What comes after the ACA?

[jim555]

Direct fee for service is more efficient since it has no insurance middleman taking a cut. 

[nereo]

I'm always surprised that so many believe that for-profit companies will inherently be less expensive than the not-for-profit government.

Bureaucratic waste is real, and it's super easy when you're spending other people's money.

Of that I have no doubt.  I'm not saying its true in every case, but for-profit companies core interest is to make money, which already puts them in a hole compared to government. To be equal (on a macro-economic sense) the bureaucratic waste simply has to be equal to the profit taking of the private company. But - corporations are not immune to waste either, and the larger the organization the more prone to waste (and competition/free-market forces becomes less effective).

...which is why I favor a hybrid approach.  Core services provided by government with comprehensive oversight to limit waste, and then more advanced coverage offered by private companies (aslo subject to regulation).

[NoStacheOhio]

Direct fee for service is more efficient since it has no insurance middleman taking a cut.

Except it induces providers to pad their bottom line.

[jim555]

Direct fee for service is more efficient since it has no insurance middleman taking a cut.

Except it induces providers to pad their bottom line.

Aren't they padding with insurers as well?

[GuitarStv]

Direct fee for service is more efficient since it has no insurance middleman taking a cut.

Except it induces providers to pad their bottom line.

Aren't they padding with insurers as well?

They can pad significantly more with insurers . . . by adding unnecessary tests and procedures that happen to be covered by the insurance for example.

[NoStacheOhio]

Direct fee for service is more efficient since it has no insurance middleman taking a cut.

Except it induces providers to pad their bottom line.

Aren't they padding with insurers as well?

Irrelevant. Fee-for-service doesn't solve anything. It's actually a pretty bad practice model.

[Bucksandreds]

...which is why I favor a hybrid approach.  Core services provided by government with comprehensive oversight to limit waste, and then more advanced coverage offered by private companies (aslo subject to regulation).

I came to this same conclusion a while ago myself. Single payer basic insurance for all paid by expansion of the payroll tax (and same percentage tax added to capital gains and dividends) coupled with tax incentives to encourage a supplemental private policy would be a perfect compromise. Dems would get what they want with no one dying in the street due to lack of care and Repubs would get they want with lower cost and a private market. The universal coverage would be more basic (cost efficient) and include generic medications, primary care and wellness visits as well as surgery necessary for your survival. Things like new high priced meds, new hips because it's difficult to walk but not life threatening, etc would be cash or covered by a supplemental policy that would be tax advantaged to encourage people to use it.

[teen persuasion]

Offered without political comment.

• In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*

[/b]

Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

$530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

@protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.

Before expansion, I believe there were asset tests to be Medicaid eligible.  Assets over $2k or so made you ineligible, depending on state rules.  The expansion removed asset tests, making more eligible.

[jim555]

Offered without political comment.

• In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*

[/b]

Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

$530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

@protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.

Before expansion, I believe there were asset tests to be Medicaid eligible.  Assets over $2k or so made you ineligible, depending on state rules.  The expansion removed asset tests, making more eligible.

The expansion added a new group with an income test only.  Old Medicaid (elderly, disabled, blind) still have asset and income tests.

[teen persuasion]

jim555, thanks for the correction and explanation of the distinction.

[sol]

Today's news includes a republican plan to repeal and replace the ACA.  Step one appears to be "don't repeal the ACA in states that want to keep the ACA" and step two is "don't force any state to have the ACA if they don't want it."

As long as step one comes with the same protections and funding as the current law, I think I support this plan?  What's not to like? 

It only hurts people who live in red states, by giving them exactly what they asked for, and this election has taught us all that we get exactly what we vote for and must then live with the consequences.

[NoStacheOhio]

Today's news includes a republican plan to repeal and replace the ACA.  Step one appears to be "don't repeal the ACA in states that want to keep the ACA" and step two is "don't force any state to have the ACA if they don't want it."

As long as step one comes with the same protections and funding as the current law, I think I support this plan?  What's not to like? 

It only hurts people who live in red states, by giving them exactly what they asked for, and this election has taught us all that we get exactly what we vote for and must then live with the consequences.

