Even if the ACA works for some, it does not work for many, sadly.

And yes, we can afford it.

(Note there are elements of satirical/sardonic thinking in my rant here, please understand I am very very very tired of telling people all this, it takes a toll on somebody, so please understand - the core is factual and please i beg you verify it and learn more about it, by googling phrases i use. We have been victimized by a huge scheme, we of planet Earth. )

In 1998 the US signed a document - part of the WTO GATS understanding on financial services which contains something called a standstill clause that freezes all regulations and creates what is in essence a one way street So called "progressive liberalisation" - You should Google that term. Basically, as Lori Wallach discussed in a Democracy Now episode around two years ago about TiSA, in a show entitled "a plan that only banksters could love" the WTO General Agreement on Trade in Services agreement which will be merged with TiSA has special dates that will apply to set a ceiling for any public "state owned enterprise" "non conforming monopoly" etc, Rollback means that regulations literally have to be - will likely have to be "rolled back" to their state when the financial part of the GATS was signed (1998) if challenged (and its guaranteed that insurance firms will challenge it because its seen as a trade barrier, preventing international firms that want to enter the market - also open hospitals or set up arrangements to treat sick Americans overseas, for example in india. this maintains a healthy profit margin and is compatible with the free trade ideology of both US political parties, generally the trade deals and the secrecy has been a model of cooperation and consensus between the two US parties. (See "Washington Consensus" )

In exchange for opening "essentially all service sectors and modes of supply" services and their labour become tradeable commodities on the international market - with contracts to perform work, such as run schools, prisons, and perhaps even legislatures - except for the politicians (privatizations scope would be determined by the two part test found at GATS Article I:3 (b) and (c) - Those services that fail the test because they are not completely free and services provided as an exercise in governmental authority to low bidding firms, (which is called Mode Four) countries corporate leaders get concessions like National Treatment and Most Favored Nation (abbreviated MFN) in the foreign lands. Also, "the rise in monthly premiums may be reduced by 2.7% over ten years" (sound familiar) . Low cost providers with offices of convenience in countries with favorable regulatory structures and low wages may even operate hospitals. International services firms already have a presence in prisons, refugee detention and health care plan management, may be able to open new facilities outside of the US to care for the indigent sick. The demand for 'cafeteria style' plans that target specific diseases for extra coverage may be popular. For example, people could pick from a list of diseases to cover, excluding ones they felt were unlikely. Also firms can offer discounts to people who are willing to agree to be put into suspended animation if they become sick, allowing them to be shipped to the other side of the world for lower cost treatment, assuming their credit card is not declined.in short I can see a huge expansion in selling of "consumer driven" health care plans in the US that offer high deductible catastrophic coverage, and US firms will get the right to sell insurance and open factories in other countries and be treated exactly as if they are a domestic firm there. Plus profitability will be maintained. Former employees, such as doctors nurses, teachers, programmers, etc who clearly have lost their jobs as a result of treaties may receive retraining benefits.
The additional regulations - enacted after the signing of the GATS likely violate its standstill which reads as follows. " Standstill Any conditions, limitations and qualifications to the commitments noted below shall be limited to existing non-conforming measures." TiSAs standstill clause is essentially the line at the very beginning of the so called "mandate" which reads as follows" In detail, the agreement should seek to bind, in general, the autonomous level of liberalisation of the
parties " Those words will be seen as basically blocking any New Deal like programs in order to ensure that corporations have a level playing field. Also, dozens of other provisions act to systematically make cost reduction impossible without maintaining the rigid ideology of good better best being bought only by money-

Limits in medical underwriting are likely to be dumped too as violative of both standstill and the "fair and equitable Treatment" (FET for short) legal standard- as violative of the rights of investors to regulatory constancy- The other poster who said that our system really doesn't have any way to ask a company to not make its accustomed profit on something, was right, the lack of cost controls is a regrettable part of our private for profit only system, a uniquely American aspect that we are now successfully exporting by means of trade deals, resistance is futile, as shown by the failure of proposals such as the one linked here to gain buy in from the stakeholders, these deals are procedurally superior to national laws so they take precedence, as shown by the tone of this UNlinked document- ht tp://ww w.euro parl.eur opa.eu/sides/getDoc.do?pubRef=-//EP//NONSGML+AMD+A8-2016-0009+002-008+DOC+PDF+V0//EN (may need to remove the spaces then plug it into browser and then when it starts arriving, right click, save it as filenameyouchoose.pdf and then open- if the mime types are wrong and it doesnt open a PDF viewer as it should-)

that violates the Constitution, also we cannot switch to single payer because that would violate around a dozen provisions in the GATS ( see "The potential impact of the World Trade Organization's general agreement on trade in services on health system reform and regulation in the United States" by the late Nicholas Skala, RIP )

