Author Topic: What comes after the ACA?  (Read 105843 times)

accolay

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Re: What comes after the ACA?
« Reply #650 on: January 23, 2017, 01:47:08 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.

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.

That's all well and good. But I don't know how many times I can repeat this: If people don't vote and Democrats don't win office it's a mute point. Dems can't win we're going to be stuck with the Republican gerrymandered winning streak for another decade.

Metric Mouse

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Re: What comes after the ACA?
« Reply #651 on: January 24, 2017, 12:47:41 AM »
Offered without political comment.

    • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
    [/b]

    Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]
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    protostache

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    Re: What comes after the ACA?
    « Reply #652 on: January 24, 2017, 05:30:10 AM »
    Offered without political comment.

      • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
      [/b]

      Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

      And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

      GuitarStv

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      Re: What comes after the ACA?
      « Reply #653 on: January 24, 2017, 06:39:06 AM »
      Offered without political comment.

        • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
        [/list][/b]

        Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?

        Because the free market solution is always better.  :P

        nereo

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        Re: What comes after the ACA?
        « Reply #654 on: January 24, 2017, 06:59:32 AM »
        Offered without political comment.

          • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
          [/list][/b]

          Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?

          Because the free market solution is always better.  :P
          I'm always surprised that so many believe that for-profit companies will inherently be less expensive than the not-for-profit government.
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          maizeman

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          Re: What comes after the ACA?
          « Reply #655 on: January 24, 2017, 07:20:07 AM »
            Offered without political comment.

            • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
            [/b]

            Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

            And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

            $530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

            @protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

            The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.
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            NoStacheOhio

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            Re: What comes after the ACA?
            « Reply #656 on: January 24, 2017, 07:20:39 AM »
            I'm always surprised that so many believe that for-profit companies will inherently be less expensive than the not-for-profit government.

            Bureaucratic waste is real, and it's super easy when you're spending other people's money.
            The first step is acknowledging you have a problem, right?

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

            jim555

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            Re: What comes after the ACA?
            « Reply #657 on: January 24, 2017, 07:24:20 AM »
            Direct fee for service is more efficient since it has no insurance middleman taking a cut. 

            nereo

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            Re: What comes after the ACA?
            « Reply #658 on: January 24, 2017, 07:28:54 AM »
            I'm always surprised that so many believe that for-profit companies will inherently be less expensive than the not-for-profit government.

            Bureaucratic waste is real, and it's super easy when you're spending other people's money.
            Of that I have no doubt.  I'm not saying its true in every case, but for-profit companies core interest is to make money, which already puts them in a hole compared to government. To be equal (on a macro-economic sense) the bureaucratic waste simply has to be equal to the profit taking of the private company. But - corporations are not immune to waste either, and the larger the organization the more prone to waste (and competition/free-market forces becomes less effective).

            ...which is why I favor a hybrid approach.  Core services provided by government with comprehensive oversight to limit waste, and then more advanced coverage offered by private companies (aslo subject to regulation).
            "Do not confuse complexity with superiority"

            NoStacheOhio

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            Re: What comes after the ACA?
            « Reply #659 on: January 24, 2017, 07:30:12 AM »
            Direct fee for service is more efficient since it has no insurance middleman taking a cut.

            Except it induces providers to pad their bottom line.
            The first step is acknowledging you have a problem, right?

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

            jim555

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            Re: What comes after the ACA?
            « Reply #660 on: January 24, 2017, 07:34:25 AM »
            Direct fee for service is more efficient since it has no insurance middleman taking a cut.

            Except it induces providers to pad their bottom line.
            Aren't they padding with insurers as well?

            GuitarStv

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            Re: What comes after the ACA?
            « Reply #661 on: January 24, 2017, 07:41:25 AM »
            Direct fee for service is more efficient since it has no insurance middleman taking a cut.

            Except it induces providers to pad their bottom line.
            Aren't they padding with insurers as well?

            They can pad significantly more with insurers . . . by adding unnecessary tests and procedures that happen to be covered by the insurance for example.

            NoStacheOhio

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            Re: What comes after the ACA?
            « Reply #662 on: January 24, 2017, 07:54:44 AM »
            Direct fee for service is more efficient since it has no insurance middleman taking a cut.

            Except it induces providers to pad their bottom line.
            Aren't they padding with insurers as well?

            Irrelevant. Fee-for-service doesn't solve anything. It's actually a pretty bad practice model.
            The first step is acknowledging you have a problem, right?

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

            Bucksandreds

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            Re: What comes after the ACA?
            « Reply #663 on: January 24, 2017, 09:16:45 AM »


            ...which is why I favor a hybrid approach.  Core services provided by government with comprehensive oversight to limit waste, and then more advanced coverage offered by private companies (aslo subject to regulation).

