Author Topic: What comes after the ACA?  (Read 1916401 times)

DreamFIRE

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Re: What comes after the ACA?
« Reply #4300 on: April 25, 2018, 05:29:44 AM »
I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.

It sounds like you have some crap insurance if they're not paying what it states right on your policy.  One of the nice things about where I work is that we have good health insurance with very low deductibles.  I haven't heard of a single problem with either of my last couple jobs going back 30 years and hundreds of employees.

Exflyboy

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Re: What comes after the ACA?
« Reply #4301 on: April 25, 2018, 09:31:05 AM »
I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.

It sounds like you have some crap insurance if they're not paying what it states right on your policy.  One of the nice things about where I work is that we have good health insurance with very low deductibles.  I haven't heard of a single problem with either of my last couple jobs going back 30 years and hundreds of employees.

This is not "crap" insurance*. This what the industry standard is these days.. What you have is especially "good" insurance.

They do pay what is stated on the policy.. But they don't make it clear. What is stated in a roundabout way is they will pay an OON provider in the same amount as IN network for emergencies and you wont have to pay your INSURANCE COMPANY any more than your OOP max.

What they don't tell you is WHAT they will pay is likely far lower then your OON provider(s) will charge you and the provider will come directly to the patient for the rest.

 In other words the OOP portion is almost meaningless when it comes to OON providers.


* Crap vs good are relative terms of course.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4302 on: April 25, 2018, 05:08:08 PM »
I live in a state that has not outlawed balance billing, and my insurance policy also has an out-of-network OOP maximum and a provision stipulating that all emergency care will be reimbursed as if it were in-network.  But the insurance company is not going to pay whatever the provider bills.  They are going to pay them what they would have paid an in-network provider, and it is up to the provider to decide whether they want to pursue the patient for the rest of the bill.

It sounds like you have some crap insurance if they're not paying what it states right on your policy.  One of the nice things about where I work is that we have good health insurance with very low deductibles.  I haven't heard of a single problem with either of my last couple jobs going back 30 years and hundreds of employees.

This is not "crap" insurance*. This what the industry standard is these days.. What you have is especially "good" insurance.

They do pay what is stated on the policy.. But they don't make it clear. What is stated in a roundabout way is they will pay an OON provider in the same amount as IN network for emergencies and you wont have to pay your INSURANCE COMPANY any more than your OOP max.

What they don't tell you is WHAT they will pay is likely far lower then your OON provider(s) will charge you and the provider will come directly to the patient for the rest.

 In other words the OOP portion is almost meaningless when it comes to OON providers.

Yes, that sounds like crap, even if it's standard.  I believe I saw in one of these threads discussing ACA about policies that didn't mention out of network at all or only in reference to "emergency" care.

I was going to see what my policy states in more detail, but I only found the provider reference that says when using an out of network provider to contact the insurance provider within 48 hours or as soon as possible.

The map I posted above is from an article posted Oct 2017, so it might not be up to date.
https://www.insidearm.com/news/00043325-most-states-still-dont-have-comprehensive/

This is something I'll have to consider when I FIRE since re-locating is a possibility for me, and it looks like most states don't have the same protections in place as I have now.  Since I'm more likely to be traveling around during FIRE, it makes it an even bigger issue at that point.

Exflyboy

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Re: What comes after the ACA?
« Reply #4303 on: April 25, 2018, 05:49:12 PM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

Mr. Green

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Re: What comes after the ACA?
« Reply #4304 on: April 26, 2018, 07:28:02 AM »
After reading the recent Ballance billing posts here I looked up the law for Maryland and North Carolina and both states prohibit balance billing for HMOs. I found it interesting that only applied to HMOs.

Exflyboy

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Re: What comes after the ACA?
« Reply #4305 on: April 26, 2018, 10:01:03 AM »
So does that mean you can go to an OON hospital and have a max OOP if you are on an HMO?

Or does that just prevent balance billing from within network hospitals?

radram

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Re: What comes after the ACA?
« Reply #4306 on: April 26, 2018, 10:18:56 AM »
Does the law that prevents balance billing cover the address of the hospital, or the address of the customer, or both?

My state does not prevent balance billing. California does. If I travel to California and have emergency services, can the hospital balance bill me in my state?

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4307 on: April 26, 2018, 11:03:45 AM »
Does the law that prevents balance billing cover the address of the hospital, or the address of the customer, or both?

