costs relating to the difference in plans we'll have to purchase compared to what we carried before.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Thu Sep 05, 2013 at 10:35:30 AM PDT

          [ Parent ]

        •  In New York State (0+ / 0-)

          only about 17,000 people (~1 out of a 1,000) buy existing individual coverage I've read.

          So if say 51,000 healthy people are encouraged to buy coverage, it would be possible to cut rates by 50% to nearly 75%.

    •  Imagine how low reasonable rates would be if there (1+ / 0-)
      Recommended by:

      was a Public Option in the mix!

  •  Do facts matter anymore? (15+ / 0-)

    people believe what they want to believe.   Reasoned argument seems ot mean little on the right and even for some parts of the left.  I think the left and left of center is more reality-based, but the prevalence of CT in the last few months here certainly shows that not all self-described leftists choose facts and logic over faith.  

    As Kurt Vonnegut so eloquently said, "and so it goes."

    Join us on the Black Kos front porch to review news and views written from a black pov—everyone is welcome.

    by TomP on Thu Sep 05, 2013 at 08:32:09 AM PDT

    •  Facts DO matter. (8+ / 0-)

       Particularly to the people who are most affected by the new law, when it finally goes into effect.

      "We the People of the United States...." -U.S. Constitution

      by elwior on Thu Sep 05, 2013 at 08:49:28 AM PDT

      [ Parent ]

    •  Since Facts and Logic Matter So Little to Societys (2+ / 0-)
      Recommended by:
      blue aardvark, TomP

      institutional powers: government, economy and the public square, reasoned argument doesn't have the utility it once did.

      We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

      by Gooserock on Thu Sep 05, 2013 at 08:49:36 AM PDT

      [ Parent ]

    •  They do matter (1+ / 0-)
      Recommended by:
      Calamity Jean

      They might not matter for the spin war, but ultimately, people are going to judge Obamacare on how it affects them in real life.

    •  An old guru of mine, formally a committed (6+ / 0-)

      Communist with his own badge of honor, a contempt of Congress for refusing to incriminate others, once told me something I'll never forget: "I think the right is almost always wrong, but the left is sorely mistaken if they think they're always right." This was the statement of a guy who'd REALLY seen it all, and been around every possible ideological situation, done some real original thinking, and saw reality pretty much the way it is.

      "They come, they come To build a wall between us We know they won't win."--Crowded House, "Don't Dream It's Over."

      by Wildthumb on Thu Sep 05, 2013 at 09:18:07 AM PDT

      [ Parent ]

    •  Absolutely, facts matter. (2+ / 0-)
      Recommended by:
      True North, Sherri in TX

      But can you blame people for being skeptical until they see it with their own eyes and pay for it out of their own pockets?

      I, for one, will trust it when I see it.

      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

      by dinotrac on Thu Sep 05, 2013 at 09:26:02 AM PDT

      [ Parent ]

      •  Since the Dems have been (0+ / 0-)

        horrible at crafting understandable narratives and clear-cut messages for decades, and the Republicans want nothing except lies to be disseminated about anything positive the government is doing, will, or can do, it is no surprise; you're 100% right. (I know, I know, coming from me? But I digress . . .)
        We just have to hope that there will not be one person, anywhere, that has something bad happen to him/her because of anything even remotely attributable to the ACA from now until the sun explodes, because if not, that single person's story will be heard as if it was December 26, 1963 when "I Want to Hold Your Hand" was just released.

        "Lone catch of the moon, the roots of the sigh of an idea there will be the outcome may be why?"--from a spam diary entitled "The Vast World."

        by bryduck on Thu Sep 05, 2013 at 12:26:52 PM PDT

        [ Parent ]

        •  Once ACA is in effect, it won't matter what (2+ / 0-)
          Recommended by:
          Calamity Jean, Sherri in TX

          happens to a few people.  Everyone will have had their own personal experience with it, and personal experience has a way of overriding what others are saying.  

          It's one reason why the health care system in the US became so expensive and came to deliver so little for the dollar.  Most people had decent health coverage through their employers and were isolated from the problem until it got too big for employers to absorb or they became unemployed. Reform wasn't all that interesting because what they had seemed pretty good.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Thu Sep 05, 2013 at 01:10:03 PM PDT

          [ Parent ]

  •  Will be interesting comparing Blue State rates (9+ / 0-)

    with Govs and state lege's who are doing all they can to see Obamacare implementation works to the Red State rates where their Gov's and State lege is trying to sabotage and muck up the works to see Obamacare roll out a mess.

