Author Topic: What comes after the ACA?  (Read 308982 times)

protostache

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Re: What comes after the ACA?
« Reply #3000 on: June 28, 2017, 08:22:21 AM »
I've heard pundits from both sides comment that if we were to really start over from scratch we'd never choose a model where the employer supplied ~2/3 of our health insurance. If we started taxing employer-provided healthcare as Roland suggests, employers would drop their healh plans like a flaming bag of poo - the only reason large corporations do this is because they can 'save' ~35¢ per dollar on corporate taxes.

Well, that and ACA mandates that any business with more than 50 employees has to provide health insurance for their full time employees. This PDF report explains how it works and how the penalties work on page 4, but it basically amounts to $2,260 per full time employee that doesn't have insurance.

nancyjnelson

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Re: What comes after the ACA?
« Reply #3001 on: June 28, 2017, 08:26:07 AM »

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system. It removes the true cost from the consumer, it does not make any sense (employers don't pay for other insurance), it creates gaps in coverage if people get laid off (which then contributes to the pre-existing conditions issue), and it actually discourages entrepreneurship. I myself have thought long and hard about starting my own solo practice, but healthcare costs are a golden handcuff that I can't seem to shake.

Put simply, I think getting rid of the employment-based healthcare system would be the single best first step we can take, because it would create a true private versus public competition.


I agree with this 100%.  A system that links health care coverage to full-time employment at medium-to-large firms (yes, some part-time positions and some tiny businesses do come with health care, but they are in the minority) does discourage entrepreneurship - and favors the bigger, already-established companies.  Health care coverage linked to employment harms the free market by preventing small companies from being able to attract the best candidates - thus limiting their growth - and keeps employees working at firms under disagreeable conditions (bad supervisor, too-long commute, not challenging, negative work environment, etc), thus wrongly rewarding these mediocre firms and their practices.

Taking it a step further, I would like to point out how the U.S. economic system is devolving into a sort of neo-feudalism, with the financial system increasingly rigged in favor of those who are already rich and powerful, and increasingly limited regarding the opportunities it offers to those who are not.  And if you replace laws chaining people to the land with medical coverage and educational debt chaining people to jobs with established companies, we are all serfs.  (Yes, I know there are many, many exceptions, but I am talking in broad brushstrokes here.)  But a discussion of this issue should happen on another thread.

The system, as it now stands, props up the status quo and makes people dependent on the current economic structure.  And this, my friends, is why MMM, FI and FU money is so important!








   

nereo

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Re: What comes after the ACA?
« Reply #3002 on: June 28, 2017, 08:57:55 AM »
Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system (snip)

I would wholeheartedly support such a plan.  Problem is, particularly under the current climate it would be politically impractical, if not impossible.
More impractical/impossible than single-payer?

I actually think that a single-payer system is the only way we could get there, but it would mean simultaneously eliminating such health-insurance giants as Unitedhealth, Wellpoint, Kaiser and Aetnia.  Don't expect those to go quietly into the night...

Because of this legacy/inertia its hard for me to see how the US will ever get to a single-payer system, and I say this as someone who's from the US but has lived under two such systems (which have both advantages and disadvantages, and isn't a cure-all to all teh problems of the US system regardless). Large corporations have been incentivized to provide health-care through favorable taxation for decades. huge for-profit corporations exist that would be harmed if we went to single payer. There's incredible disconnect between cost of care/cost-of-insurance and what people find reasonable to spend on healthcare.  And of course as EnjoyIt keeps pointing out, we spend more per-capita on healthcare than any other country, and we're not the sort to take massive tax increases to pay for our current system (even though we already pay for it in various forms).
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3003 on: June 28, 2017, 09:06:43 AM »

To my simple mind, the employment-based model of healthcare is the single biggest problem with our healthcare system. It removes the true cost from the consumer, it does not make any sense (employers don't pay for other insurance), it creates gaps in coverage if people get laid off (which then contributes to the pre-existing conditions issue), and it actually discourages entrepreneurship. I myself have thought long and hard about starting my own solo practice, but healthcare costs are a golden handcuff that I can't seem to shake.

Put simply, I think getting rid of the employment-based healthcare system would be the single best first step we can take, because it would create a true private versus public competition.



I agree with this 100%.  A system that links health care coverage to full-time employment at medium-to-large firms (yes, some part-time positions and some tiny businesses do come with health care, but they are in the minority) does discourage entrepreneurship - and favors the bigger, already-established companies.  Health care coverage linked to employment harms the free market by preventing small companies from being able to attract the best candidates - thus limiting their growth - and keeps employees working at firms under disagreeable conditions (bad supervisor, too-long commute, not challenging, negative work environment, etc), thus wrongly rewarding these mediocre firms and their practices.

Taking it a step further, I would like to point out how the U.S. economic system is devolving into a sort of neo-feudalism, with the financial system increasingly rigged in favor of those who are already rich and powerful, and increasingly limited regarding the opportunities it offers to those who are not.  And if you replace laws chaining people to the land with medical coverage and educational debt chaining people to jobs with established companies, we are all serfs.  (Yes, I know there are many, many exceptions, but I am talking in broad brushstrokes here.)  But a discussion of this issue should happen on another thread.

The system, as it now stands, props up the status quo and makes people dependent on the current economic structure.  And this, my friends, is why MMM, FI and FU money is so important!




And to add another data point in support of this hypothesis, employers make employees sign these overly broad non-compete clauses. So if you are an engineer or other occupations, and you leave your job, you're not allowed to work in your field for 2 years.

http://www.jsonline.com/story/opinion/blogs/real-time/2017/03/01/ties-bind-squeezing-wisconsins-economy/98546082/
« Last Edit: June 28, 2017, 09:10:15 AM by DavidAnnArbor »

nereo

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Re: What comes after the ACA?
« Reply #3004 on: June 28, 2017, 09:18:40 AM »
I've heard pundits from both sides comment that if we were to really start over from scratch we'd never choose a model where the employer supplied ~2/3 of our health insurance. If we started taxing employer-provided healthcare as Roland suggests, employers would drop their healh plans like a flaming bag of poo - the only reason large corporations do this is because they can 'save' ~35¢ per dollar on corporate taxes.

