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Dreadclaw69 wrote: You are trying to make false comparisons, and engaging in yet more strawmen, I have made it abundantly clear that I am talking about someone expressing their religious beliefs, of which contraception forms a component.
And I've explained to you that pacifism and vegetarianism are religious beliefs for many people. And you ignore that, because you've given up trying.
So your argument that it is trivial is based on one religion not taking legal action somehow excluding all other religions, and an example of someone you yourself have described as an "idiot" concerning State law, and not the Federal law.
My argument that it is trivial is based on one person now pretending it is a great affront to his religious liberty, when for decades before that he was forced to do the same thing and never even commented on the issue, let alone treated it as though it was a matter he was willing to go to jail over. Whether it was State or Federal law is beyond irrelevant to the fact he was being forced to do it all that time.
And as another example I gave you Jehovah's Witnesses, who were paying for other people to be allowed to choose to have blood transfusions, despite it being something they personally find morally objectionable. And yet no-one, not you or any other great defender of religious liberty, ever spent one second of your time arguing for Jehovah's Witnesses to not have to pay for such insurance.
This is because, far from being a great abuse of personal religious liberty, paying in to a fund that is used in some small portion for a service your religion doesn't approve of, is nothing more than a triviality. If that weren't true, your actions in defending the Jehovah's Witnesses would have been much different.
Yeah, that argument is a complete non sequitur. It does not follow that because one religious group chooses not to take action that others that do cannot be supported.
We're not talking about the religion, we're talking about you. What religious liberty you choose to defend, and what you choose to ignore. And for decades you've ignored the plight of the Jehovah's Witnesses, who have had to pay insurance to cover other people's blood transfusions.
And so we ask why... why did you ignore that breach of religious liberty? Is it perhaps because the idea of paying in to an insurance fund to cover surgeries that you personally don't approve of... isn't actually a breach of religious liberty, but a triviality the likes of which we all tolerate in some shape or form every single day...
Taxes - money collected by the government that goes to a central source. The money collected from a particular individual may not be used for some thing(s)he personally disagrees with.
ACA healthcare - money paid by the employer which does to certain defined items, such as contraception which the religious employer is objecting to
Where taxes are spent is defined - it's called a budget.
And whether you get given a list of estimated future costs, such as with insurance, or are simply told how much you have to pay (leaving it up to you as to whether you want to look up the budget to figure out how much goes to defence or whatever else) is completely meaningless. Any imbecile can still make the connection that taxes paid in some portion go to defence, just as insurance paid in some portion goes to covering contraception.
You again keep claiming that this is trivial, and you have not been able to support your claim. Let us be clear - multiple lawsuits have been filed on this at a Federal level, across many states, by a multitude of employers. Looking objectively at that alone should give you an indication that it is not trivial.
My point all along has been that people are treating it as a much bigger deal than it is. So of course the large number of lawsuits is part of that. The point then is to ask if there is a real breach of religious freedom that justifies the very high level of reaction. And the answer to that, given that all those same people didn't care one bit for all those decades that Jehovah's Witnesses were forced to pay to cover other people's blood transfusions... is that this reaction is due to lots of things, none of which are based on a genuine concern for protecting one's religious freedom.
Going against important religious beliefs is now trivial Sebster?
No, as I've explained multiple times now, an actual breach of a person's religious freedom is nothing but trivial. But that doesn't make every single thing that any person claims is a breach of their religious freedom a real, substantial thing.
And this case, which involves indirect subsidy of another person's private choice, in a manner which society as a whole has witnessed in many forms before without ever considering it a breach of religious freedom, is clearly of the most trivial kind.
So you're objecting to Wikipedia, and all it's sources now?
No, I'm objecting to your attempt to use a small part of a wiki, which was correct but far from the complete story, as an attempt to rebut my larger point about the religious differences that drove them to seperate themselves from the rest of the church.
I have read it, and any animosity with Catholics is not mentioned.
If you aren't aware of the animosity between the Catholics and the Protestants through that period of history, then I suggest you start reading a lot more historical texts. It was kind of a big deal. Kind of a 'several hundred years long, multiple millions killed, shaped the modern world' kind of a big deal.
However the targetting of the group that would then go on to become the Pilgrims is;
Yes, the Puritan groups who went on to become the Pilgrims were treated terribly, as I already stated several times. But what you are still not getting is what made those Puritan groups Puritans, and not just more members of the Church of England. What made them Puritans was their rejection of accepting Catholics back in to their church, or in to society, or allowing some Catholic religious traditions to resume in church.
So by not proscribing nor enforcing the use of contraceptives, rather it is left to the individual's choice and the free market, that somehow shows that the US has a long and glorious history? Again, that does not logically follow.
Unbelievable. I just exlained that across the modern world, many forms of contraception were denied to people for purely moralistic reasons. The US did not have any such ban, and that is something to be proud of. You were more free, more open minded, more progressive than most other developed countries on the issue of contraception. That is, or at least should, be something to be proud of.
Nor does your comparison of a democratic republic with a one party system.
I didn't compare the two. Read, please. I said that in not forcing contraception, it made the US not China, as China is the only country to mandate contraception of any form among the general population. Which made 'forcing contraception' a null point, meaning we should instead focus on what forms of contraception were allowed and when.
[quoteI have rejected it, and set out the reasons for doing so. The religious employer is being compelled to provide something that is at odds with their religious beliefs. That is not a passive role.
The religious employer pays in to a pool, he is given an itemised list but this list is merely suggestive, as insurance works on future estimates. It is basically just a number in total, pay this amount and your employees are covered for services should they need and choose to access them. What services are actually accessed is not up to the employer, he is entirely passive, he has no decision making.
As I have clearly said on it's face, i.e. prima facie, there is a conflict between the ACA and the Constitution.
You keep saying that, labouring under some kind of delusion that debate involves people stating their premises and never entering into any more detail to find out if their original premises makes any sense.
"A is true."
"I don't think so, because of x, y and z, and if A were true then 1, 2 and 3 wouldn't exist, so..."
"A is true."
"Oh, okay then, you've repeated your main point. It must be absolute, conversation over."
However if you need to know my qualifications I do possess a law degree.
Seriously? Wow.
So the government cannot compel people to participate in things that go against their conscience? Yet you're arguing that under the ACA the government do just that. Can you see the contradiction there?
Only if we continue pretending that all compulsion is exactly equal in all ways. As if forcing a religiously motivated pacifist to join the army is exactly equal to forcing a religiously motivated pacificst to pay his taxes, some of which go towards paying for the military.
If we pretend that is true, then yeah there's a contradiction. But of course, it isn't true, not at all, and you can observe that basic reality in how people have behaved for generations.
So you acknowledge that your comparison was incorrect then in trying to compare something that is built and used for the common good by all, and that which is only used in a private and intimate settings
You have a law degree and that's your attempt at challenging an analogy? Wow.
I have no legal standing to bring an action on behalf of the Jehovah's Witnesses, I am neither a member of the faith nor am I affected by their healthcare, but thank you for that spurious attempt at an argument grounded in fallacy.
You can fund them, you can give them free legal advice with your law degree. And yet you don't, and never have. That great and awful breach of their religious freedom has gone on all that time, and yet you did nothing to help those poor people. You must be the worst kind monster... or possibly there was no real breach of their religious liberty, because the idea that some money you pay in to an insurance fund might go to something you don't morally approve is an entirely invented, pretend outrage.
I have already rebutted your point about pacifists above
You claimed it wasn't religious, I pointed out that there are people who are pacifist due to their religious beliefs, in exactly the same way that there are people who are oppose contraception due to their religious beliefs. And to that you've given no answer.
although it is interesting to note that those with a religious underpinning to their pacifism are exempted from military service.
Yes, as I pointed out the first time I made the comparison. To contrast between actually being forced to do something against your religious beliefs (such as fight a war or use contraception) and being passively involved in something you wouldn't personally choose due to religious beliefs (such as fund the military through your taxes or subsidise an employee's contraception). I've only had to repeat the same point about seven times, and it seems you've almost understood half of the analogy.
Unless you actually want to address the crux of the matter - that religious groups are entitled to object to acting against their honestly held religious beliefs, and that the legislation is on it's face in conflict with the First Amendment - and stop dancing around the peripheral issues then don't expect any further response.
And until you actually recognise that we both agree that religious groups are entitled to object to being forced to act against their religious beliefs, and that the question is one of how far you take that principle, then you'll continue looking like an idiot repeating your same basic point over and over again, while I ask for you to add just one layer of understanding to how that principle works in the real world.
Automatically Appended Next Post:
whembly wrote: If the Republicans succeed in ending the "risk corridors" bailout to these participating insurance companies...
Watch out!
Do you see how that article doesn't give the actual numbers for how much the costs will change if the risk pool is less balanced than hoped? Don't you think it would be useful, even important information to know?
It's because when you actually give the numbers, the story gets really boring, really quickly.
If the proportion of enrolees who are in the lowest risk groups are half of what ACA planned for, then premiums increase a whopping 2.5%. No-one wants to pay 2.5% more, but in terms of it signalling any kind of risk to ACA, it's comical.
This is because, as is barely reported in the media, ACA doesn't prevent age based premiums, it merely caps them, so the amount of subsidy the youth are giving the elderly is nothing like people have guessed.
Automatically Appended Next Post:
Dreadclaw69 wrote: The fact that the POTUS's signature healthcare bill is a massive failure, and millstone around his neck with elections looming in a few months?
It does not matter how much distance the Democrats attempt to put between them and this legislation, or how they choose to re-brand it, this is their baby whether they like it or not.
That makes no sense. If the Democrats were trying to back away from ACA, then the best thing to do would be to dump it on Obama, just as parties dump everything on the outgoing president.
This message was edited 2 times. Last update was at 2014/01/13 05:02:12
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
whembly wrote: If the Republicans succeed in ending the "risk corridors" bailout to these participating insurance companies...
Watch out!
Do you see how that article doesn't give the actual numbers for how much the costs will change if the risk pool is less balanced than hoped? Don't you think it would be useful, even important information to know?
If the proportion of enrolees who are in the lowest risk groups are half of what ACA planned for, then premiums increase a whopping 2.5%. No-one wants to pay 2.5% more, but in terms of it signalling any kind of risk to ACA, it's comical.
This is because, as is barely reported in the media, ACA doesn't prevent age based premiums, it merely caps them, so the amount of subsidy the youth are giving the elderly is nothing like people have guessed.
Yeah... I don't buy that it's that small.
As you know, I work in the heathcare industry (IT dude). Here's what I trust...
The insurance industries has been warning our hospital system of these major topics:
#1) The market upheaval of people losing their old insurance and the unknowns of what the "new realities" will be. EVERYONE is so fething confused, it's ridiculous. This could take years to get this under control.
#2) We are seeing charity cases going up and a MUCH faster rate than anticipated. These are services that the hospitals give away for free (ie, ED visits, free treatments, etc...).
#3) Finally, here's a biggie... we've been told that many hospital system/medical offices will cap the number of patients they'll have who purchases their insurance from the exchange (the old Medicare patient cap is back).
Dreadclaw69 wrote: The fact that the POTUS's signature healthcare bill is a massive failure, and millstone around his neck with elections looming in a few months?
It does not matter how much distance the Democrats attempt to put between them and this legislation, or how they choose to re-brand it, this is their baby whether they like it or not.
That makes no sense. If the Democrats were trying to back away from ACA, then the best thing to do would be to dump it on Obama, just as parties dump everything on the outgoing president.
Um... Seb... the PPACA will be a huge albatross to any Democrats running for election this year. Blaming it on Obama won't work.
