Author Topic: Impending repeal of Obamacare--what to do?  (Read 22032 times)

Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #300 on: December 28, 2016, 02:54:51 PM »
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.


Neither sufficient, nor necessary.  Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount.  Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form.  When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available.  How long ago was this experience that you refer to?

Seems to me you could obtain the "cash discount" price from the provider, and then turn around and reimburse yourself from the HSA.

I can, indeed.  But I generally don't.  I try to leave the HSA funds in there, as another retirement account.  Better than a roth.  If I need the cash later, I can reimburse myself at any time.

Quote
But more broadly, I don't get how far one can take this "cash patient" idea once you get into serious disease. I had breast cancer 6 years ago and just 3 weeks ago I had the last of 5 expensive surgeries. How would this HSA/cash patient idea work in a situation like mine?

Most of the cash discounts are small percentages, somewhere between 2% and 10%.  It's really a discount for completely avoiding the costs & risks of medical billing, which can be considerable depending upon what we are talking about.  If you have a large HSA balance, and you know that an expensive procedure is soon coming, you can arrange a discount from the sponsoring hospital in advance with a cash deposit.  Even 2% would save you serious cash on a surgery.  Honestly, if there is an emergency procedure in there somewhere, it would be difficult to get a discount after the fact, but I have actually done that also.  After a certain point, though, I depend upon the high deductible insurance policy that comes with my HSA; I'm mostly talking about the more common expenses that occur in advance of hitting that deductible.  If it were still an option, I'd only carry catastrophic care with my HSA, and participate in a health cost sharing group; but the ACA prohibits me from getting a catastrophic policy and also prohibits HSA's paired with a health cost sharing group.  I'm not opposed to insurance to limit risks, but I want the option to be mostly self-insured, because it is both possible & cheaper than what the ACA now permits.  If I could just get an HSA paired with a catastrophic policy that covers anything over $50K in a single year, without also getting hit with the ACA uninsured tax, I'd do that.  I actually still can get such a catastrophic policy, it just can't legally count as medical insurance, even though I can prove that I have $50K+ of HSA funds/Roth IRA contributions that I could withdraw in a pinch.  Prior to the ACA, such a catastrophic policy was around $80 a year, as a rider to my "umbrella" insurance policy.

EDIT: I also have a set of 3 month rolling CD's, 16 in total, that function as my own unemployment insurance.  I should be able to count those funds also.
« Last Edit: December 28, 2016, 02:58:06 PM by Quidnon? »
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Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #301 on: December 28, 2016, 02:57:00 PM »
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.


Neither sufficient, nor necessary.  Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount.  Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form.  When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available.  How long ago was this experience that you refer to?
Within this fiscal year.

Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #302 on: December 28, 2016, 02:58:35 PM »
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.


Neither sufficient, nor necessary.  Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount.  Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form.  When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available.  How long ago was this experience that you refer to?
Within this fiscal year.

Well, I guess you got screwed.  Sorry.
"When plunder becomes a way of life for a group of men living together in society, they create for themselves in the course of time a legal system that authorizes it and a moral code that glorifies it."
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Unique User

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Re: Impending repeal of Obamacare--what to do?
« Reply #303 on: December 28, 2016, 03:06:13 PM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.

It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).

My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.

It is almost impossible to "shop" for procedures and especially not in the case of an emergency.

And I also +1 that Pence is *ss.

This.  This is exactly what I thought when I read Ryan's plan.  I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office.  Doctor's offices won't tell you, flat out won't tell you.  It's a crap shoot.  The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year.  His company only has HDHP plans also and fund HSAs to a certain amount.

And sounds like we all agree Pence is a sanctimonious *&%.

The practice my doctor is associated with has a cost estimator on their website.  Put in the type of visit or procedure and you get an estimate of the total cost.  And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.

It sounds like your doctors need to join the 21st century...

I've lived in three different cities in two different states (NC, MO) since we've had this insurance and no such luck.  When we lived in CO and had catastrophic insurance only, all the docs in the area had their prices clearly posted.  I did try the cash patient route recently and got the price ahead of time.  Had my husband pay them at the time of service exactly what they told me it would be, I wasn't with him and they asked for his insurance card.  I got a bill that was more than double was I should have paid just because we have insurance.  Insurance that paid nothing and no amount of discussion with them would change it.  It was a too bad, just pay it, this is the bill.  The only reason we went was because it was close by my house and we were brand new to the area, we certainly never went again.  Maybe it's just me and maybe it's because we move so much and don't have relationships with physicians, but in general, we have not had good experiences since we left CO with the exception of my husband's oncologist.   

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #304 on: December 28, 2016, 04:04:47 PM »
no amount of discussion with them would change it.  It was a too bad, just pay it, this is the bill.

