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Monday, July 9, 2012

ObamaCare Realities

Let us understand some of what ObamaCare requires by 2014, unless, of course, one chooses to pay the tax instead of ponying up for health insurance.

 I did research on the topic of availing this household of the "cheap ObamaCare policies" in 2010, shortly after ObamaCare was thrust upon our nation by Congress and the Obama administration. At that point in time, Mr. AOW was paying $584/month, and I, in the same age bracket, was paying $256/month for our separate private policies. The difference in those premiums is attributable to Mr. AOW's having pre-existing conditions even before his stroke [We have had health insurance all of our married lives, some 40 years], whereas I do not have any pre-existing conditions. Each of our policies at that time had an in-network deductible of $2500/year with a maximum of $5000/year in-network out of pocket. No prescription coverage whatsoever was included. 

Those ever-touted-by-the-Left "cheap" health insurance policies" mandated by ObamaCare and subsidized by the government in 2010 went begging, that is, people were not signing up.  It's easy to understand why if one considers the above.

So, how do those "cheap ObamaCare" policies scheduled to go in force in 2014 work?  Below the fold is what I have gleaned so far about taking preemptive action in advance of 2014.

1. One has to be without ANY health insurance for at least a full six months before applying. One cannot just drop the policy that one already has and sign on!  Furthermore, one may enjoy health that is fine and dandy one minute but a distant memory the next.  Think of what can happen at any age if one has a horrific car accident!

2. These policies have a minimum of $2500 deductible right off the top, with a sliding scale thereafter: usually 70-30 or 80-20. Usually there is an out-of-pocket maximum around $6000.

3. These policies typically offer no prescription coverage.  The best work-around is joining a pharmacy club such as Walgreen's offers.

Now, on to ObamaCare regulations taking effect in 2014 and a personal example.

I know someone who makes, at best, $14,000/year before taxes.  Her employer does not provide health insurance.  She can find no other work; besides, she is nearly sixty years old.  Her rent is $700/month, with utilities extra.  Her car, a requirement for her employment at this company, is paid for but aging and, therefore, goes into the repair shop for the occasional pricey repair.  She has not taken any kind of vacation in at least fifteen years.  Clearly, she cannot afford to buy health insurance right now!

ObamaCare will help her, right?

Maybe.  But how much?

See THIS CHART and THIS CHART.  My friend's best-case ObamaCare scenario based on current figures: an annual insurance premium of $650, with a maximum annual deductible of $2000 for the single individual  How is she going to manage that annual deductible if "the bad thing" happens?

Interactive calculator: What does the Supreme Court's health-care ruling mean for me?

DO THE MATH!

There are many such individuals and couples all over the United States in a similar plight!

As for the underlying principle of ObamaCare, it is this:
OBAMA: TAXING EVERYTHING YOU DO AND EVERYTHING YOU DON'T DO
What will another four years of the Obama regime bring?

Please watch (hat tip):


Here is the reality that may touch YOU: 75% of Obamacare Costs Will Fall on Backs of Those Making Less Than $120K a Year (Video)

Vote accordingly in November 2012.

55 comments:

  1. Memo to US Citizens....

    We the government spent all your retirement savings. We spent all the money collects for schools. We spent all of the money for roads. We spent everything.

    Of Course this is a tax. duh we need more of your money.

    The only way we could get a big new tax in place and still keep our jobs was to pretend to offer you health care...duh

    But dont worry we will manage you health care dollars better than we have managed um....ok everything.

    Trust us, we are from the government and we are here to help (ourselves)

    Your government

    ReplyDelete
  2. If it looks bad now, it will only get worse.

    ReplyDelete
  3. Yeah but just think, AOW.

    The for profit insurers are making a killing and you don't have any of that nasty single payer socialism.

    Remember, the plan has its origins in one that was drafted by the communistic HERITAGE FOUNDATION.

    Your Galtian masters are taking you for a ride. Maybe you have some insight into why leftists HATE this plan.

    ReplyDelete
  4. bloggintor -- the money was well spent spiffing the banksters, killing scary Muslims and fattening for profit insurers.

    Why are you complaining?

    ReplyDelete
  5. How can any reasonable person look at the debt and destruction wrought by our federal government and then have any confidence it could get health care right?

