Senate votes to repeal ACA

[Quidnon?]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

You're right: astronomical expense was the private market's preferred method for making health care technically available to everyone, yet functionally inaccessible to large swathes of the population. The end result of the implementation of this approach is exactly the same as providing no choice at all.

No, it was not.  Repeating propaganda does not make it so.

[Unique User]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay any price whatsoever.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

I have no idea whether it worked or not, but fixed that for you.  I find it highly amusing that you write that people could get insurance as long as they were willing to pay a high enough premium or are willing to have it be excluded.  It is simply not true.  I and many other people have personal experiences with NOT BEING ABLE TO GET INSURANCE AT ANY PRICE EVEN WITH OFFERING EXCLUSIONS.  I personally refuse to be without health insurance as I'm not interested in going bankrupt.  And pre-ACA, I was paying $300 a month for a catastrophic policy for myself and my toddler.  Your experience is your experience, but it is not everyone's.   

[Quidnon?]

I am perfectly fine with paying for it, I just want access.

Do you believe that you would lose such access, if the ACA were repealed completely?

[Greenback Reproduction Specialist]

How about we agree to not pretend that they don't threaten my freedom.  Because you know that they did and they do.  True story, first person account.

Me too, but according to some media outlets and a lot of democrats, we don't really exist....

[scantee]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

You're right: astronomical expense was the private market's preferred method for making health care technically available to everyone, yet functionally inaccessible to large swathes of the population. The end result of the implementation of this approach is exactly the same as providing no choice at all.

No, it was not.  Repeating propaganda does not make it so.

Every time you use the word propaganda to describe opinions you disagree with, a bald eagle loses a wing.

[Quidnon?]

I just don't get it.  I live in Canada, so I guess that is why, but I believe that health care should be provided to all people in a country regardless of income, and not be a for profit system.

Capitalism works in many instances, but we are playing with peoples lives here.  Take the profit out of the system, allow the people in the system to make a living.  Our Dr.'s and nurses get paid here.  and pay for it out of the taxes you collect.  Take care of your people.  Canada's system is not without fault, but I did not need to worry when they found a bone spur in my neck, after a car accident, but not as a result of the accident, that I would have to come up with some crazy co-pay or even the cost of the surgery at and estimated $350,000 in the US.  it is crazy that this is even a thing.  Take care of the people living there.  I thought this is what governments job was supposed to be, not to make laws to force insurance companies to allow you to have insurance.

I feel the need to point out, that even with my pre-ACA catastrophic insurance plan that cost way less than what you pay in extra taxes, I never had to worry about a $350,000 hospital bill.  Which is the point of buying insurance.  And we will just have to disagree on the job of government.

[chesebert]

Good riddance I say. I am paying astronomical price now for catastrophic coverage (almost $10k per year for family of 3) and pay thousands out of pocket annually in addition to the premium.

[Gin1984]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

It is most definitely true.  I know because I was one of those people.  I could find no health insurance for ANY price back in 2008 on the private market.  And I have a chronic medical condition, except not really.  I had no treatment for it for the year prior and still could get no coverage from anyone.  It is locked trapezius from trying to work and go to school.  Yes, so unhealthy. 
And no, health insurance is the only way to get real care because if you have a serious injury like a heart attack, car accident, stroke, you would not pay it without insurance, you'd put the cost on the rest of us (or die).  How about we do that, the rest of us keep ACA and those who don't want sign up to NEVER get medical care.  You get a tattoo that says don't treat and we just throw you in the walk in fridge with the corpses if you are not conscious.

[Gin1984]

I am perfectly fine with paying for it, I just want access.

Do you believe that you would lose such access, if the ACA were repealed completely?

I know I will, because I did not have it prior.

[Lagom]

Or when widespread outbreaks of preventable viruses occur because people aren't getting vaccinated.

This is a whole new ball of wax right here.

I included vaccines as an example because you had referenced them. Frankly, while I know many (misinformed) people disagree, I also don't consider that a ball of wax at all. There is literally no downside* to getting vaccinated but the minor inconvenience of going to the doctor and the slight pain of the shot, while the society-wide upsides are well documented and significant. I don't know just how old you are, but you claim to have been around the block so perhaps you remember the time before the polio vaccine? If not, it would be a good homework reading assignment.

*Barring a few rare medical cases, but those people need the benefits of herd immunity more than any of us.

How about we agree to not pretend that they don't threaten my freedom.  Because you know that they did and they do.  True story, first person account.

Well, I don't personally accept that taxes reduce freedom in absolute terms, so it's hard for me to completely agree here. But I will acknowledge that in a very narrow sense, taxes "threaten" freedom on an individual basis, even while very often increasing it on a societal basis.

I was making a list of grievances, not ranking them.  And why would the privacy concerns due to the ACA not be part of this discussion?  You are the one that wanted to hear my views on why I hated the ACA.  This is one reason why, among too many.