    Should be VERY TELLING.  I hope the Obama Admin and Sebelius has that info ready to blast out far and wide.  

    “I will be far more aggressive in my reporting from now. I am going to publish many more documents. I have many more documents on England’s spy system. I think they will be sorry for what they did.” -G.Greenwald

    by Jacoby Jonze on Thu Sep 05, 2013 at 08:52:15 AM PDT

    •  That will be epic (8+ / 0-)

      Colorado versus Kansas or Wyoming.
      Iowa versus Missouri.
      Arizona versus Utah.
      And so on.

      And we've got them. They say Obamacare is a tax - well, then, why do Republican governors want their citizens to pay higher taxes?

      Game. Set. Match.

      I'm on a mission! Testing the new site rules.

      by blue aardvark on Thu Sep 05, 2013 at 09:04:33 AM PDT

      [ Parent ]

      •  Iowa vs. Missouri ?? (1+ / 0-)
        Recommended by:
        blue aardvark

        Iowa is still a question mark. Gov. Branstad is a Republican obstructionist. He fought hard against Medicaid expansion. He finally signed a compromise between Republican House and Democratic Senate that took the federal dollars but with a plan that funneled money to insurance companies instead of Medicaid.

        It is unclear what obstacles Branstad will put up for use of the exchange. Will navigators have to pass an insurance agent test?

        •  Now if you are over 55 and single (1+ / 0-)
          Recommended by:

          Medicaid is basically legally a loan.

          If money is paid on your behalf to a private company monthly then the loan amount repayable upon probate after you die mounts monthly.

          If the state handles things itself then only amounts paid out for your actual care can be reclaimed from your estate. So if you remain healthy from age 55 to 65 then your estate won't get docked when the state handles things.

        •  The Florida Medicaid recovery statute (0+ / 0-)
          409.9101 Recovery for payments made on behalf of Medicaid-eligible persons.—
          recovery shall be accomplished by the agency filing a statement of claim against the estate of a deceased Medicaid recipient
          The acceptance of public medical assistance, as defined by Title XIX (Medicaid) of the Social Security Act, including mandatory and optional supplemental payments under the Social Security Act, shall create a debt to the agency in the total amount paid to or for the benefit of the recipient for medical assistance after the recipient reached 55 years of age
          6) The debt created under this section shall not be enforced if the recipient is survived by:
          (a) A spouse;

          (b) A child or children under 21 years of age; or

          (c) A child or children who are blind or permanently and totally disabled pursuant to the eligibility requirements of Title XIX of the Social Security Act.

          (7) No debt under this section shall be enforced against any property that is determined to be exempt from the claims of creditors under the constitution or laws of this state.

          (8) The agency shall not recover from an estate if doing so would cause undue hardship for the qualified heirs

    •  You can do this to a certain extent already. (0+ / 0-)

      The report covers 16 states and D.C., seven of which are defaulting to the use of federally managed exchanges.  The rates don't seem to be that dependent on red vs blue.

  •  I'm pretty anxiously waiting here ... (11+ / 0-)

    I had to drop my insurance a few months back - just couldn't sustain the cost any more.  Florida isn't doing squat about implementing an exchange, so I'm eagerly waiting to see what the federal system will look like for us.  Hopefully they can meet their October goal of opening early sign-up.

    Feels like playing Russian roulette, but if I can just avoid anything catastrophic until January things should be looking up.

    "That capability at any time could be turned around on the American people and no American would have any privacy left, such is the capability to monitor everything ... There would be no place to hide." - Senator Frank Church

    by jrooth on Thu Sep 05, 2013 at 08:52:23 AM PDT

    •  I hope it works out. Poor decision by FL/TX etc (7+ / 0-)

      I'm working for clients right now who are pounding both real and online pavement to gain insurance application traffic from states that don't have exchanges. When will conservabums realize that everyone having affordable access to healthcare is pro-business??

      While you dream of Utopia, we're here on Earth, getting things done.

      by GoGoGoEverton on Thu Sep 05, 2013 at 09:01:10 AM PDT

      [ Parent ]

    •  Same here. (2+ / 0-)
      Recommended by:
      jrooth, True North

      I do have insurance - sort of.  I have PCIP, a kind of bridge program until the ACA takes effect.  Most medical corporations reject it out of hand.  The response from an orthopedic "clinic" was priceless, and I quote: "Corporate says no".  Same with trying to get a primary doctor; most of them are now working for corporations.

