Author Topic: What comes after the ACA?  (Read 777620 times)

thenextguy

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Re: What comes after the ACA?
« Reply #1250 on: March 06, 2017, 05:38:59 PM »

Bucksandreds

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Re: What comes after the ACA?
« Reply #1251 on: March 06, 2017, 06:11:26 PM »
The House draft bill finally came out:

https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

No CBO score. That alone is very telling.

And when 5-10 million or more people lose insurance over this the GOP will be massacred in 2020.  At least a supermajority in the senate then should allow for Medicare for All, after this upcoming fiasco.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1252 on: March 06, 2017, 06:25:36 PM »
The House draft bill finally came out:

https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

No CBO score. That alone is very telling.

And when 5-10 million or more people lose insurance over this the GOP will be massacred in 2020.  At least a supermajority in the senate then should allow for Medicare for All, after this upcoming fiasco.
Meh. Who would vote for it? Dems passed on the chance in 2008. They've been getting creamed electorally since. Republicans won't vote for it, and if they keep control or even gain seats in 2018, we could wind up with just about anything but...

Bucksandreds

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Re: What comes after the ACA?
« Reply #1253 on: March 06, 2017, 06:29:38 PM »
The House draft bill finally came out:

https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

No CBO score. That alone is very telling.

And when 5-10 million or more people lose insurance over this the GOP will be massacred in 2020.  At least a supermajority in the senate then should allow for Medicare for All, after this upcoming fiasco.
Meh. Who would vote for it? Dems passed on the chance in 2008. They've been getting creamed electorally since. Republicans won't vote for it, and if they keep control or even gain seats in 2018, we could wind up with just about anything but...

You realize if the GOP bungles this and kicks millions off of insurance then they will get massacred in2020 when the new law is in full effect and it's a presidential year when dems show up?  They would then have a mandate to put everyone on insurance.

Paul der Krake

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Re: What comes after the ACA?
« Reply #1254 on: March 06, 2017, 06:30:53 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.




jim555

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Re: What comes after the ACA?
« Reply #1255 on: March 06, 2017, 06:32:55 PM »
The tax credit is indexed to a CPI measure, so over time medical inflation will make the credit smaller and smaller.  ACA subsidy is based on the second lowest cost Silver plan with income, so when rates go up the subsidy goes up.

Expanded Medicaid frozen starting in 2020, no new enrollees.

This bill hits the old and poor hard.  The tax credits are cheap.


Paul der Krake

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Re: What comes after the ACA?
« Reply #1256 on: March 06, 2017, 06:42:25 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
but your premiums may change greatly if they up prices for those with pre existing conditions. If they go from $500/month to $2k/month and possibly higher deductibles too lots of people could be in for sticker shock despite tax credits.
Oh yeah, I was only saying this is great for ME. The poor, the sick, and the working stiffs are on their own.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1257 on: March 06, 2017, 06:43:49 PM »
The House draft bill finally came out:

https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

No CBO score. That alone is very telling.

And when 5-10 million or more people lose insurance over this the GOP will be massacred in 2020.  At least a supermajority in the senate then should allow for Medicare for All, after this upcoming fiasco.
Meh. Who would vote for it? Dems passed on the chance in 2008. They've been getting creamed electorally since. Republicans won't vote for it, and if they keep control or even gain seats in 2018, we could wind up with just about anything but...

You realize if the GOP bungles this and kicks millions off of insurance then they will get massacred in2020 when the new law is in full effect and it's a presidential year when dems show up?  They would then have a mandate to put everyone on insurance.
Why didn't they do that in 2008? They had the votes and the same "mandate. " I  mean, they literally had the same situation you are proposing... and no medicare for all.
« Last Edit: March 06, 2017, 06:47:13 PM by Metric Mouse »

Metric Mouse

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Re: What comes after the ACA?
« Reply #1258 on: March 06, 2017, 06:46:12 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
but your premiums may change greatly if they up prices for those with pre existing conditions. If they go from $500/month to $2k/month and possibly higher deductibles too lots of people could be in for sticker shock despite tax credits.
Oh yeah. No doubt $5k per couple is not enough for low income families to match the refunds they are getting currently. Hopefully this number will change as the bill advances.

thenextguy

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Re: What comes after the ACA?
« Reply #1259 on: March 06, 2017, 06:58:07 PM »
Under the ACA, insurance companies can charge older customers no more than 3 times the youngest customers.

