South Side man living proof that new federal health insurance exchange site can work

christiefan915

Catalyst
People like this are going to benefit greatly from Obamacare. He was refused regular coverage because of his pre-existing condition. If, god forbid, Obamacare tanks, where is it going to leave people like Joe Lucas?


"Joseph Lucas is a South Side house painter who has spent much of his adult life without health insurance coverage. In his 20s and 30s, health coverage was an abstraction, and annual physicals were more of a worry for the white-collar set. "I'm a blue-collar sort of person," said Mr. Lucas, who is single. But, "I turned around 40, and figured it was something I should look into."

He did it using the federal health insurance website that has been frustrating thousands of people, as crashes and delays have plagued the site since its Oct. 1 launch...

...Mr. Lucas is an exception, someone who got help using the website and signed up for a plan. He had been waiting for the opportunity.

Through a previous employer, he had obtained health insurance -- then dropped it several years later as his premiums increased. What had been a $90-a-month premium contribution eventually grew to $450 a month. "It became totally unaffordable for me," he said.

Going without coverage is a calculated risk that many in his financial position take, particularly if they don't have dependents. And, as with many others, the gamble did not pay off. Three years after dropping coverage, on Oct. 10, 2010, he was hospitalized with an aortic aneurysm. Eleven days after that, he was given his discharge papers and a hospital bill for $69,000...

...He was also given, going forward, a pre-existing condition in the eyes of health insurers. Not only did he have a hospital tab he could not pay, but he also was looking at annual follow-up CT scans that would cost $11,000 or so a pop without insurance. "I was finding out I could not purchase insurance" following the aneurysm treatment, Mr. Lucas said. "I was either refused" or, in the case of Highmark Inc., steered toward a guaranteed-issue plan. Such plans do not take into account a patient's medical history, but it would have cost Mr. Lucas more than $900 a month in exchange for the absence of underwriting...

..That's when he learned about the provision of the 2010 Affordable Care Act that created a new "high-risk" insurance plan, meant to provide coverage for uninsured people with pre-existing health conditions. Pennsylvania's version, called PA Fair Care, began offering coverage in September 2010. The premiums for PA Fair Care were $283 a month.

Mr. Lucas had a choice of more than 30 plans from Highmark, UPMC Health Plan and HealthAmerica, he said. Ultimately, he selected a "silver-level" plan from Highmark. After a federal tax credit of $233 a month is factored in, his coverage will cost about $150 a month -- a great price, he said, for a 50-year-old man with an aortic condition.

While finding coverage took a few log-in attempts and two days of research, in his mind, that wasn't a turnoff. He describes himself as a centrist Democrat who was "on board" with Obamacare from the beginning, for reasons less to do with his party registration and much more to do with his life situation and health bills.

The Affordable Care Act benefited him twice, he says, first with the high-risk coverage, then with the health exchange and the new rules that say policies offered on the exchange can't account for a person's health.


 
They have to "bother with" him, now, Christiekins...its the law.

And haven't exclusions for pre-existing conditions been prohibited for a while now?

Not for him in 2010 when he was denied.

In 2010, Obamacare made it illegal for insurance companies to deny coverage to children under the age of 19 based on a pre-existing condition. In 2014, insurance companies cannot refuse to sell coverage or renew policies to anyone based on a pre-existing condition. - See more at:

http://thanksobamacare.org/index.php?id=9#sthash.3Ejr23jO.dpuf
 
Must we change our whole health care system to handle a problem that affects one half of one percent?


If we gave a $10,000 subsidy to each person denied coverage or paying a higher premium, we could keep our existing health-care system and solve pre-conditions for one tenth the projected cost of ObamaCare.



http://www.forbes.com/sites/paulroderickgregory/2013/10/08/lying-with-statistics-obamas-pre-existing-conditions-crisis/
 
South Side man living proof that new federal health insurance exchange site c...

Must we change our whole health care system to handle a problem that affects one half of one percent?


If we gave a $10,000 subsidy to each person denied coverage or paying a higher premium, we could keep our existing health-care system and solve pre-conditions for one tenth the projected cost of ObamaCare.



http://www.forbes.com/sites/paulroderickgregory/2013/10/08/lying-with-statistics-obamas-pre-existing-conditions-crisis/

But this wasn't about solving problems. This was and is about moving to single payor. It is going according to plan. First force the 5% to lose insurance. Next year is employer based.

