Thursday, August 2, 2012

The Affordable Care Act In Action

August 1, 2012 saw a number of "Obamacare" provisions go into effect that will benefit millions of our fellow Americans. Nearly half of American women between the ages of 19 and 64 avoided doctor visits and medical services because they couldn't afford to pay for them, a 2010 Commonwealth Fund survey revealed. However, new measures that came into effect on August 1 under the Affordable Care Act could change that statistic.

Under the new rules, eight services -- identified for the U.S. Department of Health and Human Services by the Institute of Medicine -- join 14 other preventive services for women (such as mammograms and cervical cancer screenings) that have been covered under the Affordable Care Act since September, 2010. 

That is fantastic news for all Americans except, of course, those Americans who hate women and any other American that doesn't fit a preconceived ideological mold handed down over the centuries by the delusional and small minded.

Both the Belle of Ballast Point and I were thrilled to learn of this happy event. Upon opening the day's snail mail we became even more giddy with joy. She received another "Obamacare" blessing:

This letter is to inform you that [your] Insurance Company will be rebating a portion of your health insurance premiums through your employer or group policy holder. This rebate is required by the Affordable Care Act - the health reform law. 


The Affordable Care Act requires [your] Insurance Company to rebate part of the premiums it received if it does not spend at least 80 percent of the premiums [your] Insurance Company receives on health care services, such as doctors and hospital bills, and activities to improve health care quality, such as efforts to improve patient safety. No more than 20 percent of premiums may be spent on administrative costs such as salaries, sales, and advertising. This is referred to as the "Medical Loss Ratio" standard or the 80/20 rule. The 80/20 rule in the Affordable Care Act is intended to ensure that consumers get value for their health care dollars.

What the Medical Loss Ratio Rule Means to You 

The Medical Loss Ratio rule is calculated on a State by State basis. In your State, [your] Insurance Company did not meet the 80/20 standard. In 2011, [your] Insurance Company spent only 78% of a total of $1,105,527,137.97 in premium dollars on health care and activities to improve health care quality. Since it missed the 80 percent target by 2% of premium it receives, [your] Insurance Company must rebate 2% of the total health insurance premiums paid by the employer and employees in your group health plan. We are required to send this rebate to your employer or group policyholder by August 1, 2012, or apply this rebate to the health insurance premium that is due on or after August 1, 2012. Employers or group policyholders must follow certain rules for distributing the rebate to you.

If your group health plan is a non-Federal governmental plan, the employer or group policyholder must distribute the rebate in one of two ways:

· Reducing premium for the upcoming year; or

·Providing a cash rebate to employees or subscribers that were covered by the health insurance on which the rebate is based.

If your group health plan is a church plan, the employer or group policyholder has agreed to distribute the portion of the rebate that is based on the total amount all of the employees contributed to the health insurance premium in one of the ways discussed in the prior paragraph.

If your group health plan is not a governmental plan or a church plan, it likely is subject to the Federal Employee Retirement Income Security Act of 1974 (ERISA). Under ERISA, the employer or the administrator of the group health plan may have fiduciary responsibilities regarding use of the Medical Loss Ratio rebates. Some or all of the rebate may be an asset of the plan, which must be used for the benefit of the employees covered by the policy. Employees or subscribers should contact the employer or group policyholder directly for information on how the rebate will be used.

My bride wasn't alone. Nearly $124 million in health insurance premium rebates have gone out to Florida employers and consumers, thanks to "Obamacare". Wednesday, the deadline for those checks to be sent, also marked another milestone in the Affordable Care Act: Most employers must include contraceptive and other women's health services without copays in the insurance plans they offer workers.

So, to Romney and his "I've got mine so f*#k you" supporters, I can only add, "Kiss our ass!"

Now there is some American exceptionalism for you.


  1. I got the same letter! Praise Obamacare!

    1. I agree with you - praise Obamacare! I suppose it would be too much to hope that the Romneyites would just sit down and shut up now. Maybe actually do something for the betterment of America?

      Naw. That ain't going to happen.

      I hope you are doing well. To me you are still the High Priestess of Everything (and then some, dammit).