Topic: SCOTUS Upholds Affordable Care Act!

Jun 28, 2012 09:48 AM yorkiemom wrote:

Kayb, yes indeed. The act needs a lot of tweaking, but we had to start somewhere.

Jun 28, 2012 10:01 AM peggy_j wrote:

news.yahoo.com/blogs/ticket/su...

You know you're a cancer patient when reading news like this makes you weep with relief. (seriously, tears are streaming down my face as I write it.) I was 46 at the time of my Dx and while my DH's company has fantastic health insurance coverage, knowing that I now had a serious pre-existing condition made me worried that I could one day be without. I never thought John Roberts would be the one to help me. Thank god! Really. (agreed, it's not perfect but a big step forward in the right direction).

Jun 28, 2012 12:39 PM yorkiemom wrote:

Jun 28, 2012 02:17 PM 3monstmama wrote:

I think I would have been happy-happy today even if I weren't a cancer patient but as a cancer patient, as a woman who did "everything" right, I am so much happier. 

No one goes into life thinking they will get cancer  (or any other major illness) and yet so many get whacked with the cancer stick and find themselves dealing with insurance and financial issues in ways that keep them from focusing on their cancer and getting well.   Then there's that whole preexisting condition thing and what to do about your young adult children who don't have insurance.

As for those claiming its a "bad law," I'll listen to their views as soon as I see the signed sworn statements of each giving up their own federal insurance.

Jun 28, 2012 02:46 PM, edited Jun 28, 2012 02:46 PM by Cindyl

Jun 28, 2012 03:11 PM 1Athena1 wrote:

bevin: the health care law doesn't change one iota based on how SCOTUS upheld it - although the SCOTUS arguments could affect other legal rulings on other issues. I am actually glad the court rejected the Commerce Clause argument - I always found it to be a flimsy one.

Jun 28, 2012 04:03 PM Chris13 wrote:

I also heard a commentator say that the "tax" is unenforcable, ie the IRS is prohibited from garnishing wages, etc. to collect it, as they can do for other tax deadbeats (or those who sadly are in such terrible financial shape they skip paying taxes to buy food.)

 Now that we all have a pre-existing condition, as least we know (after 2014) we cannot be denied coverage. And oh, how insurance companies love to deny coverage. 

Jun 28, 2012 04:29 PM DucorpsToo wrote:

Jun 28, 2012 04:48 PM DucorpsToo wrote:

So if they can raise rates on the general poplace, just as they're doing currently, then that certainly doesn't ensure that such rates would be affordable to the general population. As we well know, there are plenty of folks out there with no pre-existing condition that cannot afford the rates that these companies are charging. That's why  I think that another major tweak to the ACA should be some sort of regulation to these companies.  I remember a couple of years ago that Anthem Blue Cross (here in California) had hiked up rates as much as 30%! -however they were "called on the carpet" for that move...

Jun 28, 2012 05:08 PM Trisha-Anne wrote:

Hope you ladies don't mind an Aussie chiming in here. 

Our health system is based on tax.  We all pay 1.5% of our income towards Medicare.  That comes out of our paypacket along with our income tax.  This entitles all Australians to go to a hospital and be treated, tested, operated on etc at no personal cost at all.

We can also pay for private health insurance, and if we earn over a certain amount and don't have private health insurance we are taxed at a higher rate because of it.  The Australian Government also pays a subsidy of 30% of the cost of the private health insurance.  The private health insurance means that we can choose our own doctor and go into a private hospital to shorten waiting times in the public system.  I pay private insurance and for a couple it is around $190 per month.  I don't pay for "extras" insurance that covers dentists, glasses or chiropractors etc.  No private insurer can charge you more for insurance with pre-existing conditions - there may be a waiting period of up to a year though (for new joiners) where they aren't covered for a pre-existing condition.  But everyone gets charged the same amount.

I used a private hospital for my mx and my port placement and deporting (lol) and my health insurance paid all the hospital accommodation costs.  Doctor's bills rebates are a bit more difficult to explain, but there was still some out of pocket costs - and it depends on the doctor you choose and how much they charge as to how much out of pocket you are.  But Medicare and the health insurer pay some of their costs.

I use the public system for my oncology visits and scans etc.  They cost me nothing at all - everything is covered by Medicare.  So MUGA scans, mamograms, u/s, brain scans etc are all free for me.

It's a great system - it does have it's flaws, all systems do - but no-one is denied good quality care.  Women who can't afford health insurance (because they don't have a high enough income) can get a mx, and pretty much all the treatment and scans they need without paying a cent.

I hope you ladies benefit from the changes in your health system - it's worked so well for many countries, and cancer patients will be the big winners I hope.

