Category Archives: Obamacare

Benefits for Illegals Make Americans Second-Class

Posted on by

Don’t look now, it is better to be either an illegal alien or a green card holder in America than it is to be a real plain American. Sad but true. Get comfy while you read the text below that it puts many real conditions in perspective. Simply put, Americans are being punked and cheated.

SAN FRANCISCO — The growing effort to get more African Americans and Hispanics to join tech companies or start their own is hitting the road, pushing beyond Silicon Valley into the rest of the nation.

Google is backing a new pilot program from CODE2040 in three cities. Starting this year in Chicago, Austin and Durham, N.C., the San Francisco non-profit will give minority entrepreneurs in each city a one-year stipend and free office space.

CODE2040 is a non-profit founded in 2012 that focuses on getting more African Americans and Hispanics into the tech workforce. It has graduated nearly 50 fellows, many of whom have gone to work for companies such as Facebook, LinkedIn and Uber. The group’s name refers to the year the population of minorities in the U.S. is expected to overtake whites.

While building their start-ups, the three CODE2040 entrepreneurs in residence will build bridges to technology for minorities in those communities.

“There is no question that Silicon Valley is the epicenter of the tech world, and as such there’s huge opportunity for impact on inclusion in tech,” says Laura Weidman Powers, co-founder and CEO of CODE2040, who came to Austin to announce the launch of the new program at a SXSW panel Monday morning.

“However, working on diversity issues in Silicon Valley means going against the status quo,” she says. “(It means) trying to change the ratio of employees at large companies, trying to bring inclusive techniques to established hiring practices and trying to infiltrate relatively closed, powerful networks.”

That work, says Powers, is crucial in Silicon Valley because it houses the headquarters of some of the world’s most powerful tech companies, which can set an example for the rest of the tech world.

But spreading to smaller tech hubs also presents an opportunity, she says.

“Here, rather than trying to change what is, we are trying to shape what might be. In smaller tech ecosystems around the country, often the cultures and norms around talent and inclusion are not yet set. We have the opportunity to help these places bake inclusion into their DNA from the ground up,” Powers says. “It’s an opportunity to create whole ecosystems where we never see the divides we see in Silicon Valley.”

Silicon Valley has never been diverse, but until last year, no one had any idea just how dominated by white and Asian men the tech industry here is.

In May 2014, Google disclosed that 30% of its workers are female and in the U.S. 2% of its workers are African American and 3% are Hispanic.

By the end of the summer, Apple, Facebook, Twitter and other major tech companies had followed with their own statistics, all of which showed the same lack of diversity.

“Releasing our numbers last year was a really important first step, and we were really happy to see other companies do that as well,” says John Lyman, head of partnerships for Google for Entrepreneurs. “This is an issue that Google really cares about. We really believe that better products are created by a workforce as diverse as the people who use them.”

That said, “a lot of the conversation is happening in Silicon Valley, which is great. But we also want to get it out to different parts of the country,” Lyman says.

So Google is putting money and resources behind the new CODE2040 Residency. CODE2040 received $775,000 in grants from Google in February to work on bringing more African Americans and Hispanics into tech.

Beyond getting the free office space in tech hubs in Chicago, Austin and Durham for one year and $40,000 in seed funding for their start-ups, the three entrepreneurs also get a trip to Google headquarters in Mountain View, Calif., as well as face time with investors, mentoring from entrepreneurs through Google For Entrepreneurs and CODE2040’s network and support from CODE2040 on building their diversity programs.

There will be one entrepreneur each at Capital Factory in Austin, 1871 in Chicago and American Underground in Durham, N.C.

Riana Lynn, 29, is founder of FoodTrace, a year-old tech start-up making new software tools to connect consumers, restaurants and distributors with local farmers.

Lynn graduated with a degree in biology and African American Studies from the University of North Carolina at Chapel Hill, where she taught herself to code.

From spending summers planting vegetables with her grandmother to working in first lady Michelle Obama’s kitchen garden as a White House intern, Lynn says technology has given her a way to combine her interests in science and public health and the ability to fulfill her ambition of changing what people eat. The CODE2040 Residency will give her more of an opportunity to help others tap the power of technology, she says.

