Author Topic: What comes after the ACA?  (Read 822626 times)

ZiziPB

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Re: What comes after the ACA?
« Reply #3350 on: July 26, 2017, 02:47:40 PM »
What a painful process this is!  The Dems must be bored out of their minds, since they already know how they are voting in each instance.  And as far as I can tell, there is no substantive discussion of any real issues, just a push towards the lowest common denominator for the Repubs.  Ugh!

tyort1

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Re: What comes after the ACA?
« Reply #3351 on: July 26, 2017, 04:08:10 PM »
Good lord, it's like watching The Office, except that every single Republican is Michael Scott.

jim555

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Re: What comes after the ACA?
« Reply #3352 on: July 27, 2017, 02:05:54 PM »
Does anyone understand the process?  I am reading the Senate votes, if it passes it goes to the House/Senate conference, then to the House.  Then I read no guarantee it goes back to the Senate, but straight to the President for signing.  What kind of process is this??

DarkandStormy

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Re: What comes after the ACA?
« Reply #3353 on: July 27, 2017, 02:13:14 PM »
http://www.cnn.com/videos/politics/2017/07/27/report-alaska-warned-health-care-no-vote-ip.cnn

Oh good, the administration is intimidating Senators for votes.

dividendman

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Re: What comes after the ACA?
« Reply #3354 on: July 27, 2017, 02:20:50 PM »
Does anyone understand the process?  I am reading the Senate votes, if it passes it goes to the House/Senate conference, then to the House.  Then I read no guarantee it goes back to the Senate, but straight to the President for signing.  What kind of process is this??

If the bill changes in conference both houses have to pass it again.

If the senate version doesn't change, then only the house would have to pass it (because the Senate already passed it).

Mr. Green

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Re: What comes after the ACA?
« Reply #3355 on: July 27, 2017, 02:52:01 PM »
"It appears that the Republican leader has a last-ditch plan waiting in the wings," Murray said on the floor. "As soon as they have an official score from the CBO, which could be hours from now, in the dead of night, Sen. McConnell will bring forward legislation that Democrats, patients and families, and even many Senate Republicans, have not seen and try to pass it before anyone can so much as blink."

http://www.cnn.com/2017/07/27/politics/health-care-debate-thursday/index.html

The Senate Majority Leader is ready to cold cock the American public. I like your style, Senator! </sarcasm>

lbmustache

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Re: What comes after the ACA?
« Reply #3356 on: July 27, 2017, 02:59:52 PM »
Skinny repeal is a total disaster - who exactly wins in this scenario besides this looney tunes admin who can claim they finally "did something."

Healthy people drop out, which means the average healthy insured citizen has their premiums go up (to insure less people...), or they too drop out and the whole insurance system is just astronomical for the sick. Or the uninsured get sick and now have massive medical debt.

jim555

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Re: What comes after the ACA?
« Reply #3357 on: July 27, 2017, 03:15:23 PM »
Skinny repeal is a total disaster - who exactly wins in this scenario besides this looney tunes admin who can claim they finally "did something."

Healthy people drop out, which means the average healthy insured citizen has their premiums go up (to insure less people...), or they too drop out and the whole insurance system is just astronomical for the sick. Or the uninsured get sick and now have massive medical debt.
That is the whole point, undermine it, then say "look it isn't working we need to get rid of it".  They are doing everything they can to wreck it.

brooklynguy

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Re: What comes after the ACA?
« Reply #3358 on: July 27, 2017, 04:02:08 PM »
Skinny repeal is a total disaster - who exactly wins in this scenario besides this looney tunes admin who can claim they finally "did something."

Healthy people drop out, which means the average healthy insured citizen has their premiums go up (to insure less people...), or they too drop out and the whole insurance system is just astronomical for the sick. Or the uninsured get sick and now have massive medical debt.
That is the whole point, undermine it, then say "look it isn't working we need to get rid of it".  They are doing everything they can to wreck it.

Skinny repeal is just a procedural gambit intended to jumpstart joint chamber conference committee negotiations, which Senate Republicans hope will somehow magically give birth to more comprehensive legislation that can win majority approval despite their failure to come up with any themselves.  Several GOP senators are now on record as supportive of skinny repeal only if they receive assurances that it will be taken to conference and not simply passed by the House.  In other words, absurdly, they will only vote to pass the bill if they can be assured that it will not become law.

