Author Topic: Impending repeal of Obamacare--what to do?  (Read 44236 times)

Liberty Stache

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Re: Impending repeal of Obamacare--what to do?
« Reply #50 on: November 10, 2016, 07:24:17 AM »
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The saddest thing is that the people so strongly against it are the ones to benefit.
  Benefit?

um...How about the fact that pre-ACA you would have been dropped/unable to be insured if something did happen to you? You had the illusion that you had indefinite coverage when in fact you only really had coverage until your contract year was up.

While you habits of eating kale and working out 6 days a week are outstanding and will lower your risk, eventually something will happen to you or your family that is outside of our control (sports injury, car accident, cancer, etc).
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OurTown

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Re: Impending repeal of Obamacare--what to do?
« Reply #51 on: November 10, 2016, 07:32:57 AM »
I have about 9-10 years to go until potential FIRE, so I'm optimistic that something will happen by then.  If not, we will keep working.  Thanks a lot, 'Murica.

daverobev

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Re: Impending repeal of Obamacare--what to do?
« Reply #52 on: November 10, 2016, 07:55:56 AM »
This is one thing I don't understand - how so many people are so vehemently against ACA.
  Well, Brit, maybe I am just a fucking nuts American, as you say, but I paid $450 a month for insurance with a $1500 annual deductible just a few years ago, before the ACA, to cover my entire family.  Now, I have the cheapest plan available, with a $12,500 deductible, an HSA eligible plan, meaning I pay the first $12,500 each year, and for that I pay $1026 monthly.   A plan like my old one would be over $2000 monthly.  Even my current plan is going away.  It is not available in 2017.  My insurance company can't make money at that rate.  In 2017, the absolute cheapest plan available is $1380 monthly, a 35% increase for worse coverage. It goes up from there, i.e., each plan is successively more expensive.  Comparing prices for 2017 is pretty easy, because in my geographic area, there is only one plan left, thanks to the damn ACA.

It does not take a Nobel prize in economics to realize that the premium for a person like me (inhumanly low cholesterol with good ratios, such an absurdly healthy diet that friends and family poke fun at it, and intense gym sessions 6 days a week) would rise if the government mandates that anybody else will pay the exact premium I pay, no matter their state of health, no matter the preexisting conditions.  Every fat slob with diabetes or pre-diabetes pays the same as me.  Aids patients pay the same as me.

What idiot thought that would be a good idea?

I was against the ACA before it passed, because it was blatantly obvious what was going to happen to anybody with half a brain.  Now that I have had to suffer the consequences of others' delusions for a few years, yeah, I am "vehemently against ACA."

Do you still not understand, or do you at least halfway understand, even if you somehow think this is for my own good?

Health insurance went from something I did not think about very much to a burdensome, oppressive monster.  It is by far my largest bill. 

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The saddest thing is that the people so strongly against it are the ones to benefit.
  Benefit?

Quote
That, and the guns. Those two things basically take me from "yeah, I kind've get the US, sort've" to "you're all fucking nuts".
  Since I used a gun when two armed robbers confronted me and my wife last year, I just have to say that maybe the one who is nuts is the one who does not recognize my or my beautiful wife's right to exist and defend our lives as we see fit.  What is "fucking nuts" about not wanting to be at the mercy of violent criminals?

Is everybody in England so blind to other points of view?

Try opening your mind a little.  There is a whole big, wide world out there.  People in that world think differently from you, and they are not "nuts" for doing so.

Chance of being confronted by armed robbers when nobody has guns? Low.

Chance of being covered when your private healthcare lapses for whatever reason in a country with universal cover? High.

I know ACA is not perfect. Universal is what you need. Maybe I'm not the one that needs to open my mind.
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Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #53 on: November 10, 2016, 07:56:27 AM »
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Every fat slob with diabetes or pre-diabetes pays the same as me.  Aids patients pay the same as me.

What idiot thought that would be a good idea?

Seriously, fuck those aids patients. I'm all for adjusting rates based on lifestyle choices like already happens with smoking, but to me its just shitty to say "well I'm blessed with good health so the hell with those that aren't." There's a lot one can do to improve their heath, but there's also a lot of genetic or just shit happens stuff out there. I'm completely willing to pay more despite my health to not bankrupt those with chronic or acute expensive conditions.
  Yeah, it is just good fortune I suppose that I do not have Aids.  Could happen to anybody, right?

I just shake my head at some of these posts.

I do like one part of your post, though, as it actually addressed what I wrote about the ACA.  You wrote, "I'm all for adjusting rates based on lifestyle choice . . ." and that change alone would make the ACA a lot easier to live with. 

The truth is that my insurance for my family, if I were to purchase comparable insurance to what I had before the ACA, is more than 5 times as expensive.  Even the most rabid fan of the ACA has to recognize some injustice in this fact.

Yes, my premiums would have increased anyway.  They almost always did by small amounts.  But more than 500%???

But, no, I am not willing to increase my burden by 500% to cover all of these people surrounding me who are harming their own health daily.  Three quarters of men are overweight or obese.  That is not a genetic condition.  It is just what people do, kind of like spending all of their money.  The average woman in the US is heavier than the average man was in 1960.  40% of women are obese (not overweight, obese) while saying things like "real women have curves."  The culture accepts and encourages this, and the effects on health, both for the woman and her kids, are negative.

The one change to the ACA that should be made is adjusting costs based on risk.