      Less than a month to go before I can at least get insurance for 2014.

      Of course, today there was another item in the paper indicating 60-year-olds will face monthly premiums of $615.  Probably BS, but then this is Florida, where BCBS is getting ready to steal $1.6 billion from policyholders.

      I am become Man, the destroyer of worlds

      by tle on Thu Sep 05, 2013 at 09:30:34 AM PDT

      [ Parent ]

      •  Averages are a challenge (1+ / 0-)
        Recommended by:

        tle, did the newspaper article do a breakdown based on the income of the 60-year-olds they have in mind?

        If the person's income is less than about $45,000, it is more likely to be in the $350 or under range. If it is more than that, it might be around $685.

        Those were the figures I got from playing around with the Kaiser Family Foundation calculator, so they are pretty general. The KFF put the annual premiums at about $8200, but the subsidies really help, because the system places an upper limit at 9.5% of income. So at $45,000, the person pays $4,275 in premiums, but at $46,000, it is $8,191 (ouch).

        •  Wow. (2+ / 0-)
          Recommended by:
          True North, Sherri in TX

          If that $45k limit is for real, I have a decision to make.  My income is largely from withdrawing from an IRA.  Do I want to keep my total income below $45K?  Probably.

          I am become Man, the destroyer of worlds

          by tle on Thu Sep 05, 2013 at 03:20:42 PM PDT

          [ Parent ]

          •  Oh, I forgot to answer. (1+ / 0-)
            Recommended by:
            True North

            I don't think incomes were referenced, but since I took the article with an ocean of salt, it doesn't really matter.  I'll see the costs in a few weeks.

            I am become Man, the destroyer of worlds

            by tle on Thu Sep 05, 2013 at 03:26:32 PM PDT

            [ Parent ]

            •  Good decision (2+ / 0-)
              Recommended by:
              Cardinal Fang, tle

              The ocean of salt is very useful.

              With Obamacare, it is a mistake for the media to provide a single number as the "average cost," since there is such a difference between the cost with or without a subsidy.

              That $615 will look completely unaffordable to people who are going to get the largest subsidies, but not cause much angst for high-income people who are probably paying more than that now. Some readers will feel totally depressed when they read that number. Hopefully, they'll go ahead and check it out on October 1, anyway, and find out what the situation is for them.

          •  Staying below $45,000-ish is a good idea (0+ / 0-)

            It is really 400% of federal poverty guidelines, not $45,000. You might want to find out what the guideline is for your state. A few have higher guideline numbers.

            And, of course, the $45,000 only applies for a single person. For a family of four, it is more like $94,000.

            As I mentioned, the other thing that popped up when I played around with with the Kaiser calculator was the importance of that 9.5% of income limitation that applies up to 400% of of the guideline. As soon as I went past that, the real percentage of premiums to income came up in the system, and it was something like 16%.

      •  I'm sure some of the executives (1+ / 0-)
        Recommended by:

        are enjoying their $500,000 or more raises.

        The top dog gets $6.8 million/year.

        One of the comments on your linked webpage says exchanges are charging up to an 4% surcharge on premiums, which is not subsidized for anybody I believe.

        So the administrative costs on the insurance end would be up to 19% when the maximum 15% insurer margin is factored in.

        The federal surcharge will be capped at 3.5%.

        The California surcharge (unsubsidized?) might go as high as 5% in 2015.

    •  this is the link (0+ / 0-)

      There was no pricing information the last time I checked.

      Remember that it is called the Marketplace.

  •  Front page of the MKE Journal-Sentinel yesterday (4+ / 0-)

    Had a story about how the Walker administration had discovered that rates are likely to go up.

    But the main cover story featured a huge picture of a smiling medical exec who was going to help everybody understand the ACA.  The Walker line was squashed down into a tiny little spot in the corner.

    Even here, the tide may be turning.

    •  Counting the number of customers.... (0+ / 0-)

      Perhaps someone at the paper figured out the average number of subscribers and purchasers who are not governors (or their hangers-on) vs. the average number who are.

      Maybe stories featuring useful good news about the prospects for saving on insurance sells papers.