“It’s the perfect opportunity to take my company to the next level and continue some of the activities I am doing now,” Lynn says.

Joel Rojo, a 25-year-old Harvard-educated software developer in Austin hails from a small town in southern Texas five minutes from the border.

The son of Mexican immigrants, he goes back there to talk with young people about the opportunities that a college education and a career in technology can provide.

Rojo started an online real estate firm when he was 18, worked at Google’s Creative Lab and built products at job search engine Indeed. Now the avid music fan is co-founder of TicketKarma, a marketplace “for good people” to find or sell reasonably priced tickets to concerts.

“Knowledge is power,” Rojo says. “Mentors in my life showed me what I could do with my life. If I didn’t have that, who knows where I would be?”

Talib Graves-Manns, 34, is a third-generation entrepreneur. He says “Blue Blood Hustle” runs in his DNA. Passionate about education and diversity, he’s co-founder of RainbowMe, which is building an online television network for kids of color.

Adam Klein, chief strategist for American Underground, says Graves-Manns will boost the Durham tech hub’s ambitions to become the nation’s most diverse tech hub by 2016.

American Underground houses 225 companies, 23% of which are led by women and 36% are led by women or minorities.

“I feel optimistic we are going to see a major shift,” Klein says. “There is a huge business opportunity being missed. How many ideas are not coming to market because of biases that are preventing people from being full and active participants in the innovation economy?”

*** Now it is time to address those visas….

You’ve heard it from Big Government lobbyists. You’ve heard it from Big Business lackeys in both political parties. And you’ve heard it from journalists, pundits, and think-tankers ad nauseam: The H-1B foreign-guest-worker program, they claim, requires American employers to first show that they searched for and tried to recruit American workers before tapping an ever-growing government-rigged pipeline of cheap foreign workers. The foot soldiers of the open-borders brigade are lying, deluded, ignorant, or bought off. On Tuesday, the Senate Judiciary Committee brought top independent academics and informed whistle-blowers to Washington to expose the truth. Senator Charles Grassley (R., Iowa) hosted Howard University associate professor of public policy Ron Hira, Rutgers University professor Hal Salzman, Infosys whistleblower Jay Palmer, and computer-programmer-turned-lawyer John Miano, who brought much-needed reality checks on the systemic betrayal of American workers to the Beltway table. Miano’s testimony was particularly important because he explained how the little-known “OPT” (Optional Practical Training) process for foreign students is being used to circumvent H-1B and supply large corporations with cheap foreign labor. President Obama has expanded this regulatory program by unfettered administrative fiat. As Miano noted: OPT has no labor protections of any kind. Aliens on OPT do not even have to be paid at all. While DHS requires aliens to work in an area related to their major area of study, DHS has no ability to ensure that this happens. Under OPT, over 125,000 foreign workers a year are simply turned loose in America with no supervision or restrictions. Also on hand at the hearing: a few Big Tech shills toeing the Zuckerberg/Gates/Chamber of Commerce line that there’s a catastrophic American tech-worker shortage, even as thousands upon thousands of American workers are being laid off in favor of underpaid, easily exploited H-1Bs. (Just use H-1B-promoter Google’s search engine and type in “Southern California Edison” and “layoffs.”) Grassley put it plainly: Most people believe that employers are supposed to recruit Americans before they petition for an H-1B worker. Yet, under the law, most employers are not required to prove to the Department of Labor that they tried to find an American to fill the job first. He added: And, if there is an equally or even better qualified U.S. worker available, the company does not have to offer him or her the job. Over the years, the program has become a government-assisted way for employers to bring in cheaper foreign labor, and now it appears these foreign workers take over — rather than complement — the U.S. workforce. Hira affirmed: “It’s absolutely not true” that employers seeking H-1Bs must put American workers first, either by “law or regulations.” How did this myth gain such traction? Many commentators and journalists confuse the labor-certification process required for companies applying to obtain green cards (lawful permanent residency status) for H-1B workers with the Labor Condition Application (LCA) process for H-1Bs. Labor certification in the green-card process “exists to protect U.S. workers and the U.S. labor market by ensuring that foreign workers seeking immigrant visa classifications are not displacing equally qualified U.S. workers.” Only in extremely narrow and exceptional circumstances do these nominal protections exist in the H-1B LCA process. (Companies must be classified as “H-1B dependent” for the requirements to apply. Big Tech giants like Facebook have been lobbying mightily to avoid the classification.) And even those narrow exceptions are easily and often circumvented by H-1B foreign-worker traffickers. Conservative journalist W. James Antle gets to the heart of the matter: If the government has discretion in how it exercises its legitimate authority over who comes and who goes, a prerequisite for national sovereignty, then shouldn’t it exercise such discretion in a way that minimizes the impoverishment of Americans? For a very brief window, thanks to a bill from Grassley and, yes, Senator Bernie Sanders (I., Vt.), a small group of H-1B-employing banks and other financial institutions that accepted federal bailout money from the Troubled Asset Relief Program (TARP) did have to demonstrate that they had taken “good-faith steps to recruit U.S. workers” and offer them wages “at least as high” as those offered to H-1B workers. In addition, the targeted employers had to show that they “must not have laid off, and will not lay off, any U.S. worker in a job essentially equivalent to the H-1B position in the area of intended employment of the H-1B worker” within a narrow time frame. But this American-worker-first provision, vociferously opposed by Big Business and Big Government, expired in 2011. The refusal of the vast majority of politicians and the White House to embrace these protections for all U.S. workers tells you everything you need to know about H-1B’s big, fat lies.