That includes looking at pre-existing conditions.  There is a MAJOR difference between somebody who has carried coverage for years and then suffers an expensive health condition as compared to somebody who does not, suffers a health condition, and then shows up at the next enrollment window and cannot be turned away.  It's like buying car insurance after a huge wreck and expecting the car insurance company to pay to fix your car and all the judgments for personal injury damages against you from the occupants of the other car.  That scenario just does not make sense, even if you would be happy to have your car insurance go up to pay for it.


Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #54 on: November 10, 2016, 08:02:12 AM »
Maybe I'm not the one that needs to open my mind.
  I am not the one describing those who disagree with me as "fucking nuts."  Closed minds, fallacious arguments.  Opening your mind does not mean you need to convert to believing in free markets and liberty (including the right to bear arms).  Perhaps it does mean that you need to be able to open your mind a little, just a narrow, ajar, opening, to be able to understand the other side of something, rather then dismissing it with an ad hominem fallacy.

rubybeth

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Re: Impending repeal of Obamacare--what to do?
« Reply #55 on: November 10, 2016, 08:04:21 AM »
If I remember right, employer provided insurance did not have exclusions for pre-existing conditions even before ACA.

You needed to prove you had coverage before, though, and you usually had a waiting period of 30 days before you new coverage would kick in.

And, lifetime maximums were real. Get cancer or type 1 diabetes or premie baby or other chronic condition and $1 million of medical bills? You'd be booted from your plan, even with employer coverage.

And any families covering kids up to age 26 can kiss that goodbye.
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BlueHouse

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Re: Impending repeal of Obamacare--what to do?
« Reply #56 on: November 10, 2016, 08:04:46 AM »
TL;DR: Like others said, good insurance was not affordable pre-ACA.
+10,000
- If you worked at a small company, the company may have been forced to drop health insurance benefits if one worker got very sick.
One company I worked for was dropped by its carrier after one of our employees adopted a baby from another country. 

Quote
- Did you forget to list a minor illness/accident when applying for coverage?  If you had a major health care event, insurance companies could claw back the payouts, claiming insurance fraud.
Oh gawd, I forgot how hard and time-consuming it is to fill out the applications for (private) health insurance.  Those of you on employer-sponsored group plans that have never had to do this, consider yourself extremely lucky.  These applications can be hundreds of pages.  When I was 17, I had an infection in my liver.  Any infection in the liver was called (look it up) Hepatitis.  Well, a few years later and Hepatitis starts to become associated with VIRAL forms of the disease.  So 30 years after the fact, I start getting denied insurance because insurers think I have an incurable viral disease.  Not only did I have to get a battery of tests and doctors' notes to attest to the fact that I've never had viral hepatitis, I still have to fully document that I've been rejected for insurance previously, and the reasons why, and I have to fully document both the original diagnosis, and the secondary tests.  It's so frustrating that you can't just erase a mistake or misunderstanding.  You have to document the error, document the effect of the error, document the fix to the error.  Ugh! 

Sometimes nothing can be a real cool hand

Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #57 on: November 10, 2016, 08:06:18 AM »
Quote
The saddest thing is that the people so strongly against it are the ones to benefit.
  Benefit?

um...How about the fact that pre-ACA you would have been dropped/unable to be insured if something did happen to you? You had the illusion that you had indefinite coverage when in fact you only really had coverage until your contract year was up.

While you habits of eating kale and working out 6 days a week are outstanding and will lower your risk, eventually something will happen to you or your family that is outside of our control (sports injury, car accident, cancer, etc).
  Best argument yet, and of course something I was well aware of.  Such things did happen, of course (well, not the cancer), and I was not dropped, although I have heard arguments.  Knee surgery, kids being born, heck, I had a kid break a bone this week (sports injury). 

I had no illusions.

I am just relating my experience here.

The ACA has has a HUGELY negative impact on my savings and thus my ability to FIRE.  That is reality.  I am sorry if my experience does not fit anybody's political preferences here, but my experience is what it is.

StarBright

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Re: Impending repeal of Obamacare--what to do?
« Reply #58 on: November 10, 2016, 08:08:42 AM »
Quote
Every fat slob with diabetes or pre-diabetes pays the same as me.  Aids patients pay the same as me.

What idiot thought that would be a good idea?

Seriously, fuck those aids patients. I'm all for adjusting rates based on lifestyle choices like already happens with smoking, but to me its just shitty to say "well I'm blessed with good health so the hell with those that aren't." There's a lot one can do to improve their heath, but there's also a lot of genetic or just shit happens stuff out there. I'm completely willing to pay more despite my health to not bankrupt those with chronic or acute expensive conditions.
 

Yes, my premiums would have increased anyway.  They almost always did by small amounts.  But more than 500%???

But, no, I am not willing to increase my burden by 500% to cover all of these people surrounding me who are harming their own health daily.  Three quarters of men are overweight or obese.  That is not a genetic condition.  It is just what people do, kind of like spending all of their money.  The average woman in the US is heavier than the average man was in 1960.  40% of women are obese (not overweight, obese) while saying things like "real women have curves."  The culture accepts and encourages this, and the effects on health, both for the woman and her kids, are negative.


Just a reminder that the 500% increase is not just based on covering other people. It also takes into account the likelihood that people of your specific age and demographic will develop a pre-existing condition and/or have a catastrophic event in the next year, 5, 10, 15 years (etc) and lifetime (I believe those are some of the actuarial windows) because there are no longer lifetime caps and they can't cancel your coverage anymore after a medical event.

