Health Care Thoughts: Obamacare Updates

*grumble* This could have been avoided with single payer.

NC has opted out, including opting out of Medicaid expansion. Kiss our rural hospitals goodbye – the ones that had managed to hang on, that is. As for the estimated 500,000 people who will fall through the cracks, “shit happens”.
Last night our new governor gave a very mediocre State of the State address, where he touted job creation as one of his administration’s main goals. So, I guess killing the estimated 25,000 jobs they figured the Medicaid expansion and the new exchange would have generated are what? Sacrificial lambs??

ObamaCare does absolutely nothing to control health care costs. Health care costs are already increasing and projected to increase more. Private premiums are rising. The CBO estimates it will cost $1.7 trillion over the next decade (instead of the original estimate of $800 billion). Employers are dumping their employee plans. The Medicaid rolls are projected to increase substantially. Only about 60% of the uninsured are projected to get insurance. It’s a special interest group boondoggle. ObamaCare took a messy health care system and messed it up exponentially more. Congress should have just addressed specific issues like pre-existing conditions and specific cost constraint issues. That approach would have gained wide bipartisan support.

Cynthia:

You sort of agree with my “theory of complexity” (the higher the complexity the lower the possible of successful implementation).

There are many “what ifs” In PPACA and some of them might, just might, bring down costs.

A word “chaos” can be applied to the healthcare in general. Everything that has been done lately (I mean so-called improvements) did not do any good to people. Medicine is still not affordable. So where exactly people should get money in a jobless country to have a good treatment? Do they have to go to instant online payday loans? The answer is no. They should not sign up themselves for a debt! Obamacare is such a failure made by the President we’ve chosen for the second time. Well not me personally though. “Complexity” is a very good definition which says it all.

Alicia, I guess you don’t know that most of the Obamacare provisions don’t take effect until next year. Once it does, people who get healthcare insurance through it will, presumably, have access to insurance that includes a prescription benefit.

Why is it that there are still, I guess, a good number of people who think Obamacare has already taken effect–yet it somehow managed to miss them! Do they even know what Obamacare IS?

I was told that here in NC, H&R Block is warning people that they will be taxed heavily if they don’t get insurance and then direct them to Blue Cross Blue Shield. Setting aside that the tax penalties don’t kick in yet and are graduated after that, where does H&R Block, or any such entity, get off directing their clients to a particular insurance provider????

Thanks, rjs. That’s what I get for playing “telephone”. Seriously, I should have double-checked my source.

I got 900 dollars back in refund from Tufts due to the MLR restrictions on admin costs….but people tend to count loses more heavily than gains.

I also would like to compare trends in employers dumping healthcare insurance coverage over time…my assumption is that it has been ongoing as cost continues to go up regardless of Obamacare.

There is some indication the slowing of medical inflation is actually still occurring.

The whole notion of complexity and the private sector is worth exploring as well….reimbursements have steadily decreased for service for the last five years from Blue Cross Blue Shield and others to service providers, and the ‘customary’ fifty minute hour for TX has been abandoned to 45 minutes with commensurate reduction in reimbursement on top of this years reduction overall to rates.

Complexity is so rampant that BC/BS has stopped payments for the last two months and predicts into the end of March before payments begin again. Not a peep?? This is the private sector chaos…how is that not part of a larger re-alignment regardless of Obamacare.

Can someone address Plendil’s comment?

She writes, “Lower income workers with union plans will not be eligible for subsidies, and now the unions want to change the rules. Unions lobbied for this early on but were denied by the Obama administration.”

I don’t understand the comment. Lower income workers with union plans will not be eligible for subsidies, but lower income workers with union plans are not eligible for subsidies WITHOUT Obamacare. And now the unions want to change the rules. OK, what rules? They want Obamacare to allow lower-income workers with union plans to be eligible for subsidies? Why does she object to the unions’ wanting to have that rule changed? Unions lobbied for this early on but were denied by the Obama administration. So now … what?

Employers with union plans are paying higher premiums as the working class pays for improvement in coverage mandated by PPACA. But Obamacare doesn’t begin until next year. So employers with union plans may be paying higher premiums, but it’s not because of Obamacare. If employers, rather than employees, with union plans are paying higher premiums, then it’s the employers, not the working class, that will be paying for improvement in coverage mandated by PPACA, unless the employees’ wages are cut, which is unlikely in a union shop. Or is “employers” a typo, and she meant “employees”?

