Author Topic: What comes after the ACA?  (Read 554745 times)

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4050 on: January 15, 2018, 08:23:21 AM »
Looks like the Republicans' next target may be the employer mandate:

http://www.msn.com/en-us/news/politics/individual-mandate-now-gone-gop-targets-the-one-for-employers/ar-AAuGUsV

I think this would actually be a good thing because it likely would generate new business for the exchanges and help diversify the risk pool.

Of course the people who would get screwed by this move are more of the same people who are currently getting screwed: upper middle class workers who make too much to qualify for ACA tax credits.
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iris lily

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Re: What comes after the ACA?
« Reply #4051 on: January 15, 2018, 09:11:56 AM »
Looks like the Republicans' next target may be the employer mandate:

http://www.msn.com/en-us/news/politics/individual-mandate-now-gone-gop-targets-the-one-for-employers/ar-AAuGUsV

I think this would actually be a good thing because it likely would generate new business for the exchanges and help diversify the risk pool.

Of course the people who would get screwed by this move are more of the same people who are currently getting screwed: upper middle class workers who make too much to qualify for ACA tax credits.

You guys are already on the chopping block. Forgetabout the 1%, it is now the top tier of upper-middles who are in line to receive societal wrath.

The book Dream Hoarders: How the American Upper Middle Class is leaving Everyone Else in the Dust, Why that is a Problem, and What to Do About it   lays out the case as to why “income inequality” is killing America.

By the way, this author defines his target group at a household income of $112,000.

I am so happy to be out of the line of fire now that we are FIRED. Our income is $30,000 annually and there aint no way the social justice warriors will be coming after us, based on this income, while I am still alive.

I read only the first chapter of this book  and may soon abandon it. It makes me laugh. The author earnestly explained how I as a former target group member (before I retired doncha know) deliberately kept birth control out of the hands of those who need it.

I cant even make this stuff up.

He also commits sins of the Eastern Seaboard Elite where he dwells on the problems of rich people guarding coveted positions in exclusive schools, holding them hostage to those of their class. Others cannot break into that world! Tragic!

Dude, Come join me in  flyover country where State U is fine for us, we dont GAF about getting into The Right Schools. And imagine this, we manage to earn enough with our paltry State U degrees to break the Upper Middle Class barrier. Of course, we will never participate in  other societal norms that also Eastern Seaboard Elites consider de rigour such as fencing lessons and summer houses on the Cape.

This crap makes me crazy. I do forgive the author somewhat, he was raised in
England. Class distinction is part of his upbringing and he is comfortable in a world where it exists regardless of his claim otherwise.
« Last Edit: January 15, 2018, 09:49:45 AM by iris lily »

Exflyboy

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Re: What comes after the ACA?
« Reply #4052 on: January 15, 2018, 09:19:09 AM »
One great thing about being FIRED.. Don't like the income group your in? Simply change it..:)

iris lily

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Re: What comes after the ACA?
« Reply #4053 on: January 15, 2018, 09:50:03 AM »
One great thing about being FIRED.. Don't like the income group your in? Simply change it..:)
so cool, agreed!

Mr. Green

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Re: What comes after the ACA?
« Reply #4054 on: January 26, 2018, 06:42:43 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.
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DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4055 on: January 26, 2018, 07:22:25 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.

Disturbing. and everyone is temporarily able-bodied, everyone in Idaho should ponder their future health care needs.

jim555

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Re: What comes after the ACA?
« Reply #4056 on: January 26, 2018, 07:47:16 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.
That would be immediately challenged in court since it is illegal.

Mr. Green

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Re: What comes after the ACA?
« Reply #4057 on: January 26, 2018, 11:02:24 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.
That would be immediately challenged in court since it is illegal.
The article says the enforcing body is DHHS. I suppose it wouldn't matter if it was illegal if DHHS was going to overlook that fact, and judging from the actions of the DHHS over the past year it wouldn't surprise me if they turned a blind eye.
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bacchi

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Re: What comes after the ACA?
« Reply #4058 on: January 26, 2018, 11:16:41 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.

Ffs. We can't have anything good without some money grubbing asshole fucking things up.

No worries, though. It's a temporary problem that'll be fixed in 2020, at the latest.

Mr. Green

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Re: What comes after the ACA?
« Reply #4059 on: January 26, 2018, 11:30:50 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.

Ffs. We can't have anything good without some money grubbing asshole fucking things up.

No worries, though. It's a temporary problem that'll be fixed in 2020, at the latest.
You really think so? I'm not holding my breath.
Took the leap in June 2016.

Inaya

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Re: What comes after the ACA?
« Reply #4060 on: January 26, 2018, 11:47:40 AM »
Hey now, I'm sure the insurance companies will do the right thing and not charge extra for preexisting conditions just because they can and will make money doing so.

Just like the cable companies won't throttle consumers' Internet or create fast lanes now that Net Neutrality is gone.
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tyort1

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Re: What comes after the ACA?
« Reply #4061 on: January 26, 2018, 12:09:27 PM »
Hey now, I'm sure the insurance companies will do the right thing and not charge extra for preexisting conditions just because they can and will make money doing so.

Just like the cable companies won't throttle consumers' Internet or create fast lanes now that Net Neutrality is gone.

But what's good for business is good for America, dontchanknow?  /snark
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ketchup

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Re: What comes after the ACA?
« Reply #4062 on: January 26, 2018, 03:38:47 PM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.
That would be immediately challenged in court since it is illegal.
Ehh.  It's tricky.  Pot is still "illegal" federally; it's just not enforced anymore in certain states that have "legalized" it.  Laws have to be enforced to really be laws.

jim555

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Re: What comes after the ACA?
« Reply #4063 on: January 26, 2018, 04:15:06 PM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.
That would be immediately challenged in court since it is illegal.
Ehh.  It's tricky.  Pot is still "illegal" federally; it's just not enforced anymore in certain states that have "legalized" it.  Laws have to be enforced to really be laws.
Insurance companies come under State and Federal regulations.  They will be brought into a Federal court for writing a policy that violates the ACA.

talltexan

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Re: What comes after the ACA?
« Reply #4064 on: February 05, 2018, 01:00:19 PM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.

Ffs. We can't have anything good without some money grubbing asshole fucking things up.

No worries, though. It's a temporary problem that'll be fixed in 2020, at the latest.

I think this is meant to imply that Trump will certainly lose re-election in 2020. I don't want to derail the thread, but that is far from certain. Very, very far. Thirty-three months feels like an eternity these days, and conditions can very quickly swing in Trump's favor. Obama looked very week in early 2010, and he was able to defeat Romney.