    Here's an idea we haven't tried: Free Markets!

    ReplyDelete
  6. If the Heritage Foundation were a bunch of communists, then Ducky would be a charter member.

    ReplyDelete
  7. Here's an idea we haven't tried: Free Markets!

    ---
    So ask your Senator why the antitrust exemption for medical insurers hasn't been removed.

    Man, nothing's easier than powdering a conservatives ass but AOW is getting a good look at what's coming.

    Train in the tunnel and don't think you ain't on the freaking tracks.

    ReplyDelete
  8. Government will fix it! Like they've fixed everything else.

    Every government program costs way more than initially advertised and we are tens of trillions in debt.

    Right Ducky, government's the answer...

    What was the question?

    ReplyDelete
  9. Duck said:

    AOW is getting a good look at what's coming.

    Well, I think that I am getting that good luck -- earlier than most people because of the situation here in this household. Of course, getting people who have the FEP coverage and other similar coverage subsidized by the taxpayers' dollars are turning a deaf ear.

    Back when the Portability Act passed (Wasn't that Ted Kennedy's initiative) and I heard that those with pre-existing conditions could get coverage, I had no idea that those of use who had always had insurance could be rated according to pre-existing condition(s). "Rated" means, of course, a higher premium, which actually makes sense if one has been insured only a short time or hasn't had insurance although knowing full well that one has serious pre-existing condition(s).

    Before those days, Mr. AOW and I had private coverage (both of us self-employed at that time), which ridered out one eye and Mr. AOW's back problem (How strange is THAT?), but the policy covered everything else at a standard rate.

    On the other hand, I do understand the problem that companies have with insuring those with pre-existing conditions.

    Case in point:

    My cousin-in-law, whose family had a horrible history of aggressive breast cancer, worked temp work and didn't get health insurance; a real tightwad, she didn't even get a mammo for decades. Then, one day, she discovered a lump under her arm. As there was no record of any mammo, the health insurance company decided that she had no pre-existing conditions because none were trackable. She got private coverage at a very reasonable rate, ran up a bill somewhere near $600,000 at the discounted network rate (Blue Cross), and, a few years later, died. I figure that she paid in, at most, $14.400 in premiums and maybe -- just maybe -- $10,000 in copays. No matter what those paid-in figures were, no way could the insurance company not have lost a boatload! No insurance plan, be it private or government-run, can run in the red like that over and over again.

    I need to do some more research to see what ObamaCare does about pre-existing conditions. Insurers must cover those conditions, of course. At what rate? And for whom?

    ReplyDelete
  10. Mooselimb communists just don't care. Look into my eyes ... you will obey!

    ReplyDelete
  11. Well, Silverfiddle, the insurers won't fix themselves.

    As I mentioned on your blog this morning, the LIBOR rate fixing and the Fukujima disaster report (neither getting any play in the American press) are good examples of what we get when we let business regulate itself(LMFAO).

    We need government and we better find a way to make government work in our interest. However, I see absolutely no indication that conservatives are going to stop worshiping the "job creators" (LMAO).

    It's been laid out pretty well and if all you are going to do is indulge in some Reagan worship then you deserve what you are going to get.

    ReplyDelete
  12. AOW, I don't discount anything you write.

    It is a FOR PROFIT system with primary emphasis on the PROFIT.

    Other industrial nations have solved this problem much better but none have done it letting for profit (with an antitrust exemption to boot) insurers run the show.

    Kneel to your Galtian overlords.

    ReplyDelete
  13. Typo alert!

    Well, I think that I am getting that good luck...

    "Luck" should read "look." Sheesh.

    ReplyDelete
  14. Obamacare is only step one. They know many employers will drop their health insurance plans and that many people will opt to pay the penalty. This will kill the insurance industry any Government will become the single payer and we will have socialized medicine, which was the plan all along.

    ReplyDelete
  15. Duck,
    I left a note for you at your photos web site. Let me know.

    ReplyDelete
  16. Conservatives On Fire,
    I know, even in much reduced circle of friends, about one such individual. His company's plan will terminate on January 1, 2013, because THE HEALTH INSURANCE COMPANY THERE IS SHUTTERING OPERATIONS.

    ReplyDelete
  17. Sadly, no one is following the play book except for a couple of us. It will be far too late when the u no what hits.

