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www.goodeatsfanpage.com • View topic - The Affordable Care Act in Plain English

The Affordable Care Act in Plain English

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The Affordable Care Act in Plain English

Postby new cook » Tue Oct 01, 2013 7:16 pm

Jokes of the proper kind, properly told, can do more to enlighten questions of politics, philosophy, and literature than any number of dull arguments.
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Re: The Affordable Care Act in Plain English

Postby tj » Wed Oct 02, 2013 6:10 pm

A bit polemic, but it does address some of the talk about the ACA. Frankly, though it is complicated, it will probably smooth out.

My part-time employer gave me quite a screed about it that will take a while to digest but is very good to have.

I am not really affected since I am on Medicare, but I do keep thinking about my sister, who has lost her husband, is too young for Medicare or Social Security and works odd jobs. At least this may give her some kind of coverage.

What gets me is that a lot of people think they have to change, when their current coverage may be just fine.

Interesting that the signup site has been swamped. Apparently some people see it as worth the trouble and want to use the system.
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Re: The Affordable Care Act in Plain English

Postby new cook » Wed Oct 02, 2013 10:48 pm

I avoided going online to the ACA website yesterday because I knew there was going to be high demand for people to get information and start signing up, so today I did it. Having a pre-existing condition, I haven't been able to shop around for a competitive policy until now. What did I find?

Woohoo! :dance: Since California is a state that's participating, I have several plans from which to choose among each of the four levels (bronze, silver, gold, platinum). The really good news is that even if I select a Platinum level PPO (Blue Cross) I'll still save $200 a month on my premium, and because there's no deductible at that level I'll save another $1500 a year. AND the coverage is more comprehensive. I could cut my current premium costs much further, by at least 50%, if I choose a Bronze or Silver plan with a deductible. I'll have to look at my usual annual medical costs to see which is best.

I read today that some Republican governors are realizing the demand of people signing up for the ACA and are now working to change their status so they can offer a state managed exchange, which will give their constituents more options. Yay! The more people who join, the more costs will be pushed down for everyone.
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Re: The Affordable Care Act in Plain English

Postby Steve G » Wed Oct 02, 2013 11:15 pm

New Cook - Will you be able to keep your doctors, as the President promised?

Many of the plans are limiting physician and facility availability
in order to keep costs down. Going outside the network can lead to
suspension of PP/ACA protections capping cost to the patient .

LA Times: Insurers limiting doctors, hospitals in health insurance market
The doctor can't see you now.

Consumers may hear that a lot more often after getting health insurance under President Obama's Affordable Care Act.

To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state's new health insurance market opening Oct. 1.

New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.

These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation's biggest healthcare expansion in half a century.

Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.

"These narrow networks won't work because they cut off access for patients," said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles. "We don't want this to become a roadblock."

In Los Angeles County, for instance, Health Net customers in the state exchange would be limited to 2,316 primary-care doctors and specialists. That's less than a third of the doctors Health Net offers to workers on employer plans. In San Diego, there are only 204 primary-care doctors to serve Health Net patients.

Other major insurers have pared their list of medical providers too, but not to Health Net's degree. Statewide, Blue Shield of California says exchange customers will be restricted to about 50% of its regular physician network
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Re: The Affordable Care Act in Plain English

Postby okbye » Thu Oct 03, 2013 2:09 am

According to factcheck.org that^ is all propaganda buffalopoop. Like it would be anything but.
I don't mean to sound cold, cruel or vicious but I am so that's the way it comes out - Bill Hicks

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Re: The Affordable Care Act in Plain English

Postby Steve G » Thu Oct 03, 2013 6:48 am

okbye wrote:According to factcheck.org that^ is all propaganda buffalopoop. Like it would be anything but.


And as usual, you would be wrong. :shhh:

The article I referenced is from The Los Angeles Times (not Heritage or Fox),
which reviewed the health coverages being offered in the Los Angeles area.

