So the big Wall Street Journal article today is about fast-food giant, McDonald’s, threatening that new provisions in the Affordable Care Act will mean that they may need to dump healthcare coverage for thousands of employees. Here’s a handy table of exactly what sort of insurance McDonald’s provides:
Here’s the WSJ:
While many restaurants don’t offer health coverage, McDonald’s provides mini-med plans for workers at 10,500 U.S. locations, most of them franchised. A single worker can pay $14 a week for a plan that caps annual benefits at $2,000, or about $32 a week to get coverage up to $10,000 a year.
Last week, a senior McDonald’s official informed the Department of Health and Human Services that the restaurant chain’s insurer won’t meet a 2011 requirement to spend at least 80% to 85% of its premium revenue on medical care.
[…]McDonald’s, in a memo to federal officials, said “it would be economically prohibitive for our carrier to continue offering” the mini-med plan unless it got an exemption from the requirement to spend 80% to 85% of premiums on benefits. Officials said McDonald’s would probably have to hit the 85% figure, which applies to larger group plans. Its insurer, BCS Insurance Group of Oak Brook Terrace, Ill., declined to comment.
I went over to the Kaiser Family Foundation to take a look at what I might qualify for under the healthcare law if I were a single McDonald’s worker (using 2014 dollars). Generously assuming I’d make $10/hour (I believe shift managers make about $9.81/hour) I calculate my yearly salary at $20,800 – or about 181% of poverty.
Turns out I’ll be on the hook for a premium of about $1127 a year, or about $21 per week. That’s $11 less a week than I’d pay for McDonald’s mini-med benefits. But instead of yearly maximum benefit of $10,000 I’d have no maximum benefit at all since maximum benefits are no longer legal. And I’d only have a maximum out-of-pocket expense of $2,083. This plan – a ‘silver’ plan under the new law – is going to be quite a lot better than McDonald’s, actually:
The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium) is $2,083. Whether a person or family reaches this maximum level will depend on the amount of health care services they use. Currently, about one in four people use no health care services in any given year. The guaranteed plan for the person/family will have an actuarial value of 87%. This means that for all enrollees in a typical population, the plan will pay for 87% of expenses in total for covered benefits, with enrollees responsible for the rest. Specific provisions like deductibles and copayments may vary from plan to plan, and out-of-pocket costs for any given individual or family will depend on their health care expenses. Preventive services will be covered with no cost sharing required.
McDonald’s could also take advantage of the free choice vouchers built into the law (another fingerprint of the excellent Ron Wyden) which allow people to opt into the exchanges even if their employer provides coverage.
Either way, I’ll take my silver plan any day over the mini-med McDonald’s plans. A $10,000 maximum benefit provides no real health insurance at all, though it’s better than nothing. We really should have fought for universal catastrophic insurance starting immediately, which would have taken the teeth out of reports like this one. And if I were a McDonald’s employee, I’d be hoping against hope that I could lose the crappy mini-med plans and get onto an exchange as quickly as possible. Though hopefully not before 2014….
(P.S. As a cashier making $7.51 an hour I would be on the hook for a yearly premium of $494 or about $9.5 a week. I’d get far, far superior health coverage for about $4.50 less a week than the cheapest McDonald’s plan, which caps benefits at $2,000 – $83 less than my out of pocket maximum on the silver plan which has an actuarial value, at this income, of 94%.)
John Cole
Why can’t the Democrats make the case like this?
Some days I think they really, really deserve to lose.
Ajay
I am not sure why dems are behind in the generic ballot despite attacks from Right Wing media. Analysis like this should be used in ads and pound on the fact that Rs want to end it all.
Although I personally wasnt thrilled with HCR (not far enough given 59 vote minority), but what they did achieve was good and great by most standards. Unfortunately, conservadems want to run away from it.
Loneoak
Too many numbers. I can haz Gadsden flag?
Comrade Dread
“Facts. Shmacts. You can prove anything remotely true with facts.”
Kristine
I am going to spread this link around today. This is good.
A suggestion for future upgrades? Twitter and Facebook link buttons, or a Share option that covers a multitude of blogs like LJ, etc. Apologies if they’re already here and I can’t see them thanks to browser ancien.
J
Thanks for this post — very, very informative and interesting. Starting to be glad John brought you aboard.
mistermix
Excellent post. Thanks for digging this stuff up.
Looks like McDonald’s low-end plan covers one Emergency Department visit. Props to them for providing something, but it just shows how healthcare costs are just so far out of reach of the working poor.
Shrillhouse
I live in Canada. I have the same healthcare coverage working as a federal public servant as I did when I used to work at a minumum-wage retail job.
I don’t pay any premiums. I don’t have any deductibles or co-pays. I don’t do any paperwork. I don’t waste my time talking to customer service reps at a private insurance co. I can choose my doctor.
America’s healthcare “system” is teh suck. :(
And one more thing: unlike America’s, our healthcare system is sustainable:
http://www.nursesunions.ca/sites/default/files/The_Sustainability_of_Medicare.pdf
flukebucket
There are times when I think they really, really want to lose.
ruemara
Here’s the problem with this article; did you read anyone making that comparison? No. What a waste of printing ink and paper.
Stupid media.
@John Cole:
Shut up, Cole.
Hell, I could whip up a numbers ad on this.
NobodySpecial
It’s not quite as bad as Walmart’s Starbridge plan, which caps at $1,000. Of course, that’s like saying losing both your legs isn’t quite as bad as being fully paralyzed.
Anyways. My big question is still the same as it was when this was being debated. Yeah, the plan is good…but exactly which McDonald’s employees are gonna be able to shell out a minimum of $1,100 or so and which ones are gonna be able to shell out the maximum of $2,300 or thereabouts?
The answer is damn few, and the way things are running, this won’t get changed before 2014.
