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[TA]

Pretty sure there's also abolition of lifetime caps in there too.  Both are important.

[Rico]

The most hilarious bat-shit insane comment about this whole thing I think comes from Sen. McCain.  ""There will be no cooperation for the rest of the year.  They have poisoned the well in what they've done and how they've done it."

[Royal☭]

Oh, wow, that's crazy.  Did he say that after the 2008 elections?

[Thad]

I think it was Gibbs, but it might've been Axelrod, who responded with something along the lines of "So they're not going to work with us on anything?  That doesn't really sound like a change in their schedules."

[Pacobird]

A few things, after now that I have a bit more time (though not much):

I'll get back to you when I see the numbers on how many people died or went bankrupt while we sat back and waited.

I recently spent a Saturday as the least sick person waiting for care in the ER.  I do not recommend the experience, but it does tend to provide a certain perspective on the whole "let's just wait and see how this plays out" line of thinking.

Please explain how the public option would immediately make medical coverage more expansive and cheaper for the individual than the current bill.

The Democrats screwed the pooch on this from day one.  Obama stood back while Reid and Rangel dithered, they started with a compromise bill instead of asking for more than they wanted, they ceded the moral high ground and watched a popular bill turn unpopular based on lies told by crazy people, and they slobbed Lieberman's knob rather than point out that he was willing to let 150,000 people die to feed his ego.  When Obama finally DID start standing up for the bill, it was to say that well, the public option wasn't really that important, and anyway he didn't campaign on it even though it was specifically listed as part of his campaign platform.

Yes, this is exactly why the House passed a bill with the public option and was almost ready to kill the whole thing because the Senate bill didn't; clearly the fact that 3 or 4 Democratic senators and Joe Lieberman were able to kill the public option means not a one of the other 270 or so Democrat Congressmen were serious about it, not that Senate parliamentary procedure is kind of fucked and UHC is, for better or worse, an extremely  contentious issue on which a lot of good people have gambled their political careers.

Entitled?  Yeah, I guess I DO feel that way.  I feel like I'm entitled to go to a goddamn doctor, have him figure out what the hell is wrong with me, and fix it, without worrying that my annual coverage limit is going to run out before the year's half the hell over.  I see now what a douchebag I have been, what with my recent trip to the ER because the doctor thought my brain might be swelling and causing seizures.  (It wasn't, by the way.  So obviously I should have just walked it off rather than act like an entitled douchebag about it.)

See, it's things like this that really make me wonder if you've read the bill, or even summaries of the bill.

[Pacobird]

What does the Health Care bill do for you?

Notably, lifetime premiums/caps are abolished, and basic health care plans covering at least 60% of medical expenses are mandated through exchanges with annual premiums capped at 9.5% of a household's income (subsidies for payment apply if said household makes less than 400% of the poverty level).  Insurers must also offer additional plans that cover up to 90% of costs via exchanges, as well, though they may go above 9.5% (my understanding is the subsidies still apply up to the 9.5%-of-income threshold even if you take a 90% coverage plan; you just make up the difference on your own).  

If your employer offers a plan, you must accept it unless said plan covers less than 60% of your medical expenses OR it costs you more than 9.5% of your income; if that is the case, you are free to purchase your own appropriately-subsidized health care through the exchanges.  This is the solution to the Walmart problem Taibbi mentioned where employees with shitty health plans are stuck with them.

So, premiums are effectively capped by individual household income, basically.

[Brentai]

If your employer offers a plan, you must accept it unless said plan covers less than 60% of your medical expenses OR it costs you more than 9.5% of your income;

Wait, so if it meets those minimum standards, I can't keep my own?  Or am I completely misreading your summary?

Because my personal plan is way fucking better than that, Jesus.

[Pacobird]

If your employer offers a plan, you must accept it unless said plan covers less than 60% of your medical expenses OR it costs you more than 9.5% of your income;

Wait, so if it meets those minimum standards, I can't keep my own?  Or am I completely misreading your summary?

Because my personal plan is way fucking better than that, Jesus.

No, you can take your own plan if you want, but you won't qualify for subsidies/exchange access if you do.  I'm not sure about that, honestly.  I'd do more research on it if I were you.

EDIT: Actually, I'm pretty sure that doesn't apply to you, since if I'm not mistaken you aren't a full-time employee of a company with 50 or more employees.  If you make less than $44k/year or so (400% of the poverty line for a 1-person household) you can go through the exchange program and qualify for subsidies, if you choose.

[Pacobird]

From the CBO report on the bill:

CBO and JCT’s analysis of exchange premiums has also taken into account the availability of a public plan through those exchanges in some states. Premiums for the public plan as structured under the proposal would typically be somewhat higher than the average premiums of private plans offered in the exchanges.
• A public plan as structured in the proposal would probably attract a substantial number of enrollees, in part because it would include a broad network of providers and would be likely to engage in only limited management of its health care benefits. (CBO and JCT estimate that total enrollment in the public plan would be about 3 million to 4 million in 2016.) As a result, it would add some competitive pressure in the exchanges in areas that are currently served by a limited number of private insurers, thereby lowering private premiums to a small degree. By itself, that development would tend to increase average premiums in the exchanges—but a public plan would probably tend to reduce slightly the premiums of the private plans against which it is competing, for two reasons:
• A public plan is also apt to attract enrollees who are less healthy than average (again, because it would include a broad network of providers and would probably engage in limited management of benefits). Although the payments that all plans in the exchanges receive would be adjusted to account for differences in the health of their enrollees, the methods used
make such adjustments are imperfect. As a result, the higher costs of those less healthy enrollees in the public plan would probably be offset partially but not entirely; the rest of the added costs would have to be reflected in the public plan’s premiums. Correspondingly, the costs and premiums of competing private plans would, on average, be slightly lower than if no public plan was available.
Those factors would reduce the premiums of private plans in the exchanges to a small degree, but the effect on the average premium in the exchanges would be offset by the higher premium of the public plan itself. On balance, therefore, the provisions regarding a public plan would not have a substantial effect on the average premiums paid in the exchanges.

