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In reply to the discussion: since when does name calling and insulting = political criticism? [View all]frazzled
(18,402 posts)1. Indeed ... especially when people don't even understand the policy
and therefore name call inappropriately.
So let's go over this again. All insurance policies have formularies--lists of drugs they do and do not cover. This includes the insurance from your workplace, private insurance, Medicare, the VA, and, yes ... even the British and Canadian health systems.
Here's how it works, in general, from Think Progress:
Under the law, insurers must offer drug benefits as part of 10 essential health care benefits, meaning that millions of uninsured Americans will now have drug coverage for the very first time. But the coverage wont be limitless. Insurers will continue to rely on drug formularies as they currently do in the private market and Medicare Part D to decide which prescriptions are covered and which are not.
The ACA requires that issuers provide the greater of one drug from each category or class, or offer as many drugs in each category as are covered by a benchmark plan. The law allows states the choice of four different benchmarks, which Gottlieb helpfully lists in his article: 1) One of the three largest small group plans in the state by enrollment; 2) one of the three largest state employee health plans by enrollment; 3) one of the three largest federal employee health plan options by enrollment; or 4) the largest HMO plan offered in the states commercial market by enrollment.
States not the federal government select the benchmark and insurers then offer coverage for the drugs listed in those formularies. What the vast majority of states have chosen is a common small business plan, so you know its saying what will be available in the exchanges and in the individual market generally is whats popular among small businesses now and that seems like a reasonable place to start, the Kaiser Family Foundations Larry Levitt explained.
But yes, there are certain limits: a formulary, for instance, may cover three drugs for treating a certain condition but not two others. Obamacare like all insurers currently operating in the market has a fix for that. ACA regulations demand that a health plan must have an exceptions process in place that allows patients to request and gain access to clinically appropriate drugs that arent covered by the health plan (in addition to internal and external appeal processes). So, if a health plan does not cover a particular drug that a patient absolutely needs, their doctor can certify medical necessity to extend coverage. Insurers have relied on drug formularies before the law went into effect and already have exceptions processes in place, meaning that most will not have to implement significant changes.
http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/
The ACA requires that issuers provide the greater of one drug from each category or class, or offer as many drugs in each category as are covered by a benchmark plan. The law allows states the choice of four different benchmarks, which Gottlieb helpfully lists in his article: 1) One of the three largest small group plans in the state by enrollment; 2) one of the three largest state employee health plans by enrollment; 3) one of the three largest federal employee health plan options by enrollment; or 4) the largest HMO plan offered in the states commercial market by enrollment.
States not the federal government select the benchmark and insurers then offer coverage for the drugs listed in those formularies. What the vast majority of states have chosen is a common small business plan, so you know its saying what will be available in the exchanges and in the individual market generally is whats popular among small businesses now and that seems like a reasonable place to start, the Kaiser Family Foundations Larry Levitt explained.
But yes, there are certain limits: a formulary, for instance, may cover three drugs for treating a certain condition but not two others. Obamacare like all insurers currently operating in the market has a fix for that. ACA regulations demand that a health plan must have an exceptions process in place that allows patients to request and gain access to clinically appropriate drugs that arent covered by the health plan (in addition to internal and external appeal processes). So, if a health plan does not cover a particular drug that a patient absolutely needs, their doctor can certify medical necessity to extend coverage. Insurers have relied on drug formularies before the law went into effect and already have exceptions processes in place, meaning that most will not have to implement significant changes.
http://thinkprogress.org/health/2013/12/10/3042741/drugs-obamacare-coverage/
Restrictions on drugs have always existed. Ways to get around them have always existed. The ACA (and the President) did not change this in any way. And things were WORSE for the majority of previously uninsured, or privately insured, people before the ACA. Shit happens and will always happen. Often, you can fix the shit. Sometimes it's hard. The president is not responsible for everybody's shit, in every instance.
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It's a way to make people think political discussion and sharing information is disgusting to turn
freshwest
Mar 2014
#81
I really want to one-up you by citing an even older example of political invective, but I don't know
Donald Ian Rankin
Mar 2014
#64
Been called plenty of names here on DU...especially by the Snowden is a hero crowd.
Sheepshank
Mar 2014
#39
People here adore the Pope who says LGBT people are an attack on God's plan which
Bluenorthwest
Mar 2014
#12
So you've never said anything before in the heat of the moment of being upset?
Vashta Nerada
Mar 2014
#53
Sometimes it just feels good to call someone an asshole, especially when they deserve it.
badtoworse
Mar 2014
#47
We are also being told that name-calling, insults, and snark are the same things as "replies"
villager
Mar 2014
#51
My recollection is that you were quite anti-RKBA and not tolerant of other views...
badtoworse
Mar 2014
#82
Perhaps DU could set up a name-calling forum, and we can all just not go there. n/t
DebJ
Mar 2014
#67