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Obama Cares About Me?
September 12, 2011 1:32 PM   Subscribe

Can someone please explain to me, simply, how my life will be better with Obama's health plan?

I'm a political atheist, so I have no loyalties to a party and its advocacy or objections.

All I've noted, as an existing participant of an HMO, is that since the legislation was passed my insurer, Regence, did the following:

Raised my premium, raised my annual deductible (outrageously) and cut back the services I will receive. The only "plus" to this has been getting one free physical checkup a year.

What am I not seeing or understanding?

The simpler the explanation the better -- as I know this topic can stir up passion in folks -- but I'd like to understand in a clear, simple way that's free of partisanship and/or rhetoric.

Thanks.
posted by zenpop to Law & Government (27 answers total) 20 users marked this as a favorite
 
The health care bill that passed is a huge mess. That much is not genuinely disputed by any of the actual policymakers on either side of the political aisle. Most of its problems are the result of the procedure by which it passed and the fact that what passed was essentially a working draft - which resulted in unfunded mandates and contradictory provisions. I won't go into all of that here. Suffice it to say that I have worked and continue to work closely with the issues on both sides and nobody I know who is in the healthcare law world is happy about it.

So, how will your life be better? In my humble opinion, your life will be better because this mess of a health care law forces policymakers on both sides of the aisle to fix it. Republicans never cared about fixing America's health care system until now. So that's a blessing. Democrats couldn't agree on how to fix it, but now they're forced to try to stick together to actually steer the ship. And that's a blessing.

Your life will be better with Obama's health plan because it will be the catalyst for the next health plan.
posted by The World Famous at 1:37 PM on September 12, 2011 [10 favorites]


Well, the simple answer to your question is that many health insurers have been using health reform as an excuse to increase premiums. I dont know the specifics of your financial situation however you can go to http://www.healthcare.gov/ and see how it will benefit you.

Ultimately there are two things here. it may be more expensive but your insurance has gotten better overall. Your insurer is required by law to cover you, they can no longer drop you for preexsisting conditions (such as being a woman) and must cover you. Thus it has improved your insurance. In theory the state exchanges, which should be set up by the states, but they arnt really moving on it would make your insurance even better.

The second issue is that this will result in millons of more Americans receiving health insurance. It may not help you directly, but it makes society overall more productive and reduces costs in the health care system, people stop using emergency rooms and instead go to General Practitioners. Thus it will ultimately decrease the costs of health care, if the insurers pass that on to the customers may be a different question.
posted by kevinhartmn at 1:42 PM on September 12, 2011


It's worth noting, actually, that the plan Obama signed into law has not actually taken full effect, so Regence was not forced to raise its premium by the plan in and of itself. (Whether its board members voted to do so becuase THEY were spooked by the plan may be another story.)

As I understand it, since you were covered anyway, you may not have been one of the people that was being addressed by the bill as such -- PROVIDED that your health stays the same.

BUT:

Say you got cancer next year, and left work to take care of your treatment. Now say that you beat cancer, and tried to get a better health plan. The current health plan states that no insurance company can turn you down because "oh, gee, you had cancer last year, that's a pre-existing condition."

Or: say that you worked for a company that didn't offer health insurance as a benefit, even though the company was stinkin' rich. They'd have to start.

Or: say that you worked for a company that didn't offer health insurance as a benefit, and was small enough and broke enough that it just plain couldn't, and you had to get it yourself. You would be able to get a deduction on your taxes for that.
posted by EmpressCallipygos at 1:43 PM on September 12, 2011 [15 favorites]


Raised my premium, raised my annual deductible (outrageously) and cut back the services I will receive. The only "plus" to this has been getting one free physical checkup a year.

For one thing, eventually it'll make it easier to switch healthcare providers that are shafting you on premiums, because they won't be able to decline you for pre-existing conditions. Once the mandate goes through and everyone is in the system, theoretically costs will go down for everyone.
posted by empath at 1:44 PM on September 12, 2011 [6 favorites]


since the legislation was passed my insurer, Regence, did the following: Raised my premium, raised my annual deductible (outrageously) and cut back the services I will receive.