  •  Obamacare (3+ / 0-)

    Your point is critical.  What is often overlooked is that the vested interests against Obamacare have spent over $100 million on throwing as much mud as possible.  This is why 40% of Americans don't realize how and why it is actually working.  Over half of all Americans do not understand all of it's successess. Larry Roberts

  •  I am anxiously waiting too... (8+ / 0-)

    but somehow it made me feel better to go ahead to and register for the new exchange.  Kinda like - they can't take it away now, I have a user ID!!!

    Still enjoying my stimulus package.

    by Kevvboy on Thu Sep 05, 2013 at 08:58:13 AM PDT

  •  Hope My HMO Goes Down (10+ / 0-)

    My HMO costs me 52.60 per week but it has nice coverage. I hope it goes down I only make 400 per week and after deductions including health insurance I take home 265.00 per week. As a single person living alone this is not much to live on. Saving a few dollars on health care would be most helpful.

    •  Are you in a state with Medicaid expansion? (4+ / 0-)
      Recommended by:
      mwh191, imicon, guyeda, Sherri in TX

      imicon, if that's your only income, and you're in a state with Medicaid expansion, you should be eligible for Medicaid--so no charge.

      I went to the Kaiser Family Foundation calculator, which is fairly general--because there will be state-by-state variations.

      According to KFF, if your state does not have Medicaid expansion, then the premiums will be $276--per year, $23 per month.

      That would mean you'll be saving about $2,400/year. That would certainly be nice, eh?

      •  I Live In Maine (1+ / 0-)
        Recommended by:
        True North

        Gov Lepage might stop that.  I will check things out thanks I appreciate your insight.

        •  Maine, uh-oh (1+ / 0-)
          Recommended by:
          Calamity Jean

          I think you're right: the Republican governor vetoed it. Medicaid expansion did have the support of the legislature, which has a Democratic majority.

          You might want to go to now and sign up for alerts.  They say that the detailed information about plans and costs will be on the site on October 1.

          It looks like you will be saving a lot, even without the Medicaid expansion--something like 90% of what you pay now. I hope so!

          Your mean-spirited governor is up for re-election in November 2014. You might want to let him know how his veto will affect your vote next year.

  •  And therefore ... (12+ / 0-)

    Obamacare (LOVE THE NAME, FOLKS. LOVE THAT NAME) is going to bend the curve on health care costs, just as predicted, and ...

    reduce the deficit.

    Will Pete Peterson come out for it? Will Simpson or Bowles?

    No, because this is not the deficit reduction droid they are looking for.

    I'm on a mission! Testing the new site rules.

    by blue aardvark on Thu Sep 05, 2013 at 09:00:08 AM PDT

  •  Also a study out by Avalere (4+ / 0-)
    Recommended by:
    annan, Choco8, guyeda, nchristine

    with what I would call "mixed results".

    I would like to know more about the deductibles and out of pocket expenses. i still worry that many of the plans may provide health insurance , but not affordable health care.

    •  Yes (0+ / 0-)
      I still worry that many of the plans may provide health insurance , but not affordable health care.
      My concern as well.
    •  Affordable is pretty subjective to a certain (0+ / 0-)

      extent isn't it?

      Is $50 a month affordable?  Is $150 affordable?

      I am not sure what state you live in but here in California the deductibles on a silver plan are quite reasonable.   Since  the plans are going to be pretty standard go have a look at them.

      Right man, right job and right time

      by Ianb007 on Thu Sep 05, 2013 at 01:52:23 PM PDT

      [ Parent ]

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

        Of course, it is subjective to an extent.

        Say someone is making $25,000 and can get a plan in $100-$150 range. I can see where the argument that they could fit this in their budget makes sense (Although still tough).

        The ability for them to pay the $2000 deductible or the $6,350 max out of pocket  seems to me to be less of a realistic expectation.

        That seems to me to be less subjective and more mathematical.

        •  Most of the benefits in the silver plan (0+ / 0-)

          are not subject to the deductible.  e.g lab tests copays are $40.

          Where the high out of pocket costs gets you is for hospital care and outpatient surgery.  That would be the archives tendon of the plans.  Fortunately these services are rare and the most useful and common services are affordable.

          Right man, right job and right time

          by Ianb007 on Thu Sep 05, 2013 at 02:44:15 PM PDT

          [ Parent ]

  •  Your last paragraph is too much American truth (2+ / 0-)
    Recommended by:
    blue aardvark, imicon

    for the GOP to handle.  Even if the market is enforced by the govt, the market is allowed to work, and determine pricing; and that is how capitalism works.

