Author Topic: What comes after the ACA?  (Read 824815 times)

EnjoyIt

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Re: What comes after the ACA?
« Reply #2800 on: June 22, 2017, 03:40:05 PM »

We paid the additional taxes one time, and I don't mind that, we had a great year. I do appreciate the extra protections the ACA gave, but we did lose a PPO plan we liked, doctors we liked, and now have an HMO plan (PPOs no longer sold) through a local non-profit insurer (all national insurers pulled out), with a very narrow network, and $7K deductible pp, 14K max OOP. This is the reality on the ground for many middle-class folks. Not that I think the latest bill will fix any of that, of course. But I do see why so many people who use the ACA do not like it and want it gone.

^ this.

This is the exact reason why so many middle class Americans want the ACA dismantled. This is what i have been saying all along.  Some people are okay with this, while others see it as a huge insult to their well being.

Regarding the Republican bill, I am very concerned it provides an out for the insurance companies to not cover people with pre-existing conditions which would be a huge loss.  The rest of the bill is meaningless in the grand scheme of things.  Some people will pay more for healthcare while others will pay less but the cost as a whole will be unchanged.  Those who lose health insurance will suffer and get only emergency care that will be covered by increased pricing on the insured and those willing to self pay. 

I am also a big proponent of separating insurance from employer benefits.  Employer healthcare insurance is what started this whole mess.  We need the population to understand how expensive healthcare is and then maybe we can do something to address that price tag.

It would be nice to force our congress to buy health insurance on the open market.


protostache

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Re: What comes after the ACA?
« Reply #2801 on: June 22, 2017, 03:47:14 PM »
It would be nice to force our congress to buy health insurance on the open market.

They do.

Quote
As of 1 January 2014, Members of Congress (MOC) and Congressional staff purchase their insurance through the District of Columbia’s small business health options program (SHOP) exchange, also known as DC Health Link. Contrary to popular belief, Congressional members do not receive free health care. As it does for other federal employees who purchase their insurance through the Federal Employees Health Benefits Program (FEHBP), the federal government provides a subsidy equivalent to 72 percent of the weighted average of all FEHBP premiums.

nereo

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Re: What comes after the ACA?
« Reply #2802 on: June 22, 2017, 04:17:02 PM »
I think the CBO score could be catastrophic.  The Senate's new bill allows states to use the ACA's waiver process to get exempted from any of the ACA provisions, like for example the minimum coverage requirements or how it manages Medicaid.  It also appears to let them be exempted from the pre-existing conditions ban, despite their ongoing claims to the contrary.


Maybe this is why one of the party's talking points is how the CBO score is unreliable, unnecessary or just plain wrong.
Remember this gem from a couple months ago from Mick Mulvaney?
Quote
So I love the folks at the CBO, they work really hard, they do, but sometimes we ask them to do stuff they’re not capable of doing, and estimating the impact of a bill of this size probably isn’t the best use of their time.

... or more recently from Roger Marshall (R-Kansas):
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The CBO’s crazy. I said for weeks I had zero confidence in the CBO. You would never hire them to manage your retirement plan, so it came out exactly what I expected it to be.

...or maybe from Tom McCLintock (R-Cal):
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[the CBO] has demonstrated it doesn’t have the first clue about how [health care] markets work.

.... and of course Newt Gingrich has weighed in:
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If you are serious about real health reform, you must abolish the Congressional Budget Office because it lies

... and let's not forget Sean Spicer:
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If you’re looking at the CBO for accuracy, you’re looking in the wrong place
« Last Edit: June 22, 2017, 04:19:27 PM by nereo »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2803 on: June 22, 2017, 04:30:39 PM »
It would be nice to force our congress to buy health insurance on the open market.

They do.

Quote
As of 1 January 2014, Members of Congress (MOC) and Congressional staff purchase their insurance through the District of Columbia’s small business health options program (SHOP) exchange, also known as DC Health Link. Contrary to popular belief, Congressional members do not receive free health care. As it does for other federal employees who purchase their insurance through the Federal Employees Health Benefits Program (FEHBP), the federal government provides a subsidy equivalent to 72 percent of the weighted average of all FEHBP premiums.

That's nice to know, thanks for the link. It is one of the things I love so much about this forum.  So many educated people from all different backgrounds. 

I think congress should get subsidies based on income just as they want it in the law.

FireLane

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Re: What comes after the ACA?
« Reply #2804 on: June 22, 2017, 05:28:06 PM »
I was expecting the Senate bill to be bad, but it looks even worse than I was imagining. If this passes in its current form, my RE plan is dead in the water.

So: Do we hope voter outrage makes them back down, and Obamacare stays in place? Or should we hope the Republicans pass this bill, it causes catastrophe, and a wave of voter outrage throws them out of office and gets America to pass single-payer? I honestly don't know which would be better.

accolay

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Re: What comes after the ACA?
« Reply #2805 on: June 22, 2017, 05:32:29 PM »
So: Do we hope voter outrage makes them back down, and Obamacare stays in place? Or should we hope the Republicans pass this bill, it causes catastrophe, and a wave of voter outrage throws them out of office and gets America to pass single-payer? I honestly don't know which would be better.

I really have no hope for anything good to come out of this. There's going to be a lot of pain in America.

protostache

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Re: What comes after the ACA?
« Reply #2806 on: June 22, 2017, 06:10:36 PM »
So: Do we hope voter outrage makes them back down, and Obamacare stays in place? Or should we hope the Republicans pass this bill, it causes catastrophe, and a wave of voter outrage throws them out of office and gets America to pass single-payer? I honestly don't know which would be better.

If this legislation is enacted in this form it will destroy rural America. In quiet a lot of places the major employer is the hospital system, and in those places the primary payor is Medicaid. If Medicaid gets cut it'll cause a cascade effect and take out entire counties.

So no, I don't hope that this passes. I hope that McConnell can't whip the votes but holds the vote anyway, it fails, and then McConnell moves on to tax cuts qua tax cuts instead of healthcare destruction as tax cuts and stop messing with a system that is working.