    ReplyDelete
  18. AOW, you have my permission to use that photo for anything but commercial purposes.

    Two things:

    1. I am very happy you enjoy my photos and I will be happy to extend that permission at any time.

    2. I really like that shot also. You have good taste.

    ReplyDelete
  19. Duck,
    Thank you! I shall queue up a post. It may be some time before the post appears, but it WILL appear.

    You might also note that I've added your photos site to my sidebar.

    ReplyDelete
  20. Meanwhile:

    Government overpaid $14 billion in unemployment benefits

    ...Overpayments are a rampant problem in the unemployment insurance system. The federal government and states overpaid an estimated $14 billion in benefits in fiscal 2011, or roughly 11% of all the jobless benefits paid out, according to reports from the U.S. Labor Department.

    Of the states, Indiana was the worst offender, making more improper payments than it did correct ones.

    Now, the U.S. Department of Labor and the states are in the midst of a massive effort to try to recoup some of their lost funds and avoid future overpayments.

    Where does the money go?

    The vast majority of unemployment benefits do go to people in need. In 2010 alone they helped keep 3.2 million Americans out of poverty, according to the Census Bureau.

    But of the overpaid funds, most end up in the hands of three types of people: Those who aren't actively searching for a job, those who were fired or quit voluntarily, and those who continue to file claims even though they've returned to work. Any of those circumstances would make a person ineligible for benefits.

    The overpayment typically results from an administrative error made either by the government, the employer, the worker or a combination of the three.

    In much rarer situations, people deliberately defraud the system, using fake documents or identities. Common scams involve prison inmates, illegal immigrants or even the deceased....

    ReplyDelete
  21. Duck,
    I've decided that I want to post that photo for this weekend -- the first thing Saturday morning.

    The title of the post is "Weekend Break From Politics." I also created a new label: "photographic art."

    You and I often don't see eye-to-eye. But I do so enjoy particular ones of the photos you post.

    Anyway, I hope that people won't drag politics into my weekend post. That photo is so evocative for me. I hope that others will feel the same way.

    ReplyDelete
  22. THIS is ugly (dated today):

    Elderly patients are being 'deprived of food and drink so they die quicker and free up bed space', claim doctors

    Six doctors say the 'care pathway' practice could be being used in UK hospitals to ease pressure on resources

    They say in the elderly natural death was more often free of pain and distress


    Hospitals may be withholding food and drink from elderly patients so they die quicker to cut costs and save on bad spaces, leading doctors have warned.

    Thousands of terminally ill people are placed on a 'care pathway' every year to hasten the ends of their lives.

    But in a letter to the Daily Telegraph, six doctors who specialise in elderly care said hospitals across the UK could be using the controversial practice to ease the pressure on resources.

    The Liverpool Care Pathway, which got its name as it was developed at the Royal Liverpool Hospital in the 1990s, withholds fluids and drugs in a patient's final days and is used with 29 per cent of hospital patients at the end of their lives....


    I haven't yet read any of the comments to that article, but will do so now.

    ReplyDelete
  23. The big lie (or assumption) by many was that Obamacare would be free or at the minimum "cheap". Neither is true as you have pointed out.

    The Grouch and I have policies with high deductibles in order to make the premiums each month/year less. Even with high deductibles the cost is enormous, especially with any pre-existing condition.

    I'm afraid it will be too late to do anything about it by the time people understand what a scam it is.

    All this talk from some Republicans about "repeal and replace" is a crock too. There should be no replacement, no keeping of what some call "good" aspects. There is no good because it is all a scam.

    I was afraid if Romney was pushed on us by the establishment we would have problems with him on the healthcare debate, and that is exactly what is happening.

    Oh if we could have a presidential candidate like Allen West!!!

    Debbie
    Right Truth
    http://www.righttruth.typepad.com

    ReplyDelete
  24. There is a silver lining to this. Obama's second term will still be more right-wing than the wild-eyed far left entitlement junkie welfare statists of the Tea Party are offering up with their candidate Mitt Romney.

    ReplyDelete
  25. Debbie,
    Thanks for that great comment!

    Those who were supposed to be on the watch have ignored and continue to ignore the elephant in the room: the aging and ailing Boomer population.

