Author Topic: What comes after the ACA?  (Read 249429 times)

CDP45

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Re: What comes after the ACA?
« Reply #600 on: January 21, 2017, 10:00:52 AM »
Sorry if I missed the earlier mention, but the 17MM (homogenous) people of the Netherlands isn't a great comparison to the 350mm+ Americans, and the 2 multi-year studies I posted above reviewing Americans. But good job looking for evidence honestly, most just believe what they read on forums ;)

Wtf is up with this? It's always trotted out like it means something. Do non-white people need widely different health care?

Do African-American doctors go to specialists because their needs are so much different than white folk? Do Chinese-Americans go to different doctors when their legs get broken?

I've never encountered this in my community but maybe they do it elsewhere.


(If it quacks like a duck...)

Tell me how the US health care system is free of racism and discrimination against the poor and uneducated?  What community do you live in that has this solved?

The Dutch are much more uniformly wealthy as well.

packlawyer04

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Re: What comes after the ACA?
« Reply #601 on: January 21, 2017, 10:07:25 AM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.

bacchi

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Re: What comes after the ACA?
« Reply #602 on: January 21, 2017, 10:19:30 AM »
Sorry if I missed the earlier mention, but the 17MM (homogenous) people of the Netherlands isn't a great comparison to the 350mm+ Americans, and the 2 multi-year studies I posted above reviewing Americans. But good job looking for evidence honestly, most just believe what they read on forums ;)

Wtf is up with this? It's always trotted out like it means something. Do non-white people need widely different health care?

Do African-American doctors go to specialists because their needs are so much different than white folk? Do Chinese-Americans go to different doctors when their legs get broken?

I've never encountered this in my community but maybe they do it elsewhere.


(If it quacks like a duck...)

Tell me how the US health care system is free of racism and discrimination against the poor and uneducated?  What community do you live in that has this solved?

The Dutch are much more uniformly wealthy as well.

Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

It requires some planning but it's not impossible. I mean, this is America! We went to the motherfuckin' moon! Surely we can create a system that, ya know, provides more treatment for those who need it.


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Re: What comes after the ACA?
« Reply #603 on: January 21, 2017, 10:24:07 AM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.
A few responses on your post:
1) I agree that the ban against insurers denying coverage for pre-existing conditions will stay, however I (sadly) anticipate that many will find insurance premiums to be so high that they will be out of reach.  This is the tragedy of "universal access" - sure it's available, but if it's unaffordable what difference does that make?

2) I strongly disagree that people who actually pay for their own insurance will be paying a bit less.  THe ACA had numerous cost-controlling measures that are the first to go - how will insurance rates go DOWN under this new scenario?

3) Other provisions I think the ACA got right:  allowing children to stay on their parents plan until age 26 (incredibly important for those that go to graduate school), limiting the profits of insurance companies, limiting premiums to 10% of income.
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Re: What comes after the ACA?
« Reply #604 on: January 21, 2017, 10:27:00 AM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

packlawyer04

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Re: What comes after the ACA?
« Reply #605 on: January 21, 2017, 10:31:03 AM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.
A few responses on your post:
1) I agree that the ban against insurers denying coverage for pre-existing conditions will stay, however I (sadly) anticipate that many will find insurance premiums to be so high that they will be out of reach.  This is the tragedy of "universal access" - sure it's available, but if it's unaffordable what difference does that make?

2) I strongly disagree that people who actually pay for their own insurance will be paying a bit less.  THe ACA had numerous cost-controlling measures that are the first to go - how will insurance rates go DOWN under this new scenario?

3) Other provisions I think the ACA got right:  allowing children to stay on their parents plan until age 26 (incredibly important for those that go to graduate school), limiting the profits of insurance companies, limiting premiums to 10% of income.

Serious question.  have you read the law?  Like, actually went to the statute and read it. I had to for work to advise companies. Just curious because I know about 3 people who have actually read it but everybody seems to know how it works and what it does.

Bucksandreds

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Re: What comes after the ACA?
« Reply #606 on: January 21, 2017, 11:17:09 AM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

I agree. As crazy as this sounds given who's in power I think that by 2020 we will never see as conservative of a government again. Democrats got more votes for president, senate and house but do not control any due to our system. Demogrsphics are making it harder and harder for conservatives to win and independents tend to vote against whoever is currently in charge.  2018 will be interesting to see how close the dems get in the house and 2020 would be shocking if the republicans control the presidency, senate and house. If Repubs screw over millions repealing the ACA and hand out massive tax breaks to the rich it's 50/50 we'll see a dem supermajority by 2020 again. If that happens again because the repubs screwed 10s of millions out of health insurance then hello single payer.  The repubs would come right back again, I'm sure of that, but sooner or later conservatism will have to shift to the center due to demographics.  The tea party and ridiculousness going on in the GOP is a symptom of it's current iteration being in its death throes.  I'm no liberal (in center left) but looking at what the demographics shows, the current GOP platform stands a 0.00% chance to win elections by 2020.

rtrnow

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Re: What comes after the ACA?
« Reply #607 on: January 21, 2017, 12:04:44 PM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.
A few responses on your post:
1) I agree that the ban against insurers denying coverage for pre-existing conditions will stay, however I (sadly) anticipate that many will find insurance premiums to be so high that they will be out of reach.  This is the tragedy of "universal access" - sure it's available, but if it's unaffordable what difference does that make?

