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PPACA Link Dump for 2013-06-17: Please contribute!


[I'm stickying this because I have to put together the link dump for Monday while Katiebird grapples with what happens when only the spouse is covered by their employer, and so links from you all would be very helpful. We'll be doing these links every Monday, so do bear that in mind... --lambert]

As part of the PPACA FAQ, we're going to do a link dump every Monday. As the rollout approaches, we'll be forecasting future events for the coming week, but we're also interested in good links from the past week, so please, add those in comments!

We're much more interested in very concrete posts about problems with the PPACA (ObamaCare), and solutions (if any) for those problems. Issues might include successes and failures of the exchanges, what the plans really deliver, how the metals differ in their subsidies, conditions covered and not covered, navigator training, how eligibility works (especially dual eligibility), and basically anything nutsy and boltsy.

Big picture posts are fine, too, but we have "ObamaCare Clusterfuck" for the real pro-single payer trench warfare stuff.

No votes yet


Alexa's picture
Submitted by Alexa on

a good "title" for referencing your effort/project--PPACA FAQ?

BTW, I'm setting up a "test" diary which will consist of just a title and a graphic (to see if I can figure out how to schedule a diary at a later time/date).

Please "can" when it shows up. Thanks!

Alexa's picture
Submitted by Alexa on

Going on info posted here last week stating that navigators pay will start at $40,000, I would think that there won't be many "insurance brokers" (and maybe not many "agents") participating in the exchanges.

I Googled the 2012 Federal GS Salary Table, and if the figures that were posted are correct, the jobs are paying at what is high-level clerical and/or entry level GS positions (with Bachelor's).

{The Post Commander's secretary where I was last employed was a GS-07, with an upgrade to a GS-08, in the making. As soon as she got her upgrade, the next top Secretary of the Post (DEH), was going to be upgraded from a GS-06 to a GS-07.

Also, this was the entry level grade for Social Service Reps who reported to Social Workers (MSW). Just mentioned to give some "perspective" to the ranking. ;-)}

I' can't get my hands on the pay table right now, but if I recall correctly, the $40,000 annual pay shows up at about Step 7, for a GS-07 (there are 10 steps).

Brokers' compensation is way beyond that pay scale, and frankly, to a lesser degree, the same is true for most Agents.

Which makes sense if the training is only 30-something hours.

I believe that we're looking at 'call centers'--scripts and all.

IMO, if we're "lucky," they'll spring for a handful of GS-12's or higher, to actually answer "technical insurance questions."

OTOH, if they succeed in keeping this 'lousy economy' for many more years, insurance professionals may wind up clamoring for the navigators positions.

Splashoil's picture
Submitted by Splashoil on

AHCCCS is more like health insurance (1+ / 0-)
AHCCCS makes monthly payments on your behalf, whether or not you actually use any medical care that month.

Capitation Payments: The AHCCCS program is ba
sed on cost containment through preventive
care rather than emergency care. AHCCCS contracts with “program contractors” which in turn
are responsible to ensure the delivery of all
covered medical services to ALTCS members.
AHCCCS pays program contractors a monthly “capitation” payment prospectively for each
enrolled ALTCS member. This capitation concep
t is patterned on the wa
y many individuals pay
for private health care insurance. AHCCCS pays
the monthly capitation payment to the program
contractors for each month the A
LTCS member is enrolled, rega
rdless of whether the ALTCS
member received a medical service during the mont
h. If the ALTCS member is on Medicare, the
capitation payment amount for months of service
on, or after, January 1,
2010 that is subject to
estate recovery will be the amount paid to th
e program contractors ad
justed to remove the
actuarially determined amount of the
Medicare cost sharing portion.
The average contract year 2011
monthly capitation payment
to program contractors is
approximately $3,340. It is approximatel
y $3,020 without the Medicare benefit.
It is important
to be aware that capitation payments can
exceed the actual costs of services provided
during the month.
Before enrolling in ALTCS, if an applicant or
family member is concerned about AHCCCS’
claim that will be filed against the estate, the ap
plicant and/or family member should evaluate the
financial benefits of enrolling the applicant in
ALTCS. Because ALTCS payments made on the
member’s behalf can exceed the actual costs of se
rvices provided, and accrue even if no medical
service is provided, it is
very important that ALTCS applican
ts (and family members) make an
informed decision about enrolling in ALTCS.
This is especially
true for those ALTCS
applicants who elect to remain in their ow
n home and do not enter a nursing home.
applicant and family member should review whethe
r it is better financially and medically for the
applicant to pay for his/her n
eeded medical services out-of-pocket (what won’t be paid by
Medicare and/or other insuranc
e) rather than enrolling in A
LTCS and incurring a claim against
their estate. Individuals who do not require ma
ny medical services may
not wish to enroll in
ALTCS because their estate w
ill be responsible for payment to AHCCCS of all ALTCS
payments that are listed in question 5 above
When you're over age 55, they begin accumulating all the charges spent to support you, and that is claimed against your estate.