And pre-existing conditions aren't just things like diabetes and AIDS. I had stress related migraines in undergrad and had a scrip written for them. Imagine my surprise a few years later when perfectly healthy me, who had only filled that prescription once, was denied health insurance because of a pre-existing condition.

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #59 on: November 10, 2016, 08:19:18 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.


This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
But now they can, so why would they change their behavior?


Would the president have signed it?
If it was a fix like fixing the family gap, yes.  If it actually improved it, yes. 

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Paul der Krake

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Re: Impending repeal of Obamacare--what to do?
« Reply #60 on: November 10, 2016, 08:29:35 AM »
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what to do?
Sit, wait, ignore the noise. Nobody knows what's going to happen.

Early retirement was viable before the ACA. Options will emerge.

If you live in the recently expanded group of jurisdiction with legal marijuana, go smoke some.

Mississippi Mudstache

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Re: Impending repeal of Obamacare--what to do?
« Reply #61 on: November 10, 2016, 08:33:10 AM »
Sit, wait, ignore the noise. Nobody knows what's going to happen.

Early retirement was viable before the ACA. Options will emerge.

If you live in the recently expanded group of jurisdiction with legal marijuana, go smoke some.

Best advice I've heard so far. To be clear, though, many things that were not viable for me pre-ACA (entrepreneurship, working for a small company, and early retirement) will once again become non-viable for me, due to my son's condition, if the ACA is repealed in its entirety. This is especially troubling to me, given that I begin my new job with a small company on January 1.
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Malum Prohibitum

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Re: Impending repeal of Obamacare--what to do?
« Reply #62 on: November 10, 2016, 08:35:40 AM »
Just a reminder that the 500% increase is not just based on covering other people. It also takes into account the likelihood that people of your specific age and demographic will develop a pre-existing condition and/or have a catastrophic event in the next year, 5, 10, 15 years (etc) and lifetime (I believe those are some of the actuarial windows) because there are no longer lifetime caps and they can't cancel your coverage anymore after a medical event.
  Of course it is not - like I said, the premiums increased before the ACA, too.  Some small part of that 500% would have been a normal increase.  Increases before the ACA were always nominal, though, StarBright, something I shrugged off.  Like I said, before the ACA health insurance was not a cost that was burdensome or even something I thought much about.

Now, to buy the same coverage I had previously, would be about $30,000 annually.

Can anybody characterize this as not burdensome?

I have not aged that much since the ACA passed!  LOL!  :)

Car Jack

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Re: Impending repeal of Obamacare--what to do?
« Reply #63 on: November 10, 2016, 08:47:22 AM »
Depends what state you live in.  I've called ACA "RomneyCare" from the beginning.  Massachusetts has a nearly identical state plan and mandate that predated the ACA as implimented by then Governor Romney (yes, that Romney).  I expect we'll see no difference here.

I am concerned about pre-existing conditions.  I changed jobs before ACA took effect and my new company insurance contacted me after my first doctor's visit looking for proof that I had continuous coverage from my old job.  If I had not, they would not cover my chronic condition.  Under ACA, I changed jobs once again and for the first time ever, took a week off between jobs (I'm 59 and have changed jobs many times).  I would fear that going forward, I can never have a gap in insurance again, if the GOP has their way.  I really believe that the GOP's slogan for health car is "Just Die, already".

StarBright

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Re: Impending repeal of Obamacare--what to do?
« Reply #64 on: November 10, 2016, 08:50:35 AM »
Just a reminder that the 500% increase is not just based on covering other people. It also takes into account the likelihood that people of your specific age and demographic will develop a pre-existing condition and/or have a catastrophic event in the next year, 5, 10, 15 years (etc) and lifetime (I believe those are some of the actuarial windows) because there are no longer lifetime caps and they can't cancel your coverage anymore after a medical event.
  Of course it is not - like I said, the premiums increased before the ACA, too.  Some small part of that 500% would have been a normal increase.  Increases before the ACA were always nominal, though, StarBright, something I shrugged off.  Like I said, before the ACA health insurance was not a cost that was burdensome or even something I thought much about.

Now, to buy the same coverage I had previously, would be about $30,000 annually.

Can anybody characterize this as not burdensome?

I have not aged that much since the ACA passed!  LOL!  :)

I think the actuarial difference is not age, but the fact that they can no longer cap your coverage or cancel it :) It is entirely possible that you had a great plan pre-ACA with no caps but most people had something like a million dollar cap and the insurance company had a right to cancel your coverage for basically any reason. The fact that insurance companies can no longer do must now be factored into the cost of everyone's coverage.  I was just pointing out the that the total increase is not just for covering overweight people and folks with AIDS, but the increases also make sure that you have access to health insurance until you turn 65 (that was not factored in before the ACA). They help you too.

I agree it is burdensome, on middle class families in particular, but is also what happens when you get a two party compromise. I'm pro universal healthcare myself - Even with the increased taxes I suspect I would pay less for coverage than I do now, and I would have to wade through far less paperwork, and everyone would be covered. I consider it a triple win :)

hoping2retire35

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Re: Impending repeal of Obamacare--what to do?
« Reply #65 on: November 10, 2016, 08:53:44 AM »
I'm not FIREd yet. Planning to earn for an extra couple of years at least to offset the risks here.

I'm very sorry to hear that.

almost choked on my apple when reading that :D

frugaldrummer

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Re: Impending repeal of Obamacare--what to do?
« Reply #66 on: November 10, 2016, 09:33:39 AM »
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Every fat slob with diabetes or pre-diabetes pays the same as me.  Aids patients pay the same as me.

