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That’s really hosed up man. I hope you find a good job soon! What field are you in?
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Sep 25, 2018 02:11
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JustJeff88 posted:I just wanted to point out that I have basically become a walking example of what is called a "perverse incentive." I was approved for Medicad as I now live in a state that expanded it. I have been unemployed now since 1 May, and it has convinced me to avoid seeking most jobs except for jobs with excellent guaranteed benefits (of which there are very, very few) or non-benefited part-time jobs with super low salaries in order to stay under the income cap. There is a very small patient contribution that starts at $1 per month (seriously) for people with no income and goes up to I believe $15 a month for people near the monthly income cap, which is less than $1200. I would be fine to pay a higher absolute cost/percentage of my salary to keep what I have, but if I pass the maximum earnings threshold I lose everything. Naturally, any job that pays a paltry $300 a month would not allow me to purchase anything close to decent coverage, so it's in my best interest to either avoid full-time labour entirely or hold out for a "serious" job. Yeah, it sucks the way if you're <$17,000/year poor then you qualify for Medicaid in an expansion state, but if you make $17,000/year then you're in for a world of hurt with $7,000/year deductibles + the cost of insurance premiums. Remember, though, that Obamacare/Medicare eligibility is based on Modified Adjusted Gross Income, so contributions to retirement plans and deductions of student-loan interest can be deducted before insurance costs are calculated. (Not that anyone making $17k has a ton of leftover income to contribute to retirement plans, but that's the kind of thinking that comes from legislators whose own incomes are in the top 1 percent.)
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Sep 25, 2018 02:33
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Kentucky has been trying to ram work requirements into it so don’t get too cozy it’s coming down the pipeline. A judge ruled against it but I bet it won’t be much longer.
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Sep 25, 2018 03:13
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And that brings us to the most hosed-up aspect of work requirements for Medicaid in expansion states: it's very likely that people under Medicaid will then earn just enough to be broke and not broke-rear end, and thus subsequently ineligible for Medicaid and subject to those $7,000/year deductibles that the rest of us working poor enjoy.
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Sep 25, 2018 04:05
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Willa Rogers posted:And that brings us to the most hosed-up aspect of work requirements for Medicaid in expansion states: it's very likely that people under Medicaid will then earn just enough to be broke and not broke-rear end, and thus subsequently ineligible for Medicaid and subject to those $7,000/year deductibles that the rest of us working poor enjoy. 
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Sep 25, 2018 04:20
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I mean it’s all under the disguise of helping people find jobs and make their lives better. But really it’s just to get people off Medicaid since the state can’t afford the expansion on its own. Really lovely thing is it’s more strict than the SNAP work requirements because you have to go through the insurance company if you want to say you’re unable to work without already being on disability.
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Sep 25, 2018 04:29
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Arrgytehpirate posted:That’s really hosed up man. I hope you find a good job soon! I'll just say that I have a graduate degree and used to work in collegiate education for excellent benefits, shite money and no job security. I fell into the millennial trap of crippling debt, low wages and no job security, so I've committed myself to cheating the system until I eventually die prematurely. Willa Rogers posted:Yeah, it sucks the way if you're <$17,000/year poor then you qualify for Medicaid in an expansion state, but if you make $17,000/year then you're in for a world of hurt with $7,000/year deductibles + the cost of insurance premiums. Not calling you a liar, but do you have a source on the bolded bit? I thought that it was much lower; around 12-14k or so. I can't put anything into a retirement account since I don't earn anything, and I haven't paid a loving penny towards my student loans for years. I did a federal, income-based repayment consolidation years ago. When I was employed I made so little and had to relocate so often to find new work that having to pay anything towards student loans would have destroyed me... I never lied to the government, but I exploited the system and I don't apologise. I had to change jobs and relocate so often that every summer I would have to cash in my nascent 401k just to relocate to my next gig. Now that I have no money, I just don't pay; can't squeeze blood from a stone.
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Sep 25, 2018 04:37
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Income guidelines for a single person household in KY is 1100ish a month so about 13k a year so it’s pretty close.