Under this new plan, that ratio would increase to 5 times. Theoretically this could induce younger customers to buy insurance, but it would make it much harder for older customers to afford it. I imagine this is going to be a political problem. AARP has already been harping (hAARPing?) on this. Look for that to increase now that the plan is out.

jim555

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Re: What comes after the ACA?
« Reply #1260 on: March 06, 2017, 07:07:49 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
but your premiums may change greatly if they up prices for those with pre existing conditions. If they go from $500/month to $2k/month and possibly higher deductibles too lots of people could be in for sticker shock despite tax credits.
I reading through it and it looks like as long as continuous coverage is maintained (gap no more than 63 days) they won't consider pre-existing conditions.  But if continuous coverage is broken then a 30% penalty (not sure if with medical underwriting).

Gin1984

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Re: What comes after the ACA?
« Reply #1261 on: March 06, 2017, 07:11:51 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
Where do you get refundable?

jim555

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Re: What comes after the ACA?
« Reply #1262 on: March 06, 2017, 07:12:33 PM »
Under the ACA, insurance companies can charge older customers no more than 3 times the youngest customers.

Under this new plan, that ratio would increase to 5 times. Theoretically this could induce younger customers to buy insurance, but it would make it much harder for older customers to afford it. I imagine this is going to be a political problem. AARP has already been harping (hAARPing?) on this. Look for that to increase now that the plan is out.
I wonder what happens in NY where age is not considered in plan pricing.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1263 on: March 06, 2017, 07:19:49 PM »
Under the ACA, insurance companies can charge older customers no more than 3 times the youngest customers.

Under this new plan, that ratio would increase to 5 times. Theoretically this could induce younger customers to buy insurance, but it would make it much harder for older customers to afford it. I imagine this is going to be a political problem. AARP has already been harping (hAARPing?) on this. Look for that to increase now that the plan is out.
I wonder what happens in NY where age is not considered in plan pricing.
Averaged premiums for everyone?

thenextguy

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Re: What comes after the ACA?
« Reply #1264 on: March 06, 2017, 07:21:34 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
but your premiums may change greatly if they up prices for those with pre existing conditions. If they go from $500/month to $2k/month and possibly higher deductibles too lots of people could be in for sticker shock despite tax credits.
I reading through it and it looks like as long as continuous coverage is maintained (gap no more than 63 days) they won't consider pre-existing conditions.  But if continuous coverage is broken then a 30% penalty (not sure if with medical underwriting).

Everything I'm reading suggests no more medical underwriting. However, the structure of the continuous coverage clause wouldn't incentivize those who don't have insurance to purchase it until they absolutely need it. The mandate penalty is ongoing. The continuous coverage premium does not take into account how long you e been without insurance.

Also, is it constitutional? The mandate was considered constitutional because it was judged to be a tax. But here the 30% is going to the insurance companies and not the government.

Paul der Krake

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Re: What comes after the ACA?
« Reply #1265 on: March 06, 2017, 07:24:23 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
Where do you get refundable?
From the link linked:
https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

ctrl+f "refundable"

The word "refundable" does not appear in the PDF it cites as a source. But "credit" only appears twice and not in meaningful sentences. If someone has the time to parse the 66 pages of legalese, have at it. :)

jim555

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Re: What comes after the ACA?
« Reply #1266 on: March 06, 2017, 07:30:44 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
but your premiums may change greatly if they up prices for those with pre existing conditions. If they go from $500/month to $2k/month and possibly higher deductibles too lots of people could be in for sticker shock despite tax credits.
I reading through it and it looks like as long as continuous coverage is maintained (gap no more than 63 days) they won't consider pre-existing conditions.  But if continuous coverage is broken then a 30% penalty (not sure if with medical underwriting).

Everything I'm reading suggests no more medical underwriting. However, the structure of the continuous coverage clause wouldn't incentivize those who don't have insurance to purchase it until they absolutely need it. The mandate penalty is ongoing. The continuous coverage premium does not take into account how long you e been without insurance.

Also, is it constitutional? The mandate was considered constitutional because it was judged to be a tax. But here the 30% is going to the insurance companies and not the government.
I'm reading something about a Patient and State Stability fund which will assist high risk individuals to get insurance.  So that sounds like medical underwriting is back.

jim555

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Re: What comes after the ACA?
« Reply #1267 on: March 06, 2017, 07:32:40 PM »
Under the ACA, insurance companies can charge older customers no more than 3 times the youngest customers.