    When the GOP talks of a free market, unencumbered, they are talking about Obama being black.

    Ayn sucks. Please know I am not rude. I cannot rec anything from this browser. When I rec or post diaries I am a guest at some exotic locale's computer.

    by Floyd Blue on Thu Sep 05, 2013 at 09:02:25 AM PDT

  •  Funny that I'm seeing this excellent FP Story (5+ / 0-)

    here, Joan!

    Just a few minutes ago, I ran across this story on my Yahoo home page "news" feed.

    The AP story linked on Yahoo wasn't completely false, but it overstated the cost of the higher-quality policies and understated the role of premium subsidies. Of course.

    As if the article itself wasn't misleading enough, take a look at the comments. Typically for a story linked on Yahoo, the comments reflect a level of stupid I find breathtaking. Reading them is like reading WND while simultaneously listening to Limbaugh and watching Fox "News". I generally can't get past the first dozen comments without nausea taking over and then giving way to rage.

    I don't really expect much help from the MSM on getting the truth out. I'm thrilled by the preliminary estimates I've gotten from kaiser as well as from the BC/BS of NC Blue Map tool that current subscribers can use.

    With only a month to go until exchange rollout, I hope that more sane - and honest voices can make accurate information available to more people.

    "Bernie Madoff's mistake was stealing from the rich. If he'd stolen from the poor he'd have a cabinet position." -OPOL

    by blue in NC on Thu Sep 05, 2013 at 09:03:49 AM PDT

    •  There are a lot of yahoos on yahoo (2+ / 0-)
      Recommended by:
      blue in NC, Theodore J Pickle

      with nothing better to do all day but talk to each other. It keeps them believing their myths... kind of sad, really.

      Freedom isn't free. That's why we pay taxes.

      by walk2live on Thu Sep 05, 2013 at 09:22:30 AM PDT

      [ Parent ]

    •  Early adopters will get the word out, too (2+ / 0-)
      Recommended by:
      blue in NC, Calamity Jean

      Word-of-mouth will play an incredibly important role in getting people to at least find out how much insurance will cost them in the marketplace.

      The early adopters who are already keen to sign up will lead the way, and then they'll do what early adopters always do: brag to everybody they know about how great it is. They'll brag about their premiums and they'll brag about still getting the same health care.

      That will lead dubious ones in the middle to at least check it out.

      The skeptical late adopters may miss out this year, but they'll wander in eventually.

      The Fox devotees might check it out, too, if only to prove that they're right and ACA fans are wrong. If they sign up, they'll probably feel so ashamed that they'll keep it secret.

  •  Single payer universal... n/t (0+ / 0-)

    "Daddy, every time a bell rings, a Randian Libertaria­n picks up his Pan Am tickets for the Libertaria­n Paradise of West Dakota!"

    by unclebucky on Thu Sep 05, 2013 at 09:12:11 AM PDT

  •  I have group medical via Cal PERS, coverage (2+ / 0-)
    Recommended by:
    majcmb1, True North

    for both my son and I.  It's a Blue Cross PPO.  My employer gives us a chunk of money (usually enough to cover just myself) and employees pay the balance.     My son has special medical needs and he has superb docs for them, so I will not switch to another insurance plan that doesn't cover those docs.

    For some reason, my insurance rate will go up about 34%; I was pretty surprised.  Not sure why, yet.  My income is too high for any subsidy, but I guess I could look at dropping my son (he's 21) and get him coverage via the exchange.

    If that's not an option, however, I will still stand by an imperfect Obamacare as a necessary step towards the long run reconfiguration of our health care system (i.e., single payer).  

    The most violent element in society is ignorance.

    by Mr MadAsHell on Thu Sep 05, 2013 at 09:12:58 AM PDT

  •  Curious about the status of these 2 court cases (0+ / 0-)

    Can anyone shed any light on these 2 federal court cases? I don't know where to begin but clearly these are important cases because they challenge the availability of subsidies or tax credits in the 34 states that have refused to establish their own state exchanges.

    Pruitt v. Sebelius (U.S. District Court for the Eastern District of Oklahoma) and Halbig v. Sebelius (U.S. District Court for the District of Columbia) challenge the IRS regulation expanding the availability of premium subsidies to individuals enrolled in a Federally-operated Exchange. The plaintiffs claim that the issuance of the subsidies to individuals enrolled in a Federal Exchange is contrary to the specific provisions of PPACA and injures them in several ways, including forcing individuals to either pay a penalty or purchase insurance and subjecting employers to the play or pay penalties under the employer mandate from which they would otherwise be exempt due to the unavailability of subsidies to individuals in their respective State.

