Author Topic: What comes after the ACA?  (Read 1678428 times)

bigote2032

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Re: What comes after the ACA?
« Reply #5750 on: October 05, 2019, 10:59:43 AM »
Incidentally, mr. Bigote (interesting choice of screen name there...) you might want to look up papers on the effects of keto on Alzheimer's and a whole host of inflammatory conditions.  Hint, they are positive effects.  That's just one of a large number of inaccuracies in your posts, which I'm not inclined to address point by point as I have more important things to do today.

Freya, bigote is Spanish for mustache, what is freya?

Inaccuracies? Maybe for you that are another victim of the keto movement.  And no, keto is not sustainable, is not normal, you are really hurting yourself, I really wish you will quit this soon for your own good.  keto is all about favoring the meat industry, they don't care about your health.  Keto is the "cool" thing to do now, is all over mainstream media, they have brainwashed so many people.  I know I will get a lot of hate since this forum has lots of keto members, but somebody has to say it how it really is.  We are not meant to get our energy from fat.
« Last Edit: October 05, 2019, 11:02:47 AM by bigote2032 »

pecunia

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Re: What comes after the ACA?
« Reply #5751 on: October 05, 2019, 11:17:45 AM »
Lots of smart comments herein.

That "flexitarian" advice sounds pretty good.  It's hard to totally ignore meat.  I am still working long hours on the road and find it difficult to shift to vegetables and fruit.  I am trying.  However, I also believe there is a lot of truth in the keto thing.  It seems like there are just too many posts out there on the web of diabetics improving their health.  I am not diabetic, but have the sense to realize that everyone's metabolism is not the same.  What works for one will not work for all.

I read this a bit back and it just sounded too sensible to be true.  Fat is stored energy.  When are you going to use it?  You are going to use it when no other energy is available.  I've been skipping meals for a while now, feel more energetic and am shedding lbs.  The body is using the stored energy.   Common sense is winning.  Food does taste better too when you are really hungry.


Joeko

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Re: What comes after the ACA?
« Reply #5752 on: October 05, 2019, 11:31:21 AM »
How did the thread go from ACA to angry Vegan rants?

pecunia

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Re: What comes after the ACA?
« Reply #5753 on: October 05, 2019, 11:41:31 AM »
I might have pushed the button a few comments back as I noted that if we had Socialized medicine, there may be more of an incentive for the government to encourage preventive medicine.  One obvious encouragement is proper eating.  This led to the food triangle which may not be the right form of encouragement.

freya

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Re: What comes after the ACA?
« Reply #5754 on: October 05, 2019, 01:01:02 PM »
How did the thread go from ACA to angry Vegan rants?

Well, there's not much to talk about as regards the ACA at the moment.  The thread has been shifting to contributors to the ever-increasing cost of health care, which is a far more important issue, IMHO. 

Tinkering with insurance while ignoring the epidemic of metabolic disease which is driving most of the cost increases is akin to rearranging the deck chairs on the Titanic.

The angry vegan thing certainly took me by surprise.  This comes of stating facts that run contrary to someone's deeply held belief, when that person knows that the belief is open to scientific question.  It's unfortunate that the USDA dietary guidelines amount to a set of beliefs that are backed up by shoddy science - if anything.  That would be an interesting subject to debate, but perhaps in a different thread.

bigote2032

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Re: What comes after the ACA?
« Reply #5755 on: October 05, 2019, 02:25:37 PM »
You are calling me angry vegan? I am not even vegan dude.  I am whole foods plant based, there is a big difference, vegans are not my favorite kind of people to be honest.

ACA has A LOT to do with nutrition, this is one of the most unhealthy countries in the world because of what we eat and we have crappy insurance.  Reason a little bit on this.

I love the ridiculous answers people give me when I ask them why folks from countries that are predominantly rice eaters are more healthy that folks from western diet countries.  If you want to be offended by my comments be my guest, as I said, nutrition is very personal, people don't want to be told what to eat by others.  I spent five years making fun of vegans and plant-based, I did that until plant based saved my life.  Keep eating your burgers and fries and having your 10 pills a day to support your life style and let's see who makes it farther.  Mic drop.
« Last Edit: October 05, 2019, 02:37:00 PM by bigote2032 »

Paul der Krake

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Re: What comes after the ACA?
« Reply #5756 on: October 05, 2019, 02:34:30 PM »
Changing the subject... looks like premiums are stabilizing for 2020!



