Obamacare - practical discussion

Obamacare - practical discussion


“New England Journal of Medicine published a new estimate done by a team of health and labor economists.”

“The fraction of bankruptcies caused by medical events is just 4 percent. And even among those bankruptcies, it seems that medical bills may be less of a problem than the other things associated with an illness, such as lost labor income.”


The “practical discussion” has turned into a political slugging match.


Maybe just pointing out that she has the same affliction as most politicians - finding the center line of the truth highway. Just to keep this on topic, AFAIK, none of the insurance plans cover the treatment of that illness.


WSJ showing how the network quality of Obamacare plans has fallen and now no plans include access to many top hospitals. Ironically, Medicaid patients are still accepted at those, so you might actually be better off with that if you have a serious problem.


Many of the country’s top hospitals are off limits to patients covered by ObamaCare’s current plans. Take Houston’s MD Anderson Cancer Center, which was named America’s best cancer-care hospital by U.S. News & World Report in 13 of the past 16 years. The hospital’s website suggests that it takes even Medicaid, but it doesn’t accept a single private health-insurance plan sold on the individual market in Texas.

Since Blue Cross of Minnesota withdrew from the individual market in 2016, the state’s Mayo Clinic—once cited by President Obama as a model for the nation—has been off limits to Minnesotans covered by ObamaCare exchange plans. Memorial Sloan Kettering appears out of bounds for every exchange plan in New York. Both of these hospitals are open to some Medicaid patients, though Mayo’s chief executive has predicted publicly that Medicaid patients may eventually have to queue behind their privately insured peers.

The article goes on to discuss Centene, one of the few profitable Obamacare providers, who offers “Medicaid” style bottom of the barrel plans.

the remaining insurers are offering products that look a lot like Medicaid. Centene , a Medicaid contractor, stepped in to pick up more than half the U.S. counties that had no insurer for 2018. Medicaid contractors like this may be the only insurers that can survive in the ObamaCare exchanges.

Centene’s core product is Medicaid managed care. About 90% of its exchange enrollees get premium subsidies, and many rotate in and out of its Medicaid plans.

…yearlong investigation into Medicaid in Texas. The paper uncovered hundreds of cases in which “essential medical care was delayed, denied or not delivered to people with critical health needs.” Many of the insurers that provide Texas’ Medicaid plans offer similar coverage in the ObamaCare exchanges. One of Centene’s subsidiaries has the state’s highest rate of appeals for denials of care under Medicaid, but it offers plans with similar coverage to exchange enrollees.

Since the mandate to buy insurance has dozens of loopholes and has been enforced weakly, millions of healthy people choose to remain uninsured. When they get sick, however, they often enroll and choose the gold and platinum plans with the most generous coverage. These latecomers usually cause insurers to pay out much more in coverage than the insurers receive in premiums and subsidies. Companies like Centene have a solution to that kind of buyer behavior: They don’t offer gold or platinum plans.


What’s the difference between “medicaid style” and medicaid? Because medicaid is pretty comprehensive and cheap for enrollees, I’d love to be able to qualify for Medicaid. What makes these guys’ medicaid-style plans bottom of the barrel?


Their network of doctors often is missing things you might expect, like an ER doc or an anesthesiologist.


Sounds like a great idea. Discuss.


A bit less fraud might help keep down healthcare costs.

The U.S. Justice Department on Thursday announced charges against 601 people including doctors for taking part in healthcare frauds that resulted in over $2 billion in losses and contributed to the nation’s opioid epidemic in some cases.

Remember - if you’re not committing insurance fraud, you’re not getting your money’s worth (and someone else is). :confused:


Highly misleading, given that a CSR’d silver plan is usually as good as or better than gold on the ACA exchange anyway. So the way they limit cost is to reduce the networks, not by limiting the plans under the ACA.

And this was an opinion piece, not a news article in the WSJ.


CSR plans are not available to many people due to their income cutoffs - $12-29k single (and the best plans requiring <$17k AGI), or about 2x this for a family of 4. But you’re right there’s not much that beats a CSR Silver plan if you qualify. For people over 250% FPL and with expected high expenses, selecting a gold or platinum plan would usually be the right strategy, i.e. the one where the insurance company gets the least and pays out the most, so you can see why they aren’t wild about offering these.

So the way they limit cost is to reduce the networks, not by limiting the plans under the ACA.

I agree the main way Centene is cutting costs is by using minimal or substandard networks, and if that means you get care slowly due to delays or have to go through some extended appeal for an out of network doctor when there are no specialists at all in network for your problem, well, that just saves them momey and you pay with your health and your time and hopefully not your life. Sad to think the race to the bottom has gotten this bad this quickly (with Centene being the only option some places), although it was pretty much inevitable given the ACA’s incentives.

And this was an opinion piece, not a news article in the WSJ.

Yes, but the parts I was quoting were the facts about the good hospitals getting cut out of the Obamacare plans. Those definitely aren’t just an opinion, having checked some of the plans in question.


With Medicaid you are getting treated, but not necessarily conveniently or at the best hospitals. Sure it’s not the Mayo Clinic or Cedars Sinai but you are still getting high quality, first world care. A “Medicaid for all” would provide something akin to public transportation or public hospitals (in the states that have them) expanded to everyone, paid for by tax revenue. You can get treated, but it will be with doctors fresh out of school or who willingly accept working for charitable benefit; you will get drugs to treat your condition, but they may not be the latest or may have more side effects than a drug ten times more expensive; and you may have to wait to schedule appointments or in the emergency room after being triaged. But no one dies from not getting treatment and if you get hit by a car, the insurance bills don’t bankrupt you.


I can’t imagine anyone disagrees.

We should spend more money enforcing the law and I’m sure it would pay off in savings.


I think this varies. I’ve seen people claim that Medicaid sucks and they can’t find a doctor and other people claim its the best and they get virtually free medicine at the best doctors and hospitals.


Isn’t this similar to Britain? I believe they have both public and private health care systems.

Of course it wouldn’t take long in this country for it to become “the rich are allowed to live” while the [insert any non-rich person] accompanied by a picture of bereaved family member are forced into ghetto-like, underfunded, understaffed, underpaid, DEATH CAMPS.


Have you seen those “hospice facilities”? Don’t be fooled, they are literally DEATH CAMPS!


With no emoticon, I can’t be certain, but presume your arid humor is showing. :smiley:


You omitted: the Department of Medicine, Cambridge Hospital, the Harvard Medical School, Cambridge, Mass, and the Department of Sociology, Ohio University.

Actually, under ‘METHODOLOGY AND SOURCES’, the NerdWallet study states:

We also used official bankruptcy statistics, released this month through March 2013, from US Courts

Complete and utter gibberish.

Unfortunately for you, those are NOT “medical bankruptcies”.


I’ve seen a number of people reporting fairly high-deductible policies. You are aware that there is no obligation to purchase through the ACA exchange ?

Once again, if you had read my OP on the subject, that is not what I was referencing, but you seem to be like a misguided dog with a bone.


Your mischaracterizations and lying are rather juvenile.


GOP in Panic Over V.S.G’s Admission They Just Don’t Care About Your Pre-Existing Conditions

The V.S.G’s Justice Department is seeking to strike down two of the ACA’s most popular provisions: the rule that insurance companies can’t turn someone away or charge them more based on a pre-existing condition, and the rule that limits how much insurers can charge older patients for their premiums. They are requesting that the court put a halt to those provisions in January of 2019, when enforcement of the individual mandate is set to be terminated. Three career DOJ attorneys withdrew from the legal action and a political appointee was assigned instead to represent the administration in the case.

More than 130 million Americans have a pre-existing condition.