Obamacare canceled my insurance!

[GeneralVeers]

I just got my notice from BCBS this week: My insurance will be cancelled due to Obamacare.

I'm an IC with a hospital group getting no benefits. I have been paying out-of-pocket for the last 6 months for my own private health insurance plan. Far from a "junk" plan, as many Obamacare advocates have been referring to the canceled policies, mine was the most expensive PPO I could get. At $420 monthly for two people it had an open network and a $1000 deductible. Is this a junk policy?

The letter from BCBS simply states that due to the changes under the ACA, my insurance will no longer be available after July 2014. They give me no options, and no recourse. They simply state that a plan "might" be available on the Nevada exchange. Does anyone want to bet I can get a similar plan on the Exchange with the same deductible for $400/month? More likely my premium will go up, and my deductible will go up to to $5000 or more.

Luckily for me, President Obama has illegally and unconstitutionally enacted a hardship waiver for 2014 for those people who's plans had been canceled under the law.

I have always tried to be responsible, and pay my own way. Starting in July, count me in as one of the newly un-insured, as I have have no intention of getting a rip-off government exchange plan.

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[goodoldalky]

Does anyone want to bet I can get a similar plan on the Exchange with the same deductible for $400/month? More likely my premium will go up, and my deductible will go up to to $5000 or more.

There's a reason the biggest proponents of Obamacare were the insurance companies... #redflag

 

[GeneralVeers]

Wow, 517 views and only one comment. I can't believe that no one else on this forum has any opinion about this.

Doesn't anyone else here have a problem with previously insured people now being uninsured? How can anyone possibly support this law?

 

[SoCuteMD]

For every story like yours, there's someone who has found their policy/cost drastically improved. My parents used to pay 36,000/year (yes, you read that right) for a BCBS PPO. No major health problems for either of them at that time. As they live in MA, they have paid substantially less for the last few years.

From the sounds of it, you haven't even looked into what is available, so I'm a little unclear on why you are whining so much. I have family in a state adjacent to Nevada. One of them is a student and looked into policies that were available as an alternative to the school's plan (which was not one of the school plans that was eliminated, he could have kept it). He found a plan that fit his needs for $250/month. Could have had something cheaper but with good coverage if he didn't have specific prescription needs, too, based on what he said.

 

[daveyjwin]

Wow, 517 views and only one comment. I can't believe that no one else on this forum has any opinion about this.

Doesn't anyone else here have a problem with previously insured people now being uninsured? How can anyone possibly support this law?

The ACA isn't made for you, or me, or really any of us. It's made for the 80+ million people that are under or un insured. Not everyone wins with these types of things, but the ultimate goal is that we, as a society, will win. And those of us who have more will have to bear the brunt of that burden.

 

[deuist]

One of them is a student and looked into policies that were available as an alternative to the school's plan (which was not one of the school plans that was eliminated, he could have kept it). He found a plan that fit his needs for $250/month.

$250/month sounds way too expensive for a male student. In graduate school, my BCBS PPO insurance was $70/month. I wonder if the price difference is due to your family's being on the West coast.

 

[GeneralVeers]

$250/month sounds way too expensive for a male student. In graduate school, my BCBS PPO insurance was $70/month. I wonder if the price difference is due to your family's being on the West coast.

The $250 is because a young, healthy male is paying more than he should given his aggregate risk to subsidize the risk of other higher risk people.

Someone asked "why am I whining?". I'm whining because I went from certainty, meaning being insured with portable insurance I can take everywhere (I travel for work) to not knowing what will happen in July. No one can even answer my questions yet:

1. Will my new insurance cost less as promised by Obama in 2010?
2. Will my insurance be portable? I spend about 40% of my time in other states. Will a state "exchange" insurance cover me in other states?
3. Will the networks improve? My local "exchange" in Las Vegas excludes the best hospitals in my area. Vegas hospitals are not known to be quality, and excluding the few mediocre ones, leaves exchange patrons forced into going to crappy hospitals when they need care.

 

[usrael]

Let the dust settle. I'm in the same boat. My insurance was cancelled and I now have to be pay 120% more a month (270$) for significantly worse coverage (Kaiser). I shopped around but found nothing cheaper. I'm also upset, as my insurance doesn't even cover a primary care visit (deductible is 6500$). Not sure I am going to keep insurance at all, though my fear of getting an appy will likely keep me in the program. It sure feels like a health tax. We are subsidizing insurance for those who truly cannot afford it, so it's not all lost. Still, it's a mess.

 

[GeneralVeers]

Let the dust settle. I'm in the same boat. My insurance was cancelled and I now have to be pay 120% more a month (270$) for significantly worse coverage (Kaiser). I shopped around but found nothing cheaper. I'm also upset, as my insurance doesn't even cover a primary care visit (deductible is 6500$). Not sure I am going to keep insurance at all, though my fear of getting an appy will likely keep me in the program. It sure feels like a health tax. We are subsidizing insurance for those who truly cannot afford it, so it's not all lost. Still, it's a mess.

