Can anyone explain the pros/cons of Obamacare in simple terms

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I'd love to read an objective list, if possible, of the pros and cons of Obama's Health Care plan. To be honest, I don't understand the ramifications when I google it.

I'm not interested in labels such as "it's socialist", or generalizations such as it's more big government, or it is a more fair system etc. Emotional rhetoric is not helpful.

I want to understand the specifics of how it affects patients and doctors. What are the main points? If someone has insurance will it interfere even more than insurance companies between a patient and his/her doctor? How is it similar/different from what Congress has?

For those curlies who live outside the US, are you happy with your healthcare system? How does it function? What are the advantages/disadvantages?

Thanks for any clarification.
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Great question CP. I would like to know as well. I hope it is better. Especially regarding pre-existing conditions. I getting killed right now with COBRA and deductibles.

$600 a month for me excluding, the $350 of any medical up front before insurance will pay anything. Prescription coverage has been lowered, meaning I am paying between $5 to $20 additional per medication and have take 12 meds daily. After that, they will pay 85% until I pay $2200 out of pocket. Then they will pay 100%.
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Last edited by juanab; 01-21-2012 at 10:25 PM.
Great question CP. I would like to know as well. I hope it is better. Especially regarding pre-existing conditions. I getting killed right now with COBRA and deductibles.
Originally Posted by juanab
COBRA is outrageous! Have you checked on buying your own personal policy? A friend, who is self-employed, purchased a family ppo thru blue cross for 700$/month. they opted for the ppo since it's far superior to a hmo. premiums were lower for the hmo.
Great question CP. I would like to know as well. I hope it is better. Especially regarding pre-existing conditions. I getting killed right now with COBRA and deductibles.
Originally Posted by juanab
Really? COBRA is a life saver for me! I was a dependent under my dad. When he died, COBRA continued my coverage with blue cross for medical, vision and dental for $74 a month. My highest copay is $35 for emergency room visits. And I'm covered for 36 months which really worked out because I got laid off the month after my dad passed away.


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Timeline of the Affordable Care Act | HealthCare.gov

http://www.kff.org/healthreform/upload/8061.pdf

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Simply, the plan created doesn't truly take into account the economics of the problem. Forcing healthcare purchases upon folks who may not be able to find anything affordable doesn't solve a problem - it just causes new ones. It doesn't keep the insurance to a reasonable dollar amount, or really do much to ensure the poor can get adequate care.

The plan is good because there are so many people, poor or not, who are unable to get health care right now. It should be fundamental that we can all get decent preventative care in order to limit emergency/major issues, yet the current system limits that as well as treatment for major issues to a lucky few.

Even as one of the lucky few with healthcare, I am fully aware that the system is VERY broken. Just one visit to an emergency room can tell me that, as many people there are sick but have no primary care physician they can see. I've known healthy self-employed individuals who were unable to get healthcare for seemingly random reasons.

Details of the economics, etc., are a bit over my head, but I could get another explanation from my friend who analyzes health care situations for a living if you wanted more detail...
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It's very similar to what we have in Massachusetts and NetG pretty much hit the nail on the head.

You can't deny someone insurance for having a pre-existing condition. That's a good thing.

You HAVE to have health insurance or pay a fee at the end of the year. The drawback is that on paper a person may look like he can afford an insurance that costs $350 a month, but that doesn't mean he can REALLY afford it.

So it's expensive. And whether you can afford it or not you have to have it.


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Obamacare is not a blueprint for socialism. You're thinking of the New Testament. ~~ John Fugelsang



Really? COBRA is a life saver for me! I was a dependent under my dad. When he died, COBRA continued my coverage with blue cross for medical, vision and dental for $74 a month. My highest copay is $35 for emergency room visits. And I'm covered for 36 months which really worked out because I got laid off the month after my dad passed away.


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Originally Posted by IAmJordanNicole
Really? 74$ for medical, vision and dental? That's INSANE!!! You are very very lucky!
COBRA is the full premium plus 2% (could be more now)
My family insurance premium is around 1800$/month. Plus a 500$ deductible for 2 of us, then 20% of all procedures. That's just medical. Dental and vision is separate.
Plus my husband works for the state of CA so it's not like a small company. There would be no way to pay for COBRA. At the same time, I can never allow my insurance to lapse because I have pre-existing conditions.
I don't want national care but something needs to be done. I have lots of online friends in other countries with national healthcare and they have a lot of problems getting into specialist, getting medications, etc. It's a mess.
I don't know how I feel about it. It's a good thing to have "affordable" healthcare but I don't know how I feel about it wing mandatory.