White House Czar-Net on Immigration is Productive

Posted on by

There is no one person responsible for illegals getting benefits, there is an army of them and the government of Mexico is included. Mexico is a recipient of huge dollars from the United States. So, this little fact is notable:

Mexico is helping some of its citizens apply for a controversial immigration program in the U.S. called Deferred Action for Childhood Arrivals, or DACA.

Since the Obama administration created the program in 2012, more than 580,000 unauthorized immigrants brought to the U.S. as minors have received temporary relief from deportation and been given work permits that last for at least two years.

But 45 percent of those who are eligible for DACA have not applied, and the cost may be holding some back. Immigrants have to pay a total of $465 to the Department of Homeland Security for fees related to the work permit and for required fingerprinting.

Mexican consulates around the U.S. have been paying those fees for some applicants through a little-known program for Mexican citizens with financial need. ***A federal judge may have temporarily halted President Obama’s executive actions on immigration, but the White House is still proceeding as if it expects the programs to stand. In this video, The Daily Signal explores one reason why.

The Obama administration, or more specifically a government agency called Citizenship and Immigration Services, has set up an “operational center” just outside Washington, D.C., as the hub that will process thousands of applications expected to come from Obama’s immigration actions.

Though no work is currently being done at the center due to a ruling by U.S. District Judge Andrew Hanen last month, its existence shows some of the costs and change that will result from Obama’s executive actions to defer deportation for up to 5 million illegal immigrants and grant them work permits.

This video further explains the purpose of this not-so-secret operational center. *** But what about Social Security? Uh huh…that is yet another benefit.

Illegal immigrants who take advantage of President Obama’s executive actions on immigration will soon collect another benefit: Social Security. Starting in 2017, the Social Security Administration expects that thousands of undocumented immigrants will begin collecting from the Old-Age, Survivor’s, and Disability Insurance (OASDI) program as a direct result of the president’s actions. In a letter to Republican senator Ron Johnson, chairman of the Homeland Security and Governmental Affairs Committee, the SSA’s chief actuary Stephen Goss indicated that an additional 16,000 people will begin collecting OASDI benefits come 2017, and that the number of beneficiaries would continue to increase for 40 years thereafter, topping out at 695,000 people. Goss’s projection may underestimate the number of potential beneficiaries, however, as it assumes that 50,000 fewer illegal immigrants will enter the country each year starting in 2016. What’s more, the SSA is proceeding as if nothing has changed in the wake of a federal judge’s injunction against Obama’s November 2014 executive actions. Goss tells NRO that he expects 58,000 new workers will be covered under the OASDI program later this year, although they will not be eligible to collect benefits immediately. “Based on the best advice and counsel we have gotten, we’re working on the assumption that these [executive actions] will persist,” Goss says. “Most indications we seem to get are that it’s likely that this will get back on track, with some delay.” Goss notes that a law, additional regulation, or another executive action by Obama or a future president could alter the way SSA calculates and administers OASDI benefits, but says that he does not expect the court’s order will ultimately succeed in changing anything. The Social Security Administration appears to be the latest Obama administration agency to ignore the federal judge’s injunction, moving forward as if it posed no legitimate threat to the president’s actions. U.S. Customs and Border Protection continues to circumvent the judge’s injunction, adhering to the relaxed border protection and enforcement standards laid out by Department of Homeland Security Secretary Jeh Johnson in the wake of the executive actions. And, as the Justice Department noted last week, the U.S. Citizenship and Immigration Services began granting applications related to Obama’s executive amnesty well in advance of the date authorized by the president. Apparently, when Republicans in Congress caved to Obama and fully funded DHS — and the president’s executive actions — last month, they paved the way for illegal immigrants to begin collecting benefits from other agencies as well.

