My personal experience on DC’s Obamacare exchange, or, how Tom Coburn is a big fat liar

Like many of you, I checked out the Obamacare exchanges today, specifically in my case Washington, DC’s.  And it wasn’t bad.

I didn’t have any of the computer glitches that many apparently suffered in other states (problems creating the secret reminders was a particular problem), and I found two “platinum” plans that were quite interesting – one $90 more than I pay now, and one $40 less.

Now, I still have a LOT of work to do digging in to the plans more deeply.  Like any health insurance, the devil is in the details, and after an hour+ on the phone with Blue Cross Blue Shield I’m still awfully confused as to how the two plans work in practice.  (Meaning, it’s one thing to tell me I pay 10% of the allowed price for a day in the hospital under one plan, and $150 a day under the other, but what does that really mean for an average sickness, how much will it actually cost me – which one is the wiser option for me?  I don’t really know, yet.)

Obamacare exchange is better than the plan I have now

But of course, each plan is still basically better than the coverage I have now, particularly in terms of its prescription drug coverage, which is next to non-existent in my current plan.

I simply can’t afford (physically) to keep my current grandfathered pre-Obama coverage.  I mean, I CAN keep it.  That’s the way Obamacare works. You get to keep your current coverage if you want (the Republicans lied about that point, a lot – today it was definitively proven to be untrue, just call your insurance company and ask them if you can keep your current plan).  My problem is that my prescription drug coverage is limited to $1500 a year, which is not a large threshold once you reach a certain ago.  If I ever get sick in any way that requires my buying any kind of expensive prescription drugs – and I mean really sick, like MS, HIV, or even a serious infection – I’m toast. HIV drugs can cost you $2,000 a month.  And MS can be even more expensive. Who can afford $2,000 a month?  (Oh that’s right, Republicans.)

I’ve been relatively lucky so far – meaning, my Rx drug costs have maxed at around $550 per month (I’ve cut those costs by buying cheaper drugs in Europe).  Of course, only an American would call those kind of exorbitant prices “lucky.”  Europeans recoil in horror when you tell them we pay this much for medical care in America.  But I manage.  My problem is that some day I may get sick and need really expensive drugs, antibiotics, or whatever, and that’s the day I’m in trouble under my current plan.

Until Obamacare came along, I was pretty much stuck in the plan I’m in, as no one would take me for any other plans with my pre-existing conditions.  So my option without Obamacare was to stick with the expensive insurance I’ve got, and hope that the day never comes that I might need expensive prescription drugs (well, more expensive than my current $550 or so a month). And if that day did come, and I got really sick and couldn’t afford to pay for my treatment, I’d leave America all together and move to Europe in the hopes that with less expensive drugs I might live.

Of course, that day kind of did come already.  My asthma doc wants to get me off of the steroids he’s had me on for five years now – long-term steroid use isn’t terribly healthy to your other organs, and in my case, I keep having “rare” adverse reactions to the steroids, like my early onset of cataracts (though, thank you, steroids, for giving me 20/25 vision post-surgery!)  The drug he wants to put me on costs a little over $1,000 a month.  A MONTH.  That’s just insane.   My old plan would cover one month of the drug per year.  And while the new plan covers the drug, I still need to see to what degree – it’s possible that I’ll still be asked to pay $200 to $500 per month for just those 4 daily pills, and I’m not sure I can afford that.  So the new plans are not necessarily a panacea.  But under my current non-Obamacare plan, that $1,000 drug would cost me $1,000 a month.  So the new plans are still an improvement over my current coverage.

Surprise! Under the Obamacare exchange, I do get to keep my own doctor

Another thing I found out today about my two potential Obamacare exchange lans: Under the plans, I pick my own doctors 100%.

One plan is a PPO style plan, the other an HMO/PPO hybrid that requires me to pick a primary care physician (and since my current doctor takes Blue Cross Blue Shield, I should be able to choose him).  Under both plans I can pick whatever specialists I want, no referrals necessary.  And so long as the doctors I pick are in-network, I get great coverage (better than I have now apparently).  Out of network, which I don’t use a lot, I still need to delve into more to better understand what I get and don’t get.

But here’s the thing.  I’m watching Crossfire on CNN tonight, and there’s far-right Republican Senator Tom Coburn – a “doctor” – talking about how under Obamacare you don’t get to choose your own doctor.  And the thing is, I spent several hours today analyzing my Obamacare options, and I very much get to keep own my doctors under Obamacare. I called Blue Cross to confirm.  Tom Coburn is a liar.

Under Obamacare, I can either: A) stick with my old insurance policy and keep my own doctor; or B) buy one of the plans on the Obamacare exchanges, and keep my own doctor.  So what is Coburn talking about?

