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Decent Quality Since 1847

The GOP Has a Big Medical Problem

9/27/2013

23 Comments

 
The Republican Party is in serious trouble.  For a long while, much of America has been debating “How does the Affordable Care Act really affect me?  It’s been such an amorphous question that it’s allowed uncertainty to fester.  Well…the thing is, now you can find out.  And it’s not good for the GOP.

A friend called yesterday afternoon and talked me through using the California website for the Affordable Care Act, a clearinghouse of information about the new law, and how it affects Californians.  Included on the page is a form that lets you determine what insurance plans might be available to you, and how much you'll pay.

I found out how much I'll pay.

As I said, the Republican Party is in serious trouble.

My friend, who is a lawyer, is meticulous about reading everything about...well, anything, but especially insurance forms.  And most especially about the Affordable Care Act.  Better known as Obamacare.  And as far as I can tell from going through this form, Obama really does care.  A lot.  I was so flabbergasted by what I found that I kept asking my friend if he was absolutely, positively sure there were no catches.  He was sure.  There are no catches.

After entering your personal information, a page comes up that shows the plans that fit your situation. That first page was HMOs.  Clicking to a second page, I found a PPO offered by a major company that I liked. 

And then I looked at the bottom line.  The amount I would owe.  And when I did, I was gobsmack floored.

If I sign up for this plan (and honestly, there is no way I'm not), then thanks to Obamacare, I will pay around $750 LESS a month.  That works out to a savings of $9,000 a year!

My deductible?  It dropped from $2,500 down to...zero.

Maybe it's just me, but I think people are going to be very pleased by savings like that.

Actually, I had various other options.  There are Platinum, Gold, Silver and Bronze Plans.  The standard one (that I was looking at) was Silver.  Called "Silver 94."  What that "94" means is that about 94% of all health costs will be covered.

That's another Really Good Thing.

(Just out of curiosity, I looked at Bronze 60.  Only 60% of your health costs will be covered with that, but for some people -- like perhaps if you're in your 20s -- that might be all they need.  And how much would that plan have cost me?  It was $1 a month.  For those who are math-challenged, this would be $12 a year.

It's really hard to take seriously any complaints about forcing people to buy health care when for a lot of people that cost could potentially be $12 a year.

To be very clear, my numbers will not be the same as for others.  As I said above, it depends on your income, age, what state you live in, what area, how many dependents and what plan you choose.  But my numbers are actual figures and a good starting point for comparison.

(By the way, my friend said that for his own family plan, his deductible was going to drop from $7,600 a year down to $500.  It will not surprise you to learn that he's extremely happy.  I believe the medical term is "giddy.")

This will be different from state to state.  California, for example, where I live, being so populous could negotiate a better deal that others.  And being California, they were motivated to.  Not every state will be that lucky. 

And not everyone will be aware of these price drops.  Most people, after all, get their insurance through their employer.  But it's hard to imagine that word will not spread about the massive savings.

Moreover, some people may not want to leave their insurance company.  Or they might find that the new plans available for them are out-of-network with their family doctor.  But the thing is, no one has to switch.  If you want to stick with your insurance company and pay $9,000 extra a year, you can!  As for your doctor being out-of-network -- the reality is that right now, before Obamacare, my own doctor is already out-of-network.  I've never cared about that too much.  I care more about having a good doctor, having the doctor I want.  Mine saved my life.  So, I'll stick with him, thanks for asking.  Therefore, to me, a doctor being out of network is a secondary consideration -- but even if not, given the $9,000 savings starting January 1 I'd be okay with paying a few hundred dollars more over the course of a year for the doctor I want, whether he's in a network or not.

The only thing that annoys me about the Affordable Care Act is that I can't sign up until October 1, and it doesn't start until January 1.

This is spectacular.  And we now see empirical data why the GOP is freaking out about “Obamacare” going into effect on October 1.  For the past two years, the Republican Party has been running around, trying to terrify America about the supposed-hell of Obamacare -- they've been so frantic about it that they're threatening to shut down the government. 

With savings like this, you now know the reason.

And when the American public begins to understand what the Affordable Care Act is, what Obamacare is, whatever you want to call it is, they will see that the GOP has painted itself into a corner for the disgrace they have brought upon themselves, and will see that the Grand Old Party has never been grand nor had its supporters best interests, or anyone's best interests at heart.

