Those who are currently covered but might be loosing insurance from their companies (like those retailers cutting hours of part timers to get them under the minimum) are currently covered by pretty crappy plans.

rickyp wrote:Today only 3 to 4 % of Americans buy their own insurance.
Only this small number and the currently uninsured will actually be effected by the ACA immediately.

Those who are currently covered but might be loosing insurance from their companies (like those retailers cutting hours of part timers to get them under the minimum) are currently covered by pretty crappy plans. There are curently no minimum levels for health coverage only a requirement that businesses have them. So many current plans are a good deal worse than the new "bronze levels" Those people will probably be pleased at the improvement in the Bronze plans....(versus say the Walmart basic coverage...)

What is likely to happen over a few years is that business will use the ACA to stop providing blue chip coverage. Instead of paying $10,000 a year per employee they'll pay the $2,000 penalty, give their employees a raise, and save the rest. The employees go to the exchange and - if the volumes are enough - buy plans for themselves...

The dumbest thing about the US system currently is that it is anti-business. Why should a business be in the health insurance business too just because it has to hire people? The ACA offer a route to moving towards a system where people have independence, and portability, and where the true efficiencies offered by an insurance pool that inlcudes everyone can help keep costs down. (Just like every other modern nation.)

With a single point of purchase in each state, providers will face a truly competitive market place which will force savings.. (Just like in every other modern nation with single payer)

Enrollment will go through lots of ebbs and flows over the six-month enrollment period rather than remaining steady, communications adviser David Simas told reporters during a 45-minute interview at an event sponsored by Third Way at which he downplayed the Obama administration’s expectations for the law’s rollout starting next week.

“October will be light for enrollment … November will be a little bit better,” Simas said. “December will be better than the previous month … probably a dropoff in January from December, the same thing in February with another increase in March right before enrollment ends.”

“There will be ebbs and flows throughout it,” he added. “We are looking at Oct. 1 not as the beginning of the six-day or six-week push. This is six months of raising awareness.”

“Premiums nationwide will also be around 16 percent lower than originally expected,” HHS cheerfully announces in its press release. But that’s a ruse. HHS compared what the Congressional Budget Office projected rates might look like—in 2016—to its own findings. Neither of those numbers tells you the stat that really matters: how much rates will go up next year, under Obamacare, relative to this year, prior to the law taking effect. …

Based on a Manhattan Institute analysis of the HHS numbers, Obamacare will increase underlying insurance rates for younger men by an average of 97 to 99 percent, and for younger women by an average of 55 to 62 percent. Worst off is North Carolina, which will see individual-market rates triple for women, and quadruple for men.

“Consumers will need to balance lower monthly premiums against the potential for unpredictable, expensive, out-of-pocket costs in plans with higher deductibles,” Caroline Pearson, vice president of Avalere Health, said in a statement. “Furthermore, there is a risk that patients could forgo needed care when faced with high upfront deductibles.”


Read more: http://www.politico.com/story/2013/09/e ... z2g1bv0ylG

Do Democrats really want to ram this down the throats of the electorate just so President Obama can look good in the mirror?

GMTom wrote:well. so far we have heard from Rickyp ...a Canadian, Danivon ..a Brit, and Freeman ...a lawyer who can no doubt afford the extra cost? Yep, this is an excellent slice of America in favor of the plan!?

danivon wrote:As yet it's not clear what the effect is on people 'having' to move doctors. I assume that doctors who lose a lot of patients that way would perhaps notice and see how to retain them. Or they aren't much good at running their practice. It would be of interest to see actual figures rather than bluster on that.

The number of U.S. doctors treating patients enrolled in Medicare is falling, according to a recent story in The Wall Street Journal (subscription required, or published here at South Coast Today). According to the article, the increased number of doctors refusing to treat Medicare patients can be attributed to provider “frustration with [Medicare’s] payment rates and pushback against mounting rules.”

