Author Topic: What comes after the ACA?  (Read 386827 times)

Monkey Uncle

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Re: What comes after the ACA?
« Reply #2900 on: June 25, 2017, 01:15:09 PM »
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.

O.K., so does anyone know how to apply the numbers in the subsidies table?  For example, for someone who is 40 years old with an AGI that is 200% of FPL, does this mean that the premium for a bronze plan can't exceed 6.3% of income?  If that is the case, this would actually be a pretty sweet deal for a healthy mustachian FIREee living off of investment income.
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jim555

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Re: What comes after the ACA?
« Reply #2901 on: June 25, 2017, 02:00:26 PM »
It means the subsidy is hinged to a benchmark.  You can have plans that will cost you more than 6.3% but it is up to you if you want to spend on those.
AHCA Senate proposal gives less subsidy than the ACA since the benchmark is lower, also gives less with age.  ACA has no age brackets, it is strictly income based.



« Last Edit: June 25, 2017, 04:05:16 PM by jim555 »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2902 on: June 25, 2017, 07:40:33 PM »
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.

O.K., so does anyone know how to apply the numbers in the subsidies table?  For example, for someone who is 40 years old with an AGI that is 200% of FPL, does this mean that the premium for a bronze plan can't exceed 6.3% of income?  If that is the case, this would actually be a pretty sweet deal for a healthy mustachian FIREee living off of investment income.

It could as long as you have enough money saved to cover maximum out of pocket expenses for that year if your medical catastrophe actually occurs. An HSA with a nice chunk of cash in it would be the perfect solution.  I believe the max out of pocket for bronze is about $6900. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2903 on: June 25, 2017, 08:06:19 PM »
Looks like a few Republican Senators are not too thrilled with the Senate Healthcare Repeal/Replace effort, notably so far Susan Collins of Maine, Bill Cassidy of Louisiana, Lisa Murkowski of Alaska, and of course the 5 extremist Republican Senators who want to ditch health care altogether, Rand Paul, Ted Cruz and 3 others.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2904 on: June 25, 2017, 08:31:30 PM »
Looks like a few Republican Senators are not too thrilled with the Senate Healthcare Repeal/Replace effort, notably so far Susan Collins of Maine, Bill Cassidy of Louisiana, Lisa Murkowski of Alaska, and of course the 5 extremist Republican Senators who want to ditch health care altogether, Rand Paul, Ted Cruz and 3 others.

I don't know much about the other names you have listed, but attached is Rand Paul's healthcare law he recommended
https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf
Dr. Rand Paul is a physician who feels like he understands the issues involved in our overpriced healthcare system.  Just a few items he recommends:
1) Allow the same tax deductions for employees for purchasing health insurance as employers get.
2) Provide tax credits for those who contribute to an HSA and increase the maximum limit
3) remove deductible limits from being able to utilize an HSA plan
4) remove the obamacare pre-existing conditions and re-implement the HIPAA pre-existing conditions protections (I have not evaluated if this is actually reasonable)
5) Allow interstate purchases of insurance to increase completion and one up the market.
6) Allow physicians to negotiate together with insurance companies regarding rates
7) Allow small businesses to pool together across state lines and create pooled insurance plans.

I don't particularly think it is too extreme, but despite all his talk over the years regarding regulatory burdens and unnecessary cost, his plan does very little to help that.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2905 on: June 25, 2017, 09:34:34 PM »
Looks like a few Republican Senators are not too thrilled with the Senate Healthcare Repeal/Replace effort, notably so far Susan Collins of Maine, Bill Cassidy of Louisiana, Lisa Murkowski of Alaska, and of course the 5 extremist Republican Senators who want to ditch health care altogether, Rand Paul, Ted Cruz and 3 others.

I don't know much about the other names you have listed, but attached is Rand Paul's healthcare law he recommended
https://www.paul.senate.gov/imo/media/doc/ObamacareReplacementActSections.pdf
Dr. Rand Paul is a physician who feels like he understands the issues involved in our overpriced healthcare system.  Just a few items he recommends:
1) Allow the same tax deductions for employees for purchasing health insurance as employers get.
2) Provide tax credits for those who contribute to an HSA and increase the maximum limit
3) remove deductible limits from being able to utilize an HSA plan
4) remove the obamacare pre-existing conditions and re-implement the HIPAA pre-existing conditions protections (I have not evaluated if this is actually reasonable)
5) Allow interstate purchases of insurance to increase completion and one up the market.
6) Allow physicians to negotiate together with insurance companies regarding rates
7) Allow small businesses to pool together across state lines and create pooled insurance plans.

I don't particularly think it is too extreme, but despite all his talk over the years regarding regulatory burdens and unnecessary cost, his plan does very little to help that.

As you've noted before, most people aren't going to be doing a whole lot of saving, so HSA's are nice for mustachians, but not a health care policy does it make.

Add Republican Senator Dean Heller of Nevada to the list of the disgruntled.

And then there's Medicaid:

Medicaid Cuts May Force Retirees Out of Nursing Homes https://nyti.ms/2t3J2Hd

How Medicaid Works, and Who It Covers https://nyti.ms/2t0TbEK
« Last Edit: June 25, 2017, 09:57:57 PM by DavidAnnArbor »

Monkey Uncle

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Re: What comes after the ACA?
« Reply #2906 on: June 26, 2017, 04:37:51 AM »
It means the subsidy is hinged to a benchmark.  You can have plans that will cost you more than 6.3% but it is up to you if you want to spend on those.
AHCA Senate proposal gives less subsidy than the ACA since the benchmark is lower, also gives less with age.  ACA has no age brackets, it is strictly income based.

