My son lives in MO. He couldn't afford to join the company health plan until the ACA. The plan that was offered was substandard and overpriced (but, still a good plan by comparison). They had to revamp the coverage and in the process made it more affordable for my son with better coverage.

There are little 'Easter Eggs' that people will start noticing. And, yes, we'll see some downsides. Things will improve as long as we can keep it.

I personally think the pre-existing condition one is simply amazing. That's been a real problem in the U.S. for so long.

You are adding in millions of younger, less-likely-to-need-expensive-care people. This is why single payer is so much better than any kind of selective coverage. Whether the insurance companies pass these savings along in the form of lower rates without skimming off the top remains to be seen.

I guess one could argue that less "free riders" will reduce costs but I actually don't really buy it as a significant downward pressure on cost, this is an old conservative and insurance cartel chestnut of an overstated excuse but getting rid of the six trillion groups would do way more.

the old.

That said, I am not going to work for that employer forever. Now I can move with pre-existing conditions. Now I can access new care, under new circumstances. Or access care when I retire some fucking decade or other.

Net win, even if I lost some bennies in the meantime.

Some people don't take the long view.

But that doesn't stop me from advocating for ACA! I have one son on Medicare and one son without any insurance. Hell yes, I want #2 son and his wife to have affordable health insurance. ACA is the only way to accomplish this for millions of people.

And my 2 kids have been on my insurance policy since that part of the ACA kicked in. They are 23 and 21.

People seem to easily forget the "patient protection" part of the law. Those are probably the most important changes that immediately affect all policy holders.

That means that rates for even employer-based insurance will be rising more slowly.
The first year after ACA passed (I think it was then), we actually got a check from my husband's employer—the insurance company had to pay back the overage in profits, and the employer split it among the employees.

And don't forget those yummy free colonoscopies you can get!

when people find out that there will be charges if the colonoscopies reveal polyps that must be removed. But considering the alternative could be terminal colon cancer, I hope people will realize that the cost of early removal of polyps is well worth it.

Hopefully it can be wielded as a huge hammer by Democrats in the upcoming election.
The less influence Republicans have in our country, the better off we'll all be.
(Unless you're a greedy, predatory billionaire of course.)

not just the previously uninsured. They have to keep hammering on the Patient Protections and Essential Benefits that apply to everyone, no matter what the source of their insurance

Just got my well woman and there are some concerns about one of my ovaries. In the past, I would have thought twice about getting further medical treatment, but this is the first time I've been willing to say, let's move ahead without worrying about going broke and taking away from my family. Whatever happens, that is one less (and major) worry for my family and I.

I can't thank PO and everyone who supported the ACA enough.

As you know, there are serious conditions that need to be caught early. I'm glad you won't be tempted to put off treatment.

I hope every other woman out there gets the same comfort that I have gotten. Peace of mind is priceless.

We have great coverage through work. However, it did go up some for us but the company pays 65% of the premiums.

However, it's not about me. I had coverage and can go for regular wellness visits, as can my family.

It's for the families and single adults that could not afford it before, had pre existing conditions, etc.

I

I hope I'm not sounding like a broken record, but I think the more people learn about this law, the better. And there's too much ignorance being spread online and in the media.

just getting rid of THAT ALONE helped my family. And many of my friends. I'm sure everyone here knows of someone who was rejected, kicked off, or charged through the nose because of a "pre-existing condition." I used to HATE those words when I'd be talking to some underling on the phone and that would inevitably be dropped into the conversation.

the XX chromosome, which makes a person with those genes susceptible to foreign tissue growing in an abdominal organ.
They can't charge us extra for that anymore!

...I have a sincere question.

Before the question, I want to say that I am a huge proponent of the ACA and I personally take the time to educate angry, misinformed, right wing, racist, epithet-spewing rural folks on a daily basis. To say that I'm surrounded by this mindset would be putting it mildly. (Small town, Central Utah.) :/

That said, my question is this: Does the ACA have anything to offer people who fall within the insurance gap? ie: Didn't make enough money last year to qualify for ACA; told by ACA that they're qualified for Medicaid and that someone from Medicaid will be in touch asap (on the 12th of never; ) and told by Medicaid, "no children, no disability, no Medicaid."

You sound like you've done your share of research re: the ACA. I'm hoping you know what the official recommendation is for people who fall into the insurance gap in states that turned down the Medicaid expansion.

TYY

for this year -- so that they were just over the Medicaid amount for their state -- and it turned out they didn't make as much as they estimated. I've never heard about any penalties for people who over-estimated their income; that wasn't something the lawmakers ever anticipated people would do (since they expected all states to expand Medicaid, and, if anything, they expected people to under-estimate their incomes, in order to qualify for higher subsidies.)

I'll look for more info about this. What state are you in?

In the meantime, I've just found the piece below. If I'm reading this correctly, the exchanges were meant to be for people who made at least 138% of the poverty level. HOWEVER, in states where there was no Medicaid expansion, they could still purchase insurance on the Exchange with a subsidy if their income was at least 100% of the poverty level.

