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Thread: Obamacare ... more of what's in it

  1. #1
    Senior Member Gerry Clinchy's Avatar
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    Default Obamacare ... more of what's in it

    Nearly one of every five U.S. adults smokes. That share is higher among lower-income people, who also are more likely to work in jobs that don't come with health insurance and would therefore depend on the new federal health care law. Smoking increases the risk of developing heart disease, lung problems and cancer, contributing to nearly 450,000 deaths a year.

    Insurers won't be allowed to charge more under the overhaul for people who are overweight, or have a health condition like a bad back or a heart that skips beats but they can charge more if a person smokes.

    Starting next Jan. 1, the federal health care law will make it possible for people who can't get coverage now to buy private policies, providing tax credits to keep the premiums affordable. Although the law prohibits insurance companies from turning away the sick, the penalties for smokers could have the same effect in many cases, keeping out potentially costly patients.

    "We don't want to create barriers for people to get health care coverage," said California state Assemblyman Richard Pan, who is working on a law in his state that would limit insurers' ability to charge smokers more. The federal law allows states to limit or change the smoking penalty.

    "We want people who are smoking to get smoking cessation treatment," added Pan, a pediatrician who represents the Sacramento area.

    Obama administration officials declined to be interviewed for this article, but a former consumer protection regulator for the government is raising questions.

    "If you are an insurer and there is a group of smokers you don't want in your pool, the ones you really don't want are the ones who have been smoking for 20 or 30 years," said Karen Pollitz, an expert on individual health insurance markets with the nonpartisan Kaiser Family Foundation. "You would have the flexibility to discourage them."

    Several provisions in the federal health care law work together to leave older smokers with a bleak set of financial options, said Pollitz, formerly deputy director of the Office of Consumer Support in the federal Health and Human Services Department.

    First, the law allows insurers to charge older adults up to three times as much as their youngest customers.

    Second, the law allows insurers to levy the the full 50 percent penalty on older smokers while charging less to younger ones.

    Obama administration officials declined to be interviewed for this article, but a former consumer protection regulator for the government is raising questions.

    "If you are an insurer and there is a group of smokers you don't want in your pool, the ones you really don't want are the ones who have been smoking for 20 or 30 years," said Karen Pollitz, an expert on individual health insurance markets with the nonpartisan Kaiser Family Foundation. "You would have the flexibility to discourage them."

    And finally, government tax credits that will be available to help pay premiums cannot be used to offset the cost of penalties for smokers.
    20% of adults are smokers ... thus if population is 300,000,000 & 1/2 are adults, that might be about 30,000,000 who will not be able to afford health insurance? Whatever happened to, "If you like your health insurance plan, you'll be able to keep it."?

    Does that mean that the new law actually will be getting health insurance to 30,000,000 and quite possibly putting it out of reach for another group of 30,000,000? What about Medicaid? No smokers' exclusion or penalty there?

    So, I guess all those smokers wait until they get sick ... and then purchase health insurance? And if they can't afford it, they end up with Medicaid? or they just die & solve the problem that way?

    Of course, the sales taxes on tobacco often are used to subsidize health care for children. Since smokers will gradually be eliminated, one way or the other, that funding will have to come from some other form of taxation.

    Thus far the law does not allow higher premiums for obesity. However, we know that obesity can be a contributing cause to Type II diabetes, and diabetes can cause other health issues. Do we really believe that obesity or overweight will not become a penalty in the future?

    As more states legalize marijuana, will the smoker penalty apply only to tobacco?

    Take a hypothetical 60-year-old smoker making $35,000 a year. Estimated premiums for coverage in the new private health insurance markets under Obama's law would total $10,172. That person would be eligible for a tax credit that brings the cost down to $3,325.

    But the smoking penalty could add $5,086 to the cost. And since federal tax credits can't be used to offset the penalty, the smoker's total cost for health insurance would be $8,411, or 24 percent of income. That's considered unaffordable under the federal law. The numbers were estimated using the online Kaiser Health Reform Subsidy Calculator.

    "The effect of the smoking (penalty) allowed under the law would be that lower-income smokers could not afford health insurance," said Richard Curtis, president of the Institute for Health Policy Solutions, a nonpartisan research group that called attention to the issue with a study about the potential impact in California. (Of course, higher income workers would be able to afford the insurance premiums.)

    In today's world, insurers can simply turn down a smoker. Under Obama's overhaul, would they actually charge the full 50 percent? After all, workplace anti-smoking programs that use penalties usually charge far less, maybe $75 or $100 a month.

    Robert Laszewski, a consultant who previously worked in the insurance industry, says there's a good reason to charge the maximum.

    "If you don't charge the 50 percent, your competitor is going to do it, and you are going to get a disproportionate share of the less-healthy older smokers," said Laszewski. "They are going to have to play defense."
    It would appear that this part of the law makes this a windfall for the insurors ... at least until the smoking population is eradicated.