What idiot thought that would be a good idea?

Malum - people who know that DISEASE is not always the patient's fault!!!! You think you're immune because you have a healthy lifestyle?  Think again!  Plenty of diseases are also due to genetic or infectious causes.  That diabetic  might have hemochromatosis - a genetic condition that has nothing to do with lifestyle and is often missed.  That AIDS patient might have gotten it from a transfusion after a car accident.

The UNCHRISTIAN, unkind, uncaring thinking that we should not be helpful to our fellow man (because, after all, someday that may be YOU that needs help) is a disgusting feature of our culture today.  Oh, and btw?  Science now shows that obesity may be due to gut bacteria - and not a lack of willpower. 

Yes, there are lots of things that we can do to try to protect our health, but you never know when disaster will strike - this is the whole point of insurance, to spread that risk around.

Gimesalot

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Re: Impending repeal of Obamacare--what to do?
« Reply #67 on: November 10, 2016, 09:43:09 AM »
Unfortunately for my DH and I, a lack of ACA will mean that we have to change our short-term RE plans and bolt out of the US as fast as possible instead of spending some time close to family.

I have heard the BS argument that 5 years ago I was paying much less for a plan... Not a single person factors in the fact that 5 years ago you and your family were younger.  They never factor in that health insurance costs were rising so fast, that they brought about the ACA.  No one mentions the fact that even employer plans are getting more expensive, but it's not necessary just because insurance is getting more expensive but also because employers want to spend less and less.  For example, my company used to cover about $5500 of my costs every year, now they only cover about $3000.  That's not the ACA, that's business cutting the bottom line.

I am for single payer healthcare.  I think that's the best solution out there because even if people know the cost of services, I don't think it will be much of a deterrent.  Who's going to consider if spending $250k to save their kid or loved one  is worth it?

Zoot

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Re: Impending repeal of Obamacare--what to do?
« Reply #68 on: November 10, 2016, 10:03:45 AM »
So for the record, DH and I decided to keep me on my current plan, and pay the higher premium, because of fears of what would happen with pre-existing conditions.

For example, someone with a condition that is controlled with medication who changes insurers could have claims for items unrelated to that condition because of the "pre-existing condition" clause. 

According to the reading I've done in the past 24 hours, prior to the ACA the states controlled both the "lookback period" (meaning how far the insurer could look back in your medical record to identify a pre-existing condition) and the waiting period required before claims would be covered.  Different states had different periods for both of these--some states had no limit on the lookback period (so presumably they could look back to birth).  I don't recall what the waiting period was, but it was either 12 months or 24 months.

In this climate, when nobody knows what the rules are going to be, we figured it was best to keep me where I am right now until we know what the new rules are going to be.  It kills me to be paying the extra $300/month for coverage when I'd be paying $30/month for coverage from my own employer. 

I really, really, really hate this.  All of it.  I can't even believe we're having to have this kind of conversation.
« Last Edit: August 16, 2017, 02:08:34 PM by Zoot »

Gin1984

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Re: Impending repeal of Obamacare--what to do?
« Reply #69 on: November 10, 2016, 10:06:43 AM »
So for the record, DH and I decided to keep me on my current plan, and pay the higher premium, because of fears of what would happen with pre-existing conditions.

For example, I have high blood pressure (controlled via medication), but if I change insurers and the pre-existing condition claim denial is reinstated, I could be denied by my new insurer if I had any claims related to high blood pressure.  I have had issues with my shoulder that have required physical therapy, and I was called a "good candidate" for eventual shoulder replacement, so that's also in my record. 

According to the reading I've done in the past 24 hours, prior to the ACA the states controlled both the "lookback period" (meaning how far the insurer could look back in your medical record to identify a pre-existing condition) and the waiting period required before claims would be covered.  Different states had different periods for both of these--Georgia, the state where I live, had no limit on the lookback period (so presumably they could look back to birth).  I don't recall what the waiting period was, but it was either 12 months or 24 months.

In this climate, when nobody knows what the rules are going to be, we figured it was best to keep me where I am right now until we know what the new rules are going to be.  It kills me to be paying the extra $300/month to Kaiser for the coverage when I'd be paying $30/month to Cigna for the HDP/HSA plan under my own employer--but at least we had budgeted to max the HSA for 2017 anyway, so the difference to the bottom-line take-home salary is negligible.  It's just that the money will be going AWAY now instead of into a fat little HSA account.

I really, really, really hate this.  All of it.  I can't even believe we're having to have this kind of conversation.
Actually pre-birth.  I have a MD friend who had a patient who was denied care because her parents had testing done on the fetus.  The insurance company said that the damage to the fetus was pre-existing because the child (once born) had the condition prior to coverage.

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #70 on: November 10, 2016, 10:17:24 AM »
The problem that is not being addressed is the cost of services.  It doesn't matter who pays it, single payer or private pay.  As long as the medical establishment has free reign to charge whatever they feel like we are going to keep getting extorted.

Yes, the elephant in the room, the taboo subject. Why are MRIs so much cheaper in Japan?

NoStacheOhio

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Re: Impending repeal of Obamacare--what to do?
« Reply #71 on: November 10, 2016, 10:35:04 AM »
Take a deep breath, everything will probably be okay.

Regardless of who is in power, the country is heading down the path of some minimal level of healthcare for all.

Employers that generally support one side hate carrying the burden for insurance...
Uninsured who generally support the other hates not having insurance...

The economics of the pre-Obamacare heath plan and current obamacare health plan don't work.

