Medicare, Medicaid, ACA. Trump, Ryan goals? Discuss.

[Spiky Bugger]

(Let's not discuss the politicians and what unfeeling hypocrites they are...we know that. And, let's also refrain from mentioning that most political promises are not kept...we know that, too. AND, very recent polling reveals that the percentage of even Republicans who want to dump the ACA has dropped from over 60% to just about 50% in the past month or so. But I include both because the ACA makes Medicare MORE financially stable, so getting rid of the ACA will impact Medicare, either in what it covers now or how long it will last. Let's DO discuss how your insurance situation might be impacted, one way or the other.)


I have regular Medicare, base on my old-age-ness. I also have a "secondary insurance," (NOT a "Medicare Supplement") through my now-retired (but younger and not quite yet Medicare-eligible husband) and that is a REALLY good policy. I have few co-pays and most office visits are free. Because Medicare covers so much, our premiums decreased by several hundred bucks a month, as the secondary needs to cover only those things Medicare does not cover completely. When he becomes eligible, in November, our premiums should drop again. We are fortunate in that his employer covers the lion's share of the costs.

BTW, I have yet to encounter ONE Medicare beneficiary who longs for the days of regular insurance.

But, chronic worrier that I am, I was sitting here wondering what, if anything, will change on my secondary insurance if Trump and Ryan et al get their way(s) regarding Medicare, Medicaid and the ACA. I have even requested that my husband contact his union to see how they plan to keep us well-insured and volunteer for that committee.

I don't think the ACA policies are terribly generous on bariatric surgery coverage...but some might currently cover it. And I think that Medicaid "covers" it if you agree that paying a miniscule percentage of reasonable and customary costs constitutes coverage.

Another idiotic "plan" is to allow us to cross state lines to buy insurance. A few thoughts on that:
-insurance companies themselves can cross state lines, merely by complying with each state's laws.
-insurance companies want the insured to cross state lines so that the insurance companies don't have to honor local laws.
-that plan undermines "states' rights" and "local control," but is supported by those politicos who are always squawking about "states' rights" and "local control," duh.
- @DianaCox can explain in detail, but at least one state requires, for example, that insurance companies cover the cost of reconstructive surgery if, among other things, a "disease" (morbid obesity is a disease) has caused disfigurement. All insurance companies in that state factor those costs into their plans...or should. An otherwise identical policy in the next state over will cost less. So everyone who doesn't want that coverage buys a policy in the neighboring state. The "pool" in the first state decreases, it goes broke and then nobody can get coverage for reconstructive surgery after massive weight loss. (Until it became a federal law, reconstructive surgery after mastectomy was not covered in every state. I don't know where the various states stand on what to do if your kid is born without the exterior portion of his ear or loses it in an accident or from disease...that kind of thing.)

Anyway...are you comfortable with the coverage you have now? Are you expediting things to beat any problems? Got any suggestions/solutions for others?

 

[k9ophile]

My only concern is that my .03% raise in my SSA payment will be eaten up plus by the increase in Medicare Part B. I haven't seen an amount for Part B. I consider myself to be quite lucky to have Tricare for a secondary.

 

[KathrynK]

Congratulations, America, he's coming after healthcare, signaled by his hardline HHS pick, Price, who's spent his career trying to cut benefits for Medicare, Medicaid, and ACA recipients. So many of the younger members of my family use the ACA, but they didn't realize that DT's slogan "repeal and replace" may stop at "repeal" which has already been proposed by a congressman. My niece who has severe asthma and chronic knee pain and a freelance income is having anxiety atack and crying spells because they were hoping to have a child. Others thought he meant to replace ACA with plans with higher subsidies and lower premiums--wrong. My own daughter will need ACA when her father retires, given her salary and contract position. I'm on Medicare but my husbands insurance is primary until he retires at the end of next year, but I am a very expensive patient, considering my stroke (pre DS), seizures, DS related expenses, orthopedic costs, etc. Ryan's plan is to pass off greater costs to Medicare recipients (even if you have a Medigap policy they are going to mandate higher copays to stop people from using healthcare). Eventually, as early as 2020, we will be given a voucher to buy medifake insurance and if it isn't enough to cover the costs because of your health status and you can't pay the difference, you get a minimum benefit plan. A hospitalization will put you back thousands and a doctors visit will be the cost of a car payment, even with medi-fake insurance. Fewer good doctors and hospitals will take Medicare patients, even soon from now, because they will continually tighten payments. The more I read about it, the more I realize how vulnerable I am to higher and higher copays and deductibles. It's $6,900 a year now, how much worse can it get? Poof goes the retirement account. People who want bariatric surgery should probably speed up the timeline, because whatever the benefits are now, it's not going to get better. If people realize what's happening, they may put pressure on congress, but the bastards will surround reform with reassuring phrases, like "modernize Medicare" and people won't realize what they've got till its gone. This is our world now.

 

[galaxygrrl]

I had this long chat with my Dad on this very topic this morning. He was wise and said, you know if they go after health care and Medicare, we will see a Democratic House in two years. Because of that, I think Ryan et al can only go so far. At least I hope so.

