Fear, Loathing and ObamaCare

I am sitting at a table surrounded by women, nibbling on a brownie.  Tonight is "Ladies Night Out".  It began with a gorgeous antipasto plate with asparagus wrapped in black forest Ham, prosciutto, pepperoni, Kalamata Olives and artichoke hearts.  Next was meatball & spinach soup.  My waistband started to feel a little tight once I had ingested the Raviolis and some form of sausage/meatball with sauce.  And of course wine:  Pinot Grigio with the Antipasto, and Coppola Merlot with the saucy dishes.  I am replete.  I sigh, contented and laughing as the hostess describes being caught unawares while attending to private business in the head (bathroom to you landlubbers) of her boyfriend's sailboat.  All was fine, until the boat sharply heeled and all of a sudden all the screws on the toilet popped off.  Surprise!  Too much information!

Somehow, the conversation turns Medical Care in the United States.  I state that 75% of bankruptcies in the U.S. are Medical Bankruptcies (I was wrong it's 60% or 3 out of every 5).  And inevitably...it comes up...Obamacare.  I swear it wasn't me!  Paula, the 60+ cook extraordinaire who cooked everything except the Tirramasou, states, "Even Nancy Pelosi said that they didn't know what was in the law when they passed it.  How can it help anybody if they don't know what's in it."

"They know now," I say.  "There's websites for it, just google The Affordable Health Care Act."  Everybody rolls their eyes and groans.  

"Like you can get through it."  says Paula.

"No really."  I say.  "When I was canvassing for the Democratic Party this last fall, I had people attacking me about 'ObamaCare'.  I was able to get down the pertinent facts on 2 index cards back to back (I was wrong, it was 3)."

"Yeah, but how small was your writing?"  laughs Vicky.

"I had to use a magnifying glass," I laugh, "And then if anybody threatened me, I was going to tear them into small strips and swallow them."  We all laugh.

Unfortunately, we are unable to keep on laughing.  Two of the attendees are students, one of them has a small child.  The hostess works 3 jobs, but is covered by her ex-husband's Tri-Care insurance.  I am on disability and receive Medicare, Brenda and her husband are also on Medicare.  The two students are mad, angry, steaming and afraid.  They're sure that they're going to have to pay the penalty fee for not buying health insurance that they can't afford.  "The fee is only $95."  I say.  They're sure I'm lying.  I encourage them to read the website.

Tricia, the student with a child pipes up "UPS is going to lay off a lot of their employees because they can't afford   Obama Care."  she states.  She is really angry.  

"I find that very hard to believe."  I say.  "I have friends who work for UPS and they have always provided excellent benefits.  I can't imagine Obamacare asking them to provide more than they're already giving.  I'd be interested in reading that article."  

The party starts breaking up.  Tricia is going outside to say good-bye to Brenda and the other student.  "I know you just think I'm a stupid student," she says, " but I've read the Healthcare Act and I'm going to get screwed."  

I'm aghast.  I feel terrible that she thinks that's what I think of her.  "I don't think you're stupid at all," I say, "just misinformed and scared."

I am frustrated.  The two students are the very people that "ObamaCare" is intended to insure, those who don't qualify for Medicaid, CHIPs or Medicare.  These are the two that are the most angry and the most sure that they are going to have to pay the penalty/fee for non-insurance.  

Tricia comes back in.  We start drinking Cherry Daiquiris and telling silly stories.  We laugh.  Tricia is still talking to me.  When I leave,  I hug everybody, including Tricia, good-bye.

Throughout the discussion, I kept encouraging everyone to go to the official government website which is: 
www.healthcare.gov/law/timeline/index.html  "There are so many lies out there." I say.  "Don't let them terrify you with lies, ascertain the facts."  I encourage you, the reader to do the same.

Most Prevalent Lies

• "UPS is going to lay off a large part of their workforce because they can't afford to provide the insurance at the level that ObamaCare requires."  UPS is not laying anybody off because of ObamaCare.  They're not cutting health insurance.  What they are doing is no longer providing insurance for employee's spouses who are employed and already covered by their own employer's insurance.  This is a cost-saving move that a number of companies have already been implementing far prior to ObamaCare.  UPS, for whatever reason, is saying that the implementation is required because of ObamaCare and the expected increased in health expenses.  (Steven Greenhouse,  The New York Times, Business Day, August 21, 2013)
• "Obama Care is going to establish death panels and choose who receives expensive life-saving medical interventions."  Boards/Panels are going to be formed that having nothing to do with choosing who lives and who dies.  These "panels"  will be made up of appointees consisting of health care practitioners, medical experts, and consumers to identify procedures and interventions that engage in "Best Practice" techniques and procedures which improve patient outcomes, increase efficiency and reduce costs.  They will make these "Best Practices" known to all health care facilities and practitioners.
• "I am going to have to pay a fine because I can't afford health insurance."  The Affordable Health Care Act is designed for those people who could not previously afford Health Care Insurance and did not qualify for Medicaid or Medicare.  Expansion of Medicaid and CHIP will cover a lot more people who previously did not qualify.  If you live in a state that has chosen not to expand Medicaid and you would have been covered, you will not be penalized.  Between Medicaid expansion and the Health Care Exchanges, most previously uninsured people will be covered.  If you still cannot qualify for Medicaid and can't afford Health Care Insurance, you will be exempt from the penalties.  The Fine is 1% of yearly income or $95/yr, $47.50/per child but no more than $285.00 per family.  This is only for people who CAN AFFORD INSURANCE BUT CHOOSE NOT TO.  In addition, they must pay for all their own health care.
•  "Congress isn't going to participate in ObamaCare."  As part of the AHCA, members of congress will be getting health insurance through the Marketplace (Health Insurance Exchange) in 2014.  This is part of the law itself.