I've always felt the same way about car insurance. You pay and pay an pay and never get in and accident so what are you paying for?! But you're glad it's there when you do get in an accident.

My cousin was in a car accident last month, he hurt his neck and was in the hospital for a week and has to wear a brace for 8 weeks. He has no health insurance and his bill is $65 grand. Sheesh.


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Really? COBRA is a life saver for me! I was a dependent under my dad. When he died, COBRA continued my coverage with blue cross for medical, vision and dental for $74 a month. My highest copay is $35 for emergency room visits. And I'm covered for 36 months which really worked out because I got laid off the month after my dad passed away.


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Originally Posted by IAmJordanNicole
Really? 74$ for medical, vision and dental? That's INSANE!!! You are very very lucky!
COBRA is the full premium plus 2% (could be more now)
My family insurance premium is around 1800$/month. Plus a 500$ deductible for 2 of us, then 20% of all procedures. That's just medical. Dental and vision is separate.
Plus my husband works for the state of CA so it's not like a small company. There would be no way to pay for COBRA. At the same time, I can never allow my insurance to lapse because I have pre-existing conditions.
I don't want national care but something needs to be done. I have lots of online friends in other countries with national healthcare and they have a lot of problems getting into specialist, getting medications, etc. It's a mess.
Originally Posted by crimsonshedemon
My dad worked for boeing is that makes a difference...I guess they pay the rest? Plus I'm only 23 and pretty healthy. I never really use my insurance but I know I'm glad to have it!


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My dad worked for boeing is that makes a difference...I guess they pay the rest? Plus I'm only 23 and pretty healthy. I never really use my insurance but I know I'm glad to have it!


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Originally Posted by IAmJordanNicole
With COBRA, you pay the entire premium plus 2%. Mine is a family plan, husband, wife plus one kids (doesn't matter if you have 1 kid or 10- same amount). Individual plan is around 500$.

You have an amazing deal. And to be able to carry it for 36 months. There used to be a 18 month max. I've had to COBRA before and just for my kids, paid 400$/month and that was 1997- insurance has only gone up since.
I saved this a while back on my computer....I am not sure where I got it so I will have to find that out it's long and will take more that one post..but I can copy and paste:

US HEALTH CARE BILL:
WITHIN THE FIRST YEAR OF ENACTMENT
*Insurance companies will be barred from dropping people from coverage when they get sick. Lifetime coverage limits will be eliminated and annual limits are to be restricted.
*Insurers will be barred from excluding children for coverage because of pre-existing conditions.
*Young adults will be able to stay on their parents' health plans until the age of 26. Many health plans currently drop dependents from coverage when they turn 19 or finish college.
*Uninsured adults with a pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
*A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.
*Medicare drug beneficiaries who fall into the "doughnut hole" coverage gap will get a $250 rebate. The bill eventually closes that gap which currently begins after $2,700 is spent on drugs. Coverage starts again after $6,154 is spent.
*A tax credit becomes available for some small businesses to help provide coverage for workers.
*A 10 percent tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.


WHAT HAPPENS IN 2011
*Medicare provides 10 percent bonus payments to primary care physicians and general surgeons.
*Medicare beneficiaries will be able to get a free annual wellness visit and personalized prevention plan service. New health plans will be required to cover preventive services with little or no cost to patients.
*A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
*Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
*Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
*An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

WHAT HAPPENS IN 2012
*Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
*An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
*The Centers for Medicare and Medicaid Services, which oversees the government programs, begin tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.
WHAT HAPPENS IN 2013
*A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
*The threshold for claiming medical expenses on itemized tax returns is raised to 10 percent from 7.5 percent of income. The threshold remains at 7.5 percent for the elderly through 2016.
*The Medicare payroll tax is raised to 2.35 percent from 1.45 percent for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
*A 2.9 percent excise tax in imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

WHAT HAPPENS IN 2014
*State health insurance exchanges for small businesses and individuals open.
*Most people will be required to obtain health insurance coverage or pay a fine if they don't. Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
*Health plans no longer can exclude people from coverage due to pre-existing conditions.
*Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.
*Health insurance companies begin paying a fee based on their market share.