My experience with large medical bills is that they will always say "too bad, just pay it" until you say "I don't have any money and won't be paying this" and then suddenly you have all sorts of options for payment plans and discounts and such.  They are in the business of extracting your money and they are good at it, and they don't want to sell your debt to a collection agency because they get even less for it then.

I still occasionally get debt collection notices from a bill that was settled years ago.  My impression is that the whole industry is a wild west style black market with little oversight or regulation or record keeping.  In that environment, you only lose when you cave in to the bullying and agree to pay someone.

If you just say no, and are willing to live with the consequences, their price will come down.  It's a contest of wills between a well staffed bureaucratic machine and an injured or sick individual.  They exploit that imbalance with fraudulent charges that border on blackmail.

Quidnon?

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Re: Impending repeal of Obamacare--what to do?
« Reply #305 on: December 28, 2016, 04:45:15 PM »
no amount of discussion with them would change it.  It was a too bad, just pay it, this is the bill.

My experience with large medical bills is that they will always say "too bad, just pay it" until you say "I don't have any money and won't be paying this" and then suddenly you have all sorts of options for payment plans and discounts and such.  They are in the business of extracting your money and they are good at it, and they don't want to sell your debt to a collection agency because they get even less for it then.

I still occasionally get debt collection notices from a bill that was settled years ago.  My impression is that the whole industry is a wild west style black market with little oversight or regulation or record keeping.  In that environment, you only lose when you cave in to the bullying and agree to pay someone.

If you just say no, and are willing to live with the consequences, their price will come down.  It's a contest of wills between a well staffed bureaucratic machine and an injured or sick individual.  They exploit that imbalance with fraudulent charges that border on blackmail.

Yes, that is my experience also.  This is why getting a post event discount is difficult for most people, but usually a pre-event discount is not.  I once told a medical debt collector to "go ahead and sue me" and 24 hours later received a call about a 20% discount on the amount remaining.  I had it put into writing, and then paid it with a 401k loan.  This was before I had either the roth ira or the HSA.  I figured that a 20% discount that made the bill go away was worth the losses from taking a 401k loan.  I was mostly right.
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Metric Mouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #306 on: December 31, 2016, 05:02:55 AM »
That still does not negate my point which is that IMO those estimates are not worth anything and therefore that is not a sufficient solution if people have HSAs.


Neither sufficient, nor necessary.  Since I don't pay my medical bills out of the HSA anyway, I'm effectively a cash patient, so I am in the habit of asking for a cash discount.  Sometimes I can get one even if I'm going to end up getting billed, but I have always gotten one when I had any significant portion of the expected bill with me, in cash form.  When I first started doing things this way, it seemed that most places didn't know how to handle it, but now most of them know what to do with a large cash payment and what kind of discount is available.  How long ago was this experience that you refer to?

Seems to me you could obtain the "cash discount" price from the provider, and then turn around and reimburse yourself from the HSA.

But more broadly, I don't get how far one can take this "cash patient" idea once you get into serious disease. I had breast cancer 6 years ago and just 3 weeks ago I had the last of 5 expensive surgeries. How would this HSA/cash patient idea work in a situation like mine?

The bill from this surgery was ~$18K billed to/paid by insurance (on a ~$23K rack rate).

Would these treatments be covered under the HDHP portion of the HSA/HDHP umbrella?
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Re: Impending repeal of Obamacare--what to do?
« Reply #307 on: March 07, 2017, 10:40:20 AM »
Time to revive this thread.  The republicans replaced their plan last night.  So they've decided to replace Obamacare by:

1. Eliminating the tax on the richest americans

2. Expanding the access to subsidies for insurance to wealthier individuals / families.

3. Reducing the size of the subsidies per person

4. Allowing for a 5 to 1 ratio of premiums for old people to young people instead of 3 to 1, but increasing subsidies by age

5. Keeping the 10 essential benefits, preexisting conditions, and age of 26 provisions

6. Ending Medicaid for new participants after 2020

Here are my opinions for the consequences of this bill:

1. Millionaires get a bit richer

2. Self employed people who make a middle class income get access to subsidies

3. Poor people get their asses handed to them

4. The premiums should go up for old people but the subsidies go up too, so the impact is not clear

5. At least they didn't want to go back to pre-obamacare where the insurers could deny you for preexisting conditions. 

6. People that become dirt poor after 2020 get their asses handed to them, unless the Democrats come back into power and repeal this

Overall - this is a laughable bill that enforces all stereotypes of republicans as fat cats twirling their moustaches while the poor suffer.
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sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #308 on: March 07, 2017, 11:33:37 AM »
The new plan offers tax cuts for the rich, slashes benefits for the poor, and heavily restricts abortion.