            I came to this same conclusion a while ago myself. Single payer basic insurance for all paid by expansion of the payroll tax (and same percentage tax added to capital gains and dividends) coupled with tax incentives to encourage a supplemental private policy would be a perfect compromise. Dems would get what they want with no one dying in the street due to lack of care and Repubs would get they want with lower cost and a private market. The universal coverage would be more basic (cost efficient) and include generic medications, primary care and wellness visits as well as surgery necessary for your survival. Things like new high priced meds, new hips because it's difficult to walk but not life threatening, etc would be cash or covered by a supplemental policy that would be tax advantaged to encourage people to use it.

            teen persuasion

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            Re: What comes after the ACA?
            « Reply #664 on: January 24, 2017, 09:32:13 AM »
              Offered without political comment.

              • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
              [/b]

              Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

              And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

              $530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

              @protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

              The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.

              Before expansion, I believe there were asset tests to be Medicaid eligible.  Assets over $2k or so made you ineligible, depending on state rules.  The expansion removed asset tests, making more eligible.

              jim555

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              Re: What comes after the ACA?
              « Reply #665 on: January 24, 2017, 09:41:41 AM »
                Offered without political comment.

                • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
                [/b]

                Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

                And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

                $530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

                @protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

                The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.

                Before expansion, I believe there were asset tests to be Medicaid eligible.  Assets over $2k or so made you ineligible, depending on state rules.  The expansion removed asset tests, making more eligible.
                The expansion added a new group with an income test only.  Old Medicaid (elderly, disabled, blind) still have asset and income tests.

                teen persuasion

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                Re: What comes after the ACA?
                « Reply #666 on: January 24, 2017, 10:35:27 AM »
                jim555, thanks for the correction and explanation of the distinction.

                sol

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                Re: What comes after the ACA?
                « Reply #667 on: January 24, 2017, 11:31:42 AM »
                Today's news includes a republican plan to repeal and replace the ACA.  Step one appears to be "don't repeal the ACA in states that want to keep the ACA" and step two is "don't force any state to have the ACA if they don't want it."

                As long as step one comes with the same protections and funding as the current law, I think I support this plan?  What's not to like? 

                It only hurts people who live in red states, by giving them exactly what they asked for, and this election has taught us all that we get exactly what we vote for and must then live with the consequences.

                NoStacheOhio

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                Re: What comes after the ACA?
                « Reply #668 on: January 24, 2017, 11:35:52 AM »
                Today's news includes a republican plan to repeal and replace the ACA.  Step one appears to be "don't repeal the ACA in states that want to keep the ACA" and step two is "don't force any state to have the ACA if they don't want it."

                As long as step one comes with the same protections and funding as the current law, I think I support this plan?  What's not to like? 

                It only hurts people who live in red states, by giving them exactly what they asked for, and this election has taught us all that we get exactly what we vote for and must then live with the consequences.

                I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?
                The first step is acknowledging you have a problem, right?

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

                sol

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                Re: What comes after the ACA?
                « Reply #669 on: January 24, 2017, 11:51:51 AM »
                I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

                I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

                But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

                Alternately, each state could offer nothing and leave its people hanging.

                Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured. 

                thenextguy

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                Re: What comes after the ACA?
                « Reply #670 on: January 24, 2017, 11:56:39 AM »
                I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

                I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

                But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

                Alternately, each state could offer nothing and leave its people hanging.

                Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured.

                This is the best summary I've seen so far: https://storify.com/ladler11/cassidy-collins-aca-replacement-summary


                Lagom

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                Re: What comes after the ACA?
                « Reply #671 on: January 24, 2017, 12:03:58 PM »
                I mean, if that's really what moves forward, as a CA resident that works for me. Agree 100% with Sol's assessment. Could be much worse. Will have to dive into the details myself later.

                Gal2016

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                Re: What comes after the ACA?
                « Reply #672 on: January 24, 2017, 12:11:13 PM »
                  Offered without political comment.

                  • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
                  [/b]

                  Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

                  And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

                  $530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

                  That's per person -- so an average family of 4 would spend $2120/month?  For care that is reimbursed at such a low rate that hospitals would literally shut their doors if all of their patients were Medicaid patients?  Hospitals rely on payor mix to keep things afloat.  Which means they lose money on Medicaid patients. They may break even with Medicare (or actually make a little profit, depending on the service). And they typically earn money on private insurance patients.  You get too many Medicaid patients and your hospital won't make it.  This is one reason why lots of private practices don't accept Medicaid patients. They don't have the ability to absorb the loss as much as a hospital does.

                  bacchi

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                  Re: What comes after the ACA?
                  « Reply #673 on: January 24, 2017, 12:12:11 PM »
                  Pre-existing exclusions don't seem to be mentioned. Ok, Cassidy-Collins looks like it has the pre-existing exclusion. The previous incarnation, Cassidy-Sessions, didn't mention it, from my quick reading.