Yes, it's not as sweet of a deal as the ACA, but still less expensive than my current employer-provided insurance.  Out of pocket costs for a bronze plan are higher, which about balances out with the lower premiums.

The bill is a shit sandwich for most of America, but it doesn't seem like the end of the world for us.
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chasesfish

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Re: What comes after the ACA?
« Reply #2907 on: June 26, 2017, 05:44:15 AM »
I saw this short analysis posted on CNBC - Its one of the first news stories that removed a lot of emotion and rhetoric related to the senate bill (at least until you get to the last couple paragraphs with people's opinions quoted):

http://www.cnbc.com/2017/06/24/winners-and-losers-of-the-senates-health-care-proposal.html

Looks net neutral for the early retiree, might be slightly lower on the cost of insurance based on the bands, keeps pre-existing conditions.  It may hurt some of the subsidies some ER folks get based on the income test.  Higher HSA limits help people leading up to retirement.
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brooklynguy

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Re: What comes after the ACA?
« Reply #2908 on: June 26, 2017, 07:32:08 AM »
Looks net neutral for the early retiree

If you look only at first-order effects, frugal early retirees who can easily manipulate their income levels would be largely insulated from the damage this bill would inflict (except perhaps Californians and New Yorkers, who would have limited to nonexistent options for obtaining cost-subsidizing tax credits).  But if you zoom out in your perspective, it becomes clear that this legislation would be disastrous for virtually everyone.  For one thing, its defective structural design would virtually ensure the occurrence of death spirals in the individual insurance markets, and no amount of cost subsidization will help individuals purchase coverage on markets that have ceased to function entirely.

chasesfish

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Re: What comes after the ACA?
« Reply #2909 on: June 26, 2017, 07:40:57 AM »
@brooklynguy - I agree with you and think the ACA has the same issues.  Opening the band up to 5x vs. 3x may buy a little time, but the death spiral is there without compulsory requirements for insurance.

We need to move towards Switzerland's model of compulsory insurance or Costa Rica's of a public/private provider model (open the VA to the poor) quickly. 
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wenchsenior

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Re: What comes after the ACA?
« Reply #2910 on: June 26, 2017, 09:43:05 AM »
What's weird is the GOP talking points (including Ryan and McConnell on various talk shows etc) since Trump's election have been that the ACA is shit because 1) premiums are too high (definitely true for some middle income people); 2) deductibles are too high (definitely true in some cases); because 3) there are too many things insurance is mandated to cover and 4) not enough incentive for healthy people to buy in. (And this doesn't even address the majority of people that got covered under the ACA, the poor...just the smaller higher income segment).  The only thing they consistently praised about Obamacare was keeping young people on parents' plans, and making sure pre-existing conditions didn't exclude people from buying insurance.

So then they present this absolute SHIT SHOW of a bill that 1) decreases subsidies to buy insurance, resulting in higher percentage of premiums having to be paid out of pocket (OPPOSITE of what people want); 2) allows states to drop 'standard of care' requirements for the plans offered, which effectively will allow insurance companies to sell shittier plans with higher deductibles (MAYBE people want this because they think it will mean much cheaper insurance, but I'm skeptical); which then 3) opens the door for insurance companies to be allowed to sell insurance to people with pre-existing conditions THAT DOES NOT COVER THEIR PRE-EXISTING CONDITION. Sure, Mr. Cancer Survivor, this law dictates I must offer you some sort of insurance plan...so I'm offering you a plan that does not cover chemotherapy.  Pay up.  And finally, 4) this bill includes ZERO provision that incentivizes buy-in from healthy people, which means they are setting up a bill prone to immediate death spiral.

And of course, this doesn't even address the bulk of the people newly covered under Medicaid, who will be gradually kicked off their coverage over time.

And for the icing on the cake, they are ALSO gutting the funding for Medicaid that was present BEFORE the ACA expansion, so they can spread the pain over even MORE of the poor, elderly, and disabled.

So, the richest 400 families in the U.S. will get a tax cut equivalent to the cost of health care for the poor in FOUR STATES.

I cannot wrap my head it.  I am seriously starting to think Paul Ryan (who has actually been quoted describing how he used to be the guy in the corner at fraternity keggers, talking about his dreams of ending Medicaid funding) is an honest to god sociopath.

StarBright

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Re: What comes after the ACA?
« Reply #2911 on: June 26, 2017, 09:56:21 AM »

I cannot wrap my head it.  I am seriously starting to think Paul Ryan (who has actually been quoted describing how he used to be the guy in the corner at fraternity keggers, talking about his dreams of ending Medicaid funding) is an honest to god sociopath.


^this! Yes! I've been saying this for the last couple of months. I actually make a sort of strangled screaming noise every time I see his face. What sort of person, who has the real data at their fingertips, proposes these sorts of changes?

Luck12

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Re: What comes after the ACA?
« Reply #2912 on: June 26, 2017, 10:07:43 AM »
No doubt Paul Ryan is a sociopath, obviously so is Trump, and so are a majority of Republican reps and senators.   They at least used to pretend otherwise, now they are saying things that make it obvious, and dumbass voters still vote for them.   Ryan, Trump, McConell, etc:   If I saw them get run over by a bus and I could call 911 to save them, I wouldn't lol. 

Tom Perez was right when he said "Republicans don't give a shit about people". 
« Last Edit: June 26, 2017, 10:10:03 AM by Luck12 »

AdrianC

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Re: What comes after the ACA?
« Reply #2913 on: June 26, 2017, 10:09:24 AM »
This is good:

Premiums and Tax Credits under the Affordable Care Act vs. the Senate Better Care Reconciliation Act: Interactive Maps

http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/

For the oldies like me, premium costs go up, subsidies go down. Hang on, aren't we older gen-X supposed to be the core Republican voters (after the boomers)? I guess they figure they can lose us (not that they ever had me).

