<p>^^ If you were to compare British docs with US docs, are the former really worse? This whole concept of forcing most US students to waste four years of time and money builds in inefficiency into the system.</p>
<p>More states moving toward Medicaid expansion:</p>
<p>Virginia, Ohio, Michigan: [Three</a> More Key Red States Could Still Sign Onto Obamacare | TPMDC](<a href=“Category: DC - TPM – Talking Points Memo”>Category: DC - TPM – Talking Points Memo)</p>
<p>Texas: [Rick</a> Perry In Talks To Accept Obamacare Funding For Elderly | TPM LiveWire](<a href=“Category: News - TPM – Talking Points Memo”>Category: News - TPM – Talking Points Memo)</p>
<p>(This pertains to the issue of coverage for individuals and families earning under 133% of the poverty line, who technically do not qualify for subsidies on the exchange under the current wording of the ACA)</p>
<p>To expand what calmom said, initially in Obamacare, everyone was to have to get insurance. If the insurance wasn’t supplied by employment, then everyone over 400% of the poverty line would have to buy it on the individual market. Between 133% and 400% of the poverty line, people would still have to buy insurance, but it would be subsidized. </p>
<p>People under the poverty line can’t afford insurance. So the Obamacare idea was to expand Medicaid to everyone under the poverty line (right now, it basically only covers the disabled, pregnant women and children; healthy poor men are out of luck). Medicaid is a state-federal partnership, so each state would have to expand its own state program. The federal government, however, would cover the entire cost of the new enrollees, for the first few years, and then virtually the entire cost.</p>
<p>The Supreme Court struck down the requirement that states had to expand Medicaid. So now we have the odd situation in some states that everyone is required to have insurance, except poor people, who have no insurance at all and more or less no way to pay for health care.</p>
<p>The federal poverty line is about $11,500/year for a single person. So, in states where Medicaid is not being expanded, people with a little more income than that get health care subsidies, but people with less income than that get nothing.</p>
<p>The Indian doctors are the best in the world, for the simple reason that getting into medical school in the U.S. compared to India is child’s play.</p>
<p>
[UPS</a> to drop 15,000 spouses from insurance, cites Obamacare - Atlanta Business Chronicle](<a href=“http://www.bizjournals.com/atlanta/morning_call/2013/08/ups-to-drop-15000-spouses-from.html]UPS”>http://www.bizjournals.com/atlanta/morning_call/2013/08/ups-to-drop-15000-spouses-from.html)</p>
<p>^Because they use that as a fig leaf doesn’t mean it caused it. It’s just a convenient cover–nothing about the ACA mandates that. Every insurance decision now can use that line–very convenient way to hike profits and cut costs.</p>
<p>Recall, though, that Obamacare mandates two things. It mandates certain level of coverage (preventative services must be covered, no rescissions because the insured person got sick, for example). It also requires that insurance companies use 80/85% of premiums for health care, or rebate the excess to policyholders. </p>
<p>So while all companies want to hike profits and cut costs, insurance companies are limited in the ways they can do that. UPS is removing the spouses because they are already insured by their own employers. It’s not obvious to me what this has to do with Obamacare, but it’s also not obvious to me why it’s terrible.</p>
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<p>Bingo, and they even admit it. From the same article:</p>
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Is it “already insured” or has access to coverage? (I’ve heard both versions today and am confused about that.)</p>
<p>zoosermom, this is from the actual memo to employees:</p>
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</p>
<p><a href=“http://www.kaiserhealthnews.org/Stories/2013/August/21/Insurance-For-Working-Spouses-At-UPS.aspx[/url]”>http://www.kaiserhealthnews.org/Stories/2013/August/21/Insurance-For-Working-Spouses-At-UPS.aspx</a></p>
<p>(Click the link “a memo to employees” in the third paragraph.)</p>
<p>You’re awesome! Thanks LasMa.</p>
<p>BTW, this is a craven move by UPS which, as garland points out, is taking advantage of the confusion to pad its bottom line. Its coverage already has the essential benefits required by ACA, so it will not have to up its coverage or pay fines, and the reporting requirements have been delayed until 2015. So UPS literally will not be touched by ACA in 2014. The $60 million savings will be pure windfall.</p>
<p>UPS is disingenuous in blaming this on Obamacare, but otherwise, why should they have to buy insurance for people who can get it through their own employer? There is absolutely nothing wrong per se with companies trying to save money. I don’t see why this is a craven move.</p>
<p>Most companies have some rule about covering a spouse eligible for coverage elsewhere but many try to make it just more expensive in order to not cover them. I have had to certify that wife had no coverage when she was on my plan in the past or else pay an extra $100 a month outside of the premium which wouldn’t have been worthwhile for anyone who could get coverage as an employee elsewhere.</p>
<p>If UPS wanted to keep good relationship with their employees, they should have just tacked on a fee that makes it worthwhile for the spouse to go their own employer. </p>
<p>I suspect what they are actually saying is that since there would be no preexisting condition issue in the future, there is no reason we should spend money covering your spouse when his/her employer should be spending the money.</p>
<p>My H and I used to both buy family coverage from his plan and mine. We did this ever since we had kids, since we were aware that we had a $1 million cap under each plan. </p>
<p>Once the lifetime cap was eliminated, we stopped buying 2 sets of family insurance. That saved us a lot of money. </p>
<p>I don’t have a problem with companies now stopping the married spouse from buying insurance from them if they can get it elsewhere.</p>
<p>“I don’t have a problem with companies now stopping the married spouse from buying insurance from them if they can get it elsewhere.”</p>
<p>In theory it sounds like no big deal, but for the people this affects, the spouse will probably now have worse insurance at higher cost (which may or may not have been a goal of ACA, but is certainly a consequence). I’m assuming UPS offers excellent insurance, and if you are covering a family, it may have been no additional cost (or little) to insure a spouse. Now the spouse will have to pay for a separate policy, separate deductible, and unless their company offers excellent insurance, it will be worse. This will cost many middle class working families a lot of extra money. Potentially it might not be worth it for the spouse to even work, if their job was low paying.</p>
<p>I see this as just a start. I think companies will shed as many people as possible from the insurance policies using the ACA as an excuse, raising the costs and lowering the benefits. Eventually declaring that it is too expensive to provide coverage at all, and paying the fine. If that was the goal of the ACA, then I think they will be successful in achieving that. Unfortunately in a depressed economy, the companies will not raise salaries (except for executives), people will have worse insurance for much higher costs. The rich will be barely affected, the poor and the lower middle class will get subsidized, and the middle class will get hammered. So much for building up the middle class.</p>
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This is what is preparing to happen across my industry. It is a reflection of the weakness of the sector over the last few years. And the fact that the owners don’t/can’t have the same coverage as the employees and don’t want to pay for something that doesn’t benefit them.</p>
<p>Stay healthy!</p>
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Are you saying this action would have been taken even without ACA as a fig leaf?</p>
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<p>I am saying that before the ACA was passed, employers were already cutting employer-supplied insurance, switching to worse employer-supplied insurance, and hiking the employee premium cost. Employers were being hit by huge yearly jumps in health benefits costs, and they were acting in response to those jumps. If the ACA had not been passed, employers would have continued to trim health benefits in response to rising costs, though they would not have been able to blame the trimming on the ACA.</p>
<p>Cutting insurance benefits for spouses who can get insurance through their own employers seems to me to be less bad than cutting insurance benefits for employees and their dependent children, particularly now when the ACA requires all employer-supplied insurance plans to meet some minimums. (Though some bogus faux insurance policies are still grandfathered in.)</p>