Here’s Senator Tom Coburn on Crossfire:

Sen. Coburn

Sen. Coburn

We’re gonna have the government run and decide what you will get, by the different plans, we’ve decided what you’ll get, rather than you decide. Here’s the thing that’s gonna happen. Here’s what people are gonna see: You’re not ever gonna see the same doctor, year in and year out under this plan, you’re never gonna have the same care, you’re never gonna have the same access.

On its face, an outright lie.

Republicans do better in the polls when they lie. That ought to tell them something.

As I’ve written before, Republicans learned long ago that they do far better winning the public over if they simply lie.  If the Republicans actually told the American people that Obamacare would let them keep their current health insurance, but it would also provide them with additional options, that, if the price is right, they could buy instead of their current coverage, people would love it.  So the Republicans lie.

Keep in mind that the most effective argument the Republicans came up with against health care reform was Sarah Palin’s lie about the bill containing “death panels” that would decide if elderly Americans live or die.  It’s ridiculous, and a lie, and ended up working a lot better than the truth, so the GOP stuck with it.

It was truly idiotic for the Republican party to shut down the government over Obamacare on the day that the Obamacare exchanges go live.  With the click of a mouse, every single American can go online and check to see if they can get a better plan under the exchanges, check to see if the Republicans are telling the truth or whether, like Tom Coburn, they’re just liars.  If you’re going to tell a lie about something, don’t do it about something that’s so easily verifiable.  Until today, no one could really confirm that things would be better under Obamacare.  Now we know for a fact that for many Americans, it is.

In the end, I don’t know if I’m going to buy the plan on the exchange, but I suspect I will.  I can only gamble so long with my health, and even though I can switch to an exchange plan at some point in the future if I get sick, I can only switch during the open season.  But that might be too late if I’m really sick – I may not be able to afford to wait several months to change to a better plan.  So I probably will switch now, but as I said, I first have a little more math, and a few more phone conversations, to run.

But what I do know after a day of researching my options on the DC Affordable Care Act exchange, and talking to Blue Cross until we were both blue (but not so cross) in the face, is that today I have more options than I had yesterday.  And that’s not just a good thing, that’s a great thing.

Follow me on Twitter: @aravosis | @americablog | @americabloggay | Facebook | Instagram | Google+ | LinkedIn. John Aravosis is the Executive Editor of AMERICAblog, which he founded in 2004. He has a joint law degree (JD) and masters in Foreign Service from Georgetown; and has worked in the US Senate, World Bank, Children's Defense Fund, the United Nations Development Programme, and as a stringer for the Economist. He is a frequent TV pundit, having appeared on the O'Reilly Factor, Hardball, World News Tonight, Nightline, AM Joy & Reliable Sources, among others. John lives in Washington, DC. .

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82 Responses to “My personal experience on DC’s Obamacare exchange, or, how Tom Coburn is a big fat liar”

  1. lihartke says:

    Just wait until Obamacare is in full force and they realize how much you are spending each month on services. it won’t be long before “for the good of the community” you are escorted to the newly built hospice wing at your local hospital (like are being advertised in my Buffalo area now) and you are euthinized. Many people will get obamacare heathcaer it won’t be until you use it that will be the problem. And then, you will be at their mercy and we all see how “merciful” these people are that set this plan in motion without having it ready before they wrote in a law that kicked us all off our current insurance. This was NEVER about healthcare it was about controlling the people. It’s a 40 THOUSAND page NIGHTMARE and America is now living it. Throw every last Democrat out for doing this to us! This Gov’t is MAKING ME PHYSICALLY ILL and I KNOW I am not alone.

  2. Seewetoldu says:

    But look at what it took to even get her approved. She had approx 3 weeks to live. It is just a reminder on what can and does happen to real people. I am an advocate for health care probably more than most people. But unfortunately this one is so bad, it will create more problems and higher costs than people realize. And if I am right will the Democrats admit it and help get the problem resolved?I just want affordable health care for everyone.But it has got to work , be affordable and not have any connections to the IRS as distributors. I think “train wreck” will be an understatement

  3. clammer says:

    She is now healthier than you and I

  4. K_L_Carten says:

    Actually, if the employer, has insurance and it DON’T meet the min. standards then the employer has to have insurance meet to these standards. My brother works for such a company, they have over 50 employee’s and their insurance is really worthless. His boss was having a fit because the owner told him that it was coming out of his bonus, because he wasn’t making enough of a profit with having to pay the insurance costs. Although, if he don’t he will lose the contract for the job, and it will go under the union, and that is what the drivers want! Better wages, a contract, and union insurance, which they were talking about doing just that after this contract ended, the owner isn’t holding his end up so well, like the pay raises and trucks that aren’t being maintained like they are suppose to be. So, while you are troll, and feeding trolls are bad, you don’t have all of the info, just what you think, or would like to happen. One point of ObamaCare I liked was having insurance that actually paid and was usable NOT insurance in name only, the type of policies that paid very little but was only slightly useful if you had to have major surgery, it got your foot in the door but typically didn’t pay anything else. THAT is the type of insurance my brother had prior to this year, it paid nothing for labs, doc. visits, but would pay for some of a hospital bed, and proof of insurance, so you wouldn’t die waiting for a doctor in the ER, but that’s about it, they don’t actually pay for anything else.