It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation.  Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #309 on: March 07, 2017, 12:03:48 PM »
My plan is to stay in Medicaid until Medicare.  They are freezing new enrollment in 2020.  No Roth conversions for me. 

brooklynguy

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Re: Impending repeal of Obamacare--what to do?
« Reply #310 on: March 07, 2017, 12:23:16 PM »
It's not yet clear to me what the proposed legislation's impact would be on the "Basic Health Program" option made available to states under the ACA (which New York implemented in the form of its "Essential Health Plan" program -- relevant forum thread: "Any NYers catching FIRE in 2016?").  I haven't completely parsed through the full text of the bills (available here and here), but so far I haven't seen any provisions that would remove the Basic Health Program option.  Still, I can't imagine that this proposal would have left that option available to states, with continued federal funding, except perhaps through pure oversight.

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #311 on: March 07, 2017, 12:26:44 PM »
They are getting rid of CSRs and subsidies so the Basic Health Programs are almost certainly gone as well.

brooklynguy

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Re: Impending repeal of Obamacare--what to do?
« Reply #312 on: March 07, 2017, 12:33:19 PM »
They are getting rid of CSRs and subsidies so the Basic Health Programs are almost certainly gone as well.

Yeah, that's what I would have thought too, but so far I don't see how the proposed statutory language accomplishes the removal of the Basic Health Program option.  Is it possible the House Republicans overlooked that point in their rush to put together draft legislation?  Or, more likely, it's buried in there somewhere but I'm just missing it.

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #313 on: March 07, 2017, 12:40:38 PM »
Shhh..  Maybe they will miss it. 

Daleth

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Re: Impending repeal of Obamacare--what to do?
« Reply #314 on: March 07, 2017, 02:03:02 PM »
The new plan offers tax cuts for the rich, slashes benefits for the poor, and heavily restricts abortion.

It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation.  Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.

Exactly.

brooklynguy

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Re: Impending repeal of Obamacare--what to do?
« Reply #315 on: March 07, 2017, 02:24:52 PM »
Shhh..  Maybe they will miss it.

The Kaiser Family Foundation put out a plan comparison tool that seems to agree with me that the GOP plan would leave the Basic Health Program option unchanged.  Under the "State Role" dropdown window, it says "State option to establish a Basic Health Program is not changed."  Unless there's something in the bill that would otherwise mess with the federal funding of these programs, that means, for those with low enough income levels, the Essential Plan could still be a viable option in NY (as could Minnesota's comparable program in that state, which is the only other one to have availed itself of the BHP option).  And other states would be free to join the club.  Though I can't imagine how this could have been an intentional result -- I suspect it's a loophole that will be closed once it draws enough attention to itself, assuming this bill starts to gain any traction.

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #316 on: March 07, 2017, 02:37:33 PM »
Time to revive this thread.  The republicans replaced their plan last night.  So they've decided to replace Obamacare by:

1. Eliminating the tax on the richest americans

2. Expanding the access to subsidies for insurance to wealthier individuals / families.

3. Reducing the size of the subsidies per person

4. Allowing for a 5 to 1 ratio of premiums for old people to young people instead of 3 to 1, but increasing subsidies by age

5. Keeping the 10 essential benefits, preexisting conditions, and age of 26 provisions

6. Ending Medicaid for new participants after 2020

Here are my opinions for the consequences of this bill:

1. Millionaires get a bit richer

2. Self employed people who make a middle class income get access to subsidies

3. Poor people get their asses handed to them

4. The premiums should go up for old people but the subsidies go up too, so the impact is not clear

5. At least they didn't want to go back to pre-obamacare where the insurers could deny you for preexisting conditions. 

6. People that become dirt poor after 2020 get their asses handed to them, unless the Democrats come back into power and repeal this

Overall - this is a laughable bill that enforces all stereotypes of republicans as fat cats twirling their moustaches while the poor suffer.
Can you explain why you think #2 does not happen already?

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #317 on: March 07, 2017, 02:41:43 PM »
Shhh..  Maybe they will miss it.

The Kaiser Family Foundation put out a plan comparison tool that seems to agree with me that the GOP plan would leave the Basic Health Program option unchanged.  Under the "State Role" dropdown window, it says "State option to establish a Basic Health Program is not changed."  Unless there's something in the bill that would otherwise mess with the federal funding of these programs, that means, for those with low enough income levels, the Essential Plan could still be a viable option in NY (as could Minnesota's comparable program in that state, which is the only other one to have availed itself of the BHP option).  And other states would be free to join the club.  Though I can't imagine how this could have been an intentional result -- I suspect it's a loophole that will be closed once it draws enough attention to itself, assuming this bill starts to gain any traction.
Good catch, hope it remains.