What happened to:

1. If you like your doctor you can keep him/her?
2. If you like your insurance plan you can keep it?
3. The average family will save $2500 per year on insurance
4. The ACA will not add one dime to the deficit

These outright lies should be impeachable. I'm not sure why the President has gotten a pass on this from the voters and much of the media. You've upended 1/6 of the economy, led to millions getting their insurance cancelled, and will likely create trillions in excess spending. All of this was based on complete fraud and lies. How can this man not be impeached?

 

[lightthelamp4]

I am a married third year med student; my wife and I (both healthy 27 yo) were previously covered by my schools plan at a rate of 4000 per semester (about 1000/month) under a pretty crappy plan. My wife's job does not offer health insurance. This law allowed us to get essentially the same coverage + a dental plan for 400 bucks a month. It is saving us 600 dollars a month, and for someone dependent on student loans, this is pretty freaking awesome.

 

[GeneralVeers]

Not sure how a plan for two healthy people would be $1000/month. I'm not sure I believe there were no other options.

 

[lightthelamp4]

We'll my wife's job does not offer insurance, and my schools rate is what it is. I'm not playing politics, not sure why you think I
would be making things up.

 

[sylvanthus]

The ACA isn't made for you, or me, or really any of us. It's made for the 80+ million people that are under or un insured. Not everyone wins with these types of things, but the ultimate goal is that we, as a society, will win. And those of us who have more will have to bear the brunt of that burden.

Wait, what? Several million people lost their insurance and what, maybe, one million people got insurance? The net is still negative......

 

[SoCuteMD]

$250/month sounds way too expensive for a male student. In graduate school, my BCBS PPO insurance was $70/month. I wonder if the price difference is due to your family's being on the West coast.

His school plan was $150/month for a very limited network and minimal prescription coverage, so $250 with a comparable deductible and prescription coverage isn't worse given that one monthly prescription was already costing $100/month. The coverage includes one of the two major hospitals in town. He's not on the west coast, though - just in a state adjacent to Nevada. For comparison, adding him to his wife's coverage through her work would have cost $450 month and would have taken the deductible from 3,000 to 6,000.

My med school BCBS PPO was $200/month on the east coast. It was good coverage, but pricey.

 

[TravelingRunner]

It's not just people whom have more who are paying more.

My husband is active-duty enlisted military; I'm a student. We have 3 kids. Military pay is a matter of public record; we don't make much...we make enough to live, but some of the attendings here make in a day of work what my husband brings home for a month. I'm certainly proud of what he does, and I'm not complaining. But that information is pertinent to the following:

I decided to see what our Obamacare health insurance would be if we did not have Tricare. The "affordable health coverage" I was offered was 45.19% of our annual pay. Yes, you read that correctly - we'd be left to live on 54.81% of our current pay (minus other taxes, of course). And our annual out-of-pocket expenses are "only" another 60.45% of our annual income. So, we pay 45.19% of our income for the privilege of having "health insurance" and then have another 60.45% before they pay for anything meaningful. No, your math isn't off - that's 105.64% of our income. And here's the kicker: we make too little for the government tax credit to apply.

Thank God for Tricare. If we didn't have it but were making the same amount, we would have no insurance, which is not a good situation. We would also have to pay the penalty, which ironically would be a much cheaper deal than the "Affordable" Care Act.

 

[Dwindlin]

Not sure how a plan for two healthy people would be $1000/month. I'm not sure I believe there were no other options.

I believe about the $1000 a month, because that's about what I was paying for a policy from my school for me and wifey. In terms of cheaper options I don't know, as mine was required, I couldn't have switched even if I found something cheaper. Even when my wife got a job that offered insurance I had to stay with schools (which was ~$450/month without wife).

 

[Siggy]

We'll my wife's job does not offer insurance, and my schools rate is what it is. I'm not playing politics, not sure why you think I
would be making things up.

You weren't able to find your own health plan and opt out of the schools plan? My undergrad, SMP, and medical school all required students to have health insurance with the default being the school's plan. However if you found a comparable plan (not hard to do), you sent in a form and they didn't enroll/charge you for the school's plan.

 

[NinerNiner999]

At least Veers will have maternity coverage.

 

[TooMuchResearch]

You weren't able to find your own health plan and opt out of the schools plan? My undergrad, SMP, and medical school all required students to have health insurance with the default being the school's plan. However if you found a comparable plan (not hard to do), you sent in a form and they didn't enroll/charge you for the school's plan.

Some schools only allow opting out of the school plan for an employer/spouse's employer group plan.

 

[SoCuteMD]

It's not just people whom have more who are paying more.

My husband is active-duty enlisted military; I'm a student. We have 3 kids. Military pay is a matter of public record; we don't make much...we make enough to live, but some of the attendings here make in a day of work what my husband brings home for a month. I'm certainly proud of what he does, and I'm not complaining. But that information is pertinent to the following:

I decided to see what our Obamacare health insurance would be if we did not have Tricare. The "affordable health coverage" I was offered was 45.19% of our annual pay. Yes, you read that correctly - we'd be left to live on 54.81% of our current pay (minus other taxes, of course). And our annual out-of-pocket expenses are "only" another 60.45% of our annual income. So, we pay 45.19% of our income for the privilege of having "health insurance" and then have another 60.45% before they pay for anything meaningful. No, your math isn't off - that's 105.64% of our income. And here's the kicker: we make too little for the government tax credit to apply.