Under this new plan, that ratio would increase to 5 times. Theoretically this could induce younger customers to buy insurance, but it would make it much harder for older customers to afford it. I imagine this is going to be a political problem. AARP has already been harping (hAARPing?) on this. Look for that to increase now that the plan is out.
I wonder what happens in NY where age is not considered in plan pricing.
Averaged premiums for everyone?
If the tax credit is age based and the premiums don't consider age then the young people will loose and the oldsters will make out.

jim555

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Re: What comes after the ACA?
« Reply #1268 on: March 06, 2017, 07:34:55 PM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
Where do you get refundable?
From the link linked:
https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

ctrl+f "refundable"

The word "refundable" does not appear in the PDF it cites as a source. But "credit" only appears twice and not in meaningful sentences. If someone has the time to parse the 66 pages of legalese, have at it. :)
I have seen several articles say refundable.

sol

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Re: What comes after the ACA?
« Reply #1269 on: March 06, 2017, 07:36:49 PM »
Why didn't they do that in 2008? They had the votes and the same "mandate. " I  mean, they literally had the same situation you are proposing... and no medicare for all.

We've been over this already, in this very thread.  Democrats abandoned single payer because they were trying to get Republican support of the plan, as well as the support of the ACA and the insurance lobby.

They were successful with two of those three groups.  The Republicans voted as a unified block against improving healthcare, except for the ONE retiring Republican (Arlen Specter) who changed his party affiliation to Democrat just for the purpose of this vote.

sol

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Re: What comes after the ACA?
« Reply #1270 on: March 06, 2017, 08:49:12 PM »
Okay, let's break down the new GOP health care replacement plan released this afternoon:

Things about the ACA that they like, and are going to keep:

1.  The individual mandate (being changed from a penalty charged by the government to a penalty charged by insurance companies).

2.  Kids can stay on insurance until age 26.

3.  Insurance companies can't deny you if you have a pre-existing condition (though they can charge you more).

4.  Some form of refundable tax credits (though they will be smaller and applied differently).

5.  The Cadillac tax on super-plush plans is being retained (though it has never gone into effect, as Obama delayed it).

6.  The ban on lifetime caps stays in place.

Things about the ACA that they hate, and are going to change:

1.  The individual and employer mandates are technically gone.  No one "needs" to be insured.  freeeedooooooooomm! (and market collapse!)

2.  Expanded medicaid is being removed, starting in 2020, kicking millions of people off of their current insurance.

3.  The refundable tax credits are cut (roughly in half) and will now be given to old poorish people instead of all poor people.

4.  Strips all funding from Planned Parenthood.  Only poor people use planned parenthood anyway.

5.  Removes the medicare surtax for people earning over $250k/year.  Yay for tax breaks for the rich!

6.  Forbids private health insurance from covering abortion.

7.  All plan controls are removed.  You will now pay extra if you want maternity, prescriptions, or mental health care to be covered.  mostly retained.

Things NOT included in the plan, that we thought would be, but that aren't part of the ACA:

1.  HSA expansions?  Apparently not included, will stay the same.  Some sources are now reporting HSA limits would double.

2.  Removing tax exemption for employer-sponsored care?  Apparently not included, will stay the same.


As far as I can tell, this plan fails to deliver on everything Trump has promised.  It doesn't make coverage more available or more affordable, in fact it does exactly the opposite.  Tens of millions of people will lose their current insurance, and everyone else will either either pay more for their current coverage or pay the same for less coverage.  It seems designed to make health care harder to find in rural areas.  And it doesn't even begin to address any of the cost controls that might actually reduce the price of care, instead of the cost of insurance.

Basically, it makes very few structural changes to the ACA other than that poor people will get less subsidies and rich people will pay less taxes.  The only other major change is to block-grant Medicaid and restrict abortion, which are both long-time Republican fantasies and things they could have done separately from any ACA plan anyway. 