I'm optimistic we'll see a medicare-light baseline plan and then give people HSAs and the ability to buy private insurance for the same quality care we see today.  I actually think having someone who's been in business and isn't beholden to special interests might make this happen.  Businesses HATE carrying the burden of insuring their employees.

Great, are those employers going to pass the savings on to employees in the form of higher wages to afford paying for 100% of their healthcare? Color me skeptical.
The first step is acknowledging you have a problem, right?

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Wexler

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Re: Impending repeal of Obamacare--what to do?
« Reply #72 on: November 10, 2016, 10:36:49 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.

This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
There have actually been several Republicans who have published plans to replace it.  They haven't put them up for a vote because they know Obama would veto them.

That's funny.  The threat of presidential veto didn't stop Republicans from voting to repeal the ACA 60 times.  So why does a veto threat stop them from actually voting on a real plan?  I posit that it's because grandstanding is more politically effective than governance.  And, the presidential election this week has proven me right.

Republicans have paid no political cost for the "repeal" having no "replace" component. I suspect that they will repeal, make some noises about HSAs (gee, thanks-this $5000 sure is going to help me pay my $250k chemotherapy bill!), and we'll go back to seeing those jars at every gas station to pay for some sick local kid's leukemia treatment.  You know, I had actually noticed that I stopped seeing them in the last couple of years.

The ACA is not perfect, but it's better than it was before.  As for the guy who is mad about AIDS patients who pay what he pays, would it make you feel better if they were cancer patients?  How about families who have children with Downs Syndrome?  Not all medical calamities can be blamed on the patient.

Mississippi Mudstache

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Re: Impending repeal of Obamacare--what to do?
« Reply #73 on: November 10, 2016, 10:54:19 AM »
Republicans have paid no political cost for the "repeal" having no "replace" component. I suspect that they will repeal, make some noises about HSAs (gee, thanks-this $5000 sure is going to help me pay my $250k chemotherapy bill!), and we'll go back to seeing those jars at every gas station to pay for some sick local kid's leukemia treatment.  You know, I had actually noticed that I stopped seeing them in the last couple of years.

Funny you should say that. I actually saw one in a gas station this morning for the first time in years, and for the first time in my life, I put my change in it.
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daverobev

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Re: Impending repeal of Obamacare--what to do?
« Reply #74 on: November 10, 2016, 12:49:33 PM »
Maybe I'm not the one that needs to open my mind.
  I am not the one describing those who disagree with me as "fucking nuts."  Closed minds, fallacious arguments.  Opening your mind does not mean you need to convert to believing in free markets and liberty (including the right to bear arms).  Perhaps it does mean that you need to be able to open your mind a little, just a narrow, ajar, opening, to be able to understand the other side of something, rather then dismissing it with an ad hominem fallacy.

Obviously I didn't literally mean that you are *all* fucking nuts.

I understand it, I guess - people are selfish (I don't want to pay for fat slobs... well, fair enough, but it is better for society as a whole to have a comprehensive health system that deals with the whole thing - ie, educating people so they don't *become* fat slobs; not subsidising things that don't need it, encouraging people to live an at least somewhat healthy lifestyle).

But you're right, my tongue in cheek "fucking nuts" was simply exasperation. America is, at least for the time being, the richest country on the planet. But a significant number of people live in fear of visiting the doctor because of the financial cost. That's not right. I understand it's not simply "give everyone, everything, all the time; we'll make the maths work somehow" - healthcare is expensive. But it is more expensive in the US system than in pretty much all developed countries. Which makes it even harder for the poor to get it. Which, well, see above - it's madness in the wealthiest country. Ahem. Fucking nuts, so to speak. I mean, you'll riot - pretty much - to keep your access to firearms, but not to make sure everyone has access to good medical coverage.

That I cannot understand. Just can't.
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Re: Impending repeal of Obamacare--what to do?
« Reply #75 on: November 10, 2016, 01:18:50 PM »
That's funny.  The threat of presidential veto didn't stop Republicans from voting to repeal the ACA 60 times.  So why does a veto threat stop them from actually voting on a real plan?  I posit that it's because grandstanding is more politically effective than governance.  And, the presidential election this week has proven me right.

IIRC, when the legislation was being written it went something like this:
-Democrats introduce a bill they want
-Republicans counter with list of changes
-Debate
-Changes made to bill
-Republicans say no
-More debate
-More changes
-Republicans say no
-And on and on until they finally just pushed it through and quit trying to compromise

Personally, I have some faith that Obama (and enough Democratic legislators) would've listened to calm discussion of specific problems and changes, and given them real consideration, that we could've made some positive changes to a massive piece of legislation that was never going to be perfect the first go-round.
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Re: Impending repeal of Obamacare--what to do?
« Reply #76 on: November 10, 2016, 01:39:02 PM »
Obamacare was technically a Republican plan to begin with. I doubt much about it will change. It will still be a mandatory gift to insurance companies enforced by fines levied against the poorest workers who barely earn enough to survive and who can't afford the mandatory premiums for medical services they most likely won't receive if they need them.
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Re: Impending repeal of Obamacare--what to do?
« Reply #77 on: November 10, 2016, 02:30:29 PM »
Minnesota Public Radio aired a story this morning about their exchange -MnCare - and the fact that some patients are seeing 50% premium increases next year.  Even the Democratic governor (DFL party, for those of you unfamiliar) has said, "Look, we see what's not working and what needs to change."

But it's what they replace it with that worries me...