Mr. Green

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Re: What comes after the ACA?
« Reply #4065 on: February 14, 2018, 04:32:55 PM »
Here we go! Blue Cross of Idaho is taking the state up on its proposition and will begin offering insurance plans that do not meet ACA requirements. They will cap the yearly maximum benefit and will not cover pre-existing conditions. I have money that says DHHS does not challenge Idaho's decision to violate the law.

http://www.businessinsider.com/trump-idaho-obamacare-battle-2018-2?r=UK&IR=T
« Last Edit: February 14, 2018, 04:36:25 PM by Mr. Green »
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farmecologist

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Re: What comes after the ACA?
« Reply #4066 on: February 15, 2018, 07:42:47 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.

Ffs. We can't have anything good without some money grubbing asshole fucking things up.

No worries, though. It's a temporary problem that'll be fixed in 2020, at the latest.

I think this is meant to imply that Trump will certainly lose re-election in 2020. I don't want to derail the thread, but that is far from certain. Very, very far. Thirty-three months feels like an eternity these days, and conditions can very quickly swing in Trump's favor. Obama looked very week in early 2010, and he was able to defeat Romney.

Exactly...I worry when anyone has even a hint of certainty when talking about elections.   People sure have a short memory...nobody...and I mean nobody...thought Trump would win in 2016!

Also, if you look on http://fivethirtyeight.com/ Trump's approval rating is creeping up.  This absolutely boggles my mind but they must be doing a better job at appealing to their base.




iris lily

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Re: What comes after the ACA?
« Reply #4067 on: February 15, 2018, 08:13:06 AM »
http://amp.slate.com/news-and-politics/2018/01/idaho-ignoring-obamacare-pre-existing-condition-rules.html

This is a bummer. Hopefully nothing comes of it but it could open the floodgates.

Ffs. We can't have anything good without some money grubbing asshole fucking things up.

No worries, though. It's a temporary problem that'll be fixed in 2020, at the latest.

I think this is meant to imply that Trump will certainly lose re-election in 2020. I don't want to derail the thread, but that is far from certain. Very, very far. Thirty-three months feels like an eternity these days, and conditions can very quickly swing in Trump's favor. Obama looked very week in early 2010, and he was able to defeat Romney.

Exactly...I worry when anyone has even a hint of certainty when talking about elections.   People sure have a short memory...nobody...and I mean nobody...thought Trump would win in 2016!

Also, if you look on http://fivethirtyeight.com/ Trump's approval rating is creeping up.  This absolutely boggles my mind but they must be doing a better job at appealing to their base.

BS to the bolded. Even one on your team knew Trump would win

https://michaelmoore.com/
Moore has a good, and impassioned, speech about this on YouTube if you prefer your infotainment in video form.

And he is predicting a  2020 sweep by Trump.

“Its the economy stupid*”

* This is an old political saw from President Clinton’s term,, not an ad hominem attack on anyone here.



nereo

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Re: What comes after the ACA?
« Reply #4068 on: February 15, 2018, 10:34:43 AM »
We've got ~30 months before the next presidential election, which is an eternity in politics. 32 months prior to his failed reelection campaign Bush Sr. looked unbeatable with an ~80% approval rating. At a similar point Reagan, 'W' & Clinton all looked vulnerable, but each won re-election (with Clinton & Reagan winning in landslides).

As for the latest uptick of approval for DJT - he and congress finally passed a large bill (the tax-overhaul).  Whether you agree with it or not, that's why his approval has gone up a few percent. We have no idea at present who his opponent will be, whether the economy will be doing well and how many more major pieces of legislation might be signed by DJT.  time will tell.

Back on topic:DJT's latest budget request renewed calls for teh Graham-Cassidy bill which does away with the pre-existing protections and reduces funding for medicaid.
http://thehill.com/policy/healthcare/373435-trump-budget-seeks-savings-through-obamacare-repeal
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talltexan

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Re: What comes after the ACA?
« Reply #4069 on: February 19, 2018, 07:41:53 AM »
Part of what made Clinton look so vulnerable going into 1996 was the shellacking that team Gingrich orchestrated in the 1994 midterms. We simply don't know yet whether Democrats will be able to deliver that kind of victory this year. Some indicators are lining up positively for them, but some also are not.

boarder42

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Re: What comes after the ACA?
« Reply #4070 on: February 21, 2018, 06:42:44 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down.  eventually if enough people transition to this model it will be the death of insurance and hospitals and doctors will just start charging rates to maintain profit and you can eliminate the people who call or at least use a computer alogrithm to determine what claims seem excessive and scale back the negotiator pool.  This all leads to more clear and upfront pricing while allowing people to be covered the way insurance was intended - people helping people  when others are down.

The individual mandate killed the free market - so while i understand its intentions were good- i think it actually hurt the people who work for smaller companies or those who own small business or were like those here - retired prior to medicare

protostache

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Re: What comes after the ACA?
« Reply #4071 on: February 21, 2018, 06:54:32 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down.  eventually if enough people transition to this model it will be the death of insurance and hospitals and doctors will just start charging rates to maintain profit and you can eliminate the people who call or at least use a computer alogrithm to determine what claims seem excessive and scale back the negotiator pool.  This all leads to more clear and upfront pricing while allowing people to be covered the way insurance was intended - people helping people  when others are down.

The individual mandate killed the free market - so while i understand its intentions were good- i think it actually hurt the people who work for smaller companies or those who own small business or were like those here - retired prior to medicare

As long as ACA is the law of the land there will always be a market for traditional individual insurance: people with preexisting conditions and people dumped off of health shares and short term plans because they got sick. If what you're predicting comes to pass the ACA exchanges will become de facto high risk pools with incredibly high unsubsidized costs and correspondingly sky high premium subsidies for those making less than 400% FPL.

beltim

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Re: What comes after the ACA?
« Reply #4072 on: February 21, 2018, 06:56:13 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

protostache

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Re: What comes after the ACA?
« Reply #4073 on: February 21, 2018, 06:59:40 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

The salient difference is that the health share has no contractual obligation to reimburse anyone for anything.

boarder42

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Re: What comes after the ACA?
« Reply #4074 on: February 21, 2018, 07:28:21 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

The salient difference is that the health share has no contractual obligation to reimburse anyone for anything.

and they run as non profits which i think we can all agree is bsst for this industry.

the reason they are under no contractual obligation is b/c it keeps them out of the insurance red tape if they started down that path they would have increased costs added due to the regulations around the insurance industry.

The eliminate all the red tape paperwork a provider must fill out to process insurance claims - hospitals in america have insanely high volumes of nurses just to process paperwork - this eliminates the need for that and trends toward a what you see is what you pay pricing model.  - which many GPs in my area are moving towards and they arent accepting insurance - so i can use this guy who says its 100 bucks for this procedure and i dont take insurance and my healthshare just pays it - or i can use this guy who says its 350 dollars for this procedure but on insurance its 120 with company x and 180 with company y and 200 with company z and i say i dont have insurance so they send me a bill for 350 and it gets negotiated down to probably 100 bucks b/c he didnt have to fill out all the damn paperwork.

protostache

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Re: What comes after the ACA?
« Reply #4075 on: February 21, 2018, 07:35:39 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

The salient difference is that the health share has no contractual obligation to reimburse anyone for anything.

and they run as non profits which i think we can all agree is bsst for this industry.

the reason they are under no contractual obligation is b/c it keeps them out of the insurance red tape if they started down that path they would have increased costs added due to the regulations around the insurance industry.

