Dems: GOP rollback of HCR would increase the deficit.

[AOII Angel]

Originally Posted by AGDee

If you had my insurance, you would be required to see your primary care doctor at least once per year and get specific tests done annually or else you'd have a huge annual deductible and extremely high co-pays. You would re-think that hospital/urgent care visit because the co-pay is 5 times as much as going to your primary care.

Your insurance company is smart.

[Drolefille]

Originally Posted by AOII Angel

Your insurance company is smart.

My new coverage requires NO co-pay for preventative care at all. More of the carrot than the stick of AGDee's but it's very encouraging.

[AGDee]

Originally Posted by AOII Angel

Your insurance company is smart.

Originally Posted by Drolefille

My new coverage requires NO co-pay for preventative care at all. More of the carrot than the stick of AGDee's but it's very encouraging.

Our preventative care visits are also free. However, the pediatrician won't bill any of my daughter's visits as "well child" visits because she has asthma so it is always billed as asthma care since it always has to be addressed. That irks me a little.

This is a gradual thing they are implementing, with different pieces of it true in different years, but by 2013, we will have the following requirements to get the "cheap" healthcare:

1) Blood pressure below 140/90 or, if diabetic, 130/90
2) Non tobacco user
3) BMI less than 30 (not in the "obese range") or have lost 5% of your body weight since your last annual visit
4) Fasting blood sugar <120 or A1C <8 (the A1C is if you're diabetic)
5) Cholesterol: Acceptable LDL-C level, which, I believe will be below 159.

And, your spouse or domestic partner must meet all the requirements as well. Children are exempt.

It has caused quite an uproar, honestly.

[Drolefille]

Originally Posted by AGDee

Our preventative care visits are also free. However, the pediatrician won't bill any of my daughter's visits as "well child" visits because she has asthma so it is always billed as asthma care since it always has to be addressed. That irks me a little.

This is a gradual thing they are implementing, with different pieces of it true in different years, but by 2013, we will have the following requirements to get the "cheap" healthcare:

1) Blood pressure below 140/90 or, if diabetic, 130/90
2) Non tobacco user
3) BMI less than 30 (not in the "obese range") or have lost 5% of your body weight since your last annual visit
4) Fasting blood sugar <120 or A1C <8 (the A1C is if you're diabetic)
5) Cholesterol: Acceptable LDL-C level, which, I believe will be below 159.

And, your spouse or domestic partner must meet all the requirements as well. Children are exempt.

It has caused quite an uproar, honestly.

I don't like that, there are a lot of reasons why you can't control some of that. And hard and fast lines are not necessarily reflective of actual health. I understand their reasoning, and I'm not sure I have a better measure of health myself, but I wouldn't be thrilled by it. (Which is why I'm pro single-payer. If you put everyone in the same pool you distribute the risk.)

[AGDee]

Originally Posted by Drolefille

I don't like that, there are a lot of reasons why you can't control some of that. And hard and fast lines are not necessarily reflective of actual health. I understand their reasoning, and I'm not sure I have a better measure of health myself, but I wouldn't be thrilled by it. (Which is why I'm pro single-payer. If you put everyone in the same pool you distribute the risk.)

Which is why it has caused an uproar. Add to it the fact that our employer owns the HMO and people are claiming conflict of interest, concerns about HIPAA, etc. Here I sit with Crohn's Disease, which will cost my insurance company a lot over the years, if I stay with them, yet my co-worker with uncontrolled diabetes will be paying the big bucks. As I said, they are phasing it in. Last year, we only had to agree to follow our doctor's treatment plans for these conditions. Each year the requirements become more stringent.

Last year, when they were first giving us information about this plan (with NO hint of it getting more stringent), I went to an info meeting and asked for information on the deductible and increased co-pays. The representative said "Why? You don't have to pay those, just follow these steps". That really ticked me off...lol. I said "What if I have a spouse who will refuse to quit smoking?" He replied, "Just show him how much more it will cost and he will quit." I said "I was giving you a hypothetical but if you think that those increased costs will get a smoker to quit, you're wrong. Cigarettes now cost %600 more than they did when most adults started smoking but they are still smoking." He said "But smokers cost us a lot of money." I said "I quit smoking a year ago so this doesn't apply to me BUT, I was never in my life treated for a smoking related illness." He said "But if you kept smoking, you would eventually." I pointed out to him that the minute I'm that sick, I'll be on disability and no longer employed by that system and, therefore would not HAVE their insurance anymore. He didn't know what to say to that. Sorry but, my employer's HMO isn't paying for any really, really serious disease of mine.