 

 

SCOTUS on Obamacare, Facts

Posted on by

 

WASHINGTON (AP) — The Supreme Court was sharply divided Wednesday in the latest challenge to President Barack Obama’s health overhaul, this time over the tax subsidies that make insurance affordable for millions of Americans.

The justices aggressively questioned lawyers on both sides of what Justice Elena Kagan called “this never-ending saga,” the latest politically charged fight over the Affordable Care Act.

Chief Justice John Roberts said almost nothing in nearly 90 minutes of back-and-forth, and Justice Anthony Kennedy’s questions did not make clear how he will come out. Roberts was the decisive vote to uphold the law in 2012.

Otherwise, the same liberal-conservative divide that characterized the earlier case was evident.

Opponents of the law say that only residents of states that set up their own insurance markets can get federal subsidies to help pay their premiums. The administration says the law provides for subsidies in all 50 states.

The liberal justices peppered lawyer Michael Carvin almost from the outset of his argument to limit the subsidies.

Justice Ruth Bader Ginsburg said the law set up flexibility for states to either set up their own markets or rely on the federal healthcare.gov. Giving subsidies only to people in some states would be “disastrous,” Ginsburg said.

When Solicitor General Donald Verrilli Jr. stepped to the lectern, the liberal justices fell silent, and Justices Samuel Alito and Antonin Scalia took over.

“It may not be the statute Congress intended, but it may be the statute Congress wrote,” Scalia said of the provision in question. The case focuses on four words in the law, “established by the state.” The challengers say those words are clear and conclusive evidence that Congress wanted to limit subsidies to those consumers who get their insurance through a marketplace, or exchange, that was established by a state.

(AP) Members of the National Family Planning and Reproductive Health Association rally…
Full Image

Verrilli argued that the law can only be read more broadly and noted that millions of people would lose health insurance if the court rules against the administration.

Alito wondered if the justices could delay the effect of such a ruling to allow states and perhaps the federal government to act. Scalia said he believes Congress would act.

“This Congress, Your Honor?” Verrilli said to widespread laughter in a packed courtroom that included leading congressional Democrats and Republicans.

Kennedy voted to strike down the health law in 2012, but on Wednesday he asked questions of both sides that made it hard to tell where he might come out this time.

He suggested that challenger Carvin’s argument raised a “serious” constitutional problem affecting the relationship between states and the federal government. On the other hand, he seemed less than convinced by Verrilli’s reading of the law to allow the subsidies nationwide.

Millions of people could be affected by the court’s decision. The justices are trying to determine whether the law makes people in all 50 states eligible for federal tax subsidies to cut the cost of insurance premiums. Or, does it limit tax credits to people who live in states that created their own health insurance marketplaces?

A ruling that limits where subsidies are available would have dramatic consequences because roughly three dozen states opted against their own marketplace, or exchange, and instead rely on the U.S. Health and Human Services Department’s healthcare.gov. Independent studies estimate that 8 million people could lose insurance coverage.

Activists on both sides were in place outside the marble courthouse by 5:30 a.m. Wednesday. Some held placards showing how many people in each state would lose insurance if the court ruled that the law does not allow subsidies everywhere.

Opponents of the Affordable Care Act failed to kill the law in an epic, election-year Supreme Court case in 2012. Chief Justice Roberts joined with the court’s liberal justices and provided the crucial vote to uphold the law in the midst of Obama’s re-election campaign.