  5. Spending more, getting less says:

    Here are specifics for you: In California, as a member of a “group” (farm bureau, to be exact) purchasing individual insurance, we *cannot* keep our existing HSA-eligible health plan because the policy was cancelled in our area. We will now be paying $101 *more* a month for a higher annual out-of-pocket (was $10,000, now is $12,700); the monthly fee will be $998. We are in mid-50s with income higher than the $63k required for subsidies. I’ll be paying 11% more for a plan which will cost me 27% more for an annual out-of-pocket. Plus I have to put the time in shopping for a new plan. Happy? I think not.

  6. schwenksville says:

    That little girl got the transplant months ago. She is home and doing well.

  7. The Jackster says:

    maria, you do not understand how insurance works. Do you?

  8. kay says:

    where did you get this info? My insurance co. Blue Cross/Blue Shield surely has not contacted me saying they will quit collecting my monthly fees!

  9. kay says:

    Try 14k for two on retired income that we have been paying for a few years. Neither of us come anywhere near deductibles. No real medical issues. And you think the insurance industry is your friend?

  10. Hue-Man says:

    My father was diagnosed with lung cancer, quit smoking, then restarted when the lab results showed the initial diagnosis to be incorrect. He then died before 65 of all the other respiratory diseases that he had acquired from 3 packs/day smoking (unfiltered) over 45+ years.

    “Weight lost recidivism is exemplified in a study by Sarlio-Lähteenkorva et al. who followed a cohort of 911 subjects. Only 6% maintained weight loss of at least 5% after 6 years. This phenomenon has been repeatedly observed, with estimates showing that nearly one-third of weight loss is regained in the year following a weight loss intervention. These finding suggest a biological drive toward weight regain and implicate the pattern of initial weight loss as a modulating factor.”

    “After completing drug and alcohol treatment, 43.8% of graduates are
    still using marijuana on a weekly basis. In my book, that is NOT
    effective. Furthermore, 20.3% of graduates are still drinking, while a
    whopping 42.2% are using “other” illicit drugs. Again, that is NOT
    effective, particularly when you consider that the rate of using illicit
    drugs decreased by less than 6%. I’d be interested to know what the
    rate is with no drug and alcohol treatment at all. I would venture to
    guess that it’s very similar.”

    I can understand the doctor’s trying to give incentives to his patients but I don’t know that firing them after a year is the right way to deal with complex, lifelong health issues. For many patients, it’s like telling John that he has to stop wheezing within a year (caused by his chronic asthma).

  11. Badgerite says:

    No, you are in error. It isn’t a rebate. It is called the Advance Tax Credit. You estimate your 2014 income. The subsidy would be based on that as well as age, health issues like smoking, etc. The Credit is sent out periodically throughout the year as premium payments come due. At the end of the year, if you have chosen a cheaper plan like Bronze, if there is any excess subsidy not paid out you will get it as a credit on your year end taxes. Sounds good to me. The subsidies are supposed to offset about 50% of premium costs. So, more like 4K. Assuming the numbers you are giving are even accurate. And given your ignorance about the advance credit, that is questionable. Of course, I looked on the Federal Exchange.

  12. Badgerite says:

    Yeah, a better, cheaper one. Those exchanges are going to provide a lot of price and service competition to a market that barely had any.

  13. Badgerite says:

    I’m saying even if they are not made up, so what? Have you checked out what is available on those exchanges. Looks good to me.

  14. Badgerite says:

    Frankly, I’ve looked at what is available on the federal exchange in terms of cost and the subsidies provided by an Advance Tax Credit which is given out in advance to cover premium payments and I wish to God I qualified. I don’t believe I do because I think I can get affordable healthcare coverage ( defined as premiums costing of no more than 9.5% of your income ) from my employer, if I should choose to. But I tell you, I would be better off on the Federal Exchange. For people who don’t have insurance and whose employer does not provide it, those exchanges are a godsend. And even if you do not qualify for the subsidy because you make too much money, the insurance plans they offer seem pretty good. Certainly as good as whatever insurance company alleging ‘dropped’ people from coverage. So, I don’t understand your complaint, really. If people are indeed getting cancellations, good insurance at, certainly comparable rates are available there. And if they quality in terms of income, the rates are far better than comparable. So what is the problem, exactly?