From that perspective, the whole "repeal and replace" plan is basically just tax cuts for the rich, slashing welfare, and banning abortion.  There is nothing new under the sun, this is the same old GOP platform they've been pushing since the 80s.
« Last Edit: March 08, 2017, 08:47:02 AM by sol »

Scortius

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Re: What comes after the ACA?
« Reply #1271 on: March 06, 2017, 08:52:27 PM »
Why didn't they do that in 2008? They had the votes and the same "mandate. " I  mean, they literally had the same situation you are proposing... and no medicare for all.

We've been over this already, in this very thread.  Democrats abandoned single payer because they were trying to get Republican support of the plan, as well as the support of the ACA and the insurance lobby.

They were successful with two of those three groups.  The Republicans voted as a unified block against improving healthcare, except for the ONE retiring Republican (Arlen Specter) who changed his party affiliation to Democrat just for the purpose of this vote.

Also, due to Al Franken's recount and the death of Ted Kennedy, the Democrats only had a supermajority for some 20 days of active legislation.  Further, Joe Lieberman decided not to support the public option, giving the Democrats at most 59 votes out of a required 60.  Still, given Obama's 'Purple America' message during the early years of his Presidency, there's no saying that the Democrats would have pushed the public option through even if they had the opportunity.

thenextguy

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Re: What comes after the ACA?
« Reply #1272 on: March 06, 2017, 08:57:20 PM »

2.  Expanded medicaid is being removed, starting in 2020, kicking millions of people off of their current insurance.

I don't think this is true. Unless I misread, the plan is to freeze Medicaid enrollment in 2020. So they won't kick out existing people, but won't allow new people. Still shitty, though.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #1273 on: March 06, 2017, 09:12:47 PM »
The House draft bill finally came out:

https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

No CBO score. That alone is very telling.

And when 5-10 million or more people lose insurance over this the GOP will be massacred in 2020.  At least a supermajority in the senate then should allow for Medicare for All, after this upcoming fiasco.
Meh. Who would vote for it? Dems passed on the chance in 2008. They've been getting creamed electorally since. Republicans won't vote for it, and if they keep control or even gain seats in 2018, we could wind up with just about anything but...

You realize if the GOP bungles this and kicks millions off of insurance then they will get massacred in2020 when the new law is in full effect and it's a presidential year when dems show up?  They would then have a mandate to put everyone on insurance.
Why didn't they do that in 2008? They had the votes and the same "mandate. " I  mean, they literally had the same situation you are proposing... and no medicare for all.

The circumstances will be very different the second time around than things were in 2008.  That Obama made any progress on healthcare availability was much more impressive than this current desperate floundering to 'fix' it.  That Republicans see this as a partisan issue has doomed their progress from the get go, putting change in for changes sake as opposed to addressing the core complaint that it was too expensive for the government, states, and many individuals.  Expanding Medicare addresses all those issues, but that would require conceding that Obamacare wasn't such a bad plan after all.

AdrianC

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Re: What comes after the ACA?
« Reply #1274 on: March 07, 2017, 04:52:04 AM »
Good comparison here:

The Parts of Obamacare Republicans Will Keep, Change or Discard
https://www.nytimes.com/interactive/2017/03/06/us/politics/republican-obamacare-replacement.html?_r=1

AdrianC

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Re: What comes after the ACA?
« Reply #1275 on: March 07, 2017, 05:00:29 AM »
You realize if the GOP bungles this and kicks millions off of insurance then they will get massacred in2020 when the new law is in full effect and it's a presidential year when dems show up?  They would then have a mandate to put everyone on insurance.
I don't think they'll get massacred for "reducing taxes", "reducing insurance costs" and "repealing Obamacare". They're doing what they said they'd do.

You think most Americans, who have Medicare or employer coverage, want to pay (via taxes) for millions of poor people's health insurance? I don't think they do.

obstinate

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Re: What comes after the ACA?
« Reply #1276 on: March 07, 2017, 05:19:22 AM »
Adrian, you should look into the concept of diffuse costs and concentrated benefits. If everything worked based on who comes out mathematically ahead, taxes on the rich would be much higher since the vast majority of Americans are not rich.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1277 on: March 07, 2017, 05:23:16 AM »
Okay, let's break down the new GOP health care replacement plan released this afternoon:

Things about the ACA that they like, and are going to keep:

1.  The individual mandate (being changed from a penalty charged by the government to a penalty charged by insurance companies).