I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

[sol]

I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

Alternately, each state could offer nothing and leave its people hanging.

Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured. 

[thenextguy]

I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

Alternately, each state could offer nothing and leave its people hanging.

Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured.

This is the best summary I've seen so far: https://storify.com/ladler11/cassidy-collins-aca-replacement-summary

[Lagom]

I mean, if that's really what moves forward, as a CA resident that works for me. Agree 100% with Sol's assessment. Could be much worse. Will have to dive into the details myself later.

[Gal2016]

Offered without political comment.

• In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*

[/b]

Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

$530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

That's per person -- so an average family of 4 would spend $2120/month?  For care that is reimbursed at such a low rate that hospitals would literally shut their doors if all of their patients were Medicaid patients?  Hospitals rely on payor mix to keep things afloat.  Which means they lose money on Medicaid patients. They may break even with Medicare (or actually make a little profit, depending on the service). And they typically earn money on private insurance patients.  You get too many Medicaid patients and your hospital won't make it.  This is one reason why lots of private practices don't accept Medicaid patients. They don't have the ability to absorb the loss as much as a hospital does.

[bacchi]

Pre-existing exclusions don't seem to be mentioned. Ok, Cassidy-Collins looks like it has the pre-existing exclusion. The previous incarnation, Cassidy-Sessions, didn't mention it, from my quick reading.

Given that, will states be allowed to enforce a short-term exclusionary period for pre-existing conditions? I can see very sick people moving to certain states to get treatment because their cheapass (red) state won't cover enough.

[NoStacheOhio]

I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

Alternately, each state could offer nothing and leave its people hanging.

Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured.

This is the best summary I've seen so far: https://storify.com/ladler11/cassidy-collins-aca-replacement-summary

So wait, who gets Roth HSAs? Everyone over the Medicaid limit and under the income cap? What about people who have group plans?

[teen persuasion]

I'm a little confused at that, because there's so much federal involvement. Does that shift the full burden of executing a federal law to the states?

I'm still a little unclear on the details, mostly because there is no proposed legislation to evaluate yet.  It's more of an outline than a bill.

But it sounds like the federal exchanges would stay intact, and/or federal subsidies to state exchanges would stay intact, if that's what the state wants.

Alternately, each state could offer nothing and leave its people hanging.

Option three is to offer states that refuse both of those two options something like the Paul Ryan plan, with high deductible catastrophic plans and tax credits based on age instead of income.  This plan would not have an individual mandate but it would auto enroll everyone without employer coverage (and then start sending you bills for premiums) and you would have to actively opt out to become uninsured.

This is the best summary I've seen so far: https://storify.com/ladler11/cassidy-collins-aca-replacement-summary

So wait, who gets Roth HSAs? Everyone over the Medicaid limit and under the income cap? What about people who have group plans?

If I understand correctly (that Twitter stream of consciousness was confusing), those with employer coverage continue with that.  In states that reject ACA but want to cover their people, those without health insurance are auto enrolled in a catastrophic plan paid for with the state's share of ACA subsidies.  If there is any ACA subsidies left over, it will be divided and placed in Roth HSAs.  There will probably be a gap between OOP costs and HSA deposits.

[jim555]

At least they have something which is not totally go pound sand and die.

[OurTown]

So who funds the Roth HSAs?  Do I fund it or Uncle Sam?  And can anyone get a Roth HSA?

[HPstache]

I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

[sol]

I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

Many wealthy older people will probably prefer that plan.  The question then becomes which demographic group does your state want to send the welfare checks to? 

Blue states would probably keep the ACA and subsidize poor people, but I expect many red states to take that GOP option and subsidize their richer older people instead.  It's everything they always dreamed, cut benefits to the poor (who don't vote republican) and give them to the rich (their core constituents).

I'm not even making a value judgment here.  I totally understand the cold political calculus of benefiting your own tribe at the expense of another tribe. 

You have to wonder WWJD, though.

[CDP45]

I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

Many wealthy older people will probably prefer that plan.  The question then becomes which demographic group does your state want to send the welfare checks to? 

