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Thread: Obamacare ... the legal stuff

  1. #21
    Senior Member Gerry Clinchy's Avatar
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    http://www.foxnews.com/politics/2013...big-insurance/
    I hadn't even considered this angle ... premiums would increase even more in 2014 if the health insurance industry had to absorb the results of the capped out-of-pocket. So, by delaying a year, premium sticker shock will occur in two waves.

    Above, the POTUS is quoted as saying, not to worry since major medical caps will be in place ... just not the drug cost caps. However, remember the insurance companies will be insuring pre-existing conditions. Some of those conditions may cost just as much in drugs as in major medical costs:
    If the insurers were also required to absorb the cost of very expensive treatments not covered under plans, like new prescriptions for cancer treatment that cost more than $100,000 per year, at the same time, premiums would climb even higher.

    So a cancer patient could still lose everything they own during 2014 ... and/or their life.
    G.Clinchy@gmail.com
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  2. #22
    Senior Member luvmylabs23139's Avatar
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    Another hidden little twist buried in the law. If a married couple are both employed and have an employer provided plan both must take their individual employers plan regardless of whether one plan is better or more cost effective for the couple.
    So for example if one spouse works for a company that provides 100% employer paid plan that covers both the other spouse must now take their employer plan anyway even though they have zero reason to need or want it.
    Hihope Hiland Heathen of Perth CD, RE, CGC, TDI

  3. #23
    Senior Member Gerry Clinchy's Avatar
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    Quote Originally Posted by luvmylabs23139 View Post
    Another hidden little twist buried in the law. If a married couple are both employed and have an employer provided plan both must take their individual employers plan regardless of whether one plan is better or more cost effective for the couple.
    So for example if one spouse works for a company that provides 100% employer paid plan that covers both the other spouse must now take their employer plan anyway even though they have zero reason to need or want it.
    I wonder if that is correct simply because this law is so complex somebody might have misinterpreted some provision.

    OTOH, it would seem that this accomplishes two purposes: it may be easier to keep track of the individual mandate compliance when it is tracked through the employer; and it offers the insurors a way to collect full premiums for claims they'll never have to pay out on. It might be possible, if the one spouse has full spousal coverage paid for by the employer, that they could take advantage of that insurance to absorb any co-pays from the other policy through "coordination of benefits". Even if this can work that way, insuror #2 is often going to get a bit of a windfall from being the #2 in line for paying.

    If this interpretation of the law is correct, it is an even larger "tax" on the middle class. If the one employer is paying for insurance that some of his employees don't need (due to spouse's coverage), that employer is paying more in overall benefits for its employees than it needs to pay. This would mean that it would not have those funds available for higher wages or other employee benefits; or to pay their other bills, thus eating into their profit line.

    Also, people have missed that smaller employers will also have to provide benefits if they have a lot of part-time workers. The law says 50 or more full-time employees, but it also provides that an employer with 30 full-time employees, and 10 employees who work 20 hrs./wk will have to provide coverage for the full-time employees. I'd guess that an employer with 30 employees probably already provides health insurance coverage, but that may not be so in all cases.

    Temp services will be hard-hit with this. Temp employees are employed by the temp service. Typically, there are no health insurance benefits from a temp service. Some of them do provide for health coverage, but usually not much coverage for the temps. If they now are required to provide O-care-approved coverage, and their costs increase, it will make it more costly for all businesses who use temps to do continue to do so.

    Temp employees have latitude that other full-time employees don't have. For example, teachers can pick up a summer job through a temp service. Those teachers are very likely to already have coverage through their teaching job. So, during the summer, two employers are paying for coverage for the same individual. Another "double tax" situation.
    G.Clinchy@gmail.com
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  4. #24
    Senior Member huntinman's Avatar
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    All of the above discussions just reiterate what was already known... the government can't run the post office, so now we have them totally mangling our health care system? Makes perfect sense.
    Bill Davis

  5. #25
    Senior Member luvmylabs23139's Avatar
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    Quote Originally Posted by Gerry Clinchy View Post
    I wonder if that is correct simply because this law is so complex somebody might have misinterpreted some provision.

    OTOH, it would seem that this accomplishes two purposes: it may be easier to keep track of the individual mandate compliance when it is tracked through the employer; and it offers the insurors a way to collect full premiums for claims they'll never have to pay out on. It might be possible, if the one spouse has full spousal coverage paid for by the employer, that they could take advantage of that insurance to absorb any co-pays from the other policy through "coordination of benefits". Even if this can work that way, insuror #2 is often going to get a bit of a windfall from being the #2 in line for paying.

    If this interpretation of the law is correct, it is an even larger "tax" on the middle class. If the one employer is paying for insurance that some of his employees don't need (due to spouse's coverage), that employer is paying more in overall benefits for its employees than it needs to pay. This would mean that it would not have those funds available for higher wages or other employee benefits; or to pay their other bills, thus eating into their profit line.

    Also, people have missed that smaller employers will also have to provide benefits if they have a lot of part-time workers. The law says 50 or more full-time employees, but it also provides that an employer with 30 full-time employees, and 10 employees who work 20 hrs./wk will have to provide coverage for the full-time employees. I'd guess that an employer with 30 employees probably already provides health insurance coverage, but that may not be so in all cases.

    Temp services will be hard-hit with this. Temp employees are employed by the temp service. Typically, there are no health insurance benefits from a temp service. Some of them do provide for health coverage, but usually not much coverage for the temps. If they now are required to provide O-care-approved coverage, and their costs increase, it will make it more costly for all businesses who use temps to do continue to do so.

