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Offline ribbit

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Obamacare Thread
« on: April 03, 2012, 11:44:31 AM »
obamacare at the supreme court before last week, there was a poll taken amongst lawyers and 85% believed obamacare would survive intact after the supreme court reviewed the case.

intrade now has the odds of obamacare surviving at 40%.

insurance people sweating.
« Last Edit: May 22, 2015, 05:56:59 AM by Flex »

Offline Socafan

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Re: obamacare at the supreme court
« Reply #1 on: April 03, 2012, 02:46:00 PM »
Odds are it will survive, as long as the Supreme Court resists any Judicial activism. Legally most people say that it in fact is constitutional (the mandate that is), and yes, Congress CAN mandate everyone to buy say broccoli. Of course, if the people don't like that then at the next elections they need to say so.

These "Conservative judges" in a quandary.
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Offline Bitter

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Supreme Court upholds health-care law, individual mandate
« Reply #2 on: June 28, 2012, 09:31:52 AM »
Supreme Court upholds health-care law, individual mandate
http://www.washingtonpost.com/politics/supreme-court-to-rule-thursday-on-health-care-law/2012/06/28/gJQAarRm8V_story.html?hpid=z1


By William Branigin, N.C. Aizenman and Robert Barnes, Updated: Thursday, June 28, 11:18 AM

A sharply divided Supreme Court upheld President Obama’s health-care law Thursday, ruling that its key provision – an “individual mandate” to buy health insurance – is constitutional under Congress’s taxing authority.

The high court rejected the argument, advanced by the Obama administration, that the individual mandate was constitutional under the commerce clause of the Constitution. But Chief Justice John G. Roberts Jr. joined the court’s four liberal justices – Ruth Bader Ginsburg, Sonia Sotomayor, Stephen G. Breyer and Elena Kagan – in voting to uphold the mandate, ruling that a penalty for refusing to buy health insurance amounts to a tax.

Ginsburg favored going further, and allowing the mandate under the commerce clause.

The court also upheld the federal government’s ability to expand Medicaid coverage, but said the government could not withdraw existing Medicaid funding from states that opt out of the expansion.

The complex decision— a major victory for the White House less than five months before the November elections--will help redefine the power of the national government and affect the health-care choices of millions of Americans.

Passage of the Patient Protection and Affordable Care Act by the Democratic-controlled Congress in 2010 capped decades of efforts to implement a national program of health care. The legislation is supposed to eventually extend health-care coverage to more than 30 million Americans who currently lack it.

“No longer will Americans be a heart attack or a car crash away from bankruptcy,” Senate Majority Leader Harry M. Reid (D-Nev.) said in a speech on the Senate floor Thursday after the ruling. “No longer will Americans live in fear of losing their health insurance because they lose their job.”

Republicans in Congress and GOP presidential challenger Mitt Romney have vowed to try and repeal the measure after the November elections.

The health-care issue thrust the Supreme Court into the public spotlight unlike anything since its role in the 2000 presidential election. The court’s examination of the law received massive coverage — especially during three days of oral arguments in March — and its outcome remained Washington’s most closely guarded secret.

The court reviewed four questions: whether it was within Congress’s constitutional powers to impose the individual mandate to purchase health insurance; whether all or any additional parts of the law must be struck down if the mandate is rejected; whether an expansion of Medicaid was unduly coercive on the states and whether all of those questions can even be reviewed before the mandate takes effect.

On the Medicaid question, the judges found that the law’s expansion of Medicaid can move forward, but not its provision that threatens states with the loss of their existing Medicaid funding if the states declined to comply with the expansion.

The finding was unexpected—every lower court that has ruled on the issue has upheld the constitutionality of the Medicaid expansion. And it raises immediate questions as to how effectively the federal government will be able to implement a provision that is central to the law’s goal of substantially reducing the share of uninsured Americans.

Medicaid provides health insurance to the poor and disabled with a combination of federal and state dollars. Beginning in 2014, the health-care law significantly  broadens the program’s minimum eligibility requirements. About half of the tens of millions of Americans who will be newly covered through the law will gain coverage this way.

Initially, the federal government will foot the entire bill for covering the newly eligible. But its share will gradually drop to 90 percent by 2020 and beyond, with states required to pick up the rest. The 26 states challenging the expansion argued in court that this requirement would impose a crushing burden on their budgets.

The individual mandate, known technically as the “minimum coverage” provision, was considered a crucial part of the overall health-care legislation because striking it down would have jeopardized the ability of insurers to comply with other, more popular elements of the law without drastically raising premiums.

Under those other provisions, for example, insurers can no longer limit or deny benefits to children because of a preexisting condition, and young adults to up age 26 are eligible for insurance coverage under their parents’ plans.

During oral arguments in March, conservative justices indicated they were skeptical about the individual mandate, the provision in the 2,700-page health-care law that requires nearly all Americans to obtain health insurance by 2014 or pay a financial penalty.

Arguing the case for the Obama administration, Solicitor General Donald B. Verrilli Jr. defended the law as a constitutional exercise of congressional power under the charter’s commerce clause to regulate interstate commerce. He said lawmakers were regulating health insurance to deal with the problem of millions of people who lack coverage and therefore shift costs to the insured when they cannot pay for their medical care.

Paul D. Clement, representing Florida and 25 other states objecting to the health-care law, argued that Congress exceeded its power in passing the law, which he said compels people to buy a product.

The court rejected administration’s commerce-clause argument, but ruled 5-4 that Congress nevertheless “has the power to impose” the individual mandate under its taxing authority. The provision “need not be read to do more than impose a tax,” the opinion said. “This is sufficient to sustain it.”

Neither the plaintiffs in the case nor the Obama administration had argued before the court that the individual mandate was a tax. Instead, the court asked a Washington lawyer to present the argument that lawsuits against the health-care law were premature under an obscure 19th-century law, the Anti-Injunction Act, which bars suits against a tax until the tax is actually paid.

Under the health-care law, penalties for refusing to buy health insurance do not kick in until people pay their 2015 income tax returns.