Here's something that dawned on me this morning, however.  The story reported that hospitals have enjoyed significant ("YUGE") decreases in losses for care of the uninsured since the ACA went into effect.  Not surprising, really.  The hospital/medical system is a powerful lobby with a strong vested interest in keeping people insured.  I keep hoping that, even out of pure self interest, they'll unleash lobbyists and resources to fight the fight.

I'm interested in learning more about what more progressive states with exchanges might do if the ACA gets gutted.  Will they still work hard to fully insure their citizens?  Offer some sort of public option to the uninsured?  Because the way I see it, this would strongly influence where I live my FIRED life.

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Re: Impending repeal of Obamacare--what to do?
« Reply #78 on: November 10, 2016, 02:32:52 PM »

[/quote]
Back when I had employer provided insurance, pre-existing conditions were covered as long as you could show proof of insurance through another insurance company.  There was also a 12-month waiting period and then all conditions were covered. 

[/quote]

You'd think that since we have to have proof of coverage for our income taxes this would be reasonably easy to do with systems that are already in place.

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Re: Impending repeal of Obamacare--what to do?
« Reply #79 on: November 10, 2016, 02:39:06 PM »
This, so much this.
They won't take away pre-existing coverage.  It'd be a slap in the face to the nation, and I don't see that part being repealed.  However, something new will come down the line, remove the mandate on carrying health insurance, remove the subsidy, and make it once again affordable.  Yes, for those that are low income (me, I'd have a subsidy, but I have insurance through work), it might have worked.  But, in my area, which is rural, and heavy in farming, the premiums are ranging from $700-$1500 a month, for 2 people, husband and wife, with deductibles over $5k.  Seems affordable, right?

You can't have coverage for pre-existing conditions without a mandate. Otherwise any sensible person will just pay out of pocket until something expensive happens, then sign up for insurance.

This is something I wish everyone understood better. It's economically impossible for Republicans to preserve the ban on denial for pre-existing conditions, but get rid of the mandate. Either both have to be kept, or both have to be thrown out.

That's why Obamacare has been described as a three-legged stool. If you require insurance companies to accept all applicants (the first leg), people will just wait until they get sick and sign up. Without healthy people paying into the system via premiums, it will collapse in a death spiral.

So, the second leg of the stool: the mandate. Everyone has to carry insurance, even if they don't actively need it.

But then you have the problem of people potentially being forced to buy insurance they can't afford. So you create subsidies that scale with income level, so insurance is affordable for everyone. That's the third leg of the stool.

All three of these parts work together and all of them are necessary. If you repeal any part of Obamacare, the whole thing collapses.

FireLane

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Re: Impending repeal of Obamacare--what to do?
« Reply #80 on: November 10, 2016, 02:54:18 PM »
And for the record, I think the upcoming repeal of the ACA will make FIRE extremely difficult if not impossible. For the reasons I gave above, you can't repeal any part of it without junking the whole thing, and there is no universal-coverage alternative that's to the right of Obamacare. (Obamacare is the conservative solution - it's a national version of the program Mitt Romney instituted in Massachusetts.) The only viable alternatives to Obamacare are to the left, i.e., Medicare-for-all or single-payer, which a GOP Congress obviously isn't going to pass.

I'm certain we're going back to the bad old days when insurance companies would drop you because you had a sniffle twenty years ago. Everyone who isn't lucky enough to work for a large corporation is going to lose their coverage. Obviously, this is an enormous problem for those of us who want to retire early.

The one slender reed of hope I'm clinging to is that state-level Obamacare-type programs will continue to exist without federal support, in Massachusetts and possibly elsewhere. But that means FIRE will only be possible in those states.

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Re: Impending repeal of Obamacare--what to do?
« Reply #81 on: November 10, 2016, 04:21:51 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!!!!

I think there is a alot of confusion here between HDHP and HSA. The primary purpose of an HSA is to allow you to save for and pay for your healthcare out-of-pocket costs in a tax-free manner. Other than a few plan requirements such as deductible floor and max out-of-pocket ceiling, an HSA has very little to nothing to do with plan specifics. An HSA does not impact your ability to get clear information on coverage. An HSA has nothing to do with the scenario you describe above.

My point on the staring points for ACA reform is that solutions are likely to focus on reducing the rate of healthcare cost increase. You can do that by making the covered individual more responsible for their own cost of care, ie. end of the HMO "I just pay a co-pay and don't care after that" mentality. Increased individual responsibility can be done by offering HDHPs. To help offset this cost shift, HSA expansion is likely.

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Re: Impending repeal of Obamacare--what to do?
« Reply #82 on: November 10, 2016, 05:02:15 PM »
Firelane's three legged stool is a great analytical way to look at the challenges for Trump. It is going to be HARD to change.

But think creatively, outside the box. What if a few more legs are introduced and then a few legs slowly removed? What if we have 10-15 thin and less burdensome legs?

Some of the biggest innovations were created by people who took the "it can't be done" challenge.

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Re: Impending repeal of Obamacare--what to do?
« Reply #83 on: November 10, 2016, 05:10:21 PM »
Firelane's three legged stool is a great analytical way to look at the challenges for Trump. It is going to be HARD to change.

But think creatively, outside the box. What if a few more legs are introduced and then a few legs slowly removed? What if we have 10-15 thin and less burdensome legs?

Some of the biggest innovations were created by people who took the "it can't be done" challenge.

