Author Topic: What comes after the ACA?  (Read 389744 times)

protostache

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Re: What comes after the ACA?
« Reply #2750 on: June 19, 2017, 09:31:18 AM »
This is my family. We pay $12,000 per year in premiums and have a $9,000 out of pocket max which we just met this morning. We have a 2x mortgage and 2 paid for cars. I do not feel different. I am in fact very grateful for the ACA, even with it's many flaws, even though we have to pay $21,000 out of pocket for our health care. I gladly pay higher taxes so people who can't can receive Medicaid.

Explain to me why you don't get the health insurance on the marketplace that has a much lower out of pocket maximum?

Isn't that what the different metals intend to reveal, that a Gold or Platinum plan has a much lower out of pocket maximum?

A family of 3 that ends up in a negative health situation going forward would choose a plan that would have much lower deductibles.

You'll pay more for that insurance per month, but you'll probably come out ahead because you won't be paying these maximums anymore.

First, we don't qualify for any subsidies. Second, I made a massive spreadsheet that compared several on and off exchange HSA-compatible plans in all of the metal tiers, along with at least one non-HSA-compatible plan. This plan was the cheapest of those I evaluated assuming 1) max HSA contributions, b) full deduction of premiums on taxes and c) hitting our family out of pocket max.

It's actually a somewhat unconventional setup that, as far as I can tell from BCBSM's filings, isn't being offered again next year. We have a $4k individual / $8k family deductible and $4.5k individual / $9k family out of pocket max silver HSA plan. Next year our deductible will be a bit lower and our out of pocket max will be a little higher. We will likely have a 30-40% increase in premiums, based again on BCBSM's filings, 2/3 of which is due to the lack of enforcement for the individual mandate and the continued uncertainty of the CSR payments. Here is an overview of the data. I looked up BCBSM's filings on this website.

The ACA isn't going to get fixed.

But why not? ACA has over 50% approval and the repeal effort has less than 10%. The vast majority of the people that the ACA serves are better off with the law than without and a few small changes would make it work better for the rest. But no, of course we can't do that, because the people in Congress are beholden to interests that want it gone and not their actual constituents that benefit from the law.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2751 on: June 19, 2017, 09:39:34 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.


Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?
Ok, it's just that your rhetoric comes off as pretty hostile.  For example: Why do you think they don't deserve to have a decent life?
To me these suggestions that someone can't have a 'decent life' is both untrue and designed to elicit a single emotional response: anger.
It just feeds the beast.

Nereo, you are correct, my tone can be toned down.  At first, a few years ago, I was angered about the higher premiums I now have to pay, but eventually I realize that I can afford the increase and content with it since it benefits many people.  I would still rather have the entire healthcare system cost less.  Just a 20% cut would solve all our healthcare problems today without the need to raising taxes even more. 

My biggest issue with the 100% proponents of the ACA is the one sided view saying only the good things it has done and ignoring the bad. Simply saying we have more people insured does not necessarily mean they have affordable healthcare.  A family of 3 making $60k/yr may have had very inexpensive health insurance at one time that covered what they needed.  Now they have to pay 3x as much for coverage, get subsidies that cover half and now have higher deductibles making their new insurance practically useless.  Just because you have health insurance does not mean you can still afford healthcare.  I see these people every day who are unhappy with how this bill has turned out for them.  Sure it helped a significant portion of Americans, but it harmed a significant portion as well and we can't simply ignore them.

Are we that blinded by our desire to do good that we are willing to ignore the bad?
I think what you are not understanding is that people are not ignoring the bad.  ACA is just the best option we have now.  I know of no person who does not see improvements that can be made, but scraping it with harm many, many people and that is not worth it.  Because overall, it has improved things for those who needed it. 

Look up above.  Whenever I bring up a bad item about the bill I get criticism with a list of the good the bill has done.  No one is debating the positives, and no one is debating getting rid of it. I am debating the negatives and the reality of healthcare in this country which so many like to ignore.  Healthcare in the US is expensive.  We have cost shifted its price tag from the people who can't afford it to the rich who can while squeezing a subset of the middle class even further.  I am not saying it is the worst thing, but a much better solution would be to make healthcare less expensive and more affordable to everyone.  Stick with the pre-existing conditions clause and eliminate the waste cutting the cost to everyone by 20-40%

BTW, I see a subset of the lower middle class who have seen no benefit at all.  Their cost of healthcare has stayed the same despite the partial subsidies and now the higher deductibles.  I would much prefer their out of pocket expenses be lower because the delivery of healthcare is less expensive.

I see physicians not accepting healthcare.gov insurance because the patients don't always pay their deductibles and the reimbursement is too low to make it worthwhile.  I see hospital systems profit margins drop or even lose money over the last few years because the newly insured are just not paying their deductibles.  This is the current reality which we must accept in addition to all the positives the law has to offer.

The law needs to be revamped significantly by adding provisions that decrease cost substantially.  I do not see the republicans doing it. They seam to be discussing more cost shifting instead of cost cutting. The democrats are equally talking about more cost shifting but in the other direction and are also to blame.

OurTown

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Re: What comes after the ACA?
« Reply #2752 on: June 19, 2017, 09:54:17 AM »
My best hope is that the ACA "replacement" is so bad . . .

How bad is it?

. . . thanks.  It's so bad that the voting public in the near future will support truly universal healthcare, as in a single payer system. 

Right now, the public is about to get what they deserve because they voted for these ass-hats.

NESailor

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Re: What comes after the ACA?
« Reply #2753 on: June 19, 2017, 10:36:41 AM »




First, we don't qualify for any subsidies. Second, I made a massive spreadsheet that compared several on and off exchange HSA-compatible plans in all of the metal tiers, along with at least one non-HSA-compatible plan. This plan was the cheapest of those I evaluated assuming 1) max HSA contributions, b) full deduction of premiums on taxes and c) hitting our family out of pocket max.

It's actually a somewhat unconventional setup that, as far as I can tell from BCBSM's filings, isn't being offered again next year. We have a $4k individual / $8k family deductible and $4.5k individual / $9k family out of pocket max silver HSA plan. Next year our deductible will be a bit lower and our out of pocket max will be a little higher. We will likely have a 30-40% increase in premiums, based again on BCBSM's filings, 2/3 of which is due to the lack of enforcement for the individual mandate and the continued uncertainty of the CSR payments. Here is an overview of the data. I looked up BCBSM's filings on this website.

The ACA isn't going to get fixed.

But why not? ACA has over 50% approval and the repeal effort has less than 10%. The vast majority of the people that the ACA serves are better off with the law than without and a few small changes would make it work better for the rest. But no, of course we can't do that, because the people in Congress are beholden to interests that want it gone and not their actual constituents that benefit from the law.

And this is why I constantly return to my original song titled: "People are stupid" :D... Not you guys, that is.  Let me explain.  See what protostache did there when "shopping for insurance"?  A neat little ROI analysis with some additional risk/reward calculations.  That's what effectively shopping for insurance is.  Now, the free marketeers hail this as some sort of a cure-all approach that will get everyone better care for less money.  In fact, it will get everyone what they deserve - and not in the "this is t-ball and everyone gets a participatory medal because we're nice" kind of way either.  The free market judges stupidity much more harshly than society (or the big bad government).  Study after study is telling us that the average American cannot come up with a few hundred bucks in an emergency.  We expect these average Americans to go out and perform complicated actuarial analyses?  Hahahaha, that's cruel. 

We need someone to look after those who cannot do it themselves.  The market won't do that because it's programmed to do the opposite - take advantage of them.  Who would this be?  I know approximately half of the country hates the answer but it's right there.

