Obamacare - how does this cover the uninsured??

[landrun]

I've missed something here...

If you have to pay a penalty for not buying insurance, how does this help the poor who can't afford insurance and currently aren't covered?

1) either they now have to buy it or pay a penalty...
OR
2) they don't buy it because they can't afford it and they get care for free? - and you and I pay for it?

If it is #2, then what criteria is used to determine if you can afford it or not? - If you vote democrat you get free care? :)

... seriously, someone know how this is supposed to work??

[Sooner5030]

paying the penalty does not provide them coverage. So to an extent the same e-room abuse will continue but an annual tax will be collected that will go to the general fund.

A government ran baseline plan (with a tax like FICA) would have been better than what we got....IMO.

[landrun]

paying the penalty does not provide them coverage. So to an extent the same e-room abuse will continue but an annual tax will be collected that will go to the general fund.

A government ran baseline plan (with a tax like FICA) would have been better than what we got....IMO.

Sooo..... how are the millions of uninsured now covered then?
What problem does this solve?

If this is the truth, can anyone on the left tell my why they think this is so wonderful for the poor??

How do the once uncovered now get health care with this plan?

[Sooner5030]

Sooo..... how are the millions of uninsured now covered then?
What problem does this solve?

If this is the truth, can anyone on the left tell my why they think this is so wonderful for the poor??

How do the once uncovered now get health care with this plan?

Some of them will decide to get coverage rather than pay the fine.....especially if you have 4 kids and the cheap-*** premium is less than the fine. The problem is that more coverage will increase the demand for care which will result in more $ increases......in a system where it is already increasing way beyond the rate of inflation.

Medical care is unique in that the buyer and seller do not have the same rational thinking of regular buyers/sellers in the free market. If I need care (expecially accute care) I cannot just wait until I get a good bargain.....the seller of the care understands this and it results in upward pressure on prices. The ACA did not address this issue at all. Nothing will until we treat it like education.......provide a government managed/rationed baseline to all and then allow the wealthier (to still pay the taxes) the opportunity seek private alternatives through less regulated markets.

[jkjsooner]

The mandate has nothing to do with providing insurance for the uninsured. The mandate is all about preexisting conditions. At some point insurance companies will no longer be able to consider preexisting conditions. Without some kind of incentive to buy insurance, the uninsured could simply wait until they get sick before buying insurance. This would result in skyrocketing insurance costs and could possibly threaten the validity of insurance. The mandate is an attempt to encourage those who would do this to get insurance.

I'm not so sure the mandate is large enough. Some people might look at it and figure they can either pay several thousand out of pocket for coverage or a $500 or so penalty and just wait until they get sick.

That being said, something needed to be done about preexisting conditions. It's too easy for responsible people who have always maintained insurance to lose their insurance and be uninsurable when they get really ill. There have been anecdotal evidence of insurance companies actually dropping the insured themselves. I don't think that is that common but it is apparently possible. But a job loss could leave someone who had paid for insurance for decades uninsured if they happen to be from something like cancer.

Other than a mandate or socialized healthcare, it's hard to solve the preexisting condition problem. You could have provisions protecting someone if they had insurance when they got sick or remained insured for a long period of time but that would get very complicated.

Anyway, didn't answer your question but just wanted to point out why the mandate exists.

[jkjsooner]

The problem is that more coverage will increase the demand for care which will result in more $ increases......in a system where it is already increasing way beyond the rate of inflation.

I don't buy this at all. For starters, a large percentage of care is for the elderly who are already under Medicare. Additionally, most people tend to get care one way or another.

It could lead to inflation of some types of care that the uninsured don't generally qualify for but things like preventative care might reduce the cost in other areas.

[Sooner5030]

I don't buy this at all. For starters, a large percentage of care is for the elderly who are already under Medicare. Additionally, most people tend to get care one way or another.

It could lead to inflation of some types of care that the uninsured don't generally qualify for but things like preventative care might reduce the cost in other areas.

E-Room care per incident will stay consistent but routine/chronic/preventive care will all increase with an increase in those that are covered. Behaviors and rationality change when your options change. If you don't think the demand for care will increase then I'll just agree to disagree with you and move on. We are speaking a different language and will never understand each other. And I don't care if you're are not buying it......I was not selling it....it was free.

