Supreme Court upholds health care reform

[D H]

When we set a price, it's usually a multiplier (~2.5 in most places I've worked) of the Medicare fixed price. Medicare payment rates are pretty minimal for many procedures and some of the things we have to do are not paid at all.

This is one of the things that both bugs and scares me most. We who do have medical insurance are subsidizing Medicare and it's intentionally lowball prices. What happens when those rates are mandated for everyone? I can't see any outcome other than the health care industry stopping to use what they know are the best practices.

Yes, there are a lot of paperwork issues in hospital billing, but there is almost always a reason. <Lots of reasons elided>

This paperwork mess and tangled bureaucracy is where our system is an unmitigated disaster. And it's no one thing's fault. Disinterested and slow governments can't explain this mess. Capitalistic greed can't explain this mess. Profits certainly can't; streamlining operations is one thing that capitalism is very good at in general. Our health care system is neither capitalist nor socialist. It's a Rube Goldberg nightmare.

Equipment price are not all up. In many cases they are comparable or down.

I said that we pay more than anywhere else, not anywhen else. I'll try to dig up the articles I read later this evening.

IMO, there really are no simple answers. As Americans, I think we have become use to having the best and being able to demand it, and have it conveniently located.

That last one is apparently not one of the factors. Once again, I'll try to dig up the articles I read. I did try to read several and did try to look for biases.

I agree that there are no simple answers. But everyone, politicians most of all, want the simple answer. It doesn't matter if it is the wrong answer.

 

[ThinkToday]

This is one of the things that both bugs and scares me most. We who do have medical insurance are subsidizing Medicare and it's intentionally lowball prices. What happens when those rates are mandated for everyone? I can't see any outcome other than the health care industry stopping to use what they know are the best practices.

I see that now in the for-profit sector. The margins aren’t enough to do free work. My cancer center was run out of business when a for-profit company bought up the referral physician practices, and offered a “deal” to get the hospital equipment, since they weren’t going to be sending us any paying patients in the future. Up until that point, they took their paying patients to their center and sent the low/no pay patients to us. Additionally, for example, if insurance companies would pay for IMRT for a base of tongue tumor we did IMRT, otherwise, conventional shrinking field would be used. Not as good, more complications, etc. It’s not malpractice, since it is still within the “standard of care”… it’s just not the best available care, and the fact the choice is based on if the procedure would get paid is very troubling. To be clear. This isn’t a greed issue as much as simple economics. Everyone knows up-coding (charging for a service above that provided) is illegal, but so is down-coding (charging for a service below that provided). I can’t legally do IMRT and charge for a conventional shrinking field technique.

This paperwork mess and tangled bureaucracy is where our system is an unmitigated disaster. And it's no one thing's fault. Disinterested and slow governments can't explain this mess. Capitalistic greed can't explain this mess. Profits certainly can't; streamlining operations is one thing that capitalism is very good at in general. Our health care system is neither capitalist nor socialist. It's a Rube Goldberg nightmare.

Absolutely. But, I would add we (Americans) don’t seem to be wise consumers anymore. The new ACA doesn’t seem to incentivize wise choices in life style or acquiring health care services. I suspect at some point we’ll see the adoption of Appropriateness Criteria for health care such as: http://www.acr.org/Quality-Safety/Appropriateness-Criteria . The American College of Radiology (ACR) formulated these years ago to help a doctor determine when a test was justified. As best I can remember, it was a response to increased patient radiation exposures from more and more tests, as well as “cover” for when more expensive tests were being asked for authorization from an insurance payor.

I suspect we will ultimately see some access issues. I was fortunate enough to spend 10 days golfing in beautiful Alberta and British Columba several years ago with a doctor friend (BTW. I highly recommend Alberta and BC for golfing ). In my little town of 100k in TX we had more MRI than all of BC and we had more CT scanners than all of BC. Access was an issue for them, but not for us. Same day exams weren't generally a big deal.

I said that we pay more than anywhere else, not anywhen else. I'll try to dig up the articles I read later this evening.

My misread

 

[nitsuj]

Regarding the MRI, it's the same in Ontario.

My jaw dropped when I read that an MRI could be done for a mere $50.00. I doubt that would include any analysis, but still 50 bucks seems like a steal given what they do.