So what comes after the ACA?  What we deserve.

Oh...and why won't it get fixed?  Because approximately half of the country does not understand that no ACA does not mean better care for less money.  Note - I'm not calling half of the country stupid in the previous statement.  I'm saying that those who oppose the ACA without at the same time supporting a viable alternative that improves the system - do not understand what's coming.   Fine by me either way.   But a lot of harm is getting done for short term political gain and that makes me sad.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2754 on: June 19, 2017, 10:42:38 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

I would gladly pay 20% extra if it meant that 50 million Americans would not have to suffer from chronic anxiety/fear that their next illness would leave them bankrupt. I would gladly pay 20% to ensure that people don't die unnecessarily because they can't afford the ED visit for chest Pain or because they hope their strange looking mole will "just go away." I would gladly pay 20% more if that led to less families having to decide between food money and prescription money. Go Single Payer and be done with it. Take my extra 20%, and let everyone get on with their lives/use their mental energy on more productive aspects of their existence.

JGS

EnjoyIt

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Re: What comes after the ACA?
« Reply #2755 on: June 19, 2017, 11:47:39 AM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

I would gladly pay 20% extra if it meant that 50 million Americans would not have to suffer from chronic anxiety/fear that their next illness would leave them bankrupt. I would gladly pay 20% to ensure that people don't die unnecessarily because they can't afford the ED visit for chest Pain or because they hope their strange looking mole will "just go away." I would gladly pay 20% more if that led to less families having to decide between food money and prescription money. Go Single Payer and be done with it. Take my extra 20%, and let everyone get on with their lives/use their mental energy on more productive aspects of their existence.

JGS

It sounds so easy when it is hypothetical money and 50 million are helped.  It is very different when you, yourself can't have the nice house and FIRE like you have been dreaming and your 20% at best helped helped 1 person.

AdrianC

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Re: What comes after the ACA?
« Reply #2756 on: June 19, 2017, 02:45:59 PM »
The ACA isn't going to get fixed.

But why not? ACA has over 50% approval and the repeal effort has less than 10%. The vast majority of the people that the ACA serves are better off with the law than without and a few small changes would make it work better for the rest. But no, of course we can't do that, because the people in Congress are beholden to interests that want it gone and not their actual constituents that benefit from the law.

There you go.

The Republicans are not going to save "Obamacare". They will gladly encourage a death-spiral, and are doing so.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2757 on: June 19, 2017, 06:11:06 PM »
BTW, I see a subset of the lower middle class who have seen no benefit at all.  Their cost of healthcare has stayed the same despite the partial subsidies and now the higher deductibles.   

It's not just subsidies, there are cost sharing reductions. It converts what is a silver plan into gold-plated plan with almost all the costs paid for except for small amounts.

One more time now:

There are Premium Subsidies
and there are Cost Sharing Reductions, most especially for the lower middle class, if not outright Medicaid.

sol

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Re: What comes after the ACA?
« Reply #2758 on: June 20, 2017, 12:31:16 AM »
EnjoyIt, you deserve a longer response than I can muster before bed tonight.  Rest assured that I'm not ignoring you.

We all pay for insurance one way or another. Costs are not covered through thin air.  Someone must always pay the price.

Of course we do.  And the ACA had a whole list of cost control provisions that we've previously addressed in this thread.  Should I go back and find the list for you?  They worked hard to address your concerns.

But health care costs paid to the providers aren't the only problem here, there's also the problem of making healthcare available to more people, including people who cannot afford it.  That's why we have medicaid (for the disabled and the indigent) and medicare (for the elderly) for people for whom the costs of care typically exceed their ability to pay.  Managing the ability to pay is absolutely part of the solution here, because without it lowering the costs paid to providers doesn't really help anything.  If you make $20k/year, lowering the cost of your life-saving heart surgery from $400k to $200k doesn't mean squat to you, because you're still not going to get it.  Insurance (and the ACA's associated subsidies) are the mechanism to get more people access to care.

I understand the concern of wealthy white Americans, who can already afford care and do not like seeing their costs go up.  I understand why those folks are unhappy, and I recognize their concerns.  I just don't think they are as important as the concerns of tens of millions of Americans for whom basic medical care was previously unavailable.  Health insurance subsidies are absolutely a necessary part of the solution.

Quote
ACA brought customers into sporadic networks of poor coverage.

Yes, sporadic networks that already existed and were offered more customers by the ACA, in attempt to shore them up.  It didn't work in all places, because the ACA wasn't sufficient to make it profitable for anyone to provide comprehensive healthcare in places where there are almost no people  There's a clear reason why populous states have functioning markets and low population states (like Alaska) do not, and it doesn't have anything to do with the ACA.

Quote
 
It is the reason why people did not get to keep their doctors as promised.

No, the ACA is in no way related to which doctors left which provider networks.  That process has always happened.  The ACA did not make it better or worse.  I consider it a PR disaster that Obama said "You can keep your doctor" instead of "The ACA will not change your doctor" because NOBODY has been able to keep their doctor, ever.  That has never been a guarantee of any health insurance plan.  That quote made it sound like the ACA was going to somehow bind doctors to health plans, which was never going to happen.   The only way to "guarantee" that is to nationalize healthcare and have a single nationwide health plan.  And even the, some doctors will retire or die on the job, and those patients will lose their doctor.

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Because the market place is so unstable people are forced into changing coverage every year and therefor changing doctors every year.

The individual market has always been unstable.  The ACA didn't make it any worse, anyway, unless you consider establishing health exchanges so that it was easier for people to find cheaper insurance to be "making it worse".

Quote
Yes, having minimum standards has helped some, but not everyone wants prescription coverage or is willing to pay extra to have it.

Sure, and not everyone wants cancer coverage or pregnancy coverage or ambulance coverage.  But the nature of health insurance is that it covers costs you cannot forsee, and if you get cancer or pregnant or need prescription drugs, and you didn't have insurance, then you're going to get treated and the rest of us are going to pay for you costs because you're a freeloader.  The minimum coverage requirements were specifically targeted at freeloaders who wanted full coverage treatment at tiny coverage prices.  They forced everyone to pay for the care they were going to get anyway.

Quote
For example, I do not need prenatal care, nor does my 62 year old mother.

You also don't need cancer coverage, until you do.  The nature of health insurance is to pool risk.  You don't get to pick which features you want to pay for.  If you did, we would all just pay for exactly what care we actually needed, which is the same as nobody having insurance at all.  That's just fee for service.

Quote
Ohh, and anyone buying health insurance from the market place has had price increases in the 100-300% range.

Technically, nationwide health insurance costs were rising more slowly than before the ACA passed, until Congress started fucking with it by yanking the funding and encouraging people to bail.  Yes, costs have gone up for health insurance.  Also food, energy, houses, and cars.  Welcome to economics!

Quote
I think you may have misread me.  I never said everyone wants the ACA dismantled, only those that have been harmed by it.

That's fair enough.  Some people live in states where the individual health insurance market was previously a disaster, and it has not gotten notably better with the ACA, and so I understand why they want to try something different. 

Quote
Sol, please read this and if you can answer my questions

more tomorrow.   must sleep.


DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2759 on: June 20, 2017, 06:35:40 AM »
First, we don't qualify for any subsidies. Second, I made a massive spreadsheet that compared several on and off exchange HSA-compatible plans in all of the metal tiers, along with at least one non-HSA-compatible plan. This plan was the cheapest of those I evaluated assuming 1) max HSA contributions, b) full deduction of premiums on taxes and c) hitting our family out of pocket max.