Well, that and ACA mandates that any business with more than 50 employees has to provide health insurance for their full time employees. This PDF report explains how it works and how the penalties work on page 4, but it basically amounts to $2,260 per full time employee that doesn't have insurance.
Yeah... I knew this would come up, but I was speaking about the much longer time-scale of US health insurance.  Even before the ACA roughly 2/3rds of americans were covered under an employer-sponsored health insurance program. While the ACA did mandate more companies to offer health-care insurance, the % of Americans who get their insurance through their employer has remained basically steady.  Going into the weeds with this the driver seems to be the broader shift in more contract employees, though its also absoltuely true that smaller companies offer health insruance now which didn't pre-ACA.
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jim555

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Re: What comes after the ACA?
« Reply #3005 on: June 28, 2017, 09:20:45 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.

Inaya

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Re: What comes after the ACA?
« Reply #3006 on: June 28, 2017, 09:30:43 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.
The most confusing thing about this is they are directly threatening older Americans. People who have always been their staunchest supporters. What do they hope to gain that will outweigh this support?
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dividendman

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Re: What comes after the ACA?
« Reply #3007 on: June 28, 2017, 09:39:03 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.
The most confusing thing about this is they are directly threatening older Americans. People who have always been their staunchest supporters. What do they hope to gain that will outweigh this support?

It doesn't matter. They're going to vote republican regardless of what happens and blame any hardship caused by government policies on the democrats even if the republicans control both their statehouses, the governors mansion, the congress, the white house and the supreme court.

It's how religious mania works  - you believe what you believe, fuck all of those "facts".

Paul der Krake

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Re: What comes after the ACA?
« Reply #3008 on: June 28, 2017, 09:43:24 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.
Medicaid spends on two groups: poor people, and old people's hospices.

I'd wager that red states can gut the first one with almost no political consequences. It's the latter that they will have to tread on eggshells, and my guess is that they won't dare touch it. There is a good chunk of people who don't realize that Grandma is kept alive by Medicaid, but when they do, you can rest assured they will suddenly think the program is their hard earned birthright.

Seriously, who the fuck thought it was a good idea to have to programs that were guaranteed to be hotly debated have almost the same name.

sol

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Re: What comes after the ACA?
« Reply #3009 on: June 28, 2017, 09:45:32 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

I think there might be a legitimate path to single payer in the US, now that unregulated healthcare was a disaster and conservatives then shit all over their own public/private hybrid solution.

It needs to be gradual, and to phase in over time.  We might start by lowering the Medicare age and raising the Medicaid qualification limit, in little bits every year.

It needs to be minimal, so that those huge corporations still have a role to play and we don't just dismantle 1/6 of the economy.  That means reducing the benefits, so that no one goes medically bankrupt but most people will still want to buy supplemental insurance.

It needs to be fiscally responsible, which probably means repealing the employer exemption and instituting a new oasdi tax.  This will be regressive enough that rich people don't mind, but the care would mostly benefit the poor so I'm okay with it.

It needs strong cost controls.  If Medicaid/Medicare negotiated together nationwide, they could dictate prices on the basic services they covered.  This is the secret sauce that every other western democracy uses to control healthcare costs.  It works, and we should join theparty.

And we would need a lot of morning talk show messaging to convince conservatives this is good for them.  Is your state struggling with opioid addiction?  Uncle Sam is going to offer you free treatment programs and Hollywood liberals are going to pay for it.  Do you crave individual freedom?  This plan ends the Obamacare mandate, breaks the shackles of employer coverage, and unleashes America's entrepreneurial spirit.  Are you an evangelical or compassionate conservative?  This plan reaches out to the neediest among us, without creating dependency or incentivizing laziness. 

We're not there yet, but I think it's a lot less far fetched than it was just a few short years ago.

nereo

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Re: What comes after the ACA?
« Reply #3010 on: June 28, 2017, 09:46:48 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

The Republicans are discovering something - Ayn Rand meets reality.  Gut Medicaid, creates BIG problems for the states.  Who controls most of the states?  Republicans.  The idealogical dimwits in the House are not seeing the bigger picture, taking a huge dump in your own yard means you yourselves have to clean it up.  Senators WILL be hearing it from their Governors.  You can talk a lot to your base, but when the rubber meets the road and your policies create havoc you will have no one to blame but yourselves.  Are they smart enough to see this is political suicide?  People will not put up with granny being put on skid row and left to die or their Social Security and Medicare being ruined.
The most confusing thing about this is they are directly threatening older Americans. People who have always been their staunchest supporters. What do they hope to gain that will outweigh this support?
The freedom caucus + Rand see the rising costs of entitlement as an existential crisis to the United States.  In their eyes we cannot raise taxes, and failing to do this our government will be unable to do anything in the decades ahead besides pay out medical & SS UNLESS we cut back these programs and shift the responsibilites more onto individuals.

As for the political calculations, I'll bet many of htem think that lifelong GOPers are too set in their ways to ever change to 'the other side' (they might be right) and the one demographic this could actually help is the very affluent, who tend to be older white people.  The reduction in taxes these people might see could more than pay for the increased cost of insurance.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3011 on: June 28, 2017, 09:48:46 AM »
Single-payer system in the US?  Lets get real.  Never going to happen.

I think there might be a legitimate path to single payer in the US, now that unregulated healthcare was a disaster and conservatives then shit all over their own public/private hybrid solution.

It needs to be gradual, and to phase in over time.  We might start by lowering the Medicare age and raising the Medicaid qualification limit, in little bits every year.

It needs to be minimal, so that those huge corporations still have a role to play and we don't just dismantle 1/6 of the economy.  That means reducing the benefits, so that no one goes medically bankrupt but most people will still want to buy supplemental insurance.

It needs to be fiscally responsible, which probably means repealing the employer exemption and instituting a new oasdi tax.  This will be regressive enough that rich people don't mind, but the care would mostly benefit the poor so I'm okay with it.

It needs strong cost controls.  If Medicaid/Medicare negotiated together nationwide, they could dictate prices on the basic services they covered.  This is the secret sauce that every other western democracy uses to control healthcare costs.  It works, and we should join theparty.