Source: http://acasignups.net/rate-changes/2020

Open enrollment is just around the corner, starting November 1 for most states.

maizefolk

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Re: What comes after the ACA?
« Reply #5757 on: October 05, 2019, 03:02:32 PM »
Seems like good news. Thanks for posting, Paul der Krake!

I'd really been assuming we'd see a continued death spiral of higher premiums lead to more health people dropping out leading to higher premiums particularly with the zeroing out of the individual mandate for 2019.

rantk81

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Re: What comes after the ACA?
« Reply #5758 on: October 05, 2019, 03:38:04 PM »
It still might be pretty bad.  Just because the premium rates on average might be going down a little -- the overall plans could just be worse.  A lot of the plans in my area already have pretty miserable doctor networks, and out of pocket maximums that peg the federal upper limit.  Maybe the deductibles in my area will all now peg the federal maximum for that too...

seattlecyclone

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Re: What comes after the ACA?
« Reply #5759 on: October 05, 2019, 04:11:42 PM »
It still might be pretty bad.  Just because the premium rates on average might be going down a little -- the overall plans could just be worse.  A lot of the plans in my area already have pretty miserable doctor networks, and out of pocket maximums that peg the federal upper limit.  Maybe the deductibles in my area will all now peg the federal maximum for that too...

The high deductibles are likely a symptom of ever-increasing prices at hospitals. The exchange plans have to maintain a fixed "actuarial value" based on the metal value of the plan. This value is the percentage of their customers' total medical bills that they pay. A silver plan needs to pay 70%, for example. The other 30% must be paid directly by the customer in the form of deductibles and coinsurance. If the overall costs double, the overall out-of-pocket costs must also double in order to keep the plan qualifying as a silver plan.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5760 on: October 06, 2019, 08:38:44 PM »
In my area, Jared Kushner's brother, Joshua, has a health insurance company called Oscar that is bringing these dubious health insurance plans that are cheaper and thus bringing down the price of 2nd lowest silver plan.

joshuagraham_xyz

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Re: What comes after the ACA?
« Reply #5761 on: October 07, 2019, 02:22:52 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.

But what about the fact there will just be fewer workers around, period, due to the onslaught of the robot age?  We'll need to to start taxing wealth & unearned income, not earned income.  (Interestingly, it would seem that most of the earned income would come from those in the health care industry.)

pecunia

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Re: What comes after the ACA?
« Reply #5762 on: October 07, 2019, 03:43:17 PM »
Will the cost of health care go down as costs for other industries have with the onset of robotized medicine? 

Maybe with tomorrow's equivalent of Obamacare, you won't lose your doctor because he is kept in a box.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5763 on: October 07, 2019, 08:14:31 PM »
But if you're taxing workers to give money to retirees, even if the retirees are rich, funding it with a flat tax doesn't fix what an awful policy that is.

All workers will be eligible for Medicare when they reach the age at which people of ordinary means (and their employers) can no longer afford to pay for their health care.  Taxes of today's workers pay for the care of today's old people.  When today's workers are old, taxes from tomorrow's workers will pay for their health care.  That's how the social contract works.  Yes, there are serious demographic problems on the horizon due to the increasing proportion of the population that is old vs. the proportion that is working.  But that doesn't mean we just tell tomorrow's (or today's) old people that they can just suck it.  A serious republic would find a way to finance a humane level of care that doesn't bankrupt people after they've worked their entire lives.

But what about the fact there will just be fewer workers around, period, due to the onslaught of the robot age?  We'll need to to start taxing wealth & unearned income, not earned income.  (Interestingly, it would seem that most of the earned income would come from those in the health care industry.)
That concern has been around since at least the Luddites two hundred years ago.  Thus far, such fears have proven to be unfounded.  And I have little concern about that changing--every time humanity automates a job, consumers find something else to spend their money on, whether it be more clothes (in the time of the Luddites), more cars, more electronics, eating out more, bigger houses, more travel, or whatever.

pecunia

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Re: What comes after the ACA?
« Reply #5764 on: October 09, 2019, 06:54:18 PM »
I guess it can never get too bad.  If it is all automated and nobody is working, they won't have a market.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5765 on: October 23, 2019, 04:27:22 PM »
To Treat Chronic Ailments, Fix Diet First
https://nyti.ms/2pIlmZg

In this article it states that the ACA is helping to do research on how to lower hospital utilization rates through improved eating.