2) I strongly disagree that people who actually pay for their own insurance will be paying a bit less.  THe ACA had numerous cost-controlling measures that are the first to go - how will insurance rates go DOWN under this new scenario?

3) Other provisions I think the ACA got right:  allowing children to stay on their parents plan until age 26 (incredibly important for those that go to graduate school), limiting the profits of insurance companies, limiting premiums to 10% of income.

Also doing away with lifetime caps.

EnjoyIt

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Re: What comes after the ACA?
« Reply #608 on: January 21, 2017, 12:38:59 PM »
Insulin 10ml from walmart $25
https://www.goodrx.com/novolin-70-30

What's the catch? Sounds a little too good to be true since all the other prices are around $150.

no catch.  It is a decent reliable long acting insulin and is a great generic option.  Walmart often gets deals on cheap meds that cost 10x as much at Walgreens or CVS.  Both of which are thieves when paying out of pocket.

GoodRx.com is a great site to look up inexpensive medication alternatives. 

Metric Mouse

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Re: What comes after the ACA?
« Reply #609 on: January 21, 2017, 12:58:14 PM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

I agree. As crazy as this sounds given who's in power I think that by 2020 we will never see as conservative of a government again. Democrats got more votes for president, senate and house but do not control any due to our system. Demogrsphics are making it harder and harder for conservatives to win and independents tend to vote against whoever is currently in charge.  2018 will be interesting to see how close the dems get in the house and 2020 would be shocking if the republicans control the presidency, senate and house. If Repubs screw over millions repealing the ACA and hand out massive tax breaks to the rich it's 50/50 we'll see a dem supermajority by 2020 again. If that happens again because the repubs screwed 10s of millions out of health insurance then hello single payer.  The repubs would come right back again, I'm sure of that, but sooner or later conservatism will have to shift to the center due to demographics.  The tea party and ridiculousness going on in the GOP is a symptom of it's current iteration being in its death throes.  I'm no liberal (in center left) but looking at what the demographics shows, the current GOP platform stands a 0.00% chance to win elections by 2020.

I believe democrats have been waiting for the demographics to shift for several elections. Looking at the number of Latino voters that swung for Trump, the demographics fight isn't as clear cut as some claim.
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nereo

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Re: What comes after the ACA?
« Reply #610 on: January 21, 2017, 12:59:51 PM »
Since there are so many people with pre-existing conditions, why don't they get together into their own insurance pool?

Is there anything preventing a state from providing Obamacare to its own residents? Or single-payer to its own residents?

Why is the only answer total federal control of the entire health system?

The ban against insurers not insuring pre-existing conditions is going to stay.  Any new plan is going to include that provision.  That was the only good thing that came out of the ACA. Republicans know that is going to be included in future plans.

Other than that, I'm glad to see the ACA go.  It is about time.  People who actually pay for their own insurance will be paying a bit less once it goes.  I just don't see anything coming out yet to truly address the problem but we shall see.
A few responses on your post:
1) I agree that the ban against insurers denying coverage for pre-existing conditions will stay, however I (sadly) anticipate that many will find insurance premiums to be so high that they will be out of reach.  This is the tragedy of "universal access" - sure it's available, but if it's unaffordable what difference does that make?

2) I strongly disagree that people who actually pay for their own insurance will be paying a bit less.  THe ACA had numerous cost-controlling measures that are the first to go - how will insurance rates go DOWN under this new scenario?

3) Other provisions I think the ACA got right:  allowing children to stay on their parents plan until age 26 (incredibly important for those that go to graduate school), limiting the profits of insurance companies, limiting premiums to 10% of income.

Serious question.  have you read the law?  Like, actually went to the statute and read it. I had to for work to advise companies. Just curious because I know about 3 people who have actually read it but everybody seems to know how it works and what it does.
Did I read the actual 1000+ page law? No.  Have I read extensively on the various provisions included in it? Yes.  Plus (FWIW) my family is pretty steeped in it; 3 immediate family members are doctors, one is a retired nurse, and I've worked doing medical records both pre and post ACA.

Interestingly, wikipedia has a pretty decent list of the provisions included within.

My own opinion; the law has tons of problems, some of which were intentionally inserted for political reasons, yet many of the provisions are things almost everyone agrees we should have and didn't exist before its passage. There is an inherent disagreement surrounding to what degree the government should be involved in our healthcare - and unfortunately that's where a lot of people have drawn ideological lines "for" or "against" while ignoring the broader concepts. Regardless, most people have very little understanding of what is actually in the bill, starting with the fact that the bulk of it was an expansion of medicare; only a small portion was coverage for individuals, and the "individual mandate" influences a very small percentage of the total population.
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jim555

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Re: What comes after the ACA?
« Reply #611 on: January 21, 2017, 01:10:24 PM »
The market has no answer for those who can't afford any health insurance.  How can a person making $16,000 afford health insurance?  They can't and won't be buying any. 
What happens to them?  Let them rot in skid row?  Repubs answer is go to the ER.  Well who pays for the uncompensated care?  Ultimately taxpayers and jacked up prices for those with insurance.  This is the gorilla in the room.  80%+ on the ACA get subsidies, this is not a minor problem.

