Author Topic: Impending repeal of Obamacare--what to do?  (Read 37381 times)

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #150 on: November 12, 2016, 10:28:44 AM »
What's wrong with having non-sensible persons subsidize sensible ones? Seems like a good deal to me, in a Darwinian sense
Sure. And in a Darwinian sense, I should be able to shoot you and take all your money if I want to. Hope that answers your question.

Trudie

  • Handlebar Stache
  • *****
  • Posts: 1326
Re: Impending repeal of Obamacare--what to do?
« Reply #151 on: November 12, 2016, 12:46:15 PM »
We have a little time. Open enrollment now, means your plan will last until 12/31/2017. Insurance plans and rates are governed at the state level by your Dept of Insurance.

The ACA will be repealed. Republicans would use budget reconciliation to counter a filibuster, and vote to de-fund. They only need 50 votes for that (with Pence providing the tie-breaker). That would break ACA by removing the APTC tax credits. And budget reconciliation debate is limited to a day, so it can't itself be filibustered.

Medicaid block grants will really hurt, too. This translates into a massive shrinking of Medicaid (less fed dollars means more state dollars , which don't exist), which will massively inflate the ranks of the uninsured. Medicaid services will be rationed in some way - shrinking the rolls, or cutting services, or both. Meanwhile, the price of services is increasing.

Over the next year, we'll know more about our options. It's too soon to panic.

Can we just vote Axe Cleaver into office to take care of this problem?  So calm, cool, and collected.

Axecleaver

  • Magnum Stache
  • ******
  • Posts: 3033
  • Location: New York
Re: Impending repeal of Obamacare--what to do?
« Reply #152 on: November 12, 2016, 12:58:52 PM »
Lol, thanks! I've been working as a healthcare reform consultant since 2003, first with Medicaid and then in 2010, on ACA/exchange planning and implementation. So I know a few things about it and what is in the realm of the possible.

My impression is that Trump is saying he wants to keep the popular parts today, so that later he can tell us "it's too expensive, just not going to work. You have Obama to thank for that. But, good news! We can implement high risk pools for those unhealthy people who don't take care of themselves. And we will have affordable plans for people who do." Never mind that 40% of us have hypertension, high cholesterol, type 1 diabetes, or cancer from genetic inheritance. This is just a step of his marketing. I predict high risk pools in 2019, with a 40% chance they jam them into 2018.

gerardc

  • Bristles
  • ***
  • Posts: 362
  • Age: 33
  • Location: SF bay area
Re: Impending repeal of Obamacare--what to do?
« Reply #153 on: November 12, 2016, 01:30:00 PM »
For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).

sol

  • Walrus Stache
  • *******
  • Posts: 5286
  • Age: 40
  • Location: Pacific Northwest
Re: Impending repeal of Obamacare--what to do?
« Reply #154 on: November 12, 2016, 01:38:08 PM »
For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).

What about people who opt out at age 21 because they feel invincible, and then get cancer at 35?  We just let them die?

The whole idea here is for society to find a way to take care of it's least fortunate members.  If lady luck fucks you, America is supposed to have your back.

bacchi

  • Handlebar Stache
  • *****
  • Posts: 1953
Re: Impending repeal of Obamacare--what to do?
« Reply #155 on: November 12, 2016, 01:47:28 PM »
For those saying a pre-existing ban cannot work without the individual mandate, could we have a pre-existing ban (no expulsion, no price change) for those who always maintained continuous coverage? This way, people who want to opt in health insurance (likely 50%+ of people) will all be in a single risk pool, but people could also completely opt out if they choose (for life).

Yeah, this would work. But what if the person who skipped insurance was working class and it was either rent or insurance premiums?  Who gets to tell the formerly healthy person, who now has cancer, that "Dying sucks. Good luck with that."?

I'm skeptical it would ever happen that way, though. We have to consider why they're trying to shuffle chronically ill people to weak-ass high-risk pools. It's not for better care or lower premiums.

gerardc

  • Bristles
  • ***
  • Posts: 362
  • Age: 33
  • Location: SF bay area
Re: Impending repeal of Obamacare--what to do?
« Reply #156 on: November 12, 2016, 01:56:19 PM »
What about people who opt out at age 21 because they feel invincible, and then get cancer at 35?  We just let them die?

Well, those are the people who decided that they were healthy and they absolutely did not want to pay for other people's sickness. People who thought that by exercising and eating healthy, they wouldn't need subsidies and would be fine in the old system. So, yes, we can just let them participate in the high risk pools then, as was the case in the old system.

Basically, at 18, you decide if you want to live in old America, or a more socialized America. You have been warned.