"Last year, California’s version of Medicaid, Medi-Cal, introduced a three-year pilot study that’s already showing what experts in the health care field have seen anecdotally — that tailored nutrition can improve health and lower medical costs for chronically ill patients. "

"Because of high utilization rates associated with congestive heart failure, it was one of the conditions of most interest to the federal Centers for Medicare & Medicaid Services in their Hospital Readmissions Reduction Program, under the Affordable Care Act. That program incrementally reduced hospital payments for frequent readmissions. "

"...medically tailored meals can go a long way toward reversing that downward health spiral. A retrospective cohort study headed by Seth Berkowitz, M.D. at the University of North Carolina Chapel Hill School of Medicine, and published in April concluded: “Participation in a medically tailored meals program appears to be associated with fewer hospital and skilled nursing admissions and less overall medical spending.”"

pecunia

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Re: What comes after the ACA?
« Reply #5766 on: October 24, 2019, 10:38:35 AM »
Other than the sickness, I'll bet those altered diets improve those folks lives in other ways as well.  Food is a drug but we don't realize it.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5767 on: October 25, 2019, 09:25:24 PM »
Plan previews for 2020 are here! Happy shopping.

https://www.healthcare.gov/see-plans/


Exflyboy

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Re: What comes after the ACA?
« Reply #5768 on: October 26, 2019, 04:18:13 PM »
Plan previews for 2020 are here! Happy shopping.

https://www.healthcare.gov/see-plans/

Curious bugs with the system. None of the providers in my area list my local doctors offices as a provider from withing Oregon.gov.. But if you go to the individual plan and look up their provider network  (Providence in my case) then my local doctors and their location is shown as providers.

I'm assuming the plan provider network is correct.

geekette

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Re: What comes after the ACA?
« Reply #5769 on: October 26, 2019, 06:55:38 PM »
I got notification from BCBS weeks ago, and at that time, there was very little in the way of providers loaded on their own web page, but they've been trickling in.  My usual doctors are all listed there, but nothing on Healthcare.gov.  It may just take time to get contracts signed and entered.

Wolfpack Mustachian

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Re: What comes after the ACA?
« Reply #5770 on: October 26, 2019, 07:22:39 PM »
You are calling me angry vegan? I am not even vegan dude.  I am whole foods plant based, there is a big difference, vegans are not my favorite kind of people to be honest.

ACA has A LOT to do with nutrition, this is one of the most unhealthy countries in the world because of what we eat and we have crappy insurance.  Reason a little bit on this.

I love the ridiculous answers people give me when I ask them why folks from countries that are predominantly rice eaters are more healthy that folks from western diet countries.  If you want to be offended by my comments be my guest, as I said, nutrition is very personal, people don't want to be told what to eat by others.  I spent five years making fun of vegans and plant-based, I did that until plant based saved my life.  Keep eating your burgers and fries and having your 10 pills a day to support your life style and let's see who makes it farther.  Mic drop.

Just catching up on the end of this thread, but I'm doubting you really spent 5 years making fun of vegans. If you did, you must have a really short memory, because you should know that comments like yours that straw man people who are not vegan into all being people who keep eating burgers and fries and take 10 pills a day (and then you actually type mic drop for your own comment, lol) are probably not comments if you're trying to help people actually be open to your argument. Just thought it's worth saying for anyone who might be actually trying to convince people to eat more fruits and vegetables (instead of appearing to just like to argue). Eating more vegetables and less meat is a worthy thing to try to convince people of; making poor arguments to try to support it is therefore a bad thing....

freya

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Re: What comes after the ACA?
« Reply #5771 on: October 27, 2019, 10:33:04 AM »
I got notification from BCBS weeks ago, and at that time, there was very little in the way of providers loaded on their own web page, but they've been trickling in.  My usual doctors are all listed there, but nothing on Healthcare.gov.  It may just take time to get contracts signed and entered.

Maybe, but be careful about that...providers may be dropping some of these low-cost plans, because they reimburse poorly.  In my state, all Obamacare plans are Medicaid managed care, i.e. they are designed to cover the state's Medicaid population, and patients are mostly restricted to Medicaid clinics and hospitals.

I also saw there's about an 8% average price jump in premiums this year, e.g. individual silver plans went from $560-600/month to $620-$650 range, with deductible/out of pocket staying the same.  That's >4x rate of inflation...the band rolls on.  Seems to be at odds with the chart someone posted above.

geekette

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Re: What comes after the ACA?
« Reply #5772 on: October 27, 2019, 11:26:55 AM »
I’m not sure what I should be careful about - the insurance company has more up to date info than healthcare.gov.