Channel-Z

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Re: What comes after the ACA?
« Reply #3359 on: July 27, 2017, 08:30:17 PM »
This is basically what happened here in Kansas with income tax cuts in 2012. The state house passed a draconian bill.  The state senate wanted a conference, and passed the bill to move it forward. The conference never happened and the state house passed the senate's bill, which the Governor gleefully signed. Presto, bad bill becomes bad law.

shuffler

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Re: What comes after the ACA?
« Reply #3360 on: July 27, 2017, 11:59:17 PM »
Skinny repeal failed, receiving only 49 votes.  Holdouts were John McCain, Susan Collins and Lisa Murkowski.

https://www.nytimes.com/2017/07/27/us/politics/senate-health-care-vote.html
« Last Edit: July 28, 2017, 12:00:56 AM by shuffler »

Exflyboy

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Re: What comes after the ACA?
« Reply #3361 on: July 28, 2017, 03:52:08 AM »
So are we done now?

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3362 on: July 28, 2017, 04:21:32 AM »
So are we done now?

McConnell says it's "time to move on."  I guess we'll see if they can really let go of their repeal fetish.  Meanwhile, Trump is doubling down on his vow to sabotage the ACA.

protostache

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Re: What comes after the ACA?
« Reply #3363 on: July 28, 2017, 04:23:02 AM »
So are we done now?

Not until the Democratic Party holds at least one house of congress. Because until then the Republicans have as many chances as they dare to pass their horseshit legislation.

Exflyboy

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Re: What comes after the ACA?
« Reply #3364 on: July 28, 2017, 05:13:51 AM »
What a bunch of clowns.. These are our "leaders".. God help us!

jim555

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Re: What comes after the ACA?
« Reply #3365 on: July 28, 2017, 05:17:23 AM »
Can't wait for the tweetstorm today.  Sad!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3366 on: July 28, 2017, 06:17:04 AM »
Skinny repeal fell short because it fell short of our promise to repeal & replace Obamacare w/ meaningful reform https://t.co/tZISIvccOO
— John McCain (@SenJohnMcCain) July 28, 2017

After the tally was final, Mr. Trump tweeted:

3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!
— Donald J. Trump (@realDonaldTrump) July 28, 2017

jim555

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Re: What comes after the ACA?
« Reply #3367 on: July 28, 2017, 06:21:26 AM »
McCain's revenge?  I like how he let the process go forward then quashed it for maximum damage.
“He’s not a war hero. He’s a war hero because he was captured. I like people who weren’t captured.” - DJT

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3368 on: July 28, 2017, 06:28:34 AM »
"Mr. Trump directed Interior Secretary Ryan Zinke to call Ms. Murkowski, the Alaska senator, to remind her of issues affecting her state that are controlled by the Interior Department, according to people familiar with the call, who requested anonymity because they were not authorized to speak to the press.
Ms. Murkowski confirmed to reporters that she had received a call from Mr. Zinke, but she declined to describe the details. However, people familiar with the call described her reaction to it as “furious.”"

Senate Rejects Slimmed-Down Obamacare Repeal as McCain Votes No
https://nyti.ms/2h7ofOF

ZiziPB

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Re: What comes after the ACA?
« Reply #3369 on: July 28, 2017, 07:22:42 AM »
I was initially disappointed with McCain for the "yes" vote to proceed but he should be applauded for exposing the totally insane voting process as Republicans were tripping over themselves to pass something, anything, just so that Trump could have his win and a signing ceremony.  And also good for him for calling it like it is and pointing out that the Republican proposal fell in the end because of its complete lack of substance.

Now would be a good time to really try to fix ACA, although having seen the debacle so far, I doubt that there are enough sane Republicans to actually do the right thing.  Trump is hell bent on sabotaging it, so may need to wait until 2018 for something to change for the better.

