There’s been lots of political and economic discussion about exchanges and bending the cost curve and risk mitigation, but not a lot of real-world answers to some pretty basic questions about health care reform. Maybe you know these answers? Or maybe you’ll have a chance to ask a Congresscritter the answers?
1. We all know that Public Option will exclude people who have health care at work. Well, what happens when I get laid off or quit my job? Does COBRA constitute "health care at work?" Do I need to exhaust my 18 months of COBRA to be eligible for Public Option?
2. What happens when I go back to work after being on Public Option for six months? If my employer offers health insurance, but it’s pricey or suck-y, can I stay on Public Option, or does my new employer’s offered health care preclude my further participation?
3. What if I am transferred with my employer from one state to another that has opted-out of Public Option. and then I get laid off? Am I eligible for my previous state’s Public Option if I paid taxes there that calendar year? Or did being transferred to a non-Public Option state eliminate the possibility of enrolling anywhere after I’m laid off?
4. What if my laid-off spouse wants to join my employer-provided health care but would make my premiums a lot more expensive? Can I join Public Option when there’s a "family trigger event" like a layoff, a birth, or a marriage?
5. What if I’m laid off from my employer that covers my domestic partner too, but my state’s Public Option recognizes only relationships between one-man-and-one-woman? How does our family get health insurance coverage then?
6. What if I’m enrolled in my state’s Public Option when my state opts-out? How does my family get health insurance then?
7. What if my prescriptions hit my employer’s health insurance lifetime maximums? Can I enroll in Public Option when my employer’s plan stops paying for drugs to keep me alive?
8. What if my kid needs lifesaving treatment but it isn’t covered under my employer’s health care plan? Can I drop out and enroll in Public Option to get the help my child needs? Or does my employer’s health insurance on offer mean I’m ineligible despite its limitations?
9. If my spouse and I are both on Public Option in a family plan, and I get a job, do we need to take my employer’s family health care plan on offer? Or can I stay in Public Option as long as my spouse is enrolled?
10. What if my Public Option premiums go up so I join my employer’s plan after all, but the following year the premium expense flips? Can I re-join Public Option as a previous member, or must I stay in my employer’s plan?
11. Will employer health plans be available on Day One of employment, or will they still have waiting periods for enrollment? Can I stay on Public Option until my employer’s plan lets me in?
12. What if I’m being treated under Public Option and get a job? Will my employer’s health plan have to cover my treatment right away?
13. What if my employer drops domestic partner health insurance coverage as a cost-cutting measure? Is my partner then eligible for Public Option? Is our family eligible or must I stay in my employer’s plan?
14. What if I get promoted into a job that makes me no longer eligible for Medicaid but I can’t afford the employer health plan? Must I enroll in Public Option or can I stay in Medicaid that calendar year?
15. What if overtime pay makes me ineligible for Medicaid but I don’t drop out and take Public Option? Will I be penalized for staying in a program I’m ineligible for? What if my employer cuts my pay and I’m newly eligible for Medicaid? Will it still cover my kids’ current treatment being paid for under the employer plan?
I know that some of these questions will only be sorted out in the complex regulation-writing process at HHS and in the states after health care reform passes. But it would be nice, at least at a minimum, to see legislators recognize that the bill they pass needs to provide guidance in these areas. I haven’t "read the bill" so if some of my questions are answered there, please let me know.
With this summer’s foolishness over Death Panels and the current anti-abortion debate about the bill’s coverage of legal women’s health procedures, it seems to me a lot of real-world issues that affect a lot more people aren’t being talked about. If you have questions from your own real-world experience that you haven’t seen addressed as well, please leave them in the comments.





37 Comments
Spotlight
Support this site!
Subscribe to the newsletter
Advertise on Firedoglake
Send
us your tips
Make us your homepage
About The Seminal
Advanced search
I’m sure you have some questions from your own experience as well. Please add them in the comments. And if you have any answers to mine, by all means let me know! Thanks
Awesome list – thanks Teddy!
I appreciate the list but honestly after reading it my only question is, “Tell me again why we can’t just have single f***ing payer like everyone else on the go***** planet has had for sixty years?”
fab questions, Teddy.
I just think the entire process has been very academic and unrelated to the real world. If our congresscritters would answer some of these questions, and explain to people who face them how health care reform will actually affect them, we’d see even more support. People don’t really care, today, about bending the cost curve. We want to know whether we can go to the doctor.
These are good, Teddy, and I’m going to add a very basic one:
What exactly does it mean for an employer to be Exchange-eligible? Will all of its employees be compelled to accept the Exchange plan (public or private) that the employer chooses? Or will they individually be able to select from the full Exchange menu of plans?
One other very basic question: How do you insert that little thumbnail photo next to your post title?
Great questions, Teddy. They point out how important the details are when we are dealing with groups as duplicitous as health insurance companies and Congress.