New Yorker
C’mon, this post makes me have to read and try to understand something. Why would I want to do that when the chick with big knockers keeps telling me about death panels and soshulism?
georgia pig
@John Cole: Because shithooks at the WSJ headline it “McDonald’s May Drop Health Plan” instead of “McDonald’s Drops Ripoff Health Plan Because New Exchanges Offer Obviously Better Value”? What, do you expect the democrats to write WSJ stories? Even if they advertise the case E.D. makes, FNC will turn it into a giant conspiracy to put private insurers out of business, irrespective of the fact that a lot of those businesses are glorified loan sharks. The dems are at an institutional disadvantage in our current media environment, because you actually have to think to understand what they’re doing instead of emotionally reacting to “victory mosques.” Sure, the dems shoot themselves in the foot on a daily basis, but a big part of their weakness is that there are a lot really ignorant people in this country and a media complex that works overtime to keep them that way.
JenJen
This is one of those posts that should be linked-up all over the damned internets.
As a food & beverage manager, I’ve seen a lot of these mini-med plans sold to line employees as “health insurance coverage.” I’ve always found them to be a gigantic rip-off, especially for single moms who end up reaching the cap like, halfway through the year.
To me, one of the best things about HCR was knowing almost immediately that it would drive these mini-meds right out of business, and I couldn’t be happier.
Nice whine, though, McDonald’s. Oh, and E.D.? If you’re a “real” manager at McDonald’s, they give you a real health plan, not this crap, and I think it’s an important distinction to make. I’ve never worked fast-food, but in fine dining, as a manager I was always offered a much better health plan than the employees I supervised. A shift manager (as you used in your example) would indeed likely be stuck with a mini-med, but a general manager would get a completely different deal. There really are two Americas.
Dave
Ahhh…another benefit of that crappy health care legislation FDL keeps ranting about.
Bulworth
So why can’t McDonald’s meet the 85% requirement? They’re sucking up more than 15% on admin costs?
Lavocat
And, yet, how often do we hear this sort of thing trumpeted by ANY nationally-elected Democrat?
Republicans are busy self-promoting their obvious lies and deception while the Democrats are self-promoting … “we’re not as bad as the Republicans”?
Seriously, the Dems are sorely in need a major PR makeover. And damned quick!
fasteddie9318
@John Cole:
Maddow’s been on this all week; they don’t want to make that case, or any other case for that matter. They’re convinced that they’ll lose any national debate with the Republicans on any issue, regardless of the merits, so they want all their candidates to run local-centric races while the Republicans only talk about the national issues like soshulism and ZOMG KENYAN IN TEH WHITE HOUSE. Their solution to getting steamrolled by the Republicans is to throw leaves and twigs at the steamroller.
They DO deserve to lose. It will be very, very bad when (if?) they do, and they don’t deserve to lose because Jane Hamsher didn’t get her pony, but they deserve to lose the same way a football team that turns the ball over 83 times, keeps turtling up in its own end zone for safeties, and refuses to tackle anybody on the opposing team deserves to lose the game; they suck. Losers find ways to lose and, when they do, they deserve to lose.
Dennis SGMM
Maybe McDonald’s could take a bit less in kickbacks.
Corner Stone
Anyone laying the line on bets Mickey D’s gets their exemption?
TJ
You’re comparing the subsidized policies to the unsubsidized present ones, right:?
Jeff Fecke
$10,000 max? Well, that would have paid for the first three days of my chemo. Of course, surgery, doctors visits, and the other nine days of chemo….not so much.
artem1s
McDonald’s position also fails to mention that they could opt to allow there employees to take the ‘credit’ they would normally get and go with any plan they could find that would fit the 85% rule. doesn’t cost McD’s anything more EXCEPT the perks they get as a company for buying in bulk from that vendor. Bet all the money in my pocket that buying bulk crappy plans for their untermenschen gets grossly reduced rates for the supervalueadded plans for the McD’s ubermenschen overlords. in other words they are only worried about the CEO’s and franchise owners plans going south.
Thomas
And I’m sure all the media coverage of this will include this degree of analysis and context right? Right???
Hugin & Munin
John Cole: Dude, lay off the pipe, it’s destroying your memory. If you don’t recall, your former team has spent the last few decades making fact-based arguments toxic.
Now go say 20 ‘Hail Jerrys’, adopt another doggie, and sin no more!
Loneoak
@NobodySpecial:
There’s ‘afford’ and then there’s ‘afford.’ Obviously, some people can afford these plans because they are already paying more for crappier plans at McDonald’s. If they weren’t affordable, then McDonald’s wouldn’t have anyone to drop. Of course I think they should be free or nearly free for someone at McDonald’s wages, but this is a vast improvement for a lot of people.
Ash Can
Fabulous post. Thank you for this. And second the opinion that this should be linked to every last tube of the internet.
Davis X. Machina
All these numbers don’t take into consideration the massive increase in Freeeeeeeedom™ that the McDonald’s plan member has compared with the person insured under the government-subsidy plan.
(Freeeeeeeedom™ is a registered trademark of the Republican National Committee. All rights reserved. Used with permission.)
Keith
McDonald’s health insurance will not be super-sized!
Great comparison with the exchanges BTW.
TJ
@John Cole:
At a guess, since the exchange costs are lower because of the subsidies, the Dems (especially the more right-leaning ones) are terrified of being associated with anything that might look like welfare.
HotBranch
Much as I love your country, I’m not going to give up my universal, single-payer system north of the 49th. Nice attempt at a spin, though, McDs; similar to the way you pimp your products as “food”.
NobodySpecial
@Loneoak: Mm, hate to break it to you, but a McDonalds employee who took the least expensive plan only pays $700 a year.
With the new guidelines under an approximation of what I make, my age, etc., I’d be paying $1700.
Where’s the other $1000 coming from? For a lot of people like me…well, I’m honestly not sure.
The mechanism for premium credits is highly regressive and I would estimate really hurtful for anyone between 133 and 250 percent of poverty level, in that the increase in premiums will put tighter restrictions on a budget that probably won’t be moving much at all. Which was my main complaint about it from the beginning…the working poor are getting shafted in the current implementation.
db
Thank you for the post and analysis! Excellent!
WereBear
Excellent work, Mr. Kain!
It’s something people are frightened of. You show it can be explained.
Dennis SGMM
This seems of a piece with the perennial, “But, if you raise the minimum wage then we won’t hire people.”
slag
This is interesting. I wonder how much the average taxpayer has already been subsidizing McD’s craptastic healthcare plan.