In my ideal world nothing changes until 2019 after the Democratic Party flips the House and then works on some small stabilization bills that actually fix the problems with the ACA leading into the 2020 presidential election, whereupon the Democratic candidate sweeps the popular and EC votes on a platform of Medicare for all.

sol

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Re: What comes after the ACA?
« Reply #2807 on: June 22, 2017, 07:09:11 PM »
In my ideal world nothing changes until 2019 after the Democratic Party flips the House and then works on some small stabilization bills that actually fix the problems with the ACA leading into the 2020 presidential election, whereupon the Democratic candidate sweeps the popular and EC votes on a platform of Medicare for all.

This might be the liquor talking, but I think you're dreaming.  Trump won the white house, the conservatives control the Supreme Court, and voters have given Republicans majorities in both houses of Congress, 32 state legislatures, and 33 Governor's mansions.  Democrats have lost everything.  They've lost all of the special elections.  They control no committees and no branches of government.  They have no voice in US government AT ALL, despite representing more than half of the country. 

The future of America is pretty bleak.  There will be no great society.  There will be no social utopia, no land of opportunity.  There will be wars, and racism, and gloating, and a continuing concentration of wealth and power in the hands of an elite white male oligarchy while everyone else wallows in misery and despair forever and ever Amen.

Face it, you've lost.  Trump represents the new America, all fat and disgusting and ignorant and boorish and disgusting and disgusting.  This is your country now, this is what we've chosen for ourselves, how we want to be perceived and how we want to live.  We hate poor people because they are inferior.  We hate women because they can't be trusted to make good decisions.  We hate brown people because they are icky.  We hate everything except bombing brown terrorists and inhaling KFC.
« Last Edit: June 22, 2017, 07:13:05 PM by sol »

protostache

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Re: What comes after the ACA?
« Reply #2808 on: June 22, 2017, 07:17:39 PM »
In my ideal world nothing changes until 2019 after the Democratic Party flips the House and then works on some small stabilization bills that actually fix the problems with the ACA leading into the 2020 presidential election, whereupon the Democratic candidate sweeps the popular and EC votes on a platform of Medicare for all.

This might be the liquor talking, but I think you're dreaming.  Trump won the white house, the conservatives control the Supreme Court, and voters have given Republicans majorities in both houses of Congress, 32 state legislatures, and 33 Governor's mansions.  Democrats have lost everything.  They've lost all of the special elections.  They control no committees and no branches of government.  They have no voice in US government AT ALL, despite representing more than half of the country. 

The future of America is pretty bleak.  There will be no great society.  There will be no social utopia, no land of opportunity.  There will be wars, and racism, and gloating, and a continuing concentration of wealth and power in the hands of an elite white male oligarchy while everyone else wallows in misery and despair forever and ever Amen.

Face it, you've lost.  Trump represents the new America, all fat and disgusting and ignorant and boorish and disgusting and disgusting.  This is your country now, this is what we've chosen for ourselves, how we want to be perceived and how we want to live.  We hate poor people because they are inferior.  We hate women because they can't be trusted to make good decisions.  We hate brown people because they are icky.  We hate everything except bombing brown terrorists and inhaling KFC.

Well then, drunk-sol, what do we do? Abandon all hopes of FIRE because there's no way to continue living without employer-provided group health insurance? Or do we pack up and leave?

sol

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Re: What comes after the ACA?
« Reply #2809 on: June 22, 2017, 07:33:05 PM »
Well then, drunk-sol, what do we do? Abandon all hopes of FIRE because there's no way to continue living without employer-provided group health insurance? Or do we pack up and leave?

Are you a Cincinnati Bengals fan?  Hoping for a perfect (losing) season just so you can improve your draft standing is no way to build a successful organization.  Maybe start by winning one, once in a while, and then try to build on that.

The Democratic Party, despite having all of the right ideas, is apparently in total shambles.  As an organization they appear totally ineffectual.  They win at nothing.  Trump was right, Republicans must be getting tired of winning all the time.

wenchsenior

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Re: What comes after the ACA?
« Reply #2810 on: June 22, 2017, 07:37:17 PM »
In my ideal world nothing changes until 2019 after the Democratic Party flips the House and then works on some small stabilization bills that actually fix the problems with the ACA leading into the 2020 presidential election, whereupon the Democratic candidate sweeps the popular and EC votes on a platform of Medicare for all.

This might be the liquor talking, but I think you're dreaming.  Trump won the white house, the conservatives control the Supreme Court, and voters have given Republicans majorities in both houses of Congress, 32 state legislatures, and 33 Governor's mansions.  Democrats have lost everything.  They've lost all of the special elections.  They control no committees and no branches of government.  They have no voice in US government AT ALL, despite representing more than half of the country. 

The future of America is pretty bleak.  There will be no great society.  There will be no social utopia, no land of opportunity.  There will be wars, and racism, and gloating, and a continuing concentration of wealth and power in the hands of an elite white male oligarchy while everyone else wallows in misery and despair forever and ever Amen.

Face it, you've lost.  Trump represents the new America, all fat and disgusting and ignorant and boorish and disgusting and disgusting.  This is your country now, this is what we've chosen for ourselves, how we want to be perceived and how we want to live.  We hate poor people because they are inferior.  We hate women because they can't be trusted to make good decisions.  We hate brown people because they are icky.  We hate everything except bombing brown terrorists and inhaling KFC.

Well then, drunk-sol, what do we do? Abandon all hopes of FIRE because there's no way to continue living without employer-provided group health insurance? Or do we pack up and leave?

Sol's rant sounds almost exactly like what DH and I sound like at the end of another day in GOP ruled America...in our case the rant trigger is usually another day of the GOP pissing on science, the environment, public land, and public servants. Ugh.  We've been trying to plot out an exit the country strategy...but it is so hard to wrap our heads around the reality of the choices so many in this country keep persistently making.

Paul der Krake

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Re: What comes after the ACA?
« Reply #2811 on: June 22, 2017, 07:42:35 PM »
Well then, drunk-sol, what do we do? Abandon all hopes of FIRE because there's no way to continue living without employer-provided group health insurance? Or do we pack up and leave?
Leaving is always an option. People arbitrage states all the time- why not countries? I certainly don't feel like I owe it to anyone to continue living in a place where idiocy is celebrated and bone-headed policies are the law of the land. People want this. I won't lose sleep over leaving the rotten corpse of American exceptionalism behind, and I know I won't be missed.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #2812 on: June 22, 2017, 08:46:25 PM »

The Democratic Party, despite having all of the right ideas, is apparently in total shambles.  As an organization they appear totally ineffectual.  They win at nothing.  Trump was right, Republicans must be getting tired of winning all the time.

