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Answered: Why Two Obama Loyalists Lost Their Health Policies

Lack of kids’ dental benefits, other coverage gaps help “tank” couple’s Kaiser Permanente insurance plan — but so did contracts with California’s health insurance exchange.

An information table is busy at Union Station in downtown Los Angeles as people seek information on state-provided health insurance. (Reed Saxon/AP Photo)

Kaiser Permanente’s decision to cancel the insurance policies of lifelong Democrats Lee Hammack and JoEllen Brothers generated a flood of interest yesterday. The couple, supporters of President Obama, may have to spend twice as much next year for a health insurance plan that has fewer benefits than the plan they have.

Kaiser explained to them, and to me, that their plan didn’t meet the requirements of the Affordable Care Act and therefore had to be canceled. But how could it be, many readers wondered, that the seemingly inferior plan offered for next year met the requirements of the act while the richer one they currently have does not?

I spent hours yesterday trying to figure that out and in the process came upon a related dispute between California’s insurance commissioner and the state’s new health insurance marketplace over these cancellations.

Here’s what I learned:

First, President Obama’s now-infamous pledge that those who liked their health plan could keep it applied only to people enrolled in those plans as of the day the Affordable Care Act was signed into law, March 23, 2010. That became known as the “grandfather” clause.

Hammack, a San Francisco architect, and Brothers have been members of Kaiser Permanente since 1995, but they’ve only been enrolled in this particular plan since January 2011. So they do not qualify for the grandfather protection. (Even if they did, Politifact has labeled the pledge “pants on fire.”)

Next, and more importantly, the benefits their plan offered didn’t fully comply with the Affordable Care Act.

It did not cover dependents in the manner set out by the law, and it did not cover pediatric dental and vision services, as well as “habilitative services,” which includes speech, occupational therapy and physical therapy.

“We did not cover these services in 2013,” Kaiser spokesman Chris Stenrud wrote in an email. “Pediatric dental and vision obviously do not apply to this couple, but it is one benefit package, regardless of age.”

These seemed like pretty minor points. Is this really enough to tank this plan? I asked Ken Wood, senior adviser for products, marketing and health plan relations for Covered California, the state’s health insurance marketplace.

“Any tiny point tanks the plan,” he told me last night. “If it was just the pediatric dental, that alone would say it’s a noncompliant plan.”

There was a bigger issue, too. The plan was medically underwritten, meaning that it carefully chose members based on their health status. The Affordable Care Act eliminates such screening and requires that insurers take all comers. “Because their current insurance pool is comprised of healthier people who use fewer medical services, the premium level needed to pay for those services is also less,” Stenrud wrote.

Put another way, Hammack and Brothers are casualties of an insurance system in transition. Until now, insurance companies could pick and choose which consumers to accept and reject. People were forced to pay different amounts based on their age and health status.

The new system created by the Affordable Care Act does not allow plans to turn away people with pre-existing conditions or charge them more. As a result, sick people previously denied coverage and healthy people who currently have insurance will pay the same.

That makes health care more affordable for many, but less affordable for some.

But there was something else at play. Stenrud noted that Kaiser’s contract with Covered California requires that insurers doing business on the exchange cancel existing contracts at the end of this year -- rather than renew them -- if they don’t meet the requirements of the act.

“We shared Covered California’s view that most consumers would benefit from lower premiums and greater stability in the exchange if we all agreed to forgo early renewals in the individual market,” Stenrud wrote.

For more explanation of what’s going on, I called the California Department of Insurance. The agency earlier this week forced Blue Shield of California to extend the canceled health policies of 115,000 members for three months because the insurer did not give them proper notice.

Janice Rocco, the department’s deputy commissioner for health policy and reform, said she anticipates that by year’s end, between 900,000 and 1 million Californians will see their individual health insurance policies canceled.

But it didn’t have to be this way, she said.

Wait, what?

It’s not the act, but the arrangement between insurers and Covered California that mandated the cancellations right now.

While the Affordable Care Act aims to improve the quality of insurance plans offered, she said, it does not require that insurers cancel all of their contracts at the end of this year. In other states, she noted, consumers are able to keep their policies until they expire in 2014, giving more time to make thoughtful choices.