    The tsunami isn't far off. It's bearing down fast and hard as I type this in!

    There will not be enough nursing homes. No way! Even if one can afford to go that route.

    Mr. AOW was catapulted into old age when he was 59 years old. So, I know more about this topic than most people my age -- who seem to believe that it is only children who will be assisting in the care of their aging parents. Not so!

    On July 16, I will have a post on the topic.

    ReplyDelete
  26. The Affordable Care Act isn’t the “biggest tax hike in history.” It’s not even the biggest tax hike in the past 60 years. Or 50 years. Or 30 years. Or 20 years. But it does include a number of tax hikes. The individual mandate, however, isn’t one of the big ones. It’s only expected to raise $27 billion during the next decade. The largest tax increase in the law is on high earners, who will see their Medicare payroll taxes increase by 0.9 percentage point and who will also pay a slightly higher rate on investment income. That raises more than $200 billion. There’s also the tax on unusually expensive health insurance plans, which raises $30 billion in the first decade, and much more in the second. There’s a $60 billion tax on insurance companies.



    Health Insurance Reform Reality Check

    8 ways reform provides security and stability to those with or without coverage

    1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.
    2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
    3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
    4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
    5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.
    6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
    7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.
    8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

    Learn more and get details: http://www.WhiteHouse.gov/health-insura ... otections/

    ReplyDelete
  27. I'm sorry, but I'm 72 years old and I'm tired.

    All I can think to say to Obamacare is

    Aaaaaaaaaah SH*T!!!

    ~ FT

    ReplyDelete
  28. As AOW and I have discussed, I have a somewhat similar circumstance to the person she knows, given in the 'Obamacare will help her' example.

    Where the Hell will either of us come up with an extra (at least) $650 per year? Is this going to be given to us like the "Obama money" people expected during the campaign? Shall I simply quit my job and go on the dole instead of breaking my back to pay for Obama's tax/penalty?

    The bottom line is, thanks to Obama, a lot of us are going to be grabbing our socks, if you get my drift.

    ReplyDelete
  29. I don't know about everyone's policy. But I know that my company did not cancel my insurance -- even when the medical bills went sky high after the stroke I had. My rates did not go up either because of the stroke. Everybody's payments went up! Not just mine, and the bills were something like $200,000! The policy was renewed every year for 2 years, and I was costing them a lot.

    ReplyDelete
  30. I HAVE LITTLE DOUBT THAT OBAMACARE WILL CAUSE MANY TO PAY MORE FOR LESS COVERAGE. THE ONLY THING THE GOVERNMENT DOES WELL IS TO MAINTAIN THE MILITARY AND EVEN THAT MAY BE COMING TO AN END. I'VE BEEN IN MANY GOVERNMENT OFFICE AND SEE THE WASTE THERE. PRIVATE BUSINESS ARE ALWAYS MORE EFFECTIVE AND LESS COSTLY---THEY MUST BE OR THEY WOULD GO OUT OF BUSINESS. THE COST OF FAILURE IN THE GOVERNMENT IS JUST PASSED ALONG TO THE TAXPAYER.

    ReplyDelete
  31. AOW, you seem infested with liberal commentators lately. Have you tried RAID?

    ReplyDelete
  32. "Maybe you have some insight into why leftists HATE this plan."

    Which leftists hate this plan, Ducky? :-) Ridiculous.

    AOW...read THIS and weep. :-(

    my.brainshark.com/The-President-s-8-Billion-Coincidence-356086344

    ReplyDelete
  33. Liberalmann,
    I'm not going to spend time deconstructing many of your copied-and-pasted-from-the-White-House-website comments to this thread unless you return and ask (Grovel, actually) for that deconstruction.

    Not that showing you the truth will make a bit of difference to you, I know.

    ReplyDelete
  34. Brooke,
    Mr. AOW had a Medicare Advantage plan, and we are very happy with it. Of course Obama wants to dump any plan that it privately managed!

    ReplyDelete
  35. Stogie,
    Yes, there is a bit of an infestation. However, I have to admit that sometimes the infestors are a great source of amusement for me.

    ReplyDelete
  36. Hey, Stogie!

    Care to make a graphic with Raid? Hehehe.

