Monday, March 22, 2010

The open-backed medical gown

It's getting hot in here,
So take off all your clothes . . . and look to the left and cough.
Because now more of you can go get annual check-ups as part of your government-semi-mandated insurance coverage! :)

Ok. So, I have a total personal commentary blog about the health care debate, but I am going to post this one JUST in as simple terms as possible for my sister-in-law, Stacy, a self-proclaimed "not really into the political thing" person, for now, and then post my thoughts afterward. I'm going to type this like I was talking with Stacy.

Alright. According to the Congressional Budget Office, the numbers guys, there are approximately 32 million people living in America without health insurance (that's a little more than 10% of our population). With this new bill 25 million people will be required, by law, to carry some sort of minimal health insurance by the year 2014. By 2016, if you have elected to NOT have medical insurance, you will be fined ($2,085 or no more than 2.5% of your household income as your family's fee.) It's very similar to the idea of auto insurance. The money that the younger, healthier, haven't-really-needed-it-and-never-wanted-to-pay-for-it-unless-I-have-to-and-now-I-have-to generation of medical insured will help offset the costs for those who, under this new bill, CANNOT be denied health insurance because of pre-existing conditions, amongst other things.

So, out of those 25 million people who HAVE to have medical insurance, 19 MILLION of them will qualify for government subsidies (or financial aid). They figure whether you need a subsidy based on your family size and income (similar to how they figure your taxes.) If you make less money, you get more of a subsidy to help pay for your health insurance. If you make more money, you will get less of a subsidy. It's kinda like a sliding scale. As your income goes up, your help from the government to cover your medical insurance goes down. Now, if you make a bunch of money (over $250,000/year per couple) or are collecting interest and dividends on monies you have, you will pay more taxes on that sitting money AND you will have to pay more for Medicare (Part A [the hospital Medicare]). That's one reason people don't like the plan. If they make more money, they are definitely paying more money into the system for those who DON't make as much money.

The extra taxes and cutting of their Medicare for the wealthy, along with a bunch of other taxes and fees that have been enacted (i.e., new tax on expensive health insurance plans, drug manufacturers, insurance companies, and other smaller fee collections [like a 10% increase on indoor tanning tax. . . lol]) AND government monies that have been cut (like the Medicare Advantage, Home Health cuts, and certain payments to hospitals) will be where they get some of the monies they need to get this health care plan moving. IF you work full time for a company (that is over 50 employees) they must provide health insurance to you. If they don't they will be fined and if they do, but it's not enough and you qualify for a subsidy, then they have to pay into the government system $2000.00/employee for the year (first 30 employees they don't have to pay into the government system, but every full time employee after those 30, it's $2000 bucks into the system.) If they DO pay for some insurance, but it's more than 8% but less than 9.8%, this new bill would require businesses to give their employees insurance vouchers so they could go out into the marketplace to get their own insurance.

OK. SO. The marketplace is probably one of the more radical ideas of this whole concept. Shopping for medical insurance will take place in state-run EXCHANGES where individuals can shop for their family, and become part of a group (kinda like a co-op) that gets a better rate. If I understand right, it's how most of the government officials have gotten their insurance, because they have banded together and made their own bigger group. So, if you're self-employeed, or not making a ton of money, or work for a company with less than 50 employees, you can take your employer voucher or your government subsidy and check out the plans in the exchange and opt for a plan. At least a minimal plan, but each state will have 4 levels to choose from. (Bronze, Silver, Gold, Platinum). The insurance companies are now (well, in 2014) to allow the same rates for people inside a plan and for outside a plan and all plans must be "in the interest" of the people. The theory is this bill will inject competition into the medical insurance field, so even the average guy who's been paying for his own insurance can get a better deal on the exchange. The bill also expands the coverage of Medicaid so they can cover more people in the government's program if it's necessary. ALL of the subsidies and appeals about qualification as well as oversight of the state exchanges will be part of the Department of Health and Human Services. It's already a government department, they just got a whole bunch more responsibilities in their laps.