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Sep 25, 2018 04:41
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JustJeff88 posted:I'll just say that I have a graduate degree and used to work in collegiate education for excellent benefits, shite money and no job security. I fell into the millennial trap of crippling debt, low wages and no job security, so I've committed myself to cheating the system until I eventually die prematurely. Here's this year's eligibility map:  The current federal poverty level for individuals is a laughable $12,000, although it's adjusted for high-cost states like Alaska. quote:I can't put anything into a retirement account since I don't earn anything, and I haven't paid a loving penny towards my student loans for years. I did a federal, income-based repayment consolidation years ago. When I was employed I made so little and had to relocate so often to find new work that having to pay anything towards student loans would have destroyed me... I never lied to the government, but I exploited the system and I don't apologise. I had to change jobs and relocate so often that every summer I would have to cash in my nascent 401k just to relocate to my next gig. Now that I have no money, I just don't pay; can't squeeze blood from a stone.   It sucks. I could only afford a bronze plan last year with massive out-of-pocket costs but I got dinged tax-wise bc the govt. figured I should be able to pay twice what I did for that plan while netting about $15,000 in income. So now I have to pay $600 in tax "underpayments" for that glorious bronze plan I couldn't actually afford to utilize.
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Sep 25, 2018 04:51
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It never fails to amaze me how much ACA coverage sounds like some strange RPG with a bunch of arcane, barely understandable rules twisted up in a fuckload of jargon. It's bizarre, why would anyone come up with that poo poo? 
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Sep 25, 2018 16:27
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PT6A posted:It never fails to amaze me how much ACA coverage sounds like some strange RPG with a bunch of arcane, barely understandable rules twisted up in a fuckload of jargon. It's bizarre, why would anyone come up with that poo poo? A majority of healthcare spending is not what one would consider an "insurable event". Health insurance in the US started out as very basic indemnity products, you buy the insurance and if you have to go to the hospital they pay you X dollars a day for every day you go, but as health insurance covered more and more services, it slowly evolved in to what it is today.
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Sep 25, 2018 16:36
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PT6A posted:It never fails to amaze me how much ACA coverage sounds like some strange RPG with a bunch of arcane, barely understandable rules twisted up in a fuckload of jargon. It's bizarre, why would anyone come up with that poo poo? The ACA was developed by neoliberal wonk nerds who love filling out spreadsheets and they don’t care that the rest of society loving hates dealing with that poo poo. To them, wrestling with formulas and legalese is yet another way of showing off their elite education, and if you couldn’t earn that same education in our wonderfully meritocratic system then you deserve to have a hard time paying for basic medical care.
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Sep 25, 2018 16:54
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Rhesus Pieces posted:The ACA was developed by neoliberal wonk nerds who love filling out spreadsheets and they don’t care that the rest of society loving hates dealing with that poo poo. No, it's actually because of the Supreme Court decision in NFIB v. Sebelius severing mandatory Medicaid expansion from the bill. It was supposed to be: 1) You get Medicaid 2) If your income is too high for Medicaid, then you go to Healthcare.gov and get a subsidized plan. But the severing of Medicaid created a huge fuckup in states that didn't want to expand it. Because now, you have "donut holes" where people make too much for Medicaid, but too little to get a subsidized plan. And, states that don't expand can use their own formulas for Medicaid eligibility to knock even more people into that donut hole. If the bill was implemented as written, then you would still have issues with high-deductible plans (these were there by design), but there would not be these crazy situations where you have to stay under 13-17k income to maintain coverage. This was not a feature of the bill at all and you should probably not just throw random "de eleetz!" theories around if you don't know what you are saying.
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Sep 25, 2018 17:07
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It is a system designed to use health care as another for-profit commodity so that it directs money from those who have little to those who have much. All is working as intended.
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Sep 25, 2018 17:21
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Leon Trotsky 2012 posted:No, it's actually because of the Supreme Court decision in NFIB v. Sebelius severing mandatory Medicaid expansion from the bill. If you can't afford to use a high-deductible plan then you do need to stay below the Medicaid cutoff to maintain coverage
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Sep 25, 2018 17:28
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Leon Trotsky 2012 posted:
No; the ACA was set up so that expanded Medicaid included a cliff of 138 percent of the FPL. It was designed that if you earned 139 percent of the FPL you had to purchase (subsidized) insurance. This has nothing to do with "the severing of Medicaid" and happens in the bluest of states as well as the reddest. In other words, the bill was constructed so that you had to stay under $17k in order to receive Medicaid in an expansion states as well as non-expansion states. Maybe you're thinking of the donut hole that occurs in non-expansion states when people make under the $12k FPL. In their infinite wisdom, the lobbyists and legislators never considered the possibility of states rejecting Medicaid expansion (and the federal money that came along with it), or going to court to block it. As a result, people in non-expansion states who are making between 100 and 138 percent of the FPL can receive federal subsidies that entirely cover their premiums for subsidized private insurance (although they might be stuck with bronze-level plans with $7,000/year deductibles; I'm not sure which metal tiers are 100 percent subsidized for premiums), but those making less than the FPL in non-expansion states have to lie and say they're making about $12k in order to receive a subsidized marketplace plan. The Dems' solution to this unintended consequence of not anticipating expansion was to exempt the lucky duckies who fell through this hole from paying the mandate penalty.
