<p>Help me understand how the relative failure (I say “relative” because presumably it was a success for the 110,000 who were able to enroll) of this program can be rationalized away. There are supposedly 45million+ uninsured people in this country. Even with the 6 month waiting period, there should have easily been millions of people eligible within the 3 years the program was running. If cost was the impediment, how did the Feds not know that this would be the problem when they set it up? </p>
<p>Even if the eligibility criteria is remedied, which it may or may not be under the ACA, the tremendous cost miscalculation - it ended up costing three times what the actuaries were predicting - is enough to give one a little vertigo.</p>
<p>Yes, I noticed that too with my grandmother. However, in all fairness, the services that are poorly covered on Medicaid are also in general are not well covered on private market.</p>
<p>I found my state’s calculator yesterday- zero indication it is a guesstimate. This am, I was at my insurer and asked about the calculator: “Oh, the rates aren’t finalized yet.” So what the freak good does this do us?</p>
<p>I don’t think we can draw many conclusions, yet. But I agree we have plenty of questions- and that the release of info was done in a less than fully intelligent manner.</p>
They often go hand in hand because Medicaid and SSI are both for people with low income and low assets. That’s not the same thing as Medicare and SSDI. (You probably already know that, latichever, but I’m “putting it out there” for those who aren’t familiar with the acronyms and may not realize the distinction between SSI and SSDI/SSD.)</p>
<p>Bay, keep in mind that the people in PCIP – and the people who were eligible but did not sign up – are NOT representative of the American population as a whole. These are the sickest of the sick, AND they’ve had no medical attention for their dire illnesses for a long time. It makes sense that they were extremely expensive. I don’t see how an accurate estimate of their cost would ever have been possible. </p>
<p>But I do think it’s a lesson in the importance of getting early, regular and preventive care. It’s a lot cheaper in the end.</p>
<p>In California, kids of the working poor not eligible for medicaid could get Healthy Families, which was managed by the usual suspects, and paid docs their usual negotiated rates. Over the last several months they have been moved to Medicaid, last group Aug 1. Medicaid offers me about 10 cents on the dollar, and doesn’t cover “no shows”, historically a big problem with this population. There are no psychiatrists in private practice that take Medicaid in my county, or within a 60 mile radius that I am aware of. Most primary care docs do, as do many docs that work for groups. County mental health has psychiatrist that see kids with medicaid, but they have a hard time finding a keeping psychiatrists, especially good ones.</p>
<p>Note the NYT has been reporting on medical costs in the US versus elsewhere. The first was obstetrics and focused on the difficulty of even finding out how much giving birth in a US hospital would cost. The second was on colonoscopy. </p>
<p>A 3rd part is out 8/6 and is about hip replacements. You should read it if you or someone you know may need this. The bottom line is you can fly to a private hospital in Belgium or France, first class airfare included, and receive the same implant, stay in the hospital for 5 days, all doctor and hospital fees included for about $13,000. The average cost in the US was over $65k in the US - and obviously can run much higher. The article notes some plans - like CalPers - will pay up to a set amount and the patient is responsible for the rest. CalPers will pay up to $30k, meaning it would be cheaper to send their patients to Europe.</p>
<p>I think the administration has done a very poor job of educating the public about the ramifications of the individual mandate. While the vast majority of Americans are already covered under some sort of health insurance, those uninsured have had to confront a confusing array of sources with differing and confusing information about the mandate, including terms, penalties, etc. - this is maddening, even without regard to the fact that the Act is a gross unconstitutional (the Supreme Court opinion only reinforces this) overreach of government power.</p>
<p>Gross unconstitutional overreach? Let’s not get the thread shut down. The basic question is should more people be offered services, at a price they can better afford? Or should they eat cake?</p>
<p>I get that we want what we want. But this is about the common good. </p>
<p>Do I like it all, think it is perfectly envisioned? No. But, for heaven’s sake, enough with the scare tactics and summary judgment. Are you really saying, this is too confusing for those who need it most, let’s spare them the confusion and let them go on as before?</p>
