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Life after Jan. 1: Kentucky clinic offers early glimpse at realities of health-care law


?Breathitt County, Ky. — The envelopes began arriving in December across eastern Kentucky, one of the sickest and poorest corners of the country.

“Dear member .?.?. We want you to be healthy .?.?.” read the letter to Mary Combs, and with it came a plastic card representing the first insurance she ever had: a Medicaid plan made possible by the nation’s new health-care law, effective Jan. 1.

Nine days into the new year, the 41-year-old call-center worker headed to the health clinic on Highway 15. She saw a doctor about her chronic stomach ulcers, had her blood drawn for tests and collected referrals for all the specialists she had been told she needed but could never afford.

The next week, she saw a neurologist, who found lesions on her brain and prescribed medicine for the cluster headaches, which are also called “suicide headaches” for pain that is far more intense than a migraine and which Combs had been treating with an alcohol-soaked cloth wrapped around her head. She lined up a gynecologist for abnormal uterine bleeding and a hematologist for anemia and an ophthalmologist for an affliction she called “arthritis of the eye,” which was diagnosed on one of the rare occasions she decided to see a specialist, a $250 visit her husband paid for by selling his lawn mower.

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In rural Georgia, federal health insurance marketplace proves unaffordable to many


If Lee Mullins lived in Pittsburgh, he could buy mid-level health coverage for his family for $940 a month. If he lived in Beverly Hills, he would pay $1,405.

But Mullins, who builds custom swimming pools, lives in southwest Georgia. Here, a similar health plan for his family of four costs $2,654 a month.


This largely agrarian pocket of Georgia, where peanuts and pecans are major crops and hunters bag alligators up to 10 feet long, is one of the most expensive places in the nation to buy health insurance through the new online marketplaces created by the federal health law. The only places with higher premiums are the Colorado mountain resort areas around Aspen and Vail, a high-cost-of-living area unlike Georgia.

“We’re not real happy with the way things are going in our neck of the woods,” said David Hardin, Mullins’s insurance broker.

All the dynamics that drive up health costs have coalesced here in southwestern Georgia, pushing up premiums. Expensive chronic conditions such as obesity and cancer are common among the quarter million people in this region. One hospital system dominates the area, leaving little competition. Only one insurer is offering policies in the online marketplace, and many physicians are not participating, limiting consumer choice.

Until these elements are brought under control, it will be challenging for the Affordable Care Act to fully live up to its name, not just here but in other parts of the country where premiums are high. Other expensive places include rural Nevada, parts of Wisconsin, most of Wyoming, southeastern Mississippi, southwestern Connecticut and Alaska.

In these places, government subsidies are shielding people with low and moderate incomes from the full cost of the premiums. Randy Gray, a flower shop owner in Albany, is paying just $32 a month, with taxpayers picking up the remaining $805.

But for those earning too much to qualify for federal financial help, the premiums can be overwhelming. A 60-year-old making $47,000 in Albany would have to pay a quarter of her income for the least expensive mid-level “silver” policy, the level most consumers are buying.

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Originally posted by 1kiki:
The problem isn't the ACA. Kentucky expanded Medicaid, Georgia did not. It's a state problem. Maybe you should put the blame where it belongs.

http://www.commonwealthfund.org/News/News-Releases/2013/Dec/States-Rej
ecting-Medicaid-Expansion-Costing-Taxpayers.aspx

New State-by-State Analysis: States Rejecting Medicaid Expansion Under the Affordable Care Act Are Costing Their Taxpayers Billions

Commonwealth Fund Study Finds Texas, Florida, Georgia, and Virginia to See Biggest Losses Among States Not Expanding Medicaid

I think we're done here.

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Originally posted by BlueHandedMenace:
Geezer doesnt get it. Or he does get it, and is deliberately shading the truth.

The people who would have otherwise qualified for medicaid, are now forced to buy insurance on their own. This is driving up the total cost of the pool of insured, thereby costing everyone more money.

If those people (at least hundreds of thousands, if not millions) were not part of the risk pool by being already covered, the cost for everyone would be lower.

Just like Chris Christie, (almost) all republican governors feel no compunction against using their constituents misery as a political weapon against their opponents.

In this case, these 20+ governors who refused medicaid would prefer their people pay more for insurance, than allow Obamacare to succeed.

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Originally posted by BlueHandedMenace:
OK, so the gist of the article is that a series of macroeconomic conditions have come together in this region and caused health insurance costs to spike.

How are these conditions the fault of the ACA again? Did ACA make people here fat? give them high cancer rates? Cause this one hospital system to drive competition from the marketplace? Obviously the answer is no, and yet...

I dont see one line of text in that article comparing the cost of insurance under the ACA to insurance purchased outside of the ACA marketplace. And yet, your only conclusion is ACA is at fault.

Kinda telling of you, as usual your partisanship is showing.

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Until these elements are brought under control, it will be challenging for the Affordable Care Act to fully live up to its name, not just here but in other parts of the country where premiums are high. Other expensive places include rural Nevada, parts of Wisconsin, most of Wyoming, southeastern Mississippi, southwestern Connecticut and Alaska.

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Originally posted by 1kiki:
The facts in the second story don't add up, literally. Even at incomes far above the poverty line - I used a family of 4 adults earning a total household income of 75,000 per year ages 52, 51, 22 and 21 the maximum they would have to pay before qualifying for a subsidy is 9.5% of their income. The only break I gave my hypothetical family was they were all non-smokers. which, according to your philosophy is a matter of choice, and the blame for that extra high premium should rest with them.

Here, play around on the website yourself:

http://kff.org/interactive/subsidy-calculator/#state=ga&zip=31701&
amp;locale=Lee&income-type=dollars&income=75000&employer-coverage=0&people=4&alternate-plan-family=individual&adult-count=4&adults[0][age]=50&adults[0][tobacco]=0&adults[1][age]=52&adults[1][tobacco]=0&adults[2][age]=21&adults[2][tobacco]=0&adults[3][age]=22&adults[3][tobacco]=0&child-count=0&child-tobacco=0

Unless the hypothetical family is making hundreds of thousands of dollars per year - in which case I don't think there should be a lot of hand-wringing over their plight - the numbers - literally - don't add up.

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Originally posted by 1kiki:
my figures, website result


Household income in 2014:
318% of poverty level
Maximum % of income you have to pay for the premium, if eligible for a subsidy:
9.5%
Health Insurance premium in 2014 (for a silver plan, before tax credit):
$25,536 per year
You could receive a government tax credit subsidy of up to:
$18,411 per year
(which covers 72% of the overall premium)
Amount you pay for the premium:
$7,125 per year
(which equals 9.5% of your household income and covers 28% of the overall premium)

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Originally posted by 1kiki:
I put those figures in. I was hoping you would be able to click on the link and get the exact same figures I entered to see where the numbers came from. The original website is totally blank.

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Originally posted by SIGNYM:
So, the numbers don't add up. But Geezer decided to pass along an inaccurate article anyway.

Go figure!

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