  15. Sandra Taramtamtam says:


  16. BillFromDover says:

    Do ya actually believe that these dweebs even know who Malkin is?

    Otherwise, why becoming the laughingstock on this board by linking to her?

  17. BillFromDover says:

    Perhaps, ya can direct me to the part on the HuffPost article about cancellation as I couldn’t find it?

    Never mind, cuz it ain’t there.

  18. BillFromDover says:

    Funny ya should mention that.

    When I asked my grocer just yesterday why the price of milk, cigarettes and everything else just went up 15% in his store, he said OBAMACARE!

    What’s up with that?

  19. BillFromDover says:

    So… go the emergence room already for your next yearly physical… or move to any other industrial nation in the world that doesn’t have a for-profit- medical care delivery system.

    BTW, what ever happened to the right’s mantra of personal responsibility?

    Oh, almost forgot… why do ya think medical care is so expensive here in the good old US of A?

    Couldn’t have anything to do with those carrying insurance also footing the bill for the freeloaders, could it?

  20. BillFromDover says:


  21. JenH says:

    Our coverage will be changing for the worst. My husband works part time and started his own business. Part time benefits are now on the chopping block. You can say that it was bound to happen due to rising costs but the timing is sure interesting. We will be forced to have my husband give up his business and go back full time just to keep medical coverage. Doesn’t sound like we are being the given the opportunity to “pursue happiness” when we will be “forced” to make this decision. Should he decide to purchase coverage through the exchange instead of work full time, our monthly premium will go up over $200 over what we would have paid on the private market just 2 weeks ago. We will be looking at roughly 14K/yr out in cash just to have medical coverage due to monthly premiums and deductibles. I’m all for coverage for low income people but an individual mandate is going to force a lot of middle class people to go without coverage or seriously cut back on their expenses (that would’ve gone out into the economy) to have coverage. This will add up to reducing the size of the middle class and reducing small business.

  22. Mike F says:

    John: When I had surgery in April 2011 to remove a cancerous growth in my ureter, I was in the hospital for four days, including the surgery itself. Total cost for those four days, as billed by the hospital: a little over $20,000. (That didn’t include the fees from doctors, radiologists, anesthesiologists, etc) Now, I have deductibles and whatnot (I’m currently at $2800 out of a $6000 deductible, anything over which they pay; the scheduled CT scan, xrays, and bloodwork done as a follow-up tomorrow will absolutely put me over that $6K mark for this year), so there may have been those factors, as I had a number of tests prior which pushed me over the $6K threshold, but I only paid about $550 out of the $20,000. Just a hunch, but I think the 150USD/day may be a better bet. But with the confusing nature of this whole thing, I could be wrong as to the wisest choice.

  23. Jason V says:

    Finally, someone with half a brain, and a lot of knowledge about the fight over the ACA…kudos

  24. Mike F says:

    Anthem essentially said the same thing, advising me that my plan (such as it is: it kept my wife and I from declaring bankruptcy due to the costs associated with becoming cancer-free–me, BTW–in good ol’ Murka.

  25. benb says:

    Just put up a link to an article from a major newspaper like the NY Times or WSJ, or Washington Post. If people are getting their health insurance cancelled ‘left and right’, then it shouldn’t be hard to find.

  26. Jim Shaney says:

    Tom Coburn got into Med school because of his Daddy. He hasn’t practiced in 20 years, and left medicine for politics after a malpractice suit for sterilizing a young woman without her consent. Some doctor.

  27. maria says:

    This is like Ann Coulter claiming that the media makes more references to the left wing that to conservatives, and then counts every time left wing is mentioned in sports page articles on hockey games. They just figure you won’t look behind the curtain and check their facts.

  28. Clarence Whorley says:

    Yes and it has people tweeting their cancellation notices with actual images. Are you saying these are MADE UP

  29. maria says:

    And when you got a good argument destroying yours, you denied hearing it. Got it, but I doubt you did… or ever will.

  30. benb says: is founded, owned, and run by Michelle Malkin. That’s simply not a credible source of information. The HuffPo link says nothing about cancellations. I think you’re wasting everyone’s time.

  31. Clarence Whorley says:

    So when Obama was proven to have lied/misspoke you decided to change the argument.

    Got it

  32. sayit says:

    Shut your pie hole Tom Coburn…you’re an idiot standing there with crude dripping from your nose you sniveling little imp. You’re nothing but a puppet for all oilies…the frackin good ol’ boyz of the oil patch.