nereo

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Re: What comes after the ACA?
« Reply #612 on: January 21, 2017, 01:12:26 PM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

I agree. As crazy as this sounds given who's in power I think that by 2020 we will never see as conservative of a government again. Democrats got more votes for president, senate and house but do not control any due to our system. Demogrsphics are making it harder and harder for conservatives to win and independents tend to vote against whoever is currently in charge.  2018 will be interesting to see how close the dems get in the house and 2020 would be shocking if the republicans control the presidency, senate and house. If Repubs screw over millions repealing the ACA and hand out massive tax breaks to the rich it's 50/50 we'll see a dem supermajority by 2020 again. If that happens again because the repubs screwed 10s of millions out of health insurance then hello single payer.  The repubs would come right back again, I'm sure of that, but sooner or later conservatism will have to shift to the center due to demographics.  The tea party and ridiculousness going on in the GOP is a symptom of it's current iteration being in its death throes.  I'm no liberal (in center left) but looking at what the demographics shows, the current GOP platform stands a 0.00% chance to win elections by 2020.

I believe democrats have been waiting for the demographics to shift for several elections. Looking at the number of Latino voters that swung for Trump, the demographics fight isn't as clear cut as some claim.

Latino voters supported Clinton 66% to 28% % for DJT. That was on par with the 2008 election.  DJT's support was about equal to what Romney received.
The surprising portion was how few total Latinos voted in this election, particularly in states with large populations like Florida. Had the same proportion voted in this election as in 2008 and with the same level of support, CLinton would have won the electoral college.

So it isn't a question of Latinos swinging for Trump (which didn't happen), but rather why so many eligible Latinos didn't vote at all.

http://www.pewresearch.org/fact-tank/2016/11/29/hillary-clinton-wins-latino-vote-but-falls-below-2012-support-for-obama/
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BTDretire

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Re: What comes after the ACA?
« Reply #613 on: January 21, 2017, 01:22:17 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

CDP45

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Re: What comes after the ACA?
« Reply #614 on: January 21, 2017, 01:27:48 PM »
The market has no answer for those who can't afford any health insurance.  How can a person making $16,000 afford health insurance?  They can't and won't be buying any. 
What happens to them?  Let them rot in skid row?  Repubs answer is go to the ER.  Well who pays for the uncompensated care?  Ultimately taxpayers and jacked up prices for those with insurance.  This is the gorilla in the room.  80%+ on the ACA get subsidies, this is not a minor problem.

Does anyone think unlimited government spending and for those above 65 years old has any effect on the price and affordability of care?? We seem to get it with drug prices- gee there is only 1 buyer who will pay whatever the cost as long as a doctor approve it, therefore drugs cost an insane amount.

The problem with our model is we're paying for heart bypasses, hip and knee replacements, and prostate surgery for 95 year old patients, and the patient pays nothing! Why would we expect to have an affordable system with that sort of spending?
 
We understand there is a limited amount of providers, but there is basically unlimited amount of spending.

I think we do need some sort of cap that either decreases with age, or it's a lifetime cap that the patient picks which procedures.

There are 2 questions: How much are we collectively willing to pay? And who will pay for it?

nereo

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Re: What comes after the ACA?
« Reply #615 on: January 21, 2017, 01:28:57 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

Well the answer to that is "it depends".  For individuals who have no pre-existing conditions and who's income is already high enough that they did not qualify for subsidies, AND for individuals who are covered under an employers health plan - the near-term impacts may very well be negligible.

For those that have pre-existing conditions, or who were receiving subsidies, or who have adult children on their plan, then things might get quite a bit worse. If you are one of many who is now on medicare due to its expansion, it could also negatively impact you.

Much of this thread, however, is focused on the impacts to our country at large. For example, what are the economic and moral implications of having lots of people unable to afford insurance, as well as what are the impacts of more public support (i.e. 'Welfare').
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jim555

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Re: What comes after the ACA?
« Reply #616 on: January 21, 2017, 01:31:42 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?
It ultimately comes down to medical costs.  Those are market prices.  At least with the ACA we have a uniform set of insurance policies to compare against.  No more junk policies that will leave you in a lurch if you really need them.

CDP45

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Re: What comes after the ACA?
« Reply #617 on: January 21, 2017, 01:43:37 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

You ain't seen nothing yet. Multiple state budgets are imploding due to ACA medicare expansion already, cuts to every other program, but guess who consistently votes?

 Basically all private employers will be on HDHPs with HSAs, so everyone who doesn't yet have a $3k-$5k deductible, it's coming soon to you.

jim555

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Re: What comes after the ACA?
« Reply #618 on: January 21, 2017, 01:48:02 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

You ain't seen nothing yet. Multiple state budgets are imploding due to ACA medicare expansion already, cuts to every other program, but guess who consistently votes?