    ReplyDelete
  37. Other countries has solved this problem....yeah their weakthier citizens travel to the US for treatment.

    Scale folks, the leftists are comparing countries that are not even as big as some of our States. We are already bankrupt and the CBO has already doubled the cost of this to 2 trillion.

    It is pure fantasy to not believe there will not be rationing.

    The system will collapse on the weight of itself.

    In some ways, we should just let the leftists have the show and stop the aganozingly slow decline of the US.

    I agree their should be no replace. There should be a massive and sudden overall of all of the government regulations on this industry.

    Duck is right, the Obama team is in the tank for creating monopolies so much the better for extending control over the populace. UNfortunately the greed in our culture has caused us to forget the dangers of monopolies.

    Obamacare will do to employer healthcare plans what the SSA did to employer sponsored pensions...

    As to Libermann assertion agreed with AOW, no point in arguing with a mushroom, just stay in the dark and continue being happy with the ____ they are feeding you.

    ReplyDelete
  38. I go by reality -- not "reports."

    A very good friend of mine was diagnosed with terminal cancer six-and-a-half years ago. He was "supposed" to die within six-months of diagnosis, but he has put up an incredibly courageous fight against the disease which has meant undergoing actual TORTURE for three-month blocks at a time.

    He has lived with six weeks of chemo-torture six weeks off, then back again for six more weeks of chemo-torture continuously for more than six consecutive years.

    It's not just the effects of the chemo which include violent headaches, vomiting, diarrhea, painful aching in the joints, teeth loosening and falling out, and hair loss. He has had to endure many kinds of secondary infections as well, which have caused high fevers, terrible cramps, hideous rashes, bizarre painful swellings that look like acromegaly, temporary blindness, and flu-like symptoms worse than any flu you've ever put up with under normal circumstances.

    He has also undergone radical experimental treatment -- allowing himself to be used as a human guinea pig in two far off location -- and also radical surgery which they told him had only a fifty-fifty chance of surviving.

    The bravest person I have known -- or could ever hope to know -- by far!

    At any rate, after ALL THAT, he was just told today -- very abruptly -- that his insurance company, Humana, which is one of the biggest and best -- will not pay for any further treatments, because HE HAS USED UP HIS LIFETIME LIMIT of WHAT THEY WILL PAY.

    In six years his treatments have cost ONE MILLION DOLLARS.

    So now, unless a miracle occurs, he will simply be abandoned by the system and left to die.

    So, yes, Virginia, Death Panels have been in place all along -- and always will be. Don't kid yourself, Virginia. The BOGEYMAN is REAL -- and some day he's gonna GETCHA.

    And you Marxist maniacs think this is NOT going to continue happening -- EXPONENTIALLY -- once the GOVERNMENT has full control of the Medical Industry?

    DON'T MAKE ME LAUGH!!!

    If ever a person deserved every chance to life it's his guy. He has six children, and his fondest wish is to be able to see them grow up and become happy, independent adults.

    AIN'T LIFE A BITCH -- SOMETIMES?

    ~ FreeThinke, who is furious with impotent rage

    ReplyDelete
  39. I am sorry to hear about your friend.

    The current system with all of its failures allows for something that is crucial and why the survival rate in America is higher than most Socialist countries (Concorde study-UK). Experimentation on a large popultaion. This sounds cruel but it is why we lead the large in cancer research and development and why Freethinke's friend was able to live this long. Again, this sounds ort of cruel but many get to live longer and that information helps countless others. When the government runs things, that research will come to an end. It will be like socialist countries where the economic value of person is guaged and treatment refused for thousands. The result will not be shortened life expetancies for those persons but also a halt to research and development of cancer treatment. Just one of the other benefits of obamacare. Oh dont worry, the rich will still get treatment because as is the case in most socialist countries the rich can buy the best and brightest minds. It will be like our education system. The rich pay for tutors and private schools while the unshowered masses are left with government run schools....

    Again my prayers to you Freethinke and your friend.

    ReplyDelete
  40. and if you are thinking of posting that Obamacare abolishes lifetime caps consider this. Isnt it funny that Obamacare proports to offer everything, lifetime caps, no preexisting surcharge rate, mandated healthcare for children till 26 living in your house etc etc.

