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ObamaCare Clusterfuck: Campaign 2014 begins as Obama invites insurance-selling "Moms" to Oval Office

WaPo:

The Obamas, who rarely co-host events in the Oval Office, aim to enlist moms in the campaign to convince their adult children, family members and peers to sign up for health insurance under the president's signature law.

Come Wednesday, the Obamas will welcome moms from around the country who have been working to convince relatives, neighbors and friends to get covered under the Patient Protection and Affordable Care Act.

The Obama administration has been courting women for months, emphasizing that adult children can stay on their parents’ insurance until age 26 and that insurance companies can no longer deny kids coverage because of pre-existing conditions.

Winning over women would have another benefit: Democrats are relying on them in the 2014 midterm elections that will decide control of Congress. Recent polls and analysis suggest the White House faces an uphill fight. A Kaiser Family Foundation poll in November found that 49 percent of women have an unfavorable view of Obamacare, compared to 33 percent with a favorable view.

So top Obama aides, including adviser Valerie Jarrett, White House Domestic Policy Council director Cecilia Muñoz, Health and Human Services Secretary Kathleen Sebelius have reached out through media that traditionally reach women, including magazines like Woman’s Day, Parents, Cosmopolitan, Cosmo Latina, Marie Claire, Glamour, Health, Latina and Ebony.

I know Moms, like apple pie, have always been used politically, but I find this tactic especially creepy and repellent, even for Obama, because we're giving people public praise for selling a private product to their peers and personal networks; in other words, for commercializing personal relationships.

It's exactly as if Amway was taking a bunch of "top producers" to Disneyworld or Vegas. Fine in itself, but do we really want the Executive Branch to work like Amway?

You may win a trip to the White House!

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Alexa's picture
Submitted by Alexa on

will spell disaster for the ACA.

Which is not at all the same as cheering for this outcome.

I'll be posting a short NC transcript of myself and two other commenters discussing the ACA premiums.

I was surprised at one commenter's very positive outcome (I even checked it out myself), because when I checked rates for relatives in another portion of the same state--they were MUCH higher. But I did congratulate the commenter and his daughter.

However, after I made the observation in passing to the third commenter that the "uneven outcomes of the ACA" might not do much for social cohesion, the third commenter expounded quite elaborately.

And it became fairly obvious that the other commenter thought it a bit unfair that the daughter of a "rich person" would receive such a huge subsidy (IIRC 93-94%) at taxpayer's expense.

Thanks for posting this excellent article. Heard it discussed on Julie Mason's program, "The Press Pool."

White women are "dropping like flies" from the Democratic Party ranks (on this issue).

This is one of the challenges that several Democratic Senators [especially the Blue Dogs] are dealing with in several "at risk" races.

This "Mom" strategy definitely bears watching.

But if the "Dad" story that I'm going to post is any indication--it may backfire!

Rainbow Girl's picture
Submitted by Rainbow Girl on

I'm keeping my antennas finely tuned for HappyVille with ObamaCare tales after hearing one recently in New York. A woman in her late 50s with pre-existing cancer gets a policy for $250 a month (after $400 subsidy) and a total out of pocket of $1,500 (!!) after which "everything is paid 100%." M-kay. And this is a very low-information Obot who doesn't have a clue about insurance policy easter eggs like narrow networks, separate deductibles for meds, etc. etc. etc.

Splashoil's picture
Submitted by Splashoil on

From Seattle Times:

Some 55- to 64-year-olds, who may have taken early retirement or who were laid off during the recession, have found themselves plunged into a low-income bracket. Unlike Medicaid recipients in the past — who were required to reduce their assets to qualify — they’re more likely to have a home or other assets.

For health coverage through Medicaid, income is now the only financial requirement.

At first, Prins was pleased at the prospect of free coverage.

But the more she thought about the fine print, the more upset she got. Why was this provision only for people age 55 and older? Why should those insured by Medicaid have to pay back health expenses from their estates when people with just a bit more income who get federal subsidies don’t? Why didn’t she and Balhorn know about this before getting to the application stage?

As Prins began searching for answers, she found that even those trained to help people sign up for insurance under the ACA weren’t aware of this provision, nor were some government officials.

http://seattletimes.com/html/localnews/2022469957_medicaidrecoveryxml.html

Now in a second piece:

The state issued notice Monday that it will amend its estate recovery policy to avoid “unintended consequences” for people who enroll in Medicaid for health care under the expansion made possible by the Affordable Care Act.