  33. Badgerite says:

    Organ transplant policies are not affected, to my knowledge, by the new law. What’s more, those employees whose hours were cut to avoid the law requiring their employer to provide them with affordable health insurance, were not getting health insurance or transplants and now can apply for more affordable rates under the state or federal exchanges. So you are talking about someone who had no insurance, being able to buy insurance at an affordable rate and with a tax credit to help. I don’t believe the law affected transplant policy at all. What regulation exactly are you talking about.

  34. Badgerite says:

    That isn’t what he said. That is what you said.

  35. Badgerite says:

    That’s because it isn’t true.

  36. Badgerite says:

    I would block you on twitter too. You sound like a _________ (pick your poison).

  37. maria says:

    Actually all your proved is your lack of cultural literacy. Up until about 1990 the insurance companies put everyone in the same group. Everybody covered paid the same rate. Then some bright bulbs got the idea that they should insure only people who have the least possibility of getting sick. It didn’t work as younger people rejected the cheaper rates for being in a group paying low rates based on having less susceptibility of getting an illness requiring hospitalization and opted not to get covered. Then when they got unexpectedly ill or injured they went to the hospital emergency room and renigged on the resulting bills. Others who were responsible and bought health insurance got higher monthly rates to cover the unpaid bills from the irresponsible. From 1933 to about 1990, younger people paid a higher rate to cover the illnesses of older people. And when they got older there would be younger people coming up to cover there costs. That is how it worked. And how it should work again.

  38. benb says:

    I don’t belive this is true. Would you post a link to an article from a nonpartisan source backing up your claim?

  39. Clarence Whorley says:

    So you can’t keep your policy, you have to chose another one

  40. dacohenz says:

    Blue Cross Blue Shield is not sending me cancellation policies, they do want to actually keep me and pointed out some money saving options

  41. Clarence Whorley says:

    When John was shown his statement that you can keep your insurance was actually a lie, he did the civilized thing and blocked me on twitter.

    #TruthHurts #NotAffordable.

  42. Clarence Whorley says:

    The left is delusional, in Florida a 27 year old man can get the cheapest plan, its $230 a month with a 6K deductible that must be paid BEFORE any insurance kicks in. Your doctors visits, prescriptions etc must use up deductible before any insurance. So you are talking 8K+. If you got the platinum plan, same 27year old, its over 400 per month but deductible is only 850.

    So either way you are spending 8K or so and then you may qualify for a rebate next year (after you spend money you may not have).

    Go to FloridaBlue and price it out yourself. This was pricing for a 27 year old non-smoker.

    Where is 8K out of pocket Affordable for a 27 year old who doesn’t have company provided insurance?

  43. Clarence Whorley says:

    Are you an idiot? Americans are getting cancellation policies left and right. You CANNOT keep your plan if it is not Obamacare compliant.

  44. ArthurH says:

    For the Republican right, Socialism is defined as anything that benefits ordinary citizens and not just the billionaires who provide their campaign cash. They would know a real Socialist if they walked around with neon signs.

  45. ArthurH says:

    Also left out of this debate is the ACA rule that counts hours worked toward full time employees. Employers are required if they have 50 full-time employees. But on the hours-worked rule, 60 employees working 30 hours a week counts as 50 full-timers. Employers who pull the part-time worker stunt will only increase their healthcare costs. And if they cut part-time employees to under 20 hours to escape the worker count rule they’ll create such gross inefficiencies in their operations with frequent shift changes they’ll lose more money than if they provided a bronze healthcare coverage off an exchange.

  46. rmthunter says:

    On the other side of that coin — and I have no idea whether this applies to your example — finally, after years of hearing “Stop smoking!” from doctors, I actually had a doctor who took the time to sit down with me and talk about how smoking was causing/exacerbating a couple of (newish) medical conditions. End result — I’m working on quitting. All it took was him treating me like an adult. That doesn’t happen all that much, in my experience.

  47. rmthunter says:

    The whole “socialized medicine” mantra is so much BS. The ACA is a godsend to insurance companies — 30 million new customers? How can they lose? The only downside is that they have to provide what they promise, which hasn’t been a notable feature of private insurance so far.

    And it’s a truly competitive market — the Republican wet dream.

    The reason they hate the program — developed by the Heritage Foundation and first implemented by Mitt Romney in Massachusetts — is because it became law under Obama. That’s the whole reason, because he’s everything they hate, starting with not white. And if they’re terrified that it’s going to work, rightly so — from everything I’ve heard, the “pilot program” — Romneycare — has been very successful.

    For myself, I’m on Medicare, which is wonderful. I’m getting regular health care for the first time in a decade, due to the vagaries of employers who figure the place to start cutting costs is on employee benefits. So why shouldn’t everyone have the same? I guess you have to be a teabagger to believe they shouldn’t.

