by Reality Check » Tue Oct 29, 2013 7:42 pm
John quoted Robert Reich as saying wrote:"In February 1974, Republican President Richard Nixon proposed, in essence, today's Affordable Care Act. Under Nixon's plan all but the smallest employers would provide insurance to their workers or pay a penalty, an expanded Medicaid-type program would insure the poor, and subsidies would be provided to low-income individuals and small employers. Sound familiar?"
John is accepting the characterization by Reich that the Nixon plan being the same as Obamacare.
In some ways it is. The alleged beneficiaries of both these plans, some portion of the uninsured, are to some degree the same.
But the differences between the two plans, and the differences between the claims regarding what Obamacare will deliver, and the design of Obamacare ( even if it could deliver what it is designed to deliver ) is far more interesting.
http://www.cnn.com/2013/10/03/health/ob ... gap-gupta/
1st, ( First ), Obamacare, as implemented, does not provide private health insurance to the working poor. Obamacare as implemented has a minimum, yes minimum ( that is not a typo ), annual wage requirement before one dime of subsidies will be provided. This means that in all fifty states, if a working familiy of four worked 10 hours a day, 6 days a week, and earned the highest state wide minimum wage in any of the 50 states ( which is also much higher than the federal minimum wage ) they would never, ever, be eligible for one penny of subsidy to buy private health insurance under Obamacare. Never. This is the best case scenario, in many states they could work 12 hours a day 7 days a week and never receive a dime in subsidies.
http://www.cnn.com/2013/10/03/health/ob ... gap-gupta/
2nd, ( Second ), only individuals making
MORE THAN a
lower middle class ANNAUAL WAGE and less that $120,000 for a family of four will receive MODEST insurance premium subsidies from FEDERAL taxpayers.
3rd, ( Third ), the bar for what qualifies as affordable health care ( as opposed to affordable insurance premiums ) has changed. Now a policy with a $5,000 dollar deductible, PER PERSON on the policy, a $500 per hospitalization co-pay, $75 dollar doctor co-pays for specialists ( and everyone except the primary care physician is a specialist ), 30% out of pocket co-insurance for all hospital bills over and above the $5,000 dollar deductible, are considered affordable health care. This is now defined as affordable health care by federal law.
4th, ( Fourth ), employer provided health care plans now meet the tax deductible requirements for employers provided plans if they downgrade their offerings to employees to meet the lower Obamacare standards. This is a substantial downgrading of the federal tax requirement on employers and has already resulted in the doubling and tripling of the per person deductibles on most employer health plans. THESE ARE PROBABLY THE LARGEST IMMEDIATE IMPACTS OF OBAMACARE BECAUSE THEY EFFECT THE MOST PEOPLE.
http://www.cnn.com/2013/10/03/health/ob ... gap-gupta/
5th, ( Fifth ), Obamacare, as implemented, requires the working poor to apply for state welfare and state medicaid, programs to obtain any assistance in obtaining help going to the doctor or seeking medical care. The state welfare limits on assets and income vary from state to state. As noted above, even those full time workers above the poverty line and firmly in the lower middle class are prohibited, by federal law, from obtaining one dime in subsidies to buy private insurance, because they make too little money. Working poor no longer have the option of buying limited medical coverage that does not cover maternity care, and mental health treatment, and illegal drug abuse treatment ( three very expensive medical benefits ) and private policies that once were affordable are no longer affordable.
http://www.cnn.com/2013/10/03/health/ob ... gap-gupta/
6th, ( Sixth ), Obamacare projected that30,000,000 ( 30 million ) people, out of a total of 50 million who did not have medical benefits of any kind, would gain medical coverage after Obamacare was passed. But of those 30 Million, 15,000,000 of those 30,000,000 million were projected to obtain medical benefits not by getting insurance, but instead by signing up for "expanded state welfare and medicaid" benefits.
7th, ( Seventh ), as implemented by law, the states will pickup the costs for the expanded Medicaid programs, not the Federal Government. With the Federal government providing help with 90% of the expansion cost for only 3 ( three ) of the 10 year federal costs for Obamacare implementation were projected. This makes the Obamacare implementation appear less expensive than if the Federal government were too pickup the entire cost for the full 10 years, but promises have been made that federal laws will be passed in the future so the federal government will not require the states to actually pay those expanded costs of Medicaid.