My state does not prevent balance billing. California does. If I travel to California and have emergency services, can the hospital balance bill me in my state?

It applies to the location where the bill was incurred.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4308 on: April 26, 2018, 05:14:16 PM »
Does the law that prevents balance billing cover the address of the hospital, or the address of the customer, or both?

My state does not prevent balance billing. California does. If I travel to California and have emergency services, can the hospital balance bill me in my state?

From this info I found, it looks like the balance billing protections are relevant to the state where the employee is insured:

Of course, emergencies don’t always happen close to home. One way to research your plan’s coverage for care rendered out-of-state is to ask your insurance company for a copy of your certificate of coverage, which outlines specific provisions that may apply in that scenario, said Chuck Bell, programs director at Consumers Union, the policy and advocacy arm of Consumer Reports.

If a patient gets a surprise bill from care provided at an out-of-state facility, jurisdiction will depend on the patient’s health plan, Bell said. If she’s in what’s known as a fully insured small-group, large group or individual plan, then the laws that apply in that situation should be the laws of the state where she’s insured. So, for example, if a consumer covered in New York state gets billed in a state without a balance billing law, New York protections should prevail, Bell said.


Reference:
https://www.marketwatch.com/story/how-to-handle-surprise-medical-bills-2015-12-21

radram

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Re: What comes after the ACA?
« Reply #4309 on: April 26, 2018, 11:08:37 PM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

Monkey Uncle

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Re: What comes after the ACA?
« Reply #4310 on: April 27, 2018, 05:11:41 AM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

I should probably stay quiet since I have not researched this question, but I can't imagine that a hospital in Montana is going to submit to a New York law that says they can't recover a debt from a patient.

DreamFIRE

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Re: What comes after the ACA?
« Reply #4311 on: April 27, 2018, 05:24:06 AM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

If not an employee, that would still be the person insured.

My response is a direct quote from the website linked to in my previous post.  That's what I would have expected to be the case based on the wording of some of the balance billing protections I have read about.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4312 on: April 27, 2018, 12:14:57 PM »
Nostache and Dreamfire,

Your responses could not be more different. How do we determine the correct answer?

Dreamfire, what if there is no employee?

I should probably stay quiet since I have not researched this question, but I can't imagine that a hospital in Montana is going to submit to a New York law that says they can't recover a debt from a patient.

This^

State 1 has no jurisdiction in State 2. Absent a federal law on the matter, I just don't see how you could get a hospital in State 2 to abide by State 1 law. Payors could absolutely solve this problem by forcing the provider to accept their payment as payment-in-full or GTFO.

Honestly, this is the perfect scenario to apply the Commerce Clause, because it's absolutely an interstate issue.

FWIW, I don't particularly trust Marketwatch as a source for strong healthcare reporting.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4313 on: May 07, 2018, 09:47:52 PM »
What comes after the ACA?

Cuts to CHIP.

DarkandStormy

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Re: What comes after the ACA?
« Reply #4314 on: May 08, 2018, 08:25:54 AM »
What comes after the ACA?

Cuts to CHIP.

What kind of evil wants to take money out of a program that gives kids from poor families health coverage?

Meanwhile, in Michigan they're proposing to spend MORE money to take away Medicaid from citizens.

https://www.cbpp.org/blog/michigans-medicaid-proposal-would-harm-low-income-workers-and-cant-be-fixed

DarkandStormy

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Re: What comes after the ACA?
« Reply #4315 on: May 08, 2018, 08:29:26 AM »
I apologize if this has been posted (long thread, ya'll).  Here is a podcast on how to expand the ACA and get to universal coverage.

https://crooked.com/podcast/can-we-have-medicare-for-all/

Adam Gaffney is advocating a Medicare for All proposal in 2020 (hopefully).

Andy Slavitt started up United States of Care earlier this year - https://unitedstatesofcare.org/our-mission/

I think Slavitt is advocating for smaller incremental changes in 2020.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4316 on: May 08, 2018, 07:31:03 PM »
To be fair, CHIP isn't exactly for the poor. Eligibility varies by state, but it's universally much higher than Medicaid eligibility, and copays are very low. Maybe there is some fat to be cut. I don't really understand the administration's argument that the cuts won't affect the operations of the program though. What exactly are they cutting?

bacchi

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Re: What comes after the ACA?
« Reply #4317 on: May 08, 2018, 08:46:23 PM »
What comes after the ACA?