In its ruling, the court did not accept that the Anti-Injunction Act precludes a decision on the health-care law, but it appeared to embrace the argument that the penalty amounts to a tax.

No initiative has exemplified Obama’s progressive domestic agenda or inflamed his conservative opponents like the health-care law. The court’s decision will resonate throughout the election season, not only in the presidential campaign but in House and Senate races across the country.

The law provoked an unlikely debate about the Constitution. Opponents saw it as a trespass on individual and state’s rights by an omnipotent federal government, and supporters viewed it as a long-sought guarantee of health care to Americans regardless of where they live or work.

Although the most controversial provisions of the law are not scheduled to take effect until 2014, a complex web of new rules has already extended coverage and expanded benefits across the country.

As a mark of the case’s importance, the justices spent more than six hours over three days hearing oral arguments on the constitutional questions and related issues. It was the most time than the court has spent on any issue in nearly half a century.

As soon as Obama signed the health-care bill in March 2010, opponents raced to challenge it. Early court decisions followed a predictable pattern, with district judges appointed by Democratic presidents upholding the law and Republican appointees striking it down.

But at the appeals court level, that changed. In a decision by the U.S. Court of Appeals for the 11th Circuit in Atlanta, Judge Frank Hull, an appointee of President Bill Clinton, joined with a Republican colleague in saying that the individual insurance mandate in the “unprecedented” legislation exceeded congressional authority. The judges said that if the law were constitutional, it would be impossible to say what action on the part of the government would go too far.

At the U.S. Court of Appeals for the 6th Circuit in Cincinnati and the U.S. Court of Appeals for the D.C. Circuit, two prominent Republican-appointed judges agreed that the law is intrusive but said it is within Congress’s powers.

In Cincinnati, Judge Jeffrey Sutton, a George W. Bush appointee, was the deciding vote to uphold the act. In Washington, Senior Judge Laurence Silberman, named to the bench by President Ronald Reagan, wrote an opinion saying that the question was political, not constitutional.

“It certainly is an encroachment on individual liberty,” Silberman wrote. But then — alluding to other cases in which the Supreme Court has ruled that the commerce clause gives Congress power — he added that “it is no more so than a command that restaurants or hotels are obliged to serve all customers regardless of race, that gravely ill individuals cannot use a substance their doctors described as the only effective palliative for excruciating pain, or that a farmer cannot grow enough wheat to support his own family.”

Even as the legal wrangling grew to a crescendo, some aspects of the law were already being enforced. Those include requirements that many insurance plans allow young adults to stay on their parents’ policies until age 26; cover a range of preventive services, including birth control, without imposing co-payments or other out-of-pocket costs; eliminate lifetime dollar limits on coverage; and begin phasing out annual caps.

The three cases the Supreme Court considered were National Federation of Independent Business v. Sebelius; Florida, et al., v. Department of Health and Human Services; and Department of Health and Human Services v. Florida, et al.
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Offline Bakes

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Re: obamacare at the supreme court
« Reply #3 on: June 28, 2012, 11:03:31 AM »
Somebody call Daft and Ribbit and check on dem.

Offline D.H.W

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Re: Re: obamacare at the supreme court
« Reply #4 on: June 28, 2012, 12:38:35 PM »
Somebody call Daft and Ribbit and check on dem.

Hahahaha
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Offline Brownsugar

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Re: obamacare at the supreme court
« Reply #5 on: June 29, 2012, 06:10:32 AM »
All yuh foreign based in the US.  Ah here watching all de talking heads on CNN discuss the ruling.  Ah hearing dem Republicans mad as hell (and mad woman Michelle Bachman on mih screen as I type with she mad self vowing to repeal it when they win in November).

Foreign based, what it is about this law that have Americans so vex??  And ah say Americans because that's what ah hearing.  Ah know most of the noise coming from the right so ah doh know when they say Americans if they mean most Americans or is just propaganda.

Help mih out nah US foreign based....please and thanks.
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Offline D.H.W

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Re: obamacare at the supreme court
« Reply #6 on: June 29, 2012, 06:51:07 AM »
Brownie u ever see a happy Republican? Dem always seem sour about something. Always
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Offline Deeks

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Re: obamacare at the supreme court
« Reply #7 on: June 29, 2012, 07:16:42 AM »
All yuh foreign based in the US.  Ah here watching all de talking heads on CNN discuss the ruling.  Ah hearing dem Republicans mad as hell (and mad woman Michelle Bachman on mih screen as I type with she mad self vowing to repeal it when they win in November).

Foreign based, what it is about this law that have Americans so vex??  And ah say Americans because that's what ah hearing.  Ah know most of the noise coming from the right so ah doh know when they say Americans if they mean most Americans or is just propaganda.

Help mih out nah US foreign based....please and thanks.

Sugah, the bill has some very good things. Like you can stay on your parents ins. until 26. Great being a child until 26. There are things in it that we don't quite know how it is going to work out. It is a kind of wait and see. Anyhow you take good or bad, the Republicans will vote agaisnt it. Should we be concern about the rising cost. Of course. The bill is A WORK IN PROGRESS. It is not a one size fits all. A next thing is the economy. If the economy is good, then people will be able to contribute more to help keep cost down, and also for the mandate to buy your own insurance. MANDATE IS LIKE DRACULA TO the Rep. The always screeming gov't intrusion when their president is not in office. But when they in office they put the govt intrusion to good use. They give big business unprecedented liberties, even at the detriment to the economy and use gov't powers to squash disent. And I am not anti-business.

Offline JDB

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Re: obamacare at the supreme court
« Reply #8 on: July 02, 2012, 07:23:11 AM »
All yuh foreign based in the US.  Ah here watching all de talking heads on CNN discuss the ruling.  Ah hearing dem Republicans mad as hell (and mad woman Michelle Bachman on mih screen as I type with she mad self vowing to repeal it when they win in November).

