Author Topic: What comes after the ACA?  (Read 275422 times)

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3350 on: July 26, 2017, 07:46:09 AM »
I think the penalty on the individual mandate was supposed to get higher over time.

While currently at $695, the penalty seems to be toothless, but if someone discovers that the penalty is not much less than the cost of having an insurance plan for the year after subsidies kick in, then it might just be worth having the insurance anyway. This individual is likely to be a healthier young person who doesn't make a high income, and this group probably helps to stabilize the risk pool of the insurance market.

Also, if you scroll down to the middle of page 56 I posted a graph (from a healthcare journalist's blog) of how the ACA requires all three legs of the stool to exist in order to have a stable health insurance market. It shows where the mandate fits into that.
https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/2750/
« Last Edit: July 26, 2017, 07:51:26 AM by DavidAnnArbor »

shenlong55

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Re: What comes after the ACA?
« Reply #3351 on: July 26, 2017, 07:57:05 AM »
I think the penalty on the individual mandate was supposed to get higher over time.

While currently at $695, the penalty seems to be toothless, but if someone discovers that the penalty is not much less than the cost of having an insurance plan for the year after subsidies kick in, then it might just be worth having the insurance anyway. This individual is likely to be a healthier young person who doesn't make a high income, and this group probably helps to stabilize the risk pool of the insurance market.

Also, if you scroll down to the middle of page 56 I posted a graph (from a healthcare journalist's blog) of how the ACA requires all three legs of the stool to exist in order to have a stable health insurance market. It shows where the mandate fits into that.
https://forum.mrmoneymustache.com/welcome-to-the-forum/what-comes-after-the-aca/2750/

I thought the penalty was $695 OR 2.5% of your AGI, whichever is higher.

jim555

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Re: What comes after the ACA?
« Reply #3352 on: July 26, 2017, 07:59:57 AM »
I believe the tax is the greater of $695 or 2.5% of income.  That is not a small tax.  A $50,000 income would have a $1,250 tax.
As long as you never get a tax refund the IRS has no way to collect it.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3353 on: July 26, 2017, 08:06:18 AM »
Oh yes I stand corrected about the penalty.

DarkandStormy

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Re: What comes after the ACA?
« Reply #3354 on: July 26, 2017, 08:23:08 AM »
https://www.vox.com/policy-and-politics/2017/7/25/15880262/republicans-health-hearings-repeal

There were 22 public Senate hearings in 2009 on the ACA (and 22 public House hearings as well).

In 2017, the GOP held ZERO public Senate hearings on Repeal/Repeal & Replace/Trumpcare.

**** the GOP.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3355 on: July 26, 2017, 08:29:41 AM »
The NY Times editorial really spells out the sabotage of health care repeal,

"Republican senators sent a troubling message to insurers, doctors and hospitals. Many insurers must soon finalize rates and policies for next year, and experts say some might decide not to participate because they think the A.C.A. insurance marketplaces will go away, or jack up premiums due to the political uncertainty."

The Senate’s Health Care Travesty
https://nyti.ms/2tI9BDe

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3356 on: July 26, 2017, 08:41:44 AM »
Today Senators have to vote on spur of the moment amendments that they barely understand and which have not been vetted by independent experts nor scored by the CBO.
It's a vote a rama effort by McConnell to get 50 votes on a "skinny" repeal/replace.

WhiteTrashCash

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Re: What comes after the ACA?
« Reply #3357 on: July 26, 2017, 08:50:21 AM »
On the plus side for us, I think that Vanguard's health sector index fund could be deeply discounted soon after the shenanigans in Congress crush healthcare stocks, so we could all get some cheap shares. Silver linings and everything.

DarkandStormy

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Re: What comes after the ACA?
« Reply #3358 on: July 26, 2017, 08:55:04 AM »
On the plus side for us, I think that Vanguard's health sector index fund could be deeply discounted soon after the shenanigans in Congress crush healthcare stocks, so we could all get some cheap shares. Silver linings and everything.

Haha legitimately just texted a friend I was considering cashing out on VHT today and waiting for it to drop to buy back in.
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sol

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Re: What comes after the ACA?
« Reply #3359 on: July 26, 2017, 11:02:57 AM »
As of right now, it looks like the Senate Republicans will successfully pass some version of the skinny bill, repealing only the most unpopular parts of the ACA (the mandates that make the premiums affordable).  Not because that's what they want, but because that allows them to take the bill to conference committee, behind closed doors, where they can then "resolve the differences" between the Senate and the House bills and produce pretty much any bill they want to without needing a majority.

