Author Topic: What comes after the ACA?  (Read 387241 times)

Metric Mouse

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Re: What comes after the ACA?
« Reply #1450 on: March 09, 2017, 05:24:11 PM »
  Premium growth (which was happening all the while prior to ACA) has dramatically slowed nationally since ACA was enacted.
This is not true- while this seemed to be the case until last year, the most recent premium increase was 22% averaged nationally.  This brings yearly premium increases into the same range as the 10 year pre-aca averages.
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sol

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Re: What comes after the ACA?
« Reply #1451 on: March 09, 2017, 05:28:26 PM »
Ask people here in Colorado in the mountains or rural areas how they have been impacted along with many other people in other states. Costs have skyrocketed and they have few options to choose from.

Did they have a bunch of better options to choose from prior to ACA?  Premium growth (which was happening all the while prior to ACA) has dramatically slowed nationally since ACA was enacted.  If anything, now people (in many states) have access to a guaranteed, but possibly expensive health insurance policy, whereas prior to ACA there was no guarantee of coverage at all.

And they would have had access to guaranteed affordable healthcare even now if republicans hadn't fought to have the public option removed from the ACA.  The whole point of the public option was for the government to guarantee basic services in places where the private market couldn't or wouldn't, just like it does for power and mail deliver in those same communities.

But nooooo. Republicans had a fit about "socialism" and left those people at the whims of the ACA's private insurance market approach, with no recourse when the market abandoned them.  Conservatives believe that people in rural communities shouldn't have healthcare.

Well guess what?  The new GOP plan can make that a reality for you.  I almost hope they actually pass this shit sandwich so people can get exactly what they asked for, just like they did with trump.  I'm a rich white dude, I'm not the one who is going to get screwed if I lose this fight.

thenextguy

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Re: What comes after the ACA?
« Reply #1452 on: March 09, 2017, 05:29:02 PM »
  Premium growth (which was happening all the while prior to ACA) has dramatically slowed nationally since ACA was enacted.
This is not true- while this seemed to be the case until last year, the most recent premium increase was 22% averaged nationally.  This brings yearly premium increases into the same range as the 10 year pre-aca averages.

Yes, but many believe that this was a one-time adjustment and expect "normal" increases going forward. In all honesty, it's difficult to say what the effects of the ACA are on costs in a relatively short period of time.

thenextguy

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Re: What comes after the ACA?
« Reply #1453 on: March 09, 2017, 05:30:22 PM »
New Rebuplican plan allows insurers to charge older folks 5x the amount of youngsters...wtf!  I maybe in my 50s but I don't eat sugar, refined carbs or drink.  Yet I'll have to pay exorbitant rates to cover the cost of people with no regards to their health...what a joke our healthcare system is

Might wish to convey your displeasure to your Congress-people, if you have not already.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1454 on: March 09, 2017, 05:33:53 PM »
New Rebuplican plan allows insurers to charge older folks 5x the amount of youngsters...wtf!  I maybe in my 50s but I don't eat sugar, refined carbs or drink.  Yet I'll have to pay exorbitant rates to cover the cost of people with no regards to their health...what a joke our healthcare system is
Yes, but the point of insurance is that healthy people subsidize the cost of insurance for sick people. It's yhe way all insurance is set up. The ACA allows insurers to charge old people multiple times as much as younger as well; the change is that the subsidies would be larger for older people than for younger people under Trumpcare. Still much room for improvement of either plan, of course.
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doggyfizzle

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Re: What comes after the ACA?
« Reply #1455 on: March 09, 2017, 05:34:29 PM »
Ask people here in Colorado in the mountains or rural areas how they have been impacted along with many other people in other states. Costs have skyrocketed and they have few options to choose from.

Did they have a bunch of better options to choose from prior to ACA?  Premium growth (which was happening all the while prior to ACA) has dramatically slowed nationally since ACA was enacted.  If anything, now people (in many states) have access to a guaranteed, but possibly expensive health insurance policy, whereas prior to ACA there was no guarantee of coverage at all.