Bateaux

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Re: What comes after the ACA?
« Reply #3370 on: July 28, 2017, 07:35:11 AM »
Thank you Senator John McCain.  Your hero status is restored.

brooklynguy

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Re: What comes after the ACA?
« Reply #3371 on: July 28, 2017, 07:58:35 AM »
Thank you Senator John McCain.  Your hero status is restored.

I'm glad McCain helped to kill skinny repeal, but his behavior was emblematic of the entire batshit crazy process.  In his speech on Tuesday railing against the Republican "Trumpcare" bill--both its substance and the underhanded process behind it--he stated, in no uncertain terms:

Quote from: John McCain
I voted for the motion to proceed to allow debate to continue and amendments to be offered. I will not vote for the bill as it is today. It's a shell of a bill right now. We all know that. I have changes urged by my state's governor that will have to be included to earn my support for final passage of any bill. I know many of you will have to see the bill changed substantially for you to support it.

And then a few hours later, in direct violation of this explicit promise, with no material changes made to the bill, he voted in favor of it.  Words have lost all meaning.

madgeylou

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Re: What comes after the ACA?
« Reply #3372 on: July 28, 2017, 08:48:50 AM »
McCain's a grandstanding old battleax.

I'm glad he finally did the right thing but it's Collins and Murkowski and the Indivisibles who really saved this thing.

Paul der Krake

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Re: What comes after the ACA?
« Reply #3373 on: July 28, 2017, 09:22:29 AM »
Watched this dumpster fire last night. McConnell looked so fucking done with the whole thing. A part of him is probably glad it didn't pass, given how widely unpopular all the GOP bills have been.

All this political capital wasted on nothing.

In other news, have you guys ever tried running the subsidies calculator for Alaska, compared to any other state? It's an insane sweetheart deal because of how much delivering medicine sucks up there. A family of 3 with parents in their 30s making 50k has a monthly premium in the single digits, down from $1500/month...

Exflyboy

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Re: What comes after the ACA?
« Reply #3374 on: July 28, 2017, 09:37:23 AM »
Down here in Corvallis for two of us ,(52 &55) on $35k income we get $811/m subsidy.. turns into $36/m for the bronze premium.

dividendman

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Re: What comes after the ACA?
« Reply #3375 on: July 28, 2017, 09:42:38 AM »
Murkowski, Collins and McCain should just become independents and caucus with the Dems so there is some true check on presidential powers.

McCain and Collins aren't running again, so no repercussions. Actually Collins probably has a better chance at becoming the gov of maine if she did that (ran as an independent and stuck it to Trump).

And the fact that several of their republican office-holder colleagues seem to hate them because they're female should give them a boost.

Sigh... one can dream/hope.

Bucksandreds

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Re: What comes after the ACA?
« Reply #3376 on: July 28, 2017, 09:46:05 AM »
The obvious solution to the problem of people making just a little too much to qualify for subsidies is to raise the income level that earns a subsidy. You pay it by raising the obamacare taxes.  Won't happen because 3 repubs in the senate would have to vote for it, like 18 in the house and Trump. Then allow people in counties without a plan on the exchange to use some or all of their exchange subsidy off the exchange and you have real solutions to the 2 biggest problems.

PS. I prefer single payer to this all but the above would technically keep the whole thing moving along.

meatface

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Re: What comes after the ACA?
« Reply #3377 on: July 28, 2017, 09:59:32 AM »
I was initially disappointed with McCain for the "yes" vote to proceed but he should be applauded for exposing the totally insane voting process as Republicans were tripping over themselves to pass something, anything, just so that Drumpf could have his win and a signing ceremony.  And also good for him for calling it like it is and pointing out that the Republican proposal fell in the end because of its complete lack of substance.

Now would be a good time to really try to fix ACA, although having seen the debacle so far, I doubt that there are enough sane Republicans to actually do the right thing.  Drumpf is hell bent on sabotaging it, so may need to wait until 2018 for something to change for the better.

I think we're still in the things-will-get-worse-before-they-get-better phase.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3378 on: July 28, 2017, 10:10:18 AM »
I was initially disappointed with McCain for the "yes" vote to proceed but he should be applauded for exposing the totally insane voting process as Republicans were tripping over themselves to pass something, anything, just so that Drumpf could have his win and a signing ceremony.  And also good for him for calling it like it is and pointing out that the Republican proposal fell in the end because of its complete lack of substance.

