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California picks 13 health plans for state-run insurance market


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2013 May 23, 5:17am   13,115 views  66 comments

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http://www.latimes.com/business/money/la-fi-mo-covered-california-health-plans-20130523,0,2769699.story

In a southern Los Angeles County region, for instance, rates for a 40-year-old person purchasing a "Silver" plan ranged from $242 a month for Health Net Inc. to $325 per month for Kaiser Permanente. Blue Shield would charge $287 a month.

Overall, Covered California said the rates submitted for next year's individual market ranged from 2% higher to 29% below the average premium now for small-employer plans in the state's biggest metro areas.

Up to 29% CHEAPER? Wait, I thought "Obama lied". According to everyone here, rates were supposed to go through the roof.

The agency said the winning health plans whittled their profit margins down to 2% to 3% and negotiated lower reimbursements for hospitals and doctors to help hold down premiums.

Wait, didn't you guys say the only point of Obamacare was to line the pockets of the insurance industry? I'm curious how that's going to happen with only a 3% profit margin.

I currently have HealthNet through my union. It's group insurance, and qualifying depends on how much work I get that pays into the fund. I qualify every 2 years, if at all. On the odd years, I have to either go on COBRA or get a cheap high-deductible plan and go through hell trying to qualify with "pre-existing conditions". I went on COBRA several years ago. Do you know how much it cost? $480 a month. I see that ANYONE will now be able to get HealthNet insurance for $242 a month. That's 50% less.

So what say you, all the Chicken Littles who said the sky was falling, and that Obama was sending us all to the poor house?

#politics

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1   humanity   2013 May 23, 6:47am  

Wait, are you telling me I have to come up with new reasons to hate Obama because some of my old ones aren't going to be working as well ?

I don't know. I'm pretty sure there's at least a few years of using "Obamacare" as my primary reason for hating him, before everyone admits it was good.

2   Tenpoundbass   2013 May 23, 7:14am  

You don't fucking get it do you?

There's people driving cars right now, that every time they start their car they have to fill a gallon jug of water and pour it in the radiator, just so they can get to their destination. People driving on onion skin tires, so thin and bald you can see the air inside.

That $242 represents a new car payment, that they can't afford.
Also why do you Liberal shills let the ins companies off the hook for excluding any mention of copay and deductible payments? That is what will separate the patients with a successful medical chart from those who were sent home to die or progress worse until they do.

Don't answer my question, we all know why there's no mention. You bastards honestly think you stand a chance in midterms.

3   Tenpoundbass   2013 May 23, 7:21am  

Oh and I forget about all of the shit that wont even be covered.
Like colonospopies, they cover 0%. Unless you survive to be older than the average age of a colon cancer death statistic. The debates were a convoluted cluster fucks of exclustions while the Libs were running around sticking it to the religious right about what to cover and not cover. It turned into a tit for tat, that resulted in 90% of preventive health declarations that were passed under Clinton to be taken off the table. OH! 90% of cancer screening is now a 100% out of pocket expense.

Congratulations it's a swimming job, we will all be swimming in debt and debt.

4   mell   2013 May 23, 7:25am  

Without getting into whether overall it's gonna be cheaper or not (haven't done enough research for this) I can confirm the Captain's claims in copays and deductible which have been getting progressively worse every year (which may or may not be related to Obamacare) and so do the denied claims or the portions of denied claims. Also I have had 4 PPOs so far, United Healthcare which was by far the best, Blue Shield of California coming in 2nd, Anthem Blue cross coming in 3rd and HealthNet coming in dead last by far. When your annual copays and deductibles rack up a couple grand each year there is nothing "affordable" about this for lower-middle-class or even middle-class income earners, so I feel for them.

5   pkennedy   2013 May 23, 7:36am  

The problem isn't people who can barely afford their cars, can't afford health care, it's that people who can't afford cars are foregoing health care. It's like saying someone can't afford rent because they're buying designer clothing.

If your "plan" is to simply walk into a hospital when you get sick and let the government foot the bill, then you're simply pushing your bills onto someone else. These people can't afford cars, so they're simply pushing other aspects of their lives onto others.

The same goes for companies who get away with paying minimum wages and offering no healthcare, where it's impossible for that person to afford health care even if they put their whole pay checks towards private health insurance. These companies are simply operating based off handouts from the government who will foot the bills for these employees who can't afford it on these minimum, no benefits salaries.