…
Well, here’s one example:
__
So, at the very least, after this transition, we’ll have mildly better transparency into who is actually paying the bills for all that “cheap” fast food we love so much.
rageahol
I would like to print up a flyer making this comparison and drop it off at the local mcdonalds “restaurants”. would anyone like to collaborate on this with me? I do need some help…
Martin
Now that the HCR effects have really started to kick in, the family discussion has started. I have C-level health insurance execs in my immediate family, so I’ve probably spent more time talking about this stuff than Congress has.
What’s interesting is that they aren’t angry about the reform laws. As more and more data pours out (people don’t pay attention unless they have to, and now they do), they’re seeing a whole bunch of insurers doing pretty well under the new regs and a whole bunch of insurers getting reamed under the new regs and they’re seriously trying to work out why.
First on the big list is Medicare Advantage (MA). CMS (Center for Medicare and Medicaid Services) negotiates MA plans – you can’t just offer one up and expect HHS to mail you a check. This year, they cut 300 MA plans either for being below care standards, violating policy, or being too expensive relative to the care provided. Insurers weren’t allowed to raise rates unless they could demonstrate that there were immediate costs related to the increase. If they were turning profits on the plans, they were expected to reduce premiums down to meet the 85% rule, even though it doesn’t kick in for private plans for 4 more years. The average MA premium will decline by 1% from this year to next, but a fair number of people will need to find new plans. Democrats aren’t playing this news up because even though premiums will drop, having to find a new plan is a pretty serious headache, but it’s unavoidable.
MA plans are rated on a 5 star system. It’s got gaps in the rating system which HHS is fixing right now – it was hard for small plans to even get rated, let alone a good rating, etc. But the 15% premium that HHS paid MA plans is gone to be replaced with a bonus system of up to 5% for plans that earn 4 or 5 stars, so there’s still good reason to offer MA plans, but they have to work for it.
What was most interesting in the data is who is covered by those 4 and 5 star plans currently. Only 10 states have plans where 30% or more of MA enrollees are in 4 and 5 star plans. Mass, Hawaii, Cali, Oregon, Washington, Minn, PA, Colorado, NM, and Idaho. 7 states have plans with NO 4 and 5 star plans – Wyoming, ND, Neb, Iowa, Miss, Vermont, DC. Now, small states are at a real disadvantage because of the rating system, so that might be all that’s at work here since none of those states are terribly large, but Miss, Iowa and DC are decently populated.
In these states, there’s a bigger problem because the existing plans are so far from earning a 4 or 5 star rating that some of them are discontinuing their MA plans in addition to the ones that got cut by CMS. As many as half of the MA enrollees in these states are in plans that won’t continue past 2010. That’s a legitimately big problem and it’s noticed within my family. What they’re grappling with is why plans in expensive states like California are doing so well (we have the highest rated plan here with Kaiser Permanente) and plans in cheap states are doing so poorly. Further, why is fucking Idaho doing well but almost nobody in Texas (2%) is in a 4 or 5 star plan, even with their much vaunted tort reform for malpractice and huge population. Suddenly it’s gotten VERY difficult for the insurers to blame the feds for these problems when it’s quite apparent that there are insurers doing quite well in spite of the reform. It’s really settling in that much of the problem exists at the state level (the two states with the most seniors in 4 and 5 star plans? HI and Mass – the two states with real health care laws and with public plans) and with how these businesses are operating.
The good news is that the discussion is productive. It’s not teabagger ranting. They’re seriously trying to get this to work. Progress requires crisis, and now they have the crisis they need, I think.
slag
@rageahol: I like your style. But who would you like to give your flyer to? Personally, I think McD’s customers would benefit from the information, but that would involve standing outside the place and trying to get them to take it.
JPL
The insurance card allows you the negotiated fee that doctors have agreed to. McDonald’s should just let them have the insurance card for free because the $2000 limit is a joke.
Suck It Up!
@John Cole:
come on now, if a Dem did this, critics would be saying ‘it’s too haaaaard!, its gotta fit on a bumper sticker’
there are commercials, there are sites and its pretty easy to navigate.
Martin
@Bulworth: Yeah, they almost certainly are. Cost efficiency comes with fewer policyholders on larger plans. Lots and lots of people with weak-ass policies just creates a fuckton of administrative paperwork, particularly in food service where turnover is enormous and workers tend to be financially less savvy (it’s harder to rely on them to use online tools to reduce costs). Further, McDonalds is offering a 50-state plan, which means that they’re working through one of the for-profits – all of which are seriously inefficient because they expect to stick at least a 4% profit margin on top – a quarter of the 15% they have to play with. There are no national non-profits, and it’s highly unlikely that they pieced this plan together across multiple insurers.
kay
@NobodySpecial:
“The working poor” has a definition. It means you worked a half year or better out of any given year and still fell below the federal poverty level.
That’s the whole point of the phrase. “Working”, “below poverty level”.
The working poor are not, actually, getting shafted. The law has a lot of gaps and is far from perfect, but it doesn’t screw poor people.
And this is a wonderful post, E.D.
ruemara
@rageahol:
Be happy to. send me email, I will send you a simple flyer for printing.
jonas
@Shrillhouse: Humbug, I say. You Canadians think you like your healthcare system better, but you really don’t.
rageahol
slag: i figure it would be worth it to go drop a few off in the restaurant before shift changes. they need to clean the seats and tables regularly, so dropping them in a dining room regularly might have some effects.
if you want to work on this drop me an email, throwaway991 at hotmail
oh, and PLEASE if you want to just send me something print ready, make sure it’s not in a proprietary format like .psd etc. although the open source tools handle them, there are sometimes formatting issues. pdf is fine, rtf or tiff also fine.
Martin
@jonas: I hear RedKitten is still waiting in a line somewhere in Canada to deliver her baby. The pictures of Sam are just Canuck soçialist propaganda. I mean seriously, we’re supposed to believe a kid could be that cute?
Martin
@rageahol: As a food service worker in my youth, if you want workers and not management to see the flyers, put them in the restrooms.
Kyle
$728 a year for ‘possible’ benefits up to $2000 a year. Thank FSM we live in the land of freedumb.
rageahol
Martin: I think I actually want the management to see them too. Shift managers, for example, would benefit from the health care plan just as surely as the cashiers and assembly line workers. It’s not like I’d be trying to unionize them or anything fergawdsake, just get them to vote in the coming election.