Sure, and I appreciate your perspective. Not to pick at our past altercation, but you seem much more reasoned in your posts on this topic than the discussions on Trump and I'm glad for your contributions. I also have no problem discussing the privacy aspects of the ACA in depth (I know relatively little about it, although HIPAA laws are indeed quite strict), I just meant privacy is a much bigger topic when we are speaking of "freedom" in general.

[Gin1984]

I get training on HIPAA yearly and if what he is discribing actually happened all it would take would be a phone call to a certain department in the federal government and they would have the largest fine and could actually be closed down.  This "requirement" is likely that if he wants treatment the hospital is going to put his chart is their normal system.  You don't get to decide how a company holds their records.  And frankly, electronic charts are much safer for patients than paper charts.  They also keep records of ANYONE who access them so they are actually much more secure than any paper chart so he is less likely to have anyone looking without cause.

[Lagom]

I get training on HIPAA yearly and if what he is discribing actually happened all it would take would be a phone call to a certain department in the federal government and they would have the largest fine and could actually be closed down.  This "requirement" is likely that if he wants treatment the hospital is going to put his chart is their normal system.  You don't get to decide how a company holds their records.  And frankly, electronic charts are much safer for patients than paper charts. They also keep records of ANYONE who access them so they are actually much more secure than any paper chart so he is less likely to have anyone looking without cause.

This is a good point. I work with a CRM system that holds limited medical information and it is the same for us. Sure, someone could "hack" it from the outside, I suppose, but I wouldn't worry about that any more than someone stealing/making copies of physical records.

[Iplawyer]

People have strong feelings about ACA because healthcare is expensive and everyone wants it and no one wants to pay for it.

Yes and some of us don't want to be forced into paying for something we don't need or want.

Isn't it being repealed along party lines? And in all likelihood isn't all of the government's agenda for at least 2 years gong to be along party lines with half the US being left out. Your statements seem very partisan or hypocritical.

It probably is, and to the extent I have been vocal about the injustice over the last 8 years, I will do my best to be vocal about the injustices likely to occur in the next 8 years.... Which is part of the reason I don't think gov should be meddling in our affairs to begin with, because both sides are guilty of it. We don't need those wacko birds telling us how to live our lives.... We really just don't.

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

[BTDretire]

I always come back to my experience.
 I have a family of four, I'm older at 61 wife is 57, age creates higher prices.
I'm paying $8,800 a year for a BCBS policy $10,000 deductible and Max Out Of Pocket.
I pay $10,000 and I'm done, the rest is covered.

  I just looked up prices on healthcare.gov.
The Obama plans are;
 A middle Bronze plan is $17,304, with a $12,700 deductible.
The low end Silver plan is $20,040, with a $13,000 deductible.
The high end Silver is $31,788 with a $10,000 deductible and $13,777 OOP.

They start at 2 times the cost of my private policy.
The taxpayer provided subsidy is what allows people to buy the government policy,
 In my case I put in $80,000 as my income, this produces a subsidy of $13,440.
 I think this is a joke, they have inflated policy prices but then take money from
hardworking taxpayers to give to someone makeing $80,000.
It's joke, but it not funny!

ACA plans don't cost more just because they're on healthcare.gov.

 In effect. the they do.
 It is because, in general, the people that use the most healthcare picked that option, and they are expensive.
Also, I suspect a bit of padding the price since the subsidy is so big.
 Why do you think healthcare.gov policies are expensive?

 I was paying $5,256 when ACA regulations started in 2012, 5 years later, I'm at $8,800.
That's an 11% compound growth rate. I was looking for a $2,500 reduction.
 Silly me!

[Quidnon?]

Not so, because before the ACA, I had a choice to refuse that my medical history be electronic.  I had the choice to reduce my premiums in exchange for a higher deductible, catastrophic coverage, cancer optional coverage, or no coverage at all.  The power to chose, without interference in that choice, is freedom.  If I don't have the power to choose, even if that choice is wrong by any objective or subjective measure, without interference; then I am not free.

You do realize that pre-ACA there were millions of people with no choice at all. The simply couldn't get covered in the private market, by anyone. Couldn't choose between different deductible levels or catastrophic coverage or cancer coverage. None of those "choices" were available to them. You gave up a small amount of your freedom, to give a little freedom to others who previously had none at all.

This is false, and propaganda.  There were millions of people that couldn't find health insurance for a premium they were willing to pay any price whatsoever.  There were others who couldn't find health insurance that would cover a chronic medical condition that they already had, at least not without a waiting period or a very expensive rider.  And there were millions who simply chose to roll the dice and "self-insure" with a backup from chapter 7 bankruptcy.  Again, insurance is a contract to mitigate the economic risk of developing an expensive medical condition.  If a company, policy or risk pool cannot discriminate against applicants that already have such a condition, it's already not insurance.  True insurance is cheap.  Before the ACA, I could get a rider to my "umbrella" insurance policy that was truly a catastrophic "hospitalization" plan, that would cover any hospital bill at 100% beyond a very high number; $22,000 at the time if I recall correctly, incurred during a single year or during a continuous hospital stay (if it occurred across January 1st).  That rider cost me an additional $22 dollars per year in 2006 or so, maybe in the $30s by the time my insurance company dropped the optional rider in 2012.