Thank God for Tricare. If we didn't have it but were making the same amount, we would have no insurance, which is not a good situation. We would also have to pay the penalty, which ironically would be a much cheaper deal than the "Affordable" Care Act.

This is all well and sad, but do you have any idea what you would have been paying BEFORE? Given how much you would be out of pocket, it sounds like someone in your family may have a preexisting condition, and if that's the case then you either would have been paying obscene premiums or may have been unable to get insurance.

I'm not claiming the ACA is the answer to the ridiculousness that is our healthcare system and our insurance system, but I do consider parts of it a step forward.

 

[deleted547339]

At least Veers will have maternity coverage.

Zing!

 

[TravelingRunner]

This is all well and sad, but do you have any idea what you would have been paying BEFORE? Given how much you would be out of pocket, it sounds like someone in your family may have a preexisting condition, and if that's the case then you either would have been paying obscene premiums or may have been unable to get insurance.

I'm not claiming the ACA is the answer to the ridiculousness that is our healthcare system and our insurance system, but I do consider parts of it a step forward.

I have a really good idea of what our health insurance was prior to the military. I was a professional in a totally different field, moonlighting at a hospital as a CNA so we could have decent health insurance. We paid about $450/mo. for all of us, with a reasonable out-of-pocket and reasonable co-pay. We have no pre-existing conditions, and none of us smoke.

Trust me, I know our insurance and healthcare system needs help. The point of my post was not to be "sad," as you put it, but to point out that it's not just those with "more" who are taking one for the team with the ACA.

 

[SoCuteMD]

I have a really good idea of what our health insurance was prior to the military. I was a professional in a totally different field, moonlighting at a hospital as a CNA so we could have decent health insurance. We paid about $450/mo. for all of us, with a reasonable out-of-pocket and reasonable co-pay. We have no pre-existing conditions, and none of us smoke.

Trust me, I know our insurance and healthcare system needs help. The point of my post was not to be "sad," as you put it, but to point out that it's not just those with "more" who are taking one for the team with the ACA.

You paid $450 out of your salary, but your employer subsidized a significant amount of the cost. When you buy insurance on the exchange, there's no employer subsidy.

Example: For an individual at my institution with my salary (contribution towards insurance increases with salary), it costs close to $500/month to insure an individual. But I only pay $40/month. For a family where the policyholder is paid my salary, it costs $1500/month to insure the family. But the policyholder only pays $180/month - a subsidy of 88%. The cost to the policyholder maxes out at just about $500/month to insure a family as salary increases, so still a 66% subsidy.

 

[TravelingRunner]

That subsidy was the attraction of getting health insurance through an employer, pre-ACA. Unfortunately, because of ACA, many employers are reducing the amount they subsidize or eliminating it altogether.

It does not change that ACA was supposed to help the uninsured and under-insured (usually, lower-income working people who were ineligible for Medicaid) gain good health insurance and the Obamacare plans failed that, in my case and in many other cases.

In any case, I have procrastinated studying long enough. All the best to everyone here, and Happy New Year.

 

[SoCuteMD]

That subsidy was the attraction of getting health insurance through an employer, pre-ACA. Unfortunately, because of ACA, many employers are reducing the amount they subsidize or eliminating it altogether.

It does not change that ACA was supposed to help the uninsured and under-insured (usually, lower-income working people who were ineligible for Medicaid) gain good health insurance and the Obamacare plans failed that, in my case and in many other cases.

In any case, I have procrastinated studying long enough. All the best to everyone here, and Happy New Year.

My point was that you can't point to your old (subsidized) policy and say, "But it only cost $450 a month before, and now it would be 50% of my income!" My guess is that if your income is as low as you say it is, your children would qualify for CHIP or Medicaid - which would reduce the cost of insurance for your family significantly. Then again, if you live in a state that has refused to expand Medicaid, you should blame that on your legislature not on the ACA.

The people I know whose employers have cancelled their group policies are receiving a payroll credit to continue to subsidize their health insurance. Admittedly, this is not as good as having their premiums paid by employer and a pre-tax payroll deduction, but the one person I know the specifics of was able to find a better plan than his employer offered. I suspect that this is a mixed bag and that there are some people who were previously insured through their employers who have seen their costs increase.

 

[MalachiConstant]

Wait, what? Several million people lost their insurance and what, maybe, one million people got insurance? The net is still negative......

Just a comment about this, cause I've seen this argument a lot. It assumes that those who lost health plans will not subsequently seek out continued coverage for which they are eligible, either by purchasing another plan on their own or through the health exchanges. Also, depending on the state, many of these people may qualify for expanded medicaid benefits. Recent changes should also allow for about half of those with canceled policies to be eligible for 2013 policy renewals, so some could pursue this option as well.

It changes the picture a bit, as only a very very tiny percentage of people will likely lose the ability to be covered, so there's still a net positive of people who will ultimately have health coverage which was the main idea. As for the costs to those in the lost policy group though, I guess time will tell if most have to pay more or not.

 

[Perrotfish]

It's not just people whom have more who are paying more.