 

[Munchkin]

The ACA was no help for me. You have to know a year in advance how much money you will make and that just wasn't possible for me. But I paid my fine because it helped so many others. You know...I wonder if they ever took into account or even thought about how much it was going to cost to get rid of ACA. I know a lot of disabled people who are now having to quit working and go back to Medicaid and SSDI. I even know people who have to get divorced. It's very sad! This is breaking up families. At least legally speaking.

And it ruins lives as well. I have a special needs sort of step son(long story). More than anything else, he wants to be mainstreamed and do what everyone else does. He wants to work and I am pretty sure there are jobs out there he could do. But none of them would pay enough to make up for his loss of SSDI and Medicaid. With the ACA, he could work, give up his SSDI, and still have healthcare. He does require some special care and private insurance premiums would be a lot more than he would make working. But we had to tell him he can't work or really do anything. A life is a terrible thing to waste. And this kid has worked so hard to get where he is today. This is a travesty! What is this poor kid supposed to do with his life? Sad!

Then there are all the oldsters. Like me. I started paying for my Medicare when I was 12 and I'm not giving it up without a fight. My plan is to spend a couple hours a day writing and calling legislators and I will go to every protest I can. The voucher system Ryan wants to shove down our throats is only good for the insurance companies, not us. America needs single payer health insurance like every other country in the freaking world. Resist! Fight the evil empire. Be loud.

 

[Settledownnow]

I pay $700 out of pocket every month for my health insurance. More than a car or house payment. Prior to the "Affordable" Care Act, I paid 375.00 per month. I am hoping for some relief with the new administration. I see no reason why I need to pay for maternity care and substance abuse treatment -- two services I would never use. One size fits all never fits all.

 

[galaxygrrl]

Then there are all the oldsters. Like me. I started paying for my Medicare when I was 12 and I'm not giving it up without a fight. My plan is to spend a couple hours a day writing and calling legislators and I will go to every protest I can. The voucher system Ryan wants to shove down our throats is only good for the insurance companies, not us. America needs single payer health insurance like every other country in the freaking world. Resist! Fight the evil empire. Be loud.

I could not agree more. While unemployed - only been 7 weeks - I'm a high earner when I look at the numbers. I've been paying into Medicare for 30 years. I've been paying in to SS for 30 years. And you know what, I have paid way more than other people who don't earn as much.

Yes, on Single Payer.

I pay $700 out of pocket every month for my health insurance. More than a car or house payment. Prior to the "Affordable" Care Act, I paid 375.00 per month. I am hoping for some relief with the new administration. I see no reason why I need to pay for maternity care and substance abuse treatment -- two services I would never use. One size fits all never fits all.

Wow, that premuim increase sux. But, are you sure it's the ACA that raised your premiums by almost 100%? Did you change age brackets too or is there some other reason your premium went up. i don't know your situation, and I can't comment, but I would think a substance abuse patient that has never struggled with his or her weight might say, why should I pay for weight related health care issues.

 

[DianaCox]

"I see no reason why I need to pay for maternity care and substance abuse treatment -- two services I would never use. One size fits all never fits all."

I'm sorry, but this is the kind of selfish, conservative, short-sighted, compartmentalized thinking that the right-wing front for the insurance companies has promulgated to enrage people against the ACA, which has as an end-game, getting rid of the insurance company middlemen as a pointless industry in an evolved, civilized society. Like the rest of the goddamned civilized world has.

Medical care should be UNIVERSAL. It shouldn't matter if you are young, old, healthy, chronically ill, male, female, black, white, Hispanic, Asian or green or purple. You are covered, automatically, as part of your taxes. You may have some copays to prevent you from using medical care indiscriminately (like $25/visit), but your care and medicine is COVERED. EVERYONE pays higher taxes to cover it - and it will be more cost-effective by removing the insurance company button-sorters and paper-pushers, and the profit motive for hospitals and doctors. Insurance is what is WRONG with this country.

Why the hell should I have to pay for your bariatric surgery?? Why don't you just shut your damned mouth and push your damned self back from the dining table? And why should my kids pay for your higher likelihood of getting breast cancer, because you never had kids? Why should anyone else pay for your reconstructive surgery?

The reason is, everyone pays the same rate, and everyone is covered, because health care is a BASIC HUMAN RIGHT, and nobody can predict how much they will need. It shouldn't be rationed, and you should pay the same as others who are not as "lucky" as you are - they shouldn't have to worry about dying because of the draw of the genetic lottery they got, or whether they are just unlucky.

Sheesh - I HATE that kind of thinking!

Spiky - I might have violated your initial rule, and I'm sorry, but this just roasts my chestnuts.

 

[Settledownnow]

Right Diana. This is your opinion and I have mine. I do not believe I called anyone names, and I expect to be treated with the same respect as well. The posting should have been titled "Only reply if you agree with me".

Your self-righteous attitude is precisely why more people do not stay on the board for DS support.

 

[DianaCox]

1) I was criticizing the kind of thinking, not you as a person. There is a difference.

