Obamacare Victims Are “Liars” Says Top Democrat

[Michele]

Remember “I feel your pain”-- Bill Clinton’s plaintive response to the woes of Middle America turned into a signature line for his administration, which became a cliché in American politics?

Every politician wanted to connect to the pain of Americans, even in good economic times, and especially during and after the Great Recession. The biggest political attack against Mitt Romney in the 2012 presidential election related to the exposure of his remarks about the “47 percent” and how out of touch it made the wealthy Republican nominee to the plight of the struggling working classes.

That was then … this is now. Instead of feeling your pain, Harry Reid stood on the Senate floor to tell millions of Americans impacted by skyrocketing premiums, incompetent administration, and policy cancellations from the implementation of the Affordable Care Act that they don’t really feel pain at all.

Democrats find themselves hammered by an avalanche of data and personal anecdotes that demonstrate the damage done by Obamacare. Instead of addressing those – which granted, would take most of the time between now and the midterm elections – the Senate Majority Leader angrily dismissed all such information as “untrue.”

"Despite all that good news,” Reid said on the Senate floor Wednesday, “There's plenty of horror stories being told. All of them are untrue, but they're being told all over America.” Reid specifically referred to an ad from Americans for Prosperity featuring the case of Julie Boonstra, a leukemia patient whose new plan disrupted her ability to budget for medications.

Reid blamed the brothers who own Koch Industries and who are major contributors to AFP. He dismissed Boonstra and apparently every other horror story as just “stories made up from whole cloth, lies distorted by the Republicans to grab headlines or make political advertisements.”


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[Adam]

Harry "mysterious sources I won't name tell me that Mitt Romney hasn't paid his taxes in ten years" Reid calling anyone a liar is just gobsmacking.

[Novaheart]

Harry "mysterious sources I won't name tell me that Mitt Romney hasn't paid his taxes in ten years" Reid calling anyone a liar is just gobsmacking.

I can't say "every one" or quote a percentage because I have no idea how many ads have been created. Rachel Maddow has done a pretty good job of debunking these ads and the alleged victims. Like some other people, the latest guy complaining about Obamacare is someone who is on government health insurance already.

TXR's mental defects notwithstanding, my mother is on Medicare and the only thing which has changed is that they pretty much forced her into mail order prescriptions, which once we got her all signed up has worked out pretty well. Moreover, she's saving all the money she pissed away at Walgreens walking from the pharmacy out through the main check outs. No more angled LED jewelers hammers and slinky nerf dashboard idols.

[Frostbit]

I guess Phillygirl is a liar (she already related her office's investigation into health insurance change) as am I now. Just got word this week our office group insurance policy will be no more as of the end of this year. A new policy will have to replace it and initial "shopping" shows them all to be more expensive by an average of 28%.

[Novaheart]

I guess Phillygirl is a liar (she already related her office's investigation into health insurance change) as am I now. Just got word this week our office group insurance policy will be no more as of the end of this year. A new policy will have to replace it and initial "shopping" shows them all to be more expensive by an average of 28%.

I don't know what to tell you; my insurance through Megabank has gone down $4/mo.

[Frostbit]

I don't know what to tell you; my insurance through Megabank has gone down $4/mo.

What's your deductible and annual cost?

[Novaheart]

What's your deductible and annual cost?

It's an HMO:

$5 office visit
$20 specialist
$50 ER or Ambulatory Surgery
$150 a day for hospital stay days 1-7
No maximums

I pay $129/mo for individual. Individual plus one is $180. Family is $360

[Frostbit]

It's an HMO:

$5 office visit
$20 specialist
$50 ER or Ambulatory Surgery
$150 a day for hospital stay days 1-7
No maximums

I pay $129/mo for individual. Individual plus one is $180. Family is $360

I'm admittedly ignorant of HMO's. They don't exist here.

$5 office visit

That's what you pay regardless of the reason for the visit? Any limit per month on number of visits? Must you see only providers in the HMO even if you were established with someone else long-term? Do you get to choose who you see or is it "any provider available" that day in the HMO. In other words, can you choose to have continuity of care with the same provider?

$20 specialist - Similar question...who picks the specialist? Must they be on the approved list? What if there is no neurosurgeon on the list? Is it then full out of pocket for you?

$150 a day for hospital stay days 1-7 What happens day 8 onward?

[Billy Jingo]

I don't know what to tell you; my insurance through Megabank has gone down $4/mo.

It is a massive change. I have little doubt there would be winners and losers.

What I didn't expect was that the losers would be those who opposed it and the winners those who support it. Seems a bit fishy to me.

[scott]

I'm admittedly ignorant of HMO's. They don't exist here.

$5 office visit

That's what you pay regardless of the reason for the visit? Any limit per month on number of visits? Must you see only providers in the HMO even if you were established with someone else long-term? Do you get to choose who you see or is it "any provider available" that day in the HMO. In other words, can you choose to have continuity of care with the same provider?

$20 specialist - Similar question...who picks the specialist? Must they be on the approved list? What if there is no neurosurgeon on the list? Is it then full out of pocket for you?

$150 a day for hospital stay days 1-7 What happens day 8 onward?

Medicare Advantage HMOs receive a flat amount (about $1000 per beneficiary per month in the Tampa area) from Medicare.

Most HMOs pay the Primary Care Physician a flat amount per patient per month, the patient can pick their PCP from a list of doctors (those who are in the network). In most of them the patient and the PCP pick the specialist from list, but in some situations the PCPs have a group of specialists they work with and an exception needs to be granted to outside the group (sometimes called a POD).

Every major medical condition must be covered and rare conditions get exceptions if no specialist for that condition (neuro oncology for example) so the HMO covers those services.