This tactic hinges on them being able to pass something, anything, through the Senate with 51 votes.  It looks like they could pass a bill changing the name from the ACA to the AHCA and making no other changes, and still get to take it to conference committee.

So yea, I'm still predicting they pass a "repeal" and then declare victory, regardless of what actually changes in the law.

brooklynguy

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Re: What comes after the ACA?
« Reply #3360 on: July 26, 2017, 11:32:25 AM »
Not because that's what they want, but because that allows them to take the bill to conference committee, behind closed doors, where they can then "resolve the differences" between the Senate and the House bills and produce pretty much any bill they want to without needing a majority.

The end-product of conference committee reconciliation negotiations would still need to be approved by a majority of both chambers.  By all logic, one would think that if Senate Republicans can't come up with a plan amongst themselves that can win the approval a majority of their members, then there's no way a joint committee with the House (with which Senate Republicans have even bigger policy differences than amongst themselves) can either.  However, logic and reason appear to have lost all predictive power in this process, so I won't rule anything out.

GenXbiker

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Re: What comes after the ACA?
« Reply #3361 on: July 26, 2017, 11:35:50 AM »
Another thing, they can stop paying CSR at anytime.   The failed Senate bill would have extended those payments for two years, and the last I heard, they are going to be paid this month.   If that stops, that's another negative effect on premiums and providers withdrawing from specific markets.

Mr. Green

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Re: What comes after the ACA?
« Reply #3362 on: July 26, 2017, 02:10:34 PM »
So the vote didn't pass on repeal only. With all the last minute changes, I'm confused as to what exactly they voted on. Was this the "skinny repeal"?
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sol

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Re: What comes after the ACA?
« Reply #3363 on: July 26, 2017, 02:25:21 PM »
So the vote didn't pass on repeal only. With all the last minute changes, I'm confused as to what exactly they voted on. Was this the "skinny repeal"?

No, skinny vote will come at the end iff they can't manage to pass anything else more severe.  I think that what just failed was "full ACA repeal with a 2 year delay to come up with a replacement".

ZiziPB

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Re: What comes after the ACA?
« Reply #3364 on: July 26, 2017, 02:47:40 PM »
What a painful process this is!  The Dems must be bored out of their minds, since they already know how they are voting in each instance.  And as far as I can tell, there is no substantive discussion of any real issues, just a push towards the lowest common denominator for the Repubs.  Ugh!



tyort1

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Re: What comes after the ACA?
« Reply #3365 on: July 26, 2017, 04:08:10 PM »
Good lord, it's like watching The Office, except that every single Republican is Michael Scott.
Frugalite in training.

jim555

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Re: What comes after the ACA?
« Reply #3366 on: July 27, 2017, 02:05:54 PM »
Does anyone understand the process?  I am reading the Senate votes, if it passes it goes to the House/Senate conference, then to the House.  Then I read no guarantee it goes back to the Senate, but straight to the President for signing.  What kind of process is this??

DarkandStormy

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Re: What comes after the ACA?
« Reply #3367 on: July 27, 2017, 02:13:14 PM »
http://www.cnn.com/videos/politics/2017/07/27/report-alaska-warned-health-care-no-vote-ip.cnn

Oh good, the administration is intimidating Senators for votes.
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dividendman

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Re: What comes after the ACA?
« Reply #3368 on: July 27, 2017, 02:20:50 PM »
Does anyone understand the process?  I am reading the Senate votes, if it passes it goes to the House/Senate conference, then to the House.  Then I read no guarantee it goes back to the Senate, but straight to the President for signing.  What kind of process is this??

If the bill changes in conference both houses have to pass it again.

If the senate version doesn't change, then only the house would have to pass it (because the Senate already passed it).

Mr. Green

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Re: What comes after the ACA?
« Reply #3369 on: July 27, 2017, 02:52:01 PM »
"It appears that the Republican leader has a last-ditch plan waiting in the wings," Murray said on the floor. "As soon as they have an official score from the CBO, which could be hours from now, in the dead of night, Sen. McConnell will bring forward legislation that Democrats, patients and families, and even many Senate Republicans, have not seen and try to pass it before anyone can so much as blink."

http://www.cnn.com/2017/07/27/politics/health-care-debate-thursday/index.html

The Senate Majority Leader is ready to cold cock the American public. I like your style, Senator! </sarcasm>
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lbmustache

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Re: What comes after the ACA?
« Reply #3370 on: July 27, 2017, 02:59:52 PM »
Skinny repeal is a total disaster - who exactly wins in this scenario besides this looney tunes admin who can claim they finally "did something."