[jkjsooner]

And I don't care if you're are not buying it......I was not selling it....it was free.

Wow. Apparently my use of a simple meaningless phrase hit a nerve. I wasn't trying to be rude.

[Sooner5030]

Wow. Apparently my use of a simple meaningless phrase hit a nerve. I wasn't trying to be rude.

I'll get over it once I change my kotex........I had a busy day at work while the rest of the world got to watch the news about the ruling.

[landrun]

Found this: I have no idea if it is accurate and it still incomplete. If you pay 4.3% of your income as the premium, what do you get? What co-pays if any are there? What percentage of a bill are you responsible for? What is and is not covered etc...



People making less than 133% of the poverty level receive Medicaid.
People making between 134% and 400% of the poverty level qualify for subsidies that cap their maximum out-of-pocket contribution for health insurance premiums at 4.3% of annual income.

[Bourbon St Sooner]

Another question I have is what qualifies as coverage to avoid the penalty? Can you buy a high deductible plan or does it have to be full coverage?

I would think that you could get a high deductible plan for less than the penalty, but that doesn't increase access to preventative care.

[Sooner5030]

Another question I have is what qualifies as coverage to avoid the penalty? Can you buy a high deductible plan or does it have to be full coverage?

I would think that you could get a high deductible plan for less than the penalty, but that doesn't increase access to preventative care.

I think some of this was left to the discretion of DHHS and will be part of their rulemaking. If so it should hit the federal register prior to becoming regulation in 2014. But as I have admitted elsewhere......I did not read the ACA.

[jkjsooner]

Anyway, I don't think the inflation argument really has a very sound ethical foundation.

If you ignore all the other reasons one might be against the ACA and just concentrate on the inflationary side, it boils down to a desire to limit healthcare to a subset of the population so that costs can been reduced for the rest. A sister argument is about a lack of availability.

Let's say we had a perfect hard working society where everyone contributed to society, bought their own health insurance, and participated in healthcare. Would it be right to consider that a problematic situation. After all, more people participating in health care (because they each decided on their own to work hard and provide for themselves and their families) would bring inflationary pressure.


If you want to talk about higher education or housing then, yes, the government had a major role in the inflation of those areas. (Much less for real estate because the private sector went crazy on its own.) But I contend this had less to do with the number of people being served and more to do with the unlimited supply of capital given to those people. Whether you think health care is a basic human right, I think it's hard to deny that healthcare is closer than the right to own a house or even the right to a higher education.

[Sooner5030]

Anyway, I don't think the inflation argument really has a very sound ethical foundation.

If you ignore all the other reasons one might be against the ACA and just concentrate on the inflationary side, it boils down to a desire to limit healthcare to a subset of the population so that costs can been reduced for the rest. A sister argument is about a lack of availability.

Let's say we had a perfect hard working society where everyone contributed to society, bought their own health insurance, and participated in healthcare. Would it be right to consider that a problematic situation. After all, more people participating in health care (because they each decided on their own to work hard and provide for themselves and their families) would bring inflationary pressure.

That's not the case if you use trade-offs. What if we ration or limit what care is covered in order to pay for more people covered. What if Ritalin, Prozac, and all the other neat advances in the last 20 years were considered selective and not covered....with the gain being we could provide more basic care for everyone?

The problem with the dem solution is that +people covered + types of care covered + people covered for pre-existing = large increases on the current pool of people paying premiums and faster increase in demand than what supply can keep up with.

in the end I believe sickcare will be the largest contributer to a financial reset for our government. So i don't get too emotional over it.....the more free stuff given away the faster we will be forced to only provide the intervention we can actually afford.

[jkjsooner]

I think changes were on their way whether it was via the ACA or not. It has been a long time since the employees had the upper hand on the employee/employer relationship and I with globalization I don't see that changing anytime soon. Employers have reduced benefits consistently over the last 15 or so years. There was bound to be a time where employer provided healthcare was rare. Once that happened, big changes would be in store whether we wanted them or not.

[8timechamps]

I've missed something here...

