Affordable Care Act -- NOT Affordable

[QueenCat]

To answer the bolded question, an IRS ruling that "access" to employer-based insurance includes family coverage regardless of whether the employer pays a penny toward the family's coverage.  This, combined with the 9.5% of income limit being based on self-only coverage, is going to be devastating to families that would otherwise qualify for subsidies.  Assuming that the AFA stands and is not defunded, Congress needs to fix this.  But I think they're too busy arguing about the bill as a whole to stop and focus on this detail that pretty much derails the intent of the AFA for a large segment of the population.

 

ETA: IRS has to interpret the law because they are responsible for collecting the "shared-responsibility payments" from uninsured persons.  Congress is the entity that has to say, no, that wasn't our intent and fix the ambiguity in the law itself.

 

The funding for most of the provisions of Obamacare/ACA are mandatory so they will still be in effect even if the portions that are not mandatory get cut from the budget that is supposed to go in to effect tomorrow. The exchanges will still start tomorrow, as they are under mandatory funding provisions.

[aggieamy]

I feel like I'm losing sleep over this.  Our rates are going to sky rocket ... we're self-employed and $350/per month/per person is going to hit us hard.  That's more than I pay for housing. 

 

Yay.

 

Thanks government now I can't afford healthcare. 

 

 

[Georgiana Daniels]

I feel like I'm losing sleep over this.  Our rates are going to sky rocket ... we're self-employed and $350/per month/per person is going to hit us hard.  That's more than I pay for housing. 

 

Yay.

 

Thanks government now I can't afford healthcare. 

 

That really, really sucks :(

[Georgiana Daniels]

Our benefits package should be here any day now. I cringe a little every time I open the mailbox.

[QueenCat]

I feel like I'm losing sleep over this.  Our rates are going to sky rocket ... we're self-employed and $350/per month/per person is going to hit us hard.  That's more than I pay for housing. 

 

Yay.

 

Thanks government now I can't afford healthcare. 

 

Yikes............. I haven't seen rates like that on the exchange. Not for the scenarios I plugged in, even for those above the threshold for subsidies (which is pretty high). Until the various exchanges go live though, we won't really know exact numbers. There are people called Navigators that have been hired by the exchanges that will help people understand how the options work. They are not allowed to steer you towards one specific insurance company/option available on the exchange but are to help you understand your actual options.

[pdalley]

I feel like I'm losing sleep over this.  Our rates are going to sky rocket ... we're self-employed and $350/per month/per person is going to hit us hard.  That's more than I pay for housing. 

 

Yay.

 

Thanks government now I can't afford healthcare. 

 

I'm hoping things look better tomorrow because right now even making only $27,000 a year - gross - this family of five will not be able to afford to cover two adults. The boys - thankfully - get Medicaid via SSI - due to their disability. Our state is not expanding Medicaid. 

 

 

And DH was informed this morning he needs yet another root canal and crown. We're maxed out on our current dental plan, barely survived a layoff, took a pay cut and now this.  :cursing:  And that's not even talking about my brother - who works part time - though he's tried and tried to get a full time job. He doesn't qualify for a subsidy either at this point and he can barely afford to eat and pay the bills as it is!

 

And I think there are only a couple of Navigators in our area - covering about four counties - two of them rural and large. The paper mentioned that - along that NC is getting some of the worst rates in the US under ACA.

[QueenCat]

I'm hoping things look better tomorrow because right now even making only $27,000 a year - gross - this family of five will not be able to afford to cover two adults. The boys - thankfully - get Medicaid via SSI - due to their disability. Our state is not expanding Medicaid. 

 

 

And DH was informed this morning he needs yet another root canal and crown. We're maxed out on our current dental plan, barely survived a layoff, took a pay cut and now this.  :cursing:  And that's not even talking about my brother - who works part time - though he's tried and tried to get a full time job. He doesn't qualify for a subsidy either at this point and he can barely afford to eat and pay the bills as it is!