Blue states would probably keep the ACA and subsidize poor people, but I expect many red states to take that GOP option and subsidize their richer older people instead.  It's everything they always dreamed, cut benefits to the poor (who don't vote republican) and give them to the rich (their core constituents).

I'm not even making a value judgment here.  I totally understand the cold political calculus of benefiting your own tribe at the expense of another tribe. 

You have to wonder WWJD, though.

Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.

There is 0% chance California will keep paying for 1/3 of residents to be on Medi-Cal if the federal government stops the subsidy, because then there wouldn't be any money left for the core constituency of government union employees and their bankrupting pensions.

[Roland of Gilead]

I am pretty sure California is a net giver to the federal government compared to many red states

(I still consider California pretty fucked up and the pension system is abysmal there)

[bacchi]

I am pretty sure California is a net giver to the federal government compared to many red states

(I still consider California pretty fucked up and the pension system is abysmal there)

Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

[CDP45]

I am pretty sure California is a net giver to the federal government compared to many red states

(I still consider California pretty fucked up and the pension system is abysmal there)

Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

[Metric Mouse]

Offered without political comment.

• In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*

[/b]

Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

$530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

Not super cheap for premiums - but this is covering almost all healthcare expenses. So if a single person had a $300 a month premium, with a $2700 deductible - that would be pretty damn cheap, in my opinion.

[Monkey Uncle]

Offered without political comment.

• In 2015, the cost per enrollee in the medicaid expansion was $6,366/person/year.*

[/b]

Good lord. That's less than many insurance premiums! Why doesn't this get expanded so that everyone is covered for this price?[/list]

And Medicaid by definition is the high risk / unhealthy / old pool. Think how low the premiums would be with a few tens of millions of young healthy people added?

$530/month isn't particularly cheap for health insurance for a single person, is it? But then again the only time I shopped for insurance on the exchanges was back in the 2014, and people keep talking about how much prices have risen since then so my ideas may be out of date.

@protostache, why would people in the expanded medicaid eligibility window would be older? If anything, average income increases with age (at least into 50s), so I'd think the medicaid pool would be younger than the people with enough income to be on the exchanges.

The other factor to keep in mind is that medicaid reimburses doctors/hospitals at lower rates than medicare, which in turn generally reimburses at lower rates than private insurance.

Bingo.  Single payer systems have the power to force down prices, which is why the rest of the civilized world pays half what we do for better health outcomes.

[bacchi]

I am pretty sure California is a net giver to the federal government compared to many red states

(I still consider California pretty fucked up and the pension system is abysmal there)

Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

I don't think this term means what you think it means.

[nereo]

I am pretty sure California is a net giver to the federal government compared to many red states

(I still consider California pretty fucked up and the pension system is abysmal there)

Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

I don't think this term means what you think it means.

[mm1970]

I think I like the sound of the non-ACA option for my state the better so far...  But I need more details to formulate my decision when the time comes.

Many wealthy older people will probably prefer that plan.  The question then becomes which demographic group does your state want to send the welfare checks to? 

Blue states would probably keep the ACA and subsidize poor people, but I expect many red states to take that GOP option and subsidize their richer older people instead.  It's everything they always dreamed, cut benefits to the poor (who don't vote republican) and give them to the rich (their core constituents).

I'm not even making a value judgment here.  I totally understand the cold political calculus of benefiting your own tribe at the expense of another tribe. 

You have to wonder WWJD, though.

Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.

There is 0% chance California will keep paying for 1/3 of residents to be on Medi-Cal if the federal government stops the subsidy, because then there wouldn't be any money left for the core constituency of government union employees and their bankrupting pensions.

You mean Romney-care?  I love how it's all so partisan.

The ACA, in my friends, primarily benefited the middle class and self-employed and friends with pre-existing conditions.  The poor folk were *already* covered.

Engineers, scientists, contractors...those are the people I know who benefited from the ACA.

[jim555]

... The poor folk were *already* covered.

So you consider go to the ER and go bankrupt as covered?

[NoStacheOhio]

... The poor folk were *already* covered.

So you consider go to the ER and go bankrupt as covered?

