Author Topic: What comes after the ACA?  (Read 1396907 times)

SugarMountain

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Re: What comes after the ACA?
« Reply #6100 on: August 11, 2020, 11:20:43 AM »
Look, the money's being spent. The US pays anywhere from 25-50% more per capita than other industrialized countries, often with poorer results.

So rural hospitals may be faltering but someone, somewhere, is making bank. It could be United Health Care (1), it might be doctor salaries (2), it could be other community hospitals (3) or hospital networks, it's probably Big Pharma (4) and crazy-ass regulations and top heavy administration (5), but there's a leak.

If only the US could use what other countries have learned. (6)

Quote from: (6)
In fact, the United States spends about $940 per person on administrative costs — four times more than the average of other wealthy countries and significantly more than we spend on preventive or long-term healthcare.
[...]
Despite significantly higher healthcare spending, America’s health outcomes are not any better than those in other developed countries. The United States actually performs worse in some common health metrics like life expectancy, infant mortality, and unmanaged diabetes.



(1) https://www.healthcaredive.com/news/unitedhealth-reports-nearly-14b-in-2019-profit/570474/
(2) https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557/
(3) https://www.modernhealthcare.com/article/20180104/NEWS/180109966/hospital-profits-continued-their-rise-in-2016
(4) https://www.newsweek.com/big-pharma-companies-profits-industries-study-1490407
(5) https://www.pgpf.org/blog/2020/07/how-does-the-us-healthcare-system-compare-to-other-countries
(6)  https://data.oecd.org/healthres/health-spending.htm

It may not even be high cost administrators, it's not like the claims adjusters at UNH are getting paid big bucks or the people who manage it at your doctor's office.  I really think our whole insurance model is a big problem because of the overhead and paperwork involved.  There is also a flaw with the ACA wherein insurers have their profits capped at a percent of claims paid (something like 20%).  So to increase profitability they need to increase the amount the pay for claims, so they are happy to allow doctors and hospitals to charge more and do unnecessary tests as long as they can ultimately pass it along in the form of higher premiums the next year and thus increase their profitability.  This cycle is part of why $UNH has done so well since the ACA became law.

bacchi

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Re: What comes after the ACA?
« Reply #6101 on: August 11, 2020, 11:32:07 AM »
It may not even be high cost administrators, it's not like the claims adjusters at UNH are getting paid big bucks or the people who manage it at your doctor's office.  I really think our whole insurance model is a big problem because of the overhead and paperwork involved.

Agreed. It doesn't have to be well paid admin (though C-level administrators at hospitals are often very well paid); it can be too much admin.


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There is also a flaw with the ACA wherein insurers have their profits capped at a percent of claims paid (something like 20%).  So to increase profitability they need to increase the amount the pay for claims, so they are happy to allow doctors and hospitals to charge more and do unnecessary tests as long as they can ultimately pass it along in the form of higher premiums the next year and thus increase their profitability.  This cycle is part of why $UNH has done so well since the ACA became law.

It's a perverse incentive for sure.

talltexan

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Re: What comes after the ACA?
« Reply #6102 on: August 19, 2020, 08:56:25 AM »
Yes, Exflyboy, I will vote accordingly and I am sure you can imagine who that might be.

So many lies during this Presidency. He can't even come up with enough good lies now to tell us what he fake proposes for the next 4 years. He can't say the economy is good, the stock market goes up and down every day, massive unemployment, Covid-19 that he did nothing about and all the deaths. He is beating up Biden as hating God now! I don't want to hear that crap! I want to know what you are going to do for the American people. He surely did nothing good the first 4 years.

I was on ACA and moved onto Medicare but I was concerned while on it if it was going to get ripped away. The system is in place and it is a no brainer to fix it, improve it, work on it, mold it. I am not saying there aren't problems with it but people need it and it sure wasn't that affordable in my opinion. However, the Medicare choices I chose are MORE expensive than ACA. So get ready for that ride when you get on it. Medicare is one of those things that you get what you pay for. The more you pay the more you get, the less you pay the less you get.