From the article: "In 2017, the average deductible for a silver plan was $3,609 and $6,105 for a bronze plan."

That's interesting. Our silver, non-HSA plan has a $7K deductible per person.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2914 on: June 26, 2017, 10:12:24 AM »

I cannot wrap my head it.  I am seriously starting to think Paul Ryan (who has actually been quoted describing how he used to be the guy in the corner at fraternity keggers, talking about his dreams of ending Medicaid funding) is an honest to god sociopath.


^this! Yes! I've been saying this for the last couple of months. I actually make a sort of strangled screaming noise every time I see his face. What sort of person, who has the real data at their fingertips, proposes these sorts of changes?

The one who is looking to make healthcare more affordable to tax paying middle class Americans despite harming some of the non taxpaying poor Americans. Obviously there is a large portion of the population that wants this and has voted to get republicans in office.  Just a few days ago a republican nocked out a democrat out of a House seat in Georgia. It looks like there are enough people out there that want this.

Disclaimer: I am not saying I agree or disagree with this.  I am just explaining it.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2915 on: June 26, 2017, 10:22:51 AM »

And then there's Medicaid:

Medicaid Cuts May Force Retirees Out of Nursing Homes https://nyti.ms/2t3J2Hd

How Medicaid Works, and Who It Covers https://nyti.ms/2t0TbEK

It depends where they want to cut it.  It could be on the older nursing home population or the younger poor population.  Someone is going to pay the price.  There is no doubt about that. Today it is the middle class Americans.  I disagree with any plan that doesn't actively attempt to do something about cost making healthcare more affordable to all Americans not just those that vote for their party.

sol

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Re: What comes after the ACA?
« Reply #2916 on: June 26, 2017, 10:35:06 AM »

I cannot wrap my head it.  I am seriously starting to think Paul Ryan (who has actually been quoted describing how he used to be the guy in the corner at fraternity keggers, talking about his dreams of ending Medicaid funding) is an honest to god sociopath.


^this! Yes! I've been saying this for the last couple of months. I actually make a sort of strangled screaming noise every time I see his face. What sort of person, who has the real data at their fingertips, proposes these sorts of changes?

He's not a sociopath.

I know Paul Ryan.  I knew him back in high school when his name was Matt and he founded the American Values Club for after school conservative wank circles.  I knew him in college when his name was Tommy and he would buy entire pallets of Natty Ice (with his unemployment check) and host bonfire parties where he'd rail against the evils of welfare.  I still hang out with him these days, virtually and long distance from Florida, where he's addicted to pain killers and having his house foreclosed on, but absolutely loves DJ Trumpenstein because "he speaks for the real America".

These people are intelligent, well read, hard working (white male) Americans, raised in conservative Christian households where Bill Clinton was Pontius Pilate and Dad whooped your ass if your chores weren't done by the time Mom had dinner on the table.  Your pastor warned you about the dangers of slow dancing, but you sat enraptured late at night at last summer's family reunion while your older cousin told you about the first time her boyfriend went down on her.  Life seems messy and complicated, but Ayn Rand helps everything seem so clear and you don't understand why everyone else doesn't see how obvious it is.  Of COURSE Medicaid is evil, a tool of the devil made manifest by sinners and harlots to denigrate our great Christian nation.  Black people and Mexicans aren't evil, they're just really unlucky that they were born so lazy and stupid. 

Men like Paul Ryan are a product of their culture, a warped little slice of Americana where little white boys are taught that they alone will bear the burden of saving America, if only they are strong enough to drown out the drumbeat of multiculturalism and inclusiveness that will try to invade their minds as they head out into the world.  Don't listen to the liberals! They want to destroy America!  Don't even talk to them, they will try to plant little seeds of doubt in your mind, but those seeds can grow into forests that choke out Jesus's light if you're not careful.

So no, Paul Ryan is not a sociopath.  He thinks he is the only sane person left in the entire world, and he will work tirelessly to "save" America from itself.
« Last Edit: June 26, 2017, 11:09:50 AM by sol »

wenchsenior

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Re: What comes after the ACA?
« Reply #2917 on: June 26, 2017, 10:39:50 AM »

I cannot wrap my head it.  I am seriously starting to think Paul Ryan (who has actually been quoted describing how he used to be the guy in the corner at fraternity keggers, talking about his dreams of ending Medicaid funding) is an honest to god sociopath.


^this! Yes! I've been saying this for the last couple of months. I actually make a sort of strangled screaming noise every time I see his face. What sort of person, who has the real data at their fingertips, proposes these sorts of changes?

The one who is looking to make healthcare more affordable to tax paying middle class Americans despite harming some of the non taxpaying poor Americans. Obviously there is a large portion of the population that wants this and has voted to get republicans in office.  Just a few days ago a republican nocked out a democrat out of a House seat in Georgia. It looks like there are enough people out there that want this.

Disclaimer: I am not saying I agree or disagree with this.  I am just explaining it.

I don't think this is a meaningful data point. This isn't a swing district. Tribalism is strong, and this has been a GOP held seat for decades.

Anyway, polls show the house bill is historically unpopular, and I expect this one won't be much more so.  I have no doubt a lot of people want something different from the ACA. I doubt very strongly most of them thought they were voting for anything like what the GOP is proposing.

Luck12

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Re: What comes after the ACA?
« Reply #2918 on: June 26, 2017, 10:40:27 AM »
Just a few days ago a republican nocked out a democrat out of a House seat in Georgia. It looks like there are enough people out there that want this.