And they would have had access to guaranteed affordable healthcare even now if republicans hadn't fought to have the public option removed from the ACA.  The whole point of the public option was for the government to guarantee basic services in places where the private market couldn't or wouldn't, just like it does for power and mail deliver in those same communities.

But nooooo. Republicans had a fit about "socialism" and left those people at the whims of the ACA's private insurance market approach, with no recourse when the market abandoned them.  Conservatives believe that people in rural communities shouldn't have healthcare.

Well guess what?  The new GOP plan can make that a reality for you.  I almost hope they actually pass this shit sandwich so people can get exactly what they asked for, just like they did with trump.  I'm a rich white dude, I'm not the one who is going to get screwed if I lose this fight.

Dude I'm in agreement with you!  I don't understand comments like those from the_fixer that seem to envision some sort of health care utopia existed in this country pre-ACA .  Health insurance has been f*cked for 50 years, and ACA was a great start in fixing a horrible system by guaranteeing people can gain access to insurance (and medical care).  AHCA seems like an unfortunate step backwards that will definitely not help the people who "live in the mountains or rural areas of the US."

the_fixer

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Re: What comes after the ACA?
« Reply #1456 on: March 09, 2017, 06:18:36 PM »
Doggyfizzle

I never said it was utopia so do not speak for me. You do not know me or my opinion on the matter.

What I was saying that while it might work great for Sol and others in his state / situation it has had a negative impact on others.

Maybe instead of fighting along party lines we should open our eyes and see what is affecting others and think of others instead of just ourselves?

waltworks

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Re: What comes after the ACA?
« Reply #1457 on: March 09, 2017, 06:21:48 PM »
Doggyfizzle

I never said it was utopia so do not speak for me. You do not know me or my opinion on the matter.

What I was saying that while it might work great for Sol and others in his state / situation it has had a negative impact on others.

Maybe instead of fighting along party lines we should open our eyes and see what is affecting others and think of others instead of just ourselves?

Sounds good - in that case you should be strongly opposed to the current replacement proposal, as it will have a small positive or no effect on wealthy people in cities like Sol, and will make things much worse for median income and under people in rural areas.

-W

Metric Mouse

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Re: What comes after the ACA?
« Reply #1458 on: March 09, 2017, 06:34:08 PM »
  Premium growth (which was happening all the while prior to ACA) has dramatically slowed nationally since ACA was enacted.
This is not true- while this seemed to be the case until last year, the most recent premium increase was 22% averaged nationally.  This brings yearly premium increases into the same range as the 10 year pre-aca averages.

Yes, but many believe that this was a one-time adjustment and expect "normal" increases going forward. In all honesty, it's difficult to say what the effects of the ACA are on costs in a relatively short period of time.
Yes, Democrats claimed that when the ACA was passed. Has been shown to be false, but they will keep lying about it and spinning the numbers anyway. I suppose it is possible that it could lower the increases, but that has not been the case so far.
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AdrianC

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Re: What comes after the ACA?
« Reply #1459 on: March 09, 2017, 06:36:23 PM »
I was getting my info off of the Washington health plan finder, for a median income family with two 40 year old parents and three kids.  That family gets free care from apple health (expanded Medicaid) if it shows paper income under 40k, and gets subsidized care for income up to 114k/year.

I just double checked by searching again.  Still has a whole bunch of plans under $400/mo.  The second lowest silver (the benchmark) plan is $296.99/mo with a $3500 family deductible and family OOP max, and $1 copays.  For $360.85/mo you can reduce that to $1150 family deductible and $1500 OOP max with $10 copays.

I don't dispute that other parts of the country may be worse off, but in Washington state I have 23 silver plans to choose from and prices seem reasonable to me.  This is why I think the ACA is working.

