<p>This whole bungled mess is going from bad to worse, now. It’s like watching a disaster flick. That’s not political. It just is.</p>
<p>NBC is reporting that the Obama admin not only knew but specifically designed rules so that 40 to 67 percent of people who bought in the individual market would be forced out. Not sure the purpose- maybe they thought that the marketplace pools needed more support?</p>
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<p>[Obama</a> admin. knew millions could not keep their health insurance - Investigations](<a href=“Investigations: U.S. & World News Investigations | NBC News”>Investigations: U.S. & World News Investigations | NBC News)</p>
<p>^Shockingly manipulative. So the gov goal is to insure 7M who didn’t have insurance. To achieve that goal, they also cancel policies of 10M people and replacing with one of higher cost?</p>
<p>Poetgrl, it’s surprising where we agree – your post #2751 (“like public education and private education”) is exactly the model I would like to see. </p>
<p>I may be mistaken, but I think that’s how the National Health system works in the UK. </p>
<p>As you noted, you’d still be paying via your taxes, but I also agree with your statement that the dollars would be going to directly subsidize health care, not health insurance.</p>
<p>Flossy, outside of the website mess, I am not sure if it really is going from bad to worse. Until we have people on those policies using ther insurances, and following up, we don’t know. As a provider, I will know soon when I look at my payor mix and see if the percentage of self pay, my account receivables and my bad debts goes down. I can tell you what has happened with my accounts over the past 10 years, they all went up and stabilized somewhat when young adults (up to age 26) were covered by the ACA. Those are my facts. I am hopeful things may improve because of the good comments I received from my colleagues in Massachusetts. Only time will tell.</p>
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<p>[Alaskan</a> Company Suspends Obamacare Enrollments, Cites Faulty Subsidy Calculator | National Review Online](<a href=“http://www.nationalreview.com/corner/362381/alaskan-company-suspends-obamacare-enrollments-cites-faulty-subsidy-calculator]Alaskan”>http://www.nationalreview.com/corner/362381/alaskan-company-suspends-obamacare-enrollments-cites-faulty-subsidy-calculator)</p>
<p>Way to go Alaska! You are beating Oregon 3 to zero. That’s showing them.</p>
<p>Well, the new reports are going from bad to worse. The website problems are on day 28 and the explanations are changing and proving false. It’s not turning out the way were told it would work in terms of people keeping plans. Could be better or worse, I don’t know but the clear broken promises are problematic. Young & healthies think Obamacare is a joke and are giggling at viral SNL videos and that’s the ones who know anything at all. And the website girl has gone into hiding. </p>
<p>It’s not good.</p>
<p>I just saw a link to a previous national health care plan
[Nixon’s</a> Plan For Health Reform, In His Own Words - Kaiser Health News](<a href=“http://www.kaiserhealthnews.org/stories/2009/september/03/nixon-proposal.aspx]Nixon’s”>Nixon’s Plan For Health Reform, In His Own Words | KFF Health News)</p>
<p>Pretty interesting.</p>
<p>I dont know if this is misinformation but one issue that is coming up is that people are bypassing the exchanges and signing up for healthcare on insurance company websites or by phone. In reality, it shouldnt make a difference if BCBS gets a customer on its web site or on the exchanges. </p>
<p>BCBS should make the same money or more off the exchange. Really what should be looked at is not how many people sign up on an exchange but how many more people are insured and are the revenue numbers sufficient. </p>
<p>I am tempted to sign up on an exchange when it really isnt nexessary. :)</p>
<p>“Argbargy, there is some good news in the fact that some of those policies will be canceled. My COBRA just ended. My new individual policy doesn’t cover my family’s preexisting conditions or prescriptions. I would definitely be happy for that policy to be canceled and replaced with the minimum standards of the ACA. My pregnant colleague has a policy that doesn’t cover her pregnancy”</p>
<p>Why do you need your policy to be cancelled to get a new one? Why don’t you just shop around and find a better one, whether it’s through the ACA or otherwise? And I thought that pre-existing conditions were now to be covered, that was part of the ACA. Am I wrong? Do you have to get a new policy to cover pre-existing conditions, and if so, why not just do it if it’s important to you? As a doctor, it sounds odd that you would choose to have poor medical insurance.</p>
<p>“We were all puzzled. It was a great deal for us. We, of course, bypassed the website and went straight to BCBS. Every independent practitioner I work with has signed up through BCBS”</p>
<p>This also confuses me. Are you signing up for ACA insurance bypassing the website, and going straight to the individual provider, or are you signing up for private insurance? Do you know the costs of what you’re signing up for?</p>
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<p>Unless they get laid off with pre-existing conditions (which many over 50 have,and most of the top earners are over 50) High blood pressure? High cholesterol? Prostrate cancer in situ? Degenerative joints? Glucose intolerant? Breast cancer in situ? Welcome to the uninsured.</p>
<p>Busdriver11, I just read your post. And you have opinions? :)</p>
<p>Dragonmom, I agree with you. ACA really helps. Looks like many posters havent had to deal with preconditions or buying individual health insurance. </p>
