Author Topic: What comes after the ACA?  (Read 820620 times)

tyort1

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Re: What comes after the ACA?
« Reply #3150 on: July 16, 2017, 08:05:24 PM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

Lance Burkhart

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Re: What comes after the ACA?
« Reply #3151 on: July 16, 2017, 08:28:57 PM »
  There is so far no proof that OUR government will handle single payer well. 

Just not accurate.

Private health insurers have huge overhead
  • Ridiculously high executive pay
  • Marketing costs
  • Attempts to cherry-pick clients


On the other hand the government program of Medicare is extremely efficient.
Private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare.

You see only two options: health insurance or single-payer.  On my other thread, I have some ideas for eliminating the need for health insurance. 

In 2015, Medicare was a $644 billion entitlement with 55.3 million beneficiaries for a total cost per person of roughly ~$11k.  This is roughly the same or slightly more efficient than the average cost of premiums + deductibles for those buying private insurance in that year.  Medicare DOES cover the aged who are expensive to insure.  It does this, however, by taxing everyone who works and employers to pay for those who are no longer working.  You're talking about a lot more taxes on employees and employers to pay for everyone who's working and the aged and disabled.  Will this also cover the non-working?  There are - what? - 100 million people in the workforce out of a country of 320 million.  There are 100 million people not in the workforce. 

In summary, Medicare is a $600 billion entitlement that covers only 17% of the population.  Multiplying $600 billion by 5 gives you the back-of-the-envelope cost of insuring everyone ($3 trillion).  The IRS took in only $3 trillion last year, didn't it? The cost of providing single payer to just California was estimated to be $400 billion (our legislature is trying to figure out how to pay for this).  We have roughly 40 million people or 12.5 % of the population. 

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3152 on: July 16, 2017, 08:54:35 PM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

That's a good point. As it now stands with the ACA, the lower the income the more the subsidy you get. In essence it's like a tax rate that you add on.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3153 on: July 16, 2017, 08:56:32 PM »

Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3154 on: July 16, 2017, 09:02:56 PM »
  There is so far no proof that OUR government will handle single payer well. 

Just not accurate.

Private health insurers have huge overhead
  • Ridiculously high executive pay
  • Marketing costs
  • Attempts to cherry-pick clients


On the other hand the government program of Medicare is extremely efficient.
Private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare.

You see only two options: health insurance or single-payer.  On my other thread, I have some ideas for eliminating the need for health insurance. 

In 2015, Medicare was a $644 billion entitlement with 55.3 million beneficiaries for a total cost per person of roughly ~$11k.  This is roughly the same or slightly more efficient than the average cost of premiums + deductibles for those buying private insurance in that year.  Medicare DOES cover the aged who are expensive to insure.  It does this, however, by taxing everyone who works and employers to pay for those who are no longer working.  You're talking about a lot more taxes on employees and employers to pay for everyone who's working and the aged and disabled.  Will this also cover the non-working?  There are - what? - 100 million people in the workforce out of a country of 320 million.  There are 100 million people not in the workforce. 

In summary, Medicare is a $600 billion entitlement that covers only 17% of the population.  Multiplying $600 billion by 5 gives you the back-of-the-envelope cost of insuring everyone ($3 trillion).  The IRS took in only $3 trillion last year, didn't it? The cost of providing single payer to just California was estimated to be $400 billion (our legislature is trying to figure out how to pay for this).  We have roughly 40 million people or 12.5 % of the population.

I agree the cost of health care has to come down. I also don't think you can extrapolate the cost of 65 and older population to what the healthcare costs are going to be for those younger than that. Younger are going to have considerably lower health care costs on average. Many younger won't have any health care needs for years or decades. In fact you could probably just double the current cost of Medicare to cover the other 75% of people.

jim555

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Re: What comes after the ACA?
« Reply #3155 on: July 17, 2017, 11:02:37 AM »
I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.

