I think that remains to be seen. Part of the ACA mandates a percentage of premiums that insurance companies have to pay for actual patient care, and limits their profits.

Here is a link that might be useful: Health care reform

judiegal, I'd like to know also! We are self-employed and pay out the wahzoo!! I can't ever get a straight answer-because I don't think they even know!

Just a couple of months ago, when shopping (again) for lower health insurance, I found out you have had to NOT had insurance for a long time, in order to be considered for high-rish insurance, which a lot of people my age (50) is considered high risk for some reason or another. So, in the meantime, while you are waiting during that "time" and if something happens, you're still screwed-I don't get it!

Your question is the one thing they do not explain. I too wonder how much premiums will cost and if the insurance companies will be controlled regarding this. Also, for those with preexisting conditions...can they raise rates too in covering? The tax deal has me questioning how it makes any sense. Paying the tax is far less than what is still happening with people taking advantage of care without paying. Are the doctors/hospitals going to turn them away if no insurance? All we are hearing is how good the "idea" is. Nothing of concrete information for any of us.

If I can find the link I'll post it-someone spelled it out in very basic language. It's my understanding that pre-existing conditions cannot be cause for denial of insurance, there is to be no cap on lifetime coverage and that there is to be parity in cost of coverage-in other words no one would pay more unless they chose a 'cadillac' coverage

I also heard that the 'tax' is if you opt out of coverage-and that people who are low income will be eligible for a Medicaid type coverage. Employers of 50 or more staff must provide coverage or face penalties.

All I know is that this is so timely because my 29 yo daughter was working w/o HC and she had to be rushed to the ER with a potentially deadly GI infection. The bills were over $5k. She'd been sued for the bills because the hospital quickly turned it over to collection (a while other nightmare). She tried to buy HI but was denied since she's got pre-existing conditions. She has to try to come up with cash to pay for her visits to see a dr to get a prescription (for which she pays cash) for the depression and other meds she needs. Now she will finally be able to get some relief and won't endanger her health more by not being able to get access to doctors so she can get the meds she needs to live.

if the insurance companies will be controlled regarding this.

Yes, that part of the law just took effect. Insurance companies must spend between 80-85% of premiums on actual health care. Not overhead, not staff, not advertising, but care.

Are the doctors/hospitals going to turn them away if no insurance?

No, people aren't turned away now and we all pay for their care in some way or another.

And paying the tax will not absolve one of medical bills. Doctors and hospitals will still be able to bill patients for care.

Check this site..

Here is a link that might be useful: http://www.healthcare.gov/law/resources/index.html

From my understand the self employeed will be allowed to shop in an Affordable Insurance Exchange, which gives you power similar to what large businesses have to get better choices and lower prices.

I am thrilled about the healthcare ruling. Dd would have been booted off our plan until her job starts in Sept.

Here is a link that might be useful: US.gov healthcare info

The clauses regarding the denial of healthcare due to pre-existing conditions, being charged higher premiums because of age or gender, and cancellation because of sickness, unfortunately do not take effect until 2014.
Many other benefits are already effective.

Sorry forboystoo! I see you just posted the same link.

Pesky1~
Every state has PCIP.
Not being able to get insurance is not the problem for your daughter.
Being able to afford, even based on your income is a real problem.

Forboys-you're correct-she had tried to get that and for what she could afford, she had very limited coverage.

It's been a struggle for her-she's aged out of our ins-and she had had good insurance while working for the State. But then she chose to attend college full time so lost her HC bennies. She used the student ins while she was in school-but once she graduated was again out of luck. It's been a nightmare for her

I am wondering how effective it will be without a public option but I am grateful Obamacare was upheld. We are self employed and also pay through the nose for our coverage. It's now up to $1,700. Per month with a $500. Deductible, $35. Copay and generics only prescription coverage. That little clause puts us a full decade behind best treatment options. Non generics meds can cost up to $700.

(end rant)

Emagineer wrote: I too wonder how much premiums will cost and if the insurance companies will be controlled regarding this. Also, for those with preexisting conditions...can they raise rates too in covering?

Based on our experience, the answer is: you will not be denied for having a pre-existing condition, however, the insurance companies can raise the premium so high that you cannot realistically afford it.

Our story: We tried to get private insurance so that we could stop paying $1600/month for COBRA. Our youngest son was diagnosed with a minor kidney condition while I was pregnant with him. They saw on an ultrasound that he had extra fluid in one kidney. He has never had any problems or received any treatment for it.