FLD front-pagers created avatars a while back; most look like themselves, but I used this photo I took of one of the lady-bears at the SF Zoo. I’m not sure avatars are available to Seminal authors.
There’s been very little “here’s how this will work for you and your family” except for Ron Wyden’s constant reminders that the Senate bill doesn’t really offer you an option if you’re employed and have health care.
I like it when J-Rock talks about keeping your health care plan if you like it, and then Wyden says “well what if you don’t?” Seems like basic fairness, but of course it’s unfair to insurance companies. And not hurting their feelings has become paramount.
I was able to upload an avatar (pic of my feline companion) through the Profile page (same page where you can set up the link to facebook).
But don’t ask me how to actually find that again. I was just noodling around one day and got there and tried it and it worked.
Excellent diary and questions Teddy; here’s another question(apologies for not having any answers to your questions):
What in the Constitution gives the government the right to mandate to anyone that they must have health insurance?
My perspective is that the government does have the right under the Constitution to offer a government healthcare/insurance plan because of the words ‘provide for the general welfare’ BUT I don’t see where the government has the right to mandate and fine anyone for not having healthcare.
Are we all willing to trash the Constitution upon the altar of this bill?
I’m not sure about all the answers, and particularly the ones on the opt-out are unanswerable, since nobody has seen the opt-out language, but I think I can answer a few…
1. COBRA is always optional, I believe, so you should be able to drop your COBRA and go into the Exchange at any point.
2. You’ll probably have to take your employer plan (though you may be able to opt-out of it, it’s unclear). However, the House bill says your employer has to pay for a good portion of your employer plan (75% for single, 65% for families), and the basic standard of your employer plan has to be the same as the one in the Exchange, so there will likely be very little different in coverage.
4. See above, employer has to cover a good portion of the coverage for the family.
5. There are no state public options, there is a national public option, so I don’t see how this varies from state to state. That said, I’ll have to check about domestic partner stuff in general.
7. Under the House bill, lifetime maximums will be illegal.
8. I *think* you can, but this isn’t quite clear yet.
13. This can’t happen. Under the House bill, employers have to cover family benefits.
15. This one can probably be explained under current law, as people flirt with that line all the time now, though I don’t know the specific answer.
And ralphbon’s question, it’s up to the business. They could buy an Exchange plan for all their employees, or they could get a tax credit to give to their employees for them to buy their own plans.
This is one of the reasons this bill has so many pages…
It would have been simple to say “Medicare For All”, meaning from the day your born and for every American, you have Health Care Coverage. It then doesn’t matter if you quit your job, got laid off or even fired from your job, you still are covered.
Thanks for the post Teddy however we all know our solution to Health Care Reform would be much more simple.
Perfect example of why the package from congress is a package of shit. Might as well light it and ring the doorbell.
Will I be able to go to H & R Block and have my insurance papers filled out for under 100.00 each year? What will deductible limits be? How much are penalties for opting out of it altogether?
If we quit waging needless war, do we get dental?
Can those government funded Scientologists start praying for a better bill now?
I know single-payer would be the best solution. I also know if forced to choose, most members of the House and Senate would let every American who cannot afford health care die en masse before they would pull the plug on the private insurance industry.
…the package from congress is a package of shit. Might as well light it and ring the doorbell.
Can we leave it on Ms. Bachmann’s doorstep?
I mean, she *does* want to kill the bill, right?
Teddy, thanks for this great list of questions.
I only have one question. Why the hell we can’t we just have single payer?
The answer to each one of your questions is: whatever makes Big Insurance and Big Pharma more money.
Good dissection, Teddy. Do you know if answers are in the bill, or are you suggesting that these need to be addressed if they’re not? Tis sad that republicans are unable to read a bill the size of the Harry Potter series.
Speaking of the Constitution, Boehner blew it again today at Crazy Michelle’s teaparty. Pulled out his pocket copy of something or other that he called the Constitution, and then proceeded to recite the preamble to the Declaration of Independence.
Seems to me he’s done this a time or two before.
Damned tanning beds. Fried his brains.
Thanks Teddy for your comprehensive list.
How’s the city tonight??
I don’t know if this will hold but you could argue that in order to provide for any common good everyone needs to take part.
As regards health care, the premise here is that having health insurance is a common good. So everyone needs to take part. What needs clarification is whether paying private insurers is the same as taking part.
The analogy is Medicare where we deem it a common good that elderly people have health insurance and that everyone take part by paying taxes.
In the first case the results are bad and in the second they are good. but the underlying argument,I think, is the same. No?
Question #978 What if the Progressives of today had been in charge of movement for racial equality of the 1950’s and 60’s?
(A) We would still have segregation, and would be debating about whether there were enough votes for a ‘desegregation option’ for drinking fountains, that would be gradually phased in by 2019!
99 problems but a clear moral purpose sure ain’t one, for the valiant “Public Option, whatever that is, someday, please” movement.
Teddy P, you are incredible.
I have other questions but they are all about the bills at hand, what they mean, and who gets what.