Doesn't MAGI ignore the tIRA deduction?
No.  tIRA deductions reduce MAGI.

maizeman

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Re: What comes after the ACA?
« Reply #3156 on: July 17, 2017, 11:07:31 AM »
In summary, Medicare is a $600 billion entitlement that covers only 17% of the population.  Multiplying $600 billion by 5 gives you the back-of-the-envelope cost of insuring everyone ($3 trillion).  The IRS took in only $3 trillion last year, didn't it? The cost of providing single payer to just California was estimated to be $400 billion (our legislature is trying to figure out how to pay for this).  We have roughly 40 million people or 12.5 % of the population.

I agree the cost of health care has to come down. I also don't think you can extrapolate the cost of 65 and older population to what the healthcare costs are going to be for those younger than that. Younger are going to have considerably lower health care costs on average. Many younger won't have any health care needs for years or decades. In fact you could probably just double the current cost of Medicare to cover the other 75% of people.

That's actually pretty good considering that we spend $3.2 trillion a year on giving most (but not everyone) healthcare right now. And as DAA points out, taking care of folks on Medicare is going to be significantly more expensive per head than younger healthier people.

MDM

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Re: What comes after the ACA?
« Reply #3157 on: July 17, 2017, 11:12:11 AM »
I am self-employed so I know it's not easy. A lot of money is dumped into the solo 401k, both as employee and employer, as well as HSA, tIRA.
Doesn't MAGI ignore the tIRA deduction?
No.  tIRA deductions reduce MAGI.
Yes, tIRA deductions reduce the MAGI for ACA purposes.  See https://www.healthcare.gov/income-and-household-information/income/

What's confusing is there are multiple MAGIs, with each "Modified" in slightly different ways.  E.g., in the MAGI for tIRA deductibility the tIRA itself does not affect that MAGI.

brooklynguy

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Re: What comes after the ACA?
« Reply #3158 on: July 17, 2017, 11:32:48 AM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

I'll take this post as my cue to insert another reminder that the extra withdrawals needed to service a mortgage loan do not necessarily translate into extra income on a dollar-for-dollar basis, a point which is often overlooked, leading folks to overstate the adverse tax/subsidy impact of retaining a mortgage loan in retirement (feel free to follow the rabbit hole of links embedded within the linked post for more detail and discussion on this point).

Exflyboy

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Re: What comes after the ACA?
« Reply #3159 on: July 17, 2017, 11:52:56 AM »
Also if you select a plan with an HSA you can make a further MAGI deduction for that year.

JLee

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Re: What comes after the ACA?
« Reply #3160 on: July 17, 2017, 03:46:18 PM »
http://www.abc.net.au/news/2017-07-17/australian-healthcare-ranked-second-best-in-developed-world/8716326

This seems somewhat relevant to the overall discussion.  The US spends a lot of money on health care and really does a poor job overall.

Exflyboy

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Re: What comes after the ACA?
« Reply #3161 on: July 17, 2017, 04:14:49 PM »
http://www.abc.net.au/news/2017-07-17/australian-healthcare-ranked-second-best-in-developed-world/8716326

This seems somewhat relevant to the overall discussion.  The US spends a lot of money on health care and really does a poor job overall.

Massive understatement.. its shyte!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3162 on: July 17, 2017, 06:43:43 PM »
Lower your MAGI down and you get health insurance covered. Sounds perfectly valid to me.
That's not so easy if you are still employed, if you are living of your money, much easier.

Another reason to have your house paid off before FIRE - once the mortgage is gone, it's pretty easy to live off $40k per year and not really feel deprived.  If you have a mortgage after FIRE, you have to withdraw a lot more, which disqualifies you for subsidies and lower tax rates.

I'll take this post as my cue to insert another reminder that the extra withdrawals needed to service a mortgage loan do not necessarily translate into extra income on a dollar-for-dollar basis, a point which is often overlooked, leading folks to overstate the adverse tax/subsidy impact of retaining a mortgage loan in retirement (feel free to follow the rabbit hole of links embedded within the linked post for more detail and discussion on this point).

That was a fun little Easter egg hunt.

If one sells taxable stock accounts to pay for the mortgage, then that's true that all of that money will not be taxable as some of it is the cost basis of buying the stock that gets returned to you.