Axecleaver

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Re: Impending repeal of Obamacare--what to do?
« Reply #318 on: March 07, 2017, 02:45:21 PM »
Quote
It's not yet clear to me what the proposed legislation's impact would be on the "Basic Health Program" option made available to states under the ACA (which New York implemented in the form of its "Essential Health Plan" program...
Here's the proposed legislation, for anyone who hasn't seen it yet: http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/documents/AmericanHealthCareAct.pdf

Generally speaking, BHP is still intact. I believe it is an oversight which will be corrected shortly. It can be undone in reconciliation.

Don't think they have the votes to pass this. I think Sol's assessment is pretty close, this is going to have to change quite a bit before we see what the real bill is going to say.

The media is getting some things wrong. KFF is 100% accurate as far as I can tell. Don't put a lot of trust in your major media outlets (good advice for all topics, IMHO).

Some of the more esoteric changes - revocation of retroactive eligibility, civil penalties for improper eligibility determinations, for example - sounds very innocuous, but for those of us who work in this field, is a big deal on the policy side. It's all bad news for poor folks. Good news for consultants, though! We're going to be very busy for the next three or four years building this... whatever this turns out to be.

jim555

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Re: Impending repeal of Obamacare--what to do?
« Reply #319 on: March 07, 2017, 02:49:25 PM »
The hospitals are not going to like that Medicaid is no longer retroactive up to 3 months.  Poor people show up without insurance but the retro activity protects the hospital from unpaid bills.

brooklynguy

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Re: Impending repeal of Obamacare--what to do?
« Reply #320 on: March 07, 2017, 03:13:41 PM »
Generally speaking, BHP is still intact. I believe it is an oversight which will be corrected shortly. It can be undone in reconciliation.

Upon closer inspection, I believe the bill, as currently drafted, would even work in conjunction with any state-adopted Basic Health Program by treating it no differently than any other eligible individual health insurance coverage.  So, in the case of NY's Essential Plan, you could get refundable premium tax credits to cover the $20 per person per month premium (for enrollees whose income is too high to get free coverage), unless the plan renders itself disqualified by, for example, including coverage for abortions.

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #321 on: March 07, 2017, 03:14:30 PM »
Can you explain why you think #2 does not happen already?

I think he meant to say that subsidies would be made available to people earning a much higher income, so this is probably a difference in how you define "middle class".

Under the new GOP plan, married couples would get the full subsidy amount up to $150k per year of income.  Under the ACA that couple would not be subsidized.  If you think $150k/yr is middle class, then the GOP plan offers subsidies to more middle class people.

They pay for it by reducing subsidies to poor people, of course.

RangerOne

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Re: Impending repeal of Obamacare--what to do?
« Reply #322 on: March 07, 2017, 06:58:53 PM »
$150k is middle class in San Francisco. Just barely.

Most places anything over around $120k a year is not typically considered "middle" currently it seems.

Either way the assistance is phased out from $70k - $150k I believe. So if you are making closer to $150k you likely won't be getting much of a subsidy.

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #323 on: March 07, 2017, 07:01:42 PM »
$150k is middle class in San Francisco. Just barely.

Most places anything over around $120k a year is not typically considered "middle" currently it seems.

Either way the assistance is phased out from $70k - $150k I believe. So if you are making closer to $150k you likely won't be getting much of a subsidy.

Looks like the phase outs START at 75k for singles and 150k for couples.

waltworks

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Re: Impending repeal of Obamacare--what to do?
« Reply #324 on: March 07, 2017, 07:13:52 PM »
Median family income is about $52k (as of 2014, might be smidge higher now). About 28% of households are over $75k (and hence 72% below) so it's sort of hard to call anything over that "middle class" by any reasonable standard.

But almost everyone with a job, even people making $250k (I personally know plenty of people like this) considers themselves "middle class". I even know a mid-6-figure income person who once told me he considered himself "working class"...

-W

Hotstreak

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Re: Impending repeal of Obamacare--what to do?
« Reply #325 on: March 08, 2017, 11:55:28 AM »
Is it clear that marketplace coverage would actually be cheaper for people in that $75k or $150k income range?  For the young it almost certainly would, since they would be receiving subsidies or tax credits which they previously did not.  But for older marketplace participants, these tax credits may be offset by the increase in the age scale from 1:3 to 1:5.  Especially with removal of the individual mandate, which could result in less healthy young people purchasing coverage, and therefore increased price of insurance for the young (and 5x that for the old).  The real losers in that situation are the poor middle aged, who would face 2/3rds or higher premiums while also receiving a smaller tax credit due to their age.  There are lots of unskilled or low-skilled workers in their 50's making modest incomes, who voted republican last year, who would be in a bad spot if this law goes through as presented.