I understand them to be great tools for "early intervention" of some tumors.

 

[NeoDevin]

My jaw dropped when I read that an MRI could be done for a mere $50.00. I doubt that would include any analysis, but still 50 bucks seems like a steal given what they do.

I'm a little skeptical of that number. That doesn't even seem enough to pay the nurses and technicians, never mind the cost of purchasing and maintaining the machine, the cost of the facility it's in, cost of insurance, etc.

Edit: It occurs to me that $50 may refer to the incremental cost, after fixed costs like purchasing/maintenance/facilities/insurance are taken out. If that's the case, then it's a little more believable, but a less relevant number.

 

[mheslep]

...
When i went on medicare i saw ... my doctors paid qiuckly, but only about a third what my private insurance used to pay them
...

i'm tired of being gouged by insurance industry.

How much do you suppose you have paid in FICA taxes over a lifetime by comparison?

 

[jim hardy]

How much do you suppose you have paid in FICA taxes over a lifetime by comparison?

hmm as best i remember when health insurance reached $400 a month, SS/FICA was around $320 (260 + 60)


At that time i had so many old folks in my family receiving SS that i decided it was okay and i honestly didn't resent it . Sorta like a tithe , helps out your own .

Medicare operates with 3% overhead, non-profit insurance 16% overhead, and private (for-profit) insurance 26% overhead. Source: Journal of American Medicine 2007

http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

what i said above about symbiotic bureaucracies - it's Parkinson's Law.
http://masscare.org/health-care-costs/overhead-costs-of-health-care/

http://www.masscare.org/wp-content/uploads/2007/04/HospitalBilling&AdminUSvsCanada.jpg

The only way to stop a bureaucracy is to cut off its money. Instead we gave 'em taxing authority. Thank goodness Roberts clarified that.

Jim, I must be misunderstanding the limits that have been put on the insurance premiums.

nitsuj - could you point me to something on those limits? Might calm me down a bit.

old jim

 

[edward]

Pharmaceutical companies are out of control

$3 Billion fine
http://www.nytimes.com/2012/07/03/b...llion-in-fraud-settlement.html?pagewanted=all

2.5 billion dollar fine
http://www.awareandprepare.com/pfizer-to-pay-a-record-2-5-billion-fine/

another 1.5 Billion
http://www.medicaldaily.com/news/20120413/9521/johnson--johnson-penalty-risperdal-arkansas.htm

And the three above all happened after "Big pharma Pays $8 Billion"
http://abcnews.go.com/Politics/drugmakers-paid-billion-fraud-fines/story?id=15853102

Who really ends up paying for the criminal activity of big Pharma.? We know don't we.

 

[mheslep]

...
At that time i had so many old folks in my family receiving SS that i decided it was okay and i honestly didn't resent it . Sorta like a tithe , helps out your own .

At its creation SS payments were supposed to be for *your* retirement, not another's. Most still consider SS to be a pension system in that form. What you describe is more like a ponzi scheme, given SS now takes in less than it pays out.

http://www.healthpaconline.net/health-care-statistics-in-the-united-states.htm

You take those overhead figures as accurate, as in they are comparing like to like? Why?
http://www.forbes.com/sites/aroy/2011/06/30/the-myth-of-medicares-low-administrative-costs/

our aim is to ... advocate universal health care for all Americans.

http://www.masscare.org/wp-content/uploads/2007/04/HospitalBilling&AdminUSvsCanada.jpg

Mass-Care’s mission is to establish a Single Payer Health Care System...

 

[Evo]

At its creation SS payments were supposed to be for *your* retirement, not another's. Most still consider SS to be a pension system in that form. What you describe is more like a ponzi scheme, given SS now takes in less than it pays out.

You do realize that SS pays survivor benefits. If a person dies, as long as they have had a job that paid SS, their spouse and children get a large monthly payment. Even if they have paid virtually nothing into SS. I disagree with this part.

http://www.ssa.gov/survivorplan/index.htm

Also, SS pays people that are disabled. This I can understand, although fraud is rampant.

SS is not just retirement.

 

[ThinkToday]

I'm a little skeptical of that number. That doesn't even seem enough to pay the nurses and technicians, never mind the cost of purchasing and maintaining the machine, the cost of the facility it's in, cost of insurance, etc.