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Sep 25, 2018 18:00
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tbf it was inconceivable that states rejecting Medicaid would even be legal because SCOTUS overturned a bunch of precedent on exactly that. Of course this doesn't change the fact that if you can't afford the deductible for a subsidized plan then you get hosed by the cliff even in Medicaid expansion states and are forced to not work in order to not die
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Sep 25, 2018 18:07
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From KFF's latest Health Tracking Poll: The in-depth survey results are worth a glance; 81 percent of respondents said that health care was the most-important or very important factor for voting in the upcoming midterm election.
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Sep 25, 2018 18:18
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Willa Rogers posted:In their infinite wisdom, the lobbyists and legislators never considered the possibility of states rejecting Medicaid expansion (and the federal money that came along with it), or going to court to block it. This is the silliest complaint I have ever seen. They did. That was why it was MANDATORY and crafted in compliance with every Supreme Court ruling up to that point. There is nothing you can do when a 5-4 majority on the court is okay with reversing 89 years of precedent and applying it to only one law. The other poster claiming that it was an intentional decision made by academics to punish people who don't go to college is crazy. There are a million things to actually complain about, but that is not it. Leon Trotsky 2012 fucked around with this message at 18:49 on Sep 25, 2018 |
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Sep 25, 2018 18:47
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But it requires additional money to be allocated by the states in the future, I thought that didn’t really break with precedent?
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Sep 25, 2018 18:49
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hobbesmaster posted:But it requires additional money to be allocated by the states in the future, I thought that didn’t really break with precedent? If states couldn't be required to allocate money in the future, then the Civil Rights Act and Americans with Disabilities Act would be declared unconstitutional. The Sebelius decision was crazy and completely shattered all precedent in a way that even conservatives thought that they wouldn't do. The court went out of its way to say "Well, this only applies to this specific law and the civil rights act or the thousands of other laws in this scenario."
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Sep 25, 2018 18:53
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JustJeff88 posted:It is a system designed to use health care as another for-profit commodity so that it directs money from those who have little to those who have much. All is working as intended. gently caress yeah, it is:  Woo!  Just don't think about all the bankruptcy, homelessness, suffering and death on the other side of all that price gouging.
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Sep 25, 2018 20:44
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Leon Trotsky 2012 posted:This is the silliest complaint I have ever seen. Sillier than the complaint that another poster is an idiot for declaring that Medicaid is cut off in expansion states at 138 percent of the FPL, even though that is indeed what the ACA called for?
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Sep 25, 2018 21:37
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Leon Trotsky 2012 posted:There is nothing you can do when a 5-4 majority on the court is okay with reversing 89 years of precedent and applying it to only one law. https://en.wikipedia.org/wiki/Judicial_Procedures_Reform_Bill_of_1937
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Sep 26, 2018 00:27
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Leon Trotsky 2012 posted:There is nothing you can do when a 5-4 majority on the court is okay with reversing 89 years of precedent and applying it to only one law. The Medicaid expansion reversal was 7-2. The rest of NFIB v. Sebellius was decided 5-4. That majority upheld the rest of the ACA.
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Sep 26, 2018 01:08
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Czolgosz posted:The Medicaid expansion reversal was 7-2. The rest of NFIB v. Sebellius was decided 5-4. That majority upheld the rest of the ACA. Wow, I didn't remember that so I just looked it up and Breyer & Kagan joined the conservative majority on that ruling. What was the two liberal judges' reasoning for that?