My husband is active-duty enlisted military; I'm a student. We have 3 kids. Military pay is a matter of public record; we don't make much...we make enough to live, but some of the attendings here make in a day of work what my husband brings home for a month. I'm certainly proud of what he does, and I'm not complaining. But that information is pertinent to the following:

I decided to see what our Obamacare health insurance would be if we did not have Tricare. The "affordable health coverage" I was offered was 45.19% of our annual pay. Yes, you read that correctly - we'd be left to live on 54.81% of our current pay (minus other taxes, of course). And our annual out-of-pocket expenses are "only" another 60.45% of our annual income. So, we pay 45.19% of our income for the privilege of having "health insurance" and then have another 60.45% before they pay for anything meaningful. No, your math isn't off - that's 105.64% of our income. And here's the kicker: we make too little for the government tax credit to apply.

Thank God for Tricare. If we didn't have it but were making the same amount, we would have no insurance, which is not a good situation. We would also have to pay the penalty, which ironically would be a much cheaper deal than the "Affordable" Care Act.

If you make too little for the government subsidized insurance the law was written so that you are supposed to qualify for Medicaid for free. Medicaid is no longer supposed to have any kind of requirements other than an income test. Also Medicaid was supposed to be real insurance rather than insurance no one would take, since the reimbursement rates were supposed to be tied to Medicare rates. In blue states, that's what happened. The problem is that didn't end up happening nationally.

The biggest issue with Obamacare (of many) is that many states refused that coverage. So if you're in a red state Obamacare eliminated the previous government subsidies for the old safety net, which was basically a massive subsidy for charity hospital care, but the republican legislature blocked the new safety net, which was expanded Medicaid. So you don't get either. Since both parties were involved you get to decide who to blame, however the practical moral of the story is that if you're working poor in America and want healthcare you're probably going to need to live in a blue state.

 

[southerndoc]

At least my new insurance card is in color.

 

[NOsaintsfan]

If you make too little for the government subsidized insurance the law was written so that you are supposed to qualify for Medicaid for free. Medicaid is no longer supposed to have any kind of requirements other than an income test. Also Medicaid was supposed to be real insurance rather than insurance no one would take, since the reimbursement rates were supposed to be tied to Medicare rates. In blue states, that's what happened. The problem is that didn't end up happening nationally.

The biggest issue with Obamacare (of many) is that many states refused that coverage. So if you're in a red state Obamacare eliminated the previous government subsidies for the old safety net, which was basically a massive subsidy for charity hospital care, but the republican legislature blocked the new safety net, which was expanded Medicaid. So you don't get either. Since both parties were involved you get to decide who to blame, however the practical moral of the story is that if you're working poor in America and want healthcare you're probably going to need to live in a blue state.

I just want to point out that many of the states that didn't take the Medicaid expansion did so for financial reasons not simply because they dislike Obama. The federal government will only pay 100% of the cost for 3 years and after that will pay ~90% of the costs. Some of the poor states (think the south) will have a significant % of people eligible for Medicaid however the ~10% the states have to pay will in some of those states amount to billions of dollars. These same states already have budget problems, how do they cover the costs? They could always reduce money for education and roads I guess. Sure we should find a way to provide coverage for all but its not as simple as essentially saying; Obamacare fixed the problem but stupid governors of "certain" states want to put politics above peoples health. Remember the federal government doesn't care about budgets or money because to them its all "funny"money, they can always just print/borrow more, the states can't do that.

 

[SuckySurgeon7]

At my current job, I make $10.75 per hour. My insurance went from $32 per month to $74. I don't remember what the new deductible is. What I am really waiting for are some hard metrics on the effects of the exchange programs, but the websites have been so inaccessible that nothing reliable has presented itself yet. If I were an MS3 right now, I'd be considering direct pay primary care... forget all of the insurance problems.

 

[Perrotfish]

I just want to point out that many of the states that didn't take the Medicaid expansion did so for financial reasons not simply because they dislike Obama. The federal government will only pay 100% of the cost for 3 years and after that will pay ~90% of the costs. Some of the poor states (think the south) will have a significant % of people eligible for Medicaid however the ~10% the states have to pay will in some of those states amount to billions of dollars. These same states already have budget problems, how do they cover the costs? They could always reduce money for education and roads I guess. Sure we should find a way to provide coverage for all but its not as simple as essentially saying; Obamacare fixed the problem but stupid governors of "certain" states want to put politics above peoples health. Remember the federal government doesn't care about budgets or money because to them its all "funny"money, they can always just print/borrow more, the states can't do that.

While I'm sure that the red state governors didn't justify their decision to themselves in terms of partisanship, the fact is that the vote to expand vs not expand fell very much on party lines rather than economic ones. Georgia, Texas, and Virginia are not doing particularly badly and yet voted not to expand. New Jersey and DC aren't doing particularly well and voted to expand. While there were some exceptions blue states mostly voted to expand and most red states didn't: http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap#lightbox/2/

Its also an oversimplification to say that the Medicaid expansion cost sharing would cost states money. Remember that all of that federal money flows to state employees and, indirectly, into state taxes. Unlike the federal government state taxes are mostly sales and sin taxes that affect the poor who would be voting for this. The poorest states would likely see a windfall of rich state dollars even with some cost sharing. Of course you could argue that once the state is addicted to federal dollars it would be easy to alter the payer balance to push more on the states, but that hasn't yet been true for medicare so far so I'm not sure why anyone would assume it would be true for Medicaid.