The eliminate all the red tape paperwork a provider must fill out to process insurance claims - hospitals in america have insanely high volumes of nurses just to process paperwork - this eliminates the need for that and trends toward a what you see is what you pay pricing model.  - which many GPs in my area are moving towards and they arent accepting insurance - so i can use this guy who says its 100 bucks for this procedure and i dont take insurance and my healthshare just pays it - or i can use this guy who says its 350 dollars for this procedure but on insurance its 120 with company x and 180 with company y and 200 with company z and i say i dont have insurance so they send me a bill for 350 and it gets negotiated down to probably 100 bucks b/c he didnt have to fill out all the damn paperwork.

It also means they can discriminate in any way they want. Almost all of the grandfathered health shares require you to sign a statement saying you and your entire family promise to live a Christian life, free of vice, premarital sex, non-heteronormative relationships, etc. Most of them require specific health metrics for their lowest rates, and all of them will refuse to pay for preexisting conditions or conditions they determine were caused by you failing to live up to your promise.

They're simply not an option for huge swaths of the population.

boarder42

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Re: What comes after the ACA?
« Reply #4076 on: February 21, 2018, 07:41:42 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

The salient difference is that the health share has no contractual obligation to reimburse anyone for anything.

and they run as non profits which i think we can all agree is bsst for this industry.

the reason they are under no contractual obligation is b/c it keeps them out of the insurance red tape if they started down that path they would have increased costs added due to the regulations around the insurance industry.

The eliminate all the red tape paperwork a provider must fill out to process insurance claims - hospitals in america have insanely high volumes of nurses just to process paperwork - this eliminates the need for that and trends toward a what you see is what you pay pricing model.  - which many GPs in my area are moving towards and they arent accepting insurance - so i can use this guy who says its 100 bucks for this procedure and i dont take insurance and my healthshare just pays it - or i can use this guy who says its 350 dollars for this procedure but on insurance its 120 with company x and 180 with company y and 200 with company z and i say i dont have insurance so they send me a bill for 350 and it gets negotiated down to probably 100 bucks b/c he didnt have to fill out all the damn paperwork.

It also means they can discriminate in any way they want. Almost all of the grandfathered health shares require you to sign a statement saying you and your entire family promise to live a Christian life, free of vice, premarital sex, non-heteronormative relationships, etc. Most of them require specific health metrics for their lowest rates, and all of them will refuse to pay for preexisting conditions or conditions they determine were caused by you failing to live up to your promise.

They're simply not an option for huge swaths of the population.

Yes the grandfathered ones do require religion - but as was stated at the beginning of my post above there are more popping up and the individual mandate will likely be gone this year opening the door for more Health sharing companies - since the ACA has put them in the spotlight for many looking for care. - and no all do not refuse to pay for pre-existing conditions - some of the new ones are opening this door too

so you can sit here and bitch about the ACA and how do we fix this broken piece of shit - or understand that the individual mandate inherently killed the free market place and is now increasing the cost of health insurance for many while not actually targetting the real problem price transparency and lowering the cost of care - which at its core healthshare is working to achieve albeit through an unconventional method.

Really what do big corporations do - at least mine self insures through an insurance provider to have them handle the claims and use the pricing they have negotiated, but essentially at its core large companies in the US who self insure are healthshares that ride over the top of for profit insurance providers. 

protostache

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Re: What comes after the ACA?
« Reply #4077 on: February 21, 2018, 08:07:13 AM »
Yes the grandfathered ones do require religion - but as was stated at the beginning of my post above there are more popping up and the individual mandate will likely be gone this year opening the door for more Health sharing companies - since the ACA has put them in the spotlight for many looking for care. - and no all do not refuse to pay for pre-existing conditions - some of the new ones are opening this door too

Altura Health Share Statement of Standards:

Quote
  • We care for one another.
  • We keep our bodies clean and healthy with proper nutrition.
  • We believe the use of any form of tobacco, illicit drugs and excessive alcohol consumption is harmful to the body and soul.
  • We believe that marriage is a bond between a man and a woman. Sexual relations outside the bond of marriage are morally wrong.
  • We believe abortion is wrong, except in a life-threatening situation to the mother.

Sedara seems slightly more reasonable but there's a looooong list of exclusions and requirements. Also, recurrent cancer is not reimbursable.

Quote
so you can sit here and bitch about the ACA and how do we fix this broken piece of shit - or understand that the individual mandate inherently killed the free market place and is now increasing the cost of health insurance for many while not actually targetting the real problem price transparency and lowering the cost of care - which at its core healthshare is working to achieve albeit through an unconventional method.

I don't bitch about the ACA. Maybe you have me confused with someone else? The ACA allowed me to purse the life I wanted in a time when I needed significant medical care and I am eternally grateful that President Obama and the 111th Congress were able to get it done. It needs improvements, sure. It was never intended to be a perfect system, just an improvement on what existed before. The things it does do to attempt to control costs have worked, to an extent, but they need to be significantly stronger.

We've talked many times in this thread about the causes for recent premium increases, but to summarize: the increases in 2017 and 2018 (and the increases coming in 2019) are entirely due to the Trump administration's various forms of sabotage, along with the elimination of the individual mandate.

Quote
Really what do big corporations do - at least mine self insures through an insurance provider to have them handle the claims and use the pricing they have negotiated, but essentially at its core large companies in the US who self insure are healthshares that ride over the top of for profit insurance providers.

It's somewhat ironic to me that you're in this thread complaining about rising individual insurance premiums and talking about these health shares (both you cited are old organizations) and yet you're covered by employer provided insurance, just like the vast majority of people in this country under the age of 65.
« Last Edit: February 21, 2018, 09:43:25 AM by protostache »

boarder42

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Re: What comes after the ACA?
« Reply #4078 on: February 21, 2018, 08:36:03 AM »
rising individual insurance premiums are going to affect me in the next 4-5 years if the generations who came before mine can't unfuck the situation they've created. 

and the individual mandate is the biggest piece that completely restricts the freedom of people to choose how they are covered and to what level they are covered.  it killed the freemarket - outside of the exceptions for healthshare - which people have been flocking to - the numbers were up 60% in a short 2 years after the ACA went into effect b/c its one of the few free market choices left in the US.

either make it full on central govt paid or get rid of it all together half assing what they've done leads to nothing more than the situation we are in - and the way in which it was done was obviously not sustainable.  so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery that makes it hard to pull the plug for many FIREes

sol

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Re: What comes after the ACA?
« Reply #4079 on: February 21, 2018, 08:50:14 AM »
so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery

How exactly did he bypass the checks and balances? 