Lance Burkhart

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Re: What comes after the ACA?
« Reply #3163 on: July 17, 2017, 08:10:25 PM »
Quote
Younger are going to have considerably lower health care costs on average. Many younger won't have any health care needs for years or decades. In fact you could probably just double the current cost of Medicare to cover the other 75% of people.

I have 3 kids - all healthy - and they've been anything but cheap.  They were expensive to deliver and they injure themselves often.  It costs a fortune to have a baby in this country.

Mr. Green

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Re: What comes after the ACA?
« Reply #3164 on: July 17, 2017, 08:43:51 PM »
Looks like the current Senate bill is dead, once again. I can't help but wonder how long this process is going to linger.

http://www.msn.com/en-us/news/politics/2-more-gop-senators-oppose-health-bill-killing-it-for-now/ar-BBECpPW?li=BBnb7Kz

Exflyboy

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Re: What comes after the ACA?
« Reply #3165 on: July 17, 2017, 09:35:54 PM »
Looks like the current Senate bill is dead, once again. I can't help but wonder how long this process is going to linger.

http://www.msn.com/en-us/news/politics/2-more-gop-senators-oppose-health-bill-killing-it-for-now/ar-BBECpPW?li=BBnb7Kz

Who knows maybe they will work on something that will actually reduce costs rather than push the existing enourmous cost around to different players.

Naah, that will never happen!

jim555

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Re: What comes after the ACA?
« Reply #3166 on: July 17, 2017, 11:55:40 PM »
Turtle threw in the towel.  It dies yet another time!  How long until ZombiTrumpCare 4.0 is re-animated?

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3167 on: July 18, 2017, 04:35:46 AM »
Turtle threw in the towel.  It dies yet another time!  How long until ZombiTrumpCare 4.0 is re-animated?

He's already talking about resurrecting the first option that failed: "clean" repeal with a delayed replacement.  Supposedly this will force Democrats to vote for the replacement out of fear that they will get blamed for "obstructing" something that will only increase the uninsured by 22 million instead of the 30-something gajillion more that repeal-only would leave in the cold.  So we've come full circle back to what we were talking about in January.  The pundits are already predicting that this tactic will fail again.

Personally, I think the circus will continue until the repubs lose control of one of the two houses of Congress, or the presidency, or until they gain a 60-vote supermajority in the Senate.

protostache

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Re: What comes after the ACA?
« Reply #3168 on: July 18, 2017, 06:19:27 AM »
Turtle threw in the towel.  It dies yet another time!  How long until ZombiTrumpCare 4.0 is re-animated?

He's already talking about resurrecting the first option that failed: "clean" repeal with a delayed replacement.  Supposedly this will force Democrats to vote for the replacement out of fear that they will get blamed for "obstructing" something that will only increase the uninsured by 22 million instead of the 30-something gajillion more that repeal-only would leave in the cold.  So we've come full circle back to what we were talking about in January.  The pundits are already predicting that this tactic will fail again.

Personally, I think the circus will continue until the repubs lose control of one of the two houses of Congress, or the presidency, or until they gain a 60-vote supermajority in the Senate.

Or McConnell continues his campaign of destruction and nukes the filibuster for legislation and then he can try to whatever old thing he wants without threat of obstruction from the minority.

nereo

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Re: What comes after the ACA?
« Reply #3169 on: July 18, 2017, 06:30:31 AM »
.. or maybe he'll try to work with democrats, as he has 'threatened' to do...

DarkandStormy

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Re: What comes after the ACA?
« Reply #3170 on: July 18, 2017, 07:33:52 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.

nereo

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Re: What comes after the ACA?
« Reply #3171 on: July 18, 2017, 08:02:11 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...