The new case, part of a long-running political and legal fight to get rid of the law also known as Obamacare, focuses on the four words “established by the state” in a law that runs more than 900 pages.

The administration counters that the law was written to dramatically reduce the ranks of uninsured, and that it would make no sense to condition subsidies on where people live. The phrase “established by the state,” is what the administration calls a “term of art” that takes in both state- and federally run exchanges. The administration also says the term cannot be read in isolation, and that other parts of the law show that subsidies should be widely available.

Each side in the case argues that the law unambiguously supports only its position. One other option for the court is to declare the law is ambiguous when it comes to subsidies and defer to the Internal Revenue Service’s regulations making tax credits available nationwide.

Partisan and ideological divisions remain stark for a law that passed Congress in 2010 with no Republican votes. Of the judges who have ruled on lawsuits over the subsidies, Democratic appointees have sided with the administration and Republican appointees have been with the challengers.

Roberts was the only justice to essentially cross party lines with his vote in 2012. His fellow conservatives on the court voted to strike down Obamacare in its entirety.

A decision in King v. Burwell, 14-114, is expected by late June.

To understand the case that House has against the Department of Health and Human Services on Obamacare (ACA), in part this is from the lead lawyer, Jonathan Turley representing the House of Representatives:

The case could again put Chief Justice Roberts in the position of saving or dooming the ACA with a court that has been deeply divided over the Act. Roberts appeared to have switched sides soon before the issuance in the individual mandate case — a decision that saved the ACA but also produced a rather convoluted opinion. Now the Administration seems to be trying to influence Roberts with dire predictions about what would occur if he or his colleagues vote against the President. Obviously, the ramifications of a legal interpretation should not influence the Court but clearly some believe it may factor into the analysis.

Sylvia Mathews Burwell, the Health and Human Services secretary, told lawmakers in a letter on Tuesday that millions of Americans would lose their health insurance if the court rules against President Barack Obama’s administration in the case, which is expected to be decided by June. The timing of the letter is rather obvious and the question is whether such heavy-handed moves could backfire. It seems pretty obvious who the letter is really directed toward and Roberts may feel like he is being played as a chump.

Ironically, there is no need for the letter. As I have noted in the past, King and Halbig represent serious threats to the ACA, even though there could be legislative remedies. The problem is that the President has burned every bridge with Congress in continuing to take unilateral actions in violation of the the Separation of Powers (at least in the view of some of us).

In the end, this type of public campaign can irritate and alienate justices before an argument. Whether the President acted constitutionally (and I believe that he did not) should not be a question that turns on how you feel about health care or the ramification of enforcing what you believe is the constitutional mandate.

—

White House Counterfeiting Immigration Documents

Posted on by

Why Obama’s Immigration Order Was Blocked

The injunction isn’t about prosecutorial discretion. It is about granting illegal aliens benefits not allowed by law.

The Obama administration argued that DAPA is a routine application of “prosecutorial discretion”—the authority of executive officials to set priorities for enforcement of the law and to refrain from enforcement in cases where the public interest is least urgent. The district court recognized, however, that prosecutorial discretion is limited to nonenforcement and doesn’t entitle the executive branch to grant affirmative benefits such as work permits and welfare without statutory authority and notice-and-comment rule-making.

As the court explained, “DHS has not instructed its officers to merely refrain from arresting, ordering the removal of, or prosecuting unlawfully-present aliens.” Instead the department “has enacted a wide-ranging program that awards legal presence, to individuals Congress has deemed deportable or removable, as well as the ability to obtain Social Security numbers, work authorization permits, and the ability to travel.”

Despite misleading claims by administration supporters that the order interferes with executive discretion to set enforcement priorities, the district court narrowly crafted its order not to touch on prosecutorial discretion. The administration remains free to decide which illegal aliens to deport and which to permit to remain in this country. The court order is explicitly confined to the grant of work authorization and affirmative benefits, which has never been part of prosecutorial discretion.

Ted Cruz: White House ‘Counterfeiting Immigration Documents’

WASHINGTON (CBSDC/AP) — Sen. Ted Cruz, R-Texas, believes that the Obama administration is “counterfeiting immigration documents” under the president’s immigration plan.