A story in The Seattle Times Monday detailed how some low-income Washington state residents applying for health insurance through Medicaid were upset when they encountered the rule, buried in fine print in the application process, and a number contacted state officials or lawmakers.

Officials from the state Health Care Authority say they will align state rules with longstanding federal policy, which requires states to place liens on property held by Medicaid clients age 55 and over to recover costs for long-term care and related medical services from their estates.

This is a huge rollback, but just in Washington. No initiative from Obama on this at all even though many of us have beat the drums. Someone is worried.

Submitted by Dromaius on

What do you bet they'll do this for a little while and then sneak it back in when they think nobody is looking.....

Although, maybe the "clawbackpedaling" occurred on constitutional grounds? Maybe this issue alone could lead to the overturning of the mandate?

I speculate, therefore I am.

Submitted by lambert on

If it's buried here only a few will find it and link to it, and Google probably won't even show it.

If it's a post, all that is much more likely. So do yourselves and everybody else a favor.

Alexa's picture
Submitted by Alexa on

I spent close to thirty minutes checking this out before I commented to "the Dad."

When I post the transcript, you'll see that I congratulated him on her access to two of the best medical centers/hospitals in the mid-portion of the state (TN)--including Vanderbilt and Saint Thomas.

Now, the NC commenter resides in Shelby County Tennessee--Memphis. The largest (I believe) metro area in the state. Which has a considerably lower per capita income--which he pointed out--compared to the other portions of the state which largely have a lower minority population.

I scanned the entire policy brochure. And I also conducted my own search for several top notch teaching hospitals in the State.

To say the least, a $0 Deductible was impressive.

The commenter's daughter enrolled in a PPO plan.

And it appears that the commenter didn't fabricate anything--I checked it out down to the exact policy. Which was not too difficult since he gave the particulars. Including the Deductible, OOP, etc.

Others may want to conduct their own search, to double-check my results. ;-)

(Now, this is NOT TO SAY that there may not be "something" that BC/BS is "hiding." Frankly, I was astounded by the commenter's "find.")

I don't begrudge him or his daughter, or anyone, for that matter, if they benefit from the ACA, including being able to sign up for a "super policy" like the NC commenter's daughter did.

The "folks" that I hold responsible for the wildly uneven outcomes will hear from me at the Polls in 2014 and 2016, however!

Unless they do something to remediate some of the negative (if not toxic) effects of the ACA, very soon.

[Pushed, so please excuse typos, etc.]

Submitted by lambert on

From a purely tactical perspective, now you can see why the unequal outcomes frame works:

1) Copes with the good anecdotal outcomes

2) Retains credibility for the bad anecdotal outcomes

3) Let's you say "I'm happy for X" while

4) putting the onus on your interlocutor to explain why they don't want the same happy outcomes for everyone.

That's why I spent a ton of time propagating Obama's Relentless Creation of Second Class Citizens.

Rainbow Girl's picture
Submitted by Rainbow Girl on

Alexa -

Do you know if this Dad got his daughter's policy on an ObamaCare Exchange or on the open market? Also, if the plan is PPO, and it is in the Exchange, is it a Platinum or Gold plan? A PPO policy would seem to be available only in the high-end of the metals range. If so, I'm confused about subsidies the daughter is getting -- didn't we figure out at some point that subsidies are only available if you get a silver plan -- or the second cheapest silver plan?

Alexa's picture
Submitted by Alexa on

website--which is where I assumed that Mr. Mill's got his.

It was only a "SILVER" PLAN--I know--that is incredible!

But, of course, this would qualify an individual at her income level for generous subsidies.

Heck, I'm going to try to follow-up on this in (maybe) a post or Quick Hit. I'm too pushed to write a post this evening (although it would be much easier to follow.)

I can tell you (as I mentioned earlier) that not ALL premiums in the state of TN are anywhere near that low.

Memphis is (I think) the largest metro area. The median wages there are lower than in Middle and or East Tennessee (generally).

And the we're talking about a "young'n"--compared to many individuals who are shopping on the Exchange.

Can't wait to see what Dromaius comes up with.