  48. rmthunter says:

    Becca — By all indications, Republican voters don’t have much in the way of critical thinking skills to begin with. And was it in Texas or Oklahoma that they wanted to take “teaching critical thinking skills” out of the education standards? Because that might lead children to ask questions.

  49. Graeme Edgeler says:

    Why is “Doctor” in quotation mark in reference to Tom Coburn?

  50. SkippyFlipjack says:

    I’m on COBRA from my last job (now doing consulting) and need to keep it active because of a pre-existing condition in the family. COBRA is expensive so I’m looking at the Obamacare exchanges. Is anyone worried that they’ll switch to Obamacare and then Congress will change the law — say, if the makeup of the various branches changes in three years — and suddenly you’re out on your own, unable to get coverage because of preexisting conditions?

  51. karmanot says:

    As long as you bring a chicken you can see a doctor.

  52. karmanot says:

    Make that: Truth has a liberal bias. Rethuglicans make their own reality

  53. zorbear says:

    That’s not true and you know it! We also can make laws that appease greedy wall street tycoons…

  54. FauxReal says:

    A couple of other things we may hear Republicans blame on the ACA but they have actually been done by companies long before the ACA:

    I’ve heard lots of Republicans say that UPS is stopping coverage of spouses because of Obamacare. However, this isn’t anything new. My company did it years ago and it isn’t an uncommon practice. But Republicans make it sound like those spouses will not have health insurance. Of course, that isn’t true. If the spouse doesn’t have employer-provided health insurance available, then they are still eligible for the UPS health insurance. If the spouse works and has health insurance available, the spouse cannot be on your company’s health insurance.

    The company doesn’t want to be be responsible for medical expenses that should be the responsibility of the other employer and expenses for a catastrophic illness or injury that could impact your company’s premium. Plus your company could be self-insured and that means the company is directly paying the medical expenses. The insurance company is only used to process claims – provide administrative services.

    The other issue has to do with retirees. Some companies offer the same health insurance to retirees under 65 and Medicare supplemental plans for those covered by Medicare. The company contributes to the premium and the retiree paid a premium co-pay. However, it was becoming more and more expensive to cover retirees – especially with older companies because they had a very large retiree population.

    More and more companies have stopped covering retirees, especially after they become eligible for Medicare. My company did it a few years ago. They had a transition for 3 years where they would make an annual contribution to a health care spending account and the retiree could use the account to pay the premium for the individual health insurance or supplemental plan you now get on your own.

    This also isn’t about Obamacare. It’s been something more and more companies have been doing for years.

  55. FauxReal says:

    I go to a large hospital-affiliated practice. My doctor moved to a new city with her husband so I got another doctor in the same practice. He told me that after years of trying to get his patients to take responsibility for their health by stopping smoking, reducing alcohol intake, exercising, losing weight, etc. he has started to advise them they had a year to make a change or they would have to find a new doctor. He would like to have motivated patients – patients that will stay healthy and have a better quality of life for a long time.

    I liked that attitude. How frustrating it must be to advise your patients again and again of how their lifestyle choices are adversely impacting their health only to be ignored and have them come in complaining of chronic coughs and shortness of breath because they smoke, or high blood pressure of diabetes because they won’t even try losing weight.

    So I guess in a sense he was firing his patients.

  56. PeteWa says:

    you are easily manipulated.

  57. Hue-Man says:

    I’ve had the same family doctor for nearly a decade and would expect to continue until he retires or one of us dies (we’re about the same age). One of the (many) criticisms of the Canadian system was lack of choice of doctors which is ironic given your comments. I’m sure it’s possible for a doctor to fire a patient – physical or verbal abuse? – although I’ve never heard of it happening. It’s more likely that a patient would fire his/her doctor because there was a personality conflict. Any doctor in the province is “in-network” providing he or she’s accepting new patients.

    Similarly with specialist referrals, I went through the local choices with my doctor (gatekeeper) and we agreed on one I’d seen previously. I guess the only liberty-loving Americans are the 1% who don’t have to worry about mundane things like in-network physicians!

  58. ninjakiller says:

    Once again reality has a liberal bias.

  59. ninjakiller says:

    Indeed. Employers must extend coverage to all employees who work 20+ hours, problem solved. It’s economically unfeasible to have a fleet of employees all working 19 hours a week.

  60. tomtallis says:

    I think that they are in panic mode. This is the “hail mary” pass to end all “hail mary” passes; if this doesn’t succed the Republican Party is dead meat for the next generation, which would be the best thing that could happen to the country. I think that we’re going to see a party realignment such as they saw in the 1850s with the demise of the Whigs.

