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Tuesday Talk: What are your thoughts on the ACA?

December 03, 2013 By Joe Sheeran, Communications Director

Conservatives want to declare the new healthcare law a train wreck, hoping that we'll turn our backs on affordable healthcare. It's not and we won't. We need solutions, focusing on delivery real affordable healthcare choices to people.

This morning between 8 and 9:30, Colleen O’Connor Toberman, a MNsure navigator and Minnesota 2020 Hindsight Fellow, joins us to provide a ground level view of Minnesota’s exchange and what challenges remain for the national exchange, Healthcare.gov.

What are your thoughts on the ACA so far?

What questions do you have about the exchange?

 

Post your comments or questions in the box below, scroll down to see the ongoing conversation, and use "refresh" to see new comments. 

Thanks for participating! Commenting on this conversation is now closed.

26 Comments:

  • Rachel says:

    December 3, 2013 at 9:00 am

    Good Morning all! Colleen will be joining us shortly.

    To start off, we’d love to hear your thoughts… how have the many pieces of the Affordable Care Act impacted you?

  • Jeff Spartz says:

    December 3, 2013 at 9:03 am

    Sadly, it has been a near train wreck. I worked in the systems industry during my misspent youth and we never put a system into production without rigorous testing. It’s now becoming apparent that Healthcare.gov received virtually no testing before going into production. No one should be surprised at the number of bugs in the system due to the lack of testing.

    It would be a tragedy if the ACA fails because of this. I used to work in health care and I want to see as many people covered by insurance as possible. If the ACA fails, I probably won’t live long enough to see another president take up the issue of trying to get health insurance for all in this country.

    There is some kind of weird disconnect between policy development in the Administration and execution of policy. Perhaps it goes back to the fact that virtually no one in the Administration every ran operations before getting into the White House. This may be one of the reasons why we rarely elect sitting US Senators to the presidency. Before President Obama, the last sitting senator to win was Jack Kennedy.

    I’m not spouting anti-Obama propaganda here, my wife and I gave him money and voted for him twice.

    • Colleen O'Connor Toberman says:

      December 3, 2013 at 9:09 am

      I’ll agree that Healthcare.gov’s problems have been a real black eye on Obama and the ACA. The technology failings are shocking. I hope that in a few years we’ll look back and the overall positive outcomes of the ACA will overshadow these frustrating few months.

      I want to clarify for everyone that MNsure and healthcare.gov are two separate insurance marketplaces. Minnesota created our own exchange (MNsure) rather than opt for the federal exchange (healthcare.gov). I think we can all agree that was a wise choice. While MNsure’s had its bumps and challenges, it is far, far more functional than healthcare.gov. I don’t want people to be scared away from using MNsure because of what they’ve heard about healthcare.gov.

    • Bernice Vetsch says:

      December 3, 2013 at 11:34 am

      The question I’d ask is why, oh why, was the contract let to a huge Canadian company that subcontracted pieces of it to who-knows-who or where. 

      When our government thought it was ready although it actually wasn’t, the Canadian company rep. said it at a hearing (senate? house?) wasn’t their responsibility to decide when it was ready to go.

      I think it may be part of the silly belief pervading our government since Reagan that the private sector does everything better, when in many cases—including this one—we would have been better off to hire proven experts as federal employees to create the system and provide oversight over all subcontractors.

      • Colleen O'Connor Toberman says:

        December 3, 2013 at 11:46 am

        I agree that the technology rollout has been quite an embarrassment. It’s worth noting that this was a rush job, since there has been years of figuring out the nitty-gritty details of how the ACA will work, court and legislative battles, etc. Minnesota only had six months to actually build its own exchange (and yes, somehow we still did better).

  • Colleen O'Connor Toberman says:

    December 3, 2013 at 9:05 am

    Good morning all. I’m looking forward to our discussion today.

  • Colleen O'Connor Toberman says:

    December 3, 2013 at 9:22 am

    One reason for my optimism is that my role as a MNsure Navigator has allowed me to see firsthand what relief affordable, decent health insurance can bring. Just yesterday one of my clients enrolled in a new plan that will save him $4,000 a year in premiums/copays/deductibles. He doesn’t even qualify for tax credits, so it was simply a matter of having lower-cost plans open to him than there were before. He had previously been denied coverage because of his high cholesterol and was forced to enroll in the state-run high-risk insurance pool (which is going away).

    I’ve seen other folks save $700 a month (that probably kept that client out of foreclosure), $1000 a month, and other great savings. I’ve also had people who are enrolling in health insurance for the first time in many years, or even ever. The relief they find from having affordable insurance and access to medical care is really incredible.

    I find it so sad that in the past, health insurers could deny insurance to sick people, just making them sicker. The elimination of pre-existing conditions is one of the biggest changes that’s giving people better access to insurance (and who misses filling out those long health history forms and hoping your answers didn’t disqualify you?). Another big change is developing this one-stop marketplace, making insurers compete better for your business and making it easier to compare plans and costs side-by-side. Both of these changes are huge and that’s not even getting into the expansion of MA, tax credits, and other affordability programs.

