<p>TatinG; I’ve run that idea through my head. We have a wonderful, completely independent family owned radio station who might be willing to make this a show topic.</p>
<p>LF: LF: I have no desire or inclination to spend any of my life force fighting this battle. As they say on the airplane…in case of emergency, please put on your oxygen mask first before assisting others. Selfish but necessary. </p>
<p>What this issue has brought to the forefront is that there are and will continue to be hidden ‘gotcha’s’ in this bill. Frankly, I wonder if anyone every actually looked at the whole thing before it was signed and tried to assess the effects of section X when combined with section Y. My guess… not a chance…It was pieced together and way to many disparate non fitting parts were thrown into the mix. It’s like 100 engineers working on one bridge without an assigned project manager. The end result is shaky and unpredictable. And, there will be casualties – and this acceptable to a vocal supporter group (curiously…those not negatively affected are willing to throw the casualties under the bus in the name of the common good). Once in place (as has been hailed by the 8 Million subscriber crowd) it is now too big to fail. At best, it can be kludged, stitched, patched, amended and forced forward. But, it will remain a messy thing.</p>
<p>The behavior of businesses, the effects on employment status, the behavior of individuals, the response of practitioners when put under the rule of this bill is only slowly becoming evident. And, some very important (and selling points) of the act have not even been implemented!</p>
<p>So, for an individual to fight this to the State or Federal level would be quixotic. If the folks giving the information are not accountable for what they say, then really, what’s the point? </p>
<p>Dietz is right, unfortunately. Our lawmakers have no idea what this law does and they couldn’t care less. They are also stunningly comfortable with untruths.</p>
<p>Exactly my point. Moreover the folks who run Covered Cal are no dummies. They know with certainty what a single county EPO entails, and they approved it as designed.</p>
<p>D- yeah, even my head spun when I thought through how your friends can present their case to the insurer. But your post was succinct and on point. </p>
<p>Why should anyone complain to the PTB? Because “you” complain here- and “we” can’t do a darned thing about it. No one’s saying you have to be a savior. Just aim the complaints in the right direction. </p>
<p>No matter how many clever ways posters try to suggest it, “we’re” not throwing anyone under any bus. I wish you hadn’t gone back to that vapor, that useless slinging at some “8 mil crowd.” We’ve been both realistic and concerned. I daresay, a lot of info was passed to you by people with zero stake in your friends’ issue.</p>
<p>It also doesn’t sit well when one side claims they’re right and then is satisfied to just complain on a forum. If you give an s, do something. Speaking for myself, don’t tell me it’s awful and useless- and then snipe at the rest of us.</p>
<p>Adding, now that I see the AM and BB posts: kinda seems you’re making excuses to sit back and “take it.” No?</p>
<p>LF:LF; There are many many pages of this thread which amount to a counting exercise. There was a celebration when 8M new subscribers entered the system. Questions challenging the validity of this number were dismissed. </p>
<p>A small but vocal set of participants have been significantly harmed by this bill. Yes, I consider a 60% premium increase and the loss of the group option significant harm. GP is working around the limited network issues. Responses to these concerns draw yawns – or even more frustratingly – ‘you’ve been the fortunate beneficiary of the system all these years so this is just a necessary and welcomed correction.” It certainly feels like one is ‘being thrown under the bus”. </p>
<p>As far as just sitting back and taking it, I guess that depends on your point of view. I will figure out the best for my family, I will continue to inform those in my sphere of contact, making them aware of the issue(s). So, while not a grand scheme to take on the establishment…I will quietly keep up the fight. </p>
<p>Apparently we’re now at the stage where people like Dietz are figuring out certain regulations that ought to be changed or strengthened. And people like me, calmom and LF were already at the stage of looking at what alterations and tweaks ought to be enacted. So here we all are now, together, trying to figure out changes to the ACA.</p>
<p>I agree with some of the changes Dietz suggests. Certainly insurers ought to be clear and open about the exact limitations of an EPO network. As to requiring two adjacent regions for an EPO, I dunno. Is combining two small counties like Monterey and Santa Cruz really much of an improvement?</p>
<p>The irony just struck me- we’re concerned for dietz’s friends (and others in SC,) some here did a fair amount of (voluntary) hunting through the documentation on his behalf and trying to clarify what we can, agree it’s goofy, suggest the friends appeal, find the appeal link, now say register the complaint-- and get back accusations of yawns and dismissive attitudes? Are . you . kidding? </p>
<p>Wow, dietz, take a look at who did get involved to try to shed some light, if there is any- and who stayed mum until they could just summarily dismiss ACA or politicians or executives…again. </p>
<p>LF: the response and suggestions in relation to my friend’s issues were helpful, insightful and polite. I believe I did say a thank you upstream…if not…then let me say it now…thanks for the help and I have passed on the information to both the friend and two brokers. In the end this family will be an ACA winner. They are subsidized and will pay considerably less with either BS EPO or Healthnet PPO than they were with their previous plan (once any unexpected out of network charges have been settled).</p>
