dagblog - Comments for "New Health Law Frustrates Many in Middle Class"

As far as I can tell, this is

Anonymous PS — Sun, 29 Dec 2013 20:50:41 +0000

In reply to Do you realize that basically

As far as I can tell, this is NOT the pitch I'm making. In fact, I don't see how you get from what I've been saying to what you're saying. I'm not making any pitch except a pitch to separate reality from fantasy.

Point one: If the people you cite, in fact, care about anyone other than themselves, they should be saying "yay!" Many people who had NO chance of getting coverage now can. Plus they had no money to trot from specialist to specialist nor to fly out of town to consult the specialists at Mayo. If that's nothing to these commenters, then frankly I'm sorry for them. Reducing the ranks of the uninsured IS a benefit to all of us, but that's a long, complicated discussion, and they aren't likely to get it.

Point two: If they plan on voting for people who promise to return us to the status quo ante--or plan on voting out people who have at least tried to move the ball forward-- then it would be hard for me to put the full extent of my contempt for them into words. But that's just me.

Point three: In my book, it's important to separate reality from various misunderstandings of how private insurance works, etc., and what is actually happening v what is not happening. If that sort of analysis yields the conclusion that "on balance things are about the same as they were," then yes, it might be disappointing, but no great tragedy. Especially when you factor in the millions of people who are being helped. That said, from what I read, things are better on balance.

Point four: For example, I know a woman personally who was previously insured, whose policy had been grandfathered in and then canceled, who will be saving $800 a month through an Obamacare policy. She isn't alone. Should I care less about her ilk than your commenters or your husband?

Point five: If you or they can't grasp that large programs that make fundamental changes need time to work properly and can't get the facts that make this so in this case, then it's hard to know what to say.

Do you realize that basically

artappraiser — Fri, 27 Dec 2013 22:56:03 +0000

In reply to "The only major financial

Do you realize that basically you are making this sales pitch to the individually insured middle class:

It's different and forced change but on the balance not worse than what you had before. You'll see if you give it some time. And if you weren't forced to do this, your situation would have gotten worse.

And they are supposed to be saying "yay!"? They will tell the pollster that Obamacare is wonderful, just the tonic they had hoped for, that they are 100% behind it?

I can't tell you how many comments I've read on related NYTimes stories that are basically along the lines of "I was a big supporter of ACA and was really looking forward to what it might offer, and it is a good thing that Medicaid was expanded but I am very disappointed. " Some almost sound heartbroken at times.

Yes, I was going to correct

artappraiser — Fri, 27 Dec 2013 22:35:35 +0000

In reply to Where PS (not verified)

Yes, I was going to correct that too, thank you.

I was actually thinking about the implications of there being a March 31 deadline to avoid the penalty. For example, take one of those hypothetical "young invincibles." Let's say they don't sign up in Jan. or Feb., but then it hits them, say their tax advisor tells them that they are going to save like a $500 tax fine in April 2015 by signing up and paying premiums April through December. Maybe it will be a convincing factor. On the other hand, those who don't know about the "or 1% "factor and think right now that they are only going to be subject to $95 might start yelling at their Congresscritter when they finally realize it....

Where PS (not verified)

oldenGoldenDecoy — Fri, 27 Dec 2013 21:26:33 +0000

In reply to Ah, well, I thought you were

Where PS (not verified) said...

"he may only have to pay $95 in penalties...

That's for the first year and it's actually "...$95 in penalties or equal to one-percent (1%) of income, whichever is greater."

Posted for clarification.

~OGD~

Only in America would an

ANON.NCD — Fri, 27 Dec 2013 21:18:42 +0000

In reply to Then there's this, which may

Only in America would an unemployed person with no job, benefits or enough savings be given the unlikely option of having to juggle their (meager & insufficient?) retirement funds to cover (until they went broke or became homelss?) overpriced for-profit health insurance run by millionaire CEO's and Wall Street whcih may or may not ever spend one dollar towards that individuals actual medical care.

American Exceptionalism.