After he lost the 2012 (Vice-) Presidential election, Paul Ryan could have hired an aid--one policy aid--and assigned him full-time to work on a replacement for ACA to be ready when Republicans won the WH in 2016. He didn't, and--when they had the chance--the best he could come up with was the American Health Care Act, which basically accepted the underlying logic of ACA, but without the mandate. Trump has many flaws, but he cannot be blamed for this failure, it's on the GOP establishment, who invested no resources whatsoever to develop a credible alternative.

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Re: What comes after the ACA?
« Reply #6103 on: August 19, 2020, 09:37:36 AM »
The GOP didn't bother to develop a right-wing alternative to ACA because there isn't room for one - anything further right than the ACA is necessarily either about removing coverage or limiting costs.  It would like to do the first but it is politically unacceptable, the second is politically acceptable but it doesn't want to do it.

Exflyboy

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Re: What comes after the ACA?
« Reply #6104 on: August 19, 2020, 04:18:36 PM »
Supreme court to take up the ACA one week after the election.

https://www.healthleadersmedia.com/strategy/scotus-schedules-aca-oral-arguments-nov-10

This will put the issue squarely on the public's mind during the election.

American GenX

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Re: What comes after the ACA?
« Reply #6105 on: August 19, 2020, 10:13:29 PM »
Supreme court to take up the ACA one week after the election.

https://www.healthleadersmedia.com/strategy/scotus-schedules-aca-oral-arguments-nov-10

This will put the issue squarely on the public's mind during the election.

What sucks is that a ruling isn't expected until June.  This is such a drawn out process, which is frustrating if you're counting on FIREing and wanting access to health care coverage through the ACA for years to come, but you're caught up in limbo because of this issue.

Exflyboy

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Re: What comes after the ACA?
« Reply #6106 on: August 19, 2020, 10:18:34 PM »
Supreme court to take up the ACA one week after the election.

https://www.healthleadersmedia.com/strategy/scotus-schedules-aca-oral-arguments-nov-10

This will put the issue squarely on the public's mind during the election.

What sucks is that a ruling isn't expected until June.  This is such a drawn out process, which is frustrating if you're counting on FIREing and wanting access to health care coverage through the ACA for years to come, but you're caught up in limbo because of this issue.

I honestly don't think their blatant attempt at striking the ACA will be successful in any case. The point however is the Dems will use this to prove the current orange goon squad are trying to take away people's healthcare.

Thats exactly the message message (among others) we need to get this clown out of office.

Note even Colin Powell has turned against Trump!

American GenX

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Re: What comes after the ACA?
« Reply #6107 on: August 20, 2020, 10:03:04 AM »
Supreme court to take up the ACA one week after the election.

https://www.healthleadersmedia.com/strategy/scotus-schedules-aca-oral-arguments-nov-10

This will put the issue squarely on the public's mind during the election.

What sucks is that a ruling isn't expected until June.  This is such a drawn out process, which is frustrating if you're counting on FIREing and wanting access to health care coverage through the ACA for years to come, but you're caught up in limbo because of this issue.

I honestly don't think their blatant attempt at striking the ACA will be successful in any case.

With the current makeup of SCOTUS, I lean towards the ACA standing, but the makeup of the court is fragile.  There's still reasonable doubt about what will happen.  I am more concerned about that possibility than I am that Trump could actually get re-elected.

Quote
The point however is the Dems will use this to prove the current orange goon squad are trying to take away people's healthcare.

Thats exactly the message message (among others) we need to get this clown out of office.

The lawsuit was already in place, there had already been lower court rulings, SCOTUS had already agreed to hear the case.  The only thing that has changed is that it's been scheduled to be heard AFTER the election.  I don't see how this changes anything form what we knew last week or last month.  And the dems and mainstream media don't talk about this much, and they have had plenty of opportunities to do so.  I barely heard a mention of the lawsuit during all of the democratic primary debates.  I've had to search and find the info online due to lack of coverage in mainstream media.  Usually, you just hear short sound bites from the dems like "Donald Trump wants to take health care away from 20 million Americans" rather than any detail about the lawsuit.  I'll be surprised if that changes based on what I've seen to this point.

talltexan

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Re: What comes after the ACA?
« Reply #6108 on: August 21, 2020, 08:23:04 AM »
Supreme court to take up the ACA one week after the election.

https://www.healthleadersmedia.com/strategy/scotus-schedules-aca-oral-arguments-nov-10

This will put the issue squarely on the public's mind during the election.

