supreme court upholds ACA

[seebell]

That was one of the poorly-thought through aspects of the ACA. I represent the largest AL-based, non-medical, 501(c)(3) in the state. In fact, I started it. At least 80% of our 700+ employees have to be federally defined as "disabled." Here's the "Catch-22": These people are the people that Medicaid was designed for - the kind for whom you're going to provide care one way or the other, usually the "other," the ER, most expensive of all clinics. Since we have more than the minimum number of employees, if we didn't provide a health insurance plan, we'd be fined under ACA. If you want to see some hair-raising insurance rates, try forming a plan for employees like these. If we didn't, the ACA fine would be a bit short of a couple of million a year - not acceptable for a nonprofit, both with accrediting agencies and the IRS. So, we have to do the best we can do, which is to provide a plan we know is short of where they'd be on Medicaid. However, no elasticity is provided in ACA for these types of employees. It just wasn't thought through...

If Governor Bentley, in his infinite wisdom, expanded Medicaid in Alabama could your people be covered that way?

I wonder if Medicaid had been expanded in Alabama would more rural hospitals have remained open?

http://blog.al.com/wire/2014/04/10_alabama_hospitals_have_clos.html

 

[Tide1986]

I don't think they are. One SIL is a physical therapist with insurance through her job. My other SIL has a Blue Cross family plan that is paid for by our family business.

By the way, it appears that Medicaid has to offer birth control at no cost if it is offered...so I edited my original post. A third exception appears to be self-funded student health plans, which I added to my original post.

Is she using a brand name drug when a generic is available? This could explain it.

 

[seebell]

I don't think they are. One SIL is a physical therapist with insurance through her job. My other SIL has a Blue Cross family plan that is paid for by our family business.

You other SIL has a husband that makes a fair amount of money? It's mostly based on household income. Obamacare that is. Could I possibly be wrong?

Planned Parenthood says this:

http://plannedparenthood.tumblr.com...-isnt-my-birth-control-covered-for-free-under

But, there are a few reasons why your insurance may not cover a specific type of birth control at no cost.
Your insurance plan is only required to cover one type of each birth control method (e.g., implant, IUD, sterilization, and hormonal birth control), but not necessarily all of the products in that category. For example, if you want use birth control pills, you might be able to get Ortho-Tri-Cyclen at no cost, but not Loestrin. Or they may cover a generic brand of birth control pills at no cost, but require a co-pay for the brand-name version.
Plans must cover a brand name drug or a specific generic version if there’s a medical reason you need to use it over the version your plan covers. You can ask your nurse or doctor what methods are best for you, and they’ll help you request a “waiver” from your insurance company — this will allow you to use the brand name product or specific generic without a co-pay. You also want to ask your insurance company to check what the process is.
Another reason your birth control might have a co-pay is if your insurance plan is “grandfathered.” In other words, it doesn’t have to comply with certain standards under the new law because the plan already existed when Obamacare was passed. So things like birth control, STD screenings, and cancer screenings might not be covered without a co-pay

My friend Tide1986 might be right in his post above. Gee I hate to say that!:wink:

 

[Jessica4Bama]

You other SIL has a husband that makes a fair amount of money? It's mostly based on household income. Obamacare that is. Could I possibly be wrong?

Planned Parenthood says this:

http://plannedparenthood.tumblr.com...-isnt-my-birth-control-covered-for-free-under

But, there are a few reasons why your insurance may not cover a specific type of birth control at no cost.
Your insurance plan is only required to cover one type of each birth control method (e.g., implant, IUD, sterilization, and hormonal birth control), but not necessarily all of the products in that category. For example, if you want use birth control pills, you might be able to get Ortho-Tri-Cyclen at no cost, but not Loestrin. Or they may cover a generic brand of birth control pills at no cost, but require a co-pay for the brand-name version.
Plans must cover a brand name drug or a specific generic version if there’s a medical reason you need to use it over the version your plan covers. You can ask your nurse or doctor what methods are best for you, and they’ll help you request a “waiver” from your insurance company — this will allow you to use the brand name product or specific generic without a co-pay. You also want to ask your insurance company to check what the process is.
Another reason your birth control might have a co-pay is if your insurance plan is “grandfathered.” In other words, it doesn’t have to comply with certain standards under the new law because the plan already existed when Obamacare was passed. So things like birth control, STD screenings, and cancer screenings might not be covered without a co-pay

My friend Tide1986 might be right in his post above. Gee I hate to say that!:wink:

Yes, both husbands have good paying jobs. Both are therapists, and my other brother works in our family business. His wife is a nurse.

 

[Jessica4Bama]

By the way, it appears that Medicaid has to offer birth control at no cost if it is offered...so I edited my original post. A third exception appears to be self-funded student health plans, which I added to my original post.

Is she using a brand name drug when a generic is available? This could explain it.

I am not sure on that. They told me they were using the same as me, but it may not be the generic version like I take.

 

[NationalTitles18]

Jess, the reason yours is free is because you keep holding the same aspirin between your knees.

 

[bamacon]

If Governor Bentley, in his infinite wisdom, expanded Medicaid in Alabama could your people be covered that way?