WHAT HAPPENS IN 2015
*Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services
WHAT HAPPENS IN 2018
*An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions 
 
1. Your Kids are Covered
Starting this year, if you have an adult child who cannot get health insurance from his or her employer and is to some degree dependent on you financially, your child can stay on your insurance policy until he or she is 26 years old. Currently, many insurance companies do not allow adult children to remain on their parents' plan once they reach 19 or leave school.
2. You Can't be Dropped
Starting this fall, your health insurance company will no longer be allowed to "drop" you (cancel your policy) if you get sick. In 2009, "rescission" was revealed to be a relatively common cost-cutting practice by several insurance companies. The practice proved to be common enough to spur several lawsuits; for example, in 2008 and 2009, California's
largest insurers were made to pay out more than $19 million in fines for dropping policyholders who fell ill.3. You Can't be Denied Insurance
Starting this year your child (or children) cannot be denied coverage simply because they have a pre-existing health condition. Health insurance companies will also be barred from denying adults applying for coverage if they have a pre-existing condition, but not until 2014.4. You Can Spend What You Need to
Prior to the new law, health insurance companies set a maximum limit on the monetary amount of benefits that a policyholder could receive. This meant that those who developed expensive or long-lasting medical conditions could run out of coverage. Starting this year, companies will be barred from instituting caps on coverage.
4. You Can Spend What You Need to
Prior to the new law, health insurance companies set a maximum limit on the monetary amount of benefits that a policyholder could receive. This meant that those who developed expensive or long-lasting medical conditions could run out of coverage. Starting this year, companies will be barred from instituting caps on coverage.
5. You Don't Have to Wait
If you currently have pre-existing conditions that have prevented you from being able to qualify for health insurance for at least six months you will have coverage options before 2014. Starting this fall, you will be able to purchase insurance through a state-run "high-risk pool", which will cap your personal out-of-pocket expenses for healthcare. You will not be required to pay more than $5,950 of your own money for medical expenses; families will not have to pay any more than $11,900.
6. You Must be Insured
Under the new law starting in 2014, you will have to purchase health insurance or risk being fined. If your employer does not offer health insurance as a benefit or if you do not earn enough money to purchase a plan, you may get assistance from the government. The fines for not purchasing insurance will be levied according to a sliding scale based on income. Starting in 2014, the lowest fine would be $95 or 1% of a person's income (whichever is greater) and then increase to a high of $695 or 2.5% of an individual's taxable income by 2016. There will be a maximum cap on fines.

You'll Have More Options
Starting in 2014 (when you will be required by law to have health insurance), states will operate new insurance marketplaces - called "exchanges" - that will provide you with more options for buying an individual policy if you can't get, or afford, insurance from your workplace and you earn too much income to qualify for Medicaid. In addition, millions of low- and middle-income families (earning up to $88,200 annually) will be able to qualify for financial assistance from the federal government to purchase insurance through their state exchange.
8. Flexible Spending Accounts Will Become Less Flexible
Three years from now, flexible spending accounts (FSAs) will have lower contribution limits - meaning you won't be able to have as much money deducted from your paycheck pre-tax and deposited into an FSA for medical expenses as is currently allowed. The new maximum amount allowed will be $2,500. In addition, fewer expenses will qualify for FSA spending. For example, you will no longer be able to use your FSA to help defray the cost of over-the-counter drugs.

Last edited by *Marah*; 01-22-2012 at 04:26 AM.
9. If You Earn More, You'll Pay More
Starting in 2018, if your combined family income exceeds $250,000 you are going to be taking less money home each pay period. That's because you will have more money deducted from your paycheck to go toward increased Medicare payroll taxes. In addition to higher payroll taxes you will also have to pay 3.8% tax on any unearned income, which is currently tax-exempt.
10. Medicare May Cover More or Less of Your Expenses
Starting this year, if Medicare is your primary form of health insurance you will no longer have to pay for preventive care such as an annual physical, screenings for treatable conditions or routine laboratory work. In addition, you will get a $250 check from the federal government to help pay for prescription drugs currently not covered as a result of the Medicare Part D "doughnut hole".
However, if you are a high-income individual or couple (making more than $85,000 individually or $170,000 jointly), your prescription drug subsidy will be reduced. In addition, if you are one of the more than 10 million people currently enrolled in a Medicare Advantage plan you may be facing higher premiums because your insurance company's subsidy from the federal government is going to be dramatically reduced.
CurlyPearl,

I think the pros and cons are subjective because everyone's opinion is going to have a spin on it depending on their situation and views...but at least now you have some stuff to read and decide for yourself what you consider a pro and a con. I got that list a while back after they passed the Patient Protection and Affordable Care Act (PPACA)

Hope it helps..if not..sorry...just trying to help.
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In the UK, national healthcare is paid for out of taxes. I pay about 150 a month and that includes;

Paying for the NHS
Paying for the pension system
Paying for the benefit system
Roads and emergency services
Education
And a bunch of other things I can't remember

I pay privately for dental treatment because not everyone can get NHS dental but you end up paying for each cleaning, check up and X-ray etc at my dental practice with the NHS. I pay 12 a month for dental cover and it includes everything but cosmetic work. Dental is free for children, pregnant women and the over 65s. It's the same for optical.

