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Sat Jan 18, 2014, 12:06 PM

 

I've always been a single-payer advocate but I must admit...

...I had been lulled into complacency somewhat with the ACA.

The harsh ACA reality here in California is that insurance companies have combined extremely narrow and limited networks along with pitiful doctor choices for a toxic mix of substandard coverage.

People will be forced to seek care outside their networks to get adequate and in some cases the specialized care they will need to survive.

There will still be bankruptcies due to health care costs. Those with coverage are still going to see their rates rise to cover those who can't afford their care.

The ACA is a band-aid over a gaping wound.
We need a public health care system in the USA NOW more then ever!

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Blue Shield will offer only limited network Preferred Provider Organization (PPO) and Exclusive Provider Organization(EPO)plans to all new individual buyers. All new customers who have been anticipating purchasing guaranteed issue individual insurance for themselves and their families, will have access to a network that excludes 65% of current Blue Shield doctors and all the University of California Medical Centers.

Network access will be determined by county of residence. In Marin and Alameda counties, for example, Blue Shield plans to use an Exclusive Provider Organization (EPO). Buyers will find their access to medical services restricted to the doctors and medical facilities within the EPO in their county or an EPO doctor in another county. If the policyholder crosses the Golden Gate Bridge or Bay Bridge to consult with a San Francisco PPO doctor, s/he will have no insurance. If a San Francisco resident moves to Alameda, s/he will not be able to keep her San Francisco doctors.

It appears that carriers are also able to exclude residents of specific zip codes from access to their insurance plans. If one carrier can exclude residents in certain zip codes, what is the rationale to require other carriers to cover residents in that same zip code? The ACA requires insurers to accept all applicants regardless of health conditions. But California is allowing exclusion by residence location.

http://www.huffingtonpost.com/susan-shargel/protect-californians-choi_b_4158146.html


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Reply I've always been a single-payer advocate but I must admit... (Original post)
SHRED Jan 2014 OP
Adrahil Jan 2014 #1
SHRED Jan 2014 #8
SHRED Jan 2014 #10
Yo_Mama Jan 2014 #16
Loudly Jan 2014 #2
pnwmom Jan 2014 #3
Hoyt Jan 2014 #6
SHRED Jan 2014 #12
Hoyt Jan 2014 #14
LWolf Jan 2014 #4
Skidmore Jan 2014 #5
Hoyt Jan 2014 #7
Zorra Jan 2014 #9
SHRED Jan 2014 #11
Zorra Jan 2014 #13
SHRED Jan 2014 #15
Jesus Malverde Jan 2014 #17
dawg Jan 2014 #18
SHRED Jan 2014 #19
Hoyt Jan 2014 #20
dawg Jan 2014 #21
lostincalifornia Jan 2014 #34
Egalitarian Thug Jan 2014 #22
Scuba Jan 2014 #23
Shandris Jan 2014 #32
Scuba Jan 2014 #35
Romulox Jan 2014 #24
Demo_Chris Jan 2014 #25
gulliver Jan 2014 #26
MrsKirkley Jan 2014 #27
Walk away Jan 2014 #28
lostincalifornia Jan 2014 #30
lostincalifornia Jan 2014 #29
SHRED Jan 2014 #31
lostincalifornia Jan 2014 #33

Response to SHRED (Original post)

Sat Jan 18, 2014, 12:10 PM

1. Neighborhood blacklisting? What could possibly go wrong!? nt

 

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Response to Adrahil (Reply #1)

Sat Jan 18, 2014, 01:06 PM

8. Which begs the question:

 


What happens to your coverage if you move from one zip code to another?

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Response to Adrahil (Reply #1)

Sat Jan 18, 2014, 01:08 PM

10. And another...

 


What is the coverage when you travel?

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Response to SHRED (Reply #10)

Sat Jan 18, 2014, 01:54 PM

16. This is a genuine issue

In some cases it is covered by state law/regulation, in some cases not. It is entirely possible with some policies in some states to discover that if you have to travel to another state, you are either uncovered or up for a 50% copay because you are by definition out of network.

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Response to SHRED (Original post)

Sat Jan 18, 2014, 12:16 PM

2. Medicare for All is the solution, and Democratic candidates should be campaigning on that.

 

It may be the only way they avoid getting crushed this November.

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Response to SHRED (Original post)

Sat Jan 18, 2014, 12:17 PM

3. There is a simple solution within the ACA. Two states already

require insurers to accept all providers. The rest of them should, too.

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Response to pnwmom (Reply #3)

Sat Jan 18, 2014, 12:47 PM

6. Problem is, many of the providers are choosing not to participate. As usual, they want more money.

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Response to Hoyt (Reply #6)

Sat Jan 18, 2014, 01:17 PM

12. And Doctors also are refusing

 

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Response to SHRED (Reply #12)

Sat Jan 18, 2014, 01:41 PM

14. Exactly, askbthem why they are being greedy at expense of patients.

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Response to SHRED (Original post)

Sat Jan 18, 2014, 12:23 PM

4. I wasn't.

Lulled.

