Obamacare Anecdote

alan1

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I know the following is anecdotal and based upon a single experience I had, but I think it may be more common than our government realizes.

First, let me say that one of the few things I agree with concerning the ACA is letting people with pre-existing conditions get insurance, most of the rest of it I disagree with.

So, here is the background.
One of my daughters has a boyfriend with Crohns disease. He is in his early 30's. He cannot get health insurance due to his pre-existing condition. In the past seven years he has been in the hospital once or twice a year (every year) for treatment. Additionally, in the past seven years, he has been mostly unemployed. He's had jobs off and on in that time but nothing that has lasted. He is currently unemployed.
In my opinion, he is the perfect candidate for Obamacare. It will allow him to get medical care when he needs it. He is a liberal and one of the main reasons he voted for Barack Obama was because of the garunteed healthcare he was promised.

I was spending time with my family over the holidays, and I asked him if he had signed up for health insurance on the government exchange. His reply was quick and short, "No".
I explained to him that a large purpose of the ACA was to benefit people like him that had pre-existing conditions, so that they could get medical insurance. I asked if he had actually been to the healthcare.gov website. He told me he had been to the website and that he had gone through all the steps to sign up for insurance. He told me the insurance was too expensive, the out of pocket deductible was too expensive, and that he couldn't afford it. I asked him about the subsidies, surely since he is currently unemployed, the subsidies would help.
He explained that since he did have some income this past year, insurance on the exchange isn't 100% free and since he has no income now, he can't pay any premium.
Then, he sort of went off, his words, "Fuck congress, Fuck Obamacare, Fuck Obama, they aren't taking care of me. And good luck to the IRS trying to fine me, fuck them too,
I don't pay taxes on my non-existent income so they ain't getting shit from me".
I asked him what he was going to do the next time his Crohns disease flared up. He said he was going to do to the same thing he's always done, show up at the emergency room,
check into the hospital for a few weeks, and then tell them he can't pay when he checks out. "They just write it off on their taxes", he says.

My thoughts......
The first thought is quick.
He expects free medical care, he thinks it is a right, he thinks the government is supposed to take care of him.

The second thought has much more.
Obamacare was created to provide medical insurance for those that couldn't currently afford it. Be that because of a low income or a pre-existing condition, or both. Even with Obamacare, my daughters boyfriend still has his pre-existing condition and he still has the inability to pay for health insurance and health care. The insurance is still to expensive, the out of pocket deductibles are still more than he is willing to pay even if he had the insurance. He is going to continue doing what he has always done. I suspect that a lot of people with low incomes and pre-existing conditions are following the same path as my daughters boyfriend. In my opinion, Obamacare has not helped a large portion of its target market nor changed their behaviour or the outcome for them.
Early in the healthcare debate we were told 30-40 million were lacking healthcare and that this bill would fix that. 1.1 million signed up on the federal exchange.
State exchanges are unknown, but estimated at another 1 million. That would only be 2 million of the 30-40 million. Then there is the 5 million that lost their current coverage. Government just added 3 million to the original problem they were supposedly fixing. Not only did they fail to actually fix the issue, they exacerbated it.
In the future, the same foolish do-gooders that voted for the government to fix this will vote for the government to fix that which they just made worse.
 

Rozman

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Am I wrong about this?

Many will make just a little bit too much to get the subsidy.
But they will have a problem with the high deductible.

I have that problem now that my company was dropped from our plan.
We got something for the next few months so at least we have coverage.
But I now have a $6,000.00 deductible that I can't pay.
I just don't have that sort of money.

So come March if my company gets another plan that's similar I will cancel my doctors appointment
that I have scheduled.I will not get a colonoscopy that I need to have done,no more EKG or sonargrams
that check my circulation...I will maybe go to the Doctor's office once a year for a physical instead of quarterly.And if perhaps I come down with something then I will have to go.

Sorry folks.ObamaCare blows!
 

boedicca

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Obamacare was created to provide medical insurance for those that couldn't currently afford it.

Good post, but you need to check your premise. The dysfunction of ObamaCare is not a bug, it's a feature. It was NOT created to provide medical insurance for those that couldn't currently afford it. That was the pretex-pablum spoonfed to the gullible portion of the population.