I haven't read everything because I'm just coming off night shift, but the little that I did read is you dancing around the main point. Again
I did like your attempts to try and talk down to an Irish Catholic immigrant from Northern Ireland who lived through the Troubles about sectarian tensions between Catholics and Protestants though
sebster wrote: That makes no sense. If the Democrats were trying to back away from ACA, then the best thing to do would be to dump it on Obama, just as parties dump everything on the outgoing president.
Except for the fact that a lot of them went out of their way to promote the ACA, cheerlead for it, voted for it, and make sure it got passed. And a lot of them are up for re-election this year too....
Why? Because her new Obamacare benefits were not in order, forcing her to spend hours and hours on hold with her insurer, Independence Blue Cross.
Many folks who signed up for coverage through the state and federal exchanges are running into roadblocks now that they are trying to use their new benefits. And though exchange officials and insurers have urged consumers to call their insurers if they encounter problems, many say they either wait endlessly on hold or get the runaround. Coverage for the first wave of Obamacare applicants took effect Jan. 1.
Patterson's journey started New Year's Day, when she landed in the emergency room for a stomach ailment. The Independence policy number she received didn't work and the hospital required her to sign a form saying she would pay for care herself, though it agreed to bill her later. She then received an ID card for her HMO plan in the mail a few days later, so she made an appointment with her primary care doctor and a gastric specialist for follow up.
But when the 59-year-old went to her doctor last week, she was told he couldn't see her because she hadn't designated him as her primary care provider. If she wanted to be treated, she'd have to pay for the visit and lab work and request reimbursement. She spent an hour on hold with Independence trying to fix the problem and left the office without care.
Patterson, who has previously always had insurance, said she was not told she had to designate a primary care provider in Independence's system before seeing the doctor. When she got home, she went online and did that, but learned she'd have to wait until February to make an appointment.
That was too long a delay. So, she called Independence three or four times a day, spending more than an hour on hold each time hoping to get a representative to waive the waiting period. But she would hang up before reaching anyone.
"I can't get a person no matter what I do," said Patterson, who is unemployed and lives with her husband in Drexel Hill, Penn.
After being contacted by CNNMoney Friday, an Independence executive reached out to Patterson and confirmed that she has had coverage since Jan. 1 and her primary care doctor designation is in order. Brian Lobley, senior vice president of marketing and consumer business, told CNNMoney he did not know why Patterson had problems at the doctor's office or hospital, but told her to call him if any issues persisted.
The company has seen a significant number of consumers, particularly new members, calling its help line for assistance in using their benefits, getting ID cards and making payments, Lobley said. He acknowledged that hold times have increased to an average of 40 to 50 minutes, but said Independence has increased its staff by 20% to 25% and has extended its hours to accommodate the crush.
Patterson will find out this week if her coverage is in fact in order when she calls her primary care doctor to make another appointment. "I don't want to get my hopes up too high," she said Friday.
Others found they ran into similar walls. Matt and Nancy Parisi were waiting weeks to resolve a problem with Cigna (CI, Fortune 500), which could not find the Tequesta, Fla., couple in its system. They called repeatedly to get their ID number so he could fill a prescription and she could visit the doctor, but were either left waiting on hold or bounced around from department to department.
"They put you on hold until they wear you out," said Matt Parisi, 63, a fisherman, who had to pay $40 out-of-pocket to get his high blood pressure medication. "It's very uncomfortable to think that if we had to go to the hospital right now, we could face a quarter-million [dollar] bill because Cigna can't find us."
After CNNMoney reached out to the insurer Friday to check their status, the couple received a call from a Cigna supervisor, who gave them their ID number and emailed them a letter confirming coverage. However, the supervisor said the Parisis still won't show up in the insurer's system for the time being.
"As long as I have the ID number, it's a step in the right direction," Matt Parisi said, though he said they'll feel more confident that they actually have insurance when they get an ID card in the mail. That's when they'll make a doctor's appointment for his wife's shoulder issue.
A Cigna spokesman told CNNMoney the company has taken multiple steps to help new exchange applicants activate their coverage, including establishing dedicated teams specifically trained to handle new enrollees' issues. It is also offering new exchange customers a secure email address where they can submit their questions.
Some people, however, have just given up trying to get through.
Kyle Watts of Louisville, Ohio, has been trying to reach Anthem Blue Cross for a month. He and his wife were excited to sign up on healthcare.gov in early December because they were eligible for subsidies that would save them $6,000 in premiums annually.
Aware the policy wouldn't be active until they paid their first premium, they called Anthem to find out where to send the check. But they grew concerned after the check was not cashed, so they went onto the Anthem website and paid with a credit card last month. Though they got a payment confirmation email and were told they'd get an enrollment confirmation letter, they never received anything further from the company and remain without an ID number. Also, the charge has not appeared on their credit card statement.
Watts, a retired administrator for a non-profit group, has spent hours on Anthem's customer service line before hanging up in frustration. He also called healthcare.gov to try to switch to another insurer, but was told he's not allowed to cancel a policy mid-year.
Feeling he had no other alternative, he begged his former insurer to reactivate their policies on a month-to-month basis so the couple would have some coverage, though it costs $405 a month more and has higher deductibles.
If Anthem eventually comes through, he'll go with them because he feels boxed in.
"I don't want to deal with this company," said Watts, 64. "It won't be good for us. But what other choice do I have?"
A spokeswoman for WellPoint (WLP, Fortune 500), which owns Anthem, blamed the flurry of last-minute changes by the Obama administration for affecting its ability to process customer applications, issue billing statements, process payments and send out ID cards.
Also, it is experiencing "an unprecedented level of questions" from members through its call centers, the spokeswoman said. On Jan. 2 and Jan. 3, representatives fielded 1 million calls, the average number it normally receives in a month across all its health insurance divisions. WellPoint also has extended its call center hours and initiated a voice response system to direct callers in hopes of reducing wait times.
The spokeswoman said a customer service representative would look into Watts' case.
I think a quote from James Madison applies to Obamacare:
"It will be of little avail to the people, that the laws are made by men of their own choice, if the laws be so voluminous that they cannot be read, or so incoherent that they cannot be understood; if they be repealed or revised before they are promulgated, or undergo such incessant changes that no man, who knows what the law is today, can guess what it will be tomorrow."
Taxes - money collected by the government that goes to a central source. The money collected from a particular individual may not be used for some thing(s)he personally disagrees with.
You realize that's not how it works right? Taxes do not have limited use depending on what the taxed agree with. If I am very rich and pay $1millon in taxes, those tax dollars are spread out over the entire budget. If I don't like the military, part of that $1mil still goes to the military.
Homosexuality is the #1 cause of gay marriage.
kronk wrote: Every pizza is a personal sized pizza if you try hard enough and believe in yourself.
sebster wrote: Yes, indeed. What a terrible piece of cultural imperialism it is for me to say that a country shouldn't murder its own citizens
BaronIveagh wrote: Basically they went from a carrot and stick to a smaller carrot and flanged mace.
Taxes - money collected by the government that goes to a central source. The money collected from a particular individual may not be used for some thing(s)he personally disagrees with.
You realize that's not how it works right? Taxes do not have limited use depending on what the taxed agree with. If I am very rich and pay $1millon in taxes, those tax dollars are spread out over the entire budget. If I don't like the military, part of that $1mil still goes to the military.
I'm not speaking for Dread... but there's a distinction we need to make.
Our tax revenue goes into a pool. HOW its spent is really up to what our elected officials (by extension, the voters) determines.
This is VASTLY different and distinct than mandating an employer to provide/allow services under their own plans provided by their institution.
In other words... say the US goes to the Canadian model. The taxpayers really wouldn't have a say in providing BC/Abortion services via tax expenditures except when voting for a politician who advocates for/against these services.
Conversely, it's a direct violation of one's faith if they're FORCED to provide services on their plans that is diametrically opposed to their beliefs.
This message was edited 2 times. Last update was at 2014/01/13 16:43:30
Taxes - money collected by the government that goes to a central source. The money collected from a particular individual may not be used for some thing(s)he personally disagrees with.
You realize that's not how it works right? Taxes do not have limited use depending on what the taxed agree with. If I am very rich and pay $1millon in taxes, those tax dollars are spread out over the entire budget. If I don't like the military, part of that $1mil still goes to the military.
I'm not speaking for Dread... but there's a distinction we need to make.
Our tax revenue goes into a pool. HOW its spent is really up to what our elected officials (by extension, the voters) determines.
This is VASTLY different and distinct than mandating an employer to provide/allow services under their own plans provided by their institution.
In other words... say the US goes to the Canadian model. The taxpayers really wouldn't have a say in providing BC/Abortion services via tax expenditures except when voting for a politician who advocates for/against these services.
Conversely, it's a direct violation of one's faith if they're FORCED to provide services on their plans that is diametrically opposed to their beliefs.
Well that makes more sense. I thought he was saying that taxes could not be spent on things you don't agree with.
Homosexuality is the #1 cause of gay marriage.
kronk wrote: Every pizza is a personal sized pizza if you try hard enough and believe in yourself.
sebster wrote: Yes, indeed. What a terrible piece of cultural imperialism it is for me to say that a country shouldn't murder its own citizens
BaronIveagh wrote: Basically they went from a carrot and stick to a smaller carrot and flanged mace.
Taxes - money collected by the government that goes to a central source. The money collected from a particular individual may not be used for some thing(s)he personally disagrees with.
You realize that's not how it works right? Taxes do not have limited use depending on what the taxed agree with. If I am very rich and pay $1millon in taxes, those tax dollars are spread out over the entire budget. If I don't like the military, part of that $1mil still goes to the military.
I'm not speaking for Dread... but there's a distinction we need to make.
Our tax revenue goes into a pool. HOW its spent is really up to what our elected officials (by extension, the voters) determines.
This is VASTLY different and distinct than mandating an employer to provide/allow services under their own plans provided by their institution.
In other words... say the US goes to the Canadian model. The taxpayers really wouldn't have a say in providing BC/Abortion services via tax expenditures except when voting for a politician who advocates for/against these services.
Conversely, it's a direct violation of one's faith if they're FORCED to provide services on their plans that is diametrically opposed to their beliefs.
Well that makes more sense. I thought he was saying that taxes could not be spent on things you don't agree with.
Whembly was able to clarify what I meant, apologies for the confusion.
Maybe it would have been clearer had I said that an individual tax payer has no ability to know what, if any, of their taxes will be spent on something that they find objectionable. The money is collected and managed centrally. I doubt even those allocating the funds would know what each payer's tax dollars were spent on.
Whereas with healthcare the religious employers know with almost certainty that what they are obliged to contribute will be spent on providing services that conflict with their beliefs.
Dreadclaw69 wrote: I haven't read everything because I'm just coming off night shift, but the little that I did read is you dancing around the main point. Again
I'm asking you to move on from your initial, simplistic claim. Yes, religious freedom is good an important, but not all instances of it must be protected at all times, just because an individual claims it is their religious freedom. I gave many examples of this, none of which you appeared to actually grasp.
I did like your attempts to try and talk down to an Irish Catholic immigrant from Northern Ireland who lived through the Troubles about sectarian tensions between Catholics and Protestants though
I know nothing about you but what you've posted on this forum, and so to the extent you showed ignorance of the political differences that led to some puritans leaving for the US, I will make such a comment.
Except for the fact that a lot of them went out of their way to promote the ACA, cheerlead for it, voted for it, and make sure it got passed. And a lot of them are up for re-election this year too....