Trish

Jun 28, 2012 07:11 PM, edited Jun 28, 2012 07:11 PM by bevin

Well, all I  know is nothing is free, so all those coverages and payments for them will need to come from somewhere; our government will tax us to pay for it. Well, I geuss they will tax those of us who work. Those who don't work, since they pay no tax, and since the IRS  (as stated above) cant enforce it, those people I assume will get free health care; paid for by the taxes of those who do work.

Ugh, so not on board yet.  I agree the commerce clause was wrong and I'm glad that wasn't allowed to be used as the bases for law.

Jun 28, 2012 11:56 PM kayb wrote:

Bevin - people who don't have insurance now still get health care of some sort through emergency rooms. It's been said many times that each of us who has insurance pays an extra $1000.00 a year to cover their care. The whole point of requiring a mandate is to shift that burden to a larger group - thus LOWERING the costs overall. It's also the mandate that broadens the market so that people with pre-existing conditions can buy insurance at the same price as everyone else. Really - its all good.

Also - insurance companies will have to provide justification for any premium increases over 10%. In the past two years many companies have jacked prices 25% or more each year to beat the deadline for this clause. The great news of the AHA is that these things will be regulated so that insurance companies won't have the freedom to screw us like that in the future. By insuring thatat least 80 cents of every dollar must go for your care, insurance company CEOs (like the guy who ran UHC) won't be able to get 100 million+salaries each year.

Jun 29, 2012 09:59 AM Chickadee wrote:

Perhaps now would be a good time to look closely at Massachusetts (w/o the political spin) and determine what has worked well and what needed attention. I knew one person who lived in Mass. and worked, like me, as a FEMA reservist with no insurance until this came along. She was very glad of it and had no complaints.

I would expect the states to be looking at the structure and determining their setups

I personally feel this a good thing.

Jun 29, 2012 10:45 AM, edited Jun 29, 2012 11:27 AM by riley702

Sorry to jump in late, but I read the most thorough explanation on reddit. It's pretty long, so I'll just put a link, but they include lots of reference links for everything they say. It's also purposely NOT written in confusing terms (I think the asker said "explain it to me like I'm 5.")

www.reddit.com/r/explainlikeim...

•  It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
• It increases the rebates on drugs people get through Medicare (so drugs cost less)
• It makes a "high-risk pool" for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of "pre-existing conditions" altogether (coming in 2014 -riley). For now, people who already have health issues that would be considered "pre-existing conditions" can still get insurance, but at different rates than people without them.
• It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that)
• It says that health insurance companies can no longer tell customers that they won't get any more coverage because they have hit a "lifetime limit". Basically, if someone has paid for health insurance, that company can't tell that person that he's used that insurance too much throughout his life so they won't cover him any more. They can't do this for lifetime spending, and they're limited in how much they can do this for yearly spending.
• No more "pre-existing conditions" for kids under the age of 19.
• Insurers have less ability to change the amount customers have to pay for their plans.
• Insurers can't just drop customers once they get sick.

• Insurers have to tell customers what they're spending money on. (Instead of just "administrative fee", they have to be more specific).

• Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they're turned down.

A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they're not price-gouging customers.

1/1/2013:

If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word "tiny", a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we're talking about people in the top 5% of earners.

1/1/2014:

• No more "pre-existing conditions". At all. People will be charged the same regardless of their medical history.
• If you can afford insurance but do not get it, you will be charged a fee. This is the "mandate" that people are talking about. Basically, it's a trade-off for the "pre-existing conditions" bit, saying that since insurers now have to cover you regardless of what you have, you can't just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you'll have to pay the fee instead...

• Question: What determines whether or not I can afford the mandate? Will I be forced to pay for insurance I can't afford?

  Answer: There are all kinds of checks in place to keep you from getting screwed. Kaiser actually has a webpage with a pretty good rundown on it, if you're worried about it. You can see it here.

  Okay, have we got that settled? Okay, moving on...

• Small businesses get some tax credits for two years.

• Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.

• Insurers now can't do annual spending caps. Their customers can get as much health care in a given year as they need.

• Limits how high of an annual deductible insurers can charge customers.

• Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.

• (my favorite - riley) Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won't be footing their health care bills any more than any other American citizen.

• The amount you can deduct from your taxes for medical expenses increases.

1/1/2015:

Doctors' pay will be determined by the quality of their care, not how many people they treat. (includes a link to a more thorough discussion of this - riley)

1/1/2017:

• If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers).

1/1/2018:

• All health care plans must now cover preventative care (not just the new ones).

• A new tax on "Cadillac" health care plans (more expensive plans for rich people who want fancier coverage).

Not sure why it did the wonky thing with the italics, lines and bullet points not lining up. It's not there when I try to edit. Sorry.

Jun 29, 2012 11:38 AM 1Athena1 wrote:

A great site on the law and how you can find out what is available in your state is:

www.healthcare.gov - it also has a timeline.