Edit: It occurs to me that $50 may refer to the incremental cost, after fixed costs like purchasing/maintenance/facilities/insurance are taken out. If that's the case, then it's a little more believable, but a less relevant number.

In our case, the $50 is the co-pay, and yes, it only applies to the technical component of the bill. The professional component is a different bill, unless it's a global bill. If the interpreting physician is a hospitalist employed by the hospital, the exam is billed as a global charge (bundles the technical and professional charges). Specialists have a higher co-pay than a GP. I think the GP co-pay was something like $10, the specialist co-pay was $50. Hospitals with HMOs, PPOs, etc. get the balance from the insurance. So, the exam isn't just $50; rather, that's all it costs us.

The hospital I'm in now has no co-pay for some things, as long as we use their clinic.

 

[mheslep]

You do realize that SS pays survivor benefits. ...

Yes, and disability. I have a family member on SS disability.

 

[nitsuj]

nitsuj - could you point me to something on those limits? Might calm me down a bit.

old jim

I heard it in the Obama address after the ruling. It was the video in the link provided in the OP.

 

[jim hardy]

What you describe is more like a ponzi scheme, given SS now takes in less than it pays out.

Presidents are required by law to review SS and report to congress how things are going. Recall when Bush did that and suggested something needed to be done he was excoriated by the left.
If you go back and read the late 1930's federal register entries , there are two interesting things that show up:
1. Original intent was to invest in interest bearing securities. It took congress less than a year to recognize the bonanza they'd created and change it to "pay as you go" spending the copious leftovers. You won't find that on SS's website in fact they deny it.
2. The administrators figured out by 1940 (dont ask me how) that around 2020 SS would cease to be a profit maker.

So SS is and has been a ponzi scheme for seventy plus years and TPTB cannot say "We never saw it coming".. This lays right at congress' doorstep.

...

You take those overhead figures as accurate, as in they are comparing like to like? Why?
http://www.forbes.com/sites/aroy/201...trative-costs/

Indeed i do.
Look at the last chart in the Forbes article.
It shows that Medicare delivered $8500 of treatment for $509, 5.8%,(2005)
while private delivered perhaps $3500 for $ 453, 13.2%.

It is somewhere between bad arithmetic and sophistry to claim 13% is more efficient than 6%.
By Mr Roy's logic, one should ship by trailer truck instead of rail because the fuel cost is spread out over many trucks instead of one locomotive.
Further Mr Roy's article in Forbes is a near bolt-for-bolt copy of this Hertiage Foundation article two years earlier, whose author Roy mentioned (Robert Book)
http://www.heritage.org/research/re...e-higher-not-lower-than-for-private-insurance
observe the chart is identical and content is on same compass heading.

Note i did take your remark to heart and looked into it a little.
When i saw Heritage Foundation my eyebrows raised, they have been dunning me to join ever since i wrote my senator blasting her for supporting Obamacare as written(namely by the insurance lobby, Cigna to be specific, see PBS Frontline episode "Obama's Deal".)
From Heritage Foundation's homepage:

Our mission is to formulate and promote conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.

I believe Heritage Foundation is probably as unbiased and unlikely to spin facts as Sean Hannity or Thom Hartmann.

But, Heritage's Mr Book in turn used this 2007 article for a reference:

http://www.manhattan-institute.org/html/mpr_05.htm

and among its conclusions:

For the private market, non-benefit costs are about 11-14 percent of total premiums, while the direct administrative costs reported for Medicare are about 3 percent of Medicare outlays. A reasonable allocation of a share of outlays for general government functions and for the administration of justice increase direct and indirect administrative—that is, non-benefit—outlays as reported in the federal budget to about 6 percent of Medicare outlays.

Interestingly that author

Benjamin Zycher
Senior Fellow, Manhattan Institute for Policy Research

estimates Medicare admin at 5-6% as do both subsequent authors.
He suggests that deregulation would be the way to go.

To me, deregulation means un-entwining the industry from government.
And that's the drum i am pounding.


old jim

 

[mheslep]

...but to have 23% of healthcare cost going to paperwork is insanity .