Because normally that phrase is used to describe the balance of power between the three branches of US government, and ALL THREE of those branches supported the Affordable Care Act.   Maybe you're using "checks and balances" to mean something different? 


boarder42

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Re: What comes after the ACA?
« Reply #4080 on: February 21, 2018, 08:57:00 AM »
so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery

How exactly did he bypass the checks and balances? 

Because normally that phrase is used to describe the balance of power between the three branches of US government, and ALL THREE of those branches supported the Affordable Care Act.   Maybe you're using "checks and balances" to mean something different?

So trump can scrap the subsidies by himself - that means obama put them in by himself.  If it had been in the bill that went thru congress trump couldnt hand wave them away. Obama went around the people who control the money - congress - to make part of the ACA work. correct me if i'm wrong here.

beltim

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Re: What comes after the ACA?
« Reply #4081 on: February 21, 2018, 09:53:17 AM »
There are more and more healthshares starting to pop up as it seems the ACA mandate will be gone opening the door for new ones not grandfathered. 

Altura and Sedera are 2 new ones i've seen popup ... i think the healthshare side of the world will fix this. - no insurance red tape - just a group of people who call the doctors and hospitals to negotiate the services down. 

How is this different from how insurance companies work, except that insurance companies have economies of scale and don't have to negotiate every procedure individually?

The salient difference is that the health share has no contractual obligation to reimburse anyone for anything.

and they run as non profits which i think we can all agree is bsst for this industry.

the reason they are under no contractual obligation is b/c it keeps them out of the insurance red tape if they started down that path they would have increased costs added due to the regulations around the insurance industry.

The eliminate all the red tape paperwork a provider must fill out to process insurance claims - hospitals in america have insanely high volumes of nurses just to process paperwork - this eliminates the need for that and trends toward a what you see is what you pay pricing model.  - which many GPs in my area are moving towards and they arent accepting insurance - so i can use this guy who says its 100 bucks for this procedure and i dont take insurance and my healthshare just pays it - or i can use this guy who says its 350 dollars for this procedure but on insurance its 120 with company x and 180 with company y and 200 with company z and i say i dont have insurance so they send me a bill for 350 and it gets negotiated down to probably 100 bucks b/c he didnt have to fill out all the damn paperwork.

1) about half of Americans are covered by nonprofit health insurers: http://www.nonprofithealthcare.org/resources/BasicFacts-NonprofitHealthPlans.pdf

2) insurers can operate this way too. The fact that most don’t suggests it isn’t as efficient or low-cost as you think.

beltim

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Re: What comes after the ACA?
« Reply #4082 on: February 21, 2018, 09:54:31 AM »
so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery

How exactly did he bypass the checks and balances? 

Because normally that phrase is used to describe the balance of power between the three branches of US government, and ALL THREE of those branches supported the Affordable Care Act.   Maybe you're using "checks and balances" to mean something different?

So trump can scrap the subsidies by himself - that means obama put them in by himself.  If it had been in the bill that went thru congress trump couldnt hand wave them away. Obama went around the people who control the money - congress - to make part of the ACA work. correct me if i'm wrong here.

You’re wrong. To avoid unnecessary research and confusion, if you tell me which subsidies you’re talking about I’ll give you the appropriate citations.

protostache

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Re: What comes after the ACA?
« Reply #4083 on: February 21, 2018, 09:58:10 AM »
so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery

How exactly did he bypass the checks and balances? 

Because normally that phrase is used to describe the balance of power between the three branches of US government, and ALL THREE of those branches supported the Affordable Care Act.   Maybe you're using "checks and balances" to mean something different?

So trump can scrap the subsidies by himself - that means obama put them in by himself.  If it had been in the bill that went thru congress trump couldnt hand wave them away. Obama went around the people who control the money - congress - to make part of the ACA work. correct me if i'm wrong here.

You are wrong. The ACA contains the provision that says Cost Sharing Reduction payments have to be made. Because of a drafting error, the appropriation (almost literally the words "The Treasury is directed to appropriate funds for the cost sharing reduction payments") got left out in the final bill. The House used this drafting error to sue the Executive, because the Executive went ahead and paid the cost sharing reduction payments that Congress told them to pay with one hand and forgot to tell them to pay with the other. The Supreme Court hasn't ruled on this lawsuit and Trump's DoJ decided to stop defending it. It's not dead and it's not decided.

Trump just stopped paying the insurance companies. He and his Department of Health and Human Services are breaking the law. They (the insurance companies) have every right to sue in the Federal court of claims. They will win because the court will recognize that the lack of an appropriation was simply a drafting error and that the insurance companies have a valid claim against the payments they didn't get.

The other thing to keep in mind is that not paying CSRs will bite them very hard. Premium tax credits haven't changed and they keep pace with premiums. It's going to cost the government far more in premium subsidies going forward. For a future Congress, because of the way the CBO scores things, those additional premium subsidies are in the baseline. When a future Congress decides to reinstate the CSRs they'll have a whole bunch of new money with which to make improvements to the ACA, like removing the cap on premium subsidies and funding additional cost control measures. It was a stupid move by an executive that has no idea what they're doing.

Also, I want to backtrack a little bit. You are also wrong in how self-insurance works for large businesses. It's not "health sharing" in any meaningful sense. Companies who self-insure their employees always buy a reinsurance policy that covers them for large individual claims and/or a certain aggregate yearly amount. They're still transferring the risk, just not all of it. Health shares have no risk transfer because you are the only one contractually obligated to pay for your health care services.

PathtoFIRE

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Re: What comes after the ACA?
« Reply #4084 on: February 21, 2018, 11:03:12 AM »
Boarder42, can you clarify the statement that you've made several times here and elsewhere that the individual mandate destroyed the freemarket for health insurance?  Because I don't follow.

I mean, I understand that before the ACA there were low cost high deductible plans, but these were mostly used by younger, healthier individuals, families, and small businesses that could afford the (admittedly lower) premium costs and valued having health insurance in the first place. But that leaves out very large chunks of people in this country. And the individual mandate by itself added new consumers to this market while keeping the previous consumers from dropping out. Maybe other aspects of the ACA had detrimental effects on the individual marketplace, like Medicaid expansion being left up to the states (partly the result of Supreme Court rulings), or not providing enough of a subsidy to a larger group of the working and middle class.

But I just don't see how a tax penalty if you don't have some kind of insurance has anything to do with people dropping out of the market. Maybe you are just making a shorthand way of saying "forcing a bunch of sicker and poorer people to participate in this marketplace as well as adding minimum requirements has resulted in increased pricing compared to pre-ACA plans that is forcing previous consumers out", but that's more directly tied to other aspects of the ACA rather than the individual mandate itself.