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Sep 26, 2018 01:44
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Willa Rogers posted:Wow, I didn't remember that so I just looked it up and Breyer & Kagan joined the conservative majority on that ruling. What was the two liberal judges' reasoning for that? No opinion on Medicaid expansion got a majority opinion. The court technically did not issue an official opinion on Medicaid expansion constitutionality. Breyer and Kagan voted that way as a sop to Roberts because of the severability clause. The conservatives wanted to get rid of the Medicaid expansion and use that to say that "one section of the law was ruled unconstitutional and it is inseverable from the main law, so the whole thing must be struck down - even the constitutional parts." That was how Roberts was wrangled to join the liberal judges to preserve most of the law: quote:The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause. That Clause authorizes Congress to regulate interstate commerce, not to order individuals to engage in it. In this case, however, it is reasonable to construe what Congress has done as increasing taxes on those who have a certain amount of income, but choose to go without health insurance. Such legislation is within Congress's power to tax. Leon Trotsky 2012 fucked around with this message at 02:01 on Sep 26, 2018 |
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Sep 26, 2018 01:58
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And then a few years later: boom, Congress passes a law zeroing out the mandate penalty, thus nullifying their reason to vote as a sop, lol.
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Sep 26, 2018 02:11
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Willa Rogers posted:And then a few years later: boom, Congress passes a law zeroing out the mandate penalty, thus nullifying their reason to vote as a sop, lol. The vote was to preserve the overall law. There were 5 votes to get rid of Medicaid expansion and 4 to get rid of the law entirely. Roberts joined the 4 liberal judges in saying that inseverability didn't apply to the Medicaid expansion clause. So, you could remove the Medicaid expansion without removing the entire law. The 4 dissenters said that they had to strike down the whole law and allow congress to recraft a new law.
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Sep 26, 2018 02:15
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Leon Trotsky 2012 posted:No opinion on Medicaid expansion got a majority opinion. The court technically did not issue an official opinion on Medicaid expansion constitutionality. Roberts, joined by Breyer, Kagan posted:In this case, the financial “inducement” Congress has chosen is much more than “relatively mild encouragement”—it is a gun to the head. Section 1396c of the Medicaid Act provides that if a State’s Medicaid plan does not comply with the Act’s requirements, the Secretary of Health and Human Services may declare that “further payments will not be made to the State.” 42 U. S. C. §1396c. A State that opts out of the Affordable Care Act’s expansion in health care coverage thus stands to lose not merely “a relatively small percentage” of its existing Medicaid funding, but all of it. Dole, supra, at 211. Medicaid spending accounts for over 20 percent of the average State’s total budget, with federal funds covering 50 to 83 percent of those costs. See Nat. Assn. of State Budget Officers, Fiscal Year 2010 State Expenditure Report, p. 11, Table 5 (2011); 42 U. S. C. §1396d(b). The Federal Government estimates that it will pay out approximately $3.3 trillion between 2010 and 2019 in order to cover the costs of pre-expansion Medicaid. Brief for United States 10, n. 6. In addition, the States have developed intricate statutory and administrative regimes over the course of many decades to implement their objectives under existing Medicaid. It is easy to see how the Dole Court could conclude that the threatened loss of less than half of one percent of South Dakota’s budget left that State with a “prerogative” to reject Congress’s desired policy, “not merely in theory but in fact.” 483 U. S., at 211–212. The threatened loss of over 10 percent of a State’s overall budget, in contrast, is economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion. The Unsigned Dissent posted:E Leon Trotsky 2012 posted:Breyer and Kagan voted that way as a sop to Roberts because of the severability clause. Leon Trotsky 2012 posted:That was how Roberts was wrangled to join the liberal judges to preserve most of the law:
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Sep 26, 2018 03:33
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Thanks for that; I'd forgotten that the ACA had been written for expansion-or-none-at-all into the funding of Medicaid.
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Sep 26, 2018 04:06
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My attempt to get a flu shot at the pharmacy is now entering its second hour. They're on the phone with my insurance. Our health care system is so loving dumb.
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Oct 4, 2018 22:50
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Arglebargle III posted:My attempt to get a flu shot at the pharmacy is now entering its second hour. They're on the phone with my insurance. Isn't this kind Of The problem? Insurance isn't suppose to cover this really. It should be 5-10 cash and you go on your merry way? Not that I'm saying universal coverage shouldn't be the case and it costs nothing. But isn't it the way its suppose to work according to broke brain it was better in my day.