<p>ACA helps millions of people by getting rid of preconditions.</p>
<p>frugaldoctor, what kind of doctor are you? Are you a specialist? Also, are your reimbursement rates changing in 2014 for ACA-compliant plans? I know Ma is probably different from the rest of the country but I am curious if you guys are experiencing any changes for 2014. Are all doctors in Ma going to sign up for the networks for ACA exchange plans? In Ca, many doctors as of right now are not agreeing to take patients who have these plans.</p>
<p>frugaldoctor, I have read that the universal health plan in Ma has made it more difficult for people to find primary doctors willing to see them. The wait times can be many months, and many doctors will no longer see new patients. Many people in Ma are still getting their care in emergency rooms. Is this your experience?</p>
<p>I am a specialist and I have not seen the new rates under the ACA. I am worried about that for sure. But BCBS is a beast in my state, and if I don’t sign their contract, that would be a huge population of patients I would lose. Other smaller insurance companies in my state have chose not to participate in the ACA plans but still meet the minimum standards. </p>
<p>The ACA will also roll out quality metrics that penalize hospitals financially who do not meet those metrics. That should be good for patients. The bigger issue will be the lump sump payments (DRG) to the hospitals. This worries specialists a lot because it will cap payments for certain admission diagnosis. For instance: if you are admitted to the hospital with a myocardial infarction, the capped payment may be $2500. That’s all the hospital gets and physicians are capped. In the future, the total cap may be $3000 for hospitalization, tests, and physician services. This would be a complete paradigm shift. This is commonplace in Maryland but gradually making inroads in the Midwest. This is a much bigger issue for specialists because the specialists will have to get paid by the hospitals. Hence, the rapid purchasing of private physician groups by hospitals. The hospitals have figured this out. If they own the doctors, they can control expenses.</p>
<p>Midlevels are entering the world of medicine in much higher numbers to make up for the shortfall of primary care physicians. This is bad news for doctors because of the competition. But since my state did not expand Medicaid, it shouldn’t be an issue here.</p>
<p>frugaldoctor, that’s incredible you have not been told how much you will be paid in 2014 under Obamacare. You would think the insurance companies that will be participating in the exchanges would have this information available for you. I have heard from a few doctors in Ca. that the reimbursement rates are so low that they do not think they can survive if they agree to participate in the exchanges.</p>
<p>If you are or think you may be eligible for a tax credit or subsidy, then you have to sign up via an exchange. You can get the exact same policy off-exchange directly from the insurance company, but then it is NOT subsidy eligible. Because the subsidy level can reach pretty high for larger families, it may make sense to wait to sign up. </p>
<p>People can and are signing up by phone. As far as I can tell the Covered California web site is working fine (kind of slow and intermittently down for maintenance, but it seems to work). You can also download paper applications and submit them by mail. (Doing so is not evidence of a health insurance “disaster”. Filling out applications and putting them in the mail is the way I generally got insurance back in the stone age. Sometimes instead an insurance agent would come to my house or office and pick up the paperwork. It is amazing. They have this thing called an “envelope” and something else called a “stamp” and there big blue metal boxes on random street corners where you can just deposit it and somehow it gets transmitted to the place you wrote on the outside of the envelope, with a device called a “pen”.)</p>
<p>Also, when you are figuring out whether you are or may be eligible for a subsidy, keep in mind that as the law is currently written, you keep all of the above-the-line deductions in the “adjusted gross income” section of your tax return. You have to add back any any untaxed interest or income subject to the foreign earned income exemption, and also any untaxed social security income-- but that’s it. No other add backs. So if you are borderline for subsidy eligibility, you may be able to qualify simply by making a deposit to a traditional IRA in 2014. If you are self-employed, there is a lot of wiggle room.</p>
<p>(Note: I haven’t signed up yet because I’m still waiting on network info. That’s a shortfall with the insurance companies, not the exchange. I got an email from my son today asking whether he needed to sign up this month – I told him no, he had until Dec 15 for coverage to start Jan 1, but he shouldn’t wait to the last minute. I told him I thought end of Nov would be fine. I’m sure there are thousands of others who have figured out that they don’t need to pay money for premiums in October in order to secure insurance in January. The number of signups will become very relevant on Dec. 15. Before then, not so much.)</p>
<p>frugaldoctor, please take a look at my post # 2774, too</p>
<p>Frugaldoctor, you mentioned DOs and residency slots earlier. Would you tell a prospecitve medical student not to go the DO route? Do you have any opinions about DOs in general?</p>
<p>I’m still afraid to go on-line. I pay over $1125 for just me, and it covers nada (no meds, screenings), but have no idea how much more I will pay. </p>
<p>Then, as a practitioner, how much less will will we receive?</p>