Yeah, this would work. But what if the person who skipped insurance was working class and it was either rent or insurance premiums?  Who gets to tell the formerly healthy person, who now has cancer, that "Dying sucks. Good luck with that."?

We may need subsidies for the "opted into the ACA" people, for whom (progressive) income tax would be higher at higher income.

Probably way too complicated to segregate Americans like that, but I could see it theoretically work.

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #157 on: November 12, 2016, 02:24:51 PM »
Of course, Trump understands you can't have the pre-existing condition exclusion exclusion (not sure the best way to write that) without the individual mandate.  But the exclusion is popular.  So he says he supports it.  It will then be up to the insurance companies to voice that you can't keep it without the mandate.  And Trump can say, shoot, I tried to keep it, but nothing can be done because the insurance companies won't go along, and we're not going to be socialists.  And then he comes out the winner.
This is wishful thinking. If his actions lead to people being unable to get insurance, he will take some damage. Also, it's not at all clear that he does understand things like this. Walk like a buffoon, talk like a buffoon . . . you might just be a buffoon. I'd need to see some more evidence of his cleverness before I buy the idea that it's just an act.
All of this election fallout has been misguided because most people understand that politicians make promises they can't keep, but somehow then try to take Trump at face value.
This is not in line with reality. Studies have demonstrated that elected officials keep a majority of their promises, and even the ones they can't keep, they normally try their best. http://fivethirtyeight.com/features/trust-us-politicians-keep-most-of-their-promises/

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #158 on: November 12, 2016, 02:38:29 PM »
Basically, at 18, you decide if you want to live in old America, or a more socialized America. You have been warned.
Yeah, that's not really gonna fly. People don't want other people, even those who've made bad decisions, to go to their deaths early. Even when our policies tacitly endorsed this state of affairs (GWBush years pre-ACA), what actually happened is we gave these folks just enough care to limp along and be a huge drain on the system, generally by mandating that emergency rooms treat anyone, regardless of ability to pay.

wenchsenior

  • Handlebar Stache
  • *****
  • Posts: 1118
Re: Impending repeal of Obamacare--what to do?
« Reply #159 on: November 12, 2016, 02:57:46 PM »
Basically, at 18, you decide if you want to live in old America, or a more socialized America. You have been warned.
Yeah, that's not really gonna fly. People don't want other people, even those who've made bad decisions, to go to their deaths early. Even when our policies tacitly endorsed this state of affairs (GWBush years pre-ACA), what actually happened is we gave these folks just enough care to limp along and be a huge drain on the system, generally by mandating that emergency rooms treat anyone, regardless of ability to pay.

Not to mention the fact that most people are barely starting to understand economics and politics at 18, and are notoriously bad at making decisions that have long term consequences. Maybe if we had mandatory courses in school that covered this decision and its ramifications, but even then...

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #160 on: November 12, 2016, 02:59:28 PM »
Great point, wenchsenior. Yes it's true. Hyperbolic discounting is a major weakness in human reasoning.

Christof

  • Bristles
  • ***
  • Posts: 486
  • Age: 41
  • Location: Germany
Re: Impending repeal of Obamacare--what to do?
« Reply #161 on: November 12, 2016, 03:15:40 PM »
Country Start Date of Universal Health Care System Type
...
Germany 1941 Insurance Mandate
...

That is short, but misleading... Health insurance in Germany is mandatory since 2009, pretty much like in the US. We also do not have a universal health care system. Instead we have public insurance for employees, welfare coverage for various groups on benefits, governmental coverage for state and federal employees and private insurance for highly paid employees and freelancers. Public insurance is a percentage of income for family coverage, private insurance is a fixed price based on plan and benefits, welfare and governmental insurance is included because one is either receiving welfare or working for the government.

For certain groups (like me) we actually have less governmental required payments than the US. For instance, social security is optional for some groups in Germany, but mandatory in the US.

gerardc

  • Bristles
  • ***
  • Posts: 362
  • Age: 33
  • Location: SF bay area
Re: Impending repeal of Obamacare--what to do?
« Reply #162 on: November 12, 2016, 06:16:39 PM »
Not to mention the fact that most people are barely starting to understand economics and politics at 18, and are notoriously bad at making decisions that have long term consequences. Maybe if we had mandatory courses in school that covered this decision and its ramifications, but even then...

Another issue is that your life until 18 years old is a non-perfect, but non-negligible indicator of your future health. The full coverage plan would probably attract slightly more people with chronic or developing conditions. Everytime you allow healthier people to opt out, you basically skew the distribution of the 2 groups, and prices can go up in the less healthy group.