Cuts to CHIP.

What kind of evil wants to take money out of a program that gives kids from poor families health coverage?

The "Fuck you; I've got mine" crowd.

Quote
Meanwhile, in Michigan they're proposing to spend MORE money to take away Medicaid from citizens.

https://www.cbpp.org/blog/michigans-medicaid-proposal-would-harm-low-income-workers-and-cant-be-fixed

Interestingly, Idaho has a good chance of expanding Medicaid this November.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4318 on: May 08, 2018, 08:51:37 PM »
And Paul Krugman's take:
"a number of Republican-controlled states are trying to make Medicaid harder to get, notably by imposing work requirements on recipients.
What is the point of these work requirements? The ostensible justification — cracking down on able-bodied Medicaid recipients who should be working but aren’t — is nonsense: There are very few people meeting that description. The real goal is simply to make getting health care harder, by imposing onerous reporting and paperwork requirements and punishing people who lose their jobs for reasons beyond their control."

"Gnawing Away at Health Care"
https://nyti.ms/2KHDqsw

Paul der Krake

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Re: What comes after the ACA?
« Reply #4319 on: May 08, 2018, 11:09:33 PM »
There is a belief among the ideological wing of the party that numbers around benefits recipients are BS because it's in the recipients' interest to paint the most favorable picture possible. They point to towns in Appalachia with 10-20% of residents on SS(D)I. If you listen to the Kentucky governor defend his work requirements, it all sounds pretty reasonable: low hours, or job training, or demonstrable illness.

And that message works wonders on people who struggle to afford their premiums.


jim555

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Re: What comes after the ACA?
« Reply #4320 on: May 09, 2018, 06:02:50 AM »
They couldn't change the law so now they are trying to change the law through 1115 waivers to impose work requirements.  The problem is it is not legal, lawsuits have already begun.

talltexan

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Re: What comes after the ACA?
« Reply #4321 on: May 11, 2018, 12:11:47 PM »
There's excitement around universal health care, but will it be a winning issue for Democrats? I cannot help but feel like saying they'll put in single-payer is a great way to help Trump win a second term in the White House.

DarkandStormy

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Re: What comes after the ACA?
« Reply #4322 on: May 11, 2018, 12:25:08 PM »
There's excitement around universal health care, but will it be a winning issue for Democrats? I cannot help but feel like saying they'll put in single-payer is a great way to help Trump win a second term in the White House.

http://thehill.com/policy/healthcare/351928-poll-majority-supports-single-payer-healthcare

Quote
The latest Harvard-Harris Poll survey found 52 percent favor a single-payer system against 48 who oppose it. A strong majority of Democrats — 69 percent — back the idea. Republicans oppose single-payer, 65-35, and independents are split, with 51 percent opposing and 49 supporting.

talltexan

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Re: What comes after the ACA?
« Reply #4323 on: May 14, 2018, 07:02:57 AM »
Indeed I'll accept the article; but Trump would campaign on promising that no one will lose their health care--just like he did in 2016--win re-election, and then appoint a HHS secretary who will work to undermine the law as Idaho is trying http://money.cnn.com/2018/03/08/news/economy/idaho-obamacare/index.html

AdrianC

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Re: What comes after the ACA?
« Reply #4324 on: May 25, 2018, 05:44:31 AM »
Interesting piece:

Why Your Health Insurer Doesn’t Care About Your Big Bills
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It’s like if a mom said told her son he could have 3 percent of a bowl of ice cream. A clever child would say, “Make it a bigger bowl.”

Wonks call this a “perverse incentive.”

katsiki

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Re: What comes after the ACA?
« Reply #4325 on: May 25, 2018, 05:59:34 AM »
Interesting piece:

Why Your Health Insurer Doesn’t Care About Your Big Bills
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It’s like if a mom said told her son he could have 3 percent of a bowl of ice cream. A clever child would say, “Make it a bigger bowl.”

Wonks call this a “perverse incentive.”


Interesting read - thanks!