6   curious2   2013 May 23, 7:55am  

pkennedy, you don't seem to acknowledge that Obamacare increases both cost shifting and spending above prior law. If you're going to say the 2% cost shifting under EMTALA was bad, then you should acknowledge the much higher cost shifting under Obamacare must be worse.

Homefool, you can buy a generic version of your SSRIs for a lot less than those subsidized insurance premiums you look forward to so much. But, then you won't have all those highly paid prescribers stroking your ego and telling you that all your troubles are not your fault and they have a magic placebo for your pain.

7   Tenpoundbass   2013 May 23, 7:55am  

If it weren't for benefit salaries we wouldn't be in this mess in the first place.
When Marge in HR is making all of America's health decisions at their expense you're pretty much doomed. She gets sent on vacation to pick the right one.

As for ins in this day and age being a benefit is a laugh. The free ins offered by 99% of the companies out there, cost more in the long run, than if you just went to a Doctor that doesn't live in a gated community and don't take insurance.
Doctor visits will be cheaper, 90% of procedures performed in his office will be a hell of a lot cheaper than the insured counterpart. For example my wife was paying $75 for x-rays, ultrasound, and procedures like that, where as our insurance copay is $250 to $500 with insurance.

8   Tenpoundbass   2013 May 23, 8:04am  

I love this those making 17K will only have to pay $44 a month.

So if you're making 334 a week before taxes, that ends up being like 287 after taxes. About once every 4 weeks you'll have to pony up $44 for insurance.

OK elitists we all get it, $44 is peanuts, since most of can afford to use two twenties as a mainland china makeshift toilet and shit on two crisp twenty dollar bills, then hell I figure everyone can afford 44 bucks a month, right! right?
I mean come on! And well for those not even working, but not registered with the welfare system, well fuck 'em! Who needs 'em, push them over Granny run, I'll fire up the rocket test sled.

9   dublin hillz   2013 May 23, 8:06am  

Stay as healthy as possible don't go to doctor other than regular annual physical if something is uncovered during the visit, deal with it as best as possible and die on a treadmill or in your sleep in your 90s!

10   Tenpoundbass   2013 May 23, 8:14am  

dublin hillz says

don't go to doctor other than regular annual physical if something is uncovered during the visit, deal with it as best as possible

Way to fast gloss over the details.
Back up, and lets say a mass in found that needs further attention.
If you don't realize at this point, it will be the end of you, if you don't have a large reserve of money and cash on hand. Fuck being bankrupt, there is no payment plan, NO TICKIE!!!!! NO FUCKING RIDE!!!!!

Home boy is just ecstatic that you'll have to pay $287 a month, for the privilege of dying such an undignified death. But on the upside, in your case anyway, YOU WILL die a Republican, and likely Church going Republican at that.

You'll either find money or Jesus.

11   curious2   2013 May 23, 8:19am  

CaptainShuddup says

YOU WILL die a Republican, and likely Church going Republican at that.

You'll either find money or Jesus.

One of the provisions that I found especially revealing in Obamacare was the exemption for Jehovah's witnesses etc. If you adhere to the traditional beliefs of certain sects that the IRS calls "bona fide", e.g. if you're knocking on doors selling Watchtower, you're exempt from the Obamacare penalty. So now, the IRS needs to hire more staff to enforce Jehovah's Witnesses' adherence to their sect; any Witness who doesn't proselytize enough must be penalized by the federal government.

12   dublin hillz   2013 May 23, 8:42am  

I am not sure what everyone's situation is around here, but my coverage is gonna cost $60 per month starting next year through Kaiser and everything else in the plan is gonna stay the same. I've never had issues with health benefits since I started working full time. And that's assuming I even want to keep my plan. I can get added to my wife's plan and pay 0 and bank that $60 into out of market sports coverages on direct tv lol.

13   curious2   2013 May 23, 8:51am  

dublin hillz says

my coverage is gonna cost.... I can get added to my wife's plan and pay....

You seem to have no idea what it's going to cost, because you don't seem to count the deductions and subsidies that you don't see. Your comment sounds like you would look at the tip of an iceberg or shark fin and think that's all there is to it, just the tip.