<p>Unless your insurance pays for it. If your copay (or out of pocket maximum) is less than $13,000 it’s cheaper to stay here. Also, if you go to Belgium or France you’d have to fly home with a new hip 5 days after major surgery and probably in a lot of pain. I wouldn’t want to do that. I wouldn’t want someone climbing over me to get to the bathroom, or try to get into a window seat with a new hip. You’d likely be on a bunch of narcotics for pain. Would the airline allow you to fly in that condition? Not to mention it’s not a great idea to fly a few days after major surgery, and some doctors might not allow it.</p>
<p>In which case you need to pay for a hotel, and possibly someone to stay with you and help you, and some sort of PT, etc.</p>
Increased premiums for those who eat cake!!! It’s full of fat and sugar!!! ;)</p>
<p>
It really is too confusing for everyone, as evidenced by this thread of over 1100 posts by smart people, many of whom are confused about ACA as it stands right now. It would have been nice if the new plan was simpler for everyone to understand.</p>
<p>lergnom, I posted about hip replacements earlier. For some reason that link was political? </p>
<p>If it cost 15,000 for hip surgery in the US instead of 65,000, we wouldnt have a thread about ACA.</p>
<p>The high cost of healthcare in this country leads to more uninsured people and costs that arent affordable. It is just math. It isnt politics.</p>
<p>I was at Kaiser in San Rafael, Ca today and there seems to be a lot of building going on. The same at Kaiser in Redwood City. Just noticing.</p>
<p>There was a report on KCBS radio in SF that clinics all over the country that treat the poor
are going to help educate their patients about ACA. I think starting in Oct. There were 1200 clinics mentioned. </p>
<p>I think in Oct ACA will be easier to understand. </p>
<p>CNN had a story that…well this is the story why some states are seeing large increases in premiums and some arent.</p>
<p>I found this passage particularly telling in the CNN piece lined in #1194:</p>
<p>
</p>
<p>“No coverage options.” </p>
<p>What this tells us is that health insurers in Florida have been making a nice business of selling health insurance only to healthy people. And the state’s “high risk pool” is pretty much a sick joke except for those grandfathered in, because it doesn’t accept new entrants.</p>
<p>It’s also interesting that there’s no standard way of projecting premium increases or decreases. That’s up to each state, which pretty much guarantees that the numbers coming out are going to have a political/ideological spin in one direction or the other, depending on who’s in charge of state government and what they think about the ACA. It appears in Florida they compared current low-coverage, high-deductible plans to higher-coverage, lower-deductible plans that will be available on the exchange, and (surprise!) found a big increase in premiums. In fairness, those who like their present low-coverage, high-deductible plans will take a big hit. But it’s not exactly honest to present that as if it were the full story. A more accurate telling would also find some plans with comparable coverage and comparable deductibles to those that will be available on the exchanges, and compare the premiums. Most likely those increases would not be nearly as great (though they might still be increases in states like Florida where insurers have systematically excluded sick people from health insurance). And it would point out that while those now paying the lowest premiums will see their premiums increase, the trade-off is more coverage and lower deductibles.</p>
<p>lookingforward, no, I’m saying this is a regressive tax on the people. My family does not have health insurance coverage and for individuals (not like you people who are, presumably, covered under some sort of employer plan), insurance will still be very expensive under the new rates (at least from the shreds of information I’ve been able to piece together from insurance companies after hours of searching the web for information). However, the insurance and the penalty will take comparably chunks of out the family income. Now, as perfectly healthy people who have no history of hospitalizations, my family is now compelled to use a large chunk of its income to buy insurance that we, from historical trends, won’t even use! </p>
<p>So my bottom line is, has anybody found specific data/information on how this will apply to low income families and if there is any way out of it short of a constitutional challenge under the Equal Protection Clause?</p>
<p>^It’s just that with ACA, the premiums are still too high for our level of income. It’s just unreasonable and impractical for us to do so. We barely get by with me going to college and all.</p>
;)</p>