And this is how I felt from 1980-1991, and again from 2000-2007

The pendulum will swing back toward the Democrats as the Republican overreach turns off enough people or people experience enough pain. It's a shame it takes a devastating economic calamity, like the financial crisis, to get US citizens to wake up and vote their own economic interests for a change.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2813 on: June 22, 2017, 09:48:20 PM »
Very funny stuff here.  End of the world, the republicans are in power.  Ohh what do we do?

It is so amazing how polar some people are. The democrats are just as corrupt ass hats as the republicans. 

Republicans siphon money under the guise of lower taxes, freedom of speech, and smaller government while spending a crap load on military and corporate subsidies.

Democrats siphon money under the guise of taxing the rich and helping the poor while also spending tons of money on the military and corporate subsidies.  I hate to break it to you, but since passage of the ACA which was supposed to help millions, insurance company profit margins have skyrocketed.  Who is the real winner here? 

Don't worry though in 3, 7, maybe more years democrats will have control of office and republican majority forums will be complaining that the world has ended and they will talk about looking for alternate residence just like some of you. I will be giggling just the same.

sol

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Re: What comes after the ACA?
« Reply #2814 on: June 22, 2017, 11:02:27 PM »
I hate to break it to you, but since passage of the ACA which was supposed to help millions, insurance company profit margins have skyrocketed. 

Where did you get this idea?    Aren't you familiar with ACA provisions that capped insurance company profits?  I refuse to believe that any medical professional doesn't know about medical loss ratios, or how the ACA literally forced overly profitable insurance companies to refund money to customers.  Are you being deliberately obtuse by stating as fact the exact opposite of facts?

Besides, good Republican footsoldiers would never argue that the ACA made insurers too profitable, you're supposed to say it made them so unprofitable that they pulled out of the marketplace due to burdensome overregulation.  It's supposed to be collapsing all around us, not making companies too much money.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2815 on: June 23, 2017, 01:30:22 AM »
I hate to break it to you, but since passage of the ACA which was supposed to help millions, insurance company profit margins have skyrocketed. 

Where did you get this idea?    Aren't you familiar with ACA provisions that capped insurance company profits?  I refuse to believe that any medical professional doesn't know about medical loss ratios, or how the ACA literally forced overly profitable insurance companies to refund money to customers.  Are you being deliberately obtuse by stating as fact the exact opposite of facts?

Besides, good Republican footsoldiers would never argue that the ACA made insurers too profitable, you're supposed to say it made them so unprofitable that they pulled out of the marketplace due to burdensome overregulation.  It's supposed to be collapsing all around us, not making companies too much money.

Sol,
How many times do I have to tell you I am not a republican. I am pro choice, anti religion, anti war on drugs, anti war, and against foreign intervention just to name a few non republican sentiments I hold. Just because someone disagrees with some of your liberal views does not make them a republican.

Ohh and take a look at this chart of 3 insurance companies vs VTI over the last 5 years.
http://quotes.morningstar.com/chart/stock/chart.action?t=ANTM&culture=en-US&region=usa

Also feel free to take a look at their expense reports.  Insurance companies are doing great.  FYI Sol, your democrat representatives are leeches too.  Who do you think lobbied so hard for Obamacare? Insurance lobbyist.  Who do you think pushed for eliminating the public option from the ACA? Insurance lobbyist.

While you are looking at insurance companies just take a look at how much of their profit comes from Medicaid.  I'll save you some time 35-55% last I checked.  Yes that is right, private companies run government insurance and suck out a profit.  Go figure huh.


EDIT: apologies, can't get the graph to show properly.  Please click the compare button and add aetna, cigna, united health, and type in VTI to compare.  Please extend for 5 years.
« Last Edit: June 23, 2017, 01:43:06 AM by EnjoyIt »

NESailor

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Re: What comes after the ACA?
« Reply #2816 on: June 23, 2017, 08:45:59 AM »
EnjoyIt and the few more conservative members on here - whoever you may be (I know there's not a lot of you).  I don't disagree with much of the criticism you level at the crappy parts of Obamacare.  What I have a hard time with is the leap you make to directly, or indirectly, defend what the Republicans are doing in Washington with regards to healthcare. 

I'm a finance professional so I have a lot of wealthy friends (technically, we are wealthy too compared to most).  This means a good number of them fall on the conservative side of things - especially taxes etc.  When Trump won the nomination it seemed to me that the grudgingly pulled the trigger just to support "their" team.  It was "at least not Hillary"  and not much else.  Over the past few months it's turning a lot more into outright defense of the Washington Republican agenda which is quite surprising.   Same type of surprise I experience here when I see you (EnjoyIt) somehow defend the "healthcare overhaul" efforts.

We agree - Obamacare has MANY faults.  We want to fix it, nobody seems to be picking up on that.  Or, scrap it all and claim "Obamacare repeal".  HOWEVER, if the replacement is what Washington appears to favor- i.e.: a spectacular cut in benefits while funneling the money to those who really do not need it...then yeah - I will complain and complain loudly.  Especially since the promises made by Republicans and conservatives who may not identify as Republicans have been largely focused on: better coverage for less money.   What is being delivered is exactly the opposite.

So yes, Obamacare may suck for the slightly upper middle class people and the self-employed...but that is not a reason to support this abomination.  We can have more than binary opinions on Obamacare.  The fact we don't like it does not mean we can't express anything negative about the supposed replacement plan, right? 

I feel like I'm talking in circles when I discuss this with my rich friends.  There is some sort of a mental blockage that does not allow them to think about our current system in terms of fixing it, rather, the only solution is full repeal without regards for what happens between full repeal and a workable alternative (which is not being proposed at the moment).

If you really really really hate the color of your house, do you load it up with TNT and blow it to smithereens or do you try to repaint it?  You know, you still need a roof over your head.  I understand the color sucks but at least your have a roof over your head.  I just can't anymore.  One of these guys is a VP of finance at a hospital.   AHCA is supposed to blow a giant hole in the budget for this network....but Obamacare sucks!   Seriously...


chasesfish

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Re: What comes after the ACA?
« Reply #2817 on: June 23, 2017, 09:48:45 AM »
The quicker we get to Switzerland or Costa Rica style healthcare, the better.  Those are the easiest two systems to convert the US to and Top 20 in the world with some type of universal coverage.