It's actually a somewhat unconventional setup that, as far as I can tell from BCBSM's filings, isn't being offered again next year. We have a $4k individual / $8k family deductible and $4.5k individual / $9k family out of pocket max silver HSA plan. Next year our deductible will be a bit lower and our out of pocket max will be a little higher. We will likely have a 30-40% increase in premiums, based again on BCBSM's filings, 2/3 of which is due to the lack of enforcement for the individual mandate and the continued uncertainty of the CSR payments. Here is an overview of the data. I looked up BCBSM's filings on this website.



Ok thank you for sharing your thinking on this. I wish the premium subsidies were expanded, that would be a fix that a rational Congress could do.

When I first thought about getting insurance through the marketplace back in late 2014 I also found the insurance rates were double what I was already paying on my individual health insurance I got on my own. My insurance plan was grandfathered in for 2015. But then in early 2016 after sleuthing around MMM forums, the Gocurrycracker blog, and the internet I discovered how to lower my AGI on my self-employed income through the solo 401k. Moreover in 2016 my health insurance provider wanted to increase my premiums by 30%, so this spurred me to look again at the ACA marketplace and I realized I could now qualify for subsidies. Additionally, I recharacterized a Roth contribution as a traditional IRA contribution and between this and the solo 401k, the HSA, and the 457 that really lowered my AGI, suddenly my premiums after subsidies were very very affordable.
« Last Edit: June 20, 2017, 06:58:35 AM by DavidAnnArbor »

Bateaux

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Re: What comes after the ACA?
« Reply #2760 on: June 20, 2017, 06:46:05 AM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.
“Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.”
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Class of 2019

NESailor

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Re: What comes after the ACA?
« Reply #2761 on: June 20, 2017, 08:13:17 AM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.

Run for office and what...lose?  The nation may need a reality check.  The nations does not want a reality check.  We are a nation dominated by impulses and wants, not needs, not yet anyway.

Bucksandreds

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Re: What comes after the ACA?
« Reply #2762 on: June 20, 2017, 09:04:19 AM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.

I've said something similar before. If Sol ran for president I would pull a 1960's JFK thing and vote as like 5,000 different dead people. Just kidding, but he'd have my vote.

sol

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Re: What comes after the ACA?
« Reply #2763 on: June 20, 2017, 09:40:37 AM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.

I've said something similar before. If Sol ran for president I would pull a 1960's JFK thing and vote as like 5,000 different dead people. Just kidding, but he'd have my vote.

How about I start a blog instead?

I like to write, and sometimes I feel like people agree with the things I write (half of this thread not withstanding) in a way that suggests a wider audience might also find something worthwhile or agreeable.  And I'm pretty sure that I already generate approximately 10 times as much content for MMM as MMM himself does, these days.

Gin1984

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Re: What comes after the ACA?
« Reply #2764 on: June 20, 2017, 11:59:45 AM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.

Run for office and what...lose?  The nation may need a reality check.  The nations does not want a reality check.  We are a nation dominated by impulses and wants, not needs, not yet anyway.
I agree with NESailor.  Part of the reason people did not vote for Clinton is that she was honest that single payer and $15/hr were not possible right now.  People don't like politicians who are honest with them.

protostache

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Re: What comes after the ACA?
« Reply #2765 on: June 20, 2017, 01:02:45 PM »
Ok thank you for sharing your thinking on this. I wish the premium subsidies were expanded, that would be a fix that a rational Congress could do.

When I first thought about getting insurance through the marketplace back in late 2014 I also found the insurance rates were double what I was already paying on my individual health insurance I got on my own. My insurance plan was grandfathered in for 2015. But then in early 2016 after sleuthing around MMM forums, the Gocurrycracker blog, and the internet I discovered how to lower my AGI on my self-employed income through the solo 401k. Moreover in 2016 my health insurance provider wanted to increase my premiums by 30%, so this spurred me to look again at the ACA marketplace and I realized I could now qualify for subsidies. Additionally, I recharacterized a Roth contribution as a traditional IRA contribution and between this and the solo 401k, the HSA, and the 457 that really lowered my AGI, suddenly my premiums after subsidies were very very affordable.

Glad to help. Regarding the bolded bit, we do use a solo 401K with our S-corp LLC, but the math is such that we'd have to raise my salary so much in order to defer enough into the 401K to qualify for subsidies that the increased SE taxes would mostly cancel out the benefit of the subsides.

We have a Section 125 HRA plan in addition to our 401K that allows us to effectively deduct all of our medical expenses above the line. We contribute the max to our HSA and then we write off our medical, dental, and vision expenses above the minimum HSA-compatible deductible ($2,600 per family), which means we effectively double dip on $4,150 of that HSA contribution. That sort of makes up for some of the lack of subsidies.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #2766 on: June 20, 2017, 01:42:36 PM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

I would gladly pay 20% extra if it meant that 50 million Americans would not have to suffer from chronic anxiety/fear that their next illness would leave them bankrupt. I would gladly pay 20% to ensure that people don't die unnecessarily because they can't afford the ED visit for chest Pain or because they hope their strange looking mole will "just go away." I would gladly pay 20% more if that led to less families having to decide between food money and prescription money. Go Single Payer and be done with it. Take my extra 20%, and let everyone get on with their lives/use their mental energy on more productive aspects of their existence.

JGS

It sounds so easy when it is hypothetical money and 50 million are helped.  It is very different when you, yourself can't have the nice house and FIRE like you have been dreaming and your 20% at best helped helped 1 person.


Actually, it's 270 million people hoping to cover the last 50 million uninsured . it's the same way we fund public schools, roads, police stations , and even our federal government , not to mention the department of defense.  I don't understand why fire protection, which can kill or impoverish an entire family , is any more important than healthcare, which can kill or impoverish an entire family.

brooklynguy

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Re: What comes after the ACA?
« Reply #2767 on: June 20, 2017, 01:47:54 PM »
McConnell has confirmed that a draft of the Senate bill will be made public on Thursday.  I'm most curious to see how (or whether) it addresses the House version's restriction on using tax credits towards insurance plans that cover abortions and the defunding of Planned Parenthood, which are the aspects of the bill that have probably received the least attention yet, in my view, have the most potential to make or break it.

How about I start a blog instead?

Please do.  We await its publication with bated breath.

suds

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Re: What comes after the ACA?
« Reply #2768 on: June 20, 2017, 05:44:55 PM »
Sol you response to Enjoyit was exactly what our congress should be telling us.   The nation needs a reality check and honesty without all the political hype.  Please run for office.

Run for office and what...lose?  The nation may need a reality check.  The nations does not want a reality check.  We are a nation dominated by impulses and wants, not needs, not yet anyway.
I agree with NESailor.  Part of the reason people did not vote for Clinton is that she was honest that single payer and $15/hr were not possible right now.  People don't like politicians who are honest with them.

I am sorry, but I do not agree with the bolded statement. Do you have any sources? I think Clinton lost votes for a lot of reasons, but she is not renouned for her honesty on either side.....

I, too, think Sol should run. Or blog.

To keep this on track, looks like the GOP might be loosing a seat today.... http://www.bbc.com/news/world-us-canada-40340081

Bucksandreds

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Re: What comes after the ACA?
« Reply #2769 on: June 20, 2017, 05:53:19 PM »
I am not outraged. I am simply showing how some people may dislike what the ACA has to offer.

Just picture your own life and imagine some law coming through and taking away 10% extra next year. How would you feel?

