l****z
发帖数: 29846 | 1 Blows to Health-Care Law Pile Up, Cutting Its Sweep .
By LOUISE RADNOFSKY
and CHRISTOPHER WEAVER
The big expansion of health insurance envisioned under the 2010 Affordable
Care Act is now looking less sweeping.
The latest indication that the coverage net won't be as wide as initially
expected came this week when the Obama administration delayed for a year a
requirement that larger employers offer health insurance to workers or pay a
penalty. The move means businesses with 50 or more employees that don't
currently offer coverage—such as some retailers and restaurants—can
continue on that track without penalty until 2015.
While the unexpected move received attention, it is at least the third time
that a development since the law's passage has potentially limited the
expansion of insurance.
The two earlier snags involve Medicaid, a federal-state program for the poor
, and the new health-insurance exchanges where individuals can buy coverage.
The law was supposed to expand Medicaid to include more of the poorest
Americans, but a Supreme Court ruling last year allowed states to opt out of
that expansion; at least half are poised to do so.
At the same time, analysts warn that hiccups are possible in implementing
the exchanges after more than 30 states refused to set up their own versions
, forcing the federal government to operate them on states' behalf.
"You've got three body blows toward expansion of coverage," said Paul
Keckley, executive director of the Deloitte Center for Health Solutions, a
research unit of Deloitte LLP. "It's three punches in a row."
The law was designed to extend insurance to most of the 50 million Americans
who lack coverage. But when the main features of the law go live Jan. 1,
the share of those people set to remain uninsured is bigger than the
proportion set to gain coverage. That raises the prospect of a long battle
to make the law work as its supporters intended, and the likelihood that
opponents will dismiss it as a costly failure.
The nonpartisan Congressional Budget Office projected soon after the law
passed that it would reduce the number of uninsured to 23 million people in
2019, from about 50 million people now. In an updated projection earlier
this year, the economists estimated around 30 million people would still be
without coverage that year. The office has yet to revise its estimates in
the wake of this week's announcement.
Some analysts played down the employer-requirement delay. "It is much ado
about very little," said Gerard Anderson, a professor at Johns Hopkins
University. "So many people in firms larger than 50 already had health
coverage."
.
Critics of the law predicted further problems. "Much like Humpty Dumpty,
Obamacare had a great fall and all of King Obama's bureaucrats cannot put it
back together again," said Rep. Tim Huelskamp (R., Kan.).
In sectors that employ many lower-wage hourly employees, such as agriculture
and services, fewer than half of workers have employer-sponsored coverage,
according to the Bureau of Labor Statistics. Plans currently offered often
include limited-benefit policies known as "mini-meds" that can't be sold
next year because the law bans lifetime or annual payout limits, a feature
of such plans.
Under the original version of the law, states would enroll in Medicaid
everyone who earned up to about a third more than the federal poverty level.
Under that plan, many employees making up to about $10 an hour were to set
to qualify. Eligibility for Medicaid currently varies by state but in many
parts of the country, childless adults don't qualify even if they have
income significantly below the poverty line.
In the wake of the Supreme Court ruling, officials in 28 states have
indicated they plan to sit out the Medicaid expansion next year or are still
debating it.
Those 28 states are home to about 9.6 million uninsured people who would
become newly eligible for Medicaid, according to estimates from the left-
leaning Urban Institute think tank. Those people can try shopping for
coverage on the new insurance exchanges. However, an estimated 7.4 million
of them won't be able to obtain subsidies for that coverage, because they
are below the poverty level and the law is written to give subsidies only to
people above that line.
"Just when we think we have something, someone in the capital says we don't,
" said Sarah Bates, an uninsured, self-employed oboe teacher in Austin,
Texas.
Ms. Bates, 27 years old, had an income of about $4,000 last year after
adjusting for business expenses. She takes three prescriptions and needs
treatment for asthma and a hormone disorder. For now, she receives care at a
local hospital sponsored by an Austin group for uninsured musicians.
For people above the poverty level, the federal government is encouraging
enrolling for coverage through the insurance exchanges. But it has limited
funding for getting that message out in 33 states where it is partly or
fully responsible for the exchanges. Some 28 million uninsured people live
in those states, according to government data.
Despite the delay in the employer mandate, the Treasury Department said the
individual mandate requiring people to carry coverage starting in 2014 or
pay a tax penalty remains in place. So do subsidies for people who are
eligible. The penalty, however, is set to be small in the first year, with
most low-income people exempt.
Health and Human Services Secretary Kathleen Sebelius has said she believes
the administration is on track to meet its goal of enrolling seven million
people in coverage through the exchanges in the first year and her
department hopes more states will ultimately decide to join the Medicaid
expansion.
For now, groups that favor expansion under the law say the confusion is
making it harder for them to explain options to the uninsured. "This ever-
changing landscape is just getting more difficult," said José Camacho,
executive director of a Texas association for clinics treating mostly
uninsured people. | l****z
发帖数: 29846 | 2 Sara Baker Wrote:
""Just when we think we have something, someone in the capital says we don't
," said Sarah Bates, an uninsured, self-employed oboe teacher in Austin,
Texas."
This has got to be the funniest line in the whole article. Someone who makes
$4000 per year as a self-employed oboe teacher wants others to pay for her
healthcare. A simple suggestion would be returning to school and getting a
degree that might lead to a real job, such as a degree in gender studies
allowing one to be a barista. Or perhaps learn another instrument, like the
tuba, so she could double the lessons she gives.
Seriously folks. Who in their right mind thinks you can ever make a living
at being an oboe teacher. Madness. | p**j
发帖数: 7063 | 3 tuba，学生更少，而且很少看见女人吹tuba。问题在于，大部分musician都是白天打另
一份工，包括很多名校毕业的，这在圈里是正常现象。学校只负责招生，不负责毕业以
后的工作问题。只有以前的共产党政府，按照计划招生，包分配，才能让musician人人
有工作，但是，前提是那时候的音乐学院入学非常非常难，只有很少的招生名额，这样
才能保证每人毕业了政府可以给安排工作，当然，即使这样也不是人人有好工作的，其
中一部分只能去少年宫这样的，甚至中小学音乐老师而已。你喜欢学什么就学什么，出
来就能保证赚大钱，这种事情不可能。
't
makes
her
the
【在 l****z 的大作中提到】
: Sara Baker Wrote:
: ""Just when we think we have something, someone in the capital says we don't
: ," said Sarah Bates, an uninsured, self-employed oboe teacher in Austin,
: Texas."
: This has got to be the funniest line in the whole article. Someone who makes
: $4000 per year as a self-employed oboe teacher wants others to pay for her
: healthcare. A simple suggestion would be returning to school and getting a
: degree that might lead to a real job, such as a degree in gender studies
: allowing one to be a barista. Or perhaps learn another instrument, like the
: tuba, so she could double the lessons she gives.
| t*******e
发帖数: 1633 | |
|
