Senate bill fines people refusing health coverage
AP via Google ^ | 7/02/09 | RICARDO ALONSO-ZALDIVAR
Posted on July 2, 2009 5:18:48 PM CDT
Senate bill fines people refusing health coverage
By RICARDO ALONSO-ZALDIVAR – 58 minutes ago
WASHINGTON (AP) — Americans who refuse to buy affordable medical coverage could be hit with fines of more than $1,000 under a health care overhaul bill unveiled Thursday by key Senate Democrats looking to fulfill President Barack Obama’s top domestic priority.
The Congressional Budget Office estimated the fines will raise around $36 billion over 10 years. Senate aides said the penalties would be modeled on the approach taken by Massachusetts, which now imposes a fine of about $1,000 a year on individuals who refuse to get coverage. Under the federal legislation, families would pay higher penalties than individuals.
In a revamped health care system envisioned by lawmakers, people would be required to carry health insurance just like motorists must get auto coverage now. The government would provide subsidies for the poor and many middle-class families, but those who still refuse to sign up would face penalties.
Called “shared responsibility payments,” the fines would be set at least half the cost of basic medical coverage, according to the legislation.
In 2008, employer-provided coverage averaged $12,680 a year for a family plan, and $4,704 for individual coverage, according to the Kaiser Family Foundation’s annual survey. Senate aides, who spoke on condition of anonymity because they were not authorized to speak publicly, said the cost of the federal plan would be lower but declined to provide specifics.
The legislation would exempt certain hardship cases from fines.
The new proposals were released as Congress neared the end of a weeklong July 4 break, with lawmakers expected to quickly take up health care legislation when they return to Washington. With deepening divisions along partisan and ideological lines, the complex legislation faces an uncertain future.
JSandi, I am far from being a supporter of current administration, I don’t believe that they know what to do with healthcare, and I am generally opposed to mandatory-anything.
Having said that: as of March 2008 (i.e. before current economic collapse) there were approx. 40 mil uninsured people in this country, of which about 10-15 mil were categorized as “free-riders” - people who could buy some insurance and pay some money for their care but chose not to. Society tends to think of free-riders as drug addicts or illegal immigrants - and they are - but there are millions of Joe Schmoes who don’t get insurance because “I never get sick”, “I can always go to County hospital” or “my new job is going to start in 2 months so no, I don’t need that COBRA plan”. Whether proposed option is good or not is debatable, but I have absolutely zero problem with making them take some responsibility.
Wouldn’t need insurance if we brought back debtors prison.
Don’t want to buy insurance? No problem, but you will pay your hospital bill somehow, someway. I had to fork out a shit ton of cash for my child’s birth and my wife worked at the hospital, WITH GOOD INSURANCE! When the remainder was finally settled I called the hospital to complain about my bill (which had double and triple charges for certain things!) to which they responded right away with, “we can set up a payment plan based on whatever you can afford at no interest.”
Let me recap the entire thing. My wife had health insurance from the hospital for years without ever having used it. Call it, 3 years. Monthly cost for her and me was around 250ish a month. No problem with that so far. She gets pregnant late in the year. We pay our deductible, $2000 I think it was, and insurance never had to kick in. The pregnancy continues into the new year. I was informed I was going to be paying the deductible AGAIN because it was a new calendar yer. So it’s deductible per year not per “condition”. Nice… So I paid the deductible again. Wife has baby with a few small complications. I am responsible for 20% of everything the insurance didn’t cover.
THEN!!! I find out the hospital, which is the sister hospital to where she works and directly across the street from the one she works and is the ONLY hospital within 2 hours that has a mother baby unit… is considered OUT OF NETWORK which means an increased % that I’m responsible for! I’ll get to that in a min.
Moving on:
3 years of payments and no use of insurance @ 250mo: $9000
First deductible with no insurance pay out: $2000
Second deductible: $2000
20% of costs: $13,000ish
When I called the hospital to get the charges fixed I asked them “what do you do for people with no insurance?”. The lady responded they provide a discount that she wasn’t willing to share with me. I had my wife investigate. The “discount” is over 80% and most times, especially for child births, is simply written off. NOW GET THIS: While I was getting my bill fixed for the double and triple charges, which the hospital admitted they were in the wrong, they sent my bill to collections… That was another fiasco.
So after all is said is done, I paid out the f-ing ass for being responsible enough to have insurance. I eventually negotiated with the hospital at the upper management level concerning the “out of network” BS and the fact my wife is an employee etc. to a number (of the 13k) that we were both happy with. While meeting with these guys, they made the comment that they have been hemorrhaging cash with the amount of non insurance no pay people, that they have to milk every single dollar they can where they can. Great business plan fellas.