 Basically all private employers will be on HDHPs with HSAs, so everyone who doesn't yet have a $3k-$5k deductible, it's coming soon to you.
The Feds have been paying 100% of the Medicaid expansion so far, so how is that imploding states budgets?

packlawyer04

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Re: What comes after the ACA?
« Reply #619 on: January 21, 2017, 01:53:22 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

Uh oh, the folks who claim ACA did not rock the middle class will not like this post.

nereo

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Re: What comes after the ACA?
« Reply #620 on: January 21, 2017, 01:59:32 PM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

Uh oh, the folks who claim ACA did not rock the middle class will not like this post.
Why do you say that?
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waltworks

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Re: What comes after the ACA?
« Reply #621 on: January 21, 2017, 02:00:13 PM »
Of course it rocked the middle class. Just like the middle class was getting rocked before. Have none of you actually been purchasing health care for more than a decade or so? Cost increases have been huge for 20+ years.

-W

packlawyer04

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Re: What comes after the ACA?
« Reply #622 on: January 21, 2017, 02:09:05 PM »
Of course it rocked the middle class. Just like the middle class was getting rocked before. Have none of you actually been purchasing health care for more than a decade or so? Cost increases have been huge for 20+ years.

-W

exactly. Nothing changed except some people are getting subsidized health insurance now and there is a fee on every policy to pay for those subsidies.  So everyone is still paying for people who could not afford health insurance before.  Which is why the ACA is a stupid law.  It did not fix the problem.  The ACA is nothing more than a guy playing hide the ball under the cups trick on a street corner. It simply moved around who was paying for what.  Sure, I bet the people on the exchanges absolutely love it.  I would love a program that paid my mortgage but unfortunately that is not happening for me.

Hopefully at some point in time someone will propose some comprehensive legislation to address health care costs, not insurance. It is going to have to come from so many different angles that it hurts my head..... Malpractice, insurance laws, education (college and med school), penalties for unhealthy choices, access to medical care, educating the public regarding use of medical resources, changes in our culture overall regarding exercise and eating....On and on and on.

Just implementing some new payment/insurance plan is simply playing hide the ball.  Unfortunately, it appears the Republicans are heading down the same path again with their proposed ideas so it is going to be the same old same old.
« Last Edit: January 21, 2017, 02:11:51 PM by packlawyer04 »

jim555

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Re: What comes after the ACA?
« Reply #623 on: January 21, 2017, 02:11:44 PM »
At least those under 400% FPL can get some subsidy relief under the ACA.  That was not possible pre-ACA.

packlawyer04

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Re: What comes after the ACA?
« Reply #624 on: January 21, 2017, 02:17:29 PM »
At least those under 400% FPL can get some subsidy relief under the ACA.  That was not possible pre-ACA.

Yeah, sure. but instead of passing a 2,000 page bill that caused all sorts of changes, why don't you simply just put these people on medicaid if that is your goal.  Pretty simple.  Want to prevent insurers from denying pre-existing conditions, one more sentence.

that is why I asked a poster earlier if he has read the law. Most people don't really understand all of the crap that was in this statute. And that is just the statute. The regulations on this are mind blowing.  The amount of money spent complying with this law and regulations is mind numbing.


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Re: What comes after the ACA?
« Reply #625 on: January 21, 2017, 02:26:16 PM »
Medicaid for all, sounds good.  Just make sure the reimbursement rate is at Medicare level.  And it is fee for service only.  Then all this BS can end.

packlawyer04

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Re: What comes after the ACA?
« Reply #626 on: January 21, 2017, 03:17:49 PM »
Medicaid for all, sounds good.  Just make sure the reimbursement rate is at Medicare level.  And it is fee for service only.  Then all this BS can end.

Yeah sure, that will fix the rising costs of medical care........... Again, people only want to talk about insurance.

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Re: What comes after the ACA?
« Reply #627 on: January 21, 2017, 04:13:21 PM »
Medicaid for all, sounds good.  Just make sure the reimbursement rate is at Medicare level.  And it is fee for service only.  Then all this BS can end.

Yeah sure, that will fix the rising costs of medical care........... Again, people only want to talk about insurance.

Your deliberately ignoring the cost-control measures placed into the ACA.
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Re: What comes after the ACA?
« Reply #628 on: January 21, 2017, 06:11:37 PM »
Medicaid for all, sounds good.  Just make sure the reimbursement rate is at Medicare level.  And it is fee for service only.  Then all this BS can end.

Yeah sure, that will fix the rising costs of medical care........... Again, people only want to talk about insurance.

Your deliberately ignoring the cost-control measures placed into the ACA.

Can you please specify the cost control measures?
What I see are regulatory burdens that cost more to implement.

As a physician I hate agreeing with the lawyer, but there is very little talk about cost.  Just who will pay for the care.  Until we have a real changes to affect cost all of this rhetoric is pointless.

