To: FULL SITE CONTENTS (click here).
11/7/12: Obama Wins Reelection and the Senate stays Democratic. Hurray! The last obstacle (Romney and a Republican Senate) to enactment of Obamacare (=The Affordable Care Act) is taken away. The main provisions of the bill go into effect in 2014, at which time health insurers may no longer deny coverage or charge more for people with pre-existing conditions, or exclude coverage of pre-existing conditions. Further, people with lower incomes get subsidies (on a sliding scale according to income) so they can afford to buy the health insurance. This should bring us to near universal coverage. (Just like in Massachusetts, where I live, and have RomneyCare, though Romney himself was to repeal the national MA RomneyCare = ObamaCare.) Here in Massachusetts, 98% of people now have health insurance.
Though note, the radical anti-government Republicans in the House of Representatives will still obstruct the law, and try to make it, and Obama and the Democrats who enacted the law, failures. In particular, if experience shows after a few years that minor adjustments to the law are needed to make it work better, we can count on the Republicans in the House of Representatives to block it. Hopefully any adjustments needed will be able to be handled without legislation, at the Presidential administrative level, and at the new state health exchanges.
Another issue (even now that the ObamaCare law is secure post Obama-reelection), for people only who live in the blue (Republican) states is that in many of those states (particularly Colorado,
Florida,Indiana, Iowa, Louisiana, Maine, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, Ohio, Pennsylvania, South Carolina, Texas, Virginia and Wisconsin) the state's governor or other officials have asserted it will exercise its option, given in the June 2012 Supreme Court decision on ObamaCare, not to extend coverage to a large group of pretty poor people (not covered under current Medicaid but still very low income). This even though 90% of the cost of covering those people would be paid for by the Federal Government as a provision of ObamaCare. And even though most of those people don't now get Medicaid simply because they work and make a little too much too be dirt-poor to get Medicaid. (These people who will be denied health insurance in those Red states are often called the "working poor"), and may be about 10% of the population in those states. So unlike in Massachusetts now, and the rest of the states in 2014, in those red states health care coverage will not be 98%, but maybe only 88% without those working poor having coverage. (You can verify this coming red-state non-coverage issue here.)
P.S. (Post Election). Now that the near-universalization of health care is settled, we have other really big problems to deal with. Like the debt, deficit, and Medicare costs that are on schedule to bankrupt the country. (For that matter, ObamaCare has only slight and inadequate provisions for fixing the fact that our U.S. medical system is so inefficient that costs here are double that of the next least efficient country. These costs are ruining us. Substantial restructuring is needed.) I acknowledge that Obama so far has not been that great a leader on these difficult issues, and has not been forthcoming about the sacrifices that will be needed to keep things from really going to hell.
To: BY-STATE INFORMATION AND FINANCIAL-WIPEOUT DANGERS
(click here)
The Site is About Managing Pre-Existing-Condition Health Insurance Issues Under the Current System, The Passed-in-2010 Effective-In-2014 Obama Health Insurance Reform, and the Republican (Including Mitt Romney--even after 6/28/12 Supreme Court Law-Is-Constitutional Decision) Efforts to Repeal the Reform.
The Obama Reform Will Completely Do Away With Pre-Existing-Condition Health Insurance Issues starting in 2014. (That Is, Pre-Existing Conditions Will Not Be Allowed As Grounds for Claim Non-Payment, Higher Rates, Non-Coverage, Condition Exclusion from Coverage, or Policy Recision.)
However, if the Republican Repeal Efforts Succeed, the country Will Continue to Be the Only Developed Country With Medical-Financial-Wipeout Risk Due to Pre-Existing-Conditions Traps, Inter-State Moves, Job Changes, and Job Loss. (All Republican Proposed "Replacements" to Obama Care are Minor and Keep Pre-Exisiting Conditions As An Allowed Reason for Insurance to Deny Coverage, Deny Claims, Charge Higher Rates, etc.)