Our rate went down again this year.

pecunia

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Re: What comes after the ACA?
« Reply #5773 on: October 27, 2019, 07:57:46 PM »
I guess these insurance companies are doing their part to encourage us to vote for alternative medicine.  Every year as they raise their prices, it helps me to make my decision as to who to vote for.

ScreamingHeadGuy

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Re: What comes after the ACA?
« Reply #5774 on: October 28, 2019, 07:10:41 PM »
Plan previews for 2020 are here! Happy shopping.

https://www.healthcare.gov/see-plans/

I like to check so I can run estimates numbers for my FIRE spending (now only 1 ACA enrollment away).  Currently looks like a silver plan could be 50% of the number I’ve plugged into my budget, meaning my FIRE spending - which I base my necessary stache on - is 5% high.  Well, looks like I’m suddenly at 29.4x spending based on a revised health insurance cost.  ☺️

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5775 on: October 31, 2019, 04:17:34 PM »
This article from the Washington Post about the benefits of the ACA is very interesting because it helps to clarify that this law is improving the lives of many people.

https://www.washingtonpost.com/health/i-would-be-dead-or-i-would-be-financially-ruined/2019/09/29/e697149c-c80e-11e9-be05-f76ac4ec618c_story.html?wpisrc=nl_most&wpmm=1

DETROIT — Poor people in Michigan with asthma and diabetes were admitted to hospitals less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.
Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.
The evidence is accumulating just as the ACA’s future is, once again, being cast into doubt. The most immediate threat arises from a federal lawsuit, brought by a group of Republican state attorneys general, that challenges the law’s constitutionality. A trial court judge in Texas ruled late last year that the entire law is invalid, and an opinion on the case is expected at any time from the U.S. Court of Appeals for the 5th Circuit. The case could well put the ACA before the Supreme Court for a third time.

President Trump has dismantled as much of the law as his administration can, by expanding the availability of skimpy, inexpensive health plans that skirt ACA rules, for example, and slashing federal aid to help people sign up for coverage through ACA insurance marketplaces.
And some 2020 Democratic presidential candidates contend the country needs further-reaching health reforms than the ACA’s, calling for a government-financed system they call Medicare-for-all.
The ACA’s supporters have not taken political advantage of the signs that the law is translating into better health — at least, not yet.
When the sprawling 2010 statute was new, a central question was whether it would help more people gain affordable health coverage, as intended.

With about 20 million Americans now covered through private health plans under the ACA’s insurance marketplaces or Medicaid expansions, researchers have been focusing on a question that was not an explicit goal of the law: whether anyone is healthier as a result.

It is difficult to prove conclusively that the law has made a difference in people’s health, but strong evidence has emerged in the past few years. Compared with similar people who have stable coverage through their jobs, previously uninsured people who bought ACA health plans with federal subsidies had a big jump in detection of high blood pressure and in the number of prescriptions they had filled, according to a 2018 study in the journal Health Affairs.
And after the law allowed young adults to stay longer on their parents’ insurance policies, fewer 19- to 25-year-olds with asthma failed to see a doctor because it cost too much, according to an analysis of survey results published earlier this year by researchers at the Centers for Disease Control and Prevention.

Most of the emerging evidence concentrates on the health effects of joining Medicaid under the law’s expansion of the safety-net program. Medicaid is an appealing research focus because a 2012 Supreme Court decision gave each state the option to widen eligibility to people who are somewhat less poor, allowing comparisons between the three dozen states that have expanded and the rest that have not. In addition, low-income people without insurance are most likely to have built-up medical problems that get treated once they get covered.

Michigan has emerged as a hub for understanding the ACA’s effects on health because University of Michigan researchers have been rigorously evaluating the Healthy Michigan Plan, as the state calls its Medicaid expansion covering about 650,000 people.

One 2017 study compared heart surgery patients in Michigan and Virginia, which had not yet expanded Medicaid at the time. It found that those who had cardiac bypasses or valve operations in Michigan had fewer complications afterward than similar people in Virginia, where more were uninsured.
One in three Michigan women said that, after joining Medicaid, they could more easily get birth control. And four in 10 people in Healthy Michigan with a chronic health condition — such as high blood pressure, a mood disorder or chronic lung disease — learned of it only after getting the coverage, according to survey results published last month.