RG, you're great at research, as well.

Maybe you'll want to join in.

If I'm proven to have been duped--it won't matter if two of you find evidence of it.

;-D

Between my posts and Mr. Mill's comments--all the info that I had the other day, has been posted.

Good luck!

Rainbow Girl's picture
Submitted by Rainbow Girl on

Wow -- a PPO with zero deductible for pennies in monthly premiums? You all do realize that PPO means you can go out of network and get reimbursed, right? This is major Cadillac Plan territory.

We should all move to that corner of Tennessee.

Submitted by Dromaius on

With PPO, If you go out of networks, you can sometimes get reimbursed depending on the plan. The reimbursement is typically lower than for in-network, and it's typically subject to a different out of pocket maximum (something new with Obamacare). But out of network care no matter if it is or isn't PPO is subject to balance billing.

But I still hold that I think the person is confused. His info makes no sense in context with Tennessee's narrow networks.

Rainbow Girl's picture
Submitted by Rainbow Girl on

You're right -- if out of network you get gamed by the insurer's methodology for reimbursing (most are now using Medicaid or Medicare "Minus" schedules). The way OON has worked for me (in the past) is I pay the whole bill upfront and then submit to insurer, who then magically is using some secret rate schedule that only pays 3% of what the bill is. So it's not exactly balance billing but the functional equivalent, just in a different order.

But not all Insurers might be as nasty as Emblem, GHI and Cigna ... :)

Rainbow Girl's picture
Submitted by Rainbow Girl on

Yes, we have to remember that even if we were in Daughter's specific location, our rates could legally be tripled, so we multiply all her numbers by 3 to get a closer idea of what we'd be paying if we were her (plus age difference).

Alexa's picture
Submitted by Alexa on

That is, to find an exemption for a narrow slice of Medicaid beneficiaries.

That is, if I'm understanding the situation--that officials in WA state are considering making an exemption for approximately 37% of the Medicaid population (age 55 and up) from the federal and state MERP regulations.

Hopefully, progressive activists there will advocate for the roll back of this provision for ALL Medicaid beneficiaries.

One of the most toxic elements of the ACA is that it does not "allow" the poorest Americans to enroll in the same program as the rest of the country. Clearly, this would be possible with sufficient subsidization.

Talk about blatant class warfare!

Another great example of "unequal or uneven" outcomes!

(Which is not to say that I don't rejoice to see anyone escape what amounts to highway robbery--MERP. It's better than nothing, I suppose. But how will "traditional Medicaid beneficiaries" feel about this turn of events.)

Submitted by Dromaius on

No, the state is making an exception for only the STATE MERP, which is the part that allows clawback for EVERYTHING. The feds' law which allows clawback for LTC only will remain in place.

Also, the MERP generall only applies to the 55+ group, I believe. It may apply to a broader group for LTC only, say for severely disabled individuals.

Alexa's picture
Submitted by Alexa on

services other than LTC--it leaves it up to each individual state to determine whether or not they choose to include other Medicaid medical expenses--including mundane RX, doctor's visits, diagnostic tests, etc.

[At least, that's what someone posted here this past summer, IIRC].

At any rate, thanks for the clarification on the "LTC" matter.

That will be a wonderful improvement.

But does anyone know if the clawback for MERP includes ALL Medicaid beneficiaries--or ONLY those who make between 101-137% of FPL--i.e., only those who are in the Extended Medicaid Program?

This is what I'm not understanding.

And I didn't know that estate recovery applied to anyone younger than age 55, but I'm guessing that some of these severely disabled people are considered "dual eligibles." And many are in SNF, I believe. So it makes sense, I suppose.

Alexa's picture
Submitted by Alexa on

at NC (for Splashoil) for clarification, since I posted the comment. He has posted a "clarification" or reversal of this statement, over there.

I told him that I'm "confused."

But what I'm not understanding is--when did anyone UNDER the age of 55 have their estate's liened under the MERP regulations.

I never knew that this was possible.

But then, I never knew a lot about the program, LOL! (And obviously, still don't.)

Bottom line--the entire MERP needs to be abolished at the federal level.

Still looking for the language of the law, but read last night that the Bush Administration (of all things) actually passed legislation to lessen the adverse effect of the MERP passed under the Clinton Administration.