Nowadays, my wife has a new job with health care provided free for her. My department takes care of me and on top of it I have what is called a surgical and hospital plan that is around $22 a month that covers 90% of costs associated with major medical issues. Anything that I am hospitalized for and/or need surgery for. The stuff insurance is meant to protect consumers from. I know plenty MDs around here and between being friendly and my departments health care I’m covered. My daughter has her own plan (it was cheaper that way) that has full coverage.
What does a Dr. office visit cost? $200? How often do you go? Other than physicals which the department covers, I don’t think I’ve been in 5 years, maybe longer.
YVK-Take responsibility? How about they pay their bill, or they have payroll deductions, or they take out a loan? Like the idea of debtor’s prison also. The majority of the so-called uninsured are illegals. They deserve nothing but, if they show up at the emergency room, they get taken care of. 12-15 million chose not to have health care b/c they are young, independently wealthy, stupid, etc. See above ways to be made to pay.
The CBO estimated the current health care bill would increase coverage to include around 15 of the so-called 48 million uninsured. Let’s look at that.
Approx. 20 mil are illegal, they deserve nothing. Let’s go with the low estimate of 12 mil choosing not to have health care. That leaves 16 mil. that do not have health ins. But wait, if they go to an emergency room, they get care. Let’s put that to the side for now. 16 mil out of 300 mil: roughly 95% of the population has health care or chooses not to have it. I’d say our health care system is ok. But you want to penalize people for refusing insurance. It is their right to choose not to. The minute you say they should be penalized for a personal decision, you open up pandora’s box. Why do they want these people to pay? Because they know the system will be outrageously expensive. Can you say 45-50% overall tax rates, as in European countries? Lived there, the rates are that high.
10-15 million people who can pay for their care but don’t isn’t “a few folks”, it is freaking 15 mil. No, it isn’t the sole cause of health care cause, but it is a sizable chunk.
Learn to make intelligent points 'cause you are not making any 2. Learn to spell “prostate” correctly.
6933:
I actually stated that “whether proposed option is good or not is debatable”, i.e. I didn’t endorse it.
I’ve lost you a bit at the areas which I highlighted. There are 12 mil who choose not to have insurance while they can. Those are my primary “targets” - and I think you and I agree they should pay for their care. That leaves 16 mil who have no means to obtain insurance. Your statement about “their right” (above in bold) - are you referring to 12 mil of free-riders or 16 mil of truly uninsured?
ZDL: you probably figured it out, but those “write-offs” for people who have no insurance aren’t really write-offs; they are paid by means of triple-charging you and everybody else who has insurance.
People think about this for one minute. Name one program that the government manages that works. Social security is a joke. If these whores really cared about us common folks they would give us the same program that they have. You know which one right? The one that requires no payments and they get the best health care available. Or how about their pension plan. The one that pays for the rest of their lives after serving one term.
These whoes are running this country into the ground and it seems like every 24 hours they come up with another quick fix plan that they drafted in 5 minutes.
Wife is a doc, you should hear her now. Not only will we pay more taxes because we are ‘rich’, they will tax our health care (along with a lot of other people), and my wifes pay is going to eventually get cut. Talk about triple billing.
Notice how Obama’s plan doesn’t mention lawsuit reform and liability? Lots of those ‘needless’ tests are for CYA, a pushy family with no med knowldege (or worse a little bit), or ‘needless’ only in hindsight.
You cannot have universal health care and have 10,000,000 illegals here. We all will have to wait in line for care, because if we go to the emergency room they will fine the b’Jesus out of us, but illegals will only be able to go to the ER and the front of the line.
There are a lot of problems with health care. Get sick, lose your job and you eventually lose coverage. That’s not right and should be addressed.
The odd thing is, the wife is a doc, but if I got really sick, we couldn’t pay for care out of pocket. Something is wrong there.
That, and Barry keeps talking about preventive care, IF you can get people to go to the Doc once a year, and if there are enough primary care doc available, WHAT happens when you are ‘fat’ for more than two years in a row? We are going to end up with Black market twinkees and pizza. Won’t do anything about not being healthy, how about fine. Of course illegals and slackers won’t have to pay.
I know a little extrapolation, but nothing that is out of the realm of possibiility.
Just wait till people see how much free health care costs.