8th, ( Eighth ), private insurance companies, but not the Obamacare Exchange, must allow individuals to sign up for individual health care policies, anytime. By contrast, the Obamacare Exchanges will allow annual signups for the next calendar year only during a few months during the fall of each year ( except the first year when the sign up window is extended three months into March ). Any insurance company that offers individual policies in a state, and offers them outside the Obamacare exchange, must, by federal law enacted as part of Obamacare, allow a person who is diagnosed with cancer one day, to sign up for insurance the next, any month of the year. The Obamacare exchange does not have to do this, nor do employer sponsored insurance plans. As a result, as Obamacare is implemented many insurance companies are no longer offering any individual insurance policies in many states. Other insurance companies are canceling most of their policies and offering only policies that assume all applicants have pre-existing conditions that will have massive health care costs associated with them. The remaining, outside the exchange, individual policies, have massive insurance premiums for the healthy and sick applicants alike.
9th, ( Ninth ), state insurance laws vary by state. Some states require insurance companies to offer the same policies outside the exchanges as inside the exchanges. In those states few insurance companies offer individuals policies at all, neither through the exhanges nor outside the exchanges. The few individual policies that are offered in those states have very expensive premiums, since they are expecting mostly people with pre-existing conditions to sign up, along with people who sign up immediately after finding out they are sick.
10th, ( Tenth ), federal law under Obamacare has changed the definition of convenient access to health care under federal law, and pre-empted state law on these matters for all health plans with any nexus to the federal government. This includes all employer sponsored plans ( tax deductable ), all medicare advantage plans, all medicaid related plans, all plans issued through the Obamacare exchanges and eligible for subsidies. These federal law changes allow insurance companies to require patients to drive by near by hospitals to much more distant hospitals and allow insurance companies to exclude many hospitals from their Network. This is a cost saving measure that insurance companies in the Medicare advantage health insurance market are using to make up for hundreds of billions in Medicare funds cut to help pay for Obamacare. These changes that negatively impact elderly medicare recipients, as well as all others, have made the news recenly.
11th, ( Eleventh ), the threatened implementation of Obamacare employer penalties on January 1st, 2014, has resulted in all employers, and their benefit specialist contractors, to review all medical plans over the last three years and make changes that will be finalized in policies being offered in the fall of 2013, and that begin providing benefits on January 1, 2014. These changes, in total, have been, and will be, massive and will be noticed by the 70% to 80% of people who had their medical insurance through their employer prior to 2010. Seasonal employees, those that formerly worked 40 hours a week a few months a year, have now been limited to part time hours. All part time and seasonal employees have been reduced to 29 hours a week. Many employers have reduced full time positions and increased part time positions. Employer provided Health Insurance for part-time employees has been dropped. Since Obamacare exchange bronze policies are considered "quality health care policies" by federal law, and since these policies require the patient ( the employee ) to pay a huge portion of the health care costs, when compared to the typical employer plan before 2010, many employers are moving their policies toward this lower level of benefits and claiming they are proud to meet the "quality health care standards" of the "Affordable Care Act" and be in full compliance with the new federal laws on health care. In addition, every employee is giving up $65 dollars per year in health benefits paid by their employer and that amount is being paid instead to Obamacare to reduce the projected cost of Obamacare, when the ten year cost of Obamacare is calculated each year by the Congressional budget office. THESE ARE PROBABLY THE LARGEST IMMEDIATE IMPACTS OF OBAMACARE BECAUSE THEY EFFECT THE MOST PEOPLE.
12th, ( Twelth ), Obamacare, was intended and designed to shift medical costs off of employers and insurance companies and on to the higher income patients, it was intended. but only partially designed to be a transfer of wealth from the higher income to the lower income. As implemented it is shifting medical costs off of employers and insurance companies and on to patients of all incomes. Because the implementation is flawed, it may end up being solely a transfer of wealth from individual patients ( of all incomes ) to employers and insurance companies. It may also have the unintended consequence of decreasing visits to doctors and hospitals by the new class of sick under-insured ( sick patients with 5,000 dollar deductible plans who can not afford to obtain medical care unless they are dieing and willing to go bankrupt ). As implemented the plan will strand many of the working poor without insurance when they are kicked off Medicaid because they made too much money last month, but can not qualify for subsidies under the Exchanges because on an annual basis they still make too little money, and worse yet, the exchanges are only open three months a year to new enrollments.
Even the Obamacare exchanges paid and trained "navigators" have no idea how the exchanges are supposed to work for the purchase of insurance - just too complicated for anyone to figure out. Oregon, a Liberal bastion, has been working on their state run exchange for years, but zero insurance policies have been purchased through it. The navigators can not even answer simple questions about it, even when Navigators and spending hours searching for and answer, they can not answer simple questions:
http://online.wsj.com/news/articles/SB1 ... 0628710134
Except - signing up the working poor for state welfare and state medicaid in those states who elected to massively expand their state welfare and state medicaid programs, and implement their own state run Obamacare exchanges. Navigators can help sign people up for state welfare and medicaid:
http://www.cbsnews.com/8301-505267_162- ... structure/
[quote="John quoted Robert Reich as saying"]"In February 1974, Republican President Richard Nixon proposed, in essence, today's Affordable Care Act. Under Nixon's plan all but the smallest employers would provide insurance to their workers or pay a penalty, an expanded Medicaid-type program would insure the poor, and subsidies would be provided to low-income individuals and small employers. Sound familiar?"[/quote]
John is accepting the characterization by Reich that the Nixon plan being the same as Obamacare.