 If you do not qualify for Medicaid, Medicare, CHIPS and are not covered by your employer's insurance, or can't afford your employer's insurance, you can purchase your health care insurance on the exchange starting October 1, 2013.  Coverage is required January 1, 2014.  Enrollment for Health Insurance closes March 31, 2014.  Additionally,   in early July, the White House and the Treasury Department announced a one-year delay in a major Obamacare provision that would have required employers with at least 50 full-time workers to provide health insurance or pay a penalty beginning in 2014.  Employees that would have been covered under this provision are exempted from the penalties.  They can also purchase health insurance on the Marketplace if they wish or can afford to.

I have provided that information from my 3 index cards on "ObamaCare" below.  It is taken from the website listed above.  Since we're in CyberSpace, you won't even have to tear up the cards and eat them should naysayers challenge you.  You can just refer them to the same website. 

In Place Now

• 50% Discount for name-brand drugs in Medicare Donut Hole - some coverage for generic drugs
• Expands coverage of parental insurance for dependants to 26 yrs.
• Small business tax credits
• Increases matching Federal funds for Medicaid (The 14 states that are not participating in the expansion are:  Alabama, Georgia, Idaho, Iowa, Louisiana, Maine, Mississippi, North Carolina,Oklahoma,Pennsylvania, South Carolina, South Dakota, Texas and Wisconsin. The 11 states that have not officially declared their intentions are: Alaska, Indiana, Kansas, Kentucky, Nebraska, New York, Tennessee, Utah, Virginia, West Virginia and Wyoming.)
  
  • $250.00 rebate for Seniors in Medicare Donut Hole
  • Changes in Medicare, Medicaid billing has recovered more than $2.5 billion in fraudulent charges
  • Expands coverage for early retirees
  • Online Consumer Info.
  • Preventive Services Covered:   16 for Adults, 22 for Women/Pregnant Women, 27 for children  
  • Prohibits Insurance Companies from Rescinding Coverage
  • Provides for Appeals & External Reviews
  • Eliminates Lifetime Limits
  • Regulates Annual Limits
  • Insurance companies have to justify premium increases of more than 10%  to qualify for $250 million in new grants and participation in Affordable Insurance Exchange 2014.
  • Increased availability of Primary Care Workforce
  • Federal Grants for Consumer Assistance Programs
  • $15 Billion for prevention and Public Health Programs
  • New funding for constructing and expanding community Health Centers
  • Increased payments to rural health care providers
  • Free Preventive Care under Medicare
  • Employer Insurance must spend at least 85% of profit on health care services, 80% for Individual plans, or refund difference to policy holders.  I received such a refund a year ago.
  • Eliminates discrepancies between Original Medicare and Medicare Advantage to $1000 more per individual.
  • Tests new methods to increase quality and decrease growth in costs
  • Community Care Transition Programs, coordinates care, connects patients to community services, and avoids unnecessary re admissions.
  • Individual Advisory Board decreases costs, increases health outcomes, and increase access to high-quality care by submitting proposals to Congress and the President.  This is the supposed Death Panel.
  • More home and Community based services for the Disabled through Medicaid rather than Nursing Homes
  • Provides Physician incentives to coordinate patient care, increases quality of care, prevents disease and illness and decreases hospital admissions.
  • Decreases disparities due to race, ethnicity and language
  • Provides Cash benefits to adults who  become disabled
  • Decreases paperwork and Administrative Costs starting 10/1/12
  • Starting 10/1/12 link payment to quality outcomes
  • Increases preventive coverage to  state Medicaid programs
  • Increases Medicaid payment for Primary Care Doctors
  • Bundles payment to deliver healthcare more efficiently and increase quality of care in Medicare.
  • Expands funding for CHIP to 10/1/13
  
  
  Starting January 1, 2014
  •  Establishes Affordable Insurance Exchanges
  • The Individual is required to buy Basic Health Insurance or pay a fee.  If affordable coverage is not available they are exempt from requirement to buy insurance.  If you are insured, receive Medicare, Medicaid, CHIPS, are covered by Tri-Care or are a member of a federally recognized Tribe, you will not be assessed a fee.
  • Workers who cannot afford employer coverage can take employer funds to purchase a more affordable plan from the Insurance Exchange.
  • Raises Income Requirement for Medicaid to $14,000 for the individual, to $29,000 for a family of 4, 100% federal funding for the first three years to 90% after 2013.
  • Advanceable tax credits for income between 100% and 400% of poverty line for those ineligible for affordable coverage.  This credit is advanceable and can be applied immediately so that it lowers the monthly premium payment and you don't have to wait until taxes are filed in order to receive it.
  • Members of Congress will be getting their health insurance through the market place.
  • Eliminates Annual Limits
  • Ensures coverage for individuals in clinical trials
  • Ensures coverage for individuals with pre-existing conditions
  Starting January 1, 2015
  • Businesses employing more than 50 persons required to provide affordable health care coverage to employees
  • Payments linked to quality of care, not volume.

   
  Admittedly, this is not perfect.  It does not address inequities in billing nor the outrageous costs of Medical Care in this country, but it does try to address access to medical care, inequities in access and delivery and continuity of care.  If all we do is gnash our teeth and tear our hair or refuse to do anything because the proposed changes are not perfect, nothing will ever change.  A journey of a thousand miles starts with the first step.
   
  Namaste'
   
  Kismet  

   Copyright August 2013