One aspect of the proposal that would benefit me and others working towards early retirement is the increase in the HSA contribution limit to $6,550 for individuals and $13,100 for families.  For sick people who reach their out of pocket maximum, this a large enough limit for all of those expenses to be paid tax-free through an HSA.  Healthy people working towards early retirement would have an additional few thousand dollars they can tax-deffer. 

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #326 on: March 08, 2017, 12:02:14 PM »
I recommend learning about the plans put forth by Paul Ryan and in place in today in Indiana by then Gov Mike Pence (Healthy Indiana Plan and POWER accounts). To me, these seem like very likely early starting points for our future healthcare plans.

Both are built upon similar foundations - individual contribution (even if very small amounts at low income levels) and HSA or HSA-like accounts. These are things that people here in these forums likely support.

Also, listen very carefully to what Trump wants to fix - the rate of cost increase and your ability to keep your doctors. Again, things many people likely support.

HSA's are not a replacement for the ACA. I've had an HSA for years and like it. However, it does not function as the republicans promised. The idea is you would shop for care. Have you ever tried that? My insurance can't/won't tell me what's covered, and the same story with doctor's offices. I was charged a $1000 out of network ambulance fee because apparently when a bystander calls 911 and I'm unconscious on the side of the road they need to check network coverage. An HSA is a good component but doesn't address any of the many other issues pointed out by others here. I also put less they 0 faith in Pence. His top priority is to reverse my right to marry which would further limit my healthcare options. So he can go fuck himself!!!!

+1 to all this. I've had an HSA since 2008 (it is the only plan my work has offered) and I am not a fan when you actually need to use them.

It was fine until I actually had a few real medical issues pop up. I had been fighting a birthcontrol charge since 2013 that was only resolved this summer. In that case it was the facility where I had gone for all of my OB coverage, gave birth, etc and that was all in network, but for some reason 2 specific types of birth control from the same facility were considered out of network and I ended up with a bill over a thousand bucks when it should have been free under ACA. The facility didn't even know that it was considered an out of network charge. I paid it back in 2014 but kept fighting for my 1k refund which I finally got this July (and that was only because of a federal lawsuit against the insurance company).

My DH also had an emergency appendectomy and we even stated that we needed in-network coverage but ended up with an out of network anesthetist. Again we had to fight the multi-thousand dollar bill for over a year.

It is almost impossible to "shop" for procedures and especially not in the case of an emergency.

And I also +1 that Pence is *ss.

This.  This is exactly what I thought when I read Ryan's plan.  I realized none of the idiot Republicans that tout HSAs and HDHPs as the saviors of health insurance have ever tried to ACTUALLY get a price from a doctor's office.  Doctor's offices won't tell you, flat out won't tell you.  It's a crap shoot.  The ONLY time I have been able to estimate coverage was when my husband was diagnosed with cancer early in the year and we knew we would have the pay the out of pocket maximum that year.  His company only has HDHP plans also and fund HSAs to a certain amount.

And sounds like we all agree Pence is a sanctimonious *&%.

The practice my doctor is associated with has a cost estimator on their website.  Put in the type of visit or procedure and you get an estimate of the total cost. And many people (not me) have a cost estimator called "castlight" associated with their health insurance plans that gives them insight to the cost of whatever procedures or services they are anticipating.

It sounds like your doctors need to join the 21st century...

I've lived in three different cities in two different states (NC, MO) since we've had this insurance and no such luck.  When we lived in CO and had catastrophic insurance only, all the docs in the area had their prices clearly posted.  I did try the cash patient route recently and got the price ahead of time.  Had my husband pay them at the time of service exactly what they told me it would be, I wasn't with him and they asked for his insurance card.  I got a bill that was more than double was I should have paid just because we have insurance.  Insurance that paid nothing and no amount of discussion with them would change it.  It was a too bad, just pay it, this is the bill.  The only reason we went was because it was close by my house and we were brand new to the area, we certainly never went again.  Maybe it's just me and maybe it's because we move so much and don't have relationships with physicians, but in general, we have not had good experiences since we left CO with the exception of my husband's oncologist.   
I do have that estimator and it is useless.  It is not accurate at all.

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #327 on: March 08, 2017, 12:09:25 PM »
Is it clear that marketplace coverage would actually be cheaper for people in that $75k or $150k income range? 

No, I don't think that is clear at all.  Republicans are trying to advance this bill out of committee before the CBO can score it, so that nobody will have any idea how it might effect insurance rates (or coverage).

But republicans want to believe that letting healthy people opt out of insurance will somehow lower premiums for everyone else.  All of the comparisons presented here have assumed no change in rates, and have only compared the changes in subsidies.