10/4/2012 debate 1: Chameleon Romney Introduces New Deceptions on Pre-existing Conditions at Debate 1
As somewhat referenced here, Romney, realizing that more middle class people than he would like are realizing that they're gonna get completely wiped out financially if they wind up with a pre-existing health condition at the wrong time (if they don't live is Massachusetts, which has RomneyCare), has just sprinkled in some new assertions in the debate about "his health plan", whatever that completely unspecified thing in his mind might be. In any case, he seems to be asserting that he would force insurance companies to give health insurance to people holding health insurance continuously, either with no new law (and thus in the limited case as provided by the 1996 Kennedy-Kassebaum law of people losing employer coverage), or possibly by some new extension to Kennedy-Kassebaum (imagining that somehow the radical antigovernment Republicans in Congress would allow him to get it passed), which would be a Federal law to force insurance companies to give coverage to people with pre-existing conditions even if the prior insurance was not from a job.
As a quantitative person, a statistician, who has looked at the details of Kennedy-Kassebaum, let me point out that it involves a big trick. The big trick is that the insurance company (under Kennedy Kassebaum) has to offer you coverage if you have a pre-existing condition, but they can charge you whatever they want or need to to cover how expensive you are with that pre-existing condition. Thus, you might have had a pretty bad heart attack recently, so they can charge you $108,000 a year for your policy. There is, in Kennedy Kassebaum, a provision that, if the state you live in has chosen to set up a high risk pool to cover the people with pre-existing conditons losing job-based insurance, then, rather than the insurance company insurance with the unlimited rate, you get that state high risk pool insurance. But even in those states, the issue is how expensive it is -- that high risk pool insurance is much more expensive than insurance for people without pre-existing conditions, and may typically in the financial wipeout zone for older people, say in their 50s or 60s. I exhibit the case for the Insurance Capital of America State Of CT where the rates are here, as well as the brochure for the plan here, where we find out that you will likely have to toss in $7500 per person in addition to the high premium, which high premium itself is over $25,000 for a male in his early 60s. So this is one version of the no-details-available plan that Romney might have going on in his head. It is also just the status quo, with a small extension of Kennedy Kassebaum.
There is another possibility that the plan that Romney has going on in his head and has not given details on is to force insurance companies, via a new Federal law, to give coverage to people who have maintained continuous health insurance prior which is actually at the same rate whether or not they have pre-existing conditions, but without a mandate on people to carry coverage. This is precisely to make national what New York State has already done. For New York State now, rates are here. If you click on, say, the non-wealthy St. Lawrence County, you see that you've got $1200. a month for any adult on the cheapest plan. This is better than the CT high-risk option (up to $2700/mo), but it's still unduly expensive. That's because there is no mandate to carry coverage in New York State. People tend to not pick up insurance until they get sick. And there's also a constant possibility of a "death spiral", which is, as the problem of only the more expensive, sicker people buying insurance worsens, the rates go up and up rapidly, and soon maybe rates hit $60,000 a year. (This had started to happen in New York State when I lived there several years ago. Monthly rates on the cheapest available policy went from about $650. a month per adult to about $1150. a month per adult over the three years I lived there. This was around the time of the financial meltdown, when all of a sudden many people who weren't really, really sick decided they just couldn't afford insurance. So, at that time, anticipating the start of a death spiral where rates might hit $2000 or $3000 or $5000 a month, I rapidly left the state, and moved to Massachusetts, which had just enacted Romneycare. That insurance has served me well -- rates are much lower, the insurance company can't charge more if you have a pre-existing condition, and it's all made possible by penalizing people who don't carry insurance, that is, by keeping them from freeloading on the nonfreeloaders. And, it is well recognized by experts that the mandate is the only way to get reasonable rates without tossing people under bus once they get a pre-existing condition, without also having much more government involvement (like the government-only-insurance of Canada, or the fully run-by-government health care delivery of Great Britain).