I would gladly pay 20% extra if it meant that 50 million Americans would not have to suffer from chronic anxiety/fear that their next illness would leave them bankrupt. I would gladly pay 20% to ensure that people don't die unnecessarily because they can't afford the ED visit for chest Pain or because they hope their strange looking mole will "just go away." I would gladly pay 20% more if that led to less families having to decide between food money and prescription money. Go Single Payer and be done with it. Take my extra 20%, and let everyone get on with their lives/use their mental energy on more productive aspects of their existence.

JGS

It sounds so easy when it is hypothetical money and 50 million are helped.  It is very different when you, yourself can't have the nice house and FIRE like you have been dreaming and your 20% at best helped helped 1 person.


Actually, it's 270 million people hoping to cover the last 50 million uninsured . it's the same way we fund public schools, roads, police stations , and even our federal government , not to mention the department of defense.  I don't understand why fire protection, which can kill or impoverish an entire family , is any more important than healthcare, which can kill or impoverish an entire family.

It's obvious Enjoyit is only 'in it' for direct benefit for himself. Don't waste your time arguing with the morally corrupt.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2770 on: June 20, 2017, 06:49:46 PM »
This writer/blogger has done serious research into the ACA, and has updated his critique of the AHCA.

https://t.co/lWxd029APj


sol

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Re: What comes after the ACA?
« Reply #2771 on: June 20, 2017, 09:14:57 PM »
Okay, part two of his reply...

Try answering these questions:
1) Can you agree that just because someone has health insurance does not mean that they can still afford their deductible, and having health insurance vs having no insurance changes nothing regarding their ability to afford healthcare? No benefit or harm of ACA

Sure, this is the corollary to our discussion above.  Health insurance you can't afford isn't really any good to anyone, just like procedures that are too expensive aren't really any good to anyone, even if you've reduced the price of insurance or reduced the price of the procedure.

But the ACA did make insurance more affordable, for most people.  I say "most" because it specifically helped poor people, and there are lots of those, and it did it by increasing the costs for rich people, and there are fewer of those.  Of COURSE the rich people don't like it.  But the rich people had insurance before and they still have (effectively more expensive) health insurance now, so really their only complaint is a financial one.  Meanwhile, lots of poor people literally had their lives saved.  I'm for it.

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2) Can you agree that some people who had no health insurance can get partial subsidies, but still can't afford their deductibles and now are mandated to pay for an insurance that provides no benefit, but still can't afford the care because their subsidies are so high?

Is there a typo in this question? 

I agree that some people get subsidies to make health insurance more affordable than it was before, but still don't buy health insurance.  Is it affordable for them?  That kind of depends on what their priorities are.  The subsidies are income-capped so that you theoretically have a relatively fixed amount of money to live on, at which point your insurance is free, and as your income rises they take ever larger portions of that extra income to pay for the insurance, like a steep marginal tax rate.  It's designed to be affordable, but we all know that you can be flat broke on $100k/year if you're bad with money.  Lots of people who are both poor and bad with money, and who could get outstanding insurance for minimal cost, will not be able to afford that cost if it is more than zero.

To the second part of your question, no I don't agree that anyone was mandated to buy insurance.  People are offered subsidized insurance (if they are under 400% FPL), and they were issued a slowly phased-in tax penalty for declining that coverage.  Lots of people declined.  This is just like the 10% early withdrawal penalty on your 401k, it's not "forbidden" it's just taxed extra.  In some circumstances, the smart financial move is to pay the tax in order to do what you want to do.  Government incentives are rarely truly "mandates".

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3) Can you agree that many Americans had to change their doctors because their new mandated health plan is not taken by their physician?

The ACA doesn't control what doctors decide to do.  If your doctor decides to decline an insurance company, you probably can't blame Congress for that decision.

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4) Can you agree that some physicians refuse to accept healthcare.gov insurances because they are concerned they will not get paid because of the high deductible?

I've never even thought about it.  Do doctors seriously consider denying treatment to a patient if they don't like the way their insurance deductible is structured?  That's pretty shitty.

And to be clear, the deductibles on the ACA plans here aren't any higher than the deductibles on employer-sponsored plans of the same cost, meaning virtually nil if you have expensive premiums and several thousand dollars if you have cheap premiums.  That's how insurance works.

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5) Can you agree that a family of 3 making $110k/yr is now paying significantly more for healthcare compared to pre ACA passage?

No, at least not until this year when the Republicans started monkeying with the ACA.  Unsubsidized insurance on the individual market was always expensive, even before the ACA.  Costs went down for millions of people who live under the 400% FPL when the ACA was passed.  Costs for everyone else continued to grow at rates that were about what they were before the ACA was passed, slightly slower at first and now slightly faster more recently.

I guess you can argue they are paying more because their premiums have continued to go up, as they have always gone up over time.  That's not because of the ACA, though, unless you're blaming the ACA for not doing enough to lower costs.  I'm not sure you can blame a law for doing something if the law was specifially designed to stop that same thing, but was only partly effective.

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6) Can you agree that a man or a women over 45 does not require prenatal care covered through their health insurance and having it does not make their insurance better?

They may not need it, but it does make their insurance better.  Their insurance policy isn't written for just them individually.  I also don't need an annual ob-gyn visit, but my insurance still covers it because I'm part of a risk pool that applies to a million employees and some of them do need it.  It also covers allergy testing, even though I don't have allergies.  That's the point of insurance plans, they collective the risks of an entire population of people, and therefore they have to cover everyone's needs.

Otherwise, we could make insurance cheaper by excluding fat people from buying it, and not covering diabetes treatments.  We could exclude women from buying it, and it would be cheaper for not covering pregnancy, and we could exclude old people from buying it and not cover Alzheimer's.  The remaining insurance would be super cheap!  For healthy young men!  Because healthy young men don't have healthcare costs!  Meanwhile, women would pay more and the elderly would pay more and the obese would pay more, and the insurance company would spend the same amount of money treating it all but they would have a harder finding customers because tons of old/fat/female people wouldn't be able to afford their remaining insurance.  This situation is not better for anyone!

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Should we induce 1 tax payer to have unaffordable healthcare so that 1 non taxpayer can have affordable healthcare?  What about 1 tax payer suffer to benefit 10 non tax payers?  What 10 tax payers suffer to help one non tax payer?  Obviously life is not so black and white, but the concept is very important.

Is the concept "Should Americans take care of each other?"  Because in that case, I think the answer is yes.  Yes, American taxpayers should make monthly disability payments to people who are born mentally handicapped.  Yes, American taxpayers should send veteran's benefits checks to our dying WWII vets who live in rent-controlled apartments.  Yes, American taxpayers should provide health school lunches to kids from poor neighborhoods who don't get enough to eat at home.

This is what Americans do, we take care of each other.  Some of us are unlucky, and needy, and deserve a helping hand.  Some of us (like me!  and you!) are lucky, and stupidly wealthy, and they deserve to have some of that wealth reclaimed and used to support the unlucky ones.  This is the American social contract.  If you come to America and become an American citizen, and life in America shits on you, then America will help you.  If you come to America and become and American citizen, and life in America showers you with riches, America will take some of that wealth back. 

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Sol, why is it that you simply can't come to terms that the ACA is not perfect, has harmed a percentage of taxpayers and the law needs improvement on.

I don't need to come to terms, I'm way ahead of you on this one.  I have not only recognized that the ACA has harmed some people (and helped many more others, which is the part you seem to be struggling with), I have identified who is in each group and estimated the cost/benefit of that exchange.  I find the whole thing broadly positive for America, though bad for me personally.