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Oct 6, 2018 00:47
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BlueBlazer posted:Isn't this kind Of The problem? Insurance isn't suppose to cover this really. It should be 5-10 cash and you go on your merry way? Its like $40-50 at walgreens if you're not insured. Due to all the insurance plan fuckery my last employer just offered everyone a flu shot voucher on top of insurance that you could print out and use if your PPO network was being difficult for whatever reason. They had BCBS, aetna, and united administering their plan and you could pick which one you wanted.
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Oct 6, 2018 01:10
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Accretionist posted:gently caress yeah, it is: It's pretty horrific. The financialization of the healthcare industry is Holocaust levels of appalling IMO. This may have already posted in this thread but here's an article on the obscene profits raked in by pharmaceutical benefits management cos. : https://www.bloomberg.com/graphics/2018-drug-spread-pricing/?srnd=premium
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Oct 6, 2018 04:18
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Utah knows what's up. Sending government employees to Mexico to get their prescriptions much more cheaply. Will be interesting to see if there is any federal fallout over this. https://www.sltrib.com/news/2018/10/28/fight-high-drug-prices/?fbclid=IwAR1jN3TF0EqBu4U-ADAgm8WobDR6b8HZGHo_q41M2f9XoER574ql1DiAk5w
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Oct 29, 2018 14:11
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Healthcare.gov has its 2019 plans & pricing online now, even though open enrollment doesn't begin till Thursday. At least in my area, prices seem to have stabilized, and have even dropped for many insurers. A pre-medicare old like me can get an Ambetter silver plan for $33/month with no deductible and only $2600/year out-of-pocket at the income level of $19k-$20k/year. Retail cost (ie, non-subsidized) for this age group is around $800/month. Of course, these are HMOs with highly restricted networks, but those have been the only plans I can afford anyway since the marketplace began for 2014.
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Oct 30, 2018 18:08
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Willa Rogers posted:Healthcare.gov has its 2019 plans & pricing online now, even though open enrollment doesn't begin till Thursday. Unless the restricted network is so burdensome to travel to as to make it not worth it, I don't really get the complaint about narrower networks. They are an option you can take to reduce your costs. There are certain instances where people might not want to go with that, but as a general rule "picking" your doctor has no impact on your health. I know people want to "pick their own doctor," but for a GP or Family Practice Doctor, it really doesn't make any difference for 99.9% of people. And most narrow networks will restrict you to a couple facilities that will have several doctors each, so you can still choose someone. Obviously, in an ideal world everyone would get exactly what they wanted in the exact amount and size they wanted. But, my insurance is significantly subsidized already and they will subsidize/lower the cost even more if you commit to their network. As a result, my roughly $110 per month health insurance costs about $35 per month in premiums, a $3,500 deductible, and the first $1,000 of the deductible is covered in certain circumstances.
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Oct 31, 2018 14:47
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Leon Trotsky 2012 posted:Unless the restricted network is so burdensome to travel to as to make it not worth it, I don't really get the complaint about narrower networks. They are an option you can take to reduce your costs. There are certain instances where people might not want to go with that, but as a general rule "picking" your doctor has no impact on your health. One potentially important caveat (and I know almost nothing about these options beyond what has been posted here) is that if a narrower plan is not accepted by the local major academic medical center/other large tertiary care centers, you may not have access to the specialties that you need in the event of serious illness/injury. Niche/rare services like surgical or radiation oncology, physical/occupational therapy + physical med/rehab, rheumatology, infectious disease, neonatal ICU, neurosurgery/spinal surgery, etc may not necessarily be offered by the list of in-network providers. Again, knowing nothing about these plans, I'm hopeful that they do make an effort to include major tertiary care centers that can provide such services, but that would be something I would absolutely double-check if I was thinking about enrolling in such a plan. Most people don't and won't ever need a NICU or neurosurgeon... but when you need it, you really need it. Otherwise yeah beyond maybe a psychiatrist/psychologist I don't think it actually matters who your PCP or OB/GYN is as long as they do their job.
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Oct 31, 2018 14:58
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Leon Trotsky 2012 posted:Unless the restricted network is so burdensome to travel to as to make it not worth it, I don't really get the complaint about narrower networks. They are an option you can take to reduce your costs. There are certain instances where people might not want to go with that, but as a general rule "picking" your doctor has no impact on your health. The biggest problem with narrow networks is they change.
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Oct 31, 2018 15:11
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