2) The part about pushing yourself away from the table was not directed at you personally, but as sarcasm using your same "thus-and-such disease is a personal choice (like pregnancy and substance abuse), so I shouldn't have to pay for coverage of YOUR problem" analysis.

3) There is an ignore button.

 

[k9ophile]

1) I was criticizing the kind of thinking, not you as a person. There is a difference.

2) The part about pushing yourself away from the table was not directed at you personally, but as sarcasm using your same "thus-and-such disease is a personal choice (like pregnancy and substance abuse), so I shouldn't have to pay for coverage of YOUR problem" analysis.

3) There is an ignore button.

FWIW I understood your remarks to be generalized and not directed at any one person.

I'm not sure how I feel about universal healthcare because my faith in any run government program be it from city to county to state to federal is very low. They all start with honorable aims and end up mired in bureaucracy with the politicians and the administrators prospering and the people who are supposed to benefit generally get screwed. Is it even possible to get a cafeteria type of insurance? i.e. I might want more LTC coverage and less maternity benefits. (My old agedness tends to influence my thinking.)

 

[galaxygrrl]

Right Diana. This is your opinion and I have mine. I do not believe I called anyone names, and I expect to be treated with the same respect as well. The posting should have been titled "Only reply if you agree with me".

Your self-righteous attitude is precisely why more people do not stay on the board for DS support.

Hey, Diana did not start this thread, she just added to it. I know she was aggressive but really, it's a forum on the Internet and you threw out something that was meant to start a flame.

I do think tons of people find this board helpful and honestly, supportive. It's a community with different voices and we have some of the most supportive people on this board I've ever seen - @aaa @newanatomy @Larra @southernlady @hilary1617 (who always has the nicest most supportive things to say) and others who I'm sure I'm missing. @DianaCox adds a bad cop voice and that is great, she also adds lots a value. @Spiky Bugger adds her own flavor of honesty.

As a blue state, college educated progressive who is part of the new economy is what this election taught me is how far apart my world is in San Francisco from people in the red states in the mid west and that we need to talk more and listen more to each other. .

You know, your statement on healthcare points out a hard issue, but it's a fair statement. It's how I feel about public schools, I don't have kids and pay for schools. The question really is how we all live together and what is the common good, and how we pay for it.

I would just say we need to talk more. And if you are going to throw out a flame, expect to get a bit cripsy. It's the Internet. But heck, it's not nearly as bad here are ending up the wrath of Trump's twitter feed.

Cheers!

 

[DianaCox]

What we need is not a cafeteria but a buffet - one price, all you need to eat.

There are some savings built in, because you don't need servers bringing you a limited menu with whole dinners being the only choices, whether you want vegetables or would prefer the clam chowder instead, telling you what the specials are, and then bringing you predetermined amounts of only a few choices of food, whether you want or need more or less. Instead, you PRE-pay once price, and take what you need and want - a little of this, more of that, don't eat fish if you don't like it - AND YOU DON'T FREAKING STICK YOUR NOSE INTO WHETHER SOMEONE ELSE IS GETTING MORE OR LESS. Tomorrow, you might need or want more of the more expensive food, or you just might only need or want a bowl of ramen. Since it is prix fixe, and prepaid whether you eat or not, you can stop worrying about what, whether and how much you need on a given day - it will always be there, whether you need it or not, and you don't have to WORRY that it won't be there when you really DO need it.

That is the HUMANE way to dispense medical care.

 

[k9ophile]

As a blue state, college educated progressive who is part of the new economy is what this election taught me is how far apart my world is in San Francisco from people in the red states in the mid west and that we need to talk more and listen more to each other. .

Preach it. I'm a little blue and a little red. Actually I think we all have some blue and red in us. Obviously not all in equal amounts, yet we do need to listen to each other. Note, listening does not mean agreement.

What we need is not a cafeteria but a buffet - one price, all you need to eat.

You articulated it better than me; thanks.

 

[Spiky Bugger]

I pay $700 out of pocket every month for my health insurance. More than a car or house payment. Prior to the "Affordable" Care Act, I paid 375.00 per month. I am hoping for some relief with the new administration. I see no reason why I need to pay for maternity care and substance abuse treatment -- two services I would never use. One size fits all never fits all.

Uhm...that $700 isn't even 25% of my house pymt...and we're old retired folks on fixed incomes.

Your insurance premium would not have gone up under tbe ACA...if the greedy insurance companies had not WANTED it to go up. Your premiums increased because your policy changed, because changes to policies permitted rate increases.

None of us know for sure we'd never need substance abuse treatment. A horrible injury or such could start someone on the road to dependence on pain killers.

There are, as far as I can tell, two primary solutions:
We can all chip in a little, all the time, so that when any of us need care, it is available and there are fewer people living in cars on my street because all their money went to health care and I don't have to stay home all day to make sure they don't break in and steal our food...OR
We can say, "Fuck you! I've got enough for me!" and hope our aging parents or cancer-riden children don't have to move in with us when an accident or illness strikes...and hope we didn't grossly underestimate our own needs.