It's amazing the price difference. It's half the cost there versus here, with far lower deductibles, here being Cincinnati, OH (not a rural area). And that's partly why I think the ACA is not working. Prices should be much closer across the nation. Not that the new plan will fix any of that, of course.

I just watched Ryan's "TED talk" on the new plan. He seems like he doesn't know how insurance works. Must be an act. He's a smart guy.


DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1461 on: March 09, 2017, 08:05:27 PM »
The ACA is great as a wealth re-distribution scheme; it hasn't been as successful in keeping costs down overall or increasing healthcare outcomes nationally, as was touted. If it had been sold for what it is, fewer people may have been less disappointed.
I disagree totally. The ACA has been a great way to get low cost health insurance for me, as it has been for the majority of people who get their health insurance through the ACA.
The standards for insurance have been raised, and there are many more preventive medical costs that no longer have to be paid out of pocket.
As a mustachian I am able to lower my AGI by dumping money into 401k, traditional IRA, and HSA and this further enhances the effect of getting health care subsidies. It's been written extensively in one of GoCurryCracker's blog posts.

Lance Burkhart

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Re: What comes after the ACA?
« Reply #1462 on: March 09, 2017, 08:23:29 PM »
Physician compensation is not the main driver of health care costs. We are simply not willing as a society to make the tough decisions. Demand for health care is endless, and we will not limit consumption in any meaningful way.

Exactly this. A society that calls discussion of end-of-life options "DEATH PANELS!!!!!"

A society? You mean Republicans. Because they're the only ones screaming that bullshit solely as a political tactic. I don't think it's fair to say "society" when the reality is that most people are mature enough to discuss the topic in rational manner.

Republicans?  I often vote Republican and I hope to sit on your death panel. 

MOD EDIT: Whoah, way over the line. Read and abide by the forum rules, please.
« Last Edit: March 11, 2017, 12:05:50 AM by arebelspy »

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1463 on: March 09, 2017, 09:25:46 PM »
I was getting my info off of the Washington health plan finder, for a median income family with two 40 year old parents and three kids.  That family gets free care from apple health (expanded Medicaid) if it shows paper income under 40k, and gets subsidized care for income up to 114k/year.

I just double checked by searching again.  Still has a whole bunch of plans under $400/mo.  The second lowest silver (the benchmark) plan is $296.99/mo with a $3500 family deductible and family OOP max, and $1 copays.  For $360.85/mo you can reduce that to $1150 family deductible and $1500 OOP max with $10 copays.

I don't dispute that other parts of the country may be worse off, but in Washington state I have 23 silver plans to choose from and prices seem reasonable to me.  This is why I think the ACA is working.

It's amazing the price difference. It's half the cost there versus here, with far lower deductibles, here being Cincinnati, OH (not a rural area). And that's partly why I think the ACA is not working. Prices should be much closer across the nation. Not that the new plan will fix any of that, of course.

I just watched Ryan's "TED talk" on the new plan. He seems like he doesn't know how insurance works. Must be an act. He's a smart guy.

You want a shock, you should check the prices in Alaska.  A silver plan for a family with the adults in their mid 40s is around $20,000 a year!