And we would need a lot of morning talk show messaging to convince conservatives this is good for them.  Is your state struggling with opioid addiction?  Uncle Sam is going to offer you free treatment programs and Hollywood liberals are going to pay for it.  Do you crave individual freedom?  This plan ends the Obamacare mandate, breaks the shackles of employer coverage, and unleashes America's entrepreneurial spirit.  Are you an evangelical or compassionate conservative?  This plan reaches out to the neediest among us, without creating dependency or incentivizing laziness. 

We're not there yet, but I think it's a lot less far fetched than it was just a few short years ago.

Add a public option to the ACA exchange as it was originally designed to have, at least in areas where the insurance companies are dropping out anyway

EnjoyIt

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Re: What comes after the ACA?
« Reply #3012 on: June 28, 2017, 10:04:21 AM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

I think you are still fear mongering about the volume of people dying in the streets. Not having insurance does not eliminate EMTALA laws. That's the problem, fear mongering and insults only rally the people who already agree with you while alienating those who don't.

I do agree with you that the current republican plan will make healthcare unaffordable for the poor by making it more affordable to middle class Americans. I would agree that very likely more poor people will be harmed than middle class Americans will be helped which is why the republican law is shit. I would also argue with you that tax payers deserve affordable healthcare just as much as non-tax payers. I would argue a little more that tax payers may deserve it a little bit more than non-tax payers.

I would also agree with you that we need to work on making healthcare more affordable to everybody and the republicans are adding nothing to that issue.  And believe me, I hate agreeing with just on principle (just kidding.)

geekette

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Re: What comes after the ACA?
« Reply #3013 on: June 28, 2017, 10:12:43 AM »
EMTLA keeps you from dying quickly, but does little to keep you from dying slowly.   

sol

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Re: What comes after the ACA?
« Reply #3014 on: June 28, 2017, 10:13:44 AM »
Add a public option to the ACA exchange as it was originally designed to have, at least in areas where the insurance companies are dropping out anyway

This is genius!  Who thought of this great idea?

One of the main complaints about the ACA is that some rural areas, where healthcare has never been profitable due to low population density, are seeing their insurers drop out of the marketplace.  That's the textbook definition of a free market failure, and one easy solution would be for the federal public option to step in.  How could conservatives possibly object to Uncle Sam selling health insurance in markets where literally no one else is willing to do so?  There is no possibility for public/private conflicts to arise, no for-profit corporations could possibly be harmed, and rural red state citizens would have affordable insurance again!  Everyone wins!

jim555

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Re: What comes after the ACA?
« Reply #3015 on: June 28, 2017, 10:14:23 AM »
EMTLA keeps you from dying quickly, but does little to keep you from dying slowly.
People dying slowly don't get on the news, so it is ok.

sol

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Re: What comes after the ACA?
« Reply #3016 on: June 28, 2017, 10:25:40 AM »
EMTLA keeps you from dying quickly, but does little to keep you from dying slowly.

Emtala also doesn't save anybody from dying of cancer, or developing diabetes or heart disease.  Do we really need to review the leading causes of death among Americans?

Access to primary care services saves lives.  We've already posted the links in this thread that prove it.  Approximately 45,000 Americans died every year from preventable causes because they didn't have health insurance.  The ACA cut that number in half, and the Senate bill would push that number right back up to higher than it was before, because it cuts Medicaid coverage so much.

This is not fear mongering, it's math.  If you take insurance (and thus primary care) away from tens of millions of people, some tiny fraction of a percent of those people will die as a result.  That tiny fraction is still tens of thousands of people.
« Last Edit: June 28, 2017, 10:27:31 AM by sol »

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Re: What comes after the ACA?
« Reply #3017 on: June 28, 2017, 10:26:40 AM »
Add a public option to the ACA exchange as it was originally designed to have, at least in areas where the insurance companies are dropping out anyway

This is genius!  Who thought of this great idea?

One of the main complaints about the ACA is that some rural areas, where healthcare has never been profitable due to low population density, are seeing their insurers drop out of the marketplace.  That's the textbook definition of a free market failure, and one easy solution would be for the federal public option to step in.  How could conservatives possibly object to Uncle Sam selling health insurance in markets where literally no one else is willing to do so?  There is no possibility for public/private conflicts to arise, no for-profit corporations could possibly be harmed, and rural red state citizens would have affordable insurance again!  Everyone wins!

Agreed - I work in the health insurance business and I always appreciate DavidAnnArbors contributions on this subject. 

wenchsenior

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Re: What comes after the ACA?
« Reply #3018 on: June 28, 2017, 10:31:22 AM »
"Kill 22 million people."  I love lines like this. Because they add fear to the discussion without any backing of reality. 

Okay, let me offer you some reality.

22 million people will lose access to primary care within the first ten years, and then approximately that many more after that.  Not all of those peole are going to die from lack of healthcare, but SOME of them certainly will.

Some of them will contract fatal diseases, and go undiagnosed until it is too late.  Some of them will have horrible accidents and be maimed for life because they could not afford the surgeries and rehab that they need.  Some of them will fail to get lifestyle intervention that could have saved then from diabetes or skin cancer.  Some mothers and babies will die during childbirth because they had home births with complications instead of trained hospital staff with proper equipment.

It won't be 22 million deaths, but it absolutely WILL be tens of thousands, and maybe hundreds of thousands, of needless and preventable deaths and disfigurements and the only thing that republicans have to do to save them all is... nothing.  Just do nothing.  Just don't strip healthcare access away from millions of people.  Just leave it alone.  Just don't be cruel.

Is that so hard?  Then we can talk about the good republican ideas for how to improve things.  Yes, let's do a better job controlling costs.  Yes, let's figure out how to make insurance more affordable, and fix the subsidy cliffs, and prop up the market in rural areas.  But before we start working on making it better, can we please stop trying to make it worse?

The republican healthcare bill will kill people.  That is not exaggeration.

I think you are still fear mongering about the volume of people dying in the streets. Not having insurance does not eliminate EMTALA laws. That's the problem, fear mongering and insults only rally the people who already agree with you while alienating those who don't.

I do agree with you that the current republican plan will make healthcare unaffordable for the poor by making it more affordable to middle class Americans. I would agree that very likely more poor people will be harmed than middle class Americans will be helped which is why the republican law is shit. I would also argue with you that tax payers deserve affordable healthcare just as much as non-tax payers. I would argue a little more that tax payers may deserve it a little bit more than non-tax payers.