HL_Guy
It’s interesting to go over and read the comments on the WSJ article. Most of them seem to think this ‘proves’ how we’ll all be screwed out of our insurance… Obamacare is a nightmare… unintended consequences bla bla bla.
Somewhere in the middle one commenter notes to this effect- “That’s not insurance, it’s an expensive tax-deductible coupon.”
…which seems kind of like the perfect description to me, but for some reason, not to the WSJ commenters who are wailing and rending their garments for the poor, defenseless McDonald’s workers losing their great insurance.
Bender
So all that McD and seasonal employees need to do is not get sick from now until 2014, and everything will be just fine.
Thanks, Obamacare!
Enjoy NoDember 2!
gex
@John Cole: The people who start out this good with numbers and figuring out the most profitable course of action or most cost efficient course of action do better using these skills for themselves, not others.
BDeevDad
Is anyone seriously surprised by this?
Poopyman
@fasteddie9318:
Well, this seems to be a good place to ask if I’m the only one that missed the news yesterday that our awesome Senate has agreed to this?
Ash Can
Bender, translated: “It’s the Democrats’ fault that insurance companies try to gouge their customers!”
kay
@Bender:
McDonald’s now says the WSJ report is “speculative and misleading”. It’s an update at E.D.’s link.
There’s a lot of restaurant industry trade group quotes in that story, so that’s a little worrisome.
I hope the WSJ hasn’t become a print edition of FOX News, under wingnut leadership. That would be a shame.
Just Some Fuckhead
Awesome. Now if we could get McDonalds shift workers to vote..
Martin
@Bender: Actually, my guess is that the plans will remain. Whoever is backing McDs plans isn’t going to want to lose that account as it’s wicked profitable for them. They’ll bring the costs in line to keep the account.
If Medicare Advantage providers can reduce premiums by 1% and expand services and still conclude that offering those plans makes business sense, then getting the McD plans under the 85% threshold will also be possible. Up until now, McD really had no incentive to negotiate for a better deal. Where was their incentive? Now they have one.
El Cid
This soshullist move by the government is going to threaten the incredible loyalty that McDonald’s customer and kitchen service employees have to their company.
Legalize
Cut to:
55 year old Teabagger opening his disability check:
Teabagger: “But Obamacare is welfare!!!!”
THE END.
Martin
@kay:
Dear, that ship sailed long ago. Go wade through their op-ed page, it’s free-market wingnut heaven over there.
Martin
@Just Some Fuckhead: Fair point. Ruemara needs to add basic GOTV language to the flyer. They’re definitely deep in the non-voter demographics.
sparky
it’s about time someone threw a little light on crap insurance, so that’s all to the good.
that said, i still think this is a crap bit of legislation. i ran this table too, and according to it, i have a 9k premium that i am supposed to afford by having a 7k tax credit on an income of 20k. would someone please explain to me how this credit is somehow going to materialize into something that i can use to pay an insurance company bill?
it makes far more sense for low-wage earners to simply default and have the IRS bill them. that will play well.
those of you with comfy jobs (and decent employer-paid insurance) really need to understand why people are upset with this garbage.
General Stuck
And herein lies the existential fear of the republican party and it’s wingnut members. Their greatest fear, that dems via government works will add up to lots of people getting better HC insurance. It is the closed circle of The New Deal and why they will fight just as hard to destroy it as they did against it getting passed into law, with whatever weapons they can get their grubby little hands on, if given the majority, especially of the House that controls the appropriations and taxation process in this country. It won’t matter to them a whit the political risk. And every day that passes, that American’s see HCR working for them is one day closer to electoral death for the wingnut. If they get the House, there will be two goals, one to run Obama out of the WH, like with Clinton, and the other to dismantle HCR via the funding of it. And it has to be done sooner, rather than later for any chance of success.
kay
@Martin:
We canceled, for good this time. I used to love the news section. I’d subscribe, then have a hissy fit over the op-ed page, and cancel. It was nuts. It was causing me a lot of stress, not to mention the poor carrier, who never knew what the hell was up.
Finally I just said “screw it”. I can’t subsidize crazed neoconservative warmongers, their villas in France and such.
Their coverage of the auto bailout was the best in the country, by far. They did a whole issue on it, and it was just excellent. It was like a primer on the US auto industry.
Oh, well. Conservatives ruin everything.
Bender
You got the wrong “gougers.” The pharma and med supplies industries make TWICE as much marginal profit as the health insurance companies which pay for the drugs and med supplies. The health insurance industry profit margin is in line with food products suppliers and office equipment makers.
kay
@Martin:
Schumer (who is a hard ass, and probably insisted on some demographic voter screen) told the New Yorker that they only expect 11% of the people who directly benefit from the bill to VOTE.
You’ve seen the stats. 94% of college educated white people have health insurance. 85% of all people have health insurance. You already know the exchanges are going to be small, initially, relative to population.
You start to understand why this has been kicked down the road by every President. It’s not easy, or quick.
Martin
@sparky: We don’t know enough about your situation to be able to say. (And I don’t expect you to share if you don’t want to.) It’s possible that the employer mandate would kick in to cover you, or some other provision.
The new law is complex. It’s a patchwork of overlapping provisions that are expected to catch most people. There will certainly people that get fucked, however. But because the private sector is involved (and there was zero chance we’d get a fully public health care system) the government can’t fully predict what will happen. They can react to it, however, and that’s much of the reason for the long implementation. Different components are phased in at different times so Congress wouldn’t get overwhelmed trying to patch more problems than then can manage. The early components were the federally funded ones (Medicare, Medicaid) because the main point of the reform wasn’t to save you money, but to save the Feds money. Saving you money is the bonus.
As we get closer to each deadline, we see what the insurers are going to do and states and the feds can react to it. Part of what people don’t understand about the new legislation is how much additional authority it grants HHS to solve some of these problems that don’t need to go back to Congress for every little adjustment.
Relax, things are going to change a fair bit before 2014.
Felanius Kootea (formerly Salt and freshly ground black people)
@slag: Thanks for this. I’m definitely sharing it.