Have you looked at the past election results?  This is a district where Tom Price's 23 point victory in 2016 is smaller than every other election result from 2002-2014 (wiki didn't list results prior to 2002).  I would not use this as evidence that "people want this bill".  You know, you could perhaps look at polls to gauge this.   

If this bill(s) was about helping middle class americans and stabilizing the insurance marketplace, why cut Medicaid even below the pre-ACA levels?   Gee I don't know, it couldn't possibly be because they want to fuck over the poor and because they are sociopaths. 
« Last Edit: June 26, 2017, 10:42:58 AM by Luck12 »

jim555

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Re: What comes after the ACA?
« Reply #2919 on: June 26, 2017, 10:44:22 AM »

sol

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Re: What comes after the ACA?
« Reply #2920 on: June 26, 2017, 11:00:03 AM »
On the bright side, since we are rich we would benefit from the HSA expansion.  Increasing the limit to $13,100 per year per family would save us about $1800/yr in the 28% tax bracket.  Hooray for tax dodging!

Not that it does us any good, if insurance prices spike for equivalent coverage, in the way republicans seem to want it to.

wenchsenior

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Re: What comes after the ACA?
« Reply #2921 on: June 26, 2017, 11:03:37 AM »

I cannot wrap my head it.  I am seriously starting to think Paul Ryan (who has actually been quoted describing how he used to be the guy in the corner at fraternity keggers, talking about his dreams of ending Medicaid funding) is an honest to god sociopath.


^this! Yes! I've been saying this for the last couple of months. I actually make a sort of strangled screaming noise every time I see his face. What sort of person, who has the real data at their fingertips, proposes these sorts of changes?

He's not a sociopath.

I know Paul Ryan.  I knew him back in high school when his name was Matt and he founded the American Values Club for after school conservative wank circles.  I knew him in college when his name was Tommy and he would buy entire pallets of Natty Ice (with his unemployment check) and host bonfire parties where he'd rail against the evils of welfare.  I still hang out with him these days, virtually and long distance from Florida, where he's addicted to pain killers and having his house foreclosed on, but absolutely loves DJ Trumpenstein because "he speaks for the real America".

These people are intelligent, well read, hard working (white male) Americans, raised in conservative Christian households where Bill Clinton was Pontius Pilate and Dad whooped your ass if your chores weren't done by the time Mom had dinner on the table.  Your pastor warned you about the dangers of slow dancing, but you sat enraptured late at night at last summer's family reunion while your older cousin told you about the first time her boyfriend went down on her.  Life seems messy and complicated, but Ayn Rand helps everything seem so clear and you don't understand why everyone else doesn't see how obvious it is.  Of COURSE Medicaid is evil, a tool of the devil made manifest by sinners and harlots to denigrate our great Christian nation.  Black people and Mexicans aren't evil, they're just really unlucky that they were born so lazy and stupid. 

Men like Paul Ryan are a product of their culture, a warped little slice of Americana where little white boys are taught that they alone will bear the burden of saving America, if only they are strong enough to drown out the drumbeat of multiculturalism and inclusiveness that will try to invade their minds as they head out into the world.  Don't listen to the liberals! They want to destroy America!  Don't even talk to them, they will try plant little seeds of doubt in your mind, but those seeds can grow into forests that choke out Jesus's light if you're not careful.

So no, Paul Ryan is not a sociopath.  He thinks he is the only same person left in the entire world, and he will work tirelessly to "save" America from itself.

You know, I've been trying to figure out the Paul Ryan type for years, and it is so confusing to me EVEN THOUGH MY FATHER IS ONE OF THEM LOL.  In fact, most of my paternal family is 'one of them'.  And they aren't sociopaths, precisely, but they do really lack an ability to empathize with anyone not making the same choices they did. 

My father didn't have an easy road psychologically, but he DID have a position of huge privilege...born into an upper middle class family that owned two successful family business, who bought him his first couple cars, paid for his college education (which he dicked off through), and then offered two family businesses as employment to fall back on.  They preached WASP values, the evils of the Liberals, the fundamental inferiority of non whites, the fundamental inferiority of all poor people (for which they seemed to have actual physical revulsion, as though poverty was a communicable disease), the fundamental worthlessness of intellectual pursuits (reading fiction was discouraged), and the fundamental worthlessness of their own sister (born mentally disabled AND with epilepsy...my father is also so revolted by her he can hardly stand to talk to her).

My fathers family LOVED Nixon, loved the military, exhibited rigidly upright behavior in public while constantly cheating on their spouses (and eventually dumping them for younger models) on the sly.  Constantly bitched about welfare and medicare and taxes, etc.

I have tried and tried to make sense of my father's weird reaction of rage and revulsion toward blue collar workers, the poor, men with facial hair, minorities of all types, etc etc etc.  The only consistent underlying thing I have ever seen in him that might explain it is clinical narcissism (which he has) and abject terror of EVERYTHING in the world that he can't control, which comes out as either anger or revulsion. And since we can control very little in life, almost everything seems to fill  him with fear.

Despite all his material advantages in life, my father attributes 100% of his subsequent business success (which was admirable, no doubt) to his own awesomeness in the face of what he perceives as overwhelming odds stacked against him (basically, just a dick father who died young).  He really thinks he had a hard row to hoe, and that he is superior to most other people because he was a business success.  It's so weird..

Could most of the conservative mindset just be explainable by fear? Sometimes I wonder...

chasesfish

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Re: What comes after the ACA?
« Reply #2922 on: June 26, 2017, 11:44:36 AM »
Just a few days ago a republican nocked out a democrat out of a House seat in Georgia. It looks like there are enough people out there that want this.