There are always situations where people wait to see a specialist or surgeon, I didn't have to wait as long as I felt like I was for my spinal surgery last year.

If something is urgent, you get in fast. There's a recommended 2 week wait for cancer treatment. My dad has had excellent care from the NHS with his cancer treatment over the last 5-6 years.

One of my friends has MS and if she has a flare up, she gets an appointment for the next day with the neurosurgeon.

People slag off the NHS but it's great. I wouldn't get rid of it for anything I bet most people are thankful for not having to pay 100s each month just for healthcare. I cannot imagine what it's like worrying about money with health. Personally, I think every government should provide an all round healthcare system for it's people, paid for by the people. Health shouldn't be dependent on wealth.

Prescriptions are free for the vast majority of patients (even though with the amount of whinging you wouldn't have thought so). Only something like 11% of people in England pay for their prescriptions. Each item on a prescription costs 7.40, even if the medication costs 28p or 500. This fee subsidises the NHS. Scotland and Wales have free prescriptions for all their patients.

Getting dental and eye appointments is easy, you just find an optician and book an appointment and a dental surgery and get on their books then make appointments.

Seeing a GP can be a little more difficult in my experience because of the amount of people wanting to see one. But you will see one. All appointments to specialists under the NHS system are arranged through the GP rather than having to find one yourself.

Also we don't practice Youth In Asia here
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I personally think it's a step in the right direction.


Economically, it can work. The individual mandate is key. Without it, it simply will not work. It's about getting more people in the insurance pool (particularly the young and "healthy); the more healthy your pool is, the better your insurance rating. If the only people invested in the system are severely ill and draining it, you will end up paying for it anyway. Because those people soon get kicked off their insurance by the company and enroll in government assistance. Whether that's Medicaid spend-down, then Medicaid or one of the special pools that (most) states have for people who have pre-existing conditions. The pre-existing conditions provisions in the law are therefore vital, too.

The truth is we're all going to need the healthcare system at some point. Unless we all die from something that kills us instantaneously before we can get to a healthcare provider. The point of PPACA is getting people to pay into the system now instead of holding out their hands later when the system is sorely needed.

Something close to half of the healthcare dollars spent in this country are spent by like 5% of the population. Yeah. That's a whole lot of spending.

I'll find some reports to back up this.

http://www.ahrq.gov/research/ria19/expendria.htm#HowAre

Here's is a really long PDF on the healthcare spending: http://www.kff.org/insurance/upload/7670_02.pdf

Truth is our system works fine if you have money. It works best if you have a lot of money. It doesn't work well at all if you're poor or living paycheck to paycheck and have no substantial savings. Which is the majority of the population. There's a chart on page 7 of the second document that shows how some other countries compare to the US on healthcare spending.

The reason making the insurance pool is so important is because in the next 10-20 years we are going to get slammed with a whole lot of elderly and ill people entering the healthcare system. PPACA will help move us in a direction of managing the financial burden.

I like the idea of letting people remain on their parents' insurance until 26. It's a way of conditioning young, "healthy" people used to being insured, making it more likely for them to invest in healthcare sooner.

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Last edited by curlyarca; 01-22-2012 at 07:15 AM.
I don't know how I feel about it. It's a good thing to have "affordable" healthcare but I don't know how I feel about it wing mandatory.

I've always felt the same way about car insurance. You pay and pay an pay and never get in and accident so what are you paying for?! But you're glad it's there when you do get in an accident.

My cousin was in a car accident last month, he hurt his neck and was in the hospital for a week and has to wear a brace for 8 weeks. He has no health insurance and his bill is $65 grand. Sheesh.


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Originally Posted by IAmJordanNicole
I see the economics of making it "mandatory" for everyone. This isn't saying I am for this plan or not; I just do understand this aspect. We all want insurance companies to cover us if we have a pre-existing condition. Most times we think of someone with a pre-existing condition as someone who has changed jobs, lost their insurance, etc. and want to ensure they can get coverage because of an illness they already have. That to me is very important. But what about the person who just says "I don't want insurance. I have no reason for it. I'm not going to pay into it while everyone else does, but you sure as better cover me if and when I get an illness and have a pre-existing condition." You are carrying their burden all along while they get a free ride.

It is the same reason we all pay for car insurance. Everyone carrying it keeps the costs down in the long run.
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