It'd be great if it was fixed. The big problem, of course, is that healthcare in the US is fuckin' expensive. Can't get around that. It's also difficult to make decisions while bleeding out in an ambulance.

therethere

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Re: Impending repeal of Obamacare--what to do?
« Reply #84 on: November 10, 2016, 05:39:37 PM »

My point on the staring points for ACA reform is that solutions are likely to focus on reducing the rate of healthcare cost increase. You can do that by making the covered individual more responsible for their own cost of care, ie. end of the HMO "I just pay a co-pay and don't care after that" mentality. Increased individual responsibility can be done by offering HDHPs. To help offset this cost shift, HSA expansion is likely.

Hm... I see HMO's as "Hey, I can feel free to go to the doctor on something I'm concerned about and not have to worry about random 1k bills coming in for months afterwards...." You know. Using health insurance as preventative measure to find things early. Instead of not going to the doctor because you are afraid of the bills even with HDHP insurance. Then you let something lag farther and it becomes a bigger deal. If you actually care about people's health you shouldn't be adding barriers for them to be proactive. Leaving it up to high deductibles and more on the individual just turns healthcare into a deep reactive cycle. I mean we are lucky that we are able to put the maximum amount in an HSA now. Lots of people don't have that luxury.

The problem is not individual responsibility putting it more on the individual will only make things worse. The problem is the actual cost of care, malpractice insurance, medication monopolies, inability to have transparent costs, etc.

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Re: Impending repeal of Obamacare--what to do?
« Reply #85 on: November 10, 2016, 06:55:40 PM »
The problem is not individual responsibility putting it more on the individual will only make things worse. The problem is the actual cost of care, malpractice insurance, medication monopolies, inability to have transparent costs, etc.

Agree.

2 Things that seem like good ideas.

1 - Address end of life care. A Planet Money podcast talked about how people in La Crosse, WI have the highest percentage of end of life directives and thus the lowest end of life costs. We need to have open discussions with patients and families. And no, this isn't death panels.

2 - Drug reimportation. Why do US patients pay so much more than Canadians and other first world countries? Big Pharma talks about "safety" but that's baloney.

FireLane

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Re: Impending repeal of Obamacare--what to do?
« Reply #86 on: November 10, 2016, 06:56:56 PM »
Update: Trump says he wants to scrap the ban on discrimination for pre-existing conditions and bring back high-risk pools instead. Sorry, FIRE folk, and sorry to the millions of people who are about to lose their coverage entirely.

https://twitter.com/MortuaryReport/status/796862287822798848

Indexer

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Re: Impending repeal of Obamacare--what to do?
« Reply #87 on: November 10, 2016, 07:19:43 PM »
There are a lot of people talking about how bad things were pre-ACA. I just wanted to point out one very important detail.

Every STATE had different rules for insurance!

In many(maybe most) states an insurance company couldn't kick someone off their insurance unless they lied on the application, and in some states you couldn't kick them off after 2 years even if they lied on the application. You could have a pre-existing condition, lie about it, keep quiet about it for 2 years, hope they didn't find out, and then the insurance company would pay for anything after that.  In other states, oh you broke your foot, well no more insurance for you![Which completely defeats the point of insurance.]

This is also the reason insurance cost different amounts in different states. Low regulation, they can kick you whenever they want, cheap insurance. High regulation, they can't kick you, expensive insurance. 

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #88 on: November 10, 2016, 07:26:14 PM »
Update: Trump says he wants to scrap the ban on discrimination for pre-existing conditions and bring back high-risk pools instead. Sorry, FIRE folk, and sorry to the millions of people who are about to lose their coverage entirely.

https://twitter.com/MortuaryReport/status/796862287822798848

Wow. The rest of that post is pretty scary, too.

https://www.greatagain.gov/policy/healthcare.html

So, yeah, things could get as worse as we fear.

simplified

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Re: Impending repeal of Obamacare--what to do?
« Reply #89 on: November 10, 2016, 11:46:22 PM »
If you have a gambling problem, you can expect to spend more at the casinos. If you have expensive hobbies, you can expect to spend more money on your hobbies and you may likely save up on other things. If you are not very intelligent, you can expect to earn less and achieve less compared to more intelligent people. May be you try to work hard and make up for some of your deficiencies.

Similarly, if you have preexisting conditions either because of unexpected/unfortunate circumstances or willful negligence of your health, you can expect to pay more than others for healthcare.

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Re: Impending repeal of Obamacare--what to do?
« Reply #90 on: November 11, 2016, 12:22:32 AM »
t's like buying car insurance after a huge wreck and expecting the car insurance company to pay to fix your car and all the judgments for personal injury damages against you from the occupants of the other car.  That scenario just does not make sense,

I agree that we would have problems if insurance companies were required to cover costs for people who were not previously uninsured.

The difference is that some people want to remedy this situation by refusing to provide medical care (the old US system) and some people want to remedy it by insuring everyone (universal healthcare).

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Re: Impending repeal of Obamacare--what to do?
« Reply #91 on: November 11, 2016, 01:16:58 AM »

The difference is that some people want to remedy this situation by refusing to provide medical care (the old US system) and some people want to remedy it by insuring everyone (universal healthcare).

I think the biggest mistake in this discussion is that many people somehow confuse mandated health insurance with universal healthcare. They are separate things and are not interchangeable.
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Re: Impending repeal of Obamacare--what to do?
« Reply #92 on: November 11, 2016, 08:13:56 AM »
Firelane's three legged stool is a great analytical way to look at the challenges for Trump. It is going to be HARD to change.