Not advocating free health care or any government ran program at all. I’m not even faulting the insurance company matter of fact. I should have read the fine print better. Lesson learned. I do blame the hospital for double and triple charging me, intentionally, to cover the degenerates financial responsibility.
Pay your bills people. Don’t buy bullshit policies. Use the free market to cast your vote on the current health care system. I’d venture to say that if people actually paid their bills through payment plans with the hospital, the hospitals would fare better. Pipe dream for sure but it begs the discussion. Only a course of action containing such drastic shift in cash flow would cause insurance companies and everyone else involved to change course.
I still default to the idea of debtors prison though.
Wait, Wait…Yes!!!I finally I understand Obama. When he say’s Overhaul Healthcare what he really means is Ruin…Or no, NO. He means Rape Health Care, Yeah that’s what he means. Whew…I didn’t think I was ever going to understand what the Hell he was up to. That’s a Relief.
Taking responsibility is making them pay their bills – garnish wages, etc until they are paid. Not forcing people to “buy insurance.”
Also, of that 40mil, a very large portion are not permanently without insurance, but may be between jobs. This survey that generates this number basically asks if they are without insurance at any time during the year so the number is a BS number
i’m not sure what the answer is. i know we need one, though. medical care has gotten out of fuckin hand, as many of you have already stated.
i’m a disabled vet- i have VA coverage for life (or at least until they do away with that). I’m also basically self-employed. no one will insure my wife, due to her medical history- so i cant even GET insurance for her. i just write a check when she goes to the doctor… excruciatingly expensive, i might add.
i had private insurance for myself and my boys… until i went to the ER one night for a chronic service-connected condition… somehow- don’t know how exactly, never did get a straight answer- i ended up with a $6,400 bill from one night in the ER and a couple of blood tests. i wasn’t even admitted- i have to pay 20% of the total bill, so i didn’t want to soak up a huge bill from being admitted and all the tests and crap they wanted to do to me. so, because i refused to be admitted, the insurance WOULDNT PAY FOR THE ER VISIT!
i expected the $22,000 bill for my last born’s delivery… as i said, no one will insure my wife. we saw that coming. but I’m supposedly insured- $6,400 for a fuckin ER visit? and you know what? it would have cost me LESS had i not had insurance at all, because i would have been elligiable for the their uninsured patient discount!
so now i have no insurance for myself… just VA. i just make damn sure i don’t get hurt/sick. i hate the VA.
my wife… God protect her, cause if she ever needs anything major, it’ll be out 20, 50, 100K just like that.
Those who don’t have insurance but could if they wanted to are not freeloading. They pay their bills when they come – they choose to pay cash for services etc. Those people are a non issue in terms of the “health care crisis.” The govt wants these people to have coverage as a way of extracting $$$ from them. This won’t make a bit of difference to the cost of health care for everyone else.
The problems are the ones who don’t have coverage because they cannot afford to or otherwise cannot get it. That is much smaller than 40 million. Illegals, drug users, etc. My wife is a nurse and sees these frequent fliers all the time. Forcing me to pay for those peoples coverage is ridiculous.
Do you want to know how to solve it? Get rid if 3rd party payers as the first in line to pay. Get rid of govt mandates and community rating. Go to “consumer directed” health care where each person is in charge of paying their own bills and has insurance as a fall back for catastrophic need. These are the so-called high deductible plans. You pay your families first 3000 or 5000 in bills and after that they cover you at 80 or 90% or whatever. This way you don’t waste healthcare dollars that you are responsible for. This is the sort of plan we have through my wife’s hospital job. She works part time so we have to pay about $2500 a year anyway for a family plan. If she worked full time (she works 28-30 hours a week on average, I think full time is 36 hours or more) that would be a “free” plan. We have to cover the first $5000 (it was $5000, it may have gone down a bit this year) of costs except for routine well-checkups which we only pay a $20 co-pay for. After that it is 20% we pay up until some limit at which point they pay 100%. We stick $250 a month about in our HSA so that if we do need to pay for something, the money is there (untaxed). It is still cheaper for us than the $750 a year family deductible plan which costs like $450 or more a month. We have 2 kids. Our normal yearly costs for healthcare, not including the high deductible catastrophic plan fees, is less than $1000 a year.
Everyone (almost) should be on such a plan. That alone would drive down healthcare costs as people would be aware of what they pay in healthcare and would be wiser in their use.
The more government has become involved in healthcare the more expensive it has become.