Tangentially, there's a similar phenomenon with emigration/immigration into countries where universal care is provided (or states with subsidies). If the US gets universal care, it may attract more unhealthy people in general. For example, I'm a Canadian citizen living in the US, and I know I can get back to Canada if I get really sick in the future. This is a bad deal for Canada. Granted, crossing borders isn't as easy as hopping in and out of a plan, but with globalization and cheap air travel, it may be easier than before. What we really need is WORLDWIDE fully universal care :D
« Last Edit: November 12, 2016, 06:18:41 PM by gerardc »

gerardc

  • Bristles
  • ***
  • Posts: 362
  • Age: 33
  • Location: SF bay area
Re: Impending repeal of Obamacare--what to do?
« Reply #163 on: November 12, 2016, 06:34:20 PM »
Thinking about it some more, could it be that this skew in the health distribution of different groups is the reason Americans are reluctant to universal care or even ACA? With ACA, everyone is basically covering the cost of the average. However, if anyone can come to the US and buy off-the-shelf insurance plans, then these plans would attract unhealthy potential immigrants from other regions/countries, and the US would end up paying more for them, due to the different distribution that jack up prices. Maybe Americans want the contrary to happen by keeping the old system, i.e. keep a healthy population in the US, and have sick people expatriate themselves and seek cheaper or subsidized care elsewhere in the world. That would be extremely evil, surely that's not how American people think.

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #164 on: November 12, 2016, 06:47:13 PM »
gerardc, it seems very far-fetched to believe that is the main line of reasoning, since I've never heard anyone vocalize it before. More likely, folks who have (health in this case) just don't want to pay to help those who have not.

gerardc

  • Bristles
  • ***
  • Posts: 362
  • Age: 33
  • Location: SF bay area
Re: Impending repeal of Obamacare--what to do?
« Reply #165 on: November 12, 2016, 07:08:23 PM »
gerardc, it seems very far-fetched to believe that is the main line of reasoning, since I've never heard anyone vocalize it before. More likely, folks who have (health in this case) just don't want to pay to help those who have not.

One thing I've learned from US companies is that you don't need to be malicious to unintentionally optimize for an "evil" outcome that advantages you. You just need a blind optimization process (e.g. survival of the fittest and emulating successful people) that preserves your good intentions and plausible deniability. Examples: monopolies and price fixing via merges/acquisitions, deception with click-bait ads, bait-and-switch. In those cases, your advantageous position is only possible with evil consequences, whether you realize it or not.

oldtoyota

  • Magnum Stache
  • ******
  • Posts: 2967
Re: Impending repeal of Obamacare--what to do?
« Reply #166 on: November 12, 2016, 08:04:57 PM »
The latest I heard is he doesn't plan to repeal Obamacare.

Broken campaign promise #1.

Who knows? He could change his mind tomorrow.

mtnrider

  • Bristles
  • ***
  • Posts: 256
  • Location: Frozen tundra in the Northeast
Re: Impending repeal of Obamacare--what to do?
« Reply #167 on: November 12, 2016, 08:19:48 PM »
The latest I heard is he doesn't plan to repeal Obamacare.

Broken campaign promise #1.

Who knows? He could change his mind tomorrow.

I wonder if he's mincing words?  News sites have listed a number of ways of killing Obamacare, and repealing is among the hardest.

Other options:
 - There's at least one lawsuit in-flight that is on appeal by the executive.  He could drop the appeal.  Easy.
 - Have congress removing funding for it (this is a budgetary processes and not subject to filibuster).
 - Issue an executive order not to run the exchanges or some other necessary part.

All are technical not a "repeal" but will also effectively kill it.

waltworks

  • Handlebar Stache
  • *****
  • Posts: 2367
Re: Impending repeal of Obamacare--what to do?
« Reply #168 on: November 12, 2016, 08:37:00 PM »
If he really wants to go all-in on free-market healthcare, go all-in.

Repeal EMTALA.

See, we already made the decision (with a signature from Ronald Reagan himself) that we wouldn't, as a society, let the less fortunate die on the doorstep of the hospital.

Socialized healthcare. Who knew?

Yet we insist on denying this and needlessly wasting money by not actually offering the useful "let's catch it early!" type of care that would save money, and we give a fortune to useless middlemen (insurance companies) for basically no benefit to anyone. Instead, we'll wait until you're almost dead, then spend a fortune to keep you alive and probably fail - instead of keeping you alive for good and making it possible for you/your kid to contribute something awesome to society.

Nice work, America.

So yes, president-elect Trump - the system needs blowing up. Maybe you're the guy to do it. Maybe it's time to think about it as the president of the biggest company on earth - the USA. You need your employees kicking ass, not sick and dying. You want to do it as cheaply as possible.

Let me know what you come up with.