The true purpose was to expand Government control over our lives, to expand the ranks of those who are dependent upon government via income transfers, and to enrich the usual suspects of Big Government Cronies.

If the true purpose were to provide a safety net for the uninsured, that could have been done via welfare-style taxes and benefits for a far lower cost than the Obamanation.
 
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LoneLaugher

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It is possible that your daughters boyfriend is one who is slipping through the cracks of the law as it is currently being administered.

I suspect that he lives in a State that has not expanded Medicaid. I have a neighbor with a relative in a similar situation. Zero income......does not qualify. That IS fucked up.

But....please note that neither your guy or mine is WORSE OFF now than they were.

The math at the end of your post is rife with false assumptions. Sorry. 5 million people did not lose their insurance. They had their vp coverage changed....and on a VERY SMALL percentage of them ( 1-2% ) are going to have to pay more in premiums.
 

NLT

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My health care premiums from my employer based insurance doubled, wheres my $2500 in savings?
 

LoneLaugher

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Am I wrong about this?

Many will make just a little bit too much to get the subsidy.
But they will have a problem with the high deductible.

I have that problem now that my company was dropped from our plan.
We got something for the next few months so at least we have coverage.
But I now have a $6,000.00 deductible that I can't pay.
I just don't have that sort of money.

So come March if my company gets another plan that's similar I will cancel my doctors appointment
that I have scheduled.I will not get a colonoscopy that I need to have done,no more EKG or sonargrams
that check my circulation...I will maybe go to the Doctor's office once a year for a physical instead of quarterly.And if perhaps I come down with something then I will have to go.

Sorry folks.ObamaCare blows!
Your company was dropped from your plan? Why? What plan? How much were you paying, how much was your employer paying and what were the deductibles?

You got something for the next few months? Where? What plan?

Have you looked on the exchange? Your employer should qualify for a plan similar to what is on the exchange.

Do you know that your colonoscopy will likely be covered under any new plan?
 
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alan1

alan1

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Obamacare was created to provide medical insurance for those that couldn't currently afford it.

Good post, but you need to check your premise. The dysfunction of ObamaCare is not a bug, it's a feature. It was NOT created to provide medical insurance for those that couldn't currently afford it. That was the pretex-pablum spoonfed to the gullible portion of the population.

The true purpose was to expand Government control over our lives, expand the ranks of those who are dependent upon government via income transfers, and enrich the usual suspects of Big Government Cronies.

If the true purpose were to provide a safety net for the uninsured, that could have been done via welfare-style taxes and benefits for a far lower cost than the Obamanation.
OK, the premise that was sold to those that didn't have medical insurance and believed by the meddling do-gooders.

The ultimate goal is a single payer government controlled healthcare system, this is just the first step.

I was merely pointing out how the first step failed to actually help the poor with pre-existing conditions. I think that is partly why the enrollment has been so dismal.

Of course, the liberal do-gooders that fucked this up will insist more government action on it from the same government that fucked it up to begin with.
 
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alan1

alan1

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It is possible that your daughters boyfriend is one who is slipping through the cracks of the law as it is currently being administered.
See my previous post.
It seems that Lonelaugher is already calling for more government action on the shit they already fucked up.
 

Antares

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It is possible that your daughters boyfriend is one who is slipping through the cracks of the law as it is currently being administered.

I suspect that he lives in a State that has not expanded Medicaid. I have a neighbor with a relative in a similar situation. Zero income......does not qualify. That IS fucked up.

But....please note that neither your guy or mine is WORSE OFF now than they were.

The math at the end of your post is rife with false assumptions. Sorry. 5 million people did not lose their insurance. They had their vp coverage changed....and on a VERY SMALL percentage of them ( 1-2% ) are going to have to pay more in premiums.
I suspect that he lives in a State that has not expanded Medicaid. I have a neighbor with a relative in a similar situation. Zero income......does not qualify. That IS fucked up.


$11500 is the income floor, less than that and you are screwed.

5 million people did not lose their insurance.

Yes they did, they lost plans they were happy with.

I suspect that he lives in a State that has not expanded Medicaid

Let's clarify this debate...the debate becomes Fed dollars vs. State Dollars...why do you think the Feds wanted to push so many people to Medicaid?