And I think I'm also way ahead of you on the needed improvements.  In the 56 pages of this thread we have identified specific problems with the ACA, and specific improved fixes for those problems, and specific alternatives to the ACA that we all seem to agree would be better, and a bunch of (GOP draft legislation) specific alternatives to the ACA that seem kind of counterproductive.  That's why I started this thread in the first place, to discuss these kinds of specifics. 

Personally, the longer we talk about this issue the more convinced I have become that a single payer healthcare system would offer Americans better coverage at lower cost than does our current public-private hybrid system.  We tried the free market approach and it failed us.  Then we tried the conservative's hybrid approach, and it was better but not as good as we had hoped.  Every other western democracy (okay there are only 11 of them) in the world has some form of taxpayer supported universal healthcare, and every single one costs less than the American system for better outcomes. 
« Last Edit: June 20, 2017, 09:20:00 PM by sol »

fuzzy math

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Re: What comes after the ACA?
« Reply #2772 on: June 21, 2017, 09:48:38 AM »
Quote
Should we induce 1 tax payer to have unaffordable healthcare so that 1 non taxpayer can have affordable healthcare?  What about 1 tax payer suffer to benefit 10 non tax payers?  What 10 tax payers suffer to help one non tax payer?  Obviously life is not so black and white, but the concept is very important.

There seems to be a misunderstanding by EnjoyIt, possibly fed by certain cable news companies. There are very few people in this country who "don't pay taxes". There have been numerous papers, articles etc written showing that even the poorest amongst us - those who do not make enough to owe federal income taxes - pay taxes in other ways. These other methods often come up to an equal percentage or more of their small incomes. I will list them here now: payroll tax, social security tax, Medicare tax, state income tax, gas tax, local sales tax (many states often taxing food, which is frequently the highest cost amongst the poor),  vehicle registration fees, alcohol/cigarettes/lotto tix (which they are more likely to purchase than wealthier ppl).

I will now link you to one of these articles, so that you may enlighten yourself and quit using false information to boost your POV.
https://mobile.nytimes.com/2015/01/14/business/local-taxes-hit-lower-wage-earners-harder-study-finds.html?smid=fb-share&_r=0&referrer=
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Re: What comes after the ACA?
« Reply #2773 on: June 21, 2017, 11:31:43 AM »
Quote
Should we induce 1 tax payer to have unaffordable healthcare so that 1 non taxpayer can have affordable healthcare?  What about 1 tax payer suffer to benefit 10 non tax payers?  What 10 tax payers suffer to help one non tax payer?  Obviously life is not so black and white, but the concept is very important.
[/quote]

This is a fundamental concept with taxation - those that earn more pay more in taxes.  It isn't simply limited to healthcare insurance.  Compare a doctor who pays $40k in federal taxes to a teacher who pays $4k in federal taxes.  The doctor will pay 10x as much for the military, and for science programs and towards the education department.

fuzzy math already tackled the 'myth of the non-taxpayer,' but the amount one pays in taxes has never been an appropriate standard. Someone who is unemployed is equally entitled to drive on the freeway, be protected by the police, have a functional electric grid, etc
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AdrianC

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Re: What comes after the ACA?
« Reply #2774 on: June 21, 2017, 11:42:32 AM »
I don't need to come to terms, I'm way ahead of you on this one.  I have not only recognized that the ACA has harmed some people (and helped many more others, which is the part you seem to be struggling with), I have identified who is in each group and estimated the cost/benefit of that exchange.  I find the whole thing broadly positive for America, though bad for me personally.

How has the ACA been bad for you personally, if you don't mind me asking.

Paul der Krake

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Re: What comes after the ACA?
« Reply #2775 on: June 21, 2017, 02:04:06 PM »
Quote
Should we induce 1 tax payer to have unaffordable healthcare so that 1 non taxpayer can have affordable healthcare?  What about 1 tax payer suffer to benefit 10 non tax payers?  What 10 tax payers suffer to help one non tax payer?  Obviously life is not so black and white, but the concept is very important.

There seems to be a misunderstanding by EnjoyIt, possibly fed by certain cable news companies. There are very few people in this country who "don't pay taxes". There have been numerous papers, articles etc written showing that even the poorest amongst us - those who do not make enough to owe federal income taxes - pay taxes in other ways. These other methods often come up to an equal percentage or more of their small incomes. I will list them here now: payroll tax, social security tax, Medicare tax, state income tax, gas tax, local sales tax (many states often taxing food, which is frequently the highest cost amongst the poor),  vehicle registration fees, alcohol/cigarettes/lotto tix (which they are more likely to purchase than wealthier ppl).

I will now link you to one of these articles, so that you may enlighten yourself and quit using false information to boost your POV.
https://mobile.nytimes.com/2015/01/14/business/local-taxes-hit-lower-wage-earners-harder-study-finds.html?smid=fb-share&_r=0&referrer=
The report quoted in that article puts Washington at the top of the list for tax regressivity, and is quoted every week like clockwork in the Seattle Times. And while they are right that Washington does have a regressive tax system, the 16% of income going to taxes if you're poor is BS. Sales tax is 10%, and non-prepared food is 0%. The only way you can get to 16% is if you spend most of your money on things that are subject to high excise taxes like booze and gasoline, or you start doing some really questionable accounting and counting things like "imputed tax from renting". It's cool that they get people thinking about their total tax burden, but it's intellectually dishonest to count things like imputed taxes from renting, but not the 35% corporate tax paid by business owners indirectly.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2776 on: June 21, 2017, 05:30:18 PM »
Sol,
Thanks for replying.  I think we agree on more than we disagree.  We agree that the ACA has helped a substantial pool of poor Americans and those with preexisting conditions.  We also agree that the cost of healthcare needs to decrease but I don't think we have come to an agreeable solution on how. We agree that some people have been harmed by the ACA but not on the demographic of who those people are.

We disagree on the word rich.  I think you use it as a blanket statement on people of a certain income level without actually giving it a physical number.  Either way, there is definitely a subset of middle class Americans who pay a lot more for healthcare now making it unaffordable to them while making it more affordable to those who pay no taxes.  You keep saying they don't exist and I tell you I meet them regularly. Yesterday I met a family who is paying $2400 a month for healthcare.  They are in their mid 50s and now can't afford to save for retirement.  This couple is definitely hurt by the law.  I have no idea what their income is, or their other expenses, but that is the reality they describe to me.  I also meet people in the lower middle class who used to be able to afford health insurance but because prices are so high and deductibles are so high, the cost is now too much to bear despite having subsidies.  These people are not hypotheticals.  They are real human beings who have been harmed by the law.

You mentioned
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Do doctors seriously consider denying treatment to a patient if they don't like the way their insurance deductible is structured?  That's pretty shitty.

Many Healthcare.gov insurance plans pay medicaid rates. Medicaid is anywhere between 80-90% of the cost of taking care of the patient. Therefor those patients are unprofitable and if a doctor's practice is full of them, they go out of business and then treat nobody.  Also ACA has deductibles that patients are not willing to pay which makes the care free and doctors can not sustain a practice when they can't afford to keep the lights on and pay their staff. It isn't shitty, it is economics.

Healthcare cost has been rising higher than inflation for decades.  Premiums have gone up by double digits but the ACA plans have skyrocketed for some middle class taxpayers by 200-300%.  A far cry of the 10-20% increases of years past.  Not only that, those increases came with higher deductibles making it even more expensive than just the premium increase.

Insurances change their healthcare.gov plans yearly which is why patients are forced to which plans and they losing their doctors. Prior to the ACA I had the same doctor for about 5 years.  Since the ACA I have been forced to change plans and therefor doctors on a yearly basis.  Here is the map how many areas have only 1 or 2 insurance providers.  They are not only in small town areas.  Big cities have the same problem as well. https://www.nytimes.com/2016/08/20/upshot/obamacare-options-in-many-parts-of-country-only-one-insurer-will-remain.html This is 2016.  I'm sure it looks even worse now. You can blame it on the GOP, but I believe it is more a problem with the unrealistic expectations of the plan.