AZmando
Is this right? McDonalds insures really healthy young kids for a max of $2,000 per year (after a 20% copay) and charges them $727 per year?
Am I reading this right?
Who needs to sell burgers when you can sell really expensive insurance to young people who will likely never use it? What a racket!
Bender
@Martin:
I think you’re half-right. The mini-med plans will remain, but there’s no real way to “bring costs in line” because of the administrative costs of high-turnover (seasonal/fast-food) employees. The plans will remain, I’m sure, because Congress will grant a waiver of the 85% threshold for seasonal and fast-food employers.
Martin
@Bender: And as someone who has Thanksgiving dinner with executives from those health insurers, they’ve had virtually no bargaining power against big Pharma. That’s why they supported Obama cutting a deal with Pharma. The law also provides them with quite a bit of bargaining power because HCR puts them in a box they can’t easily get out of, and with additional reimbursement for things like generic drugs, the insurers can start to push the suppliers on costs a lot harder than they could before.
They insurers don’t like having to work that hard, but they have something to negotiate from that they didn’t have before.
kay
@Martin:
Unmarried parents have a health insurance mandate now, re: their children, in every state, if they have a child support order. If they apply for any state subsidized benefit, they have a child support order.
The way it operates, as a practical matter, is a process of elimination. Start with employer-provided, see if it fits “reasonable”, if it doesn’t, they fall out of that requirement, and you go to middle class children’s public program, then go to under 150% of poverty level, and on and on.
This sounds complex, but it’s not, and we’ve been doing it at the state level since 2007. It’s one person at a time. You sort of slot them in. It works.
Chyron HR
@Bender:
Someone who invests other people’s money in imaginary things for a 5000% profit to himself = Producer(tm).
Someone who just “produces” medical supplies and drugs = A leech on society.
Got it. Put them all out of business! Who needs Warfarin when you’ve got Jesus?
Martin
@Bender: Ultimately the costs will come in line because of the mandate. That’ll force the efficiency into the system, so yeah, I wouldn’t be surprised if they got some kind of leeway to policy for a few years. Alternatively, you might see the home state or HHS work with them in other ways to bring administrative costs in line.
Plus, as everyone goes through this exercise things will naturally streamline to a certain degree. There was little incentive to do it before, but if care providers start losing insurers to reimburse them, they’re going to change how they bill, etc. There’s a LOT of action going on now in the medical billing/records arena. They know what’s coming.
kay
@AZmando:
I think states were going to act if the federal government didn’t. The situation was intolerable, for states. They were ending up holding the bag.
You’re subsidizing these huge corporations that don’t offer health insurance, because we don’t (yet!) allow people to die on the street. They’d get emergency care. They just didn’t pay for it. They’d also qualify for the state children’s health insurance programs, because they’re low wage.
It was a sweet deal for McDonald’s and Wal Mart. You were picking up the cost of their employee’s health care.
That’s the dirty little secret behind “free markets”. Someone is paying for it. Just not these companies.
lol
Can we get a post explaining why Pete Rouse as Chief of Staff is a slap in the face and a stab in the back of all true progressives here already? I’ve already seen non-snark comments at DailyKos complaining it wasn’t Howard Dean.
Martin
@kay: Yeah, it does work. And some fall through the cracks, but we can fix that as we discover it. But to the consumer, it sounds complex as all get-out, and everyone assumes they’ll be the one to fall through. I don’t blame them. No amount of marketing will address that unless it comes with a public commitment to legislatively address problems as they come up. With one party threatening to repeal the whole system, that can’t happen. The GOP actually wants the citizenry to feel insecure. They could have committed themselves to making this work (even if that proved to involve the private sector more), but they’d rather go for the tactical political victory and have the people they represent feel vulnerable.
General Stuck
@lol: Obama was smart to change CoS now, before the election, whilst the true progressives are busy on the street corner preaching the end is nigh for democrats. Hard to switch spittle gears in mid panic.
Koamark
This argument reminds me of the people who used to say we were the best country in the world, then compare us to the USSR or Cuba. Of course we are better than the worst countries in the world…of course almost any plan would be better than the rip-off McDonalds offers. McDonalds is a con artist corporation from the start. There is no part of the way they do business that is not intended to mislead people, both customers and employees, that they are giving something of value, rather than the truth of deadly food and a lousy job.
Just Some Fuckhead
@sparky:
What??? “Obamacare Better Than Crappy McDonalds Insurance” ain’t ringin yer bell? :)
kay
@Martin:
I thought people would object to the part of a Medical Support Order that mandates payment to the state when your children are on Medicaid, and you earn over percent poverty level.
There wasn’t the anger I expected.
That made sense to people, that they’d have to kick in some for the state program, and they wanted their children covered. I say, simply, “that reimburses the state of Ohio for Buckeye”. They get it.
What amazed me is they didn’t object to this part: married parents don’t have to reimburse the state for children’s Medicaid. It was a true Bush-era rule change. It has that ever-present moral tone of conservatism.
General Stuck
@Just Some Fuckhead: behold the sound of wankers wanking. That’s the only bell I hear. Gong
trollhattan
Also, too, Steve Benen covers the WSJ non-story, including a McDonald’s statement that it’s “completely false.”
http://www.washingtonmonthly.com/archives/individual/2010_09/025922.php
Way to go, New Improved WSJ.
Just Some Fuckhead
@General Stuck: I already said it was awesome, douchebag. We’re allowed to snark here, too, right? You haven’t outlawed that have you?
General Stuck
@Just Some Fuckhead:
You can snark, I can snark. Just another tricky day on BJ.
kay
@trollhattan:
I think it came from restaurant industry trade groups. It has that reek. The WSJ should stop printing emails from lobbyists.
Our local (private) hospital CEO is doing this incredibly sleazy thing, where he trashes the health care law in the local paper. He’s our “health care expert” and he’s also on the GOP central committee.
His latest bulletin claimed physicians were going to be making “minimum wage”. He’s a clown.
He borrowed a bunch of money for expansion in 2006, prior to crash, and now has a huge, empty hospital wing, and a note to pay. We now have two big private hospitals within a 30 mile radius. He over-built.