(It was a provision that applied to a narrow slice of the MSP portion of Medicaid recipients. But still, it allows those people to escape "recovery.")

Things just get stranger and stranger, the more one digs!

I will take it then, that it do

Splashoil's picture
Submitted by Splashoil on

I used the "less than" and "greater than" accounting symbols which were auto-eliminated. Then could not figure out how to edit. Got the links in there anyway and hoped that information might spark more research on "clawback." To borrow a phrase from the 1993 tie-breaker Al Gore, clawback is "an inconvenient truth." No one wants to discuss it across the "liberal blogosphere."
One question I have is if the Feds are picking up the tab for the Medicaid expansion, why are the States not waiving the clawback and passing on the savings? This really needs a first bench writer to sort this out.

Submitted by lambert on

Use the HTML entity references "<" for less then, and "&gt" for greater than. That will always work in all cases.

Rainbow Girl's picture
Submitted by Rainbow Girl on

The Paul Craig Roberts piece that first revealed this little-known looting device came out -- what, 11 months ago?! And the theme has been written and commented on here since then with great regularity.

It is truly fascinating to observe how profoundly the MSM has served Obama's goal of keeping his marks ignorant. But it's good to know that the MERP, one of the Really Nasty Easterggs in ObamaCare, is seeing a broader light.

It really is like living in parallel galaxies. The "Fourth Estate" has been subsumed into the White House.

None of the people to whom I forwarded the MERP stuff from PC Roberts ages ago deigned to betray any shock or horror. I got that look like "you're one of the troublemakers who hates Obama." Now that they'll see that MERP doesn't just affect "those poor people" (pearl clutch, sigh), who knows if they'll pull their cowardly heads out of the sand.

Wish it felt good to gloat, but it really doesn't.

Alexa's picture
Submitted by Alexa on

davidgmills December 17, 2013 at 4:20 pm

Now that she has coverage and I am able to find out who is in her network, I have to say it is pretty darn good. Every single major hospital in Memphis is on the plan and University of Tennessee Medical Group is on it which is by far the largest physicians’ group in the area covering every specialty.

So I think this is going to work out fine. Might be better than my own and mine is through a Methodist Hospital where my wife works as an RN. I have to use the Methodist Hospitals (about 7 in the area and the largest hospital group here.

But my daughter will have many more hospital choices than I, including the best Trauma Center which is not part of Methodist.

Guess this is definitely one success story!

Alexa's picture
Submitted by Alexa on

and I did check out a couple of top hospitals in Nashville (and Vanderbilt University Medical Center/Hospital is one of the best in the entire southern region--actually, so is Saint Thomas in several specialties--and because his daughter is enrolled in a really good BC/BS "PPO," she has been spared the "narrow network" business.

And the other "particulars" checked out, as well.

But is it this very disparity or unevenness of outcome that I suspect will cause the ACA to implode, eventually. [If not "fixed."]

And the people that the Administration "use" to tell their stories might want to be careful not to "tell too much."

That is partly what made the other NC commenter a bit unsettled. But I'm guessing that the Democrats "PR Machine" will be savvy in this matter.

(In the end, I'm glad that this young girl and her parents can have some peace of mind. She's been needing care for several years--I think that he said--and was too old to be covered under her parents--and could not afford a "rated" policy for her preexisting problems.)

Submitted by Dromaius on

I would love to know which plan this is, because from what I've read Tennessee has narrow networks just like everyone else.

I expect he's assuming that the plans on the Exchange from a particular provider have the same doctor networks as the ones off the Exchange?...or something.

The other possibility is it's an HMO plan? While the daughter theoretically has access to all of the providers, the primary care physician gate-keeps which ones can actually be seen.

Alexa's picture
Submitted by Alexa on

NC Transcript, December 15-16, 2013

davidgmills December 15, 2013 at 2:15 pm

I finally got my 29 year old daughter signed up for healthcare yesterday. Since she is in dental hygiene school and only working about one day a week now, we had to estimate next year’s income at $13,000. She qualifies for Medicaid, but since I was not sure whether she would get it since my state did not expand it, and since she never has qualified for it in the past, I signed her up for her own insurance.