 

Your brother should qualify if he is only working part time, as should your family. The online calculators don't seem to be calibrated correctly to deal with those states not expanding Medicaid. Once the exchanges are up, you'll have a clearer picture to your options.

[LizzyBee]

The funding for most of the provisions of Obamacare/ACA are mandatory so they will still be in effect even if the portions that are not mandatory get cut from the budget that is supposed to go in to effect tomorrow. The exchanges will still start tomorrow, as they are under mandatory funding provisions.

 

Got this message at work today:

FYI: BCBS announced this morning that the Exchange is not going to be operational for “auto enroll†tomorrow and they are recommending waiting until things are working properly. BCBS and Coventry, the carriers on the Exchange, are scrambling!!

 

This is for NC.

[QueenCat]

Got this message at work today:

FYI: BCBS announced this morning that the Exchange is not going to be operational for “auto enroll†tomorrow and they are recommending waiting until things are working properly. BCBS and Coventry, the carriers on the Exchange, are scrambling!!

 

This is for NC.

 

In a quick search, I couldn't find anything on the North Carolina Exchange delay. Makes sense though that there could be issues. It is being run by the federal govt but it is still it's own exchange. It's state's is separate, regardless of who is running ti.

[ThatHomeschoolDad]

I am SO confused reading this. I "thought" your current   government  was bringing in some kind of universal health care like other countries have.

 

 

Churchill said "You can always count on Americans to do the right thing - after they've tried everything else."

 

Give it a generation, our grown kids have universal coverage, and they'll look back and think how quaint we were.  Either that, or we'll still be aruguing the same points -- it could go either way.

[duckabell]

We just received our letters that our high-deductible HSA health plan will be dropped after Dec 31st.  We are self-employed and most likely our premiums will triple or quadruple.  Luckily our business is growing, but it means less money to pay down student loans or save for a down payment on a house.  We'll see if it affects any future hiring decisions. Right now there's too many unknowns.

[ChiMomNP]

I've found this (in answer to the question about subsidies for families if one member of the family can cover the rest on his/her employer based plan):

https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

But I'm not sure what it means.

 

Kaiser has this: "In general, employees who are offered insurance through work are not eligible for subsidized exchange coverage, so long as their insurance meets specified requirements. You would only be eligible for subsidized exchange coverage if your income is between 1 and 4 times the federal poverty level and you would have to pay more than 9.5% of your household income for your own coverage through the insurance offered by your employer."

 

But the family isn't an employee, so it still seems vague to me.  What am I missing?

 

But then there's this article: http://medcitynews.com/2013/09/millions-of-americans-with-employer-provided-health-insurance-may-be-better-off-with-subsidized-aca-plans/

"Roughly "37 million people would be financially better off switching to the exchange" from employer-sponsored insurance, said Dr. Jay Bhattacharya of Stanford School of Medicine, who led the study.

"The reason is that these workers would qualify for substantial subsidies to buy exchange insurance," he said. As a result, the subsidized Obamacare premium will be less than what they pay for employer-based insurance. The cost to the federal treasury if all 37 million switch: $132 billion a year in subsidies, according to the study."

 

So you can dump the employer plan if you choose and then qualify for the subsidies?  But this seems contrary to what other sites are saying.  (Which is that you can dump the employer based plan, but you won't get subsidies.)

 

Or is there just a lot of misinformation out there?  Problem is knowing which one is right.

 

 

My husband's employer notified him today that his plan meets the ACA requirements, the payments for him are less than 9.5% of his income (it ONLY takes into consideration the employee coverage, not the family coverage) and because of that if we choose to give up insurance through the company and go to the exchange, we will NOT qualify for ANY subsidies. We would also lose paying for it with pre-tax dollars. We will know the end of October what plans they will be offering for next year and what the new costs will be.

[rjand6more]

We just received our letters that our high-deductible HSA health plan will be dropped after Dec 31st.  We are self-employed and most likely our premiums will triple or quadruple.  Luckily our business is growing, but it means less money to pay down student loans or save for a down payment on a house.  We'll see if it affects any future hiring decisions. Right now there's too many unknowns.