-W

jim555

  • Handlebar Stache
  • *****
  • Posts: 1209
Re: Impending repeal of Obamacare--what to do?
« Reply #169 on: November 13, 2016, 03:05:59 AM »
Defunding is worse then repealing it.  Defunding means the individual mandate remains.  The penalty probably won't apply to most since insurance will be unaffordable.
Catastrophic plans would come to the front.

FIRE me

  • Handlebar Stache
  • *****
  • Posts: 1100
  • Location: Louisville, KY
  • So much technology, so little talent.
Re: Impending repeal of Obamacare--what to do?
« Reply #170 on: November 13, 2016, 10:23:33 AM »
The popular part of Obamacare that is least likely to survive is the subsidy. It would be replaced by a tax credit that will be nearly useless to Mustachians living a low expenses, low income, low tax, Root of Good type of early retirement.

Well that's not entirely true.  For some of us, at least, additional tax credits would allow us to move larger annual chunks of money out of our 401ks and into our Roth IRAs as part of the 5 year Roth pipeline process, if it effectively expands the 0% tax bracket.

Which is not to say I support a return to high-risk pools as good for anyone.  We've been trying to fix American healthcare for decades now, from both sides of the isle, and the insurance industry has been the only consistent opposition.  For some reason, House Republicans have now sided with the insurance industry on this issue.  Maybe I shouldn't be surprised that they've chosen to support American businesses over American citizens, yet again?

I just want Americans to have affordable medical care.  I don't care what we call it, or which party gets credit for it.  The Democrats were the only group that was actually willing to try something, but if the Republicans can pull something together I'm all for that too.  Just don't tear the whole thing down and send us back to the obviously badly broken system we had before.

Sol, that's true for some, but not all. And not for me. A Roth ladder would not do much for me, as once I'm retired (in 7 weeks) my Federal tax would run about $670 per year. Obviously $670 isn't going to buy a year of unsubsidized health insurance.

I do well on my $52,000 gross income to put $30,500 (I'm over 55) in my tax advantaged 401k and traditional IRA, so I currently have no Roth accounts.

One update though. Paul Ryan is now talking about a refundable tax credit! To be used as a voucher to buy insurance. By refundable, I am assuming he means fully payable in a tax refund check, as opposed simply reducing your Federal tax liability to zero.

From:
http://www.cnn.com/2016/11/13/politics/paul-ryan-donald-trump-obamacare-deportation-force/index.html

“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”

Not sure how paying for the first year would work for most people. But I could afford to pay a year in advance, as long as 80% or better of the cost were refunded at year end.

Prior to Ryan's recent statement, if I could not afford to pay full price for a high deductible plan, I was already resigned to the worst case possibility of going “bare” until old enough for Medicare, which was a risk I did not want to take.
FIRE'd on January 4, 2017

sol

  • Walrus Stache
  • *******
  • Posts: 5286
  • Age: 40
  • Location: Pacific Northwest
Re: Impending repeal of Obamacare--what to do?
« Reply #171 on: November 13, 2016, 10:53:34 AM »
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”

So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.

Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare. 

So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate.  Great!  I'm totally on board with this plan.  The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit).  Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off.  Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.

Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions.  That's just basic capitalist economics.  If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference).  If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone.  That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).

So far, this whole thing is a clusterfuck of the highest order.  We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it.  They're on record as violently opposed to their own plan A, so what's their plan B?

I admit there's a certain sense of schadenfreude in it for me, as a liberal.  You didn't like your own idea when we tried to pass it for you?  Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want.  If only you could figure out what that is.  Once you decide, you will own it.  Good luck!

golden1

  • Handlebar Stache
  • *****
  • Posts: 1401
  • Location: MA
Re: Impending repeal of Obamacare--what to do?
« Reply #172 on: November 13, 2016, 12:11:19 PM »
I would say that this is where the lack of GOP plans will come back to haunt them, but no.  They will make some small change in Obamacare, and if it succeeds they will take credit and if it fails, then it was Obama's fault.  We are in post factual America now after all.  All that matters is winning and keeping their jobs, not actually doing anything to help, or telling the truth, and Trump has now perfected the art of the con on America. Notice how the markets went up after he was elected?  The plutocrats are laughing all the way to the bank.

jim555

  • Handlebar Stache
  • *****
  • Posts: 1209
Re: Impending repeal of Obamacare--what to do?
« Reply #173 on: November 13, 2016, 12:13:29 PM »
Kinda hard to blame Obama for a fail when your party controls all branches.  They will own whatever happens, like it or not.

Metric Mouse

  • Walrus Stache
  • *******
  • Posts: 5311
  • FU @ 22. F.I.R.E before 23
Re: Impending repeal of Obamacare--what to do?
« Reply #174 on: November 13, 2016, 12:18:44 PM »
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”

So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.

Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare. 