He’s a little bitter, but I hardly think his poor decisions are Obama’s fault.
Zifnab
@John Cole:
They do make cases like this. You just never see them printed in the WSJ.
The real question is why Democrats didn’t take a page from their Republican counterparts and heavily invest in media. Air America was a great step in the right direction. Perhaps Warren Buffet and George Soros can look into buying up MSNBC. I mean, you only have to browse briefly through the internet to find a plethora of left-wing bloggers. So you clearly have an audience AND a sizable aspiring talent pool.
But until liberals start matching conservatives in the media marketplace, Democrats are never going to get heard.
Just Some Fuckhead
@General Stuck: Thanks for your permission.
General Stuck
@Just Some Fuckhead:
No permission needed , this is a free snark zone
MarkJ
@AZmando:
That’s what struck me too – who would pay $700 for a policy that would pay out a maximum of $2,000? $2,000 is going to cover a tiny fraction of the bill if you actually get seriously sick or injured, and if you don’t, you’re better off paying for primary care visits out of pocket and keeping your $700.
Every one of those plans looks like a colossal ripoff. I bet the employees that enroll are told it’s “health insurance” by McD’s, but not about the low coverage limits, which are probably hidden in the fine print. It’s not until they actually need the coverage that employees find out they’ve been paying $700 for virtually nothing.
Bruce (formerly Steve S.)
@John Cole:
“The new health care exchanges — better than the shitty plans they have at McDonald’s!”
Yep, that’s a winner.
Henry Lazarus
McDonalds will probably go all franchise and limit the number of employees in each store to twenty five to avoid providing health insurance to any under the new law.
kay
Ouch. So much for the WSJ’s stellar reputation.
The news section is completely isolated from the wingnut/liar section. Uh huh.
There’s like a WALL.
geg6
@JenJen:
To be fair to Mickey D, they are saying that the WSJ is full of shit in how they are characterizing this. I believe their words were “completely false.”
General Stuck
@MarkJ: The way the free market usually works, is for companies like Mcdee to keep a somewhat stable work force it will have to pay employees at least the bare minimum in their market to keep them for any length of time. The payoff for Mcdee is they no longer have the admin costs of insuring their employees. As time goes on and more comparable companies drop their previous plans in liew of the new health plans they will have to do the same. So HC now is a competitive feature, that will likely move upward workers salaries, at least to the point companies were paying for previous admin costs.
I am always in deep water with talking about economics, so if this is wrong, please correct.
Belafon (formerly anonevent)
@Bender: Bender, try blaming the people who created this situation: The Republicans.
Mark S.
The more expensive McD’s plans seem like a bigger ripoff than the cheapest one. The maximum annual benefit for the most expensive one is $10,000, but only $2,000 for outpatient, which is what you’re going to be 98% of the time. Am I reading that right?
slag
@Bruce (formerly Steve S.): Actually, that IS a winner. Better is just that. Better. I’m all about better. It’s such a winner that if I could go to Jon Stewart’s rally, I would start a chant:
What do I want? Better! When do I want it? As frequently as possible!
General Stuck
@slag:
You may be a real true progressive.
Bruce (formerly Steve S.)
@slag:
Let me break this to you as gently as I can.
The question isn’t whether the plan is objectively better — how could it not be? — the question John posed is why the Dems don’t point to this as a selling point. Telling the public that the new plan they’re all skeptical about is better than the world’s dog-shittiest plan is not telling them very much. HTH.
joe from Lowell
You know, if you combined private mini-plans like that with John Kerry’s 2004 proposal for a universal system of catastrophic coverage, we’d really be getting somewhere.
But, hey, he lost a close election to an incumbent wartime president, so, you know. WE HATE JOHN KERRY!
Suck It Up!
@lol:
lol. I swear, if Obama’s dog ran away, they’d demand that Howard Dean to replace him. Anything to get him into the WH.
Just a few days ago I saw comments saying the CoS was beneath Dean and he needs a position with actual power. Yet those same folks will tell you that Rahm (former CoS) was the one making all the decisions.
NobodySpecial
@kay: You’ll have to pardon me. The phrase ‘People between 133 and 250 percent of poverty level’ just won’t fit on a bumper sticker.
You have a more pithy definition in mind?
General Stuck
@Bruce (formerly Steve S.):
Implicit in this horseshit is the meme that making something better for the poorest workers doesn’t count for much. It is what it is in the very early stages of this law going into effect. And since Mcdee’s is just mulling it over right now, it’s not really ripe for Obama and dems to tout.
The public, with something like this sweeping change ,will not start approving of it until it starts going into effect over time, and they benefit, or their friends and family benefits. Obama has worn out the speechifying touting HCR, now it starts to become real in the lives of everyday Americans, and that is when firm and lasting judgments will be made.
Tancrudo
@Bruce (formerly Steve S.): Tired of your shitty McCoverage? Get a real health plan. Thanks, Obama!
Is that any better, or do we have to go for Where’s the Beef?
Just Some Fuckhead
@General Stuck: Your continued goodwill is appreciated.
batgirl
@MarkJ: Not only that, but it is precisely this “junk insurance” that is the Republican response to health care. That is what is meant by deregulate and allow insurance to sell across state lines.
They tell us it will be cheaper. Of course it will be “cheaper.” You’ll be buying bogus junk policies that is all gain for the insurance companies and all cost for the “insured” party.
Martin
@Bruce (formerly Steve S.): It’s a selling point in 2014. It’s not a selling point today. There are few pure wins in HCR. The biggest wins are too abstract for the public to understand until they see it for themselves.
Every benefit to consumers or to the government in lower costs comes with the price of it being a non-trivial upheaval for quite a few people. It’s super, super easy to line up the people that have to switch plans, or get screwed because they’re right in that sliver of income where the subsidies fuck them over to put in front of the public and say ‘see, HCR fucked me, and it’ll fuck you too’. It’s harder to line up people to say ‘Hey, my premiums went down by 1%!’, or ‘Look at how much these changes have trimmed the deficit!’.
