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ACA Running Thread

My bad, many women have plans without ob/gyn coverage.

You're so right. These plans don't exists and the millions of people who have had to go bankrupt due to medical costs, in spite of reams of evidence, didn't happen over the past many decades. They didn't happen.

Insurance companies haven't had the deny, deny, deny, delay tactic as policy.
 
"He knows everything. And yet he seems to know nothing. He’s passionate about the details of domestic policy but wasn’t privy to the details of his own legacy law. He’s an academic with a command of every issue at once but seemingly only finds out what his administration is doing in news reports. He’s so brilliant every normal endeavor he’s tried has bored him, but he couldn’t bother to entertain himself with more than one monthly meeting on the make-or-break program of his presidency. He’s the captain of the Culture of Competency who has overseen the most incompetent rollout of an entitlement program in history.

I was struck by a moment in President Obama’s press conference today where this paradox was on full display. The president floated, throughout the press conference, from profession of utter ignorance to confident declaration and directive. Allahpundit noted that Obama distanced himself from the website’s problems by saying he was never informed of its problems. He knew nothing.

PRESIDENT OBAMA: OK. On the website, I was not informed directly that the website would not be working as — the way it was supposed to. Has I been informed, I wouldn’t be going out saying, boy, this is going to be great. You know, I’m accused of a lot of things, but I don’t think I’m stupid enough to go around saying, this is going to be like shopping on Amazon or Travelocity, a week before the website opens, if I thought that it wasn’t going to work.

So, clearly, we and I did not have enough awareness about the problems in the website. Even a week into it, the thinking was that these were some glitches that would be fixed with patches, as opposed to some broader systemic problems that took much longer to fix and we’re still working on them.
Neat how his ignorance is proof of his smarts. “I don’t think I’m stupid enough…”

But he later explained how cumbersome and problematic federal IT procurement is, and that he knew that before the website build started, yet inexplicably did not act on this knowledge:

What is true is that, as I said before, our IT systems, how we purchase technology in the federal government is cumbersome, complicated and outdated. And so this isn’t a situation where — on my campaign, I could simply say, who are the best folks out there, let’s get them around a table, let’s figure out what we’re doing and we’re just going to continue to improve it and refine it and work on our goals.

If you’re doing it at the federal government level, you know, you’re going through, you know, 40 pages of specs and this and that and the other and there’s all kinds of law involved. And it makes it more difficult — it’s part of the reason why chronically federal IT programs are overbudget, behind schedule.

And one of the — you know, when I do some Monday morning quarterbacking on myself, one of the things that I do recognize is since I know that the federal government has not been good at this stuff in the past, two years ago as we were thinking about this, you know, we might have done more to make sure that we were breaking the mold on how we were going to be setting this up. But that doesn’t help us now. We got to move forward.
Ya think?! More time dealing with a problem you claim you knew about and less time spent smearing people who pointed out this problem would have been productive. So, in this instance, Obama knew the federal government’s bad track record with IT but did nothing to correct the problem.

So, what does the president act on? Why, an utter lack of knowledge, of course:

One thing that we’ve discovered, though, that I think is — is worth noting, a lot of focus has been on the website and the technology, and that’s partly because that’s how we initially identified it; you know, these are glitches. What we’re discovering is that part of the problem has been technology, hardware and software, and that’s being upgraded. But even if we get the — the hardware and software working exactly the way it’s supposed to with relatively minor glitches, what we’re also discovering is that insurance is complicated to buy. And another mistake that we made, I think, was underestimating the difficulties of people purchasing insurance online and shopping for a lot of options with a lot of costs and lot of different benefits and plans and — and somehow expecting that that would be very smooth, and then they’ve also got to try to apply for tax credits on the website.
Apparently entirely ignorant of the process of buying insurance, the president decided to demand an overhaul of the entire insurance industry, building the purchasing mechanism himself.

So, when you know something pertinent about federal technology failures that could increase the chances of success for your pet project, do nothing. When you know absolutely nothing about the subject of your ambitious pet project to remake 1/6 of the economy, try to do everything. And, when you do nothing with the knowledge you do have to prevent the Charlie Foxtrot created by your insistence on acting, ahem, audaciously with knowledge you don’t have, insist that your lack of knowledge is proof of your intelligence. Hey, I’m smart enough that if I knew this was going to be such a lumbering catastrophe, I wouldn’t have said those dumb things about how it would be great!