    You do realize the current medicare medicaid system is bankrupt and yet somehow this one which is advertised to provide even more along with the "effeciency of government" and we are supposed to believe it will not go bankrupt? pure fantasy

    You dont bait a hook with month old pizza...you bait it with fresh meat.

    ReplyDelete
  41. Here's some more truth for you:

    Romney: President Obama’s response to even more bad economic news is a massive tax increase.

    Lie #1: "Massive Tax Increase"
    Only in Karl Rove's America could it be true that maintaining lower tax rates for 98 percent of individual taxpayers is a "massive tax increase." Just in case there's any doubt here, we are talking about less than a 5 percent increase in taxes on anyone with earned income in excess of $250,000. Will someone at the Romney campaign please let me know how this "massive tax increase" compares with the Affordable Care Act as the "biggest tax increase in US history"? Settle down, boys. Your caviar might rebel if you don't. Onward.

    Romney: It just proves again that the President doesn’t have a clue how to get America working again and help the middle class. The President’s latest bad idea is to raise taxes on families, job creators, and small businesses.

    Lie #2: "Raising taxes on families, job creators and small businesses."

    First, a look at what Mitt Romney calls "small business." Romney is referring to those "small businesses" known as pass-through entities. Rachel Maddow explained how these work to the benefit of the ultra-wealthy a couple of years back.

    In a nutshell, those "pass-through entities", usually LLCs (Limited Liability Companies) or LPs (Limited Partnerships) pass through all of the income and expenses to owners instead of paying taxes as a business entity. Those owners then include that business income and/or expense on their tax returns. On the one tax return Mitt Romney released, for example, nearly all of the $26 million he declared as income was attributable to pass-through entities, some of them located in the Cayman Islands and Bermuda and others located here in the United States. Because some of that pass-through income came to him as "carried interest", he also paid a far lower tax rate on $12.5 million in income in 2010.

    ReplyDelete
  42. Obama care is merely a means to an end; an end that has nothing whatever to do with health care.

    ReplyDelete
  43. FT,
    ...he was just told today -- very abruptly -- that his insurance company, Humana, which is one of the biggest and best -- will not pay for any further treatments, because HE HAS USED UP HIS LIFETIME LIMIT of WHAT THEY WILL PAY.

    I don't doubt that you are relating the story exactly as it has happened.

    But let me tell you this: One does not have to reach the limits of coverage to have services stopped by a health insurance company.

    I will now relate the reality that Mr. AOW and I discovered with no hyperbole whatsoever....

    Mr. AOW's health insurance plan (contracted June 1, 2009, his stroke occurring on September 15, 2009) offered 60 days of rehab in the hospital. I believe that this level of care was called "sub acute."

    About 10 days into the rehab, I was informed by the head of the rehab unit that termination of rehab was nigh. I protested, of course. I could see that he was making significant progress (won't go into the graphic details at this time). Too bad! He wasn't meeting particular benchmarks -- never mind that those benchmarks were unrealistic for a thalamic hemorrhage the size of a plum. The head honcho said to me (I'll never forget the words!), "We never keep patients more than three weeks."

    The unit did have empty beds, so the issue was not one of needing space.

    Anyway, out the door he went within about two weeks of admission. Anybody could see that he couldn't come home in that condition: incontinent, no sense of balance on all four sides, mental confusion, pureed food required because of swallowing issues, etc.; he could communicate with no problem at that point. The hospital tried to force us onto Medicaid. I balked, and Mr. AOW went to an exceptionally nice "skilled care facility," one with rehab and a facility exactly 1 miles from the door of our home.

    He was in the skilled nursing facility for 10 weeks and clearly would have been able to return home (with caregiving support, of course) within 8 weeks of his admission to the sub acute facility.

    I took Mr. AOW out of the skilled nursing facility at the 10-week mark, but he could have come home from there at the 8 week mark.

    I have no doubt that he would have made enough progress in 60 days in the sub acute facility to have returned directly home from there or, at worst, with only two weeks in the nursing home. He would have made more progress in the hosptial as he was getting 3 hours a day/7 days a week of therapy there but only one half to one hour of therapy a day 6 days a week at the nursing home.

    As I mentioned above, Mr. AOW had a new policy. He was nowhere near having exceeded the policy limitation that you referred to in your comment.