And medical insurance is not the only way to afford care.

I have no idea whether it worked or not, but fixed that for you.

Those were two different classes of people, the one you fixed broke didn't apply to your situation.

  I find it highly amusing that you write that people could get insurance as long as they were willing to pay a high enough premium or are willing to have it be excluded.  It is simply not true.  I and many other people have personal experiences with NOT BEING ABLE TO GET INSURANCE AT ANY PRICE EVEN WITH OFFERING EXCLUSIONS.

I don't believe you, because I don't believe you actually exhausted your options.  The actual number of people that absolutely could not get basic insurance coverage; with or without a waiting period, with or without an exclusion, with or without a state subsidized high risk pool; is so vanishingly small that it would be hard to believe that it included any citizen that wasn't already a resident of a long term care facility.  I believe that you believe it, and I believe that you failed to find what you would consider an acceptable solution, but I don't believe that it did not exist beyond your knowledge.  The only reservation that I have with the above statements, is that I don't know what your condition actually is, nor which state you lived in, so I can't do the research to prove it.  You are correct that I don't have an expensive pre-existing condition (I'm a man of a certain age, so I do have conditions now, for which letting my health insurance lapse would be unwise today.  But it's not especially expensive, well within what a reasonable person would consider a cost of living expense at my age), however I have known many people in my life, two that were able to get pre-existing health coverage, despite a gap in coverage, prior to the ACA, even though they couldn't get life insurance anymore due to the same condition.  One did it by accepting a coverage delay with a permanent rider, even though it was very expensive (by his account, I didn't ask for numbers); the other through a government subsidized high risk pool, also expensive but fairly comprehensive.  The latter was my own mother.  I do not know what the rules, exclusions or requirements were for either path; simply because I don't pry, but the options did exist.

  I personally refuse to be without health insurance as I'm not interested in going bankrupt.  And pre-ACA, I was paying $300 a month for a catastrophic policy for myself and my toddler.  Your experience is your experience, but it is not everyone's.

And your experience is your experience.

[Greenback Reproduction Specialist]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

That's fair, car insurance can cover medical costs though.

I do wonder sometimes if insurance is the main culprit of rising healthcare costs... because it creates a situation where the patient doesn't care how much is being charged, so in affect the doctor can charge how ever much he feels he needs to, which in turn means the suppliers know they can charge more, and on, and on.... It seems that insurance is such a big pocket to pull from it creates carelessness with keep costs in line with market demands.

[BTDretire]

I still don't get how the ACA got everyone insurance.  My dad is 59 and kinda forced retired.  He brings $1400 a month from pension.  After any side work he may have, his income is maybe $24k per year.  Yet for him to get insurance thru Obamacare it was $60 per month with a $10,000 deductible or almost $400 a month with a couple hundred deductible.  Neither of which he can afford.  These were after the credits. 

My mom used to buy her own PPO from Blue Cross for around $350 a month.  After ACA, her plan was gone and the next plan available was over $1500 a month with a huge deductible.

So I just don't understand how this benefited people.

Well, as a counter:

My dad had cancer twice. Paid almost $1500 A MONTH to be insured, with a reasonable deductible, pre-ACA. Could only find one insurer  to cover him - Kaiser Permanente. After ACA, he paid $350/month with a $6k deductible.

 And how much did the taxpayers pay?
 "After ACA, he paid $350/month" but that was not the true cost of the policy.
If we were going to give $10,000 to $15,000 a year to people to pay their insurance,
why did we need to go through all the commotion?

[Quidnon?]

I get training on HIPAA yearly and if what he is discribing actually happened all it would take would be a phone call to a certain department in the federal government and they would have the largest fine and could actually be closed down. This "requirement" is likely that if he wants treatment the hospital is going to put his chart is their normal system.  You don't get to decide how a company holds their records.  And frankly, electronic charts are much safer for patients than paper charts.  They also keep records of ANYONE who access them so they are actually much more secure than any paper chart so he is less likely to have anyone looking without cause.