You may be right that single payer is the solution, I don't fully accept that since all it will do is shift cost as opposed to decrease the cost.  Remember even Medicare uses private insurance companies to manage some regions. Cost may come down some, but not enough to make a real difference.  Healthcare is expensive and cost shifting will not make it any cheaper.  Even those countries with socialized healthcare are currently struggling with cost. I honestly hope the California single payer initiative goes through to see if the government can do a better job than the highly regulated and corrupt private market is currently doing.

Here is where we really disagree:
I do not think it is fair to financially ruin 1 tax payer in favor of helping 1 non taxpayer. There is a line and for some Americans that line has been crossed.  I think if that American was you, then you would be pretty pissed at the system.  While at the same time prior to the ACA if you were the American that was ruined by huge healthcare costs you would be pissed and want to do anything possible to keep the law.  I understand both sides. In my opinion the only way to fix the problem is not cost shifting but instead making healthcare more affordable for every American, not just the rich, the very poor and the lower middle class.

AdrianC

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Re: What comes after the ACA?
« Reply #2777 on: June 21, 2017, 05:37:48 PM »
Senate Bill draft is out:

https://www.washingtonpost.com/powerpost/senate-health-care-draft-repeals-obamacare-taxes-provides-bigger-subsidies-for-low-income-americans-than-house-bill/2017/06/21/3f2226ee-56bd-11e7-ba90-f5875b7d1876_story.html?utm_term=.7b582704011a

The bill largely mirrors the House measure that narrowly passed last month but with some significant changes. While the House legislation pegged federal insurance subsidies to age, the Senate bill would link them to income as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally-subsidized health plans from covering abortions, which may have run afoul of complex budget rules.



EnjoyIt

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Re: What comes after the ACA?
« Reply #2778 on: June 21, 2017, 05:38:10 PM »

It's obvious Enjoyit is only 'in it' for direct benefit for himself. Don't waste your time arguing with the morally corrupt.


Using insults are a last ditch effort of those with nothing of value to add.  Often times they use insults like immoral or racist to stifle the freedom of speech from those they disagree with.  Congrats for identifying yourself.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2779 on: June 21, 2017, 05:43:40 PM »
Senate Bill draft is out:

https://www.washingtonpost.com/powerpost/senate-health-care-draft-repeals-obamacare-taxes-provides-bigger-subsidies-for-low-income-americans-than-house-bill/2017/06/21/3f2226ee-56bd-11e7-ba90-f5875b7d1876_story.html?utm_term=.7b582704011a

The bill largely mirrors the House measure that narrowly passed last month but with some significant changes. While the House legislation pegged federal insurance subsidies to age, the Senate bill would link them to income as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally-subsidized health plans from covering abortions, which may have run afoul of complex budget rules.


Based on this article, it is hard to tell if pre-existing conditions will still be covered under this law. I would be strongly against it if that was the case and hope it isn't so. I'm looking forward to reading more info as it becomes available.

fuzzy math

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Re: What comes after the ACA?
« Reply #2780 on: June 21, 2017, 06:25:37 PM »
Senate Bill draft is out:

https://www.washingtonpost.com/powerpost/senate-health-care-draft-repeals-obamacare-taxes-provides-bigger-subsidies-for-low-income-americans-than-house-bill/2017/06/21/3f2226ee-56bd-11e7-ba90-f5875b7d1876_story.html?utm_term=.7b582704011a

The bill largely mirrors the House measure that narrowly passed last month but with some significant changes. While the House legislation pegged federal insurance subsidies to age, the Senate bill would link them to income as the ACA does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally-subsidized health plans from covering abortions, which may have run afoul of complex budget rules.


Hot damn it's out!!! I honestly believed we wouldn't see it before the vote. I had seen news articles claiming a vote could come Thurs so I will not hold my breath that there is still essentially 0 time for debate on it.
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Bucksandreds

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Re: What comes after the ACA?
« Reply #2781 on: June 21, 2017, 06:50:56 PM »

It's obvious Enjoyit is only 'in it' for direct benefit for himself. Don't waste your time arguing with the morally corrupt.


Using insults are a last ditch effort of those with nothing of value to add.  Often times they use insults like immoral or racist to stifle the freedom of speech from those they disagree with.  Congrats for identifying yourself.

Normally I would get upset and defensively respond but when it comes to dealing with you I'm already wasting my time typing this back to you so, you win.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2782 on: June 21, 2017, 07:08:10 PM »
The Senate bill is somewhat better than the House version based on that Washington Post article. Nonetheless, the effects on Medicaid would eventually become very negative.
I'm not sure why they just don't continue the cost-sharing indefinitely, why does it just have to be for 2018 and 2019?

Honestly I don't see conservative Republicans in the House supporting the Senate version. I really don't understand how the Republicans are going to finally get this through.

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Re: What comes after the ACA?
« Reply #2783 on: June 21, 2017, 08:01:25 PM »
The Senate bill is somewhat better than the House version based on that Washington Post article. Nonetheless, the effects on Medicaid would eventually become very negative.
I'm not sure why they just don't continue the cost-sharing indefinitely, why does it just have to be for 2018 and 2019?

Honestly I don't see conservative Republicans in the House supporting the Senate version. I really don't understand how the Republicans are going to finally get this through.
1) it's only been a few hours, not enough time for ample analysis to come out.  Expect a lot more details to emerge in the next 48 hours
2) re: why is cost sharing only for 2018-2019?  Simple: elections. They're betting they can stave off a lot of pissed off people for another election cycle.
3) regarding passage:  we'll see.  Fiscal hawks will support it because it costs less than the ACA, which is ultimately what they care about (not total # covered)
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sol

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Re: What comes after the ACA?
« Reply #2784 on: June 21, 2017, 10:55:12 PM »
Details of the Senate bill released this afternoon are still coming into focus, but in broad strokes it looks just like the House monstrosity, with slightly different coloring around the edges.  More Tea Partyish coloring.

1.  It's still primarily a giant tax cut for the wealthy paid for by killing Medicaid.  In fact, it cuts Medicaid even more harshly than the House version did.  They also proposed delaying the Medicaid cuts until after the next election, though, because they're politically craven.

2.  It still repeals all of the ACA's consumer protections, allowing state's to offer basically any form of garbage insurance they want to.  It's not yet clear if this includes allowing states to deny coverage to people with pre-existing conditions; Republicans are saying publicly that they didn't go that far, because you know that would be crazy, but the text of the bill seems to suggest that they did, in fact, go that far. 

3.  They reduced the ACA's premium subsidies, both in terms of dollar amounts and eligibility criteria, so that fewer people will get subsidized insurance and those who do get it will pay more for it.  Unlike the House bill, the subsidies will be tied to income instead of age.  Like the ACA already is, so this feels like a benefit cut, but not really a repeal.

4. Yes, it kills funding for Planned Parenthood.  Because it seems conservatives can't do anything these days without also trying to sneak in some restrictions on abortion access or women's health services.  It's a healthcare bill!

I fail to see how this keeps any of the promises Trump made about better coverage for everyone.  This is still going to take insurance away from tens of millions of people, raise costs for everyone else, and use the savings to give tax breaks to millionaires.  In fact, they repealed every single ACA tax except the one that hits Democrats the hardest (through labor unions): the Cadillac tax on super-fancy health insurance plans.  They kept that one, because it takes money away from Democrats that they can then give to Republicans as a tax break.  Sometimes I think the entire Republican party only exists for the sole purpose of consolidating wealth (and thus power) in the hands of rich white men. 