Metric Mouse

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Re: What comes after the ACA?
« Reply #1464 on: March 10, 2017, 03:09:59 AM »
The ACA is great as a wealth re-distribution scheme; it hasn't been as successful in keeping costs down overall or increasing healthcare outcomes nationally, as was touted. If it had been sold for what it is, fewer people may have been less disappointed.
I disagree totally. The ACA has been a great way to get low cost health insurance for me, as it has been for the majority of people who get their health insurance through the ACA.
The standards for insurance have been raised, and there are many more preventive medical costs that no longer have to be paid out of pocket.
As a mustachian I am able to lower my AGI by dumping money into 401k, traditional IRA, and HSA and this further enhances the effect of getting health care subsidies. It's been written extensively in one of GoCurryCracker's blog posts.
I think we agree on this; it takes massive amounts of money and funnels it to other people- including rich white people who make enough money to tax advantage large portions of their income.  Costs have been rising just as fast as years prior to the ACA; prices have merely been subsidized by the wealth of others, which is what I think you wefe referring to. The other, largest part of the ACA was the expansion of medicare, which is what a majority of the "newly insured" are using (not the exchanges.)  Absolutely the insurance now covers more conditions, more people and many of those coverage provisions are an extremely positive step forward and should be celebrated (I mean, even Republicans support them!) but costs and healthcare outcomes have not been among the "successes". Typical political Democrat changing of the goal posts.
« Last Edit: March 10, 2017, 05:55:48 AM by Metric Mouse »
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Re: What comes after the ACA?
« Reply #1465 on: March 10, 2017, 05:39:05 AM »
And they would have had access to guaranteed affordable healthcare even now if republicans hadn't fought to have the public option removed from the ACA.  The whole point of the public option was for the government to guarantee basic services in places where the private market couldn't or wouldn't, just like it does for power and mail deliver in those same communities.

But nooooo. Republicans had a fit about "socialism" and left those people at the whims of the ACA's private insurance market approach, with no recourse when the market abandoned them.  Conservatives believe that people in rural communities shouldn't have healthcare.

Well guess what?  The new GOP plan can make that a reality for you.  I almost hope they actually pass this shit sandwich so people can get exactly what they asked for, just like they did with trump.  I'm a rich white dude, I'm not the one who is going to get screwed if I lose this fight.
This part is not true. The ACA passed without any Republican votes, and it was Obama's insistence on handing the writing of the law to the Baucus caucus that led to the non-consideration of the public option, the ridiculous 4-year delay in implementation, and the handouts to insurance and drug companies. Democrats had a chance to do something good (House majority, filibuster-proof Senate majority) and instead triangulated and got their asses handed to them in the midterms.

Iplawyer

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Re: What comes after the ACA?
« Reply #1466 on: March 10, 2017, 06:40:34 AM »
Doggyfizzle

I never said it was utopia so do not speak for me. You do not know me or my opinion on the matter.

What I was saying that while it might work great for Sol and others in his state / situation it has had a negative impact on others.

Maybe instead of fighting along party lines we should open our eyes and see what is affecting others and think of others instead of just ourselves?
Agreed - and so you should be STRONGLY opposed to Trumpcare since very poor and older people will not get care, women will have less access to birth control (do you want more babies going on the public dole?), etc.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #1467 on: March 10, 2017, 07:03:18 AM »
Costs have been rising just as fast as years prior to the ACA

ACA hasn't been around long enough to know this. There were premium increases in 2016, but if you were getting subsidies you didn't experience this increase.  In 2015 there were no premium increases.
Prior to ACA the individual health insurance marketplace saw premium increases constantly well above inflation.

The other, largest part of the ACA was the expansion of medicare, which is what a majority of the "newly insured" are using (not the exchanges.) 

This is plain wrong. Medicaid, not Medicare was expanded. And Medicaid expansion is a vital way to provide coverage to the working poor, people who work low paid jobs in poorer counties, mainly rural. This program supported hospitals in these poor counties that were on the verge of closing. In turn these hospitals provided good paying healthcare jobs in these regions. Without Medicaid expansion we would have a TV episode of Doctors without Borders coming to these regions to provide free urgent medical care.

Absolutely the insurance now covers more conditions, more people and many of those coverage provisions are an extremely positive step forward and should be celebrated (I mean, even Republicans support them!) but costs and healthcare outcomes have not been among the "successes". Typical political Democrat changing of the goal posts.

More wrong illogical thinking here, free colonoscopies are a vital and easily preventive method to lower the rate of very expensive colon cancer rates.
ACA came in around the budget projections or even lower.
ACA needed to be improved upon, and now we have Republicans who destroy everything they touch.

wenchsenior

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Re: What comes after the ACA?
« Reply #1468 on: March 10, 2017, 07:49:52 AM »

Correct. It was Medicaid that was expanded.  The majority of the people who got new access to health coverage under the ACA were the poor.  This is also, of course, one of the reasons it cost a lot to implement.

