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ObamaCare Clusterfuck: Ask a simple question, get a complicated answer

Kaiser's Michelle Andrews takes questions. I'm just going to quote the Q&A in its entirety:

Q. I expect the annual premium for my company's group plan to be about $24,000, or 50 percent of my family's income. Will my family be eligible for subsidized coverage on the state insurance exchanges in 2014, provided we meet the poverty-level requirements?

A. It depends. Under the Affordable Care Act, companies with 50 or more workers must offer health insurance coverage that is both affordable and adequate; otherwise, their workers may be eligible for subsidized coverage on the online health insurance exchanges if their income is less than 400 percent of the federal poverty level ($94,200 for a family of four in 2013).

A plan is considered adequate if it covers at least 60 percent of an employee's covered medical expenses and affordable if the cost for employee-only coverage doesn't exceed 9.5 percent of a worker's income.

Some consumer advocates argued that the 9.5 percent test should also apply to the cost of family coverage, which is generally much more expensive than employee-only coverage. But in a final rule issued in February, the Internal Revenue Service said that it would not consider the premium for family coverage in determining affordability.

If the premium for employee-only coverage at your company is less than 9.5 percent of your income, your family may be out of luck.

"The whole family could be barred from premium tax credits on the exchange," says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. Depending on family income and size, however, the kids could be eligible for coverage under their state's Medicaid or CHIP program, Park says.

Coulda, woulda, shoulda....

NOTE Of course, with single payer Medicare for All, there is a very simple, one word answer: Yes.

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Average: 5 (1 vote)

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Rainbow Girl's picture
Submitted by Rainbow Girl on

And nice result:

"... kids could be eligible for coverage under their state's Medicaid or CHIP program."

Translation: Under ObamaCare you might be covered but your wife won't and your kids might go on Medicaid. Classy. And totally humane.

beowulf's picture
Submitted by beowulf on

"Translation: Under ObamaCare you might be covered but your wife won't and your kids might go on Medicaid. Classy. And totally humane."

Its worse than that, from this WSJ story Lambert linked to a few weeks ago, even if worker is "covered" by employer insurance that word doesn't mean much.

Employers are increasingly recognizing they may be able to avoid certain penalties under the federal health law by offering very limited plans that can lack key benefits such as hospital coverage...

Administration officials confirmed in interviews that the skinny plans, in concept, would be sufficient to avoid the across-the-workforce penalty. Several expressed surprise that employers would consider the approach.
"We wouldn't have anticipated that there'd be demand for these types of band-aid plans in 2014," said Robert Kocher, a former White House health adviser who helped shepherd the law. "Our expectation was that employers would offer high quality insurance." Part of the problem: lawmakers left vague the definition of employer-sponsored coverage, opening the door to unexpected interpretations, say people involved in drafting the law.
http://online.wsj.com/article/SB1000142412788732478700457849327403059818...

Rainbow Girl's picture
Submitted by Rainbow Girl on

Thank you for the timely reference Beowulf. It's so important to hold all the details and scraps that have been coming to light (many thanks to Lambert) together as we ascertain the true shape and nature of this hideous scheme.

So the translation of how ObamaCare is just as likely to play out (as not): Dad's on the "Skinny Plan" (with the equivalent of sup-par Medicaid coverage), Mom's not covered, and the kids are on CHIPS or Medicaid. ObamaCare is increasingly looking like Privatized Medicaid for All. Its absurd. And horrifying.

"We wouldn't have anticipated ..." A pox on their houses.

katiebird's picture
Submitted by katiebird on

There is A LOT to hate. But, to pretend that making the employee's share of a premium at or less than 9.5% of salary is affordable even while the FAMILY premium is 50% of the salary -- that's just insane. Crazy. Nuts. How are regular people supposed to navigate this mishmash?

And the Bizarre thing is, this answer is one of the clearest explanations of the inexplicable that I've read yet.

Rainbow Girl's picture
Submitted by Rainbow Girl on

is "affordable"?

I'd love to see the "analysis" that undergirds that particular bureaucratic benchmark. I would imagine it would have had to allot percentages of gross to things like food, shelter, utilities and transportation ... any pie chart in such as study would be a fascinating read. If I had to guess, the question framing the analysis might have been "how much can we squeeze out of the customer for the insurer's profit without eliminating their ability to buy food and stuff."

Any readers know if such a document -- or reference to such -- exists (publicly available)?