Now would be a good time to really try to fix ACA, although having seen the debacle so far, I doubt that there are enough sane Republicans to actually do the right thing.  Drumpf is hell bent on sabotaging it, so may need to wait until 2018 for something to change for the better.

I think we're still in the things-will-get-worse-before-they-get-better phase.

Yes that's a real sensible solution, and sane people would try to enact that.

JustGettingStarted1980

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Re: What comes after the ACA?
« Reply #3379 on: July 28, 2017, 10:35:39 AM »
You have to read between the lines.  The Senators all talk to each other. I wouldn't be surprised if he made a deal with them to position their no votes so that none of the 3 bills pass, but that all of them have something they can say they voted for in case their conservative base gets angry.  McCain taking the final no vote shielded Heller from having to do it, as McCain probably won't live to run again he was the obvious sacrifice.

McCain obviously remembers Trump saying he was not a war hero, and he enacted his revenge as he is literally dying.  This is poetic justice in my opinion.
[/quote]

Completely agree with your analysis. McCain took the Glory (and the Rancor) so that other sane Republicans wouldn't have the take the Axe later.  It's a dirty business this political game.

lbmustache

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Re: What comes after the ACA?
« Reply #3380 on: July 28, 2017, 11:53:46 AM »
I believe one of the Republican reps spoke to the media today and said that they are going to try and get another bill going in a couple of weeks. They really just need to move on (or - horror - work with Dems) from this IMO. 7 years of nothing, 7 months of wasted time.

Mr. Green

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Re: What comes after the ACA?
« Reply #3381 on: July 28, 2017, 11:56:55 AM »
They have to move on to the budget at some point. They can only delay that so long.

jim555

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Re: What comes after the ACA?
« Reply #3382 on: July 28, 2017, 12:55:05 PM »
Down here in Corvallis for two of us ,(52 &55) on $35k income we get $811/m subsidy.. turns into $36/m for the bronze premium.
Pretty good deal.  NY has some great plans for <=200 FPLers.

New York Essential Plan 1 150-200% FPL
$20 Monthly Premium
$0 Deductable
$2,000 MaxOOP
$25 Specialist
$15 PCP
$6/$15/$30 Tiers Rx

Exflyboy

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Re: What comes after the ACA?
« Reply #3383 on: July 28, 2017, 02:18:19 PM »
That's awesome!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #3384 on: July 28, 2017, 06:05:19 PM »
So where do we go from here?

Sabotage ?

"It would be foolish to underestimate the administration, which has the power to do substantial damage. The administration could stop making subsidy payments to insurance companies authorized by the A.C.A. to help reduce deductibles for lower-income people. And it could stop enforcing the penalty for people who do not buy insurance, which would result in fewer young and healthy people signing up, leading insurers to stop offering policies in some parts of the country."

The A.C.A. Lives Another Day, but It Is Not Yet Safe
https://nyti.ms/2u5GyVL

jim555

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Re: What comes after the ACA?
« Reply #3385 on: July 29, 2017, 09:43:14 AM »
Trump tweet: "If Republicans are going to pass great future legislation in the Senate, they must immediately go to a 51 vote majority, not senseless 60..."

Dude, you got 49 votes
Math is hard.

He is tweeting again this morning about getting rid of the filibuster. 

jim555

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Re: What comes after the ACA?
« Reply #3386 on: July 31, 2017, 07:12:27 AM »
Hopefully he keeps beating the dead horse and totally expend all his political capital. 

protostache

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Re: What comes after the ACA?
« Reply #3387 on: July 31, 2017, 07:26:12 AM »
I'm have alot of trouble figuring out the end game now.  Trump is threatening all kinds of stuff in a hissy fit if congress doesn't repeal Obamacare.  Here is the list:

1. End the obamacare subsidies for poor people
2. End the subsidies for members of congress
3. Won't let congress work on budget and debt ceiling until Obamacare is repealed.

The third one is scary.  Is he that crazy to tank the world economy over this?