We can’t even have a conversation about the deficit that doesn’t guarantee bald-faced lies. Some of these topics are almost impossible to rationally discuss in that kind of climate. I mean, how much HCR wonkiness did I need to lay out in post 39 just to explain where Medicare Advantage was going? This shit is complicated. There’s just no getting past that. And trying to make it simple will only give the Republicans a million opportunities to call you a liar as they nutpick the details you had to leave out.
Don
What’s mind-boggling about the WSJ article* ASIDE from the deliberate ignoring of the total year cost:benefit comparison is that nobody asks anyone “why can’t you manage to offer a plan that pays out 85% of that $768 a year you take in?”
It’s obliquely implied – there’s mention that Wal-mart manages to do it by simply self-insuring. Something that isn’t a huge challenge when you’re talking about a per-enrollee cost that is so low. But otherwise this is a perfect example of Colbert’s not-really-a-joke. “… and you people of the press type those decisions down. Make, announce, type. Just put ’em through a spell check and go home.”
*No, I am not actually mind-boggled, I sadly know what’s really going on here with what used to be a top-notch newspaper that just happened to have an insane editorial board. I am sad about it, though.
Martin
@joe from Lowell: Yeah, I think that the most rational approach the government should have taken (if half of Congress weren’t pigfuckers, that is) is to extend Medicare Part A (hospitalization) to everyone, and to use Medicare Part C as a framework for private sector policies to cover medical (these would obviously be different because C doesn’t cover the kinds of things that affect young people, but the cost framework could be similar.)
So everyone would be guaranteed critical care and have to pay into it. It’d be a fully public health care system at that level, and the stuff above that level would be a mishmash of Part B medicare, medicare advantage, and this new mandatory medical plan that people could get through the private sector.
It keeps the insurers going in the most cost-predictable area and doesn’t put them on the hook for the riskiest stuff (extended hospitalization, surgery, etc.) They’d be okay with that. Medicare A is where the cost overruns are, so the infusion of premiums from those under 65 and handing full control to the government would bring those costs very quickly in line. Basically, the hospitals lose most of their ability to negotiate rates because *everything* is Medicare, and because they can’t negotiate, neither can the most expensive elements of the supply and drug industries.
It’d simplify things in the most important area – hospitalization, and give the government a massive ability to bend cost curves (hospitalization is the single largest fraction of health care costs) without destroying the insurance market or the ability of people to seek choice in the areas they most care about – primary care doctor, OBGYN, etc.
I still think that’s what HCR has set us up toward. We just need some time to get there.
Stefan
I live in Canada. I have the same healthcare coverage working as a federal public servant as I did when I used to work at a minumum-wage retail job. I don’t pay any premiums. I don’t have any deductibles or co-pays. I don’t do any paperwork. I don’t waste my time talking to customer service reps at a private insurance co. I can choose my doctor. merica’s healthcare “system” is teh suck. :(And one more thing: unlike America’s, our healthcare system is sustainable:
Yes, but what about the waiting times in Canada? When a friend of mine who was living in Canada got pregnant, they made her wait NINE MONTHS to schedule her delivery.
Bruce (formerly Steve S.)
@Tancrudo:
And this PR campaign is aimed at who exactly? The vast demographic of 18 year old voters who won’t want either health plan because they think the third world wages they’re being paid might better go to something else? Them?
Honestly, I don’t get the point of this exercise. Telling some small percentage of the working poor that you’ve got a plan that’s better than horrible isn’t going to inspire anybody, is it? Except maybe BJers, but they’re already on board.
Ailuridae
@slag:
Not to be a dick but all employer provided health care, high quality or sham insurance is subsidized by the tax payer.
Brachiator
@John Cole:
and
@E.D. Kain:
Even Forbes is taking notice:
Interesting that an unexpected benefit of health care reform is to reveal the inadequacy of some present private sector limited-benefit plans.
General Stuck
@Bruce (formerly Steve S.):
Teenagers, or many of them will get coverage from their parents plans until they are 26, I think, so they are already covered. This little provision is going to go a long ways in putting a donkey smile on the faces of Ma and Pa Kettle regardless of what Mcdees does.
Martin
@Brachiator: Oh, that wasn’t unexpected by Congress, I can assure you. It was unexpected by the people complaining about HCR though.
This is going to work a lot better than most on the left realize.
General Stuck
@Martin:
But but but. No PO! No Pony! No I told you so!
Ailuridae
I am surprised nobody mentioned what seems to be obvious; McDonald’s is likely profiting directly from these current plans. To be clear, a source of McDonald’s annual revenue is almost certainly selling bad insurance to their own employees. There aren’t a whole lot of other explanations for a less than 3:1 ratio between maximum benefit and annual cost especially given McDonald’s employee demographics.
Ailuridae
@General Stuck:
Additionally many working class and poor teenagers are covered by S-CHiP and/or Medicaid.
When people talk about progressive victories one of things that rarely gets mentioned is that over the last 14 or so years (starting with the first S-Chip bill adn finishing with PPACA) the US has moved exceptionally close to universal coverage for everyone under 18.
JenJen
@geg6: You’re right, and of course I’m not surprised that the WSJ was, once again, full of shit.
However, it doesn’t change the fact that McDonald’s mini-meds (and mini-meds in general) are pretty fucking weak from the get-go. My issue (as it pertains to the F&B world) is and has always been with the way these things are sold to employees as though they were “healthcare.”
Eric S.
@Koamark:
They just don’t compare our infant mortality rate or life expectancy with Cuba’s.
Martin
@Ailuridae: I don’t think so, actually. They benefit simply by offering a plan, which does help them attract full-time workers which they need M-F.
And this is pretty much what BCS does, so whatever problems they’re having with McDs, they’re having with every single other company that they offer mini-med plans. If they’re telling McDs that they can’t hit the 85% ratio, then that’s going to hold true for most of their plans, which means that they’re out of business as an insurer. I think they’ll find a way to modify the plans to stay in business.
What’s become clear to me here is that BCS, being a mid-sized insurance group comprised of smaller insurers across the states doesn’t have enough pull to get HHSs attention for a waiver, but McDs does, as do other other companies, so BCS is likely the ones behind this story to generate outrage, hoping to get that waiver to hold their profits up.