 

[VA Hopeful Dr]

While I'm sure that the red state governors didn't justify their decision to themselves in terms of partisanship, the fact is that the vote to expand vs not expand fell very much on party lines rather than economic ones. Georgia, Texas, and Virginia are not doing particularly badly and yet voted not to expand. New Jersey and DC aren't doing particularly well and voted to expand. While there were some exceptions blue states mostly voted to expand and most red states didn't: http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap#lightbox/2/

Its also an oversimplification to say that the Medicaid expansion cost sharing would cost states money. Remember that all of that federal money flows to state employees and, indirectly, into state taxes. Unlike the federal government state taxes are mostly sales and sin taxes that affect the poor who would be voting for this. The poorest states would likely see a windfall of rich state dollars even with some cost sharing. Of course you could argue that once the state is addicted to federal dollars it would be easy to alter the payer balance to push more on the states, but that hasn't yet been true for medicare so far so I'm not sure why anyone would assume it would be true for Medicaid.

Because medicare is run by the federal government while medicaid is mostly run by the states.

 

[Birdstrike]

I just got my notice from BCBS this week: My insurance will be cancelled due to Obamacare.

I'm an IC with a hospital group getting no benefits. I have been paying out-of-pocket for the last 6 months for my own private health insurance plan. Far from a "junk" plan, as many Obamacare advocates have been referring to the canceled policies, mine was the most expensive PPO I could get. At $420 monthly for two people it had an open network and a $1000 deductible. Is this a junk policy?

The letter from BCBS simply states that due to the changes under the ACA, my insurance will no longer be available after July 2014. They give me no options, and no recourse. They simply state that a plan "might" be available on the Nevada exchange. Does anyone want to bet I can get a similar plan on the Exchange with the same deductible for $400/month? More likely my premium will go up, and my deductible will go up to to $5000 or more.

Luckily for me, President Obama has illegally and unconstitutionally enacted a hardship waiver for 2014 for those people who's plans had been canceled under the law.

I have always tried to be responsible, and pay my own way. Starting in July, count me in as one of the newly un-insured, as I have have no intention of getting a rip-off government exchange plan.

Surprise! Obamacare Is Here!

The only thing that surprises me about what you posted, is that anyone is surprised by this. I honestly can't understand, with all the lies told by politicians, over, and over and over again in just our lifetimes let alone throughout history, that anyone trusts a word any of them say. It's unfathomable to me, that anyone ever believes a politicians or trusts any of them to "fix" anything, let alone something as incredibly important, and utterly breakable as our own healthcare and profession. Not only did Obama know this would happen, it's in the law itself, or at least the laws "regulations." Yes, that's right, it actually says within the Affordable Care Act ("Obamacare") regulations themselves that this was going to happen. As he was running around telling you that, "You can keep your plan," his staff was writing into his own law's regulations that he knew you couldn't. From left-, not right-leaning ABC News itself:

"Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, 'the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.'
That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them. Yet President Obama, who had promised in 2009, 'if you like your health plan, you will be able to keep your health plan,' was still saying in 2012, 'If [you] already have health insurance, you will keep your health insurance.'"

http://investigations.nbcnews.com/_...ns-could-not-keep-their-health-insurance?lite

All politics aside, this thing (Obamacare) is just terrible. I have never been more convinced that not only is he destroying what's left of our profession of Medicine, but our entire healthcare system. I truly think he's pushing it over the cliff, and pulling the plug on our sickest patient: American Healthcare. When people predicted Obama was hell bent on destroying private physician practice and destroying what did function within our previous healthcare system to replace it with a "better one" that would involve much greater control and involvement by his government I believed it. If anyone doubts it now, I think you really have to dig deep and check yourself and determine if you still buy into this thing, and if so, why? The most frightening thing about those predictions is the "rebuild" phase of Obamacare. After they've crushed the private system we have/had, they plan on "rebuilding it" and replacing it with a better one. As a physician that has at least 20-25 more years left in this profession, I am truly afraid to see the Frankenstein he creates to replace our system he claimed was "broken."

Do anyone really trust them to rebuild a system that's not so much worse than the one they're destroying?

 

[NOsaintsfan]

Surprise! Obamacare Is Here!

The only thing that surprises me about what you posted, is that anyone is surprised by this. I honestly can't understand, with all the lies told by politicians, over, and over and over again in just our lifetimes let alone throughout history, that anyone trusts a word any of them say. It's unfathomable to me, that anyone ever believes a politicians or trusts any of them to "fix" anything, let alone something as incredibly important, and utterly breakable as our own healthcare and profession. Not only did Obama know this would happen, it's in the law itself, or at least the laws "regulations." Yes, that's right, it actually says within the Affordable Care Act ("Obamacare") regulations themselves that this was going to happen. As he was running around telling you that, "You can keep your plan," his staff was writing into his own law's regulations that he knew you couldn't. From left-, not right-leaning ABC News itself:

"Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, 'the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.'
That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them. Yet President Obama, who had promised in 2009, 'if you like your health plan, you will be able to keep your health plan,' was still saying in 2012, 'If [you] already have health insurance, you will keep your health insurance.'"

