<p>You may be right that for any given individual, the new law may not end up being more complicated than it is now. But for those of us who want to understand how it impacts the country as a whole, it is very complex.</p>
<p>Yes, you’re right about that, Bay. The law tried to address payment, marketing, delivery systems - and even quality performance and electronic records. So the sheer breadth of the law makes it very complicated.</p>
<p>Everyone still believe it’s paid for…</p>
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<p>I think you are confusing the small business subsidies with the individual subsidies. There is no time limit on the individual subsidies – they are tied to the federal poverty rates and will be reindexed from one year to the next, but if anything that will tend to expand the income ranges which qualify as the cost of living goes up.</p>
<p>However, because the subsidies are tied to income, you would lose eligibility as your income rises. </p>
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<p>That’s unlikely. Most of the cheaper policies on the individual market now simply don’t comply with the ACA basic requirements. You may still be able to buy them post-ACA – but if you are insured with a noncompliant plan, you will also end up paying the tax penalty. So you would have cheaper premium + less coverage + higher taxes. </p>
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<p>The metal tier levels have nothing to do with doctor selection – they simply have to do with compensation rate. You’ll pay a higher copay and percentage of bills with a bronze plan than someone else who opts for a gold plan, but see the same doctors. The same insurance companies that now exist will be offering the policies within the exchanges, probably with the same provider networks.</p>
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<p>Actually, from the individual consumer end of things, it seems quite simple – at least in the states that have expanded Medicaid and set up exchanges as the law contemplates. </p>
<p>It works like this:</p>
<p>Everybody needs to have insurance.</p>
<p>If you already have insurance through your employer – you’re set. No change needed.</p>
<p>If you are already covered by Medicaid, Medicare, TriCare, etc… – no changes needed. </p>
<p>If you don’t have insurance, instead of having to shop around, you’ll have a one-stop insurance shopping experience – you’ll go to the exchange, look at what is available in your area, and make a choice based on availability and whatever factors differentiate one plan from another. </p>
<p>As someone who has alway shopped on the individual market, I think this step will be easier – in the past I always had to spend hours looking at the small print behind the teaser rates. Now, if I go to an exchange, I will know that every policy covers meets the basic requirements. </p>
<p>No more lengthy health forms to fill out in order to qualify, with detailed checklists asking my entire personal and family health history. Just fill out one simple form that is the same for any policy, and submit. Seems a whole lot less complicated than the old system.</p>
<p>Potential problem for the providers, though. Will edit/summarize from another listserv:</p>
<p>… people who join through an exchange who are financially eligible for a tax credit (to cover part of premium) have a grace period to pay their premiums. If they do not pay in a given month, they have up to 3 months to pay before they are terminated from coverage. If a patient is seen during that grace period (and if a provider is already seeing some patients they are expected to see them during the grace period) and the patient is eventually terminated, the provider will not be paid from insurance. The provider could attempt to bill the patient if they are terminated from coverage. <<name of="" insu="" co="">> insists that this will be a tiny fraction of people, but of great concern to physicians who currently work with large numbers of low income patients. Info about their payment status will not be available online, but IF the provider has already billed for a patient, they will get a letter from <<name of="" insu="" co="">> saying that they (the pts) have not paid their bill. </name></name></p>
<p>A provider could see someone who says they have insurance (Having paid one months premium) and would never see that letter until after seeing the patient for healthcare services over this three month period. So insurance company can actually request money back from the provider if they paid the provider during the first month of grace period and later terminate patient.</p>
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<p>I have no idea if this is fact…but if it is…it’s terrifying. DH and I have coverage through our employer (small group plan), the catch…we ARE our employer. So are you saying there is a chance our employer (us) will buy a plan that is non ACA compliant and then we ( or our employer - who are one and the same) will be fined???</p>
<p>I thought that ‘if you liked your insurance you could keep your insurance’ this seems to be a blatant lie.</p>
<p>“Most of the cheaper policies on the individual market now simply don’t comply with the ACA basic requirements. You may still be able to buy them post-ACA – but if you are insured with a noncompliant plan, you will also end up paying the tax penalty. So you would have cheaper premium + less coverage + higher taxes.”</p>
<p>I am wondering who is being helped by forcing people to pay for more expensive coverage, if they don’t desire it. I guess the, “If you like your health care plan, you can keep your health care plan,” only meant if your plan was compliant with what they decided it should be, or if you wanted to pay tax penalties.</p>
<p>It sounds to me that forcing people to pay additional monies only enriches the insurance companies, who can sell more expensive plans that people may not need nor want. Or maybe they are trying to push as many people as possible into the exchanges, even if they liked their insurance. Is this consumer friendly?</p>
<p>This reminds me of my homeowners insurance company, which I promptly dumped, when they pretended that the cost to rebuild my house had magically increased by over 60% in the last five years, skyrocketing the cost of my insurance, yet increasing the payout if the home was destroyed. Sure, it may be more useful if my home was completely burned down, but it was making us massively overinsure. The only entity I saw making money on that deal was the insurance company. Maybe it would help the insurance company stay solvent longer if people were paying far more for their policies, but really.</p>
<p>“So are you saying there is a chance our employer (us) will buy a plan that is non ACA compliant and then we ( or our employer - who are one and the same) will be fined!!!???”</p>
<p>I wonder if you will be fined as the employer, and also fined as the employee?</p>
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<p>But as per a recent BS mailing, coverages can not be limited by gender. So, I guess DH can have his annual OB-GYN exam and I can have my annual prostate inspection - oh the joy.</p>
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<p>I think you both are confusing federal government subsidies with individual subsidies. Doesn’t the law provide that the federal government will subsidize the state exchanges in an amount that decreases over time?</p>
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If it doesn’t provide adequate coverage, it’s not really “insurance”. </p>
<p>Many of the cut-rate policies have annual and lifetime maximum benefit limits that are simply not adequate to deal with high end medical costs.</p>
<p>What happens to illegal immigrants who are not insured?</p>
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<p>Or it (a higher premium) makes it possible for some people to have an OB-GYN exam or prostate inspection who otherwise wouldn’t have had one. </p>
<p>Which, paradoxically, illustrates how preventive care can raise healthcare costs. Catch cancer early and you have to pay for treatment, catch it later and the only expense might be palliative care. </p>
<p>So we, as a society, have to decide if better outcomes are worth the extra cost.</p>
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All of other people who end up paying for the unpaid costs incurred by underinsured individuals who can’t pay for the really expensive stuff. (Chronic illnesses, chemotherapy, prolonged hospitalization, etc.). </p>
<p>All of those unpaid costs are passed onto others int the form of higher costs to others.</p>
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<p>What happens if you go to the exchange, and find out that your premium is going to be say, $20,000 per year, and for various reasons (mortgage, huge debt load, college tuition), you cannot come up with the money?</p>
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<p>They will continue using ER for their health care needs.</p>
<p>This is what I was referring to, with regards to less doctor options in some tiers. </p>
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<p>[Will</a> health reform make you change doctors? - Elizabeth O’Brien’s Retire Well - MarketWatch](<a href=“Will health reform make you change doctors? - MarketWatch”>Will health reform make you change doctors? - MarketWatch)</p>
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<p>That is what I assumed. Are there any data on how many of the 11 million currently have coverage?</p>
<p>The looming doctor shortage is a big, big deal, ACA or no ACA.</p>