So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate.  Great!  I'm totally on board with this plan.  The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit).  Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off.  Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.

Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions.  That's just basic capitalist economics.  If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference).  If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone.  That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).

So far, this whole thing is a clusterfuck of the highest order.  We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it.  They're on record as violently opposed to their own plan A, so what's their plan B?

I admit there's a certain sense of schadenfreude in it for me, as a liberal.  You didn't like your own idea when we tried to pass it for you?  Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want.  If only you could figure out what that is.  Once you decide, you will own it.  Good luck!

All the good parts of the current plan, none of the bad. Its not like costs haven't  skyrocketed  before the ACA, and they hardly  even slowed down with the current plan. Now, at least people will have a choice to pay for assured ly overpriced care, can't  be denied if they want it, and will still be reimbursed if they are low income, and the insurance  industry gets a big middle finger. This sounds pretty damn good to me.
Give me one fine day of plain sailing weather and I can mess up anything.

MustacheMathTM

sol

  • Walrus Stache
  • *******
  • Posts: 5286
  • Age: 40
  • Location: Pacific Northwest
Re: Impending repeal of Obamacare--what to do?
« Reply #175 on: November 13, 2016, 12:32:45 PM »
Now, at least people will have a choice to pay for assured ly overpriced care, can't  be denied if they want it, and will still be reimbursed if they are low income, and the insurance  industry gets a big middle finger. This sounds pretty damn good to me.

Now we're in fantasy land again.  The system you describe is basically rich people paying for insurance for poor people.  What are the odds Republicans will endorse a plan like that?  This seems like the antithesis of everything they have campaigned on for my entire lifetime.

Metric Mouse

  • Walrus Stache
  • *******
  • Posts: 5311
  • FU @ 22. F.I.R.E before 23
Re: Impending repeal of Obamacare--what to do?
« Reply #176 on: November 13, 2016, 01:00:21 PM »
Now, at least people will have a choice to pay for assured ly overpriced care, can't  be denied if they want it, and will still be reimbursed if they are low income, and the insurance  industry gets a big middle finger. This sounds pretty damn good to me.

Now we're in fantasy land again.  The system you describe is basically rich people paying for insurance for poor people.  What are the odds Republicans will endorse a plan like that?  This seems like the antithesis of everything they have campaigned on for my entire lifetime.

Thats the plan we have now? So it wouldnt really be that different; it would just allow people to opt out if they choose. A good compromise; i could see it happening. I can't say the exact odds on endorsing that plan, but it seems to be the direction they are claiming they are going.
Give me one fine day of plain sailing weather and I can mess up anything.

MustacheMathTM

sol

  • Walrus Stache
  • *******
  • Posts: 5286
  • Age: 40
  • Location: Pacific Northwest
Re: Impending repeal of Obamacare--what to do?
« Reply #177 on: November 13, 2016, 01:08:49 PM »
So it wouldnt really be that different; it would just allow people to opt out if they choose. A good compromise; i could see it happening.

It's the exact opposite of the Republican narrative about individual responsibility, for one thing.  Emergency rooms won't turn away people who show up gravely sick without insurance, so hospitals will continue to provide care and then write off the expenses as an uncollectable debt.  Insurers will charge people more to carry insurance to pay for people who sign up after they get a cancer diagnosis, so if you're a hard working employee at a big corporation you will be punished with more aggressively rising rates because you're not a deadbeat.

It would probably work out fine for my family.  We'll quit our jobs and give up employer-sponsored health insurance, just in time to bank those refundable tax credits year after year, until someone actually gets sick or injured.  At which point I can apparently sign up for insurance right there on the spot, with blood spurting forth, and pay for it with all those years of tax rebates I've had invested in the stock market.  Then I'll cancel again as soon as I get care.  I won't even have to wait until the provider has been paid, because hey that's not my problem anymore!

Metric Mouse

  • Walrus Stache
  • *******
  • Posts: 5311
  • FU @ 22. F.I.R.E before 23
Re: Impending repeal of Obamacare--what to do?
« Reply #178 on: November 13, 2016, 01:14:43 PM »
Maybe against  their narrative, but hardly outside what the party actually tends to vote for. I have tended to judge more on what parties accomplish (or don't  ) than on what they promise.
Give me one fine day of plain sailing weather and I can mess up anything.

MustacheMathTM

mtnrider

  • Bristles
  • ***
  • Posts: 256
  • Location: Frozen tundra in the Northeast
Re: Impending repeal of Obamacare--what to do?
« Reply #179 on: November 13, 2016, 03:30:31 PM »
“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”

So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.

Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare. 

So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate.  Great!  I'm totally on board with this plan.  The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit).  Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off.  Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.

Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions.  That's just basic capitalist economics.  If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference).  If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone.  That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).