What sucks is that a ruling isn't expected until June.  This is such a drawn out process, which is frustrating if you're counting on FIREing and wanting access to health care coverage through the ACA for years to come, but you're caught up in limbo because of this issue.

I honestly don't think their blatant attempt at striking the ACA will be successful in any case. The point however is the Dems will use this to prove the current orange goon squad are trying to take away people's healthcare.

Thats exactly the message message (among others) we need to get this clown out of office.

Note even Colin Powell has turned against Trump!

I think if you did some searching, you'd see Powell favored Clinton over Trump four years ago.

joleran

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Re: What comes after the ACA?
« Reply #6109 on: August 21, 2020, 08:28:59 AM »
Other than the court case, are there any known current efforts to dismantle the ACA?  I'm more on the conservative side myself (though I support the ACA and expanding it) and haven't heard anything about it recently from conservative media.

talltexan

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Re: What comes after the ACA?
« Reply #6110 on: August 21, 2020, 10:45:42 AM »

joleran

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Re: What comes after the ACA?
« Reply #6111 on: August 21, 2020, 11:02:42 AM »
Making statements like this: https://www.usnews.com/news/top-news/articles/2020-08-07/trump-says-hes-working-on-health-insurance-executive-order-on-pre-existing-conditions

and then not issuing the order.

I mean, that's weird, but "a major executive order requiring health insurance companies to cover all pre-existing conditions for all customers" seems like what the ACA already has or even stronger?

jim555

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Re: What comes after the ACA?
« Reply #6112 on: August 21, 2020, 11:08:29 AM »
I mean, that's weird, but "a major executive order requiring health insurance companies to cover all pre-existing conditions for all customers" seems like what the ACA already has or even stronger?
Ground breaking, Trump signs EO giving women the right to vote.  He is counting on his base being idiots and ignorant of the current law.

Exflyboy

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Re: What comes after the ACA?
« Reply #6113 on: August 21, 2020, 11:17:03 AM »
I mean, that's weird, but "a major executive order requiring health insurance companies to cover all pre-existing conditions for all customers" seems like what the ACA already has or even stronger?
Ground breaking, Trump signs EO giving women the right to vote.  He is counting on his base being idiots and ignorant of the current law.

Even those "Suburban Housewives"?.. Gosh..

rantk81

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Re: What comes after the ACA?
« Reply #6114 on: September 18, 2020, 07:27:45 PM »
Unfortunately RBG just passed away.

This could spell the end of the ACA in the coming years, regardless of the outcome of the election in November now.

frugalecon

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Re: What comes after the ACA?
« Reply #6115 on: September 18, 2020, 07:49:53 PM »
Unfortunately RBG just passed away.

This could spell the end of the ACA in the coming years, regardless of the outcome of the election in November now.

Yeah, I have been reading a thread on another forum, some mid-30s people wanting to FIRE, counting on the ACA for health insurance. Seems kind of risky at this juncture. 30 years until Medicare is a mighty long time. Better have some kind of Plan B in case it is necessary to get health insurance another way.

Exflyboy

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Re: What comes after the ACA?
« Reply #6116 on: September 18, 2020, 08:01:12 PM »
I suspect we will see some super high deductible insurance plans.. $20k, $50k out of pocket plans.

Either that or its emigrate to somewhere with affordable HC.

bacchi

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Re: What comes after the ACA?
« Reply #6117 on: September 18, 2020, 08:08:53 PM »
I suspect we will see some super high deductible insurance plans.. $20k, $50k out of pocket plans.

Either that or its emigrate to somewhere with affordable HC.

I'm thinking the latter but I wonder if some states will try to maintain state exchanges.

Paul der Krake

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Re: What comes after the ACA?
« Reply #6118 on: September 18, 2020, 08:12:06 PM »
Everybody chill the fuck out.