I would also agree with you that we need to work on making healthcare more affordable to everybody and the republicans are adding nothing to that issue.  And believe me, I hate agreeing with just on principle (just kidding.)

Except the current GOP proposal does NOT necessarily do the second part of the bolded statement. Right now, projected premiums and deductibles under the proposed GOP law are expected to INCREASE on nearly all the private market plans of equivalent value under the ACA, with only the hypothetical possibility (not yet tested), that they MIGHT decrease gradually in the future due to competition among insurers.

The GOP criticized the financial burden placed on some middle class households by the ACA as the main reason the law was terrible.  McConnell and Ryan would talk about how deductibles and premiums were far too high for middle class households on the exchanges, leaving people paying very high $ amounts for insurance they couldn't afford to use. Personally, as a supporter of the ACA, I find this a totally fair criticism about the ACA, which needs to be addressed. 

But then, the GOP turned out to be doing a bait and switch, since the law they proposed is not currently projected to make health insurance more affordable for either the poor OR the middle class. It actually will INCREASE the cost for the middle class, at least in the next few years. After that, we do not know. 

So yes, you could hypothetically make insurance 'more affordable' for your middle class self by buying a plan that covers a lot less, but one can definitely question whether that is making insurance more affordable.

nereo

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Re: What comes after the ACA?
« Reply #3019 on: June 28, 2017, 10:39:15 AM »
"Do not confuse complexity with superiority"

sol

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Re: What comes after the ACA?
« Reply #3020 on: June 28, 2017, 10:45:51 AM »
So yes, you could hypothetically make insurance 'more affordable' for your middle class self by buying a plan that covers a lot less, but one can definitely question whether that is making insurance more affordable.

Senate republicans have been playing a very delicate game of semantics on this one.  For some groups of people, the Senate plan would lower premiums by raising deductibles.  Those families would end up spending more for their healthcare, on average, but Ted Cruz went on tv and claimed victory for "lowering premiums" without admitting that he had raised total costs.

Watch them carefully, especially Ted Cruz.  That guy is a snake.

Of course, Trump doesn't care about the semantics.  He doesn't appear to be even trying to avoid being caught in a lie, as usual.

the_fixer

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Re: What comes after the ACA?
« Reply #3021 on: June 28, 2017, 11:02:23 AM »
I haven't dipped my toe into this thread because it's painfully clear to me that a lot of people posting in this thread know far more about healthcare than I do.

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

I will put my hand up in the pro employer sponsored healthcare care camp. Over 20 years in different employer plans.

In the current environment I see employer based insurance is about the closest you can get to single payer.

Everyone at my work pays into it
Some use more some use less
Some have families some do not
I have never heard of anyone getting kicked off or any caps
It costs less (including employer portion) than a similar plan on the ACA would cost. Each year my employer sends a statement showing the total cost so I am aware how much it costs.

I am a low user of the plan and I am ok with paying into our plan knowing that there are people having babies, getting cancer, having strokes becuse if I need it someday I will be happy to know it is there.

I honestly shudder to think what would happen if they got rid of employer sponsored plans. With no single payer I would be forced to the ACA market ( or whatever it is at that point ) or go without.

You want to talk about causing a bunch of people to go without insurance that would certainly do it.

Or are employer sponsored plans bad because they are an unfair advantage given to the employeed class?


Gin1984

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Re: What comes after the ACA?
« Reply #3022 on: June 28, 2017, 11:12:24 AM »
I haven't dipped my toe into this thread because it's painfully clear to me that a lot of people posting in this thread know far more about healthcare than I do.

Yet I have one single question, which I'm hoping can start an informative dialogue: what do you guys think of banning employers offering healthcare as a benefit?

I will put my hand up in the pro employer sponsored healthcare care camp. Over 20 years in different employer plans.

In the current environment I see employer based insurance is about the closest you can get to single payer.

Everyone at my work pays into it
Some use more some use less
Some have families some do not
I have never heard of anyone getting kicked off or any caps
It costs less (including employer portion) than a similar plan on the ACA would cost. Each year my employer sends a statement showing the total cost so I am aware how much it costs.

I am a low user of the plan and I am ok with paying into our plan knowing that there are people having babies, getting cancer, having strokes becuse if I need it someday I will be happy to know it is there.

I honestly shudder to think what would happen if they got rid of employer sponsored plans. With no single payer I would be forced to the ACA market ( or whatever it is at that point ) or go without.

You want to talk about causing a bunch of people to go without insurance that would certainly do it.

Or are employer sponsored plans bad because they are an unfair advantage given to the employeed class?
I don't see the employer plans to be cheaper than ACA on average in my area.  Comparing COBRA to ACA were about the same.

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sol

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Re: What comes after the ACA?
« Reply #3023 on: June 28, 2017, 11:17:18 AM »
I honestly shudder to think what would happen if they got rid of employer sponsored plans. With no single payer I would be forced to the ACA market ( or whatever it is at that point ) or go without.

You want to talk about causing a bunch of people to go without insurance that would certainly do it.

I think the idea is to remove the employer sponsored health insurance but raise your salary by the (tax adjusted) amount your employer was previously paying on your behalf, then auto-enroll every American into a high deductible catastrophic plan with premiums equal to the federal subsidy (making it effectively free), and then let you decide whether to spend your extra salary on additional insurance or something else.

Your insurance costs/coverage wouldn't have to change, but you would have the option of paying less for less insurance.  And we'd all move a little closer to universal coverage.

People like me would benefit.  My spouse and I both work, and we both have access to employer sponsored health insurance, and we both receive less salary because of that benefit.  But we don't both need to buy insurance, because one of us buys a family plan that covers the other one (and our kids), so effectively we both get paid less but only one of us receives the insurance benefit that supposedly offsets our reduced salaries.  Every dual income family lives with this insurance penalty.  I'd much rather have the money, thanks.

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Re: What comes after the ACA?
« Reply #3024 on: June 28, 2017, 11:24:26 AM »
...
You want to talk about causing a bunch of people to go without insurance that would certainly do it.