They knew this was coming which is why they delayed the amplyer mandate. Had the employer mandate stayed in place more people would be kicked off and the dems would be looking at a complete wipeout in 2014 as in veto proof majorities. Obama still holds veto pen which makes full repeal unlikely

The dems bet is that they can use any marginal benefit such as keeping kids on insurance til 26 will buy them time. If history is correct they may be right. We will see
 
it amazes me that liberals are unable to comprehend that you can get rid of all the crap that's happening currently and still have provisions that prevent companies from denying coverage for pre-existing conditions.......

its like saying you can't get rid of sun tan oil because we can't afford to get rid of the sun......
 
It's a giant clusterfuck of a fumble!
Are repubs agile enough to scoop it up and run.
Or do they taunt with fingers pointed " hah you fumbled" until dems fix it enough
 
I love to see Republicans speculate about why the Heritage Foundation and the Health Care Industry and at least some of the Republicans in the Senate got together to formulate a Health Insurance Reform package that they are now claiming completely changes the way health insurance is delivered and is the first step on the way to a single payer system. In fact, no one except a few apocalyptic idiots on the far right, and a few dreamers on the left, even think that there are going to be any major modifications to this bill in the next ten years. The reforms so far initiated are not going to make much difference to the vast majority of people who already have some health insurance. I don't think it is even going to help the people whose benefits have been slowly eroding and now find themselves having to pay something like the first $1,000 or more costs per year out of their own pockets, as many now are forced to do. This is in addition to higher and higher co-pays, and this affects workers who just a few years ago had what they thought were great plans.

The problem with this reform—and it is something of a reform--is that it keeps the worst aspects of the American Health Care Delivery System, and only tinkers with the Health Insurance Delivery System by imposing a few more regulations on the system and gives Medicaid a bigger role to play in helping those who for several structural reasons now find themselves on the margins and unable to have heath care at all. That is, those who have jobs and can afford to pay something, but because wages have stagnated and benefits have been relegated to the dust heap as a result of the demise of union representation and the globalization of the international workforce are stuck like this guy is with a pre-existing condition and an inability to pay the premium, because in spite of his drop in wages and benefits in over the last 40 years, the cost of health care and insurance, like the cost of a college education, has continued to increase in cost every year. Now he is stuck, and because he is lucky enough to have steady year round employment he is now able to have his yearly checkups and to have his emergency care covered as long as he can continue to pay his share of his insurance policy.

What is missing from this story is what he is going to have to pay out of pocket to see the doctor in the first place and what exactly his coverage is. How much he has to pay annually before his insurance coverage even kicks in. That is, the actual details of his coverage under this policy that he is getting for his $15O or so a month and that the insurance companies are selling for what amounts to about $400 a month or more. I would bet that he is still going to be paying plenty for his health care. And that is the rub. Instead of having the cost of health care taken out of each workers check every month for all of the people in the country—truly single payer—and the government then covering the cost of health care for all Americans like they do in Canada; and that means everything, psychological, dental, and eye care as well, what we now have is just more of the same with a greater contribution by the government. With the guarantee of more paying customers, the health care industry agreed to a stronger set of regulations. That was the trade off, and that was all this was and all it is. It is not the end of the health care delivery system as we know it, and it is not the end of the health care insurance industry as we know it. In fact, except for a few really fraudulent policies that it turns out many more people than even knew they were paying for, not that much has changed or will change simply because a group of highly conservative Republican governors have decided to abstain and leave their constituents without health care or access to the changes that have occurred under this new law.

This is what all of this propaganda is really about. There are something like 30 states with Republican governors who don't want to do anything at all about health care and they don't want to offer any care or change to their constituents whatsoever. But they don't want their constituents to start clamoring for the coverage that the Republicans are refusing to give them either. So they have to demonize the improvements in the law, slight though they are, and of course the roll out has been so terrible and so fraught with problems that it is making the jobs of the Republican demonizers, and there are several here just above me, far easier than they ever imagined it would be. And that is what all of this is really about. Simply making sure that the people in the Red States never even start to think that the expansion of Medicaid or the increase in the availability of health insurance through the government run exchanges might actually be of benefit to them. As long as these people with lower IQs, and yes they do have lower IQs—the average IQ in Mississippi is 85 and in Louisiana it is only slightly higher at 90—continue to be sold lies by their Republican governors and continue to vote for conservatives who don’t want to change a damn thing except the death tax and corporate tax rates, their Republican rulers will continue to press them to believe that no health care is still better than even a marginally better situation. And it looks like these people with the lower IQs are falling for it. Sadly, they seem to be accepting the status quo because change is so scary.