2.  Kids can stay on insurance until age 26.

3.  Insurance companies can't deny you if you have a pre-existing condition (though they can charge you more).

4.  Some form of refundable tax credits (though they will be smaller and applied differently).

5.  The Cadillac tax on super-plush plans is being retained (though it has never gone into effect, as Obama delayed it).

6.  The ban on lifetime caps stays in place.

Things about the ACA that they hate, and are going to change:

1.  The individual and employer mandates are technically gone.  No one "needs" to be insured.  freeeedooooooooomm! (and market collapse!)

2.  Expanded medicaid is being removed, starting in 2020, kicking millions of people off of their current insurance.

3.  The refundable tax credits are cut (roughly in half) and will now be given to old poorish people instead of all poor people.

4.  Strips all funding from Planned Parenthood.  Only poor people use planned parenthood anyway.

5.  Removes the medicare surtax for people earning over $250k/year.  Yay for tax breaks for the rich!

6.  Forbids private health insurance from covering abortion.

7.  All plan controls are removed.  You will now pay extra if you want maternity, prescriptions, or mental health care to be covered.

Things NOT included in the plan, that we thought would be, but that aren't part of the ACA:

1.  HSA expansions?  Apparently not included, will stay the same.  Some sources are now reporting HSA limits would double.

2.  Removing tax exemption for employer-sponsored care?  Apparently not included, will stay the same.


As far as I can tell, this plan fails to deliver on everything Trump has promised.  It doesn't make coverage more available or more affordable, in fact it does exactly the opposite.  Tens of millions of people will lose their current insurance, and everyone else will either either pay more for their current coverage or pay the same for less coverage.  It seems designed to make health care harder to find in rural areas.  And it doesn't even begin to address any of the cost controls that might actually reduce the price of care, instead of the cost of insurance.

Basically, it makes very few structural changes to the ACA other than that poor people will get less subsidies and rich people will pay less taxes.  The only other major change is to block-grant Medicaid and restrict abortion, which are both long-time Republican fantasies and things they could have done separately from any ACA plan anyway. 

From that perspective, the whole "repeal and replace" plan is basically just tax cuts for the rich, slashing welfare, and banning abortion.  There is nothing new under the sun, this is the same old GOP platform they've been pushing since the 80s.
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

jim555

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Re: What comes after the ACA?
« Reply #1278 on: March 07, 2017, 05:37:29 AM »
Out of the 60 something pages 6 are dedicated to knocking lottery winners off Medicaid??  So that is like 0.00000001% of all recipients.  They have strange priorities.

LadyStache in Baja

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Re: What comes after the ACA?
« Reply #1279 on: March 07, 2017, 05:59:11 AM »
Does insurance currently cover abortion?  If so, this change is f'ked up.

Iplawyer

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Re: What comes after the ACA?
« Reply #1280 on: March 07, 2017, 05:59:23 AM »
Quote
The GOP bill would keep the ObamaCare protection that bans insurers from rejecting people with pre-existing conditions - but with a twist.

Insurers would be allowed to charge people 30 percent higher premiums for one year if they have had a gap in their healthcare coverage.

So once we've kicked low income people off of their health insurance, we're going to make it even harder for them to get back on.  Mwu-ha-ha-ha-ha-ha-ha.


That 30% provision sounds really reasonable, it's similar to the ACA penalty for opting out. The premiums will always stay in a reasonable range whether you're chronically sick or not.

The only thing that would be nice is giving more credits to low income. But complaining about it when you have a $2m stash and you want to FIRE is a little disingenuous.

How in the world do you think "the premiums will always stay in a reasonable range whether you're chronically sick or not?"  I just did not see that in the plan since insurance companies control that.  And they will not be reasonable.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1281 on: March 07, 2017, 06:22:10 AM »
Does insurance currently cover abortion?  If so, this change is f'ked up.
That's a good question. I would hope in "medically necessary " cases where the mother is at risk it would. Not sure though.

Gin1984

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Re: What comes after the ACA?
« Reply #1282 on: March 07, 2017, 06:36:25 AM »
Does insurance currently cover abortion?  If so, this change is f'ked up.
That's a good question. I would hope in "medically necessary " cases where the mother is at risk it would. Not sure though.
It depends on the insurance and the state.  The federal government does not require any insurance to cover it but does not ban it.