<p>You took issue with my ‘under the bus’ and 8M subscriber comments. I stand by those. Those comments are tied to the sustained lack of sympathy or empathy for those who are hit hard financially by this bill. </p>
<p>While we’re on the subject of tweaks, I think the subsidy “cliff” is a problem. Not everyone just over 400% of poverty is paying more for their insurance than they did last year, but a lot of people are, and they don’t get any subsidy. That ought to be fixed, though I don’t know what fix is possible. </p>
<p>I’m trying to understand the objection to the 8M number. The insurers are saying that 85-90% of the 8 million have paid, which is in the ballpark of what private insurance subscribers have paid historically. I’m not seeing any deception, because saying, oh, of the 8 million enrollees, only 87% have paid, it’s 87% of 8 million-- so what, that’s still the predicted 7 million.</p>
<p>The cliff is an issue. A fix is simple in nature - raise the income level for subsidies to say 250K and implement a sliding scale. The tough part is of course coming up with the funds.</p>
<p>The issue with the 8M is it did not subtract out those new subscribers who were forced into that market because they lost their previous policies. There was much back and forth about validity of ‘8M new subscribers who previously were uninsured’. But, IIRC the general concensus was it didn’t matter that the 8M was a straight forward indicator of success. </p>
<p>Let’s just say Cardiology and Oncology services in my area are very limited. We do not have the population to support provider choice in certain specialties. </p>
<p>This is what makes no financial sense to me…certain counties are limited to EPO networks because they are considered ‘expensive’. They are expensive because the population is small and can’t support many types of practitioners. And these practitioners have to charge more (presumably) because they have a limited population from which to draw patients. It just seems (again, from a reasonable and logical vantage point) that it would be cheaper to send - for example oncology and cardio - over to where the population density is highest. Thus forcing the expensive county residents to get themselves to the less expensive providers.</p>
<p>The 8 million includes people who were previously insured. I don’t know why that would be a problem for you. What number are you trying to calculate? The number of previously uninsured Americans who now have insurance? That’s not 8 million. According to Gallup’s interviews, it’s 11 million: 242 million adult Americans, 18% uninsured last year, 13.4% uninsured as of April.
<a href=“U.S. Uninsured Rate Drops to 13.4%”>http://www.gallup.com/poll/168821/uninsured-rate-drops.aspx</a></p>
<p>And yet, GP, my niece DID get sick, and she is not squealing. And lots of other people have gotten sick and not squealed. Most people who get sick will find that even a narrow network will have doctors that can treat them.</p>
<p>CF: the 8M was only an issue on this thread - part of some bet I believe. Frankly, don’t recall the exact threshold the bettors had designated as a winning number. In that context it would have been important to subtract out the number of previously insured from the running tally. Again, only an issue (and then probably only for me and a few nagging others) on this venue.</p>
<p>I am curious as to which plan and which network you niece subscribed? There is narrow, and then there is really really narrow.</p>
<p>So the people in Santa Cruz are going to come over to Santa Clara County to go to Suzie’s Bargain Oncology and Cardiologists R Us? I don’t actually think that we have cheap providers here in Santa Clara County.</p>
<p>Then why is Santa Cruz considered a high cost area? This is what makes no sense. We are certainly no sicker than certain parts of the Peninsula.</p>
<p>And, depending on where in Santa Cruz one lives it is much much easier to get to San Jose than the other end of the Santa Cruz corridor.</p>
<p>CF, I am in the subsidy cliff position … but I take issue with the “over the cliff” view. </p>
<p>Here’s why: without ACA, I would by insurance and pay 100% of the premium out of pocket. I am age now age 60 – that premium was going to be high no matter what. </p>
<p>With ACA, at my income level, there is a likelihood that I will pay 100% of the premium out of pocket, but a possibility instead that I will get a big tax credit instead. I won’t know until the end of the year which it will be … but then again if I decide to invest some money in my retirement account in a particular fund or equity…I don’t always know whether I will make or lose money either. </p>
<p>So I don’t look at it so much as a “cliff” but as a possible windfall.</p>
<p>Keep in mind that the “loss” only represents a narrow band of income. There is a point at which my end-of-the-year income nets me enough to push up the cost of my insurance, but not enough to fill the gap. Then there is a point somewhat higher up the income chain where I come out ahead, though not as much “ahead” as I would without the insurance structure. But the again… without ACA there would be no subsidy at all. And far less in the way of guarantees. Some of the guarantees in ACA don’t help me - I don’t need maternity coverage, for example – but other guarantees help me a lot. For example, I know now that I will have the freedom to move to a plan with a lower deductible and better out-of-pocket benefits in future years if I get sick, whereas I can save money now by going with the high deductible/lower benefit plan. At age 60… this is a very real concern to me. (I’m really healthy now… but I’m not all that certain I can count on continued good health and freedom from dependence on prescription meds for the next 5 years until I age into Medicare.)</p>