    Today, Mr. AOW, pronounced compos mentis about 1.5 years after the stroke, can ride the paratransit system alone, manage his credit card, use the phone, etc., etc. Yes, his limitations are severe: hospital bed in the living room with bedside potty. HOWEVER, the cognizance is there, and he is making progress physically -- albeit at a snail's pace. We may well be approaching the day when I can rent a handicapped-equipped van and take a short road trip for a vacation (Charlestown races?). We make museum trips all the time.

    Back to the health insurance industry....Although we had a few bad moments with Blue Cross, overall the company was most cooperative. In fact, they extended home therapy well beyond the normal policy limits and did the same for outpatient therapy. At the one-year mark, they terminated all therapy. However, now that Medicare is on board, Mr. AOW should be receiving another round of therapy very shortly for a short period of time.

    ReplyDelete
  44. FT and Liberalmann, too,
    And one more thing....Mr. AOW recently had cataract surgery. As far as we can tell, the results are miraculous.

    HOWEVER,

    as of January 1, 2012 (Thank you, Obama. NOT!), Medicare will not authorize the YAG laser procedure for a man not yet 63 years old and balance compromised due to a brain tumor excision in 1993 if his "potential for vision isn't good enough," whatever that means. This is a new restriction that went into effect on January 1. 2012, as part of ObamaCare.

    As one who has twice undergone the YAG procedure, I know what a miracle it is. Maybe you do as well.

    Anyway, if Medicare denies, we will pay for the YAG laser procedure out of our own pockets -- provided that the eye surgeon agrees to do the procedure, of course. I hope that ObamaCare doesn't tie his hands! We'll get the verdict toward the end of this month.

    ReplyDelete
  45. Liberalmann,
    I will now address a couple of matters that you copied and pasted in. You are talking to a consumer expert about this matter. Keep that in mind, please.

    Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.

    That prohibition has been in place for ages -- if one has had health insurance for the immediately preceding 18 months! The catch is this: "rating" those with pre-existing conditions. I've yet to learn if ObamaCare "rates" or not.

    Also, it has been true for decades that one can take out an individual policy at the going without any penalty with a 10-month exclusion of pre-existing conditions; at the 10-month mark, all pre-exising conditions are considered null and void.

    Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.

    Ahem. This family has been down the road with two medical events that could well have canceled the policy -- a brain tumor in 1993 and a massive brain hemorrhage in 2009. Guess what? No change in rate for the policy in force nor any cancellation BECAUSE WE KEPT PAYING THE PREMIUM. Insurance companies typically do not cancel coverage if premiums are paid and/or the patient doesn't proceed against medical advice (the latter a specific term in insurance).

    Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.

    Not a good thing! Why? Because insurance is based on the principle of high risk and low risk being in the same pool. Most in that age group are low risk and need to be paying their own premiums.

    Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

    Ahem. That has always been true! Sometimes, of course, renewal means a higher rate.

    More in the next comment.

    ReplyDelete
  46. (continued from above)

    Reform will stop "rationing"...

    That is a lie. Period. The new terms are "risk assessment" and "potential for recovery."

    Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses.

    Another lie! Many businesses, large and small, cannot afford to offer employees employer-based coverage. How do I know? My husband lost his job in 2008 for that very reason. The company wasn't a huge one, but was substantial in size; my husband had worked there for nearly 12 years.

    You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.

    The forcing out occurs because of the rise in premium costs. Since 2011, the premiums for employer-based health policies has soared to the moon! ObamaCare was supposed to curb that rise; it has not.

    No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts.

    I call a huge BS on that one. If IRS is involved in the administration of ObamaCare, IRS automatically has access to your bank account. Most taxpayers already get any refunds automatically deposited, particularly now that electronic tax returns are the norm for most. Thus, IRS already has access to individuals' bank accounts; in fact, since at least the 1950s, IRS has had the ability to freeze accounts. How do I know? My mother was an IRS auditor.

    ReplyDelete
  47. (continued from above)

    Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill.

    Not that last clause -- although policy limits and rationing have always applied.

    Mr. AOW was denied individual coverage in 2009; however, Virginia is a HIPAA state, so coverage had to be given -- albeit at double the normal premium.