Just for the record having a health insurance plan does not mean you getting healthcare.  Also, if you are a person who can't afford health insurance, you are the same person who can't afford the deductibles.  Therefor just because you have insurance does not make the healthcare any more accessible (Outside of the free yearly checkup.)

waltworks

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Re: What comes after the ACA?
« Reply #629 on: January 21, 2017, 07:30:14 PM »
From the WaPo (https://www.washingtonpost.com/news/storyline/wp/2014/10/06/we-know-how-to-expand-health-care-we-know-a-lot-less-on-how-to-make-it-cheaper/?utm_term=.c04498fe1e98):

"Here are some of the Affordable Care Act’s cost-cutting creations:

The Patient-Centered Outcomes Research Institute conducts comparative-effectiveness research, which aims to uncover the positives and negatives of different treatment options. The institute’s objective: Help doctors, patients and policymakers make informed choices amid an ever-shifting health climate.
Hospitals can apply to become Accountable Care Organizations. That means doctors, nurses and social workers band together to deliver continuous, coordinated care to patients. If they slash government spending, they get to keep a share of the savings.
The Readmissions Reduction Program penalizes hospitals when patients return too frequently with, for example, heart problems or pneumonia. The idea: Doctors should prevent these maladies after a patient’s first stay. Readmissions result in Medicare payment cuts.
Starting next year, the Independent Payment Advisory Board will recommend changes to Medicare if costs exceed a certain target (GDP plus 0.5 percent). The 15-member agency, comprised of experts across the health-care industry, will focus on curbing costs without affecting coverage or quality.
Pilot programs for “bundled” Medicare payments give health-care providers a lump sum for certain treatments. The idea: Hospitals gain flexibility to better allocate resources — and save money through reduced complications and readmissions."

Just FYI. I don't know that any of that worked. Probably we will never know?

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Bucksandreds

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Re: What comes after the ACA?
« Reply #630 on: January 22, 2017, 06:15:07 AM »
Ah, ok, that makes sense. So the US would need more services for poor areas and more focus on certain ailments, like diabetes, in certain areas.

I think you're misunderstanding.

When conservatives say "universal health care can't work in America because America is too big and diverse" they aren't saying that we need to address the issue of unequal access to care, they are saying that we have too many poor and black people who need care and they don't want rich and white people to pay for that.

It's not a call to action, which is how you seem to have interpreted it.  It's not a plan to make things better.  It's just another reason to say "diversity is bad, we should be a more homogenous country" and "black people are bad, we can't have nice things anymore because we've given up on white superiority".  It's only thinly veiled racism.  You can stop giving them the benefit of the doubt on this one.

I agree. As crazy as this sounds given who's in power I think that by 2020 we will never see as conservative of a government again. Democrats got more votes for president, senate and house but do not control any due to our system. Demogrsphics are making it harder and harder for conservatives to win and independents tend to vote against whoever is currently in charge.  2018 will be interesting to see how close the dems get in the house and 2020 would be shocking if the republicans control the presidency, senate and house. If Repubs screw over millions repealing the ACA and hand out massive tax breaks to the rich it's 50/50 we'll see a dem supermajority by 2020 again. If that happens again because the repubs screwed 10s of millions out of health insurance then hello single payer.  The repubs would come right back again, I'm sure of that, but sooner or later conservatism will have to shift to the center due to demographics.  The tea party and ridiculousness going on in the GOP is a symptom of it's current iteration being in its death throes.  I'm no liberal (in center left) but looking at what the demographics shows, the current GOP platform stands a 0.00% chance to win elections by 2020.

I believe democrats have been waiting for the demographics to shift for several elections. Looking at the number of Latino voters that swung for Trump, the demographics fight isn't as clear cut as some claim.

Latino voters supported Clinton 66% to 28% % for DJT. That was on par with the 2008 election.  DJT's support was about equal to what Romney received.
The surprising portion was how few total Latinos voted in this election, particularly in states with large populations like Florida. Had the same proportion voted in this election as in 2008 and with the same level of support, CLinton would have won the electoral college.

So it isn't a question of Latinos swinging for Trump (which didn't happen), but rather why so many eligible Latinos didn't vote at all.

http://www.pewresearch.org/fact-tank/2016/11/29/hillary-clinton-wins-latino-vote-but-falls-below-2012-support-for-obama/

Even the ultra conservative National Review has an article pleading for Repubs to update their platform so that over the coming elections they have a chance.  ( http://www.nationalreview.com/article/441595/voter-demographics-diversifying-republicans-falling-behind ) They say it's the Tea Party holding back the party. I look forward to the destruction of the Repub party, hopefully by 2020, followed by a new Repub party that more closely aligns itself with middle class Americans and not just the interests of the rich. Ther's only so many times they can trick the less educated before it's over for them.

jim555

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Re: What comes after the ACA?
« Reply #631 on: January 22, 2017, 08:27:05 AM »
Just a reminder of what Trump promised about healthcare.
Will he break his promise to give a massive tax break for billionaires?
60 Minutes - September 27, 2015
----------------------------
Scott Pelley: What's your plan for Obamacare?

Donald Trump: Obamacare's going to be repealed and replaced. Obamacare is a disaster if you look at what's going on with premiums where they're up 45, 50, 55 percent.

Scott Pelley: How do you fix it?

Donald Trump: There's many different ways, by the way. Everybody's got to be covered. This is an un-Republican thing for me to say because a lot of times they say, "No, no, the lower 25 percent that can't afford private." But--

Scott Pelley: Universal health care?