Yeah... so if they were to back away from ACA, they'd do so by dumping it on Obama and emphasise the Obamacare label. They're doing the opposite of that, meaning your claim makes no sense.
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
Reading your prior post now I can see that I was right to limit my response. You have chosen again to dance around the central issue, avoid any serious discussion, misinterpret my posts, and now you're sinking further into ad hominem .
sebster wrote: I'm asking you to move on from your initial, simplistic claim. Yes, religious freedom is good an important, but not all instances of it must be protected at all times, just because an individual claims it is their religious freedom. I gave many examples of this, none of which you appeared to actually grasp.
You gave examples that were little, if anything to do with the facts in this instance and I have already dealt with those prior. I do not feel the need to revisit them yet again. I'm still waiting on you to square;
- the conflict between the ACA and the Constitution
- how you can continue to claim that this is a trivial matter given the fact that there are multiple law suits from religious institutions who were not obligated to provide birth control before the ACA, were promised that their religious beliefs be respected, and have found out that the ACA now compels them to act in a manner incompatible with their faith. So far your argument is that this is trivial/spurious/manufactured outrage because one religion is not taking any action, or one individual in California was wrong about his State's law. You are not addressing the actual argument.
In 1968, Pope Paul VI issued his landmark encyclical letter Humanae Vitae (Latin, "Human Life"), which reemphasized the Church’s constant teaching that it is always intrinsically wrong to use contraception to prevent new human beings from coming into existence.
Contraception is "any action which, either in anticipation of the conjugal act [sexual intercourse], or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible" (Humanae Vitae 14). This includes sterilization, condoms and other barrier methods, spermicides, coitus interruptus (withdrawal method), the Pill, and all other such methods.
Scripture
Is contraception a modern invention? Hardly! Birth control has been around for millennia. Scrolls found in Egypt, dating to 1900 B.C., describe ancient methods of birth control that were later practiced in the Roman empire during the apostolic age. Wool that absorbed sperm, poisons that fumigated the uterus, potions, and other methods were used to prevent conception. In some centuries, even condoms were used (though made out of animal skin rather than latex).
The Bible mentions at least one form of contraception specifically and condemns it. Coitus interruptus, was used by Onan to avoid fulfilling his duty according to the ancient Jewish law of fathering children for one’s dead brother. "Judah said to Onan, ‘Go in to your brother’s wife, and perform the duty of a brother-in-law to her, and raise up offspring for your brother.’ But Onan knew that the offspring would not be his; so when he went in to his brother’s wife he spilled the semen on the ground, lest he should give offspring to his brother. And what he did was displeasing in the sight of the Lord, and he slew him also" (Gen. 38:8–10).
The biblical penalty for not giving your brother’s widow children was public humiliation, not death (Deut. 25:7–10). But Onan received death as punishment for his crime. This means his crime was more than simply not fulfilling the duty of a brother-in-law. He lost his life because he violated natural law, as Jewish and Christian commentators have always understood. For this reason, certain forms of contraception have historically been known as "Onanism," after the man who practiced it, just as homosexuality has historically been known as "Sodomy," after the men of Sodom, who practiced that vice (cf. Gen. 19).
Contraception was so far outside the biblical mindset and so obviously wrong that it did not need the frequent condemnations other sins did. Scripture condemns the practice when it mentions it. Once a moral principle has been established in the Bible, every possible application of it need not be mentioned. For example, the general principle that theft is wrong was clearly established in Scripture; but there’s no need to provide an exhaustive list of every kind of theft. Similarly, since the principle that contraception is wrong has been established by being condemned when it’s mentioned in the Bible, every particular form of contraception does not need to be dealt with in Scripture in order for us to see that it is condemned.
Apostolic Tradition
The biblical teaching that birth control is wrong is found even more explicitly among the Church Fathers, who recognized the biblical and natural law principles underlying the condemnation.
In A.D. 195, Clement of Alexandria wrote, "Because of its divine institution for the propagation of man, the seed is not to be vainly ejaculated, nor is it to be damaged, nor is it to be wasted" (The Instructor of Children 2:10:91:2).
Hippolytus of Rome wrote in 255 that "on account of their prominent ancestry and great property, the so-called faithful [certain Christian women who had affairs with male servants] want no children from slaves or lowborn commoners, [so] they use drugs of sterility or bind themselves tightly in order to expel a fetus which has already been engendered" (Refutation of All Heresies9:12).
Around 307 Lactantius explained that some "complain of the scantiness of their means, and allege that they have not enough for bringing up more children, as though, in truth, their means were in [their] power . . . or God did not daily make the rich poor and the poor rich. Wherefore, if any one on any account of poverty shall be unable to bring up children, it is better to abstain from relations with his wife" (Divine Institutes 6:20).
The First Council of Nicaea, the first ecumenical council and the one that defined Christ’s divinity, declared in 325, "If anyone in sound health has castrated himself, it behooves that such a one, if enrolled among the clergy, should cease [from his ministry], and that from henceforth no such person should be promoted. But, as it is evident that this is said of those who willfully do the thing and presume to castrate themselves, so if any have been made eunuchs by barbarians, or by their masters, and should otherwise be found worthy, such men this canon admits to the clergy" (Canon 1).
Augustine wrote in 419, "I am supposing, then, although you are not lying [with your wife] for the sake of procreating offspring, you are not for the sake of lust obstructing their procreation by an evil prayer or an evil deed. Those who do this, although they are called husband and wife, are not; nor do they retain any reality of marriage, but with a respectable name cover a shame. Sometimes this lustful cruelty, or cruel lust, comes to this, that they even procure poisons of sterility [oral contraceptives]" (Marriage and Concupiscence 1:15:17).
The apostolic tradition’s condemnation of contraception is so great that it was followed by Protestants until 1930 and was upheld by all key Protestant Reformers. Martin Luther said, "[T]he exceedingly foul deed of Onan, the basest of wretches . . . is a most disgraceful sin. It is far more atrocious than incest and adultery. We call it unchastity, yes, a sodomitic sin. For Onan goes in to her; that is, he lies with her and copulates, and when it comes to the point of insemination, spills the semen, lest the woman conceive. Surely at such a time the order of nature established by God in procreation should be followed. Accordingly, it was a most disgraceful crime. . . . Consequently, he deserved to be killed by God. He committed an evil deed. Therefore, God punished him."
John Calvin said, "The voluntary spilling of semen outside of intercourse between man and woman is a monstrous thing. Deliberately to withdraw from coitus in order that semen may fall on the ground is doubly monstrous. For this is to extinguish the hope of the race and to kill before he is born the hoped-for offspring."
John Wesley warned, "Those sins that dishonor the body are very displeasing to God, and the evidence of vile affections. Observe, the thing which he [Onan] did displeased the Lord—and it is to be feared; thousands, especially of single persons, by this very thing, still displease the Lord, and destroy their own souls." (These passages are quoted in Charles D. Provan, The Bible and Birth Control, which contains many quotes by historic Protestant figures who recognize contraception’s evils.)
The Magisterium
The Church also, fulfilling the role given it by Christ as the identifier and interpreter of apostolic Scripture and apostolic tradition, has constantly condemned contraception as gravely sinful.
In Humanae Vitae, Pope Paul VI stated, "[W]e must once again declare that the direct interruption of the generative process already begun, and, above all, directly willed and procured abortion, even if for therapeutic reasons, are to be absolutely excluded as licit means of regulating birth. Equally to be excluded, as the teaching authority of the Church has frequently declared, is direct sterilization, whether perpetual or temporary, whether of the man or of the woman. Similarly excluded is every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible" (HV 14).
This was reiterated in the Catechism of the Catholic Church: "[E]very action which, whether in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible is intrinsically evil" (CCC 2370). "Legitimate intentions on the part of the spouses do not justify recourse to morally unacceptable means . . . for example, direct sterilization or contraception" (CCC 2399).
The Church also has affirmed that the illicitness of contraception is an infallible doctrine: "The Church has always taught the intrinsic evil of contraception, that is, of every marital act intentionally rendered unfruitful. This teaching is to be held as definitive and irreformable. Contraception is gravely opposed to marital chastity, it is contrary to the good of the transmission of life (the procreative.aspect of matrimony), and to the reciprocal self-giving of the spouses (the unitive.aspect of matrimony); it harms true love and denies the sovereign role of God in the transmission of human life" (Vademecum for Confessors 2:4, Feb. 12, 1997).
Human Experience
Pope Paul VI predicted grave consequences that would arise from the widespread and unrestrained use of contraception. He warned, "Upright men can even better convince themselves of the solid grounds on which the teaching of the Church in this field is based if they care to reflect upon the consequences of methods of artificially limiting the increase of children. Let them consider, first of all, how wide and easy a road would thus be opened up towards conjugal infidelity and the general lowering of morality. Not much experience is needed in order to know human weakness, and to understand that men—especially the young, who are so vulnerable on this point—have need of encouragement to be faithful to the moral law, so that they must not be offered some easy means of eluding its observance. It is also to be feared that the man, growing used to the employment of anti-conceptive practices, may finally lose respect for the woman and, no longer caring for her physical and psychological equilibrium, may come to the point of considering her as a mere instrument of selfish enjoyment, and no longer as his respected and beloved companion" (HV 17).
No one can doubt the fulfillment of these prophetic words. They have all been more than fulfilled in this country as a result of the widespread availability of contraceptives, the "free love" movement that started in the 1960s, and the loose sexual morality that it spawned and that continues to pervade Western culture.
Indeed, recent studies reveal a far greater divorce rate in marriages in which contraception is regularly practiced than in those marriages where it is not. Experience, natural law, Scripture, Tradition, and the magisterium, all testify to the moral evil of contraception.
Wishful Thinking
Ignoring the mountain of evidence, some maintain that the Church considers the use of contraception a matter for each married couple to decide according to their "individual conscience." Yet, nothing could be further from the truth. The Church has always maintained the historic Christian teaching that deliberate acts of contraception are always gravely sinful, which means that it is mortally sinful if done with full knowledge and deliberate consent (CCC 1857). This teaching cannot be changed and has been taught by the Church infallibly.
There is no way to deny the fact that the Church has always and everywhere condemned artificial contraception. The matter has already been infallibly decided. The so-called "individual conscience" argument amounts to "individual disobedience."
Church Teaching on Contraception (Part 1)
FR. WILLIAM SAUNDERS
The topic of contraception is so controversial. It seems to always come up at work and many bash the Church for its teaching, including Catholics. I do not seem to know how to defend the Church as well as I should. Could you give an explanation? (note: This is the first in a six-part series on contraception.)
On July 25, we mark the 35th anniversary of Pope Paul VI's encyclical Humanae Vitae which affirmed the consistent Catholic teaching on the sanctity of marital love and the error of contraception. Granted, this topic is definitely the one that prompts headlines and excites some people to say, "I disagree with the Church" or "The Church is wrong." I have even had Catholics report to me that when they have visited a Protestant Church, they have heard sermons denounce the Church's teaching on this subject. Sadly, many Catholics do not understand the Church's teaching on this issue. Moreover, many priests have failed to address this subject from the pulpit — whether in a positive, rational way or at all. So we need to put aside our prejudices and our misconceptions, open our minds and hearts, and approach this issue. The next several issues of Straight Answers will be devoted to this topic and hopefully provide a clear and better understanding about this subject.
However, before addressing the issue of contraception per se, one must first understand the Church's moral teaching concerning marriage. The Church does not simply deliver a moral teaching in isolation; rather, the moral teaching is undergirded by a moral framework of how life ought to be lived in the eyes of God. In this case, the moral framework is what God has revealed concerning marriage.