That made me a bad, disloyal Democrat to many.

Of course, I, in turn, thought those celebrating how much they were paying for their insurance was bad and disloyal, since I don't think anyone should be paying anything for health insurance OR care.

It was clear, though, from the time that single payer, which IS the compromise as far as I'm concerned, was not allowed on the table or even in the room, when it became clear that a huge piece was going to be about private, for-profit insurance, that it wasn't going to be something I could get behind.

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Response to SHRED (Original post)

Sat Jan 18, 2014, 12:27 PM

5. I've never seen ACA as the end game, but have been extremely grateful

that this huge step forward was taken, and it was a huge step forward in terms of regulating the insurance industry. It gave people with preexisting condition access to health care coverage that was not available to them before, and I am one of them. Having survived cancer doesn't mean that they would have insured you in the past.

ACA is a step up and the next step has yet to be built.

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Response to Skidmore (Reply #5)

Sat Jan 18, 2014, 12:50 PM

7. +100000. We had to get through obstructors that defeated Hilliarycare and tried to defeat O'care.

Now, changes can be made much more easily.

Glad you have coverage now.

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Response to SHRED (Original post)

Sat Jan 18, 2014, 01:06 PM

9. Yeh, I see the ACA as a step toward eliminating private health insurance companies from the face

of the earth forever.

That is one of the things I would love see the most before I die.

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Response to Zorra (Reply #9)

Sat Jan 18, 2014, 01:09 PM

11. How will it do that?

 


What will happen for this to occur?

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Response to SHRED (Reply #11)

Sat Jan 18, 2014, 01:24 PM

13. You already answered that question.

Insurance companies will commit suicide by greed and inefficiency.

The harsh ACA reality here in California is that insurance companies have combined extremely narrow and limited networks along with pitiful doctor choices for a toxic mix of substandard coverage.

People will be forced to seek care outside their networks to get adequate and in some cases the specialized care they will need to survive.

There will still be bankruptcies due to health care costs. Those with coverage are still going to see their rates rise to cover those who can't afford their care.

The ACA is a band-aid over a gaping wound.
We need a public health care system in the USA NOW more then ever!


I have a good insurance policy under the ACA. It costs me a little more than I can really afford. Next year, I know that they will jack up the premium on me; bait and switch is their MO.

The self-corruption of this system and the obvious need for universal Medicare will cause health insurance companies to dig their own graves, lie down in them, and shoot themselves in the head.

Good fucking riddance, I despise them, for so many good reasons.

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Response to Zorra (Reply #13)

Sat Jan 18, 2014, 01:41 PM

15. Or...

 


Compelling consumers to buy their product or face legal fines has breathed new life into corporate health care.

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Response to SHRED (Original post)

Sat Jan 18, 2014, 02:17 PM

17. bump... nt

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Response to SHRED (Original post)

Sat Jan 18, 2014, 02:48 PM

18. Two huge ACA reforms are needed:

1. We need to close the "Red State" donut hole.

2. We need to push for open networks. Practicing medicine is not a right in this country. It is a privilege that is granted by government and heavily regulated. No provider should be an out-of-network provider for an ACA policy.

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Response to dawg (Reply #18)

Sat Jan 18, 2014, 05:33 PM

19. yep!

 

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Response to dawg (Reply #18)

Sat Jan 18, 2014, 06:05 PM

20. Sorry, but there are providers who don't make the quality or cost cut.

They should be excluded from networks.

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Response to Hoyt (Reply #20)

Sat Jan 18, 2014, 06:08 PM

21. I don't think you understand me.

If they don't make the cost cut, they should be required to accept the prevailing reimbursement as a condition of being licensed to practice medicine in this country.

If they don't make the quality cut, they shouldn't be practicing medicine in this country at all.

What we do not need is a system that gives lower-class insurance to the masses that only entitles them to care from cut-rate providers.

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Response to dawg (Reply #21)

Sun Jan 19, 2014, 04:10 PM

34. Unfortunately even with Medicare doctors are not required to accept Medicare

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Response to SHRED (Original post)

Sat Jan 18, 2014, 06:28 PM

22. K&R That complacency one of its primary goals. Nothing about our health care system is designed

 

with the delivery of care as its primary function. Nothing about our system is easy or convenient and that makes health care something to be avoided for as long as possible. Remember all those polls that kept coming out during the "debate" telling us how a huge majority of Americans love their insurance companies? Have you ever known anybody that became seriously ill and had to deal with their insurance company's denials and endless restrictions and fees, all while trying to heal, that claimed to still love them?

American love the illusion of security that the little card gives them. As long as they believe they would be covered in the event it is needed, that's enough to keep them happily ignoring the cries of those that learn the truth in what is usually the worst time of their lives.

U.S. Health care delivery is about money, first and foremost, and so is the ACA. So, while it is better than nothing, it is also worse because it lets people believe that they will get what they need when they need it.