Healthy people drop out, which means the average healthy insured citizen has their premiums go up (to insure less people...), or they too drop out and the whole insurance system is just astronomical for the sick. Or the uninsured get sick and now have massive medical debt.

jim555

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Re: What comes after the ACA?
« Reply #3371 on: July 27, 2017, 03:15:23 PM »
Skinny repeal is a total disaster - who exactly wins in this scenario besides this looney tunes admin who can claim they finally "did something."

Healthy people drop out, which means the average healthy insured citizen has their premiums go up (to insure less people...), or they too drop out and the whole insurance system is just astronomical for the sick. Or the uninsured get sick and now have massive medical debt.
That is the whole point, undermine it, then say "look it isn't working we need to get rid of it".  They are doing everything they can to wreck it.

brooklynguy

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Re: What comes after the ACA?
« Reply #3372 on: July 27, 2017, 04:02:08 PM »
Skinny repeal is a total disaster - who exactly wins in this scenario besides this looney tunes admin who can claim they finally "did something."

Healthy people drop out, which means the average healthy insured citizen has their premiums go up (to insure less people...), or they too drop out and the whole insurance system is just astronomical for the sick. Or the uninsured get sick and now have massive medical debt.
That is the whole point, undermine it, then say "look it isn't working we need to get rid of it".  They are doing everything they can to wreck it.

Skinny repeal is just a procedural gambit intended to jumpstart joint chamber conference committee negotiations, which Senate Republicans hope will somehow magically give birth to more comprehensive legislation that can win majority approval despite their failure to come up with any themselves.  Several GOP senators are now on record as supportive of skinny repeal only if they receive assurances that it will be taken to conference and not simply passed by the House.  In other words, absurdly, they will only vote to pass the bill if they can be assured that it will not become law.

Channel-Z

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Re: What comes after the ACA?
« Reply #3373 on: July 27, 2017, 08:30:17 PM »
This is basically what happened here in Kansas with income tax cuts in 2012. The state house passed a draconian bill.  The state senate wanted a conference, and passed the bill to move it forward. The conference never happened and the state house passed the senate's bill, which the Governor gleefully signed. Presto, bad bill becomes bad law.

shuffler

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Re: What comes after the ACA?
« Reply #3374 on: July 27, 2017, 11:59:17 PM »
Skinny repeal failed, receiving only 49 votes.  Holdouts were John McCain, Susan Collins and Lisa Murkowski.

https://www.nytimes.com/2017/07/27/us/politics/senate-health-care-vote.html
« Last Edit: July 28, 2017, 12:00:56 AM by shuffler »

Exflyboy

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Re: What comes after the ACA?
« Reply #3375 on: July 28, 2017, 03:52:08 AM »
So are we done now?

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3376 on: July 28, 2017, 04:21:32 AM »
So are we done now?

McConnell says it's "time to move on."  I guess we'll see if they can really let go of their repeal fetish.  Meanwhile, Trump is doubling down on his vow to sabotage the ACA.
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protostache

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Re: What comes after the ACA?
« Reply #3377 on: July 28, 2017, 04:23:02 AM »
So are we done now?

Not until the Democratic Party holds at least one house of congress. Because until then the Republicans have as many chances as they dare to pass their horseshit legislation.

Exflyboy

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Re: What comes after the ACA?
« Reply #3378 on: July 28, 2017, 05:13:51 AM »
What a bunch of clowns.. These are our "leaders".. God help us!

jim555

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Re: What comes after the ACA?
« Reply #3379 on: July 28, 2017, 05:17:23 AM »
Can't wait for the tweetstorm today.  Sad!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3380 on: July 28, 2017, 06:17:04 AM »
Skinny repeal fell short because it fell short of our promise to repeal & replace Obamacare w/ meaningful reform https://t.co/tZISIvccOO
— John McCain (@SenJohnMcCain) July 28, 2017

After the tally was final, Mr. Trump tweeted:

3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!
— Donald J. Trump (@realDonaldTrump) July 28, 2017

jim555

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Re: What comes after the ACA?
« Reply #3381 on: July 28, 2017, 06:21:26 AM »
McCain's revenge?  I like how he let the process go forward then quashed it for maximum damage.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3382 on: July 28, 2017, 06:28:34 AM »
"Mr. Trump directed Interior Secretary Ryan Zinke to call Ms. Murkowski, the Alaska senator, to remind her of issues affecting her state that are controlled by the Interior Department, according to people familiar with the call, who requested anonymity because they were not authorized to speak to the press.
Ms. Murkowski confirmed to reporters that she had received a call from Mr. Zinke, but she declined to describe the details. However, people familiar with the call described her reaction to it as “furious.”"