This lines up with an experience at my job.  My employer has started paying cash for many tests and procedures (might not be the right word - things like an MRI).  They found it is cheaper for them to do so than have the insurance company pay for it.  We have an interesting plan involving concierge care / direct primary care for many basic items.  I guess it is a form of self-insurance.  Working very well so far.

swampwiz

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Re: What comes after the ACA?
« Reply #4326 on: May 25, 2018, 12:17:49 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

Does this calculation take into account that circular issue that if you get a subsidy it lowers health insurance expense, which raises AGI, which then lowers the subsidy, which then in turn raises the AGI ?

https://obamacareguide.wordpress.com/2014/07/25/self-employed-health-insurance-deduction-the-iterative-calculation/
« Last Edit: May 25, 2018, 12:24:41 PM by swampwiz »

swampwiz

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Re: What comes after the ACA?
« Reply #4327 on: May 25, 2018, 12:22:29 PM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

What if I'm a pagan?
« Last Edit: May 25, 2018, 12:24:29 PM by swampwiz »

MDM

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Re: What comes after the ACA?
« Reply #4328 on: May 25, 2018, 12:56:15 PM »
I'm looking at adding ACA tax effects to the case study spreadsheet.

Current plan is to add Form 8962 calculations, assuming all months for Form 1095-A were the same.

Thus one would enter
- Monthly enrollment premiums, and
- Monthly advance payment of premium tax credit
in the "Monthly Average Expenses" section, and
- Annual second lowest cost silver plan (SLCSP) premium in a Form 8962 section.

For those with more ACA knowledge: any suggestions for additions, deletions, or other changes to that plan?

Does this calculation take into account that circular issue that if you get a subsidy it lowers health insurance expense, which raises AGI, which then lowers the subsidy, which then in turn raises the AGI ?

https://obamacareguide.wordpress.com/2014/07/25/self-employed-health-insurance-deduction-the-iterative-calculation/
Thanks.  I've looked at that and other sites.  So far the work required to code that in the spreadsheet has appeared too high.  Maybe some day....  Of course, if anyone is so inclined to provide a version of the case study spreadsheet that does include this, crediting that person for the upgrade is work I'd be happy to do. :)

boarder42

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Re: What comes after the ACA?
« Reply #4329 on: May 25, 2018, 01:09:55 PM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

What if I'm a pagan?

how can they prove that you are or not.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4330 on: May 25, 2018, 06:03:34 PM »
Thank you Swampwiz

Mr Mark

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Re: What comes after the ACA?
« Reply #4331 on: May 27, 2018, 04:53:17 AM »
For travelling around you might be better off with a health sharing ministry thing as these appear to offer USA wide coverage. They are more expensive if you get a substantial ACA subsidy.. But cheaper if you don't.

What if I'm a pagan?

how can they prove that you are or not.

They'd probably ask God to run a Soul Credit Check.

Paul der Krake

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Re: What comes after the ACA?
« Reply #4332 on: May 27, 2018, 10:29:59 AM »
Interesting piece:

Why Your Health Insurer Doesn’t Care About Your Big Bills
Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority.

https://www.propublica.org/article/why-your-health-insurer-does-not-care-about-your-big-bills

The Affordable Care Act kept profit margins in check by requiring companies to use at least 80 percent of the premiums for medical care. That’s good in theory but it actually contributes to rising health care costs. If the insurance company has accurately built high costs into the premium, it can make more money. Here’s how: Let’s say administrative expenses eat up about 17 percent of each premium dollar and around 3 percent is profit. Making a 3 percent profit is better if the company spends more.

It’s like if a mom said told her son he could have 3 percent of a bowl of ice cream. A clever child would say, “Make it a bigger bowl.”

Wonks call this a “perverse incentive.”

The arrogance of the hospital's attorney is incredible. The plaintiff is a bloody actuarial expert, he clearly understands the concept of modern medical billing like coinsurance.

DarkandStormy

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Re: What comes after the ACA?
« Reply #4333 on: June 08, 2018, 09:50:40 AM »
The federal government will not defend the ACA in court, putting 130 million Americans with pre-existing conditions at risk.

https://www.axios.com/trumps-justice-department-says-aca-is-unconstitutional-06f8714d-7606-4104-9982-f057786828a7.html

Quote
The Justice Department will not defend the Affordable Care Act in court, and says it believes the law's individual mandate — the provision the Supreme Court upheld in 2012 — has become unconstitutional.

Luck12

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Re: What comes after the ACA?
« Reply #4334 on: June 08, 2018, 10:26:51 AM »
Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.       