and also TiSA which is almost completed Also TPP and TTIP its likely. (see https://www.policyalternatives.ca/sites/default/files/uploads/publications/National%20Office/2016/02/Major_Complications.pdf especially the discussion of Achmea/Eureko v. Slovak Republic which you can find a factual summary of in the document here ) An long planned "solution" to the crisis created by rigid mercantile ideology is of course, more of the same- TiSA likely will push wages down by globalizing healthcare and education, maintaining profitability by opening services - "everything you cannot drop on your foot" to competition. Global subcontracting with no wage parity requirement, with disciplines on domestic regulation" to insure that no regulation is "more burdensome than necessary to ensure the quality of the service" Its likely that the convenient emergency would help with the sensitive nature of the transition, that, especially if they get the timing just right so it all falls apart creating a health care emergency just as the TiSA is signed. TiSA is almost completed in Geneva. So that is all basically in the pipeline -

May the Good Lord have mercy on our souls.

Too much </sarcasm>

eom

eom

There is no "fixed profit" either, that 20% of all non-medical-benefit costs is a maximum, not a guarantee. Some are incurring losses on their ACA business. What their profit margin is depends on how competitive their market is, whether they estimated their costs and claims experience correctly when they set their premiums, etc.

A family of 4 can get subsidized up to $90k a year

..

They make too much money...if you make more than 400% of poverty level....be thankful for the caps....rhats what pays off for them.....I am not fooled by this bullshit....they wont go bankrupt by medical bills anymore....

By the way....caps on overhead now 20% thanks Obamacares.....

They apply in all 50 states. I believe 2015 poverty levels are used for 2016 subsidies. ACA subsidies go up to 400% of poverty levels, which is $97,000 for a family of 4. Family of 5, which the OP indicates he has, is $113,640.

http://obamacarefacts.com/federal-poverty-level/

Persons in household, Poverty level, 400% of poverty level

1 $11,770 $47,080
2 15,930 63,720
3 20,090 80,360
4 24,250 97,000
5 28,410 113,640
6 32,570 130,280
7 36,730 146,920
8 40,890 163,560

Medicaid expansion only goes up to 138% of the poverty level in Medicaid expansion states.

the ACA tax credits that go up to 400% of the poverty level. Those apply in all 50 states.

there's always the open market.

BCBS to United Healthcare, the only 2 choices, and they have the same rate.

Like going bankrupt now!

How would a major surgery work for you without that cap?

How about some cancer or open heart surgery?

I am unaware of a surgery that would have exceeded $1 million cap that was on my pre-ACA plan, but nice try.

Thats why even those with insurance filed for bankruptcy....not any more....nice try..

.http://obamacarefacts.com/dollar-limits/

I think that is what VanillaR was referring to. The cap on the total of the deductible + copays in a year.

[font color = red]on edit:[/font] http://obamacarefacts.com/health-insurance/out-of-pocket-maximum/

My daughter had an emergency appendectomy. I paid a $75 copay.

I think now I would have to pay $12500, the max out of pocket? I am not sure how the 70/30 copay and 6000 deductible works for something like an appendectomy.

Last edited Sun Dec 6, 2015, 02:47 PM - Edit history (1)

Thanks!

According to the table, that means you make over $113,640 per year or more than $9,470 per month before taxes, FICA etc. Seems like it should be doable.

Also the $1699/month premium is about equal to the total monthly cost of my employer provided insurance (employee + employer contribution of which I pay about 45%).

The premiums are increasing 31%!!! Not sure where I will find the extra $400, since there are no raises this year.

Were we not promised the ACA would bend the cost curve down? Hah! It has bent it way up instead!

31% increase! The bronze plan now costs more than my silver plan last year!

Not buying...

That's just the year. It went up 141% the first year! You are right in not buying the "affordable" part.

Whats your yearly....tell us how much it hurts!

Cause I won't pay it! How much do you make a year? Hurry, so I can tell you how to spend it.

Last edited Sun Dec 6, 2015, 02:59 AM - Edit history (1)

Hope you stay well...

Thats a high stakes gamble with your health ...

3 kids in college!

can stay on your insurance while in college?

Cry me a river....

And those 3 kids can now stay on your insurance until they graduate and beyond.....THANKS to Obamacare.

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I am sorely disappointed in DU now. I thought this site would be at least somewhat liberal. Looks to me I am surrounded by freepers.

putting his kids through college. I've been here since Day 1 and can't believe what I'm seeing. No one should have to choose between educating his kids and paying for health insurance for his family. It's unacceptable that rising costs continue to put the squeeze on people. You'd think that would be one thing most people who call themselves Democrats could agree on, but apparently not. The ACA is simply not working for some, including the OP who appears to be new to DU. He probably thought he was coming to a safe haven for Dems and ended up unfortunately in the lion's den.