    Less Care for More Costs

    That is conjecture. Could happen, but probably not -- particularly if insurance companies are forced to insure high risk individuals and groups at a "regular rate."

    The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone.

    Actually, those personal bankruptcies exceed the one-half mark for particular age groups. And that $300,000 figure is incorrect; it is at least that for each elderly person. Without Medigap or Medicare Advantage (the latter of which ObamaCare cancels this coming October), there is not limit to the out-of-pocket annual amount under regular Medicare.

    ReplyDelete
  48. (continued)

    Liberalmann copied and pasted:

    The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets.

    Aha! A point of agreement! At least from the words "will continue" on.

    However, even with reform, health care costs will continue to rise as ObamaCare does not address the following:

    1. Tort reform

    2. The burden that illegals and other foreign nationals without health insurance are placing on the system -- especially in the ER and like facilities.

    Besides, the Boomers are aging. Regardless of how one zealously guards one's health, age takes its toll. As people live longer, more people are ailing, particularly those in the 80s. Many Boomers will end up in long term care even without extraordinary life-saving measures having been taken (Think osteoporosis, stroke, and the like); I see no way around that coming tsunami of aging and ailing Boomers -- short of euthanasia. Medicare does not pay for long term care per se. And long-term care insurance is nearly useless. I know!

    3. ObamaCare does not address medical bankruptcy in any way.

    My upcoming post of July 16 will address some of what I see bearing down on us.

    ReplyDelete
  49. AOW; Remember when Obama was compromising with the GOP with Obamacare? Remember how the GOP got insurance companies back ing hte picture? They also voted out tort reform-so blame them.

    FreeThinke said;"
    So, yes, Virginia, Death Panels have been in place all along -- and always will be. Don't kid yourself, Virginia. The BOGEYMAN is REAL -- and some day he's gonna GETCHA.

    And you Marxist maniacs think this is NOT going to continue happening -- EXPONENTIALLY -- once the GOVERNMENT has full control of the Medical Industry?
    -----

    Marxist? How would I be a Marxist by believing this? You're just throwing crap out there again, aren't ya? Lol. No FT, one of the biggest parts of Obama care is they cannot deny coverage.

    You've make the case very well in support of Obamacare. Thanks.

    ReplyDelete
  50. Liberalmann,
    Remember when Obama was compromising with the GOP with Obamacare? Remember how the GOP got insurance companies back ing hte picture? They also voted out tort reform-so blame them.

    Look here, fellow....

    I am one of those people who fully knows the benefits and flaws of the health insurance industry. Been there, done that. And, yes, I beat the system without one thin dime of government assistance -- until Mr. AOW qualified for Medicare. Now that he has Medicare, he is subject to rationing that he didn't have to be subjected to before -- rationing that didn't come into place for Medicare until January 1, 2012.

    And Mr. AOW is only 61 years old! He is projected to have a normal life span in spite of the stroke that he had in 2009. That means that he will likely live into his ripe old 80s, and I'll be damned if he'll be blind because the government decrees that it will be so.

    If necessary, we will step outside of Medicare and self pay (in this particular case, so as to save his eyesight in his dominant eye. Yes, we have saved our money for 40 years and also had some good fortune along the way.

    I could explain to you some of the reasons that the health insurance industry is so screwed up. But, being of the intractable mindset that you are, you would not believe me no matter how many facts I laid before you.

    ReplyDelete
  51. And yet you offer no 'facts' to repudiate mine, lol!

    ReplyDelete
  52. Liberalmann,
    And yet you offer no 'facts' to repudiate mine, lol!

    Stop it. Now.

    I have other things to do besides babysitting my blog. For one thing, I am sole caregiver for my totally disabled spouse. So, don't talk to ME about any failures of health insurance. I know more about that topic than you likely ever will.

    ReplyDelete
  53. There both pros and cons to the Obamacare plan. We just have to weigh them out. When the situation gets worse, they could also see it. Let us just hope they do not pretend to be blind not to see the effects.

    ReplyDelete
  54. There both pros and cons to the Obamacare plan. We just have to weigh them out. When the situation gets worse, they could also see it. Let us just hope they do not pretend to be blind not to see the effects.

    ReplyDelete
  55. Christine,
    I have located your comment.

    Thanks for making it!

    ReplyDelete

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