At that income level she qualified for a 94% government subsidy. So we were able to get her a silver plan for $50 a month with a 0 deductible, 20% co-pay, and an out of pocket maximum of $750. And this maximum outlay includes her co-payments for labs, prescriptions, mental health, hospitalization, ER, and doctor’s visits. So for a max of $1,350 annually she has some really good coverage.

She hasn’t had health insurance to speak of since she was 21 (due to a combination of employers who didn’t provide it and pre-existing mental health conditions) so I am pretty excited about this. Last time she had lab work, the bill was $1300, which I negotiated down to $900. Her meds cost us about $100 a month getting them from Canada.

Carrier is Blue Cross Blue Shield and is a PPO.

It took a while to apply but it was worth it. There will be lots of people in my position who will eventually be very happy with Obamacare. Still I would have preferred a public option — still may get that with Medicaid — but Medicaid is not available for everyone.

*****

kareninca December 15, 2013 at 5:36 pm

I do not find credible accounts like this, when they do not include the state that the person lives in. That means there is not enough info to be able to google around and find out if it is BS. I call this a fake propaganda post.

Also, it was my strong impression that if you use the websites (state or federal), and you qualify for Medicaid, you could not buy a gold/silver/bronze policy: you were automatically dumped into Medicaid (didn’t we all see this: http://online.wsj.com/news/articles/SB1000142405270230353120457920772415...)(the “my mom was forced into Medicaid” article) (and automatically put on food stamps too: is your daughter mow on food stamps?). If she got the subsidy you describe, she had to have bought the policy from a website, and so she would have faced these issues. Please explain.
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kareninca December 15, 2013 at 5:40 pm

sorry, the link didn’t work. Just google “ObamaCare forced Mom into Medicaid WSJ”

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kareninca December 15, 2013 at 9:08 pm

hey, davidgmills, I see that you had time to give a “policy” opinion to Lambert well over an hour ago, but still no answer to my simple questions. Could you tell me what state your daughter signed up in? It should only take you a second. Also, whether it was on the federal site, or a state site, and how she avoided Medicaid, if she is eligible for it. It would make your description of her wonderful success much more credible.

I find it interesting that your “daughter” (if any of this is real) so readily fits into the demographic that Obamacare hopes to sign on.

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davidgmills December 15, 2013 at 9:13 pm

I posted an answer and it didn’t show up.

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davidgmills December 15, 2013 at 9:28 pm

A second post didn’t make it either. I give up. Both were long. Short story I live in Shelby County Tennessee and you can check the rates out yourself for a 29 year old woman. And yes, if Medicaid accepts my daughter then we must use Medicaid. But you have to be accepted by the state and not just be eligible according to the federal government is my understanding.

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Alexa December 15, 2013 at 10:38 pm

davidgmills,

She DID get an excellent deal–even the cost without subsidy, was not bad for the policy type (PPO).

And I checked–she has access to Vanderbilt Medical Center and Saint Thomas Hospital in Nashville (not to say Memphis doesn’t have decent hospitals, of course).

Don’t believe that these rates are “the norm.” Must be because you are in a metropolitan area.

Good for her!

And by extension, her parents. ;-)

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kareninca December 15, 2013 at 10:54 pm

No, these rates are not the norm. From the Memphis Business Journal: Obamacare rate estimates: Tennessee, Memphis among lowest in U.S.: http://www.bizjournals.com/memphis/news/2013/09/26/obamacare-rate-estima...

“The average U.S. premium for the benchmark plan – the second-lowest cost “silver” policy for the 36 states where the federal government will be running the exchanges — will be $214 per month for individual coverage and $774/month for a family of four, before subsidies.

In Tennessee, such a person would pay an average monthly premium of $161 for individual coverage and $584 for family coverage – the lowest costs of any of the 36 states where HHS will be running the exchanges.”

So, what your daughter is getting seems to the the LOWEST cost of any of the 36 states where HHS is running the exchanges. Congrats.

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Alexa December 16, 2013 at 12:38 am

Spot on, kareninca–thanks for the additional info!

It is interesting, because we have many relatives in some the more eastern part of the state–and none of them got quotes that low (and the ages span from 2 to 95, although with Medicare, no one over age 64 looked up any quotes).

This reminds me of a couple of articles that I’ve seen over the past several months.

One of which spoke of the huge disparities in the Exchange premiums–including literally “county to county.”