Insurers, including Kaiser and Blue Shield, wanted the California Legislature to require that all existing individual contracts expire at the end of this year, Rocco said. That could give them a marketing edge because of their size and the short window to make choices, she said. But her department opposed it, and lawmakers didn’t go along.

The insurers were more successful with Covered California, which adopted the requirement, Rocco said.

“People who did the right thing, played by the rules, were responsible and had health insurance coverage are being forced out of their policies on December 31 by most of the health insurers in this state. This is not required by state or federal law,” Rocco said.

“People without insurance today will have until March 31 to choose which product is best for them,” she said, noting the end of the 2014 open enrollment period.

Covered California defended its requirement.

“It has always been one of our stated goals to try to start on a level playing field in 2014 and start out the new year with a single risk pool,” meaning a melding of young and old, sick and healthy, said Anne Gonzales, a spokeswoman for the exchange.

Gonzales acknowledged that there will be winners and losers in this transition. “There are going to be people out there that are going to find that their premiums are about the same, some are going to have them go up, some are going to have them go down,” Gonzales said.

Of the 900,000 or so people whose policies are being canceled in California, she said, about 310,000 will qualify for financial assistance, in the form of premium subsidies, which will lower the cost of coverage. The rest will not.

“The flip side is 32 million people [in California] will be keeping their plans, and 4 million people will get plans that they couldn’t afford to buy before this reform,” she said.

Wood said the situation facing Hammack and Brothers is “unique in my experience” and that the rate they have been paying is more akin to rates for people in their 20s. Hammack is 60; Brothers, 59.

Together, they pay $550 a month now and could pay up to $1,300 a month after Jan. 1. “At their respective ages, a more typical rate would be $550 each,” Wood said.

Hammack told me that he doesn’t know what he’s going to do. He makes slightly more than 400 percent of the federal poverty level — $62,000 for a couple — which means he isn’t eligible for premium subsidies. But he’s considering reducing his income below that level, which would reduce his premiums substantially.

Wood says that’s smart. If Hammack is able to get his income at or below $62,000, he stands to save $10,740, Wood told me in an email.

“Just as people think about the tax consequences of home ownership and retirement savings, I think health care will now become another area where the middle class will need to think about the tax implications of purchasing individual health insurance,” he said.

Has your insurance been canceled? Have you tried signing up for coverage through the new exchanges? Help us cover the Affordable Care Act by sharing your insurance story.

Brandon Adams

Nov. 7, 2013, 1:03 p.m.

The income reduction incentive is just bizarre.

I used to have to point out to people that the marginal nature of the tax system means you can never end up with a net loss because you made more in income.

Now those ignorant folks get to be right.

The real story here is that Lee and JoEllen are willing to lower their income so other hard working people can pay more so they pay less. What a disgrace to their political party, their families, and themselves. “Rather than work hard to earn more, we’ll work less and let others pay our bills.” This from “Obama Loyalists”! Not very loyal to your fellow Americans!

OTOH, you’re implying that Lee and JoEllen should pay more so that other Americans can pay less.  I don’t blame them one bit for looking to lower their income. Mr. Obama pretty much misled the American people. Doubt he’d get elected again.

Keep in mind that the ACA had the full blessing of every one of the major insurance corporations.  Nobody should be surprised.

“First, President Obama’s now-infamous pledge that those who liked their health plan could keep it applied only to people enrolled in those plans as of the day the Affordable Care Act was signed into law, March 23, 2010.”

That’s not what he said. ProPublica is acting like White House spin control by inserting an asterisk after the president’s simple promise—if you like your plan, you can keep your plan.He made that promise about a law that would take effect two years later which to millions of intelligent listeners meant just that - if you like your plan when this law takes effect, you can keep your plan.