You take those overhead figures as accurate, as in they are comparing like to like? Why?
http://www.forbes.com/sites/aroy/201...trative-costs/

Indeed i do.
Look at the last chart in the Forbes article.
It shows that Medicare delivered $8500 of treatment for $509, 5.8%,(2005)
while private delivered perhaps $3500 for $ 453, 13.2%.
It is somewhere between bad arithmetic and sophistry to claim 13% is more efficient than 6%

First: Do you concede the 23% figure you referenced earlier for private insurance is way high, or not? That the 3% you referenced for Medicare is way low, or not?

Second:

.

By Mr Roy's logic, one should ship by trailer truck instead of rail because the fuel cost is spread out over many trucks instead of one locomotive.

I do not think such is the logic proposed by Roy or his sources. That aside, I note there are different different figures of merit for overhead costs. One method I grant is overhead per treatment dollars spent. Another is overhead dollars spent per patient, in this case $509/patient for Medicare and $453/patient for private insurance according to the article. Are you dismissing the latter as irrelevant? While I don't know for a fact that the latter per patient figure is the most important, I surely do not dismiss it.

Forbes-Roy/Book make the case (with sources) that Medicare spends more treatment dollars per patient because it attends to the elderly who have higher medical costs:

...because Medicare patients are older, they are substantially sicker than the average insured patient — driving up the denominator of such calculations significantly.

I don't know how all the admin costs are spent with either system, though I have some insights. But consider the naive case that most all the costs are up front in the initial admission of the patient to the system, e.g. say for computer system costs that are all per patient, with a negligible difference in computer system cost between patients that are in/out in one day and another with three years of cancer treatment. IF such an assumption was valid, then the financial consequences of moving the entire US health system to 100% Medicare (single payer) would mean an *increase* in overhead costs, not a decrease.

Further Mr Roy's article in Forbes is a near bolt-for-bolt copy of this Hertiage Foundation article two years earlier, whose author Roy mentioned (Robert Book)
http://www.heritage.org/research/re...e-higher-not-lower-than-for-private-insurance
observe the chart is identical and content is on same compass heading.

Note i did take your remark to heart and looked into it a little.
When i saw Heritage Foundation my eyebrows raised, they have been dunning me to join ever since i wrote my senator blasting her for supporting Obamacare as written(namely by the insurance lobby, Cigna to be specific, see PBS Frontline episode "Obama's Deal".)
From Heritage Foundation's homepage:

I believe Heritage Foundation is probably as unbiased and unlikely to spin facts as Sean Hannity or Thom Hartmann.

Heritage is a think tank, they like anyone can be wrong, and they have a politically conservative view point. They also have a large staff of experts that publish frequently and testify in Congressional hearings, like a Brookings, like a Cato. You think that's the same as a TV talking head? That said, we're not asked to trust simply reputation as references are provided. Some of the key figures are taken directly from CMS accessible references [7] and [8].

...
[6]Benjamin Zycher, "Comparing Public and Private Health Insurance: Would a Single-Payer System Save Enough to Cover the Uninsured?" Manhattan Institute for Policy Research, October 2007, at http://www
.manhattan-institute.org/html/mpr_05.htm (June 25, 2009); Mark E. Litow, "Medicare Versus Private Health Insurance: The Cost of Administration," Milliman, Inc., January 6, 2006; at http://www.cahi.org/cahi_contents/
resources/pdf/CAHIMedicareTechnicalPaper.pdf (June 25, 2009).
[7]Centers for Medicare and Medicaid Service, "National Health Expenditure Accounts," Table 12, at http://www.cms.hhs.gov/NationalHealthExpendData/
downloads/tables.pdf (June 25, 2009).
[8]Centers for Medicare and Medicaid Services, "Justification of Estimates for Appropriations> Committees, Fiscal Year 2009," February 2008, p. 27, at /static/reportimages/542AA7F3C79882DB4513785E91472515.pdf (June 25, 2009)...

One other point: I don't see the issue of fraud mentioned in either article, but I expect it figures heavily off the books. According to the current US Attorney General, Medicare fraud is in the tens of billions of dollars per year. If Medicare is doing less than due diligence with respect to fraud, that fact might explain why some report Medicare billing practices to be easier than those of private insurers. Regardless of the reason, I suggest fraud dollars should be counted towards Medicare admin costs.