So far, this whole thing is a clusterfuck of the highest order.  We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it.  They're on record as violently opposed to their own plan A, so what's their plan B?

I admit there's a certain sense of schadenfreude in it for me, as a liberal.  You didn't like your own idea when we tried to pass it for you?  Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want.  If only you could figure out what that is.  Once you decide, you will own it.  Good luck!


I think there's a regulatory cap on insurance company profits, so they can't artificially raise rates.  Most of their revenue is used.

http://healthcare-economist.com/2012/01/31/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/

Quote
The ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs.  The corresponding figure for large groups is 85 percent.

I don't know if that survived the 2013 supreme court ruling though.

gerardc

  • Bristles
  • ***
  • Posts: 362
  • Age: 33
  • Location: SF bay area
Re: Impending repeal of Obamacare--what to do?
« Reply #180 on: November 13, 2016, 04:01:37 PM »
It would probably work out fine for my family.  We'll quit our jobs and give up employer-sponsored health insurance, just in time to bank those refundable tax credits year after year, until someone actually gets sick or injured.  At which point I can apparently sign up for insurance right there on the spot, with blood spurting forth, and pay for it with all those years of tax rebates I've had invested in the stock market.  Then I'll cancel again as soon as I get care.  I won't even have to wait until the provider has been paid, because hey that's not my problem anymore!

I'm not convinced anymore that the mandate is necessary for the pre-existing conditions ban to function correctly.

Think about it. You still need to sign up for insurance in an enrollment window. So, the strategy of waiting to get cancer to sign up doesn't really work, because you have to wait up to a year uninsured in the meantime, and 1 year of health expenses can absolutely wreck you financially. So, a sensible person will still stay insured even without a mandate. They may jump on a catastrophic plan though, and switch to a Platinum plan once they get a chronic condition. However, that's still the case even with a mandate -- you can cruise on a high-deductible plan until you need coverage for consistent expenses. So, removing the mandate won't change much IMO.

Mandate or not, it seems only the HDP will stay at competitive prices, since only chronically ill folks would buy the comprehensive plans. But that's not what happens in pratice because of the subsidies, and because many rich people are very risk adverse.

FireLane

  • Stubble
  • **
  • Posts: 184
  • Location: NYC
Re: Impending repeal of Obamacare--what to do?
« Reply #181 on: November 13, 2016, 05:24:33 PM »
Prior to Ryan's recent statement, if I could not afford to pay full price for a high deductible plan, I was already resigned to the worst case possibility of going “bare” until old enough for Medicare, which was a risk I did not want to take.

Yeah, about that...

http://talkingpointsmemo.com/edblog/ryan-plans-to-phase-out-medicare-in-2017

Waiting for Medicare isn't the "worst case" possibility anymore. Paul Ryan wants to eliminate Medicare and replace it with a check for a fixed amount of money. If that's not enough to pay for the medical care you need, tough shit!

geekette

  • Handlebar Stache
  • *****
  • Posts: 1538
Re: Impending repeal of Obamacare--what to do?
« Reply #182 on: November 13, 2016, 07:47:37 PM »
I think there's a regulatory cap on insurance company profits, so they can't artificially raise rates.  Most of their revenue is used.

http://healthcare-economist.com/2012/01/31/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/

Quote
The ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs.  The corresponding figure for large groups is 85 percent.

I don't know if that survived the 2013 supreme court ruling though.
Interesting chat with my doctor a while ago.  Per him, this means they have no incentive to negotiate lower costs because the higher the costs, the higher the rates, therefore their 20% cut is correspondingly higher.

Metric Mouse

  • Walrus Stache
  • *******
  • Posts: 5311
  • FU @ 22. F.I.R.E before 23
Re: Impending repeal of Obamacare--what to do?
« Reply #183 on: November 14, 2016, 05:17:49 AM »
I think there's a regulatory cap on insurance company profits, so they can't artificially raise rates.  Most of their revenue is used.

http://healthcare-economist.com/2012/01/31/does-obamacare-limit-profits-for-health-insurance-companies-in-your-state/

Quote
The ACA requires health insurers in the individual and small group market to spend 80 percent of their premiums (after subtracting taxes and regulatory fees) on medical costs.  The corresponding figure for large groups is 85 percent.

I don't know if that survived the 2013 supreme court ruling though.
Interesting chat with my doctor a while ago.  Per him, this means they have no incentive to negotiate lower costs because the higher the costs, the higher the rates, therefore their 20% cut is correspondingly higher.

Genius... who could have forseen that?
Give me one fine day of plain sailing weather and I can mess up anything.