    • Joe says:

      December 3, 2013 at 9:39 am

      What about the criticism that the majority of folks signing up are mainly enrolling in the public portion, and very few are buying from private insurance companies?

      • Colleen O'Connor Toberman says:

        December 3, 2013 at 9:47 am

        It’s definitely a fact that the majority of new insurance enrollees are enrolling in Medicaid or other public plans. Experts have said that they expect that to balance out somewhat, since very poor people without insurance are most likely to enroll right away, while other people might take their time switching from their current plan to an exchange plan. But yes, the majority of exchange customers are expected to be Medicaid enrollees.

        I’m not enough of an expert to understand all of the implications of this. In the short-term it’s expensive (at least for the federal government, which is picking up most of the tab for newly-eligible Medicaid enrollees for the first couple of years). But study after study shows that access to affordable preventative care decreases health-care costs, and that access to affordable primary care decreases ER visits and uncompensated crisis care. So I’m hopeful that we’ll see better health outcomes and lower costs in the long run. Of course, I think it’ll be years before we can fully judge the effectiveness of the ACA. Right now we’re in a big, challenging marketplace shakeup. These new provisions are a total game-changer in so many years.

  • Joe says:

    December 3, 2013 at 9:23 am

    Colleen, can you tell us a little about your early success as a navigator? How are things going in Minnesota?

    • Colleen O'Connor Toberman says:

      December 3, 2013 at 9:41 am

      In addition to the successes I mentioned above, I do want to draw attention to the expansion of Medicaid (we call it Medical Assistance in MN). Increasing MA eligibility and access in Minnesota has really helped us a create a decent spectrum of affordability assistance. MA, Minnesota Care (similar to MA, but with sliding-scale premiums), and tax credits will assist the majority of people who struggle to afford the full cost of health insurance on their own. (This spectrum isn’t perfect, of course; people will still fall through the cracks or struggle to afford what MNsure determines they should be able to pay—for instance, if they have high debt or other financial drains).

      In states that haven’t chosen to expand MA, there is this awful gap in which low-income adults still can’t obtain affordable insurance. Essentially, people with incomes below 200% of the federal poverty level (FPL) aren’t eligible for tax credits to lower the cost of private insurance plans. People below 200% FPL are highly unlikely to afford private plans without tax credits, so they have to rely on goverment-run programs like MA. In Minnesota, MA and MinnesotaCare cover the full spectrum from 0% FPL to 200% FPL, but many states have rejected expanded MA eligibility and don’t offer other options (particularly for childless adults). These people fall into a doughnut hole, unable to qualify for government insurance and unable to afford private insurance. Their access to medical care hasn’t improved at all. It’s a really serious issue in many states.

      For anyone interested in this issue, I’d highly, highly recommend this read: http://www.texasobserver.org/a-galveston-med-student-describes-life-and-death-in-the-safety-net/

  • Rick says:

    December 3, 2013 at 9:49 am

    I’ll just share a brief story of my own. After working and living in a “universal healthcare” country for 3 years, I came back this summer to Mn. and had to find insurance as a self employed business person. While being in my fifties, healthy and fit, with no pre-existing conditions, I applied for an individual policy. I was denied by mail barely after I submitted the app. online and was immediately pushed to the “high risk” pool. I called and was told I needed a thorough exam at my own expense which was significant. And, even if everything was good, there would be no guarantee of approval. Personally, I am very thankful for the ACA and MNSURE. Despite the disappointing rollout, I’m confident this will work.

    • Colleen O'Connor Toberman says:

      December 3, 2013 at 9:56 am

      I share your optimism, and I’ve met a lot of people with stories similar to yours. Thanks for sharing! Have you found a better option through MNsure?

  • Joe says:

    December 3, 2013 at 9:51 am

    I know this is a sore point in Minnesota, but it seems things like the medical device tax are critical in helping finance the additional MA enrollments. It seems logical that if more folks have insurance more folks will be able to buy medical devices and thus balance out the tax for those companies. Why are some of MN’s normally progressive congressional members fighting this?

    • Colleen O'Connor Toberman says:

      December 3, 2013 at 10:12 am

      That’s beyond my sphere of knowledge, but a great questions for discussion. Does anyone else have thoughts on that issue? Will medical device companies stand to benefit in the end with greater access to medical care?

  • Rick says:

    December 3, 2013 at 10:03 am

    Colleen:
    I’ve narrowed my choices down on MnSure to about 3 policies. I’ll make my choice here in the next week or so. Thanks!

    • Joe says:

      December 3, 2013 at 10:28 am

      Rick, let us know what you choose. We’d also invite you to submit a commentary on your experience that we can run at MN2020. Shoot it to me at .(JavaScript must be enabled to view this email address)

  • Colleen O'Connor Toberman says:

    December 3, 2013 at 10:36 am

    Thanks to the folks who weighed in this morning. I’ll keep checking back in throughout the day to respond to comments and questions as they arise.