[AOII Angel]

Uncontrolled diabetics are more likely to cost your insurance carrier more over time than a single patient with Crohn's disease. I think the idea is a good one, but unfortunately, like the weight, there should be some phase in. If you have an A1C of 10, a decrease of 1 point each time you come demonstrating progress is helpful. Patient's don't do well with all or nothing. Saying they must be Less than and A1C of 8 to get the benefits is tough, especially if you are giving the obese a way to keep their lower rates by decreasing their weight over time. The whole point is to encourage improved health over time. For those who can't control it, there are medications that when taken (like for cholesterol) will bring them into those ranges.

[AGDee]

Originally Posted by AOII Angel

Uncontrolled diabetics are more likely to cost your insurance carrier more over time than a single patient with Crohn's disease. I think the idea is a good one, but unfortunately, like the weight, there should be some phase in. If you have an A1C of 10, a decrease of 1 point each time you come demonstrating progress is helpful. Patient's don't do well with all or nothing. Saying they must be Less than and A1C of 8 to get the benefits is tough, especially if you are giving the obese a way to keep their lower rates by decreasing their weight over time. The whole point is to encourage improved health over time. For those who can't control it, there are medications that when taken (like for cholesterol) will bring them into those ranges.

I think what we all found most interesting was the blurb written before the detailed requirements for the upcoming years, which said "We are informing you of these changes now so that you can plan for the financial impact." NOT "So that you can work on your health improvements" ...LOL. Duly noted Employer Sir!

[Drolefille]

Originally Posted by AOII Angel

Uncontrolled diabetics are more likely to cost your insurance carrier more over time than a single patient with Crohn's disease. I think the idea is a good one, but unfortunately, like the weight, there should be some phase in. If you have an A1C of 10, a decrease of 1 point each time you come demonstrating progress is helpful. Patient's don't do well with all or nothing. Saying they must be Less than and A1C of 8 to get the benefits is tough, especially if you are giving the obese a way to keep their lower rates by decreasing their weight over time. The whole point is to encourage improved health over time. For those who can't control it, there are medications that when taken (like for cholesterol) will bring them into those ranges.

Ideally medication would solve that, but not always. I don't know how reasonable the numbers are, but my mom has HBP, the only thing that has actually lowered her BP was a low-carb diet. She's tried everything, but staying low carb dropped her weight, her BP and her cholesterol and has kept it there. Someone who is trying to figure out WHY their numbers are high and a successful treatment hasn't been found for that individual yet is going to be rather unfairly punished. So would someone who is an outlier and is incredibly healthy despite not falling in those ranges.

[AOII Angel]

Originally Posted by Drolefille

Ideally medication would solve that, but not always. I don't know how reasonable the numbers are, but my mom has HBP, the only thing that has actually lowered her BP was a low-carb diet. She's tried everything, but staying low carb dropped her weight, her BP and her cholesterol and has kept it there. Someone who is trying to figure out WHY their numbers are high and a successful treatment hasn't been found for that individual yet is going to be rather unfairly punished. So would someone who is an outlier and is incredibly healthy despite not falling in those ranges.

Yes, but it is in the best interest of the patient and definitely in the best interest of cost containment (the only interest of the health insurance company) to control these variables which are all markers of future complications. HBP, Diabetes, cigarette smoking and cholesterol are all risk factors for heart disease, stroke, renal disease, peripheral artery disease, which are the biggest preventable costs in health care. Cancer, genetic diseases, auto immune disease, etc are pretty much uncontrollable risks for the insurance companies. If your patient population can't decrease their controllable risk factors, then they potentially cost the company more money. It's one of the ways to distribute cost while also improving health. It came into vogue earlier this decade. Who knows how well it works. Haven't really seen any data, but it puts some of the responsibility of health back with the patient. AGDee's insurance scheme seems a little harsh to me, though.

[Drolefille]

Originally Posted by AOII Angel

Yes, but it is in the best interest of the patient and definitely in the best interest of cost containment (the only interest of the health insurance company) to control these variables which are all markers of future complications. HBP, Diabetes, cigarette smoking and cholesterol are all risk factors for heart disease, stroke, renal disease, peripheral artery disease, which are the biggest preventable costs in health care. Cancer, genetic diseases, auto immune disease, etc are pretty much uncontrollable risks for the insurance companies. If your patient population can't decrease their controllable risk factors, then they potentially cost the company more money. It's one of the ways to distribute cost while also improving health. It came into vogue earlier this decade. Who knows how well it works. Haven't really seen any data, but it puts some of the responsibility of health back with the patient. AGDee's insurance scheme seems a little harsh to me, though.

Yeah as I said, I get it, but I'd argue that those factors are not always controllable. In general they are, but not for everyone.

[AOII Angel]

Originally Posted by Drolefille

Yeah as I said, I get it, but I'd argue that those factors are not always controllable. In general they are, but not for everyone.

And they don't care. It's all the bottom line.

In the end, I think we are essentially on the same page about HCR, Drole.