In a few neighborhoods here in Detroit, the consequences for patients and their doctors are clear.
*****
Bonnie Sparks, dripping sweat in a mint-green ­T-shirt, reached the finish line of the CHASS community health center’s 5K run/walk. As she trudged the final steps, the center’s chief medical officer, Richard Bryce, urged workers and some medical students to walk alongside her in the 97-degree heat, chanting her name. Then, Bryce wrapped Sparks in a hug.

Sparks came in last of the event’s 270 runners and walkers in late July in a southwest Detroit neighborhood pocked with vacant lots. She was halfway to Clark Park when the center’s executive director found her at the back of the pack and offered a ride. “No way,” Sparks said, insisting on continuing under her own power.

The miracle was that, at 47, she walked the course at all.

CHASS has been a medical haven in Detroit’s Mexicantown for a half-century, since the city’s riots prompted hospitals to close and physicians to move to the suburbs. Five years ago, when Bryce, a family physician, arrived and took over Sparks’s care, she weighed more than 300 pounds and could not get from the clinic parking lot to the front door without help. She’d had her first heart attack at 34. Her anxiety was so sharp she often could not leave her apartment.
On a rare family road trip — to Daytona Beach — she waded into Florida waters where flesh-eating bacteria infected an open sore on her right leg. Back home, she landed in a hospital for 3½ weeks.

For 13 years, Sparks had worked for a defense contractor, NCI Information Systems, overseeing two computer help desks. But when the company lost a contract, her job ended in late 2010, and her good HMO insurance disappeared.

Living on unemployment, she kept taking pills for her diabetes and high blood pressure because she could get the prescriptions for $4 a month through a Walmart discount. But she did not have the $300 a month to pay for Plavix — a blood thinner she needed because of a stent put in her heart — so she stopped.
“I talked to my doctor at the time. I said, ‘I can’t afford this,’ ” recalls Sparks. “He said, ‘You could have another heart attack.’

“And I did.”
The second heart attack, in early 2012, was serious. Afterward, her doctors told her she should not work. She applied for Medicaid twice and received form letters telling her she was denied because she was not under 21, pregnant, blind or taking care of a child.
The following year, she appealed in writing, then asked for a hearing, but a state administrative law judge concluded that, though Sparks had a solid job history and significant medical problems that made it difficult for her to work, she was not technically disabled, so did not qualify for insurance.

“I felt abandoned,” Sparks recalls. “I nearly died. I kept thinking, ‘I am just sick right now.’ ”

So Sparks was uninsured when her boyfriend rushed her to an emergency room for a second time within days after the Florida trip. This time, she was diagnosed with the flesh-eating necrotizing fasciitis. She was having breathing distress and kidney failure because of the infection and was placed in a medically induced coma for most of her time in the Henry Ford Hospital.
But the day she was admitted, April 3, 2014, was the third day the state had begun accepting applications for the Healthy Michigan Plan. On April 29, Sparks got a letter. She was insured.
Medicaid paid her $132,000 hospital bill.
Since then, social workers and a psychologist have helped ease her out of her smoking habit and her anxiety. She met with a bariatric surgeon to consider a gastric bypass but, by that point, had started to lose so much weight by improving her diet and walking that she decided she did not need the surgery. By August, she was down to 234 pounds.

Sparks has an endocrinologist for her diabetes. A cardiologist approved a catheterization when she had more chest pains — and inserted additional stents. And she has an OB/GYN who treated her worsening fibroids and, when they got too severe, made sure she got a hysterectomy.

Bryce, who arrived at CHASS at about the time of Sparks’s infection, says she was like many sick and uninsured patients who can get primary care through the health center but have trouble finding medical specialists willing to treat them.
If not for the health plan she has through Healthy Michigan and Medicare, which she has had since the state eventually classified her as disabled, Sparks said, “I would be dead, or I would be financially ruined.”
On the east side of Detroit, the part of town where poverty and illness are most common and life expectancy is shortest, Healthy Michigan has transformed the lives of patients at the Mercy Primary Care Center. Like Sparks, David Brown says that, without it, “I probably would not be here. I would have had a heart attack and died.”