This can be critical in bid areas such as construction. Is she saying that employers with union plans can’t compete with non-unionized employees because the employers will have to pay more in coverage mandated by the PPACA? But why would that be? Aren’t non-unionized employers and employees subject to the PPACA, too?

What gives? Does anyone know?

Thanks, rjs. I clicked the link to the Washington Times article and flatly didn’t understand it. It was an incoherent rant. Or at least like coming in in the middle of a movie you know nothing about.

So I clicked the Heritage article link. The article is coherent. It also is ridiculous. The highlight is:

“However, it appears the unions were too busy supporting Obamacare to do the math. Unions are now asking for a reprieve from the higher costs in the form of taxpayer subsidies for their lower income workers with employer-sponsored insurance. However, the subsidies are only intended to go to those purchasing coverage in the new exchanges, not to anyone with employer-sponsored insurance.

“To be clear, they want taxpayer subsidies to offset the cost of their insurance while non-union workers in the same predicament would not receive help.”

However, the subsidies are only intended to go to those purchasing coverage in the new exchanges, not to anyone with employer-sponsored insurance. Um, OK, but the union members aren’t employees of the union; they’re members of the union, which is an organization that is in no way affiliated with the union members’ employers.

And while the subsidies may be intended to go mainly to those purchasing coverage in the new exchanges, the reason for that is that almost everyone who already has insurance has it through their employer, which pays all or much of the premiums as part of the employee-compensation package. Which makes pretending that union members are union employees ridiculous.

That last sentence–“To be clear, they want taxpayer subsidies to offset the cost of their insurance while non-union workers in the same predicament would not receive help.”–is, um, well, not clear at all. Or, more likely, not accurate. Non-union workers are not in the same predicament. They get their insurance through their employer, who will be paying the additional premium costs. Thus, the Walmart tack.

I was pretty sure Plendil’s comment was, um, misinformed, or just made no sense, but I thought maybe there was something I was missing. And there was: she gets her news from the rightwing media loop. She should try reading some impartial news sites. I recommend NPR’s website. It’s really informative gets its info from experts and others with actual knowledge of the subject rather than a wacky political agenda. These are important enough issues that she should take the trouble to wander outside of her comfort-zone zone.

And, btw, those articles both were published within the last week and they indicate that the unions only recently made the request to the Obama administration. There’s been no denial, nor approval, of the request.

I just clicked the Beck link you gave, which is from Jan. 31. Here’s the main part:

Here is what the Wall Street Journal is reporting:

Labor unions enthusiastically backed the Obama administration’s health-care overhaul when it was up for debate. Now that the law is rolling out, some are turning sour.

Union leaders say many of the law’s requirements will drive up the costs for their health-care plans and make unionized workers less competitive. Among other things, the law eliminates the caps on medical benefits and prescription drugs used as cost-containment measures in many health-care plans. It also allows children to stay on their parents’ plans until they turn 26.

To offset that, the nation’s largest labor groups want their lower-paid members to be able to get federal insurance subsidies while remaining on their plans. In the law, these subsidies were designed only for low-income workers without employer coverage as a way to help them buy private insurance.

In early talks, the Obama administration dismissed the idea of applying the subsidies to people in union-sponsored plans, according to officials from the trade group, the National Coordinating Committee for Multiemployer Plans, that represents these insurance plans.

“Here’s the point of the story: The point of the story is these labor unions that knew,” Glenn said candidly. “They helped design it [Obamacare].”

“They knew full well. Anybody knew. These guys are supposed to be in the business world. If you don’t run from your labor union at this point, if you actually believe that they didn’t know, you are beyond help,” Glenn added.
What this means is, all of the union members who have been paying dues to be protected and well insured are out of luck. They’re going to be dumped into the federal pool.

“Congratulations. Teamsters, AFL‑CIO, you are the first to be dumped into universal healthcare,” Glenn said.

—-
Sooo. Here’s the actual main point of the story: Among other things, the law eliminates the caps on medical benefits and prescription drugs used as cost-containment measures in many health-care plans. It also allows children to stay on their parents’ plans until they turn 26.