But think creatively, outside the box. What if a few more legs are introduced and then a few legs slowly removed? What if we have 10-15 thin and less burdensome legs?

Some of the biggest innovations were created by people who took the "it can't be done" challenge.

It'd be great if it was fixed. The big problem, of course, is that healthcare in the US is fuckin' expensive. Can't get around that. It's also difficult to make decisions while bleeding out in an ambulance.

Yes. Watch this for a pretty in-depth analysis of US health care costs: https://www.youtube.com/watch?v=qSjGouBmo0M

I think the best part of the video is around the 6 minute mark. Health care providers can charge what they want--because of inelastic demand. You can't negotiate when you're bleeding out is exactly right. Right now, my husband is on a medication that would cost us over $2,000 per month, but there's no way to negotiate that down. The only way we can afford is through one of those weird "lower your Rx cost" cards from the company who makes the drug (?!?!?), and having a low enough deductible on our High Deductible Health Plan of $3,000 that we can "afford" it.
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Axecleaver

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Re: Impending repeal of Obamacare--what to do?
« Reply #93 on: November 11, 2016, 08:53:51 AM »
Here's a preview of Paul Ryan's plan: a return to high-risk pools for anyone with a pre-existing condition. Lower rates for healthy people, high rates for sick people. God help you if you can't afford the premiums.

http://www.modernhealthcare.com/article/20160428/blog/160429901

"House Speaker Paul Ryan said Wednesday he wants to eliminate that ban and replace it with an alternative way of covering sicker people—high-risk pools. But similar pools had a long and rocky history in many states before Obamacare's guaranteed coverage took effect, and they would cost taxpayers billions of dollars a year.

...annual public cost would exceed $24 billion. Even in such an expensive program, the pools likely would impose mandatory waiting periods, as state high-risk pools did in the past, to protect against adverse selection and high costs, and that would lead to patient hardships and poor health outcomes."

bacchi

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Re: Impending repeal of Obamacare--what to do?
« Reply #94 on: November 11, 2016, 10:45:35 AM »
Here's a preview of Paul Ryan's plan: a return to high-risk pools for anyone with a pre-existing condition. Lower rates for healthy people, high rates for sick people. God help you if you can't afford the premiums.

http://www.modernhealthcare.com/article/20160428/blog/160429901

"House Speaker Paul Ryan said Wednesday he wants to eliminate that ban and replace it with an alternative way of covering sicker people—high-risk pools. But similar pools had a long and rocky history in many states before Obamacare's guaranteed coverage took effect, and they would cost taxpayers billions of dollars a year.

...annual public cost would exceed $24 billion. Even in such an expensive program, the pools likely would impose mandatory waiting periods, as state high-risk pools did in the past, to protect against adverse selection and high costs, and that would lead to patient hardships and poor health outcomes."

So it's basically the "Fuck you if you're chronically ill" plan?

And conservatives wonder why they're so maligned.

Axecleaver

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Re: Impending repeal of Obamacare--what to do?
« Reply #95 on: November 11, 2016, 11:26:22 AM »
Yes. To calculate the potential premiums for the high risk pools, take your state's average platinum plan cost, add 10-20% to account for increase in healthcare costs, then double it. In my case, this would take my premiums from $7500 a year (2017) to ~$17k (2018).

Chronic conditions include some rather common ones - hypertension, for example, which 70m Americans have today. About 35-40% would be forced into a high risk pool plan.

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Re: Impending repeal of Obamacare--what to do?
« Reply #96 on: November 11, 2016, 11:31:09 AM »
Lower rates for healthy people, high rates for sick people.
Bad drivers have to pay substantially higher rates than good drivers for automobile insurance.  From a strictly economic perspective, I don't see why health insurance would be any different.

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Re: Impending repeal of Obamacare--what to do?
« Reply #97 on: November 11, 2016, 11:33:35 AM »
Lower rates for healthy people, high rates for sick people.
Bad drivers have to pay substantially higher rates than good drivers for automobile insurance.  From a strictly economic perspective, I don't see why health insurance would be any different.

So - careless driving is now on par with getting cancer.  Brilliant.

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Re: Impending repeal of Obamacare--what to do?
« Reply #98 on: November 11, 2016, 11:33:50 AM »
I mentioned this on another thread and maybe its wishful thinking BUT if the republicans really want to make the ACA look worse than it already was and I think they need to if they want more than a one term candidate(and lets not kid ourselves it was going bad in a hurry) is to rename it and improve it. No one will be able to take away that the Dems got this started no matter what its called and again I just feel the Republicans want to show they can do better. But as others mentioned at the very least you will have some time.


This is what they should have been doing for the last 6 years. Instead of trying to repeal it >60 times.
There have actually been several Republicans who have published plans to replace it.  They haven't put them up for a vote because they know Obama would veto them.

Because Obama? The reality is that there was never a plan. I'll wait for a source. They've had seven years to improve this shitshow, but did not. I have little faith that they will provide anything better than what already is.

Schaefer Light

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Re: Impending repeal of Obamacare--what to do?
« Reply #99 on: November 11, 2016, 11:36:33 AM »
Lower rates for healthy people, high rates for sick people.
Bad drivers have to pay substantially higher rates than good drivers for automobile insurance.  From a strictly economic perspective, I don't see why health insurance would be any different.

So - careless driving is now on par with getting cancer.  Brilliant.
I said from a strictly economic perspective.  What I really think most people need is just catastrophic coverage.  Find a way to do that without taking 25% of people's paychecks and you may have a winner.