14   EBGuy   2013 May 23, 9:17am  

Our small company group plan went to HealthNet when we jumped ship from our previous plan. I had never heard of them before, but so far, no complaints (after 1.5 years). Well, their insurance cards are cheap (heavy, but non laminated, paper) ... They seem to be taking this whole competition thing seriously. I hope they take share from the turds that refused to participate.

15   mell   2013 May 23, 9:25am  

EBGuy says

Our small company group plan went to HealthNet when we jumped ship from our previous plan. I had never heard of them before, but so far, no complaints (after 1.5 years). Well, their insurance cards are cheap (heavy, but non laminated, paper) ... They seem to be taking this whole competition thing seriously. I hope they take share from the turds that refused to participate.

HMO or PPO?

16   Homeboy   2013 May 23, 9:32am  

mell says

Without getting into whether overall it's gonna be cheaper or not (haven't done enough research for this) I can confirm the Captain's claims in copays and deductible which have been getting progressively worse every year (which may or may not be related to Obamacare) and so do the denied claims or the portions of denied claims. Also I have had 4 PPOs so far, United Healthcare which was by far the best, Blue Shield of California coming in 2nd, Anthem Blue cross coming in 3rd and HealthNet coming in dead last by far. When your annual copays and deductibles rack up a couple grand each year there is nothing "affordable" about this for lower-middle-class or even middle-class income earners, so I feel for them.

Speaking of "doesn't get it", you are describing all the problems of the OLD system, not the new one. How exactly is Obama responsible for rates, co-pays, and deductibles that were rising every year before he was even president?

17   EBGuy   2013 May 23, 9:32am  

HMO or PPO?
HMO $30 co-pay. We were able to keep our existing primary physicians, OB/GYN, and pediatricians (we've hopped insurers every 2 to 3 years with "HMO plans" and never had problems keeping our doctors).

18   mell   2013 May 23, 9:35am  

EBGuy says

HMO or PPO?

HMO $30 co-pay. We were able to keep our existing primary physicians, OB/GYN, and pediatricians (we've hopped insurers every 2 to 3 years with "HMO plans" and never had problems keeping our doctors).

Thanks, that's what I suspected. They are generally more cost-effective, but if you have anything that is hard to diagnose or want to get 2nd opinions they are not feasible. Same goes if you have established a great relationship with a good functional doc you can trust they will always be out-of-network, but even PPOs only pay little in that case.

19   mell   2013 May 23, 9:36am  

Homeboy says

Speaking of "doesn't get it", you are describing all the problems of the OLD system, not the new one. How exactly is Obama responsible for rates, co-pays, and deductibles that were rising every year before he was even president?

He is serving his second term already if you haven't noticed yet.

20   dublin hillz   2013 May 23, 9:37am  

curious2 says

dublin hillz says



my coverage is gonna cost.... I can get added to my wife's plan and pay....


You seem to have no idea what it's going to cost, because you don't seem to count the deductions and subsidies that you don't see. Your comment sounds like you would look at the tip of an iceberg or shark fin and think that's all there is to it, just the tip.

What we do know is that previous system had serious issues such as lack of coverage for pre-existing conditions and significant bankruptcy risk for serious illnesses. Thus, it was unacceptable. Regarding new system, it will ultimately be judged (at least by me) on dimensions of access, cost and quality. If it results in collective improvement over the previous status quo, at least it will be a step in the right direction.

21   Homeboy   2013 May 23, 9:38am  

CaptainShuddup says

I love this those making 17K will only have to pay $44 a month.

So if you're making 334 a week before taxes, that ends up being like 287 after taxes. About once every 4 weeks you'll have to pony up $44 for insurance.

OK elitists we all get it, $44 is peanuts, since most of can afford to use two twenties as a mainland china makeshift toilet and shit on two crisp twenty dollar bills, then hell I figure everyone can afford 44 bucks a month, right! right?

I mean come on! And well for those not even working, but not registered with the welfare system, well fuck 'em! Who needs 'em, push them over Granny run, I'll fire up the rocket test sled.

You bitch about poor people getting too much stuff from the government, then you bitch about poor people not getting ENOUGH stuff from the government. You are all over the map. You must have done a LOT of acid in the 60s.