[PeppyGPhiB]

My mother has been struggling to control her type II diabetes since she was diagnosed with it nearly 10 years ago. First the doctor and dietitians worked with her on controlling it just with diet. She made a ton of progress, lost a lot of weight, eventually retired (which happened to also improve her health), but even after all that work, her blood sugar readings and organ functioning tests still aren't good enough. So now she's finally on insulin...after all this time. Diabetes is extremely hard to control, even with medication. And to punish people for trying to control it is WRONG. Since your company owns the HMO I'm sure they know what happens to their employees when they don't treat their diabetes.

I would be furious if my company went with an insurance plan with a list of qualifications like that. Pretty much the only group of people that qualify for those low rates are young employees, since high blood pressure, high cholesterol, weight gain and diabetes are common in older demographics.

[AGDee]

I feel the same way emotionally about it, honestly I do, but I understand the overall rationale also. For every other type of insurance, higher risk factors make your insurance go up but this has not been true of health insurance. If you have tickets, drive a certain type of car (high theft risk) or drive a lot of miles for your work, live in a certain area.. your auto insurance rates go up. If you live far from a fire hydrant and fire station, in a shady neighborhood, or if you are a smoker, your home owners insurance goes up. If you make frequent claims on either, your rates go up. We are used to that and never complain about it. Should healthcare be different? I was spitting nails when they first announced it, and when they released all the increases in expectations over the next few years too.

I believe this is a trend that you can expect to see grow. Blue Cross in this area started it with their Healthy Blue Living plan. Then our system's HMO picked up on it and implemented it. It started with us getting a bonus if we completed a health risk assessment and did some online educational modules that addressed the areas where we were lacking. The next year, we had to do the risk assessment, complete a module and see our PCP once and do our annual screenings (pap, mammogram.. nothing for men, I might note) to get the bonus. Then they switched it to "You have a $1000 deductible and your co-pays are doubled but you can stay at the same old rates if you do..."

THIS is also the reason I'm against a single payer system. I believe competition among health insurers is important in helping keep costs down and giving consumers a choice. I would like to see this totally removed from the employer though. When you work for an employer that owns a HMO, guess what insurance you get? We have the option of Blue Cross, but it is so incredibly expensive in comparison that nobody can afford it, except maybe the doctors/PhDs. I would like to see employers give health insurance vouchers that are good for the insurance of your choice instead of giving you the options that they choose and that are cheapest for them.

Also new this year is that we can only use system pharmacies to fill our prescriptions or they will not be covered. We used to get significant discounts if we filled a 'script at a system pharmacy but now it's required. There are a couple exceptions, like urgent medications such as antibiotics needed, so you don't have to drive in to work to fill your prescription when you have pnuemonia. We can fill 3 prescriptions over our LIFETIME at another pharmacy. So, if you're on vacation and you run out of meds, you can get it filled elsewhere. But only 3 times.. lifetime.

I understand the idea of supporting the system you work for.. the "I work at Ford, I drive a Ford" mentality and I very well might do that anyway, but I want a choice, especially since 70% of my co-workers have access to my health information.

Also Peppy, African Americans have significantly higher rates of hypertension demographically.

On the flip side, there are several people in my department who have become motivated to lose significant amounts of weight. It may be most effective among that group. I was a little peeved that I lost my 58 pounds right before this went into effect..lol. I gained some when I broke my foot earlier this year. I'm trying to get down now to the weight I was the last time I saw the doc so that I'm breaking even for this year. Interestingly, some co-workers have been overheard talking that they are going for exactly 5% of their body weight each year because they are afraid if they lose too much in one year, they won't be able to qualify the next year. Losing 10 pounds a year sounds reasonable to them. I'm taking the opposite approach, I just want to get to the acceptable range this year so I don't have to worry about it anymore. I wanted to do that anyway

[Kevin]

The folks in D.C. who kept the tax cuts for the wealthy whilst extending unemployment benefits from ridiculous to ludicrous length are complaining that something might negatively impact the deficit?

[AGDee]

Originally Posted by Kevin

The folks in D.C. who kept the tax cuts for the wealthy whilst extending unemployment benefits from ridiculous to ludicrous length are complaining that something might negatively impact the deficit?

Not sure which articles you were reading, but everything that I read indicated that the original bill by the Dems did NOT include those tax cuts for the wealthy but that one failed because the Republicans insisted that they'd only vote for it if it included an extension of all the Bush tax cuts, not just the ones for the middle and lower class.

Additionally, the Republicans argument for rolling this back is that the plan itself would increase the deficit too much. This is the counter argument that rolling it back would increase it.

Lastly, the title of this thread is actually not very accurate because it wasn't the Dems who said this, it was the CBO:

Originally Posted by DaemonSeid

The nonpartisan Congressional Budget Office (CBO) just released an estimate of the Republican bill to repeal the Affordable Care Act and finds the GOP plan explodes the deficit and will have a devastating impact on the health of millions of Americans.