It is their finding (and their word choice) that to hold down premiums,
major insurers in California have sharply limited the number of doctors and
hospitals available to patients in the state's new health insurance market opening
Oct. 1. In the past, Dr G has been frozen out of certain BCBS/MI plans, it's a
proven method to keep costs down.

Yes, Obamacare's Exchanges Will Narrow Your Choice Of Doctors -- And That's A Good Thing
Robert Pear of the New York Times discussed an emerging concern with Obamacare’s
soon-to-be-online health insurance exchanges. “Many insurers,” he writes, “are significantly
limiting the choices of doctors and hospitals available to consumers” in the market. Many critics
of the health law made note of the news, holding President Obama to account for his repeated
promise that “if you like your doctor, you can keep your doctor.” But here’s the twist: it’s actually
a good thing that insurers are forcing hospitals and doctors to compete on price. Indeed, these
“narrow networks” may be one of Obamacare’s best features.


The Link provided in the original post even confirms:
Can I Still Choose My Own Doctor?

Yes. In fact, the new protections under ObamaCare will make it so that you will have
access to more doctors and better doctors. If you are enrolled in a health plan that
requires you to designate a specific primary care provider, the new law guarantees
your right to choose that doctor yourself. The only stipulation is that the doctor must
be enrolled in your plan’s provider network and must be accepting new patients at the
time. Not all health plans require you to designate a doctor. In those cases, you will be
able to visit any doctor who is enrolled in your plan’s provider network.


And if the plan you choose doesn't enroll your doctor... :think:

Thanks for proving that it was a mistake to poke my toe back into the cesspool and
reinforcing that actual discussion is the last thing desired in this forum. I guess a year
isn't sufficient time for anything to change... and I had such high hopes... :snooty:
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Re: The Affordable Care Act in Plain English

Postby ABwannabe » Thu Oct 03, 2013 9:05 am

I first read this as "The Adorable Care Act in Plain English". That should be the name of animal control laws, or something.

Steve, intelligent discussion can happen, and has, here in Pli-FRY. Yes the conservative viewpoint appears to be the minority but my friends "across the aisle" can, and often do, make good and well-thought out points.

You just have to look past or through the raw opinions and insults (intended or just perceived). When it stops being intelligent, then just stop discussing. My approach is: when I start thinking of responding out of offense, I stop responding. Once I become offended, either I'm taking things too personal, or the other person is getting too personal. In either case, it's time to "walk away. Just walk away" as AB says.
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Re: The Affordable Care Act in Plain English

Postby Steve G » Thu Oct 03, 2013 10:45 am

ABwannabe wrote:intelligent discussion can happen, and has, here in Pli-FRY

No argument from me. the key operative is CAN. I still read most of the discussions here.
Ironically, I wasn't even looking for intelligent discussion - I know that isn't possible if I'm involved. :wink:

I simply asked a question to an individual, based on that individual's experience with the signup process.
I've read stories, opinions and seen propaganda from both sides on what is coming, I thought it interesting
to get an actual 'boots on the ground' perspective from someone that has experienced the process at a deeper
level than I will anytime in the near term. After my retirement, that may change... :think:

I was not and will not express any opinion on the PP/ACA or current politics and am re-imposing my self-
imposed exile for this forum other than this question. There have been a few times past when I was tempted
to participate, but I really do have more important things to focus on:

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Re: The Affordable Care Act in Plain English

Postby new cook » Thu Oct 03, 2013 12:31 pm

ABwannabe wrote:I first read this as "The Adorable Care Act in Plain English". That should be the name of animal control laws, or something.
:lol: That's very funny. :D

Steve, I think a few things have evolved since the L.A. Times article was published, as recent as it was. But your question is a good one, and something I need to look into.