Foreign based, what it is about this law that have Americans so vex??  And ah say Americans because that's what ah hearing.  Ah know most of the noise coming from the right so ah doh know when they say Americans if they mean most Americans or is just propaganda.

Help mih out nah US foreign based....please and thanks.


The problem is that it is a plan by the Democrats. This is the same old inter-party nonsense. The part of the plan that they object too as being ‘unconstitutional’ has been proposed by Republicans in the past (and opposed by democrats) and Romney’s health care bill in MA (the state with probably the best health care nationwide) is based on the this individual madate.

The plan is half-arsed and flawed. It has benefits over the existing structure in the fact that it covers more people and subsidizes care for those who cannot afford it. The problem is:

     if it is viewed as a resolution to the Health Care ills there will be no further movement toward a more comprehensive, affordable system

     if it is viewed as a failure/injustice there will be no real attampts to develop a truly affordable, comprehensive system

Also  the Republican party has been playing up a divide between the parties and framing it as a tax (if you don’t have insurance), artifact of the nanny state (if you are encouraged to buy insurance) and then there is the canard about taking from the rich and giving to the poor. In this case the middle snad upper classes will pay taxes on health care (currently it is a pre-tax deduction). And also there is a libertarian argument that a healthy person should be able to choose whether they want to be insured. Of course when they actually get sick they might change their mind about government healthcare and just go and get seen to on the government dime anyway.

The current Republican plan is to de-regulate insurance completely so you can buy it any quality of insurance to be insured in name only if you wish. This would further increase the gap in quality of care between the rich and the poor and the healthy and the sick because it is the healthy people being enrolled with less healthy people that makes insurance possible. If you have a patient pool where everybody maxes out their benefits its not really insurance.


The truth is that healthcare is an incredibly complex problem. With the current political system in the US where it is antagonistic betweent the two parties and both parties are driven by money and special interests and benevolence it is a problem that absolutely cannot be fixed in the US.
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Offline lefty

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Obamacare is it good |bad | somewhere in between
« Reply #9 on: September 19, 2013, 12:25:26 PM »
Yes ah know it have real info out there but would like to hear from people livin out there....some seem to love it, some hate it .............wais d deal wit dat
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Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #10 on: September 19, 2013, 01:23:46 PM »
Hasn't gone into effect yet (at least not for most people) so nobody has anymore information than what's "out there."  Only people who hating it are the rich and the ignorant, redundant as that may be.

Offline kounty

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Re: Obamacare is it good |bad | somewhere in between
« Reply #11 on: September 19, 2013, 03:40:45 PM »
good question Lefty. I ask my Obama lovin in-laws how it any different from right now except that it make having health insurance mandatory. Same insurance companies I'm pretty sure i could buy insurance from right now if I wanted to. Now they force people to have to support the industry on a whole (with the hopes that this will cause them to lower prices for everybody with the increase in low-payout 'healthy people' paying into the system). Cynics (like me) will say Insurance companies just going to scrape off them profits (Chain-up #1), not having to entice people with low price now cuz it mandatory . Middle class, upper middle age people in america  (who generally have insurance already) think they going to get a bargain so they smiling (see Chain-up #1 above). People like me who have no health insurance right now know that is bullsh!t. Obama continuing to chain up with the "employers have to provide insurance" chain-up (#2). Walmart and dem done find the loop-hole and  only hiring a set of part-time workers (so they don't have to pay for insurance). I foresee the whole country moving to contract and part time workers to preserve the bottom line.  So the bottom line? Take a listen to Sizzla.

Offline Deeks

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Re: Obamacare is it good |bad | somewhere in between
« Reply #12 on: September 19, 2013, 04:23:23 PM »
Whether you for it or not, you will still end up paying for the uninsured, some way or the other.

Offline OutsideMan

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Re: Obamacare is it good |bad | somewhere in between
« Reply #13 on: September 19, 2013, 05:48:05 PM »
good question Lefty. I ask my Obama lovin in-laws how it any different from right now except that it make having health insurance mandatory. Same insurance companies I'm pretty sure i could buy insurance from right now if I wanted to. Now they force people to have to support the industry on a whole (with the hopes that this will cause them to lower prices for everybody with the increase in low-payout 'healthy people' paying into the system). Cynics (like me) will say Insurance companies just going to scrape off them profits (Chain-up #1), not having to entice people with low price now cuz it mandatory . Middle class, upper middle age people in america  (who generally have insurance already) think they going to get a bargain so they smiling (see Chain-up #1 above). People like me who have no health insurance right now know that is bullsh!t. Obama continuing to chain up with the "employers have to provide insurance" chain-up (#2). Walmart and dem done find the loop-hole and  only hiring a set of part-time workers (so they don't have to pay for insurance). I foresee the whole country moving to contract and part time workers to preserve the bottom line.  So the bottom line? Take a listen to Sizzla.

Well put, kounty.  You obviously have been paying attention, and not caught up in the 'mindless celebrity worship' or the 'senseless hate' of the Pres. 

What you wrote is fair, and hits the nail right on the head.    :beermug:
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Offline OutsideMan

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Re: Obamacare is it good |bad | somewhere in between
« Reply #14 on: September 19, 2013, 05:48:54 PM »
Whether you for it or not, you will still end up paying for the uninsured, some way or the other.

Deeks...absolutely correct.
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Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #15 on: September 19, 2013, 07:14:27 PM »
good question Lefty. I ask my Obama lovin in-laws how it any different from right now except that it make having health insurance mandatory. Same insurance companies I'm pretty sure i could buy insurance from right now if I wanted to. Now they force people to have to support the industry on a whole (with the hopes that this will cause them to lower prices for everybody with the increase in low-payout 'healthy people' paying into the system). Cynics (like me) will say Insurance companies just going to scrape off them profits (Chain-up #1), not having to entice people with low price now cuz it mandatory . Middle class, upper middle age people in america  (who generally have insurance already) think they going to get a bargain so they smiling (see Chain-up #1 above). People like me who have no health insurance right now know that is bullsh!t. Obama continuing to chain up with the "employers have to provide insurance" chain-up (#2). Walmart and dem done find the loop-hole and  only hiring a set of part-time workers (so they don't have to pay for insurance). I foresee the whole country moving to contract and part time workers to preserve the bottom line.  So the bottom line? Take a listen to Sizzla.