Before Medicaid expanded, all of Mercy’s patients were uninsured. Now, at 55, Brown is among the half at the clinic covered by Healthy Michigan.
Right after he got laid off in 2007 from a job with Wayne County, driving trucks and front-end loaders at the airport, he began having spells in which his chest was tight, his head spinning. Finally, a friend took him to an emergency room. He was prescribed rest and ordered to follow up with his primary care doctor. Except he did not have one.
Over the next few years, the spells came more often, and he was going to emergency rooms around town, dizzy and with headaches, two or three times a month. When the bills showed up, he stored them, unpaid, in the brown plastic crates where he keeps files.
He does not remember anyone checking his blood sugar, even though his favorite foods were fried chicken, Burger King, cinnamon doughnuts, chocolate milk and — especially — Snickers bars.
Finally, during an emergency room visit, someone mentioned he might be borderline diabetic.
When he finally heard about Mercy and was diagnosed with diabetes by Pamela Williams, a staff physician, Brown recalls, “she started telling me what could happen — amputation, kidney failure, heart failure. I was like, ‘I could lose my foot, my hand?’ I had never heard of anything like that.”

On a Mediterranean diet, Brown, also a licensed pastor who does online counseling, has gone from 340 pounds to 215. His blood sugar has been under control the past few years.
“But unfortunately, the damage was done when he didn’t have insurance,” Williams says.
With coverage from Healthy Michigan, Brown sees a nephrologist for his chronic kidney disease, a cardiologist for his congestive heart failure, an ophthalmologist for eye damage — all downstream effects of the years he did not know he had out-of-control diabetes.
Brown now has three stents in his heart, including a new one this summer after he had balloon angioplasty to open a clogged artery. He takes medicines that, if he had to pay retail, would cost about $2,400 a month.
“This stuff was not available to me without insurance,” Brown says. “I am grateful for it.”
****
Understanding the ways the ACA has affected Americans’ health is a work in progress. In the law’s first years, results were mixed, but signs of improvements have accelerated lately, as people uninsured before now have more years of coverage, giving researchers better data to study.
It is too soon to know whether the patterns might reverse with new U.S. Census Bureau data showing that the uninsured rate rose significantly last year for the first time since the ACA has existed.
The findings that exist are not perfect. One National Bureau of Economic Research paper in July, looking at deaths from all causes among adults from their mid-50s to mid-60s, found that dying in a given year has been significantly less common in the states that expanded Medicaid. The paper said that perhaps 15,600 deaths could have been avoided if the expansion had been nationwide, but it cautioned that is a rough estimate in part because the study was unable to look specifically at the people who signed up for Medicaid.
Similarly, a study last year found that infant deaths — especially among black babies — were dropping more rapidly in parts of the country that had expanded Medicaid. But the study does not distinguish families that got coverage through the ACA expansions.
The University of Michigan work, including on trends in hospital stays for four main chronic diseases, was able to focus specifically on people who had joined Healthy Michigan. It found that from the first year in the program to the second, hospital stays for asthma plummeted by half and also fell for diabetes complications. But hospital stays for heart failure became more common. The researchers have not yet looked at the patterns for additional years.
Still, John Ayanian, director of the University of Michigan’s Institute for Healthcare Policy and Innovation, said, “the weight of evidence is on the positive side.”


pecunia

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Re: What comes after the ACA?
« Reply #5776 on: October 31, 2019, 04:55:24 PM »
Good article - The thing that impressed me was how much good the example people did for themselves by diet and exercise, not pills.  Is it true that an ounce of prevention is worth a lb of cure?

Paul der Krake

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Re: What comes after the ACA?
« Reply #5777 on: November 01, 2019, 12:41:26 PM »
Anyone else having issues with healthcare.gov on this beautiful open enrollment morning?

bacchi

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Re: What comes after the ACA?
« Reply #5778 on: November 01, 2019, 02:42:57 PM »
Anyone else having issues with healthcare.gov on this beautiful open enrollment morning?

Yeah. Seeing an error page,

"The System is down at the moment."

seattlecyclone

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Re: What comes after the ACA?
« Reply #5779 on: November 01, 2019, 03:40:36 PM »
The Washington state exchange seems to be working pretty well at the moment.

geekette

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Re: What comes after the ACA?
« Reply #5780 on: November 01, 2019, 05:14:22 PM »
Seems to be working at this time (in NC).

Annoying glitch.  Healthcare.gov shows all doctors I search for as out of network, but when click the link to the provider network, they're all there.  It's a new plan that doesn't start until 1/1/20, so they aren't in network until...1/1/20.
« Last Edit: November 01, 2019, 05:19:54 PM by geekette »

Exflyboy

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Re: What comes after the ACA?
« Reply #5781 on: November 01, 2019, 07:18:08 PM »
Seems to be working at this time (in NC).

