FSTDT Forums
Community => Politics and Government => Topic started by: The Illusive Man on November 14, 2013, 07:55:32 pm
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I’m getting real tired of how the media is turning the implementation of the ACA into a horse race. Can someone help me make the following more publicly known?
Canceled plans are caused by insurers alone.
Blue Cross Blue Shield are scumbags, deceive their customers. (http://www.consumerreports.org/cro/news/2013/10/florida-woman-s-canceled-blue-cross-plan-is-junk/index.htm)
All about grandfathered plans in plain English.
Fact sheet from www.dmhc.ca.gov (http://www.dmhc.ca.gov/library/reports/news/fsghp.pdf)
From http://laborcenter.berkeley.edu on grandfathered insurance plans:
The ACA introduces new standards for employer-sponsored health plans. The implementation dates for these requirements vary based on the plan’s effective date, whether the plan is subject to a Collective Bargaining Agreement (CBA), and whether the plan is self-insured or fully-insured.
PLAN TYPES
Grandfathered plans:
Plans that had enrollees as of March 23, 2010, may be grandfathered. Some requirements will not apply to grandfathered plans, while other provisions apply to grandfathered plans on the same date they become effective for all plans. Certain changes to plan design will nullify a plan’s grandfathered status, such as: elimination of benefits for certain conditions, certain increases in cost sharing (any increase in coinsurance percentage, an increase in deductible or out-of-pocket limit by more than 15 percent plus medical inflation, or an increase in co-payment by more than $5 adjusted for medical inflation or 15 percent plus medical inflation, whichever is greater), increases in employee share of premium by more than 5 percentage points, or certain changes in annual benefits limits. These limits are applied on a cumulative basis, not an annual basis.
Changes to premiums, changes made to comply with federal or state laws, or changes in third
party administrator will not cause a plan to lose its grandfathered status. Employers that
change insurers can maintain grandfathered status as long as the new plan has similar cost
sharing and benefits as the original plan.The grandfathering rules apply separately to
each benefit package under a health plan. The White House predicts that between one- and
two-thirds of large group plans will remain grandfathered by 2013.
Collectively bargained plans:
Fully-insured plans pursuant to a CBA are grandfathered until the last expiration date of a CBA related to that coverage. Multi-employer plans are grandfathered until the last expiration date of a CBA related to that plan regardless of employer. Grandfathered status may be maintained upon the CBA expiration date if no changes were made since March 23, 2010, that would have otherwise caused the plan to lose its grandfathered status. For more information, see the grandfathering regulation.
Self-insured plans:
Self-insured plans subject to a CBA are not eligible for the same delayed implementation as collectively bargained fully-insured plans. All self-insured plans are exempt from some plan requirements, as noted below. For more information, see the grandfathering regulation.
PLAN REQUIREMENT DETAILS
Grandfathered plans are exempt from the following requirements until the plan loses its grandfathered status:
Preventive services:
Plans must offer first-dollar coverage (no co-payment or deductible) for certain preventive services effective now. Examples of preventive services covered under this provision include blood pressure, diabetes, and cholesterol tests; many cancer screen-ings; certain types of health counseling; certain routine vaccines; flu and pneumonia shots; pregnancy counseling, screening, and vaccines; and well-baby and well-child visits. The White House estimates that this provision will increase premiums by 1.5 percent, on average. See the list of covered preventive services. For more information, see the preventive services
regulation.
Patient protections:
Plans are prohibited from requiring a referral to see an obstetrician/gynecologist and from requiring prior authorization or higher cost sharing for
out-of-network emergency services, effective now. These protections are already existing law in California. For more information, see the Patient’s Bill of Rights regulation.
Out-of-pocket maximums:
Group plans must limit out-of-pocket costs to $6,050 for single coverage and $12,100 for family coverage (2012 dollars) effective in 2014 for non-grandfathered plans. Self-insured plans are exempt.
Pricing:
For small group plans (100 or fewer employees), medical underwriting is
prohibited and rating variation is only allowed based on age (3:1 ratio), tobacco use (1.5:1.0),family composition, and geography effective in 2014. In states permitting large group plans in the exchange in 2017, these pricing standards will apply to all fully-insured large group plans in and out of the exchange. Self-insured plans are exempt.
Deductibles:
Small group plans (100 or fewer employees) must limit deductibles to $2,000 for single coverage and $4,000 for family coverage beginning in 2014 for non-grandfathered plans. Self-insured plans are exempt.
Minimum services covered:
Fully-insured small group plans (100 or fewer employees) in and out of the exchange and large group plans in the exchange must cover preventive and primary care, emergency, hospital, physician, outpatient, maternity and newborn care, pediatric (including dental and vision), medical/surgical care, prescription drugs, lab, and mental health and substance abuse, effective in 2014 for non-grandfathered plans. States have the flexibility to set the benchmarks within each category. For more information see the HHS news release.
(http://laborcenter.berkeley.edu/healthpolicy/acaguide12.pdf)
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I think we should have switched to a government-run single-payer system like Medicare for all and we should have abolished the health insurance industry. Even so, I think the ACA is better than what we have now and the Republicans are desperately trying to slam on it (despite it originally being floated by the Heritage foundation) simply because it will be remembered as Obama's legacy.
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I agree with ironchewtoy on both counts.
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Same here.
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(despite it originally being floated by the Heritage foundation)
Pisses me off. It's a good idea until the black guy says it, then it's the end of the world as we know it.
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Florida is continuing to screw over people and blame the ACA (Scott is acting more and more like an ass every day). While, I don't blame Obama for this, I'm waiting to see what he does about it. I mean, he was so gungo ho about making the ACA happen, and now that people are getting screwed over, he's become pretty quiet about it.
And yes, he recently gave a speech promising to fix some problems, but I don't see anything about those including the crap happening in FL.
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This stumbling start is, I fear, a monumental blunder. ACA was cobbled together like the Frankenstein monster to begin with. And regardless of any merits it may have, the Repubs will use it as a cudgel forever. I think Obama has suffered severe damage to his credibility, and from this point on will just be along for the ride.
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This stumbling start is, I fear, a monumental blunder. ACA was cobbled together like the Frankenstein monster to begin with. And regardless of any merits it may have, the Repubs will use it as a cudgel forever. I think Obama has suffered severe damage to his credibility, and from this point on will just be along for the ride.
I am curious if this will play out just like the Benghazi spam.
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By the time of the 2016 election, ACA will likely be functioning fine for over 18 mos, and the mercurial, fruit fly-like public attention span will be five or six "scandals" beyond it.