In some ways it is. The alleged beneficiaries of both these plans, some portion of the uninsured, are to some degree the same.
But the differences between the two plans, and the differences between the claims regarding what Obamacare will deliver, and the design of Obamacare ( even if it could deliver what it is designed to deliver ) is far more interesting.
[url]http://www.cnn.com/2013/10/03/health/obamacare-medicaid-gap-gupta/[/url]
1st, ( First ), Obamacare, as implemented, does not provide private health insurance to the working poor. Obamacare as implemented has a minimum, yes minimum ( that is not a typo ), annual wage requirement before one dime of subsidies will be provided. This means that in all fifty states, if a working familiy of four worked 10 hours a day, 6 days a week, and earned the highest state wide minimum wage in any of the 50 states ( which is also much higher than the federal minimum wage ) they would never, ever, be eligible for one penny of subsidy to buy private health insurance under Obamacare. Never. This is the best case scenario, in many states they could work 12 hours a day 7 days a week and never receive a dime in subsidies.
[url]http://www.cnn.com/2013/10/03/health/obamacare-medicaid-gap-gupta/[/url]
2nd, ( Second ), only individuals making [b]MORE THAN [/b]a [b]lower middle class ANNAUAL WAGE[/b] and less that $120,000 for a family of four will receive MODEST insurance premium subsidies from FEDERAL taxpayers.
3rd, ( Third ), the bar for what qualifies as affordable health care ( as opposed to affordable insurance premiums ) has changed. Now a policy with a $5,000 dollar deductible, PER PERSON on the policy, a $500 per hospitalization co-pay, $75 dollar doctor co-pays for specialists ( and everyone except the primary care physician is a specialist ), 30% out of pocket co-insurance for all hospital bills over and above the $5,000 dollar deductible, are considered affordable health care. This is now defined as affordable health care by federal law.
4th, ( Fourth ), employer provided health care plans now meet the tax deductible requirements for employers provided plans if they downgrade their offerings to employees to meet the lower Obamacare standards. This is a substantial downgrading of the federal tax requirement on employers and has already resulted in the doubling and tripling of the per person deductibles on most employer health plans. THESE ARE PROBABLY THE LARGEST IMMEDIATE IMPACTS OF OBAMACARE BECAUSE THEY EFFECT THE MOST PEOPLE.
[url]http://www.cnn.com/2013/10/03/health/obamacare-medicaid-gap-gupta/[/url]
5th, ( Fifth ), Obamacare, as implemented, requires the working poor to apply for state welfare and state medicaid, programs to obtain any assistance in obtaining help going to the doctor or seeking medical care. The state welfare limits on assets and income vary from state to state. As noted above, even those full time workers above the poverty line and firmly in the lower middle class are prohibited, by federal law, from obtaining one dime in subsidies to buy private insurance, because they make too little money. Working poor no longer have the option of buying limited medical coverage that does not cover maternity care, and mental health treatment, and illegal drug abuse treatment ( three very expensive medical benefits ) and private policies that once were affordable are no longer affordable.
[url]http://www.cnn.com/2013/10/03/health/obamacare-medicaid-gap-gupta/[/url]
6th, ( Sixth ), Obamacare projected that30,000,000 ( 30 million ) people, out of a total of 50 million who did not have medical benefits of any kind, would gain medical coverage after Obamacare was passed. But of those 30 Million, 15,000,000 of those 30,000,000 million were projected to obtain medical benefits not by getting insurance, but instead by signing up for "expanded state welfare and medicaid" benefits.
7th, ( Seventh ), as implemented by law, the states will pickup the costs for the expanded Medicaid programs, not the Federal Government. With the Federal government providing help with 90% of the expansion cost for only 3 ( three ) of the 10 year federal costs for Obamacare implementation were projected. This makes the Obamacare implementation appear less expensive than if the Federal government were too pickup the entire cost for the full 10 years, but promises have been made that federal laws will be passed in the future so the federal government will not require the states to actually pay those expanded costs of Medicaid.