22   Homeboy   2013 May 23, 9:39am  

mell says

He is serving his second term already if you haven't noticed yet.

I said "before he was president", not "before his second term".

What is your point? You hate Obamacare, but you wish he had enacted it sooner? LOL.

23   curious2   2013 May 23, 9:40am  

Homeboy says

Poor people will be covered by medicare - that's part of the ACA.

No, it isn't. There were proposals to reduce the age of Medicare eligibility from 65 to 50, or to eliminate the age restriction entirely, but Democrats rejected those in order to enact Obamacare instead.

Homeboy says

I currently have HealthNet through my union. It's group insurance, and qualifying depends on how much work I get that pays into the fund. I qualify every 2 years, if at all.

You're so committed to Obamacare, you really ought to read it, because otherwise you sound like one of those religious fundamentalists who have never actually read the whole book that they claim to believe every word of. Next time you're sitting at your union hall, use some of that time to read the legislation that they sold you.

24   mell   2013 May 23, 9:43am  

Homeboy says

mell says

He is serving his second term already if you haven't noticed yet.

Your point? I said "before he was president", not "before his second term".

Well, part of the increases happened before Obama and part happened since he took office - that's why I didn't explicitly blame him but this trend seems to have accelerated over the past few years. Or maybe employers switched to crappier insurances.

25   mell   2013 May 23, 9:49am  

Homeboy says

mell says

He is serving his second term already if you haven't noticed yet.

I said "before he was president", not "before his second term".

What is your point? You hate Obamacare, but you wish he had enacted it sooner? LOL.

What? Where do you come up with this shit? I don't "hate" Obamacare and I don't "wish" he had enacted it sooner. You need to learn how to discuss in a rational manner, data, observations, input from others without assuming political partisanship everywhere and personalizing everything.

26   turtledove   2013 May 23, 9:55am  

The whole system makes me absolutely sick. Fee schedules have been pretty constant for the last 20 years in areas considered to be elective. Since insurance doesn't traditionally cover things like plastic surgery or IVF, prices are based on actual costs and what people can actually pay for such treatment. What's gone up in price? The drugs! Of course, those are often covered by insurance. Insurance companies inflate the costs of everything they touch. Now, with costs as they are, we are virtual prisoners of the system.

27   Homeboy   2013 May 23, 10:00am  

mell says

What? Where do you come up with this shit? I don't "hate" Obamacare and I don't "wish" he had enacted it sooner. You need to learn how to discuss in a rational manner, data, observations, input from others without assuming political partisanship everywhere and personalizing everything.

What??? You described all the problems of the OLD system. When I pointed out that those problems existed BEFORE Obama was president, you whined that it was already his second term.

You need to learn to start making sense.

28   EBGuy   2013 May 23, 10:06am  

mesll said: Same goes if you have established a great relationship with a good functional doc you can trust they will always be out-of-network, but even PPOs only pay little in that case.
I've had PPO plans at larger companies; I've noticed no functional difference with the HMO plans I have now. I'm in an urban area so YMMV -- Sutter East Bay Medical Foundation.

29   curious2   2013 May 23, 10:50am  

turtledove says

Insurance companies inflate the costs of everything they touch.

Exactly. Typically, insurers write that expressly into their contracts with providers, i.e. 'we'll include you in our network if you agree to charge triple to everyone who is outside our network.' Obamacare maximizes those forces, with the mandates controlled from DC and every state and provider lobbyist (the real beneficiaries are the revenue recipients) being issued a blank checkbook to write themselves money at public expense. The reason Obamacare was enacted when it was, is because prices had already exceeded what the market would bear and had to fall; in rush the lobbyists, like cavalry charging over the hill, to keep those prices climbing.

30   justme   2013 May 23, 11:31am  

Here are more details, from the official source:

http://www.healthexchange.ca.gov/Pages/Default.aspx

In particular, these documents are useful

http://www.healthexchange.ca.gov/Documents/COVERED%20CA%20-%20Health%20Plans%20PRESS%20RELEASE%20FINAL%205%2023%2013.pdf

http://coveredca.com/news/PDFs/CC_Health_Plans_Booklet.pdf

What is MISSING: Complete rate tables for all age groups. I guess we have to wait for that. But in the meanwhile, let us have a look at available facts before jumping to conclusions.