                  Given that, will states be allowed to enforce a short-term exclusionary period for pre-existing conditions? I can see very sick people moving to certain states to get treatment because their cheapass (red) state won't cover enough.

                  « Last Edit: January 24, 2017, 12:15:55 PM by bacchi »

                  NoStacheOhio

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                  Re: What comes after the ACA?
                  « Reply #674 on: January 24, 2017, 01:01:46 PM »
                  I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

                  I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

                  But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

                  Alternately, each state could offer nothing and leave its people hanging.

                  Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured.

                  This is the best summary I've seen so far: https://storify.com/ladler11/cassidy-collins-aca-replacement-summary

                  So wait, who gets Roth HSAs? Everyone over the Medicaid limit and under the income cap? What about people who have group plans?
                  The first step is acknowledging you have a problem, right?

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

                  teen persuasion

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                  Re: What comes after the ACA?
                  « Reply #675 on: January 24, 2017, 01:13:46 PM »
                  I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

                  I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

                  But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

                  Alternately, each state could offer nothing and leave its people hanging.

                  Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured.

                  This is the best summary I've seen so far: https://storify.com/ladler11/cassidy-collins-aca-replacement-summary

                  So wait, who gets Roth HSAs? Everyone over the Medicaid limit and under the income cap? What about people who have group plans?
                  If I understand correctly (that Twitter stream of consciousness was confusing), those with employer coverage continue with that.  In states that reject ACA but want to cover their people, those without health insurance are auto enrolled in a catastrophic plan paid for with the state's share of ACA subsidies.  If there is any ACA subsidies left over, it will be divided and placed in Roth HSAs.  There will probably be a gap between OOP costs and HSA deposits.

                  jim555

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                  Re: What comes after the ACA?
                  « Reply #676 on: January 24, 2017, 03:24:40 PM »
                  At least they have something which is not totally go pound sand and die.

                  OurTown

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                  Re: What comes after the ACA?
                  « Reply #677 on: January 24, 2017, 03:28:52 PM »
                  So who funds the Roth HSAs?  Do I fund it or Uncle Sam?  And can anyone get a Roth HSA?

                  v8rx7guy

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                  Re: What comes after the ACA?
                  « Reply #678 on: January 24, 2017, 04:44:31 PM »
                  I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

                  sol

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                  Re: What comes after the ACA?
                  « Reply #679 on: January 24, 2017, 05:29:25 PM »
                  I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

                  Many wealthy older people will probably prefer that plan.  The question then becomes which demographic group does your state want to send the welfare checks to? 

                  Blue states would probably keep the ACA and subsidize poor people, but I expect many red states to take that GOP option and subsidize their richer older people instead.  It's everything they always dreamed, cut benefits to the poor (who don't vote republican) and give them to the rich (their core constituents).

                  I'm not even making a value judgment here.  I totally understand the cold political calculus of benefiting your own tribe at the expense of another tribe. 

                  You have to wonder WWJD, though.

                  CDP45

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                  Re: What comes after the ACA?
                  « Reply #680 on: January 24, 2017, 08:00:07 PM »
                  I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

                  Many wealthy older people will probably prefer that plan.  The question then becomes which demographic group does your state want to send the welfare checks to? 

                  Blue states would probably keep the ACA and subsidize poor people, but I expect many red states to take that GOP option and subsidize their richer older people instead.  It's everything they always dreamed, cut benefits to the poor (who don't vote republican) and give them to the rich (their core constituents).

                  I'm not even making a value judgment here.  I totally understand the cold political calculus of benefiting your own tribe at the expense of another tribe. 

                  You have to wonder WWJD, though.

                  Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.

                  There is 0% chance California will keep paying for 1/3 of residents to be on Medi-Cal if the federal government stops the subsidy, because then there wouldn't be any money left for the core constituency of government union employees and their bankrupting pensions.