MustacheMathTM

NoStacheOhio

  • Handlebar Stache
  • *****
  • Posts: 1514
  • Location: Cleveland
Re: Impending repeal of Obamacare--what to do?
« Reply #184 on: November 14, 2016, 06:28:47 AM »
Thinking about it some more, could it be that this skew in the health distribution of different groups is the reason Americans are reluctant to universal care or even ACA? With ACA, everyone is basically covering the cost of the average. However, if anyone can come to the US and buy off-the-shelf insurance plans, then these plans would attract unhealthy potential immigrants from other regions/countries, and the US would end up paying more for them, due to the different distribution that jack up prices. Maybe Americans want the contrary to happen by keeping the old system, i.e. keep a healthy population in the US, and have sick people expatriate themselves and seek cheaper or subsidized care elsewhere in the world. That would be extremely evil, surely that's not how American people think.

That would make sense if Americans were healthier than other people. They're not.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #185 on: November 14, 2016, 07:36:00 AM »
@geekette, your doctor is wrong. Forgivable since he's not an economist. But insurance companies still have plenty of incentive to control prices. Particularly, people tend not to buy higher priced policies that do the same thing. This effect is obvious when you consider how insurance companies were cutting prices to capture more of the market in the first years of the exchanges.

deadlymonkey

  • Bristles
  • ***
  • Posts: 400
Re: Impending repeal of Obamacare--what to do?
« Reply #186 on: November 14, 2016, 08:21:03 AM »
In reply to the original post:

Look at Paul Ryan's healthcare plan because that is probably what you are going to get.

Pretty much the same as before but expanded options for HSAs

Tort reform to shaft patients in Malpractice suits

Tax credits for insurance premiums or health expenses

Getting rid of Medicare and replacing it with block grants to help defray costs of private insurance.

Paul der Krake

  • Magnum Stache
  • ******
  • Posts: 3493
  • Age: 9
  • Location: WA
Re: Impending repeal of Obamacare--what to do?
« Reply #187 on: November 14, 2016, 08:57:05 AM »
@geekette, your doctor is wrong. Forgivable since he's not an economist. But insurance companies still have plenty of incentive to control prices. Particularly, people tend not to buy higher priced policies that do the same thing. This effect is obvious when you consider how insurance companies were cutting prices to capture more of the market in the first years of the exchanges.
This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!

Policies sold on the exchange were opening up a brand new market, of course they want to make sure as many people sign up.

Northwestie

  • Handlebar Stache
  • *****
  • Posts: 1224
Re: Impending repeal of Obamacare--what to do?
« Reply #188 on: November 14, 2016, 09:06:33 AM »
In reply to the original post:

Look at Paul Ryan's healthcare plan because that is probably what you are going to get.

Pretty much the same as before but expanded options for HSAs

Tort reform to shaft patients in Malpractice suits

Tax credits for insurance premiums or health expenses

Getting rid of Medicare and replacing it with block grants to help defray costs of private insurance.

That's what he has said in the past - never mind trying to get ACA coverage for early retirement, could be more of a challenge just getting coverage after retirement.

rubybeth

  • Handlebar Stache
  • *****
  • Posts: 1104
  • Location: Minnesota
    • Money makes the world go 'round
Re: Impending repeal of Obamacare--what to do?
« Reply #189 on: November 14, 2016, 09:34:36 AM »
If Medicare goes away, we'll all screwed. It's the one thing keeping the old/dying out of our insurance pools. If we have to pay for the 65+ crowd, expect prices to rise very quickly. This would be a true "death panel" situation.
My financial blog: http://rubybeth.wordpress.com

"Done is the engine of more." - the Done Manifesto

wenchsenior

  • Handlebar Stache
  • *****
  • Posts: 1118
Re: Impending repeal of Obamacare--what to do?
« Reply #190 on: November 14, 2016, 09:40:35 AM »
If Medicare goes away, we'll all screwed. It's the one thing keeping the old/dying out of our insurance pools. If we have to pay for the 65+ crowd, expect prices to rise very quickly. This would be a true "death panel" situation.

I actually woke up at 3 a.m. and had a full on anxiety attack about this scenario. Couldn't sleep for hours, had to get up and distract myself with work.  For years I've figured, "no way would the GOP ACTUALLY mess with Medicare in any serious way...that program has more than 75% approval ratings with the public." But I have been consistently wrong the past few years, so I no longer believe myself.

jim555

  • Handlebar Stache
  • *****
  • Posts: 1209
Re: Impending repeal of Obamacare--what to do?
« Reply #191 on: November 14, 2016, 09:53:53 AM »
Don't forget they will crush Medicaid.  So when you need long term care they will make sure you will barely survive.
Everything since FDR is on the table.  They have been waiting for this day for decades.