Ask yourself if Regence's actions were in any way linked to the new law. Might Regence have raised your premium and deductible and cut service anyway? I have never known an insurer to lower premiums, lower deductibles, and increase service.

The one huge thing that is obvious right away is that if you get something like cancer or diabetes now, you will still be able to switch insurance later. Insurers cannot reject you for having a preexisting condition. Historically it has been very hard for people with a preexisting condition to get new insurance, which can affect decisions on work, moving from state to state, etc.
posted by rikschell at 1:45 PM on September 12, 2011 [1 favorite]


The simple version-- once the ACA takes full effect:

You can't be turned down for health insurance if you have any pre-existing conditions

If you're under 26, you can stay on your parents' health insurance (this has already gone into effect)

Insurance can't cap your "lifetime" payouts at $1 million, as they usually do, leaving those with severe problems out to pasture (and who can't then be re-insured, given that they'd be turned down for having a pre-existing condition)

If your income is too high to qualify for medicaid but too low to afford insurance on the individual market, you will get subsidies to pay your health insurance bill.
since the legislation was passed my insurer, Regence, did the following:

Raised my premium, raised my annual deductible (outrageously) and cut back the services I will receive. The only "plus" to this has been getting one free physical checkup a year.
Keep in mind that insurers have done that every year for the last 20 years or so.
posted by deanc at 1:48 PM on September 12, 2011 [15 favorites]


You might want to look at the Kaiser Family Foundation's page on Health Reform: The Basics. Start with their summary (PDF).

But here are a few points:

If you get sick, you will still be able to get health insurance.

If you lose your job, you will still be able to get health insurance.

If you get poor, you will be able to get subsidized health insurance.

If you get very poor, you will get free health insurance.
posted by Mr.Know-it-some at 1:48 PM on September 12, 2011 [2 favorites]


Don't fall into the post hoc ergo propter hoc fallacy. Just because your insurer raised your premiums, it does not mean that Obama was responsible.

In addition to what others have said upthread, I'd also point out that allowing people to remain on their parents' health insurance for longer means that the people on whom you rely, such as doctors and lawyers and other people with advanced degrees, will have less debt burden and less health problems to worry about, meaning that their money will be spent more productively elsewhere in the economy and that their studies will be impeded less than if they have to worry more about finances.
posted by Sticherbeast at 1:49 PM on September 12, 2011 [6 favorites]


Regence was going to raise premiums anyway. They have lost a number of very large groups. As was already mentioned, the whole plan doesn't even go into effect until 2014, so it's not likely that Regence was forced by this law to raise it's premiums. They also have not been the only ones to raise them, it's just the way it goes in insurance land.
posted by DrGirlfriend at 1:54 PM on September 12, 2011 [2 favorites]


This 2010 .pdf report about insurance in Oregon might be of interest. (I found it via the Regence Wiki Page, which is interesting in and of itself, as it includes information about executive compensation.

On page 15:

"In 2008 and 2009, however, the individual market experienced sharp increases in annual premiums, averaging 17.7 percent and 17.1 percent, respectively. One reason is that in 2006, following a profitable period, Regence Blue-Cross BlueShield of Oregon lowered its rates by 16 percent. Regence had the largest share of the individual market and its action prompted many other insurers to suppress rate increases. It soon became apparent that insurers could not maintain these artificially low rates in the face of continuing increases in medical costs, forcing them to increase rates significantly. As Figure 2-4 shows, rates increased significantly in 2008 and continued to rise in 2009."

Looks like a 17.1 % increase for individual insurance product premiums in both '08 and '09 - was your increase in line with that? Group rate increases during that period were somewhat less (around 11%) but still significant.
posted by anastasiav at 2:02 PM on September 12, 2011


As several have stated, what was passed was a messy working draft. Mr Know-it-some underlined the fundamental principles.