I have a feeling that the good ol’ ACA is not going to be especially helpful when it comes to fostering “social cohesion.”

Which is truly a shame, and totally unnecessary.

And I can’t honestly imagine the insurance industry agreeing to give up this windfall–ever!

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kareninca December 16, 2013 at 3:33 am

Wow, I had not even thought of that, Alexa: your point re the hit to social cohesion is exactly right.

I think that the first thing that many people will think re davidgmills’ case is that it is unfair that they should be subsidizing the insurance costs of the daughter of a rich man (retired PI lawyer). And that every time people see someone with a better deal than they have, they will feel that they are subsidizing that person, and will be pissed off, unless the person is piteous in a way they approve of. We can leave aside any discussion of whether it makes sense for people to think this way; it is simply the case that they WILL. The time-honored practice of being mad at the poor for getting something for nothing, will be directed at a huge range of people. It will be felt with bitterness, since so many people will be stretching so much in order to afford insurance.

This will be MASSIVELY corrosive.

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davidgmills December 16, 2013 at 9:39 am

If only I were a rich man… But I think that what is even worse is the Medicaid expansion. I have read that in Minnesota a family can qualify for Medicaid if they make less than $40,000 but in Alabama (the other extreme) a family can not qualify if it makes more than $4,000.

Sometimes it makes me wonder whether we are even a country when you see these kinds of extreme situations. And of course Vermont is going to go single payer so that everyone will essentially have Medicaid/Medicare.

davidgmills December 16, 2013 at 9:55 am

I knew Tennessee rates were low, but I didn’t realize they were that low. But I would think this is just reflective of the medical costs in different states just as labor costs and wages are different. Tennessee has some very low wages, and almost no unions, and so that people can’t afford as much either. Housing is certainly below national average as well.

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Alexa December 16, 2013 at 5:13 pm

Great points, kareninca & davidgmills!

May I add, however, that the example quoted is “low” within the entire state.

The family “rate” is higher than numerous quotes for both Bronze and Silver (much less Gold!) plans, for individuals over the age of 55.

I believe that the ACA allows for 3:1 ratio “age rating.”

And from what we found, every policy reflects this fully (for this cohort).

Several ACA articles that I’ve read allude to policies being higher (in all states) in less populated cities and towns, much less rural areas,

So David’s 29-year-old daughter’s premium is somewhat of an anomaly–even for TN.

Actually, according to insurance brokers in TN, the premiums are considerably “higher” than HHS first published.

This is because there were several insurers who were going to offer policies.

But in many areas, there is only one provider–Blue Cross/Blue Shield.

Thus–the higher premiums that were once projected!

Obviously her age and location (TN’s largest Metro area, I believe) are HUGE factors.

But again, good for her!

It is good to see that someone actually benefits from this (IMO) mostly disastrous law!
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**********

December 17, 2013

Here are the last four comments [that I'm aware of].[/that]

davidgmills December 17, 2013 at 3:35 pm

On Sunday I reported that I had enrolled in Obamacare for my 29 year old daughter who is a dental hygiene student and who has not really had insurance since she was 21. Since she is a full time student we estimated her income next year at $13,000 which qualified h3er for a 94% subsidy. I reported that her premiums for a Blue Cross Blue Shield silver plan in Memphis, Shelby County Tennessee would be $50 a month, 20% co-pay and $750 max out of pocket for a very good insurance plan covering mental health, drugs, doctors, ER and hospitalization. Today I had to call Blue Cross to check on the status. If premium was not paid before 12/23, I could not get coverage for January.

Was it too good to be true? No. It turned out to be exactly what the assistant at healthcare.gov signed me up for. Actually dealing with Blue Cross was worse than healthcare.gov. But I was able to get her a website account with ID and password, after a few phone calls able to find out what her Blue Cross member ID number was and her Group number and log in. Then I was able to print a temporary Blue Cross ID card and was able to get someone on the phone to accept payment. There were long phone delays due to swamped personnel. Probably took about an hour and a half to do and in all fairness, a lot of people might have been frustrated or would not have had the time to finish. Would a public option or single payer been easier to acquire? I would hope so.

But at least she is covered beginning January 1 and we are going to start getting appointments with providers. It has been a long time coming.