The law for pre-existing conditions for children has already been phased in. The insurance companies did not deny him a policy, but they marked up his premium by 1000% and told us that our monthly premium would be over $2,500/month for our family of four. We opted to keep paying Cobra and then my husband was able to change companies and now we have group insurance again.

I am curious to see how this all plays out!

baylor, EXACTLY! You can get insurance with pre-existing conditions, but, they up the premium up so high, most people can't afford it. OR, one company, BCBS, was going to accept me, BUT, I would have to sign a waiver for any breast related issues, because I had to get a biopsy, which ended up being fine. Yeah right, like a woman is suppose to have insurance without breast coverage??

I wonder what goes into effect when?

My niece, a full-time social worker, is pregnant with her first child and she'd love to be a stay at home mom for a while. She & her dh think they can swing living on just his paycheck...except for the health insurance. She has her own health insurance through work as does he. If he adds her on to his plan, it will cost an extra $800.00 a month! Once the child is born, I assume the price would go up more. They can not afford that expense.

She is due the end of January. I wonder if the health care bill changes will help them out on their timetable.

Below is a link to a concise and clear explanation, at least I think so. There is a section for the impact on small business owners.

My son works but gets no HC. He does no qualify for Medicaid and cannot afford it on his own. I hope that will change for him now.

I think this is a good thing.

Here is a link that might be useful: Guide to Health Law

I think health insurance will continue to be a big expense for all those who qualify to pay it and that is almost everyone in the middle class or above. For those who are self insured the plan will group you collectively and than offer more purchasing power as a group and thus offering a bit more competitive pricing but over all health insurance premiums for both self employed and company covered plans have already increased and are slated to continue to increase for at least the next five years.
SG none of this will help your niece now. Most is not even coming into play until 2014. States do, however, carry health coverage for children and sometimes their moms. Here in ct we have "Huskies" and in RI it is done through WIC(women, infant and child). I believe every state has such programs, if your niece can qualify I am not certain, but she can look into it. Also she should ask an accountant if the tax breaks for parents might offset some of her lost income.
Health care is expensive where ever one lives, it is never free. I think this new plan is trying to cover those who need it the most(Those with very low incomes) and for many it will mean that they will actually pay more than they are use to. But more will be covered than were previously.
The real goal of the plan as I see it and it is a good goal, was to increase the number of insured americans from 84% to 92% covered.

We are also self-employed and we pay (for two adults) about $17,250 a year ($13,00 for premiums and $4,250 deductible.) And we actually like this policy as it is the best we can find. It's from one of the non-profit Blue Shields

The answer to Judiegals question is this: Once the PPACA is fully implemented you will have guaranteed access to many more plans. The costs will vary according to the benefits (with a basic menu of benefits like health screenings, preventive care, etc. included in every policy).

What you will pay will depend on your family income (and size). Under a certain level income level (IRRC this is about 88K) there will be substantial federal support of the cost in form of tax credits.

Below is a calculator for figuring a rough estimate of premium costs once the law is phased in. It comes from the non-partisan Kaiser Family Foundation. There is a lot of other useful info on their home page which you can go to: www.kff.org

If your income is low (but under current plans too high for Medicaid) you will become eligible for Medicaid, this is the Medicaid expansion that you're hearing about. Medicaid is free to its clients. From there on up (to a certain level) you would be eligible for the tax-credit subsidies for your insurance coverage. Above the income limits you would have to pay the full cost.

The advantage is that you will have a much wider number of companies offering plans; you can not be denied insurance if you have a health problem (nor can your premiums be dependant on how sick you may be); you can not be kicked off your insurance if you become sick and there is no life-time limit on how much care you need.

Access to insurance (if you are self-employed or don't have an employer-sponsored plan) will greatly increase. No longer will families like mine pay an enormous extra premium just because we are a group of one. (One employee and dependant.) People with employer-based insurance have no idea what the cost - and the difficulty in even obtaining any insurance, much less good insurance - is for people who don't get coverage at work. It's an annual white-knuckle time when we wait to see it the insurance company will even offer us a plan, never mind what it might cost. I have friends who complain mightily when when their co-pays increase by 5 or 10 bucks. We pay $47.26 every single day of the year to have insurance before we see a dime's worth of reimbursement.