Annoying glitch.  Healthcare.gov shows all doctors I search for as out of network, but when click the link to the provider network, they're all there.  It's a new plan that doesn't start until 1/1/20, so they aren't in network until...1/1/20.

Yeah same here.. I actually called the insurance company and made sure my doc was going to be part of their plan for 2020, even though they were shown for 2019, HC.gov still did not show them as being covered.
« Last Edit: November 01, 2019, 07:22:28 PM by Exflyboy »

Exflyboy

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Re: What comes after the ACA?
« Reply #5782 on: November 01, 2019, 07:26:48 PM »
I got all the way to the end of my application to select my plan.. Then hit submit and the little waiting icon just kept going and going.

After n hour I hit screen refresh and it all disappeared!

So have I applied or not? I went back in and it listed the plan I selected for 2020 and it said it was "active".

Of course you don't get any receipt sent by email so you're never really sure!

pecunia

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Re: What comes after the ACA?
« Reply #5783 on: November 02, 2019, 01:23:43 PM »
I have plans to quit at the end of this year or early next year.  Will the ACA consider that a "life change?"  Seems to me I had no trouble signing up a few years ago when I was without work a month or two.  However, then I had to pay them back because my income went back up.

Exflyboy

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Re: What comes after the ACA?
« Reply #5784 on: November 02, 2019, 01:32:40 PM »
I have plans to quit at the end of this year or early next year.  Will the ACA consider that a "life change?"  Seems to me I had no trouble signing up a few years ago when I was without work a month or two.  However, then I had to pay them back because my income went back up.

Yes.. that is a life change no matter how you "lose" your job and qualifies for a "special Enrollment".

jim555

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Re: What comes after the ACA?
« Reply #5785 on: November 06, 2019, 05:04:33 AM »
Good news, Kentucky will have a Democratic Governor, he will stop the press for Medicaid work requirements.  The courts have been litigating the issue since the law has no such requirements.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5786 on: November 06, 2019, 08:06:00 AM »
Fascinating Bloomberg story about UHC operating transitional housing for their "worst" Medicaid patients.

https://www.bloomberg.com/news/features/2019-11-05/unitedhealth-s-myconnections-houses-the-homeless-through-medicaid

I wish there was more data available about the clear abuse of ERs by a very tiny minority. Maybe something that can be improved legislatively to prevent frequent fliers from getting $300 sandwiches.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5787 on: December 18, 2019, 07:47:12 PM »
Unfortunately the Democrats and the Republicans worked together to kill the tax on Cadillac health insurance plans .

The portion of health insurance that cost above $11,200 for an individual or $30,150 for a family plan was supposed to get taxed.
This tax was part of Obamacare and it was supposed to help yield revenue for the program.
The tax was also an effort to stop the market distortion of providing untaxed compensation to employees who got these super ridiculously expensive health insurance plans.
Such health insurance plans drove up increased and excessive use of healthcare without any consideration for the costs involved.
Essentially the federal government was providing tax subsidies for crazy fancy health plans, because the cost of the plans, which are essentially employee income, went untaxed.
The winners are employees of large megacorps/fancy union employees  that provide deluxe health insurance plans.
The losers are everyone else that has to foot the bill for health insurance for everyone else, and the increased costs of health care that result from heedless health care spending.

The repeal of the ‘Cadillac tax’ showed a hazard of bipartisanship
https://www.washingtonpost.com/opinions/the-repeal-of-the-cadillac-tax-showed-a-hazard-of-bipartisanship/2019/07/24/28e169aa-ad76-11e9-a0c9-6d2d7818f3da_story.html

Killing the ‘Cadillac tax’ would throw our health care even more out of whack
https://www.washingtonpost.com/opinions/killing-the-cadillac-tax-would-throw-our-health-care-even-more-out-of-whack/2019/06/06/acbc0842-8707-11e9-98c1-

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5788 on: December 18, 2019, 10:08:00 PM »
More bad news for the ACA today:  The 5th Circuit ruled the individual mandate unconstitutional.  Back when the GOP controlled house, senate, and WH, they set the "shared responsibility payment" to zero, and the 5th circuit ruled that without the mandate requiring dollars, it could no longer be considered a tax.  The "considered a tax" part is what Chief Justice Roberts used to rule that the ACA passed constitutional muster way back when.

It'll be a while before it bubbles back up--the lower courts now need to decide whether the mandate is severable from the rest of the law.  Logically, it really can't be severable--without the mandate, you get perverse incentives, and the individual market is destined to a death spiral.