                  Roland of Gilead

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                  Re: What comes after the ACA?
                  « Reply #681 on: January 24, 2017, 09:03:37 PM »
                  I am pretty sure California is a net giver to the federal government compared to many red states

                  (I still consider California pretty fucked up and the pension system is abysmal there)

                  bacchi

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                  Re: What comes after the ACA?
                  « Reply #682 on: January 24, 2017, 09:48:26 PM »
                  I am pretty sure California is a net giver to the federal government compared to many red states

                  (I still consider California pretty fucked up and the pension system is abysmal there)

                  Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

                  CDP45

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                  Re: What comes after the ACA?
                  « Reply #683 on: January 24, 2017, 10:41:48 PM »
                  I am pretty sure California is a net giver to the federal government compared to many red states

                  (I still consider California pretty fucked up and the pension system is abysmal there)

                  Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

                  Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

                  Metric Mouse

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                  Re: What comes after the ACA?
                  « Reply #684 on: January 24, 2017, 11:48:29 PM »
                    Offered without political comment.

                    • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
                    [/b]

                    Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

                    And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

                    $530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

                    Not super cheap for premiums - but this is covering almost all healthcare expenses. So if a single person had a $300 a month premium, with a $2700 deductible - that would be pretty damn cheap, in my opinion.
                    Give me one fine day of plain sailing weather and I can mess up anything.

                    MustacheMathTM

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                    Re: What comes after the ACA?
                    « Reply #685 on: January 25, 2017, 04:41:33 AM »
                      Offered without political comment.

                      • In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*
                      [/b]

                      Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

                      And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

                      $530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

                      @protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

                      The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.

                      Bingo.  Single payer systems have the power to force down prices, which is why the rest of the civilized world pays half what we do for better health outcomes.
                      "Take this job and shove it" - David Allan Coe

                      bacchi

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                      Re: What comes after the ACA?
                      « Reply #686 on: January 25, 2017, 08:34:35 AM »
                      I am pretty sure California is a net giver to the federal government compared to many red states

                      (I still consider California pretty fucked up and the pension system is abysmal there)

                      Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

                      Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

                      I don't think this term means what you think it means.

                      nereo

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                      Re: What comes after the ACA?
                      « Reply #687 on: January 25, 2017, 09:13:24 AM »
                      I am pretty sure California is a net giver to the federal government compared to many red states

                      (I still consider California pretty fucked up and the pension system is abysmal there)

                      Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

                      Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

                      I don't think this term means what you think it means.
                      "Do not confuse complexity with superiority"

                      mm1970

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                      Re: What comes after the ACA?
                      « Reply #688 on: January 25, 2017, 10:31:44 AM »
                      I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

                      Many wealthy older people will probably prefer that plan.  The question then becomes which demographic group does your state want to send the welfare checks to? 

                      Blue states would probably keep the ACA and subsidize poor people, but I expect many red states to take that GOP option and subsidize their richer older people instead.  It's everything they always dreamed, cut benefits to the poor (who don't vote republican) and give them to the rich (their core constituents).

                      I'm not even making a value judgment here.  I totally understand the cold political calculus of benefiting your own tribe at the expense of another tribe. 

                      You have to wonder WWJD, though.

                      Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.

                      There is 0% chance California will keep paying for 1/3 of residents to be on Medi-Cal if the federal government stops the subsidy, because then there wouldn't be any money left for the core constituency of government union employees and their bankrupting pensions.
                      You mean Romney-care?  I love how it's all so partisan.

                      The ACA, in my friends, primarily benefited the middle class and self-employed and friends with pre-existing conditions.  The poor folk were *already* covered.

                      Engineers, scientists, contractors...those are the people I know who benefited from the ACA.

                      jim555

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                      Re: What comes after the ACA?
                      « Reply #689 on: January 25, 2017, 11:34:07 AM »
                      ... The poor folk were *already* covered.
                      So you consider go to the ER and go bankrupt as covered?

                      NoStacheOhio

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                      Re: What comes after the ACA?
                      « Reply #690 on: January 25, 2017, 11:42:45 AM »
                      ... The poor folk were *already* covered.
                      So you consider go to the ER and go bankrupt as covered?

                      It depends on your definition of "poor." Generally, when Republicans say this, they mean "Medicaid exists and covers some people."
                      The first step is acknowledging you have a problem, right?

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

                      jim555

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                      Re: What comes after the ACA?
                      « Reply #691 on: January 25, 2017, 11:47:30 AM »
                      ... The poor folk were *already* covered.
                      So you consider go to the ER and go bankrupt as covered?

                      It depends on your definition of "poor." Generally, when Republicans say this, they mean "Medicaid exists and covers some people."
                      Pre-ACA (or in a non-expanded state now) you can't qualify for Medicaid as a non-disabled person.  You would have to be classified as disabled and spend down almost all your assets before it would kick in.

                      obstinate

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                      Re: What comes after the ACA?
                      « Reply #692 on: January 25, 2017, 11:55:13 AM »
                      Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.
                      Um. You're aware that costs rose more slowly under the ACA, right? In no objective sense did the law quicken the implosion of the health delivery system in this country.