Obviously, this wouldn't help you if your income is below 100% of poverty level -- and that is terribly unfair and completely indefensible. (Those Governors should be tarred and feathered.) Please try to find a navigator ASAP to explain all this. If you qualify for an exchange, it's not too late to get an extension. You'll just have to explain, on the honor system, that you've been trying to get insurance and haven't been successful.

http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/

The ACA envisioned people below 138% of poverty receiving Medicaid and thus does not provide premium tax credits for the lowest income. As a result, individuals below poverty are not eligible for Marketplace tax credits, even if Medicaid coverage is not available to them. Individuals with incomes above 100% of poverty in states that do not expand may be eligible to purchase subsidized coverage through the Marketplaces; however, only about a third of uninsured adults (3 million people) who could have been eligible for Medicaid if their state expanded fall into this income range. Thus, there will be a large gap in coverage for adults in states that do not expand Medicaid (Figure 3).

SNIP

The population in the coverage gap represents over a quarter (27%) of the uninsured adult population who could have gained coverage under the ACA in states that are not expanding Medicaid (Table 2). This share ranges across states, from a low of 18% in Alaska to a high of 37% in Mississippi. This variation reflects not only variation in Medicaid eligibility but also variation in the income distribution of the uninsured by state. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014. Looking only at uninsured adults with incomes at or below 138% of poverty in non-expansion states— the income range originally targeted for the Medicaid expansion— about half fall into the coverage gap. The remaining share either may be eligible for Medicaid under non-expansion rules or could receive tax credits to purchase coverage in the Marketplace. The share of the Medicaid-target population that falls into the coverage gap varies by state, from 40% in Alaska (again, 0% in Wisconsin) to 65% in Oklahoma.

...for taking the time to research an answer to my question. Btw, I'm in Utah.

I did apply for ACA in January so I'm not worried about penalties. After processing my application, ACA informed me that I qualify for Medicaid. Utah Medicaid says I don't qualify because I don't have kids and I'm not on Disability.

As you mentioned in your OP, the preventative care offered through the ACA is a big deal. I guess I was hoping there might be something along those lines that applied to everyone. Of course, I realize that was just a pipe dream on my part.

Hopefully, Utah will come around but I'm not holding my breath.

Thanks again, pnwmom.

TYY

So, putting this together with the other post, if your income was above that threshold -- 100% of poverty level -- but below 138%, than you would be part of the 1/3 of people who should be covered by the Medicaid expansion (if your governor wasn't evil) but would still be eligible for a subsidy on the Exchange.

I hope this helps, TeeYiYi!

http://www.direct.ed.gov/RepayCalc/poverty.html

Thanks again, pnwmom.

TYY

It explains that it can be difficult, especially for part-time and seasonal workers, to estimate an annual income. And that as long as you estimate it as at least $11,500 for an individual, you are eligible for an exchange. And that if it turns out you make less this year, there isn't a penalty for your mistake.

Thanks for asking this question. I'm glad I found this article!

http://www.kaiserhealthnews.org/Stories/2013/August/12/income-projections-low-income-Obamacare-state-medicaid-marketplace-exchange.aspx

Experts say the key is for them to project their 2014 income to at least the federal poverty level, about $11,500 per person or $23,500 for a family of four.

That would entitle them to federal subsidies that would cover nearly all the cost of private coverage sold on new online insurance marketplaces set up by the federal health law. The subsidies are available on a sliding scale to people making between the poverty level and four times that amount.

Everyone applying for subsidies must estimate their 2014 income. For the poor, the difference between qualifying -- or not -- could be $1,000 or less a year. Since many rely on hourly or seasonal work, their incomes often fluctuate by a few thousand dollars each year. That's one reason why people often lose eligibility for Medicaid, the state federal insurance program for the poor.

While there are steep fines for knowingly lying on a government application for financial assistance, if someone merely miscalculates their income above the poverty level in 2014, and is later found to have made less than the poverty level, they won't have to pay any money back, according to the Treasury Department.

TYY

1) This law has undeniably led to an historic change in the rate of HC cost inflation. For the first 3 years, the media and beltway morons wanted to argue that the historically unprecedented drop in the rate of HC inflation was because we were in a recession because -- I don't know -- I guess people don't get as sick during recessions. But we have had 4 slid years of recovery, yet the rate of HC inflation remains in the low single digits. No, it wasn't because of the recession. it was because the law shines a bright light on the worst abuses and forces insurance companies to put at least 80% of the premiums into actual HC. That benefits everybody and leads to ...

2) Lower deficits. This law included the funding to offset all of its expected costs. But the bending of the cost curve reduces our deficits in ways that the CBO did not include. Our government spends a lot of money on heath care, whether it is the VA, Medicare, Medicaid, or health policies for government employees. The bending of the cost curve is lowering all of those costs by billions of dollars. That is good for all Americans (except those who were profiteering off the old system.

3) There are now 15 million fewer people who are much less likely to stiff doctors and hospitals with bills they cannot pay. You know who was paying for that before? Anybody who paid their medical bills. Well, getting rid of 15,000,000 potential bad debts means that future premiums will absolutely be lower than they otherwise would have been. That helps everybody, including those who are on employer group policies. If the employer saves money on the HC policy, that make them more profitable and more able to expand, increase salaries, pay bonuses, etc.

Every single American benefits (except for the gangsters who were getting fat on the prior system)

no matter how they pay their medical bills.

that they are "paying" for the people on ACA, too.

ACA went into effect, we have more preventative coverage. Insurance didn't cover flu shots in the past. Now ours does. (Simple little things like that!)