Nothing has changed, yet. Elections, both past and future, have consequences.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #6119 on: September 19, 2020, 07:20:03 AM »
Unfortunately RBG just passed away.

This could spell the end of the ACA in the coming years, regardless of the outcome of the election in November now.
I think enough Republican senators have said "no" to confirmation hearings before the election that it'd be hard for them to force anything through.

If Trump somehow wins, the consequences will be...significant. A 5.5-3.5 split (since Roberts has moderated noticeably) is definitely something to sit up and take notice of.

rantk81

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Re: What comes after the ACA?
« Reply #6120 on: September 19, 2020, 10:36:09 AM »
Everybody chill the fuck out.

Nothing has changed, yet. Elections, both past and future, have consequences.

I think part of the issue is, a lot of the younger voter demographic (who no doubt tends to lean more toward the left-side of the aisle) feels quite alienated.   For the presidential elections, the Dems have won the popular vote for 6 of the last 8 elections, yet they've only been able to appoint few SCOTUS members.

« Last Edit: September 19, 2020, 10:38:35 AM by rantk81 »

waltworks

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Re: What comes after the ACA?
« Reply #6121 on: September 19, 2020, 01:39:33 PM »
I'm not sure if the Republican party would survive some of their legislative priorities actually being passed into law and upheld. A lot of it is only popular within the party (ie making abortion totally illegal), and a lot only popular in the abstract (ie, ACA repeal). From the standpoint of the party, if we're cynical about the motivations of politicians, they're better off running against the same things every year than they are actually getting those things annulled and then having to deal with the fallout. 

-W

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Re: What comes after the ACA?
« Reply #6122 on: September 19, 2020, 02:36:29 PM »
With the current makeup of SCOTUS, I lean towards the ACA standing, but the makeup of the court is fragile.  There's still reasonable doubt about what will happen.  I am more concerned about that possibility than I am that Trump could actually get re-elected.

Clearly, my concerns were justified.  This is definitely a sad  time.

ysette9

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Re: What comes after the ACA?
« Reply #6123 on: September 19, 2020, 04:29:36 PM »
It is a sorry state of affairs when I realize that my future of healthcare and bodily autonomy might be in question because one old lady died.

Exflyboy

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Re: What comes after the ACA?
« Reply #6124 on: September 19, 2020, 05:53:28 PM »
It is a sorry state of affairs when I realize that my future of healthcare and bodily autonomy might be in question because one old lady died.

Oh wait till all the redundant smart people get sent to the "Trump re-education camps".. I mean we don't need no smart people in the new MAGA World order.

Look at how well the cultural revolution worked in China..

amberfocus

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Re: What comes after the ACA?
« Reply #6125 on: September 19, 2020, 09:08:43 PM »
I think enough Republican senators have said "no" to confirmation hearings before the election that it'd be hard for them to force anything through.

I've been too despondent to check the news diligently, but who? A fact-check article from USA Today said that even though viral social media posts claimed that Collins, Murkowski, Romney, and Grassley are against confirmation hearings, only Collins and Murkowski have made statements affirming their stance since Ginsburg's death.

We already know that McConnell and Trump have no shame, and the Republicans have no spines. I've learned not to hold my breath. Every single time you think that 2020 can't get any worse, it does. At this rate this is going, 2020 may very well top itself with Trump winning re-election.

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Re: What comes after the ACA?
« Reply #6126 on: September 20, 2020, 03:45:58 AM »
I think enough Republican senators have said "no" to confirmation hearings before the election that it'd be hard for them to force anything through.

I've been too despondent to check the news diligently, but who? A fact-check article from USA Today said that even though viral social media posts claimed that Collins, Murkowski, Romney, and Grassley are against confirmation hearings, only Collins and Murkowski have made statements affirming their stance since Ginsburg's death.