Compare what is considered "affordable" rent in the so-called affordable housing projects launched by Michael Bloomberg -- roughly $2 grand is considered "affordable" for someone making $80,000 (which with NYC, NYS, Fed, and FICA) is about $40K take home or roughly $3.3K a month, for an "affordability" rate of 60% of your take home pay!

katiebird's picture
Submitted by katiebird on

is that 9.5 would/will (can't tell yet) be WAY more affordable. We're paying 25% of our gross income on premiums now. It is a killing burden but, we've seen enough dramatic health issues in our families that we can't risk being uninsured.

Oh, and then it all turns inside out when my husband turns 65 because then his premiums aren't included in that 9.5% cap and I can't tell if we need supplemental insurance or not.

It's not even in effect yet and I'm sick of thinking about these f*ckin' buckets.

One Bucket for ALL. Please. And just include ALL the costs in our Federal Tax Bill. I'm so sick of this.

Submitted by lambert on

BWA-HA-HA-HA-HA-HA-HA!!!

Sorry, I don't mean to stir up anxiety (or, rather, be driven my own anxieties) but ObamaCare really does suck. It's just so poorly designed from a user (citizen) perspective.

I wish we could start a support group (again)... Be our own navigators, if you will. But for me personally that's hard because I have a blog to run....

katiebird's picture
Submitted by katiebird on

Percentage of Income Caps count only if you get a subsidy (households with incomes of more than 400% could be charged ANYTHING for their premiums) (except for some serious questions about employer coverage which might totally f*ck your family) but the out-of-pocket limits are dependent on which Metal you pick (or which picks you)

(is that what you were asking?)

Rainbow Girl's picture
Submitted by Rainbow Girl on

This is probably confusing on purpose because it goes straight to the heart of the matter, which is the amount of money in dollars that an ObamaCare Insurance Product is going to cost (upfront and potentially down the road) for households that sign up for one -- whether under the label "premium," "deductible," "cap," "out of pocket limit," etc.

I'm not confused about what I want to know, which should be answerable as a dollar amount for any combination under the Clusterf**k Matrix of ObamaCare -- but I can't make heads or tails if ACA makes some kind of semantic distinction between "caps" and "out of pocket limits" and/or "deductibles."

katiebird's picture
Submitted by katiebird on

(nodding) and add to that the 40%, 30%, 20%, 10% actuary values of the various metals. What does THAT mean in the context of caps?

Rainbow Girl's picture
Submitted by Rainbow Girl on

this pseudo-technical "analysis" of what is "affordable" and, along the way, deciding all the huge moral and social issues involved from his high perch of inexperience with real life (and his attachment to very large paychecks from masters he then slavishly serves.)

Another one that I don't know how he can look at himself in the mirror in the morning. Thanks for the reference, though -- I had missed that entirely and it is pretty fundamental. I think there's a series of posts to be done on the framing and "solving" of the "affordability" questions.

Submitted by hipparchia on

Another one that I don't know how he can look at himself in the mirror in the morning.

maybe he has a cloak of invisibility for a bathrobe.

I had missed that entirely

that wouldn't be your fault. it wasn't exactly blogged widely by the ezra kleins of the world.

I think there's a series of posts to be done on the framing and "solving" of the "affordability" questions.

it's certainly a target-rich environment, but my two all-time, most-favorite, best-quotes-ever on that are from avedon carol:

Remember, Americans are already paying more in taxes for health care per person than the British public is paying for the entire National Health Service. We shouldn't have to pay another dime to the insurance industry.

and

It's a libertoonian meme that we are unhealthy because we don't make the individual choice to "live right". But, you know, people in England and France eat plenty of fat and sugar, and they even smoke more, and they are still healthier than Americans. Now, maybe that's because they never got New Coke and still use real sugar in their Coke, or maybe it's because of a lot of other things, but when people who invented the Deep-Fried Mars Bar (and deep-fried pizza) are in better health than you are, it certainly isn't just because of your individual slovenly and immoral lifestyle choices.

Rainbow Girl's picture
Submitted by Rainbow Girl on

Great quotes! And a good time to bring up the recent revelations about Ensure (pure corn syrup) and how the medical establishment has endorsed is as a mono-diet for the elderly (which turns out to be a mono-slow-death by starvation).

katiebird's picture
Submitted by katiebird on

If they're anything like the "helpful" pages on the Medicare site then they're practically useless. No practical advise at all.

What you said about going to HR Block for Income Taxes so you can sleep? I think that's what we'll need. A gigantic (and for me local) company that guarantees their service.