Switzerland just requires all citizens to buy healthcare.  Mandatory, no execeptions.  Easy for us to do, just stop giving people tax refunds or issuing IDs until they prove they have insurance.

Costa Rica has a public/private system - Just open up the VA Hospitals to everyone as a form of baseline coverage, then if you want more, you're welcome to buy/pay for more through the private system we have.

Of course neither side wants to do that - Both are against mandatory insurance requirements (look at the list of "exemptions" in the ACA and how low the penalty is) nor do they want to have the perception of an inferior product being delivered to the 10-20% in poverty.

jim555

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Re: What comes after the ACA?
« Reply #2818 on: June 23, 2017, 09:51:26 AM »
I don't see how what the Republicans are proposing solves any of the problems they are complaining about.  High premiums, their solution, strip the policies of what they cover and create junk policies.  Don't address the sky-rocketing costs.  Take away subsidization so the net effect is not lower premiums for most people.  Hope you never need to use your junk policy then you are screwed.

Thin insurance markets, how are they fixing this?  They could create a Medicare/Medicaid buy in as an option, but that is unfreedom I guess.

I can't stand the constant lie machine about the facts they keep spewing, really makes me sick.




sol

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Re: What comes after the ACA?
« Reply #2819 on: June 23, 2017, 10:07:45 AM »
I don't see how what the Republicans are proposing solves any of the problems they are complaining about. 

It doesn't.  Arguably, it makes them all worse.  The very things religions claim is wrong the ACA are the exact same things the new Senate bill is going to amplify.  How did they manage to go from "these things are problems that we hate" to "these same things are the solutions we are proposing"?

Crafted in secret
Premiums too high
Deductibles too high
Subsidy cliffs too abrupt
not enough insurers in some markets
not enough support for the self employed
not enough support for thr elderly
not enough people covered
Gives too much money insurers instead of patients
Doesn't bring down costs of care

Every one of those was a conservative complaint about the ACA, and every one of them would be worse under the Senate bill than it is under the ACA right now.  The proof is in the pudding on this one, they clearly don't care about healthcare in any way and are simply proposing tax cuts for billionaires and gutting the American healthcare system to pay for it.  Look at what they've actually proposed, rather than what they are saying into television cameras.

John123

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Re: What comes after the ACA?
« Reply #2820 on: June 23, 2017, 10:15:18 AM »
I'm a finance professional so I have a lot of wealthy friends (technically, we are wealthy too compared to most).  This means a good number of them fall on the conservative side of things - especially taxes etc.  When Trump won the nomination it seemed to me that the grudgingly pulled the trigger just to support "their" team.

You have actual "friends" who voted for Trump?  I don't know how I would handle that.  Incessant torment comes to mind.  Like, really next level torment.  It could've been fun, but I don't know anyone who will admit to it. :sad

dividendman

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Re: What comes after the ACA?
« Reply #2821 on: June 23, 2017, 10:44:06 AM »
I'm a finance professional so I have a lot of wealthy friends (technically, we are wealthy too compared to most).  This means a good number of them fall on the conservative side of things - especially taxes etc.  When Trump won the nomination it seemed to me that the grudgingly pulled the trigger just to support "their" team.

You have actual "friends" who voted for Trump?  I don't know how I would handle that.  Incessant torment comes to mind.  Like, really next level torment.  It could've been fun, but I don't know anyone who will admit to it. :sad

The vast majority of people who vote don't dwell on the outcome of an election. Internet forums, and especially political threads, are a self selecting group of people who are really into politics.

I know people who voted for Trump and people who voted for other candidates who don't really follow what's happening, who don't hate Clinton when they voted Trump and vice versa.

sol

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Re: What comes after the ACA?
« Reply #2822 on: June 23, 2017, 11:38:57 AM »
I know a handful of Trump voters, and without exception they all HATE Hillary Clinton.  Most them were only weakly pro-Trump and they even recognized his inexperience and his character flaws and his business conflicts of interest as weaknesses as a candidate, but they honestly thought Clinton was the devil incarnate.  It wouldn't have mattered to them what Trump said or did during the campaign (and it obviously didn't), because they would have voted for Romney or Obama our McCain or big bird, just literally anyone except Clinton.

That Russian hacking campaign really did a number on the American electorate by planting fake information into the mainstream media coverage.  Added to decades of GOP character assassination, it was enough to tip the balance in a few key states (though I remind you again that Clinton still got almost 3 million more votes than Trump did).
« Last Edit: June 23, 2017, 11:41:08 AM by sol »

EnjoyIt

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Re: What comes after the ACA?
« Reply #2823 on: June 23, 2017, 12:06:13 PM »
NESailor,

I fully agree with you.  The republican plan accomplishes very little that is positive. It just shifts the cost one more time. It will help some of the people who have been fiscally hurt by the bill and harm those who are poor.  It may also eliminate the pre-existing condition clause which would be very bad for everybody. As a fiscal conservative this is not an appropriate direction for our healthcare system. I think you and I agree much more than we disagree. But just because we disagree on some things does not make me some heartless monster that fiscal conservatives are portrayed as being.

Also, what you are seeing from your rich friends is exactly what I see here from many liberal posters. It is almost impossible to get most of them to admit that the ACA has some serious flaws that actually increased the cost of healthcare for a significant subset of the population. Despite showing clear cut examples of these people, they get ignored and then I get insulted by one of the forum members.  The blinders are on not just on the conservatives but also on the liberals.

Example:  Just a few posts above I bring up how well our private insurance industry is doing and that private insurance makes a ton of money by managing medicaid for the government. Blinders go up and I am told I am wrong.  I show examples, and I am ignored.

To really understand our political system and actually do something good, we need to step back away from the news and the media.  We need to keep open minded and look at every angle.  We need to understand how the laws affect not just one small subset of the population, but everybody.  Even those who you don't like or disagree with. This opens our mind to formulate our own opinions based on facts and all sides of the equation. At times your hard thought beliefs will be questioned which is the time to not stubbornly put your heals into the ground like you see your rich friends do, and I see so many on this forum do, but accept that information. You can admit to yourself that you may have to amend your views and that is OK. altering your beliefs a little is actually very difficult to do. It forces us to accept that maybe we were not 100% right and our minds resist that every step of the way. It is human nature and very difficult to break even when you know this phenomena exists. The best negotiators listen to the views of others and accept them as important and real to them. 