In the creation account of Genesis, we find the beautiful truth, "God made man in His image; in the divine image He created him; male and female He created them" (Genesis 1:27). In this one verse, we find an intrinsic goodness and dignity to each human being. We also recognize a goodness to our human sexuality — both man and woman are made in God's image and likeness, and both masculinity and femininity are equally good. Yes, man and woman are different — anatomically, physiologically, and even psychologically (as admitted by many psychologists, even "feminist" ones). These differences do not indicate inequality, instead complementarity.
With this truth, we must also view our human life not just by the confines of this world, but also with a view to a supernatural and eternal destiny. God has made us for Himself, and we hope one day to find this life fulfilled in the Kingdom of Heaven.
In the next verse of Genesis (1:28), we read, "God blessed them, saying, 'Be fertile and multiply; fill the earth and subdue it.'" Here is marriage, a God-given, God-designed institution. If we could think of the best way to realize that "image and likeness of God," it would then be in marriage. In this sacred union, man and woman — each made in God's image and likeness with their similarity and their uniqueness — come together as one.
The second creation account of Genesis reinforces this idea: Here, God takes the rib from the man to create "a suitable partner," whom the man recognizes as "'This one, at last, is bone of my bones and flesh of my flesh; this one shall be called 'woman' for out of 'her man' this one has been taken.' That is why a man leaves his father and mother and clings to his wife, and the two of them become one body" (2:23-24). Pope John Paul II reflected that in marriage "man" in the moment of communion truly becomes the image of God, "an image of an inscrutable divine communion of Persons."
Our Lord, Jesus Christ, in the gospel affirmed the teaching of Genesis. When asked by the Pharisees about divorce, Jesus replied, "Have you not read that at the beginning the Creator made them male and female, and declared, 'For this reason a man shall leave his father and mother and cling to his wife, and the two shall become as one'? Thus, they are no longer two but one flesh. Therefore, let no man separate what God has joined" (Matthew 19:3ff).
Given this basis in Sacred Scripture, we hold marriage as a sacrament in our Catholic belief. Vatican II's Pastoral Constitution of the Church in the Modern World (Gaudium et Spes) spoke beautifully about marriage: Marriage is a partnership of life and love designed by God and endowed by Him with its own proper laws, with various benefits, and with various ends in view. Both husband and wife "surrender themselves to each other" and give their "irrevocable personal consent." Marriage involves a mutual giving of two persons, which entails total fidelity and permanence.
Moreover, the love of husband and wife which binds them together as one overflows, and they may participate in creation, giving birth to children. Through the sacrament they live and the bountiful graces offered by our Lord, couples are fortified to fulfill their duties to each other and their family. As such, marriage is clearly the foundation of the family and the whole human race.
Therefore, we speak of marriage not as a contract but as a covenant. Just as God made a covenant of life and love with His people of the Old Testament through Abraham and Moses, just as Christ made the perfect, everlasting, and life-giving covenant through the blood of His cross, so marriage is a covenant, a permanent bonding of life and love. (For this reason, St. Paul frequently used the image of Christ and His Church in explaining the love of husband and wife (e.g. Ephesians 5:22ff).) Therefore, when a couple exchanges vows, they are promising a love of fidelity, permanence, exclusivity, and perpetuity to each other and God. Man and woman enter into a life-giving covenant with God as husband and wife.
As I have already mentioned this matter is of such importance to the Catholic faith that it forms part of the classes that couples must take before marriage, and that couples about to wed must give their assurance that they will not take action that prevents their conceiving a child.
sebster wrote: I know nothing about you but what you've posted on this forum, and so to the extent you showed ignorance of the political differences that led to some puritans leaving for the US, I will make such a comment.
Good thing that I have not mentioned my background before. In several threads. Shame that I also gave evidence and examples for my points too, which was wryly and rebutted in full with what was essentially "Uh, Wikipedia".
sebster wrote: Yeah... so if they were to back away from ACA, they'd do so by dumping it on Obama and emphasise the Obamacare label. They're doing the opposite of that, meaning your claim makes no sense.
Yes, because clearly that is going to work when Democrats are on record extolling the virtues of the ACA, and telling the population just how good it will be for their constituents;
"Yes, I know that I said this would benefit you. And I know that everything that I said was a lie. And that the leader of my party that I represent and supported was untruthful. And that I followed the party line instead of objectively looking at what would actually benefit you, the people I represent. But it is all Obama's fault"
Somehow Sebster I do not think that the 'A Big Boy did it, and ran away' excuse is going to find a lot of sympathy when the re-elections are pending.
If you'd like to continue this discussion I welcome it. But I would ask that you come back with a civil tongue, or you do not come back at all.
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An Obamacare supporter recounts his misadventures dealing with HealthCare.gov
As we hoisted champagne flutes in the first seconds of 2014, my partner and I toasted all the usual things people do as they look ahead to the coming year. Health. Happiness. Love. Optimism. Hope.
To that traditional list, we added one more: Obamacare. My husband, Miles, was enrolled in what appeared to be an excellent, affordable plan at the stroke of midnight. Celebration seemed in order.
It had been a tough slog, of course. We’d worried the GOP would succeed in defunding it or undermining it in some other way that would put affordable coverage further out of our reach. Then we’d wrestled with that horrific website, struggled to understand the choices before us and waited nervously after we did so to see if the insurance card would actually materialize. It did.
On Jan. 1, we rejoiced. And on Jan. 10, we gave up.
Ten days in, we decided to cancel Miles’ Obamacare plan, swallow hundreds of dollars we’ll probably never recover and buy him a private policy away from the Federal Health Insurance Exchange Marketplace. His new plan does benefit from many requirements of the Affordable Care Act as well, so that’s good.
But even the administrators at Obamacare’s headquarters have agreed this is the best option. Really.
That’s not how it was supposed to be. After dozens of hours of phone calls that displaced my usual work obligations this week, only one thing is clear: Nobody can give anybody a straight or consistent answer to anything.
Our troubles may strike some as trivial and particular, although they wouldn’t if it happened to them. And anyone who wants a successful system – as we do – must understand that these nightmares are happening across the nation to the very people who want Obamacare to work.
Most just don’t have a way to tell the world.
In the summer of 2013, Miles and I, both 41 years old, quit our jobs in Washington. Miles was a producer at WJLA, the ABC affiliate in Washington D.C., but he longed to return to school for a new degree and a different career. I was at POLITICO realizing that my life as a freelance journalist was far more engaging, empowering and lucrative than chronicling the petty, overly intertwined worlds of D.C. politics and journalism.
Even a year earlier, it would have been unthinkable for Miles to walk away from a proper job. He has pre-existing conditions. None are life-threatening or unmanageable, but one requires expensive medication.
This is one of the promises of Obamacare we most appreciated, the idea that unshackling health decisions from employment can liberate people to leave unsatisfying jobs and engage their entrepreneurial sides. How many people have been prevented from pursuing careers that would make them more productive and passionate out of fear that a health calamity could ruin them?
Obamacare helped to embolden Miles to change his life. It is why we left Washington and headed back to the Midwest, a region we came to love while I had an academic fellowship at University of Michigan in 2011 and 2012. I wanted to freelance, write books and teach, and he wanted to go back to school.
We made our move when we did because the academic year was coming, figuring we could shoulder a few months of COBRA coverage for Miles – about $420 a month – until Obamacare began.
(With no important pre-existing conditions, I got a very good private plan right away through Aetna for about $210 a month. It’s evidently Obamacare-compliant, because I liked my plan and, as the applause line goes, I was able to keep it.)
Shortly after midnight on Oct. 1, we hopped onto healthcare.gov to see what the federal exchange had for Miles. As you may have heard, that didn’t go so well. When I wrote about that first-day misadventure of glitches and unhelpful phone assistance for New York Magazine, my liberal friends attacked me for judging too soon and providing anti-Obamacare fodder to the haters.
But to us, this really is not about politics. It’s about our lives. Miles and I support health reform because we believe that, executed correctly, it can liberate people to pursue their highest and best purposes. As recently as a week ago, that was the angle of a piece I pitched to Time.Com, where I regularly contribute.
And then Jan. 3 happened.
We struggled with the healthcare.gov website for months. Every so often, we’d return to find Miles’ application for eligibility stuck in some “pending” netherworld. The Phone People said to wait a few weeks and try again. Nothing ever happened, except that the site said at varying times the application was “in progress” or “incomplete.” I lost count of how many times I re-entered the same information because some Phone Person told me to try that.
The deadline to sign up was Dec. 23, so by Dec. 20 we were frantic. I finally broke down and called the Obamacare navigators in our region, the folks supposedly deputized to guide helpless souls to the finish line. Only two of the five I reached out to even responded, one to say she’d be on vacation for the rest of the year (?!?) and the other to say she was booked solid with other desperate customers. I guess we were supposed to know that the website would never, ever work and plan ahead for that.
The second lady did help, though. She suggested we create a whole new account for Miles because the old one, created in the earliest days of the troubled site, might be corrupted and stuck in some digital purgatory. I did that — and, gosh darn it, it worked. Well, sort of.
It turned out that Miles, despite planning to be a student and not expecting to have much income, did not qualify for any subsidy. We received a document supposedly explaining why, but it looked like this to us:
We kept asking the Phone People why. They suggested we download it again or log out and log in again or wait an hour and try again or reboot our computers. I was surprised nobody recommended a little club soda.
On Dec. 21, with two days to go, we shrugged off the perplexing notion that the ACA actually does not provide help for people who have low incomes. Maybe we could figure out an appeal or, perhaps, our accountant could figure it out later.
Subsidy or no, Obamacare offered Miles a seemingly terrific deal: $246 a month for health insurance with a $1,650 deductible through the Blue Care Network, a Michigan subsidiary of Blue Cross Blue Shield. This was comforting; Miles’ COBRA policy from his WJLA job was under BCBS and our coverage at University of Michigan was under Blue Cross Blue Shield of Michigan. His doctor was in the plan, the price was good, the benefits and co-pays seemed adequate. At long last, he had his coverage. Done.
We should’ve known new problems lurked, but it was Christmas and we wanted to be merry. Then, on Dec. 27, I realized the $30 per month dental plan I chose for Miles offered no dentists within a 20-mile radius of our home. When I ventured back into the morass of healthcare.gov to pick another one, the site wouldn’t let me. A Phone Person explained that if I changed the dental plan, it would also invalidate Miles’ medical plan, too, and he wouldn’t be able to start any coverage until Feb. 1. I left the dental plan as it was; the Phone Person told me I could come back in January and change it.
The Phone Person lied. They lie a lot. And this would become very important later.
Three days into 2014, Miles took his Obamacare out for its maiden drive. His stop at the doctor went fine. At the pharmacy, it crashed.
His medication — which has cost us a co-pay of between $10 and $30 under every other plan he’s had since 2004 including one under Blue Cross Blue Shield of Michigan — would not be covered. At all.
That’s $438 out of pocket. Every month. And it won’t even go against the plan deductible.
In other words, this nifty $246 Obamacare plan would actually cost $686 a month.
Miles put the $438 on a credit card, all the while wondering what someone without a credit card would have done in the face of going without important medication. He, like most Americans, assumed the insurer’s word, via the pharmacist, was final. Also, it was late on a Friday, a blizzard and epic cold snap bore down on us and he couldn’t know when he’d be able to go get it again.
The Pollyanna in me was sure this was some mistake. We spent a lovely weekend watching the snow pile up, confident that the matter would be handled in a call or two whenever business resumed after the storm and polar vortex.
