So what is the real world latest story on Obamacare? I am very interested in what is happening around the country. This is a complicated mix of individual needs, business, politics, law and is scary, especially if you have an illness like MG.

There's a lot of 'news' out there on Obamacare but some of it is contradictory and sounds like political spin. It's hard to know what the truth is. I thought I'd ask a few questions and also share what I thought was supposed to be happening. I may not have it right but I tried to ask questions below that go to the heart of the matter.

So who's deciding what we can buy? Is it true the feds are not the ones deciding the available insurance policies or prices but rather the insurance companies? I know the feds can set limits for what a minimum policy covers but that's not what we are talking about if the discussion is about IVIG coverage or coverage of 'off label' meds. In that case it was supposed to be free market competition without the need for a 'group'. Is that really happening? Is there real competition in different states?

I understand Obamacare operates on a state by state basis. That's the same as pre-Obamacare. So are the good plans offered in different states really that different? That would seem very unfair but I thought it would be decided by insurance companies, not the feds.

There seems to be at least five different cases to consider:
a) free care plans for low income people
b) partially fed subsidized plans for 'lowish' income people
c) plans offered (and typically partially subsidized) by employers
d) individual plans purchased by 'full paying' individuals
e) medicare supplemental coverage

a) I thought free care plans would stay about the same as pre-Obamacare. I thought nothing would change under Obamacare.

b) I thought that 'lowish income' people who could previously not have afforded insurance (like those whose employers did not offer a plan or kept work hours below 24 hrs) could now apply for a fed subsidy and purchase a reasonable plan. In the past, this would have been impossible because there would not be an employer subsidy and as an individual, the insurance company would charge very high rates and exclude people because of pre-existing conditions etc. Since the notion of being in a group is eliminated by the exchanges, the person could get reasonable coverage for a reasonable rate, partially subsidized if incomes were 'lowish'. The exchanges were supposed to provide competition to keep rates low. Many young people fall into this category. This is a new Obamacare category.

c) If your employer offers a plan it is likely subsidized at least 50% by the employer and it is in the employer's best interest to offer decent plans. Working people whose employers offer subsidized group plans will probably get a low rate because the employer pays a substantial portion of the cost. This is supposed to be the same with or without Obamacare.

d) People who don't have access to an employer plan but can afford coverage can buy through the exchanges and get 'group rates' as individuals. The exchanges would eliminate the need for a group and competition would keep rates low. I thought competition and the elimination of groups would make it easier for this category to get good plans at a lower rate. In this case, Obamacare was supposed to make it so individuals could get good rates despite not being part of a group.

e) I don't really know about supplemental plans. I have relatives who are very afraid right now. I thought these plans would be similar before and after Obamacare. In both cases they are purchased by individuals and I would think the free market would set pricing and coverage.

I know I've probably way over-simplified but that's the limit of my understanding. I personally fall in category C and I haven't seen a change except even employer based coverage seems to change from year to year. I've had to switch plans several times even with the same employer. My employer covers about 50% of my health insurance cost and to keep costs down, the plan has become leaner and leaner as time passes. My MG coverage has been good but I don't know what will happen down the road and that is a concern.

If I was an insurance company I would be very scared right now. I doubt I would offer my best deal to anyone because there is a lot of uncertainty. Obamacare hopes that hoards of young uninsured people will flock to purchase insurance and provide a larger 'pool' for everyone, but no one knows if that will happen. Supposedly, if that happens, we will all benefit but I doubt the insurance companies are willing to bet their profitability on anything right now. Wall Street doesn't reward CEOs that make bad bets and I think insurance company CEOs are not willing to make bets that can get them fired.

Because I have an employer based plan, I have a (perhaps misguided) sense of security right now but I do know what it's like to be scared of the uncertainty of MG and my heart goes out to those who now have to face the double uncertainty of Obamacare on top of MG. I'm very interested to hear what is happening to people in different states and in different situations because it could affect all of us. We don't have a lot of health insurance security in this country and a lost job or other misfortune can cause anyone to be in the shoes of another.

I hope I didn't step in some political pothole by writing this. I'm OK hearing people's opinions and it would be nice to also get some facts on the table. We've all heard a lot about what Obamacare will be and now is when we find out what it is. I hope whatever happens works out for all of us. We deserve good care.