Exflyboy

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Re: What comes after the ACA?
« Reply #3172 on: July 18, 2017, 08:13:23 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

nereo

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Re: What comes after the ACA?
« Reply #3173 on: July 18, 2017, 08:32:10 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

I agree that the ACA (and the AHCA) don't do a very good job of this, BUT I think this ought to be done with two seperate pieces of legislation.  One (the ACA - ideally tweaked for improvements) which increases health care coverage, and an entirely different bill that would address why the system is so damn expensive.  Heck, here's where the GOP could really make their mark (if they had the clout and balls, which I don't think they do right now). The "Medical Affordability Act".  Here they can pass long ballyhooed legislation about limiting liability and 'needless' beautification projects in hospitals, but also stuff like corporate profits (they won't touch this with a 100' pole), preventative medicine (again, good prevention limits profits down the road), medical school cost (not likely), doctor compensation (also not likely), allowing more foreign-born & trained doctors to fill staffing needs, particularly in rural areas (unlikely with this WH and congress afraid of immigration), drug costs (see profits, above), etc.

tl/dr: we need an entirely seperate piece of legislation to further reduce medical costs in the US.  It seems unlikely to happen.

Exflyboy

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Re: What comes after the ACA?
« Reply #3174 on: July 18, 2017, 08:44:15 AM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

I agree that the ACA (and the AHCA) don't do a very good job of this, BUT I think this ought to be done with two seperate pieces of legislation.  One (the ACA - ideally tweaked for improvements) which increases health care coverage, and an entirely different bill that would address why the system is so damn expensive.  Heck, here's where the GOP could really make their mark (if they had the clout and balls, which I don't think they do right now). The "Medical Affordability Act".  Here they can pass long ballyhooed legislation about limiting liability and 'needless' beautification projects in hospitals, but also stuff like corporate profits (they won't touch this with a 100' pole), preventative medicine (again, good prevention limits profits down the road), medical school cost (not likely), doctor compensation (also not likely), allowing more foreign-born & trained doctors to fill staffing needs, particularly in rural areas (unlikely with this WH and congress afraid of immigration), drug costs (see profits, above), etc.

tl/dr: we need an entirely seperate piece of legislation to further reduce medical costs in the US.  It seems unlikely to happen.

Bingo!

jim555

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Re: What comes after the ACA?
« Reply #3175 on: July 18, 2017, 09:29:39 AM »
Sounds like commie price controls = unfreedom!  Nothing is going to be done, these guys are well greased.

TrudgingAlong

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Re: What comes after the ACA?
« Reply #3176 on: July 18, 2017, 10:07:46 AM »
Never have I been more grateful we decided to stay the course to military retirement, as miserable as that choice can be at times.

nereo

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Re: What comes after the ACA?
« Reply #3177 on: July 18, 2017, 10:12:30 AM »
Well here's what DJT had to say about it on Twitter a few hours ago (emphasis added):
Quote from: Trump
“We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!”

So: it's all Dems fault that they didn't want to destroy their own signature healthcare law. ::eyeroll::
Note the stress on loyalty.  Substance doesn't enter into it, just whether you were loyal and worked hard.

This was followed up by him urging to "let Obamacare Fail".  Am I the only one disgusted at the thought of routing for failure of the healthcare people depend on just because your own bill was so unpopular?

Mr. Green

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Re: What comes after the ACA?
« Reply #3178 on: July 18, 2017, 12:34:06 PM »
Well here's what DJT had to say about it on Twitter a few hours ago (emphasis added):
Quote from: Trump
“We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!”

So: it's all Dems fault that they didn't want to destroy their own signature healthcare law. ::eyeroll::
Note the stress on loyalty.  Substance doesn't enter into it, just whether you were loyal and worked hard.

This was followed up by him urging to "let Obamacare Fail".  Am I the only one disgusted at the thought of routing for failure of the healthcare people depend on just because your own bill was so unpopular?
In order to be "let down" the expectation of cooperation has to exist first. Since that was never there in the first place, being let down is a misnomer.

nereo

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Re: What comes after the ACA?
« Reply #3179 on: July 18, 2017, 12:50:35 PM »

You really need to treat him like he is your crazy grandpa.  At some point, old people get cranky and say random things that don't make any sense.  You just smile and nod at their racist, sexist comments.  Because they are really old and don't know what they are saying and are going to die before you do.

AFAIK, my grandpa does not have any nuclear weapons, nor can he alter the lives of millions just by signing his name.