Then there's this, which may

Peter Schwartz — Fri, 27 Dec 2013 20:25:28 +0000

In reply to Ah, well, I thought you were

Then there's this, which may or may no longer apply with the new law:

"1. Un-reimbursed Medical Expenses
If you do not have health insurance or your medical expenses are more than your insurance will cover for the year, you may be able to take penalty-free distributions from your IRA to cover these expenses. Note, however, that only the difference between these expenses and 7.5% of your adjusted gross income (AGI) is eligible for this exception. For example, if your adjusted gross income is $100,000 and your un-reimbursed medical expenses are $10,000, the maximum amount that you can distribute penalty free is $2,500, which is the difference between $10,000 and 7.5% of your AGI ($7,500). Your tax professional should be able to help you determine your AGI."

2. Medical Insurance
If you are unemployed, you may take penalty-free distributions from your IRA to pay for your medical insurance. In order for the distribution amount to be eligible for the penalty-free treatment, you must meet these certain conditions:

You lost your job.You received unemployment compensation paid under any federal or state law for 12 consecutive weeks.
You received the distributions during either the year you received the unemployment compensation or the following year. You received the distributions no later than 60 days after you were re-employed."

In any event, he can always put some of the premiums he won't be paying--say the amount he formerly paid for his cancelled policy--into his IRA and get some of the tax benefits of an HSA.

Ah, well, I thought you were

Anonymous PS — Fri, 27 Dec 2013 20:14:57 +0000

In reply to Fearful is not an emotion

Ah, well, I thought you were fearful for him. I guess not.

In that case, his solution is simple.

1) He's been paying out of pocket for his medical expenses up to now and going to the doctors he wants to see. He can continue doing that--unchanged. And can save the premiums he's been paying up to now. Cancellation has been a blessing in disguise.

2) He won't get the tax deduction but, as you say, your income has gone down. That means the loss of tax breaks won't be all that much.

3) If you ARE going to lose serious tax breaks, then that means you're still doing pretty well and could probably afford one of the new plans. If it's a concern...

4) If he wants to risk going without insurance, then he'll be paying less than he did before. He'll lose his tax breaks, but that should be offset by not having to pay for premiums. And these savings will be immediate; he won't have to wait until the end of the year to claim them. A much better deal than an HSA.

5) If he has reason to believe he won't fall victim to an acute illness, he'll make out in all ways. In the first year, he may only have to pay $95 in penalties and, in any case, there's barely any mechanism for enforcing the penalty. So he might not have to pay even that...if he's angry enough. Another win-win for him.

6) If he does develop a serious illness, then one year from now, thanks to Obamacare, he'll be able scurry back in and get himself covered.

7) You could also move out of New York to a state with a better exchange (I recommend VA). It's the sort of advice out of work factory workers get all the time when their town's factory moves. Hey, why not.

In short, I fail to see what he's angry about. Seems like he could easily make out like a bandit. In fact, he could've been making out like a bandit all these many years. Millions of people have had it FAR worse than he.

"The only major financial

Anonymous PS — Fri, 27 Dec 2013 15:49:52 +0000

In reply to How I square it: There were

"The only major financial risk being taken not being insured is an expensive acute illness (like one where the costs run way over $10K.) And there are lots of plus factors to not signing up, like being able to go to any doctor or lab or clinic that takes money as well as insurance. You can be paying the insurance company the $4,000 or $5,000 or $6,000 deductible a year, as well as premiums, if you need medical care, or can remain uninsured and pay that or less directly to providers of your choice without any insurance premium costs."

Without that "major financial risk," no one would sign up for individual insurance at all. Even before Obamacare. Why would they? For decades, long before HSAs, I paid out of pocket for everything. I went without recommended procedures because I was below my deductible. All because of the risk of the actue illness.

(At one time, you might remember, you couldn't even get reimbursed for an annual check up. My doctors always made up some excuse for the visit, so I could submit it against my deductible.)

I suspect most people in the individual market--especially if they're as cost-conscious as you portray them--paid a lot of medical expenses out of pocket to keep premiums as low as possible. It's not as if these plans were all that generous --and as is the case now--you had to balance premium costs and deductibles and copays and formularies to arrive at true cost figure.

