Panoptic Posted November 19, 2013 Posted November 19, 2013 I am 100% uneducated in economics and law is too damn confusing to follow for me. I've been looking into ObamaCare and have a few questions about it. Please bear with me, I have absolutely no idea how any of this works and I would like to understand this because I live in the U.S. (for now). If ObamaCare contains an individual mandate does that not mean that all 315 million Americans will be forced to obtain healthcare? I watched Stef's video The Truth About ObamaCare and it says that 16 million will be affected but what about the other 299 million people in the U.S.? If you sign up for a private healthcare plan why should I do it through the Obamacare website? Is there some sort of requirement that I must use that site in order to get insurance? I'll probably have more questions after these initial ones are answered. If anybody answering could provide me with reliable sources as well that would be great.
tasmlab Posted November 20, 2013 Posted November 20, 2013 We've had it in Massachusetts for six years. The online exchange is the only shopping place, they will not allow you to buy it outside of the site. Low cost insurance (catastrophic) is illegal due to coverage laws. There's a one month a year (August) where you can buy or switch plans. You can't do anything otherwise. If you don't comply, there is the mandate: a fee paid to the government for 1/2 of the least expensive plan. Both the enrollment period and the mandate are to prevent you from only signing up for insurance only if and when you are sick. The no pre-existing conditions rule. Without the above, they would quickly go bankrupt. The state negotiates rates with the insurers, thereby destroying the pricing system. Premiums go up 17% per year, predictably. The made-to-pay/mandate system has a republicanny sense of personal responsibility or markets, but it is no different if they just made us pay more taxes and then gave the healthcare corporations the money. It's wholesale fascism / third position economics, but nobody in the media or government says that out loud. In MA, the subsidies are generous. If you have a large family, for example, you can be low income and subsidized with a $108K salary. The care itself so far is superb. But I think that is going to diminish quickly. Esp after people start beefing on the price. I could write another 5,000 words on this. Let me know if there is something else you'd like to know. __________________ Here's a reply I've written in the past: MY STORY WITH ROMNEY/OBAMA CARE (surely a re-post) As politically neutral as I can be, I'll describe my experience under the past seven years of Romneycare (the model for this bill) in Massachusetts where I was just an ordinary guy who bought health insurance for the sole and boring purpose of taking my family to the doctor and hedging against catastrophic acute interventions. My first plan I bought on my own around 2004-2005 was about $350/month for husband/wife. I didn't replicate my previous employer plan, as it was too expensive. By around 2006, I had a baby and had to upgrade to a family plan, the premium was about $1,100 per month. Or about $13,000 per year. No deductible, minimal co-pays. No co-insurance. THE MECHANICS OF THE SYSTEM How it works is you go to a website (the connector) and shop for different plans from different HMOs. They are rated Gold, Silver, and Bronze for quality and have different sub-levels based on coverage and premiums. You are only allowed to switch plan for two months out of the year and then are locked in. These two months are the 'enrollment period'. If you are low income, the government will subsidize your payment i.e., they will send a check to the corporate HMO on your behalf. The qualifications are generous. If you have a big family for example, you can earn $108,000/year and still be considered low-income. The HMO, like an employer, sends everybody a special 1099 type document that you file with your taxes. If you don't have one, you get a fine. This is the 'mandate'. The penalty is 50% of the lowest premium. Currently that would be about $6,000 and you still would not have insurance, just the regular bad-debt ER room crap that many endure now. The mandate is the counterweight to the "no pre-existing conditions" aspect. Neither can function without the other. Without the mandate, you wouldn't bother to pay premiums until you needed care. Even that first night in the hospital after the heart attack would be less expensive without insurance than paying the premium month after month. Just to keep this straight - Penalties are paid to the govt - Premiums are paid to the HMO corporations - Subsidies ultimately get paid to the HMO corporations - HMOs pay doctors and hospital systems - Medicare payments are from govt to HMO corporations MORE ABOUT ME So by around 2009 or so my premiums had grown to $1,550 per month or about $19,000 per year. No deductible, reasonable co-pays. Had I stuck with my employer's plan it would've been around $26,000 per year. Finding this rate unattractive, I downgraded to a plan that was only $700/month but had a $10,000 deductible and more meaty co-pays and fewer things covered. For example, ER visits would be $500 co-pay. THE STATE PROTECTS THE CONSUMER AGAINST PRICE GOUGING Premiums are actually negotiated by the state government on the public's behalf by our democratically elected representatives. This is the public's safeguard that the companies won't gouge us. I've gotten several letters in the mail from the state explaining how they have frozen and reversed previous decisions. Rates rise about 15-17% annually. This is a great case study for monopoly buyer vs. monopoly seller, but we can do economics lessons some other time. By 2012 this exact same plan had rose from $700 to $1,200 per month, or around $14,000/year. $10,000 deductible, same coverage. This year I've now switched to the lowest tier of the Bronze i.e., the very lowest payment to be compliant with the law. $970/month or about $12,000 per year. This is the absolutely lowest level of coverage available with the most out-of-pocket cost and the narrowest of provider networks. GREAT CARE The care we receive is generally superb. We go to the doctor frequently. We pursue anything and everything medically. I even got an MRI once because my golf swing was causing me pain in my shoulder. So, congrats everybody. I personally wish it was done differently.
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