 

[ThinkToday]

First: Do you concede the 23% figure you referenced earlier for private insurance is way high, or not? That the 3% you referenced for Medicare is way low, or not?

http://www.factcheck.org/kerry_paperwork_ad_accurate.html The range of the paperwork cost in the NE Journal of Medicine study are 7.6%-31%. However, as noted in the article, it's unlikely a reliable estimate is achievable. For example, paperwork includes admission papers, pre-authorization, examination paperwork (dictations, etc.) required for the doctor to get paid, paperwork to get lab work down, paperwork to get x-rays done, insurance billing paperwork, appeals (seems like something is always getting rejected or questioned), resubmissions, etc. We have some serious documentation requirements that must be met to get paid.

It's kind of funny. I remember when I was very young going to the doctor. My "file" was a small stack of 4x6 index cards with a date, what I had (cold, flu, broken finger), what was done/given, and a notation of the charge (usually $5). Each time I saw the doctor, it added 1 or 2 lines to my "medical record", when one side of the card was full, he wrote on the other side, when the card was full on both sides, I got another 4x6 card added to the pack. Over the past 5 decades, I see little improvement in basic care, yet cost and paperwork are through the roof. As a parent that has taken my children to the doctor many times, the reasons I go are largely the same as they were 5 decades ago, it just costs more, takes longer, more paperwork, etc., and doctors still treat the same things the same old ways. Not much is any more high tech than it was back then for most things I needed them for.

 

[jim hardy]

First: Do you concede the 23% figure you referenced earlier for private insurance is way high, or not? That the 3% you referenced for Medicare is way low, or not?

no, not at all to both.
Figures are adjusted by individual authors to suit their hypoththeses.
But i'll allow that they could represent upper and lower bounds of reasonable estimates.

I do not think such is the logic proposed by Roy or his sources. That aside, I note there are different different figures of merit for overhead costs. One method I grant is overhead per treatment dollars spent. Another is overhead dollars spent per patient, in this case $509/patient for Medicare and $453/patient for private insurance according to the article. Are you dismissing the latter as irrelevant?

irrelevant to discussion of efficiency, yes. It's an interesting statistic though.
IIRC the $509 includes an apportioned part of gov't's cost to collect taxes which, i believe is not correct. IRS is incredibly efficient and would exist irrespective of Medicare. So if Medicare does drive up cost of tax collection it's not significant and probably immeasurable.

Heritage is a think tank, they like anyone can be wrong, and they have a politically conservative view point. They also have a large staff of experts that publish frequently and testify in Congressional hearings, like a Brookings, like a Cato. You think that's the same as a TV talking head?

Ahh exaggeration is sometimes a useful tool of communication. And i didn't mean to disrespect the highbrow world of think tanks.

But it is their mission to influence public thought and government policy.
To a considerable extent they propagandize
and the talking heads are by and large their useful idiots.

Reading Eric Hoffer's "True Believer" changed how i look at mass media. That book is a study of mass psychology and how one can manipulate it, and how it was done in 1930's Europe. When you go to those thinktank websites and look at who's their directors it becomes apparent they all have a mission. Well the ones i have checked into, anyhow. I don't remember looking into that Manhattan Institute.

So i try to take in a variety of news sources and take just their observations, make my own conclusions.
Had you told me when i was a kid i'd be watching Russia Today's newscasts (280 on Dish) and finding their coverage superior , i'd have beaned you.
But their proselytizing is as flagrant as FoxNews.

old jim

 

[BobG]

I do think putting some limits on the Commerce Clause is a good idea.

Inherently, an individual mandate forcing people to buy insurance should be unconstitutional. Historically, cases such as Gonzalez vs Raich and Wickard vs Filburn seemed to make it unlikely the court would strike down the individual mandate. Historically, Congress has been able to use the Commerce Clause to do whatever it darn well pleases.

If the Commerce Clause allows the federal government to overrule state laws on medical marijuana for private consumption and allows the federal government to outlaw growing wheat for private consumption (by the growers' chickens), then it seems like the Commerce Clause can pretty much control anything.