Instead, it turned out to be all I did all last week. My work deadlines got pushed back, interviews rescheduled, emails unreturned. Day after day, I found myself on lengthy calls with countless Phone People trying to understand why this very common medication, covered under every plan Miles has ever had, was now about to become a significant monthly expense. Every time I hung up believing I understood something, it would be contradicted by something else in my notes or some lapse in logic. So I’d call again, and I’d get some other Phone Person who would blindfold me, spin me around a few more times and let me grope for the donkey’s tail yet again.
One thing remained consistent: Miles’ medication was not in the “formulary” anymore. I’d never heard that term, either, but it’s the document in which insurers state what they will cover and at what level.
From there, the situation made progressively less sense. The Obamacare Phone People offered no information or explanation, only a mild scolding that I should have checked the formulary before I signed Miles up for this plan. They couldn’t have been nicer — or more useless.
The Blue Care Phone People, however, were aggressively obnoxious and unhelpful. Time and again, they came up with different answers I would later learn to be wrong: that Miles had exceeded his lifetime limit of a component of the medication (creative, but false), that the Affordable Care Act forced the medication off the formulary (mostly false), that the FDA had pulled the medication from use (made up out of thin air), that no insurer was allowed to cover it anymore (big fat lie).
One Blue Care Phone Lady read off a list of other medications for the same condition that the doctor could prescribe, including the same medication in a different form. That was a possibility, but that wasn’t what Miles’ doctor wants him to take.
Much more troubling than the fact that we received so much worthless and conflicting information was that there was nobody to appeal to, nobody to trust.
For days, I attempted to obtain a credible, consistent answer as a “normal” person. Then, realizing how futile that was, I contacted the public relations offices of both Blue Care Network and the Centers for Medicare and Medicaid Services, the Health and Human Services division administering the Affordable Care Act. I explained I was chronicling this experience because thousands of people must be encountering similar frustrations.
The CMS folks promised to gather the information I requested, and I did get some. I sent one spokeswoman the illegible eligibility document that showed only pages of weird symbols; she opened it on her computer just fine. I sent her screenshots of what I saw, she acknowledged that this was weird and faxed me the actual document. It did explain that Miles didn’t qualify for a subsidy because his expected student income was so low that he should apply for Medicaid. That seems like an easy enough, perhaps even reasonable, answer. Why couldn’t any of the many Obamacare Phone People have told us that? And is it really possible I was the only one having trouble opening the document properly?
Nobody from Blue Care Network responded to my request for information or an interview.
When the Blue Care Phone People claimed the FDA and/or Obamacare had banned this form of Miles’ medication, I became skeptical. If that had been so, it would’ve been a gigantic medical news story given the millions who take this medication, but it wasn’t. So I logged onto my Aetna account to check if my policy covered it. I learned it was considered generic and would cost not $438 but a whopping $15. Huh. I called Aetna; a Phone Person confirmed this. Their “formulary” still included the drug. We were more baffled than ever.
Aetna had plans on the federal marketplace as well, so I returned to HealthCare.gov to seek out a different plan for Miles. The site, however, incorrectly — surprise! — believed Miles hadn’t yet enrolled in the plan he was in.
Thus, I found myself back on the line with an Obamcare Phone Person. This time, however, I was told that once someone is enrolled in a plan via the marketplace, they cannot change it until the next open enrollment period in November. The only time to change plans, I learned, was before we paid the first premium.
This was news. In late December, remember, I had asked about changing the dental plan. I had been told then that I couldn’t do so without canceling the medical plan as well and postponing coverage to February. All we could do, they said, was cancel our plans. We were stuck.
All of this was passed along to CMS’s publicists, who vowed repeatedly to provide answers. They promised, that is, until they changed their minds. On Wednesday, I received some boilerplate information and a note: “Unfortunately, nobody is available for an interview.” The material they sent was clearly cut-and-pasted off HealthCare.gov – an explanation of why we couldn’t change our plans and how we should have known that this common medication would not be covered in our plan. There was a line in there about a three-day appeals process when a medication is denied; this was the first time in countless phone calls or emails that anyone even suggested there was such a process. Shouldn’t that have been the first thing the Obamacare Phone People said?
It was time to get out of the Obamacare fun house.
Our math had changed. Initially we hoped to get Miles a plan for less than the $421 cost of his COBRA. Now Miles was stuck in an Obamacare plan for $246 plus $438 out of pocket for his medications. Anything less than $690 a month was now a bargain.
Miles hadn’t been able to get covered independently in 2013 because of his pre-existing conditions, but the ACA now prohibits that exclusion. And I knew from earlier research that Aetna covers his medication. So I called Aetna. They had an excellent plan for Miles for $335 a month that we could start in February. It was outside the federal exchange and wasn’t eligible for any subsidies but, at this point, so what?
Knowing this restored a modicum of confidence in the ACA. Without it, Aetna wouldn’t — as we learned in 2013 — offer Miles any plan at all. So we were grateful, at least, for that.
But I still needed answers, so we held off on signing on with Aetna. Why did Aetna cover the drug but Blue Care didn’t? Why didn’t Blue Care cover the drug when every other Blue Cross Blue Shield plan Miles had had did? Why were we told we couldn’t change the dental plan and still have coverage on Jan. 1? How do we cancel our Obamacare plan?
After CMS’s no-comment email, I offered a respectful but pointed reply: “Thanks for trying. This system, which I toasted on Jan. 1 and had such high hopes for, is unraveling. I hope you understand that. If you with your access can’t obtain actual answers to these very common problems, there is no hope for it.”
That actually dislodged something. The next morning, Tony Dawson, a specialist from CMS’s Center For Consumer Information and Insurance Oversight division called. He listened to the whole story. His conclusion was startling: He agreed that our best course would be to dump our Obamacare plan and buy the Aetna one.
Dawson was sympathetic and, dare I say, honest. He reiterated that we couldn’t change plans in the exchange, but he said he would see about getting special permission to switch dental plans because I had tried before the deadline and had received incorrect information.
He also offered a plausible answer to the mystery of the formulary. Insurers write their own formularies. Neither the FDA nor the Affordable Care Act forced them to remove this medication. It was likely, however, that Blue Care made the change in part during negotiations with CMS regarding what plans would be made available on the exchange.
Dawson said he would find out why the drug had been dropped. I asked how fast he could do so; he said it would take a quick email. I explained I had a Jan. 15 deadline to enroll Miles with Aetna and be covered for February.
The most refreshing part of the conversation with Dawson was his acknowledgement that normal people, buying health insurance, usually don’t think to request the formulary to check on whether a common drug is covered. The boilerplate material that had been provided by CMS suggested the formulary had been easily accessible when we were browsing for plans, but I went back and saw that it actually is still not available on HealthCare.gov. (In mid-December, Forbes writer Scott Gottlieb wrote that the formularies were usually not available as people chose their plans, and he warned people with certain chronic conditions in need of expensive medication might face sticker shock at the pharmacy.)
Anyhow, Dawson promised to get back to me, and he did. He called Monday to confirm this form of the medicine wasn’t covered and our best choice was, in fact, to dump our plan.
On Jan. 10, I signed Miles up for the Aetna plan and called Blue Care to cancel. A Phone Person said they can’t do it, that policies created through the exchange had to be canceled through the exchange.
I called the Obamacare line. This Phone Person apologized at the outset because the “system is down,” so he wouldn’t be able to access Miles’ account. Nonetheless, how could he help me?
“We want to cancel this policy,” I told him.
“Oh, we can’t do that,” he said.
“You what?”
“I can’t cancel policies,” he said. “I suggest you call the insurance company. They’re the only ones who can do it.”
“But they just told me to call you.”
“I’m sorry, that’s not something we can do here.”
I know it’s rude, but I just hung up without saying goodbye. It was all I could do to avoid saying something cruel and regrettable to a poor soul who may or may not be right.
I figured if Dawson ever called me back, maybe he could straighten this out. Otherwise, Blue Care will drop us sooner or later when they realize we’re not giving them our money anymore.
Some may boil our misadventures down to its core, a bratty dirge by privileged whiners who don’t even need Obamacare and are sore they couldn’t get their medication covered. But that’s just it — we, too, need and want more affordable health care. We are precisely the kind of folks they need to make these exchanges work. If it’s all poor, very sick people, Obama can kiss his legacy goodbye.
What’s more, we have the time and initiative to dig for answers. As journalists, we could tap on the shoulders of people who ought to know, but that failed, too. Even with the looming prospect of being subject to this sort of publicity, nobody could give us complete, prompt or useful information. How are people who don’t badger public figures for a living, people who have no other option than to contend with Phone People, supposed to work it out?
But this isn’t merely a failure of government — though it is that. It’s also a failure of the private sector in the form of the insurance industry. They’ve received an unbelievable gift, a government-backed money-minting machine on an epic scale. Nobody really likes them, either. This is their chance, too. And their Phone People are no better despite being significantly more experienced. Their media spokespeople were even less responsive than the government’s, and that’s a pretty low bar.
Come November, we’ll check back and see what Obamacare plans are available for 2015. We want the ACA to work; the previous status quo certainly did not.
Right now, though, it’s time to move on. It’s easy to shrug that these are the expected growing pains of a massive new system. That’s probably true. But in real time, it is destructive to our finances and potentially bad for our health.
The president promised a system that would make obtaining insurance as easy as buying a book on Amazon.com. Instead, he gave us – so far, anyhow – one that’s about as easy as getting the NSA to stop listening to our phone calls.
TPM Reader TC on the difficulty of getting young adults to sign up for Obamacare:
Love your reporting and wanted to drop a line tonight to offer my position on the ACA.
I'm a 32 year-old healthy male that wants, but can't afford, Obamacare. I think the law is a step in the right direction, it just doesn't go far enough to capture my peers in large numbers.
Let me offer my situation:
I earn 55,000 a year working in a restaurant, though I have a Masters Degree. I live in Brooklyn. I earn too much to qualify for assistance with healthcare, so my premium is $308/month.
My apartment rent is $1400/month, student loans are just under $800/month, I pay around $200/month in credit card bills, $100 for a cell phone, and $50 for car insurance. Then we have food, movies, metro cards, etc, etc ...
Run the numbers, where do I find room for another $308/month???
I've been off my parents insurance for 8 years. I've been to the doctor less than 5 times in those years, for a total cost of under $500. It's hard for me to justify spending almost $3800 a year on a bronze plan when that's more than 7 times what I've paid over the last 8 years! And even spending that much, I've still got a large deductible to cover.
I know I'm not getting any younger, but man, these numbers are hard to swallow, much less get excited about!
As I stated before, I'm a supporter of the law. I voted for Obama with pride and I would again. ... I just don't believe this is the final solution, rather, only the first step.
More On Young, Healthy And Scraping By I posted a reader email yesterday from a 30something Brooklynite, TC, who is supportive of Obamacare but still can't afford the premiums for health insurance on the exchange.
It prompted several emails from other readers with a range of reactions that basically fell into three categories: readers who could relate; older readers who, in almost a parental way, urged TC to reassess the financial risk of going without insurance; and readers who, if I can freely summarize, had little patience for underemployed hipster financial predicaments.
Here's a sampling:
From the "me, too" category, TPM Reader GS:
Hey, I've been a close follower of TPM for a long time, and I can't tell you how good it made me feel to read TC's letter about being a young adult unable to afford the new plans available through the ACA.
I had been purchasing one of those bare bones, catastrophic plans in order to placate worried parents. The few times I went to the doctor it paid for next to nothing and certainly didn't help with any prescriptions I needed. As a big Obama supporter the past elections, I was actually excited to enroll and help support the ACA's enrollment numbers. I tried enrolling within the first few days of the website's rollout, and continued logging into the site for months as they were fixing it. Imagine my disappointment to find myself in the exact same predicament as TC.