Your objections are unfounded. 

"Chain-up #1": Yuh argument is that the insurance companies will just scrape off the profits and not pass them along to policyholders.  Of course you have nothing substantial to support this; whereas (a) empirical evidence has shown that most high-cost procedures are due to preventable medical issues.  Therefore it stands to reason that if you intervene and treat these ailments earlier, you don't have to opt for the high-cost procedures.  In addition to this, even when the procedures aren't high-cost, (b) the sheer numbers of uninsured being treated for preventable illnesses is a huge strain on the system.  If you treat these preventable illnesses then (at least in theory) you reduce the numbers of uninsured who show up for treatment.

So addressing (a) Insurers won't have to pay for the high-cost items, and (b) Hospitals don't have to absorb the cost of treating the uninsured, and therefore won't have to rely on government subsidies to offset this expense, as is currently the case in many jurisdictions.  The latter is easily measurable and will result in direct savings to the tax-paying public.  While there is nothing to force insurers to pass along the savings from not having to pay for high-cost items, there are additional savings from having a healthier population, individual patients are discharged and returned to work (where applicable) much sooner, and bed space is freed up to treat another patient.  So really your criticism is more philosophical objection to the mandate, rather than anything concrete that you could point to.  If we try hard enough, we could always conjure up the most extreme outcomes to any situation and posit them as criticism... sorta like a modified reductio ad absurdum.

As for (2)  You say "poor people... knows it's bullshit."  How come?  How is guaranteed healthcare for those who can't afford it "bullshit"?

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Re: Obamacare is it good |bad | somewhere in between
« Reply #16 on: September 19, 2013, 07:24:24 PM »
@kounty --- Again...as per your first comment, WELL SAID.  It's takes wisdom to 'read-between-the-lines', which you have clearly done. 

This 2000+ page insurance Bill was written by the Health Insurance lobbyist, and was not read at all by anyone in Congress before it was signed by Rep Charles Rangel and others, and before it was passed. 

Any Bill written by lobbyists representing business interests, is suspect at best.  This is one of de most shadiest Bills in recent memory.

 
 
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Offline Deeks

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Re: Obamacare is it good |bad | somewhere in between
« Reply #17 on: September 19, 2013, 07:27:41 PM »
shadiest Bills in recent memory.

Bull!

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Re: Obamacare is it good |bad | somewhere in between
« Reply #18 on: September 19, 2013, 07:35:34 PM »
shadiest Bills in recent memory.

Bull!

Well it is SHADY. 

Bill H.R.3962 was signed by Rep Charles Rangel, Dingell, Waxman, George Miller of California, Stark, Pallone, and Andrews --- ALL signed the Bill (presenting it as if THEY wrote it), but they did not pen the Bill, nor did they READ the Bill.

H.R 3962 was written by the Health Insurance industry, and given to a few members of Congress to 'sign' and present it as their own.

If that's not the definition of shady then I don't know what is, eh.   :)

One might as well done say that ALL of Jack Warner's business dealings are above-board and not shady either. 

    http://housedocs.house.gov/rules/health/111_ahcaa.pdf
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Offline kounty

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Re: Obamacare is it good |bad | somewhere in between
« Reply #19 on: September 19, 2013, 08:56:03 PM »

... (a) empirical evidence has shown that most high-cost procedures are due to preventable medical issues.  Therefore it stands to reason that if you intervene and treat these ailments earlier, you don't have to opt for the high-cost procedures.  In addition to this, even when the procedures aren't high-cost, (b) the sheer numbers of uninsured being treated for preventable illnesses is a huge strain on the system.  If you treat these preventable illnesses then (at least in theory) you reduce the numbers of uninsured who show up for treatment.

So addressing (a) Insurers won't have to pay for the high-cost items, and (b) Hospitals don't have to absorb the cost of treating the uninsured, and therefore won't have to rely on government subsidies to offset this expense, as is currently the case in many jurisdictions.  The latter is easily measurable and will result in direct savings to the tax-paying public.


(a) Silver Plan

Still significant out-of-pocket (I pay the same without insurance to see the doctor now). So I would infer that this "insurance" won't  spark a stampede to identify & cure preventable diseases. (cost of doctor's visit is not zero)

(b) Are you assuming that insurance will cover all the costs of these expensive procedures? part? (patients default on the rest as usual)? (illegal immigrants etc?) insurance cover most (and not pass on that increased cost to the public?)?

While there is nothing to force insurers to pass along the savings from not having to pay for high-cost items,
I see you partially answer me here.
there are additional savings from having a healthier population, individual patients are discharged and returned to work (where applicable) much sooner, and bed space is freed up to treat another patient.
good points..but more side benefits.
 
As for (2)  You say "poor people... knows it's bullshit."  How come?  How is guaranteed healthcare for those who can't afford it "bullshit"?
Let me tax you and the citizens of Cali $200K and guarantee every family housing. Am I trustworthy? Insurance companies? (time to dust off Michael Moore breakout flick).

Offline Conquering Lion

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Re: Obamacare is it good |bad | somewhere in between
« Reply #20 on: September 19, 2013, 09:01:39 PM »
good question Lefty. I ask my Obama lovin in-laws how it any different from right now except that it make having health insurance mandatory. Same insurance companies I'm pretty sure i could buy insurance from right now if I wanted to. Now they force people to have to support the industry on a whole (with the hopes that this will cause them to lower prices for everybody with the increase in low-payout 'healthy people' paying into the system). Cynics (like me) will say Insurance companies just going to scrape off them profits (Chain-up #1), not having to entice people with low price now cuz it mandatory . Middle class, upper middle age people in america  (who generally have insurance already) think they going to get a bargain so they smiling (see Chain-up #1 above). People like me who have no health insurance right now know that is bullsh!t. Obama continuing to chain up with the "employers have to provide insurance" chain-up (#2). Walmart and dem done find the loop-hole and  only hiring a set of part-time workers (so they don't have to pay for insurance). I foresee the whole country moving to contract and part time workers to preserve the bottom line.  So the bottom line? Take a listen to Sizzla.