Senate Rejects Slimmed-Down Obamacare Repeal as McCain Votes No
https://nyti.ms/2h7ofOF

ZiziPB

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Re: What comes after the ACA?
« Reply #3383 on: July 28, 2017, 07:22:42 AM »
I was initially disappointed with McCain for the "yes" vote to proceed but he should be applauded for exposing the totally insane voting process as Republicans were tripping over themselves to pass something, anything, just so that Trump could have his win and a signing ceremony.  And also good for him for calling it like it is and pointing out that the Republican proposal fell in the end because of its complete lack of substance.

Now would be a good time to really try to fix ACA, although having seen the debacle so far, I doubt that there are enough sane Republicans to actually do the right thing.  Trump is hell bent on sabotaging it, so may need to wait until 2018 for something to change for the better.



Bateaux

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Re: What comes after the ACA?
« Reply #3384 on: July 28, 2017, 07:35:11 AM »
Thank you Senator John McCain.  Your hero status is restored.
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brooklynguy

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Re: What comes after the ACA?
« Reply #3385 on: July 28, 2017, 07:58:35 AM »
Thank you Senator John McCain.  Your hero status is restored.

I'm glad McCain helped to kill skinny repeal, but his behavior was emblematic of the entire batshit crazy process.  In his speech on Tuesday railing against the Republican "Trumpcare" bill--both its substance and the underhanded process behind it--he stated, in no uncertain terms:

Quote from: John McCain
I voted for the motion to proceed to allow debate to continue and amendments to be offered. I will not vote for the bill as it is today. It's a shell of a bill right now. We all know that. I have changes urged by my state's governor that will have to be included to earn my support for final passage of any bill. I know many of you will have to see the bill changed substantially for you to support it.

And then a few hours later, in direct violation of this explicit promise, with no material changes made to the bill, he voted in favor of it.  Words have lost all meaning.

madgeylou

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Re: What comes after the ACA?
« Reply #3386 on: July 28, 2017, 08:48:50 AM »
McCain's a grandstanding old battleax.

I'm glad he finally did the right thing but it's Collins and Murkowski and the Indivisibles who really saved this thing.

Paul der Krake

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Re: What comes after the ACA?
« Reply #3387 on: July 28, 2017, 09:22:29 AM »
Watched this dumpster fire last night. McConnell looked so fucking done with the whole thing. A part of him is probably glad it didn't pass, given how widely unpopular all the GOP bills have been.

All this political capital wasted on nothing.

In other news, have you guys ever tried running the subsidies calculator for Alaska, compared to any other state? It's an insane sweetheart deal because of how much delivering medicine sucks up there. A family of 3 with parents in their 30s making 50k has a monthly premium in the single digits, down from $1500/month...

Exflyboy

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Re: What comes after the ACA?
« Reply #3388 on: July 28, 2017, 09:37:23 AM »
Down here in Corvallis for two of us ,(52 &55) on $35k income we get $811/m subsidy.. turns into $36/m for the bronze premium.

dividendman

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Re: What comes after the ACA?
« Reply #3389 on: July 28, 2017, 09:42:38 AM »
Murkowski, Collins and McCain should just become independents and caucus with the Dems so there is some true check on presidential powers.

McCain and Collins aren't running again, so no repercussions. Actually Collins probably has a better chance at becoming the gov of maine if she did that (ran as an independent and stuck it to Trump).

And the fact that several of their republican office-holder colleagues seem to hate them because they're female should give them a boost.

Sigh... one can dream/hope.

Bucksandreds

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Re: What comes after the ACA?
« Reply #3390 on: July 28, 2017, 09:46:05 AM »
The obvious solution to the problem of people making just a little too much to qualify for subsidies is to raise the income level that earns a subsidy. You pay it by raising the obamacare taxes.  Won't happen because 3 repubs in the senate would have to vote for it, like 18 in the house and Trump. Then allow people in counties without a plan on the exchange to use some or all of their exchange subsidy off the exchange and you have real solutions to the 2 biggest problems.