I'm in the same boat, living in NYC, 30 years old, working in a restaurant, paying a ton for rent, utilities and expenses while also not qualifying for any financial assistance. It kills me to stay on my cheaper, catastrophic plan, but I have no other option. I just can't afford the $310 premiums.
There are a huge number of folks in my same situation, working jobs in the service industry without access to real healthcare and making just enough for them to not be able to qualify for assistance. Couple that with the crippling cost of higher education and a lack of viable career options, and what are your real options?
When I finally got through on the website and saw what my options were, I felt terrible. It's bad enough knowing your financial situation is tenuous in general, but this just felt like a kick in the gut.
From those urging TC to reassess his risk, TPM Reader MH:
I know how TPM reader TC feels--I went without insurance for a few years after college (pre-Obamacare) and it's easy to feel like it's cheaper to pay for the occasional medical care out of pocket than shell out for insurance every year.
But.
Anyone who still has their appendix has a $30,000 ticking time bomb in their abdomen. There are no risk factors for appendicitis, no warning signs, it can strike at any age, and the only treatment is an appendectomy. When I had mine out a few years ago at the ripe old age of 29, the retail (pre-insurance discount) price tag was just under $30,000. I had great, employer-provided insurance, so I paid $50 for the ER and $400 for the hospital stay. But had it struck a few years earlier, when I was an unpaid, uninsured intern, I would have been bankrupted. Before the age of 30.
And there are dozens of things like this, that are independent of age, health, or lifestyle. You can obey every traffic law and never jaywalk a day in your life, and a bad driver can put you in the hospital for months.
That's why you carry insurance. Yes, perhaps it's cheaper to pay for the occasional doctor's visit out of pocket--but real health insurance is what stands between each of us and bankruptcy.
TPM Reader MC:
Regarding the post from TC explaining why he/she cannot afford health insurance, my thought is that a person cannot afford NOT to have insurance. I have been self-employed for years and have paid very high premiums to insure myself and my family. My husband is also self-employed but I covered him under my policy because I found a group I could belong to who offered insurance to group members. Even though I had insurance, I knew that I was only one serious illness or accident away from financial devastation. If I were seriously ill, my insurer might rescind coverage because they could. At least now they cannot do this.
When my children started their work lives, their employers often did not offer health insurance either because the job was not full time, or insurance was only offered after you had worked at the company for a period of time. So I paid their premiums so that they would have some kind of insurance. Again, I knew they were only one accident or devastating illness away from my complete financial devastation. What parent would allow their child, no matter how old, to have to forego medical care because they had no insurance. If the parent had any savings at all, they would use it all to help their child.
What I would say to TC is it is short-sighted not to find some way, if at all possible, to pay for insurance. If TC’s parents or other family can provide help,TC should let them. Families are all in this together, no matter how old the children are. Health insurance should be a top household budget priority, after food and shelter. I am thrilled that we now have the ACA and after the fits and starts of its rollout, I hope we will see it grow in quality. It is one of the single most important laws ever passed.
And from the give me an effing break category, TPM Reader RM:
Was the TC story a joke?
What I'm supposed to feel bad that some 32 year old has made a series of wrong and terrible decisions and now can't afford $308/month? Oh no! He wouldn't be able to go to movies!? The horror!
He's right, we should massively overhaul our entire system yet again so that he can have other Americans cover his tab allowing him to still make it to the opening of this weekend's blockbuster (which he can pay for with his credit card). I'd love to hear what the other "etc" entailed.
It's his fault he's buried in credit card debt. It's his fault he took out loans to get a Masters degree and then work in a restaurant. It's his choice to live in NYC with the substantially higher cost of living... If you're "scraping by" why have a car and car insurance if you live in NYC?! The public transportation (which he's paying for as well) there is more than adequate for daily life.
I'm all for helping the poor to get coverage, but this story was simply a whiny 32 year old who has made dumb decisions in his life and now wants everyone else to foot the bill for him.
TPM Reader JZ:
I'm not sure what the take-home message of the post by David Kurtz "Young, Healthy And Scraping By" is supposed to be, other than that young adults have misplace priorities, poor money management skills, and an insufficient appreciation of the value of health insurance.
It is incredible that the reader pays roughly 25% of his or her income for debt but balks at paying 7% for health insurance. It is unfortunate that the reader is not putting the master's degree to good use, but $55,000 is a good salary. Many people are doing worse.
This is not a problem with Obamacare. Even if the premium were half as much, the reader would still have difficulty with those spending priorities. Get a roommate or cut some expenses, and then pay down that debt.
This shows why the individual mandate and penalties are needed.
I'm in a situation similar to that of the reader: I'm a 33-year-old American, I earn 6,000,000 yen (about $57,000), I live near Tokyo (high cost of living), and I pay about $300 dollars for my health insurance from the Japanese government. But I have no debt. I used to have about $30,000 in credit card and student loan debt that I worked to pay off (when I was making half as much money). When I came to Japan, I was amazed by the easy access to health insurance, which is similar to Obamacare in terms of cost and level of service. Now that Obamacare is available, it would be a shame for people my age not to take advantage of it.
TPM Reader DC:
Mandatory insurance purchase is not unlike other regulations that prevent people from cutting corners; TC may have been living beyond his means, and either needs to spend less or earn more.
The whole point of many regulations is to prevent people from cutting risk corners in a race to the bottom -- truck drivers DO need to take breaks, and if these were not mandated, those who need the least sleep (or more likely, are the most overconfident) will force a lower standard for everyone else.
Same for health insurance -- if people scraping by can pay a higher rent by skipping health insurance, they might do that, and it drives up the rent for everyone else, including the responsible people who do buy health insurance. If a bank can offer an apparently higher interest rate to depositors by relaxing loan or capital cushion standards, they'll do that, too, and if their competitors don't follow suit, the competitors will lose depositors.
Interfering with the market? You betcha. If not for laws and regulations, the market would grind up humans for dog food, if there was a buck to be made doing that.
TPM Reader EO:
Never written in before, but I call bs on TC.
He has plenty of money to afford health insurance, but doesn't think he needs insurance, and obviously doesn't care enough about making the program successful to sign up.
Really it's no better than a Tea Party response - I don't need no stinking health insurance, and if something does happen I'll just go to the emergencyroom.
With friends like that, the opponents of Obamacare won't have to do much at all.
I saw similar on DemocraticUnderground. When it first came out, many were saying their premiums went through the roof. They were savagely attacked for it. People demanded proof, that they show screenshots, and the like. Folks called for their banning.
It was sick honestly. People who just flat our refuse to see the truth of the matter.
djones520 wrote: I saw similar on DemocraticUnderground. When it first came out, many were saying their premiums went through the roof. They were savagely attacked for it. People demanded proof, that they show screenshots, and the like. Folks called for their banning.
It was sick honestly. People who just flat our refuse to see the truth of the matter.
djones520 wrote: I saw similar on DemocraticUnderground. When it first came out, many were saying their premiums went through the roof. They were savagely attacked for it. People demanded proof, that they show screenshots, and the like. Folks called for their banning.
It was sick honestly. People who just flat our refuse to see the truth of the matter.
How do you survive the DU?
o.O
That place is treacherous.
I don't, I've been banned there at least a dozen times. I just read it now for the stupidity.
This message was edited 1 time. Last update was at 2014/01/16 21:38:02
djones520 wrote: I saw similar on DemocraticUnderground. When it first came out, many were saying their premiums went through the roof. They were savagely attacked for it. People demanded proof, that they show screenshots, and the like. Folks called for their banning.
It was sick honestly. People who just flat our refuse to see the truth of the matter.
How do you survive the DU?
o.O
That place is treacherous.
I don't, I've been banned there at least a dozen times. I just read it now for the stupidity.
I'd need some mental bleach if I had to go through that muck.
You sir, is one tough mofo.
This message was edited 2 times. Last update was at 2014/01/16 21:39:34
djones520 wrote: I've never heard a Republican bitch at someone for not wanting to pay more for things.
I was referring to the "grow up hippy" comments.
Oh and I don't they're bitching at him for not paying more. I think they're mad that he acknowledges that he doesn't have to pay as much (at least, he supports the politics) but that's still not good enough for him.
TBH, I agree that ACA should just be a first step. Health care is still too inaccessible and costly.
This message was edited 1 time. Last update was at 2014/01/16 21:44:23
I'll be honest, $55,000 is good money. I don't see how working class folk could make it, especially if one had ongoing medical condition.
Frazzled, again supporting a Canadian/Swiss type system.
-"Wait a minute.....who is that Frazz is talking to in the gallery? Hmmm something is going on here.....Oh.... it seems there is some dispute over video taping of some sort......Frazz is really upset now..........wait a minute......whats he go there.......is it? Can it be?....Frazz has just unleashed his hidden weiner dog from his mini bag, while quoting shakespeares "Let slip the dogs the war!!" GG
-"Don't mind Frazzled. He's just Dakka's crazy old dude locked in the attic. He's harmless. Mostly."
-TBone the Magnificent 1999-2014, Long Live the King!
djones520 wrote: I saw similar on DemocraticUnderground. When it first came out, many were saying their premiums went through the roof. They were savagely attacked for it. People demanded proof, that they show screenshots, and the like. Folks called for their banning.
It was sick honestly. People who just flat our refuse to see the truth of the matter.
How do you survive the DU?
o.O
That place is treacherous.
If you want a nice opposite experience, Sigforum.com is a nice hive of scum and treachery.
"So, do please come along when we're promoting something new and need photos for the facebook page or to send to our regional manager, do please engage in our gaming when we're pushing something specific hard and need to get the little kiddies drifting past to want to come in an see what all the fuss is about. But otherwise, stay the feth out, you smelly, antisocial bastards, because we're scared you are going to say something that goes against our mantra of absolute devotion to the corporate motherland and we actually perceive any of you who've been gaming more than a year to be a hostile entity as you've been exposed to the internet and 'dangerous ideas'. " - MeanGreenStompa
"Then someone mentions Infinity and everyone ignores it because no one really plays it." - nkelsch
It looks as if I am not going to be able to complete my application and secure a plan by the proposed deadline to have insurance by January 1st. According to the website, I have to be signed up by today to have coverage on January 1st.
While I have heard through the grapevine that I will have longer to sign up, the OFFICIAL website says that I have until the end of the day, so until I read an official statement, I will assume that is what the deadline is. (BTW it takes about 2 minutes to update basic text in a website, so there really is not an excuse for that one.)
I appreciate the desire for reasonable healthcare for everyone. I also agree that our previous system was not functioning in an efficient or even fair way, but based on my experience with the Healthcare Reform so far, the promise that has been made to my family about receiving affordable healthcare has not been followed through on. I know I am not alone in this, as many other Americans are struggling and have struggled to secure health insurance through the program.
Here is an account of my experience so far:
June 2013 - I was informed that my Health Insurance provider would no longer be issuing policies in my state (Indiana). I immediately began researching my options for healthcare for the next year. I hate procrastinating and wanted to get a policy in place ASAP to avoid any gaps in coverage so I IMMEDIATELY started working on getting a plan in place.
Despite getting a jump on transitioning over, I was told that I would have to wait due to information not being completely available to the health insurance brokers that I was working with.
July – August 2013 – I continued researching options for health insurance coverage, reading up on the laws and making calls to insurance brokers. I did my research on what my I am required to have as far as health insurance, and waited for the brokers and Healthcare.gov website to become available and ready for me to buy health insurance. I made sure to give the brokers my information so they would be able to quote me as soon as they received their new rates.
