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    Helping the Working Poor -- A Practical Defense of PPACA

    The Health Care Bill, more often than not, raises the ire of both conservatives and progressives. They've teamed up to spread as much misinformation about the bill as possible. Why? I am not sure, because this bill goes a long way to get more people access to health care.

    I think it all began with a guy named Howard Dean and some comments he made In December of 2009.  Dean was very angry that the public option was eliminated from the Senate bill. The target of Dean’s rant was Joe Lieberman, ( I)CT, he was pretty pissed at Lieberman and he seemed to feel no bill would be better than this bill now. He was angry at the process. And his anger is not unfounded. This Senate has become a branch of our government that is immovable, ideologically entrenched, almost completely unable to pass any worthwhile legislation. Dr. Dean was pretty pissed about that, as we all should be. However, instead of directing his anger at the improbable 60 vote requirement to pass any legislation of substance, he decided it would be time to just let Republicans win by killing the bill. That didn't happen of course, but that was an extreme reaction, one Republicans were relying upon, this is where they were able to begin to sow the seeds of discontent among voters, they have filled the air with misinformation, with the help of people who are otherwise quite progressive. All that discontent, and the Executive Branches unbelievable inability to fight back against the propaganda has left people with a sour taste in their mouths when it comes to their thoughts about PPACA.

    A number of people jumped on Dr. Dean's bandwagon, Keith Olbermann went on the air to loudly proclaim why the Senate Bill should not be passed. Two days after Dean’s rant against the bill, a number of left leaning organizations and people banded together to help kill the bill:

    Dave Linderhoff of The Public Record
    Jane Hamsher of FireDogLake
    Markos Moulitsas; Daily Kos Founder
    Darcy Bruner; a past candidate for Congress

    Lying about ACA has become something of a cottage industry. But don't believe the hype, the reforms already implemented have brought down insurance costs, added more people to insurance rolls, new benefits for senior citizens, implemented necessary regulations regarding pre-existing conditions and an 80% requirement that premiums be spend on the consumers health care costs, with 20% mandated for administrative costs.

    People who will benefit most from the bill:

    1. Those without any insurance.
    2. Those who have paid for expensive individual policies on their own.
    3. Employees of small businesses that have trouble affording the cost of joining a group plan.
    4. Low income Medicare participants who are left paying for whatever is not covered by Medicare for their medical bills and prescriptions.

    Who is without access to health insurance? Some of those people are the working poor. It has been a long struggle to get federal legislation dealing with this problem, the estimates are there are some 45 million people without access to basic heath care.  In the past, some states attempted to solve this problem on their own by setting up their own state run “group” for people who didn’t qualify for Medicaid. When the boom of the 1990’s ran its course, those programs began to be cut severely because of the expense of running the programs and because states don't have as much revenue since the economic downturn and they are having to make tough choices.  Many states of course never attempted such things. Washington State has such a program, but its funding has been cut in the past few years so although people may qualify by their income, there are no slots open to take them as customers, in fact the plan has had to disenroll people because of a lack of funding, in total 17,000 members were disenrolled.  

    However the results of PPACA have been positive.

    • More young adults have coverage
    • Requires beginning this year, insurers must spend 80% - 85% of premiums in actually delivering care
    • Premiums decreasing even for state employees.
    • Our health insurance plans now have to justify their premium rate increases to the State and pass an approval process before they can raise prices.
    • Because of the ACA, young adults can now stay on their parents’ insurance until the age of 26.
    • New York has something called “community rating,” which means that health insurers can’t charge you higher rates simply because of your age, gender, or health history.
    • Because of the ACA, we no longer have to pay co-pays for many preventative care services.
    • Because of the ACA, people with pre-existing conditions now have choices for coverage, one example the NY Bridge Plan.
    • Because of the ACA, seniors who hit the Medicare “donut hole” are now getting help with their prescription drug costs.
    • States like New York have a law in place called “guaranteed issue,” which means that insurers have to offer health insurance to everyone, even if they have a pre-existing condition (even though they have waiting periods for coverage related to that condition.  But thanks to the ACA - those waiting periods will soon be a thing of the past!). 
    • More changes to Pre-existing condition plans by states, here is a preview, premiums have decreased.
    • Premium and Cost sharing subsidies to individuals: the mechanism provides refundable and advanceable premium credits to eligible individuals and families who fall between 133% and 400% of FPL (Federal Poverty Level) to purchase insurance through state created health exchanges.
    • Provide Cost sharing subsidies to eligible individuals and families. Cost-sharing credits reduce the cost sharing amounts and annual cost-sharing limits and have the effect of increasing the actuarial value of basic benefit plan to the following percentages of the full value of the plan:
      • 100 - 150% FPL  94%
      • 150 – 200% FPL  87%
      • 200 – 250% FPL  73%
      • 250 – 400% FPL  70%

    Health Exchanges: a few examples

    • Vermont : passed legislation to build a single payer plan for the state of Vermont and in October  of this year, (2011) that plan got one step closer to implementation.