Some of the GOP governors did not accept the Medicaid expansion, but many GOP governors of states that DID are now pushing back on the GOP congress' desire to gut the Medicaid expansion, because it really helped them provide better health care to the poor in their states. 

This is one of the reasons there is speculation that the GOP might not actually be able to pass new legislation:  The Tea Party types are pissed because the replacement proposals look like "Obamacare Lite" to them and they want to just scrap the whole thing and go back to the dog-eat-dog old days (possibly gutting Medicare along the way, as well).

Meanwhile, the old school mainstream GOP deep down admits that Obamacare is actually the 'conservative' plan the GOP used to propose in the 90s and 2000, and wouldn't be adverse to just tweaking it to work better. 

At the state level, the GOP governors are concerned about losing the Medicaid expansion and are raising a ruckus about it to their GOP representatives.

And the rank and file voters don't want to lose some of the popular provisions in the law but don't want to pay to make the popular provisions that they want to keep work. 

Also, don't they need 5 or 6 Dem senators to vote for a replacement plan? And they already have some GOP senators getting ready to bail.  I will be surprised if something similar to the House Bill passes.  But you never know....

Metric Mouse

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Re: What comes after the ACA?
« Reply #1469 on: March 10, 2017, 08:07:52 AM »
Costs have been rising just as fast as years prior to the ACA

ACA hasn't been around long enough to know this. There were premium increases in 2016, but if you were getting subsidies you didn't experience this increase.  In 2015 there were no premium increases.
Prior to ACA the individual health insurance marketplace saw premium increases constantly well above inflation.

The other, largest part of the ACA was the expansion of medicare, which is what a majority of the "newly insured" are using (not the exchanges.) 

This is plain wrong. Medicaid, not Medicare was expanded. And Medicaid expansion is a vital way to provide coverage to the working poor, people who work low paid jobs in poorer counties, mainly rural. This program supported hospitals in these poor counties that were on the verge of closing. In turn these hospitals provided good paying healthcare jobs in these regions. Without Medicaid expansion we would have a TV episode of Doctors without Borders coming to these regions to provide free urgent medical care.

Absolutely the insurance now covers more conditions, more people and many of those coverage provisions are an extremely positive step forward and should be celebrated (I mean, even Republicans support them!) but costs and healthcare outcomes have not been among the "successes". Typical political Democrat changing of the goal posts.

More wrong illogical thinking here, free colonoscopies are a vital and easily preventive method to lower the rate of very expensive colon cancer rates.
ACA came in around the budget projections or even lower.
ACA needed to be improved upon, and now we have Republicans who destroy everything they touch.
Sorry, medicaid. Thank you for the correction. Though my point still stands that more people are insured through this program than through the ACA exchanges.

I'll disagree with you on the cost increases for the reasons I stated; costs have gone up, even when premiums didn't. More money was simply diverted to pay larger subsidies to keep the price down without the insurance company taking losses. These cost increases have averaged the same as before the ACA; there are several years worth of data to back this up, and I feel it is inaccurate to say that the ACA "hasn't been around long enough to know this. "  While i will agree that the thought that preventive care is cheaper than emergency care is sound, the ACA has not lowered insurance costs, or slowed their rise, so perhaps the issue is more complex than the argument you presented.
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sol

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Re: What comes after the ACA?
« Reply #1470 on: March 10, 2017, 08:19:26 AM »
Democrats had a chance to do something good (House majority, filibuster-proof Senate majority) and instead triangulated and got their asses handed to them in the midterms.

My wife thinks that this is why the new Republican plan will remain law forever, if it gets passed. 