I don't see where you come up with "lots of plus factors." If folks want to pay cash for medical expenses in order to be able to see the specialist of their choice, they can do that with or without a policy. As, I guess, they've been doing up to now. The only difference is that, with an HSA, which, as I say, is clearly an option in VA, you can write it off, in effect. Yes, they still have to pay a premium to get coverage, but that goes back to acute coverage. Do they want to go without that? Be my guest.

And frankly, if these folks have the money to pay out of pocket to see any doctor or specialist anywhere in the country--if they're big out of pocket health care consumers--then they should have the money to protect themselves against catastrophic illness. If they don't want to, well, that's their choice. But they aren't getting "priced out," as it were.

"Throw into the mix that if they sign up they might have plenty of inconveniences or outright real troubles like changing doctors, getting approval for seeing specialists and waiting longer for appointments. I suspect of those with canceled plans who have not signed up, many will weigh this risk and take it. Especially since if they get an expensive chronic rather than an acute illness, there is no pre-existing condition prohibition to keep them from signing up in a later open enrollment period as their expenses mount."

True. But again, these folks have been paying for most of these things out of pocket all along. And you're painting a scenario in which most of the expenses won't put them over the deductible limit anyway. So they are free to see all these people and pay cash as before. It won't be covered, but then, it wasn't really covered before AND they paid for it.

All this said, people who aren't regular doctor-see-ers because they don't have chronic or special or acute situations shouldn't have a problem changing doctors. They will save money.

In my experience, the doctors I wanted to see (based on recommendations) NEVER participated in my insurance plan. They were always out of network AND the insurance companies had developed TWO separate deductibles--one for in-network and one for out-of-network doctors.

There is no pre-existing condition exclusion, but somehow, I doubt the companies will pay for a year's worth of expenses racked up during a year when you weren't covered. Do you feel lucky?

Throw into the mix that if they sign up they might have plenty of inconveniences or outright real troubles like changing doctors, getting approval for seeing specialists and waiting longer for appointments. I suspect of those with canceled plans who have not signed up, many will weigh this risk and take it. Especially since if they get an expensive chronic rather than an acute illness, there is no pre-existing condition prohibition to keep them from signing up in a later open enrollment period as their expenses mount.

"I think this is a real

Anonymous PS — Fri, 27 Dec 2013 15:14:03 +0000

In reply to How I square it: There were

"I think this is a real danger because all the plans except Platinum level have high deductibles where people have to pay a significant amount of money out of pocket for most average health care problems that are most likely before coverage kicks in. So if they don't know it already, many of these people will learn that signing up won't save them any money excepting the case of catastrophic acute illness. That if they happen to need more than the preventive basics, even if they sign up, they would still have to pay basically the same costs they would have to pay while uninsured, but also pay a hefty montly premium, too."

If they are like me, most of the people with somewhat affordable individual plans had high deductibles BEFORE Obamacare. And so they were paying out of pocket for most ordinary medical expenses BEFORE Obamacare. As was I...for 35 years.

Some of them--the wealthier ones in the scheme of things--were funneling these payments through an HSA to get their tax break at the end of the year. (This was cumbersome since, in my experience at least, you had to mail in a check, but no matter.)

However, a tax break a year from now is small consolation if, in fact, you're juggling competing expenses now, e.g., food v medicine, mortgage v doctors' visits.

So, in terms of money out of pocket at the time of services provided, there is NO difference between then and now. The only potential difference is the tax break.

There are some nice additions, however: They will get basic preventive services for free. And if they DO come down with a catastrophic illness, they will be covered (isn't this what drives most people in the heretofore crappy individual market to get coverage in the first place?) and there will be no caps on the money paid out.

And, as I say, at least here in VA, there are PPOs and HSAs being offered...

No, this is what article

Anonymous PS — Fri, 27 Dec 2013 15:00:07 +0000

In reply to How I square it: There were

No, this is what article says:

"So the gap between plan cancellations and new plan sign-ups is considerably smaller than these numbers suggest."