CMS – which has never before released Medicare opt-out figures – reports that 9,539 physicians opted out of the Medicare program in 2012. That is up from 3,700 physicians opting out in 2009. All in all, the number of doctors who opted out of Medicare in 2012 nearly tripled from just three years prior. According to The WSJ, many other doctors who are not opting out of the program are at least limiting the number of Medicare patients that they treat.

Likewise, a study from the American Academy of Family Physicians reports that 81 percent of family doctors accepted new Medicare patients last year, which was down from 83 percent in 2010.

The WSJ quotes Jeffrey Cain, president of the American Academy of Family Physicians. According to Cain, “Family physicians have been fed up for a long time and it’s getting worse.” He told The WSJ that by opting out of Medicare, doctors can focus on patient’s needs rather than what insurers are willing to pay.

Physicians and patients alike are feeling the impact of Medicare reimbursement cuts that went into effect on January 1, 2013. With an additional 2% sequestration cut to roll out on April 1, it's likely that physicians who treat Medicare patients will be faced with difficult decisions as operating margins continue to shrink.

The the 2% cuts may seem modest, but they come on the heels of much larger cuts to reimbursement for nerve conduction studies (NCSs) of 40-70% for Medicare beneficiaries. These cuts were announced November 1, 2012, and went into effect on January 1, 2013, allowing providers little time to prepare.

While all Medicare providers are feeling the squeeze, private practices are likely to experience the most impact. "These cuts may force private practice physicians to choose between seeing Medicare patients and keeping their practice open," said Catherine French, AANEM senior analyst of medical economic affairs. French is concerned that the sequestration cuts will be adopted by private insurers, too. "It is possible that private insurers will follow suit and reduce reimbursement by 2% because most model their payment rates on Medicare."

Cuts Threaten Access to Care
According to Kristi Snihurowych, MD, a spine interventionalist in Salt Lake City, UT, the cuts pose a serious risk to access to care. Snihurowych has decided to discontinue EMG and NCS testing, which previously made up an eighth of her total practice. "Given the cuts, it's no longer feasible to perform these tests in-house. The problem is, I cannot find anyone to do them for me," said Snihurowych. "It seems everyone has had to give them up, and not just for Medicare patients. Providers anticipate that other payers will soon follow suit, so many have stopped offering EMGs all together."

Doctor Fate wrote:It's basic economics: cut what you pay doctors and they suddenly become a bit more picky. Here are some "actual numbers":

danivon wrote:

Doctor Fate wrote:It's basic economics: cut what you pay doctors and they suddenly become a bit more picky. Here are some "actual numbers":

I read the whole article. No numbers on how many doctors will change, or how many patients would have to find new doctors. It is still conjecture.

It is also basic economics that a doctor will need to have a certain number of patients in order to make enough money to practice, depending on the rates. So if they cut out Medicare, they need to attract other patients to fill the gap.

Of course the main cuts in medicare reimbursements are not a result of the ACA. They are a result of sequestration (and how it is being carried out), and previous legislation going back to the 1987 Balanced Budget Act bringing in the Medicare Sustainable Growth Rate . Even without the ACA they would be happening. Every year the rates are supposed to go down, and most years Congress puts in a 'doc fix' to reduce the effect, meaning every year the gap between the rates and what the formula says it should be grows. It is up to 27%.

GMTom wrote:http://www.theonion.com/articles/man-who-understands-8-of-obamacare-vigorously-defe,34022/
sounds like Redscape

GMTom wrote:http://www.theonion.com/articles/man-who-understands-8-of-obamacare-vigorously-defe,34022/
sounds like Redscape

danivon wrote:I did not say that it was 'THE' cut. I said it was the sequester and legislation going bact to the 1987 Balanced Budget Act. If you read on you'd see I mention doc fixes which are where the rate cuts are diluted or passed on.

Perhaps the elipses confused you by breaking the flow of the sentence.

Doctor Fate wrote:What were the "main cuts?"

"Sequestration . . . and previous legislation."

I'm not confused. If that wasn't your intent, it's poorly written.

Doctor Fate wrote:The sequester was 2%, which belies your assertion re it being THE cut.