As someone who has always lived in countries with public healthcare, it's hard to understand what all the difficulty in the US is about healthcare. In a way, we tend to think of the healthcare system in much the same way as you might think about your toaster. It's there, it works (mostly), but you don't really talk about it much. It would be certainly very weird if half of every magazine were ads for special kind of bread or toaster add-ons, and basically unthinkable if you could only use one manufacturer's bread in your toaster and/or your right to make toast would be revoked if you'd previously had a bagel stuck in yours.
posted by scruss at 2:07 PM on September 12, 2011 [20 favorites]


One of the most obvious examples of a positive change I have heard was via this NPR segment from last September. Some medical problems, combined with yearly or lifetime limits on coverage, have resulted in people either having to change jobs and plans on a regular basis or being flat-out denied coverage for having a chronic condition.

The legislation has already removed lifetime limits. The so-called death panels that were name-checked by politicians attempting to discredit the bill (which is another issue entirely, but hold with me here)? Imagine having a possibly-deadly illness, and being told by your insurer that you were no longer covered so you'd have to seek out whatever treatment you can still get, at great expense. Medical bills have been one of the leading contributors to bankruptcy.
posted by mikeh at 2:21 PM on September 12, 2011


What everyone else has said, and yes, they would have raised your premiums anyway. This is what single and family premiums have been doing since 1999.

My usual disclaimer: I work for KFF, but not on the policy side, and had nothing to do with the research/writing/creation of this chart or its associated report.
posted by rtha at 2:22 PM on September 12, 2011 [1 favorite]


(Okay, feel 100% free to dissuade me from this, because I don't really like my thoughts and would be glad to be wrong.

Here's what I expect to happen: Most large employers will worsen (or get rid of) the coverage they provide employees in an attempt to force employees into the market, figuring that the fines for doing this are cheaper than providing insurance. There are no price caps - as I understand it - on insurance, so all that insurers have to do is keep raising the rates together, with all companies basically accepting that premiums will jump every year. I can't be turned down for insurance, but as I understand it I can pay a MUCH higher premium if I have a pre-existing condition, high blood pressure, etc.

Middle class families will get completely screwed because we will make too much to get subsidies but we won't be able to afford whatever ridiculous monthly rates that most of us will have to pay. It's like car insurance - I was getting screwed on that too because I live in a redlined neighborhood - $200/month in 2007, never had an accident, late twenties woman with a Chevy Prism). My parents paid under $100 for two cars in the suburbs, by comparison.

My employer is basically already using the new law as an excuse to trash our plan, which used to be quite good.

I think things are going to a lot WORSE for most people, with some gains for people who were just grievously screwed under the old system - the people who couldn't get insurance for ANY price. Those folks will just go from being 100% uninsurable to being impoverished by their insurance. Unfortunately, I'll be joining them.

(Again, you're welcome to dissuade me and I will gladly eat my words...but I wouldn't trust this dog's breakfast of an administration on anything)
posted by Frowner at 2:40 PM on September 12, 2011


Raised my premium, raised my annual deductible (outrageously) and cut back the services I will receive. The only "plus" to this has been getting one free physical checkup a year.

What am I not seeing or understanding?


Insurers have been doing the same thing every year for over a decade, which was a big part of the impetus for trying to reform health care. Keep in mind too that your employer, if that is who you have your insurance through, shapes the cost and benefits offered through your health plan. Both may see a convenient scapegoat in the health care reform legislation.
posted by Good Brain at 2:55 PM on September 12, 2011


Here's what I expect to happen: Most large employers will worsen (or get rid of) the coverage they provide employees in an attempt to force employees into the market, figuring that the fines for doing this are cheaper than providing insurance.

Employers must provide affordable (<9> 167.00 dollars per month per employee, I suppose it might be worth it to them to just pay the fines, but why not offer the perk of insurance to employees in that case?
posted by oneirodynia at 5:13 PM on September 12, 2011


I believe the plus you attribute to Regence below is actually a mandate of Obama's plan, going into effect now. So that's what it has done for you so far.

"Raised my premium, raised my annual deductible (outrageously) and cut back the services I will receive. The only "plus" to this has been getting one free physical checkup a year."
posted by Tandem Affinity at 5:23 PM on September 12, 2011


Keep in mind that the increases in your rates (and the lower quality of your insurance) is probably more a factor of your employer deciding they don't want to pay as much for your insurance as they used to. In fact, starting soon, employers will have to actually tell their employees how much they're paying, as a result of the act.