Her argument is that Democrats got hammered in their next election, for trying to improve healthcare with the ACA.  She thinks the Republicans will also get hammered for their proposed changes.  When the next democratic majority comes along, and they have the power to change things again, why would they?  If there are always electoral punishments for doing anything, the party may decide to just leave it alone.

The ACA made things a lot better for millions of people, and imposed new taxes on people with investment income above $250k/year.  The Republicans want to basically undo those changes, giving a tax break to the rich while reducing benefits for the poor (and don't forget about the new abortion restrictions).  One party got punished for making things better, the other will get punished for making things worse.  I'm not sure either party will be eager about additional tinkering after that.

brooklynguy

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Re: What comes after the ACA?
« Reply #1471 on: March 10, 2017, 09:02:30 AM »
When the next democratic majority comes along, and they have the power to change things again, why would they?

One possible answer is that the new plan, if implemented, will substantially increase the likelihood of the actual occurrence of a death spiral of the type that ACA-opponents argue (incorrectly, I agree) is already underway.  In the face of a total, full-blown meltdown of the individual health insurance market, whichever party is then in power will be forced to do something in response.  Bread and circuses, if nothing else.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1472 on: March 10, 2017, 09:32:31 AM »
When the next democratic majority comes along, and they have the power to change things again, why would they?

One possible answer is that the new plan, if implemented, will substantially increase the likelihood of the actual occurrence of a death spiral of the type that ACA-opponents argue (incorrectly, I agree) is already underway.  In the face of a total, full-blown meltdown of the individual health insurance market, whichever party is then in power will be forced to do something in response.  Bread and circuses, if nothing else.
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jim555

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Re: What comes after the ACA?
« Reply #1473 on: March 10, 2017, 09:41:51 AM »
Looks like they REALLY hate those poors.
Loose your job and loose your health cover forever.

"...freeze Medicaid enrollment under enhanced Obamacare rates at the end of 2017, two years sooner than the GOP repeal bill allows.
The group is also backing an amendment from Rep. Morgan Griffith (R-Va.) to institute work requirements in Medicaid for able-bodied, childless adults."

http://www.politico.com/story/2017/03/republican-study-committee-obamacare-repeal-medicaid-235870
« Last Edit: March 10, 2017, 09:47:05 AM by jim555 »

AdrianC

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Re: What comes after the ACA?
« Reply #1474 on: March 10, 2017, 10:54:17 AM »
The ACA made things a lot better for millions of people, and imposed new taxes on people with investment income above $250k/year.
Quibble:

An additional 0.9 percent payroll tax on earnings and a 3.8 percent tax on net investment income (NII) for individuals with incomes exceeding $200,000 and couples with incomes exceeding $250,000.

http://www.taxpolicycenter.org/briefing-book/what-tax-changes-did-affordable-care-act-make

AdrianC

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Re: What comes after the ACA?
« Reply #1475 on: March 10, 2017, 02:35:31 PM »
Designed to fail?

http://www.vox.com/policy-and-politics/2017/3/10/14872916/republican-health-plan-designed-to-fail-ahca

There’s a theory going around Washington that Republicans don’t want their health bill to pass.

protostache

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Re: What comes after the ACA?
« Reply #1476 on: March 10, 2017, 03:23:08 PM »
Designed to fail?

http://www.vox.com/policy-and-politics/2017/3/10/14872916/republican-health-plan-designed-to-fail-ahca

There’s a theory going around Washington that Republicans don’t want their health bill to pass.

Quote
In some ways, the scariest outcome for Republicans now isn’t that they fail, as expected, but that they unexpectedly succeed, and have to implement a bill no one really believes will work.

This is terrifying and irresponsible governing.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1477 on: March 10, 2017, 04:02:01 PM »
Quote

You're describing the system working. A practice with say, ten midlevels working with three physicians can take good care of lots of people for a reasonable cost, while still catching the more serious stuff that actually requires a doctor. They just need to be working closely enough to know when to bump someone up the food chain.
EnjoyIt -- Wouldn't you rather deal with challenging cases rather than the mundane colds/coughs/sprains? I agree with NoStacheOhio that the system appears to be working. And as you put it, mid-level providers are good for 95% of the cases and experts such as yourself are needed in the more advanced 5%.