We already know that McConnell and Trump have no shame, and the Republicans have no spines. I've learned not to hold my breath. Every single time you think that 2020 can't get any worse, it does. At this rate this is going, 2020 may very well top itself with Trump winning re-election.
Collins and Murkowski have said they are not in favour, which presumably means they won't vote for a Supreme Court nomination.  It doesn't necessarily mean that they will vote against, though, they could just abstain, which would leave the vote at 51 in favour and only 47 against.  Getting Republicans to vote against a nomination could be harder than just getting them to abstain.

rantk81

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Re: What comes after the ACA?
« Reply #6127 on: September 20, 2020, 06:31:12 AM »
Collins and Murkowski have said they are not in favour, which presumably means they won't vote for a Supreme Court nomination.  It doesn't necessarily mean that they will vote against, though, they could just abstain, which would leave the vote at 51 in favour and only 47 against.  Getting Republicans to vote against a nomination could be harder than just getting them to abstain.

To stop this, 4 republicans would need to break ranks, since the VP breaks a 50-50 tie.

I think it is highly likely that they vote and confirm a new SCOTUS appointment.  A lot of the News/Spin seems to say that the filling of Scalia's vacant seat might have been one of the big reasons why many conservative voters may have "held their nose" and voted for Trump last time.

I think there are a lot of "(primarily) one topic voters" who will only ever consider a candidate who shares their views on that specific issue -- most all other issues notwithstanding.  Many of those are "pro-life" voters, and there are also a lot of "pro gun" voters too.  Some of the "pro-life" voters have made it their life's mission to pack the courts with justices who share their views on that one issue -- regardless of anything else.

« Last Edit: September 20, 2020, 06:34:35 AM by rantk81 »

Omy

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Re: What comes after the ACA?
« Reply #6128 on: September 20, 2020, 07:37:43 AM »
Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?

Channel-Z

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Re: What comes after the ACA?
« Reply #6129 on: September 20, 2020, 07:54:33 AM »
Nothing comes after the ACA unfortunately. And even if you have a job with health insurance, you might find it hard to get proper coverage for a pre-existing condition. Almost every American has one. COVID-19 would be one. It shows how fragile our nation is, that one old woman's death could mean the end of affordable medical care for millions of people.


pecunia

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Re: What comes after the ACA?
« Reply #6130 on: September 20, 2020, 08:00:34 AM »
Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?

Vote for those who will reform the medical system in the United States, write letters to your Senators, become involved in groups that will help implement the change and take other actions to generate an awareness that things could be better and to help implement the change.

Sitting back and watching those politicians which are supported by the vast resources of the health insurance companies walk all over these valid health care improvements without lifting a finger to support what you believe in will make you complicit in the bad results of their actions.

rmorris50

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Re: What comes after the ACA?
« Reply #6131 on: September 20, 2020, 08:53:57 AM »
Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?
This is why I affectionately tell my spouse he will be my health care sugar daddy when I retire in the next 2-3 years. He’s the one who wants to keep working! But hopefully the ACA stays intact because we may need it one day.


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AdrianC

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Re: What comes after the ACA?
« Reply #6132 on: September 20, 2020, 10:18:32 AM »
Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?
1. The Repugs might come up with a replacement. Probably a very high deductible insurance plan. It’ll be unaffordable for most due to the deductibles but we’ll likely be ok with it. We need some kind of “insurance” so we pay the negotiated rate, not the ridiculous “full price”. It would have to cover preexisting conditions, though. We most definitely have one.

2. One of us gets a job. Not attractive, but totally doable.

3. Move to Canada/UK/etc.

seattlecyclone

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Re: What comes after the ACA?
« Reply #6133 on: September 20, 2020, 10:28:02 AM »
3. Move to Canada/UK/etc.

Or a blue state? Massachusetts had RomneyCare before the ACA. I presume they'll go back to that, or something even more socialist, and many other states will do something similar.

Mr. Green

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Re: What comes after the ACA?
« Reply #6134 on: September 20, 2020, 12:14:56 PM »
The possibility that the ACA will be overturned is definitely a valid concern if Trump gets to seat another Justice. We've been considering buying a house in North Carolina and we may put that on hold until we see what happens. We've got a rental that covers us through May of next year. Thankfully, my wife's former employer loved her and would rehire her without issue if we suddenly needed employment just for healthcare. That's a really depressing thought though, and I'm not going to dwell on any of it. Sounds like our attitude over the next 9 months should be "Carpe Diem" in case some of our freedom goes away after that.

rantk81

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Re: What comes after the ACA?
« Reply #6135 on: September 20, 2020, 12:27:56 PM »
I find myself this morning googling about the Express Entry immigration process for Canada.