Also, I think it was pointed out earlier in this thread (or maybe another) that Obama and the 111th Congress should have anticipated that this new system would be under dire threat with a change in leadership. Well I think any rational person would argue that taking a Republican idea championed by conservative think tanks and essentially implementing it nearly whole cloth would provide political protection.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #4085 on: February 22, 2018, 12:07:25 AM »
so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery

How exactly did he bypass the checks and balances? 

Because normally that phrase is used to describe the balance of power between the three branches of US government, and ALL THREE of those branches supported the Affordable Care Act.   Maybe you're using "checks and balances" to mean something different?

So trump can scrap the subsidies by himself - that means obama put them in by himself.  If it had been in the bill that went thru congress trump couldnt hand wave them away. Obama went around the people who control the money - congress - to make part of the ACA work. correct me if i'm wrong here.

You are wrong. The ACA contains the provision that says Cost Sharing Reduction payments have to be made. Because of a drafting error, the appropriation (almost literally the words "The Treasury is directed to appropriate funds for the cost sharing reduction payments") got left out in the final bill. The House used this drafting error to sue the Executive, because the Executive went ahead and paid the cost sharing reduction payments that Congress told them to pay with one hand and forgot to tell them to pay with the other. The Supreme Court hasn't ruled on this lawsuit and Trump's DoJ decided to stop defending it. It's not dead and it's not decided.

Trump just stopped paying the insurance companies. He and his Department of Health and Human Services are breaking the law. They (the insurance companies) have every right to sue in the Federal court of claims. They will win because the court will recognize that the lack of an appropriation was simply a drafting error and that the insurance companies have a valid claim against the payments they didn't get.

The other thing to keep in mind is that not paying CSRs will bite them very hard. Premium tax credits haven't changed and they keep pace with premiums. It's going to cost the government far more in premium subsidies going forward. For a future Congress, because of the way the CBO scores things, those additional premium subsidies are in the baseline. When a future Congress decides to reinstate the CSRs they'll have a whole bunch of new money with which to make improvements to the ACA, like removing the cap on premium subsidies and funding additional cost control measures. It was a stupid move by an executive that has no idea what they're doing.

Also, I want to backtrack a little bit. You are also wrong in how self-insurance works for large businesses. It's not "health sharing" in any meaningful sense. Companies who self-insure their employees always buy a reinsurance policy that covers them for large individual claims and/or a certain aggregate yearly amount. They're still transferring the risk, just not all of it. Health shares have no risk transfer because you are the only one contractually obligated to pay for your health care services.

As I was reading this, I almost couldn't finish from the laughter and tears pouring down my face.  How can anyone in their right mind actually believe this 'Wrinkle in Time'-like fantasy?  First and foremost, the Trump government has given away any Federal-tax income surplus that could ever exist in your lifetime (unless some amazing politician emerges promising higher taxes and wins).  The administration is burning bridges to ensure there will never be trading surplus, and generally ensuring that these days, like right now, are the best it can ever be in the US financially.  'Make America Great Again' was akin to the excitement leading up to lighting a firecracker and then maybe enjoying the bang for a few moments afterwards.  There is no quick fix back to status quo now that the hard won fuel was burned and sparkled momentarily in the sky. 

Healthcare in the US is only going to get worse.  We were on the crest of a positive wave and it just didn't work out.  Lots of fingers will be pointed and politicians will promise they will get back to fixing it, but the ACA train left the US with no-one on board.  Maybe a few people will realize that they miss it and complain, but it's an easy thing to dismiss since only a very few people got to appreciate how great it really could have been.
Transitioning to FIRE'd albeit somewhat cautiously...

protostache

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Re: What comes after the ACA?
« Reply #4086 on: February 22, 2018, 05:09:33 AM »
so you can thank the guy who created this mess all you want but he and his congress bypassed checks and balances and now we're in a state of fuckery

How exactly did he bypass the checks and balances? 

Because normally that phrase is used to describe the balance of power between the three branches of US government, and ALL THREE of those branches supported the Affordable Care Act.   Maybe you're using "checks and balances" to mean something different?

So trump can scrap the subsidies by himself - that means obama put them in by himself.  If it had been in the bill that went thru congress trump couldnt hand wave them away. Obama went around the people who control the money - congress - to make part of the ACA work. correct me if i'm wrong here.

You are wrong. The ACA contains the provision that says Cost Sharing Reduction payments have to be made. Because of a drafting error, the appropriation (almost literally the words "The Treasury is directed to appropriate funds for the cost sharing reduction payments") got left out in the final bill. The House used this drafting error to sue the Executive, because the Executive went ahead and paid the cost sharing reduction payments that Congress told them to pay with one hand and forgot to tell them to pay with the other. The Supreme Court hasn't ruled on this lawsuit and Trump's DoJ decided to stop defending it. It's not dead and it's not decided.

Trump just stopped paying the insurance companies. He and his Department of Health and Human Services are breaking the law. They (the insurance companies) have every right to sue in the Federal court of claims. They will win because the court will recognize that the lack of an appropriation was simply a drafting error and that the insurance companies have a valid claim against the payments they didn't get.

The other thing to keep in mind is that not paying CSRs will bite them very hard. Premium tax credits haven't changed and they keep pace with premiums. It's going to cost the government far more in premium subsidies going forward. For a future Congress, because of the way the CBO scores things, those additional premium subsidies are in the baseline. When a future Congress decides to reinstate the CSRs they'll have a whole bunch of new money with which to make improvements to the ACA, like removing the cap on premium subsidies and funding additional cost control measures. It was a stupid move by an executive that has no idea what they're doing.

Also, I want to backtrack a little bit. You are also wrong in how self-insurance works for large businesses. It's not "health sharing" in any meaningful sense. Companies who self-insure their employees always buy a reinsurance policy that covers them for large individual claims and/or a certain aggregate yearly amount. They're still transferring the risk, just not all of it. Health shares have no risk transfer because you are the only one contractually obligated to pay for your health care services.

As I was reading this, I almost couldn't finish from the laughter and tears pouring down my face.  How can anyone in their right mind actually believe this 'Wrinkle in Time'-like fantasy?  First and foremost, the Trump government has given away any Federal-tax income surplus that could ever exist in your lifetime (unless some amazing politician emerges promising higher taxes and wins).  The administration is burning bridges to ensure there will never be trading surplus, and generally ensuring that these days, like right now, are the best it can ever be in the US financially.  'Make America Great Again' was akin to the excitement leading up to lighting a firecracker and then maybe enjoying the bang for a few moments afterwards.  There is no quick fix back to status quo now that the hard won fuel was burned and sparkled momentarily in the sky. 