I hope there will be many more successes like hers. But when you think of all the subsidies she is getting, it seems to me that all the insurance companies are doing in her situation is acting like third party administrators and that the government is really paying for her healthcare. It seems to be nothing more than back door single payer with a private administrator.
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davidgmills December 17, 2013 at 4:20 pm

Now that she has coverage and I am able to find out who is in her network, I have to say it is pretty darn good. Every single major hospital in Memphis is on the plan and University of Tennessee Medical Group is on it which is by far the largest physicians’ group in the area covering every specialty. So I think this is going to work out fine. Might be better than my own and mine is through a Methodist Hospital where my wife works as an RN. I have to use the Methodist Hospitals (about 7 in the area and the largest hospital group here). But my daughter will have many more hospital choices than I, including the best Trauma Center which is not part of Methodist.

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just_kate December 17, 2013 at 5:24 pm

“the government is really paying for her healthcare” … um, you’re welcome? And your 29 year old daughter should take you out for a nice lunch or something similar for taking care of that for her.
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kareninca December 17, 2013 at 7:39 pm

Yes, “the government” paying for it, means that when we pay our taxes, we are paying for it. Or the government is borrowing it, to be paid (or not) by future generations. One can argue that it is a good use of one’s tax money (better use than e.g. military excursions and bank bailouts), but it is ultimately from your fellow taxpayers (those ones who are not in a position to evade it), not from “the government.”

I wonder how much system gaming this will produce. I’m assuming david’s daughter’s free rent, food, and health care research, are not counted as income for purposes of her subsidy. Just her 13k a year of money income. So she gets the same subsidy as someone who earns 13k, without having free housing. It could be rational for people to live with their relatives and not try to earn more, in order to get a big subsidy, rather than earning more and losing the subsidy, or getting a smaller one.

So, although I’m 50, my parents are in okay shape. I could move in with them (they’d be happy with that), earn a very little, and get a big subsidy. Any more I earn would count against the subsidy, and if I earn a lot and move out I have to pay rent and get no subsidy. Hmmm. I am going to go out on a limb here (not) and say that this is not going to increase the “household formation” rate.

I also think that I need to find out how to “go long” black market wages.

I’m not trying to be mean, david. I do think your daughter needs health insurance, and the system she has been dealing with has been horrible. However, from what I’m reading, it sounds like her fair share (given that she is supported by relatives who are comfortably off) should be more than $50 per month. She’s not really poor; she is only poor on paper. I’m very sure that your family could afford $350 per month without difficulty. Again, I’m not trying to be mean, but I know plenty of people who are truly poor, and she is not in that boat.
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**********

I highlighted karenica's ending comment above because this is a good example of what I'm saying about the ACA having a "deleterious effect on social cohesion."

I sometimes wonder if this is WHY the "Powers To Be" concocted a health care system with such "uneven benefits.".

Could it be another "divide and conquer" tactic?

With all the best and the brightest supposedly writing the ACA, I cannot believe that none of them are aware of the resentment that an almost "hari-kari like scheme" would produce.

They could have included some level of subsidy (even if miniscule) for all income levels, which may have served to tamp down some of the intra-class resentments.

Go figure.

Good luck with your sleuthing, Dromaius. ;-)

(Know this is a mess. But it's the best that I could do this evening.)

Submitted by hipparchia on

i'm still a bit skeptical...

i did find a tennessee plan that fits that description for that cost, and the network seems pretty decent, so i hope it's all true.

but here's a copy of the cheapest silver plan in my county - pretty much everything is free, it looks like - http://www.aetna.com/individuals-families/document-library/SBC/FL/FL_AET... - which sure sounds too good to be true if you ask me, even given the narrow hospital network.

Submitted by hipparchia on

same for their cheapest bronze plan - http://www.aetna.com/individuals-families/document-library/SBC/FL/FL_AET... - everything looks free.

both of these plans say they have no out of pocket maximum, so presumably the patient would get hit with all kinds of balance billing and penalties for not getting preauthorization for using out of network providers.

Alexa's picture
Submitted by Alexa on

a little more from Mr. Mills, "to chew on." (posted later this afternoon)

davidgmills December 17, 2013 at 4:20 pm

Now that she has coverage and I am able to find out who is in her network,

I have to say it is pretty darn good. Every single major hospital in Memphis is on the plan and University of Tennessee Medical Group is on it which is by far the largest physicians’ group in the area covering every specialty. So I think this is going to work out fine.