7+0 to leave it. Lol.. What a freaking joke!!!

conception of what it takes to put a kid through college today and apparently labors under the illusion that money grows on trees.

I don't like to post much here any more. Seems you get 'attacked' no matter what you post.

Aren't we all on the same side?

I posted in the lounge about a horrific restaurant experience I had in which the kid at the next table screamed for twenty minutes straight and threw food and plates while his parents ignored the whole thing. That innocuous post ignited a flame war the likes of which I couldn't fathom. I had people on here telling me it was that kid's God given right to scream his lungs out and I should stay home if I didn't like it.

That experience convinced me that on DU there is no such thing as general agreement about anything. A new poster explains his health care premium situation and backs it up with facts and becomes a target. Par for the course. I post way less than I once did, too, and for the same reason.

It sounds like it's a third party. The guy's paying a lot in premium for health care.

Sounds like the guy can afford it.....read the entire thread.....

It is a lot of premium.

I pay health care premiums for my employees. On principle, I still refuse to make them pay any part of the premium, but the amount keeps increasing rapidly, so I may have to reassess that policy.

He makes alot of money apparently....

He will never be pre-existing conditioned.....has a cap....is guaranteed yearly exams and preventative medicine free of charge....and his kids can stay in his policy through college and beyond......he is still getting more for his money than ever before ...

what you can afford. I just finished putting my daughter through 4 years of a public university. My bank account is way, way down. Over the course of those 4 years, I shelled out over 125K. I can only imagine the hit you are taking with 3 kids in school. And, I agree, your health insurance premiums are outrageous. For you and many others, the ACA is not affordable -- not if you want to eat, have a roof over your head, pay your utility bills, deal with the cost of transportation, and on and on....and pay for college for 3. I totally get where you're coming from.

Its called The Affordable Care Act....

If one if those 3 kids came down with a major illness. ..he would be thanking his lucky stars....at least the other 2 would not have to sacrifice as a result...

Should he pull his kids out of school to be able to afford the health insurance?

What would he do if one of the 3 got Cancer? What would happen to the other 2 then?

ACA doesn't even work in the states wich refused the Medicaid expansion!
If a poor person , who doesn't make yne required 13.5k a year in one of those states , will be shit out of luck and probably lose their life! Because the ACA left it up to the States, to expand the Medicaid, among other messed up things.

So don't even go there.

Even Sanders says we should defend it....

However, we can have a frank discussion about the extent to which it is successful. And, if necessary, conclude that SP is a better overall system (look what group you are commenting in) to expand and improve the ACA into.

with single payer, that just isn't going to happen for some time, regardless of who becomes President. At the very minimum, until the next census occurs will we have a shot at taking back the house.

That is why in the interim, they need to change the criteria so more people qualify for the subsidy. While that won't be a difficult as getting single-payer passed, it is still unlikely to happen for the same reason

his "silver" plan, I have no reason to doubt him. I have personal experience, however, with the silver plan sold through Covered California. Premiums are high, coverage sucks, and policy holders are not thanking their lucky stars when they discover that their shitty insurance covers practically nothing.

I am still helping a relative pay off $11,000 in uncovered medical expenses for a 2 day hospital ordeal in July of 2014. His bullshit ACA "silver plan" through Covered California with a $700/mo. premium proved to be mostly useless.

This country needs single payer/Medicare for all. Until that happens people will continue to be priced out of the market. Some will go without insurance. Others will buy ridiculously overpriced policies that are a joke. The winners for now are the insurance companies, which continue to charge more and cover less. What a racket.

Please elaborate or go on....

Before. You sure are abusively defensive about the ACA, and seem willingly oblivious to it's myriad flaws!

Then you would understand its significance....

their own retirement, too.

For most people all this shit is undoable.

child whose savings were decimated by her college education, it is incredibly difficult to save or even make ends meet. Husband recently turned 65 and has no hope of retitring. I'm 63, still working, and taking care of my 93-year-old mother. House is falling apart. Car needs a major repair. Health insurance premiums through the roof.

On paper our income looks decent and we should be doing ok. The reality is far different, as I suspect it is for many.

greedy CEOs of the insurance industry. It has nothing to do with providing care at a reasonable cost to the American consumer.

When was the last time you had to choose between food and a prescription?

Do not have a couple million stashed away for retirement

People tend to forget the loopholes put into the ACA by GOP in committee in order to protect profits for the health insurance industry whose interests they serve.

Democrats on the committee should NEVER have accommodated the GOP on the proposals they added. They forced them through and then wouldn't support the overall bill, anyway. They are Lucy with the football, and Dems remain the trusting Charlie Brown - idiots.

