Author Topic: What comes after the ACA?  (Read 275420 times)

jim555

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Re: What comes after the ACA?
« Reply #3400 on: July 31, 2017, 07:12:27 AM »
Hopefully he keeps beating the dead horse and totally expend all his political capital. 

protostache

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Re: What comes after the ACA?
« Reply #3401 on: July 31, 2017, 07:26:12 AM »
I'm have alot of trouble figuring out the end game now.  Trump is threatening all kinds of stuff in a hissy fit if congress doesn't repeal Obamacare.  Here is the list:

1. End the obamacare subsidies for poor people
2. End the subsidies for members of congress
3. Won't let congress work on budget and debt ceiling until Obamacare is repealed.

The third one is scary.  Is he that crazy to tank the world economy over this?

Number one is illegal. The law says in black and white that the insurance companies are owed that money but either through a mistake in drafting or deliberate sabotage an explicit appropriation never made it into the final ACA bill or the "sidecar" reconciliation bill (HCERA) that fixed a number of things. The insurance companies would sue for what they're owed and they would win.

Number two is legal because Congressional staffers get an employer match for their health insurance via an Obama-era regulation. Ending it would require him to go through the whole rules-making process with public comments and the whole shebang, but he (technically Price as head of HHS) could do it.

He can't do number three but he doesn't know that because he doesn't understand basic civics. The Executive branch and Legislative branch are equal. He's not their boss and in a lot of ways a sitting senator has more day-to-day power to effect change than the president does. The Senate, in particular, is extremely protective of their individual and collective power and doesn't appreciate process moments from the peanut gallery.

There is a way for the executive to try to influence how the Senate goes about it's business but it would not go well for them. At the start of business every day the presiding officer of the Senate recognizes the majority leader (McConnell) who then sets the agenda for the day. Pence can choose to be the presiding officer whenever he wants, and he could just recognize someone else to set the agenda. That would almost inevitably result in McConnell raising a point of order and getting a majority vote (probably unanimous) to ignore the presiding officer, further eroding the set of norms and traditions that the Senate has built up over the last 240 years.

BuildingFrugalHabits

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Re: What comes after the ACA?
« Reply #3402 on: July 31, 2017, 07:41:00 AM »
Hopefully, our leaders can start to act to fix and improve the current system in a bipartisan manner. I thought this was encouraging:

http://www.politico.com/story/2017/07/30/obamacare-health-care-stabilization-241151

Republicans and democrats working together to stabilize the insurance markets under the current ACA.  Not sure how they plan to tackle the affordability problem. 

Mr. Green

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Re: What comes after the ACA?
« Reply #3403 on: July 31, 2017, 08:33:45 AM »
Maybe someone can clear up a CSR question I have. If Trump were to cease making CSR payments moving forward, the real effect on subsidized purchasers of ACA plans would be nothing, correct? The total cost might go up but their contribution is limited by income so all he would be doing is increasing the amount the government is paying? So in effect he's cutting one payment only to increase another? If that's accurate it seems kinda stupid and ineffective. Granted it hurts the 20% of subscribers who get no subsidy but it still seems like a weak play. Am I missing something?
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sol

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Re: What comes after the ACA?
« Reply #3404 on: July 31, 2017, 08:43:41 AM »
Maybe someone can clear up a CSR question I have. If Trump were to cease making CSR payments moving forward, the real effect on subsidized purchasers of ACA plans would be nothing, correct? The total cost might go up but their contribution is limited by income so all he would be doing is increasing the amount the government is paying? So in effect he's cutting one payment only to increase another? If that's accurate it seems kinda stupid and ineffective. Granted it hurts the 20% of subscribers who get no subsidy but it still seems like a weak play. Am I missing something?

It's about optics, not dollars.  Cutting the CSR payments would (eventually) raise the total listed premiums the insurers would charge.  Republicans have demonstrated over and over again that they don't really care about what people pay for healthcare, they only care about the total premiums (because those go up, even though people aren't actually paying any more for insurance).

Trump is just following the same playbook.  He wants premiums to rise so that he can claim the ACA is failing, and he'll conveniently forget to mention that premiums will, by law, hold steady for people under 400% of the Federal Poverty Level. 