Have you looked at the past election results?  This is a district where Tom Price's 23 point victory in 2016 is smaller than every other election result from 2002-2014 (wiki didn't list results prior to 2002).  I would not use this as evidence that "people want this bill".  You know, you could perhaps look at polls to gauge this.   

If this bill(s) was about helping middle class americans and stabilizing the insurance marketplace, why cut Medicaid even below the pre-ACA levels?   Gee I don't know, it couldn't possibly be because they want to fuck over the poor and because they are sociopaths.

That comment about a "knockout" was really funny.  I lived next to this district for 7 years including the last redistricting, it was basically Newt Gingrich and Phil Gingrey's district and hasn't sniffed a democrat in over 15 years.

The democrats then run a terrible candidate, John Osoff, a 30 year old staffer for Hank Johnson who didn't even live in the district.   He got less total votes than the 2016 candidate, Rodney Stooksbury, who ran against Price with $0 in campaign spending and was jokingly labeled "ghost candidate".   I think the thing was only close because Karen Handel was the opponent, who had quite a loosing record prior to this and barely any platform.

Neither side should read too much in to these special elections, I think Democrats are 0-4 including the guy in Montana who was charged with assault the day before election.  The appointees are generally from safe republican districts.
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Dabnasty

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Re: What comes after the ACA?
« Reply #2923 on: June 26, 2017, 11:57:54 AM »
Could most of the conservative mindset just be explainable by fear? Sometimes I wonder...

Maybe something like that -

http://www.cell.com/current-biology/abstract/S0960-9822(11)00289-2

https://www.psychologytoday.com/blog/the-human-beast/201104/conservatives-big-fear-brain-study-finds

Of course studies involving the brain typically aren't as well understood as some would like to believe -

https://www.psychologytoday.com/blog/i-got-mind-tell-you/201508/the-amygdala-is-not-the-brains-fear-center

If you read one, please see all three. They are not necessarily in agreement.

mm1970

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Re: What comes after the ACA?
« Reply #2924 on: June 26, 2017, 12:01:54 PM »
It feels unfair that a Mustachian who saved $1M and needs end-of-life skilled care will slowly deplete their savings before getting on Medicaid while a spendypants with $10k savings will use that in a month;  both will leave no inheritance. A workaround for the saver would be to give the inheritance to their children before they die, which may be what this bill is trying to avoid.

But more importantly, it feels unfair that a Mustachian who lived their whole life frugally would get the same end result as a careless spender who enjoyed a life with less work, less stress or more indulgences. Liberals often try to push their ideal of giving from the rich to the poor, with the argument that the rich are born into wealth and the poor simply got unlucky to be stuck in shitty jobs, but high earners pay a lot in terms of quality of life, and it doesn't seem fair to favor the poor too much just because "poor them, they got unlucky". Kinda like parents giving more inheritance to one child (the spender, low education, low income, or high debt one) because the other child was more frugal and serious with their career and doesn't need the money. Is that what we want our tax system to incentivize? We have a good thing with the US economy in general and some people don't realize the full consequences and side effects of introducing changes in that running system.
Come on now, life is not fair.

But mostly -
I know several women who lived to be in their 90s, and ended up in nursing homes.

The two who were wealthier had a *much* nicer time.  They lived in nursing facilities where they had their own apartments, and friends, and bus trips.

The one who was poor and on Medicaid (husband's other grandmother) - that place was fucking depressing.

One would think that if you are mustachian and frugal that you are saving money for a reason.  For me, it's a rainy day.  College for my kids, more comfort in the future.  If I have to end up in a nursing facility, and I have the money, why on EARTH would I expect a bunch of poor people (regardless of why they got there) to subsidize me when I have a million in the bank?  Yes, the spendypants maybe lived high on the hog for a couple of decades, but end up in a miserable home for the last 2 years.

So what?

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2925 on: June 26, 2017, 02:33:11 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/2u9M1Lu

sol

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Re: What comes after the ACA?
« Reply #2926 on: June 26, 2017, 03:04:15 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/2u9M1Lu

Countdown is running until someone points out that the Senate saved two million people from losing their insurance (compared to the House version of the bill).  See, they really do have heart!

jim555

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Re: What comes after the ACA?
« Reply #2927 on: June 26, 2017, 03:10:18 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/2u9M1Lu
From that link:
"Earlier Monday afternoon, Senate Republican leaders altered their health bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the prior year."

Every iteration gets worse than the last one.  Can't wait for the final version.

sol

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Re: What comes after the ACA?
« Reply #2928 on: June 26, 2017, 03:36:43 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/2u9M1Lu
From that link:
"Earlier Monday afternoon, Senate Republican leaders altered their health bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the prior year."

Every iteration gets worse than the last one.  Can't wait for the final version.

I'm not sure this version is worse.  Yes, they're penalizing people for not having insurance by taking away their insurance, but at least they've recognized that without some sort of individual incentive (call it a mandate if you must) they would just be kick starting the death spiral. 

So at least they've recognized the necessity of another pillar of Obamacare, just like they have with income-based subsidies pegged to benchmark plans, keeping kids on until age 26, the public marketplace exchanges for buying policies, the Medicare provider enhancements, funding the cost sharing reductions (for 2 more years),  enforcing medical loss ratios to cap insurance company profits (though at only 5:1), in network vs out of network subsidy equivalence, individual out of pocket maximums enforced by cost sharing, and the wellness incentives for preventative care.  It looks like most of the text of the ACA would stay conceptually intact, they just cut all the taxes out and gutted Medicaid for poor people.