    "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

    by annan on Thu Sep 05, 2013 at 09:17:38 AM PDT

    •  Wow, some service to Oklahoma residents (1+ / 0-)
      Recommended by:

      annan, I wasn't aware of these cases and I'm not familiar with them.

      But, boy, that's some Attorney General that the poor people of Oklahoma have in Scott Pruitt, the "Pruitt" in Pruitt v. Sebelius.

      As I understand Pruitt's argument, it is that ONLY people who get their insurance from a state exchange are entitled to a subsidy. People who get their insurance through a federal exchange because their state doesn't have an exchange are not eligible for a subsidy.

      Oklahoma hasn't set up a state exchange. Oklahomans will get insurance through the federal exchange.

      It sounds to me like he is so ideologically committed to thwarting ACA that he will throw his own state residents under the bus. No subsidies for his state's residents, he says.

      •  Thanks for writing this synopsis. (1+ / 0-)
        Recommended by:
        True North

        The other case argues that the IRS doesn't have jurisdiction. The plaintiffs are individuals and businesses from Virginia, West Virginia, Tennessee, Missouri, Texas and Kansas.

        The legal argument that the plaintiffs will be injured if the subsidies and tax credits are available in their state simply boggles my mind. However, the possibility that the IRS ruling is in itself illegal is unnerving.

        2. To encourage states to establish Exchanges, Congress used carrots, such as start-up grants to help fund the creation of Exchanges; and sticks, such as prohibiting states from tightening Medicaid eligibility standards before setting up Exchanges. The biggest carrot was the offer of premium-assistance subsidies from the Federal Treasury—refundable tax credits to help a state’s low- and moderate-income residents buy insurance—if that state set up its own Exchange. States rejecting the offer got a stick instead: the imposition of a federally-established, federally-operated Exchange in the state, with no subsidies at all.
        4. Notwithstanding express statutory language limiting premium-assistance subsidies to Exchanges established by states, the Internal Revenue Service (“IRS”) has promulgated a regulation (“the IRS Rule” or “the Subsidy Expansion Rule”) purporting to authorize subsidies even in states with only federally-established Exchanges, thereby disbursing monies from the Federal Treasury in excess of the authority granted by the Act. The IRS Rule squarely contravenes the express text of the ACA, ignoring the clear limitations that Congress imposed on the availability of the federal subsidies. And the IRS promulgated the regulation without any reasoned effort to reconcile it with the contrary provisions of the statute.
        I would love for one of our legal beagles here on dKos to take a look at this and tell me why I'm crazy to be concerned about these 2 cases.

        "Let us not look back to the past with anger, nor towards the future with fear, but look around with awareness." James Thurber

        by annan on Thu Sep 05, 2013 at 12:17:36 PM PDT

        [ Parent ]

        •  The IRS might argue (2+ / 0-)
          Recommended by:
          annan, True North

          that it is simply eliminating constitutionally unfair residential restrictions that a federal court would order removed if a person irrationally and unfairly denied subsidies sued the IRS.

          It would be like giving an estate tax refund prior to being told to do so after a DOMA court case ruling.

        •  Early days yet (1+ / 0-)
          Recommended by:

          annan, those cases are in federal district court now. It will probably be months before a decision is reached. However they turn out, they'll be appealed to their respective Circuit Court. More time will pass. Then they'll be appealed to the Supreme Court.

          We're a few years away from a final decision. There will probably be a new president and a new health secretary in place by then. Heck, there might well be a new Obama appointee on the Supreme Court.

          One thing I'm pretty sure of: the subsidies for both state and federal exchanges will be in place for a few years before this ever gets settled in the courts.

          This provides one more reason to do all we can in 2014 and 2016.

    •  I'm a lay person (1+ / 0-)
      Recommended by:

      The second petition seems well argued to me.

      I tend to think the first petition might have standing problems since subsidies are not really the Attorney General of Oklahoma's business in my opinion.

      As for employer penalties a Kansas employer might accidently hire a person properly getting federally subsidized coverage from say New York State after moving from say Albany so being located in a no-subsidy state is not a surefire way of avoiding employer mandate penalties.