Donald Trump: I am going to take care of everybody. I don't care if it costs me votes or not. Everybody's going to be taken care of much better than they're taken care of now.

Scott Pelley: The uninsured person is going to be taken care of how?

Donald Trump: They're going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably--

Scott Pelley: Make a deal? Who pays for it?

Donald Trump: --the government's gonna pay for it. But we're going to save so much money on the other side. But for the most it's going to be a private plan and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.

http://www.cbsnews.com/news/donald-trump-60-minutes-scott-pelley/

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Re: What comes after the ACA?
« Reply #632 on: January 22, 2017, 08:45:27 AM »

Even the ultra conservative National Review has an article pleading for Repubs to update their platform so that over the coming elections they have a chance.  ( http://www.nationalreview.com/article/441595/voter-demographics-diversifying-republicans-falling-behind ) They say it's the Tea Party holding back the party. I look forward to the destruction of the Repub party, hopefully by 2020, followed by a new Repub party that more closely aligns itself with middle class Americans and not just the interests of the rich. Ther's only so many times they can trick the less educated before it's over for them.

I think many people are hoping the republican party implodes in 2020 and rebuilds itself. I've heard just as many calls for the democratic party to do the same, especially after the stunning defeat this past November. If this happens, it would be a vast improvement over the parties we currently have.
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Re: What comes after the ACA?
« Reply #633 on: January 22, 2017, 08:57:25 AM »

...

I think many people are hoping the republican party implodes in 2020 and rebuilds itself. I've heard just as many calls for the democratic party to do the same, especially after the stunning defeat this past November. If this happens, it would be a vast improvement over the parties we currently have.

If there was ever a time for both major parties to be rebuilt from the ground up, right after a presidential election that featured both of the two most disliked major party nominees for as long as we've been collecting numbers certainly seems like the right time to do it!
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CDP45

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Re: What comes after the ACA?
« Reply #634 on: January 22, 2017, 08:58:50 AM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

You ain't seen nothing yet. Multiple state budgets are imploding due to ACA medicare expansion already, cuts to every other program, but guess who consistently votes?

 Basically all private employers will be on HDHPs with HSAs, so everyone who doesn't yet have a $3k-$5k deductible, it's coming soon to you.
The Feds have been paying 100% of the Medicaid expansion so far, so how is that imploding states budgets?
This is how:

Code: [Select]
Year Newly-Eligible Parents & Childless Adults (up to 138% FPL)  Medicaid-Eligible Childless Adults in “Expansion” States Only(I.e., States that Had Already Expanded to Adults >100% FPL as of March 23, 2010)
Transition Percentage used to Calculate Enhanced Match Example: State with 50% Original FMAPRegular FMAP + [(Newly-Eligible Enhanced Match Rate – Regular FMAP) x Transition Percentage] Example: State with 60% Original FMAPRegular FMAP + [(Newly-Eligible Enhanced Match Rate – Regular FMAP) x Transition Percentage]
2014 100% 50% 75% 80%
2015 100% 60% 80% 84%
2016 100% 70% 85% 88%
2017 95% 80% 86% 88%
2018 94% 90% 89.6% 90.6%
2019 93% 100% 93% 93%
2020+ 90% 100% 90% 90%

http://kff.org/medicaid/issue-brief/understanding-how-states-access-the-aca-enhanced-medicaid-match-rates/

Got to start writing 2018's budget today.


jim555

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Re: What comes after the ACA?
« Reply #635 on: January 22, 2017, 09:04:58 AM »
Let me see if I understand this.
 I had an affordable non ACA policy in early 2012.
ACA regulations  were put in to effect in 2012.
I had a 19.4% increase in the middle of 2012.
I had a 21% increase in the middle of 2013.
I had a 18.8% increase in the middle 2014.
 And now you tell me things are about to get worse?

You ain't seen nothing yet. Multiple state budgets are imploding due to ACA medicare expansion already, cuts to every other program, but guess who consistently votes?

 Basically all private employers will be on HDHPs with HSAs, so everyone who doesn't yet have a $3k-$5k deductible, it's coming soon to you.
The Feds have been paying 100% of the Medicaid expansion so far, so how is that imploding states budgets?
This is how:

Code: [Select]
Year Newly-Eligible Parents & Childless Adults (up to 138% FPL)  Medicaid-Eligible Childless Adults in “Expansion” States Only(I.e., States that Had Already Expanded to Adults >100% FPL as of March 23, 2010)
Transition Percentage used to Calculate Enhanced Match Example: State with 50% Original FMAPRegular FMAP + [(Newly-Eligible Enhanced Match Rate – Regular FMAP) x Transition Percentage] Example: State with 60% Original FMAPRegular FMAP + [(Newly-Eligible Enhanced Match Rate – Regular FMAP) x Transition Percentage]
2014 100% 50% 75% 80%
2015 100% 60% 80% 84%
2016 100% 70% 85% 88%
2017 95% 80% 86% 88%
2018 94% 90% 89.6% 90.6%
2019 93% 100% 93% 93%
2020+ 90% 100% 90% 90%

http://kff.org/medicaid/issue-brief/understanding-how-states-access-the-aca-enhanced-medicaid-match-rates/

Got to start writing 2018's budget today.
It drops from 100% to 95% this year, so how is that imploding a budget?  Billions of Federal funds pouring into a state, after all is said and done the states are probably making some money, even with them paying 5-10%.