And that's an important point, because the ACA guarantees your premiums regardless of rate changes, which is why it is both true that premiums have stayed the same AND true the premiums have gone up.  They went up for insurance companies and stayed the same for consumers, and the ACA paid the difference.

The GOP's new AHCA plan would remove this feature and pass all premium costs along to the consumer.  If rates go up because healthy people opt out, the rest of us will pay more.  This is by design, since the whole point of the new AHCA is to reduce federal spending on subsidized healthcare.

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Re: Impending repeal of Obamacare--what to do?
« Reply #328 on: March 08, 2017, 03:22:47 PM »
On the potential upside is that insurers may reduce premium rates to entice younger healthier people to buy a plan if enough of them drop coverage with no mandate. That "may" lower premium prices overall.


I don't have specific #'s to back this up and I think it would nice if it were possible, but it doesn't strike me as economically feasible.  It doesn't seem likely for two reasons.  First is that by lowering the price for the young, they lower the max limit they can charge older individuals based on the proposed 1:5 rule.  Second is that they will only add a marginal number of new healthy customers (those who's price point falls within the range of the change), while simultaneously reducing profitability on their entire non-healthy population, who has already signed up for insurance.  Also they won't just add "healthy" people when they reduce the price point, you will also add "sick" people who decided not to buy at the higher cost.  For instance, people who earn too much to qualify for medicaid but don't earn enough to purchase insurance with the level of tax credit they qualify for.



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Re: Impending repeal of Obamacare--what to do?
« Reply #329 on: March 09, 2017, 06:30:50 AM »
Median family income is about $52k (as of 2014, might be smidge higher now). About 28% of households are over $75k (and hence 72% below) so it's sort of hard to call anything over that "middle class" by any reasonable standard.

But almost everyone with a job, even people making $250k (I personally know plenty of people like this) considers themselves "middle class". I even know a mid-6-figure income person who once told me he considered himself "working class"...

-W

I don't think there is a standard definition of middle class.  Check out this short article for a few interesting definitions of middle class:

http://money.cnn.com/infographic/economy/what-is-middle-class-anyway/

My original point was that the republican plan gives less money per person but does give subsidies to people of higher incomes than Obamacare.  And self employed people of middle to high middle / low upper class incomes will benefit.
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Re: Impending repeal of Obamacare--what to do?
« Reply #330 on: March 09, 2017, 06:35:22 AM »
The new plan offers tax cuts for the rich, slashes benefits for the poor, and heavily restricts abortion.

It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation.  Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.

I completely agree with this.  This plan is Obamacare 2.0 with a shift in focus from providing equally affordable care by redistributing income from the rich to the poor and to improve the safety net, to a focus on removing incentives to not work and to retire early.  The republicans are not able to admit this politically but it's clear from the subsidy structures.


This is a fantastic article that talks about what the bill really intends versus what the republicans will say about it:
http://www.vox.com/2017/3/8/14843762/ahca-republican-lies-obamacare

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Re: Impending repeal of Obamacare--what to do?
« Reply #331 on: March 09, 2017, 12:15:11 PM »
The new plan offers tax cuts for the rich, slashes benefits for the poor, and heavily restricts abortion.

It's not so much a health care plan as it is a standard republican wish list of conservative fantasy legislation.  Frankly I'm surprised it doesn't somehow make assault rifles easier to buy or mention trickle down economics.

The Republican are just expanding on the trickle down theory. Trickledown healthcare. 


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Re: Impending repeal of Obamacare--what to do?
« Reply #332 on: March 09, 2017, 02:13:07 PM »
Well now my employer is insisting on getting my children's SS#. Not gonna happen.

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Re: Impending repeal of Obamacare--what to do?
« Reply #333 on: March 09, 2017, 04:48:08 PM »
Well now my employer is insisting on getting my children's SS#. Not gonna happen.
You are concerned about them having it?
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Re: Impending repeal of Obamacare--what to do?
« Reply #334 on: March 10, 2017, 04:37:44 AM »
Well now my employer is insisting on getting my children's SS#. Not gonna happen.

If you don't provide it, you will be costing your employer a find of $1,000 dollars a day -

http://www.calbizlit.com/00166591.PDF

I don't think you're that valuable to them.
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Re: Impending repeal of Obamacare--what to do?
« Reply #335 on: March 10, 2017, 05:08:18 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.

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Re: Impending repeal of Obamacare--what to do?
« Reply #336 on: March 10, 2017, 05:35:34 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.
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Re: Impending repeal of Obamacare--what to do?
« Reply #337 on: March 10, 2017, 08:22:04 AM »
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them

I think you might have misunderstood the primary function of the Republican party.