Interestingly, the republican plan makes no mention of some of their previous talking points, like "buying insurance across state lines" or "bringing down costs" or "letting the government negotiate drug prices" even in cases where these idea have bipartisan support.

But it does do some unusually cruel things, like slashing Medicaid and, to a lesser extent, Medicare (yes really!)

And the cruelest of all is returning to the bad old days of care exceptions.  Yes, they've kept the guaranteed issue clause for people with pre existing conditions, but they would let insurers exempt specific care types.  So if you get cancer, they do have to offer you health insurance but that insurance doesn't have to cover cancer treatment, which makes it effectively useless that you can technically get insurance.
« Last Edit: June 26, 2017, 03:40:57 PM by sol »

ZiziPB

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Re: What comes after the ACA?
« Reply #2929 on: June 26, 2017, 03:39:29 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/2u9M1Lu
From that link:
"Earlier Monday afternoon, Senate Republican leaders altered their health bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the prior year."

Every iteration gets worse than the last one.  Can't wait for the final version.
Yup, the 6 months waiting period would make sure that some of them die before they could get insurance...  An easy way to solve the problem. 

Requiring people to buy insurance = infringement on individual freedoms

Prohibiting people from buying insurance = no infringement on individual freedoms



EnjoyIt

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Re: What comes after the ACA?
« Reply #2930 on: June 26, 2017, 04:01:14 PM »

Interestingly, the republican plan makes no mention of some of their previous talking points, like "buying insurance across state lines" or "bringing down costs" or "letting the government negotiate drug prices" even in cases where these idea have bipartisan support.


Yup, our politicians at their best doing absolutely nothing of real value.  Just moving the money around is all. Sounds like some lobbyists got their claws on this plan as well.

sol

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Re: What comes after the ACA?
« Reply #2931 on: June 26, 2017, 04:20:22 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/quiCkLy

Thinking about it more carefully, I find the CBO score for the Senate's bill to be shockingly generous.  How does it cover 1m more people than the House bill, while making even more drastic cuts to Medicaid funding, and allowing states to opt out of Medicaid entirely?  The CBO must have assumed every state would raise taxes in order to keep their Medicaid spending flat, or that the Senate plan somehow got more middle class people onto insurance to make up for all of the poor people who would lose it.

chasesfish

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Re: What comes after the ACA?
« Reply #2932 on: June 26, 2017, 04:33:03 PM »
Yeah, I don't know how the Senate Bill passes...

I also don't understand the CBO's score of "more" people loose coverage, that would have the assumption either the insurance companies keep absorbing losses from exchange based plans or receive taxpayer subsidies.

Looking forward to this failing this week so all these politicians can have an adult conversation with each other.
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sol

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Re: What comes after the ACA?
« Reply #2933 on: June 26, 2017, 04:40:45 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/quiCkLy

Thinking about it more carefully, I find the CBO score for the Senate's bill to be shockingly generous.  How does it cover 1m more people than the House bill, while making even more drastic cuts to Medicaid funding, and allowing states to opt out of Medicaid entirely?  The CBO must have assumed every state would raise taxes in order to keep their Medicaid spending flat, or that the Senate plan somehow got more middle class people onto insurance to make up for all of the poor people who would lose it.

Further research has solved this mystery.  The reason that the CBO says the Senate's bill isn't woefully worse for coverage numbers than the House bill is that the Senate bill postpones the Medicaid cuts long enough that people don't lose coverage until after the 10 year time horizon that the CBO uses.  It's years 11-15 that see the extra tens of millions of people lose Medicaid (up to half of all Medicaid recipients, eventually).

That's dirty pool.  The Senate cut an extra half trillion or so from medicaid, so they get the full financial accounting available immediately to finance their tax cuts for billionaires, but the coverage losses are beyond the time window for comparison of how many poor people will lose access to healthcare.
« Last Edit: June 26, 2017, 11:34:38 PM by sol »

wenchsenior

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Re: What comes after the ACA?
« Reply #2934 on: June 26, 2017, 04:45:50 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/quiCkLy

Thinking about it more carefully, I find the CBO score for the Senate's bill to be shockingly generous.  How does it cover 1m more people than the House bill, while making even more drastic cuts to Medicaid funding, and allowing states to opt out of Medicaid entirely?  The CBO must have assumed every state would raise taxes in order to keep their Medicaid spending flat, or that the Senate plan somehow got more middle class people onto insurance to make up for all of the poor people who would lose it.

Further research has solved this mystery.  The reason that the CBO says the Senate's bill isn't woefully worse for coverage numbers than the House bill is that the Senate bill postpones the Medicaid cuts long enough that people don't lost coverage until after the 10 year time horizon that the CBO uses.  It's years 11-15 that see the extra tens of millions of people lose Medicaid (up to half of all Medicaid recipients, eventually).

That's dirty pool.  The Senate cut an extra half trillion or so from medicaid, so they get the full financial accounting available immediately to finance their tax cuts for billionaires, but the coverage loses are beyond the time window for comparison of how many poor people will lose access to healthcare.

Yup. I predicted this exact strategy to my husband last week, but even I wasn't cynical enough to think they'd try to use it to gut Medicaid beyond the expansion provided by the ACA.  It also allows them to postpone a lot of the pain (and potentially voter rage) in the hopes that a Dem president might be available to take the heat.

sol

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Re: What comes after the ACA?
« Reply #2935 on: June 26, 2017, 05:20:47 PM »
Looking forward to this failing this week so all these politicians can have an adult conversation with each other.

I think it will pass.