It depends on your definition of "poor." Generally, when Republicans say this, they mean "Medicaid exists and covers some people."

[jim555]

... The poor folk were *already* covered.

So you consider go to the ER and go bankrupt as covered?

It depends on your definition of "poor." Generally, when Republicans say this, they mean "Medicaid exists and covers some people."

Pre-ACA (or in a non-expanded state now) you can't qualify for Medicaid as a non-disabled person.  You would have to be classified as disabled and spend down almost all your assets before it would kick in.

[obstinate]

Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.

Um. You're aware that costs rose more slowly under the ACA, right? In no objective sense did the law quicken the implosion of the health delivery system in this country.

[Bucksandreds]

Sounds like the obamacare I know, 100% partisan bill passed that screwed over the middle class to benefit the few who couldn't easily navigate the healthcare system, and quicken the implosion of the health delivery system in the country.

Um. You're aware that costs rose more slowly under the ACA, right? In no objective sense did the law quicken the implosion of the health delivery system in this country.

Yeah it did. Paul Ryan and Mitch McConnell have been telling him that for years now so it must be true.

[Bucksandreds]

I am pretty sure California is a net giver to the federal government compared to many red states

(I still consider California pretty fucked up and the pension system is abysmal there)

Yeah, California is a major net giver. It'll be in better condition than ever if it doesn't have to send so much money to the red states.

Haha, the hypocrisy is incredible! Newly minted federalists, successions, and calls of illegitimate presidency.  Less than 90 days ago these were tenants of team red. I am continually amazed...

Successions?  Jeff Sessions? Secessionists?  I've always known the more conservative you are the less likely you are to understand big words.  'We're just simple country people trying to keep the government off our backs' even though we probably get farm subsidies or live in a state that is a net taker of federal dollars.

[titan2k10]

ACA has some serious damn problems. I have gone from paying 6700 in premiums a year to over 21000 with worst coverage since ACA became law. This is a HUGE problem for many many American families.

This being said, and considering myself very conservative, there are some really really good things about ACA.

1. Guaranteed access to INSURANCE NOT HEALTHCARE
2. No denial for pre-existing conditions
3. Kids can stay on till 26 on parents yada yada.

Things in my mind that could drastically reduce the costs that I don't hear or have the time to read 14 pages of posts about.
1. Open up the exchanges across state lines and allow providers to compete in every state (should drive premiums down)
2. NEGOTIATE PHARMACEUTICAL DRUG COSTS
3. Give everyone, regardless of plan, an HSA

The 3 things I like should remain and anyone who thinks removing them is good is wrong. The next 3 should help lower premiums and the pharma drug cost reduction would save TONS of money.

This is just an extremely complex issue to solve. I see people discussing people no longer having to go to the ER now that they have insurance....hate to be the bearer of bad news but these people will never NOT use the ER.

Source: Hospital operations....

[mm1970]

... The poor folk were *already* covered.

So you consider go to the ER and go bankrupt as covered?

Medicaid, MediCal, people on SNAP.

Heck I have a friend who is a SAHM with 4 kids - and the kids get state medical.  Husband makes a decent middle-class wage in marketing, and they are eligible.

[Lagom]

ACA has some serious damn problems. I have gone from paying 6700 in premiums a year to over 21000 with worst coverage since ACA became law. This is a HUGE problem for many many American families.

I don't mean to ignore your thoughtful contributions with the rest of your post, but it bears repeating that this sort of view is part of the problem from a politicization standpoint. Premiums were going up and coverage going down for almost everyone before the ACA and there is evidence that for many if not most, that slowed after the ACA was enacted. It's very easy to say "my rates went up thus the ACA was a failure!" But that is an entirely emotional argument. 

[rtrnow]

... The poor folk were *already* covered.

So you consider go to the ER and go bankrupt as covered?

Medicaid, MediCal, people on SNAP.

Heck I have a friend who is a SAHM with 4 kids - and the kids get state medical.  Husband makes a decent middle-class wage in marketing, and they are eligible.

This varies by state.  In most red states (GA for sure) a non-disabled male cannot get medicaid.

