Obamacare

[classicman]

Stormie - not sure I get your point. Are you saying that smokers are going to be surcharged under the PPACA?

[Lamplighter]

Originally Posted by classicman

Stormie - not sure I get your point. Are you saying that smokers are going to be surcharged under the PPACA?

A partial answer (here) is, Yes, except it is worded in the opposite direction

The rules also give employers new freedom to reward employees who participate
in workplace wellness programs intended to help them lower blood pressure,
lose weight or reduce cholesterol levels. <snip>

[classicman]

That would be incorrect Mr. Lamp.
The correct answer is NO. No one is penalized at all for anything.
Links here and the summary here are to the complete law and the summary.

[Lamplighter]

Originally Posted by classicman

That would be incorrect Mr. Lamp.
The correct answer is NO. No one is penalized at all for anything.
Links here and the summary here are to the complete law and the summary.

I had a boss years ago that just that same strategy
(but he used the most up to date references available)

[Stormieweather]

No, I'm not saying it's GOING in that direction, I am saying that smokers and obese individuals have paid more in insurance costs, already.

From 2006:
Higher Insurance Rates

If you are/were not a smoker, you may not even have noticed, but all the questionaires you fill out when you purchase insurance ask if you smoke, or have smoked, in X# years. And then, how much you smoke. And drink, and BMI, etc. If you check yes to these, your rates are higher than if you say no. It has been this way for years.

(I get to answer NO to all of them, finally!)

[orthodoc]

It's not more expensive (to you) if your copay is $3 and you refuse to pay it, and your premiums don't go up no matter how much you use the ER, and there's no limit on the number of ER visits you can make. You still have to be seen. But you're right, people with private insurance and hefty ER co-pays already get penalized for frivolous ER use.

[Happy Monkey]

Part of Obamacare is to get more people on private insurance.

If you don't have insurance, and you don't have money, your options may be a $1200 ER visit you can't afford, or a $300 doctor visit you can't afford. You can't afford either, so you might as well go to the one that is set up to accept walk-ins.

If you have insurance, a new option is added - a doctor visit with a $20 copay.

Not everyone will take advantage of it. The people you'd rather not get into, perhaps. But many will. Once the hurdle (sometimes mental as much as financial) of getting enrolled is overcome, it's much easier to do it.

[orthodoc]

Originally Posted by Happy Monkey

Part of Obamacare is to get more people on private insurance.

Not everyone will take advantage of it. The people you'd rather not get into, perhaps. But many will. Once the hurdle (sometimes mental as much as financial) of getting enrolled is overcome, it's much easier to do it.

Yes, many will (hopefully) take advantage of the chance to get private insurance and will behave as you expect. The mental hurdle you mention, though, is significant. The healthy 20-somethings who choose not to have insurance now, because they feel the odds of needing it are low, will resent paying premiums and copays. They aren't likely to take on that expense unless forced to, when they've been getting along without. (There are quite a few young adults in smalltown who work full-time, decline to enroll in the health insurance their employer offers because it would cost them $20/month although they choose to spend funds on smoking 2 ppd, and still expect to be seen in less than an hour at the local ER while fully intending never to pay for that service. This is very common in the smalltown area.)

Another part of Obamacare is expanding eligibility for MA. This sounds like a good thing on the surface; however, it will be a serious problem for hospitals. At the moment they can write off non-payment from self-pay patients. If the percent of MA patients they see goes up substantially they will get the MA rates (which are less than overhead for both private practices and hospitals), no copays even at $3, no writeoffs, and they'll go bankrupt. Especially when there are no limits to the number of ER visits on MA - there are individuals, and not just a few, who have 200 ER visits/year in smalltown.

Please understand, this isn't a rant at self-pay or MA patients. One of my sons is on MA and I see the system from his perspective as well as from that of a provider. But people don't always behave as you'd expect, and there are always unexpected results from programs that seem beneficial at first glance.

[glatt]

Originally Posted by orthodoc

The healthy 20-somethings who choose not to have insurance now

They are part of the problem.

This group will have no choice but to get health insurance once obamacare is completely implemented. And that's good for the system as a whole.