Maybe that's the point?  Maybe he's only speaking to his rich and self-employed base voters, who might actually pay rising premiums because they are too wealthy to qualify for subsidies (over $114,000 this year, for my family).

jim555

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Re: What comes after the ACA?
« Reply #3405 on: July 31, 2017, 08:54:10 AM »
I read that when all is said and done it will cost the Feds more not to pay the CSRs since the subsidies will increase due to higher premiums.  It will hurt the higher income people the most since they will pay more with no offsetting subsidy.  The insurers will certainly sue the Feds and probably win.  So the exercise is to create havoc for no good reason and hurt a lot of people.  Just another day in Trump-topia.

protostache

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Re: What comes after the ACA?
« Reply #3406 on: July 31, 2017, 09:22:15 AM »
I read that when all is said and done it will cost the Feds more not to pay the CSRs since the subsidies will increase due to higher premiums.  It will hurt the higher income people the most since they will pay more with no offsetting subsidy.  The insurers will certainly sue the Feds and probably win.  So the exercise is to create havoc for no good reason and hurt a lot of people.  Just another day in Trump-topia.

ACASignups.net has a good (if slightly wonky) explanation for how this will likely play out.

tl;dr: Insurers raise prices only for on-exchange silver plans and offer a very similar but cheaper off-exchange silver plan. All other premiums stay the same net of medical inflation and insurer tax. People who qualify for subsidies and CSRs buy the on-exchange silver plan, people who want that silver plan but don't qualify for subsidies buy the similar off-exchange plan. Net result is that the federal government absorbs all of the CSR costs via increased premium subsidies instead of via direct payments.

brooklynguy

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Re: What comes after the ACA?
« Reply #3407 on: July 31, 2017, 09:25:18 AM »
I read that when all is said and done it will cost the Feds more not to pay the CSRs since the subsidies will increase due to higher premiums.

Yes, the Kaiser Family Foundation estimated that the increased cost to the federal government of higher premium tax credits would be 23% more than the savings from eliminating cost-sharing reduction payments.

http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3408 on: August 01, 2017, 04:37:58 AM »
Hopefully he keeps beating the dead horse and totally expend all his political capital.

Political capital - heh heh.  That's a good one.
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GenXbiker

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Re: What comes after the ACA?
« Reply #3409 on: August 01, 2017, 08:31:38 AM »
Maybe someone can clear up a CSR question I have. If Trump were to cease making CSR payments moving forward, the real effect on subsidized purchasers of ACA plans would be nothing, correct? The total cost might go up but their contribution is limited by income so all he would be doing is increasing the amount the government is paying? So in effect he's cutting one payment only to increase another? If that's accurate it seems kinda stupid and ineffective. Granted it hurts the 20% of subscribers who get no subsidy but it still seems like a weak play. Am I missing something?
You got some responses about the higher premiums as a result, but as I mentioned a page or so back in this thread, if CSR subsidies aren't guaranteed going forward, more insurers will pull out of specific marketplaces.  This was again mentioned in an article this morning:
http://money.cnn.com/2017/08/01/news/economy/health-care-subsidies-bailout/

Blonde Lawyer

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Re: What comes after the ACA?
« Reply #3410 on: August 01, 2017, 10:15:44 AM »
Just posting to follow.

jim555

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Re: What comes after the ACA?
« Reply #3411 on: August 02, 2017, 10:49:16 AM »
CSR lawsuit now enjoined with the interests of the states who will harmed if it is not defended properly.

"Court allows Democratic states to defend Obamacare payments"
https://www.reuters.com/article/us-usa-court-obamacare-idUSKBN1AH5HA

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3412 on: August 10, 2017, 10:32:48 PM »
Sorry if I am a bit out of the loop, just returned from a great and needed reset road trip away from heat and tech.  This truly is a beautiful world.  Anywho, my wife just reminded me that we have access to an annual income at least 10x the credit card piggybacking thread (would add link but I'm on a tablet).  Anyway, we could buy meds through our health insurance and resell.  Very low risk, cash agreed with people who paid much more on their own... but that's what is so distorted about our healthcare, that I could make that much money, 'piggybacking' others...  I guess, in a way,that's Capitalism, that I actually am so valuable that my healthcare (as long as I use it only for myself) is a reasonable cost premium for my employer.

But ultimately, this is just another case of the rich getting richer....

So yeah, there is a credit bubble and now healthcare bubble.  Seems like housing has continued to reinflate...  easy time to make Hollywood easy money, which of course means it's a great time to be alive.  Never lasts tho.
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gerardc

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Re: What comes after the ACA?
« Reply #3413 on: August 11, 2017, 12:26:17 AM »
Anyway, we could buy meds through our health insurance and resell.  Very low risk, cash agreed with people who paid much more on their own...

I don't get it... is this legal? How does it work?

Gin1984

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Re: What comes after the ACA?
« Reply #3414 on: August 11, 2017, 05:37:54 AM »
Anyway, we could buy meds through our health insurance and resell.  Very low risk, cash agreed with people who paid much more on their own...