[Gal2016]

Back in 2005, I paid $125/month for insurance for my family.  2007, I paid $153/month. Before that, premiums had been fairly steady.

2017, I'll pay $598/month and have higher deductibles and larger co-pays and I also pay $100/month to have my husband on my insurance because he also has access through his work; so total monthly cost is $698/month. 

At the rate of 19% increase every 2 years (2005-2007) -- I should only be paying around $365/month for excellent insurance. I no longer have excellent insurance (nobody does).

[Lagom]

Back in 2005, I paid $125/month for insurance for my family.  2007, I paid $153/month. Before that, premiums had been fairly steady.

2017, I'll pay $598/month and have higher deductibles and larger co-pays and I also pay $100/month to have my husband on my insurance because he also has access through his work; so total monthly cost is $698/month. 

At the rate of 19% increase every 2 years (2005-2007) -- I should only be paying around $365/month for excellent insurance. I no longer have excellent insurance (nobody does).

Indeed. Thank you for your anecdotal and emotionally driven contribution to this topic.

[obstinate]

I no longer have excellent insurance (nobody does).

Are you trolling?

[protostache]

Back in 2005, I paid $125/month for insurance for my family.  2007, I paid $153/month. Before that, premiums had been fairly steady.

2017, I'll pay $598/month and have higher deductibles and larger co-pays and I also pay $100/month to have my husband on my insurance because he also has access through his work; so total monthly cost is $698/month. 

At the rate of 19% increase every 2 years (2005-2007) -- I should only be paying around $365/month for excellent insurance. I no longer have excellent insurance (nobody does).

Are these individual rates or employer rates? If employer, what did they pay on your behalf?

[maizefolk]

Back in 2005, I paid $125/month for insurance for my family.  2007, I paid $153/month. Before that, premiums had been fairly steady.

2017, I'll pay $598/month and have higher deductibles and larger co-pays and I also pay $100/month to have my husband on my insurance because he also has access through his work; so total monthly cost is $698/month. 

At the rate of 19% increase every 2 years (2005-2007) -- I should only be paying around $365/month for excellent insurance. I no longer have excellent insurance (nobody does).

Did you have a cap on lifetime benefits on your old plan? And if you ever have to use it to cover something major (five+ figures)?

For a short while right before the ACA kicked in I was paying $80/month for private health insurance. And right after I was paying $250-some for an HSA eligible plan off of an exchange. (I think? I remember it was a 3x increase). But for me increase in peace of mind from the removal of lifetime caps and not having to worry about my insurer going back through my medical history trying to find a way to kick me off if I ever actually needed it was worth the increase.

But I'll be the first to acknowledge that not everyone puts the same relative value on peace of mind vs lower monthly expenses.

[sol]

Today's Republican proposal to replace the ACA is to repeal the ACA outright and then offer every American a $5k tax break to buy private insurance on the individual market, with no market restrictions.  So no guaranteed issue to people with pre existing conditions, a return of lifetime caps, no guaranteed access to birth control or preventative care, and insurers can go back to exclusionary policies that cover everything except what you already have wrong with you.

Technically this might make insurance affordable to everyone, if they choose to buy really crappy insurance with a $20k deductible that can just drop you if you get sick or injured.  That's about the nicest thing I can say about this plan.

[waltworks]

If it's a straight refundable credit, that's not a horrible deal (assuming children are included). If it's only applicable to taxes owed - not so great for most folks.

If we're going to try letting the market work, that might be a way to do it, I suppose. Hand out money (sort of), have people spend it as they choose.

Obviously all the insurance-denied horror stories will come back/continue, and people with chronic illnesses will be f'd. That's not so good.

-W

[protostache]

If it's a straight refundable credit, that's not a horrible deal (assuming children are included). If it's only applicable to taxes owed - not so great for most folks.

If we're going to try letting the market work, that might be a way to do it, I suppose. Hand out money (sort of), have people spend it as they choose.

Obviously all the insurance-denied horror stories will come back/continue, and people with chronic illnesses will be f'd. That's not so good.

-W

Everyone has or will have a disqualifying preexisting condition in their lifetime. Everyone. So no, it's not so good.