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #4335 on: June 08, 2018, 11:26:03 AM »
It's confusing what the implications are of a successful challenge to the individual mandate - but not defending those with pre-existing conditions could be devastating for millions of people. Moreover, most people are only temporarily able bodied.

FIRE@50

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Re: What comes after the ACA?
« Reply #4336 on: June 08, 2018, 11:30:49 AM »
I think the sooner the ACA dies, the sooner we will have a single payer system. I can only hope that not too many people are hurt during the transition.

NoStacheOhio

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Re: What comes after the ACA?
« Reply #4337 on: June 08, 2018, 11:37:57 AM »
I think the sooner the ACA dies, the sooner we will have a single payer system. I can only hope that not too many people are hurt during the transition.

While I agree that single-payer, in the end, would be better than what we have or had, I think a lot of people will be harmed during the transition.

Roadrunner53

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Re: What comes after the ACA?
« Reply #4338 on: June 08, 2018, 01:57:21 PM »
What does single payer mean?

I am on ACA but will be on Medicare August 1.

I heard today that the price of ACA policies may double this next sign up period. I pay $495 a month now for one person and get a subsidy. If it doubles, I am guessing that would be around $1,000.

orangepalm

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Re: What comes after the ACA?
« Reply #4339 on: June 08, 2018, 02:03:24 PM »
I heard today that the price of ACA policies may double this next sign up period. I pay $495 a month now for one person and get a subsidy. If it doubles, I am guessing that would be around $1,000.

If you already get a subsidy now and your income level relative to the federal poverty line remains the same next year, then your subsidy will simply go up together with the premium. So no loss to you. It's the people that earn too much (MAGI above 400%) that are really screwed!

DarkandStormy

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Re: What comes after the ACA?
« Reply #4340 on: June 08, 2018, 02:15:31 PM »
Republicans are truly fucking evil.   Mobilize your friends, family, anybody you know that gives a shit about people to vote these assholes out this year and in 2020.     

Short of vaccinations, the best thing you can do to protect your kids is to crush the Republican party in elections.

Luck12

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Re: What comes after the ACA?
« Reply #4341 on: June 08, 2018, 02:44:01 PM »
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.   

Threshkin

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Re: What comes after the ACA?
« Reply #4342 on: June 08, 2018, 10:30:08 PM »
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.

We already have two single payer health care systems in the US.  One is the VA and we have all heard how "well" that system runs.  Health care run by entrenched bureaucrats who are more concerned about job security than patient care....ugh.

The second is Medicare which is actually pretty efficient overall.  It is not popular with doctors and hospitals because it severely limits the reimbursement amounts.  Cry me a river.

Expanding Medicare to cover more at-risk patients is a good idea provided the price control side is maintained.  Medicare should be expanded to cover anyone who wants to use it.

Continuing to prop up ACA is a mistake.  It was written by and for the benefit of the health insurance industry.  Premiums are increasing faster than ever.  Subsidies hide these increases for most people but ultimately we all pay for it in the long run.

Using taxpayer money to mask the cost of health care through subsidies is a recipe for disaster.  The student loan crisis is a good example of what can happen when the government masks costs to the consumer but doesn't control the actual amount billed.

Many countries have a two-tier health care system.  A public system available to everyone and a private system available as well.  I would not oppose something like that through a combination of expanded Medicaid and private insurance.

Realistically however I think that too many of our elected "representatives" on all sides of the political spectrum are corrupted by health care and insurance industry money for this to happen.  Instead we will wind up with another travesty of a health care bill that ensures the continued profitability of the health care industry while sticking the public with the costs.

obstinate

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Re: What comes after the ACA?
« Reply #4343 on: June 11, 2018, 11:31:35 AM »
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.

We already have two single payer health care systems in the US.  One is the VA and we have all heard how "well" that system runs.  Health care run by entrenched bureaucrats who are more concerned about job security than patient care....ugh.
The VA actually works quite well overall. That's why it's such a sensation when there are reports of corruption.

jlcnuke

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Re: What comes after the ACA?
« Reply #4344 on: June 11, 2018, 01:12:31 PM »
To be fair, the VA did have some significant issues with providing adequate care for a while. Most of that was due to massive underfunding and has largely been corrected however. I use them primarily now and am just as pleased as when I used my private care.
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.