I'm pretty disgusted right now, as the Senate health care bill is worse than I ever thought possible.  Not only did they fail to moderate that POS House bill, they actually made it worse.  It looks like it's an even more radical right wing proposal than what came out of the Freedom Caucus over in the House of Representatives. They should just call it the "Fuck Poor People Law of 2017 hahaha liberals suck!" and they'd get every GOP congressperson to sign on. 

I bet they'll have a big press conference celebrating when this thing passes, and Trump will look right at the camera and say "We did it!  With the passage of this bill we've finally destroyed the last vestige of human decency in the US government!  To all of you hard working blue collar Americans out there who voted for me because I promised to fix health care, whoops!  I ruined it instead, and you're still going to vote for me in 2022, you fucking idiots!  See you on the campaign trail!"

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Re: What comes after the ACA?
« Reply #2785 on: June 22, 2017, 07:34:56 AM »
Details of the Senate bill released this afternoon are still coming into focus, but in broad strokes it looks just like the House monstrosity, with slightly different coloring around the edges.  More Tea Partyish coloring.

1.  It's still primarily a giant tax cut for the wealthy paid for by killing Medicaid.  In fact, it cuts Medicaid even more harshly than the House version did.  They also proposed delaying the Medicaid cuts until after the next election, though, because they're politically craven.

2.  It still repeals all of the ACA's consumer protections, allowing state's to offer basically any form of garbage insurance they want to.  It's not yet clear if this includes allowing states to deny coverage to people with pre-existing conditions; Republicans are saying publicly that they didn't go that far, because you know that would be crazy, but the text of the bill seems to suggest that they did, in fact, go that far. 

3.  They reduced the ACA's premium subsidies, both in terms of dollar amounts and eligibility criteria, so that fewer people will get subsidized insurance and those who do get it will pay more for it.  Unlike the House bill, the subsidies will be tied to income instead of age.  Like the ACA already is, so this feels like a benefit cut, but not really a repeal.

4. Yes, it kills funding for Planned Parenthood.  Because it seems conservatives can't do anything these days without also trying to sneak in some restrictions on abortion access or women's health services.  It's a healthcare bill!

I fail to see how this keeps any of the promises Trump made about better coverage for everyone.  This is still going to take insurance away from tens of millions of people, raise costs for everyone else, and use the savings to give tax breaks to millionaires.  In fact, they repealed every single ACA tax except the one that hits Democrats the hardest (through labor unions): the Cadillac tax on super-fancy health insurance plans.  They kept that one, because it takes money away from Democrats that they can then give to Republicans as a tax break.  Sometimes I think the entire Republican party only exists for the sole purpose of consolidating wealth (and thus power) in the hands of rich white men. 

I'm pretty disgusted right now, as the Senate health care bill is worse than I ever thought possible.  Not only did they fail to moderate that POS House bill, they actually made it worse.  It looks like it's an even more radical right wing proposal than what came out of the Freedom Caucus over in the House of Representatives. They should just call it the "Fuck Poor People Law of 2017 hahaha liberals suck!" and they'd get every GOP congressperson to sign on. 

I bet they'll have a big press conference celebrating when this thing passes, and Trump will look right at the camera and say "We did it!  With the passage of this bill we've finally destroyed the last vestige of human decency in the US government!  To all of you hard working blue collar Americans out there who voted for me because I promised to fix health care, whoops!  I ruined it instead, and you're still going to vote for me in 2022, you fucking idiots!  See you on the campaign trail!"

I think number one is the reason for every baffling idea the GOP ever has put forward about health care 'reform' in the past 20 years. Fundamentally, most members of the GOP just don't give a shit about health care access (deep down, a lot of conservatives feel that poor people are garbage people and deserve whatever misery they get...my father and his entire family, who are a mix of conservative and libertarian, talk this way).

Also, the GOP doesn't really care about cutting costs of healthcare, except that it would allow them to cut taxes for the wealthy.

Basically, with most GOP-proposed legislation, the underlying principle is cutting taxes rather than whatever the legislation is supposed to be about. Because that appears to be the only thing other than gun rights that unites the GOP any more.

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Re: What comes after the ACA?
« Reply #2786 on: June 22, 2017, 08:00:18 AM »

Quote
1.  It's still primarily a giant tax cut for the wealthy paid for by killing Medicaid.  In fact, it cuts Medicaid even more harshly than the House version did.  They also proposed delaying the Medicaid cuts until after the next election, though, because they're politically craven.
I think number one is the reason for every baffling idea the GOP ever has put forward about health care 'reform' in the past 20 years. Fundamentally, most members of the GOP just don't give a shit about health care access (deep down, a lot of conservatives feel that poor people are garbage people and deserve whatever misery they get...my father and his entire family, who are a mix of conservative and libertarian, talk this way).
Or, to put it another way, many in the GOP see being poor as a moral failing - the result of an endless series of individual choices. There's a widespread sentiment that you cannot permanently lift poor people out of poverty; once the program ends they'll just slip back down again. These beliefs manifest themselves in the rhetoric and stigma surrounding food stamps, 'welfare-queens' and subsidized housing.
Ironically, they also passionately argue that middle-class families (particularly the upper-middle) are being held back from becoming truly wealthy because their well is being transferred to the poor through government subsides. There the argument goes that if only we could only eliminate or reduce these programs the middle class would suddenly be wealthy because thye'd get to keep a great deal more of "their" money.  And of course the wealthy are viewed as the patrons and economic engines of everything; give the rich a taxbreak and it'll be passed to all hardworking Americans (the basic tenant of trickle-down economics).

tl/dr: the poor don't deserve benefits, the middle-class shouldn't support them and the rich need less taxes to generate job growth.
"Do not confuse complexity with superiority"

AdrianC

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Re: What comes after the ACA?
« Reply #2787 on: June 22, 2017, 08:56:58 AM »
1.  It's still primarily a giant tax cut for the wealthy paid for by killing Medicaid.  In fact, it cuts Medicaid even more harshly than the House version did.  They also proposed delaying the Medicaid cuts until after the next election, though, because they're politically craven.

Well, I suppose some see this not as tax cuts but as a repeal of unjustified tax increases...the real tax cuts will be in the next bill, the one they really want to get to - tax reform.

You said the ACA had been bad for you personally, how is that?

We paid the additional taxes one time, and I don't mind that, we had a great year. I do appreciate the extra protections the ACA gave, but we did lose a PPO plan we liked, doctors we liked, and now have an HMO plan (PPOs no longer sold) through a local non-profit insurer (all national insurers pulled out), with a very narrow network, and $7K deductible pp, 14K max OOP. This is the reality on the ground for many middle-class folks. Not that I think the latest bill will fix any of that, of course. But I do see why so many people who use the ACA do not like it and want it gone.


jim555

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Re: What comes after the ACA?
« Reply #2788 on: June 22, 2017, 09:02:42 AM »
Senate bill subsidies screenshot:

The benchmark is no longer the second lowest cost Silver plan (SLCSP), but a benchmark plan rated at 58% actuarial value.  The current Silver plans are rated at 70% AV (with additional CSRs).

The employer mandate and individual mandate fines are reduced to $0.  Say goodbye to employer health coverage.
« Last Edit: June 22, 2017, 09:25:29 AM by jim555 »

sol

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Re: What comes after the ACA?
« Reply #2789 on: June 22, 2017, 09:59:16 AM »
You said the ACA had been bad for you personally, how is that?