At first, if they don't get health care, they will look at the penalties and do the math and see that the penalty is the better deal, but the penalties get more and more severe as obamacare is phased in. And when it is fully implemented in 2018, the healthy 20 somethings will have to decide whether they want to pay an arm and a leg for nothing or an arm and a leg for healthcare.

And the policies offered at the exchanges will be subsidized based on need.

[Lamplighter]

It always devilishly amusing to read David Brooks in the NY Times.
He wants so badly to be a leader, a guru, or at least be on the winning team.
He's just not sure which team will win.
Today, he joined the Limbaugh team...

It's going to fail HOORAY ! YEA! YEA! ... I told you so


NY Times
DAVID BROOKS
April 25, 2013
Health Chaos Ahead

It was always going to be difficult to implement Obamacare,
but even fervent supporters of the law admit that things are going worse than expected.
<snip>
I’ve been talking with a bipartisan bunch of health care experts,
trying to get a sense of exactly how bad things are.
In my conversations with this extremely well-informed group
of providers, academics and former government officials, I’d say
there is a minority, including some supporters of the law,
who think the whole situation is a complete disaster. They predict
Obamacare will collapse and do serious damage to the underlying health system.

But wait a minute, David.
After showing us your width of knowledge... yada, yada, yada
You go on to say:

But the clear majority, including some of the law’s opponents,
believe that we’re probably in for a few years of shambolic messiness,
during which time everybody will scramble and adjust,
and eventually we will settle down to a new normal.
<snip>
Over all, it seems likely that in some form or another Obamacare is here to stay.
But the turmoil around it could dominate politics for another election cycle, and the changes after that
— to finally control costs, to fix the mind-boggling complexities and the unintended consequences
— will never end.

Regulatory regimes can be simple and dumb or complex and sprawling.
When you build complex, it takes a while to work through the consequences.

So which is it, David ... CHAOS ... or just take a while ?

Next month David will be telling us of all the benefits and success
that he predicted for Obamacare.

.

[richlevy]

We will all know when Obamacare has succeeded when the first Republicans go back to calling it it The Affordable Care Act. This of course will not work well, since they have spent years attaching Obama's name to it.

You know it's too late when wiki puts in a redirect ....

http://en.wikipedia.org/wiki/Obamacare

If they had tried this bullshit decades ago, Social Security would be called Roosevelt Security.

BTW, Brooks is right about one thing. Obamacare is a sea change. It is not a band-aid. For good or ill is an at least partial overhaul of an entire system. There will be adjustments. We will see the real result in 5-10 years. There will always be detractors, even if there is a consensus that it turns out to be an improvement. But then again, some of the people who disagree with Obamacare still think the Earth is only 10,000 years old.

[classicman]

I am saying that smokers and obese individuals have paid more in insurance costs, already.

OH, gotcha. Yep, I know all about that. I had poison ivy last spring, lost my job and had to buy individual insurance in the fall. I was rated because I had a "skin condition."

If you have insurance, a new option is added - a doctor visit with a $20 copay.

OR ... Dr. visit with a $20 co-pay vs ER with a $20 copay. If the copays are the same, the behavior will likely not change. However if the Dr. visit has a $20 copay and the hospital has a $100 copay, the behavior may change.
Same goes with meds. generic vs name brand where available.

Total aside, I did read an article about some doctors group advocating that birth control should be available over the counter. THAT makes a lot of sense & removes the whole religious "whatever" from that situation. Seems like a win-win idea to me.

[Ibby]

Originally Posted by classicman

Total aside, I did read an article about some doctors group advocating that birth control should be available over the counter. THAT makes a lot of sense & removes the whole religious "whatever" from that situation. Seems like a win-win idea to me.

The only issue is, I'm not okay with that if it means that low-income/impoverished people do not have access to birth control without paying out-of-pocket. That and the potential for accidental or uninformed misuse, without a doctor making sure the treatment is taken correctly. Birth control - like ALL medical care - should have little or no out-of-pocket cost. the only things that should cost anything at ALL, and even then maybe less than what it costs now, are things to treat mild mild mild ailments not worth seeing a doctor, like a cold or a headache or gas or indigestion.

[Happy Monkey]

ER copay is usually more, and on top of the actual ER cost, instead of in lieu of it.

[classicman]

I'm aware of that HM. With a son like mine the ER staff are not strangers, not by a long shot. Did you get the point I was making though?