 

 

We received the same letters today.  Thought we would be able to keep our insurance if we were happy with it??  I expected to be hit with a rate increase, not to be dropped.  I am so not happy.

[nmoira]

My husband's employer notified him today that his plan meets the ACA requirements, the payments for him are less than 9.5% of his income (it ONLY takes into consideration the employee coverage, not the family coverage) and because of that if we choose to give up insurance through the company and go to the exchange, we will NOT qualify for ANY subsidies. We would also lose paying for it with pre-tax dollars. We will know the end of October what plans they will be offering for next year and what the new costs will be.

 

There was an article in today's Oregonian about some local businesses giving up dependent coverage to better benefit their employees because of this oversight. I hope they fix it, but I'm not optimistic in the current political climate.

[Renee in NC]

Also, you need to include total household income for all dependents when calculating for the subsidy.  This would include working teens.  

 

You sure about that?  Most gov't programs don't include the teen's income until they are 18.

[Excelsior! Academy]

You sure about that?  Most gov't programs don't include the teen's income until they are 18.

Ugh!  I hope not, that seems really unfair.  It would encourage teens to delay working and the possibility of under-reporting.  We obey the law, but ugh!

[QueenCat]

We received the same letters today.  Thought we would be able to keep our insurance if we were happy with it??  I expected to be hit with a rate increase, not to be dropped.  I am so not happy.

 

I'm thinking that's because the insurer dropped that type of plan, or the employer (if yours is employer based) chose to go a different route with the options available. Either that or the plan didn't meet the requirements of the law.

[HRAAB]

You sure about that?  Most gov't programs don't include the teen's income until they are 18.

 

 Household income includes incomes of the taxpayer, spouse, and dependents.

 

http://kff.org/interactive/subsidy-calculator/

 

 

I would like to be wrong.

[hsmamainva]

Has anyone tried to enroll today?  I've been trying off and on since 8am and I can't get past the log-in section!  

 

Extremely frustrating!!!   :cursing:

 

 

[MomtoCandJ]

Has anyone tried to enroll today? I've been trying off and on since 8am and I can't get past the log-in section!

 

Extremely frustrating!!! :cursing:

I have and been about as far as you, I'm just going to wait. Dd and I have Medicaid right now ( I have it for pregnancy) so in more looking for after the baby is born for dh and I. Dh's employer did offer insurance for a while, it was good insurance though it only covered dh (company paid for it all). The insurance sky rocketed just after Dh's cousin passed away (who was also on this policy), so they had to cancel everyone :(.

[HRAAB]

I can't get past the registration page where you answer the security questions.  There aren't any questions to answer....

[mommaduck]

I don't even know where to begin with this :sad: We don't have insurance. We just moved, got off of assistance. My husband technically will be making almost $200k a year...we might see $60k (more than we've ever seen) after the first year. We will then be taxed on the higher amount....so that will come out of the lower amount. We have eleven people in our family. I don't even know where to begin. Right now, we are dealing with three weeks with no paycheck since home time + truck payment = starting out in the hole every time he goes back onto the road. I've been ignoring this issue on purpose because just the thought makes me want to cry.

 

The calculator says we would have to pay around $10k for our plan plus a 50% tax because my nephew smokes. So $15k?!

[Trish]

I wish they had gone with a single payer system that covers everyone instead of this complicated monstrosity. Affordable Care ACK.I

[Mrs Mungo]

This calculator looks a little different, might work better? It also has a pretty good FAQ attached to it:

 

http://blog.turbotax.intuit.com/2013/03/27/turbotax-health-care-eligibility-calculator/

 

 

[NicAnn]

I can't get past the registration page where you answer the security questions. There aren't any questions to answer....

Yep,here too.

[QueenCat]

Has anyone tried to enroll today?  I've been trying off and on since 8am and I can't get past the log-in section!  

 

Extremely frustrating!!!   :cursing:

 

I heard, on NPR, that the sites have had very high volume.... wait a few days (or even a week) and it should be better.