We already have two single payer health care systems in the US.  One is the VA and we have all heard how "well" that system runs.  Health care run by entrenched bureaucrats who are more concerned about job security than patient care....ugh.
The VA actually works quite well overall. That's why it's such a sensation when there are reports of corruption.

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DreamFIRE

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Re: What comes after the ACA?
« Reply #4345 on: June 11, 2018, 05:51:49 PM »
Continuing to prop up ACA is a mistake. 

It's better than what we had before.  I think this thread has dug into those details repeatedly.  So until we have single payer, we need to prop up ACA so that there's an eventual direct switch-over to single payer with no time in limbo without coverage for millions of Americans.

ACA plans do have cost controls, which is why you can't just go to any doctor you want and will be billed directly for going out of network.  Scroll back a ways to the "balance billing" discussion.
« Last Edit: June 11, 2018, 05:54:52 PM by DreamFIRE »

Threshkin

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Re: What comes after the ACA?
« Reply #4346 on: June 11, 2018, 08:42:00 PM »
To be fair, the VA did have some significant issues with providing adequate care for a while. Most of that was due to massive underfunding and has largely been corrected however. I use them primarily now and am just as pleased as when I used my private care.
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.

We already have two single payer health care systems in the US.  One is the VA and we have all heard how "well" that system runs.  Health care run by entrenched bureaucrats who are more concerned about job security than patient care....ugh.
The VA actually works quite well overall. That's why it's such a sensation when there are reports of corruption.

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Glad to hear that!

swampwiz

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Re: What comes after the ACA?
« Reply #4347 on: June 12, 2018, 01:18:51 PM »
If you already get a subsidy now and your income level relative to the federal poverty line remains the same next year, then your subsidy will simply go up together with the premium. So no loss to you. It's the people that earn too much (MAGI above 400%) that are really screwed!

Yes, basically the ACA plans will be very high-priced to make up for the risk pool which will only have lower-income folks who have enough of a subsidy so that it doesn't cost much, and therefore is a good deal, and the higher-income folks who are sick and are forced to buy a plan.  The folks who don't get much of a subsidy could take their chances and hope that even if they get sick, they'll figure out a way, such as quitting their job, cyberbegging @ GoFundMe, etc., or waiting it out until the next signup period.  This could get fixed in large part by simply increasing the income limit for the subsidies and implementing high-risk-pool adjustments - you know, the "insurer bailout that that creep Marco Rubio bellyached about.  Of course that would require a certain party in Washington to give a ...

TrudgingAlong

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Re: What comes after the ACA?
« Reply #4348 on: June 12, 2018, 01:40:37 PM »
To be fair, the VA did have some significant issues with providing adequate care for a while. Most of that was due to massive underfunding and has largely been corrected however. I use them primarily now and am just as pleased as when I used my private care.
What does single payer mean?


It just means one single entity (e.g. government, financed by taxes) finances health care costs.   I don't think single payer federally will occur for a long time mainly because most people are selfish and myopic (i.e. "I have my employer health care so F anybody else").   I think best shot at universal health care is the existing Democratic proposal Medicare Extra for All.    That way people could still keep their employer health care if they wanted to.

We already have two single payer health care systems in the US.  One is the VA and we have all heard how "well" that system runs.  Health care run by entrenched bureaucrats who are more concerned about job security than patient care....ugh.
The VA actually works quite well overall. That's why it's such a sensation when there are reports of corruption.

Sent from my XT1635-01 using Tapatalk

Glad to hear that!

Yes! Drives me crazy the VA has such a bad rep just because our news slant is always so negative. If it’s working, they don’t bother to report. Shulkin was fired because he resisted privatization, and my understanding is people thought he was doing a good job. We get healthcare from the active duty side, and it’s fantastic. It’s a huge reason I support single payer because I think everyone should get good healthcare, not just those who sign their lives away to the government.

jim555

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Re: What comes after the ACA?
« Reply #4349 on: June 12, 2018, 02:10:44 PM »
I don't see how single payer ever gets to the US.  Both parties would need to be on board, and that is not happening.  Even if it happened it would be constantly sabotaged until it would fail by a thousand cuts.

If you look at European and Canadian politics the conservatives are not gunning to get rid of their national health systems.  Though the Tories have massively underfunded the NHS that are not overtly advocating for its removal.