Or are employer sponsored plans bad because they are an unfair advantage given to the employeed class?
I'm not arguing that the health insurance offered through most employers isn't very good - it typically is.  For those who have this option it's great.  What I'm arguing is that as a system its a very bad idea, for several reasons.
1) it ties your healthcare to an individual employer.  This reduces employee mobility and for those with chronic conditions means they live in fear of losing their jobs.
2) it grossly distorts the tax revenue.  Employers offer health care plans because its a tax write-off (this was intentionally done by Congress several decades ago).  The ACA made it a requirement. Rather than this revenue going towards the government (and allowing us to reduce the nonesensical corporate tax rate) it goes to for-profit companies.  This is the other side of the coin for what employer-sponsored health care plans tend to cost less than corresponding private-market insurance.
3) if you are unemployed, an early retiree etc. you're left out and have to go to individual markets.
4) there's an inherent pricing advantage I simply don't like; large corporations are able to get favorable prices by bringing in several thousand clients. This means the same procedure performed by the same doctor at the same clinic gets reimbursed a different rate for those lucky individuals vs. someone buying individual insurance or paying OOP.
5) for dual-income earners which both have access to family plans they are essentially paying twice for health care coverage (by their employers).  There's no 'opt-out' where you would receive that unused portion as salary or retirement benefits.

those are the big ones that jump to the top of my head - others may chime in with additional reasons.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3025 on: June 28, 2017, 11:27:36 AM »

I do agree with you that the current republican plan will make healthcare unaffordable for the poor by making it more affordable to middle class Americans.

Middle class Americans are not going to find the Senate nor the House changes more affordable.
As you approach age 65 the Senate bill makes the insurance increasingly more and more unaffordable for middle class Americans.

I'd like to add that in 2015 Republican Senator Marco Rubio successfully got Congress not to assist the health insurance companies that were taking a risk in these individual market exchanges - even though these insurance companies were promised compensation if they incurred losses.

wenchsenior

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Re: What comes after the ACA?
« Reply #3026 on: June 28, 2017, 11:36:04 AM »
So yes, you could hypothetically make insurance 'more affordable' for your middle class self by buying a plan that covers a lot less, but one can definitely question whether that is making insurance more affordable.

Senate republicans have been playing a very delicate game of semantics on this one.  For some groups of people, the Senate plan would lower premiums by raising deductibles.  Those families would end up spending more for their healthcare, on average, but Ted Cruz went on tv and claimed victory for "lowering premiums" without admitting that he had raised total costs.

Watch them carefully, especially Ted Cruz.  That guy is a snake.

Of course, Trump doesn't care about the semantics.  He doesn't appear to be even trying to avoid being caught in a lie, as usual.

It's totally the same strategy they took with the semantics of "everyone will have access" to insurance (meaning, no one would be technically excluded from buying...just like no one is technically prevented from purchasing a yacht).

Exflyboy

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Re: What comes after the ACA?
« Reply #3027 on: June 28, 2017, 12:14:26 PM »
I was just having the conversation with a friend yesterday.. i.e, whatever they do to healthcare, SS, Medicaire or any other "entitlement" program.. The thing to make sure is you save up a big pile of moolah so you can insulate yourself from these clowns.

Unless they start taxing wealth that is!

Never been a better argument to be FI as one poster noted above.

ketchup

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Re: What comes after the ACA?
« Reply #3028 on: June 28, 2017, 12:28:13 PM »
4) there's an inherent pricing advantage I simply don't like; large corporations are able to get favorable prices by bringing in several thousand clients. This means the same procedure performed by the same doctor at the same clinic gets reimbursed a different rate for those lucky individuals vs. someone buying individual insurance or paying OOP.
Very much this.  It sure sounds like (on average) the "rich" pay less and the "poor" pay more here.  If you work for some hotshot big company with fancy insurance, the hospital or whatever ends up getting paid less (and therefore you indirectly pay less) than if you work as a manager at the local Dairy Queen franchise and are on a less "negotiated" plan.  That's pretty messed up.  "The rich pay more than the poor" would probably make certain republicans upset, but I don't see how anyone can get behind "The poor pay more than the rich."  At least make it equal.

Maybe this is what that "Cadillac tax" is supposed to combat?  I'll admit I don't know much about that.

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Re: What comes after the ACA?
« Reply #3029 on: June 28, 2017, 12:41:28 PM »
You want to talk about causing a bunch of people to go without insurance that would certainly do it.

Or are employer sponsored plans bad because they are an unfair advantage given to the employeed class?
I'm not arguing that the health insurance offered through most employers isn't very good - it typically is.  For those who have this option it's great.  What I'm arguing is that as a system its a very bad idea, for several reasons.
1) it ties your healthcare to an individual employer.  This reduces employee mobility and for those with chronic conditions means they live in fear of losing their jobs.
My wife and I have moved from job to job as we found better ones or wanted to relocate, we have never really felt tied to one certain company because of insurance. We looked at what they offered and calculated that into our considerations for the new job.

I do not disagree that people feel tied to insurance if deciding to retire or start a business but that is not a failure of the employer sponsored plan it is a failure of the market to be able to provide insurance that is reasonably obtainable. The ACA helped with the early retire but made it harder for someone to start a small business that was making decent money


2) it grossly distorts the tax revenue.  Employers offer health care plans because its a tax write-off (this was intentionally done by Congress several decades ago).  The ACA made it a requirement. Rather than this revenue going towards the government (and allowing us to reduce the nonesensical corporate tax rate) it goes to for-profit companies.  This is the other side of the coin for what employer-sponsored health care plans tend to cost less than corresponding private-market insurance.
Sorry I am not familiar enough with the tax codes and how they are applied to comment on this

3) if you are unemployed, an early retiree etc. you're left out and have to go to individual markets.
Again not a fault of the employees or the employer sponsored plan... Until both side of the aisle come can together and find a way to provide reasonable healthcare and a reasonable rate people will have to decide between working and having the benefit of being part of a risk pool and the benefits that come with it, going without or heading to the open market. Does that suck? Yes but againg that is not the fault of the pool of employess it is the insurance companies, medical pratice and the goverment

4) there's an inherent pricing advantage I simply don't like; large corporations are able to get favorable prices by bringing in several thousand clients. This means the same procedure performed by the same doctor at the same clinic gets reimbursed a different rate for those lucky individuals vs. someone buying individual insurance or paying OOP.
And the US Government / Individual market consist of what percentage of people in the US compared to employer sponsored plans? I think the real question is why they do not use their buying power to negotiate a better deal? Why punish everyone for the failure of the state, government, individual markets to provide the same cost sharing?