[rjand6more]

I called this morning.  The rep said that they are being told to tell everyone that they should keep trying and it should be up by tomorrow...

 

So anxious here.  I had not planned on looking right away, but our insurance company dropped us because our policy was not in compliance with new fed guidelines. 

[FairClaire]

We are self-employed with a high deductible HSA through BCBS.  I've seen several posts about people being dropped by BCBS completely.  If I haven't gotten a letter yet, does that mean I can keep my plan?  And if I do keep my plan, does anyone have any idea how much the premiums will increase?  Every December we get a notice with the new premium price and in the past it has gone up between 10 and 15% a year before the ACA.

[hsmamainva]

Success this morning!  Sort of...

 

Took about 45 minutes to finally get a profile set up...but then the application process (filling in all the names and other info) went very quickly.

 

Now waiting for application info to be verified...supposed to take less than 24 hours (we'll see!). 

 

Then we'll be able to actually see the quotes!  :crosses fingers:

 

Our own insurance saga -- dh is self-employed and we've been without health insurance for almost 10 years....so if this works the way I think it's supposed to work, this should be great for us!

 

I mean ... I look at this program as government-subsidized Select Quote.  You can go to Select Quote and fill out all of your info for life insurance and then they give you quotes from different insurance companies.  You choose the one you want and pay the premium and...voila...you have life insurance.  For this, the government is going to help you pay for that insurance if you meet the income qualifications. 

 

I don't mind paying ... just keep it affordable!!  The last time we had health insurance - almost 10 years ago - we were paying over $1000 a month for coverage.  A decade ago!  It was easier to just go self-pay and that's what we've done...and it's been hard --- our youngest has special needs and therapy is expensive .. our oldest had her appendix out several years ago, etc.

 

Will keep everyone updated!

[ktgrok]

I'm hoping things look better tomorrow because right now even making only $27,000 a year - gross - this family of five will not be able to afford to cover two adults. The boys - thankfully - get Medicaid via SSI - due to their disability. Our state is not expanding Medicaid. 

 

 

And DH was informed this morning he needs yet another root canal and crown. We're maxed out on our current dental plan, barely survived a layoff, took a pay cut and now this.  :cursing:  And that's not even talking about my brother - who works part time - though he's tried and tried to get a full time job. He doesn't qualify for a subsidy either at this point and he can barely afford to eat and pay the bills as it is!

 

And I think there are only a couple of Navigators in our area - covering about four counties - two of them rural and large. The paper mentioned that - along that NC is getting some of the worst rates in the US under ACA.

 

 

Your info, 27,000 for a family of five show that at least the kids should qualify for medicaid. That's why it isn't showing a subsidy for your insurance on the exchange...you should apply for medicaid instead. Have you done that?

[Trish]

Success this morning!  Sort of...

 

Took about 45 minutes to finally get a profile set up...but then the application process (filling in all the names and other info) went very quickly.

 

Now waiting for application info to be verified...supposed to take less than 24 hours (we'll see!). 

 

Then we'll be able to actually see the quotes!  :crosses fingers:

 

Our own insurance saga -- dh is self-employed and we've been without health insurance for almost 10 years....so if this works the way I think it's supposed to work, this should be great for us!

 

I mean ... I look at this program as government-subsidized Select Quote.  You can go to Select Quote and fill out all of your info for life insurance and then they give you quotes from different insurance companies.  You choose the one you want and pay the premium and...voila...you have life insurance.  For this, the government is going to help you pay for that insurance if you meet the income qualifications. 

 

I don't mind paying ... just keep it affordable!!  The last time we had health insurance - almost 10 years ago - we were paying over $1000 a month for coverage.  A decade ago!  It was easier to just go self-pay and that's what we've done...and it's been hard --- our youngest has special needs and therapy is expensive .. our oldest had her appendix out several years ago, etc.

 

Will keep everyone updated!

 

Yes please do, I think you are a great test case.

 

I read somewhere that the navigators are not required to have background checks, so be careful what information you give them. Don't know if that's true, just that it was part of a discussion I read online recently.

