How the Healthcare Reform Law Could Help Us

[rebecca1995]

Lesley, you're right. From today's medscape, http://www.medscape.com/viewarticle/719197?sssdmh=dm1.607151&src=ddd&uac=133610CK:

In addition, under the bill, notoriously low Medicaid reimbursement rates
will be hiked to Medicare levels in 2013 and 2014 for general internists,
family physicians, and pediatricians.

Also, don't forget hospitals will be getting a lot more money because they'll no longer have to foot the bill for uninsured who go to emergency rooms (the only way uninsured could get healthcare before). Treating them gratis cost hospitals (and us) untold hundreds of millions.

I was holding out for a public option--and still think we could get one, down the road--but this bill is a good, solid start.

(I hope it wasn't a bad idea to introduce an inherently political topic...but someone else already had a Sarah Palin thread, ferchrissakes! )

 

[starryeyes]

Thank you Diesel. I'm worried about what this healthcare bill means for PWC too. I think it's great that millions of children and others will no longer be denied health insurance because of preexisting conditions but many other things have me nervous. I think that more PWC here may find themselves in situations like you're describing.

 

[Tammie]

Tammie, I really appreciate your views on this. .........

Thanks for the appreciation! : )

As to the rest, I will try to get back to you soon, but I am crashing rt now.....just didn't want it to seem like I was ignoring your response

 

[beckster]

called my congresspersons

Called my congress persons about these issues. The bill is so complex even their health expert, after taking several days, responded but couldnt tell me much. That is, the bill is so complex, no one seems to know! Some of the language is written so that some things will be written in the future.

What i have read is that payments to hospitals will be cut, as will to nursing homes, and hospice. That gives some indication.

Specifically some of us asked, as had been going around, if low income folks on medicare were now going to be automatically thrown into medicaid. AGain, the congresspersons took time but couldnt answer in a straight way...

What i did find, in reading around, is that starting in 1997 as part of a budget bill, all folks who are "dual elgibles" , their docs are paid at medicaid rates, not medicare rates, which might explain some things to some folks.

Some research showed that there were advocates for expanding medicaid, which makes sense in some situations, such as hiv folks, whose meds are so expensive. So that would be covered for low incomes folks. But its different for PWC or similar illness where there is not a dedicated group of docs and protocols to follow . . .

If you look in some of the disability rags, you will see that they are angered. For example, they had supported a program to help keep some out of nursing homes and in home, but none of that got included. Also, there is a new program where you can pay into a program for assistance should you need long term care (i think its more like in home assistance) in the future, but if you are already sick or disabled, it is not available to you. So that's a discrimination of a "pre-existing" which they otherwise brag about.

 

[JillBohr]

Hi Diesel,

I lived in Germany for almost 8 years and did not at all experience what you are experiencing. Our taxes did not even come close to the 70 percent you are quoting. Heck, we would not even be able to survive if we paid that amount in taxes. I was able to get any doctor that I wanted on DKV. I do remember when they became more americanized and they made the change that we had to pay 10 euros per quarter if we visited the doctor. As an American, we laughed when the receptionist or doctor would apologize and tell me that we had to pay 10 euros. For the majority of my life, I very rarely had to use health insurance because I was very healthy and only experienced some minor problems. When I was in Germany, it was very differerent. Both of my children were diagnosed with autism. I was able to get them tested and treated with no money out of pocket. DKV paid money for my children every month so that I could use it for providers, cleaning, etc. I would also get a Rx written up for speech, ergotherapy, etc. and the Kindertagesstaete would provide the services they required. Ironically, I had more difficulty here in the states although English is my native language. They system is very complex and you have to walk through landmines to obtain services for the children. I am very thankful that my children have medicaid through their I/O waivers and they are now able to obtain ABA services. We are also working to pass legislation here in Ohio so that private insurance companies will pay for those services for children that are not fortunate enough to have medicaid. With this new health bill, the insurance companies are already trying to eliminate children with special needs and President Obama has already issued a statement that they will make sure that children with existing conditions are covered. Just a lot to sort out at the moment.

 

[JillBohr]

The employer in Germany pays 40-50% social contributions and tax of your wage. You pay 19% VAT, 75% taxes on fuel and lots of other taxes like for your car. This sums up to about 70% total tax burden.

Ach so, that is how go you got the 70 percent tax. We do not pay anywhere near the tax you do on fuel but we have "other" taxes as well that will add up. Each state has a different rate on retail sales tax (ex. it is 6.5% in Ohio) and it is not built into the prices which does shock some foreigners when they come to visit, we have "sin" taxes on tobacco, alcohol, etc. Plus we have our state, local and property taxes on top of the federal, social security and medicare/medicaid tax. Our employers also contribute to our social security and medicare/medicaid taxes and then some employers also pay towards our health insurance (depending on the employer).