Why would Medicaid be a less expensive option than the ACA?
 
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alan1

alan1

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LoneLaugher

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I'm thinking that if he moves to Somalia it doesn't help him one bit, why do you think it would?
Not him. You. You can live free of government there. Have fun.
Ah, I see. Rather than discuss issues your solution is to to tell people to leave the United States when you don't like their opinion.
How very close-minded of you, carry on.
I discussed the issue. I posted a calm reply to your emotional OP. You went nutter on me. Try harder. Remove the bullshit talking points from your personal anecdotes next time.

Shit.
 
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alan1

alan1

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Not him. You. You can live free of government there. Have fun.
Ah, I see. Rather than discuss issues your solution is to to tell people to leave the United States when you don't like their opinion.
How very close-minded of you, carry on.
I discussed the issue. I posted a calm reply to your emotional OP. You went nutter on me. Try harder. Remove the bullshit talking points from your personal anecdotes next time.

Shit.
Sure you did,
Move to Somalia. Problem solved.
Yay you, with your (not) reasonable response.

The ACA isn't helping poor people with pre-existing conditions and you can't deny that so your response is, "Move to Somalia. Problem solved.", simply because I pointed it out and because you have no other defense of that piss-poor law.
 

Care4all

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Ah, I see. Rather than discuss issues your solution is to to tell people to leave the United States when you don't like their opinion.
How very close-minded of you, carry on.
I discussed the issue. I posted a calm reply to your emotional OP. You went nutter on me. Try harder. Remove the bullshit talking points from your personal anecdotes next time.

Shit.
Sure you did,
Move to Somalia. Problem solved.
Yay you, with your (not) reasonable response.

The ACA isn't helping poor people with pre-existing conditions and you can't deny that so your response is, "Move to Somalia. Problem solved.", simply because I pointed it out and because you have no other defense of that piss-poor law.
Alan,

please let me help your daughter's boyfriend navigate Obamacare....for his sake.

what State and county does he live in?

what is his estimated income for next year?

he's 30 yrs old right?

you can PM me with this info, and I can walk you through it...or even your daughter's boyfriend through it....
-------------------------------------------------------------

see, if you are single and make less than 28k a year, then in addition to the gvt subsidy that helps pay for the premium, if you buy a ''silver'' plan, then the gvt comes in and will help fund your deductibles and help fund your out of pocket expences....as example, if the copays to see a doctor on the plan he bought are $25, then the gvt will pay $15 of that copay and make him only pay $10, if the plan is a 30/70% plan, then the gvt will come in and make it a 20%/80% plan or a 10%/90% plan, depending on how little you make...

if the deductible is $2500, then the gvt will pay the $2000 of it and make his plan with $500 deductible or even $200 yearly deductible, the gvt pays the rest...

if the silver plan has a $6300 out of pocket expense then they may pick up the cost of the most of it and make it where his total yrly out of pocket expense is $1500 instead of the $6300, or $500 instead of the $6300....all depending on his income....

if the silver plan has a fee of $20 per prescription, the gvt may make it where he only has to pay $5 per prescription, generic or branded...or they may make it where he pays Zero for prescriptions...again, depending on his income....

It sounds to me that your daughter's boyfriend has not been advised correctly and does not know about:

Cost Sharing Reductions:
The Marketplace cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance, and copayments. These are costs you have to pay when you get care.
This savings is based on your income and family size.
Savings depend on your income

Health insurance companies offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts. (Incomes below are based on 2013 numbers. They are likely to be slightly higher in 2014. Amounts are different for each family size, up to 8.)