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Re: Impending repeal of Obamacare--what to do?
« Reply #338 on: March 10, 2017, 08:59:54 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

So are you saying you think we should legalize heroin? 
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Re: Impending repeal of Obamacare--what to do?
« Reply #339 on: March 10, 2017, 09:19:58 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

I am not ok with legalizing heroin.

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Re: Impending repeal of Obamacare--what to do?
« Reply #340 on: March 10, 2017, 09:29:00 AM »
Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them

I think you might have misunderstood the primary function of the Republican party.
Maybe just the primary objective of them. Though they don't seem to be functioning much lately either: could be that you're right and they are just performing a completely different primary function than I expect.
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Re: Impending repeal of Obamacare--what to do?
« Reply #341 on: March 10, 2017, 10:21:06 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

I am not ok with legalizing heroin.

Why do you want to control other people?

Well now my employer is insisting on getting my children's SS#. Not gonna happen.
You are concerned about them having it?

I think I am now 100% for repeal. We did have adata breach recently, they had to give us physical checks.

sol

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Re: Impending repeal of Obamacare--what to do?
« Reply #342 on: March 10, 2017, 10:34:48 AM »
I am not ok with legalizing heroin.

Why do you want to control other people?

...

I think I am now 100% for repeal.

Am I understanding this correctly?  The first part of your post protests against infringing someone's freedom to do heroin, and the second part calls to deny someone's freedom to join a union?

Do you not see the contradiction there?

hoping2retire35

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Re: Impending repeal of Obamacare--what to do?
« Reply #343 on: March 10, 2017, 10:39:10 AM »
I am not ok with legalizing heroin.

Why do you want to control other people?

...

I think I am now 100% for repeal.

Am I understanding this correctly?  The first part of your post protests against infringing someone's freedom to do heroin, and the second part calls to deny someone's freedom to join a union?

Do you not see the contradiction there?
I don't follow?

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Re: Impending repeal of Obamacare--what to do?
« Reply #344 on: March 10, 2017, 11:30:53 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

I am not ok with legalizing heroin.

Why do you want to control other people?

Are you ok with child abuse?
« Last Edit: March 10, 2017, 11:34:22 AM by BeginnerStache »

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Re: Impending repeal of Obamacare--what to do?
« Reply #345 on: March 10, 2017, 03:20:54 PM »
Median family income is about $52k (as of 2014, might be smidge higher now). About 28% of households are over $75k (and hence 72% below) so it's sort of hard to call anything over that "middle class" by any reasonable standard.

But almost everyone with a job, even people making $250k (I personally know plenty of people like this) considers themselves "middle class". I even know a mid-6-figure income person who once told me he considered himself "working class"...

-W

Most people making $250k a year would probably categorize themselves as upper-middle class to signify that they aren't "rich" but to also recognize that they live better than the vast majority of people. People in that income range generally can afford average homes in the nicest neighborhoods. Send their kids to private schools. Pay for their kids college. And a whole slew of other opportunities not available to average middle class people.

Typically middle class starts as you say in this country at around $40k. Where depending on family size we can generally say someone is not in a state of poverty. Thats all middle class means initially.

Then beyond that we generally assign cutoffs based on earnings relative to the total working population. Because generally we are interested in our wealth with regards to other people. That makes sense since the ultimate purchasing power we have rests with how many competing buyers we can outspend for limited goods.

Pew research defines middle class for the country at large as anyone not in the top 20% or bottom 20% of earners. The other major relevant factors you always have to consider are where you live and how many people that income is supporting. At large ignoring location and family size, middle class is generally around $40k-$140k currently.

The thing that really skews the thinking and makes almost everyone feel middle class, or in other words not feel rich, is that the difference earnings between someone in the top 5%, top 1% and top 0.1% are drastically different than the difference between a top 20% earner and a middle 50% earner.

Of course the other factors that go in to defining middle class and upper class with regards to wealth are, raw net worth and consumption. But generally we are more enamored by income as a means of differentiation.

I would say upper-middle class, from an experience standpoint, begins when you can do things like. Max out your $401k. Easily save 10% or more of take home post tax money a month on top of a full funded retirement. Easily maintain a 3 month + emergency savings. Buy any necessary item short of a house without ever have to go into debt.

I think another interesting metric when considering who is middle class along the lines of consumption would be to look at savings rates. One potential luxury of being middle or upper middle class is that in theory you may never have to live paycheck to paycheck or borrow money for basic necessities and minor luxuries.

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Re: Impending repeal of Obamacare--what to do?
« Reply #346 on: March 10, 2017, 03:32:37 PM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

I am not ok with legalizing heroin.

Why do you want to control other people?

Are you ok with child abuse?

The whole stop trying to control people argument is really ringing pretty hollow coming from any Republican who voted Trump. He is pretty much all about force and control. He his just directing it at different shit than the Democrats. This is not entirely Trumps doing. Most Libertarians recognize that the Repubs are generally as controlling and spendy as the Democrats. Their priorities are just different.