I don't get to chose how a hospital stores records, but I should have the ability to limit those records to that institution.  I used to, but no longer.  I've seen it in action, whether you think that it would result in a fine or not.  And I know that it was imposed upon the city I live in by regulations related to the ACA.  Nor do I care about the argument that electronic charts may be safer for patients; I used to have a right to medical privacy, and now that is effectively defunct, even if it is still a law on the books somewhere.  I was in a car wreck a couple of years ago, for which I was not harmed but the person who rear-ended me was obviously in bad shape.  The EMTs didn't really give me the choice to refuse a trip to the emergency room with the other driver, and I didn't really put up much of an argument.  On the trip, after the other driver was secured & doing okay, I asked the EMT not driving to look me up in his mobile system, just out of curiosity.  He couldn't see everything, but he could see a hell of a lot, including everything that would have been required for a very effective theft of identity.  I've never had my identity stolen, but if this were the path, how would you ever know who to sue for a  HIPAA violation anyway?

And you might think, "well, that was emergency services, they need access even if you are unresponsive!"  Maybe so, but I did the same thing in a Wal-Mart health clinic once too, and they could see everything that the EMT could.  In their defense, they did ask me to sign a permission waver before accessing this data; but that was a piece of paper.  There is no way that, should they wanted to do it anyway, for any malicious reason, they wouldn't have been able to do it and get away with it.

[Quidnon?]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

You're right about that.  That isn't the case now, and it wasn't the case before the ACA either.  The ACA didn't solve this problem, and has no path to do so even if the mandate remains in effect.  So do you actually have a valid reason to keep the ACA that you'd like to mention?

[Greenback Reproduction Specialist]

might think, "well, that was emergency services, they need access even if you are unresponsive!"  Maybe so, but I did the same thing in a Wal-Mart health clinic once too, and they could see everything that the EMT could.  In their defense, they did ask me to sign a permission waver before accessing this data; but that was a piece of paper.  There is no way that, should they wanted to do it anyway, for any malicious reason, they wouldn't have been able to do it and get away with it.

Well at least our data is secure lol..... Right? I mean we never have our systems broken into.... hehe... Sorry its not really that funny, but its Friday and I'm excited to go home : )

[protostache]

And you might think, "well, that was emergency services, they need access even if you are unresponsive!"  Maybe so, but I did the same thing in a Wal-Mart health clinic once too, and they could see everything that the EMT could.  In their defense, they did ask me to sign a permission waver before accessing this data; but that was a piece of paper.  There is no way that, should they wanted to do it anyway, for any malicious reason, they wouldn't have been able to do it and get away with it.

I guarantee that every access to that (frankly amazing sounding) shared system is logged with a username, time stamp, and what they accessed. At the very least there are also periodic random audits on access logs, meaning maybe someone gets away with something for a little while but not for long. That piece of paper is there so that Wal-Mart can show it to the federal department of health and human services when (not if) they show up to audit, because you asked them to access something outside of their normal purview. HIPPA violations are an extremely serious matter. The fines are astronomical and unconditional.

The only weird part is the SSN. Nobody outside of a very select group of people (hospital registration and maybe billing) should have access to that.

[scantee]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

You're right about that.  That isn't the case now, and it wasn't the case before the ACA either.  The ACA didn't solve this problem, and has no path to do so even if the mandate remains in effect.  So do you actually have a valid reason to keep the ACA that you'd like to mention?

The obvious answer for you is to choose to not enroll in ACA, pay the penalty (or don't, its only $675, so less than what you're spending on premiums, you decide!), and pay for your expenses out-of-pocket. This is the arrangement that provides you the most freedom and control, and that was true for the period pre-ACA as well.  Going this route will mean you'll never be beholden to any of the restrictions or changes an insurance company will make to your individual policy or the federal government to national health care policy.

[Quidnon?]

And you might think, "well, that was emergency services, they need access even if you are unresponsive!"  Maybe so, but I did the same thing in a Wal-Mart health clinic once too, and they could see everything that the EMT could.  In their defense, they did ask me to sign a permission waver before accessing this data; but that was a piece of paper.  There is no way that, should they wanted to do it anyway, for any malicious reason, they wouldn't have been able to do it and get away with it.

I guarantee that every access to that (frankly amazing sounding) shared system is logged with a username, time stamp, and what they accessed. At the very least there are also periodic random audits on access logs, meaning maybe someone gets away with something for a little while but not for long. That piece of paper is there so that Wal-Mart can show it to the federal department of health and human services when (not if) they show up to audit, because you asked them to access something outside of their normal purview. HIPPA violations are an extremely serious matter. The fines are astronomical and unconditional.

Yeah, that's never going to happen.  You know that receipt you sign when you buy things with your credit card?  That's security theater also.  No one ever looks at that unless there is a lawsuit, either.  No audit is ever going to question my signature on that paper.  No red flags will pop-up because any random EMT or clinic secretary accessed my records.  In order for that to ever matter, I'd have to at least suspect that my identity was stolen by way of the health records database.  How would I ever know?  Even if I did, it would take nothing less than legal discovery during a lawsuit to prove it, and even then HIPPA restrictions might prevent it simply because other records might be exposed to me.