Number one is illegal. The law says in black and white that the insurance companies are owed that money but either through a mistake in drafting or deliberate sabotage an explicit appropriation never made it into the final ACA bill or the "sidecar" reconciliation bill (HCERA) that fixed a number of things. The insurance companies would sue for what they're owed and they would win.

Number two is legal because Congressional staffers get an employer match for their health insurance via an Obama-era regulation. Ending it would require him to go through the whole rules-making process with public comments and the whole shebang, but he (technically Price as head of HHS) could do it.

He can't do number three but he doesn't know that because he doesn't understand basic civics. The Executive branch and Legislative branch are equal. He's not their boss and in a lot of ways a sitting senator has more day-to-day power to effect change than the president does. The Senate, in particular, is extremely protective of their individual and collective power and doesn't appreciate process moments from the peanut gallery.

There is a way for the executive to try to influence how the Senate goes about it's business but it would not go well for them. At the start of business every day the presiding officer of the Senate recognizes the majority leader (McConnell) who then sets the agenda for the day. Pence can choose to be the presiding officer whenever he wants, and he could just recognize someone else to set the agenda. That would almost inevitably result in McConnell raising a point of order and getting a majority vote (probably unanimous) to ignore the presiding officer, further eroding the set of norms and traditions that the Senate has built up over the last 240 years.

BuildingFrugalHabits

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Re: What comes after the ACA?
« Reply #3388 on: July 31, 2017, 07:41:00 AM »
Hopefully, our leaders can start to act to fix and improve the current system in a bipartisan manner. I thought this was encouraging:

http://www.politico.com/story/2017/07/30/obamacare-health-care-stabilization-241151

Republicans and democrats working together to stabilize the insurance markets under the current ACA.  Not sure how they plan to tackle the affordability problem. 

Mr. Green

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Re: What comes after the ACA?
« Reply #3389 on: July 31, 2017, 08:33:45 AM »
Maybe someone can clear up a CSR question I have. If Trump were to cease making CSR payments moving forward, the real effect on subsidized purchasers of ACA plans would be nothing, correct? The total cost might go up but their contribution is limited by income so all he would be doing is increasing the amount the government is paying? So in effect he's cutting one payment only to increase another? If that's accurate it seems kinda stupid and ineffective. Granted it hurts the 20% of subscribers who get no subsidy but it still seems like a weak play. Am I missing something?

sol

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Re: What comes after the ACA?
« Reply #3390 on: July 31, 2017, 08:43:41 AM »
Maybe someone can clear up a CSR question I have. If Trump were to cease making CSR payments moving forward, the real effect on subsidized purchasers of ACA plans would be nothing, correct? The total cost might go up but their contribution is limited by income so all he would be doing is increasing the amount the government is paying? So in effect he's cutting one payment only to increase another? If that's accurate it seems kinda stupid and ineffective. Granted it hurts the 20% of subscribers who get no subsidy but it still seems like a weak play. Am I missing something?

It's about optics, not dollars.  Cutting the CSR payments would (eventually) raise the total listed premiums the insurers would charge.  Republicans have demonstrated over and over again that they don't really care about what people pay for healthcare, they only care about the total premiums (because those go up, even though people aren't actually paying any more for insurance).

Trump is just following the same playbook.  He wants premiums to rise so that he can claim the ACA is failing, and he'll conveniently forget to mention that premiums will, by law, hold steady for people under 400% of the Federal Poverty Level. 

Maybe that's the point?  Maybe he's only speaking to his rich and self-employed base voters, who might actually pay rising premiums because they are too wealthy to qualify for subsidies (over $114,000 this year, for my family).

jim555

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Re: What comes after the ACA?
« Reply #3391 on: July 31, 2017, 08:54:10 AM »
I read that when all is said and done it will cost the Feds more not to pay the CSRs since the subsidies will increase due to higher premiums.  It will hurt the higher income people the most since they will pay more with no offsetting subsidy.  The insurers will certainly sue the Feds and probably win.  So the exercise is to create havoc for no good reason and hurt a lot of people.  Just another day in Trump-topia.

protostache

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Re: What comes after the ACA?
« Reply #3392 on: July 31, 2017, 09:22:15 AM »
I read that when all is said and done it will cost the Feds more not to pay the CSRs since the subsidies will increase due to higher premiums.  It will hurt the higher income people the most since they will pay more with no offsetting subsidy.  The insurers will certainly sue the Feds and probably win.  So the exercise is to create havoc for no good reason and hurt a lot of people.  Just another day in Trump-topia.