Speaking to Fox News following a federal judge’s decision to temporarily halt President Barack Obama’s executive action on immigration, the potential Republican presidential contender said the commander in chief is ignoring federal law.

“One of the things it points out is the president has claimed, rather absurdly, that the basis of his authority is ‘prosecutorial discretion.’ That he’s simply choosing not to prosecute 4.5 million people here illegally,” Cruz told Fox News. “But what the district court concluded, quite rightly, is they’re doing far more than that. The administration is printing work authorizations. It is affirmatively acting in contravention of federal law. Basically, what its doing is counterfeiting immigration documents, because the work authorizations its printing are directly contrary to the text of federal law. It is dangerous when the president ignores federal law.”

U.S. District Judge Andrew Hanen’s decision late Monday puts on hold Obama’s orders that could spare from deportation as many as 5 million people who are in the U.S. illegally.

In a memorandum accompanying his order, Hanen said the lawsuit should go forward and that the states would “suffer irreparable harm in this case” without a preliminary injunction.

“The genie would be impossible to put back into the bottle,” he wrote, adding that he agreed that legalizing the presence of millions of people is a “virtually irreversible” action.

Talking to reporters in the Oval Office, Obama said he disagreed with the ruling by Hanen that the administration had exceeded its authority. But he said that, for now, he must abide by it.

“We’re not going to disregard this federal court ruling,” Obama said, but he added that administration officials would continue to prepare to roll out the program. “I think the law is on our side and history is on our side,” he said.

Cruz called it a “major victory for the rule of law.”

“It’s interesting, (Obama) said the law is on his side. There’s at least one person who calls himself a legal scholar who disagrees, and his name is Barack Obama,” Cruz said. “Twenty-two times President Obama has admitted he doesn’t have the authority to issue unilateral amnesty. Twenty-two times he says the constitution doesn’t allow it. He said, ‘This is not a monarchy.’ That’s his quote. And then after the last election, he said never mind and issued it anyway.”

Obama’s directives would make more than 4 million immigrants in the United States illegally eligible for three-year deportation stays and work permits. Mostly those are people who have been in the country for more than five years and have children who are U.S. citizens or legal permanent residents. Applications for the first phase were to begin Wednesday, when as many as 300,000 immigrants brought illegally to the country as children could begin applying for an expansion of Obama’s 2012 program aimed at the younger immigrants known as Dreamers.

Hanen’s ruling late Monday night, in a case brought by 26 states led by Texas, said that Obama and his Homeland Security Department lacked the authority to take the actions they did.

“No statute gives the DHS the discretion it is trying to exercise here,” wrote Hanen, and he issued a stay blocking the actions from taking effect. His order was not a big surprise from a Republican-appointed judge who has showed a hard line on border issues.

The Obama administration could seek a stay of his order in addition to appealing to the 5th U.S. Circuit Court of Appeals in New Orleans. Attorney General Eric Holder said Tuesday that the Justice Department was deciding its next move.

He said, “I’ve always expected that this is a matter that will ultimately be decided by a higher court — if not the Supreme Court then a federal court of appeals.”

Even the NYT’s Admits Obamacare Purgatory

Posted on by

Ah, Sylvia Burwell if you received the memo, would you please call the White House for comment? The next step is beyond repealing Obamacare, if all else fails, at least rename it from ‘Affordable’ to Hell on Earthcare. Then last week while Burwell was providing testimony to Congress, the exchange did not go too well. During a hearing on the Health and Human Services (HHS) department budget, Secretary Sylvia Burwell had a contentious exchange with Sen. John Cornyn, R-Texas, over whether the administration has a contingency plan should it lose the Supreme Court case that will be argued this session over the fate of the health care law.

The case, King v. Burwell, deals with whether the federal government can give subsidies to Obamacare recipients in states with federally-run health care exchanges.

Cornyn asked Burwell, “If the administration loses in the King vs. Burwell case, do you believe you already have the authority to make an administrative fix, or will you come to congress to ask for additional legislation?

Insured, but Not Covered

WHEN Karen Pineman of Manhattan received notice that her longtime health insurance policy didn’t comply with the Affordable Care Act’s requirements, she gamely set about shopping for a new policy through the public marketplace. After all, she’d supported President Obama and the act as a matter of principle.