I think an individual mandate is unconstitutional, but I'm still surprised the court said it was unconstitutional.

Or, in a more cynical vein, does this precendent only apply when an alternative justification for action is available, such as calling it a tax - an option that would have been impossible in the medical marijuana and the wheat for chickens cases?

A lot of times, it seems like justices decide on a decision and then search for legal justification rather than start with a set of legal principles that apply to a case no matter where that leads (both Kennedy and Scalia switched from the pro-Commerce Clause position they held in Gonzalez vs Raich to an anti-Commerce Clause postion).

I'm less convinced with their argument on Medicare, even though I think limiting Congress's use of federal funds to force states to adopt federal 'suggestions' is also a good idea. The proper solution for the problem is to reduce federal taxes, increase state taxes, and let states handle more issues on their own; not declare the practice unconstitutional (which I don't think it is). And in this case, Medicare is a federal program (rightly or wrongly) and I would think the federal government is perfectly within its right to set the rules.

I'm really surprised that went down 7-2.

 

[Windowmaker]

What happens if the family of four makes like 40,000 a year and don't have insurance? Do they get subsidized insurance premiums or tax credits?

http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/General%20DHS/FPL.pdf

This means at 130 percent above the poverty line a family of 4 is just below 30,000. So at 133 percent would mean almost at 30k a year. What if a family of four makes 32000 a year? If both parents are working, they are each earning 16000 a year. That's about 8.33 an hour, doubt they have benefits or work at a large company.

Sounds like a tax increase to me.

 

[Evo]

What happens if the family of four makes like 40,000 a year and don't have insurance? Do they get subsidized insurance premiums or tax credits?

http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/General%20DHS/FPL.pdf

This means at 130 percent above the poverty line a family of 4 is just below 30,000. So at 133 percent would mean almost at 30k a year. What if a family of four makes 32000 a year? If both parents are working, they are each earning 16000 a year. That's about 8.33 an hour, doubt they have benefits or work at a large company.

Sounds like a tax increase to me.

Here you go, the information on the act. Instead of guessing you can actually read it.

http://www.healthcare.gov/law/full/index.html

You do know that what you are referring to is "medicaid" which is handled differently by each state. Under the ACA, many more people will be eligible for medicaid than before. And yes, if they work, but can't afford premiums, they will get subsidies.

Consumers

Although "nothing will change tomorrow," some consumers will see big changes by Jan. 1, 2014, when more aspects of the law take effect, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation. Those changes include:

•Insurers will no longer be allowed to turn anyone down because of a pre-existing medical condition, such as cancer, Pollitz says.

•More patients will be eligible for Medicaid, a federal insurance program administered by the states that serves the poor and disabled. Today, people can qualify for Medicaid only if they are poor, pregnant , disabled or a child. Each state sets different financial standards to qualify for Medicaid, and some states have required that people be not just poor but "subpoor," with incomes substantially below the federal poverty level.

By 2014, however, people will become eligible for Medicaid based only on their incomes, Pollitz says, meaning single adult men with incomes up to 130% of the federal poverty level will also qualify.

•Also by 2014, the "working poor" — many of whom are eligible for employer-sponsored health care but can't afford the monthly premiums — will be eligible for subsidies to help them pay for their health insurance, said Mary Grealy, president of the Healthcare Leadership Council.

•Federal standards for health insurance plans will eliminate "junk" plans with huge deductibles that provide little to no real benefits for consumers, Pollitz says. That means consumers will have more confidence that any plan they buy on the private market will provide at least a minimum standard of quality that includes drug coverage, hospital care, maternity care and other essentials.

http://www.usatoday.com/money/indus...6-28/health-care-ruling-whats-next/55900370/1

 

[Alfi]

What happens if the family of four makes like 40,000 a year and don't have insurance? Do they get subsidized insurance premiums or tax credits?

http://www.dhs.ri.gov/Portals/0/Uploads/Documents/Public/General%20DHS/FPL.pdf

This means at 130 percent above the poverty line a family of 4 is just below 30,000. So at 133 percent would mean almost at 30k a year. What if a family of four makes 32000 a year? If both parents are working, they are each earning 16000 a year. That's about 8.33 an hour, doubt they have benefits or work at a large company.

Sounds like a tax increase to me.