No, it is not true. Nobody can afford current healthcare rates out of pocket. I do see my patients’ bills once in a while and they are incredulous. I could go broke easily if I paid out of pocket what my hospital charges for my services. Those “self-guaranteed payers” pay fraction of their bills, and then most of them drop off from long-term care, just to come back through ER in worse condition. And, unless I can figure their med regimen through 4-dollar Walmart’s formulary, they don’t take pills.
Those people are just the same uninsured as other uninsured are in terms of societal burden.
This is a good plan, although it implies you can afford $5000 out of pocket; many families can’t. I wonder if your wife works for an IHC facility, because the plan you’re describing is similar to mine. As much as a bad rep IHC gets, it is actually one of the most, if not the most, efficient healthcare system in this country with very good quality of care.
This whole thing pisses me off to no living end. Seriously, I’m sitting here fuming now, and that’s just from skimming the thread.
Solving healthcare with more insurance is like plugging the holes in a leaky dam with sticks of lit dynamite.
Healthcare reform is always talked about in terms of “health insurance coverage for all” but no one wants to acknowledge that health insurance itself is the MAJORITY of the problem! The whole system is completely fucked up, and there’s no better way to say that. It’s just fucked up.
I don’t want socialized medicine to become official policy, but let’s admit that the insurance system we currently use is really just “privatized socialism” anyway. Some people pay in more than they use, and some people take far more than they put in, subsidized by the healthy folks. It’s a damn good example of “from each according to his ability, to each according to his need”, the only difference is that there’s a corporate middle man making a killing skimming profit off the top.
Meanwhile, that system has allowed the actual medical field to become so bloated, mismanaged, and inefficient that it can’t survive on it’s own without the insurance teat, and an individual can never afford to pay the non-insurance prices. Ever really think about the extreme difference in insured vs. non-insured costs? It’s not just the difference in what you pay, but also in what the hospital/doctor accepts. The total the hospital accepts an amount from the insurance that is often far, FAR less than they originally billed. Yet there’s a fat chance that an individual can look at a $10k bill and go, “Hey, I’m only going to pay $2.5k of this, just knock the rest off” and have the hospital agree – they’ll just try and set up a payment plan :rolleyes: Yet the big reason they cite for requiring insurance is that non-insured people won’t pay their bills. Well no shit! Maybe if you actually charged everyone the smaller amount that insurance pays, then people could afford to pay some of their bills off. I don’t know about everyone else, but getting hit with a $1000 bill is unpleasant; getting hit with at $10,000 bill is a disaster.
Now about the billing itself: I have never in my life seen a more inefficient clusterfuck than the medical billing system. This is only a single example, but here’s a case study: my wife just had a baby, and had some preterm labor problems requiring her to go in and get checked out pretty often. Every time she went through the door, we’d get a new bill for about $50, which they would set up on a whole new account, each time! We literally have 25-30 open accounts with them right now, which they can’t even manage to total and explain to us so we can begin to pay it all off!
You want to fix healthcare? Abolish insurance. Make efficiency and customer service paramount. Charge everyone the same, and allow the pricing and service drive the customers to choose their doctors.
Actually, yes. We were talking about those people who do not have insurance coverage but could afford to buy it f they wanted. Those people do pay out of pocket for their medical needs. They are generally young, healthy, and/or better off. They don’t usually have many costs and I would bet that many of them live in states where health insurance has been priced out of sight by govt intrusion (NY, NJ, and any of another dozen or two progressive states) through community ratings, mandates, etc. Where a private policy can cost $12-18000 a year as it is.
Also, most doctors and hospitals have a “cash” rate. You tell them up front you are not using insurance and you are paying cash and your bill is 50-60% less than it would be otherwise.
Also, most insurance companies have brokered special rates for their policy holders (which is why when you get your explanation of benefits and/or a bill you will see [on an EOB] what was charged, what was approved, and what your share of that approved amount is or [on the bill once insurance has paid] you will see adjustments etc made to the total before insurance payments were applied leaving you with your balance). Their list rates are only charged the walk-in insuranceless folks and that is so they have something to bargain away. Very few people pay the “list” price that is charged. So if you are self-insuring, you can go in and negotiate to at least get the preferred rates insurance companies get.
This is a good plan, although it implies you can afford $5000 out of pocket; many families can’t.
Well, yes and no. First, most people do not regularly have that many health care bills every year. They may occasionally get there but most don’t regularly. THERE ARE exceptions where people have conditions or whatever which are high maintenance/cost but in general most people do not reach the high deductible and do not need to except for rare catastrophic needs. Second, these sorts of plans are usually associated with an HSA so you put a small amount aside every month or pay period that is saved in an account that you can use for health care costs. An account where the money is put in pre-tax, is used tax-free for health care, and which you own and can take with you and also which you can invest, depending on the HSA. And after retirement you can withdraw the money for any purpose, not just healthcare, though it would incur taxes like an IRA does at that point if used for non health care.