Who is going to vote against it?  Conservatives like Ted Cruz are saying they can't vote for it, but remember that Ted Cruz literally wrote this bill.  Conservative hardliners hate Obama so much they will vote for ANYTHING that looks like a repeal bill. 

You think moderate republicans will vote against it?  When has that ever happened?  I literally can't think of a single time that moderate republicans in the Senate have joined with democrats to block GOP legislation, unless the bill was going to fail anyway and they have plenty of political cover.  When it comes down crunch time, they always opt for party unity.  Always.

Lots of republicans would like to be the only no vote, as long as they're sure it will pass anyway.  Nobody wants to actually be the deciding vote, though.  I think this bill either passes easily, or if it's clear it won't pass they'll flee it like rats and it only get like 25 yays.  I think a closely voted defeat, like 49 yays, is literally impossible.
« Last Edit: June 26, 2017, 05:23:26 PM by sol »

jim555

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Re: What comes after the ACA?
« Reply #2936 on: June 26, 2017, 05:43:00 PM »
The newest version:
https://www.budget.senate.gov/imo/media/doc/BetterCareReconcilistionAct.6.26.17.pdf

Page 137 has about the 6 month waiting period.

wenchsenior

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Re: What comes after the ACA?
« Reply #2937 on: June 26, 2017, 06:06:30 PM »
Looking forward to this failing this week so all these politicians can have an adult conversation with each other.

I think it will pass.

Who is going to vote against it?  Conservatives like Ted Cruz are saying they can't vote for it, but remember that Ted Cruz literally wrote this bill.  Conservative hardliners hate Obama so much they will vote for ANYTHING that looks like a repeal bill. 

You think moderate republicans will vote against it?  When has that ever happened?  I literally can't think of a single time that moderate republicans in the Senate have joined with democrats to block GOP legislation, unless the bill was going to fail anyway and they have plenty of political cover.  When it comes down crunch time, they always opt for party unity.  Always.

Lots of republicans would like to be the only no vote, as long as they're sure it will pass anyway.  Nobody wants to actually be the deciding vote, though.  I think this bill either passes easily, or if it's clear it won't pass they'll flee it like rats and it only get like 25 yays.  I think a closely voted defeat, like 49 yays, is literally impossible.

Agree with this, as well.  My husband was holding  out hope that Cruz (regrettably, our senator) would vote against because it wasn't conservative enough (opposite of our beliefs, but we'll take any 'no' we can get).  And I said: no WAY he votes no unless about 10-12 other people vote no as well.  No WAY the conservative block supposedly standing in the way of this bill holds firm if the vote is close.  The only one I'm not sure would cave in that case is Rand Paul. Cruz is a craven POS, but I'm not sure Paul is. Repugnant  in many ways, but he does seem to have more balls than Cruz could ever dream on  his best day.

chasesfish

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Re: What comes after the ACA?
« Reply #2938 on: June 26, 2017, 07:17:52 PM »
Looking forward to this failing this week so all these politicians can have an adult conversation with each other.

I think it will pass.

Who is going to vote against it?  Conservatives like Ted Cruz are saying they can't vote for it, but remember that Ted Cruz literally wrote this bill.  Conservative hardliners hate Obama so much they will vote for ANYTHING that looks like a repeal bill. 

You think moderate republicans will vote against it?  When has that ever happened?  I literally can't think of a single time that moderate republicans in the Senate have joined with democrats to block GOP legislation, unless the bill was going to fail anyway and they have plenty of political cover.  When it comes down crunch time, they always opt for party unity.  Always.

Lots of republicans would like to be the only no vote, as long as they're sure it will pass anyway.  Nobody wants to actually be the deciding vote, though.  I think this bill either passes easily, or if it's clear it won't pass they'll flee it like rats and it only get like 25 yays.  I think a closely voted defeat, like 49 yays, is literally impossible.

I may be eating these words shortly, but I don't think it passes with opposition from Collins, Heller, and Johnson.  There's not a path even if they can somehow pull Rand Paul in.

I don't know why they're insistent on changing anything, politicians don't get credit for fixing something early and more than half the population doesn't think the ACA is broken.  Who the hell is advising these people?
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2939 on: June 26, 2017, 08:06:07 PM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/quiCkLy

Thinking about it more carefully, I find the CBO score for the Senate's bill to be shockingly generous.  How does it cover 1m more people than the House bill, while making even more drastic cuts to Medicaid funding, and allowing states to opt out of Medicaid entirely?  The CBO must have assumed every state would raise taxes in order to keep their Medicaid spending flat, or that the Senate plan somehow got more middle class people onto insurance to make up for all of the poor people who would lose it.

Further research has solved this mystery.  The reason that the CBO says the Senate's bill isn't woefully worse for coverage numbers than the House bill is that the Senate bill postpones the Medicaid cuts long enough that people don't lose coverage until after the 10 year time horizon that the CBO uses.  It's years 11-15 that see the extra tens of millions of people lose Medicaid (up to half of all Medicaid recipients, eventually).

That's dirty pool.  The Senate cut an extra half trillion or so from medicaid, so they get the full financial accounting available immediately to finance their tax cuts for billionaires, but the coverage loses are beyond the time window for comparison of how many poor people will lose access to healthcare.

Clever in an evil way for the Senate Republicans to do this.

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Re: What comes after the ACA?
« Reply #2940 on: June 27, 2017, 05:32:34 AM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/quiCkLy

Thinking about it more carefully, I find the CBO score for the Senate's bill to be shockingly generous.  How does it cover 1m more people than the House bill, while making even more drastic cuts to Medicaid funding, and allowing states to opt out of Medicaid entirely?  The CBO must have assumed every state would raise taxes in order to keep their Medicaid spending flat, or that the Senate plan somehow got more middle class people onto insurance to make up for all of the poor people who would lose it.

