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Can we drop the "ER" hand-wave? The ER is obliged to stabilize you, not treat you. If you need maintenance medication or chemotherapy or a hip replacement, the ER is no help at all.
Now, tons of doctors do their best to game the system (and may their lives be blessed for what they do) and sneak actual treatment in, but the "OH, they can just go to the ER" is a canard.
That is to say nothing of the fact that it's the least cost-effective way of providing care.
Exactly, it's nothing but a myth that non-insured can just go to the ER and oh my look at that they get red carpet treatment somehow. It's stabilizing treatment only and that's it. Our local hospital even has it posted on the walls what they by law must do and what they will not do.
Aren't almost all ACA plans PPO's or HMO's? With either of those rates are negotiated, providers can bill for whatever they want but the insurer will only pay the negotiated rate and you are not responsible for any excess charges.
The point is - the ACA plan doesn't pay a single dime UNTIL the High Deductible is met. It's doesn't matter to the Patient what the ACA plan has "negotiated", they don't get the benefit of that "negotiation".
Keep in mind - it's not just the high premiums that most people who are not chronically ill object to, it's the High Deductible they must meet before the ACA policy even kicks in. Due to these 2 factors (High Premium/High Deductible) people are dropping coverage. No value to the ACA policies when you still pay/pay/pay.
The Cruz amendment — which has been inserted into the GOP Senate health plan — is smart, because it doesn’t take anything away from anyone. If you want Obamacare — you can have it. You can have the coverage for the 10 “essential benefits,?” you can have the subsidies and the exchanges that were supposed to save $2,500 per family. It’s still there for you.
The Cruz amendment creates what is called a “Consumer Freedom Option.” This essentially allows an “off-ramp” from Obamacare for the tens of millions of Americans who don’t want it. The “Consumer Freedom Option” allows insurers who offer Obamacare-compliant plans to offer a range of much less costly plans. In other words, it empowers people and families to pick and choose what they want in their own insurance package. Cruz provides billions of dollars of subsidies for people who have pre-existing conditions and high medical costs.
Essentially -- If you like your ObamaCare, you can keep it and all it's 10 required items and its high premiums/deductibles. If you don't need/want all that coverage, then you have the "Consumer Freedom Option". It's understandable that the Insurance Companies would much prefer Billions of Dollars in Bailouts every year.
The problem with the Cruz ammendment as that it allows the insurance company to cancel/refuse to pay past claims if you get sick. They can refuse you for pre-existing conditions. They can say that you lied and had a pre-existing condition and refuse past claims, saying they were for something you had before and lied about. If this part was removed from the Cruz amendment, it would be ok. But because the Cruz amendment doesn't protect for pre-existing conditions (or insurance company saying you had a preexisting condition but you didn't) - then the new Senate healthcare bill is terrible specifically because the Cruz ammendment doesn't protect for pre-existing conditions. It will split the insurance market into 2 parts and will cause massive price increases for those that get the policies that cover pre-existing.
All the need to do with the Cruz amendment is force it to cover pre-existing conditions - but let them drop some of the mandatory items and also allow higher deductibles.
The point is - the ACA plan doesn't pay a single dime UNTIL the High Deductible is met. It's doesn't matter to the Patient what the ACA plan has "negotiated", they don't get the benefit of that "negotiation".
This is incorrect. The patient gets to pay the pre-negotiated rate before their deductible kicks in. Patient simply picks a doctor that's accepts that insurance plan (aka use in-network provider) and patient submits insurance card to the doctor. Doctor then sends the bill to the insurance company. The insurance company determines the pre-negotiated rate for each line item on the bill and tells the doctor what the 'allowed charge' is. Doctor then modifies the bill and sets it to the 'allowed charges' which are the pre-negotiated rate. Doctor then sends patient the bill with the 'allowed charges'. Patient pays the bill. The pre-negotiated rate is typically an 80% discount off the original charges.
The doctor is not allowed to charge the patient for the difference between the original sticker price charge and the pre-negotiated rate. This is called "balance billing" and the insurance carrier isn't allowed to charge for this.
Last edited by sware2cod; 07-17-2017 at 02:13 PM..