AdrianC

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Re: What comes after the ACA?
« Reply #1283 on: March 07, 2017, 06:36:47 AM »
Adrian, you should look into the concept of diffuse costs and concentrated benefits. If everything worked based on who comes out mathematically ahead, taxes on the rich would be much higher since the vast majority of Americans are not rich.
I think you misunderstood my point. The Republicans said they'd repeal Obamacare, which we all know means millions of poor people will lose their health insurance. Many millions of people voted for this. They want this, because they don't want to have to pay for it.

People who are not rich voted in the millions for a party that promises to cut taxes on the rich. They won't vote against this party at the next election, when the party is just doing what they said they'd do. There's no bait and switch.

boarder42

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Re: What comes after the ACA?
« Reply #1284 on: March 07, 2017, 06:42:12 AM »
this plan is great for my retirement plans.  i get a 2-4k tax credit per person in my family.  i get to double my HSA contributions.  not seeing any real issues for mustachians.  the real issues are if you want to cover everyone.  which the only way i believe to do that affordably is to have a central payer and cutout insurance companies.  but thats never gonna happen. so i'll take this.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1285 on: March 07, 2017, 06:49:17 AM »
this plan is great for my retirement plans.  i get a 2-4k tax credit per person in my family.  i get to double my HSA contributions.  not seeing any real issues for mustachians.  the real issues are if you want to cover everyone.  which the only way i believe to do that affordably is to have a central payer and cutout insurance companies.  but thats never gonna happen. so i'll take this.
I don't mind parts of the plan, but wish the refunds and medicare numbers were a bit higher to cover more people. We'll see how it progresses.

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Re: What comes after the ACA?
« Reply #1286 on: March 07, 2017, 06:55:23 AM »
Adrian, you should look into the concept of diffuse costs and concentrated benefits. If everything worked based on who comes out mathematically ahead, taxes on the rich would be much higher since the vast majority of Americans are not rich.
I think you misunderstood my point. The Republicans said they'd repeal Obamacare, which we all know means millions of poor people will lose their health insurance. Many millions of people voted for this. They want this, because they don't want to have to pay for it.

People who are not rich voted in the millions for a party that promises to cut taxes on the rich. They won't vote against this party at the next election, when the party is just doing what they said they'd do. There's no bait and switch.
Trump ran on replacing ACA with something better, lower costs/premiums/deductibles - with everyone covered.  When his red capped voters find out how much they are screwed by this they will not be voting R again for a while.  I am assuming they are smart enough not to blame Obama for the changes.

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Re: What comes after the ACA?
« Reply #1287 on: March 07, 2017, 07:01:11 AM »
They are saying the maniac caucus thinks this isn't brutal enough and it might not even pass the House.  But if they make it more brutal it will not pass the Senate.  Interesting times. 

BeanCounter

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Re: What comes after the ACA?
« Reply #1288 on: March 07, 2017, 07:05:31 AM »
I'm glad they are at least keeping the pre-existing condition mandate and the ban against lifetime maximums. However this does very little to keep health insurance affordable. Especially for the >50 crowd. There goes my early retirement plan.
I'm not sure the GOP understands how health insurance works.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1289 on: March 07, 2017, 07:10:47 AM »
Adrian, you should look into the concept of diffuse costs and concentrated benefits. If everything worked based on who comes out mathematically ahead, taxes on the rich would be much higher since the vast majority of Americans are not rich.
I think you misunderstood my point. The Republicans said they'd repeal Obamacare, which we all know means millions of poor people will lose their health insurance. Many millions of people voted for this. They want this, because they don't want to have to pay for it.

People who are not rich voted in the millions for a party that promises to cut taxes on the rich. They won't vote against this party at the next election, when the party is just doing what they said they'd do. There's no bait and switch.
Trump ran on replacing ACA with something better, lower costs/premiums/deductibles - with everyone covered.  When his red capped voters find out how much they are screwed by this they will not be voting R again for a while.  I am assuming they are smart enough not to blame Obama for the changes.
Hard to say. They might like the tax refund and the lack of mandate to buy healthcare with it. The medicare issues could be blamed on the states for not ponying up the money, and Trump comes out looking like a winner.

Maybe not, but the spin machine has been in high gear for awhile.

jim555

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Re: What comes after the ACA?
« Reply #1290 on: March 07, 2017, 07:12:02 AM »
In order to go through Reconciliation (simple majority) it must be revenue neutral for 10 years.  How will they know if that is true if they don't have OMB mark up the bill?
They can't repeal the ACA without 60 Senate votes.