The only weird part is the SSN. Nobody outside of a very select group of people (hospital registration and maybe billing) should have access to that.

Thinking about it, it might have just been my last 4 on the records screen, but the SSN was in there somewhere, because that was one of the search parameters available to the users.  And while just the last 4 is better than the whole thing; if I knew your last 4, the state you were born in, and your birth year; I have a reasonable chance at guessing your SSN within about 100 possibilities.  Particularly if I have access to a database that I can keep entering guesses into until it confirms my accuracy.  The truth is, electronic databases are weak on practical security, mostly because we have to trade off usefulness with security.  Paper records could be photocopied, but only by someone with physical access to the records room; and I'm inclined to believe that, in practice, that was better privacy security most of the time.

[Quidnon?]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

You're right about that.  That isn't the case now, and it wasn't the case before the ACA either.  The ACA didn't solve this problem, and has no path to do so even if the mandate remains in effect.  So do you actually have a valid reason to keep the ACA that you'd like to mention?

The obvious answer for you is to choose to not enroll in ACA, pay the penalty (or don't, its only $675, so less than what you're spending on premiums, you decide!), and pay for your expenses out-of-pocket. This is the arrangement that provides you the most freedom and control, and that was true for the period pre-ACA as well.  Going this route will mean you'll never be beholden to any of the restrictions or changes an insurance company will make to your individual policy or the federal government to national health care policy.

It's more expensive than that for some.  I believe that your quite is the minimum penalty, and that it's also determined by a percentage of your gross income.  On the other hand, the penalty isn't a prosecutable offense for the IRS, so if you don't make much income and/or you can effectively avoid contributing more in payroll deductions than you will owe at the end of the year, you might be able to get away with it anyway.

[Iplawyer]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

That's fair, car insurance can cover medical costs though.

I do wonder sometimes if insurance is the main culprit of rising healthcare costs... because it creates a situation where the patient doesn't care how much is being charged, so in affect the doctor can charge how ever much he feels he needs to, which in turn means the suppliers know they can charge more, and on, and on.... It seems that insurance is such a big pocket to pull from it creates carelessness with keep costs in line with market demands.

Car insurance has hard limits on medical payments.  What if you fall while hiking and have to be airlifted and then spend 3 months and $3+M for treatment? No car insurance to help defray those costs.  The point is that many, many people were going uninsured and using the "free" emergency room since emergency rooms cannot turn anyone away. 

[Iplawyer]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

You're right about that.  That isn't the case now, and it wasn't the case before the ACA either.  The ACA didn't solve this problem, and has no path to do so even if the mandate remains in effect.  So do you actually have a valid reason to keep the ACA that you'd like to mention?

The obvious answer for you is to choose to not enroll in ACA, pay the penalty (or don't, its only $675, so less than what you're spending on premiums, you decide!), and pay for your expenses out-of-pocket. This is the arrangement that provides you the most freedom and control, and that was true for the period pre-ACA as well.  Going this route will mean you'll never be beholden to any of the restrictions or changes an insurance company will make to your individual policy or the federal government to national health care policy.

It's more expensive than that for some.  I believe that your quite is the minimum penalty, and that it's also determined by a percentage of your gross income.  On the other hand, the penalty isn't a prosecutable offense for the IRS, so if you don't make much income and/or you can effectively avoid contributing more in payroll deductions than you will owe at the end of the year, you might be able to get away with it anyway.

There is no penalty if your withholding meets your tax bill.  Because if they cannot take the penalty out of your tax refund there is no other enforceable way to get it.  Simple solution.

[Quidnon?]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

That's fair, car insurance can cover medical costs though.

I do wonder sometimes if insurance is the main culprit of rising healthcare costs... because it creates a situation where the patient doesn't care how much is being charged, so in affect the doctor can charge how ever much he feels he needs to, which in turn means the suppliers know they can charge more, and on, and on.... It seems that insurance is such a big pocket to pull from it creates carelessness with keep costs in line with market demands.

Car insurance has hard limits on medical payments. 

True, mine has a hard lifetime limit of $3 million.

What if you fall while hiking and have to be airlifted and then spend 3 months and $3+M for treatment? No car insurance to help defray those costs. 

Um, about that....

The point is that many, many people were going uninsured and using the "free" emergency room since emergency rooms cannot turn anyone away.

Yes, and that was a matter of law well before the ACA.  And it's still mostly true.  The ACA has had a negligible effect on the over-utilization of emergency health services; plenty of people still use the emergency room as their regular pediatric care, and that is still mostly written off as a loss or subsidized by taxpayer funds.  Actual trauma care is still a fraction of the care provided by emergency care facilities, and the premium for such an insurance policy (covering only emergency care or hospitalization) is incredibly small.  As a compromise, I could accept that such a mandate to carry such a catastrophic care policy OR pay the tax penalty (for the "public option" version of this).  I cannot accept the ACA as it is, however.  I will never accept it as it is.