How many other gotcha astericks will show up - especially the one about nobody going to jail for not signing up for Obama care. The ObamaCare-to-Jail vector is easy to identify. So far, no tax liens may be placed against those who don’t pay the insurance tax. But millions of marginal individuals who previously earned to little to file taxes could simply not file. Is everyone now obligated to file, to report whether or not they paid the tax or signed up for an unwanted subsidy?  Those are the people most likely to be systematically harassed, arrested and charged with crimes for failing to pay taxes - especially if they happen to be politically outspoken and the NSA tips the IRS to watch them and create a “parallel construction” case against them.

“That makes health care more affordable for many, but less affordable for some.”

This line is exactly backwards. It should read:

That makes health care more affordable for SOME, but less affordable for MANY.”

B. Anne - What about insurance don’t you understand?  All insurance works this way.

I pay for other people’s auto accidents despite having never caused one in my driving career (over 30 years).  All the money I’ve given the auto insurance companies have been pure profit on their part.

Are they only “loyalists” for the parts of his campaign that suits them?
If they’re loyal shouldn’t they follow through, rather than count on others to pick up the pieces. They made a choice, own it.

William Crane

Nov. 7, 2013, 2:33 p.m.

Actually this is not a failure in the ACA but a failure in the private, competitive American healthcare system. A single payer, government operated system would be the most fair and most economical system for all but the top 4% of Americans.
Further, if the couple described above was only “slightly above the 400% poverty level in income, only a slight reduction would result in a significant savings. It is the kind of financial management manipulation that wealthy people do all the time.

All of this information ought to have been included in the initial article. I understand that jumping on the Obamacare-Death-Star bandwagon is great for clickbait, but your readers expect a much higher level of *investigative* reporting than was reflected in the first article about this couple’s “health care woes.”

Jeff Stein, I agree with your comment—this “every man for himself” attitude, that belief in self-exceptionalism especially when it comes to playing into the system, is the very core of our country’s economic problems.

Hermann Helmholtz

Nov. 7, 2013, 2:54 p.m.

What one takes from this article is that trying to fix a system dominated by private enterprise is impossible.

The fact is clear: the new health insurance scheme cost some people more than the old. Anybody with a modicum of understanding of how private enterprise operates could have foreseen that.

Indeed, the Deputy Insurance Commissioner in California did. She advised the state legislature not to acquiesce to the trick Kaiser and others were pushing - no doubt with adequate “oil” and other unspeakable deals in a totally corrupt “representative democracy.”

But the authors of the act must have seen that too. The act should have stated clearly that one can keep his or her existing policy, if one chose to. Omitting it fro m the act cannot be simply a mistake, considering that it must have gone through tens of legal and insurance specialists.

Why they didn’t is an interesting question. It may turn out to be just another give away to the insurance “industry” along with the magnificent doll out to the drugs insurers and the pharmaceutical “industry” in the act.

This act will either collapse or end up amended to liquidate all its merits and replace it, as with the tax laws, as legalization to the day-light robbery of the insurance companies and their unending exploitation of human suffering.

Franklin Reeder

Nov. 7, 2013, 3:03 p.m.

It may have been obvious to everyone else but this is the is the first article that I have seen that puts into context President Obama’s now-infamous pledge that those who liked their health plan could keep it.  First, the pledge applied only to plans that people had as of the date that the law was signed.  For everyone who changed plans since or is newly enrolling, their plans must meet minimum standards that are, in my opinion, altogether reasonable.  Both provisions were thoroughly debated and clear from the outset.

Note that the case that Propublica describes is about a couple enrolled in a plan that was comparatively inexpensive because it cherry-picked; i.e. , it enrolled only comparatively healthy people.  That is exactly the practice that the ACA was intended to discourage if not eliminate.  If a plan only enrolls the young and healthy, older or sicker people are thrown into a more expensive pool, which would render insurance unaffordable for many.  The program that everyone holds up as a model - the Federal Employee Health Benefits Program - works precisely for the same reasons.  All plans have to meet a minimum standard and everyone, regardless of age or health status, pays the same premium.

Christine Gernant

Nov. 7, 2013, 3:06 p.m.

CA had a chance to set up its own single payer model and legislation should be reintroduced to try again.
Time to get for profit “health” insurance and go to MedicareCA where the overhead is 4% instead of the 20% overhead that goes to investors.