That's about 8.33 an hour, doubt they have benefits or work at a large company.

back this up ... please ... it would be a good point.

 

[chemisttree]

You do know that what you are referring to is "medicaid" which is handled differently by each state. Under the ACA, many more people will be eligible for medicaid than before. And yes, if they work, but can't afford premiums, they will get subsidies.

That's not quite true. The bolded items you quoted...

•Also by 2014, the "working poor" — many of whom are eligible for employer-sponsored health care but can't afford the monthly premiums — will be eligible for subsidies to help them pay for their health insurance, said Mary Grealy, president of the Healthcare Leadership Council.

refers to the "Working Poor". The "Working Poor" is defined as someone who works at least 27 weeks per year and who's income falls below the official poverty level (US Department of Labor). If they earn greater than 133 percent of poverty level, they are not the "working poor" and are not eligible for the "subsidies" mentioned by Mary Grealy. They certainly aren't eligible for the subsidies if their state opts out of the program as Texas has indicated it will.

Could you please find where in the ACA someone earning a dollar more than 133 percent of poverty level wages is elegible for these "subsidies"?

It IS a tax increase for those folks that Windowmaker referred to.

 

[chemisttree]

back this up ... please ... it would be a good point.

Here you go...

It is not surprising that affordability is the most significant of the various barriers to having health coverage. A recent analysis commissioned by HLC shows that 16 percent of those in families with incomes under the federal poverty level with an offer of insurance are uninsured, compared to six percent of those in families with incomes over three times the poverty level.

Cost is a barrier to insurance enrollment for low-income workers and their dependents, in part because their share of premiums consumes a higher percentage of their income than is the case for workers with higher incomes. Also, workers in middle and upper-income brackets tend to work for employers who subsidize a larger portion of their health insurance premiums, whereas low-wage firms offer a smaller subsidy to their employees.

from testimony given by Mary Grealy to the Subcomittee on Health, Feb. 2002.

and

Large firms pay higher wages than small firms. In 2005, the average
hourly wage in establishments with less than 100 workers was $15.69
and increased consistently with establishment size. Wages increased to
$27.05 (a 72 percent premium) for establishments with 2,500 or more
workers (Chart 2). Smaller businesses are also much more likely to
employ low-wage workers. In 2004, establishments with less than 100
workers paid nearly a fourth of their workers less than $8 per hour.
Establishments with 2,500 or more workers paid only 3 percent of their
workers less than $8 per hour (Bureau of Labor Statistics 2004). Again,
the percentage of workers earning low wages declines consistently as
establishment size increases. The gap does not appear to be narrowing,
as research finds wage growth at large firms equals or exceeds that at
small firms (Hu).⁷

7. The firm size-wage effect persists across other countries as well. Similar
results have been found, for example, in Canada (Morisette), Germany (Schmidt
and Zimmermann), Austria (Winter-Ember), the United Kingdom (Belfield and
Wei), and Switzerland (Winter-Ember and Zweimüller), among others.

Hu, L. 2003. “The Hiring Decisions and Compensation Structures of Large
Firms,” Industrial and Labor Relations Review, vol. 56, no. 4, pp. 663-81.

from http://www.kc.frb.org/publicat/econrev/PDF/2q07edmi.pdf

 

[rolerbe]

I'll step in for Russ. This is wrong on two points. First, the federal govt does not require insurance for vehicle drivers, only states do. Second, the states do not require you to own a vehicle and hence, they do not require you to have insurance.

and you can self-insure, which is not a provision in the health-care law.

 

[mheslep]

and you can self-insure, which is not a provision in the health-care law.

Eh no, one can choose to self insure for collision, i.e. damage to your own vehicle and/or health, and many do, but some minimum liability insurance is a requirement in all fifty. Note the minimum varies substantially from state to state (wisely IMO).

http://personalinsure.about.com/cs/vehicleratings/a/blautominimum.htm

 

[Zefram]

Could you please find where in the ACA someone earning a dollar more than 133 percent of poverty level wages is elegible for these "subsidies"?

You've got it a bit backwards. The private insurance subsidies are primarily for folks over 133% of the poverty line (and below 400% of it) who don't have an offer of employer-sponsored coverage, or who do have an offer that's unaffordable for them. That's Section 1401 of the ACA, or if you prefer to cut the chase and go right to the page of the U.S. Code that's available here.