[thenextguy]

I always come back to my experience.
 I have a family of four, I'm older at 61 wife is 57, age creates higher prices.
I'm paying $8,800 a year for a BCBS policy $10,000 deductible and Max Out Of Pocket.
I pay $10,000 and I'm done, the rest is covered.

  I just looked up prices on healthcare.gov.
The Obama plans are;
 A middle Bronze plan is $17,304, with a $12,700 deductible.
The low end Silver plan is $20,040, with a $13,000 deductible.
The high end Silver is $31,788 with a $10,000 deductible and $13,777 OOP.

They start at 2 times the cost of my private policy.
The taxpayer provided subsidy is what allows people to buy the government policy,
 In my case I put in $80,000 as my income, this produces a subsidy of $13,440.
 I think this is a joke, they have inflated policy prices but then take money from
hardworking taxpayers to give to someone makeing $80,000.
It's joke, but it not funny!

Post like these are just sad. The ACA has been in effect for how long and there are still people that don't have a clue how it works.

There aren't any government policies. They are all private policies.

[Metric Mouse]

The subsidies for a person making $80k would be a government policy.

[sol]

The subsidies for a person making $80k would be a government policy.

Do you think it's a "government policy" when the government gives a private citizen a refundable tax credit to buy private insurance from a private insurance company?

[BTDretire]

I always come back to my experience.
 I have a family of four, I'm older at 61 wife is 57, age creates higher prices.
I'm paying $8,800 a year for a BCBS policy $10,000 deductible and Max Out Of Pocket.
I pay $10,000 and I'm done, the rest is covered.

  I just looked up prices on healthcare.gov.
The Obama plans are;
 A middle Bronze plan is $17,304, with a $12,700 deductible.
The low end Silver plan is $20,040, with a $13,000 deductible.
The high end Silver is $31,788 with a $10,000 deductible and $13,777 OOP.

They start at 2 times the cost of my private policy.
The taxpayer provided subsidy is what allows people to buy the government policy,
 In my case I put in $80,000 as my income, this produces a subsidy of $13,440.
 I think this is a joke, they have inflated policy prices but then take money from
hardworking taxpayers to give to someone makeing $80,000.
It's joke, but it not funny!

Post like these are just sad. The ACA has been in effect for how long and there are still people that don't have a clue how it works.

There aren't any government policies. They are all private policies.

  Yes, I stated that poorly, I'm well aware, that most of the policies I could get through the ACA are from BCBS.
Would you feel better if I said policies that meet the strict regulations required by the federal government in order to qualify
for subsidies from hardworking taxpayers?

[Metric Mouse]

The subsidies for a person making $80k would be a government policy.

Do you think it's a "government policy" when the government gives a private citizen a refundable tax credit to buy private insurance from a private insurance company?

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

[rpr]

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

I would go further and say that giving a tax deduction for medical expenses including insurance premiums payments (both employee and employer) is a government tax policy that should absolutely be done away with.

[sol]

The subsidies for a person making $80k would be a government policy.

Do you think it's a "government policy" when the government gives a private citizen a refundable tax credit to buy private insurance from a private insurance company?

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

We have a miscommunication.  This use of "government policy" was used in contrast with "private insurance policy" to suggest it was a government insurance plan. 

You're using "policy" to mean "this is an official action by the government" instead of "this is an insurance plan provided by the government".

[Quidnon?]

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

I would go further and say that giving a tax deduction for medical expenses including insurance premiums payments (both employee and employer) is a government tax policy that should absolutely be done away with.

Why do you feel this way?  Are you opposed to deductions on living expenses as a rule?

[rpr]

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

I would go further and say that giving a tax deduction for medical expenses including insurance premiums payments (both employee and employer) is a government tax policy that should absolutely be done away with.

Why do you feel this way?  Are you opposed to deductions on living expenses as a rule?

That is one part of it. Such targeted deductions usually end up raising prices for those services.  (I am also opposed to itemized deductions for mortgage interest, student loan interest, IRA and 401k deductions.) I would rather just raise the standard deduction for everyone and be done with it. It would simplify things a lot from the tax code point of view.

PS: I say this even though I have benefited greatly from  mortgage interest and health insurance deductions, as well as the 401k and IRA deductions.   

[Quidnon?]

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

I would go further and say that giving a tax deduction for medical expenses including insurance premiums payments (both employee and employer) is a government tax policy that should absolutely be done away with.

Why do you feel this way?  Are you opposed to deductions on living expenses as a rule?

That is one part of it. Such targeted deductions usually end up raising prices for those services.  (I am also opposed to itemized deductions for mortgage interest, student loan interest, IRA and 401k deductions.) I would rather just raise the standard deduction for everyone and be done with it. It would simplify things a lot from the tax code point of view.