    Workers covered on the job would be able to avoid tobacco penalties by joining smoking cessation programs, because employer plans operate under different rules. But experts say that option is not guaranteed to smokers trying to purchase coverage individually.
    This last item would certainly be impactful to employees of small businesses.
    G.Clinchy@gmail.com
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  2. #2
    Senior Member Gerry Clinchy's Avatar
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    The unaffordable Affordable Care Act ... this is such a mess ...
    Advocates for the poor are now suddenly concerned about a new oxymoron, the so-called “affordability glitch,” where your employer can no longer afford to cover you and your family, and you will be forced to go to the state exchanges for your health insurance only to discover that you can’t afford the rising premiums there and don’t qualify for a federal subsidy. The only “good news” about this glitch is that new IRS regulations may exempt you from paying the 2.5% tax for non-compliance, which is hardly a consolation when you still lack insurance.

    Employers simply can’t afford to pay these health insurance premiums, especially for family plans, and remain in business. And you are no longer allowed to pick up the slack. Consider that ObamaCare will allow you to pay only 9.5% of your income towards an employer plan.

    Read more: http://www.foxnews.com/opinion/2013/...#ixzz2KcW5Bqb6
    Twenty-three million of us will go to the state exchanges, according to the CBO, leaving 30 million non-elderly people still lacking health insurance by 2023.

    How ironic are these estimates when you consider that ObamaCare’s stated purpose is to provide affordable insurance for all. So why the glitch? The answer is that premiums are rising to the point of unaffordability, something that the new law should have anticipated given its taste for comprehensive plans with low co-pays and limited deductibles ($2000 for an individual, $4000 per family maximum).

    Consider the state exchanges, where beginning this October ObamaCare will offer four basic types of plans; Bronze, Silver, Gold, or Platinum. Bronze is considered a basic, catastrophic-type plan, but this is simply false advertising by the Obama administration when you consider what the plan must cover; ambulatory and emergency patient services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitation, laboratory, preventive and wellness services and chronic disease management, and pediatric services including oral and vision care.

    Sounds great until you consider the cost of all these non-catastrophic services. Traditionally, high deductibles have kept premiums down by promoting cost-sharing; you pay out of pocket for basic well care and utilize a health savings accounts to provide you with a tax deduction for most or all of these payments. ObamaCare doesn’t believe in this kind of common-sense cost sharing and is trying to decrease out of pocket payments. When you take away these proven disincentives for overuse, you are left with an entitlement behemoth.

    Rising premiums automatically accompany comprehensive insurance plans in an age of expensive medical technology. Insurers transfer costs to the consumer. The bronze and silver plans on the state exchanges will limit the amount you can pay for premiums to 9.5% of your income if your income is 300-400% of the poverty line, but on average, the IRS estimates that a family of 5 will be paying $20,000 for a bronze plan. This is simply unaffordable to most families.

    Read more: http://www.foxnews.com/opinion/2013/...#ixzz2KcWZsRkC
    Are these gloomy predictions correct? We'll find out in not too long. If this kind of spit hits the fan, I think that workers for companies and unions who didn't get a "waiver", are not going to be too happy with the D party. The D party will have to "own" this one ... or the spin on how it is really Bush's fault will be fascinating to watch.
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  3. #3
    Senior Member Raymond Little's Avatar
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    Went to a healthcare round table in Louisiana last week put on by an insurer I have placed the majority of my accounts with the past 13 years. Health care providers made a deal with the devil and supported the ACA and now can't figure out how long they will be in business past 2016. It was evident from the discussion that the ACA wants the majority of Americans to fall into Medicade thus the reason to expand it so quickly and the penalties for the states who don't. Louisiana health care providers will be taxed 36.4 million per year beginning in 2014 or 2.5 % per policy holder statewide. In 2016 and beyond the increase is 3.5% and 4.5% but those are just actuarial numbers based on hypotheticals right now. I left when the CEO said group plans would probably see a 40% increase in rates beginning in 2014.
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    Senior Member road kill's Avatar
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    It's about SOCIAL JUSTICE!!!!!


    Even the most ardent KOOL-AIDE sippers are understanding what a terrible boondoggle this is.
    Of course the low information voters are getting free insurance from Obama's "stash!!!"
    How "just!"
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    Senior Member Gawthorpe's Avatar
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    I don't often post here, but let the roast begin.
    I am also employed in the benefits industry. I personally feel if you smoke and you are over weight you should be forced to pay more for insurance from the gov or private industry. Our citizens have forgotten about personal responsibility of their health. My family and I do our best to stay healthy. We make individual choices to do so.

    Doctors can longer say "you are obese and you need to do something about it" If you want to see what my good health is paying for take a minute to visit a hospital or chemo treatment center. America has had to make extra wide sturdy chairs. Our Medicare pays for chemo after chemo after chemo after chemo until the smoker dies.

    Lack of personal responsibility is costing everyone too much heartache and money.
    KARMA - The return on your entries will increase the sooner you decide to contribute one of your weekends to be in the judge's chair and judge others who have done the same for you.

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    Senior Member Gerry Clinchy's Avatar
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    Is it kind of interesting that Obamacare wants to make sure that women can get free contraception and abortions, but nobody has yet felt it necessary to give free smoking cessation and weight-loss/maintenance aids? How about alcohol cessation? It would seem that the latter would be as instrumental in cost savings as the former?