It's not just about the ACA/HealthCare issue... but it's more of, getting tired of the shit in the USA. As one other poster mentioned, how Fucked Up it is that control over her body may hinge on the death of some old lady she never met in person. Yep.

It's disgusting and dysfunctional that a probable one-term president -- who won basically due to how lines are drawn on a map and how population is distributed throughout that land -- and not based on the raw number of people who supported him -- is able to nominate one third of one branch of the federal government, to life-time appointment.  Especially so, with the circumstances surrounding how those seats are filled.

What would be even more disgusting is, if he isn't a one-term president -- and that makes me want to leave the USA for other reasons -- Not really wanting to be part of this anymore where nearly 1/2 of the population is perfectly happy to support that narcissist.

jim555

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Re: What comes after the ACA?
« Reply #6136 on: September 20, 2020, 12:34:52 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406

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Re: What comes after the ACA?
« Reply #6137 on: September 20, 2020, 01:21:40 PM »

Nothing has changed, yet. Elections, both past and future, have consequences.

In NATIONAL FEDERATION OF INDEPENDENT BUSINESS v. SEBELIUS (2012), the "Obamacare" case, C.J. Roberts, who delivered the opinion,  cited the "consequences...of political choices" in support of upholding the ACA.


We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders.

We ask only whether Congress has the power under the Constitution to enact the challenged provisions.


Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments.

Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them.

It is not our job to protect the people from the consequences of their political choices.
« Last Edit: September 20, 2020, 01:33:23 PM by John Galt incarnate! »

Exflyboy

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Re: What comes after the ACA?
« Reply #6138 on: September 20, 2020, 01:37:35 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406

Good article.

If a decision is unfavourable it seems like the ACA will still be in place for 2021 and possibly 2222.


John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6139 on: September 20, 2020, 01:46:46 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406

Who would ever have thought that the death of a justice of the Supreme Court would spawn such a welter of   uncertainty and anxiety with respect to the ACA and other political matters.

GuitarStv

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Re: What comes after the ACA?
« Reply #6140 on: September 20, 2020, 02:09:07 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406

Who would ever have thought that the death of a justice of the Supreme Court would spawn such a welter of   uncertainty and anxiety with respect to the ACA and other political matters.

Well . . . clearly Republicans under McConnell did.  That's why they denied allowing Obama his Supreme Court appointment 3/4s into his second term, and why they're likely to fast track an appointment before the election now.

American GenX

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Re: What comes after the ACA?
« Reply #6141 on: September 20, 2020, 02:27:29 PM »

Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?
1. The Repugs might come up with a replacement.

That haven't come up with anything to this point after all the time wasted.

I think it could be a long wait to see something come out to replace it.   Even at the state level - most can't afford it, especially after COVID.

Anyway, my plan is to be prepared to continue working with my decent insurance through work because after the ACA is overturned, insurance is going to be unaffordable with higher premiums, higher deductibles, higher co-pays, no coverage for pre-existing conditions, and getting dropped if you attempt to make a large claim.    For a while, until the dems can fix it if they can get control of Congress and the White House.

American GenX

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Re: What comes after the ACA?
« Reply #6142 on: September 20, 2020, 02:30:44 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406

Who would ever have thought that the death of a justice of the Supreme Court would spawn such a welter of   uncertainty and anxiety with respect to the ACA and other political matters.

I would have thought about anyone would have thought that if they gave it much thought at all, as I did months ago and posted about in this thread at the time, with respect to the ACA, since that's what this thread is about.  I just hoped it wouldn't happen.

jim555

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Re: What comes after the ACA?
« Reply #6143 on: September 20, 2020, 02:32:12 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406
Good article.