  • Up to $28,725 for individuals
  • Up to $38,775 for a family of 2
  • Up to $48,825 for a family of 3
  • Up to $58,875 for a family of 4
  • Up to $68,925 for a family of 5
  • Up to $78,975 for a family of 6
  • Up to $89,025 for a family of 7
  • Up to $99,075 for a family of 8
When you apply for coverage in the Marketplace, you'll learn if you’re eligible for these savings on out-of-pocket costs.
Incomes that qualify for lower costs are higher in Alaska and Hawaii. See Alaska and Hawaii information.
Learn how to estimate your income and report on your household makeup for the Marketplace.
Out-of-pocket savings apply only to Silver plans

Plans in the Marketplace are separated into 4 different categories: Bronze, Silver, Gold, and Platinum. These categories are based on how much of your medical costs you pay and how much the plan pays when you get medical care. They are not based on plan quality. Learn more about plan categories and what they mean.
If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings. If you qualify for these savings, you'll get the out-of-pocket savings benefits of a Gold or Platinum plan for a Silver plan price. You can choose any category of plan, but you'll get the out-of-pocket savings only if you enroll in a Silver plan.
You'll be able to choose your plan category when you fill out your Marketplace application.
Get an estimate of your costs and savings

You can get an estimate of your costs and savings by browsing plans and prices in your area and by using the Kaiser Family Foundation calculator.
If your income is too high to qualify for lower costs, there are 4 ways you can buy a health plan.
Cost sharing reductions are available for the needy IN ADDITION to the subsidy given for the insurance premium.

HMMMMMMM after reading the quote, sounds like the insurance company may be footing the cost sharing reduction and not the gvt? not certain? regardless, I bet the boyfriend went in and looked at the bronze plan cuz he thought it was cheaper, but in actuality, for him, the silver plan with Cost sharing Reductions would be better....?

in addition, the boyfriend would not be required to pay the penalty if he makes little or is unemployed, there is no penalty for not having insurance if you are poor...
 
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LoneLaugher

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Ah, I see. Rather than discuss issues your solution is to to tell people to leave the United States when you don't like their opinion.
How very close-minded of you, carry on.
I discussed the issue. I posted a calm reply to your emotional OP. You went nutter on me. Try harder. Remove the bullshit talking points from your personal anecdotes next time.

Shit.
Sure you did,
Move to Somalia. Problem solved.
Yay you, with your (not) reasonable response.

The ACA isn't helping poor people with pre-existing conditions and you can't deny that so your response is, "Move to Somalia. Problem solved.", simply because I pointed it out and because you have no other defense of that piss-poor law.
You saw my first reply to your OP...why are you ignoring it now? I didn't try to deny anything.

Take Care4all up on her offer.
 

LisaBren

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... I now have a $6,000.00 deductible that I can't pay.
I just don't have that sort of money. ...

I will not get a colonoscopy that I need to have done,no more EKG or sonargrams
that check my circulation...
Do you know that your colonoscopy will likely be covered under any new plan?
He knows that the colonoscopy will be "covered" under a new plan, meaning they will count it towards his $6,000 deductible, which he won't be able to afford.

Even with Obamacare, my daughters boyfriend still has his pre-existing condition and he still has the inability to pay for health insurance and health care. The insurance is still to expensive, the out of pocket deductibles are still more than he is willing to pay even if he had the insurance. He is going to continue doing what he has always done. I suspect that a lot of people with low incomes and pre-existing conditions are following the same path as my daughters boyfriend. In my opinion, Obamacare has not helped a large portion of its target market nor changed their behaviour or the outcome for them.
You're right. The insurance is still too expensive, and not only for low-income people. My premium is higher than it ever was when I was working, and so are the co-pays. I don't know how it will affect the 'target market's" behavior. Low-income is one target market; people with pre-existing conditions are another. They overlap, but probably not for the majority of people. Those who just can't afford it will simply pay the penalty fee. If their income is low enough, they won't be required to file taxes anyway, so it won't be assessed against them. And they will show up at the ER when they need healthcare.

If your daughter's boyfriend has zero income, he should qualify for Medicaid, but if he is living off his savings, he still might not. Plus, if he gets insurance through healthcare.gov, he has to send in proof of last year's income so they can see whether his estimated income for this year is right. I don't know how they'll deal with people who worked but are unemployed now.
 
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LoneLaugher

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... I now have a $6,000.00 deductible that I can't pay.
I just don't have that sort of money. ...

I will not get a colonoscopy that I need to have done,no more EKG or sonargrams
that check my circulation...
Do you know that your colonoscopy will likely be covered under any new plan?
He knows that the colonoscopy will be "covered" under a new plan, meaning they will count it towards his $6,000 deductible, which he won't be able to afford.
Not true. You lose. And so soon after entering the game.
 

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