He knows everything. And yet he knows nothing. The reason for this is the animating feature of Obama’s leadership style, if you can call it that, is not presuming to know all the facts and micromanaging every project ala Jimmy Carter. Nor is it acknowledging he doesn’t know all the facts and surrounding himself with experts he trusts ala George W. Bush. And, no, it’s not combining an intellectual strength and a mind for policy detail with a populist flair ala Bill Clinton. The animating feature of Obama’s leadership style is simply making pronouncements. Making them about things he knows, things he knows not, and waiting for everyone and everything to fall in line. And, when things don’t magically come together, he pronounces his disappointment and anger. Wash, rinse, repeat.

“We’re going to get this done, all right?”

Sure. If you say so."
 
A friend of mine thought he had excellent coverage. It has paid for many things,. Last he hurt his foot pretty badly. he insurance company waited and waited and waited. It took him a week of being pain before they would allow him to see a doctor for his broken foot.
 
A friend of mine thought he had excellent coverage. It has paid for many things,. Last he hurt his foot pretty badly. he insurance company waited and waited and waited. It took him a week of being pain before they would allow him to see a doctor for his broken foot.

Bullshit.
 
Im certainly not arguing that junk plans don't exist. BUT, most people in this market have insurance that looks/smells and feels a lot like group coverage. The CR article was good in what it said to look for...I just am suggesting these aren't the majority of plans. Not even close.

Actually, people do use their plans all the time, one of the reasons there are usually rate increases each year. Ive also down testimonials for advertising and there are some crazy stories out there about how individual junk policies saved the day. I remember one where the customer was in Bali during the terrorist bombing and his junk individual plan covered him there, covered him getting airlifted to a burn center, etc.

Maternity is the one example of a rider that most plans need to have added. I can explain why insurers do this BUT it is a "gap" in some policies.

I'll admit I am very very close to this issue and its hits me at a personal level. But, I think there is a lot of misleading info out there.

Do you work off of 15-501 near Durham and chapel hill?
 
A friend of mine was pregnant and thought she had excellent coverage. She went into early labor and was rushed to the hospital before she had a chance to work out the details with her insurance company. Right as she's crowning the doctor's cell phone rings - it's the insurance company. Doctor yells at her to stop pushing, he jams the little guy back in and now she's in a wheelchair with her legs tied shut waiting for the insurance company to approve the delivery.

And that was 6 MONTHS AGO.
 
Lets not confuse insurance horror stories (fact or fiction) with the issue we are discussing here....Are current plans junky are not as the Dems argue.

As someone in this space for 20 years, I stand by everything I've said. And I think thats why so many people are upset. They want to keep their perfectly fine and cheaper plans.

In NC, BCBS will file new rates per Thursday's announcement. Rate notices coming 12.1ish.
 
Lets not confuse insurance horror stories (fact or fiction) with the issue we are discussing here....Are current plans junky are not as the Dems argue.

As someone in this space for 20 years, I stand by everything I've said. And I think thats why so many people are upset. They want to keep their perfectly fine and cheaper plans.

In NC, BCBS will file new rates per Thursday's announcement. Rate notices coming 12.1ish.

Operation B.O.H.I.C.A. will commence at dawn.
 
"The president's guests at Friday's meeting included CEOs of Cigna, Aetna, Humana, and Blue Cross Blue Shield."

Yet we are supposed to believe that these same leading companies are selling junk policies? On its face, that is not an honest argument. That point is especially irritating to the people who had the policies and know that they were good.
 
A friend of mine thought he had excellent coverage. It had paid for many things. Then he broke his coccyx during the Running of the Bulls in Pamplona. His insurance company is suing the pastores, the dobladores, the City of Pamplona, and the bull. Meanwhile, my friend is awaiting treatment and his ass is in a sling.
 
Lets not confuse insurance horror stories (fact or fiction) with the issue we are discussing here....Are current plans junky are not as the Dems argue.

As someone in this space for 20 years, I stand by everything I've said. And I think thats why so many people are upset. They want to keep their perfectly fine and cheaper plans.

In NC, BCBS will file new rates per Thursday's announcement. Rate notices coming 12.1ish.

Are you calling me a liar? Do you want to talk to Roger?
 
Lets not confuse insurance horror stories (fact or fiction) with the issue we are discussing here....Are current plans junky are not as the Dems argue.

As someone in this space for 20 years, I stand by everything I've said. And I think thats why so many people are upset. They want to keep their perfectly fine and cheaper plans.

In NC, BCBS will file new rates per Thursday's announcement. Rate notices coming 12.1ish.

CH, I had a surgery recently that occurred at an in-network hospital, by an in-network surgeon. Then the bill came, and the anesthesiologist that day wasn't in-network. Does that happen often?
 
Are you calling me a liar? Do you want to talk to Roger?

Why do you LIE??????!!!!!!!???????