5) for dual-income earners which both have access to family plans they are essentially paying twice for health care coverage (by their employers).  There's no 'opt-out' where you would receive that unused portion as salary or retirement benefits.I suppose that my wife and I do get penalized since I carry the insurance for both of us and she does nto get extra for not using her companies insurance but that is a price I am willing to pay to have consistent, good coverage

those are the big ones that jump to the top of my head - others may chime in with additional reasons.
[/quote]

stoaX

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Re: What comes after the ACA?
« Reply #3030 on: June 28, 2017, 12:44:20 PM »
4) there's an inherent pricing advantage I simply don't like; large corporations are able to get favorable prices by bringing in several thousand clients. This means the same procedure performed by the same doctor at the same clinic gets reimbursed a different rate for those lucky individuals vs. someone buying individual insurance or paying OOP.
Very much this.  It sure sounds like (on average) the "rich" pay less and the "poor" pay more here.  If you work for some hotshot big company with fancy insurance, the hospital or whatever ends up getting paid less (and therefore you indirectly pay less) than if you work as a manager at the local Dairy Queen franchise and are on a less "negotiated" plan.  That's pretty messed up.  "The rich pay more than the poor" would probably make certain republicans upset, but I don't see how anyone can get behind "The poor pay more than the rich."  At least make it equal.

Maybe this is what that "Cadillac tax" is supposed to combat?  I'll admit I don't know much about that.

Hospital and doctor prices are generally negotiated at the insurance company level.  Big companies don't necessarily have fancier insurance than small companies. More custom benefit choices perhaps...  And plans with health savings accounts attached to them are favored by rich people for the tax benefits - and those plans require a minimum $1350 deductible so they are nowhere near "Cadillac" plans.  If .the Cadillac tax was ever implemented, union plans would've been hit hard because they tend to have rich benefits. 

the_fixer

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Re: What comes after the ACA?
« Reply #3031 on: June 28, 2017, 12:51:09 PM »
Very much this.  It sure sounds like (on average) the "rich" pay less and the "poor" pay more here.  If you work for some hotshot big company with fancy insurance, the hospital or whatever ends up getting paid less (and therefore you indirectly pay less) than if you work as a manager at the local Dairy Queen franchise and are on a less "negotiated" plan.  That's pretty messed up.  "The rich pay more than the poor" would probably make certain republicans upset, but I don't see how anyone can get behind "The poor pay more than the rich."  At least make it equal.

Maybe this is what that "Cadillac tax" is supposed to combat?  I'll admit I don't know much about that.

Do you really think that the employer sponsored plans are the ones that are not paying the doctors and hospitals fairly? I know for a fact that they love my insurance. They drool over it and love to take my insurance.

If that were the case they would be refusing to take new patients on plan XYZ or doing as little as possible because they were not going to get paid a fair amount like they do with some forms of government based insurance.

And what about all of the people that do not buy insurance, or do not pay their bills? Who pays for them?

« Last Edit: June 28, 2017, 12:54:05 PM by the_fixer »

stoaX

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Re: What comes after the ACA?
« Reply #3032 on: June 28, 2017, 12:59:44 PM »
Very much this.  It sure sounds like (on average) the "rich" pay less and the "poor" pay more here.  If you work for some hotshot big company with fancy insurance, the hospital or whatever ends up getting paid less (and therefore you indirectly pay less) than if you work as a manager at the local Dairy Queen franchise and are on a less "negotiated" plan.  That's pretty messed up.  "The rich pay more than the poor" would probably make certain republicans upset, but I don't see how anyone can get behind "The poor pay more than the rich."  At least make it equal.

Maybe this is what that "Cadillac tax" is supposed to combat?  I'll admit I don't know much about that.

Do you really think that the employer sponsored plans are the ones that are not paying the doctors and hospitals fairly? I know for a fact that they love my insurance. They drool over it and love to take my insurance.

If that were the case they would be refusing to take new patients on plan XYZ or doing as little as possible because they were not going to get paid a fair amount like they do with some forms of government based insurance.

And what about all of the people that do not buy insurance, or do not pay their bills? Who pays for them?

In the health insurance business this phenomena has been recognized as part of the reason the health insurance costs that employers pay has consistently increased over the years - Medicaid and medicare reimbursements to doctors and hospitals has not kept pace with inflation causing the insurance company negotiated prices to increase at a faster pace.  It's passed on to the employers in the form of higher premiums, so employers (and their employees) have shouldered a greater portion of healthcare costs over time. 

dividendman

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Re: What comes after the ACA?
« Reply #3033 on: June 28, 2017, 01:04:53 PM »
And what about all of the people that do not buy insurance, or do not pay their bills? Who pays for them?

You can always mandate (like currently - but perhaps with steeper penalties) people have health insurance.

Some people will still not have health insurance, then, just like with car insurance, there is an extra fee for everyone called "uninsured person fee" that makes up for the rest.

stoaX

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Re: What comes after the ACA?
« Reply #3034 on: June 28, 2017, 02:44:15 PM »
And what about all of the people that do not buy insurance, or do not pay their bills? Who pays for them?

You can always mandate (like currently - but perhaps with steeper penalties) people have health insurance.

Some people will still not have health insurance, then, just like with car insurance, there is an extra fee for everyone called "uninsured person fee" that makes up for the rest.

Yup.  Unfortunately the ACA / Obamacare may have been quite a bit more successful if the penalty for not enrolling would've been steeper and better enforced.  And that would've had the benefit of making the uninsured person portion of the costs smaller.   The current proposals don't seem to address this either. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3035 on: June 28, 2017, 02:56:03 PM »

I'm not arguing that the health insurance offered through most employers isn't very good - it typically is.  For those who have this option it's great. 