Mr. Green

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Re: What comes after the ACA?
« Reply #3180 on: July 18, 2017, 01:38:04 PM »

jim555

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Re: What comes after the ACA?
« Reply #3181 on: July 18, 2017, 01:40:46 PM »

ZiziPB

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Re: What comes after the ACA?
« Reply #3182 on: July 18, 2017, 02:10:11 PM »
It looks like a simple repeal vote is going to fail too.

https://www.usatoday.com/story/news/politics/2017/07/18/senate-plan-repeal-obamacare-already-jeopardy/487671001/
That lasted all of 5 hours.
Yup, now our "president" is tweeting that he's just going to let Obamacare fail (read: the Republicans are going to sabotage it so that they can make sure it fails)...

Mr. Green

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Re: What comes after the ACA?
« Reply #3183 on: July 18, 2017, 02:34:27 PM »
It looks like a simple repeal vote is going to fail too.

https://www.usatoday.com/story/news/politics/2017/07/18/senate-plan-repeal-obamacare-already-jeopardy/487671001/
That lasted all of 5 hours.
Yup, now our "president" is tweeting that he's just going to let Obamacare fail (read: the Republicans are going to sabotage it so that they can make sure it fails)...
Now that they've basically exhausted all their other options it seems like allowing it to fail would be political suicide. They already have multiple insurance companies on record stating the situation is tenuous in some states because of the non-committal attitude coming from Washington, not because of the actual insurance process itself. I don't know how you spin that into something that doesn't lose votes next year, especially as people start to become affected by destabilized markets.

dividendman

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Re: What comes after the ACA?
« Reply #3184 on: July 18, 2017, 04:26:46 PM »
It looks like a simple repeal vote is going to fail too.

https://www.usatoday.com/story/news/politics/2017/07/18/senate-plan-repeal-obamacare-already-jeopardy/487671001/
That lasted all of 5 hours.
Yup, now our "president" is tweeting that he's just going to let Obamacare fail (read: the Republicans are going to sabotage it so that they can make sure it fails)...
Now that they've basically exhausted all their other options it seems like allowing it to fail would be political suicide. They already have multiple insurance companies on record stating the situation is tenuous in some states because of the non-committal attitude coming from Washington, not because of the actual insurance process itself. I don't know how you spin that into something that doesn't lose votes next year, especially as people start to become affected by destabilized markets.

Well, most of the areas that are at risk of losing all insurers in the ACA markets are in areas that voted for Trump.... so they are getting what they want I guess.

Exflyboy

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Re: What comes after the ACA?
« Reply #3185 on: July 18, 2017, 06:16:31 PM »
Apparently the right wing media (Rush Limbagh is the one I heard) is accusing the GOP Republicans of basically sabotaging Trump's grand plan.

Oh and the ACA is evil and we're all going to Hell etc.

I could almost see the guy foaming at the mouth. If it wasn't so serious it would be quite funny.

BTDretire

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Re: What comes after the ACA?
« Reply #3186 on: July 18, 2017, 06:37:43 PM »
 All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?

wenchsenior

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Re: What comes after the ACA?
« Reply #3187 on: July 18, 2017, 06:39:51 PM »
Apparently the right wing media (Rush Limbagh is the one I heard) is accusing the GOP Republicans of basically sabotaging Trump's grand plan.

Oh and the ACA is evil and we're all going to Hell etc.

I could almost see the guy foaming at the mouth. If it wasn't so serious it would be quite funny.

Hopefully he'll work himself into a fatal aneurysm.

ixtap

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Re: What comes after the ACA?
« Reply #3188 on: July 18, 2017, 06:42:43 PM »
All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?

You seem to think that only the exchanges are covered under the ACA. It affects your insurance even if you are covered through your employment.

Could it be you don't understand the disruption because you don't understand ACA?

protostache

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Re: What comes after the ACA?
« Reply #3189 on: July 18, 2017, 07:07:39 PM »
All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?

ACA completely changed the fabric of the health care system in this country. It affects anyone getting insurance on the individual market, group market, and Medicaid. It changed how Medicare works in a few ways as well. It is an incredibly important and far reaching piece of legislation and I'm astounded that you're trying to minimize seventeen million people losing health insurance coverage. Why do you think it's such a big deal to repeal it? Why do you think it's so hard for the Republicans to execute their seven year vision?