Some may wonder why Democrats haven't been calling this out from rooftops for the past two years.  I would suspect that a big reason is that even as recently as a few months ago they might not have had all the numbers.  States had to negotiate with insurance companies to get the prices, so these figures might only have been available recently, for all I know.

They might also argue that they did get the word out, but Republicans yelled hell and damnation louder.

I ran the numbers for a naturally-skeptical friend, who has a rehab condition that he hasn’t been able to afford for the past few years.  When he heard what his new cost would be and that his former rehab doctor is in the program, this natural skeptic got excited that “This means I might be able to start doing rehab again."

This is life-changing law for many.  The Republican Party is in serious trouble.

(To use the form, go to www.coveredca.com, click Shop Now / Get Started and then fill in the simple boxes.  If you’re not from California and are just curious, make up a California zip code.  Downtown L.A. is 90004.  The only box that might be a little tricky is "Household Income."  This is your Adjusted Gross Income.  On your IRS tax form 1040, it's line 37.)

Yesterday, President Obama was giving a speech and talking about the unrelenting Republican effort to slam and defund the program they've been trying to belittle as"Obamacare." Looking out over the audience, he said, "And once it's working really well, I guarantee you, they will not call it Obamacare."

Obamacare already seems to be working really well.
23 Comments
Douglass Abramson
9/27/2013 02:30:57 am

The link isn't connecting with the website. Could you double check and re-post?

Reply
Robert Elisberg
9/27/2013 03:50:43 am

Thanks. Yeah, I had an errant "l" in there. I fixed it in the text, but forgot to fix it in the link. 'Tis now been fixed.

Reply
Anthony
9/27/2013 08:30:15 am

I just checked my options and I will actually be paying more even after tax credits with only a slightly lower and still ridiculous 6K + deductible...not sure who are these folks getting the massive discounts?

Reply
Robert Elisberg
9/27/2013 08:37:17 am

Well, as my article said, one of the people getting the massive discounts is me. And two others are friends I mentioned in the piece. Obviously, as I said, not everyone will be getting discounts. There are so many variables. The biggest discounts are mainly for middle to lower income people and those with a lot of dependents and deductibles. I can't speak to others and their variables. Keep in mind though when you say you will be "paying more," there are now a lot of things covered in ACA that are included that you had to pay for before, or have lower co-pays. So, it's not just about the yearly rate.

Reply
William
9/28/2013 10:14:09 am

Anthony,

Just to be sure, when you fill in your annual income make sure to use your adjusted gross income this can be determined from last year's tax return.Line 4 on a Form 1040EZ, Line 21 on a Form 1040A and Line 37 on a Form 1040.

Also, it's only fair to try and compare apples to apples as best as possible. The benefits of these plans are, in essence, a percentage split between what the insurer pays and what you personally pay for your total medical needs during the year. The bronze plans are 60/40 points(with you paying the 40), silver is 70/30, gold 80/20 and platinum 90/10.

Additionally, please note ,that if your income falls below the 200% of poverty line for the number of people in your family the silver and bronze plans while not only getting less expensive per month, increase their benefits. Hence in one instance, I am aware of a silver plan paying 94% of a person's anticipated annual medical expense rather than the 70 that is normally covered. This is all income related, state related and number of members in one's family related. The formulas used are way too complicated for a simple post but go to your state site and play around with the numbers a little and you'll see what I'm talking about.

These plans are comparable to those in the private market. If you are comparing what you pay for through your employment, it is an unfair comparison.

I have personally checked the websites for six states as well as the Kaiser foundation calculator for an additional six states and have found that in each and every instance at the $25,000, $50,000 and $75,000 income range with family size of both two and four members, the premiums were less than that same company offered on their own website for private health insurance. And please note the coverage on the private health care available through those companies was not as inclusive, and, with only a couple of exceptions, have much higher annual out-of-pocket costs as well as annual deductions.

Of course your mileage may vary but I suggest you look again before coming to the conclusion to have reached.

Reply
Robert Elisberg
9/28/2013 11:40:11 am

William, it's SO nice for me to only have to write, "Ditto."

Thanks for your terrific, detailed update. Much appreciated.

Charlie
9/30/2013 04:28:29 pm

Take a look at the NY State plans. Deductibles are about $3000. Copays up to 60%. Your whole article is a lie.

Reply
Douglass Abramson
9/30/2013 04:43:02 pm

His post is an accurate portrait of the plans offered on California's exchange. Which is where the provided link takes you. Your numbers can mean one of four things: 1) The State of New York did a really bad job of setting up their exchange. 2) You misunderstood the article or web site that gave you those numbers. 3) You used a source that is giving the public erroneous information. 4) You done made them sums up yourself. Only you know which one applies; and I'm assuming that number four is not applicable.