You can thank the ACA for making your employer based health insurance even better

"the A.C.A. brought such popular changes as uncapped coverage, inclusion of children up to the age of twenty-six, and requirements that insurers cover not only primary care but also pediatric dental and vision care, mental-health care, and, with no co-payments, preventive care. The Republicans probably won’t risk eliminating these provisions—except for contraceptive coverage..."

Dr. Atul Gawande, surgeon at Brigham and Women’s Hospital, in Boston, also writes that a "Harvard study shows that ACA/Obamacare saves tens of thousands of lives a year.."

http://www.newyorker.com/magazine/2017/03/06/trumpcare-vs-obamacare




EnjoyIt

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Re: What comes after the ACA?
« Reply #3036 on: June 29, 2017, 01:52:51 AM »
I thought you might find this interesting. According to real clear politics about half the US population wants the ACA repealed and the other half doesn't. Not that these polls are supper accurate considering the Trump victory, but still interesting.

https://www.realclearpolitics.com/epolls/other/repeal_of_health_care_law_favoroppose-1947.html

Personally I am not in favor of the republican alternative.

Alim Nassor

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Re: What comes after the ACA?
« Reply #3037 on: June 29, 2017, 02:14:03 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.

It does when you realize that pro-life is a misnomer.  Republicans are pro-punishment, and view children as punishment for sexual indiscretions.

Boy, that's the way to add to a discussion. 

Bucksandreds

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Re: What comes after the ACA?
« Reply #3038 on: June 29, 2017, 04:28:29 AM »
The senate GOP is discussing leaving the 3.8% Obamacare tax on the wealthy in place and using that to support subsidies for the middle class. That's halfway there. Now don't gut Medicaid and they'll be right where they need to be. Obamacare with the small tweaks it's always needed.


wenchsenior

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Re: What comes after the ACA?
« Reply #3039 on: June 29, 2017, 08:12:59 AM »
I thought you might find this interesting. According to real clear politics about half the US population wants the ACA repealed and the other half doesn't. Not that these polls are supper accurate considering the Trump victory, but still interesting.

https://www.realclearpolitics.com/epolls/other/repeal_of_health_care_law_favoroppose-1947.html

Personally I am not in favor of the republican alternative.

:sigh:  Those data are from more than three years ago.

protostache

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Re: What comes after the ACA?
« Reply #3040 on: June 29, 2017, 09:42:02 AM »
The senate GOP is discussing leaving the 3.8% Obamacare tax on the wealthy in place and using that to support subsidies for the middle class. That's halfway there. Now don't gut Medicaid and they'll be right where they need to be. Obamacare with the small tweaks it's always needed.

This whole process will come full circle back to Obamacare 2.0, that would be hilarious.

I just read that Ted Cruz would support an amendment to allow insurers to issue non obamacare compliant plans if they issue 1 obamacare compliant plan in a particular state.  I could see that as a way for republicans to get through this mess.

Get through the political mess and destroy the ACA at the same time. That one compliant plan becomes a de facto high risk pool, federally funded for everyone not on Medicaid expansion, up to just 350% of FPL. Everyone else is stuck because that one plan is going to be atrociously expensive without subsidies and non-compliant plans won't be issued for people with pre-existing conditions.

EnjoyIt

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Re: What comes after the ACA?
« Reply #3041 on: June 29, 2017, 10:27:20 AM »
I thought you might find this interesting. According to real clear politics about half the US population wants the ACA repealed and the other half doesn't. Not that these polls are supper accurate considering the Trump victory, but still interesting.

https://www.realclearpolitics.com/epolls/other/repeal_of_health_care_law_favoroppose-1947.html

Personally I am not in favor of the republican alternative.

I believe that's 1 year ago not 3. And it still represented some of the views of the people. About 50/50 on repealing the ACA.
:sigh:  Those data are from more than three years ago.

Inaya

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Re: What comes after the ACA?
« Reply #3042 on: June 29, 2017, 10:40:04 AM »
I thought you might find this interesting. According to real clear politics about half the US population wants the ACA repealed and the other half doesn't. Not that these polls are supper accurate considering the Trump victory, but still interesting.

https://www.realclearpolitics.com/epolls/other/repeal_of_health_care_law_favoroppose-1947.html

Personally I am not in favor of the republican alternative.

:sigh:  Those data are from more than three years ago.
I have nothing to add. Just want to let you know I appreciate your proper conjugation for the latin plural.
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wenchsenior

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Re: What comes after the ACA?
« Reply #3043 on: June 29, 2017, 11:33:50 AM »
I thought you might find this interesting. According to real clear politics about half the US population wants the ACA repealed and the other half doesn't. Not that these polls are supper accurate considering the Trump victory, but still interesting.

https://www.realclearpolitics.com/epolls/other/repeal_of_health_care_law_favoroppose-1947.html

Personally I am not in favor of the republican alternative.

I believe that's 1 year ago not 3. And it still represented some of the views of the people. About 50/50 on repealing the ACA.
:sigh:  Those data are from more than three years ago.

Right, but we all know that. It's been endlessly reported on and it's been the same since the ACA was passed all those years ago.  It's been about a 45/55 split against the ACA more or less since its inception.  Most big legislation since ~2000 that has strong partisan support in congress ends up in a split of approx 50:50 support along party lines. Almost no conservatives supported the ACA; most liberals did; and there was a notable fraction of liberals that did not support the ACA because they only want public option or single payer. (As slightly left of center type, I support the ACA ONLY over GOP alternatives, but NOT over offering a public option...so I'm wishy washy in support).  And the independents split as well. So the final polling consistently has run very slightly underwater.

The only thing of interest about the ACA's popularity is that once the GOP took power in January and talking about alternatives, ACA's popularity suddenly jumped radically for the first time since its passage, and now is consistently running about 5-10 points above water in approval.  Also of interest is that the GOP's proposed alternatives (so far) are shockingly unpopular for major legislation, which means even a fair number of conservatives aren't supporting them.


Inaya

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Re: What comes after the ACA?
« Reply #3044 on: June 29, 2017, 12:00:51 PM »
I thought you might find this interesting. According to real clear politics about half the US population wants the ACA repealed and the other half doesn't. Not that these polls are supper accurate considering the Trump victory, but still interesting.

https://www.realclearpolitics.com/epolls/other/repeal_of_health_care_law_favoroppose-1947.html

Personally I am not in favor of the republican alternative.