And all of the union members who have been paying dues to be protected and well insured will now be better protected and better insured. Unless of course you think caps on medical benefits and on prescription drugs are better than no caps on medical benefits and on prescription drugs.

quoting the WSJ after that Beck excerpt:

Contacted for this article, Obama administration officials said the issue is subject to regulations still being written.

Some 20 million Americans are covered by the health-care plans at issue in labor’s push for subsidies. The plans are jointly managed by unions and employers and used mostly by small companies. They are popular in industries such as construction or trucking or hotels, where workers’ hours fluctuate. By contrast, unionized workers at big employers such as Goodyear Tire & Rubber Co. GT -2.38%tend to have a more traditional insurance arrangement run through only one employer.

Top officers at the International Brotherhood of Teamsters, the AFL-CIO and other large labor groups plan to keep pressing the Obama administration to expand the federal subsidies to these jointly run plans, warning that unionized employers may otherwise drop coverage. A handful of unions say they already have examined whether it makes sense to shift workers off their current plans and onto private coverage subsidized by the government. But dropping insurance altogether would undermine a central point of joining a union, labor leaders say.

“We are going back to the administration to say that this is not acceptable,” said Ken Hall, general secretary-treasurer for the Teamsters, which has 1.6 million members and dependents in health-care plans. Other unions involved in the push include the United Food and Commercial Workers International Union and Unite Here, which represents service and other workers.

Employers and consumers across the country will see big changes under the health law, which goes into full effect next year. Insurers will no longer be able to deny coverage to people with pre-existing conditions. Most individuals will be taxed if they don’t carry insurance, and employers with at least 50 workers will face a fine if they don’t provide it. About 30 million Americans are expected to gain insurance under the law.

& more:
Under the health law, households earning up to 400% of the poverty level—$92,200 for a family of four last year—will be eligible for tax credits to offset the cost of private insurance. The less a household earns the more generous the subsidy.

Union plans covering 2.3 million people won waivers to the health law’s early requirements, as did a number of nonunion plans. That has put many unionized plans behind in adapting to the law.

Among them is the Sheet Metal Workers Local 85 in Atlanta, which has about 1,900 members. Next year it must lift the $250,000 annual cap on the amount it will pay for medical claims. The law’s requirements will add between 50 cents to $1 an hour to the cost of members’ compensation package, said Randy Beall, business representative and political director for the local.

Mr. Beall worries this will give small, nonunion contractors who don’t provide health insurance an edge in getting work. Those with fewer than 50 workers won’t have to pay a penalty for not providing health insurance and their workers can tap federally subsidized plans, giving the contractors an insured workforce at lower cost.

The Sheet Metal Workers International Association helped push for passage of the health law. Mr. Beall said he still believes everyone should have health insurance, but worries the law is undermining the union’s ability to offer coverage.

“If we’re not offering our members insurance and pension, why would you want to be union?” he asked.

it’s beyond me, beverly; i gave up trying to figure out what the law did when we didnt get single payer…i see many articles about hidden costs, penalties and taxes and i cant tell if theyve got something or just putting a negative spin on it…rube goldberg couldnt have come up with a more conplicated contraption himself..

Beverly:

Plendil (?) reported most of one of my old posts.

It appears from the thread that all of you have found enough sources to sort of figure this out.

The whole world of health insurance, both pre-PPACA and post-PPACA is immensely complex, and the union-employer thing is something many haven’t thought about.

The law of unintended consequences is very cruel, especially in complex systems.

my reform plan was pretty simple, bill…outlaw private insurance and nationalize pharma & the health care providers…

So true. rusty.

And, great post, Bill.

I’m certainly for single-payer insurance, rjs, but I would not nationalize pharma or care providers. I would, though, place limits on pharma’s freedom to set prices on drugs and devices whose development came in part from federally funded research. And I would have the federal government pay medical school tuition, thus eliminating an important supposed ground for outsized physician fees, bringing them more in line with physician compensation in other developed countries. (I’m NOT a physician basher, and I’m well aware that internists and other primary-care docs’ incomes are not astonomical.) As for hospitals, I don’t know what I would do. I don’t know enough about how they operate. But the for-profit ones strike me as really troubling.

Ooops. That’s what I get for being in a humorless mood today.