Your objections are unfounded. 

"Chain-up #1": Yuh argument is that the insurance companies will just scrape off the profits and not pass them along to policyholders.  Of course you have nothing substantial to support this; whereas (a) empirical evidence has shown that most high-cost procedures are due to preventable medical issues.  Therefore it stands to reason that if you intervene and treat these ailments earlier, you don't have to opt for the high-cost procedures.  In addition to this, even when the procedures aren't high-cost, (b) the sheer numbers of uninsured being treated for preventable illnesses is a huge strain on the system.  If you treat these preventable illnesses then (at least in theory) you reduce the numbers of uninsured who show up for treatment.

So addressing (a) Insurers won't have to pay for the high-cost items, and (b) Hospitals don't have to absorb the cost of treating the uninsured, and therefore won't have to rely on government subsidies to offset this expense, as is currently the case in many jurisdictions.  The latter is easily measurable and will result in direct savings to the tax-paying public.  While there is nothing to force insurers to pass along the savings from not having to pay for high-cost items, there are additional savings from having a healthier population, individual patients are discharged and returned to work (where applicable) much sooner, and bed space is freed up to treat another patient.  So really your criticism is more philosophical objection to the mandate, rather than anything concrete that you could point to.  If we try hard enough, we could always conjure up the most extreme outcomes to any situation and posit them as criticism... sorta like a modified reductio ad absurdum.

As for (2)  You say "poor people... knows it's bullshit."  How come?  How is guaranteed healthcare for those who can't afford it "bullshit"?

Bakes....you answer like a lawyer by refuting what the guy trying to say and talking in hypotheticals, but u never really answer the real question...."is it good, bad or in between." The Walmart scenario just illustrates what a company can to to avoid the headache ....hire them as 1099 workers (independent contractors), pay them what the market can take and let the people decide whatever they want to do with their own insurance. In this job market unskilled workers doh really have much choice.

This is what I know thus far (and I welcome any corrections or additional input).....nobody knows exactly what is going to happen because the rates are yet to be released and are due to come out in October. When that happens, people will have the option of keeping their present plans or finding a plan in the "marketplace" set up by the gov't. Some insurances are offering the option of early renewal in 2013 where u can hold your present rates for a year (which is a good idea so u can get to see what really going on) and some have opted not to enter Obama program.

In the marketplace, there will be tiered plans (gold, silver, platinum etc.) with different coverage levels as well as different percentage amounts that you are responsible for. The problem arises where people that previously had no coverage, or those with coverage that might have cost $100-$200/month might now be in a situation where the same coverage may cost $400/month plus your percentage to pay. Again these are scenarios based on what little info is there.

So that is where the problem lies.....because people will still not participate, regardless of the tax penalty. How are you going to fund it?





We fire de old set ah managers we had wukkin..and iz ah new group we went and we bring in. And if the goods we require de new managers not supplying, when election time come back round iz new ones we bringin. For iz one ting about my people I can guarantee..They will never ever vote party b4 country

Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #21 on: September 19, 2013, 11:36:36 PM »
Bakes....you answer like a lawyer by refuting what the guy trying to say and talking in hypotheticals, but u never really answer the real question...."is it good, bad or in between." The Walmart scenario just illustrates what a company can to to avoid the headache ....hire them as 1099 workers (independent contractors), pay them what the market can take and let the people decide whatever they want to do with their own insurance. In this job market unskilled workers doh really have much choice.

This is what I know thus far (and I welcome any corrections or additional input).....nobody knows exactly what is going to happen because the rates are yet to be released and are due to come out in October. When that happens, people will have the option of keeping their present plans or finding a plan in the "marketplace" set up by the gov't. Some insurances are offering the option of early renewal in 2013 where u can hold your present rates for a year (which is a good idea so u can get to see what really going on) and some have opted not to enter Obama program.

In the marketplace, there will be tiered plans (gold, silver, platinum etc.) with different coverage levels as well as different percentage amounts that you are responsible for. The problem arises where people that previously had no coverage, or those with coverage that might have cost $100-$200/month might now be in a situation where the same coverage may cost $400/month plus your percentage to pay. Again these are scenarios based on what little info is there.

So that is where the problem lies.....because people will still not participate, regardless of the tax penalty. How are you going to fund it?

What shit you self talking?  Kounty posed a hypothetical situation, or at best a projection (as he sees it) how the system might fail.  How am I to answer that in a less-than-hypothetical manner, given as you yuhself say "nobody knows exactly what is going to happen because the rates are yet to be released and are due to come out in October"?  Clearly the man who posed the question didn't find my answer that ambiguous that he couldn't understand it. 

No law is foolproof, and this bill is just another example.  So what if Walmart may (and I emphasize may) have seemingly found a loophole?  The bill wasn't intended to be a perfect fix... just as good a fix under the circumstances.  If Congressional Republicans weren't being so damn obstructionist who knows what might have been.  As it stands, where there are loopholes there can be legislative and other regulatory amendments to plug those... that is how legislation works.

I don't know where you're getting that some insurers opting to not participate in Obamacare... that's like saying FORD has decided to not sell cars on the east coast.  Insurers will offer insurance to whomever is willing to buy it.  Certainly all the big insurers are participating... there will be no shortage of choices for consumers to choose from.

You say that some people's premiums will increase... well guess what, government don't control the cost of premiums right now so that scenario is possible with or without Obamacare.  Some people's premiums won't be affected at all... so that's hardly an argument against the ACA.  As for people opting for the penalty and not participating... that is their choice, but the penalty could be steep.  You will pay either $95 or 1% of your AGI... whichever is greater.  So if your taxable income is $50,000 and you don't want to participate in the plan, just make yuh $500 check payable to the government next April. In 2014 that increases to $325 or 2% of your taxable income and in 2016 $695 or 2.5% of your taxable income.  I think you'll see the 'holdouts' running to get insurance then.