I don't get it... is this legal? How does it work?
No, it is not legal at all.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #3415 on: August 11, 2017, 07:10:43 AM »
Anyway, we could buy meds through our health insurance and resell.  Very low risk, cash agreed with people who paid much more on their own...

I don't get it... is this legal? How does it work?
No, it is not legal at all.


How is this not insurance fraud?

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3416 on: August 11, 2017, 08:31:54 AM »
Bizarre post sure, but that's how I roll, I just prefer to call it thinking outside the box :)  Like I prefaced, I've been on vacation for a while (and was catching up on bits and pieces of threads that I follow, so I kinda threw a bunch of thoughts together into this one post).  I've seen people calling it insurance fraud, but I'm interested exactly how this is the case... 

For a hypothetical example, we have neighbors with cheap insurance and pay $400/mo for a common medication.  I can get the exact thing for $50/mo and can also get a monthly perscription by asking for it (as I said, it is a common med and most dr's prescribe if you claim to need it - nothing 'abusable' like opioids, but say something like allergy, heart, or other 'maintainance' meds that are unreasonably expensive).  So out of the kindness of my heart, I buy it for myself and sell some of it to them for a very reasonable $100/mo.  I'm not doing this (just like I'm not piggybacking my credit or taking government subsidies that I don't need (see the RootofGood AMA on Reddit for that discussion)), but I also don't see how it is insurance fraud (and also don't see how I'd ever get caught, but that is beside the point).  Maybe it is on the borderline of being unethical, but that is a whole other discussion...
« Last Edit: August 11, 2017, 08:59:45 AM by EscapeVelocity2020 »
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protostache

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Re: What comes after the ACA?
« Reply #3417 on: August 11, 2017, 09:21:03 AM »
Bizarre post sure, but that's how I roll, I just prefer to call it thinking outside the box :)  Like I prefaced, I've been on vacation for a while (and was catching up on bits and pieces of threads that I follow, so I kinda threw a bunch of thoughts together into this one post).  I've seen people calling it insurance fraud, but I'm interested exactly how this is the case... 

For a hypothetical example, we have neighbors with cheap insurance and pay $400/mo for a common medication.  I can get the exact thing for $50/mo and can also get a monthly perscription by asking for it (as I said, it is a common med and most dr's prescribe if you claim to need it - nothing 'abusable' like opioids, but say something like allergy, heart, or other 'maintainance' meds that are unreasonably expensive).  So out of the kindness of my heart, I buy it for myself and sell some of it to them for a very reasonable $100/mo.  I'm not doing this (just like I'm not piggybacking my credit or taking government subsidies that I don't need (see the RootofGood AMA on Reddit for that discussion)), but I also don't see how it is insurance fraud (and also don't see how I'd ever get caught, but that is beside the point).  Maybe it is on the borderline of being unethical, but that is a whole other discussion...

It's the very definition of fraud. You don't need the medication but you lie to your doctor so they write you a scrip for it. Then you take that scrip and buy the medication using the insurance discount, thus defrauding the insurance company.

Prescription medication is always intended to be used by the person who's name is on the scrip and it's illegal to distribute prescription drugs without a license to do so, so you're actually committing at least two crimes with your scheme.

GenXbiker

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Re: What comes after the ACA?
« Reply #3418 on: August 11, 2017, 09:28:45 AM »
It's the very definition of fraud. You don't need the medication but you lie to your doctor so they write you a scrip for it. Then you take that scrip and buy the medication using the insurance discount, thus defrauding the insurance company.

Prescription medication is always intended to be used by the person who's name is on the scrip and it's illegal to distribute prescription drugs without a license to do so, so you're actually committing at least two crimes with your scheme.

That's what I was thinking as well.  Craziness.

protostache

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Re: What comes after the ACA?
« Reply #3419 on: August 11, 2017, 09:44:32 AM »
Bizarre post sure, but that's how I roll, I just prefer to call it thinking outside the box :)  Like I prefaced, I've been on vacation for a while (and was catching up on bits and pieces of threads that I follow, so I kinda threw a bunch of thoughts together into this one post).  I've seen people calling it insurance fraud, but I'm interested exactly how this is the case... 

For a hypothetical example, we have neighbors with cheap insurance and pay $400/mo for a common medication.  I can get the exact thing for $50/mo and can also get a monthly perscription by asking for it (as I said, it is a common med and most dr's prescribe if you claim to need it - nothing 'abusable' like opioids, but say something like allergy, heart, or other 'maintainance' meds that are unreasonably expensive).  So out of the kindness of my heart, I buy it for myself and sell some of it to them for a very reasonable $100/mo.  I'm not doing this (just like I'm not piggybacking my credit or taking government subsidies that I don't need (see the RootofGood AMA on Reddit for that discussion)), but I also don't see how it is insurance fraud (and also don't see how I'd ever get caught, but that is beside the point).  Maybe it is on the borderline of being unethical, but that is a whole other discussion...