 

[julius]

Income tax is relative as well. For instance in Canada, our average minimum wage is $9.52. In the US it's $7.25. So we pay more income tax, but our wages are higher (considering cost of living differences etc. as well). Our employer don't offer medical coverage to the extent that american employers have to. So they are able to offer higher base salary.

 

[JillBohr]

Well, the basic problem we have in the U.S. is that the average person has private health insurance through their employer. Most of us pay for private health insurance through an employee plan and our employer also contributes to it. So, we have health insurance and most of us are basically healthy. The problem comes in when we get sick. We are unable to work and then lose our health insurance. For example, where I work, I have 2 coworkers that became ill with cancer within the last 2 years. They both missed too much work and then lost their jobs. They could not afford Cobra (nor their houses for that matter). When this happens, they usually try to qualify for medicaid. As a result, we pay health insurance companies while we are healthy (and they pocket the premiums) but our federal and state government has to pay for those that are elderly or just very ill and/or disabled. Most of the states are going broke and we will lose Medicare for all senior citizens and the disabled if do not revise how we are doing things currently. Of course, that is the goal for a certain wing of the republican party. They never wanted medicare for the elderly and disabled and they have wanted to dismantle it since it began. I come from a very republican family and my grandmother thought FDR was the devil and never forgave him for Social Security. I am not sure how effective this health insurance bill will be but I do hope it will be effective in passing some of the health care costs back to the private health insurance companies and off the taxpayers.

 

[julius]

Most of us pay for private health insurance through an employee plan and our employer also contributes to it. So, we have health insurance and most of us are basically healthy.

Yeah, that's what I was saying. You pay for it already. People who complain that taxes will go up are missing that fact. You don't have to pay premiums any more, your employer will pay you more when he doesn't have to pay your premiums as well. But at the end of it, when you do get sick you are ACTUALLY covered. No more 'pre-existing' nonsense.

Man, if I gave a guy $20 000 for a new car, then when I was about to drive off with it he said...'no, you can't have it. you owned a car before. So I will keep the car and your money. See you later" I would be so pissed. But it happened every day with the insurance companies and people now want to keep it that way????? :innocent1:

that's the part that blows my mind to pieces.

 

[Tammie]

Julius, where are you getting the idea that people won't have to pay premiums anymore? Everythign I have read said that they expect premiums to go up.

 

[julius]

Julius, where are you getting the idea that people won't have to pay premiums anymore? Everythign I have read said that they expect premiums to go up.

Geez. I totally lost myself there. I was thinking for some reason that you guys had gotten the same system we have. Massive brain fog moment.

I still feel the same about the idea of the companies finding ways of getting our of paying. Tammie, as an opponent of the reforms, how do you feel about not having the pre existing conditions thing?

 

[Tammie]

Geez. I totally lost myself there. I was thinking for some reason that you guys had gotten the same system we have. Massive brain fog moment.

I still feel the same about the idea of the companies finding ways of getting our of paying. Tammie, as an opponent of the reforms, how do you feel about not having the pre existing conditions thing?

First off, I am not an opponent of reforming the healthcare system in general. I just want that to be clear. I think it is a mess and definitley needs a lot of reform. What I am opposed to is the way that they are trying to do it. From everythign I have read, it seems like they are making a lot of promises that they can't keep and they are also making things much worse for a lot of people....and many of those are the people who need the most care and have the least money (like disabled people and seniors)

As far as the preexisting thign goes, even though it won't effect me bc I am on Medicare, I do absolutely believe that it is LONG overdo, and I am VERY happy for the people it will help. The thing is that even that is not really going to be in effect right away, excpet for children, and the convulted way that it is set up actually still makes some people wait 6 months. (I am really incredibly foggy myself rt now, though, so I could be getting that part confused. I know for sure that the way it was worded in the plan's earlier version was intended to make it sound like it was going to fix that and in reality it wasn't going to work the way they tried to make it sound.) And, that actually is part of what upsets me about this, too. The lenght and the language is set up so that much of it is very deceptive and makes it sound liek what most people want to hear, instead of claerly stating the reality.

(and speaking of clarity I apologize for all the typos - way too tired to type accurately and/or to go abck & fix what i wrote)

 

[julius]

Thanks Tammie. That helps me understand a little better. From what I was hearing in general it sounded like most of those opposed to it were 100% opposed. And I just couldn't get my head around the idea.

 

[liverock]

Although the US Healthcare Reform Bill is nothing to do with me personally, and looking at it from a neutral point of view, a couple of things stick out which could cause future problems with the costs of premiums.

The ban on “discriminating” against anyone with a pre-existing condition.

It could result in a lot of healthy people who dont already have insurance, waiting until they are ill before getting insurance. The bill supposedly has a $750 fine for not buying insurance but that won’t even be enforced. Even if people have to pay a $750 fine, that’s much less than the $20,000 plus that it could cost a family to buy insurance.