If a decision is unfavourable it seems like the ACA will still be in place for 2021 and possibly 2222.
From reading various articles they would need to agree that the portion of the law in the suit is unconstitutional and the law is not severable.  Since Congress already altered the ACA with the CARES act just recently, and they did it with a $0 penalty in place, then they set a legal precedent.  The argument that the entire law needs to be thrown out because the individual mandate is integral to the law can no longer be made, since Congress altered the law with no individual mandate in place.  Worst case is only parts of the law concerning pre-existing conditions gets thrown out, but other parts stay, like subsidies and the Medicaid expansion.  Post election Congress can fix whatever needs fixing, with the right people in charge.

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Re: What comes after the ACA?
« Reply #6144 on: September 20, 2020, 02:59:46 PM »
Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?

This is why I affectionately tell my spouse he will be my health care sugar daddy when I retire in the next 2-3 years. He’s the one who wants to keep working! But hopefully the ACA stays intact because we may need it one day.

A working spouse is our backup plan as well. In fact, my SO has no plans to retire unless healthcare is guaranteed by his employer (which will happen in 15 years, at age 55), or the US government passes universal coverage in the form of a public option or Medicare For All.

The other alternatives that I can think of, in no particular order, are --

1. Vote in representatives that will protect and expand healthcare.
2. Plan to pony up unsubsidized rates for marketplace insurance plans.
3. Go uninsured and hope that you don't suffer a health catastrophe that bankrupts you.
4. Return to the workforce just for healthcare benefits.
5. Move to a locale with additional coverage options.

In the long term, #1 is what will solve this dilemma, but given how long the ACA has been under assault, I don't trust that a public option or Medicare For All won't be rescinded as soon as the political winds shift -- especially if the current administration succeeds in jamming another conservative onto the Supreme Court for life. It's really hard not to feel hopeless and helpless right now, especially if you'd like to retire with pre-existing conditions or a leanFIRE stash.

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Re: What comes after the ACA?
« Reply #6145 on: September 20, 2020, 03:07:34 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406
Good article.

If a decision is unfavourable it seems like the ACA will still be in place for 2021 and possibly 2222.
From reading various articles they would need to agree that the portion of the law in the suit is unconstitutional and the law is not severable.  Since Congress already altered the ACA with the CARES act just recently, and they did it with a $0 penalty in place, then they set a legal precedent.  The argument that the entire law needs to be thrown out because the individual mandate is integral to the law can no longer be made, since Congress altered the law with no individual mandate in place.  Worst case is only parts of the law concerning pre-existing conditions gets thrown out, but other parts stay, like subsidies and the Medicaid expansion.  Post election Congress can fix whatever needs fixing, with the right people in charge.

There are plenty of constitutional law experts, including many known as conservative, who think the pending case is a farce and shouldn't have made it as far as it did.

The fact that it's before the SC means that what is lawful doesn't matter. If the cultural wars demand it, the conservative Justices will get rid of it and make up a rationale why, even if the reasoning is held together with twine and tape.

Exflyboy

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Re: What comes after the ACA?
« Reply #6146 on: September 20, 2020, 03:16:21 PM »
Assuming they confirm a justice and then declare the ACA unconstitutional...what's the plan for those of us who are FIREd and dependent on the protections and relative affordability that the ACA provides?

Getting a job with health benefits to bridge the decade until we are eligible for Medicare is a depressing thought right now...any other ideas?

This is why I affectionately tell my spouse he will be my health care sugar daddy when I retire in the next 2-3 years. He’s the one who wants to keep working! But hopefully the ACA stays intact because we may need it one day.

A working spouse is our backup plan as well. In fact, my SO has no plans to retire unless healthcare is guaranteed by his employer (which will happen in 15 years, at age 55), or the US government passes universal coverage in the form of a public option or Medicare For All.

The other alternatives that I can think of, in no particular order, are --

1. Vote in representatives that will protect and expand healthcare.
2. Plan to pony up unsubsidized rates for marketplace insurance plans.
3. Go uninsured and hope that you don't suffer a health catastrophe that bankrupts you.
4. Return to the workforce just for healthcare benefits.
5. Move to a locale with additional coverage options.