Exflyboy

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Re: What comes after the ACA?
« Reply #5789 on: December 18, 2019, 10:27:09 PM »
I still think it will be a brave GOP that would kill the ACA without some kind of replacement.

They got some pretty vicious pushback last they tried it.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5790 on: December 19, 2019, 04:43:46 AM »
I still think it will be a brave GOP that would kill the ACA without some kind of replacement.

They got some pretty vicious pushback last they tried it.
I think they're trying to get the courts to do it for them.

rantk81

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Re: What comes after the ACA?
« Reply #5791 on: December 19, 2019, 06:01:13 AM »
The portion of health insurance that cost above $11,200 for an individual or $30,150 for a family plan was supposed to get taxed.

We debate on whether those outrageously large sums should be taxable or not.... Meanwhile, the rest of the world can't possibly conceive how it could possibly cost that much per year to medically cover/insure the average person/family.

Mr. Green

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Re: What comes after the ACA?
« Reply #5792 on: December 19, 2019, 05:29:53 PM »
More bad news for the ACA today:  The 5th Circuit ruled the individual mandate unconstitutional.  Back when the GOP controlled house, senate, and WH, they set the "shared responsibility payment" to zero, and the 5th circuit ruled that without the mandate requiring dollars, it could no longer be considered a tax.  The "considered a tax" part is what Chief Justice Roberts used to rule that the ACA passed constitutional muster way back when.

It'll be a while before it bubbles back up--the lower courts now need to decide whether the mandate is severable from the rest of the law.  Logically, it really can't be severable--without the mandate, you get perverse incentives, and the individual market is destined to a death spiral.
With this ruling directing the lower courts to opine on specifics, and the chance that additional lawsuits can arise out of those opinions, I say this decision makes it at least 5 years before this case sits before the Supreme Court, and that's assuming nothing changes politically and the case remains relevant. If anything it's a boon for advocates because insurance rates are now coming down and insurers are rejoining markets in many places. This will just give that much more time to show the law has had solid success in raising the rate of the insured, and make it harder to kill.

pecunia

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Re: What comes after the ACA?
« Reply #5793 on: December 19, 2019, 07:04:09 PM »
I still think it will be a brave GOP that would kill the ACA without some kind of replacement.

They got some pretty vicious pushback last they tried it.

Yes - I think the political pendulum is swinging quickly away from those guys.  I figure health care is the number one issue in the country and they are doing nothing to fix it.

Paul der Krake

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Re: What comes after the ACA?
« Reply #5794 on: December 21, 2019, 01:52:47 AM »
This article just made my head explode:
http://acasignups.net/19/12/20/coming-trumps-hhs-2020-hey-everyone-remember-pay-your-abortion-bill-each-month

Read in full, it gets more and more ridiculous.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5795 on: December 21, 2019, 07:25:40 AM »
I couldn't read the whole thing, it's so insane.

Mr. Green

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Re: What comes after the ACA?
« Reply #5796 on: December 21, 2019, 07:35:00 PM »
This article just made my head explode:
http://acasignups.net/19/12/20/coming-trumps-hhs-2020-hey-everyone-remember-pay-your-abortion-bill-each-month

Read in full, it gets more and more ridiculous.
I really feel bad for the person(s) who thought up this idea, that they have don't have something better to do with their time. They must be miserable people.

talltexan

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Re: What comes after the ACA?
« Reply #5797 on: January 03, 2020, 05:30:38 AM »
Not miserable. Just people who believe that hitting people who buy subsidized health insurance in the head with the fact that some of it is paying for abortions will lead to a political shift on how much abortion can be accessed by women over time.

rantk81

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Re: What comes after the ACA?
« Reply #5798 on: January 03, 2020, 07:52:17 AM »
Why stop there? Why not cut up the medical premium cost into a few thousand different bills, each pro-rated for how much the insurance plans are paying out.  Cancer. Heart disease. Organ transplants. Diabetes. HIV treatment. Primary care visits. etc.   Why don't we all receive 10,000 individual bills and write 10,000 individual checks for our health insurance premiums each month!

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5799 on: January 03, 2020, 08:33:29 AM »
Not miserable. Just people who believe that hitting people who buy subsidized health insurance in the head with the fact that some of it is paying for abortions will lead to a political shift on how much abortion can be accessed by women over time.

What's next?  Should we know what portion of the subsidy is going toward men's vasectomies?