From ACA to AHCA - ObamaCare to TrumpCare

Discussion in 'Health Care Reform Forum' started by AllenChicago, May 5, 2017.

  1. toddoxley
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    toddoxley Well-Known Member

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    Do not hate the federal government, just believe there are limitations. Medicare only works well to the degree it does cause it is propped up by the private system. The VA is the closest thing we have to single payer and it doesn't work so great. Some things are best done by private enterprise not government. Do you even sell health insurance?
     
  2. FLM2
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    FLM2 Well-Known Member

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    It needs to be a bi-partisan effort, not the bs that comes from both sides.

    The only thing that can truly be done to reduce the cost of health insurance is to reduce the cost of healthcare itself and that could easily be done by making provider and hospital pricing transparent yet not a single Republican or Democrat has identified that as the primary issue.

    There are far more moderates on both sides of the aisle that need to work together to find answers-if the right had a true solution to the current status it would have been presented clearly over the past 5 years, instead we get the continuous spewing of attacks and statements like 'it's getting better every day and it will be great' by the orange buffoon in the White House, someone who doesn't have a clue about anything other than self promotion.
     
  3. scagnt83
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    scagnt83 Well-Known Member

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    That would be a network issue. Is the same happening for the Anthem Policyholders in CT?

    The comment I responded to was "NOBODY can see a doctor". Which we all know is a MAJOR exaggeration generally speaking.

    And the question I asked was "are doctors denying care to In-Network patients". Because that would be what it would take for NOBODY to be able to see a doctor.


    And how many people will not be able to see a doctor when they no longer can afford to pay for their Health Insurance?


    I never doubted that there are major issues with networks in certain states. Hell, I even said that in one of my posts! You want to cherry pick comments but not take the conversation as a whole.


    All I said was that millions are going to lose coverage because they will be priced out, or the States will eff up the High Risk Pools, or Congress will eff up the funding for the Pools.

    If you would like to respond to that feel free.

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    Amen.

    Hate, Spite, & Blame only make a bad situation worse. And they fix nothing.

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    I wonder why the client wasnt told that?

    I didnt think that FL had network issues if you were on Blue. I THINK the same goes for CT. If you want a decent network go Blue.

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    OK. Im a group agent but not ACA. Im very curious how pre-ex is a problem for people under ACA.
     
    Last edited: May 9, 2017
  4. Yagents
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    Yagents Well-Known Member

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    Your Pre-ex is not covered under ACA....... when you can't find a doctor to treat your Pre-ex condition.

    Not everybody can pay 33% more or hundreds of dollars a month to "buy up" to an EPO or PPO network (if even available). Which also contributed to the ACA implosion as the best networks are targets for adverse selection. This is why AZ went from 13 PPO carriers down to 1 HMO. Nobody took the low cost HMO each of the 3 years, which set a low tax credits, and to keep your doctors, you were forced to buy up the network and pay much more.

    (Metro Phoenix we have 300k on the ACA, the network only has 31 endocronologists, we have 12 gynecologists, 219 OBGYN's, 68 oncologists, and probably 1/3rd are listed incorrectly. The best hospital chain is not in network, and every senior in Sun City is 10 miles from nearest hospital.

    And not everybody can just choose to forgo the APTC and buy OFF exchange to avoid the O'care label.

    Try a little experiment, and report your findings.

    1. bring up the HMO carrier in your state that was the benchmark second silver plan that most subsidized clients buy.
    2. Search their network for an oncologist, or a PCP.
    3. Call a handful looking for an appointment within next 2 months.

    You will find:

    1. Even though they are on the list, they are not contracted and don't know why they continue to be listed. Too bad the client purchased based on that list. Or, they've decided mid year or stop taking or honoring the contract. Most won't file a complaint.
    2. Disclose that you are on Obamacare and ask if they will see you. You will feel the scarlet letter "O" on your chest.
    3. Good luck getting in within a couple months to treat the condition due to overload of patients to doctor ratios.