For the person who was questioning the current high-risk pools and the need to be uninsured for a certain time before applying. That only applies for the next few years and was written in to make sure that those who can not now (at any price) get insurance because of health issues have access to it. The requirement for being uninsured was written in to prevent people from just dropping their current insurance and signing up for the (temporary, it expires in 2014) high risk pool policy that is heavily subsidized for the next few years. Once the full program kicks in EVERYBODY will have access to insurance, regardless of health status. Subsidized insurance will be available to EVERYBODY who meets the income guidelines.

There are bound to be bugs as the system phases in, but I for one am really looking forward to it, even though by then I will nearly be eligible for Medicare by then. The situation we in ti country have now is simply awful.

I was overjoyed by the news on Thursday!

L.

Here is a link that might be useful: Kaiser Family Foundation Affordable care premium subsidy calculator

Thanks for your feedback, Roarah! They are not low-income enough to qualify for WIC benefits, but are not high-income enough to absorb the loss of her income plus another $800.00 a month to be on his plan. I hope they can figure something out! This pregnancy is a lifetime dream for her (yes, even as little girl, all she ever wanted was to be a mommy!) She'd love to stay home at least for the first couple of years. Family can help them make the payment, but I know they prefer to come up with a plan of their own. She's a social worker, so I know she's doing her homework.

Thanks for all of your explanations. I get it a little more I guess.

All these contortions and labyrinths just to mask that the only *true* health *care* reform would be Medicare for All. Let's do it and be done with it and join the rest of the civilized world.

Oh, flyleft, if only we would.

I agree, if only we could.

Though paying for it would give the anti-tax crowd the vapors.

And even if we just opened up Medicare to younger self (or employer)-paying customers, it's not exactly cost-less to the users. My DH who has turned 65 just went on Medicare and in the aggregate we are paying only slightly less than we did for his half of our private insurance what with the need to pay for Part D, Part B, Supplemental Insurance and deductibles/co-pays, etc. And what was once one simple policy has now morphed into four separate policies: Part A, Part B, Part D and the wrap-around supplemental one. Increased paperwork enormously to keep track of them.

Simple single-payer might be easier, but that would set loose the complaints of "socialized medicine" and provoke squeals from medical providers over their diminished income possibilities.

L.

Ironically, our current government here in Canada is slowly trying to do away with our medicare system (along with anything else that makes us uniquely Canadian, it seems). While it's far from a perfect system, it works much better than private health insurance for the majority of the population.

daisychain - oh no! Having lived with 'socialized' medicine in the UK for my first 40 years I know how much better the system is than the one here in the US. As you say, not perfect, but much, much better!

I would like someone to explain to me how it makes sense to insure against illness rather than all pay into a scheme to pay for healthcare for all. How can having the insurers in the middle taking their large profits for their shareholders make the system less expensive for the people? Not to mention the inhumane way sick people are dropped by insurers, or have their rates hiked!

My vote is definitely for single payer too!

liriodendron, you make a good point: Medicare needs to be streamlined and de-profitized as well. "Part D" stands for "Disgrace" IMO. I should have said simply "single-payer".

I've heard that Canada is moving in that direction, daisychain. Soon even Jack Donaghy won't be able to make jokes about them anymore...

Hah, sis, it cannot be explained. It is ridiculous on the face of it. I would like to shake those who oppose single payer and make them see reason. This current system is much more expensive and nowhere near as effective and efficient as SOCIALIZED MEDICINE! I don't know why people can't read the facts and figures and see that.

Doing it piecemeal like we are is a start, though. I hope we see the light soon. The irony is that once we finally go single payer, everyone will be happy about it.

It's all about the taxes. A lot of people resent paying them especially when someone else is paying less.

Kelly, boy is that the truth. You should read some of the posts on Hot Topics. You'd think the government was asking for an arm and a leg.

How can having the insurers in the middle taking their large profits for their shareholders make the system less expensive for the people? Not to mention the inhumane way sick people are dropped by insurers, or have their rates hiked!

The ACA does address these issues. Health insurance companies now must spend 80-85% of premium dollars on actual care, thus limiting profits, and starting in 2014 they will not be able to drop sick people or hike up their premiums.

And you might be surprised by what the insurance companies are currently using as reasons to turn down an applicant. It's not just someone who is a cancer survivor or MS patient. If you have been prescribed antidepressants, blood pressure meds or cholesterol medication in an attempt to take charge of your health you are likely to be turned down. I've known several otherwise very healthy people this has happened to.

My biggest disappointment with the ACA as it now stands is the lack of a public option. If young healthy people were allowed to buy into Medicare, the premiums should go down because of the larger and healthier risk pool.