[NicksMama-Zack's Mama Too]

How come ehealthinsurance.com could give you a quote almost instantly and the federal marketplace takes up to 24 hours?

[NicksMama-Zack's Mama Too]

How come ehealthinsurance.com could give you a quote almost instantly and the federal marketplace takes up to 24 hours?

[pdalley]

Your info, 27,000 for a family of five show that at least the kids should qualify for medicaid. That's why it isn't showing a subsidy for your insurance on the exchange...you should apply for medicaid instead. Have you done that?

 

We don't qualify for Medicaid in NC. They didn't expand. The kids are on medicaid via their SSI. I just dropped $500 for dh's COBRA and he's not eligible for coverage under the new boss until Nov. And I have no idea what that will cost or if we can afford to put me on the plan then either.

 

So far, based on the calculators, going through the exchange is not going to be affordable at all. We'll take the penalty for me I guess.

[Scarlett]

We don't qualify for Medicaid in NC. They didn't expand. The kids are on medicaid via their SSI. I just dropped $500 for dh's COBRA and he's not eligible for coverage under the new boss until Nov. And I have no idea what that will cost or if we can afford to put me on the plan then either.

 

So far, based on the calculators, going through the exchange is not going to be affordable at all. We'll take the penalty for me I guess.

It's is pretty much where we are. All our kids are covered under their other parents health insurance. Dh has started a new job and will be eligible for insurance there late November. I have no idea how much it will be.....I fear we will only be able to insure dh and I will have to pay the penalty.

[Mom-ninja.]

How come ehealthinsurance.com could give you a quote almost instantly and the federal marketplace takes up to 24 hours?

 

Because they were not prepared for the sheer amount of traffic they are having since yesterday.

[Kathryn]

We have BCBS PPO through DH's work right now. According to what we got in the mail, it's only going up $20 a month in premiums with no changes to deductibles or OOP maximum. Or we can switch to BCBS HSA and have premiums go down $160 a month, again with no change in deductible or OOP maximum. This year, we can choose which one, but next year they will only have the HSA. Why is it changing so little compared to what others are experiencing? Are they going to gouge us next year?

 

Other question: we've always qualified for the optional coverage for pregnant women Medicaid. I was just denied and told that it was because my oldest child is on TEFRA Medicaid so he doesn't count as a member of our family, making our family size 4 instead of 5. Since we're over the limit for a family of 4, i was denied. Does anyone know if this is true? I can't find anything about this.

[NicksMama-Zack's Mama Too]

We have BCBS PPO through DH's work right now. According to what we got in the mail, it's only going up $20 a month in premiums with no changes to deductibles or OOP maximum. Or we can switch to BCBS HSA and have premiums go down $160 a month, again with no change in deductible or OOP maximum. This year, we can choose which one, but next year they will only have the HSA. Why is it changing so little compared to what others are experiencing? Are they going to gouge us next year?

 

Other question: we've always qualified for the optional coverage for pregnant women Medicaid. I was just denied and told that it was because my oldest child is on TEFRA Medicaid so he doesn't count as a member of our family, making our family size 4 instead of 5. Since we're over the limit for a family of 4, i was denied. Does anyone know if this is true? I can't find anything about this.

 

I'm going to guess that you are experiencing very little change in your premiums or policy because you live in a state that mandates that health insurance in your state cover services that are more in line with the Affordable Care Act minimums than other states.  By any chance, are you in CA or NY?  

 

Also, FEHB (Federal employee insurance) only went up 4% on average.

 

 

K

[Kathryn]

I'm going to guess that you are experiencing very little change in your premiums or policy because you live in a state that mandates that health insurance in your state cover services that are more in line with the Affordable Care Act minimums than other states. By any chance, are you in CA or NY?

 

Also, FEHB (Federal employee insurance) only went up 4% on average.

 

 

K

Not by a long shot! South Carolina.

[LizzyBee]

We are self-employed with a high deductible HSA through BCBS.  I've seen several posts about people being dropped by BCBS completely.  If I haven't gotten a letter yet, does that mean I can keep my plan?  And if I do keep my plan, does anyone have any idea how much the premiums will increase?  Every December we get a notice with the new premium price and in the past it has gone up between 10 and 15% a year before the ACA.