Reply
Robert Elisberg
9/30/2013 05:40:52 pm

Charlie, thanks for taking the time to write. I will be gracious to your note, because I like to think that's the kind of person I am. You called my whole article "a lie." My article was about my personal experience in CA, and it clearly states that other people's experiences will be different. For you to call that "a lie" is...well, let's just say wrong-headed, which is the polite term.

To be fair, I just now went to the NY State health "tax estimator" website for ACA. I did a cursory check for a single adult making $40,000. I found a Bronze plan for as low as $233 a month. I couldn't find any info on deductibles, and didn't want to waste any more time looking. But given that low monthly cost and my experience in CA, my short response -- and polite one -- is that I don't believe your figures. For the rest, I will defer to Douglass Abramson's reply.

Reply
Charlie
10/1/2013 04:49:05 pm

I didn't get the figures from a right wing article or anything. Right from the exchanges themselves. For a middle class income, the deductible is $4500 and 40% copay. So if a doctor visit is $300, I have to pay $120!! My employee plan right now I pay $25 copay. So, with the numbers you site you'd have to basically have no income.

Reply
Douglass Abramson
10/1/2013 05:07:09 pm

A. That's a Bronze Plan you're referring to. There are others with slightly higher deductibles and lower out of pocket. B. If you have insurance from your employer, you'll keep it. (Unless you're working for a crap company, looking to dump insurance costs and blaming someone other than themselves.) C. You still called an article that was plainly NOT about New York a lie. Come back after you've done some research comparing plans at the same level to each other.

Reply
William
10/1/2013 10:25:46 pm

Charlie you seem to have missed the entire point of the ACA. This program is for persons who do not get their insurance through their employer. Employee insurance is usually going to be less expensive. The simple reason, your employer subsidizes the plan by paying part of the premium.

In all likelihood, where you to add what your employer pays monthly to what you pay monthly under your current plan, you would not be able to afford it and it would cost much more than the available plan under the ACA. What you have now, is most likely similar to one of the gold or platinum plans.

What is more, the plans do not list doctors visits and many medical expenses as percentages. Rather they list a flat amount of a co-pay. Such as $40 co-pay for a doctor's visit. Not a 40% co-pay in California the only place where an actual percentage is listed, as a percentage of the hospital bills that you would be responsible for.

Reply
Robert Elisberg
10/2/2013 12:50:28 am

William, So, wait, are you and Douglass *both* saying that my whole article *isn't* "a lie"?? You mean, I was honest and got it right?! Thank goodness...

Charlie
10/2/2013 09:28:47 am

An individual has to have a very low income in order to enjoy the Obamacare subsidies. It's the middle class who this is hurting. A family or an individual that has a middle class income will have to pay the large deductible and premiums. So basically, if you want cheap health care, it pays not to work.
Also, some businesses would rather pay the fine than offer employees health care when they know they can get it through Obamacare. It's not because they are crap companies, but they are responsible companies looking to stay in business. My current plan (which is not Obamacare compliant) had to be changed. You remember, "If you like your plan, you can keep it?" Thankfully, my company downsized a little bit to get under the 50 employee threshold so we can continue with our much cheaper plan.
So a small percentage of the population will get cheaper rates than the individual markets. I am not willing to help the few at the expense of the many. Health care should be a complete free market system.

Robert Elisberg
10/1/2013 05:12:27 pm

Mr. Chairman, I defer the remainder of my time to Mr. Abramson.


Reply
Robert Elisberg
10/2/2013 10:23:59 am

"Charlie," what you say isn't true. An individual does NOT need to "have a very low income in order to enjoy the Obamacare subsidies." But that's all I say about your comments, since you lost all credibility for me with your "your whole article is a lie" comment, something you've never backed off of.

Reply
William
10/2/2013 10:52:32 am

Charlie,

Some people just don't like the facts so they create their own.A family of four with an income approaching $96,000 is eligible for a discount and government tax subsidy under the ACA.

As to plans being compliant under the guidelines of the ACA there actually were very few requirements that were not met by most Health insurance policies. The first is there cannot be a lifetime cap on coverage, the second that the plan had to include pharmaceuticals prescribed by your physician and finally preventative care has to be covered without a co-pay. This means you get preventative inoculations and an annual physical at no cost and without a co-pay. This includes medically necessary colonoscopies every two or three years as recommended by the American Cancer Society for persons over the age of 40, mammograms, Pap smears as well as annual bloodwork.