We have to admit that despite all the good the ACA has done, it also harmed many Americans.  Voting, tax paying Americans.  I'm not talking about the 1%. They weren't harmed. They can afford paying an extra $1k/month.  Once you see that, you can understand why so many Americans do not like the ACA. You can then understand why so many liberal seats were lost to republicans this last election. I see plenty of examples every day where the ACA has helped a family.  I also see every day examples of the ACA harming families.  Despite all the media mumbo jumbo I see it play out in real life and how it actually affects people. Even when forum members here point out how their costs have skyrocketed 100-300% over just a few short years, those comments are ignored and we stubbornly stick to ACA good everything else bad heal digging. I need to pause for a second and remind you that I am not a fan of the AHCA despite all those negative things I just said about Obamacare.

The only real way to fix healthcare is to fix costs, but that would not fly in our congress. Cutting costs affects the healthcare industry which spends tons of money lobbying on both sides of the isle.  Imagine removing unnecessary healthcare on the brain dead with no quality of life.  Imagine we stop spending money uselessly on the super users/abusers of the system.  Some studies show it can drop healthcare spending by over 20%. 20% reduction would fix all our problems and even allow returning taxes
back to the way they were before the ACA was enacted. There are so many other great ways to decrease cost and spending which can be done over time so as to not create too much turbulence in the economy.  So simple, but it will never happen. Our politicians are crooks and we need to accept that before we move on.

accolay

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Re: What comes after the ACA?
« Reply #2824 on: June 23, 2017, 12:42:16 PM »
NESailor,
But just because we disagree on some things does not make me some heartless monster that fiscal conservatives are portrayed as being.
Dude, everyone on this forum is a "fiscal conservative." I think you've lost the plot. Nobody is arguing that the ACA is perfect just that it is a step in the right direction. The "liberals" are arguing for single payer- the only way this is going to be fair. Instead of Republicans fixing anything with their "Health" care bill, they're going to destroy any progress on making anything affordable, and we're going to go back to a system like we had before: Soup Sandwich.
To really understand our political system and actually do something good, we need to step back away from the news and the media.  We need to keep open minded and look at every angle.  We need to understand how the laws affect not just one small subset of the population, but everybody.  Even those who you don't like or disagree with. This opens our mind to formulate our own opinions based on facts and all sides of the equation. At times your hard thought beliefs will be questioned which is the time to not stubbornly put your heals into the ground like you see your rich friends do, and I see so many on this forum do, but accept that information. You can admit to yourself that you may have to amend your views and that is OK. altering your beliefs a little is actually very difficult to do. It forces us to accept that maybe we were not 100% right and our minds resist that every step of the way. It is human nature and very difficult to break even when you know this phenomena exists. The best negotiators listen to the views of others and accept them as important and real to them. 
Excellent advice for the party in power.

meatface

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Re: What comes after the ACA?
« Reply #2825 on: June 23, 2017, 01:33:37 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

protostache

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Re: What comes after the ACA?
« Reply #2826 on: June 23, 2017, 01:45:53 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.


sol

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Re: What comes after the ACA?
« Reply #2827 on: June 23, 2017, 01:49:46 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Significantly worse, if you're poor or elderly.  About the same as pre-ACA (which is to say, not good) for most middle class people.

Not only does it undo all of the ACA coverage gains and cost controls, it also cuts Medicaid funding to levels way below what they were before the ACA.

To the non-Medicaid population, it will be very similar to what things were like before the ACA.  Except labour unions would be taxed more, planned parenthood would be defunded, and abortion coverage would be prohibited for everyone including private insurance plans.  Insurance costs will be higher but you'd get a (smaller than ACA) tax credit on the individual market to help offset part of it.

Really though, it's the Medicaid cuts that are most severe.  They're overturning an entitlement program that is over half a century old, converting it to per capita block grants, reducing the future funding per person to shrink it over time, and giving states the option to end it entirely.

Most of the cuts are set to phase in slowly, after the politicians who vote for them are out of office or at least until after the next election cycle.

nereo

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Re: What comes after the ACA?
« Reply #2828 on: June 23, 2017, 01:52:12 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Well the answer depends on how you define "better/worse"
Both the Senate and House bill will ultimately result in tens of millions having no medical coverage, mostly by shrinking Medicare.  It will also allow insurers to sell policies that cover very little.  So in terms of defining it as a health-care/health-insurance bill it will be much, much worse than what the ACA offers.

However, to be fair the plan will drastically cut government entitlements and reduce taxes on the wealthiest.  It will also allow states to have a lot more freedom with how they manage Medicare dollars.  So it will reduce government expenditures by hundreds-of-billions and also reduce taxation.  Some will call that "better", but that's looking at it from a (limited) financial lens.  If you are of the mindset that the government should both do less and tax less it could be considered a win.


sol

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Re: What comes after the ACA?
« Reply #2829 on: June 23, 2017, 02:01:42 PM »
So it will reduce government expenditures by hundreds-of-billions and also reduce taxation. 

NO!  It doesn't reduce government expenditures AT ALL.  It just redirects those expenditures, and gives them to rich people as tax breaks instead of giving it to poor people as subsidized health insurance.

If they were actually taking health insurance away from people for fiscal reasons, and using the savings to reduce the deficit, they would have a lot more support.  But they're not savng any money, their just spending it on rich folks instead of poor folks.  It's purely a regressive tax break for the wealthy, at the expense of the impoverished.  It's just transferring wealth up the economic ladder.  It's classic republicanism in action.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2830 on: June 23, 2017, 02:01:57 PM »
Dude, everyone on this forum is a "fiscal conservative." I think you've lost the plot. Nobody is arguing that the ACA is perfect just that it is a step in the right direction. The "liberals" are arguing for single payer- the only way this is going to be fair. Instead of Republicans fixing anything with their "Health" care bill, they're going to destroy any progress on making anything affordable, and we're going to go back to a system like we had before: Soup Sandwich.