31   justme   2013 May 23, 11:39am  

CaptainShuddup says

Oh and I forget about all of the shit that wont even be covered.

Like colonospopies, they cover 0%.

Are you SURE about that? Reference? I think you may be wrong, because in 2013 there was a new rule that ALL California health plans were required to cover colonoscopy screenings. I doubt that will be reversed in 2014.

Captain, I am suspicuous that you have again posted propaganda that is untrue.

32   Homeboy   2013 May 23, 6:30pm  

mell says

Well, part of the increases happened before Obama and part happened since he took office - that's why I didn't explicitly blame him but this trend seems to have accelerated over the past few years.

Do you have any actual evidence to support the assertion that rate increases "accelerated" after Obama took office? Any at all?

33   Homeboy   2013 May 23, 6:36pm  

CaptainShuddup says

For example my wife was paying $75 for x-rays, ultrasound, and procedures like that, where as our insurance copay is $250 to $500 with insurance.

Fucking bullshit. The co-pay for an xray is not $500. You are a god damn liar, Ten Pound Ass.

34   Homeboy   2013 May 23, 6:38pm  

justme says

CaptainShuddup says

Oh and I forget about all of the shit that wont even be covered.


Like colonospopies, they cover 0%.

Are you SURE about that? Reference? I think you may be wrong, because in 2013 there was a new rule that ALL California health plans were required to cover colonoscopy screenings. I doubt that will be reversed in 2014.

Captain, I am suspicuous that you have again posted propaganda that is untrue.

No, colonoscopies are covered. It's "colonospopies" that aren't covered. :D

35   Tenpoundbass   2013 May 23, 11:30pm  

justme says

Captain, I am suspicuous that you have again posted propaganda that is untrue.

What since you don't have any clarity on OC, everyone else is lying?

36   Tenpoundbass   2013 May 23, 11:32pm  

Homeboy says

No, colonoscopies are covered.

Sure for people over 52. The Doctor sent my wife we did not ask to go. And what the fuck are we complicated insurance lawyers, that know what's covered and what is not?

37   mell   2013 May 24, 12:46am  

Homeboy says

mell says

Well, part of the increases happened before Obama and part happened since he took office - that's why I didn't explicitly blame him but this trend seems to have accelerated over the past few years.

Do you have any actual evidence to support the assertion that rate increases "accelerated" after Obama took office? Any at all?

Yes, plenty. Do your homework.

38   mell   2013 May 24, 12:50am  

Homeboy says

CaptainShuddup says

For example my wife was paying $75 for x-rays, ultrasound, and procedures like that, where as our insurance copay is $250 to $500 with insurance.

Fucking bullshit. The co-pay for an xray is not $500. You are a god damn liar, Ten Pound Ass.

You are the one talking BS - if you have to take your kid into the ER after hours you pay way over $500 for an xray plus 5 minutes with the doc. Fuck copays, this is real life.

39   Tenpoundbass   2013 May 24, 1:06am  

Homeboy says

Do you have any actual evidence to support the assertion that rate increases "accelerated" after Obama took office? Any at all?

Homeslice, are you saying, Obama didn't say...
"And everybody is going to pay their fair share, so people don't abuse the healthcare we're going to have higher co pays and deductibles and coins payments to discourage unnecessary doctor visits. "

Homeboy says

No, YOU don't fucking get it. Poor people will be covered by medicare - that's part of the ACA.

Many people will qualify for federal assistance toward their premiums based on their income.

In California, individuals earning less than about $16,000 a year will qualify for an expansion of Medi-Cal, the state's Medicaid program for the poor. Above that threshold, individuals making less than $46,000 a year and families earning below $94,000 annually will qualify for federal subsidies.

If you think people making 17K can afford to pay a $44 premium, then the deductibles on top of that, then I can't reach you.
At least some of us here in this thread have actually been to the Doctor lately.
Hint, they aren't the ones calling people liars.

40   humanity   2013 May 24, 1:14am  

CaptainShuddup says

Sure for people over 52

Who wants a colonoscopy before the age of 52 ? That is the preventive maintenance type of colonoscopy is what you're talking about, given after age 52.

If someone is diagnosed to have an intestinal problem that requires a colonoscopy for diagnosis, (under age 52) obviously that would be covered too.

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