      Also a Kansas-resident person born in say New York might buy federally subsidized insurance from say the New York exchange using a New York address of say a parent.

  •  When the premiums everywhere are announced (1+ / 0-)
    Recommended by:
    True North

    then we'll know.  I check the Kentucky website everyday to see what will happen here.  Frankly, I've stopped telling all and sundry about how great the premiums are going to be with subsidies kicking in since I found out about the higher rates for older people and the 50% smoking penalty the federal law permits (unless state law is passed to override it).  If the fifty percent penalty is not overridden by state law, or the insurance companies just decide not to penalize in this market, I'm going to look pretty dumb to the low-income smokers I've all but PROMISED good rates to.  The subsidies won't help cover a smoking penalty, and low income smokers will probably end up paying penalties and remaining uninsured.  They won't be able to afford coverage.  I still can't believe the ACA has left this huge ratings loophole for the insurance companies.

    •  Tobacco cessation (1+ / 0-)
      Recommended by:
      Kentucky DeanDemocrat

      Kentucky, if your friends have insurance, then I believe that they are already eligible for free tobacco cessation preventive health care under the insurance they have.

      It may well be that the premiums they will pay in the marketplace will still be cheaper than what they could get pre-marketplace--because smoking has long been a factor that raises premiums.

      So you were probably right about the lower premiums.

      If they can manage to kick the habit, then they'll do even better--much, much, cheaper than whatever they pay now as smokers on current insurance.

      •  I'm thinking of 2 people in particular (0+ / 0-)

        Neither is currently insured because they make barely above minimum wage and they can't afford it.  They won't be able to afford this either, unless Kentucky overrides federal law on the penalty.

        Yeah, sure, everybody should quit.  The price of cigarettes quadrupling over the past few years hasn't made them quit, though, and this won't either.  these guys are young and don't expect to get sick.  And odds are they won't.  They will have to pay a penalty when they don't purchase the insurance they can't afford, though.  

        •  Of course, they may qualify for Medicaid. (1+ / 0-)
          Recommended by:
          True North

          If that's so, they won't face any penalty at all.  I fear they make just enough to be above the Medicaid line, though.

          •  Kentucky (0+ / 0-)

            Kentucky has Medicaid expansion and it has its own state exchange.

            I didn't see a Kentucky calculator, but the Kaiser Family Foundation calculator indicates that a person at that income level (single person, minimum wage, full-time work, in Kentucky) will be eligible for Medicaid. (Annual income: $15,080.)

            If not, then the tobacoo factor really does hit pretty hard.

            The KFF calculator indicates that the unsubsidized premium is $5786, which includes $1929 for the tobacco surcharge. A person who uses tobacco would pay $2231 per year--but a person who doesn't would pay $302. Yikes.

            The KFF calculator is very general, of course, because states will vary. But, at the moment, it looks like those who work full-time for minimum wage in Kentucky will be eligible for Medicaid.

            If so--then you were definitely right to encourage them to check this out and sign up in October!

  •  I hope you're right...but will the exchanges (2+ / 0-)
    Recommended by:
    annan, Willa Rogers

    roll back the 50% increases I've endured over the last two years?

    Will it still be affordable when I can no longer buy my current insurance because it won't meet the criteria of a qualifying plan?

    I certainly hope so.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Thu Sep 05, 2013 at 09:22:02 AM PDT

  •  I can't wait to the see the numbers for PA (2+ / 0-)
    Recommended by:
    chloris creator, True North

    Wife and I are paying over $500/mo for our insurance right now- the exchange should save us at least a 1/3 of that.

    It's stupid all the way down.

    by xenothaulus on Thu Sep 05, 2013 at 09:27:58 AM PDT

  •  It's not that the insurance companies are (2+ / 0-)
    Recommended by:
    True North, nchristine

    getting a lot of new customers. They're getting a lot of young, healthy, new customers.

    That's the critical part. Don't understate it. They WANT those young healthy customers. They won't cost the insurers much, and will bring in a ton of cash.

  •  That $111/month for a subsidized... (2+ / 0-)
    Recommended by:
    SingleVoter, annan

    ...bronze plan is accompanied by another $6350/year in "cost-sharing" according to Kaiser; i.e., deductibles and out-of-pocket costs. That's a pretty big chunk of money to cough up every year if you're making only $29,000--and it's on top of the $111/month in subsidized premiums.