September 2013 – I received two phone calls from different insurance brokers who told me that I would need to wait until the new rates were released before I would be able to know what my costs would be.
October 2013 – Received quotes from my broker for health insurance coverage. Here is a snapshot of one of the quotes that I received. This is when I realized that going without subsidies was not an option. The premium and deductibles that I would have to pay would eat up over HALF of my family’s take home pay.
We could not afford to cover living expenses for a family of four and pay for health insurance. (And these are LOW premium, HIGH deductible plans! This is not gold or platinum level coverage.) Here is a snapshot of the quotes:
My recently quoted private health insurance plans.
It was at this point that I ventured into the healthcare.gov website to buy insurance through the exchange.
I probably don’t need to spend too much time going into the various problems that people have experienced, as you have probably heard most of them already. If you have heard it, I have probably experienced it
November 2013 – Spent time contacting other options while attempting each week to get my application through.
I also attempted the “Live Chat” feature with no luck. Apparently, the live chat really can’t help you with your application. Here are some screenshots from my attempt on Nov. 8th:
December 2013 – I ramped up my attempts at submitting my application to roughly once a day, but did not have any luck getting through the last screen. At this point I began to call and attempt to have marketplace reps fill out applications for me.
Here is the dreaded “ERROR” Screen that I have received no less than 100 times.
Dreaded Error screen!
I had one extremely helpful rep spend close to two hours on the phone with me walking me through my application, but unfortunately she was not able to get through due to her system being down.
This brings me to last week
Friday December 20th, 2013 – Spent the majority of the day on the phone and website trying to push my application through with no luck. The website experienced tons of moments where it was down and it was hit or miss at best.
Monday December 23rd 2013
So I was given a tip that if you go through a health insurance company directly, then they would be able to walk through the application and get you signed up. So that is what I did.
I called the health insurance provider Anthem and spent another hour and a half walking through an application before I was told that I would have to contact healthcare.gov in order to complete my application!
YAY!
So I called the website again and attempted to get answers with no luck.
The last phone call was 1 hour 36 minutes and I ended by deciding that I was going to appeal. I spent most of my time today crafting this letter and typing out my experience to share with others.
I am not sure what to say, other than I am frustrated and am ready to go to bed. I will update as I hear more.
Zack
P.S. – I would love to hear your experience with the website and application process below in the comments. Share if you have a story to tell!
I am currently typing this blog post as I sit on hold with the Healthcare.gov marketplace help line. I am doing everything I possibly can to sign up for health insurance (which is required by law) so that my family can have the care that they need next year now that our current plan has been taken away from us.
Despite repeated attempts since October (no less than a dozen, including roughly four alone last week) to submit an application and select a plan, I have run into a myriad of different issues.
While simply signing up has been extremely frustrating and still needs to be resolved, a much more pressing problem that I am having with this process is that according to my recently received eligibility notice from healthcare.gov, my kids (ages 1 and 3) are not eligible to buy health insurance through the exchange.
What is confusing about this is that my wife and I are eligible.
Not only is my oldest son not able to receive insurance through the exchange, he is not eligible for ANY other government program according to my official eligibility requirement.
Here is a screenshot of the eligibility notice that I received:
Notice that my wife and I are eligible. Calls to healthcare.gov confirmed this, but they could not do anything to help me or answer our questions about his eligibility. Why is he not eligible when we meet all of the requirements (income level, no employer provided insurance, etc)?
Here is my problem:
I have spent many hours on the phone help line with different healthcare representatives and not a single one can give me an answer. Each one of the representatives has said that this eligibility status is “weird” and they have all wondered aloud why my oldest son is not eligible for anything.
One even exclaimed, “That’s not right!”
Each one told me that I could appeal the decision and that to appeal I should check the page on the healthcare.gov site that gives instructions about how I should go about appealing. However, they also made it clear that because this process takes two weeks, either way, we will not have insurance on January 1 if we don’t sign up by today.
If I do not receive a favorable judgment in my appeal, I will have no choice but to buy health insurance at full price for my boys (one of which desperately needs surgery on his ears).
Again, my question is: Why are they not eligible when we meet all of the requirements?
Having previously purchased private insurance I am completely willing to do this, but after taking an initial look at premiums and deductibles I am going to be paying much more than ever for health insurance, with WORSE COVERAGE. Here is a screenshot of the first quotes that I have received after checking in the last couple of hours.
Also, this is a quote for only one of my boys; I would have to buy another plan for my other son.
THIS IS NOT DOABLE for us financially.
What I am asking:
I do not spend a lot of time voicing my political opinion and have been extremely patient (see my detailed experience here) in giving the government time to fix the website and system, but since you have failed to meet the goals that you set for us and for yourself, I am simply holding the government accountable to the promise that was made to not deny anyone affordable healthcare coverage.
At the very least, I feel that it is not unreasonable for me to ask for an explanation about why my son has not been allowed to sign up.
I am not throwing stones or doing this to rebel against the governmental authority that is over me, I am simply writing to you on behalf of my boys who have been denied what you think they should be required to have.
I am also asking anyone who comes across this letter to send it on and share it to bring awareness to the situation.
Last Wednesday, Scott Gottlieb and I debated Jonathan Chait and Douglas Kamerow on this proposition: “Resolved: Obamacare Is Now Beyond Rescue.” I was feeling a little trepid, for three reasons: First, I’ve never done any formal debate; second, the resolution gave the “for” side a built-in handicap, as the “against” side just had to prove that Obamacare might not be completely beyond rescue; and third, we were debating on the Upper West Side. Now, I grew up on the Upper West Side and love it dearly. But for this particular resolution, it’s about the unfriendliest territory this side of Pyongyang.
Nonetheless, I greatly enjoyed the debate. I’m not ashamed to admit that the other side had a lot of powerful moments. Kamerow, a doctor who is also a former assistant surgeon general, made good points about the problems with the previous status quo. In the other seat, Chait was as passionate, witty and well-reasoned in his arguments as ever. (You can read his account of the debate here.) Given the various difficulties, we went in assuming that we would lose, so we were pretty surprised and pleased when we won.
What was the winning argument? We argued that the Patient Protection and Affordable Care Act is an unstable program that doesn't deliver what was expected. For a lot of people, that hardly needs proving, given all the recent technical and legal gyrations. But for others, it does, and because most of them weren’t at the debate, let me elaborate. Scott spoke eloquently about the ways in which narrow networks and the focus on Medicaid are going to deliver an unacceptable quality of care. I talked about why this, among other things, makes the system so unstable.
In a nutshell, Obamacare has so far fallen dramatically short of what was expected -- technically, and in almost every other way. Enrollment is below expectations: According to the data we have so far, more than half of the much-touted Medicaid expansion came from people who were already eligible before the health-care law passed, and this weekend, the Wall Street Journal reported that the overwhelming majority of people buying insurance through the exchanges seem to be folks who already had insurance. Coverage is less generous than many people expected, with narrower provider networks and higher deductibles. The promised $2,500 that the average family was told they could save on premiums has predictably failed to materialize. And of course, we now know that if you like your doctor and plan, there is no reason to think you can keep them. Which is one reason the law has not gotten any more popular since it passed.
The administration and its supporters have been counting on the coverage expansion to put Obamacare beyond repeal. So what if the coverage expansion is anemic, the plans bare-bones, the website sort of a disaster? It’s a foundation upon which we can build -- and now that so many people have coverage, the thinking goes, Republicans will never dare to touch it. The inevitable problems can be fixed down the road.
But it’s far from clear that this is true. The law is unpopular, not only with voters, but also apparently with the consumers who are supposed to buy insurance. The political forces that were supposed to guarantee its survival look weaker by the day. The Barack Obama administration is in emergency mode, pasting over political problems with administrative fixes of dubious legality, just to ensure the law’s bare survival -- which is now their incredibly low bar for “success.”
Although the fixes may solve the short-term political problems, however, they destabilize the markets, which also need to work to ensure the law’s survival. The president is destroying his own law in order to save it.
Obamacare’s exchange facility was conceived as a “three-legged stool”: guaranteed issue, community rating, mandate. Guaranteed issue means that an insurer can’t refuse to sell you a policy. And community rating means that they can’t agree to sell you a policy -- for a million dollars. The problem is that if you set things up this way, it makes a lot of sense to wait to buy insurance until you get sick, at which point premiums start spiraling into the stratosphere and coverage drops. Enter the mandate: You can’t wait. You have to buy when you’re healthy or pay a fine.
There are actually other legs -- the subsidies, in particular, are needed so that you’re not ordering people to buy a product they can’t afford. But it doesn’t really matter how many legs the stool has; what matters is that it needs all of them. Take one away, and the whole thing is in danger of collapsing.
Unfortunately, whenever someone has voiced discontent with the way things are going, the administration has taken a hacksaw to another leg. For example, some folks who had policies they liked before were being forced to drop them and buy new policies they didn’t like so much. That caused an outcry, followed by an emergency grandfathering rule. Other major emergency fixes include:
· A one-year delay of the employer mandate (which our own Ezra Klein has shown is critical to both coverage expansion and cost control). It seems unclear that this will ever go into effect, as the regulatory difficulties of tracking compliance are enormous, and enforcing it will trigger unpopular changes in working hours and other conditions for many workers.
· Numerous extensions of enrollment and payment deadlines, even though these have led to consumer confusion.
· Changes in the rules governing the “risk corridor” programs that cover excess losses at insurers, with more potentially in the works. This buys peace with the insurers, but is going to be incredibly politically difficult for the administration to defend when the costs become clear.
Why does this put the law beyond rescue?
First, let’s define what we mean by “beyond rescue.” Is Obamacare going to be repealed in its entirety? No. Some of the provisions, such as letting parents keep their kids on their insurance until they’re 26 years old, have no chance of being repealed. Others, such as the Medicaid expansion, will almost certainly stand in some form, though I could see Medicaid being block-granted and then slowly whittled away under another administration. The fate of other pieces, such as the cost-control procedures and the exchanges, is still too cloudy to predict.
By “beyond rescue,” I mean that the original vision of the law will not be fulfilled -- the cost-controlling, delivery-system-improving, health-enhancing, deficit-reducing, highly popular, tightly integrated (and smoothly functioning) system for ensuring that everyone who wants coverage can get it.
The law still lacks the political legitimacy to survive in the long term. And in a bid to increase that legitimacy, the administration has set two very dangerous precedents: It has convinced voters that no unpopular provisions should ever be allowed to take effect, and it has asserted an executive right to rewrite the law, which Republicans can just as easily use to unravel this tangled web altogether.
Many of the commentators I’ve read seem to think that the worst is over, as far as unpopular surprises. In fact, the worst is yet to come. Here’s what’s ahead:
· 2014: Small-business policy cancellations. This year, the small-business market is going to get hit with the policy cancellations that roiled the individual market last year. Some firms will get better deals, but others will find that their coverage is being canceled in favor of more expensive policies that don’t cover as many of the doctors or procedures that they want. This is going to be a rolling problem throughout the year.
· Summer 2014: Insurers get a sizable chunk of money from the government to cover any excess losses. When the costs are published, this is going to be wildly unpopular: The administration has spent three years saying that Obamacare was the antidote to abuses by Big, Bad Insurance Companies, and suddenly it’s a mechanism to funnel taxpayer money to them?
· Fall 2014: New premiums are announced.
· 2014 and onward: Medicare reimbursement cuts eat into hospital margins, triggering a lot of lobbying and sad ads about how Beloved Local Hospital may have to close.