 

FWIW, I have employer based insurance with BCBS of NC.  Our insurance has been going up about 15%/year unless we cut benefits.  For 2014, BCBS is telling us that our premiums are projected to increase 35-40%.

[ktgrok]

We don't qualify for Medicaid in NC. They didn't expand. The kids are on medicaid via their SSI. I just dropped $500 for dh's COBRA and he's not eligible for coverage under the new boss until Nov. And I have no idea what that will cost or if we can afford to put me on the plan then either.

 

So far, based on the calculators, going through the exchange is not going to be affordable at all. We'll take the penalty for me I guess.

 

 

Well, good news is you won't have to pay the penalty, because your premium is higher than 8% of your income, so no worries there. BUT...I think it is SHAMEFUL that your state is refusing to expand medicaid, given that it is FREE to the state for the first 3 years. The subsidies on the exhanges pick up where the expanded medicaid leaves off. You are in the category to get great coverage under the expanded medicaid, which is why you don't qualify for the subsidies. But your state declined to do it, even though the federal government would pay the cost. I'm sorry. I think that is shameful, and am angry on your behalf. 

[Scarlett]

Well, good news is you won't have to pay the penalty, because your premium is higher than 8% of your income, so no worries there. BUT...I think it is SHAMEFUL that your state is refusing to expand medicaid, given that it is FREE to the state for the first 3 years. The subsidies on the exhanges pick up where the expanded medicaid leaves off. You are in the category to get great coverage under the expanded medicaid, which is why you don't qualify for the subsidies. But your state declined to do it, even though the federal government would pay the cost. I'm sorry. I think that is shameful, and am angry on your behalf. 

 

 

I am confused how you know the premium is higher than 8% of their income.  She said they didn't yet know how much it would cost.

[mommaduck]

Not by a long shot! South Carolina.

 

Exactly. Even SC's assistance program is difficult to navigate and broken.

[zoobie]

Because they were not prepared for the sheer amount of traffic they are having since yesterday.

 

How can you prepare for 2.8 million people? Any why would you? Overall there won't be a need for a computer infrastructure that would support that kind of web traffic on a daily basis. ehealthinsurance.com is not the same thing, and if 2.8 million people tried to get quotes on one day, they would have delays too.

[ktgrok]

I am confused how you know the premium is higher than 8% of their income.  She said they didn't yet know how much it would cost.

I was basing it on the calculator, for someone in her state, with their income, without subsidies. And I think she did say in another post how much it was, but maybe I'm thinking of someone else that said $350 a person. 

[pdalley]

I am confused how you know the premium is higher than 8% of their income.  She said they didn't yet know how much it would cost.

 

 I never provided a quote for us - just our gross salary.  And that's certainly not what the two calculators I've tried previously said. I heard from someone in the insurance industry to wait a week before trying to get a quote  and I think I will do that. Worrying is not helping. 

 

I could perhaps try to reapply for Medicaid but with the shutdown it's my understanding they aren't going to be able to process new applications now anyway. I'm hoping Dh's new employer's plan will work for us.  NC was worried that it would be able to maintain the Medicaid expansion past the three years. They didn't want to give benefits they'd have to take away later and given the state of our economy down here it's very hard for me to fault them for that. 

[ktgrok]

 I never provided a quote for us - just our gross salary.  And that's certainly not what the two calculators I've tried previously said. I heard from someone in the insurance industry to wait a week before trying to get a quote  and I think I will do that. Worrying is not helping. 

 

I could perhaps try to reapply for Medicaid but with the shutdown it's my understanding they aren't going to be able to process new applications now anyway. I'm hoping Dh's new employer's plan will work for us.  NC was worried that it would be able to maintain the Medicaid expansion past the three years. They didn't want to give benefits they'd have to take away later and given the state of our economy down here it's very hard for me to fault them for that. 