In the long term, #1 is what will solve this dilemma, but given how long the ACA has been under assault, I don't trust that a public option or Medicare For All won't be rescinded as soon as the political winds shift -- especially if the current administration succeeds in jamming another conservative onto the Supreme Court for life. It's really hard not to feel hopeless and helpless right now, especially if you'd like to retire with pre-existing conditions or a leanFIRE stash.

Remember that Medicare is very expensive too. Last time I looked at it my Social Security check at 65 years old would cover my and the SO for our Medicare costs plus about 10%!


Paul der Krake

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Re: What comes after the ACA?
« Reply #6147 on: September 20, 2020, 06:51:19 PM »

Nothing has changed, yet. Elections, both past and future, have consequences.

In NATIONAL FEDERATION OF INDEPENDENT BUSINESS v. SEBELIUS (2012), the "Obamacare" case, C.J. Roberts, who delivered the opinion,  cited the "consequences...of political choices" in support of upholding the ACA.


We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation’s elected leaders.

We ask only whether Congress has the power under the Constitution to enact the challenged provisions.


Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments.

Those decisions are entrusted to our Nation’s elected leaders, who can be thrown out of office if the people disagree with them.

It is not our job to protect the people from the consequences of their political choices.

Yeah I’m so tired of people looking at the Supreme Court to make large policy decisions to overcome the shortcomings of the legislative branch. As Scalia used to say, just because something is a bad policy, or even downright stupid, doesn’t make it unconstitutional.

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Re: What comes after the ACA?
« Reply #6148 on: September 20, 2020, 07:03:18 PM »
Ginsburg’s death leaves Obamacare in greater danger than ever
https://www.politico.com/news/2020/09/19/what-happens-to-obamacare-ginsburg-418406
Good article.

If a decision is unfavourable it seems like the ACA will still be in place for 2021 and possibly 2222.
From reading various articles they would need to agree that the portion of the law in the suit is unconstitutional and the law is not severable.  Since Congress already altered the ACA with the CARES act just recently, and they did it with a $0 penalty in place, then they set a legal precedent.  The argument that the entire law needs to be thrown out because the individual mandate is integral to the law can no longer be made, since Congress altered the law with no individual mandate in place.  Worst case is only parts of the law concerning pre-existing conditions gets thrown out, but other parts stay, like subsidies and the Medicaid expansion.  Post election Congress can fix whatever needs fixing, with the right people in charge.

There are plenty of constitutional law experts, including many known as conservative, who think the pending case is a farce and shouldn't have made it as far as it did.

The fact that it's before the SC means that what is lawful doesn't matter. If the cultural wars demand it, the conservative Justices will get rid of it and make up a rationale why, even if the reasoning is held together with twine and tape.

I think that's true of Thomas and Alito, who always vote the Republican party line, legal rationale be damned.  That isn't true of Roberts, who has shown a willingness to break with the conservative bloc on a few consequential decisions (including two previous votes to uphold the ACA).  After the LGBTQ discrimination decision, I have hope that maybe Gorsuch will also rule according to the law instead of ideology.  Kavanaugh is a wild card at this point, so I think we have to assume he will toe the party line.  If I am right, this situation would produce a 5-vote majority for upholding the ACA.

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Re: What comes after the ACA?
« Reply #6149 on: September 20, 2020, 09:49:14 PM »
3. Move to Canada/UK/etc.

Or a blue state? Massachusetts had RomneyCare before the ACA. I presume they'll go back to that, or something even more socialist, and many other states will do something similar.

Pretty sure Hawaii will maintain a more socialist healthcare system, and it's not a bad place to live. There's the whole world, as well. People who are FI and, therefore, don't need to work at a job to make money, can pick and choose where we get our healthcare. Just make sure you're covered for catastrophic emergencies in the US with a HDHP. There are many, many places in the world where extremely high quality health/dental care is available for pennies on the dollar of what it costs in the US. A few years ago, my wife had high-quality crowns put on three of her molars for US$600 in Vietnam. So far, so good. When we were in Malaysia, she saw a doctor to get treated for a UTI. The exam by an English speaking doctor who studied medicine in the US, plus the pills, cost a total of US$6...