Ms. Pineman, who is self-employed, accepted that she’d have to pay higher premiums for a plan with a narrower provider network and no out-of-network coverage. She accepted that she’d have to pay out of pocket to see her primary care physician, who didn’t participate. She even accepted having co-pays of nearly $1,800 to have a cast put on her ankle in an emergency room after she broke it while playing tennis.

But her frustration bubbled over when she tried to arrange a follow-up visit with an orthopedist in her Empire Blue Cross/Blue Shield network: The nearest doctor available who treated ankle problems was in Stamford, Conn. When she called to protest, her insurer said that Stamford was 14 miles from her home and 15 was considered a reasonable travel distance. “It was ridiculous — didn’t they notice it was in another state?” said Ms. Pineman, 46, who was on crutches.

She instead paid $350 to see a nearby orthopedist and bought a boot on Amazon as he suggested. She has since forked over hundreds of dollars more for a physical therapist that insurance didn’t cover, even though that provider was in-network.

                                           

The Affordable Care Act has ushered in an era of complex new health insurance products featuring legions of out-of-pocket coinsurance fees, high deductibles and narrow provider networks. Though commercial insurers had already begun to shift toward such policies, the health care law gave them added legitimacy and has vastly accelerated the trend, experts say.

The theory behind the policies is that patients should bear more financial risk so they will be more conscious and cautious about health care spending. But some experts say the new policies have also left many Americans scrambling to track expenses from a multitude of sources — such as separate deductibles for network and non-network care, or payments for drugs on an insurer’s ever-changing list of drugs that require high co-pays or are not covered at all. For some, like Ms. Pineman, narrow networks can necessitate footing bills privately. For others, the constant changes in policy guidelines — annual shifts in what’s covered and what’s not, monthly shifts in which doctors are in and out of network — can produce surprise bills for services they assumed would be covered. For still others, the new fees are so confusing and unsupportable that they just avoid seeing doctors.

It is true that the Affordable Care Act has erased some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills. Insurers can no longer deny coverage to those with pre-existing conditions, for example. And the new policies cap out-of-pocket spending so long as the patient receives care within the plan. Most important, the act has offered health insurance to an estimated 10 million Americans who did not have any, often by expanding Medicaid or providing subsidies.

But by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

“I’m always curious when I read this ‘good news’ that health costs are moderating, because my health care costs go up significantly each year, and I think that’s a common experience,” said Mark Rukavina, president of Community Health Advisors in Massachusetts.

While much of the focus in the past has been on keeping premiums manageable, “premiums now tell only a part of the story,” Mr. Rukavina said, adding: “A big part of the way they’ve kept premiums down is to shift costs to patients in the form of co-pays and deductibles and other types of out-of-pocket expenses. And that can leave patients very vulnerable.”

Such policies desperately need improvement, patients and professionals like Mr. Rukavina say. But with the Republicans attacking the Affordable Care Act at all turns, even political supporters seem reluctant to acknowledge that it has some flaws. The narrative has been cast in black or white: It’s working, or it’s a failure. The reality, of course, is gray.

AT this point, we don’t have a good definition of “affordable” — or how to measure it fully and fairly. Many studies show that national health costs, while still rising, are not growing as fast as they once were. But what does that mean for individual patients? So far the research has yielded mixed results.

A study by the Commonwealth Fund this month found that the rise in health insurance premiums in employer-based plans had slowed in 31 states since the passage of the Affordable Care Act (good news, right?). But premiums were still rising faster than median incomes (hmm). More important, perhaps, the researchers found that patients were paying more in health care expenses than ever before, during a time of stagnant wages (not so great). In fact, nearly 10 percent of median household income now goes to pay premiums and deductibles, the study found. And that does not include other kinds of health payments that patients now encounter, such as co-pays and uncovered drugs or services.

A recent New York Times/CBS poll found that 46 percent of Americans said they had trouble affording health care, up 10 percentage points in just one year. Some of the cost problems may ease as patients — now known as health care consumers — learn what to expect and how to choose and navigate their plans.