The Covered California plans - my point of reference - are outrageously expensive with huge premiums, big deductibles, and lousy coverage. Those who just miss the subsidy cut off are majorly screwed. This thread suggests that health care coverage in the US is still in need of significant overhaul. Single payer/Medicare would be a Godsend for many.

And leave if up to the private insurances to increase premiums?? The ACA is no where close to perfect or appropriate. Poor people here in FL are left to DIE, because the ACA left it up to our local gov to decide the faith of medicaid expansion. And our gov VOTED AGAINSt IT.

We need single payer, period. The ACA is flawed and its not working.

Supreme Court decision.

Maybe he couldn't, I don't know. But the matter of fact is that many of the very poor are left to die.

The $13.5 K a year requirement is a bunch of baloney , and the poor are losing their lives because of it.

We need SINGLE PAYER STAT!!

Nobody at the time the ACA was written and passed dreamed that the Supreme Court would object to the Medicaid expansion and effectively make it optional for the states. There is nothing in the ACA that specifies that it is optional for the states, nothing for Obama to have vetoed on that score.

Single payer would be good, far better than the nonsense we have. But it is not the paradise that people make it out to be. Medicare is "single-payer", and yet it is estimated that Medicare beneficiaries over their lifetime after 65, pay on average 50% of their medical costs. It is definitely not free like so many think.

What I'm saying is we want to make sure single payer is really single payer (the government), and not the government and the patient. Or that the average patient ends up paying maybe 10% of the total cost, not 50%.

We are still "we, the people" arent we?

Are not going to let that happen...

Its not just a problem of private insurance getting in the way....

Their Republican governors...

There is nothing in the ACA that prevents any state from going Single Payer.....even Bernie's home state of Vermont STILL hasn't done that.

and trying to advocate for a better system, regardless of primary contests. You keep bringing up Sanders when others don't.

Last edited Tue Dec 8, 2015, 09:47 AM - Edit history (1)

13 thousand posts and you believe it may be possible for the POTUS to veto a supreme court decision

in tuition payments and living expenses for hs kids every couple of months. College, even public college, is ridiculously expensive. My one daughter graduated in June from a public university that cost $125K for 4 years. We struggled mightily to pay for it so she woukdn't be saddled with a bunch of loans. Very easy to see that the extra $1700 a month for health insurance which probably has high deductibles and co-pays could be a huge burden. Only someone without kids in college could have made your statement.

What do you think poor people are dealing with

Would you trade with them?

a year, I could afford to educate three kids. I know because I made a little under that and I educated three kids, two with advanced degrees and two with Summa Cum Laudes. And you bet your bippy I kept them insured.

Tuition, room and board are $8500 per semester, after scholarship for 1 child, at state run schools. Throw in miscellaneous expenses, books, blah blah, and 60% of that annual GROSS income of yours is gone. (I have 3 kids, do the math) Tack on another $20k for payroll and income taxes, and $20k for the ACA, and, well, there is literally nothing left!

You know not of what you speak!

obnoxiously vocal one on ignore this morning) seem to think that just because you don't qualify for a subsidy, you have unlimited funds that make it easy to meet all expenses. I put one child through public college and it took a huge chunk of my retirement savings. I did it gladly, but it was not easy.

No one should have to pay $1700 a month for health insurance - especially for the silver plan, which in my state, California, sucks. That's insane regardless of income. I guarantee that the crooks in Congress don't pay that kind of money for their insurance, and they'd be outraged if they had to.

I hope you don't give up on DU based on the posters who live in la la land and assume you can just go out to your garden and pick money off of trees. There are many people on here who live in the real world and work to make it better for everyone. At any rate, welcome to DU and thanks for sharing your story.

If you cannot afford that.....there are other options.....and.there are loans.....

think a 100k is middle class or greater, it depends on a lot of factors, and one size does not fit all

They really should take more things into consideration in determining the subsidy

insurance, automobile insurance, car payments? The way the ACA is setup if this family of 4 makes 98000, no subsidy.

Maybe some here do not understand, but I could see how a family of four making 100K could very will struggle to pay a health insurance premium of 1000+ dollars a month because they do NOT qualify for the subsidy.

However, if you want to talk what it was before the ACA, the premiums with much less coverage for a family of four, not covered by an employer plan were considerably more money than the ACA premiums are today. That still doesn't mean someone based on their circumstances wouldn't have problems with such a premium.

I stand by my post, more criteria needs to be taken into account to determine the subsidy

Sounds like Obamacares is not really your problem

I didnt have a rich daddy that foot the bill for my college education....somehow I manage...

Most people do not have Daddy pay for thier college outright.....must be nice...

have a problem making ends meet, which is why more criteria needs to be taken into consideration so more qualify for the subsidy

Be real....

and are making more than 8 grand a month....yeah...that pretty much says it all...

Ridic....I am not buying that load he is peddling....