And -- yes -- I see the hilarity of needing yet another private entity help me navigate/understand/feel-secure in/with my health insurance (not health care) decisions.

I think a support group. Or site. would be good. I was thinking about a sort of calculator that would let people plug in elements of their needs and spit out the plans that cover that.

But, how could we keep up with all the plan-changes to make sure that our forms/calculators were up to date?

It's the sort of programing I love (forms and databases) but, I don't know about the changeable criteria.

Submitted by lambert on

Drupal (this platform) makes a lot of form generation/polling etc. pretty easy to do. And then we can map the results and slice and dice them. And as a bonus there's a community aspect to it (ie people can comment).

If you worked up a set of requirements I'd be happy to see what I could do. Or you could do some of it if you know PHP (I know the APIs....)

katiebird's picture
Submitted by katiebird on

I'm about 5 years out of date with PHP but, I'm not bad with project design & pseudo code and can usually get myself up to coding speed pretty quickly when I have to.

I'll see if I can find a local group into training navigators. Because I really think that without that training it's a hopeless project.

In the meantime, I'll start thinking about what (information, details, actual suggestions for plans?) I would like to get out of our system.

Submitted by lambert on

It would be nice to have those training materials, too....

Submitted by hipparchia on

Nothing within this site or linked to by this site constitutes investment (snort) advice, or legal advice, or medical advice, or any kind of advice.

katiebird's picture
Submitted by katiebird on

I have a feeling that training navigators isn't that high a priority:

Kansas navigator news:

Sheppard said that because Gov. Sam Brownback last year decided to have federal rather than Kansas officials set up the state’s ACA-required health insurance exchange, the decision making on the grants would rest solely with U.S. Department of Health and Human Services.

“This is a consequence of not having a state-run exchange,” she said, during a meeting with representatives of the Kansas Health Consumer Coalition, Kansas Association for the Medically Underserved, and Oral Health Kansas.

The navigators, Sheppard said, would be trained by HHS without input from the insurance department.

Submitted by lambert on

... to get the Federal training, since I would think it drives everything.

Rainbow Girl's picture
Submitted by Rainbow Girl on

... in the event that a #FAIL in the training results directly in someone going bankrupt because of wrong advice.

Adding (though). We can't rule out that somewhere in that 2000 pages Pelosi didn't read before voting for the ACA and in the scads of regulations coming out of HHS, IRS and [any other agencies regulating in this space?] there isn't a tiny-type clause immunizing any and all actors in the chain of turning citizens into hostages of insurance companies for any and all actions pertaining to said process.

Alexa's picture
Submitted by Alexa on

I'm wondering, however, if the 'navigators' aren't exempt. Here's an excerpt from some material that hipparchia linked to:

Exchange regulations, at 45 CFR 155.400(a), state that “[t]he Exchange must accept a QHP selection from an applicant * * * and must—(1) Notify the issuer of the applicant's selected QHP; and (2) Transmit information necessary to enable the QHP issuer to enroll the applicant” (emphasis added). Additionally, as articulated in 45 CFR § 155.310(d), the Exchange is responsible for making eligibility determinations. Taken together, these regulations clearly mean that the Exchange, not Navigators, must determine eligibility and enroll applicants into QHPs. Additionally, a Navigator cannot make the decision for an applicant as to which QHP to select. That said, Navigators may play an important role in facilitating a consumer's enrollment in a QHP by providing fair, impartial, and accurate information that assists consumers with submitting the eligibility application, clarifying the distinctions among QHPs, and helping qualified individuals make informed decisions during the health plan selection process.

Sounds to me that this innoculates the Navigator.

And since 'the Exchange' is the federal government--good luck to all of us trying to redress our grievances with them.

Hey, looks like we're sc**wed, no matter which way we turn. ;-)

Submitted by hipparchia on

I was thinking about a sort of calculator that would let people plug in elements of their needs and spit out the plans that cover that.

a cautionary tale....

But for that process to be effortless for the end user, the exchange has to perform a lot of work behind the scenes. That’s where Brian Keane, a principal at Deloitte Consulting, which is building the exchange’s website, and his team take over. They have to launch a website that’s analogous to Expedia or Travelocity—though much more complicated—in the next five months. It has to synthesize information from the four insurers offering a combined 28 plans on the exchange into something that the lay person can understand. It has to send and receive information from a federal data hub that will determine whether people are eligible for help in purchasing their insurance and how much help they’re allowed to receive. Between 2,000 and 5,000 federal rules must be coded into the exchange’s software infrastructure. All of this has to be condensed into an easy web experience that won’t discourage the average Rhode Islander so much that they give up; Keane describes the actual consumer interface as the tip of the exchange’s proverbial iceberg.