& R

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Response to SHRED (Original post)

Sun Jan 19, 2014, 10:01 AM

23. I will continue to advocate for Medicare for All, including dental, optical and hearing aids.

 

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Response to Scuba (Reply #23)

Sun Jan 19, 2014, 01:52 PM

32. We've mentioned these before, as I recall.

 

We also need to add at least two things that I know are missing from current Medicare: coverage for all health-related procedures (that includes mental health, thus preventing them from excluding SRS and associated procedures for transfolk) and an expansion of Medicaid or some other type of low-income coverage that Medicare alone doesn't provide. For instance, were it not for the kindness of the Catholic hospital* I go to, I would be sunk even with full Medicare and disability. I have a simple outpatient procedure every 6 weeks that costs, -after- all adjustments for Medicare, ~$500. That's just under 5 months disposable income for me. I suppose I could ditch my internet and WoW subscription if absolutely necessary and do it in 2.8 months, then off myself from having absolutely no entertainment whatsoever while being mostly housebound. But otherwise, yah...that's 4.8 months to pay off something I have to have every 6 weeks. That math doesn't work out for long. There has to be a way to expand Medicaid (or something similar) that the Rethuglicans can't crush by dissent.

There also needs to be systematic reform for nursing homes and such. Watching my grandparents fight with one of them going to a nursing home (something I had to see with my great grandparents as well) has been heartbreaking. They shouldn't be forced into destitution just to appease some arcane rule that a person who actually -had- money would be able to avoid in a matter of moments to begin with.

*I have no connection with the Catholic church and am not meaning to give the hint that I do, or convince others they should. I am giving credit where credit is due, and these people helped me when I was in a very bad way.

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Response to Shandris (Reply #32)

Sun Jan 19, 2014, 09:36 PM

35. Excellent points, thanks for posting.

 

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Response to SHRED (Original post)

Sun Jan 19, 2014, 10:52 AM

24. Perhaps one day we can figure a way to *trick* these amoral corporate behemoths to do our bidding.

Until then, the problem was "solved" by forcing you to buy corporate insurance; getting care is your problem.

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Response to SHRED (Original post)

Sun Jan 19, 2014, 11:12 AM

25. The ACA leads to universal care the way Free Trade leads to more jobs. nt

 

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Response to SHRED (Original post)

Sun Jan 19, 2014, 11:25 AM

26. I wonder if the ACA has save anyone's life yet.

I'm betting it's probably quite a few. You should look up those people who were saved in the last 18 days and explain to them why you think they should be dead.

Sorry if you became complacent about single payer, but I think that is your error. I don't think you should try to blame it on the ACA.

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Response to SHRED (Original post)

Sun Jan 19, 2014, 11:43 AM

27. Then there's that stupid family glitch that makes low income families ineligible for subsidies.

In the health care law's 9.5% affordability test of employer provided health insurance, the IRS only counts the employee's portion of the premium, not the premiums of their spouse and/or children. But despite their premiums not being counted, they are ineligible for subsidies. I was actually told that if enough people called Sue-Jean Kim or John B. Lovelace at (202) 622-4960 (not a toll-free number) and complain, they would change how they calculate the affordability test to include the entire family's premiums. I asked her if the IRS had the authority to do that without congressional approval and she said yes. Whether or not that's true.......I'm just repeating what I was told.

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Response to SHRED (Original post)

Sun Jan 19, 2014, 11:49 AM

28. I have all of the same doctors etc but better coverage....

If New Jersey can do it with that asshat Christie standing in our way...any state can do it.

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Response to Walk away (Reply #28)

Sun Jan 19, 2014, 12:07 PM

30. This is a post of Oct 2013, by an insurance executive.

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Response to SHRED (Original post)

Sun Jan 19, 2014, 12:04 PM

29. wow, what a surprise, an article by Susan Shargel, President, Shargel & Co Insurance Services. Hmmm

an insurance insider who is critical of the ACA

Also, not a very timely article, since this was published back in Oct 2013, just when the ACA was starting up enrollment

Something doesn't pass the smell test here


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Response to lostincalifornia (Reply #29)

Sun Jan 19, 2014, 12:42 PM

31. Have you checked into the coverage?

 

What part of the paragraphs I placed in BOLD is untrue?

Here is my experience:
http://www.democraticunderground.com/10405186

--

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Response to SHRED (Reply #31)

Sun Jan 19, 2014, 03:12 PM

33. Stanford, ucsf, Palo Alto medical foundation, ucla, all of those facilities accept the ACA

Last edited Sun Jan 19, 2014, 04:07 PM - Edit history (1)

All my doctors are covered. I cannot speak for others only myself, but I do not trust an insurance industry spokesperson

Also if you have a PPO under the ACA, if your doctor or clinic doesn't accept the ACA you can still see them, it will cost you more though. If it isn't a PPO your choices are limited

By definition a PPO allows you to go anywhere, but if it isn't a network doctor or facility it will cost you more, perhaps significantly more

Medicare for all might present the same issue. A lot of doctors in Tesas for example won't take Medicare

The answer is socialized medicine, but that doesn't look in the cards for now

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