BeanCounter

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Re: What comes after the ACA?
« Reply #1291 on: March 07, 2017, 07:55:12 AM »
Still no conversation about the cost of care, only talking about who will pay for it.  It makes no difference if it is Obamacare or Trumpcare.  In the long run the system is fucked because the cost is too high.  Too much bureaucracy in our healthcare.  Until we have complete transparency in cost, decrease regulatory waste, and remove the insurance middleman from most medical issues, the cost will continue to rise. There is no reason why gauze should cost $50 dollars at a hospital and $3 at a pharmacy.  There is no reason why a physician can't tell their patient how much a procedure will cost because it varies by different insurance companies.We need to stop talking about who will pay and start talking about how much we all pay.

Yes. Exactly

I just looked at the balance sheet for a large non for profit hospital system in my area.  According to their figures Medicare/Medicaid together cover about 81% of what it costs to care for those patients.  If every patient was on government insurance, that hospital would be out of business. Therefor single payer is not the answer either.  The cost of care needs to come down and it must happen soon.  The system is imploding and it makes no difference which president cares the most.

We need to stop talking about who will pay and start talking about how much we all pay.

Well, not exactly. Medicare and Medicaid have a margin built into their pricing so it should cover the cost of care. The hospital systems, even the "not for profit systems" are at fault if they cannot provide care in that pricing. Well, at least to some extent.
Ever wonder why hospital systems continually put up new buildings and renovate their hospitals? Pull up some hospital system's 990's and check out how much their administration makes.
Yes the insurance industry is a problem, but the hospitals are equally if not more culpable.IMHO

EnjoyIt

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Re: What comes after the ACA?
« Reply #1292 on: March 07, 2017, 07:58:40 AM »
beancounter, I apologize I removed my post and started a new thread on this subject.  Please repost in the new thread

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Re: What comes after the ACA?
« Reply #1293 on: March 07, 2017, 08:40:32 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

boarder42

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Re: What comes after the ACA?
« Reply #1294 on: March 07, 2017, 08:55:52 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.
.

in any other form of insurance you pay based on your risk profile.  older people are riskier and cost more i like the fact that they can be charged up to 5x more.  you can tell much of this plan was made with insurance companies in mind.  If its going to stay private i want the choice to control my costs.  this plan allows for me to do just that.  and guess what.  if the aca had stayed in place we would start to see larger migration to healthshare and insurers may have all left the market place.  if you plan to retire right around the top of the 15% bracket then this plan helps you loads more than the previous one.  i see no way we can affordably insure all people and have insurance companies make profit.  So i guess i just dont care about leaving people under insured b/c if we dont have a central payer then we have determined health coverage is a privledge not a right.  you have to fundamentally change that to make this "affordable"

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Re: What comes after the ACA?
« Reply #1295 on: March 07, 2017, 09:06:55 AM »
Sounds like a neutral change for early retirees. If I am reading this right, it will be a $5k refundable tax credit for a married couple in their 30s, plus $2k per kid up to a total of $14k.
Where do you get refundable?
From the link linked:
https://consumerist.com/2017/03/06/congressional-committee-releases-text-of-obamacare-repeal-replacement-bill/

ctrl+f "refundable"

The word "refundable" does not appear in the PDF it cites as a source. But "credit" only appears twice and not in meaningful sentences. If someone has the time to parse the 66 pages of legalese, have at it. :)

The PDF of the full-text bill linked to in the Consumerist article is not the bill that contains the provisions for the refundable tax credit.  Those provisions are in a separate bill (here's a link to a PDF copy:  Ways and Means Committee Legislative Recommendations) -- the tax credit language is contained in Section 15 of the bill (starting on page 23 of the PDF file), which adds a new refundable tax credit to subpart C of part IV of subchapter A of chapter 1 of the Internal Revenue Code (which is the area of the tax code where refundable tax credits for personal income taxes are generally located).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The difference is that under this plan no penalty would apply to individuals who opt never to purchase health insurance at all.  In practice, for anyone who ends up purchasing health insurance after a lapse in coverage, the effect is as you described.  But the proposed structure will allow the GOP to credibly claim that people are no longer forced, under pain of penalty, to purchase coverage they don't want, because you can choose to purchase no insurance at all and face no penalty.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1296 on: March 07, 2017, 09:08:28 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.