http://investigations.nbcnews.com/_...ns-could-not-keep-their-health-insurance?lite

All politics aside, this thing (Obamacare) is just terrible. I have never been more convinced that not only is he destroying what's left of our profession of Medicine, but our entire healthcare system. I truly think he's pushing it over the cliff, and pulling the plug on our sickest patient: American Healthcare. When people predicted Obama was hell bent on destroying private physician practice and destroying what did function within our previous healthcare system to replace it with a "better one" that would involve much greater control and involvement by his government I believed it. If anyone doubts it now, I think you really have to dig deep and check yourself and determine if you still buy into this thing, and if so, why? The most frightening thing about those predictions is the "rebuild" phase of Obamacare. After they've crushed the private system we have/had, they plan on "rebuilding it" and replacing it with a better one. As a physician that has at least 20-25 more years left in this profession, I am truly afraid to see the Frankenstein he creates to replace our system he claimed was "broken."

Do anyone really trust them to rebuild a system that's not so much worse than the one they're destroying?

I've posted this before and it really is "fairly" simple. If you look at the basic constraints of the law with out a political backdrop and predict what will happen it becomes clear. Forget what any politician has told you from any party and simply look at the law.

Medical insurance companies can no longer price their product based on risk stratification, everyone get charged the same for similar coverage. What impact do you think this will have on cost?
Insurance companies can no longer deny anyone coverage, no matter what their current state of health is. What do you think this will do to costs?

The above post is dead on. I know there are a lot of things in the law but the two questions I have raised tells you all you need to know about the big picture on where this law is going.

Many people have got caught up in politics or ideals of wanting to provide medical care for all and overlooked or chosen not to believe the true implications of this law.

So what's going to happen?
In my opinion unless major changes are made you will see an end to the private insurance market as we currently know it and a "crisis" will be upon us. This will open the door to a single payer system. This is what Obama and many in government have wanted all along. The problem is that single payer will be thrust upon us in the mist of a healthcare crisis and it will be chaotic and painful to implement, not to mention inherent problems with government inefficiency and problems related specifically to single payer itself.

 

[NOsaintsfan]

While I'm sure that the red state governors didn't justify their decision to themselves in terms of partisanship, the fact is that the vote to expand vs not expand fell very much on party lines rather than economic ones. Georgia, Texas, and Virginia are not doing particularly badly and yet voted not to expand. New Jersey and DC aren't doing particularly well and voted to expand. While there were some exceptions blue states mostly voted to expand and most red states didn't: http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap#lightbox/2/

Its also an oversimplification to say that the Medicaid expansion cost sharing would cost states money. Remember that all of that federal money flows to state employees and, indirectly, into state taxes. Unlike the federal government state taxes are mostly sales and sin taxes that affect the poor who would be voting for this. The poorest states would likely see a windfall of rich state dollars even with some cost sharing. Of course you could argue that once the state is addicted to federal dollars it would be easy to alter the payer balance to push more on the states, but that hasn't yet been true for medicare so far so I'm not sure why anyone would assume it would be true for Medicaid.

No doubt politics played a role however the bigger point that I was trying to highlight was that the whole Medicaid expansion is a ticking time bomb that many simply don't want to deal with (surprise, surprise).

The states 10% share is not insignificant and will be a big burden on many states budgets.

This applies to blue and red states alike. Tough decisions will have to be made on how states will come up with large amounts of money to cover this expansion and not many seem concerned about it. Eventually the piper will have to be paid. There will be a trade off for providing more medical coverage and to act as if major cuts to other areas won't have to be made is irresponsible. Our government leaders are doing an injustice by not informing their constituents about this. It will be interesting to se this unfold and see where states decide to cut from. Bottom line cuts will HAVE to be made, in some states those cuts will be painful.

 

[EvoDevo]

I just wanted to point out an eye-raising and thought-provoking discussion being had in this article's comments section.

- Look for the crazy "doctors make too much" atttitude from many posters, even those who self-report 6-7 figure incomes.
- Look for really well written responses from "TheStigg."
- Drives me crazy that yet another writer (article's author) seems to think that NPs/PAs are the equal of a trained MD.

http://www.theatlantic.com/business...tage-might-mean-trouble-for-obamacare/282818/

 

[TravelingRunner]

Off-topic, but, EvoDevo, love your signature. Too funny.

 

[Old_Mil]

This is the brainchild of a politician who either actually believes - or was using for propaganda - the idea that physicians perform unnecessary tonsillectomies and amputations for profit. I'm not sure which scenario is worse: that he is so out of touch that he believes it, or that he is willing to use propaganda to try and turn the public against the medical profession and advance his agenda. It never ceases to amaze me how someone supposedly intelligent enough to get in to medical school isn't intelligent enough to see through this.

 

[Perrotfish]

This is the brainchild of a politician who either actually believes - or was using for propaganda - the idea that physicians perform unnecessary tonsillectomies and amputations for profit. I'm not sure which scenario is worse: that he is so out of touch that he believes it, or that he is willing to use propaganda to try and turn the public against the medical profession and advance his agenda. It never ceases to amaze me how someone supposedly intelligent enough to get in to medical school isn't intelligent enough to see through this.