Alexa's picture
Submitted by Alexa on

the 'cautionary tale.'

Honestly, based upon my own couple decades experience in the federal health care system, it may be fruitless to try and ferret out the information that it appears that many folks here would like (not a criticism--I don't blame them).

We bought ALL of our family's health insurance through the FEHB, and frankly, I don't recall ever being offered 'the detail' that folks here are seeking. It just wasn't made available during open season.

Once you ENROLLED in a plan, you got a bit more detail in the mail (with your health insurance plan card).

Now, we at least had a very clear understanding of the premium that would be deducted from our paychecks, every two weeks. Don't recall every being 'queasy' about this detail.

But, other than the basics: 80/20, 90/10, the annual deductible (don't remember regarding 'the cap' for annual out-of-pocket), probably a mention of the RX program 'co-pays,' we weren't provided much detail, at all.

Also, I left federal service BEFORE the internet was very prevalent in 'home use.'

I would be curious if there are other Correntians who are current, or former federal employees (surely there are). I imagine that 'things' may have changed considerably since my service.

After all, the FEHB is likely going to serve [somewhat] as an administrative 'model' for the ACA.

So, someone with more current employment with the Feds could probably contribute quite a bit to the conversation. ;-)

Submitted by hipparchia on

former fehbp participant, long ago, when the employee's share was very small, the insurance very comprehensive and the insurance companies very responsive.

and yes, of course everyone wants detailed information up front, and expert advice too, before making any important "your money or your life" kinds of decisions. any responsible, rational, intelligent being would.

yes, in the present, insurance companies do not actually have to tell you in detail what they are or are not going to provide you in exchange for taking your money. they only have give out a general overview before you buy a plan, and after you buy it, you get much more detail, but still very few iron-clad guarantees. in the future, they will have to give out more and better detail ahead of time, but still not anywhere enough.

gruber is a real piece of work. marcy wheeler did a real service for all humankind with her blogging there.

katiebird's picture
Submitted by katiebird on

It just occurred to me just why I was so mad at Krugman and Klein last week. It is that they were arguing against the lack of rate shock in CA on the grounds that health insurance for a lot of people in CA is effectively unavailable now -- so there are no plans at any price.

And that's true.

But, I think the name of the act was all wrong. It SHOULD have been the Available Health Insurance Act.

I was just reading through that LONG brochure from Covered California and it JUST ISN'T all that affordable. See page 43 of the brochure as an example. These are the prices for a 40 year old individual who doesn't qualify for subsidies (could be anyone whose household makes one penny more than 400% of poverty) When you consider that those costs would be double for a couple (presumably -- they don't actually say) and then more for each (?) child (again not clear). Oh, and 40 seems pretty young to me -- what are the premiums for a 60 year old? (shudder)

Then looking at this document - Benefit Brochure - and my heart almost stops. The silver and Bronze plans are HORRIBLE. Maybe it's just my lifetime experience in plans negotiated by my employers But, those plans are an awful deal. I already know from the Long Brochure on page 43 that the premiums are expensive. This shows me that the benefits for Silver and Bronze make the premiums almost extortion. Although they try to hide it (what is 30% of plans negotiated rate and how are we supposed to verify THAT before we get put in the hospital)

Well, I've long given up on Klein being an advocate for anything I care about. But why is Krugman playing games with this? If California is the best we're going to see then what's going to happen to us here in Kansas?

**************

I've been thinking about what we could put together as a support group.

Maybe the first thing would be a cheat-sheet listing things to question. For Example:

Do I qualify for subsidy?
Does premium cover more than one family member?
Can I go to hospitals in other cities if I'm out of town?
What if I get Cancer, can I go to any hospital or doctor I choose?
It's a long list.

jo6pac's picture
Submitted by jo6pac on

http://www.coveredca.com/calculating_the_cost.html

I’m using the above site for pricing, I’m 64 and earn 30,500 per yr until 0bummer get done with cuts to SS and other grand not a bargain ideas from his friends like pete peterson/larry summers and this is what I would pay for silver and it isn’t much of a plan.

Estimated monthly silver plan premium (without subsidy) $690 per month
Estimated tax credit from the government. $474
Your estimated monthly silver plan premium $216.

Then the disclaimer. It should read everything we just told you is a lie so get over it. Pay up or die sucker.