    When it comes to health care we will all end up with expensive end-of-life treatments for something (unless the govt starts stipulating how much $ will be spent). The obese and smokers may die sooner, but it just means that those end-of-life expenses would come sooner, rather than later.

    It also occurs to me that the same people who are in favor of legalizing marijuana, may become annoyed with all the no-smoking regs, as in restaurants, eventually Wouldn't surprise me if they come up with statutes permitting "smoking permitted" places for those who favor marijuana as their apertif
    G.Clinchy@gmail.com
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    Senior Member Brad Turner's Avatar
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    A conglomerate that owns hospitals in this region will no longer hire people that smoke. Current employees are "exempt," but I wonder how long it will be before they are fired for some other reason. When this was first reported, my first thought was about the cost of their insurance.
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    Senior Member Gerry Clinchy's Avatar
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    This is kind of interesting ... didn't realize that workers who had union or employer health care would not be eligible for premum subsidies; that subsidies would only apply to workers who had to purchase their coverage themselves. Can see why the unions are pretty upset! Even though the union plans may have waivers for certain rules of ACA, their premiums will be affected as well.

    A number of provisions in the health care law threaten to raise the cost of coverage, including the elimination of caps on benefits. The unions, echoing statements by employers across the country, voiced concern that the increase in up-front coverage costs could lead unionized employers to drop health coverage.

    But the senators said workers with an employer-based plan simply cannot, under the law, receive subsidies intended for those who don't get insurance through their jobs.


    "The Patient Protection and Affordable Care Act (PPACA) is not ambiguous, in fact it is explicit, on this point," the lawmakers wrote. "Any consideration of expanding access to subsidies therefore is not subject to regulation, but a change in the law."

    They cited one Congressional Research Service report that said employer-sponsored coverage would "generally" make an employee "ineligible to receive a premium subsidy."

    The subsidies, along with most major provisions of the health care law, are set to go into effect next year.


    According to the Journal, 20 million people are covered in plans run by unions and employers.

    Those signing the letter to Obama included Senate Republican Leader Mitch McConnell, R-Ky., Sen. Orrin Hatch, R-Utah., and Sen. John Barrasso, R-Wyo.

    "Concerns about rising premiums are driven by policies in (the health care law)," they wrote. "Rather than considering a diversion of subsidies not remotely contemplated in the statute, perhaps the concerns being raised by union plans should be cause to revisit the taxes, fees and other policies that drive premium increases."


    Read more: http://www.foxnews.com/politics/2013...#ixzz2KtRsurtQ
    Thirty-one Republican senators are urging the White House to reject union "demands" that ObamaCare subsidies be extended to some workers that already have coverage through their jobs, saying this is blatantly prohibited under the law.

    The senators fired off a letter to President Obama Thursday following a newspaper report that unions -- worried that the law's other requirements would drive up the price of health care plans -- want lower-paid workers to have access to federal subsidies.


    According to The Wall Street Journal, the Obama administration dismissed the idea early on of giving aid to workers in union-sponsored policies.

    But a Treasury official, in the same article, said the issue is "the subject of pending regulations."


    This raised a red flag for senators.


    "We respectfully, but strongly, disagree," the senators wrote. "The statement made by Treasury simply ignores the letter of the law."
    G.Clinchy@gmail.com
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    Senior Member GoldenSail's Avatar
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    Quote Originally Posted by Gerry Clinchy View Post
    Is it kind of interesting that Obamacare wants to make sure that women can get free contraception and abortions, but nobody has yet felt it necessary to give free smoking cessation and weight-loss/maintenance aids? How about alcohol cessation? It would seem that the latter would be as instrumental in cost savings as the former?
    Actually the law is requiring better coverage for smoking cessation products. And I think it is about time. We need to focus on prevention rather than treatment in this country.

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    Senior Member GoldenSail's Avatar
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    Quote Originally Posted by Gawthorpe View Post
    I don't often post here, but let the roast begin.
    I am also employed in the benefits industry. I personally feel if you smoke and you are over weight you should be forced to pay more for insurance from the gov or private industry. Our citizens have forgotten about personal responsibility of their health. My family and I do our best to stay healthy. We make individual choices to do so.

    Doctors can longer say "you are obese and you need to do something about it" If you want to see what my good health is paying for take a minute to visit a hospital or chemo treatment center. America has had to make extra wide sturdy chairs. Our Medicare pays for chemo after chemo after chemo after chemo until the smoker dies.

    Lack of personal responsibility is costing everyone too much heartache and money.
    I agree 100%. As a woman I already have to pay higher premiums for my gender--something I have no control over. I have no problem with smokers being required to pay more for choosing to damage themselves. Smoking is horrible, horrible, horrible to your health and a contributing factor to many health problems. I also agree with obesity and I think they should also have higher premiums for that. At my job we actually have health screenings for employees and if you are within healthy parameters (BMI, cholesterol, BP, blood sugar) they pay you money to go toward your deductible. It actually has encouraged people to take better control of their lives.

    I work hard to keep myself healthy. I go to the gym five days a week and I try to make good choices in my diet.

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