I wonder if Medicaid had been expanded in Alabama would more rural hospitals have remained open?

http://blog.al.com/wire/2014/04/10_alabama_hospitals_have_clos.html

Do you know why he didn't?


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[Tide1986]

Do you know why he didn't?


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Apparently we can't afford to do so.

 

[seebell]

Do you know why he didn't?


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Apparently we can't afford to do so.

I know what he said in his 2014 State of the State speech. http://governor.alabama.gov/newsroom/2014/01/governor-bentleys-2014-state-state-address/

I know that he has been hinting at expanding Medicaid.

I know that the majority of the states, including some red states, have expanded Medicaid.

http://familiesusa.org/product/50-state-look-medicaid-expansion

UAB study from 2012. http://www.uab.edu/news/latest/item/2970-medicaid-expansion-could-mean-1-billion-gain-for-alabama

Troy study disputing the UAB study.

http://business.troy.edu/johnsoncen...ma_2014_johnson-center-at-troy-university.pdf

RSA's Bonner from 2013.

http://www.al.com/opinion/index.ssf/2013/08/eight_reasons_why_alabama_shou.html

 

[bamacon]

Medicaid is by far the largest expense in most state budgets. The federal money on OBamacare ran out after a couple of years and then would be 100% the state's responsibility. If you think we're having budget issues now...shoooooot. These states are all going to collapse with their exchanges just like many already have. They're simply not viable.


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[Tide1986]

Medicaid is by far the largest expense in most state budgets. The federal money on OBamacare ran out after a couple of years and then would be 100% the state's responsibility. If you think we're having budget issues now...shoooooot. These states are all going to collapse with their exchanges just like many already have. They're simply not viable.


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But apparently that was the point all along...degrade the current health care system to make way for a single-payer one.

 

[TIDE-HSV]

If Governor Bentley, in his infinite wisdom, expanded Medicaid in Alabama could your people be covered that way?

I wonder if Medicaid had been expanded in Alabama would more rural hospitals have remained open?

http://blog.al.com/wire/2014/04/10_alabama_hospitals_have_clos.html

Well you've posed two questions. The answer to the first is "no." Or, at least, not as the law is presently written. If we discontinued our health plan and let them go on Medicaid, we'd still pay an enormous annual fine. Nonprofits cannot do that, in reality. On rural hospitals, IDK. I've heard that, but the fact is that the larger regional hospitals - just like here - are either buying up small hospitals or competing them out of existence. This extends to their also buying up doctor's practices, one after another. I've left two hospital-owned practices in the last two years. It was not because of ideological reasons. It was because they weren't delivering services because of relentless pressure from above to crank through more patients and fatten the bottom line. (I have some insight into this from the inside - one of the docs involved was an old friend and client.) There is a great deal more wrong with our system, the most expensive in the world, but all too frequently delivering 3rd world care, than the ACA...

 

[seebell]

Medicaid is by far the largest expense in most state budgets. The federal money on OBamacare ran out after a couple of years and then would be 100% the state's responsibility. If you think we're having budget issues now...shoooooot. These states are all going to collapse with their exchanges just like many already have. They're simply not viable.


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You are mistaken bamacon. The feds would pay 100% of medicaid for four years (I think) and then pay 90% thereafter. IMO Bentley's opposition to Medicaid expansion is philosophical rather than financial.

 

[Tide1986]

You are mistaken bamacon. The feds would pay 100% of medicaid for four years (I think) and then pay 90% thereafter. IMO Bentley's opposition to Medicaid expansion is philosophical rather than financial.

I believe the 100% funding expires by the end of 2016. At the 10% funding level assuming the federal government doesn't move the goal posts on us, I have read that Alabama will face a minimum of $100M in additional state expenditures per year. Given what you know of the Alabama budget, can we afford an increase of $100M per year in state expenditures?

 

[Catfish]

i guess us commies are going to rue the day

Rue the day? Who talks like that?

 

[TIDE-HSV]

Rue the day? Who talks like that?

Well, it's in my written vocabulary, if not my spoken...

 

[Bamaro]

Rue the day? Who talks like that?

 

[Catfish]

 

[NationalTitles18]

http://reason.com/blog/2015/07/07/health-insurers-request-big-premium-hike

Health Insurers Request Big Premium Hikes Under Obamacare—And One State Regulator is Pushing Rates Even Higher

 

[Tide1986]

http://reason.com/blog/2015/07/07/health-insurers-request-big-premium-hike

Health Insurers Request Big Premium Hikes Under Obamacare—And One State Regulator is Pushing Rates Even Higher

Here's a related article. This one is about the health of the temporary risk corridor (a.k.a. profit redistribution) program created by the ACA:

http://www.cnbc.com/id/102646422

When this Obamacare bill comes due, will there be nearly enough money to pay it?

An important tool meant to limit the financial risk of Obamacare insurers is expected to be grossly underfunded and "may make the U.S. insurance market less stable, not more," a new analysis warns.

The amount of money that profitable insurers expect to pay into the program was less than an estimated 10 percent what is expected to be paid out to unprofitable insurers, the Standard & Poor's Ratings Services report found.