Based on the information you provided, you can determine your estimated monthly premium payments and also see how much you will receive in federal assistance. Please remember this is just an estimate

I've never like klein and as for pk I truly think the committee for the NBP for $ has been dumb down in his case.

Rainbow Girl's picture
Submitted by Rainbow Girl on

and other "cost-sharing" in addition to what the monthly premium (just one item of "cost sharing") would be? Because those dollar amounts come straight out of your pocket -- just like the premium -- before you get one iota of "benefits" under these plans. It would seem at a minimum deceptive if these government-sponsored estimators don't give you that information up front. I mean, to the extent that these calculators are designed to assist individuals in making an informed decision about something as serious as health care coverage and as financially committing as paying for it.

Submitted by lambert on

Not necessarily with answers. Of course the whole system is to fragmented, it's almost if if they wanted to atomize people....

Submitted by lambert on

Just think of this as the opening of Campaign 2014 and Campaign 2016. Because it is. They are all going to say whatever they have to say.

Rainbow Girl's picture
Submitted by Rainbow Girl on

That's why they fail to address, or deliberately ignore, the Gorilla in the nation: the unaffordability of comprehensive, quality health care to anybody but the very wealthy who can self-pay ad infinitum or employees of entities granting fabulous first-class health care.

"It's the price, stupid" is what should be yelled into the ears of Krugman and Klein until their ear drums burst.

But no, instead they focus on a red herring -- the lack of insurance available to the "uninsurable." Which, frankly, neither Krugman nor Klein even seem to bother to get some numbers as to how large that group is given that many states have state plans for just such people -- granted they suck, but so does overpriced Bronze ObamaCare.

Rainbow Girl's picture
Submitted by Rainbow Girl on

I wonder if applications to get contracts to become navigators are an open and public process or whether you have to be politically connected to find out about a faux open process or whether its "by invitation" only.

If it is a truly open process without biases towards particular vendors (ahem) then perhaps between Katiebird, Lambert, myself and [other Correntians?] we could submit a grant proposal to become navigators! Such an outfit would have the benefit of honestly evaluating whether any ObamaCare insurance product would even be appropriate in the first place -- sort of like the "suitability" standard the financial brokers are supposed to use when investing clients' money (though we know how that works out in practice).

On second thought, it might be advisable to not be tied to HHS funding to preserve independence -- I wonder whether PNHP or some similar organization would be interesting in partnering in a totally not-for-pay service that would provide honest insight to confused potential customers of ObamaCare.

katiebird's picture
Submitted by katiebird on

Could we do a conference call to talk about this? I think it's an excellent idea.

katiebird's picture
Submitted by katiebird on

1) http://watchdog.org/85584/obamacare-navigators-will-cost-taxpayers-milli...

I don't know anything about the site but, it's the first place I've read any specific qualifications for Navigators (30 hours of training, etc)

The U.S. Department of Health and Human Services will provide Wisconsin with $829,300 in navigator grant funds as part of the $54 million HHS set aside nationally for one year’s worth of navigators. There is $1.7 million more available for community health centers through HHS.

Republicans on the state Legislature’s Joint Finance Committee want to make sure that not just any schlub who passes 30 hours of HHS-administered training, and navigates through the host of other regulations set by the federal government in its 63 pages of rules, gets to be an Affordable Care Act navigator.

“Basically what you’re looking at (with the JFC regulations) is a focus on Wisconsin-based issues, which the federal regulations for the exchange is not going to do,”J.P. Wieske, spokesman at the state Office of the Commissioner of Insurance, said in a telephone interview. “You’ve got a consumer coming in and they’re vulnerable. We need to make sure (the navigators) know what they’re talking about and are acting appropriately.”

State oversight would include an additional 16 hours of pre-licensing training and completion of a written examination that passes muster with the Office of the Commissioner of Insurance. The commissioner also can set testing requirements and fees for the tests, if the JFC’s motion passes through the House and Senate and survives the governor’s pen.

In addition to testing fees, the JFC set the initial license fee for a navigator at $75, with an annual license renewal of $35, which can be changed by the commissioner. The fees are $100 for entities that hire navigators.

Navigators, or their sponsoring entities, also will have to furnish a bond of at least $100,000 to protect “against the wrongful acts, misrepresentations, errors, omissions, or negligence of the navigator.”

Then, embedded in that article is a link to the Federal Register regulations regarding the establishment and requirements for Navigators:

https://www.federalregister.gov/articles/2013/04/05/2013-07951/patient-p...

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