You want to know the real solution to illegal immigration if you don't like it, instead of creating more laws, spending billions on enforcement and walls? Make sure there are no jobs for them when they come here. The only reason they come and stay is because they can make money and there is demand for their unskilled labor...

Wake me up when you find an army of unskilled white workers that are going to clean houses for $100 or pick fruit for 12-16 hours a day in 100 degree humid weather for $10 an hour....

This is not necessarily meant to say that there isn't a nontrivial percentage of unskilled, see high school drop out, American natives that are being displaced or undercut by immigrants. I think current estimates put that percentage of unskilled native workers at around 10% of the population. I am not sure if that is 10% of the working population or just the population in general...

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Re: Impending repeal of Obamacare--what to do?
« Reply #347 on: March 10, 2017, 06:55:23 PM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

I am not ok with legalizing heroin.

Why do you want to control other people?

Are you ok with child abuse?

The whole stop trying to control people argument is really ringing pretty hollow coming from any Republican who voted Trump. He is pretty much all about force and control. He his just directing it at different shit than the Democrats. This is not entirely Trumps doing. Most Libertarians recognize that the Repubs are generally as controlling and spendy as the Democrats. Their priorities are just different.

You want to know the real solution to illegal immigration if you don't like it, instead of creating more laws, spending billions on enforcement and walls? Make sure there are no jobs for them when they come here. The only reason they come and stay is because they can make money and there is demand for their unskilled labor...

Wake me up when you find an army of unskilled white workers that are going to clean houses for $100 or pick fruit for 12-16 hours a day in 100 degree humid weather for $10 an hour....

This is not necessarily meant to say that there isn't a nontrivial percentage of unskilled, see high school drop out, American natives that are being displaced or undercut by immigrants. I think current estimates put that percentage of unskilled native workers at around 10% of the population. I am not sure if that is 10% of the working population or just the population in general...
Why would we have to pay these highschool drop outs the same rate we pay illegal immigrants? Why would they not be paid market rate or minimum wage at the very least? Certainly without immigrants being paid under the table, wages would rise. Nothing wrong with that, except fruit and almonds might cost a bit more. A small price to pay for people to have a living wage.
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Re: Impending repeal of Obamacare--what to do?
« Reply #348 on: March 11, 2017, 06:14:23 AM »
Another horrible side affect of Trumpcare, which has gotten really bad in our area. By cutting benefits to Medicaid, it's going to be much more difficult for heroin addicts to get the help they need.
Maybe it would spur discussion on legalization of drugs, and the taxing of them to fund addiction assistance.

Or, Trumpcare could be re-worked to equal or expand state medicare payments, instead of curtailing them as currently written. Always hope, I  guess.

I am not ok with legalizing heroin.

Why do you want to control other people?

Are you ok with child abuse?

The whole stop trying to control people argument is really ringing pretty hollow coming from any Republican who voted Trump. He is pretty much all about force and control. He his just directing it at different shit than the Democrats. This is not entirely Trumps doing. Most Libertarians recognize that the Repubs are generally as controlling and spendy as the Democrats. Their priorities are just different.

You want to know the real solution to illegal immigration if you don't like it, instead of creating more laws, spending billions on enforcement and walls? Make sure there are no jobs for them when they come here. The only reason they come and stay is because they can make money and there is demand for their unskilled labor...

Wake me up when you find an army of unskilled white workers that are going to clean houses for $100 or pick fruit for 12-16 hours a day in 100 degree humid weather for $10 an hour....

This is not necessarily meant to say that there isn't a nontrivial percentage of unskilled, see high school drop out, American natives that are being displaced or undercut by immigrants. I think current estimates put that percentage of unskilled native workers at around 10% of the population. I am not sure if that is 10% of the working population or just the population in general...
Why would we have to pay these highschool drop outs the same rate we pay illegal immigrants? Why would they not be paid market rate or minimum wage at the very least? Certainly without immigrants being paid under the table, wages would rise. Nothing wrong with that, except fruit and almonds might cost a bit more. A small price to pay for people to have a living wage.

Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds. 

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Re: Impending repeal of Obamacare--what to do?
« Reply #349 on: March 11, 2017, 06:29:52 AM »
Minimum wage is not a living wage. Good luck enticing unemployed High school dropouts to work manual labor jobs for minimum wage, long hours, little to no benefits. Not to mention it's routinely proven immigrants tend to have a much better work ethic and are more reliable. They would actually fair better at their local McDonalds.
Perfect! If the work needs to be done, then wages will rise until they are high enough to attract people to do the work. I don't see a downside with this?
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