This comment by Kossack Barker Sr. is very enlightening about the monthly charges against a medicaid recipients which start once you are "auto enrolled." Unbelievable.

Alexa's picture
Submitted by Alexa on

Am I reading this correctly?

Does it mean that there will be "estate recovery" for the Medicare program "proper," or does this refer to the Medicare/Medicaid "dual eligibles" program?

And do you know what AHCCCS and ALTCS stand for? (If I've missed it, and it's obvious--apologize. We're a bit pushed for time.)

I thank you in advance for a reply (if you know), since we'll be on the road shortly.

And thanks for all you do, to spread the word. Great thread. Maybe the DKos Community will "wake up," after all, LOL!

Submitted by lambert on

Anybody got any links?

HINT Check All Blogroll for Health Care...

Splashoil's picture
Submitted by Splashoil on

Looks like it's Arizona Health Care Cost Containment System!
What a great resource! I believe they are only after the Medicaid portion of dual eligibles in their record breaking recovery efforts (first in the nation!).
Arizona Long Term Care System will recover their own using AHCCCS.
Now during the initial period of Medicaid expansion, when the Federal Government is paying most of the costs, will the meter be running as normal?

Submitted by marym on

General questions - LINK
This post covers many of the steps involved in applying/qualifying on the exchanges, and some of the pitfalls of Medicaid. It’s a little confusing to read straight through, but probably contains many of the topics for which Q and A would be helpful, as well as lots of links to additional info (which I haven’t yet followed).

Funding for subsidies: LINK and LINK

There was some info last year about the possibility that the bill didn’t actually provide funding for subsidies on the national exchange, just state exchanges. Has anyone seen anything further on this?

Options for small business: LINK

The law calls for a new insurance marketplace specifically for small businesses, starting next year. But in most states, employers will not be able to get what Congress intended: the option to provide workers with a choice of health plans. They will instead be limited to a single plan.

I understand the separation in coverage between OC/single payer advocacy and a separate approach for Q&A. However, depending on the format for the Q&A, maybe it would be possible for each topic (maybe each category of topics) to include a brief bullet point or two on how the issue at hand (application process, eligibility, paying the bills, family coverage, etc.) would not be an issue with Medicare for All. When this whole thing crumbles, right away or over time, our opponents will no doubt be ready to paint it as a failure of “government run healthcare” and we should be equally prepared to argue for actual publicly administered health care. We should look for any opportunity to educate people about how that would work.

List of links from above:

Splashoil's picture
Submitted by Splashoil on

Here is the similar Medicaid link for Washington State:

Recovery of Funds From Your Estate
By law, Washington State may recover (be paid back) payments DSHS made for all Medicaid and long-term care services you received prior to your death. Payment is taken from the your estate (assets you owned or had an interest in at the time of death). This is called Estate Recovery.
Washington State will recover the cost of all Medicaid-funded services (federal and state-funded programs) and long-term care services from age 55, including:
• Doctor visits
• Hospital stays
• Prescription drugs
• Medical equipment
• All other medical services
• Nursing home services
• Waivers services (COPES and New Freedom) • Medicaid personal care services
• Adult day health
• Private duty nursing
• Managed care premiums

Over 55 under the bus you go if you are poor...