    And with someone recovering from Cancer, and had a bad experience with O'care in CT and not being able to see doctors, I ain't gonna promise that FB doctors will show their love if he buys on marketplace.

    The first step is to admit their is a problem, have yet to hear it from anyone on the left.
     
  5. taterpeeler
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    taterpeeler Well-Known Member

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    So SC Agent thinks that the indy market works to a degree like group? Feels like exposing is in order regarding network issues?.... I make a deal with ya... you stay out of indy and I will stay the hell away from group.

    Lets discuss doctors.

    Several carriers that sell in the indy market do a deaming(sp) of providers into their indy plan. I found out this the hard way when Molina told me this point blank. The carrier sent a letter to All providers that were in one of their other networks and indicated that failure to respond deemed them as in network... that did not go over very well.

    Next, once the providers figured out how screwey Care was they wanted no part of it and even though they signed a contract they wanted no part and said wither not seeing new patients of were out of network.

    Back in 2014 BCBS had the same PPO network as their group(oh crap, I promised you I would stay out of group, sorry) and since they were the same BCBS had leverage to brow beat them into taking the plan by treating them that if they did not take the OCare client they would term their BCBS PPO agreement meaning huge losses in patients that worked to a degree but when they went to the separate free standing network HMO the client was SOL...

    Obamacare has failed in all the critical areas with 2 massive problems being the root. First is the marketplace being in the middle as the quasi 3rd party administrator paper pusher and the other problem which gets me called a flaming liberal by my GOP brothers is control the providers pay schedule. Control the cost and you control the rates.
     
  6. SamIam
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    SamIam Well-Known Member

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    Ummm... all those programs you mentioned are a mess or are way over budget with a lot of fraud.
     
  7. scagnt83
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    scagnt83 Well-Known Member

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    So its an issue with networks. Like I stated already. Got it.

    Im well aware that it is really bad in some states. But its not in most. I have clients with ACA policies. I have friends with ACA policies. In more than one state.

    To make some generalization that "nobody" can see a doctor is misleading at best. I pointed out in one of my original posts that there were serious network issues in some states.

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    I never said that. I just disagree that "nobody can find a doctor". Its a gross overgeneralization.

    And I would never touch an individual health policy ever again as an agent. I try to be nice to myself. Stopped selling them the day ACA started.
    ............

    I never said Obamacare is not failing. If you pay attention around here, you would have seen my many posts talking about it being a total failure and terrible for this country.

    But the current proposal is just as bad for the country. At this point in time, it might be worse, just in different ways.

    Call me a lib. Call me a commie. Call me whatever you want. Im a realist.
     
  8. taterpeeler
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    taterpeeler Well-Known Member

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    Like I said before, I live in Texas. Texas is a massive state. I only sell in Texas. i don't care about any other state because I'm a Texan first, American second. This crap don't work in Texas... never should have been passed as its should have been left to the states... little thing called states rights which is how this country was formed.

    We are rednecks we don't play nice with others. If we left this republic and went back to being our own country the other 56 could not make it without us.

    States rights should trump all else.
     
  9. Yagents
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    Yagents Well-Known Member

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    Ok, "many" can't see doctors. Agree? Not going to test it?
     
  10. FLM2
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    FLM2 Well-Known Member

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    It's not just an ACA issue, it can be just as difficult to make a specialist appointment under Medicare-I had to schedule an opthamologist visit 8 weeks out for a routine pre-cataract surgery visit with original Medicare. A week later the office called me and 'squeezed me in' for the following week.

    We all know that limited network HMO plans are worthless and I have very few clients on them because of that. At the same time most consumers have no clue about their plan and if they have a Blue Options plan purchased either on or off the Marketplace the access is exactly the same, the doctor's office can't differentiate, the only thing they know is the name of the network, copays and deductible. I would not hesitate for 1 second to advise a client to go with a Blue Options plan from the Marketplace regardless of other issues.
     
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