                      Bucksandreds

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                      Re: What comes after the ACA?
                      « Reply #693 on: January 25, 2017, 12:06:46 PM »
                      Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.
                      Um. You're aware that costs rose more slowly under the ACA, right? In no objective sense did the law quicken the implosion of the health delivery system in this country.

                      Yeah it did. Paul Ryan and Mitch McConnell have been telling him that for years now so it must be true.

                      Bucksandreds

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                      Re: What comes after the ACA?
                      « Reply #694 on: January 25, 2017, 12:09:53 PM »
                      I am pretty sure California is a net giver to the federal government compared to many red states

                      (I still consider California pretty fucked up and the pension system is abysmal there)

                      Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

                      Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

                      Successions?  Jeff Sessions? Secessionists?  I've always known the more conservative you are the less likely you are to understand big words.  'We're just simple country people trying to keep the government off our backs' even though we probably get farm subsidies or live in a state that is a net taker of federal dollars.

                      titan2k10

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                      Re: What comes after the ACA?
                      « Reply #695 on: January 25, 2017, 01:32:50 PM »
                      ACA has some serious damn problems. I have gone from paying 6700 in premiums a year to over 21000 with worst coverage since ACA became law. This is a HUGE problem for many many American families.

                      This being said, and considering myself very conservative, there are some really really good things about ACA.

                      1. Guaranteed access to INSURANCE NOT HEALTHCARE
                      2. No denial for pre-existing conditions
                      3. Kids can stay on till 26 on parents yada yada.

                      Things in my mind that could drastically reduce the costs that I don't hear or have the time to read 14 pages of posts about.
                      1. Open up the exchanges across state lines and allow providers to compete in every state (should drive premiums down)
                      2. NEGOTIATE PHARMACEUTICAL DRUG COSTS
                      3. Give everyone, regardless of plan, an HSA

                      The 3 things I like should remain and anyone who thinks removing them is good is wrong. The next 3 should help lower premiums and the pharma drug cost reduction would save TONS of money.

                      This is just an extremely complex issue to solve. I see people discussing people no longer having to go to the ER now that they have insurance....hate to be the bearer of bad news but these people will never NOT use the ER.

                      Source: Hospital operations....

                      mm1970

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                      Re: What comes after the ACA?
                      « Reply #696 on: January 25, 2017, 01:34:06 PM »
                      ... The poor folk were *already* covered.
                      So you consider go to the ER and go bankrupt as covered?
                      Medicaid, MediCal, people on SNAP.

                      Heck I have a friend who is a SAHM with 4 kids - and the kids get state medical.  Husband makes a decent middle-class wage in marketing, and they are eligible.

                      Lagom

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                      Re: What comes after the ACA?
                      « Reply #697 on: January 25, 2017, 01:38:20 PM »
                      ACA has some serious damn problems. I have gone from paying 6700 in premiums a year to over 21000 with worst coverage since ACA became law. This is a HUGE problem for many many American families.

                      I don't mean to ignore your thoughtful contributions with the rest of your post, but it bears repeating that this sort of view is part of the problem from a politicization standpoint. Premiums were going up and coverage going down for almost everyone before the ACA and there is evidence that for many if not most, that slowed after the ACA was enacted. It's very easy to say "my rates went up thus the ACA was a failure!" But that is an entirely emotional argument. 

                      rtrnow

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                      Re: What comes after the ACA?
                      « Reply #698 on: January 25, 2017, 01:52:23 PM »
                      ... The poor folk were *already* covered.
                      So you consider go to the ER and go bankrupt as covered?
                      Medicaid, MediCal, people on SNAP.

                      Heck I have a friend who is a SAHM with 4 kids - and the kids get state medical.  Husband makes a decent middle-class wage in marketing, and they are eligible.
                      This varies by state.  In most red states (GA for sure) a non-disabled male cannot get medicaid.

                      Gal2016

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                      Re: What comes after the ACA?
                      « Reply #699 on: January 25, 2017, 02:00:32 PM »
                      Back in 2005, I paid $125/month for insurance for my family.  2007, I paid $153/month. Before that, premiums had been fairly steady.

                      2017, I'll pay $598/month and have higher deductibles and larger co-pays and I also pay $100/month to have my husband on my insurance because he also has access through his work; so total monthly cost is $698/month. 

                      At the rate of 19% increase every 2 years (2005-2007) -- I should only be paying around $365/month for excellent insurance. I no longer have excellent insurance (nobody does).