It is important to note that the couple could get the rates they were getting because of their terrific health status. 

They are on the individual market and well into middle age.( I am a health nut and have been for decades, never sick and was just diagnosed with a chronic disease at 59.) They are very vulnerable at their ages because if they ever had to use this policy in any real way, the insurance company would find a way to squeeze them out. They would become “unprofitable.”

If disease happens, the cost of their policy will skyrocket. Without the ACA there were no lifetime or annual limits for some policies.  The question is what would this policy give them in the event of very expensive medical event that would leave them chronically ill and needing long term medical attention?  And how long before their insurance company raised their rates so high, they would be forced to drop it? And where would they turn until they qualified for Medicare?

Remember, it’s their great health NOW that gets them a cheaper rate.

Also, they are eligible for catastrophic insurance (high deductible plans) on the exchanges even at their ages if they can’t get a policy that is LESS than 8% of their income. (Yes, that’s possible under the ACA for people over 30.)

8% of $62,000 is $4,960 ($416/month). They are even exempt from the law of they can’t get any insurance that is less than 8% of their income. But I understand they want insurance. So, if I am understanding correctly, if they can’t find a policy for less that $416/month, they are eligible to purchase a catastrophic plan.

They are leveraging their good health and getting a good deal on the individual market now

They could leverage their health under the ACA and get a catastrophic plan on the marketplace (because they would qualify to purchase it), and start a health savings account.  Considering their good health, they would have time to sock away $ in the health savings account to pay the high out-of-pocket which they would have to do before coverage starts.

Keep in mind that the ACA caps out of pocket expenses at $6350 for an individual; $12,700 for a family even for high deductible plans. So they would have the protection of not going bankrupt because of a medical event.

Although catastrophic plans require you pay all your out-of-pocket costs before coverage starts, the subscriber STILL gets 3 primary care visits/year for free along with all the preventive screenings.

There is more of this story to come, I’ll wager.

Susan Caulfield

Nov. 7, 2013, 3:33 p.m.

“The plan was medically underwritten, meaning that it carefully chose members based on their health status.”

Before the ACA, did this couple have a guarantee of staying on this plan at the low rate at renewal time, regardless of health status? The linked plan details say that “Your premium is subject to change based on your medical history.”

Could they have been dropped if they had developed cancer or another expensive condition?

If so, their Kaiser plan was only inexpensive unless they got sick.

Bruce J Fernandes

Nov. 7, 2013, 4:05 p.m.

My late wife and I were Kaiser members when I lived in CA as a self-employed.  I no longer live in CA but if I did I would still be on Kaiser.  I had been on Kaiser for 20 years when my late wife was diagnosed with a brain tumor.

It didn’t even cross my mind that Kaiser would drop us.  In fact shortly after her diagnosis I was called in by social services to go over the long term plan from today until hospice care was needed.  I was also immediately put into a support group for spouses who had lost or would lose their spouse to cancer.  My wife was offered the opportunity to have surgery at Stanford or USF which are both top of the line but we chose Kaiser’s neurosurgeon because I was able to find out he was one of the best in the world.

This goes to something not talked about much and that is personal choice to purchase the correct policy from a QUALITY provider.  If you pick one of those cheapo repot depot industrial type policies then you are almost always dropped…. but the premium is so inexpensive what would anyone expect.  You get what you pay for in the final analysis.  Healthcare horror stories are more a function of people paying next to nothing for…............. nothing!

I paid up for Kaiser for years hoping I would never need to use it.  When the worst happen they were there for me from initial diagnosis to the end. 

OK, we are all done with crummy health insurance.  The big question now is whether people can afford co-pays and deductibles up to $6,250/year per person up to double that for husband/wife?  I think we are still in the same predicament.  People wanted free healthcare.  Look at this couple from San Francisco featured in ProPublica… they wanted someone else to pay their premiums and are now going to manipulate the system to get as much of their premiums paid for by someone else.