So, when is all this going to happen? Like, SHAZAM? No. The bill was passed by the House, and now the Senate and the House will go back and forth working out the terms. Plus, there's 2 more elections before it's supposed to go into action. One of the reasons people have been upset that this was being "pushed" through was because there's a Democratic majority and so, the chances of it passing were REALLY good, especially since, in these times, most all major decisions are decided by party lines [which I will get more into when I have my say on the next post.] Another reason for people getting more upset is that they're mandating that we HAVE to have insurance . . . [again, later I can talk about that.] There has been some issues (quite a lot, actually) about this new bill allowing money from the federal government to be used to fund abortions. It's one of the reasons why they weren't sure the bill would pass because several of the Democrat representatives wouldn't vote for it UNTIL President Obama signed an executive order specifically stating that no federal monies would be used to fund abortions. What we have now is that there canNOT be any lifetime caps OR annual caps on existing health coverage. SO, if you get really sick, you can't be kicked off your insurance for using up too much money. Children cannot be excluded from insurance coverage for pre-existing conditions and can stay on their parents insurance until they're 26, guaranteed by this bill. Until the "exchange" program is available (in 2014) there will be a temporary "high risk" National plan that's available for some, and a credit available to senior who fell into the "gap" of the Medicare prescription plans. Also, effective immediately, businesses that already offer insurance to their employees will recieve tax credits of up to 50% of their premium costs (that's a big plus to businesses.)

Is this the answer? I do not think it's the complete answer. I can see where there is a lot of wiggle room for the plan to work one way for the good of the people and another for the tighter control by government . . . but that gets all too personally motivated for me, to keep it simple, so I will have to talk about that next.

Hope this helps, Stac.

15 comments:

Stac said...

Whoa! That is complicated!! Thanks for taking
the time to explain it a little simpler for me.
Still not sure what side I would be on. I mostly
just want to know how much money is it gonna
cost me and what other effects it will have on my
family. It just sounds like one big mess right
now and according to everyone on FB (minus you)
the world is coming to an end and we are all
gonna die. I am not sure what I think about all
this health stuff but I think everyone needs to simmer
down a bit. :)

Jeannie said...

Scary to think that is the simplified version. :) I'm frustrated by the lack of unbiased media outlets, just like I was during the election. And all the partisan stuff drives me crazy. I think everyone has their opinions based on the experiences they have had so there is definitely at least two legitimate sides to it all. I can understand employers being worried about the survival of their business but I can also see the need for many more people to be insured. I wish there was a more apparent middle ground and not so much partisanship and animosity. Should be interesting!

Beth said...

No matter what side you, I, or anyone else takes on this matter, you make me proud for your intelligence and understanding of the basic issue. This is a huge issue. No one side will be ALL right and no one side will be ALL wrong. It shouldn't have to be so hard to come up with workable program. But, whenever monetary profit is at stake, there will be parties who will not be looking after what is best for everyone. Problem is, what's "best" for one, isn't necessarily "best" for another. If your child has cancer and you and or your husband got laid off their job and you have no insurance,you might think it would be "best" for your child to have coverage. But, if you're in the upper income bracket, helping to pay for not only that child, but others that you may deem are not so deserving, you might not think it's such a good thing. So...compromise seems to be the answer. It usually is, in politics. I just think that the system was way broken and while this might not be the complete answer, it's a step in the right direction. People have been talking about the need for healthcare reform for over a decade and it finally has happened. Good or bad, at least the Democrats got SOMETHING done about it.

John Petersen said...

Socialist medicine rocks! I loved it every time I got a chance to try it in france. I can't wait until going to the hospital is as great as going to the DMV.

I really really tried not to post, but I just couldn't help myself.

Kathy said...

This is such a complicated problem and there's no simple solution. I just think all the gloom and doom is silly. The whole idea that this is not what "the people" want is a bit presumptious. Every poll I've seen here in the most condervative state in the US shows that the majority is for health care reform. It's time to work together and stop fighting. Thanks, Sarah.

MollyE said...

Hmmmm. Oh dear. I hope we can still be friends. I guess we made it through the Obama posts, and hopefully I can make it through these too. You are one of my favortie people, so I guess we can just agree to disagree. All I know is that my son has been on Medicaid for the past 3 years and government run health insurance is a black hole nightmare. Ugh! Love ya!!

Dylan said...

Jeannie, there is an unbiased media outlet. It just doesn't run 24 hours, filling up the time with informational diarrhea. Try watching the NewsHour on PBS. It's thoughtful, so in-depth it verges on being boring and very unsexy. I swear by it.