So yeah, not really that big a deal.

[Brentai]

EDIT: Actually, I'm pretty sure that doesn't apply to you, since if I'm not mistaken you aren't a full-time employee of a company with 50 or more employees.  If you make less than $44k/year or so (400% of the poverty line for a 1-person household) you can go through the exchange program and qualify for subsidies, if you choose.

I'm actually a permatemp and am kind of wondering how all that's going to be affected; there's no actual insurance through the agency right now, but it seems that's 7 kinds of illegal now?  Or not?  It's really confusing!

I'd figure it out myself but I barely have time to jerk off these days, so I complain about it on the internet until someone digests it for me.

[Thad]

What does the Health Care bill do for you?

[...]

If your employer offers a plan, you must accept it unless said plan covers less than 60% of your medical expenses OR it costs you more than 9.5% of your income

In other words, the bill does fuck-all for me.  Because I'm too sick for my insurance to cover all my meds and not sick enough to be eligible for the exchange.

What's this I hear about fixing donut holes?

[jsnlxndrlv]

What's this I hear about fixing donut holes?

The donut hole is the Coverage Gap for Medicare-covered prescription drug plans, whether standalone or as part of a Medicare Advantage package. In 2010, the Initial Coverage period ends once you and your plan pay a combined total of $2830; you then get no further Rx assistance until you've paid a total of $4550 out of your own pocket (or the year ends). This is what's eventually being eliminated.

EDIT: Try this article for a better explanation.

This is the thing that most affects me, in that this makes my job a lot easier.

[Pacobird]

Because I'm too sick for my insurance to cover all my meds and not sick enough to be eligible for the exchange.

Any sentence that involves "too sick" or "not sick enough" is not relevant to this discussion unless it also includes the words "no longer relevant to your coverage".

The only people who are not elgible for the exchange are

1) undocumented aliens

2) prisoners

3) unicorns

and your health never enters into the equation AT ALL; the entire point of the exchanges is to make the process as blind and "negotiation"-free as possible.  Once you are on a plan, the only reason an insurer may drop you is non-payment (remember the poor are subsidized) and the only factors that may adjust your premiums are:

1) age (the elderly may be charged up to 3 times as much as the young, which is substantially less than today for private insurance)

2) geographic area (I understand the rationale here but am critical nonetheless)

3) whether you are a smoker (though you can only be charged 1.5x as much, in a staggering victory for [strike]Big Tobacco[/strike] me)

and

4) the size of your household (which is totally fair I think  and offset by the fact that the size of your household determines where your income falls relative to the poverty line, which dictates your % costs)

Though fulltime employees of large (50+ FT employees) employers offering health care with at least 60% cost coverage and a premium cap of 9.5% of your annual income (a great deal of which will be subsidized for you by the government if you make less than 400% of the poverty line) who REFUSE that coverage are not elgible for government subsidies when purchasing insurance through the exchanges.

In general, our HC system now more-closely resembles the Japanese system than any other.


If I am wrong about this feel free to correct me.

[Thad]

Ahhh-har.  Thank you for the explanation; it is informative!

I will acknowledge that you've obviously studied this stuff closer than I have -- though I HAVE read multiple studies, and I'm not just shooting from the hip here either.

Seems to me that we basically agree (bill is improvement, would like to see more improvement) and are merely quibbling about hypotheticals.

@Newb: Yeah, I know what the Medicare donut hole was.  My reading of Paco's post was that I was sitting directly in the middle of a NEW donut hole.  He has explained that this is not the case, which if true is good news for me.

Although I sincerely hope not to be sick/on the same insurance by the time the exchanges open anyway.

[Pacobird]

Well, honestly, I am overall pretty happy with the the bill as-is; single-payer would have been nice, sure, but completely nationalizing a large portion of such a huge industry would wreak havoc with peoples' savings as common shareholders were wiped out.  I also would have liked to see more specifics about provisions for preventative care (particularly pre-natal care, given that our infant mortality rate is at best embarassing), but I suppose we will just have to see how the community health centers pan out.

I think I will make a Q&A thread!

[Thad]

Not to mention that abortion is only covered if you plan to have an abortion in advance.

Q&A thread's a good idea.  I do my homework but I'm not a lawyer.

[Disposable Ninja]

Tripp Palin has government provided Health Insurance.

[Büge]

[Thad]

So, funny story: Obama promised the lobbyists there would be no public option, pretty much from the beginning.

On Monday, Ed Shultz interviewed New York Times Washington reporter David Kirkpatrick on his MSNBC TV show, and Kirkpatrick confirmed the existence of the deal. Shultz quoted Chip Kahn, chief lobbyist for the for-profit hospital industry on Kahn's confidence that the White House would honor the no public option deal, and Kirkpatrick responded:

"That's a lobbyist for the hospital industry and he's talking about the hospital industry's specific deal with the White House and the Senate Finance Committee and, yeah, I think the hospital industry's got a deal here. There really were only two deals, meaning quid pro quo handshake deals on both sides, one with the hospitals and the other with the drug industry. And I think what you're interested in is that in the background of these deals was the presumption, shared on behalf of the lobbyists on the one side and the White House on the other, that the public option was not going to be in the final product."

But it was totally worth it to get all that support from the hospital and drug industries.

[TA]

What I've been reading is not that Obama promised this, but that Rahm Emmanuel was running around making these promises behind Obama's back.