This nation cannot function this way…. people trying to depress their income and lower their lifestyle in order to get subsidies… there will be a host of long term unintended consequences if the nation marches in the direction of creating a new class of middle to lower middle class dependency in the form of these subsidies.

Very deceitfully written.

The point remains that it is unlikely that there are more than a handfull of plans in the entire country that covered the four corners of requirements HHS wrote into the rules. In short, the ACA cancelled nearly everyone’s individual plans. Whether insurance companies lobbied for a uniform cancellation date is immaterial.

This was known and voted on by the senate when Charles Grassley brought a resolution to the senate floor in Septemebr 2010. It was clear then that HHS’ June 2010 rules would cancel plans across the country and Grassley’s resolution would have stopped that. Senate democrats voted unanimously to defeat it - they’ve been lying ever since.

The cost to administer this monstrosity will likely be 25-30% when you factor in HHS, CMS, IRS, Justice and on and on. Unlike insurance companies, the feds spread administrative costs around so you won’t know how outrageous they are.

It makes no sense to disrupt 85% of the country to fix the fact that 15% of the population was uninsured. It’s a bad bill and a bad plan.

It will not work because it is:
1) Technologically inept
2) Consumer fraud on a grand scale
3) Economically inviable

Why not report the truth - your plan is being cancelled so we can overcharge you in order to subsidize everybody else. Is that so hard to say?

Brandon Adams

Nov. 7, 2013, 4:49 p.m.

I don’t understand the folks complaining that the couple might reduce their income to obtain a net savings.

Given the tone of the comments, it seems that they’re fundamentally opposed to the law, presumably because they’re free market boosters.  It only makes sense that if you’re a free market booster, you believe that people respond to incentives.

The couple is just responding to incentives.  They’re not trying to game the system, they’re trying to obtain the best outcome within its set of rules.

It’s the perverse incentive that’s the problem.

The comments are as interesting as the article.  The net of it is, the ACA presents the fault line of socialism or socialized medicine and health insurance.  We are trying to blend down the standard of and spread the costs as evenly as possible.  This is one step away from enforcing caps on income and net worth.  This is what happens when a major sector of the economy—healthcare—becomes irresponsible, impenetrable, and greedy.

Losing “coverage” from Kaiser is probably a blessing in disguise.

I am Grandfathered into a high deductible HSA plan.  Blue Shield sent me a “good news” letter which reminds me that should my health status change then my rates will go up.  I also won’t get any other benefit of the ACA like a few visits per year and screening unless I pay out of my own pocket for them.

So why would I keep a Grandfathered plan?  Maybe if was a lot cheaper, but it’s not and if they get the rate increase of 9.9% that is filed it will be less of a deal.

I like the idea that my rates won’t go up if I get sick so I’ll be moving to a ACA plan Jan 1.  No more healthcare roulette in this house.

That level playing field can require quite a hard drop to reach.

April, I find it interesting that the insurance company is asking for a 9.9% increase just below the trigger for an outside review.

The ACA put in place a consumer protection that says if insurance companies ask for a 10% increase or more, an outside review is triggered There would be a 3rd party snooping around their records looking for justification for the increase.

Was ObamaCare really the best and only solution? This is a mess. From people taking advantage by lowering their income, to the insurance industry finding a way to capitalize on it(why would businesses need profits?), to politicians campaigning on it. They’re all gaming the game.
God forbid healthy people were getting better rates. Maybe the gov’t can force banks to give everybody loans at the same rate regardless of credit.

“Insurers, including Kaiser and Blue Shield, wanted the California Legislature to require that all existing individual contracts expire at the end of this year, Rocco said. That could give them a marketing edge because of their size and the short window to make choices, she said.”

Actually, the bigger reason is to avoid adverse selection. If people could keep their current coverage into 2014, those who were healthy would do so, while those who weren’t would immediately jump to a compliant 2014 community-rated plan. That would skew costs of the community-rated ones higher, and might start a death spiral.

Doug.

Wait a second.

From the documents you posted yesterday, the old plan was an *Individual plan* with *no dependent coverage* that covered the *subscriber only*.

The newer, 2x as expensive plan was a *family plan* for both of them.