obstinate

  • Pencil Stache
  • ****
  • Posts: 648
Re: Impending repeal of Obamacare--what to do?
« Reply #192 on: November 14, 2016, 10:45:58 AM »
This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!
Yes, the fact that grocery stores put things on sale is evidence that they have an incentive to keep costs low.  I agree. What of it?

stoaX

  • Bristles
  • ***
  • Posts: 364
  • Location: SoCal
  • 'tis nothing good nor bad but thinking makes it so
Re: Impending repeal of Obamacare--what to do?
« Reply #193 on: November 14, 2016, 10:53:14 AM »
@geekette, your doctor is wrong. Forgivable since he's not an economist. But insurance companies still have plenty of incentive to control prices. Particularly, people tend not to buy higher priced policies that do the same thing. This effect is obvious when you consider how insurance companies were cutting prices to capture more of the market in the first years of the exchanges.
This is a little bit like saying that grocery stores have an incentive to keep prices low- look, they have tomatoes on sale for no reason!

Policies sold on the exchange were opening up a brand new market, of course they want to make sure as many people sign up.

Also, speaking as an underwriters, the "20%" cut is incorrect.  Most large health insurance companies fix their admin expenses and profit (their "cut") on an $x dollar per person basis.  So it doesn't change, or change very much when premiums go up or go down.  The percentage that their cut represents changes as the premium goes up or down.  There's a lot more nuance to it, but that's the essence of it. 

And there is strong incentive to find ways to have lower premiums and win marketshare - the hard part is doing that without going in the red.

Zoot

  • Stubble
  • **
  • Posts: 203
  • Location: Atlanta (OTP)
Re: Impending repeal of Obamacare--what to do?
« Reply #194 on: November 14, 2016, 11:15:05 AM »
OP here--I had the same realization about Medicare in the past 24 hours, and I'm so frightened of what it's going to look like for "standard age" retirees, much less early retirees who are banking enough stash to cover health care costs until Medicare kicks in (at 65 currently, but who knows if that'll get pushed back to 67 or even further, as did Social Security). 

If Medicare is basically a grant for private insurance, and if pre-existing condition protection goes away, then you basically have a bunch of people over 65 who need to consume health care in ever-greater and ever-more-complicated ways, who can't be covered because they had hemorrhoids or acid reflux or acne decades before.

The whole health care thing really throws a wrench not only in to EARLY retirement, but in to retirement PERIOD. 

God help us all.

chesebert

  • Pencil Stache
  • ****
  • Posts: 745
Re: Impending repeal of Obamacare--what to do?
« Reply #195 on: November 14, 2016, 11:18:07 AM »
Does anyone have a sense why doctors/hospitals cost so much. I have been quoted $7-10k for a full body CT scan. Similar test in other countries costs a fraction of what it costs in the US. Hospital stays are like $1500-2000 per day - WTF!

Northwestie

  • Handlebar Stache
  • *****
  • Posts: 1224
Re: Impending repeal of Obamacare--what to do?
« Reply #196 on: November 14, 2016, 11:19:45 AM »
Well, to start, we have a gazillion insurance companies who all want a piece of the profit, prices are not regulated, and consumer pricing information is not available. 

stoaX

  • Bristles
  • ***
  • Posts: 364
  • Location: SoCal
  • 'tis nothing good nor bad but thinking makes it so
Re: Impending repeal of Obamacare--what to do?
« Reply #197 on: November 14, 2016, 11:25:11 AM »
Does anyone have a sense why doctors/hospitals cost so much. I have been quoted $7-10k for a full body CT scan. Similar test in other countries costs a fraction of what it costs in the US. Hospital stays are like $1500-2000 per day - WTF!

A few reasons often cited are:
- The US medical costs include a disproportionate share of the research and development costs of new technologies
- Salaries of medical workers in the US are higher if you are comparing to third world hospitals.
Both of these strike me as inadequate explanations.  I would be interested to hear if non-US medical providers have less redundancy and less unnecessary care built into their pricing.  So I will join you in your WFT!

sol

  • Walrus Stache
  • *******
  • Posts: 5286
  • Age: 40
  • Location: Pacific Northwest
Re: Impending repeal of Obamacare--what to do?
« Reply #198 on: November 14, 2016, 11:28:52 AM »
I think that the two biggest reasons why medical care in the US costs so much more than anywhere else in the world are

1.  We have a lot of uninsured people who still consume medical care.  People who pay for medical care end up paying for the ones who don't pay for it, since everyone uses it.
2.  We have very few protections against malpractice lawsuits.  Especially for small private doctor offices, the malpractice insurance can sometimes be the largest expense of the entire business, higher than salaries or rent.

Northwestie

  • Handlebar Stache
  • *****
  • Posts: 1224