Again, the real benefit is that more people will be able to afford healthcare.  Even for those currently with insurance

Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #22 on: September 20, 2013, 12:00:13 AM »
(a) Silver Plan

Still significant out-of-pocket (I pay the same without insurance to see the doctor now). So I would infer that this "insurance" won't  spark a stampede to identify & cure preventable diseases. (cost of doctor's visit is not zero)

This is a curious comment... not sure what it has to do with anything.  No one is suggesting the ACA will have any impact on medical research or breakthroughs.  You say that you will be paying the same out of pocket costs as under this silver plan.  Remember that this is still just a projection and there will be other plans available separate from the Healthcare Exchange that potentially could be cheaper.  Your co-pays are determined by the insurer, so it stands to reason that other insurers, even others participating in the Exchange will offer different pricing.  All this and we haven't even addressed whether you're eligible for tax credits and subsidies.

(b) Are you assuming that insurance will cover all the costs of these expensive procedures? part? (patients default on the rest as usual)? (illegal immigrants etc?) insurance cover most (and not pass on that increased cost to the public?)?

Illegal immigrants rarely get more than the bare minimum service in the ER.  I could almost guarantee you that they ent getting no expensive medical treatment unless they paying out of pocket.  Right now, whether insurance covers all or just part the cost is still high.  The idea is to offer medical insurance to people who traditionally were priced out of the market... thereby improving the health of a wider swath of the population and preventing the need for the high-cost treatment.  There will always be individuals who early intervention wouldn't help, who will end up with some sudden or catastrophic injury/health concern, who will need high-cost treatment.  Under the ACA this will be no different, just the numbers of individuals presenting for these high-cost Tx's is expected to drop.

there are additional savings from having a healthier population, individual patients are discharged and returned to work (where applicable) much sooner, and bed space is freed up to treat another patient.
good points..but more side benefits.

You saying it's a side benefit... it's more a long-term benefit, not at all a side benefit.  The goal has always been to reduce the overall cost of healthcare and the related impact on the economy (cost, lost productivity etc.) in general.

 
As for (2)  You say "poor people... knows it's bullshit."  How come?  How is guaranteed healthcare for those who can't afford it "bullshit"?
Let me tax you and the citizens of Cali $200K and guarantee every family housing. Am I trustworthy? Insurance companies? (time to dust off Michael Moore breakout flick).

I'm really not understanding this response.  Part of my confusion is that you choose to answer the question with a question, and a question posed as an analogy at that.  Whether you think the government is trustworthy or not poor people who only present for treatment when they body under attack/breaking down is a drain on the system.  Since yuh like analogies... of course preventive maintenance on your car is expensive... but is it as expensive as waiting until something break?  I doh know about you, but I learn my lesson on that.  $800 serpentine belt job that I ignored ended up turning into $4,000 job (new engine and labor) when that same belt break 6 months later.

Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #23 on: September 20, 2013, 12:02:34 AM »
This link is a great resource... and it's provided by Independence Blue Cross of all people.

Offline lefty

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Re: Obamacare is it good |bad | somewhere in between
« Reply #24 on: September 20, 2013, 08:21:35 AM »
I ent leave d question and gone, jus suddenly get busy wit work, almost like ah flash flood lol............but I now gettin d impression that there seems to be a fair bit of mass confusion about who will pay what and how much more or less as d case may be......has been interestin readin so for....bakes ah will check dat link once I get out from under d work flood.
I pity the fool....

Offline kounty

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Re: Obamacare is it good |bad | somewhere in between
« Reply #25 on: September 20, 2013, 08:21:41 AM »

I'm really not understanding this response.  ...
The point was (is) that making somebody buy something, even if the patronizing middle class & higher think it's for their own good, shouldn't be viewed as some sort of virtuous act .  The gov't doesn't mandate that every car owner buy a dealer approved service plan for their car. $250 for a junk yard engine and if you know the right people $250 to put it in. People without health insurance aren't retards just sitting around waiting for people like you and my in-laws to tell us it's a good idea, go get it.

Take away the people who have health insurance now for a minute cuz in the end they cud just keep things as they are. This law is really about people without - Who know by and large that health insurance is a ripoff. You pay through your nose and still have to pay again when you see the doctor (call it co-pay, deductible whatever the hell). Upper & middle class people think insurance is a good thing cuz they have "good insurance".  And they (liberal leaning ones at least) want everybody to have it. They don't realize that their good health insurance is a sort of tax haven for their employers (I only pay$50K in salary, but the benefits are EXCELLENT), who foot the real cost of their employees' healthcare in a clandestine way (I remember having this debate with eman). The people who do not have heath insurance now are generally going to have to foot this bill in large co-pays (b/c their employers like Walmart aren't footing no bill).  So in the end? Free $100 to the insurance companies (people aren't going to spend $45 b/c they can now save $5).

I quoted the silver plan above b/c this is what I hear it will look like in Florida (in terms of cost)...Floridians please chime in. I know Obamacare is extensively advertised in Oregon, but the cost savings to consumer is almost never mentioned (also pointing to same cost of plans). October we will find out for sure, but excuse me for not believing that America gives a f0rk about its poor.

Offline Bitter

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Re: Obamacare is it good |bad | somewhere in between
« Reply #26 on: September 20, 2013, 09:12:56 AM »
I have to jump in here with a comment on insurance.

Like a lawyer, it is one of those things you never need - until you need it.

I have been both with and without insurance and while I have never needed to have anything major, I have put off visits to the doctor before because of the costs.

I have seen people get teeth pulled because it cost $25 rather than get a filling, which cost $100.