How were they both covered previously on an *individual plan* with *no family coverage*? Something doesn’t add up here.

“It did not cover dependents in the manner set out by the law, and it did not cover pediatric dental and vision services, as well as “habilitative services,” which includes speech, occupational therapy and physical therapy.”

Oh come on! OLDER PEOPLE HAVE STROKES and need EXPENSIVE
“speech, occupational therapy and physical therapy.” all the TIME!
So what if all the plans have to cover everything. In the long run - there will be so many people insured that the cost will go down. How about that? Is that good? Kvetch, kvetch, kvetch rich people. Upper middle class people are now RICH people. Look at the median income.

“That makes health care more affordable for many, but less affordable for some.”

No, not “SOME” - “A FEW”- in the big picture.
You KNOW that it has been acceptable for 5 percent of Americans who wish to be employed to be unemployed at any time, for the last umpteen years. THat is considered A FEW PEOPLE. So is the percentage of people that will be cut off - they just make more noise because they have more money. boo hoo. Join your fellow man in dealing with injustice in your personal daily life for a change. It’s a character builder.

“Janice Rocco, the department’s deputy commissioner for health policy and reform, said she anticipates that by year’s end, between 900,000 and 1 million Californians will see their individual health insurance policies canceled.”

OUT OF 40 MILLION PEOPLE. That is not “some” - that is “very few”

Just because they are upper middle class doesn’t mean they count for three people each.

““People who did the right thing, played by the rules, were responsible and had health insurance coverage are being forced out of their policies on December 31 by most of the health insurers in this state. This is not required by state or federal law,” Rocco said.”

This is how Cali dems are smart - let CC do the deed - you can’t blame your elected. I’m for it!

“:“Just as people think about the tax consequences of home ownership and retirement savings, I think health care will now become another area where the middle class will need to think about the tax implications of purchasing individual health insurance,” he said.”

Just goes to show that $62K is not very much money any more, and is barely middle class in most parts of California.

Kaiser in NorCal is giving long time employees golden—-er, make that bronze—parachutes at this very moment to reduce their costs on the backs of their lower wage workers.

@Jeff Stein - You know absolutely nothing about how hard they work for what they earn, therefore your comment is hot air and means nothing, except that it represents so many Americans nowadays, which is why it’s failing….

@jeff stein

“Are they only “loyalists” for the parts of his campaign that suits them?
If they’re loyal shouldn’t they follow through, rather than count on others to pick up the pieces. They made a choice, own it.”

Eh-eh-eh! Your hatred is on display.

[I posted this comment at the TPM version of this story and thought I should post it here as well]

If their income is “slightly more” than the limit for qualifying for PPACA tax credits, the solution would seem to be to contribute to a Health Savings Account (to which they can contribute in 2014 up to a maximum $7,550), which would presumably take him below the threshold, because HSA contributions are deducted “above the line” in arriving at the Modified Adjusted Gross Income used to determine PPACA tax credit eligibility. He could in effect be using savings from the tax credit to fund an HSA for future use.

Having said that (Disclaimer: I’m not a tax accountant or attorney!!) I wonder if this is really true, i.e., HSA contributions will continue to be deductible for PPACA tax credit purposes. The discussions here….

http://www.cahba.com/advice/2013/09/magi_and_hsa_c...

...seem to come to the conclusion that it is, and link to Covered CA documents that support that conclusion.

@Pub123
The republicans have not set forth any way to help people get insurance. Who gives a rats patooty what Grassley did to grandstand to his corn-stituents.

@cm berger - what you’re calling hatred I see as accountability. Crazy, I know! Then again, if I’m going to campaign for a candidate and their programs, their “signature” program! I would be very careful to understand all that I am promoting. I certainly wouldn’t whine about it, and try work loopholes in the program I just promoted.
Not hatred, disbelief.

You also say 900,000 to a million is very few. Tell me, out of the 2013 census of 38,000,000 Californians, how many of those have individual plans? Because it is 900,000 to 1,000,000 INDIVIDUAL plans that will be cancelled. Surely there are not 38,000,000 individual plans in California. Please don’t skew the numbers to suit your argument, tell the truth, or at least admit if you don’t know.