Healthcare in the US is only going to get worse.  We were on the crest of a positive wave and it just didn't work out.  Lots of fingers will be pointed and politicians will promise they will get back to fixing it, but the ACA train left the US with no-one on board.  Maybe a few people will realize that they miss it and complain, but it's an easy thing to dismiss since only a very few people got to appreciate how great it really could have been.

Optimism about what comes after is what helps me get through today. If bleak dystopianism is what does it for you, that’s fine I guess.

boarder42

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Re: What comes after the ACA?
« Reply #4087 on: February 22, 2018, 06:33:46 AM »
Boarder42, can you clarify the statement that you've made several times here and elsewhere that the individual mandate destroyed the freemarket for health insurance?  Because I don't follow.

I mean, I understand that before the ACA there were low cost high deductible plans, but these were mostly used by younger, healthier individuals, families, and small businesses that could afford the (admittedly lower) premium costs and valued having health insurance in the first place. But that leaves out very large chunks of people in this country. And the individual mandate by itself added new consumers to this market while keeping the previous consumers from dropping out. Maybe other aspects of the ACA had detrimental effects on the individual marketplace, like Medicaid expansion being left up to the states (partly the result of Supreme Court rulings), or not providing enough of a subsidy to a larger group of the working and middle class.

But I just don't see how a tax penalty if you don't have some kind of insurance has anything to do with people dropping out of the market. Maybe you are just making a shorthand way of saying "forcing a bunch of sicker and poorer people to participate in this marketplace as well as adding minimum requirements has resulted in increased pricing compared to pre-ACA plans that is forcing previous consumers out", but that's more directly tied to other aspects of the ACA rather than the individual mandate itself.

Also, I think it was pointed out earlier in this thread (or maybe another) that Obama and the 111th Congress should have anticipated that this new system would be under dire threat with a change in leadership. Well I think any rational person would argue that taking a Republican idea championed by conservative think tanks and essentially implementing it nearly whole cloth would provide political protection.

a tax penalty does destroy that free market b/c the market place dried up for those plans - and they "let" a few religious based plans bypass the requirements.  in addition the ACA has seen nothing but insurance companies pulling out even prior to the changing of the guard .  there is another post here about how the out of market coverage for the ACA is non existent so FIREes cant even travel to another state without buying more coverage.  So now i'm forced to buy this plan that may not even exist in my county anymore or pay a tax penalty.  vs choosing to insure as i see fit and incuring no penalty.  My state has i think 60% of rural counties now not covered in the ACA marketplace. 

for the record i'm a huge advocate for a non profit central payer and focusing on price control - but the indvidual mandate - which i believe this administration will get overturned is going to allow FIREes much more control over their health insurance choices and the cost of those choices.  ie Healthshare plan for up to 100k with a catasrophic plan from traditional insurance over the top to protect against big issues.  i also believe there will be more cost control methods implemented to actually start decreasing the cost of health insurance in the next 4-5 years - when everyone is screaming something is too expensive - some one revolutionizes the model and turns it on its head - its currently happening with the growing number of care givers who wont accept any insurance and publish what you see is what you pay prices.  combine the healthshare model(remove the religion but keep the healthy living requirements) with publicized pricing that allows for people to choose a cost effective care provider and you have a much lower cost system overall.  add to it the advancement in robotic technology and you're not going to see prices rise much longer in my personal opinion, regardless of how we decide who is paying for it. 

geekette

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Re: What comes after the ACA?
« Reply #4088 on: February 22, 2018, 07:14:00 AM »
While there were many stories last year about how there could be areas with no ACA providers, insurance companies stepped in and everyone has coverage available.

As someone with pre-ex conditions, there are no other options besides the ACA. If you and Drumpf get your way, I will join the ranks of the uninsured until age 65 (or later, if the Repupubs screw that up too).

boarder42

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Re: What comes after the ACA?
« Reply #4089 on: February 22, 2018, 07:19:22 AM »
While there were many stories last year about how there could be areas with no ACA providers, insurance companies stepped in and everyone has coverage available.

As someone with pre-ex conditions, there are no other options besides the ACA. If you and Drumpf get your way, I will join the ranks of the uninsured until age 65 (or later, if the Repupubs screw that up too).

oh great i can get crap coverage that works with one doctor and one hospital 100 miles away - hey but i've got coverage right - oh and i'm paying out the ass for this service.  but at least i'm covered.

And i dont know that this was targetted at me or not but my way is a non profit govt run expansion of medicare for all with costs made visible to all consumers so that they can choose where they go and if they want to pay more for a service than is covered by the plan.  but in the mean time the release of the individual mandate (not pre existing conditions - i havent said to remove that clause once ) is what i'd prefer.  so that we all can choose the level of coverage we want and those with pre existing conditions can still be covered (though their coverage costs will likely go thru the roof)

being covered for the sake of being covered is a shitty metric

former player

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Re: What comes after the ACA?
« Reply #4090 on: February 22, 2018, 07:32:09 AM »
While there were many stories last year about how there could be areas with no ACA providers, insurance companies stepped in and everyone has coverage available.

As someone with pre-ex conditions, there are no other options besides the ACA. If you and Drumpf get your way, I will join the ranks of the uninsured until age 65 (or later, if the Repupubs screw that up too).

oh great i can get crap coverage that works with one doctor and one hospital 100 miles away - hey but i've got coverage right - oh and i'm paying out the ass for this service.  but at least i'm covered.

And i dont know that this was targetted at me or not but my way is a non profit govt run expansion of medicare for all with costs made visible to all consumers so that they can choose where they go and if they want to pay more for a service than is covered by the plan.  but in the mean time the release of the individual mandate (not pre existing conditions - i havent said to remove that clause once ) is what i'd prefer.  so that we all can choose the level of coverage we want and those with pre existing conditions can still be covered (though their coverage costs will likely go thru the roof)

being covered for the sake of being covered is a shitty metric
Not sure I understand this - are you saying that people with pre-existing conditions are entitled to coverage only if they can afford premiums that are "through the roof"?  Because as you should know, there are many people with pre-existing conditions who will not be able to afford premiums that are "through the roof", leaving them uninsured and uninsurable without an individual mandate.
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PathtoFIRE

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Re: What comes after the ACA?
« Reply #4091 on: February 22, 2018, 08:33:55 AM »
Boarder42, can you clarify the statement that you've made several times here and elsewhere that the individual mandate destroyed the freemarket for health insurance?  Because I don't follow.
<snip>

a tax penalty does destroy that free market b/c the market place dried up for those plans - and they "let" a few religious based plans bypass the requirements.
<snip>

Again, I still don't see even a hypothesis to explain how the mandate itself leads to fewer consumers on the market (once we get that settled, we can start diving into the data). If the ACA was only the individual mandate, i.e. the only thing it did was mandate that every person carry some form of insurance, you would see increased numbers of individual marketplace consumers as those people who chose no insurance would be mostly compelled to buy a plan and avoid the tax penalty. My point is that it just doesn't make sense to argue that the mandate is going to kill the individual market. While I don't know that the actual data bears any of this out, I think it makes a lot more sense to propose that the minimum insurance requirements, the fragmented nature of the marketplaces by state and county, and the lack of a final basic federal policy available to anyone are much better candidates for our "what-ifs".