Might be better than my own and mine is through a Methodist Hospital where my wife works as an RN. I have to use the Methodist Hospitals (about 7 in the area and the largest hospital group here).

But my daughter will have many more hospital choices than I, including the best Trauma Center which is not part of Methodist.

Like I said, he could be sitting in the Oval Office typing this message, LOL!

Who really knows?

[Seriously, I think that she is just lucky, and that the combination of the "location" and her "age" are the biggest two factors. Certainly, premiums for older age groups--especially over age 55--and other counties, are considerably more expensive with quite high Deductibles and OOP. And narrow networks, in some instances (non-PPO). So this young lady ought to "thank her lucky stars."]

Submitted by hipparchia on

my premium, as a boomer, so not a young invincible, for the free-everything bronze plan (above) would be about $30/month... except that it looks like the free-everything part is probably going to turn out to be a bunch of typos. that dad in tn may want to do a bit of double-checking.

Submitted by Dromaius on

Yes, I looked at the plans too. If she has a silver "S" plan at least, then she gets a mid-level network that includes a bunch of hospitals. The "E" plan is narrow. The "P" plan is not on the Exchange and is much broader.

I think the difference we're seeing is Tennessee is a 'rural' state. Health care in general is cheaper. Thus, it's cost-effective for insurance companies to bring in more providers.

And BTW, I keep seeing PPO equated with broad networks. Whether or not a plan is PPO or not is independent of what it's network is although until Obamacare, PPO's did typically have broader networks than HMO's do. The P in PPO simply means that you have to use the in-network providers to get the best coverage. The PPOs in my state's Exchange plans have narrow networks.

Submitted by Dromaius on

Here in the Northwest, Idaho and Oregon both have Children's Hospitals and Trauma Centers. However, when a child is suffering a severe or rare illness, or when the trauma is especially grave, patients are brought from the other states to the Seattle hospitals, which are considered "regional" medical centers. For whatever reason, real or perceived, the care here is considered premium over what is had in the other neighboring states. And no surprise, our Children's Hospital and our trauma center are not in-network on our BC/BS Exchange plan (which is a PPO). This is considered unprecedented over what we've seen in the recent past.

I see that Tennessee has Children's Hospitals. They probably also have trauma centers. I am guessing that neither is the "premiere" source of care in the region, and is likely why their costs are presumably low enough that the insurers are including them in their networks.

Submitted by Dromaius on

Large urban areas such as NYC, Seattle, LA, etc are known for having better hospitals than smaller urban areas such as Memphis. The larger urban areas tend to attract more research physicians and have better research facilities. In addition, they tend to attract more of the seriously ill patients.

Here's a nice map that outlines rural versus urban states:

Rainbow Girl's picture
Submitted by Rainbow Girl on

... had gone! It was so cool following their Twitter "Conversation" about ObamaCare a few months back.

Mom's Rising has to be one of the more unctuous PR products rolled out during the Great ObamaCare Scam PR Campaign. And man, the bar is high (or low).

Alexa's picture
Submitted by Alexa on

do a standalone post tonight, but I'll do a quick "copy & paste" reply to your comment (from NC), as best as I can do in a bit of a hurry.

It will contain the information that I used to check out Mr. Mills' "daughter's plan."

As I mentioned above--would welcome others to do so! The only discrepancy that I found was by $1 (IIRC)--in that he said that she had to pay a $50 premium out of pocket--and the healthcare.gov website said $51 (IIRC--I have thrown away my yellow stickies--or I could have given you the exact BC/BS Plan code).

Look for my "transcript-comment" in a very few minutes.

Oh, and it is TN, Shelby County, age 29 (which is in his comment, I believe).

Mills claims that she enrolled in a PPO PLan.

Oh, about the article you posted. Couldn't tell the date.

But it MAY be a bit dated. I say that because some insurers "balked" at the last minute, and did not join the Marketplace--even after HHS announced that they would participate (from what I understand).

Hey--for all I know, it could have been a Democratic Party apparatchik sitting in the White House that wrote the NC comment.

Go for it!

I'm going to NC now to starting copying it.

Look forward to seeing what you come up with!

[I searched at least 15-25 plans before I found what I "thought" was the "Mills plan."]