It's because going backwards isn't a realistic option. Nobody actually wants what we had before, not when you really dig into the nitty gritty. People want affordable comprehensive healthcare, and in this country right now we mostly deliver that via private insurance. The ACA is a workable system of compromises that mostly delivers what it promised. Fixing the flaws (mostly caused by Republicsn ratfucking) is not a hard thing to do, but it takes compromise and discussion and effort.

jim555

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Re: What comes after the ACA?
« Reply #3190 on: July 18, 2017, 07:10:38 PM »
Just to clarify the current ACA numbers:
12,962,593 - Total Exchange QHPs and BHPs
14,409,400 - Expansion enrollees


protostache

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Re: What comes after the ACA?
« Reply #3191 on: July 18, 2017, 07:17:19 PM »
Just to clarify the current ACA numbers:
12,962,593 - Total Exchange QHPs and BHPs
14,409,400 - Expansion enrollees

Thanks. I was using the other posters numbers for simplicity, but you're right that they're totally off.

JLee

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Re: What comes after the ACA?
« Reply #3192 on: July 18, 2017, 07:31:01 PM »
The entire GOP platform for the last 7 year was "Repeal & Replace Obamacare"...and they can't do it with control of both houses of Congress.  Amazing.
It is amazing.  I'm wondering how this will get spun.  No doubt there will be lots of talk about it being Dems fault.  Shocker, they don't want to repeal their signature legislation of the last decade...
Here's where a rational person might say: where can we find common ground to get at least some support from the opposing party?  Sadly, compromise has become akin to traitorism in this day and age...


And.. How about solving the real problem of "Healthcare is just too damned expensive", rather than rearranging the deck chairs on the Titanic again.

I agree that the ACA (and the AHCA) don't do a very good job of this, BUT I think this ought to be done with two seperate pieces of legislation.  One (the ACA - ideally tweaked for improvements) which increases health care coverage, and an entirely different bill that would address why the system is so damn expensive.  Heck, here's where the GOP could really make their mark (if they had the clout and balls, which I don't think they do right now). The "Medical Affordability Act".  Here they can pass long ballyhooed legislation about limiting liability and 'needless' beautification projects in hospitals, but also stuff like corporate profits (they won't touch this with a 100' pole), preventative medicine (again, good prevention limits profits down the road), medical school cost (not likely), doctor compensation (also not likely), allowing more foreign-born & trained doctors to fill staffing needs, particularly in rural areas (unlikely with this WH and congress afraid of immigration), drug costs (see profits, above), etc.

tl/dr: we need an entirely seperate piece of legislation to further reduce medical costs in the US.  It seems unlikely to happen.

Given that the hallowed ground of the GOP is corporate profits, cutting health care costs to even the same realm as reasonable is basically a lost cause.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3193 on: July 18, 2017, 08:03:26 PM »
If the executive branch doesn't follow the law with respect to the ACA, the executive branch can be sued.

jim555

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Re: What comes after the ACA?
« Reply #3194 on: July 18, 2017, 08:14:42 PM »
Just to clarify the current ACA numbers:
12,962,593 - Total Exchange QHPs and BHPs
14,409,400 - Expansion enrollees
318,868,500 - The number of people between 18 and 64 (ACA ages)
27,371,993 - ACA enrollees
8.6% of the age group are ACA enrollees

BTDretire

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Re: What comes after the ACA?
« Reply #3195 on: July 18, 2017, 09:01:17 PM »
All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?

 
You seem to think that only the exchanges are covered under the ACA. It affects your insurance even if you are covered through your employment.

Could it be you don't understand the disruption because you don't understand ACA?