I'll also state my preference, which is for a Canadian style single payor system relegating insurance company roles to either facilitators or peripheral and very unessential healthcare.

boarder42

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Re: What comes after the ACA?
« Reply #4092 on: February 22, 2018, 08:41:10 AM »
While there were many stories last year about how there could be areas with no ACA providers, insurance companies stepped in and everyone has coverage available.

As someone with pre-ex conditions, there are no other options besides the ACA. If you and Drumpf get your way, I will join the ranks of the uninsured until age 65 (or later, if the Repupubs screw that up too).

oh great i can get crap coverage that works with one doctor and one hospital 100 miles away - hey but i've got coverage right - oh and i'm paying out the ass for this service.  but at least i'm covered.

And i dont know that this was targetted at me or not but my way is a non profit govt run expansion of medicare for all with costs made visible to all consumers so that they can choose where they go and if they want to pay more for a service than is covered by the plan.  but in the mean time the release of the individual mandate (not pre existing conditions - i havent said to remove that clause once ) is what i'd prefer.  so that we all can choose the level of coverage we want and those with pre existing conditions can still be covered (though their coverage costs will likely go thru the roof)

being covered for the sake of being covered is a shitty metric
Not sure I understand this - are you saying that people with pre-existing conditions are entitled to coverage only if they can afford premiums that are "through the roof"?  Because as you should know, there are many people with pre-existing conditions who will not be able to afford premiums that are "through the roof", leaving them uninsured and uninsurable without an individual mandate.

thats the way the current system is trending anyways - shitty coverage for all in the name of coverage in order to allow for those with pre-existing conditions to be covered cheaper than their condition costs.  if you cant afford your premiums then you limit your income down to the point the govt is covering them if you have pre existing conditions dont drag all the healthy people into shitty ass plans that dont allow me to walk across the stateline and get covered by a hospital or doctor. Have you even looked at what the ACA plans look like now they are purely a benefit for those with pre-existing conditions and know their care will be higher than what they pay - at the rate of increase in the cost and decrease in coverage area of these plans - you may not have to remove the individual mandate b/c paying the tax and getting my own catastrophic plan will be more reasonable and other healthy people will pursue similar methods- including health share- they already have.

boarder42

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Re: What comes after the ACA?
« Reply #4093 on: February 22, 2018, 08:50:41 AM »
Boarder42, can you clarify the statement that you've made several times here and elsewhere that the individual mandate destroyed the freemarket for health insurance?  Because I don't follow.
<snip>

a tax penalty does destroy that free market b/c the market place dried up for those plans - and they "let" a few religious based plans bypass the requirements.
<snip>

Again, I still don't see even a hypothesis to explain how the mandate itself leads to fewer consumers on the market (once we get that settled, we can start diving into the data). If the ACA was only the individual mandate, i.e. the only thing it did was mandate that every person carry some form of insurance, you would see increased numbers of individual marketplace consumers as those people who chose no insurance would be mostly compelled to buy a plan and avoid the tax penalty. My point is that it just doesn't make sense to argue that the mandate is going to kill the individual market. While I don't know that the actual data bears any of this out, I think it makes a lot more sense to propose that the minimum insurance requirements, the fragmented nature of the marketplaces by state and county, and the lack of a final basic federal policy available to anyone are much better candidates for our "what-ifs".

I'll also state my preference, which is for a Canadian style single payor system relegating insurance company roles to either facilitators or peripheral and very unessential healthcare.

ok so its not the individual mandate alone is that the individual mandate AND it must meet these requirements that drove it thru the roof.  repealing the indvidual mandate does not change the minimum requirement for those that seek plans that meet them.  and reopens the market place for other plans. but as i just stated above if/when the coverage gets expensive enough and doesnt allow for freedom of movement within the states, individuals will choose other paths if they dont have pre existing conditions.

Mr. Green

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Re: What comes after the ACA?
« Reply #4094 on: February 22, 2018, 12:41:59 PM »
For now, I console myself with the knowledge that, despite everything that is going on, I can get affordable coverage as long as an insurer remains in my state and my income is below the subsidy cliff. Provided the administration isn't able to make any more big waves, the 2019 healthcare year should look a whole lot like 2018. Maybe some insurers will even come back to the table when they see how everyone else has compensated for the loss of CSR payments.

I know this doesn't help anyone making more than the subsidy cliff but as someone who has already given up the golden goose and can't go back, I'm hoping the system will continue limping along for those using it until a replacement comes along.
Took the leap in June 2016.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4095 on: February 22, 2018, 02:10:02 PM »
For now, I console myself with the knowledge that, despite everything that is going on, I can get affordable coverage as long as an insurer remains in my state and my income is below the subsidy cliff. Provided the administration isn't able to make any more big waves, the 2019 healthcare year should look a whole lot like 2018. Maybe some insurers will even come back to the table when they see how everyone else has compensated for the loss of CSR payments.

I know this doesn't help anyone making more than the subsidy cliff but as someone who has already given up the golden goose and can't go back, I'm hoping the system will continue limping along for those using it until a replacement comes along.

I haven't given up the golden goose yet, but I really would like to in 2019.   If I lose the option of an ACA subsidized plan in any of the following years after I FIRE, I'll still be able to easily cover my expenses, but it will put a huge dent into my FIRE travel/entertainment fund, which I'm estimating will allow me to spend $30,000/yr just to have fun (if I keep living where I do now.)  I certainly don't want to allocate half of that to insurance premiums/co-pays/deductibles for a decent insurance plan outside of the ACA marketplace.  And I don't want to settle for a somewhat low cost shitty non-ACA plan that provides inadequate insurance due to coverage exclusions, caps, higher co-pays/deductibles, and the fact that they can kick you off if you get to be too expensive for them.  I'm watching all of this closely.  My "best" FIRE depends on them getting the ACA stabilized.
« Last Edit: February 22, 2018, 04:20:25 PM by DreamFIRE »

farmecologist

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Re: What comes after the ACA?
« Reply #4096 on: February 23, 2018, 08:43:44 AM »
While there were many stories last year about how there could be areas with no ACA providers, insurance companies stepped in and everyone has coverage available.

As someone with pre-ex conditions, there are no other options besides the ACA. If you and Drumpf get your way, I will join the ranks of the uninsured until age 65 (or later, if the Repupubs screw that up too).

oh great i can get crap coverage that works with one doctor and one hospital 100 miles away - hey but i've got coverage right - oh and i'm paying out the ass for this service.  but at least i'm covered.