Thus, the chameleon Romney, having said he'll repeal National RomneyCare = ObamaCare on day one of his taking office, can only have something in his mind like the current Kennedy Kassebaum / high risk pool system (very expensive if you get a pre-existing condition and you don't have humongo savings, and will throw you under the bus completely if the state you live hasn't chosen to set up a high risk pool to implement Kennedy Kassebaum), or the New York State Community-Rated but No Mandate system, where the insurance costs maybe double what it costs in MA, and further, where you can get a death spiral at any moment, and the insurance might start costing $10,000 a month or so for everyone.
P.S. I, personally, have moved from state to state kind of a lot in the last few years, completely to be in a state where the health insurance is, at the moment, safe. Since the states I have to move to for the insurance don't happen to be the same states where the work that I am most productive at, and get paid much more at, are, I no longer work. This is done because of my calculation that the, say, $600,000 I might lose in a year in one of the numerous states with unsafe health insurance is more important than the considerable but smaller amount of money I might earn by doing something productive in the economy. I'm having a really good time not working, since I have a lot of interests, so don't worry about me. But what I was producing has been lost to the economy, and, well, a pretty good amount of tax revenue paid be me has been lost that would reduce our humongous debt that we are burdening everone's children with. (This is what Romney's leave it to each state has yielded for the economy in my case.)
P.P.S. Yet another issue I can foresee with "leave it to each state" is that people can easily move between states. For Massachusetts itself, the Presidential campaign coverage has let the cat out of the bag that a person with no insurance living in State A which is not Massachusetts, where he or she may be accumulating say $200,000 a year in uncovered medical bills, or otherwise perhaps may have a serious pre-existing condition and be paying $50,000 a year for health insurance, can move to Massachusetts and immediately or almost immediately get complete health insurance for between $0. a year and $5,000 a year (depending on his/her income) under our MA RomneyCare. Well, then, we have a problem here in Massachusetts, with a big load of sick and poor and sick but not poor people from the other states flocking to Massachusetts. Then the people of Massachusetts have to pay humongous state taxes to support the subsidies needed for the new poor-sick, and rates skyrocket in non-subsidized policies with all the high proportion of non-poor sick now in the state. Thus we have a new kind of health insurance "death spiral" for Massachusetts with "leave it to each state". Massachusetts might be able to break this death spiral by rapidly enacting a law requiring say 5 years prior Massachusetts residency in order to get health insurance, but we can foresee that this might violate the U.S. Constitution for some reason, and even if it doesn't, we have to wait maybe 4 years for that to get decided by the U.S. Supreme Court. I expect some residents with foresight hear in MA are anticipating that possibility, and have an eye on an eventual relocation to some place where you don't need health insurance at all, but rather costs are low enough so you can just pay cash for care. Perhaps Panama, Costa Rica, Argentina, or Chile.
P.P.P.S. Not to mention in all of this what happens if Romney dies in office, and radical antigovernment Vice-President Paul Ryan becomes president.
10/16/2012 Romney/Obama debate 2: Romney, in his response to the final question, cites our Massachusetts 98% health insured rate (vs 85% elsewhere) as his success as MA governor, but leaves off that what he did in the state is virtually identical to what ObamaCare does nationally, including the mandate to carry coverage. Further, as Romney indicated in debate #1 and #2 both, he has pledged to repeal ObamaCare, but what most people who are not experts on health insurance don't know is that ObamaCare=National RomneyCare is, of the workable systems for healthcare, the one with least government involvement. Other workable alternatives are the full government-run paid-for-by-taxes insurance like Canada, and the fully socialized governmen-run-and-paid-for-by-taxes hospitals and doctors of Great Britain. (As discussed in comments above on the first debate, any other set of laws with less government involvement, which would keep health insurance and hospitals private, and keeping it optional for people to have insurance, fail, as health insurance under them is really expensive, because people game the system and pick up health insurance just when they get sick, and otherwise freeload by going to the emergency room for care with disguised identities so the hospital can't collect when it bills them. This is why, all of the other industrialized countries, which by now have for a long-time (20 to 100 years) had universal health insurance coverage, use either the ObamaCare=MA RomneyCare system, or the Canadian system, or the British fully socialized system -- nothing else can work.)