· Spring 2015: The Internal Revenue Service starts collecting individual mandate penalties: 1 percent of income in the first year. That’s going to be a nasty shock to folks who thought the penalty was just $95. I, like many other analysts, expect the administration to announce a temporary delay sometime after April 1, 2014.
· Spring 2015: The IRS demands that people whose income was higher than they projected pay back their excess subsidies. This could be thousands of dollars.
· Spring 2015: Cuts to Medicare Advantage, which the administration punted on in 2013, are scheduled to go into effect. This will reduce benefits currently enjoyed by millions of seniors, which is why they didn’t let them go into effect this year.
· Fall 2015: This is when expert Bob Laszewski says insurers will begin exiting the market if the exchange policies aren’t profitable.
· Fall 2017: Companies and unions start learning whether their plans will get hit by the “Cadillac tax,” a stiff excise tax on expensive policies that will hit plans with generous benefits or an older and sicker employee base. Expect a lot of companies and unions to radically decrease benefits and increase cost-sharing as a result.
· January 2018: The temporary risk-adjustment plans, which the administration is relying on to keep insurers in the marketplaces even if their customer pool is older and sicker than projected, run out. Now if insurers take losses, they just lose the money.
· Fall 2018: Buyers find out that subsidy growth is capped for next year’s premiums; instead of simply being pegged to the price of the second-cheapest silver plan, whatever that cost is, their growth is fixed. This will show up in higher premiums for families -- and, potentially, in an adverse-selection death spiral.
Each of these is likely to trigger either public outcry or providers leaving the market (leading to public outcry). Policy analysts can say that this is unfortunate but necessary -- that you can’t make an omelet without breaking eggs. Fair enough, but the administration has been manifestly unwilling to tell the eggs that. Instead, it’s emergency administrative fixes for everyone. And we sure can’t count on Republicans to save Obamacare by tackling the egg lobby.
Instead, I expect that the administration is going to issue “temporary” administrative fixes for most of the law’s unpopular bits -- just as it has so far. That’s not going to get any easier as midterms and then a presidential election creep closer. And then Republicans will make the “temporary” fixes permanent. And by the time everyone’s done “fixing” the original grand vision, not much of it will be left. This is why I argued that Obamacare, the vision, is now beyond rescue. And a surprising number of Upper West Siders apparently agreed with me.
Target Corp. (TGT) will end health insurance for part-time employees in April, joining Trader Joe’s Co., Home Depot Inc. and other U.S. retailers that have scaled back benefits in response to changes from Obamacare.
About 10 percent of part-time employees, defined as those working fewer than 30 hours a week, use Target’s health plans now, according to a posting yesterday on the Minneapolis-based company’s website. Target is the second-largest U.S. discount retailer by sales and had about 361,000 total employees last fiscal year, according to data compiled by Bloomberg.
The U.S. Patient Protection and Affordable Care Act is the largest regulatory overhaul of health care since the 1960s, creating a system of penalties and rewards to encourage people to obtain medical insurance. The law known as Obamacare doesn’t require most companies to cover part-time workers, and offering them health plans may disqualify those people from subsidies in new government-run insurance exchanges that opened in October.
“You see a lot of retailers making adjustments in contemplation of the full effect of the employer mandate penalties in 2015,” Neil Trautwein, a lobbyist with the National Retail Federation, a trade group in Washington, said in a phone interview. “Even though it is not effective yet, it is already having an effect on the job market and putting companies where they would probably not otherwise want to be.”
The move should also reduce the cost of Target’s health benefits, Trautwein said.
Target fell less than 1 percent to $59.98 in New York. The shares have declined 4.1 percent in the last 12 months.
New Options
The health law requires all companies employing 50 or more people to offer health insurance to those working at least 30 hours a week starting in 2015. Those that don’t comply may be liable for fines of as much as $3,000 per worker.
“Health-care reform is transforming the benefits landscape and affecting how all employers, including Target, administer health benefits coverage,” Jodee Kozlak, Target’s executive vice president of human resources, said in yesterday’s web posting. She cited “new options available for our part-time team, and the historically low number of team members who elected to enroll in the part-time plan.”
No Target workers will see their hours cut as part of the change, she said. A Target spokeswoman, Jill Hornbacher, wouldn’t say how many part-time workers the company employs, saying in an e-mail that the number “fluctuates often.”
Affordable Plans
The company wouldn’t disclose how much it spends on health benefits or how much the change would save, or what part-timers pay for their insurance, Hornbacher said.
The Affordable Care Act created new government-run health insurance exchanges to sell coverage to uninsured people, often with premiums discounted by federal subsidies. It disqualifies Americans for subsidies at the exchanges if they have an offer of “affordable” coverage from their employers, defined as an insurance premium less than 9.5 percent of their income.
Target plans a one-time $500 payment to part-timers losing coverage and a consulting firm will help those workers sign up for new Obamacare plans. It said on its website that many part-time workers may prefer coverage from the health law’s exchanges, and that by offering them insurance, “we could actually disqualify many of them from being eligible” for subsidies.
Coverage for Target employees who work fewer than 30 hours will end April 1, the company said. Open enrollment for 2014 under the Affordable Care Act closes a day earlier.
Hourly Threshold
Trautwein’s organization is lobbying Congress to raise the threshold that determines whether workers must be offered insurance to 40 hours per week. Labor unions have also complained that the 30-hour limit may lead to reductions in hours for part-time employees, as companies seek to avoid offering them health insurance.
Employers had been dropping coverage for workers for more than a decade preceding passage of the Affordable Care Act, said Joanne Peters, a spokeswoman for the U.S. Department of Health and Human Services.
“But now, unlike before, employees have the option of shopping in the marketplace for quality, affordable coverage, where they may be able to qualify for a tax credit to help pay for the cost,” Peters said in an e-mail.
Now it is being reported that Obamacare may bankrupt insurance providers. This "law of the land", as everyone that thought the sun rose and set on Obamacare called it at first, is like a mad dog that needs to be put down.
Relapse wrote: Now it is being reported that Obamacare may bankrupt insurance providers. This "law of the land", as everyone that thought the sun rose and set on Obamacare called it at first, is like a mad dog that needs to be put down.
Aetna CEO Mark Bertolini told CNBC on Wednesday that Obamacare has failed to attract the uninsured, and he offered a scenario in which the insurance company could be forced to pull out of program.
The company will be submitting Obamacare rates for 2015 on May 15.
"Are they going to be double-digit [increases] or are we going to get beat up because they're double-digit or are we just going to have to pull out of the program?" Bertolini asked in a "Squawk Box" interview from the World Economic Forum in Davos, Switzerland. "Those questions can't be answered until we see the population we have today. And we really don't have a good view on that."
He said that so far, Obamacare has just shifted people who were insured in the individual market to the public exchanges where they could get a better deal on a subsidy for coverage. "We see only 11 percent of the population is actually people that were firmly uninsured that are now insured. So [it] didn't really eat into the uninsured population."
For Obamacare to work better, it needs more flexibility and choice of insurance programs, Bertolini said. "We need to make it a lot more simpler for people. There needs to be more choice. When you get more choice, you make it more of a market and you get more people in the program."
As for Aetna, Obamacare plans make up 3 percent of its revenue, he said. "Whether or not there's a government bailout because we lose some money on members is irrelevant to us from our standpoint of our earnings."
By 2020, Bertolini said he sees 75 million people buying health-care insurance from exchanges. "Some portion of that will be public exchanges—probably 20 million to 25 million will be public exchanges—the rest will be private exchanges."
"We're going to have individuals buying health care with a subsidy from their government or a subsidy from their employer," he said.
Charity gets win for now over Obamacare on contraception
(CNN) -- A U.S. Supreme Court ruling on Friday will enable a religious-affiliated non-profit and other groups like it to remain temporarily exempt from Obamacare requirements to cover birth control and other reproductive health they oppose on moral grounds.
The justices extended an injunction first granted on an emergency basis just before the New Year for a Catholic charity for the elderly run by nuns, the Little Sisters of the Poor.
The order, which also covers its insurance administrator, will remain in effect while lower courts continue to wrangle with the merits of the primary challenge to the health law mandates on contraception.
Although temporary, it is an important victory for those objecting to the socially charged requirements that were a negotiated compromise aimed at allowing coverage but also allowing a workaround for those opposing it.
In a once-sentence order without any noted dissent, the Supreme Court said the Obama administration could not enforce the mandates if those involved tell the Health and Human Services Department in writing that they are a non-profit and hold themselves "out as religious and have religious objections to providing coverage for contraceptive services."
Although the high court order applies specifically to the Little Sisters of the Poor and its administrator, Christian Brothers Services, it will likely have the practical effect of keeping the government from forcing other religious non-profits that raised similar objections to comply with the mandates.
For instance, Christian Brothers, an Ohio-based non-profit, handles insurance policies for a number of religious-affiliated organizations.
The contraception issue has been a major sticking point in the health law, President Barack Obama's signature diplomatic achievement that overall has been the subject of enormous legal and political controversy.
The requirements in question that took effect January 1 were designed by the administration to give women employed at nonprofit, religious-based organizations -- such as certain hospitals and private faith-based universities -- the ability to receive contraception through separate health policies with no co-pay.
The central dispute revolves around a negotiated requirement for those religious-affiliated groups not wanting to comply to sign a form explaining their objections. So-called self-certification would permit third-party administrators to provide the coverage. Churches and houses of worships are exempt from the requirement outright.
Religious-based groups sought delays, saying that signing the form would force them "to choose between onerous penalties or becoming complicit in a grave moral wrong."
But the justices in their unsigned order concluded that to "meet the condition for injunction pending appeal, applicants need not use the form prescribed by the government and need not send copies to third-party administrators."
A Justice Department spokesman said in a statement that the ruling was narrowly applied to the plaintiffs and "is not a ruling on the merits" of the charity's larger legal appeal.
The statement also said the Little Sisters of the Poor and Christian Brothers have "always been eligible for an accommodation from the contraceptive coverage requirement."
The White House had said previously the birth control requirement was lawful and "essential to a woman's health" and that its rules struck the right balance.
Others talked past each other in reacting to the decision.
"We are delighted that the Supreme Court has issued this order protecting the Little Sisters," said Mark Rienzi, senior counsel for the Becket Fund, the group representing the nuns in court. "The government has lots of ways to deliver contraceptives to people. It doesn't need to force nuns to participate."
But Cecile Richards, president, Planned Parenthood Federation of America, agreed with the Justice Department in that the decision was "narrow and specific" and centered around an administrative mechanism for claiming exemption.
"This is a case about paperwork, not religious liberty," Richards said in a statement.
The issue now goes back to the 10th Circuit U.S. Court of Appeals in Denver, which will hold oral arguments in coming weeks.
A ruling by mid-year could then prompt a final, eventual high court review.
Recognizing that, the Supreme Court made clear it has not decided the larger legal and constitutional issues at stake, merely acted on the enforcement question.
"The court issues this order based on all of the circumstances of the case, and this order should not be construed as an expression of the court's views on the merits," the justices said.
In March, they will take up a related challenge to the birth control mandate when the court hears arguments over whether some for-profit corporations should be exempt, again on religious liberty grounds.
Key requirements of the Affordable Care Act are just now kicking into gear following years of fierce political and other turmoil that included a Supreme Court ruling that found it constitutional, and a flawed rollout of its online enrollment process this past fall.
The case is Little Sisters of the Poor v. Sebelius (13a691).
This message was edited 1 time. Last update was at 2014/01/25 00:04:45