This is incorrect. The patient gets to pay the pre-negotiated rate before their deductible kicks in. Patient simply picks a doctor that's accepts that insurance plan (aka use in-network provider) and patient submits insurance card to the doctor. Doctor then sends the bill to the insurance company. The insurance company determines the pre-negotiated rate for each line item on the bill and tells the doctor what the 'allowed charge' is. Doctor then modifies the bill and sets it to the 'allowed charges' which are the pre-negotiated rate. Doctor them sends patient the bill with the 'allowed charges'. Patient pays the bill. The pre-negotiated rate is typically an 80% discount off the original charges.
This is all a racket also.......
Charge: $3500.
Negotiated amount: $1895
Guess what happens to that $1605? It gets written off as a loss.
The Cruz amendment — which has been inserted into the GOP Senate health plan — is smart, because it doesn’t take anything away from anyone. If you want Obamacare — you can have it. You can have the coverage for the 10 “essential benefits,?†you can have the subsidies and the exchanges that were supposed to save $2,500 per family. It’s still there for you.
The Cruz amendment creates what is called a “Consumer Freedom Option.†This essentially allows an “off-ramp†from Obamacare for the tens of millions of Americans who don’t want it. The “Consumer Freedom Option†allows insurers who offer Obamacare-compliant plans to offer a range of much less costly plans. In other words, it empowers people and families to pick and choose what they want in their own insurance package. Cruz provides billions of dollars of subsidies for people who have pre-existing conditions and high medical costs.
Essentially -- If you like your ObamaCare, you can keep it and all it's 10 required items and its high premiums/deductibles. If you don't need/want all that coverage, then you have the "Consumer Freedom Option". It's understandable that the Insurance Companies would much prefer Billions of Dollars in Bailouts every year.
It sounds good in theory but the problem is it divides the risk pool, so you're going to have all healthy people self-selecting into the "non-ACA plan" and the sick people in the ACA plan. The costs for the ACA plan are going to get WAY worse once you take out all the healthy people from it. OTOH, the non-ACA plan will be a lot cheaper... which sounds great until you get sick and that plan doesn't cover what you need and you have to buy into the really expensive ACA plan to get covered. If we were going to do that, might as well just wholesale repeal ACA and go back to the original system... it's basically the same thing (sick people pay through the nose/can't get insurance, and healthy people pay very little) except no more huge subsidies in the first place.
There will still be subsidies for the Pre-Existing and chronically ill ..... I don't think there is any way around that, and it's the right thing to do. I would rather see Federal Taxpayer Subsidies for this 5% than the exorbitant deductibles and premium prices for the majority of the middle class.
Medicare and Medicaid are here to stay - and they are ripe for Fraud as we just saw with the DOJ arrests. Clearly we are not a "one size fits all nation" (i.e. younger/healthier, elderly/poor/disabled, chronically ill) - and it's penalizing the vast majority to cater to the 5%.
What is the 5%? I ask because if that is your estimate of the number of people with pre-existing conditions you might be interested in knowing that the reality is that half of nonelderly Americans have one or more pre-existing health conditions.
The don't want to only insure "healthy people". They want to be able to charge premiums that offset actual risk. That's how they make a profit. Insurance companies are businesses, not charities.
The reason insurance companies exist is to spread risk. They make insurance affordable not by excluding high-risk parties by pricing them out of the pool, but by making the pool as large as possible. Insurance companies may be businesses, but their function isn't just to make a profit. They are supposed to be a safety net.
I'm pretty sure that the conservative approach to healthcare can be summed up as: screw sick people.
I didn't read through all of the posts, but I'd say you get the prize for the most astute observation! Doubly applicable for Libertarian's mindset! I really believe this issue speaks to the moral imperative that a society must have in caring for the sick (and, at least, making insurance affordable for the poor, children, sick, older people). You get cancer and lose your job--sorry buddy. Please, when a society heads down this path, we are all in trouble. Even Republicans.
The reason insurance companies exist is to spread risk. They make insurance affordable not by excluding high-risk parties by pricing them out of the pool, but by making the pool as large as possible. Insurance companies may be businesses, but their function isn't just to make a profit. They are supposed to be a safety net.
LOL......this is even more far fetched than the 9-11 WTT thread.
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I really believe this issue speaks to the moral imperative that a society must have in caring for the sick (and, at least, making insurance affordable for the poor, children, sick, older people). You get cancer and lose your job--sorry buddy. Please, when a society heads down this path, we are all in trouble. Even Republicans.