Further, Republican Vice Presidential Candidate Paul Ryan's "Ryan Plan", announced in 2010, (see here), would, take Medicare, now covering people 65 and over with a premium not dependent on pre-existing conditions, and, starting in 2022, convert it to mainly private plans which are under the bill allowed to charge much more or deny coverage for seniors with pre-existing conditions. Though subsequent documents on Ryan Budget Plans become ambiguous with tricky wording on whether seniors with pre-existing-conditions will wind up paying more, since Ryan, Romney, and the Republicans have all made clear that they are determined to repeal Obamacare and keep the current premium-may-be-much-much-higher with pre-existing conditions for people under 65 rules, we should assume that there is a good possibility that they will switch Medicare to the same higher-premiums-for-pre-existing-conditions systems that they have already at times indicated.
Even if Paul Ryan doesn't lead the Republicans into extending pre-existing-conditions problems to seniors on Medicare, he, as well as all the other Republicans, are intent on repealing ObamaCare and keeping people below Medicare age on a pre-existing-conditions-nightmare set of laws, and also raising Medicare age to 67. Thus at a minimum from Ryan, we get a pre-existing-conditions nightmare for people until they are 67, including two new, very expensive-with-pre-existing-conditions years 65 and 66.
(You can check aul Ryan's 2013 Budget Resolution "The Path to Prosperity" (here), and see on p. 5 the ObamaCare repeal. Further, that his plan also calls for raising Medicare eligiblity age to 67: see Ryan Medicare Plan pp. 265-267 here, and further you can check on a Google News search of both Republican-leaning and Democrat-leaning news sources that this eligibility age increase is still Paul Ryan's intent.)
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Romney Position to Repeal Above a Bit Curious, Since:
Examine Mitt-Romney's-Championed-as-Governor Massachusetts State Tax Schedule HC (=Health Care) penalty/mandate/tax forms here:
Form, at Mass Revenue Department /
Instructions (non-coverage penalty worksheet next-to-last page), at Mass Revenue Department
Form, backup copy up at my site /
Instructions (non-coverage penalty worksheet next-to-last page), backup copy up at my site
See Mitt Romney Championing the Massachusetts Mandate to Carry Health Insurance here
and here.
Note that the "ObamaCare" that Romney has promised to repeal is pretty exactly a National version of Romney's Massachussets "RomneyCare".
Strange Platform: "Vote for Romney to Repeal National RomneyCare"??? (Those crazy Republicans!)
Strange in-state Republican governor's platforms in many Republican States: "If Republicans in Federal Government do not succeed in repealing ObamaCare = National RomneyCare we will exercise the option the Supreme Court gave us of not extending Medicaid insurance to the working poor in our state and leave them uninsured -- despite that 90% of medical costs will be paid for by the Federal Government. We aren't generous enough in our state to raise state taxes just a smidgen to cover the remaining 10% of the doctors' and hospitals' costs, and in any case the state government I run is so inefficient that the administrative costs that we will have to pay are not say a tiny 2% like Federal Medicare, but really, really high so we just can't help those annoying working poor who make a little too much to qualify for current non-extended Medicaid! If they want insurance, let them just not bother working so their income is low enough for non-extended Medicaid." (This is the platform of the Republican governor of Texas (check here,) Florida
(check here),
and possilby also Colorado, Indiana, Iowa, Louisiana, Maine, Mississippi, Mosssouri, Nebraska, New Hampshire, New Jersey, Ohio, Pennsylvania, South Carolina, Virginia, and Wisconsin (check here).