And, if it wasn't your employer, it was probably the insurance company just getting ready, because soon they won't be able to freely increase premiums anymore.

It's starting to look like a mandate in the legislation that requires plans to spend 80-85% of their premiums is already lowering premiums.

In addition, any increase of 10% or more will be automatically scrutinized by the federal government and states, which started just this month.

What else do you get? Well, starting next year, preventative measures cannot come with a co-pay. If you're a women especially, that means reproductive checkups and preventative medicine.

To double what others have said: You won't be able to denied for a preexisting condition. You will be given assistance if you cannot afford insurance. There will be an easier-to-shop exchange system that lets you compare products if you're on the open market. They will be required to give you simpler explanations of their policies.
posted by General Malaise at 5:42 PM on September 12, 2011


There are no price caps - as I understand it - on insurance, so all that insurers have to do is keep raising the rates together, with all companies basically accepting that premiums will jump every year.

Wrong. The law includes a medical loss ratio (that means benefits paid from premiums) of at least 80% for small plans and 85% for large plans. This means that if the insurance company pays out less than that amount in benefits, it has to refund the excess. So raising rates without increasing the benefits paid gains the company nothing. They have to refund it.

I can't be turned down for insurance, but as I understand it I can pay a MUCH higher premium if I have a pre-existing condition, high blood pressure, etc.

Wrong again. Insurance companies will not be allowed to charge higher rates for pre-existing conditions. This is one of the reasons for the insurance mandate. Otherwise people could game the system by waiting until they develop an illness and then sign up for insurance.
posted by JackFlash at 9:43 PM on September 12, 2011 [1 favorite]


You now have more security.

Americans have very little security compared to other developed nations, but it's a step in the right direction.

Should you invent (what you think will be) The Next Big Thing, and suddenly you want to quit your job so you can take a risk and try to make your fortune, now you have one less thing stopping you. You're one checkbox closer to starting your own business being a wise risk worth taking, rather than a very dangerous one from which you might never recover.

You still have a ton of other things stopping you (ironically The American Dream is far easier to pursue and attain if you're not in America) but some of the more dire healthcare consequences of entrepreneurship have been reined in.

And maybe you don't start a company, but maybe someone else decides that now they finally can - and maybe you'll benefit from that?
posted by -harlequin- at 2:01 AM on September 13, 2011 [1 favorite]


A thought:

The only "plus" to this has been getting one free physical checkup a year.

With all due respect, that's a mighty big plus. Especially when you consider that a lot of other people are getting that -- many of them people who hadn't had it before.

And when that many more people get a free checkup, that means more people have serious health problems caught early, which means their treatment will not need to be as extensive, which means it'll be cheaper.

Which means the insurance companies won't have to pay out as much, which means they won't have to raise their rates as much. If at all.

Another thought: does anyone else get the feeling raymorphic's comment is a bit "Pepsi Red-State"?
posted by EmpressCallipygos at 5:05 AM on September 13, 2011


(I didn't read the other responses, I work at a health insurance company)
While it's true that health insurance companies are raising premiums annually due to increased costs, I think it's probably not correct to assume that Regence raised premiums due to any healthcare legislation.

Did you obtain this insurance through your employer? If so, this will apply to you. Your employer is generally going to be the biggest mitigating factor for your insurance cost. If you look at two employees at two different companies with the same insurance plan, one could be paying more (sometimes thousands more). While the policies could be priced differently due to the "risk" of the employer's members, it's more likely due to the fact that each employer's contribution toward the overall insurance cost varies. If you get any sort of benefits statement or income statement, you might be able to compare year over year to see if your employer has reduced their contribution.
posted by smalls at 8:11 AM on September 13, 2011


Seconding harlequin's statement above: be sure to consider the indirect effects on you now that entrepreneurs and inventors have a little more freedom to create cool things.

As an anecdote: I was able to quit my finance job to join a small tech/sports start-up focused on helping kids improve their fitness and get into college because Massachusetts allows me to purchase health insurance on the state run private health insurance marketplace.