    Then a new, liberal, party arose called the Republican Party. I think that we are seeing the demise of the Republican Party, and I think that there will be a new, further center-left party, and the Democratic Party will become the new right wing party, but not nearly as far out as the teabaggers, who will once again, have to crawl back under their rocks.

  61. NCMan says:

    The transplant issue has nothing to do with ObamaCare. And, ObamaCare certainly doesn’t require employers to be assholes. In fact, what it does is provide tax incentives for employers who provide insurance.

  62. tomtallis says:

    I’m on Medicare so essentially nothing changes for me, but my husband has Kaiser on an individual plan because he works for himself. For us Obamacare has been a godsend. His premiums will be $900/year less, and most of his copays have dropped (a regular doctor visit has dropped 25%).

    We’re happy campers!

  63. NCMan says:

    absolutely. I’ve been saying this for years. Single payer, medicare for all, with everyone paying based on their income level prior to their retirement. The payment could either be through premiums or through taxes. Businesses would no longer be saddled with healthcare costs. They would become more competitive. This would also free up money to be able to pay employees more. And, then employees would have more income to be able to use to purchase products from these same businesses. And, those businesses that want to could provide “medi-gap” style insurance that would be a good benefit for their employees to reduce their healthcare costs even more.

  64. judybrowni says:

    When I had private insurance I never knew if I’d see the same doctor or not, half the time.

    First, when forced to switch plans– and I was forced several times, for instance when a plan dropped everyone in my state.

    Another plan, and I “chose” as my gynecologist a supposed high muckymuck at the local hospital, and got each visit a different (I suspect) intern working under that doctor.

    Or, in one other case, a nurse practitioner.working under the doctor I was supposed to see.

    So a very specific problem I had wasn’t treated for two years:

    California began Obamacare changes early, and I’m now on a new government plan WHERE I SEE MY OWN DOCTOR EVERY APPOINTMENT.

    (Unless it’s something that needs tending to a day, other than one she’s in office. However, they’ll make an appointment with her later that week, too.)

  65. nicho says:

    And all the more reason to extend coverage to part-time employees. Problem solved,

  66. Hue-Man says:

    These protocols have been tested innumerable times by professionals in the field. If we’re going to talk about barbaric rationing, how about the 50,000 Americans who die every year because they don’t have money to pay for needed health care?

    I have no skin in this game, living under the tyranny of a socialist, freedom-hating single payer system (with zero co-pays, zero pre-existing conditions, and zero annual or lifetime maximums. I can’t say zero premiums because I live in one of the few provinces that has an annual premium, in my case, less than $1,000. It does have pharma coverage, however). I find John’s experiences today fascinating on many different levels:

    1. If a highly-educated man is struggling with the decision tree analysis for himself, imagine what happens if you didn’t graduate high school and have a spouse and kids to include in the analysis.

    2. PBS Newshour tonight had a piece on Massachusetts plan which started out with the ACA approach then moved to more comparable policies. From the transcript:

    “PAUL SOLMAN: And I would’ve just seen plan after plan after plan after plan?

    JEAN YANG: Correct, yes. And it very quickly became too confusing. So, we standardized our product design. You know what is covered, what is not covered, how much is covered. If I go see a doctor, if I go to the emergency room, how much am I supposed to pay? It’s the same.”

    3. John references in/out of network but I’ve seen nothing about what happens if you move to a different state. Is this a way to get coverage for a “new ailment” or do the same renewal windows apply regardless of your move? If you’re insured in Kentucky, how likely is your network going to include doctors where you’re moving to, say Honolulu? Related question, are employees going to become more mobile with ACA because they won’t be at risk of having zero health insurance? (Nicho, I don’t expect you to answer these! I wanted to pick up on the lung transplant case and got carried away.)

  67. AdmNaismith says:

    And it should be at this point that businesses and employees should all be asking for a Single Payer System.

    Big Business complains that the US car makers cannot compete with Japan because here in the US corporations have to foot the bill for medical insurance. Lets fix that with a Single-Payer System. Car Makers: Health insurance no longer has to be your problem. GM , tell Congress wants a single payer system.

  68. Monoceros Forth says:

    Time to get informed folks.But the good news is you will have plenty of time when your employer cuts you down to part time.

    I love the implication of this sort of comment. Apparently we’re supposed to make only laws that appease vindictive employers.

  69. pappyvet says:

    Under current regulations she would have to wait for a pediatric donor because only those age 12 and older are candidates for adult lung transplants.

    Kathleen Sebelius couldn’t change the transplant rules for one case when there are 1,700 people nationwide on the waiting list for a lung, including 31 children under the age of 11. (A federal judge, however, temporarily ordered her on the adult list after the family sued.)