My primary MD hasn't been part of any plan for many years, he got sick of dealing with insurance companies. But because I think he's the best in the world :mrgreen: I've stayed with him. My current insurance is a PPO plan, so they cover a certain percentage if I stay in PPO and less if I go outside of it. I pay my doctor upfront (and rack up cash back on my credit card), then submit the bill for reimbursement from the insurance company.

Fortunately, most of the specialist referrals, labs, and my hospital are within PPO in the current plan, just not my primary MD.

For this reason, I'm avoiding going with an HMO or EPO through the new exchange and am choosing a PPO. But I will look into whether they will still cover my doctor as out of network. I'll let you know what I find out.

In the meantime, here's another person's experience:

http://thinkprogress.org/health/2013/10 ... e-convert/
Jokes of the proper kind, properly told, can do more to enlighten questions of politics, philosophy, and literature than any number of dull arguments.
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Re: The Affordable Care Act in Plain English

Postby okbye » Thu Oct 03, 2013 1:15 pm

Our choice of doctors is limited by those that accept our insurance plans NOW, it always has been. Workman's comp is my main insurance due to my injury and it is IMPOSSIBLE to find a doctor who takes it anymore. There are 2 urologists in the state that do, one in Tucson, one an hour away. I have been unable to find a primary care doctor since the one I had quit taking it 2 years ago. Medicare, my secondary, is better but still can be difficult. There is no insurance plan taken by every doctor. That is a moot point.

Why do I keep you blocked Steve? Because you cannot post here without insulting anyone who responds to you. Every. Single Time. "Why do I come here" "Nothing has changed" "I should know better" Every. Single. Time. And most times I am too stupid to leave your posts blocked, I think you may have changed. But you never do either.
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Re: The Affordable Care Act in Plain English

Postby Steve G » Thu Oct 03, 2013 7:00 pm

okbye wrote:Our choice of doctors is limited by those that accept our insurance plans NOW, it always has been
True, but with plans being disallowed under PP/ACA, the need to change doctors becomes
more likely, in spite of the admonitions of "If you like your plan, you can keep it" and
"If you like your doctor, you can keep it" made during the pre-vote sales pitch of PP/ACA.
I've had some experience with this - I had to change cardiologists recently, because my original
doc (who I really liked) decided to move to another hospital group. I found a more than acceptable
replacement, but it isn't the same (nor do I attribute any of this to PP/ACA).

okbye wrote:According to factcheck.org that^ is all propaganda buffalopoop. Like it would be anything but.
According to Factcheck(dot)org's Sept 2013 compilation of Obamacare Myths:
Claim: If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor.
FactCheck.org: Misleading.

Obama has repeatedly made this claim, and the White House continues to use the line on its website.
The law doesn’t force Americans to pick new plans or new doctors, but the president simply can’t make
this promise to everyone. There’s no guarantee that your employer won’t switch plans, just as companies
could have done before the law. And if you switch jobs, your new work-based coverage might not have
your doctor as an in-network provider, either.
Sounds like propaganda buffalopoop to me... and considering the source... :think: :wink:

new cook wrote:My primary MD hasn't been part of any plan for many years, he got sick of dealing with insurance companies
Dr G is considering converting her practice to no insurance as well, she stopped seeing Medicaid patients
and stopped accepting new Medicare patients a few years ago because of diminishing reimbursements.
Eventually she's either going to retire because of the changing environment and overhead in the practice
or transition to a position as a cruise ship physician. There is even a possibility of converting her position
as Associate Professor of Clinical Medicine at two of the local medical schools into a full time teaching position.

new cook wrote:I will look into whether they will still cover my doctor as out of network. I'll let you know what I find out.
I would be interested in what you find out. The Michigan exchanges are having technical issues and
since I still currently have employer provided coverage, there is no need for me to access the site.