But other problems may be related to the process by which the plans are created. Under the Affordable Care Act each state was asked to select a benchmark plan as its standard. It had to cover certain “essential health benefits” like maternity care and prescription drugs; it had to have a defined actuarial value depending on the level of plan. Silver plans, for example, had to cover 70 percent of charges, leaving consumers with 30 percent. But within those parameters, competing insurers had leeway to set premiums, co-payments and deductibles, and to create networks by negotiating with doctors and hospitals. Naturally, they created policies that met the core criteria while minimizing their financial risk.

Suddenly there were hundreds of new insurance products that had never been tested in real time. Their shortcomings are now playing out in various ways.

Alison Chavez, 36, who is self-employed, signed up for a marketplace plan in October 2013 that she hoped would be an improvement on her previous plan. She had recently been given a diagnosis of breast cancer and was just beginning therapy, so she was careful to choose a policy on the Covered California marketplace that included her physicians.

But in March, while in the middle of treatment, she was notified that several of her doctors and the hospital were leaving the plan’s network. She was forced to postpone a surgery as she scrambled to buy a new commercial policy that included her doctors. “I’ve been through hell and back, but I came out alive and kicking (just broke),” she wrote in an email.

Dr. Alexis Gersten, a dentist in East Quogue, N.Y., switched her family and 11 employees to a new Blue Cross/Blue Shield plan for 2014, after a previous small-business group plan was canceled. She bought the plan through a broker, and says she was unaware that it was an Affordable Care Act plan. When her son needed an ear, nose and throat specialist, the nearest was in Albany, five hours away. Though her cardiologist was on the network list, he said he did not take the plan. She ended up driving an hour to see a new one. A dispute with the insurer about how to count deductibles left her with a $457 pediatrician’s bill. This year she has chosen a new policy.

“People may have a checklist when they buy insurance: First, premiums, then the deductible — and those are pretty easy to understand because they’re set dollar amounts,” said Lynn Quincy, associate director of health reform policy at Consumers Union. But new policies demand different and more difficult kinds of calculations, she said: “The terms are unfamiliar, and figuring out networks is especially murky.”

Compounding the problem is the lack of basic information to shop effectively. When Andrea Greenberg, a New York lawyer, called the help line of Health Republic to clarify the difference between two plans, she found herself speaking to someone reading off a script in the Philippines. “I was really outraged,” she said. “This is an important decision with potentially dire consequences. It’s not like you’re choosing a sweater.”

Likewise, it took many phone calls for Aviva Starkman Williams, a California computer engineer with insurance through her employer, to determine whether the pediatrician doing her son’s 2-year-old checkup was in-network for 2015. Only three of the pediatricians in her doctor’s six-person group were listed in her plan’s online directory, and since her deductible had tripled from the previous year’s, she wanted to limit her out-of-pocket payments.

The practice’s office manager couldn’t tell her for sure. The insurer’s representative said he didn’t know because doctors came in and out of network all the time, likening the situation to players’ switching teams in the National Basketball Association. “If you don’t have updated information, who does?” she asked. “Isn’t it your job to know?”

Ms. Quincy said regulators needed to do a much better job setting requirements and policing plan practices and offerings, particularly provider networks. Few states have clear standards and many rely on consumer complaints to ferret out problems.

Last month, the California insurance commissioner, Dave Jones, announced new emergency regulations concerning networks, noting: “Health insurers’ medical provider directories have been inaccurate, misleading consumers into signing up with a health insurer for access to a doctor, specialist or hospital, only to learn that these medical providers are not actually a part of the health insurer’s network.”

But for now, patients are most often left to fend for themselves. When Amy Moses, a tech entrepreneur in New York City, went online to select a plan, she paid a relatively pricey $650 per month for a United Healthcare plan to make sure her network included a longtime physician. One month into the year, the doctor’s practice was bought by a hospital, which then dropped the plan, so her doctor did as well. (A year later the doctor was still listed in the network directory.)

She discovered the change only when she contacted the physician for a referral for an urgent outpatient procedure costing thousands of dollars that had been recommended by an in-network surgeon. (Both the referring doctor and the surgeon had to be in-network for coverage.) “I literally had three days to find a new in-network internist and score an appointment to get a referral, or cancel my procedure,” she said. “I was stuck in insurance purgatory.”