    Temp employees have latitude that other full-time employees don't have. For example, teachers can pick up a summer job through a temp service. Those teachers are very likely to already have coverage through their teaching job. So, during the summer, two employers are paying for coverage for the same individual. Another "double tax" situation.
    I think it is buried in the rule about not being able to refuse employer coverage and credits. I used to work for a company that touted 100% employer paid family coverage as a benefit. I was first hired as the payroll manager and then somehow ended up as Payroll/HR director so I know what was paid by the company for this benefit. I can also compare to the direct competitor in the industry as at one point I had my job and my husband was the Accounting manager for our only direct competition in the industry in the US.
    Prior to taking the job with this company it was better for DH to insure both of us than me take my prior company's individual coverage. I was the payroll manager then for a huge national retailer that is now out of business and even back in the late 90's as a corp employee his insurance beat mine hands down. Then I quit the sinking ship before the world knew it was sinking. I got hired by the only direct US competetor to the company DH worked for. We dumped his insurance for mine as we got better for zero cost and that more than made up for the cut in salary I took for less hours, tons less stress, shorter comute etc.
    As for BUMMA's insurance crap, we are totally screwed. As we are both now self employed and HAVE INSURANCE that works for us we have already been told that we can't keep our current policy because while it is what we want and need (and since we both are CPA's whether practicing or not) we do know what works and is best for us, we can not have that anymore. BCBS NC will only tell us to expect a "substanial increase." Again this increase is not a result of claims but rather OBUMMACARE> that from BCBSNC.
    I can only say that there is no way I will pay more per month for health insurance than my mortgage.
    Hihope Hiland Heathen of Perth CD, RE, CGC, TDI

  6. #26
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    Quote Originally Posted by huntinman View Post
    All of the above discussions just reiterate what was already known... the government can't run the post office, so now we have them totally mangling our health care system? Makes perfect sense.
    Clap, Clap, Clap !!!!!!!! That's it in a nutshell. When medicare became a fact of our lives it started a slide downhill. I can't get in to see my "cancer" doctor now without my primary care Dr.'s okay ( time frame expired is I guess the way to express it ). 3 calls to the primay's office before I could get a reply. We
    do not have free access to medical care now if we use medicare ( old people should just die already ! ). And soon it will be everyone who is waiting for permission to see a Dr. etc. I have to leave a message ( by phone ) at the primary's office and if they decide to answer they may.........in a few day's time. You have to go to the ER for just about anything anymore if you want to see a dr. without waiting a month.
    charly

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  7. #27
    Senior Member Gerry Clinchy's Avatar
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    Subsidies—paid directly to insurance companies—are available for those with incomes from 138% ($15,415 for individuals; $29,326 for a family of four) to 400% ($45,960 for individuals; $94,200 for a family of four) of the poverty level.
    Another wrinkle in the program could limit access to care. If enrollees pay one month’s premium, exchanges must provide a grace period of three consecutive months during which coverage cannot be terminated. However, insurers are only required to pay claims during the first 30 days of the grace period.

    Thus, patients with valid insurance cards in hand can seek treatment at a doctor’s office on day 31 through 90 of the grace period. When the physician in good faith submits a claim to the insurer, the claim can be denied. Although the physician can bill the patient, realistically, many patients simply will not pay. Chalk up another win for the insurance industry, which has off-loaded two-thirds of the risk of nonpayment onto physicians.
    two recent studies in the journal Health Affairs demonstrate that people do not change merely because you tell them to. Uninsured and Medicaid patients reported that they preferred care in an emergency room to a doctor’s office. For Medicaid patients the financial cost of an ER visit and the physician’s office were similar, but the ER was more convenient. The uninsured reported the cost of office care was higher because of additional testing or specialist visits.[/QUOTE]
    This is the bio of the author of the above:
    Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) member. Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. Dr. Singleton recently returned from El Salvador where she conducted make-shift medical clinics in two rural villages. Her latest presentation to physicians was at the AAPS annual meeting about challenging the political elite.
    G.Clinchy@gmail.com
    "Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim

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  8. #28
    Senior Member swampcollielover's Avatar
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    All the elimination of access and benefits is already starting. My physician stopped practicing medicine and went to work in hospital administration. He was a fine doctor, but said he could not allow the government to further get between him and his patients. He could not provide the quality of care that he deems minimally acceptable...he could ":do no harm"....that was his oath and he lives by it! God Bless him for that, but now he is lost as a physician....what a waste.

  9. #29
    Senior Member Gerry Clinchy's Avatar
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    Unreal:
    CRS Report Reveals Administration Has Missed 50% of Obamacare's Implementation Deadlines


    http://townhall.com/tipsheet/kateand...lines-n1668077
    G.Clinchy@gmail.com
    "Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim

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  10. #30
    Senior Member Gerry Clinchy's Avatar
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    The latest casualty of Obamacare may be a low-cost New Jersey health-care policy. Though President Obama promised “if you like your health care plan, you’ll be able to keep your health care plan, period,” that will not be the case for approximately 106,000 New Jersey residents whose plans will disappear under the law.
    http://www.nationalreview.com/corner...nder-obamacare

    Premiums for these low-cost plans now run about $150/mo for a single male, age 25. It is anticipated that this cost will be 3-to-4X as much for the new plans that meet Obamacare minimum coverages. Guess who will be paying the penalty tax instead?
    G.Clinchy@gmail.com
    "Know in your heart that all things are possible. We couldn't conceive of a miracle if none ever happened." -Libby Fudim

    ​I don't use the PM feature, so just email me direct at the address shown above.

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