okbye wrote:Why do I keep you blocked Steve? Because you cannot post here without
insulting anyone who responds to you. Every. Single Time.
Glad you have me figured out, Every.Single Time. Insulting anyone that responds to me... :think:
My anti-social, psychotic episodes aren't well controlled at this time. The meds haven't fully
kicked in yet, but don't fret, I'll be out of your hair momentarily. I do have one last thing to
say to you, okbye, specifically:

My response to your original response was rude and I do apologize for the tone.
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Re: The Affordable Care Act in Plain English

Postby tj » Thu Oct 03, 2013 7:28 pm

When I went from being unemployed, to COBRA, to nothing, to Medicare, I had to make choices when I enrolled in Medicare concerning doctors. I decided to go with an HMO that restricted my choices for a podiaatrist and a dermatologist. I am not stuck there forever. We went through this every time we considered changes of coverage at the office. My boss was very good about bringing us in on the process.

Having to make these choices is a routine part of choosing health plans and has been for a long time.

Good to remember that the exchanges are simply comparative tools. If a company decides not to participate in them, it does not mean that you cannot use that company, just that you have to do the comparing on your own.

It sounds like NewCook will be able to have some possibilities that present an expansion of choices, not a restriction of them.
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Re: The Affordable Care Act in Plain English

Postby new cook » Thu Oct 03, 2013 7:45 pm

^^^ EXACTLY, tj. I agree with you on all points made, and yes — it is a major relief to me to finally have real options.

Steve, to clarify, my doctor accepts Medicare, it's the private insurers he dropped. He was sick of them trying to tell him how he could and couldn't treat his patients. I just called his office to verify that he does indeed accept Medicare, but also to find out if they knew if the policy I'm looking at switching to would reimburse for out of network doctors like him. As far as his staff knows, the answer is yes but they recommend I call Blue Cross to be sure.

I'm traveling right now so probably won't make that call until tomorrow or Monday, but I'll keep you posted.

Btw, did anyone check out that link I'd posted? I thought it was pretty great. :)
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Re: The Affordable Care Act in Plain English

Postby Steve G » Thu Oct 03, 2013 8:10 pm

new cook wrote: private insurers...He was sick of them trying to tell him how he could and couldn't treat his patients

Understood. Dr G could also tell some pretty harrowing stories about CMS and their oversight,
if not for HIPAA restrictions. BCBS/MI is the primary carrier for the Autos, they make most
of the rules in the area. The Medicaid population in our immediate area is relatively small,
there is a sufficient provider pool to handle care. That's not true for other parts of the region.

tj wrote:Having to make these choices is a routine part of choosing health plans and has been for a long time.

I guess I should feel fortunate. I've had the same set of doctors for the past 25+ years, with
the one previously noted exception.

new cook wrote:Btw, did anyone check out that link I'd posted? I thought it was pretty great.

I started to read it, but was called away to a meeting. It's good to see that some will benefit.
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Re: The Affordable Care Act in Plain English

Postby new cook » Fri Oct 04, 2013 3:16 pm

Steve G wrote:
new cook wrote:Btw, did anyone check out that link I'd posted? I thought it was pretty great.

I started to read it, but was called away to a meeting. It's good to see that some will benefit.

Yes, it is. I think it's also important for people to understand why some people may not.

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Re: The Affordable Care Act in Plain English

Postby okbye » Fri Oct 04, 2013 4:03 pm

That doesn't match the figures on the ACA site, are those state regulations?
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Re: The Affordable Care Act in Plain English

Postby new cook » Fri Oct 04, 2013 10:29 pm

okbye wrote:That doesn't match the figures on the ACA site, are those state regulations?

There is one Federal poverty level but when it comes to Medicaid benefits each state can set their own threshold, whether higher or lower, for qualifying to receive aid. There are also different thresholds by category of recipient: children, pregnant women, etc.

The FPL in 2013 for a family of 3 is $19,530. In Alabama the threshold is 16%, that is a family of 3 must have income equal to or lower than $3,124.80 if they're to qualify to receive Medicaid.