You will also see MAJOR savings on prescriptions. Paying $25 for a prescription is a whole lot different than paying $200.
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Offline grimm01

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Re: Obamacare is it good |bad | somewhere in between
« Reply #27 on: September 20, 2013, 09:26:06 AM »
Allyuh talking about one of my favorite subjects; healthcare. I have been in the healthcare space for over 12 years as a consultant and working for one of the big US health insurance companies. I actually worked on an insurance company's strategy team when Obamacare was passed. Say what you want about the law, but status quo was unsustainable. The biggest misconception I heard from people was they doh want to pay for the uninsured, when in fact is under the US system, they were paying for the uninsured every time their premiums increased. One of my biggest issues with the law is it's really insurance reform more than healthcare reform because it doesn't do much to address the drivers of healthcare costs.

For the insurance industry there is a love-hate with the law, they got the individual mandate (everyone must have coverage) which they lobbied hard for, but also got a Medical Loss Ratio (MLR) restriction. MLR is the ratio of claims paid to premium dollars received. For example a plan running at 90% means that $0.90 cents of every $1 in premiums pays medical costs, which leaves $0.10 for company expenses and profit. Obviously the lower the MLR, the more money for the company and a plan running over 100% is costing them money. The law says that carriers must spend a minimum of 85%/80% (large groups/small groups & individuals) of premiums on medical costs. If MLRs come in lower, the plans must provide a rebate, if they come in higher they lose profit margin. Hence you are seeing carrier diversifying into all other aspects of healthcare.

For individuals its a mixed bag with positives like simplification of underwriting rules, removal of denial for pre-existing conditions, allowing kids to be covered on parental plans up to age 26, creating a minimum level of coverage, actual innovation around plans and services etc. However that may be offset by possible rising cost of plans, increase in shitty plan designs (e.g. high deductible plans), employers dropping coverage or reducing benefits, more difficult access to doctors, docs dropping Medicare and/or Medicaid patients etc.

With the exchanges, the stuff i am seeing is that generally the premiums are coming in lower than expected (geographically dependent). However, if yuh didn't have insurance before, have to spend $100/$200 a month is a new expense. Since the penalty for not having insurance starts at $95/ individual for the first year (or 1% of eligible income), I expect to see folks do the math and realize that paying the penalty cheaper than insurance and pick up insurance only when they need it (since companies can no longer deny for preexisting conditions).

What Walmart is doing is essentially making their employees the government's problem. Part-timers make less, become eligible for Medicaid or subsidies for insurance on the exchanges. To be honest, Walmart wasn't providing any big set of coverage for employees in the first place and like other companies with low paid staff, the coverage they did provide probably didn't meet the minimum levels under the law. By changing work eligibility, they reduce the number of people eligible for employer coverage, provide compliant plans for a smaller group of people (managing costs) and let their employees get coverage courtesy of the US taxpayer.

Insurance carriers don't want their prized large customers dumping employees onto public exchanges because fighting for them one at a time is very hard and they won't ever get back the volume. So what you will see is a rise in private exchanges run by large consultants like AonHewitt/Towers Watson, private companies like Liazon/Bloom Health, and insurance companies like United/Aetna/BCBS. Essentially what they are saying to employers is don't get rid of employees and benefits, but send them here, given them a fixed contribution (just like a 401K), and let them choose a plan. If they choose one that's less than the benefit, they keep the change; if it's more they pay the difference. The employer gets to cut their benefits budget, reduce HR staff,and still say they offer a range of benefits with employee choice; the carrier gets to keep a client or has a reasonable shot at keeping a portion of the business or win new business; the employee loses that nice HMO with the $20 copay and probably pays more a month for a new plan with a $4,000 deductible they have to hit before the plan pays 70% of costs...

Our former CEO used to say that it's a mess, but the government won't let it fail. They will make changes and amendments in order to make things work. At this point repealing it is nonsense (the Republicans are putting on a show), the way things were before the law are probably worse that where we are now, but few believe that the current state is the final state. The Republicians would probably get further with proposing sensible improvements to the law. Right now, no one knows how things will shake out in 2014, the established players are being really cautious and there are a lot of start-ups and entrepreneurs trying to use that caution to their advantage. Should be interesting for a while.
« Last Edit: September 20, 2013, 10:17:28 AM by grimm01 »

Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #28 on: September 20, 2013, 01:14:49 PM »

I'm really not understanding this response.  ...
The point was (is) that making somebody buy something, even if the patronizing middle class & higher think it's for their own good, shouldn't be viewed as some sort of virtuous act .  The gov't doesn't mandate that every car owner buy a dealer approved service plan for their car. $250 for a junk yard engine and if you know the right people $250 to put it in. People without health insurance aren't retards just sitting around waiting for people like you and my in-laws to tell us it's a good idea, go get it.

Take away the people who have health insurance now for a minute cuz in the end they cud just keep things as they are. This law is really about people without - Who know by and large that health insurance is a ripoff. You pay through your nose and still have to pay again when you see the doctor (call it co-pay, deductible whatever the hell). Upper & middle class people think insurance is a good thing cuz they have "good insurance".  And they (liberal leaning ones at least) want everybody to have it. They don't realize that their good health insurance is a sort of tax haven for their employers (I only pay$50K in salary, but the benefits are EXCELLENT), who foot the real cost of their employees' healthcare in a clandestine way (I remember having this debate with eman). The people who do not have heath insurance now are generally going to have to foot this bill in large co-pays (b/c their employers like Walmart aren't footing no bill).  So in the end? Free $100 to the insurance companies (people aren't going to spend $45 b/c they can now save $5).

I quoted the silver plan above b/c this is what I hear it will look like in Florida (in terms of cost)...Floridians please chime in. I know Obamacare is extensively advertised in Oregon, but the cost savings to consumer is almost never mentioned (also pointing to same cost of plans). October we will find out for sure, but excuse me for not believing that America gives a f0rk about its poor.

Kounty you making all kinda assumptions... and the last bolded one sums up your intransigence to the plan.  First off when you talking about people without medical insurance and what their mindsets are you should probably speak from experience, and if you are speaking from experience, speak for yourself.  I have spent most of my adult life without healthcare, not because I think is some rip off or because I didn't think it was good for me... simply put, I couldn't afford it.  Every day that I left my house was like playing Russian roulette... especially back when I was playing all kinda recreational sports after work. 