I believe that's 1 year ago not 3. And it still represented some of the views of the people. About 50/50 on repealing the ACA.
:sigh:  Those data are from more than three years ago.

Right, but we all know that. It's been endlessly reported on and it's been the same since the ACA was passed all those years ago.  It's been about a 45/55 split against the ACA more or less since its inception.  Most big legislation since ~2000 that has strong partisan support in congress ends up in a split of approx 50:50 support along party lines. Almost no conservatives supported the ACA; most liberals did; and there was a notable fraction of liberals that did not support the ACA because they only want public option or single payer. (As slightly left of center type, I support the ACA ONLY over GOP alternatives, but NOT over offering a public option...so I'm wishy washy in support).  And the independents split as well. So the final polling consistently has run very slightly underwater.

The only thing of interest about the ACA's popularity is that once the GOP took power in January and talking about alternatives, ACA's popularity suddenly jumped radically for the first time since its passage, and now is consistently running about 5-10 points above water in approval.  Also of interest is that the GOP's proposed alternatives (so far) are shockingly unpopular for major legislation, which means even a fair number of conservatives aren't supporting them.
I wonder if part of the increased popularity is because some people are now actually bothering to learn what the ACA actually does and--lo and behold--they actually want it after all.
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Luck12

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Re: What comes after the ACA?
« Reply #3045 on: June 29, 2017, 12:15:33 PM »
I wonder if part of the increased popularity is because some people are now actually bothering to learn what the ACA actually does and--lo and behold--they actually want it after all.

No doubt.  Just anecdotally, I have friends and family who have graduate degrees in sciences who didn't know about the removal of caps on annual and lifetime limits until it came up recently.   Not to mention I'm sure vast majority of people don't know about Rubio leading the charge to not fund risk corridors.   Let's face it, majority of public is either just stupid or doesn't care until it happens to them. 

doggyfizzle

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Re: What comes after the ACA?
« Reply #3046 on: June 29, 2017, 12:30:29 PM »
Every dual income family lives with this insurance penalty.  I'd much rather have the money, thanks.

My wife's employer does just that; because she elects not to take medical insurance (because mine is better and less expensive), she gets an extra $700/paycheck in lieu of medical insurance - 90% of the employer contribution to medical insurance.  I wouldn't say this perk is common, but it is definitely appreciated and makes you realize how expensive the total (employer+employee) cost of medical insurance can be even by "larger" employer standards.

Inaya

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Re: What comes after the ACA?
« Reply #3047 on: June 29, 2017, 12:40:07 PM »
Every dual income family lives with this insurance penalty.  I'd much rather have the money, thanks.

My wife's employer does just that; because she elects not to take medical insurance (because mine is better and less expensive), she gets an extra $700/paycheck in lieu of medical insurance - 90% of the employer contribution to medical insurance.  I wouldn't say this perk is common, but it is definitely appreciated and makes you realize how expensive the total (employer+employee) cost of medical insurance can be even by "larger" employer standards.
I had a previous employer (2013-2014 ish) who did something similar, but bad. If you accepted their insurance, they would add a very stiff surcharge to your premium if your spouse was employed by a company who also offered insurance. So if I was on my company's insurance, but my husband's company offered crappy insurance, I'd have to pay something like an additional $150/mo on my premiums (whether or not he was actually on my insurance).
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mm1970

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Re: What comes after the ACA?
« Reply #3048 on: June 29, 2017, 12:59:12 PM »
Every dual income family lives with this insurance penalty.  I'd much rather have the money, thanks.

My wife's employer does just that; because she elects not to take medical insurance (because mine is better and less expensive), she gets an extra $700/paycheck in lieu of medical insurance - 90% of the employer contribution to medical insurance.  I wouldn't say this perk is common, but it is definitely appreciated and makes you realize how expensive the total (employer+employee) cost of medical insurance can be even by "larger" employer standards.
Hm.  I've thought of it that way.  I guess a few years ago, when my second kid was born, we elected double coverage.

My husband's HSA and HDHP covered everyone fully (no premiums, and the company provided half of the HSA amount).  When I found out I was pregnant (in Oct), I elected to join my company's HMO for me and the kids.

That embarked on a few years of almost zero medical costs, aside from my $100 a month premiums.   Kids and I were primarily covered by my HMO (I did not cover my husband).  Husband's insurance covered the co-pays.  That $20,000+ surgery my baby had?  Cost us $125 from the HSA.   It wasn't until this year that I opted to give myself a raise and drop the kids from my insurance, because our costs went up (company reclassified from medium sized to small).  So nobody is double covered anymore.

Of course I've had exactly one raise in 5.5 years, but that's another story.

Hubby's company does not provide vision or dental, so I cover the family for those.

Inaya

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Re: What comes after the ACA?
« Reply #3049 on: June 29, 2017, 01:24:02 PM »
Every dual income family lives with this insurance penalty.  I'd much rather have the money, thanks.

My wife's employer does just that; because she elects not to take medical insurance (because mine is better and less expensive), she gets an extra $700/paycheck in lieu of medical insurance - 90% of the employer contribution to medical insurance.  I wouldn't say this perk is common, but it is definitely appreciated and makes you realize how expensive the total (employer+employee) cost of medical insurance can be even by "larger" employer standards.
I had a previous employer (2013-2014 ish) who did something similar, but bad. If you accepted their insurance, they would add a very stiff surcharge to your premium if your spouse was employed by a company who also offered insurance. So if I was on my company's insurance, but my husband's company offered crappy insurance, I'd have to pay something like an additional $150/mo on my premiums (whether or not he was actually on my insurance).

That is bizarre, I've never heard of something like that.  How would they enforce something like that?  You would need to report to your employer your spouses health insurance availability?  What if they gained/lost insurance availability mid-stream?
I don't remember the details, since I wasn't married at the time. But from my recollection, it was self-reported. So you could probably lie about it, but there was always the chance they would catch you. And maybe I remember a huge penalty if they did catch you? I only remember it at all because I was horrified by it.

So glad to be gone from that company. When I gave notice, my boss begged me not to go. One month after I left, my whole (former) team was laid off. Yeah dodged that bullet.
« Last Edit: June 29, 2017, 01:26:20 PM by Inaya »
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