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Re: What comes after the ACA?
« Reply #1297 on: March 07, 2017, 09:12:14 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.
Exactly how did the ACA harm the middle class, given the median income is $51000 for a family and that is well within the subsidy range?

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Wexler

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Re: What comes after the ACA?
« Reply #1298 on: March 07, 2017, 09:13:20 AM »
Adrian, you should look into the concept of diffuse costs and concentrated benefits. If everything worked based on who comes out mathematically ahead, taxes on the rich would be much higher since the vast majority of Americans are not rich.
I think you misunderstood my point. The Republicans said they'd repeal Obamacare, which we all know means millions of poor people will lose their health insurance. Many millions of people voted for this. They want this, because they don't want to have to pay for it.

People who are not rich voted in the millions for a party that promises to cut taxes on the rich. They won't vote against this party at the next election, when the party is just doing what they said they'd do. There's no bait and switch.
Trump ran on replacing ACA with something better, lower costs/premiums/deductibles - with everyone covered.  When his red capped voters find out how much they are screwed by this they will not be voting R again for a while.  I am assuming they are smart enough not to blame Obama for the changes.
Hard to say. They might like the tax refund and the lack of mandate to buy healthcare with it. The medicare issues could be blamed on the states for not ponying up the money, and Trump comes out looking like a winner.

Maybe not, but the spin machine has been in high gear for awhile.

Can the refundable tax credits go to households that don't use them for health insurance? That doesn't seem like it should work that way.  If so, it would just be a new tax credit based on age and with an income-based phaseout.  Full stop.  If you have to buy health insurance to get a tax credit, isn't that a "mandate to buy healthcare with it"?  There would be no mandate to buy healthcare in general, but to get the credit, you'd have a mandate to use it.

Wexler

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Re: What comes after the ACA?
« Reply #1299 on: March 07, 2017, 09:18:39 AM »
Pretty much on, except that Kaiser is reporting younger, healtheir people will have lower premiums and higher subsidies - saving between  $700 and $4000 a year, while getting tax refunds up to $2000, versus an average $103 subsidy currently.

So there are winners under this plan, though lower income people are in for reduced benefits and older people who use more healthcare will have to pay more.

That's a VERY cherry-picked example, of a young person who earns barely too much for ACA subsidies but little enough to get the the GOP subsidies.  This new plan is worse for virtually everyone, and that's be design.  They openly stated that their goal was to reduce the amount of money government spends on supporting healthcare, which means people will pay more (or have less coverage).

I'm also confused why so many news outlets are reporting about the "repeal" of the individual mandate.  They didn't repeal it, they made it worse.  The fine for not having insurance under the new plan is thousands of dollars higher than the ACA fine for not having insurance.  They literally made the individual mandate stronger, and are now claiming they have repealed it because it is paid to insurance companies instead of to the government.  It's masterful spin.

The real winners in this new plan are the super-rich, who get massive tax breaks worth hundreds of thousands of dollars per year.  The losers are poor people, who will not be able to afford insurance without the ACA subsidies or will lose their medicaid coverage.  Also women, who will get to pay more for health insurance.  Also old people, who will get to pay more for health insurance.  But if you're a lower middle class white guy (key Trump demographic), it looks like the new plan doesn't make you much better or worse off than you were under the ACA.

It is the middle-class who gets screwed over the most with all this government bureaucracy.  The middle class got fucked with Obamacare and I'm sure the middle class will get fucked with Trumpcare.  The rich pay or keep an extra $10k does not change their life in any single way.  The middle class paying an extra $1k-$2k in premiums and another $3k-$5k in deductibles can be devastating.  The reason why Trump won is because the middle class has been fucked over for so long that they are sick and tired of both Democrats and Republicans and chose something different.  Someone that will cut their expenses, maybe even increase jobs, and boost the economy. Personally I agree with them.  The government has been fucking over the middle class for way too long.

But then why do they keep voting for the "whatever else, keep cutting taxes on the rich" school of government?  I mean, the Medicare surcharge tax of 0.9% on earned income over 250k  AND (this is a huge boon to the investment class) on investment income over 250k is eliminated as part of this bill.  How does this help the middle class?  This isn't choosing something different, it's just choosing a tackier facade papered over Mitt Romney's economic policies.