Beyond the preposterous notion that your "friend" couldn't get medical treatment via a trip to the emergency room, no. Poor Rodger, too stupid to have someone drive him to the hospital to take care of himself. And yes, all of us are bright enough to know Roger may have fought with his insurance company over payment.

My mother just had a partial knee replacement last winter. She asked for an itemized copy of the hospital bill. Somehow the insurance company (she too is on the "individual" market) had no problem paying for $13 bars of soap during her stay.

Obama is so full of shit it just astounds. He desperately needs the insurance companies to play ball so his law can get off the ground. Yet they are all evil and out to kill people. The dumbest part of his rhetoric is this notion that he and that fucking moron Ezekiel Emanuel keep pushing that it wasn't the ACA that caused all these cancellation notices but rather the insurance companies just being heartless - as if insurance companies would in masse deliver 5 million cancellation notices at the exact same time of their own free will.
 
Why do you LIE??????!!!!!!!???????

Beyond the preposterous notion that your "friend" couldn't get medical treatment via a trip to the emergency room, no. Poor Rodger, too stupid to have someone drive him to the hospital to take care of himself. And yes, all of us are bright enough to know Roger may have fought with his insurance company over payment.

My mother just had a partial knee replacement last winter. She asked for an itemized copy of the hospital bill. Somehow the insurance company (she too is on the "individual" market) had no problem paying for $13 bars of soap during her stay.

Obama is so full of shit it just astounds. He desperately needs the insurance companies to play ball so his law can get off the ground. Yet they are all evil and out to kill people. The dumbest part of his rhetoric is this notion that he and that fucking moron Ezekiel Emanuel keep pushing that it wasn't the ACA that caused all these cancellation notices but rather the insurance companies just being heartless - as if insurance companies would in masse deliver 5 million cancellation notices at the exact same time of their own free will.

I NEVER said he couldn't go to the emergency room. He chose not to do it that way. He wasn't sure it was broken, but there is no reason he couldn't just go to his doctor immediately without the insurance company's permission.

As you have proven for over a decade, you'd always act like complete asshole rather than to try to carry on a civil discussion. It's always been about who and what you are.
 
I NEVER said he couldn't go to the emergency room. He chose not to do it that way. He wasn't sure it was broken, but there is no reason he couldn't just go to his doctor immediately without the insurance company's permission.

As you have proven for over a decade, you'd always act like complete asshole rather than to try to carry on a civil discussion. It's always been about who and what you are.

Says the boards resident fuck-wad
 
Are you calling me a liar? Do you want to talk to Roger?

No. I have no clue what happened or what his policy was. I still stand by my point that these ind plans largely arent junk insurance. Also, I have seen very few policies that prohibit you to go see an urgent care or PCP without a referral. Do they exist? Sure, some plans dont cover this at all but I haven't seen too many of them for us to make blanket policy positions.

Lets illustrate one of the more nuanced aspects of the law which makes my point. As we all know, the feds make insurers classify plans into a metal/medal. Platinum is 90% actuarial value, gold 80%, etc. They allow you to get plans within 2% to fit it into that metal so plat is 88% to 92%, gold is 78% to 82%, etc.. We had plans that were 84% to 87%. These plans covered virtually all of the EHBs (in NC, they were based off our plans) except for pediatric dental/vision (not visits, those were already covered but glasses, etc). These plans had to be discontinued and mapped to either a platinum plan with the 88% floor or to a gold plan with the 82% ceiling. Sure, they added the pediatric add on benefits but do we really want to call these plans junk because they were too rich to be "gold"?
 
No. I have no clue what happened or what his policy was. I still stand by my point that these ind plans largely arent junk insurance. Also, I have seen very few policies that prohibit you to go see an urgent care or PCP without a referral. Do they exist? Sure, some plans dont cover this at all but I haven't seen too many of them for us to make blanket policy positions.

Lets illustrate one of the more nuanced aspects of the law which makes my point. As we all know, the feds make insurers classify plans into a metal/medal. Platinum is 90% actuarial value, gold 80%, etc. They allow you to get plans within 2% to fit it into that metal so plat is 88% to 92%, gold is 78% to 82%, etc.. We had plans that were 84% to 87%. These plans covered virtually all of the EHBs (in NC, they were based off our plans) except for pediatric dental/vision (not visits, those were already covered but glasses, etc). These plans had to be discontinued and mapped to either a platinum plan with the 88% floor or to a gold plan with the 82% ceiling. Sure, they added the pediatric add on benefits but do we really want to call these plans junk because they were too rich to be "gold"?

Why did they create gaps? Why not go with above or below 85% as a delineation?
 
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