Personally, if I were providing health care for my employees I would want these protections for them.

I'm sorry that you believe your company was smart to lay off people so that they didn't have to meet these requirements it says a lot about your company and about the person who admires them having taken that step.

Robert Elisberg
10/2/2013 11:09:18 am

The chair continues to recognize William. Thanks, great post and actually factual information.

Reply
Douglass Abramson
10/2/2013 12:22:32 pm

Look, I've been nice; but you're an idiot. We've had free market healthcare in this country since before the Revolution. IT AIN"T WORKING! Thousands of hard working people go bankrupt every year because of healthcare costs (including people with insurance), thousands more die because they can't afford to see a doctor and ignore symptoms of serious conditions. You're thankful that your company laid off people to avoid having to supply insurance? I don't even know what to say about that. I don't know what to tell you. You keep putting out "facts" that run counter to information on the Federal website, the State of California website and Fact Check.org. I don't know if you're not understanding what you're reading, if your source is full of errors or if you're just a Troll. I don't care either. Mr. Elisberg and I have repeatedly given you the facts as they stand in California, where we both happen to live. If New York has screwed things up as badly as you claim, complain to Albany, not us.

Reply
William
10/2/2013 12:25:55 pm

Hear...Hear! Nuff said.

Reply
Former Democrat
10/6/2013 03:47:40 pm

This whole article is irrelevant to middle class and lower middle class America, which are the segments of the population most likely to suffer greatly under Obamacare. Mr. Elisberg crows about paying $750 LESS under Obamacare than his current premium. Frankly, Mr. Elisberg, if you can afford to pay $750 a month for ANYTHING besides a mortgage or rent, you're not middle class in 2013 America. You're one of the 1% who are completely out of touch with what the average American is going through.

Reply
Douglass Abramson
10/6/2013 04:20:40 pm

First, most of the people you claim to be concerned about will qualify for subsidies to reduce their costs or (in most of the country) expanded Medicare programs. Second, anybody with an expense larger than $750 per month is rich if it isn't for rent or a mortgage payment? Bwahahaha! Your statement might have applied to most of Southern California circa 1980; but in 2013, it demonstrates a lack of knowledge about where Mr. Elisberg resides. I'm pretty sure that he doesn't drive a Maxwell, either.

Reply
Robert Elisberg
10/6/2013 04:31:32 pm

Dear Former Democrat. First, from your note and your insistence on identifying yourself that way, I don't think you are a former Democrat, but I'll give you the benefit of the doubt. Second, thanks for taking the time to write. And third, your note is so weird.

Are you seriously suggesting that I'm in the upper 1%, and am therefore out of touch?? Seriously?? If that's your level of observation, it discredits your note. The larger point, though, is if I was actually in the upper 1%, I wouldn't be saving a nickle from the ACA, let alone $750 a month.

You were serious?!

That aside, you are so wildly wrong about how the middle class and lower middle class will suffer from Obamacare. Those are people who ARE benefiting from it. Keep in mind, the ACA not only provides monetary benefits in monthly payments, but also far better coverage. Annual checkpoints, critical shots, pre-existing conditions, children covered up to the age of 26.

By the way, just so you know, the reason I am saving the amount I said is not because I went out and bought Rolls Royce coverage with my sack of diamonds, but because my health insurance cost is extremely high -- from a number of factors, one of which is a pre-existing condition. Despite the use of your word, "Frankly," which was anything but frank, nothing in my article said I could "afford to pay" what I was paying. (Frankly, that's none of your business.) But when one has a pre-existing condition, it's often very unwise to drop your health insurance, and so many people pay it, no matter how crushing the cost or how it impacts your life.

Which is the point of the Affordable Care Act.

Reply



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    Robert J. Elisberg is a political commentator, screenwriter, novelist, tech writer and also some other things that I just tend to keep forgetting. 

    Elisberg is a two-time recipient of the Lucille Ball Award for comedy screenwriting. He's written for film, TV, the stage, and two best-selling novels, is a regular columnist for the Writers Guild of America and was for
    the Huffington Post.  Among his other writing, he has a long-time column on technology (which he sometimes understands), and co-wrote a book on world travel.  As a lyricist, he is a member of ASCAP, and has contributed to numerous publications.

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