From California Healthline website:


Middle-income Californians in the individual market could face a 30% rate increase on average when they sign up for new plans.
However, about half of state residents who have policies through the individual market will not be affected by the law because they have “grandfathered” plans that were purchased before March 2010 (California Healthline, 10/28).


How Many ‘Cancellations’ Are There, Really?
At least half of the 14 million people who shop in the individual insurance market can expect to receive a cancellation letter ahead of next year.
A review by “Road to Reform” found that hundreds of thousands of cancellation letters had already been sent in states like Oregon, Florida and Georgia. And about 1 million of consumers affected are in California.

This sounds like much more than “very few”

As the history of the 20th century and its hundreds of millions of dead long since established, progressives will put up with any sort of horrifying, destructive, society-rending outcomes so long as they meant well when they started and still feel good about themselves.  It’s always someone else’s fault, be it obstructionists, headwinds, counter-revolutionaries, or whatever.  They will never change, and cannot be reasoned with.

Two adults enroll in a certain Kaiser policy in January 2011, a year after the grandfather clause took effect; hence they’re not protected by it. Kaiser recently cancelled those policies because that plan didn’t meet the requirements of the Affordable Care Act (ACA).”  Specifically the plan did not cover:
dental and vision services for children, (no children were involved)
speech, occupational therapy and physical therapy for adults.

However, according to Janice Rocco of the California Department of Insurance, neither the ACA nor state statute required Kaiser to terminate policies for not meeting the Act’s standards.  By law, that act was at the discretion of the provider. 

However, Kaiser and the new independent state commission (called “Covered California”) put together to regulate the medical exchange, entered into a contract wherein Kaiser agreed to cancel all policies that do not meet ACA standards, regardless of whether the offending provisions applied to the specific policyholder or not.  In short, the ACA is being blamed for imposing a restriction it did not, which restriction Kaiser worked to have imposed on itself.

For some reason, articles like this ignore the disadvantaged position this couple was in before the ACA, a disadvantage that has in fact been exacerbated by a policy that favors those who have found someone else to pay their bills.

We don’t know how much Hammack was making last year, but if it was say $70K and they were paying $550/month in premiums, that was already more 9% of their income.  How many commenters here with employer-paid insurance could afford to give up 9% off the top?  Most self-payers were initially very supportive of reform because they honestly believed the “affordable” part of the conversation. 

I never saw any serious examination of what the act would mean to healthy middle-aged adults.  The arguments were all sob stories about the uninsured and uninsurable.  Now we find that those who were paying their way all along are essentially being penalized and suggested remedies all seem to revolve around how they should be happy getting less coverage what they had for the same or higher cost. 

The comments from the fortunate 40% who get their bills paid by their employers and who are largely unaffected are insulting.  How many people with employer provided coverage console themselves that its okay to pay higher copays and deductibles with more limited networks because…well just because?

We need a universal coverage system where everyone gets the same deal.  We don’t need to go off into the weeds of single-payer—the most popular universal systems are actually more privatized than the US.  We need to start by putting everyone in the same program.

BTW, although most pundits claim that 80% of Americans get their care through their employers, that is a misrepresentation.  The correct figure is that of those with private insurance, 80% is employer—provided.  In other words, only 40% of the total population is covered by employer-provided plans—the other 60% are self-payers, government programs, or uninsured.  In other words, we have a policy that was designed to leave a minority of the populace untouched and self-satisfied.

My situation is similar to Brothers’ and Hammack’s. I’m a Democrat who supports universal health care, self-employed, live in CA and my comprehensive health care plan was cancelled. I’ve been covered by Aetna for 5 years, and as of Dec 31, Aetna will no longer offer individual policies in CA. Premiums for Covered California’s Bronze plan (the one with the fewest benefits) are 60% higher than my current premium, and the co-pay is higher. Under Covered CA, far fewer insurance companies are offering coverage and hence the rates have sky rocketed for those of us with solid, existing policies. I see that New York City’s rates have dropped significantly because multiple insurers are participating. Why is that not the case in CA?