I’ve checked around a bit and the problem with the 85% requirement on these plans is that their annual caps are so low that they simply don’t pay out enough. It’s not actually administrative costs. The costs are high, but these plans should still be profitable with higher caps and the higher caps would allow them to hit the 85% mark. I don’t think HHS is going to fall for this stunt, but it would be nice if there was better reporting on this issue other than the ‘ZOMG, Obamacare is going to kill us all!’
Martin
@JenJen: Another thing that Dems aren’t getting credit for on HCR is that the regulations (starting now) were designed to kill these shitty plans. These plans are extremely profitable, and insurers could modify them to meet the 85% requirement (they’re allowed to overcharge and then offer rebates to policyholders if need be, so they don’t even need to risk exceeding costs) if they so desired.
This shouldn’t be controversial. And these plans won’t vanish before 2014 – too many insurance companies live and die by them. They’ll get them in compliance. They go out of business if they don’t.
MobiusKlein
@Eric S.: It would not surprise me to find out Cuba’s stats are cooked, somehow.
Or that America’s stats are made worse because we’re a bunch of fat loafs, causing more prenatal issues.
Brachiator
@Martin:
There is also this (Medicaid enrollment spikes to 48M in weak economy):
Tea Party people and the official GOP should be asked what they would do to help people who lose medical coverage when they lose their jobs.
Martin
@Brachiator: Probably hand out band-aids with little purple hearts on them. They were big on that 6 years ago.
StevenDS
Martin, I just want to drop you a note and thank you for your very informative comments on this thread about Health Insurers, HCR, its implementation and related regulations.
Very, very interesting and informative. Keep posting. Or better yet, someone put this guys’ posts on the front page.
General Stuck
I second that emotion
@StevenDS:
bmull
@Martin
Best defense of Obamacare I’ve seen. I remain skeptical that the mandate will control costs. That seems like hand-waving to me. There are clearly going to be some savings due to better regulation, but at some point we’re going to hit the wall and costs will creep up again. U.S. health care remains fundamentally inefficient. I like your idea of enrolling everyone in Part A, but mainly as a down payment on a full-blown single payer system.
Zach
I agree with your basic statement – the exchange plan will be better coverage; however, the price is the main question. The government has no idea what it will cost them in 2014, nobody does.
McDonalds by offering these garbage plans, and pawning them off as “medical insurance” should be ashamed of themselves. We wouldn’t need “health insurance reform” if companies like them and Wal-Mart would make actual health insurance available to their employees.
The exchange is a joke b/c the current administration never addressed things like COST – what things cost in the medical field. Health insurance is a direct relation to what things cost. Access was never the problem – Affordability is still the problem. I guess in 2015 maybe they’ll address that.
Robert
You have a computer at your house. It isn’t very good; it does boot and you can get online but it isn’t much of a machine. Still, it runs.
I come to your house, telling you that you deserve a much nicer computer. It’s just awful that you have to put up with such a piece of crap. So I smash it into a million pieces.
But don’t worry! In 2014, three years from now, if I don’t lose any elections or court cases in the meantime, I’m going to come and give you a much better computer.
So you’re much better off, what with my heroic intervention into your life.
Right?
eRobin
re: why can’t the dems make a case like this?
Because as you made your case, you were mean to McDonald’s. Dems are not mean to large corporations as a rule.
Randy
Just a brief thought, which no one here apparently understands. Companies need a reasonable rate of return on investment to attract investors. I’ve already lost you if you believe “profit” is evil but hear me out.
I agree that the “insurance” that McDonald’s is offering is crap but consider the industry that they are in. They sell hamburgers for pity sake. You want their workers to have good insurance, then pay $5.00 for their cheeseburger; it’s that simple.
Shave company profits to the bone by increasing cost of goods sold and investors bail on you because they will not get a return on their investment capital that they entrusted you with. Lose investment capital and you no longer grow. You stop growing and you have to let employees go because you need to maintain a profit margin to stay in business and everything spirals down from there.
On a different note; just how much do you think we can bleed any one industry and hope they survive? Like it or not, money drives private enterprise. Look at pages 41-45 of the following government report.
The Health Care Insurance industry only has a 3.1% profit margin or Profits as a percentage of revenue (or all sales). I hope most of your anger is directed at CEO’s who make obscene salaries and not industries who make marginal profits as they hire you and me.
In short, you have to come to grips with your belief system. On either extreme, you either believe that the government should do it all at the EXPENSE of private interprise and the cost of goods to you and me rise OR you believe in a strictly capitalistic society where the only the fitest in the business community survive.
There is a happy medium between those two extremes but Obamacare is not it. The government will ultimately raise taxes (as EVERY COUNTRY HAS that has a nationalized system) or you ration resources; a.k.a. who is it among us that “deserves” immediate medical care, everyone else waits.
I am NOT saying that Obamacare is wrong, but please, recognize there is a cost!! If you believe that you should be paying for your neighbors health care than so be it. Recognize, however, that the “rich” (personal or corporate) cannot pay for the services by themselves. It will cost YOU. Just ask the Brits who now pay a 17.6% value added tax for their health care system. NOTHING COMES FREE.
Randy
Link to report cited above.
Alex
Just ask the Brits who now pay a 17.6% value added tax for their health care system
We’ve had that since 1973. It was a condition of joining the European Union that various customs duties were abolished and rolled into VAT – learn more here.
Randy
OK Alex, right you are, but for discussion’s sake, let’s see what the media is saying about health care in Britain.
http://www.liberty-page.com/issues/healthcare/socialized.html#britain
And having not figured out how to publish a link on this site, here is the link for the report I refer to above talking about profit margins by industry in America. An interesting read.
http://www.fas.org/sgp/crs/misc/R40834.pdf
Alex
I am not impressed by your assortment of probably inaccurate anecdotes compiled by horrible right-wing tabloid newspapers.
Randy
So Alex; correct me if I am wrong but your objection to anything that the BBC or the Times Online (UK) says means that you believe everything they report is inaccurate or a downright lie?
I can only refer you to Susan Sontag who said, “The truth is balance. However the opposite of truth, which is unbalance, may not be a lie.”
Your failure to objectively judge or investigate “horrible right-wing” tabloids or left wing rags leaves you wide open to whole sale deception. That’s a pity. It is how the socialist movement was born and is currently propagated.