And i dont know that this was targetted at me or not but my way is a non profit govt run expansion of medicare for all with costs made visible to all consumers so that they can choose where they go and if they want to pay more for a service than is covered by the plan.  but in the mean time the release of the individual mandate (not pre existing conditions - i havent said to remove that clause once ) is what i'd prefer.  so that we all can choose the level of coverage we want and those with pre existing conditions can still be covered (though their coverage costs will likely go thru the roof)

being covered for the sake of being covered is a shitty metric
Not sure I understand this - are you saying that people with pre-existing conditions are entitled to coverage only if they can afford premiums that are "through the roof"?  Because as you should know, there are many people with pre-existing conditions who will not be able to afford premiums that are "through the roof", leaving them uninsured and uninsurable without an individual mandate.

What completely boggles my mind is the 'healthy' contingent that often bash those with pre-existing conditions for 'raising their premiums'.  However, they don't seem to realize that they could become one of 'those people' at literally any moment.  I get a good laugh out of those that think they will never fall ill, etc...because they 'take care of themselves'.  Well, that's a complete BS argument.  Not sure if they are really that dumb or they really believe it...scary in both cases!  Note: I'm NOT targeting anyone here with these comments but using folks with pre-existing conditions as the scapegoat happens all too frequently.

Granted, the ACA wasn't anywhere near perfect...mostly due to the politics at the time.   However, these quick non-fixes the current administration are imposing are doing anything but fixing anything.   The individual mandate wasn't perfect either..again it was a compromise..because politics.  However, at least it required everyone contributing to a common goal.   The current state of hacked-up ACA (with more to come..I'm sure) is complete insanity. 

As far as the non-profit vs for-profit debate goes...the 'insurer profit rule' of the ACA attempted to address that.  Again...not perfect but it has helped....a bit.

  https://www.healthinsurance.org/obamacare/billions-in-aca-rebates-show-80-20-rules-impact/

I agree in principle that the only real 'fix' would be to have a base level of care provided by some kind of government entity where people below a certain age would pay some sort of base 'premium'.  As boarder mentioned, expanded medicare seems to fit this model quite well.   Then there can be any number of enhanced private or public-private policies for better/quicker/etc... services.  Will this ever happen?  Very doubtful given today's politics.






 

tyort1

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Re: What comes after the ACA?
« Reply #4097 on: February 23, 2018, 10:38:13 AM »
People like boarder42 are the same ones that bitch about paying school taxes.  "My kid isn't going to school so why should I pay for other people's kids to go to school?".  Yeah, these people have almost no concept of "The Common Good".  And in fact, their thinking is usually reduced down to:

Government Bad
Free Market Good

In free market health insurance, low risk people pay (much) lower premiums, and high risk people pay (much) higher premiums.  With things like the ACA or single payer, EVERYONE pays moderately higher premiums and EVERYONE gets covered.  The people that had sky high premiums are given relief and have better lives.  The people that used to pay very low premiums bitch about the cost and how unfair it is. 

This is why single payer is a better option than something like the ACA.  Make it a tax and roll it out to everyone based on income, like we do with every other tax.  Then everyone gets covered and all the waste/expense of multiple market places and state to state variation gets solved in one fell swoop. 

We did it with Social Security and Medicare.  We can do it for single payer, too.  In fact, one of my secret hopes is that the Trump administration garners so much anger and so much ill will among the voting populace, that he'll be replaced in 3 years and we'll ram through single payer as a big middle finger to the conservatives. 

Of course, as always, given how poor the red states are, they'll actually BENEFIT disproportionately from single payer.  But even when you make their lives better, they're gonna carp about it. 
Frugalite in training.

boarder42

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Re: What comes after the ACA?
« Reply #4098 on: February 23, 2018, 11:01:29 AM »
People like boarder42 are the same ones that bitch about paying school taxes.  "My kid isn't going to school so why should I pay for other people's kids to go to school?".  Yeah, these people have almost no concept of "The Common Good".  And in fact, their thinking is usually reduced down to:

Government Bad
Free Market Good

In free market health insurance, low risk people pay (much) lower premiums, and high risk people pay (much) higher premiums.  With things like the ACA or single payer, EVERYONE pays moderately higher premiums and EVERYONE gets covered.  The people that had sky high premiums are given relief and have better lives.  The people that used to pay very low premiums bitch about the cost and how unfair it is. 

This is why single payer is a better option than something like the ACA.  Make it a tax and roll it out to everyone based on income, like we do with every other tax.  Then everyone gets covered and all the waste/expense of multiple market places and state to state variation gets solved in one fell swoop. 

We did it with Social Security and Medicare.  We can do it for single payer, too.  In fact, one of my secret hopes is that the Trump administration garners so much anger and so much ill will among the voting populace, that he'll be replaced in 3 years and we'll ram through single payer as a big middle finger to the conservatives. 

Of course, as always, given how poor the red states are, they'll actually BENEFIT disproportionately from single payer.  But even when you make their lives better, they're gonna carp about it.

before you try to put words in my mouth and speak for me - more or less a personal attack here @tyort1 making shit up about what i said and extrapolating on it.

you havent fully read any of my posts most of them i'm for a single payer central system that covers all.  Insurance companies exist to make profits i want no part in paying higher rates so insurance companies can still make profits while we're "insuring for the common good".  the ACA is crap it was designed poorly and we're all self serving to some end so i'm sorry if i would side with the fact that under the current options i think those with pre existing conditions should choose to find gainful employment with their pre existing condtions that cover them vs putting this burden on the rest of society - work til you're 65 or covered by something else - move to a country that covers you - etc.

the central payer system negates alot of the costs - the way current insurance works drives up the cost of healthcare in addition to the profit they make over the top.  give the poeple the full 20% back get rid of all the nurses doing paperwork and let them focus on patient care. Tax insentivize being and living a healthy lifesytle (hint there is a reason corporations fund preventative care and good healthy habits - IT WORKS - to lower health care costs)

you can choose to differ but dont PUT FUCKING WORDS IN MY MOUTH.
« Last Edit: February 23, 2018, 11:12:07 AM by boarder42 »

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4099 on: February 23, 2018, 11:07:49 AM »
i think those with pre existing conditions should choose to find gainful employment with their pre existing condtions that cover them vs putting this burden on the rest of society - work til you're 65 or covered by something else - move to a country that covers you - etc.

So now people with preexisting conditions are also welfare queens? FFS, how many stories do you need to hear about employers just paying the penalty and not covering people, or cutting hours so their workers are just below benefits eligibility? Tying health insurance to employment was bone-headed to begin with. It's even worse given the current and future state of employment in America.
The first step is acknowledging you have a problem, right?

https://forum.mrmoneymustache.com/journals/digging-out-of-a-hole/