This sight is fiscally conservative when it comes to themselves but not the government.  Many here are willing to tax more and spend more if it helps their social beliefs which is not fiscally conservative. I disagree with the need to tax more until we clean up the waste currently plaguing our government. 

Republicans are making it more affordable for one group and making it less affordable for another.  Just like the ACA did.  They are cost shifting instead of doing anything of real value. Personally I am a little skeptical of single payer but eager to see what it does in California if it passes. If it succeeds I will have no problem saying I am wrong. The reason I think single payor will fail is because it will do little to nothing to address the real problem which is the overall cost of healthcare. It makes no difference who pays for it if it is too expensive.

Just remember private insurance runs medicaid/medicare in many locations therefor private insurance will still be taking their cut of profit no matter who is actually paying the bills.

I am eager to see what happens next.

Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?


It depends: For some it will be much worse, for some it will be much better, and for others it will make no difference at all.

wenchsenior

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Re: What comes after the ACA?
« Reply #2831 on: June 23, 2017, 02:10:28 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.


EnjoyIt

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Re: What comes after the ACA?
« Reply #2832 on: June 23, 2017, 02:12:14 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

I think we are confusing 2 government programs both of which are run by CMS:
Medicaid: Health insurance for the poor and disabled
Medicare: Health insurance for the 65 and over which is mandatory for everyone over 65.

wenchsenior

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Re: What comes after the ACA?
« Reply #2833 on: June 23, 2017, 02:14:33 PM »
So it will reduce government expenditures by hundreds-of-billions and also reduce taxation. 

NO!  It doesn't reduce government expenditures AT ALL.  It just redirects those expenditures, and gives them to rich people as tax breaks instead of giving it to poor people as subsidized health insurance.

If they were actually taking health insurance away from people for fiscal reasons, and using the savings to reduce the deficit, they would have a lot more support.  But they're not savng any money, their just spending it on rich folks instead of poor folks.  It's purely a regressive tax break for the wealthy, at the expense of the impoverished.  It's just transferring wealth up the economic ladder.  It's classic republicanism in action.

Pretty much.

People have got to get it through their heads. The ONLY thing that this current GOP congress appears interested in doing is tax cuts for the wealthy.  And no matter what bill they take up, rest assured, the underlying focus of the bill will be tax cuts for the wealthy, rather than whatever the bill is supposed to be about.  Even the new infrastructure plan to MAGA that is being discussed is taking the form of tax cuts to businesses as incentives for them to take on infrastructure projects.

protostache

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Re: What comes after the ACA?
« Reply #2834 on: June 23, 2017, 02:14:50 PM »
Republicans are making it more affordable for one group and making it less affordable for another.  Just like the ACA did.

No! You're wrong! This is not a "both sides do it" issue! ACA lifted people up who would otherwise not be able to afford health care. This bill would send those people back to the quiet hell of home remedies and duct taping wounds together because a to the ER is as realistic as a jaunt to the moon. This bill would send people back to the days of dying of unknown causes because they can't afford to see a doctor about the pain that turns out to be colon cancer. This bill would curse everyone with an elderly parent to directly caring for them making it impossible for them to hold down a job, which disproportionally affects women (because caring for elderly parents is women's work, you see).

Quote
The reason I think single payor will fail is because it will do little to nothing to address the real problem which is the overall cost of healthcare. It makes no difference who pays for it if it is too expensive.

Cost control is only possible with sufficient leverage. Nobody has that leverage right now because nobody has systemic control. Single payer, and to a lesser extent Medicare and Medicare Advantage, give a single entity enough leverage to bring down prices by force, which is not something that will ever happen in the fucked up sort of but not really market based system we have today and will have as the result of this legislation.

Quote
I am eager to see what happens next.

Tens of thousands of people each year are going to die completely unnecessary avoidable deaths because of this legislation. I'm not eager for any of this.

Gin1984

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Re: What comes after the ACA?
« Reply #2835 on: June 23, 2017, 02:14:59 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

I think we are confusing 2 government programs both of which are run by CMS:
Medicaid: Health insurance for the poor and disabled
Medicare: Health insurance for the 65 and over which is mandatory for everyone over 65.
No, we are not
Enjoy, you really keep making pronouncements and people keep proving you wrong.  I really think you need to look more in depth in this instead of assuming you actually know this stuff.

wenchsenior

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Re: What comes after the ACA?
« Reply #2836 on: June 23, 2017, 02:16:44 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

I think we are confusing 2 government programs both of which are run by CMS:
Medicaid: Health insurance for the poor and disabled
Medicare: Health insurance for the 65 and over which is mandatory for everyone over 65.

Holy shit. Didn't you say you were a doctor? And you don't know this stuff?  : mind: fucking: boggled:

NO.  MediCAID pays for long term care. NOT MEDICARE.

How can you post so much and be so ignorant? It is astonishing.

TrudgingAlong

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Re: What comes after the ACA?
« Reply #2837 on: June 23, 2017, 02:17:15 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

I've been wondering the same thing! Good question.

protostache

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Re: What comes after the ACA?
« Reply #2838 on: June 23, 2017, 02:19:40 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

I think we are confusing 2 government programs both of which are run by CMS:
Medicaid: Health insurance for the poor and disabled
Medicare: Health insurance for the 65 and over which is mandatory for everyone over 65.

Wrong! You're supposedly a medical provider that supposedly knows all this crap and you don't know what Medicaid does? Why are we even having this discussion?

Medicaid is for poor and disabled people. The biggest single use of Medicaid funds is for old age nursing home care for poor seniors. Do you understand how they got to be poor?

By spending all of their money on nursing homes.

My father in law is going through this process right now, my grandmother went through it a few years ago, and my grandfather was in the process but now he's in hospice. It goes by the euphemism "spend down", but the reality is that every single person who needs skilled end of life nursing care will spend their entire life savings on that care before Medicaid kicks in (because, you see, now they are poor) and pays for it until they die. And this Senate bill will make it so that last part doesn't actually happen, so elderly people will rely on children to take care of them, 24/7/365, until they die. Or the children will pay out of pocket for nursing home care. It's a literal nightmare even today and I don't understand how anyone would even fathom making it worse, but here we are.
« Last Edit: June 23, 2017, 02:21:39 PM by protostache »

BFGirl

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Re: What comes after the ACA?
« Reply #2839 on: June 23, 2017, 02:21:53 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

If long term care under Medicaid gets cut, there will be a lot of homeless elderly on the street.