And I think that when we're talking about objectivity in journalism, it helps if we're sure we don't really mean, "journalism that fits our preferred biases." Not judgin', just sayin'.

Yeah, John. Cuz what Sarah outlined sounds *exactly* like socialized medicine. Why, it's like we're living in Europe! THE HORROR! Seriously, what did you hope to accomplish by posting that? Cuz it didn't make you look smart, clever or informed.

And Molly, do you really think that a private insurer would be any less of a hassle? Really? And, as long as I'm being a total comment-jerk, how much did all of this "black hole nightmare" cost you out-of-pocket?

And what happens when your son is too old for the CHIP or Medicaid programs? Because Autism is a pre-existing condition and, under the (well, now-)previous law, insurers could choose not to cover you for that or could jack up your rates if they deemed your son too much of a risk. There ought to be a law against dirty stuff like that.

And furthermore, Medicaid is, basically, a state-run insurance company (and by "state" I mean, "state-by-state" not, "state" in the - gasp! - Socialist use, though if we're being honest that could apply here, too) whereas under the plan that was signed into law, states would pool their resources to purchase insurance from companies at a reduced rate, as they're buying insurance for a bulk group of people. That's the Marketplace/Exchange Sarah explained so wonderfully.

"But wait?" you say, "The states are buying insurance from insurance companies? B-b-but that's a market-based solution. That's a, uh, Capitalist solution."

Um, yes. Yes it is.

So logic follows that this whole "Socailist!" storyline we've been sold is a canard, somethign to distract us from the fact that the Republicans fought a bill – tooth-and-nail, might I add – that will benefit America and that, yet again - as with Medicare and the Civil Rights movement - they're on the wrong side of history.

The Fatman said...

I am not sure if I wanna shake Dylan's hand or kick him in the nuts!

Erin said...

I (heart) Dylan. He's a rock star.

John Petersen said...
This comment has been removed by the author.
MollyE said...

To the comment jerk: First of all I was talking to Sarah who knows more about my son's situation. He has special needs, and is covered by medicaid and private insurance. I pay a whopping $320.00 a month for medicaid in my lovely state, yes out of my pocket. I also pay for my private insurance as well. Of course insurance companies always give you hassles, but medicaid has been double the trouble of our private, and it costs more. Unfortunately we need both.

Dylan said...

@John: I was just saying that poking your head out and yelling "Socialism!" didn't add anything to the discussion, especially when, as I explained, this is not a socialist program. Rather than taking the time to rationally explain why you disagree with this law (the mandate, the initial cost, possibility of rate hikes, elevation of risk pools, etc.), you chose to be glib. I'm not saying you're stupid; you just missed an opportunity.

@Molly: It's true, I don't know your situation and I think it's terrible that people and parents of children with persistent medical issues have to fight with insurance providers - private or state-run - to get the coverage they need. Hopefully this law is a step in the right direction that will lead to the power being put back in the customers' hands rather than the insurance providers'.

But your issue is with your state's Medicaid provider, which, as I explained and as Sarah summarized, has little to do with the bill that has just been signed into law. If you have insurance you like, you keep it. If you qualify for Medicaid, you will continue to do so.

barlows said...

Ohhh, remember, this post was more about just sharing what I learned about the bill that was passed (and now signed by the Pres.) Stac, just don't be apathetic. And no, the world is not coming to an end. Jeannie, totally feelin' ya! Thanks Mom. John, I KNOW you loved France's medical system AND you confessed your love for my husband during one of your experiences, THUS socialist medicine, you, us, we all just go together so well. Kathy, I totally agree with the presumptions being made because EVERY person (regardless of party lines) has agreed health care reform is needed. Molly, if only we could sit on our washing machines in the basement and talk more on these issues, your life, etc. Thanks for being vocal and sharing your experiences. And to the comment-jerk/rockstar, Dylan, I'm glad we're friends and share so many of the same perspectives. I can't wait to read your blog about the health care reform when you get to it . . . yes, I'm egging on that post . . . you know you wanna write it . . . gentlemen broncos, shmentlemen broncos.

John Petersen said...

I wasn't trying to look smart, clever or informed. I adore Sarah, love teasing her about her political views, and just wanted to needle her a bit. Looks like I ended up needling a few of you.

Dylan said...

Not needled. More like "baffled."