    The subsidized premiums under PPACA make insurance affordable. The out-of-pocket costs are another matter entirely, and I think a lot of folks are going to be unpleasantly surprised with the fairly high caps on cost-sharing under the subsidized plans.

  •  Uh-oh! (0+ / 0-)

    One more nail in the Tea Party coffin...

    In other news, Rand Paul threatened to have himself crucified in Louisville if "the hideous monstrosity that is Obamacare is not removed from our land".
    /snark for the snark-impaired

    What stronger breast-plate than a heart untainted! Thrice is he arm'd, that hath his quarrel just; And he but naked, though lock'd up in steel, Whose conscience with injustice is corrupted. King Henry, scene ii

    by TerryDarc on Thu Sep 05, 2013 at 10:18:29 AM PDT

  •  My family is saving about $4000 in premiums (3+ / 0-)
    Recommended by:
    Theodore J Pickle, guyeda, Ianb007

    over the next 12 months.  We're not direct beneficiaries of the ACA, but because of competitive pressures generated by the ACA, my wife's employer offered her PPO health insurance (as a part time worker) at a cheap rate, which meant that I could take her off of my insurance, and lower our family's total cost.  Thanks Mr. President!

    Global Shakedown - Alternative rock with something to say. Check out their latest release, "A Time to Recognize": Available on iTunes, Amazon, Google Play, Spotify and other major online music sites. Visit

    by khyber900 on Thu Sep 05, 2013 at 10:26:56 AM PDT

  •  Utah (1+ / 0-)
    Recommended by:
    belinda ridgewood

    Utah has set up an exchange of sorts called Avenue H. The policies posted now are not affordable at all. I am waiting to see what happens after Oct. 1. They claim they are following the law but if so, they take a very strange view of what "following" means.

  •  on a California Bronze or Silver plan (0+ / 0-)

    "High cost and infrequent
    services like Hospital Care and
    Outpatient Surgery"

    Bronze plan "co-pay":
    "30% of your plan’s
    negotiated rate

    Silver plan "co-pay"
    "20% of your plan’s
    negotiated rate

    These "co-pays" are actually co-insurance which are legally frowned upon by the PPACA but apparently are legally permitted.

    Bear in mind that these "co-pays" will normally be demanded to be paid in advance by a hospital unless the hospital is required by the EMTALA to treat you.

    A 30% bronze "co-pay" on a $20,000 hospital appendectomy bill is $6,000.

    A 20% silver "co-pay" on a $20,000 hospital appendectomy bill is $4,000.

    Have your VISA/MasterCard/checkbook handy.

    Since an inflamed appendix might kill you, the hospital will probably extort what it can and treat you, but if your back is hurting real bad opiates will be your best friends.

    The PPACA envisioned one pricing scheme for each hospital for all patients and all insurers, but apparently the old negotiated rate stuff will still be allowed.

  •  "upgrade to a “silver” plan" (1+ / 0-)
    Recommended by:
    Willa Rogers

    Which means starting from a bronze plan that pays only 60% of the group policyholders' medical bills.

    The term "upgrade" is putting a pretty face on what is simply going from an 60% [awful] to 70% [shoddy] actuarial rate product.

    •  High out-of-pocket costs are the new normal... (1+ / 0-)
      Recommended by:

      ...and one of the things sticking in labor's craw at the moment, since many collective bargaining agreements called for lower healthcare costs in lieu of salary increases.

      Everyone's been focusing on savings in premiums under PPACA, particularly with the subsidized plans, but the last time I checked the Kaiser calculator, out-of-pocket costs were not subsidized to the same degree as premiums, and I think we need to be prepared for the sticker shock that will hit consumers.

      Remember: Over half of all Americans have said they wouldn't be able to come up with $1,000 in an emergency. This is the group that will be subsidized in purchasing insurance but won't have the money to actually use it.

  •  The 60% coverage you crow about (0+ / 0-)

    is almost as bad as finding yourself having to pay French-level medical costs all by yourself.

  •  Maryland is the only state (0+ / 0-)

    that regulates hospital prices.

    The lowest monthly premium for a 40-year-old in the 17 states surveyed by Kaiser would be $146 in Baltimore.
    Maryland also leaned hard on insurers.

    Keep leaning!

  •  what about ohio and florida? (0+ / 0-) If the dnc dscc or dccc send you mailers, send that link back to them and tell them you won't send money to people who defend democrats who betray progressive principals!

    by daeros on Fri Sep 06, 2013 at 11:52:56 AM PDT

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