PS. I prefer single payer to this all but the above would technically keep the whole thing moving along.

meatface

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Re: What comes after the ACA?
« Reply #3391 on: July 28, 2017, 09:59:32 AM »
I was initially disappointed with McCain for the "yes" vote to proceed but he should be applauded for exposing the totally insane voting process as Republicans were tripping over themselves to pass something, anything, just so that Drumpf could have his win and a signing ceremony.  And also good for him for calling it like it is and pointing out that the Republican proposal fell in the end because of its complete lack of substance.

Now would be a good time to really try to fix ACA, although having seen the debacle so far, I doubt that there are enough sane Republicans to actually do the right thing.  Drumpf is hell bent on sabotaging it, so may need to wait until 2018 for something to change for the better.

I think we're still in the things-will-get-worse-before-they-get-better phase.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3392 on: July 28, 2017, 10:10:18 AM »
I was initially disappointed with McCain for the "yes" vote to proceed but he should be applauded for exposing the totally insane voting process as Republicans were tripping over themselves to pass something, anything, just so that Drumpf could have his win and a signing ceremony.  And also good for him for calling it like it is and pointing out that the Republican proposal fell in the end because of its complete lack of substance.

Now would be a good time to really try to fix ACA, although having seen the debacle so far, I doubt that there are enough sane Republicans to actually do the right thing.  Drumpf is hell bent on sabotaging it, so may need to wait until 2018 for something to change for the better.

I think we're still in the things-will-get-worse-before-they-get-better phase.

Yes that's a real sensible solution, and sane people would try to enact that.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #3393 on: July 28, 2017, 10:35:39 AM »
You have to read between the lines.  The Senators all talk to each other. I wouldn't be surprised if he made a deal with them to position their no votes so that none of the 3 bills pass, but that all of them have something they can say they voted for in case their conservative base gets angry.  McCain taking the final no vote shielded Heller from having to do it, as McCain probably won't live to run again he was the obvious sacrifice.

McCain obviously remembers Trump saying he was not a war hero, and he enacted his revenge as he is literally dying.  This is poetic justice in my opinion.
[/quote]

Completely agree with your analysis. McCain took the Glory (and the Rancor) so that other sane Republicans wouldn't have the take the Axe later.  It's a dirty business this political game.

lbmustache

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Re: What comes after the ACA?
« Reply #3394 on: July 28, 2017, 11:53:46 AM »
I believe one of the Republican reps spoke to the media today and said that they are going to try and get another bill going in a couple of weeks. They really just need to move on (or - horror - work with Dems) from this IMO. 7 years of nothing, 7 months of wasted time.

Mr. Green

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Re: What comes after the ACA?
« Reply #3395 on: July 28, 2017, 11:56:55 AM »
They have to move on to the budget at some point. They can only delay that so long.
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jim555

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Re: What comes after the ACA?
« Reply #3396 on: July 28, 2017, 12:55:05 PM »
Down here in Corvallis for two of us ,(52 &55) on $35k income we get $811/m subsidy.. turns into $36/m for the bronze premium.
Pretty good deal.  NY has some great plans for <=200 FPLers.

New York Essential Plan 1 150-200% FPL
$20 Monthly Premium
$0 Deductable
$2,000 MaxOOP
$25 Specialist
$15 PCP
$6/$15/$30 Tiers Rx

Exflyboy

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Re: What comes after the ACA?
« Reply #3397 on: July 28, 2017, 02:18:19 PM »
That's awesome!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3398 on: July 28, 2017, 06:05:19 PM »
So where do we go from here?

Sabotage ?

"It would be foolish to underestimate the administration, which has the power to do substantial damage. The administration could stop making subsidy payments to insurance companies authorized by the A.C.A. to help reduce deductibles for lower-income people. And it could stop enforcing the penalty for people who do not buy insurance, which would result in fewer young and healthy people signing up, leading insurers to stop offering policies in some parts of the country."

The A.C.A. Lives Another Day, but It Is Not Yet Safe
https://nyti.ms/2u5GyVL

jim555

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Re: What comes after the ACA?
« Reply #3399 on: July 29, 2017, 09:43:14 AM »
Trump tweet: "If Republicans are going to pass great future legislation in the Senate, they must immediately go to a 51 vote majority, not senseless 60..."

Dude, you got 49 votes
Math is hard.

He is tweeting again this morning about getting rid of the filibuster.