It could result in a situation where the majority of people in the scheme are pre-existing conditions and premiums could skyrocket. The only wayround this is to fine people who wont take out insurance what their annual premium would have been.

Good luck with that.!

Health schemes in Europe take at least some of the costs (and in some cases all costs),directly out of people's salaries.

Most of the projected cost savings which the government has quoted would be made through the increased numbers taking out insurance for the first time. If there's not a big increase then there wont be savings and healthy people having the option to come in only when they are sick and become people with"pre-existing conditions" is unworkable IMO.

The bill also forces all insurance plans to cover "at least... maternity and newborn care... substance disorder services... behavioral health treatment.... pediatric services." In the real world, some people want these and some don’t.

By requiring insurance companies to pay for all,and not tailoring to individual requirements,you are forcing people to buy insurance for conditions they may never need which puts up costs.

 

[*GG*]

I have no problem with some reform of course, things typically need tweaking. I mean the pre-existing conditon thing and more competion would have been good. But I am 100% against the Feds taking this over!

We will see this November how the majority feels.

PS I believe the pre-existing condition thing is not going to go into effect until 2014?

Thanks Tammie. That helps me understand a little better. From what I was hearing in general it sounded like most of those opposed to it were 100% opposed. And I just couldn't get my head around the idea.

 

[Tammie]

Thanks Tammie. That helps me understand a little better. From what I was hearing in general it sounded like most of those opposed to it were 100% opposed. And I just couldn't get my head around the idea.

you're welcome, and just so you know, I have actually "talked" to quite a few people who agree that change is needed, but who are not in favor of this particular bill

unfortunatley so much of what people hear, read, etc is the extreme viewpoints and that does tend to give the impression that people are either completely for or completely against it

 

[Tammie]

The bill also forces all insurance plans to cover "at least... maternity and newborn care... substance disorder services... behavioral health treatment.... pediatric services." In the real world, some people want these and some don’t.

By requiring insurance companies to pay for all,and not tailoring to individual requirements,you are forcing people to buy insurance for conditions they may never need which puts up costs.

I agree with much of the rest of what you wrote, but I wanted to specifically comment on this part, bc not only are you rt, but this is another area where Medicare is different and is going to be made worse by this bill.....as it has been, Medicare Advantage plans offered various options, so people could pick and choose somewhat based on their own needs (avoiding this very issue to a degree)

....with the way they are planning to change the Advantage plans, they will most likely become substantially more expensive and are going to pay the doctors way less, so most people are no longer going to be able to afford them and most doctors are not going to take them (making them worthless) - this will mean that there is a good chance (& this is what is being predicted) that these plans will die out

.....if/when that happens, or even before when doctors won't accept them, that will eliminate the option of finding a more personalized plan - people will be forced into some insurance for things that they don't need, and at the same time, since standard Medicare does not cover things like counseling or specialists w/o exorbitant copays (meaning that it might as well not be covering them), people will not be able to get the care they do need

 

[Tammie]

For children, it is supposed to go into effect immediately. For adults, there is going to be a possibility of joining a state run high-risk pool until 2014, and at that point the rest of the companies will have to get rid of the pre-existing clasue; however, this has actually been in place in most states already - it's just that most people are not aware of it and it is not usually very affordable. The way that it works, though, is that the state in essence becomes your grp (like a workplace would be), but since it is a grp of people with pre-exisiting conditions and others who are unable to get insurance any other way, it can still be failry expensive - just less than trying to get an individual high risk policy.

There is also something in the policy that I am not remembering clearly rt now, and I will say also that I did not research this part as thoroughly, bc it does not affect me personally rt now. I do think it is very important, so I did find out about it, but it is possible that I am getting it wrong or that it has changed since I looked into it.......but from my understanding, when the pre-exist part of the bill was first brought up, there was somethign to do with an application period or somethign like that, that basically makes it so that people still have to wait 6 months before they can take advantage of not being excluded for pre-existing condition. (That is for the new bill; not the state grps).

So, if I am understanding it rt, in a way not a lot has changed. In most employee grp insurance policies, if you had a pre-existing condition, and you went for 6 months without it being covered, they looked at it like it was no longer a pre-exisitng condition. Then you were elligible for coverage. So, in otehr words, you had to basically pretend that your condition was in remition or that it has been cured for 6 months. After that six months, it was assumed that a new occurance of the condition was just that; a new occurrance, and no longer consdiered pre-exisitng. Then it was covered. Now, you don't have to act like it has been cured, but you still have to wait 6 months for it to be coeverd.

The one big difference in this bill that is very good, is that for some poeple any occurrance of certain illnesses any time during their lives automatically made many insuracne companies refuse to cover them at any time, and sometimes allowed thier existing companies to drop them. This is not actually the same as a pre-existing thing, though. Even if you had no symptoms of the illness or were even consdiered to have been cured, simply having had one of these illnesses at any time, made you uninsurable. Companies will no longer be able to do that with the new bill.