Metric Mouse

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Re: What comes after the ACA?
« Reply #636 on: January 22, 2017, 09:39:56 AM »
It drops from 100% to 95% this year, so how is that imploding a budget?  Billions of Federal funds pouring into a state, after all is said and done the states are probably making some money, even with them paying 5-10%.
Umm... I'm not sure that's how this works. Funding 5% of the expanded medicare rolls, which include millions of people, could easily have drastic, negative effects upon state budgets. This is why many states declined to expand medicare via the ACA.
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CDP45

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Re: What comes after the ACA?
« Reply #637 on: January 22, 2017, 11:47:21 AM »
Medicaid spending accounts for nearly one-quarter of a state's budget on average, second only to states' K-12 education funding. KFF estimates medicaid spending costs will increase 4.2% in 2017.

So let's take California that spends $100B on medi-cal, and the state budget deficit is currently $1.6B...now add $4.2B to those medi-cal costs and there you have an increase that's nearly triple the deficit.

This was before the election. ACA expansion subsidies to Medi-Cal total $15B. Do the math.

jim555

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Re: What comes after the ACA?
« Reply #638 on: January 22, 2017, 11:55:12 AM »
Medicaid spending accounts for nearly one-quarter of a state's budget on average, second only to states' K-12 education funding. KFF estimates medicaid spending costs will increase 4.2% in 2017.

So let's take California that spends $100B on medi-cal, and the state budget deficit is currently $1.6B...now add $4.2B to those medi-cal costs and there you have an increase that's nearly triple the deficit.

This was before the election. ACA expansion subsidies to Medi-Cal total $15B. Do the math.
Do the math, 2014, 2015, 2016 was 100% paid for by the Feds for the expansion.  Stop lying.  This has not "imploded budgets".

One more "talking point" taken down due to BS.
« Last Edit: January 22, 2017, 12:13:48 PM by jim555 »

CDP45

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Re: What comes after the ACA?
« Reply #639 on: January 22, 2017, 12:39:11 PM »
Medicaid spending accounts for nearly one-quarter of a state's budget on average, second only to states' K-12 education funding. KFF estimates medicaid spending costs will increase 4.2% in 2017.

So let's take California that spends $100B on medi-cal, and the state budget deficit is currently $1.6B...now add $4.2B to those medi-cal costs and there you have an increase that's nearly triple the deficit.

This was before the election. ACA expansion subsidies to Medi-Cal total $15B. Do the math.
Do the math, 2014, 2015, 2016 was 100% paid for by the Feds for the expansion.  Stop lying.  This has not "imploded budgets".

One more "talking point" taken down due to BS.

Good work being an equivocating internet tough guy, you've really made the world a better place.

But your reading comprehension is lacking. As can be seen in my quoted text, I'm not talking about the past, so I'll clarify.  Already (in 2017 as in FY2017) Multiple state budgets are imploding. You haven't seen nothing yet comparing 2012-2016 to 2017-2020 in terms of healthcare and specifically medicaid growing so large as to cause structural budget deficits.

The 2 questions remain: How much are we willing to pay (as a percent of the economy, share of govt spending) and who will pay?

waltworks

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Re: What comes after the ACA?
« Reply #640 on: January 22, 2017, 12:43:10 PM »
Yes, there is no magic formula here. We need to decide if we want to provide everyone with some form of healthcare, and then we need to decide how to collectively pay for it. TANSTAAFL. If you want a universal system, you're going to have to deal with A) increasing taxes on a significant portion of the population, and/or B) rationing care, especially for the elderly.

Those are both political nonstarters right now. I don't have an answer, but it will be interesting to see how Trump keeps his "we're gonna cover everybody" promise (or doesn't) without grappling with those problems. The most free-market possible solution if universal coverage is your goal is probably something with an insurance mandate.

-W

nereo

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Re: What comes after the ACA?
« Reply #641 on: January 22, 2017, 12:46:25 PM »

The 2 questions remain: How much are we willing to pay (as a percent of the economy, share of govt spending) and who will pay?

THese questions remain regardless of what kind of federal healthcare plan we go with.
To that end, having uninsured people who wind up passing on their healthcare costs to everyone else never struck me as an optimal solution.

Still no details about future plans, though portions of the ACA are being taken down.  I'd like a proposed solution sooner rather than later.
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jim555

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Re: What comes after the ACA?
« Reply #642 on: January 22, 2017, 12:46:44 PM »
My comprehension is fine.  Nursing homes and old Medicaid costs are not part of the ACA.  You (and other in this thread) are trying to falsely assert the ACA is the cause of imploding state budgets, which isn't true.  If anything state budgets have been helped since the Feds are paying 100% of the expansion costs, which goes to 90% in 2020.

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Re: What comes after the ACA?
« Reply #643 on: January 22, 2017, 01:01:44 PM »
Yes, there is no magic formula here. We need to decide if we want to provide everyone with some form of healthcare, and then we need to decide how to collectively pay for it. TANSTAAFL. If you want a universal system, you're going to have to deal with A) increasing taxes on a significant portion of the population, and/or B) rationing care, especially for the elderly.