As far as having to pay for parents and grandparents, is there a reference to this being a legal obligation or is this mainly a moral obligation that we are talking about?

(This actually will effect how I do my job and that is why I ask)

protostache

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Re: What comes after the ACA?
« Reply #2840 on: June 23, 2017, 02:24:53 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

If long term care under Medicaid gets cut, there will be a lot of homeless elderly on the street.

As far as having to pay for parents and grandparents, is there a reference to this being a legal obligation or is this mainly a moral obligation that we are talking about?

(This actually will effect how I do my job and that is why I ask)

Look up "filial responsibility" laws. Currently Medicaid payments are considered "payment in full" for nursing home care, but if Federal cost sharing stops coming in look for state laws to start changing. Look for states with filial responsibility laws on the books to start enforcing them and for states that don't have them to enact them. If I were in charge of a state budget and the Federal cost sharing money that I depend on started drying up, that is exactly where I would start.

wenchsenior

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Re: What comes after the ACA?
« Reply #2841 on: June 23, 2017, 02:26:54 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

If long term care under Medicaid gets cut, there will be a lot of homeless elderly on the street.

As far as having to pay for parents and grandparents, is there a reference to this being a legal obligation or is this mainly a moral obligation that we are talking about?

(This actually will effect how I do my job and that is why I ask)

It's going to depend on whether the elder person just dies at home or on the street, or seeks care that they can't pay for or run out of money for...after that it would depend on whether the state had filial support laws on the books (some do now), and how/whether they decided to enforce them by coming after the elderly person's kids for payment of bills due.

EnjoyIt

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Re: What comes after the ACA?
« Reply #2842 on: June 23, 2017, 02:37:45 PM »
My apologies I misunderstood the topic which did indeed make me look foolish.  Egg on my face.
Medicare covers the medical care in hospitals for those over 65. Which means those people will get medical attention.  Yes, Medicaid covers nursing homes and long term care facilities. I do know a decent amount about our healthcare industry and fully admit I do not know everything. I did knew the above fact despite my blunder. Medicare covers cost for the first 100 days of skilled nursing.

Let me be clear...I am human and I make mistakes.
Please give me permission to make those mistakes without abetting me up too much.

Okay, just being devils advocate here: I keep clamoring about cutting cost on end of life care.  Maybe by cutting funding to long term care, we may stop putting in feeding tubes and performing unnecessary surgeries on the bed ridden practically brain dead population living in them. Unfortunately those procedures are covered by Medicare and that won't happen.

Realistically, the elderly have a very high voter turn out. If they find their friends and relatives being forced on the street when they are too old to pay for assisted living or nursing home every republican will be out of office.
« Last Edit: June 23, 2017, 02:48:17 PM by EnjoyIt »

nereo

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Re: What comes after the ACA?
« Reply #2843 on: June 23, 2017, 02:47:08 PM »
So it will reduce government expenditures by hundreds-of-billions and also reduce taxation. 

NO!  It doesn't reduce government expenditures AT ALL.  It just redirects those expenditures, and gives them to rich people as tax breaks instead of giving it to poor people as subsidized health insurance.

Sol -
I'm not sure I read this the same way.  As I understand the Senate and House bills, both reduce the government's expenditures on health care, primarily with huge (~$800B over 10 years) reductions in Medicare.  However, you are correct that it doesn't reduce the deficit because it ALSO reduces tax revenue, primarily by eliminating the Net Investment Income Tax (aka "Obamacare tax") and tax penalties for not having insurance and a number of other taxes (e.g. on tanning beds)

So - correct me if I'm wrong - but it does what I said.  It reduces the amount the US Government spends on health care while ALSO cutting taxes primarily those with the highest income.
Where have I misspoke?

For the record I think both plans are horrible.

BFGirl

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Re: What comes after the ACA?
« Reply #2844 on: June 23, 2017, 02:50:38 PM »
Someone please clarify for me, will the end result (when this passes) be worse, better, or the same as pre-Obamacare?

Thanks.

Depends on what time frame you're talking about, but after 2020 it's inarguably worse. For employer-provided and individual policies it's about the same. Individuals get some subsidies but not a whole lot. After 2020 the 10 essential health benefits sunset and states can seek waivers for any provision in the bill, including lifetime and annual caps. Large employers can get a plan in any state they want, which means some state is going to waive everything in the bill and large employers are going to flock to it because plans there will be cheaper.

The big deal is that the Senate bill effectively unwinds Medicaid as a program. It does this by capping benefits per person and then only allowing those benefits to grow at the urban CPI rate, which is significantly less than the medical inflation rate. Over (not much) time lower reimbursements from the Federal government will obliterate state government budgets, causing huge cuts in benefits to seniors, people with disabilities, not to mention people who finally got access to medical care under the Medicaid expansion.

If this bill passes, and there's little evidence to support it not passing in some form, everyone on this board, and in fact everyone in the entire country, now has to worry about paying for their parents' nursing home bills and end of life care out of pocket. How does someone plan for any kind of retirement, let alone FIRE, if they are going to be on the hook for $5,000 per month per person in 2017 dollars for one or two (or three or four, for a married couple) parents' nursing home bills? It's a gigantic step backwards for the country as a whole.

This is the part I can't believe they can sell people.

Although, most  Americans seem dumber than tree stumps, and apparently do not realize that Medicaid covers not only ~40% of births in this country ("won't someone think of the children!"), but it is paying for the end of life bills for approximately 50% of those who require it. Costs that would otherwise bankrupt most families.  For fucks sake, most people in this country don't even save for retirement, let alone end of life care.  Now, imagine that you are not only going to have to fund your own end of life care (cost of which currently runs ~40-100K/year), but that of your parents AND potentially grandparents.  It is INSANE.

If long term care under Medicaid gets cut, there will be a lot of homeless elderly on the street.

As far as having to pay for parents and grandparents, is there a reference to this being a legal obligation or is this mainly a moral obligation that we are talking about?

(This actually will effect how I do my job and that is why I ask)

Look up "filial responsibility" laws. Currently Medicaid payments are considered "payment in full" for nursing home care, but if Federal cost sharing stops coming in look for state laws to start changing. Look for states with filial responsibility laws on the books to start enforcing them and for states that don't have them to enact them. If I were in charge of a state budget and the Federal cost sharing money that I depend on started drying up, that is exactly where I would start.