If their state takes up the option, folks below 133% become eligible for Medicaid (though technically those between 100% and 133% of the poverty line can get access to the private insurance subsidies--that will become important in states that don't immediately decide to proceed with the Medicaid expansion).

 

[ThinkToday]

Under the ACA, many more people will be eligible for medicaid than before.

I'm not so sure that's still accurate. Medicaid is a State program, and several states have already said they weren't going to go along with the expansion, since the SCOTUS said Congress can't force them to. So, will that still be the case?

 

[Evo]

I'm not so sure that's still accurate. Medicaid is a State program, and several states have already said they weren't going to go along with the expansion, since the SCOTUS said Congress can't force them to. So, will that still be the case?

In participating states, Medicaid eligibility is expanded; all individuals with income up to 133% of the poverty line qualify for coverage, including adults without dependent children.[19][81] As written, the PPACA withheld all Medicaid funding from states declining to participate in the expansion. However, the Supreme Court ruled, in National Federation of Independent Business v. Sebelius, that this withdrawal of funding was unconstitutionally coercive, and that individual states had the right to opt out of the Medicaid expansion without losing pre-existing Medicaid funding from the federal government. As of July 10, 2012, the governors of five states: Texas, Florida, Mississippi, Louisiana, and South Carolina, had announced that they would decline to participate in the Medicaid expansion.

http://en.wikipedia.org/wiki/Patien...dable_Care_Act#Effective_by_January_1.2C_2014

So, the vast majority of states are opting in.

 

[chemisttree]

You've got it a bit backwards. The private insurance subsidies are primarily for folks over 133% of the poverty line (and below 400% of it) who don't have an offer of employer-sponsored coverage, or who do have an offer that's unaffordable for them. That's Section 1401 of the ACA, or if you prefer to cut the chase and go right to the page of the U.S. Code that's available here.

If their state takes up the option, folks below 133% become eligible for Medicaid (though technically those between 100% and 133% of the poverty line can get access to the private insurance subsidies--that will become important in states that don't immediately decide to proceed with the Medicaid expansion).

No, I didn't have it backwards... I didn't have it at all. So, if I read the section correctly, a family of 4 with income just over 133% of poverty will receive a subsidy equal to the lesser of the full price of the monthly premium of a 'silver' program (only if they are enrolled in a 'silver' program) or the excess cost above around 2% of their annual income/12. That limits that family's cost to about $55 per month for health coverage if they choose a 'silver' plan.

Evo is right again.

 

[Evo]

Evo is right again.

What?? What??

Occasionally something I google is correct, shear luck. :tongue:

*sticks GOOBF cards into chem's computer*

 

[chemisttree]

Please don't crash my computer with some GOOBF virus! It's getting harder and harder to keep this Windows 3.0 system working.

 

[Evo]

Please don't crash my computer with some GOOBF virus! It's getting harder and harder to keep this Windows 3.0 system working.

:rofl:

 

[jim hardy]

Eh no, one can choose to self insure for collision, i.e. damage to your own vehicle and/or health, and many do, but some minimum liability insurance is a requirement in all fifty. Note the minimum varies substantially from state to state (wisely IMO).

http://personalinsure.about.com/cs/vehicleratings/a/blautominimum.htm

it's a fine point, but some states do allow people of means to self insure.

But i don't see why anybody who's sane would.

http://www.flhsmv.gov/ddl/frfaqself_person.html#method1

METHOD III - FINANCIAL RESPONSIBILITY CERTIFICATE (BASED ON SURETY BOND)

Persons posting with the department a satisfactory bond of a surety company authorized to do business in this state, conditioned for payment of the amount specified in section 324.021(7), Florida Statutes. Bond forms are available upon request.

Individual - Filing Requirements


Surety Bond from a surety company authorized to do business in this state, conditioned for payment with the amounts of: $10,000 of bodily injury to, or death of, one person in anyone crash; $20,000 bodily injury to, or death of, two or more persons in anyone crash; and $10,000 injury to, or destruction of, property of others in anyone crash ($10,000/20,000/10,000).