Oh I understand the ACA affected my non-ACA, non-employer, non-government policy. I'm self employed, I pay for my families policy. I had just got comfortable with the cost of my families health insurance cost after raising my deductible to $10,000* and getting my premium down to $4,512 a year. This was two years before the ACA regulations went into effect.
 In 2010 I had a 7.7% increase, in 2011 I had a 8.1% increase, then came the ACA reg's in 2012, I got a whooping 19.4% increase, 2013 it was a 21% increase and in 2014 it was 18.8% increase. That's a 72% increase in 3 years.
 But, I got these forced benefits 'cough' because of the ACA.
 I got a 'free' physical each year, (but notice it wasn't free, I paid way more for it with the premium increase.)
  I also got my $5,000,000 lifetime cap increased to unlimited. (is it right to force society to pay more tham $5,000,000 to keep me alive?)
 I get a 'free' Colonoscopy every 5 years.
 I got increased coverage for drug rehab.
I got a little more coverage for mental healthcare.
 All of those extras have saved me about $250 in doctor fees over those 5 years,
but I have paid an additional $17,070 in premium.
 I'll admit some of that $17k was because I got older.

*$10,000 deductible. I raised my deductible from $2,500 to $10,000, the lowered my premium from $9,900 to $4,512, people said I was crazy with that high deductible plan, but notice when the ACA came out most families have $12,600 deductible.
 Notice in 17 months the premium savings, paid for my $10k deductible. Plus With my high deductible plan I could deduct and HSA plan from my taxes.

BTDretire

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Re: What comes after the ACA?
« Reply #3196 on: July 18, 2017, 09:02:44 PM »
Just to clarify the current ACA numbers:
12,962,593 - Total Exchange QHPs and BHPs
14,409,400 - Expansion enrollees

Thanks. I was using the other posters numbers for simplicity, but you're right that they're totally off.
I used 2016 numbers that I found.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3197 on: July 18, 2017, 09:04:34 PM »
About a 1/3 of that increase is related to getting older, maybe even more than a 1/3

You should really take advantage of that free colonoscopy, it could save your life.

JLee

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Re: What comes after the ACA?
« Reply #3198 on: July 18, 2017, 09:51:11 PM »
All this discussion about the ACA and the actual ACA only covers about 7 million of the
320 million people in the US. (0.3%) a few million of those had insurance before the ACA and either it no longer qualified or with the subsidy the ACA was cheaper so they switched.
 There are another 10 million that were put onto Medicaid, because they were below the income threshold to qualify for the ACA.
 Seems like a massive social eruption for such a small part of the population.
 Could it be because the ACA legislation cause a huge increase in the cost of health insurance?

 
You seem to think that only the exchanges are covered under the ACA. It affects your insurance even if you are covered through your employment.

Could it be you don't understand the disruption because you don't understand ACA?

Oh I understand the ACA affected my non-ACA, non-employer, non-government policy. I'm self employed, I pay for my families policy. I had just got comfortable with the cost of my families health insurance cost after raising my deductible to $10,000* and getting my premium down to $4,512 a year. This was two years before the ACA regulations went into effect.
 In 2010 I had a 7.7% increase, in 2011 I had a 8.1% increase, then came the ACA reg's in 2012, I got a whooping 19.4% increase, 2013 it was a 21% increase and in 2014 it was 18.8% increase. That's a 72% increase in 3 years.
 But, I got these forced benefits 'cough' because of the ACA.
 I got a 'free' physical each year, (but notice it wasn't free, I paid way more for it with the premium increase.)
  I also got my $5,000,000 lifetime cap increased to unlimited. (is it right to force society to pay more tham $5,000,000 to keep me alive?)
 I get a 'free' Colonoscopy every 5 years.
 I got increased coverage for drug rehab.
I got a little more coverage for mental healthcare.
 All of those extras have saved me about $250 in doctor fees over those 5 years,
but I have paid an additional $17,070 in premium.
 I'll admit some of that $17k was because I got older.

*$10,000 deductible. I raised my deductible from $2,500 to $10,000, the lowered my premium from $9,900 to $4,512, people said I was crazy with that high deductible plan, but notice when the ACA came out most families have $12,600 deductible.
 Notice in 17 months the premium savings, paid for my $10k deductible. Plus With my high deductible plan I could deduct and HSA plan from my taxes.

Is it right to only allow the ludicrously wealthy to live?

jim555

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Re: What comes after the ACA?
« Reply #3199 on: July 19, 2017, 08:03:41 AM »
I am reading they will do a clean repeal vote next week.  I thought they said that it already died yesterday.  Guess they want to get the loss on record.
All this winning is wearing me out.  Where is that big beautiful see through solar powered wall?