I wasn't ignoring you, just distracted (enraged) by the release of the Senate's draft legislation.

But it's a thought provoking question.  Like most Americans, I currently have an employer sponsored family health insurance plan.  My insurance costs appear be ridiculously low, because my employer pays for virtually all of the premium for a comprehensive plan (and then takes the tax write off, and lowers my salary by a corresponding amount).  And I think this situation is the reason why so many people are outraged by the cost of insurance on the public exchanges; they are comparing the cost of ACA insurance to subsidized employer coverage without recognizing how much their previous employer was paying on their behalf.

But to answer your question more directly, I have not yet been harmed by the ACA, and I don't really expect to be.  In the near future I might to be in that pool of people who need to buy unsubsidized insurance on the individual market (because my retirement income will temporarily be too high), but the ACA hasn't increased my expected costs for comprehensive coverage there.  If I were single I might have opted for skimpy catastrophic coverage, since I am not old or fat or female, and the ACA has made this plans more expensive with minimum coverage requirements.  Since I have a family, I don't think I would have bought one of those anyway.

The republican health care proposals will hurt, though.  They are designed to offer smaller subsidies to fewer people, so my eventual private insurance will be more expensive.  On the bright side, I would be able to lower my premiums if I only buy catastrophic coverage (and then get kicked off of it if I had a catastrophe, since that is apparently going to be allowable again).

If I were not quite as good at optimizing my taxable income, the ACA would ding me with surtaxes and such, but our income as professionally educated public servants is not so high to qualify me for that honor.

brooklynguy

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Re: What comes after the ACA?
« Reply #2790 on: June 22, 2017, 10:05:58 AM »
Contrary to last night's news reports, the bill (the full text of which is available here), like the House's version, disqualifies from tax credit eligibility insurance plans that provide abortion coverage (see the modification to the tax code definition of "qualified heath plan" on page 8 of the pdf), which would effectively make all residents of CA and NY (where insurance coverage of abortions is mandated by state law) ineligible for tax credits.  This provision would seem to blatantly violate Senate procedural rules against including in reconciliation legislation items not directly related to budgetary matters, so what's the strategy here?  Procedural gymnastics to circumvent parliamentarian review?  Or is this bill designed to fail?

The official moniker of the bill, which in nearly every respect operates to make our nation's health care situation worse, is the "Better Care Reconciliation Act of 2017."  That's some true Orwellian shit right there.

jim555

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Re: What comes after the ACA?
« Reply #2791 on: June 22, 2017, 10:54:27 AM »
In New York Fidelis, which is run by the Roman Catholics, has a special exception regarding family planning and abortion.  This would make them the only provider where you could get tax credits.

Gin1984

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Re: What comes after the ACA?
« Reply #2792 on: June 22, 2017, 11:00:35 AM »
Contrary to last night's news reports, the bill (the full text of which is available here), like the House's version, disqualifies from tax credit eligibility insurance plans that provide abortion coverage (see the modification to the tax code definition of "qualified heath plan" on page 8 of the pdf), which would effectively make all residents of CA and NY (where insurance coverage of abortions is mandated by state law) ineligible for tax credits.  This provision would seem to blatantly violate Senate procedural rules against including in reconciliation legislation items not directly related to budgetary matters, so what's the strategy here?  Procedural gymnastics to circumvent parliamentarian review?  Or is this bill designed to fail?

The official moniker of the bill, which in nearly every respect operates to make our nation's health care situation worse, is the "Better Care Reconciliation Act of 2017."  That's some true Orwellian shit right there.
Or they don't care about violating the procedures just like Tx did not care until enough citizens did. 

sol

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Re: What comes after the ACA?
« Reply #2793 on: June 22, 2017, 11:36:55 AM »
All this talk about "striking a balance" with the Senate bill is complete bullshit.  The republican's new healthcare bill seems to be even more extreme than what the House came up with.  They didn't even try to win over any moderates, they just kowtowed to the right wing conservatives in every possible way.

At this point, I think they are guaranteed to pass this pile of cruelty through the House without any problems with reconciliation, so the only people standing between us and tens of millions of poor people having their insurance stripped away are a handful of moderate Senate republicans.  The original concern was how to get a more moderate Senate bill through the extremists in the House, but their solution is apparently to go even more extrem with the Senate bill to guarantee House approval and only worry about whipping a handful of Senate Republicans.

But the House version was reviled by the American people, and I think it only passed the House because a minority of moderate-ish house republicans were promised that the Senate wouldn't allow such catastrophically bad policy to stand.  Turns out they not only let it stand, they doubled down.
 

jim555

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Re: What comes after the ACA?
« Reply #2794 on: June 22, 2017, 11:39:38 AM »
They really went after Medicaid even worse than the House bill.  This is totally going to pass.  Senators need the tax cuts.

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Re: What comes after the ACA?
« Reply #2795 on: June 22, 2017, 11:42:30 AM »
Remember when Trump said "no cuts to medicaid"?

The GOP house and senate health bills are disgusting. At least they are also releasing them just before a big summer holiday and will likely vote while people are distracted by fireworks. Ugh.

sol

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Re: What comes after the ACA?
« Reply #2796 on: June 22, 2017, 11:46:05 AM »
Moderate republicans totally folded on their previous claims of protecting Medicaid.  Now they're trying to claim that kicking even more people off of Medicaid is defensible, as long as it happens after they leave office, so they supported deeper cuts in exchange for a slower phase-in.

I think the tea party takeover of the GOP is now complete.  The Mitt Romney wing of the party has no remaining power.  My racist relatives were right, Mitt lost the election because he wasn't right wing enough.  He should have publicly gone full on racist/sexist/plutocrat instead of being secretly only kind of racist/sexist/plutocrat while trying to publicly appeal to a broader swath of America.

Rosy

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Re: What comes after the ACA?
« Reply #2797 on: June 22, 2017, 11:47:09 AM »
Oh I remember his pledge about no cutting Medicaid - Medicare will be next.

No wonder Ryan was looking so happy.

brooklynguy

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Re: What comes after the ACA?
« Reply #2798 on: June 22, 2017, 11:48:30 AM »
All this talk about "striking a balance" with the Senate bill is complete bullshit.

The bill also flies in the face of the one and only underlying objective Republicans have publicly articulated for it--to save us from the failure of Obamacare, which, as Trump reminds us with twice-daily tweets, is collapsing around us.  Yet this bill is a perfect recipe for death spirals in the individual insurance markets.  It almost appears to have been deliberately designed to create adverse selection--it cuts back on subsidies, making coverage less affordable, at the same time that it repeals the individual mandate, replacing it (unlike the House version) with absolutely no mechanism at all to disincentivize healthy people from waiting to purchase coverage until they get sick and need it.  So the GOP's answer to Obamacare's supposedly imminent collapse-by-death-spiral is to give it a good hard shove over the edge?

sol

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Re: What comes after the ACA?
« Reply #2799 on: June 22, 2017, 11:51:40 AM »
Remember when Trump said "no cuts to medicaid"?

Trump has been cut out of the loop.  All of the reporting says he was asked to stay out of the negotiations entirely, because his previous involvement only made things worse.

When he first got elected, there was some discussion of whether congress would adopt his populist message or whether trump would be a rubber stamp on the Paul Ryan wing's vivisection of America's policies.  Right now, I see Trump's supporters being thrown under the bus as the great negotiator becomes a meaningless rubber stamp for the very policies he campaigned against.
« Last Edit: June 22, 2017, 12:02:21 PM by sol »