The HMO pays the hospital the Medicare rate for a hospital stay. The co-pays Nova listed are for the first 7 days and it's no cost to the patient after that.

[scott]

It is a massive change. I have little doubt there would be winners and losers.

What I didn't expect was that the losers would be those who opposed it and the winners those who support it. Seems a bit fishy to me.

That's not true. Most of the supporters have plans provided by their companies or the government so they support it because it's not affecting them yet.

Pretty much everyone who had a private insurance plan before this law is against it now.

https://www.youtube.com/watch?v=otmjtqU7tQU

http://www.propublica.org/article/loyal-obama-supporters-canceled-by-obamacare

[Novaheart]

I'm admittedly ignorant of HMO's. They don't exist here.

$5 office visit

That's what you pay regardless of the reason for the visit? Any limit per month on number of visits? Must you see only providers in the HMO even if you were established with someone else long-term? Do you get to choose who you see or is it "any provider available" that day in the HMO. In other words, can you choose to have continuity of care with the same provider?

That's what you pay regardless of the reason you see your primary care physician. In an HMO, all of your care goes through your primary. So if I need to see a dermatologist, I call a dermatologist on the approved list, they make the appointment, and I call my primary for a referral.

I always see the same doctor. It's her office, just like POS, except that she's a member of the HMO. So from the customer's perspective it looks the same as regular insurance. I had to switch doctors when I switched from the POS to the HMO because my old doctor doesn't like my HMO…. so fuck him.

$20 specialist - Similar question...who picks the specialist? Must they be on the approved list? What if there is no neurosurgeon on the list? Is it then full out of pocket for you?

There is an approved list of specialists. If I want to see a specialist for a second opinion, then the HMO pays him and I pay a 20% co-pay for that office visit. So typically, that would cost me $30 instead of $20. If I want the specialist to be my doctor because I find the HMO approved doctors to be unacceptable, then my primary writes a referral to refer me out of network, and I pay 20% co pay. If there is no specialist on the list for what I need, then I get referred out of network and I pay in net work copay. I have only left the network once, for a vascular surgeon, and my GP subsequently took over the reason I was going out of network. Your GP's office works kind of like a case manager.

$150 a day for hospital stay days 1-7 What happens day 8 onward?

I forget exactly. It's one thing for days 1-7, then something else for days 8-24 but whatever it is the out of pocket maximum is $2500 a year with an event exception, meaning that if I were to be hospitalized on December 18, 2013 and not discharged until January 18, 2014 then I wouldn't have an out of pocket maximum of $5,000, the $2500 would still apply.

The HMO made the most sense for someone with the potential for chronic issues.

[Frostbit]

That's what you pay regardless of the reason you see your primary care physician. In an HMO, all of your care goes through your primary. So if I need to see a dermatologist, I call a dermatologist on the approved list, they make the appointment, and I call my primary for a referral.

I always see the same doctor. It's her office, just like POS, except that she's a member of the HMO. So from the customer's perspective it looks the same as regular insurance. I had to switch doctors when I switched from the POS to the HMO because my old doctor doesn't like my HMO…. so fuck him.



There is an approved list of specialists. If I want to see a specialist for a second opinion, then the HMO pays him and I pay a 20% co-pay for that office visit. So typically, that would cost me $30 instead of $20. If I want the specialist to be my doctor because I find the HMO approved doctors to be unacceptable, then my primary writes a referral to refer me out of network, and I pay 20% co pay. If there is no specialist on the list for what I need, then I get referred out of network and I pay in net work copay. I have only left the network once, for a vascular surgeon, and my GP subsequently took over the reason I was going out of network. Your GP's office works kind of like a case manager.



I forget exactly. It's one thing for days 1-7, then something else for days 8-24 but whatever it is the out of pocket maximum is $2500 a year with an event exception, meaning that if I were to be hospitalized on December 18, 2013 and not discharged until January 18, 2014 then I wouldn't have an out of pocket maximum of $5,000, the $2500 would still apply.

The HMO made the most sense for someone with the potential for chronic issues.

What about if you travel to someplace on vacation and something happens? Do you have a bunch of pre-approval hoops to jump through if you are outside the network and have you ever actually done it. My experience with insurance companies, I imagine HMO's are no friendlier, is they will make things difficult when you stray from their network.

[Michele]

One-size-fits-all is not appealing to most people and certainly not coming from the government. Obamacare was not going to affect anyone except those who were non insured, under insured, or the people who just wanted the super-duper special government insurance. We all now know how that shook out.

[Gingersnap]

What about if you travel to someplace on vacation and something happens? Do you have a bunch of pre-approval hoops to jump through if you are outside the network and have you ever actually done it. My experience with insurance companies, I imagine HMO's are no friendlier, is they will make things difficult when you stray from their network.

HMOs have very good and very bad points. I've been in one for years. When I travel outside the network, it depends. Some other states have my HMO so it's no different than if I was taken to a non-HMO hospital in my state - my emergency treatment would be covered and I would be taken to an in-network hospital if I had a long stay. If my HMO had no presence in that state, I'd be covered for emergency services but not for just random treatment like a mammogram or an office visit for a non-emergency situation like an allergy.

The good points of HMOs depend on your situation. If you have chronic health issues or basically no health issues, it's great. If you have trauma stuff or cardiovascular stuff, it's great. If you have anything exotic, not so much. You can't expect cutting-edge treatment for cancer or neurological issues. The nutrition counseling at HMOs is standard crap advice. Fatness issues get crap advice. Mental health stuff is the same. Drug/alcohol - ditto.

I was going to switch to a high deductible/low monthly plan with steeper co-pays but that's off the table with the ACA plans available to me now. As it is, I have the HMO but I pay entirely for OCD stuff through a group specializing in that and I pay my own way for holistic therapies.