C) Reducing costs.

Also a political nonstarter. I suspect the health insurance minimum medical loss ratio will go away shortly too.


With the widening wealth gap between the haves and haves-a-little/have-nots, the most likely option is a period where people actually die from lack of care. That'll last until the haves-a-little get pissed -- the lesson being, don't piss off the middle class, as we learned from the French.

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Re: What comes after the ACA?
« Reply #644 on: January 22, 2017, 01:24:09 PM »
Offered without political comment.

  • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
  • There are approximately 10.7 million people newly enrolled in the expanded medicare.**
  • So the total cost of the expansion is $68.1 billion/year. Once the federal government ramps down to covering 90% of the bill instead of 100%, states will have to come up with $6.8 billion to cover their share of the tab.
  • Total state tax revenue is approx. $2 Trillion (2,000 billion). Although only 31 of 50 of states have participated in the expansion. Let's say those states represent half of all tax revenue (hopefully conservative as the expansion states look like they tend to be the higher tax rate, higher per capita income ones).
  • 6.8/1000= 0.68% of state tax revenue in expansion states which is going to have to be reallocated to cover the states' share of the medicare expansion in coming years.

One can certainly argue that $6.8 billion is a lot. And one can also argue that 0.68% is not much. But it helps to have the real numbers in front of us anyway.

*Original source: https://www.medicaid.gov/medicaid/financing-and-reimbursement/downloads/medicaid-actuarial-report-2015.pdf
**Original source: http://kff.org/health-reform/state-indicator/medicaid-expansion-enrollment/?currentTimeframe=0
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CDP45

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Re: What comes after the ACA?
« Reply #645 on: January 22, 2017, 01:47:11 PM »
What happens if next week $68B isn't coming anymore?

I think federally we're at the end of debt financing, tough choices are coming, Hillary is lucky she doesn't have to deal with this.

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Re: What comes after the ACA?
« Reply #646 on: January 22, 2017, 01:55:10 PM »
I think federally we're at the end of debt financing, tough choices are coming, Hillary is lucky she doesn't have to deal with this.

Trump (and Steve Bannon) disagree with you.  They have argued that now is the time for stimulative infrastructure spending, because interest rates are so low bordering on negative.  Wouldn't it be great if other countries would loan us money to rebuild America, and we only had to pay them back less money than they loaned us?

Bucksandreds

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Re: What comes after the ACA?
« Reply #647 on: January 22, 2017, 02:01:17 PM »

Even the ultra conservative National Review has an article pleading for Repubs to update their platform so that over the coming elections they have a chance.  ( http://www.nationalreview.com/article/441595/voter-demographics-diversifying-republicans-falling-behind ) They say it's the Tea Party holding back the party. I look forward to the destruction of the Repub party, hopefully by 2020, followed by a new Repub party that more closely aligns itself with middle class Americans and not just the interests of the rich. Ther's only so many times they can trick the less educated before it's over for them.

I think many people are hoping the republican party implodes in 2020 and rebuilds itself. I've heard just as many calls for the democratic party to do the same, especially after the stunning defeat this past November. If this happens, it would be a vast improvement over the parties we currently have.

The dems got more votes for House, Senate and president than the Repubs and that was with a democrat in the White House which favors the other party. On top of that the demographics continue to help them every election. Dems need to remessage their already popular platform. Republicans need a platform that will speak to enough people to possibly contend. Every election has millions of less likely republican voter and millions of more likely democrat voter. The current Republican Party is doomed and instead of rebranding and staying relevant they will wait until they completely collapse and then rebuild by speaking to the middle class and not just the rich and lower class whites. There's not enough of those 2 groups to control government over the coming years.

chasesfish

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Re: What comes after the ACA?
« Reply #648 on: January 22, 2017, 07:01:32 PM »
The expansion of 3:1 to 5:1 could work, provided an individual mandate is enforced.

The reality is its not enforced now, so any "repeal the individual mandate" is just a waste of time.

It is enforced in that your penalty is taken out of any tax refund or check from the government.  That will catch up with everyone eventually - maybe not until social security time - but it will.

Have you seen the list of exclusions from the tax?  Just don't pay one utility bill until you get a shut-off notice

https://www.healthcare.gov/health-coverage-exemptions/hardship-exemptions/

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chasesfish

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Re: What comes after the ACA?
« Reply #649 on: January 22, 2017, 07:13:33 PM »
I really enjoy reading this debate, especially since Sol and I want to see a similar outcome but are on complete different sides of how you get there.

The existing ACA still has 30 million people uncovered, premiums are still rising quickly, and there are less insurers in most states each year.  It benefits the low income worker with enough net worth to cover the high deductible (and us soon to be retired mustachians love that!).   

I only see two possible end games with this:

1) Canadian-Style Single Payer Healthcare

2) A baseline public health care option with the majority of citizens still getting private insurance/private care. 

I'm in favor of #2.   You can expand the VA hospitals and "free clinics" to Medicaid recipients and move on. 

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