Further research has solved this mystery.  The reason that the CBO says the Senate's bill isn't woefully worse for coverage numbers than the House bill is that the Senate bill postpones the Medicaid cuts long enough that people don't lose coverage until after the 10 year time horizon that the CBO uses.  It's years 11-15 that see the extra tens of millions of people lose Medicaid (up to half of all Medicaid recipients, eventually).

That's dirty pool.  The Senate cut an extra half trillion or so from medicaid, so they get the full financial accounting available immediately to finance their tax cuts for billionaires, but the coverage loses are beyond the time window for comparison of how many poor people will lose access to healthcare.

Clever in an evil way for the Senate Republicans to do this.

Yeah.  They made sure that the cuts to Medicaid don't go into effect until after the 2020 election.
They made sure that biggest coverage losses (other than the upfront ~15MM they couldn't avoid) would come starting at year 11 as Medicaid gets progressively smaller.

I've often criticized SSA for putting out comicly long 75 year projections, but it seems 10 years is too short when the bulk of the phase-out will happen towards their predicted time period, and few of its effects will be felt.
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WhiteTrashCash

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Re: What comes after the ACA?
« Reply #2941 on: June 27, 2017, 05:59:34 AM »
The biggest problem in trying to understand the mindset of people who want to do away with the ACA and replace it with something that will help fewer people is that you are approaching this from the point of view that helping people is a good thing. People like Paul Ryan don't see it that way. They see a dog-eat-dog world which rewards the strong and punishes the weak and anything that helps the weak simply reinforces their deficiencies. They don't want to help people because in their mind helping people creates dependence. Many of them will refer to it as "feeding the animals" because the poor and needy are subhuman.

That's what you need to remember while you try to make sense of what's going on with the ACA replacement bills right now.

zing12

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Re: What comes after the ACA?
« Reply #2942 on: June 27, 2017, 06:59:27 AM »
^ I wish they were honest about that. Instead, they lie and create the falsehood that they are ok with the goals of the ACA and that it is just "bad" at what it is supposed to do, when in reality they are opposed to the goals.

talltexan

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Re: What comes after the ACA?
« Reply #2943 on: June 27, 2017, 07:49:26 AM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

I was actually thinking...$9,000...but I may be considering higher-end levels of care.

marion10

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Re: What comes after the ACA?
« Reply #2944 on: June 27, 2017, 08:28:35 AM »
MY MIL  had Alzheimer's, diabetes (developed in her 90s), atrial fib and a broken pelvis that would not heal was $9,000 a month in rural Wisconsin.
« Last Edit: June 27, 2017, 08:57:48 AM by marion10 »

Inaya

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Re: What comes after the ACA?
« Reply #2945 on: June 27, 2017, 08:29:59 AM »
Senate Health Bill Would Leave 22 Million More Uninsured, C.B.O. Says

https://nyti.ms/2u9M1Lu
From that link:
"Earlier Monday afternoon, Senate Republican leaders altered their health bill to penalize people who go without health insurance by requiring them to wait six months before their coverage would begin. Insurers would generally be required to impose the waiting period on people who lacked coverage for more than about two months in the prior year."

Every iteration gets worse than the last one.  Can't wait for the final version.
The wording on this is interesting. "Wait six months before their coverage would begin" implies that they are on the insurance for six months already when their coverage starts. Does this mean that they will be paying premiums for those six months without receiving benefits? And if coverage begins at month 6, does that mean that anything that happens during months 0-5 won't be covered? (E.g., cancer diagnosis during month 3 wouldn't be covered after the waiting period because you weren't technically covered at the time of the diagnosis?) Or are they simply prohibited from being covered by any health insurance for six months?

And what's with "more than about two months the prior year"? That's not very precise. And is that cumulative, or counted within a single stretch? (E.g., if I went without insurance for all of February and all of November, 2017, will I be hit with the waiting period in 2018? What if I hold my new insurance from Nov '17 through Nov '18, but lose my job and am unable to replace it. Do I still get hit with the waiting period even though I held it for 12 months, just because of the two one-month lapses in 2017?)

I'm not sure how this is an improvement on the individual mandate.
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protostache

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Re: What comes after the ACA?
« Reply #2946 on: June 27, 2017, 08:40:11 AM »
I'm not sure how this is an improvement on the individual mandate.

It's not. It's punishingly cruel to people who get dropped if, for example, they forget to make a payment because they're in the hospital, or they're taking care of a family member, or for whatever reason.

Bucksandreds

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Re: What comes after the ACA?
« Reply #2947 on: June 27, 2017, 08:42:29 AM »
I'm not sure how this is an improvement on the individual mandate.

It's not. It's punishingly cruel to people who get dropped if, for example, they forget to make a payment because they're in the hospital, or they're taking care of a family member, or for whatever reason.

It is 63 days so they wanted to make sure it's more than 2 missed payments but it's still cruel.

Inaya

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Re: What comes after the ACA?
« Reply #2948 on: June 27, 2017, 08:43:57 AM »
I'm not sure how this is an improvement on the individual mandate.

It's not. It's punishingly cruel to people who get dropped if, for example, they forget to make a payment because they're in the hospital, or they're taking care of a family member, or for whatever reason.
I mean from the perspective of trying to get more people paying into insurance. If anything this is going to chase more people away from insurance than the individual mandate did.
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Roland of Gilead

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Re: What comes after the ACA?
« Reply #2949 on: June 27, 2017, 08:58:50 AM »
Why do republicans put so much time and money into pro-life efforts and then try and kill 22 million people?

It doesn't make any logical sense.