These high deductible plans are often cheaper overall than the more normal low deductible plans that cost much more per month. If you have a $5000 high deductible plan ($5000 per family / $3000 per individual like we have) and save $300 a month in premiums (for a family plan) over a $500 or $750 deductible plan (per family) you save almost that $5000 in costs EACH YEAR ($3600 plus the deductible so $4100-$4250 is what the low deductible plan costs you each year if you need at least $500 or $750 in actual healt care) and even if you don’t use it you have paid that. The high deductible plan only costs you $5000 if you really need a lot of health care in a year – we did last year with a new baby but the year before and most likely this year we will use much much less) and otherwise you are ahead. And the money you save you can stick in the HSA to cover that $5000 in case of catastrophe.
[these numbers are roughly pulled from our own plan, form memory, and are only for used to illustrate the points – there are many plans out there, some more expensive, some less, but in general the idea holds from what I have been able to see reading a health care think tank newsletter most months plus my own research]
I wonder if your wife works for an IHC facility, because the plan you’re describing is similar to mine. As much as a bad rep IHC gets, it is actually one of the most, if not the most, efficient healthcare system in this country with very good quality of care.
Yes, she does work for Intermountain Health Care (as they are called now – whoopdee do – IHC was easier to say ). Their efficiency is at least built partly on the backs of their employees who lose out. For example, nursing staff can be called at 5am the morning they are supposed to be at work at 7:30am and told they are cancelled for the day. They get 0 for that and of course they are not told until they are waking up to get ready and so it is not like you can use the day for any pre planned events. Earlier this year my wife lost significant hours and $$$ this way across several pay periods and some full time nurses were losing 25-30% of their hours or more for the pay period. Some weeks things are really full and some weeks the nurses get called off a lot. Abuse of employees. Many of her nurse friends are divorced single moms and cannot afford to not have a reliable job and be called off a lot. Her department has also been trying to put people on call without paying on-call money. They do it by only cancelling you for the first 4 hours of your shift. You then have to call in to see whether you will be cancelled for the rest of the shift. They are putting you on call but calling it something else to avoid paying the on-call 12.5% rate.
THAT is how IHC saves money. Employee abuse. I would like to see Nursing Managers forfeit the same percentage of salary as the average nurse in their department loses to being called off each pay period. Right now there is no incentive to properly staff a department since they can call off what they don’t really need so they can overstaff without cost. If the nursing manager had to lose money equal to the average call off amount in the department they would make much more effort to properly staff. Also, the executive team should also lose their salary at the same percentage that nursing and other employees are called off and lose theirs. Spread the pain.
The wife always tells me about how the management says they have to “meet their budget” which is why they aggressively call off nursing staff. If they gave a 45 bed hospital, as an example, and the budget does not allow them to have enough nurses for 45 beds, then they need to not accept patients for all the beds. If the beds are all full, they will bust their budget, and if not, then why are they getting called off? They are expected to do all sorts of in-service training, paperwork, etc. so if a day is “light” they should be able to enjoy that and get their required training done for which they are not otherwise given extra time.
The Salt Lake Valley IHC hospitals, at least some of them, were given “Nursing Magnet” status, whatever that means. But now that they have it, IHC has been rolling back some of the things they had to do to get it (I don’t know all the details but they had to have a nurse on some sort of advisory board, etc, and that has been cancelled now my wife said)
Sorry for my rant. IHC is not a bunch of angels. They get all sorts of accolades by abusing their staff.
). Their efficiency is at least built partly on the backs of their employees who lose out. For example, nursing staff can be called at 5am the morning they are supposed to be at work at 7:30am and told they are cancelled for the day. They get 0 for that and of course they are not told until they are waking up to get ready and so it is not like you can use the day for any pre planned events. Earlier this year my wife lost significant hours and $$$ this way across several pay periods and some full time nurses were losing 25-30% of their hours or more for the pay period. Some weeks things are really full and some weeks the nurses get called off a lot. Abuse of employees. Many of her nurse friends are divorced single moms and cannot afford to not have a reliable job and be called off a lot. Her department has also been trying to put people on call without paying on-call money. They do it by only cancelling you for the first 4 hours of your shift. You then have to call in to see whether you will be cancelled for the rest of the shift. They are putting you on call but calling it something else to avoid paying the on-call 12.5% rate.