    These new federal policies are working. I think this is good. There seems to be a small, but loud coalition of people on both sides of the ideological aisle who would have you believe PPACA is a complete failure, but the evidence says otherwise. Let’s stop letting them get away with their propaganda war against delivering health care to those who would not otherwise have access. Let’s fight back with the facts at hand, because the facts indicate the legislation is working.

    Crossposted at TheAngriestLiberal


    I think the problem is more, "if it's a problem for me, then I don't like the bill."  People are judging the bill not on how noble it is or on all the good things it does, they are looking at whether or not their health insurance premiums are going up or not, and for a lot of people they are going up.  Period. End of discussion.  The arguments against the bill are just rationalizations that people use as cover, so they don't have to appear to be whining about their own health care problems.  Insurance costs may be coming down, but those dang capitalist HMOs are still raising premium rates. 

    I'd like to be generous and feel good about all the wonderful things the bill accomplishes for other people,  but my premiums in January of 2012 are scheduled to go up to a point where I will be paying nearly 33 % of my yearly salary for my health insurance.  I am the working poor.  In the last couple of years, I've seen my premiums go up in leaps and bounds, nearly tripling the amount I pay per quarter.  So, if there's no public option, I'm going to be ticked off about any bill that allows my premiums to continue to go up, even if it helps a lot of other people who are worse off than me. Admittingly, I've probably been thrown into the 'high risk' group; because I'm one of the millions of people who take Anti-TNF meds like Enbrel and Remicade, which are expensive and HMOs hate to pay for, but even so... I thought the health care bill was supposed to lower my premium rates, but instead, my HMO has dramatically raised my rates twice since the bill passed.   I can intellectually approve of all the good things the bill accomplishes, but how enthusiastic can anyone really get about a bill that does not affect their own situation in a positive way?  I think a lot of Americans would support this bill, but, as in most things, they wonder, where's the good part for ME?  

    You are right Mr. Smith, that is the problem, where are the good parts for you?  I can't answer that question specifically, although I wish I could. Community Health Advocates help people keep their coverage in NY State and possibly have information on how to get subsidies for the rising cost of health insurance in your area. They would have better advice than I have on the particulars of your case.

    Another excellent resource is Health Care for All New York. This year one of their proposed legislative goals is to challenge proposed health insurance rate increases under the newly reinstated prior approval process.  This includes submitting letters in opposition to proposed rate increases, determining if rate increases can be justified (will require us to obtain insurer memos currently not public), and monitoring the prior approval process. This seems like your particular issue, because it seems some insurers in NY have dramatically upped premiums for certain subscribers, because of a loophole. I would like to think HCANY could offer some assistance.

    I wish I could offer you more information.

    I like a number of the talking points about the bill; obviously, the not getting kicked out because of a pre-existing condition thing, the young people being able to stay on their parent's health insurance until the age of 26, the mandate, which, libertarians' complaints to the contrary, I think will eventually bring down medical costs that citizens pay, not on themselves directly, but in the required support of local emergency rooms having to give non-emergency medical treatment to people without health insurance.  That loophole was one that should have been seen and it seems naive to have thought that given the loophole, the HMOs wouldn't take advantage of it.  Oh well. 


    The good part for you (and most people, especially people who have yet to see their health care costs go down) is on the way shortly.

    The truly best part of the bill went into effect, by my count yesterday now, as it is 12/3/2011.

    Health insurers now must pay 80% of the premium dollars they collect on actual health care. And if they cannot meet that, then they must send out refund checks to all insurees to cover the difference.

    Best of all, the Department of Health and Human Services (HHS) also released the rules of what does and what does not constitute medical expenses for the purposes of meeting that 80% requirement, and they are not screwing around.


    One example: For months, insurance brokers and salespeople have been lobbying to include commissions they earn for selling an insurer's program to be counted as a 'medical expense.' Yesterday, HHS ruled that this is NOT a medical expense.


    I would expect a refund check and probably reduced costs coming YOUR way in the coming months. THIS is the good part for YOU.

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