In 2013 the Medicaid threshold in Minnesota is 215% of the FPL for a family of 3, so their income must be equal to or lower than $41,989.50 if they're to qualify.

I need to run off right now, so don't have time to look up 2014 numbers, but with the Federal Medicaid expansion families can earn up to 138% of the FPL to receive a supplement for ACA premiums. States who have accepted the expansion can exceed that percentage, and Minnesota is one of those states. Alabama has not accepted the expansion for its citizens so you really have to be dirt poor before qualifying for any aid.
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Re: The Affordable Care Act in Plain English

Postby okbye » Sat Oct 05, 2013 1:38 am

But that is already their Medicaid threshhold right? It doesn't really have anything to do with the new law, it's bunnypoopish state laws to begin with. Sounds like some states have poorly funded Medicaid programs and their citizens need to do something about that. They should have before now anyway, what are these people doing now for medical care?
I don't mean to sound cold, cruel or vicious but I am so that's the way it comes out - Bill Hicks

"Just because I don't care doesn't mean I don't understand.“ Homer Simpson

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David Mitchell: "Worry about death."
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Re: The Affordable Care Act in Plain English

Postby new cook » Sat Oct 05, 2013 8:52 am

okbye wrote:But that is already their Medicaid threshhold right? It doesn't really have anything to do with the new law, it's bunnypoopish state laws to begin with. Sounds like some states have poorly funded Medicaid programs and their citizens need to do something about that. They should have before now anyway, what are these people doing now for medical care?

Yes and no to your first two questions. Medicaid is a joint Federal and State program.

Maybe Kaiser can better explain what Medicaid has to do with the ACA:

Kaiser Foundation wrote:The ACA opens Medicaid to millions of uninsured adults.
The ACA expands Medicaid by establishing a new Medicaid eligibility group for adults under age 65 with income at or below 138% FPL.

• These adults make up about half the uninsured. Accounting for enrollment among adults who gain Medicaid eligibility due to the expansion, as well as increases in participation among children and adults eligible for Medicaid prior to the ACA, Medicaid enrollment is expected to increase by 21.3 million by 2022.20 21 (Note: The ACA does not change Medicaid eligibility for the elderly and people with disabilities.)

• The Medicaid expansion is effectively a state option. Although the ACA required states to expand Medicaid, in its June 28, 2012 ruling on the constitutionality of the ACA, the Supreme Court curtailed HHS’ ability to enforce the requirement. Specifically, the Justices ruled that HHS cannot withhold federal matching funds for the “traditional” Medicaid program if a state does not implement the Medicaid expansion. The Court’s decision effectively converted the Medicaid expansion to a state option. States that do expand Medicaid must expand it to the 138% FPL threshold to receive the enhanced federal match.

• Non-citizens will continue to face restrictions from Medicaid under the ACA. Lawfully present immigrants will continue to face the five-year waiting period or, in the case of some categories, remain excluded from Medicaid. Undocumented immigrants will remain ineligible for Medicaid.


Some states, like Alabama, rejected not only setting up a state run exchange that could have offered their people more insurance options, but they also refused to accept the additional federal funds for Medicaid expansion. In those states, like Alabama, many uninsured people are still left without coverage they can afford but only because their state doesn't want to help them by participating.

And yeah, I agree: the citizens of those states need to do something about that, but as I said earlier you would not believe the buffalopoop they've been fed and believe. So instead of being angry with their governors they're blaming "Obamacare" for "not working."

I can't tell you how many times I've had to post this, in addition to other info, in an attempt to set people straight:

http://www.politifact.com/truth-o-meter ... -care-law/

But sadly, and frustratingly, there are those who will not accept any new information.
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Re: The Affordable Care Act in Plain English

Postby tj » Sat Oct 05, 2013 1:29 pm

Thanks, new cook. The Politi-Fact info is actually very helpful. Further, it demonstrates that a lot of people are operating on hearsay and panic.
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