It would have been a much different consideration if my only option were employer-sponsored healthcare, and I may not have left. And I honestly think my new position is better for society as a whole.

All that said, this was due to Massachusetts' health insurance program, and not Obama's national one. Just wanted to point out the type of indirect effects that may benefit you without you realizing.
posted by losvedir at 8:26 AM on September 13, 2011


As you requested leaving the politics out of it:

Removing the pre-existing condition clause is a big one.

I disagree with the kevinhartmn's comment of "such as being a woman". I am a woman, and I have not been denied for a pre-existing condition. However my husband is a Type I diabetic so when we change insurance companies we are quite familiar with proving he has continuous coverage. Clearly when you loose your job you are able to purchase COBRA, but this is not available if the company goes under. In some states the state insurance premium is so high it is difficult to afford - similar to COBRA. We have paid for COBRA, but when we moved from one state to another in search for jobs and tried to purchase private insurance ourselves we were unable to because of his pre-existing condition. I recently went through a serious medical condition which is considered to be a pre-existing condition to a new insurance company.

The ability to purchase insurance regardless of state lines is important.
As losvedir stated, the ability to obtain affordable insurance without a job is helpful because it opens the door for those that want to leave their companies, or start their own company. It is my husband's pre-existing condition which I believe caused us to loose our jobs at the small company in the state we moved from. I believe insurance related discrimination is rampant. Removing employers from the mix as much as possible is good. I find it creepy my past employers know so much about my own medical health. Granted - they were paying for most of it. Though the healthcare plan does not remove employers completely it is a start.

The only "plus" to this has been getting one free physical checkup a year.
I agree with you that this isn't much of a plus. I did go to my doctor regularly. My serious medical condition did not occur because of my good diet and healthy weight. It took several specialists before it was found.
posted by BuffaloChickenWing at 8:48 AM on September 13, 2011


[folks, this is not where we stump for our own platforms. Question is specific, your answers nee dto be or you need to take this to email or metatalk.]
posted by jessamyn at 8:57 AM on September 13, 2011


Many great responses here and it's difficult to single just one out as 'the best'. Thanks to those who responded.

To address some of the questions presented:

No. I am self-employed. So the increase has nothing to do with my employer.

Yes, a free physical each year is a benefit, and I see the preventative angle of course. But it hardly rationalizes the big increase from Regence. I think my doctor charges 200 dollars for the kind of physical they will allow. Meanwhile my monthly rate (having turned 55 last month) is jumping a whopping 100 dollars A MONTH. I'm going to shop around for another provider.

And yes, my understanding is that the 'free physical' is related to the Obama plan -- something scheduled to occur before 2014.

Being self-employed I will most likely drop my health plan in 2014 and take the IRS penalty, and then simply sign-up for insurance should I need it after the fact -- seeing that I can not legally be turned down. I've heard many self-employed friends discussing this same strategy -- as awful as that sounds. But what I'm paying now is OUTRAGEOUS -- and this is simply for 'catastrophic' coverage.
posted by zenpop at 10:45 AM on September 14, 2011


I see the preventative angle of course. But it hardly rationalizes the big increase from Regence. I think my doctor charges 200 dollars for the kind of physical they will allow. Meanwhile my monthly rate (having turned 55 last month) is jumping a whopping 100 dollars A MONTH. I'm going to shop around for another provider.

This brings up a good point -- you have the freedom TO shop for another provider without being unnecessarily penalized by a "preexisting condition" if you had one. Insurance companies had free reign to raise their rates like this, and a lot of people used to be trapped with them becacuse other insurers would deny them service becuase of "pre-existing conditions." Now, they have the freedom to shop around for another provider, because someone CAN no longer be turned down for a pre-existing condition.

What this means to you is, no other insurer can claim that they're turning you down because 'oh, look, you had high blood pressure last year, that's a pre-exisiting condition" or something like that. So you CAN shop around and punish Regency for raising your rates like that.
posted by EmpressCallipygos at 11:03 AM on September 14, 2011


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