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tripLexie
06-28-2012, 10:39 AM
What does the AFA mean for us as Lupus sufferers? Personally, I do not like the idea of the gov't being in charge of MY treatment. Mandating MY preventitive screenings. Seizing MY medical records. Anyone (in the USA) wanna shed any light?

tgal
06-28-2012, 10:57 AM
I don't like the government being in charge of anything of mine either but try living with Lupus for 3 years and being without insurance for 2 1/2 of those years. I promise it changes your perspective on "we have the best medical system in the world. we don't need to change it". We do have a great medical system... if you can afford it

Derrie
06-28-2012, 11:32 AM
A massive benefit of the Act to folks with chronic illness is that we cannot be denied coverage by insurance companies because of our health status. Also, the Act prevents insurance companies from putting lifetime or annual benefit maximums on policies, which is relevant to folks with lupus who may have very expensive treatments and medications or even organ transplants. Finally, the "individual mandate" portion of the Act refers to the requirement that all Americans carry some type of health coverage. This is quite important for the other provisions of the Act to work. Because insurance companies cannot deny coverage to those of us with pre-existing conditions, if everyone was not required to have some form of health insurance, insurance companies would be swamped by already-sick people, and be forced to either drive up premiums sky-high or go out of business.

Lexie, which parts of the Act are concerning to you? I'm curious to look at what you're referring to. I don't think the Act is going to get the government all up in your healthcare choices-- more likely, it's going to keep you from being treated poorly or outright rejected by insurance companies because of your lupus.

I honestly think this is a step in the right direction to protect people with chronic illness and/or limited financial means.

magistramarla
06-28-2012, 12:00 PM
I'm in complete agreement with Derrie's excellent response on this. I was thinking of Mari and other friends with chronic illnesses when I rejoiced at hearing this decision. I would definitely rather have a government regulation that has been put there to make things fair for all than to have some insurance official whose mandate is to guarantee the profits for the company making the decisions about my medical care.
I have decent insurance, but I've had to call, beg, write letters and appeal decisions to get them to pay for procedures that I needed. I also often choose to skip expensive tests that the docs want to do because the insurance company keeps raising the deductible and the portion that I have to pay for those tests.
I'm hoping that this is a first step toward having a healthcare system like those in the UK and other countries.

Mica
06-28-2012, 12:35 PM
Im still unsure about all this, mostly because i'm not fully educated on it. Problem is i think were going to find is even though we can get coverage now is that I doubt we will be paying the same price as a healthy person. I know when I had insurance all my doctor and med co-pays were more expensive than what my mother or sisters were.

magistramarla
06-28-2012, 12:54 PM
Mica,
It's supposed to end those unfair charges. Here's something that I just saw written up by a women's group.
Hopefully, it will answer your questions.

Here are some of the incredibly important protections and opportunities the Affordable Care Act offers women.
• Being a woman is no longer a "pre-existing condition." Yes, women were denied coverage for just being women before the Affordable Care Act was law.
• Insurance companies can't charge you more for being a woman either. Before the Affordable Care Act was law, women were sometimes charged up to 150% more than men of the same age.
• Breast cancer screenings, cervical cancer screenings, domestic violence counseling and screenings and a whole bunch of other preventive care measures must be covered by insurance companies.
• Birth control is now covered by health insurance.
• Children can stay on their parents' health insurance until they're 26 years old. And if you want to have kids, the law will help you get pre-natal care and counseling and help with breast feeding and supplies too.
And here are some of the important benefits for everyone.2
• Insurance companies can't take away your coverage if you become too sick.
• You cannot be denied insurance coverage because of a pre-existing condition.
• Seniors receive a 50 percent discount on prescription drugs when they hit the "donut hole."
• Small businesses get tax credits to purchase insurance.
• There are no more lifetime limits on your coverage.
• 15 million more people will receive coverage because of expanded access to Medicaid.
• Millions of Americans are going to receive tax credits to help them get insurance--people who wouldn't be able to afford it otherwise.
• 12 million seniors are currently receiving free preventative care through Medicare.

I like the part about the preventative care. I remember years ago, when my kids had to have yearly check-ups that were required by the school, I was shocked when I had to pay for them out-of-pocket. The insurance wouldn't pay for preventative care. I had five kids, so that was expensive! Now, the insurance is required to cover it. I'm also happy that things like mammograms will be covered completely. I used to have to pay 20% of the cost of the test.
My daughter was severely injured in an accident when she was 21, just six weeks after she was no longer on our insurance. Her credit was ruined because of her medical expenses. With the new law, she would have still been covered until she was 26.

Now, if we can just keep it from being repealed...
Hugs,
Marla

theLword
06-28-2012, 12:55 PM
Thanks Derrie! I know there's a lot of fear that occurs when government makes big changes, but this is definitely a step in the right direction. The biggest point as Derrie has pointed out, is that we can no longer be denied coverage due to a pre-existing condition. Also, I know I have been positively affected by this because while I was in graduate school I was able to stay under my parents insurance since I was under the age of 26.

I know there are still a lot of questions that I have and the Act still needs some fine tweaking, but what occurred today is that the Supreme Court declared that the Act is in fact constitutional. There was a lot of back lash in the beginning because people felt like they had the freedom to choose if they want healthcare or not. That affects all of us because then we collectively pay higher taxes when uninsured individuals use emergency room services because they don't have the coverage to go to a primary care doctor.

The Act also covers preventative care for those who receive Medicaid, so everyone can now receive routine mammograms.