8th, ( Eighth ), private insurance companies, but not the Obamacare Exchange, must allow individuals to sign up for individual health care policies, anytime. By contrast, the Obamacare Exchanges will allow annual signups for the next calendar year only during a few months during the fall of each year ( except the first year when the sign up window is extended three months into March ). Any insurance company that offers individual policies in a state, and offers them outside the Obamacare exchange, must, by federal law enacted as part of Obamacare, allow a person who is diagnosed with cancer one day, to sign up for insurance the next, any month of the year. The Obamacare exchange does not have to do this, nor do employer sponsored insurance plans. As a result, as Obamacare is implemented many insurance companies are no longer offering any individual insurance policies in many states. Other insurance companies are canceling most of their policies and offering only policies that assume all applicants have pre-existing conditions that will have massive health care costs associated with them. The remaining, outside the exchange, individual policies, have massive insurance premiums for the healthy and sick applicants alike.
9th, ( Ninth ), state insurance laws vary by state. Some states require insurance companies to offer the same policies outside the exchanges as inside the exchanges. In those states few insurance companies offer individuals policies at all, neither through the exhanges nor outside the exchanges. The few individual policies that are offered in those states have very expensive premiums, since they are expecting mostly people with pre-existing conditions to sign up, along with people who sign up immediately after finding out they are sick.
10th, ( Tenth ), federal law under Obamacare has changed the definition of convenient access to health care under federal law, and pre-empted state law on these matters for all health plans with any nexus to the federal government. This includes all employer sponsored plans ( tax deductable ), all medicare advantage plans, all medicaid related plans, all plans issued through the Obamacare exchanges and eligible for subsidies. These federal law changes allow insurance companies to require patients to drive by near by hospitals to much more distant hospitals and allow insurance companies to exclude many hospitals from their Network. This is a cost saving measure that insurance companies in the Medicare advantage health insurance market are using to make up for hundreds of billions in Medicare funds cut to help pay for Obamacare. These changes that negatively impact elderly medicare recipients, as well as all others, have made the news recenly.
11th, ( Eleventh ), the threatened implementation of Obamacare employer penalties on January 1st, 2014, has resulted in all employers, and their benefit specialist contractors, to review all medical plans over the last three years and make changes that will be finalized in policies being offered in the fall of 2013, and that begin providing benefits on January 1, 2014. These changes, in total, have been, and will be, massive and will be noticed by the 70% to 80% of people who had their medical insurance through their employer prior to 2010. Seasonal employees, those that formerly worked 40 hours a week a few months a year, have now been limited to part time hours. All part time and seasonal employees have been reduced to 29 hours a week. Many employers have reduced full time positions and increased part time positions. Employer provided Health Insurance for part-time employees has been dropped. Since Obamacare exchange bronze policies are considered "quality health care policies" by federal law, and since these policies require the patient ( the employee ) to pay a huge portion of the health care costs, when compared to the typical employer plan before 2010, many employers are moving their policies toward this lower level of benefits and claiming they are proud to meet the "quality health care standards" of the "Affordable Care Act" and be in full compliance with the new federal laws on health care. In addition, every employee is giving up $65 dollars per year in health benefits paid by their employer and that amount is being paid instead to Obamacare to reduce the projected cost of Obamacare, when the ten year cost of Obamacare is calculated each year by the Congressional budget office. THESE ARE PROBABLY THE LARGEST IMMEDIATE IMPACTS OF OBAMACARE BECAUSE THEY EFFECT THE MOST PEOPLE.
12th, ( Twelth ), Obamacare, was intended and designed to shift medical costs off of employers and insurance companies and on to the higher income patients, it was intended. but only partially designed to be a transfer of wealth from the higher income to the lower income. As implemented it is shifting medical costs off of employers and insurance companies and on to patients of all incomes. Because the implementation is flawed, it may end up being solely a transfer of wealth from individual patients ( of all incomes ) to employers and insurance companies. It may also have the unintended consequence of decreasing visits to doctors and hospitals by the new class of sick under-insured ( sick patients with 5,000 dollar deductible plans who can not afford to obtain medical care unless they are dieing and willing to go bankrupt ). As implemented the plan will strand many of the working poor without insurance when they are kicked off Medicaid because they made too much money last month, but can not qualify for subsidies under the Exchanges because on an annual basis they still make too little money, and worse yet, the exchanges are only open three months a year to new enrollments.
Even the Obamacare exchanges paid and trained "navigators" have no idea how the exchanges are supposed to work for the purchase of insurance - just too complicated for anyone to figure out. Oregon, a Liberal bastion, has been working on their state run exchange for years, but zero insurance policies have been purchased through it. The navigators can not even answer simple questions about it, even when Navigators and spending hours searching for and answer, they can not answer simple questions:
http://online.wsj.com/news/articles/SB10001424052702304799404579157630628710134
Except - signing up the working poor for state welfare and state medicaid in those states who elected to massively expand their state welfare and state medicaid programs, and implement their own state run Obamacare exchanges. Navigators can help sign people up for state welfare and medicaid:
http://www.cbsnews.com/8301-505267_162-57609254/medicaid-enrollment-spike-a-threat-to-obamacare-structure/