Back in college I sprained my ankle real bad and end up tearing two ligaments playing pick-up basketball, and how it happen was so surprising... and worrying to me.  Nobody even touch me, went up for a rebound and came down on the outside edge of my foot, rolling the ankle.  Heard three distinct pops even before I hit the ground.  Thank God the school had forced all students to carry insurance... which I was paying $750 a year for.  That's $62 a month... a bargain now, but quite an expense to me back then.  Even so, that four-year period was the longest in my life that I actually had health insurance... matched by the current streak I'm on, having had continuous health insurance since June, 2009.  I know many just like me, including a lawyer pardner of mine who doing well financially but who don't have health insurance right now because of the cost.

Not everybody have co-pay... the poorest don't, and where they do they pay some nominal fee, a $1 dollar here a $5 dollar there.  I know because my mother falls in that category and when I take her prescriptions to be filled and picking them up is me who does pay the co-pay.  You making this out to be some liberal condescension argument ("we smart and know what's best fuh allyuh poor, dotish people") when in fact it's not about altruism, but doing what's right and what's smart financially.  Nobody loves being beholden to the insurance companies... but nobody loves having to pay thru their noses because insurance companies passing on costs to policyholders, who have no choice but to pay the extortion price.  At least this way, from an Economics model standpoint, it makes sense to try and reduce the overall burden on the system by aiming at improved healthcare for all, which then in theory will reduce costs for all.  And yeah, if there's some altruistic benefit on the side then more power.

Offline Bakes

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Re: Obamacare is it good |bad | somewhere in between
« Reply #29 on: September 20, 2013, 01:15:35 PM »
Allyuh talking about one of my favorite subjects; healthcare. I have been in the healthcare space for over 12 years as a consultant and working for one of the big US health insurance companies. I actually worked on an insurance company's strategy team when Obamacare was passed. Say what you want about the law, but status quo was unsustainable. The biggest misconception I heard from people was they doh want to pay for the uninsured, when in fact is under the US system, they were paying for the uninsured every time their premiums increased. One of my biggest issues with the law is it's really insurance reform more than healthcare reform because it doesn't do much to address the drivers of healthcare costs.

For the insurance industry there is a love-hate with the law, they got the individual mandate (everyone must have coverage) which they lobbied hard for, but also got a Medical Loss Ratio (MLR) restriction. MLR is the ratio of claims paid to premium dollars received. For example a plan running at 90% means that $0.90 cents of every $1 in premiums pays medical costs, which leaves $0.10 for company expenses and profit. Obviously the lower the MLR, the more money for the company and a plan running over 100% is costing them money. The law says that carriers must spend a minimum of 85%/80% (large groups/small groups & individuals) of premiums on medical costs. If MLRs come in lower, the plans must provide a rebate, if they come in higher they lose profit margin. Hence you are seeing carrier diversifying into all other aspects of healthcare.

For individuals its a mixed bag with positives like simplification of underwriting rules, removal of denial for pre-existing conditions, allowing kids to be covered on parental plans up to age 26, creating a minimum level of coverage, actual innovation around plans and services etc. However that may be offset by possible rising cost of plans, increase in shitty plan designs (e.g. high deductible plans), employers dropping coverage or reducing benefits, more difficult access to doctors, docs dropping Medicare and/or Medicaid patients etc.

With the exchanges, the stuff i am seeing is that generally the premiums are coming in lower than expected (geographically dependent). However, if yuh didn't have insurance before, have to spend $100/$200 a month is a new expense. Since the penalty for not having insurance starts at $95/ individual for the first year (or 1% of eligible income), I expect to see folks do the math and realize that paying the penalty cheaper than insurance and pick up insurance only when they need it (since companies can no longer deny for preexisting conditions).

(They anticipate this... which is why the penalties going up even steeper next year and the year after... see my earlier post on that).

What Walmart is doing is essentially making their employees the government's problem. Part-timers make less, become eligible for Medicaid or subsidies for insurance on the exchanges. To be honest, Walmart wasn't providing any big set of coverage for employees in the first place and like other companies with low paid staff, the coverage they did provide probably didn't meet the minimum levels under the law. By changing work eligibility, they reduce the number of people eligible for employer coverage, provide compliant plans for a smaller group of people (managing costs) and let their employees get coverage courtesy of the US taxpayer.

Insurance carriers don't want their prized large customers dumping employees onto public exchanges because fighting for them one at a time is very hard and they won't ever get back the volume. So what you will see is a rise in private exchanges run by large consultants like AonHewitt/Towers Watson, private companies like Liazon/Bloom Health, and insurance companies like United/Aetna/BCBS. Essentially what they are saying to employers is don't get rid of employees and benefits, but send them here, given them a fixed contribution (just like a 401K), and let them choose a plan. If they choose one that's less than the benefit, they keep the change; if it's more they pay the difference. The employer gets to cut their benefits budget, reduce HR staff,and still say they offer a range of benefits with employee choice; the carrier gets to keep a client or has a reasonable shot at keeping a portion of the business or win new business; the employee loses that nice HMO with the $20 copay and probably pays more a month for a new plan with a $4,000 deductible they have to hit before the plan pays 70% of costs...

Our former CEO used to say that it's a mess, but the government won't let it fail. They will make changes and amendments in order to make things work. At this point repealing it is nonsense (the Republicans are putting on a show), the way things were before the law are probably worse that where we are now, but few believe that the current state is the final state. The Republicians would probably get further with proposing sensible improvements to the law. Right now, no one knows how things will shake out in 2014, the established players are being really cautious and there are a lot of start-ups and entrepreneurs trying to use that caution to their advantage. Should be interesting for a while.

Good post... hits on everything I've been saying and everthing as I understand it to be  :beermug:
« Last Edit: September 20, 2013, 01:19:48 PM by Bakes »