But if you are a person in a Red State who is being bamboozled by your ignorant governor and your Republican dominated legislature and you are being denied even these marginal improvements in your health care options, you can do something about your miserable existence and your miserable state of life: you can vote the fucking Republicans out of office and change from red to blue! They just did it in Virginia and you can too! I am especially thinking of all the women, children and men in Texas who have been fucked by Rick Perry. Isn't it time you did something about your miserable existence and got rid of the government you have and get something like the government you deserve. No one in this country deserves to be treated the way the vast majority of the citizens of Texas are treated. No one! Remember Texans you have it in your power to give your state a makeover and give yourself a better shot. So do it! And this goes for the rest of you people in the Red States out there. Don't listen to the shit spewing forth from the likes of Republicans like the Big Dummy and I Hate Americans. You have the power to change your life and circumstances, so vote the bastards out and change your lives for the better! At least give yourselves a chance to see a damn doctor occasionally, isn’t that worth something?

Go ahead do it!
 
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They have to "bother with" him, now, Christiekins...its the law.

And haven't exclusions for pre-existing conditions been prohibited for a while now?


yeah because of the ACA.



didn't you know that was part of it?


also the poart where you can keep your adult kid on your policy until 26
 
People like this are going to benefit greatly from Obamacare. He was refused regular coverage because of his pre-existing condition. If, god forbid, Obamacare tanks, where is it going to leave people like Joe Lucas?


"Joseph Lucas is a South Side house painter who has spent much of his adult life without health insurance coverage. In his 20s and 30s, health coverage was an abstraction, and annual physicals were more of a worry for the white-collar set. "I'm a blue-collar sort of person," said Mr. Lucas, who is single. But, "I turned around 40, and figured it was something I should look into."

He did it using the federal health insurance website that has been frustrating thousands of people, as crashes and delays have plagued the site since its Oct. 1 launch...

...Mr. Lucas is an exception, someone who got help using the website and signed up for a plan. He had been waiting for the opportunity.

Through a previous employer, he had obtained health insurance -- then dropped it several years later as his premiums increased. What had been a $90-a-month premium contribution eventually grew to $450 a month. "It became totally unaffordable for me," he said.

Going without coverage is a calculated risk that many in his financial position take, particularly if they don't have dependents. And, as with many others, the gamble did not pay off. Three years after dropping coverage, on Oct. 10, 2010, he was hospitalized with an aortic aneurysm. Eleven days after that, he was given his discharge papers and a hospital bill for $69,000...

...He was also given, going forward, a pre-existing condition in the eyes of health insurers. Not only did he have a hospital tab he could not pay, but he also was looking at annual follow-up CT scans that would cost $11,000 or so a pop without insurance. "I was finding out I could not purchase insurance" following the aneurysm treatment, Mr. Lucas said. "I was either refused" or, in the case of Highmark Inc., steered toward a guaranteed-issue plan. Such plans do not take into account a patient's medical history, but it would have cost Mr. Lucas more than $900 a month in exchange for the absence of underwriting...

..That's when he learned about the provision of the 2010 Affordable Care Act that created a new "high-risk" insurance plan, meant to provide coverage for uninsured people with pre-existing health conditions. Pennsylvania's version, called PA Fair Care, began offering coverage in September 2010. The premiums for PA Fair Care were $283 a month.

Mr. Lucas had a choice of more than 30 plans from Highmark, UPMC Health Plan and HealthAmerica, he said. Ultimately, he selected a "silver-level" plan from Highmark. After a federal tax credit of $233 a month is factored in, his coverage will cost about $150 a month -- a great price, he said, for a 50-year-old man with an aortic condition.

While finding coverage took a few log-in attempts and two days of research, in his mind, that wasn't a turnoff. He describes himself as a centrist Democrat who was "on board" with Obamacare from the beginning, for reasons less to do with his party registration and much more to do with his life situation and health bills.