I hope I provided some additional clarification and with time we will see how the Act is implemented and what exactly it means for all of us.

ritzbit2
06-28-2012, 01:28 PM
I don't think its a perfect thing but it is such a good thing. I dont have a job, and have insurance through my parents. If I had to stop going to school previously I would have lost my insurance because I wasn't a fulltime student. Now I can stay on their insurance no matter what until I'm 26. I also don't have to worry about when I do have to get my own insurance, being denied because I have a pre-existing condition. I think there will probably still be a few changes made to it over time that will keep its purpose but upset less people. People were seriously posting on the LFAs facebook post about it that they were going to stop donating to the LFA because they didn't like that they thought it was a good thing. Blows my mind. I feel so blessed to have a family that can provide relatively cheap medical care for me, but can not imagine what its like for those who don't have that luxury. Some of my meds are hundreds of dollars without insurance and they are life saving! I can't imagine now being able to have easy access to them.

Mica
06-28-2012, 07:23 PM
I don't think its a perfect thing but it is such a good thing. I dont have a job, and have insurance through my parents. If I had to stop going to school previously I would have lost my insurance because I wasn't a fulltime student. Now I can stay on their insurance no matter what until I'm 26. I also don't have to worry about when I do have to get my own insurance, being denied because I have a pre-existing condition. I think there will probably still be a few changes made to it over time that will keep its purpose but upset less people. People were seriously posting on the LFAs facebook post about it that they were going to stop donating to the LFA because they didn't like that they thought it was a good thing. Blows my mind. I feel so blessed to have a family that can provide relatively cheap medical care for me, but can not imagine what its like for those who don't have that luxury. Some of my meds are hundreds of dollars without insurance and they are life saving! I can't imagine now being able to have easy access to them.

Yea it really sucks when you have to pay for everything out of pocket, I actually pay less now than when I did have insurance. I do hope this does turn out to be a good thing and not have a bunch of hidden things.

n.mac
06-29-2012, 03:26 PM
It is true that US health care needs reform but I'm not sure we are going about it the right way.

For 2 years we were told the insurance mandate was not a tax, but it is because it is a tax that the supreme court upheld its legality.

It will be hard to get everyone to obtain insurance(which is now the law) as long as the penalty for not having insurance is cheaper.
And the only way this will work is if everyone young ,old ,healthy and sick all particapate.

This system has been modeled on european programs at a time when most of europe is in worse shape finacially than the US.

Both my parents were from Ireland.My father from Northern Ireland which has the same system as Great Britian and my mother from The Republic of Ireland
both were US citizens (I have dual US and Irish). When they retired they moved back to Northern Ireland.

I have seen first hand health care rationing-not so much my parents as they were covered by us social security and my father had worked in england long enough to qualify under thier system as well.
But I have seen friends and cousins wait weeks or months for a phone call to set up an appointment or test-routine stuff we take for granted.

As well it is much more difficult to qualify for treatment-for example if a dr.recomends you lose weight or stop smoking and you don't you could be considered a poor candidate and be denied certain procedures.

In many ways they do a better job of taking care of the sick and elderly-but overall I think our system is fundamentaly better but obviously needs much reform !

I think health care should be a fundamental human right- I just don't think this is the right way to go about it.

I will now climb down off my soap box! Take Care Niall

Derrie
06-29-2012, 03:47 PM
Niall,

Thanks for sharing your thoughts and experiences -- I know I, personally, appreciate understanding the range of opinions people have about the state of healthcare in our country.

I would like to provide a little explanation of the "tax" issue because I know it's confusing. The reason the individual mandate was called a "tax" in the Supreme Court's opinion is basically some fancy footwork on Chief Justice Roberts's part to uphold the individual mandate without strengthening the Commerce Clause of the U.S. Constitution. Without getting too in depth into the weeds of constitutional law (I am a lawyer), the Commerce Clause is a part of the Constitution that allows the federal government to regulate economic matters between the states. So, the argument supporters of the individual mandate made and the most obvious way to uphold the mandate would be to say it falls under the federal governments Commerce Clause powers.

However, Roberts and the rest of the conservative wing of the court really, really don't want to strengthen the Commerce Clause. So, to uphold the individual mandate without expanding the Commerce Clause, Roberts rather creatively decided to refer to the penalty imposed when people who can afford it don't get insurance as a "tax" because the penalty is paid to the IRS. And the law clearly recognizes that Congress has the power to impose taxes! This way, he was able to uphold the law without making precedent he really didn't want to make. In fact, he was able to add language to the opinion that limits the Commerce Clause. I honestly think this is brilliant on his part (even if I don't agree with it) because while he's ceding the battle here to the liberals, by further weakening Congress's Commerce Clause powers, he is setting the stage to win his own constitutional law war in the long run-- to further limit the power the federal government has to impose laws on the states.

Some legal scholars think Roberts went too far in calling the penalty a "tax" to get around the Commerce Clause, though. I tend to agree Having to pay a fine for not doing something required by law has always been defined as a "penalty" and not a "tax," and the law is clear about separating those two things. So, that is why we were told for two years that the individual mandate is not a tax. According to the state of law up until yesterday, such a fine is a penalty, not a tax. It has become a game of semantics in the Supreme Court to call it a "tax" now.

Anyway, I hope that clears up some confusion on this "tax" issue. This is just skimming the surface. If anyone has any more specific questions about the law or the Court's opinion, I'd be happy to do my best to answer them, though bear in mind, I am neither a health lawyer nor a constitutional scholar!