grumble stupid lack of an edit function.

grumble stupid lack of proofreading.

Regarding religous exemptions, I AM using common sense, TYVM. When the groups who do not receive benefits go to the ED, I expect they will get excellent treatment from you or another doctor, and then they will PAY THEIR BILLS. Do you currently have problems with Amish patients skipping out on their bills? Are there hordes of homeless Mennonites roaming your city, sleeping in doorways and asking for spare change? These folks have historically been allowed to opt out of the social safety net precisely because they have demonstrated that they can and do take care of their own. I don’t understand why you expect that to change.

Allowing people to opt out of the PPACA would create a huge logistical headache; aside from that, I wouldn’t be too opposed. Someone who wanted to opt out would have to show that they have the means to pay their bills should they get sick, which effectively limits this option only to the very rich. Or we could allow just anybody to opt out, provided that they also opt out of the EMTALA — but that would lead to libertarian-types being denied care at the ED for lack of funds, and fraud when people who opted out lied about doing so in order to get treatment. Furthermore, we would have to ensure that nobody was forced to opt out for financial reasons.

Of course, anybody who opted out would have to jump through some hoops (i.e. prove that they are healthy) before being allowed to opt back in. Bottom line, I really don’t think it’s worth the hassle, just to please the whackos who think they’ll never get sick, or who want to commit delayed suicide by ensuring that they won’t have access to medical care.

I don’t think the PPACA is perfect; not by a long shot. But while you and I can likely propose half a dozen better ideas, none of them are going to be implemented. The PPACA is what we have to work with; it’s not going to be repealed anytime soon, and while valid criticism can be very useful, tearing it down with FUD doesn’t help anybody.

Regarding religious exemptions, use some common sense. What’s going to happen when the groups that do NOT receive benefits go to the emergency department? Will there be some change in the federal law so that they can be refused service? Doubt it. So all those with religious exemptions go to the hospital uninsured, get their care, and then the hospital attempts to collect for the care provided. Many hospitals just give up trying to collect those debts.
Will mandated and unfunded care provided to those without insurance “bankrupt” the system? Unlikely. But it will be another “hole in the dike” that will drain the system if it is not plugged.
If religious exemptions are such a good idea, then why not let everyone decide whether or not to pay into the system if they agree NOT to receive benefits?

Of course those who can afford them will have policies in 2014. The problem will be that policies provided by corporations will be the least expensive bare bones policies available and will have the most number of allowable exclusions. Then think about the tens of millions of people who will soon be entering Medicaid. What do their “policies” say? What about Medicare? What do their “policies” say?

All I can do is encourage you to watch and see how much the system gets gamed in the next 5 years.

I don’t advocate a single payer healthcare plan. I think that there should be a fee for service plan with transparency. Providers advertise their prices. Patients are aware of prices before they utilize the services. Patients can make a choice on which hospital to patronize based on reputation, cost, promptness of care, or a combination of those variables.
Such a plan would leave many poor patients without the ability to afford medical care. For that reason, I also propose a “fall back” system or a “safety net” where there is a “single provider” of health care to which everyone in this country has access. You pay into the system, you have a right to utilize the system.
I just think that the feds want to stay out of the business of providing medical care. If they do so and the care is not up to everyone’s expectations, then that would just be another battle cry that opponents could use – much like what is happening in Canada now. Oh, and could an avoidance of lawsuit liability have anything to do with such a decision?
Instead, by staying in the “insurance” business, the feds can just point their fingers at the providers, pay them less and less, then try to turn public sentiment against them.
The fee for service system naturally wouldn’t have the ability to provide unlimited care – much in the same way that it can’t do so now. Rationing through time or through limiting available services is a necessary part of any plan. That’s something that we have to become comfortable with if we don’t want to pay an even larger portion of our GNP for our health care.
For those with the “booga booga” cries, I encourage them to propose something better.

“Unfortunately, today, limited benefit plans, or “mini-med” plans are often the only type of insurance offered to some workers. In 2014, the Affordable Care Act will end mini-med plans when Americans will have better access to affordable, comprehensive health insurance plans that cannot use high deductibles or annual limits to limit benefits. In the meantime, the law requires insurers to phase out the use of annual dollar limits on benefits. In 2011, most plans can impose an annual limit of no less than $750,000.

Mini-med plans have lower limits than allowed under the Affordable Care Act. While mini-med plans do not provide security in the event of serious illness or accident, they are unfortunately the only option that some employers offer. In order to protect coverage for these workers, the Affordable Care Act allows these plans to apply for temporary waivers from rules restricting the size of annual limits to some group health plans and health insurance issuers.

Waivers only last for one year and are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage. In addition, enrollees must be informed that their plan does not meet the requirements of the Affordable Care Act. No other provision of the Affordable Care Act is affected by these waivers: they only apply to the annual limit policy.

As of today, a total of 733 waivers have been granted for 2011. Key facts about annual limits waivers:

•There was an increase in the number of applications received at the end of 2010 because December 1 was the final day to apply for a waiver for a plan or policy year that begins on January 1 – as many plans do. Over 500 waivers were granted in December. While the number of approved waivers increased by more than 200 percent, the total number of enrollees in plans receiving waivers has increased by only 48 percent since the previous posting.
•Of all the waivers granted to date:
◦Employment-Based Coverage: The vast majority – 712 plans representing 97 percent of all waivers – were granted to health plans that are employment-related.
■Self-Insured Employer Plans Applicants: Employer-based health plans received most of the waivers – 359.
■Collectively-Bargained Employer-Based Plan Applicants: Most of the other health plans receiving waivers are multi-employer health funds created by a collective bargaining agreement between a union and two or more employers, pursuant to the Taft-Hartley Act. These “union plans” are employment based group health plans and operate for the sole benefit of workers. They tend to be larger than other typical group health plans because they cover multiple employers. There are also single-employer union plans that have received a waiver. In total, 182 collectively-bargained plans have received waivers.
■Health Reimbursement Arrangements (HRAs): HRAs are employer-funded group health plans where employees are reimbursed tax-free for qualified medical expenses up to a maximum dollar amount for a coverage period. In total, HHS has approved 171 applications for waivers for HRAs.
◦Health Insurers: Sixteen waivers were granted to health insurers, which can apply for a waiver for multiple mini-med products sold to employers or individuals.
◦State Governments: Four waivers have gone to State governments. States may apply for a waiver of the restricted annual limits on behalf of issuers of state-mandated policies if state law required the policies to be offered by the issuers prior to September 23, 2010.
•The number of enrollees in plans with annual limits waivers is 2.1 million, representing only about 1 percent of all Americans who have private health insurance today.”

And WC’s example of the man paying fines for not having health insurance…How can you honestly believe that even if the gov’t collects the fines, they would be using it to reinvest it in the system? I can almost guarantee there is some caveat that will allow a “surplus” to be applied anywhere but the system it was meant to serve!!