PS: I say this even though I have benefited greatly from  mortgage interest and health insurance deductions, as well as the 401k and IRA deductions.

I can respect that position.

[dividendman]

I'm pretty sure this wasn't a vote to repeal the ACA.

It wasn't even a budgetary vote to have it treated as a budget item.

It was a vote to start debate on repealing portions of the ACA as a budget item.

Also, why don't progressive states just band together and create their own health care system? All states invited, of course.

Edit: I also don't understand why the progressive states don't take any tax cut the feds do and increase the state rates by the same amount. Same amount of taxation, better allocation of funds to your state. As it is now the progressive states heavily subsidize the conservative ones through the federal income tax.

[calimom]

When my husband died at a young age (killed by a drunk driver on his way home from work), the software firm he was employed by offered, as part of their benefit plan, a years' worth of health insurance premiums. I was very grateful. And the HR person teased it through another couple of months until it was red-flagged by the new owners. In the intervening time, my eldest needed grief counseling. My five year old son fell out of a tree he was climbing and broke his arm. My baby daughter was diagnosed with asthma and needed basic treatment. As a result, we were deemed "high risk". The most affordable private plan I could find was over $1100 per month. OK, I got it, I'm head of household, my responsibility. I started a small business, of course no insurance, after day care I netted probably a buck seventy five a month.

Flash forward to the ACA. After making inquiries, I wound up with Covered California at $650 per month, which is what I currently pay. Truly after the initial flurry of expenses, my family is not a huge consumer of healthcare. My eldest (actually my stepdaughter I gained custody of after my husband's death) graduated from college and works 3 low paying jobs and is on my plan. As I was used to paying the larger amount, after the welcome subsidy, I started putting the difference into my younger kids' 529 college plans and started my first ever ROTH.

Who knows what I will pay with the new regime? Back to $1100? Up to $1500? My eldest will surely be kicked off in any case, and the careful savings I make for my children's future and my own responsible retirement will by diminished.  So basically, FUCK YOU PAUL RYAN. His healthcare, and that of his family's, is secured by the government. He and everyone else committing what is essentially a crime a giant the people he purports to serve, are being shafted.

[sol]

Edit: I also don't understand why the progressive states don't take any tax cut the feds do and increase the state rates by the same amount. Same amount of taxation, better allocation of funds to your state. As it is now the progressive states heavily subsidize the conservative ones through the federal income tax.

Because they are progressive, and progressives don't want people to suffer needlessly even if they live in a red state.

This has been widely discussed, in some circles.  Individual states could replicate the ACA.  Just pass an individual mandate, require guaranteed issue, implement new taxes on high earners, and offer state tax subsidies in place of the federal ones.  The west coast and the east coast could each become combined insurance pools.   Basically, nothing would change for them. 

But there are lots of red states where things would change dramatically.  People in those states would not have access to health insurance anymore.  Their state governments want to reduce (and have turned down expanding) medicaid eligibility.  Insurers have pulled out of their markets already.  The death spiral is real.  The fact that blue states would be exempt from this problem does not mean it's not a real problem for real Americans. 

Congressional Democrats agreed to try implementing the Heritage Foundation's free-market approach to expanding health insurance coverage, even though they knew blue states would be subsidizing red states, because it was what they thought was best for America.  Republicans have worked to break that deal apart ever since, and now they will succeed in it just as much as they always dreamed.  So be it.  I say let the voters have what they asked for, not what they really want.

[rpr]

I say let the voters have what they asked for, not what they really want.

I agree, just like that person in Florida mentioned in one of the news articles in an earlier post in this thread. It is a given that he and others like him get what they chose and lose their lower cost health insurance and consequently the profitability of their small businesses. The only tragedy is that his actions will hurt a whole bunch of people who really need  health insurance.

When it come to the health care situation in this country, it is so messed up.  It's going to be an interesting few years.

[markbike528CBX]

.......The American people don't generally respond well to the government telling them how to live. Michelle Obama's big mission from the start was tackling childhood obesity......

Result ~0.

  Pokemon Go, result, zillions of kids WALKING semi-aimlessly in parks etc.

[chasesfish]

I love this discussion.

I'm the odd duck out there, I think Obamacare is a disaster and pretty libertarian, but I think its a disaster because they don't enforce everyone carrying at least a minimum level of insurance.  By enforce, I mean no tax refunds issued until proof of insurance is provided.

We need a base level of insurance everyone is required to have.  The non-payers drive up the cost for everyone.

[Metric Mouse]

The subsidies for a person making $80k would be a government policy.

Do you think it's a "government policy" when the government gives a private citizen a refundable tax credit to buy private insurance from a private insurance company?

Ummm.... yes. Giving a tax credit to every citizen that purchases health insurance sounds like a perfect example of governmental policy.

We have a miscommunication.  This use of "government policy" was used in contrast with "private insurance policy" to suggest it was a government insurance plan. 