You don't think physicians make medical decisions based on fee schedules? I don't think anyone is intentionally causing harm for fees, but when there's conflicting evidence concerning the risks and benefits of different procedures its very easy to let yourself be convinced that the correct management is the financially advantageous one. I don't think there was anything unfair about this comment.



On of the best studied examples of this is reimbursement schedules for C-sections. Multiple studies have found that the differential in reimbursement between C-sections and SVDs is directly related to the rate of cesarean delivery. I'm sure none of the OB-Gyns truly believed that they were performing an unnecessary procedure. Interestingly the few studies on populations that underwent a sudden rapid change in reimbursement show no change in physican C-section rates, strongly suggesting that physicians continue to adhere to what they believe is the standard of care. However the standard of care that they adhere to reliably matches the fee schedule they have spent most of their career practicing under, given enough time physicians seem to generally convince themselves that the best financial decision is the right decision for the patient. I'm pretty sure that people in states with high fee differentials do not have more indications for cesarians than patients in states with equalized pay for deliveries, so I think there is a case to be made for getting rid of fee for service.

Some hastily googled Sources:
http://www.sciencedirect.com/science/article/pii/S0167629608001288
http://www.sciencedirect.com/science/article/pii/S0167629699000090
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069989/

 

[VA Hopeful Dr]

You don't think physicians make medical decisions based on fee schedules? I don't think anyone is intentionally causing harm for fees, but when there's conflicting evidence concerning the risks and benefits of different procedures its very easy to let yourself be convinced that the correct management is the financially advantageous one. I don't think there was anything unfair about this comment.



On of the best studied examples of this is reimbursement schedules for C-sections. Multiple studies have found that the differential in reimbursement between C-sections and SVDs is directly related to the rate of cesarean delivery. I'm sure none of the OB-Gyns truly believed that they were performing an unnecessary procedure. Interestingly the few studies on populations that underwent a sudden rapid change in reimbursement show no change in physican C-section rates, strongly suggesting that physicians continue to adhere to what they believe is the standard of care. However the standard of care that they adhere to reliably matches the fee schedule they have spent most of their career practicing under, given enough time physicians seem to generally convince themselves that the best financial decision is the right decision for the patient. I'm pretty sure that people in states with high fee differentials do not have more indications for cesarians than patients in states with equalized pay for deliveries, so I think there is a case to be made for getting rid of fee for service.

Some hastily googled Sources:
http://www.sciencedirect.com/science/article/pii/S0167629608001288
http://www.sciencedirect.com/science/article/pii/S0167629699000090
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069989/

I think you're looking at this the wrong way. Its not a positive correlation with increasing c-section rates but rather a negative correlation with declining rates. My father-in-law is an OB/GYN and we often talk politics/economics of medicine. He's told me that at a certain reimbursement point, doing the c-section isn't worth the risk/time/pain in the ass level.

In addition, as to your first point.... wait til you're out on your own. When I was a resident, I jumped at any chance to do a procedure. Since finishing, I find that I now lean more heavily towards the conservative route than before since now if there's a problem its entirely my ass on the line. And that's with my now having the financial incentive that I didn't have in residency.

 

[NOsaintsfan]

You don't think physicians make medical decisions based on fee schedules? I don't think anyone is intentionally causing harm for fees, but when there's conflicting evidence concerning the risks and benefits of different procedures its very easy to let yourself be convinced that the correct management is the financially advantageous one. I don't think there was anything unfair about this comment.



On of the best studied examples of this is reimbursement schedules for C-sections. Multiple studies have found that the differential in reimbursement between C-sections and SVDs is directly related to the rate of cesarean delivery. I'm sure none of the OB-Gyns truly believed that they were performing an unnecessary procedure. Interestingly the few studies on populations that underwent a sudden rapid change in reimbursement show no change in physican C-section rates, strongly suggesting that physicians continue to adhere to what they believe is the standard of care. However the standard of care that they adhere to reliably matches the fee schedule they have spent most of their career practicing under, given enough time physicians seem to generally convince themselves that the best financial decision is the right decision for the patient. I'm pretty sure that people in states with high fee differentials do not have more indications for cesarians than patients in states with equalized pay for deliveries, so I think there is a case to be made for getting rid of fee for service.

Some hastily googled Sources:
http://www.sciencedirect.com/science/article/pii/S0167629608001288
http://www.sciencedirect.com/science/article/pii/S0167629699000090
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069989/

I get what your saying but the comment your replying to is about the president and his understanding of the medical field (in a general sense). Do you really believe that our president understands medicine from a doc's perspective based on his public comments? He said in one speech that docs would rather amputate a diabetics foot instead of managing the condition because it pays more. Really? Maybe its just me but he (based on his public comments) sounds as if he doesn't have a clue. It seems entirely political to me, its supported by the fact that he championed a bill (the ACA) that has NO chance of doing what he and others have said it will do. Mainly lower costs while expanding coverage. Anyone who is willing to look objectively at the bill can see that there is zero chance of costs being lowered and slightly less than zero chance of overall coverage being expanded, unless you want to count on the collapse of private insurance and the eventual single payer system that is coming as expanding coverage and lowering costs. In that case the ACA will be a success although indirectly.