Idiots!! Vote for socialism, and then cry when you get it. If you voted for Obama you’re getting what you deserve.

Bruce J Fernandes

Nov. 12, 2013, 6:12 p.m.

The real story is two Obama loyalists will do everything possible to make sure they pay nothing and get something in return.  Liberals always believe someone else should subsidize their liberal propensities. 

Biden doesn’t give squat in the way of charitable donations on his tax returns.  Clinton’s gave overvalued underwear as non cash donations with very little cash donations.

Well, socialists are finally finding out that socialism costs real people real money and finally they are getting caught in the trap.  I have lived my life being trapped this way so on behalf of all of us who have subsidized takers for an entire generation or more: Welcome to the party, aint it fun to watch hard-earned income taken from you to give to someone like that woman who gets disability and her Obama phone and she is just happy as a clam.

Used to be people did everything possible to avoid government handouts.  Politicians used to talk about the truly needy.  Now, Obama and his minions fully intend to create so many layers of dependency people will simply vote democrat in order to keep whatever goodies they are getting from whatever government line they end up in.

Britain finally recognizing they had run out of other people’s money to redistribute elected Thatcher to clean it up.  I suspect that will be the eventual outcome that occurs here someday.

Only someone wholly ignorant of the basics regarding socialism would say that either Obama or the ACA is “socialistic”.  And only those who have been deluded into believing that they are somehow entitled to the subsidy conferred by employer-paid coverage would criticize hard working citizens who have been paying 100% of their own care when they voice their dissatisfaction with the fact that they were largely ignored in the development of the program.

As someone who has worked in three different countries with widely differing universal care schemes, I can definitely see that this is neither “universal”, nor socialist.  It’s just botched policy.

Ok Karen, enlighten me. How, exactly, is requiring someone to purchase something that they neither want, need, or will use, in order to defray the cost of said same product for someone else who will use it is NOT socialistic?

For example, take a 60 year old single woman, with no kids. She is required to purchase insurance that includes prenatal care, well baby care, and well child card among other things. She neither wants or will ever use this, but she is forced to pay for it to subsidize the cost for those who do use it. If she refuses to buy it she will be fined. If she continues to refuse she will be jailed for tax evasion. If she resists this arrest she will be subject to violence or even death.

Sounds like the very essence of socalism to me…

Anyone, anyone, who buys any type of insurance is part of a pool that contains both higher risks and lower risks. That is the very essence of insurance.
If the ACA was socialist, it would be state-run, single healthcare agency that everyone would be eligible for.
The health insurance companies are still making a profit from the ACA.
That is the very essence of capitalism.

True Bill, but no one was being forced to purchase coverage, by the government, that they neither wanted or needed. Now were they?

Hermann Helmholtz

Nov. 13, 2013, 12:45 a.m.

Cool down Ben Anderson!

Insurance means pooling the risks and the benefits. A 60-year old woman may not be likely to bear a child, but a 30-year old woman is similarly unlikely to have osteoporosis!

If you do not wish to be a part of the ACA, or any other insurance scheme, please do not come to the emergency room and make the insured people pay for you through their higher premiums.

Obamacare is not a solution either. It is already being manipulated by the insurance companies through cherry-picking states and corrupt deals with state regulators - as in California.

It is obvious that the only solution to the healthcare problem (of those who prefer to be insured) is a single payer coupled with a massive program for building public hospitals and clinics.

Making profit from people’s health is in every sense a crime against humanity.

Then again, if you prefer to be out of the system, you should have the choice, but you cannot expect those who participate in the insurance scheme to pay for you or your like.

Finally your idea about socialism belongs to the McCarthy era. That is decades ago. One would have thought that you have had all the time to read about it, and be critical, if you wish, but not silly!

Hermann, I agree 100%.  The only solution to provide heath care for all and hold down the cost is a single payer system. Several medical advocacy groups have demonstrated this reality.

This article is part of an ongoing investigation:
Obamacare and You

Obamacare and You

The Rollout of the Affordable Care Act has been marred by glitches and political opposition.

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