YOUR questions bring it all back home to US, we the people, of all stripes.
And that’s what the fucking Public Options bullshit are lacking at this point.
When’s it about us?
And our politicians so far, other than Rockerfeller, seem to be fighting a fight that don’t really behoove their constituents. They ain’t goin to the mat for us, they ain’t laying their careers on the line for us, they ain’t doin SQUAT for us.
Damn, your questions should be sent out en masse, daily, till our pols fax machines, emails, phone lines break.
And then, the same questions should flood the media, till their faxes, emails and phones break.
Question, after question, after question.
To point out, the politics are failing us, we the people, and ALL of them are held accountable for this.
Bless You, Teddy P.
Rightous, hoss, very, very rightous.
*bows*
I love it when you get all snarky bitchy and such, yer usually such a kewl kuke! *G*
Rant on, hoss . . *G*
Will those on Medicaid be able to switch to the public option? Will the public option guarantee dental care? Will the PO close the two year gap between receiving Medicaid and then Medicare? Will lower cost insurance paid for by the PO be accepted by all providers or will it continue to support or increase the predatory substandard care system, which is the only available health care for the poor and disabled?
One question I have. What if(just having a little fun) Dickhead Armey is right and we are all over insured? Won’t insurance company revenues drop a lot? And what’s wrong with having just catastrophic coverage?
And think of all the other tough questions you might stumble upon as this charade continues to “passage”. But the one question that I can’t get a legitimate answer to is “why do we have to wait 3-4 years after the legislation is passed and signed by the Pres? All these real questions tell me there are too many obstacles taking this approach to result in any meaningful reform. Not worth all the time, energy, and frustration. Single payer is the only way to do this, the only approach that will result in meaningful reform and cost almost nothing. I’ve been using it for 2 years now and it’s great (Medicare). We already have it.
Who cares about any of the details, or if it will really help people. Barack W. Obama will have passed “landmark healthcare reform” and all of the conditions that cause us to spend more than twice that of any other nation per person on healthcare will still exist.
pull yourself up by your bootstraps or something, now watch me hit this drive
If you think this bill is designed to help YOU out, you are out of your fucking mind. All it does is give more power and money to the companies who shit on sick people everyday, after skimming doctors’ pay off the top.
Those are fine questions deserving of a clear answer before implementing such a hea;th care deal.
What of a high risk dare devil or say a bad Formula race car driver that is aleays in harmful wrecks?
The Evel kneivel that risks jumping Grand Canyons on motercycles. Breaks every bone in his body for fame and fortune?
Will he have the same premium as the Librarian?
One other thought,
Why is it that in most all other industries in America. We have competing choices. Like Toyota and Honda vs Ford and GM. But we have no foriegn health insurance companies competing in the U.S. ?
Why is that?
There are Banks. As Bank of Italy started out and ended up Bank of America if I recall correctly?
We have doctors from India that practice medicine here?
Can anyone think of a foriegn health insurance company doing insurance business here?
If the across state lines for health insurance is in the bill and My Governor of my red state decides to go right-postal-wing and refuse the health plan in his state.
Doesn’t the provision of crossing state lines to aquire insurance apply?
Why bother asking them any damn thing. Half will lie to you, the other half will feed you a bushel of bullshit and not answer the damn question. I do have a question for the White House, however. When do I get my seat at the god-damn table?
We all need to be asking these questions. I, for one, asked my Rep if mandating purchase of a product ( insurance) is even constitutional? Because I think that will be the part that comes into play right off the bat.That and premiums thru the roof…as IF they needed a “trigger”!!!!!
It’s starting to look like an enforced bailout on the backs of the people again to me.
One of the things which suddenly sprang to my magic mind this morning is the 2 year committee running around America to see what works best in holding down costs in the states.
OK, Why not look at European health systems as well, or is America just too good to do THAT?
I do know this that part of our overspending on health care is the heroic intervention of drugs ( which can kill) that cost the moon and surgery.
Now, in Europe, many countries use chiropractic to avoid spinal surgeries, they use acupuncture for pain, they use Feldenkrais for physical therapy ( among other modalities), massage for stress, homeopathy for all sorts of pill replacements and THAT brings the costs down because their medical delivery systems do not depend primarily on PhRMA and doctors/surgeons.
I missed alot of what Europe does in it’s health delivery systems.
Can you IMAGINE how the AMA would scream if there were alternatives to them! Look what they did with the mercury amalgams in teeth! I hear the FDA just re-approved this poisonous substance for use in the human mouth. My dentist tried to put some in my head the other day!I told him I’d rather have my tooth pulled than that stuff in my body!
Meanwhile, Europe has recognized the danger of this stuff and has either banned it altogether or uses it VERY sparingly.
So, I guess we’re doomed to the same American Exclusivity ’til the day we die to fund the status quo
Great questions! A lot of the answers can be found here: http://cli.gs/z3AtaY/