The Affordable Care Act benefited him twice, he says, first with the high-risk coverage, then with the health exchange and the new rules that say policies offered on the exchange can't account for a person's health.


I'm sure this makes all those people losing their ins, and/or doctor feel much better.
 
I'm sure this makes all those people losing their ins, and/or doctor feel much better.

And who would all those be exactly? Since you seem to have such horror stories like the rest of the apocalyptic "sky is falling" screamers let's see some evidence from somewhere other than Brietbart, Glenn Beck's fiery, Blaze, Limbaugh's cigar or the main source of fear and fear mongering Rupert Murdoch's asshole!

So let's see it?
 
Must we change our whole health care system to handle a problem that affects one half of one percent?

If we gave a $10,000 subsidy to each person denied coverage or paying a higher premium, we could keep our existing health-care system and solve pre-conditions for one tenth the projected cost of ObamaCare.

http://www.forbes.com/sites/paulroderickgregory/2013/10/08/lying-with-statistics-obamas-pre-existing-conditions-crisis/
Obama says half of Americans have a pre-existing condition

rulings%2Ftom-mostlytrue.gif


The Obama administration is trying to rebut critics who have labeled Obamacare one of the most destructive laws in the nation’s history. At an event in Maryland on Sept. 26, 2013, President Barack Obama highlighted the program’s benefits. High on his list was the new rule about pre-existing conditions, health problems that insurance companies use to deny coverage to would-be new customers. Under the Affordable Care Act, no insurer will be allowed to turn someone down due to a pre-existing condition. This, Obama said, will make a big difference. "Up to half of all Americans have a pre-existing condition," he told the crowd in Maryland.

A reader found this confusing and asked us, "So that meant 150 million people could not have insurance?"

The answer is "no" and here we’ll explain why and rate the accuracy of the president’s claim. We looked into a very similar statement not too long ago.

A problem with your health versus a problem with the insurance company

When Obama said as many as half of all Americans have a pre-existing condition, he was describing the number of people who have heart disease, cancer, diabetes, hypertension, mental illness or any of a number of other maladies. It was a statement about the prevalence of those illnesses across the population.

If you already have insurance and develop one of these problems, generally, your insurance company will pay for treatment. But if you show up in the individual insurance market wanting to buy coverage, and you already have one of these diseases, generally speaking, you would be out of luck. In the view of the insurance company, you would have a pre-existing condition and they would not pay to treat it. Or they might charge you a much higher premium.

Since about 85 percent of Americans already have insurance, many through large group plans, this would not be a concern. But for those who don’t, it matters. The Affordable Care Act provision is aimed at those people. By the way, the law has had this protection for children since it was passed in 2010.As of Jan. 1, 2014, the rule extends to adults.

Getting back to the reader’s confusion, while half of all Americans might have one of these illnesses, most of them don’t bump up against the insurance companies’ restrictions. Obama was talking about the benefit to the smaller group for whom this would be a problem.

(Continued)

http://www.politifact.com/truth-o-m...says-half-americans-have-preexisting-conditi/
 
it amazes me that liberals are unable to comprehend that you can get rid of all the crap that's happening currently and still have provisions that prevent companies from denying coverage for pre-existing conditions.......

its like saying you can't get rid of sun tan oil because we can't afford to get rid of the sun......

Then why was it never done before?
 
Then why was it never done before?

I don't know.....think of all those years when we had a Democrat president and a Democratically controlled congress and it never happened.....go figure.....

granted, we did have a two year window with a Republican president and a Republican controlled congress.......but we also had 9/1/01 and we weren't thinking much about insurance then.......
 
I love to see Republicans speculate about why the Heritage Foundation and the Health Care Industry and at least some of the Republicans in the Senate got together to formulate a Health Insurance Reform package that they are now claiming completely changes the way health insurance is delivered and is the first step on the way to a single payer system. In fact, no one except a few apocalyptic idiots on the far right, and a few dreamers on the left, even think that there are going to be any major modifications to this bill in the next ten years. The reforms so far initiated are not going to make much difference to the vast majority of people who already have some health insurance. I don't think it is even going to help the people whose benefits have been slowly eroding and now find themselves having to pay something like the first $1,000 or more costs per year out of their own pockets, as many now are forced to do. This is in addition to higher and higher co-pays, and this affects workers who just a few years ago had what they thought were great plans.