ACASignups.net has a good (if slightly wonky) explanation for how this will likely play out.

tl;dr: Insurers raise prices only for on-exchange silver plans and offer a very similar but cheaper off-exchange silver plan. All other premiums stay the same net of medical inflation and insurer tax. People who qualify for subsidies and CSRs buy the on-exchange silver plan, people who want that silver plan but don't qualify for subsidies buy the similar off-exchange plan. Net result is that the federal government absorbs all of the CSR costs via increased premium subsidies instead of via direct payments.

brooklynguy

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Re: What comes after the ACA?
« Reply #3393 on: July 31, 2017, 09:25:18 AM »
I read that when all is said and done it will cost the Feds more not to pay the CSRs since the subsidies will increase due to higher premiums.

Yes, the Kaiser Family Foundation estimated that the increased cost to the federal government of higher premium tax credits would be 23% more than the savings from eliminating cost-sharing reduction payments.

http://www.kff.org/health-reform/issue-brief/the-effects-of-ending-the-affordable-care-acts-cost-sharing-reduction-payments/

Monkey Uncle

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Re: What comes after the ACA?
« Reply #3394 on: August 01, 2017, 04:37:58 AM »
Hopefully he keeps beating the dead horse and totally expend all his political capital.

Political capital - heh heh.  That's a good one.

GenXbiker

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Re: What comes after the ACA?
« Reply #3395 on: August 01, 2017, 08:31:38 AM »
Maybe someone can clear up a CSR question I have. If Trump were to cease making CSR payments moving forward, the real effect on subsidized purchasers of ACA plans would be nothing, correct? The total cost might go up but their contribution is limited by income so all he would be doing is increasing the amount the government is paying? So in effect he's cutting one payment only to increase another? If that's accurate it seems kinda stupid and ineffective. Granted it hurts the 20% of subscribers who get no subsidy but it still seems like a weak play. Am I missing something?
You got some responses about the higher premiums as a result, but as I mentioned a page or so back in this thread, if CSR subsidies aren't guaranteed going forward, more insurers will pull out of specific marketplaces.  This was again mentioned in an article this morning:
http://money.cnn.com/2017/08/01/news/economy/health-care-subsidies-bailout/

Blonde Lawyer

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Re: What comes after the ACA?
« Reply #3396 on: August 01, 2017, 10:15:44 AM »
Just posting to follow.

jim555

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Re: What comes after the ACA?
« Reply #3397 on: August 02, 2017, 10:49:16 AM »
CSR lawsuit now enjoined with the interests of the states who will harmed if it is not defended properly.

"Court allows Democratic states to defend Obamacare payments"
https://www.reuters.com/article/us-usa-court-obamacare-idUSKBN1AH5HA

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #3398 on: August 10, 2017, 10:32:48 PM »
Sorry if I am a bit out of the loop, just returned from a great and needed reset road trip away from heat and tech.  This truly is a beautiful world.  Anywho, my wife just reminded me that we have access to an annual income at least 10x the credit card piggybacking thread (would add link but I'm on a tablet).  Anyway, we could buy meds through our health insurance and resell.  Very low risk, cash agreed with people who paid much more on their own... but that's what is so distorted about our healthcare, that I could make that much money, 'piggybacking' others...  I guess, in a way,that's Capitalism, that I actually am so valuable that my healthcare (as long as I use it only for myself) is a reasonable cost premium for my employer.

But ultimately, this is just another case of the rich getting richer....

So yeah, there is a credit bubble and now healthcare bubble.  Seems like housing has continued to reinflate...  easy time to make Hollywood easy money, which of course means it's a great time to be alive.  Never lasts tho.

gerardc

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Re: What comes after the ACA?
« Reply #3399 on: August 11, 2017, 12:26:17 AM »
Anyway, we could buy meds through our health insurance and resell.  Very low risk, cash agreed with people who paid much more on their own...

I don't get it... is this legal? How does it work?