If you have to pay a penalty for not buying insurance, how does this help the poor who can't afford insurance and currently aren't covered?

1) either they now have to buy it or pay a penalty...
OR
2) they don't buy it because they can't afford it and they get care for free? - and you and I pay for it?

If it is #2, then what criteria is used to determine if you can afford it or not? - If you vote democrat you get free care? :)

... seriously, someone know how this is supposed to work??

Good question.

I've researched this to death, and I still can't find the "sweet spot" of the uninsured population that this is intended to help. From what I've seen/read, the mandate will not apply to people too poor to pay for coverage, or folks already covered by government plans (Medicare/Medicaid). If I am correct, there must be some massive part of the population that isn't insured because they aren't offered an option with their employer, and/or choose not to purchase any insurance.

I find it hard to believe that there is a large part of the population uninsured because of either of those reasons. I'm sure that there are people that fall into those categories, but I just can't believe it's a big number.

jk mentioned a big driver of this mandate, and that's the pre-existing condition elimination. There's also a part that forces insurance companies to cover "wellness care" (mammograms, well woman visits, colonoscopies, etc.) or "preventative care" without deductibles. Both great ideas, but isn't there an easier way to make those changes without the current version of Obamacare?

In the end, I think this will just drive medical care cost up, up, up. If insurance companies have to cover things they haven't had to cover in the past, the providers will charge more for those services (simple supply and demand). So, if you end up with a "basic" plan (because you purchase it rather than pay the "tax"), you end up spending a lot more in the long run.

[cleller]

Lets just hope it works as well as the programs we started back in the 60's to help people. You know, the housing projects, Procreation Payments, Food Stamps. Stuff that has really helped American to become a safer, more self reliant country.

[ictsooner7]

Same way Romneycare does, seeing how its the same plan!

[cleller]

Now, how will they know if you've bought insurance? Have a box to check "yes" or "non" on your tax return?

The IRS can only audit about 2% of tax returns as it is. They won't be able to confirm insurance coverage on 150 million filers.

[jkjsooner]

Now, how will they know if you've bought insurance? Have a box to check "yes" or "non" on your tax return?

The IRS can only audit about 2% of tax returns as it is. They won't be able to confirm insurance coverage on 150 million filers.

How do they know you actually gave to the church? If you get caught lying you're in a lot of trouble. Of course there are some automatic checks and flags but for the most part the severe punishment is the driving factor behind people being honest on their taxes. This is no different.

[cleller]

How do they know you actually gave to the church? If you get caught lying you're in a lot of trouble. Of course there are some automatic checks and flags but for the most part the severe punishment is the driving factor behind people being honest on their taxes. This is no different.

Here's the part that I wonder about, this is part of the law I saw elsewhere:

(2) Special rules
Notwithstanding any other provision of law—
(A) Waiver of criminal penalties
In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure.
(B) Limitations on liens and levies
The Secretary shall not—
(i) file notice of lien with respect to any property of a taxpayer by reason of any failure to pay the penalty imposed by this section, or
(ii) levy on any such property with respect to such failure.

It basically says you cannot be prosecuted for not buying the insurance. If you filed you taxes, and checked "yes", then didn't buy insurance, I don't think there is much chance you'd get prosecuted. You can always claim you misunderstood, lost the paperwork, or whatever. Since you did not fail to pay a tax you already owed.

Kinda hard to express, I just don't feel there is much likelihood of people getting jammed up on this. Realistically the worst that would probably happen is you'd get a $695 penalty pulled out of any future refunds.

[8timechamps]

Same way Romneycare does, seeing how its the same plan!

It will be interesting to see how the spin doctors work this one. So far, I've heard "Romneycare was completely different because it was on a state level".

I don't put myself in either the Republican party or the Democratic party, so I really want to see how this plays out. I'm genuinely interested to learn if there really is a difference, and if not, how it gets spun.

[Sooner_Bob]

Some families will decide to purchase insurance rather than pay the fine . . . . I doubt that will do much to actually increase doctor visits though.

If it ultimately makes it easier for my parents (with their pre-existing conditions who dropped their insurance because when they retired the premiums went up a ton) to get insurance I'm ok with it.