The problem with this reform—and it is something of a reform--is that it keeps the worst aspects of the American Health Care Delivery System, and only tinkers with the Health Insurance Delivery System by imposing a few more regulations on the system and gives Medicaid a bigger role to play in helping those who for several structural reasons now find themselves on the margins and unable to have heath care at all. That is, those who have jobs and can afford to pay something, but because wages have stagnated and benefits have been relegated to the dust heap as a result of the demise of union representation and the globalization of the international workforce are stuck like this guy is with a pre-existing condition and an inability to pay the premium, because in spite of his drop in wages and benefits in over the last 40 years, the cost of health care and insurance, like the cost of a college education, has continued to increase in cost every year. Now he is stuck, and because he is lucky enough to have steady year round employment he is now able to have his yearly checkups and to have his emergency care covered as long as he can continue to pay his share of his insurance policy.

What is missing from this story is what he is going to have to pay out of pocket to see the doctor in the first place and what exactly his coverage is. How much he has to pay annually before his insurance coverage even kicks in. That is, the actual details of his coverage under this policy that he is getting for his $15O or so a month and that the insurance companies are selling for what amounts to about $400 a month or more. I would bet that he is still going to be paying plenty for his health care. And that is the rub. Instead of having the cost of health care taken out of each workers check every month for all of the people in the country—truly single payer—and the government then covering the cost of health care for all Americans like they do in Canada; and that means everything, psychological, dental, and eye care as well, what we now have is just more of the same with a greater contribution by the government. With the guarantee of more paying customers, the health care industry agreed to a stronger set of regulations. That was the trade off, and that was all this was and all it is. It is not the end of the health care delivery system as we know it, and it is not the end of the health care insurance industry as we know it. In fact, except for a few really fraudulent policies that it turns out many more people than even knew they were paying for, not that much has changed or will change simply because a group of highly conservative Republican governors have decided to abstain and leave their constituents without health care or access to the changes that have occurred under this new law.

This is what all of this propaganda is really about. There are something like 30 states with Republican governors who don't want to do anything at all about health care and they don't want to offer any care or change to their constituents whatsoever. But they don't want their constituents to start clamoring for the coverage that the Republicans are refusing to give them either. So they have to demonize the improvements in the law, slight though they are, and of course the roll out has been so terrible and so fraught with problems that it is making the jobs of the Republican demonizers, and there are several here just above me, far easier than they ever imagined it would be. And that is what all of this is really about. Simply making sure that the people in the Red States never even start to think that the expansion of Medicaid or the increase in the availability of health insurance through the government run exchanges might actually be of benefit to them. As long as these people with lower IQs, and yes they do have lower IQs—the average IQ in Mississippi is 85 and in Louisiana it is only slightly higher at 90—continue to be sold lies by their Republican governors and continue to vote for conservatives who don’t want to change a damn thing except the death tax and corporate tax rates, their Republican rulers will continue to press them to believe that no health care is still better than even a marginally better situation. And it looks like these people with the lower IQs are falling for it. Sadly, they seem to be accepting the status quo because change is so scary.

But if you are a person in a Red State who is being bamboozled by your ignorant governor and your Republican dominated legislature and you are being denied even these marginal improvements in your health care options, you can do something about your miserable existence and your miserable state of life: you can vote the fucking Republicans out of office and change from red to blue! They just did it in Virginia and you can too! I am especially thinking of all the women, children and men in Texas who have been fucked by Rick Perry. Isn't it time you did something about your miserable existence and got rid of the government you have and get something like the government you deserve. No one in this country deserves to be treated the way the vast majority of the citizens of Texas are treated. No one! Remember Texans you have it in your power to give your state a makeover and give yourself a better shot. So do it! And this goes for the rest of you people in the Red States out there. Don't listen to the shit spewing forth from the likes of Republicans like the Big Dummy and I Hate Americans. You have the power to change your life and circumstances, so vote the bastards out and change your lives for the better! At least give yourselves a chance to see a damn doctor occasionally, isn’t that worth something?

Go ahead do it!

so, in summary, those states that took control of the system are doing better than those states that left it up to the federal government?......
 
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