 

Ok, so the $350 number I got from someone else. But the calculator I used, given your salary and family size, definitely would put you as over 8 percent of your income, so you would get a waiver on the fine. 

 

As for not wanting to do the expansion because they might not be able to continue...I fail to see how zero years of healthcare is better than 3 years of healthcare. There are people out there with cancer, for whom 3 years of coverage might mean remission. Who will die now, without coverage. I think legislators forget these are real people, not numbers. I'm ceratin you'd rather have 3 years of coverage than no coverage at all. 

[Leav97]

I just got our re-enrollment paperwork.  I was getting worried with the #'s some people posting.  It's going up $15 a month.  I can breathe again.  I know they did some allignment with ACA the last 2 years.  But, everyone was talking about high deductible plans being canceled.

[pdalley]

Ok, so the $350 number I got from someone else. But the calculator I used, given your salary and family size, definitely would put you as over 8 percent of your income, so you would get a waiver on the fine. 

 

As for not wanting to do the expansion because they might not be able to continue...I fail to see how zero years of healthcare is better than 3 years of healthcare. There are people out there with cancer, for whom 3 years of coverage might mean remission. Who will die now, without coverage. I think legislators forget these are real people, not numbers. I'm ceratin you'd rather have 3 years of coverage than no coverage at all. 

 

Actually no, I'd rather not have it and suddenly have to learn to do without it - probably when I need it the most.  And I know a lot about Cancer. I just lost my mother and grandmother within three months of each other to it. My mother had wonderful private plan insurance she never used because she hated going to the Doctor. Early detection - had she gone - would have probably saved her life. My Grandmother was 87 and because she had medicare she was pretty much told to go home and die. Yes, same oncologist.  When my grandmother worked and had private insurance she had early detection that made her a breast cancer survivor for over thirty years. The pancreatic cancer that wound up killing her had nothing to do with the breast cancer my mother knew darn good and well she should have gotten screened for. 

 

Having insurance didn't save either of them in the long run. Just because one has it doesn't mean they will actually use it. Even if they are forced to buy it. Nor does it mean the facility giving care will bill the insurance in a timely manner. I just got a whopper of a bill for Hospice care for my mother - which would have been fully covered if they hadn't waited a year after her death to file with the insurance company.

[LMV]

 

As for not wanting to do the expansion because they might not be able to continue...I fail to see how zero years of healthcare is better than 3 years of healthcare. There are people out there with cancer, for whom 3 years of coverage might mean remission. Who will die now, without coverage. I think legislators forget these are real people, not numbers. I'm ceratin you'd rather have 3 years of coverage than no coverage at all. 

 

 

The problem is that it isn't as simple as the state just deciding to drop their expansion after three years when the federal funding cuts out.  Medicaid has always been a joint effort with regards to state and federal funding.  States who opt to expand Medicaid will see their portion for those individuals drop to 0% through 2016.  In 2017 then the federal portion for those individuals will start to drop.  At this point states will need to come up with their portion they can't just say well now that we have to contribute we're going back to the way it was before.  The other issue is that individuals who would have been eligible for Medicaid prior to the expansion but for some reason did not sign up will now only be covered by the standard federal portion (currently around 57%).  If a state has a very large and very poor uninsured population and little revenue then when they crunch their numbers they just may not be able to see how to sustain this.  Unfortunately this leads to a problem because subsidies are only eligible through ACA to families between 100-400% of FPL.  Individuals below this who are not eligible for Medicaid in their state are in a limbo situation.  I really do feel for these individuals and I think we need to come up with some solution,  I'm just not sure that directing anger and venom at their state legislature is helpful.

 

To avoid controversy I will fully admit that:

1.)I am a physician. [However, NC is not one of the states I am licensed in so I really don't have a good understanding of their local situation.]

2.)I feel strongly that access to quality health care is a right rather than a privilege.

3.)I also feel strongly that adults with decision making capacity have the right to make their own choices regarding how they access those rights in #2.  

4.)I am concerned that ACA will not be a good or fair approach to ensure either of the above tenets are preserved.