What does this have to do with the ACA healthcare debate?

Absolutely nothing, but there's nothing going on with the ACA healthcare debate so why not foam it up a bit? :)

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3420 on: August 11, 2017, 10:18:17 AM »
Yeah, sorry, I'll lay off my nonsequiters.  Thanks for the responses.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3421 on: August 11, 2017, 06:05:23 PM »
Does enrollment for the 2018 year start in November ?

jim555

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Re: What comes after the ACA?
« Reply #3422 on: August 11, 2017, 06:12:07 PM »
Does enrollment for the 2018 year start in November ?
November 1 through December 15, 2017, they propose to narrow the window by half.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3423 on: August 11, 2017, 07:06:26 PM »
Well, now there's something to talk about.  Seems the head freedummy is actually entertaining stabilizing the ACA.

http://www.msn.com/en-us/news/politics/conservative-chairman-in-talks-about-obamacare-stabilization-deal/ar-AApTbPM
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nereo

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Re: What comes after the ACA?
« Reply #3424 on: August 15, 2017, 09:04:08 AM »
They have to do something, I would love it if they tinker with obamacare enough that they can claim victory, while the reality is not much changes or it actually improves as they stop undermining it.

The GOP freedom caucus is rattling their sabers again, asking for a strait repeal vote.  Zombie bill still isn't dead.

The (perhaps only) way forward seems obvious now - tweak the ACA enough so that it's stable, declare victory (we fixed it!), deny it's still Obamacare (our's is much better... even though we kept most things the same) and go home (to less caustic town hall meetings).

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EnjoyIt

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Re: What comes after the ACA?
« Reply #3425 on: August 15, 2017, 09:19:12 AM »
They have to do something, I would love it if they tinker with obamacare enough that they can claim victory, while the reality is not much changes or it actually improves as they stop undermining it.

The GOP freedom caucus is rattling their sabers again, asking for a strait repeal vote.  Zombie bill still isn't dead.

The (perhaps only) way forward seems obvious now - tweak the ACA enough so that it's stable, declare victory (we fixed it!), deny it's still Obamacare (our's is much better... even though we kept most things the same) and go home (to less caustic town hall meetings).

How do you tinker with it?  What do you add? Only way to fix it is either add laws that somehow decrease cost or tax people more to fund it.  Neither will go through because republicans hate increasing taxes and lobbyist will not allow cutting costs.  Nothing will change unless republicans work with the democrats and ignore the lobbyists.

nereo

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Re: What comes after the ACA?
« Reply #3426 on: August 15, 2017, 09:27:43 AM »
They have to do something, I would love it if they tinker with obamacare enough that they can claim victory, while the reality is not much changes or it actually improves as they stop undermining it.

The GOP freedom caucus is rattling their sabers again, asking for a strait repeal vote.  Zombie bill still isn't dead.

The (perhaps only) way forward seems obvious now - tweak the ACA enough so that it's stable, declare victory (we fixed it!), deny it's still Obamacare (our's is much better... even though we kept most things the same) and go home (to less caustic town hall meetings).

How do you tinker with it?  What do you add? Only way to fix it is either add laws that somehow decrease cost or tax people more to fund it.  Neither will go through because republicans hate increasing taxes and lobbyist will not allow cutting costs.  Nothing will change unless republicans work with the democrats and ignore the lobbyists.
seems the answer is in your question.  I think a few dozen Dems would definitely work with the GOP to maintain the ACA.  Ironically both could go back to their home districts and declare victory (Dems: "we saved it, even in the face of total GOP control" / GOP: "We fixed it!").
Republicans love to talk about deficit cutting and fiscal responsibility but have done the exact opposite for at least the last two decades.
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protostache

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Re: What comes after the ACA?
« Reply #3427 on: August 15, 2017, 02:22:03 PM »
CBO released their estimate of what would happen if the President decided to stop paying CSRs on January 1st 2018.

Summary:

  • Gross premiums for Silver plans offered through the marketplace would increase 20%-25% but net premiums would stay the same because the only people buying those plans would be people eligible for cost sharing reductions. Others would either buy Bronze or Gold on-exchange with their increased premium subsidies or off-exchange Silver which CBO is projecting insurance commissioners will allow to have a different rate than on-exchange (i.e. the Silver Switcharoo).
  • Federal deficits would increase by $6 billion in 2018, $21 billion in 2020, and $26 billion in 2026, for a total of $194 billion over the 20172026 period.
  • The number of people uninsured would be slightly higher in 2018 but slightly lower starting in 2020.