Yep, I looked those up while you were posting.  It is scary stuff.  My state doesn't have them yet, so that's why I am not as familiar.  However, I read an article by an attorney in my state that discussed the probability that filial support laws in one state could be used to go after a child in another state without those laws.  It is indeed a scary proposition.  Maybe I just need to start living paycheck to paycheck and spend my savings on lots of fun things, lol.  ;-)

protostache

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Re: What comes after the ACA?
« Reply #2845 on: June 23, 2017, 02:55:47 PM »
Let me be clear...I am human and I make mistakes.
Please give me permission to make those mistakes without abetting me up too much.

Fuck that. You don't get to come in here and make these grand pronouncements and take devils advocate positions without knowing the barest minimum about the topic at hand. I'll take your word that you're a well educated medical professional, but every single post you've made in this thread reveals just a little more that you know nothing about how the macro system works, nor what an ordinary person actually experiences while navigating the system.

We're talking about at least tens of millions of people's financial and bodily well being. Maybe this is just some game to you because you've got doctor money, but it's life and death for so many people, probably including people in this thread. Please have some respect and educate yourself before continuing to post.
« Last Edit: June 23, 2017, 02:58:13 PM by protostache »

ketchup

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Re: What comes after the ACA?
« Reply #2846 on: June 23, 2017, 02:59:25 PM »
Welp, the Senate version seems pretty troubling.  Seems like a pretty big middle finger to Medicaid mostly, and just ACA-lite elsewhere (same spirit, less effective) with some anti-abortion rhetoric thrown in.  The shitty thing is that the Medicaid fuckery won't take effect for a few years, so people get to hum along like normal until the bottom falls out because of something decided years ago (now).  I hope it doesn't pass, but it sure looks like it will (in some form).

Let me be clear...I am human and I make mistakes.
Please give me permission to make those mistakes without abetting me up too much.

Fuck that. You don't get to come in here and make these grand pronouncements and take devils advocate positions without knowing the barest minimum about the topic at hand. I'll take your word that you're a well educated medical professional, but every single post you've made in this thread reveals just a little more that you know nothing about how the macro system works, nor what an ordinary person actually experiences while navigating the system.
Yeesh, he made a mistake, and he owned it.  That's plenty.

Scortius

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Re: What comes after the ACA?
« Reply #2847 on: June 23, 2017, 03:09:19 PM »
Let me be clear...I am human and I make mistakes.
Please give me permission to make those mistakes without abetting me up too much.

Fuck that. You don't get to come in here and make these grand pronouncements and take devils advocate positions without knowing the barest minimum about the topic at hand. I'll take your word that you're a well educated medical professional, but every single post you've made in this thread reveals just a little more that you know nothing about how the macro system works, nor what an ordinary person actually experiences while navigating the system.

We're talking about at least tens of millions of people's financial and bodily well being. Maybe this is just some game to you because you've got doctor money, but it's life and death for so many people, probably including people in this thread. Please have some respect and educate yourself before continuing to post.

I'd give him a bit more of a break.  Without EnjoyIt, there wouldn't even be a discussion here, which I feel I've learned a lot from.  He should get some credit for being willing to come back and discuss his side in the face of such opposition.  I've been impressed with the civility that he and Sol have been able to maintain throughout this huge thread.  Plus, the whole point of debates in good faith is to find the areas where disagreements come from to better educate both sides.

As for the bill, yes, it's utter insanity.  But, given that half the country seems to think this is a positive step forward, I'm not sure what else can be done to move the USA towards a modern health care system other than letting this law pass so that people can see the consequences.  Currently people are blaming things on ObamaCare that were simply going to suck regardless of whether or not the ACA passed.  Perhaps once the Republicans get a shot at fixing things and fail, people will realize that the true solution to the problems people are upset about will require a solution more in line with our foreign peers.  It's sad and cynical and really morally reprehensible, but at this point I just don't see another way out.

sol

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Re: What comes after the ACA?
« Reply #2848 on: June 23, 2017, 03:16:51 PM »
So - correct me if I'm wrong - but it does what I said.  It reduces the amount the US Government spends on health care while ALSO cutting taxes primarily those with the highest income.
Where have I misspoke?

For the record I think both plans are horrible.

You're not wrong.  It's just a matter of spin. 

The government spends money on lots of physical things, like tanks and roads, but also on programs that give away money as tax breaks, like agricultural subsidies and the mortgage interest deduction.  Both are "spending" when they have to balance the books.

From an accountant's perspective, you can ruin your budget by decreasing your cash coming in or by increasing your cash going out.  In the case of the republican health care bill (either one), they want to decrease their cash going out (subsidizing health insurance for poor people) but also decrease their cash coming in (by giving tax breaks to billionaires).

Conservatives will spin this as two positives, because they are philosophically committed to reducing the size of government, despite it making no net change.  They will say that cutting healthcare is good because it reduces spending (and they like that it hurts morally inferior poor people) and that cutting taxes is good (because it helps virtuous rich people) even though the two cancel out, in a financial (though not ethical) sense.

I'm merely pointing out that they are choosing to spend that money on tax breaks for billionaires, just like they could have spent it on agricultural subsidies or mortgage interest deductions or deficit reduction.  They took the savings from reducing healthcare coverage for the poor and elderly and funneled it into a program that helps people making more than $250k per year.  They didn't really save it, they just spent it somewhere else.
« Last Edit: June 23, 2017, 03:19:08 PM by sol »

chasesfish

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Re: What comes after the ACA?
« Reply #2849 on: June 23, 2017, 03:25:15 PM »
Reading these comments, its interesting the term "spending money" on people who make more than $250,000 is used.  I'm curious how letting someone keep money is an expense...

Anyways, both sides still suck.   There are only two country examples we can easily convert our healthcare system into, Costa Rica or Switzerland.

Costa Rica = Government run hospitals for the poor and everyone else has private insurance.  Just convert the VA hospital system and move on.
Switzerland - Mandated insurance.  No proof of insurance, no ID, no tax refund, nothing.

Unfortunately both of those options require political will and courage, which neither side has.  They're still busy promising everyone better/free healthcare with no taxes/mandates.