    The Murnaghan case has nothing to do with Obamacare, aka the Affordable Health Act. The current rules governing transplants were set up in 2004, when Republicans controlled the White House and both houses of Congress, and Obama was still sitting in the Illinois state Senate.
    Those paying attention to the Sarah Murnaghan case know how ridiculously wrong the right wing and Rush Limbaugh’s version of the story really is.

  70. nicho says:

    It became a spin zone when you showed up.

  71. pappyvet says:

    I think the bottom line here is that the repubes know that it will work. They simply cannot allow that to happen. So it must be lied about,demonized,and harped upon. They act like a group in panic mode. But then,it was people from their side of the aisle that applauded the idea of a man dying in the streets because he would not or could not come up with all the vigorish that the insurance companies demand.

  72. BeccaM says:

    The “can’t keep your doctor” lie has been a pernicious one, hasn’t it? And it depends on people not having any critical thinking skills at all.

    If you change jobs and your new employer doesn’t have the same network plans available — which is quite common — you might not be able to keep your doctor.

    If you lose your job and your COBRA lapses or you just can’t afford it — you’ll definitely lose your doctor, unless you have a ton of savings to pay for visits.

    In fact, any change in your health insurance plan can result in your doctor suddenly being “out of network.” And it has nothing to do with where that insurance is coming from. Hell, I remember a time back in the late 80s when I was informed that my current doctor had dropped out of the network I was enrolled in; they referred me to someone else who still was.

    BTW, John? There’s probably a good chance those ‘platinum’ plans you’ve been checking out have relatively modest yearly out-of-pocket maximums. I can’t say for certain, but it wouldn’t surprise me if your prescription bills went way down as a consequence. Not costing you a thousand bucks a month. Even with my PPACA high risk pool temporary insurance, my co-pays for name-brand medications are quite low.

  73. Seewetoldu says:

    This is definitively NOT a NO SPIN ZONE. Time to get informed folks.But the good news is you will have plenty of time when your employer cuts you down to part time.A little girl in Pennsylvania who was being denied a lung transplant because she’s 10 years old.Her congressman has begged Sebelius to waive the regulation, but she has refused. No Death Panels?

  74. NCMan says:

    It hasn’t “always” been true. This all started when HMOs and PPOs came into existence. Prior to that time, insurance plans were the old 80/20 plans with some level of deductible and co-pays didn’t exist. In those days there was no plan with participating doctors. All doctors were accepted by all insurance plans.

  75. Houndentenor says:

    If you change insurance plans, your doctor might not be on the new plan. That was always true when people changed plans. Always. It has nothing to do with ACA. Coburn knows that. He’s a doctor. That’s what makes the lie so unforgiveable. It’s not as if he’s repeating something that he believes is true. He’s lying and he knows he’s lying. What a piece of shit.

  76. cole3244 says:

    how can you tell when a republican is lying, ta da, their lips are moving lol!!!

  77. Monoceros Forth says:

    They really, really, really love to pull out the, “The mean nasty gummint will tell you what doctor you can see.” And I’m thinking, how is that different? When I was working at a health insurance company I had to pick my primary care physician out of a book or pay a full 50% of medical expenses incurred by seeing someone of my choice.

  78. NCMan says:

    And, Republicans will blame this on Obamacare even though it is the fault of the doctor and the insurance company not coming to terms in a agreement and this has been going on ever since HMOs and PPOs created “networks” to lower costs long before Obamacare was ever thought of.

  79. NCMan says:

    When republicans say you won’t be able to keep your old coverage, I believe they are talking about people who currently get their insurance from their employers. Some of those employers, and emphasize “some”, may decide to drop their current plans and have their employees put into Obamacare instead to buy their own insurance. But, this isn’t the fault of Obamacare, it’s the fault of your employer. Some employers will decide to pay the $2,000 per employee fine instead of continuing to provide insurance that currently costs them more than the $2,000 fine to provide. Republicans will blame Obamacare for this if your employer does it.

  80. FauxReal says:

    I used to be a benefits manager. We offered several different health plans and some of the same doctors participated in more than one plan. However, those doctors are under contract with the insurance company. I’ve had instances where the doctor didn’t renew their contract in a particular plan and the employee had to choose a new participating provider. Sometimes they had to do it at open enrollment but most often the doctor’s contract ended during the plan year and employees who had selected that doctor were notified to choose a new participating provider.

    The employee could continue to see that doctor who no longer participated but they would incur a larger expense because they would now be under the nonparticipating provider rules (a higher co-pay and a higher deductible plus the provider can charge any balance left on the full charge).The participating provider has agreed to accept the insurance reimbursement and the employee co-pay as payment in full. The non-participating provider can balance bill.

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