 

[d2305]

I didn't realize that the supreme court decision limited the fine that opting out can impose. The death spiral has begun. Now congress has to block insurance company bail outs.

 

[PassingBy245]

You had a policy for only '$420 monthly for two people it had an open network and a $1000 deductible' ??? Where!!?? How did you get such a great plan??? I don't believe it. My policy for 2 people was about $815, a limited PPO, no out of network coverage, a copay of $30 per doc visit, $50 for specialist, $100 e.r., and 50% rx copays for all drugs. Granted no deductible, but when I ran into trouble with a dental problem, needed hospital surgery and the oral surgeon only belonged to *dental* plans, how much more than your piddly $1K deductible do you think I had to pay for the surgery?

My policy was canceled too... so happily! We all knew 1-2 yrs ago that it would be because the ins co sent notices that the plan didn't comply, so there was time to investigate.. I don't think any ins co didn't say so, after all they wanted to sell a better plan for more $ and never mention the ObamaCare subsidy. Thanks to 'ObamaCare', I now have a plan with - yes - a too high a deductible (as they all do), but that surgery I needed would have been covered.

 

[GeneralVeers]

You had a policy for only '$420 monthly for two people it had an open network and a $1000 deductible' ??? Where!!?? How did you get such a great plan??? I don't believe it. My policy for 2 people was about $815, a limited PPO, no out of network coverage, a copay of $30 per doc visit, $50 for specialist, $100 e.r., and 50% rx copays for all drugs. Granted no deductible, but when I ran into trouble with a dental problem, needed hospital surgery and the oral surgeon only belonged to *dental* plans, how much more than your piddly $1K deductible do you think I had to pay for the surgery?

My policy was canceled too... so happily! We all knew 1-2 yrs ago that it would be because the ins co sent notices that the plan didn't comply, so there was time to investigate.. I don't think any ins co didn't say so, after all they wanted to sell a better plan for more $ and never mention the ObamaCare subsidy. Thanks to 'ObamaCare', I now have a plan with - yes - a too high a deductible (as they all do), but that surgery I needed would have been covered.

It's a Nevada BCBS PPO plan. I'm happy to post a screenshot of the bill if you want proof.

 

[@JackShephard]

You had a policy for only '$420 monthly for two people it had an open network and a $1000 deductible' ??? Where!!?? How did you get such a great plan??? I don't believe it. My policy for 2 people was about $815, a limited PPO, no out of network coverage, a copay of $30 per doc visit, $50 for specialist, $100 e.r., and 50% rx copays for all drugs. Granted no deductible, but when I ran into trouble with a dental problem, needed hospital surgery and the oral surgeon only belonged to *dental* plans, how much more than your piddly $1K deductible do you think I had to pay for the surgery?

My policy was canceled too... so happily! We all knew 1-2 yrs ago that it would be because the ins co sent notices that the plan didn't comply, so there was time to investigate.. I don't think any ins co didn't say so, after all they wanted to sell a better plan for more $ and never mention the ObamaCare subsidy. Thanks to 'ObamaCare', I now have a plan with - yes - a too high a deductible (as they all do), but that surgery I needed would have been covered.

I don't think it's any surprise that Obamacare did help some people - it's likely a minority but there are definitely benefits to some people in America.

The problem is that it didn't address any of the major problems of healthcare - it just added a bunch of people. The average person didn't save money either, regardless of your experience.

 

[Birdstrike]

I'm on the Board of Directors of my group. I just got off the phone with our CEO. In 2015 we can longer afford to keep our current insurance plan for our group and employees. We must either,

1- Pay much more for same or worse insurance,

2-Pay the fine to be uninsured, or

3-Opt for similarly priced but inferior insurance through the exchange where the network is likely to be too narrow to keep our doctors.

"Why are we forced to choose only between the lesser of three evils?" I asked him.

"Simple. It's because of ObamaCare," he answered.

True story.

 

[GeneralVeers]

Luckily I had my private policy extended until December. Now I have to sign up for an Obama-approved plan. I cannot go through BCBS and they have simply directed me to Healthcare.gov. My options now to change from my PPO:

1. Sign up for an Obama care PPO which costs $768 per month.
2. Sign up for a lesser Silver HMO with a $2500 deductible ando a narrow network for $500 per month.
3. Get an HSA plan for $350 per month with $6000 deductible.

All of the options are terrible, (thanks Obama) but I am looking at the HSA as at least I can save some money tax free and screw the government in a bit ofor payback for their terrible policy decisions.

 

[xaelia]

Quit whining. At least now your birth control and triennial pap smears are covered.

 

[Old_Mil]

This will open the door to a single payer system. This is what Obama and many in government have wanted all along. The problem is that single payer will be thrust upon us in the mist of a healthcare crisis and it will be chaotic and painful to implement, not to mention inherent problems with government inefficiency and problems related specifically to single payer itself.

...don't forget that in addition to the issues that single payer systems have we will add the wrinkle of a society unwilling to give up the right to sue its physicians for entertainment and profit.

 

[IlDestriero]

Only a fool would go uninsured when they have real assets to lose.
Good luck finding a new plan that meets your needs.