Yet more embarassing, because in my state, Massachusetts under RomneyCare, we cover the working class / working poor by paying the full cost, not just the 10% you won't even pay. That's how we get only 1.9% of legal residents non-covered, (as here). What these Republican governors are promising to do will keep maybe 12% of legal residents non-covered, and these will be the low-wage workers in your state. Shame on you!
Amazing Success of Republican Deceptions--how do they manage to keep it up?: Since 1994, all industrial countries except the U.S. have had universal healthcare and without non-coverage or additional charges for people with pre-existing conditions. Switzerland was the last country, which switched in 1994 (check here). Still, the Republicans manage to pull one over on enough of the people to keep this health and financial security away from us. Republicans scream "socialism" about ObamaCare = National RomneyCare. I point out that Switzerland, the last hold-out country in the industrialized world, is non-socialist enough for Mitt Romney to feel it is safe to keep some of his money there (check on Swiss bank account here).
By the way, I also checked (here near the end of the page), and the Cayman Islands also has Universal Health Insurance Coverage with a mandate to carry coverage. (Romney has some money there, too -- check here.) I'm really not trying to be money- or business- bashing by pointing this out. Business is indeed the engine of making us wealthy, and having a good lifestyle. I'm no economically-soft-headed bleeding-heart liberal. But, the Republicans assert that ObamaCare = National RomneyCare = (near) Universal Health Care is socialism that will destroy our country and our wealth and the wealth of business people, and yet the business people send their wealth to two places with Universal health care. The Republicans are deceiving us, don't you see!
(Incidentally, I live in MA, and love my RomneyCare. It makes my health and savings so much more secure, particularly between and moving to different jobs. Health insurance premiums here are the same whether or not you have pre-existing medical conditions, and coverage is always complete, without any exclusion of coverage of pre-existing conditions, or any waiting period for coverage of pre-existing conditions. People who make too little money to pay the premium get the premium partly or fully paid for, depending on income. The insurance companies and hospitals are all private. All of this just like in ObamaCare.
Too bad for people in the rest of the country if enough people who don't have a good grasp on the rate-dynamics of cherry-picking-allowed insurance want to repeal the extension to the other states. My main worry for us here in Massachusetts is that Romney, by not allowing RomneyCare to extend to the other 49 states, will be setting us up for numerous people with serious pre-existing conditions from other states to move here for the insurance. These people moving in from other states would break our state lower-income-insurance-subsidy budget, and generally cause premiums to go really high -- due to lots more really sick people now being covered. Thus, Romney would be wrecking the system he created here. Thanks a lot, Mitt.)
Note on Minimal pre-2014 ObamaCare Provisions: Certain minor and temporary provisions of ObamaCare=National RomneyCare=the Affordable Care Act are already in effect, but these temporary provisions are, frankly, half-assed. (For example, it makes some relatively cheaper insurance available for people with pre-existing conditions who have been uninsured for more than 6 months --info on such insurance is here). The main problem with this pre-2014 insurance is, of course, that you have to play Russian Roulette with your finances to get it, by being uninsured for 6 months. The reason the legislators put in the 6 month rule is to keep too many people from getting it, to keep down cost before the main changes in 2014. Of course, seeing this half-assed temporary plan, a person not familiar with the final 2014 details could be worried that the final 2014 ObamaCare plan is just as goofy. However, actually, the final plan that goes into effect in 2014 is pretty sound -- making insurance available at a uniform rate regardless of pre-existing conditions, and without any sort of goofy requirement of 6 months non-coverage, and follows the already-tested-for-a-few-years MA Romneycare model.)
Paul Ryan: Honest, Committed Leader?? Try Paul Ryan, Sneak. (People with a good grasp on the English Language, verify here.)
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Plot below is based on Congressional Budget Office data, taken from this page. 
Who am I? I am Norm Spier, a mathematical statistician who has spent most of his life in Metro NYC, Upstate New York, and Connecticut. Recently (3/2010), I moved from Vestal, in Upstate New York, to the Five Colleges area of Massachusetts.