    • Arty Dorman says:

      December 3, 2013 at 11:10 am

      I have been fortunate as far as having health insurance either through my employer or my spouse’s employer,  but thanks to the ACA, we are also able to cover our 24 year old daughter who is working 3 part time jobs, none of which offer insurance, while she gets herself settled career-wise.  Aside from that, I agree that the roll-out of the exchange has been a disaster, but mostly from a PR perspective.  There is nothing that can’t be fixed and improved.  What is critical is that we took the first step toward more inclusive and equitable access to health care - not yet universal care, but at least forward movement.  To give up on the ACA because of these early stumbles is the epitome of throwing out the baby with the bathwater.

      • Colleen O'Connor Toberman says:

        December 3, 2013 at 11:48 am

        I agree 100 percent. The ACA has already had a lot of positive effects beyond the exchanges, and we’ll continue to see a lot of positive outcomes. In the long run, a few months of a bad website is only a hiccup.

  • Kurt Anderson says:

    December 3, 2013 at 11:48 am

    Because you had already decided how the discussion should resolve itself, I did not bother attending your discussion.  However, as a self-employed purchaser of insurance, who generally supports Obomneycare, here is how I described the experience in a previous message to my friends:

    I realize you are not waiting at the edge of your seats for the next chapter in this saga.  However, as non-group insurance purchasers we seem to be a bellwether on the success or failure of Obomneycare, and an update to the gloomy story [in a previous episode] is in order.

    We gave up on the MNSure site [after repeated technical problems with it] and worked thru the Blue Cross site.  I was about to give up on that as well but as I was scanning and OCRing months of paper mail (don’t ask!) I came across a BCBS brochure that seemed to offer a better alternative.  Sure enough, we are now enrolled in 2014 plans that increase our total out of pocket annual risk (total deductibles and copays) by a “mere” 34% while cutting the monthly premium by about 16% from the current 2013 rates, and about 30% from the eye-popping proposed 2014 rates under the old plan.

    A fringe benefit of the new law is that we were able to split our policies, deductibles, and premiums right down the middle into two individual policies without worrying about present and future preexisting condition and other coverage problems.  That means that each of us cut our deductibles in half (for the same premium total) by taking individual policies instead of family policies.  So measured individually each of our out of pocket risk numbers was reduced from the current plan, but our two policies together – if we both have major medical expenses – increase our risk by the 34%. 

    Fortunately we rarely approach any of these high annual deductibles, and the only certain benefit from our insurance is the forced writedown of the providers’ bills.  For example, Blue Cross assigned a recent medical bill (from our CA trip) about 25% to us and 75% to a provider writedown.  Imagine the kinds of bills uninsured persons had to pay!!

    One final irony is that the BCBS web page also didn’t like us and we ended up purchasing the 2014 policies by telephone with a BCBS representative.

    Overall, it looks like something close to a draw, or perhaps a slight vindication of the new law, for unsubsidized* non-group insurance purchasers.

    (* to avoid prolonging the discussion I am passing over consideration of indirect tax subsidies)

  • TONY says:

    December 3, 2013 at 1:47 pm

    You maybe cant answer this but may know who can. Our company insurance broker told us that the reason the ACA plans are so cheap is that those companies only pay the first $80000 in claims & the govt picks up the rest. Is this true? If not, where can I find the facts so I can rub it in his face?

  • Christeen Stone says:

    December 3, 2013 at 1:58 pm

    I support what is being done and thank those who forged ahead to pass the bill. I am a supporter of Single Payer plan, but that wasn’t on the table. I have to wonder if the GOP and Insurance industry wasn’t able to get “moles” in there to help screw up this program. I am sure they did if that was possible. I sincerely want to see this work as it was intended to help the uninsured, we desperately need this.

  • Nancy Hone says:

    December 3, 2013 at 2:18 pm

    It is costing me and a LOT of folks a LOT more money as have now lost
    my high deductible. I have never ever made a claim. I have paid my own
    insurance since 1978 as am self employed.

    many having to take extra jobs to afford it.I saw on TV a sweet little family whose insurance


    I pay for all of my own health care. I have not seen an MD for almost 40 years because of that.
    I use natural remedies at my own expense.

    the problem that should be solved is the trillions bigpharma and the biopharmaceutical industry
    makes on sick people. it is sinful. laws should be passed in that area, not on the burden of the government
    or sick people

    • Colleen O'Connor Toberman says:

      December 3, 2013 at 2:31 pm

      It’s true that a small percentage of consumers are paying higher premiums because they had high-deductible plans whose deductibles are too high to meet new guidelines. For the majority of people, tax credits will help offset this. I’d say it’s a system that serves far more people well than our previous systems did, but it’s not perfect.

      People who really don’t want to buy insurance always have the option to skip insurance and pay the tax penalty (and be held liable to pay for any medical bills they do incur, for instance in case of a serious accident).