You're using "policy" to mean "this is an official action by the government" instead of "this is an insurance plan provided by the government".

Ahh. I see that you were confused by my terminology.  No problem. 

[Iplawyer]

I would be fine with all of that - but if you are uninsured and show up at the emergency room after wrapping your car around the tree I - and everybody insured and the tax payers pay your bill.  So until we come to a system such that hospitals and medical providers can turn down those of you who "don't need those wacko birds telling us how to live," I want a way to make sure I don't end up paying for whatever you are doing if you choose no insurance.  Right now that isn't the case.

You're right about that.  That isn't the case now, and it wasn't the case before the ACA either.  The ACA didn't solve this problem, and has no path to do so even if the mandate remains in effect.  So do you actually have a valid reason to keep the ACA that you'd like to mention?

The obvious answer for you is to choose to not enroll in ACA, pay the penalty (or don't, its only $675, so less than what you're spending on premiums, you decide!), and pay for your expenses out-of-pocket. This is the arrangement that provides you the most freedom and control, and that was true for the period pre-ACA as well.  Going this route will mean you'll never be beholden to any of the restrictions or changes an insurance company will make to your individual policy or the federal government to national health care policy.

It's more expensive than that for some.  I believe that your quite is the minimum penalty, and that it's also determined by a percentage of your gross income.  On the other hand, the penalty isn't a prosecutable offense for the IRS, so if you don't make much income and/or you can effectively avoid contributing more in payroll deductions than you will owe at the end of the year, you might be able to get away with it anyway.

There is no penalty if your withholding meets your tax bill.  Because if they cannot take the penalty out of your tax refund there is no other enforceable way to get it.  Simple solution.

That is the only way it is enforced.  I'm not following your logic.  They can take the penalty out of your tax refund - but that is the only method of enforcement.

[dividendman]

Edit: I also don't understand why the progressive states don't take any tax cut the feds do and increase the state rates by the same amount. Same amount of taxation, better allocation of funds to your state. As it is now the progressive states heavily subsidize the conservative ones through the federal income tax.

Because they are progressive, and progressives don't want people to suffer needlessly even if they live in a red state.

This has been widely discussed, in some circles.  Individual states could replicate the ACA.  Just pass an individual mandate, require guaranteed issue, implement new taxes on high earners, and offer state tax subsidies in place of the federal ones.  The west coast and the east coast could each become combined insurance pools.   Basically, nothing would change for them. 

But there are lots of red states where things would change dramatically.  People in those states would not have access to health insurance anymore.  Their state governments want to reduce (and have turned down expanding) medicaid eligibility.  Insurers have pulled out of their markets already.  The death spiral is real.  The fact that blue states would be exempt from this problem does not mean it's not a real problem for real Americans. 

Congressional Democrats agreed to try implementing the Heritage Foundation's free-market approach to expanding health insurance coverage, even though they knew blue states would be subsidizing red states, because it was what they thought was best for America.  Republicans have worked to break that deal apart ever since, and now they will succeed in it just as much as they always dreamed.  So be it.  I say let the voters have what they asked for, not what they really want.

Yes, but state governments aren't there to aid other states. They are there to help their own states and citizens. Also, the problem would be self-correcting as, hopefully, people use their freedom of mobility rights to move to the progressive states which  should eventually get more people because of the policies they have and then get more representatives, more electoral college seats and more elections.

Yeah, people will suffer and die in the meantime in mostly red states...... but that's going to happen anyway now right? It sucks but that's how it is.

[sol]

Yeah, people will suffer and die in the meantime in mostly red states...... but that's going to happen anyway now right? It sucks but that's how it is.

Right.  I feel like we tried to save them, and they said no thanks, so now we're going to have to focus on just saving ourselves instead.  Sorry guys.  I hear confederate flags make good emergency bandages.

[Roland of Gilead]

Maybe the solution *is* to make it state based.   Give each state $x and let them either use that to provide healthcare for their residents or use it to build walls or whatever.

Then see how things work out.

[jim555]

In Trump's 60 Minute interview in Nov. he states that repeal and replace will happen at the same time.
Don't worry Trumpcare will be fantastic, fabulous even.
----
Lesley Stahl: And there’s going to be a period if you repeal it and before you replace it, when millions of people could lose -– no?

Donald Trump: No, we’re going to do it simultaneously. It’ll be just fine. We’re not going to have, like, a two-day period and we’re not going to have a two-year period where there’s nothing. It will be repealed and replaced. And we’ll know. And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.
----
http://www.cbsnews.com/news/60-minutes-donald-trump-family-melania-ivanka-lesley-stahl/

[Abe]

I think larger states will probably keep their requirements +/- individual mandates (like Massachusetts' system pre-ACA). California and New York come to mind, and have large enough pools to pay for it. The smaller states will likely have to band together. The states opposed to ACA will just have crap health insurance options again.