Good question.  The answer is, yes, those patients should go to their primary care doctor/provider and not the ER.  But I as a single physician can not supervise 13 midlevel providers at the same time.  It is physically impossible.  I can in reality supervise 2-3 midlevel providers at a time which I already do and how we can catch those 5% of cases efficiently. 

I have a feeling you may not understand how medicine is practiced and what is required of us. 
« Last Edit: March 10, 2017, 04:19:58 PM by EnjoyIt »

EnjoyIt

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Re: What comes after the ACA?
« Reply #1478 on: March 10, 2017, 04:06:29 PM »
I read that the most $ is spent in the last 30 days of a person's life. Many people in my family had DNR's and used hospice when facing the end. Doctors try to talk people that are terminal and old into treatment all the time. When my Mom was 87 she was diagnosed with lymphoma that was in her stomach, liver, etc. She was not going to do chemo but the doctor talked her into it. She died 2 1/2 years later and really suffered during that time. I went to visit about a month before she died and her doc had sent her to a radiologist who wanted to do radiation on her 5 days/week. I asked him would it extend her life and he said no but she would be more comfortable. Are you kidding me?

Not all doctors are like that, but I find this practice very common with oncologists and some surgeons.  Frankly I think it is immoral.

Most people are not like your family though.  Most people want everything done and extend the life of a loved one for as long as possible.  Even when they are bed ridden or no sense of their surroundings.  There are some people who even take advantage of their sickly older family member who collects a pension or social security.  They keep that family member at home and just barely take care of them, but want everything done to keep them alive so that check keeps rolling in.  It is very sad.

EnjoyIt

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Re: What comes after the ACA?
« Reply #1479 on: March 10, 2017, 04:12:22 PM »

Dude I'm in agreement with you!  I don't understand comments like those from the_fixer that seem to envision some sort of health care utopia existed in this country pre-ACA .  Health insurance has been f*cked for 50 years, and ACA was a great start in fixing a horrible system by guaranteeing people can gain access to insurance (and medical care).  AHCA seems like an unfortunate step backwards that will definitely not help the people who "live in the mountains or rural areas of the US."

I find this statement a little lacking some knowledge.  Although the ACA has given more people health insurance it has not made healthcare more affordable for many of them because their deductibles are so high that they can't afford care anyways.  What it also did was place people who had decent insurance into the same high deductible plans giving them essentially less access to healthcare then they had before.  This is the middle class and they got hosed by the ACA.

The ACA did do some good things such as expand medicare thereby giving better access to healthcare for those people and it made pre-existing conditions not an issue any more.

Either way, the republican plan sucks just as much because all it does is move around who pays for healthcare instead of actually lowering the cost.  Nothing will fix our system until we gain control over cost.


Yes, but the point of insurance is that healthy people subsidize the cost of insurance for sick people. It's yhe way all insurance is set up. The ACA allows insurers to charge old people multiple times as much as younger as well; the change is that the subsidies would be larger for older people than for younger people under Trumpcare. Still much room for improvement of either plan, of course.

No, the point of insurance is so that you insure against a catastrophic event.  Insurance should not be the middle man that pays for regular care.  it should insure against very costly medical conditions.  You don't by home owners insurance to pay your electricity.  You buy it to repair your roof when a hurricane blows it away.  You buy health insurance when you are diagnosed with lymphoma and need $250k worth of treatment.  You don't buy health insurance to buy you a $4 blood pressure medicine.
« Last Edit: March 10, 2017, 04:17:16 PM by EnjoyIt »

SwordGuy

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Re: What comes after the ACA?
« Reply #1480 on: March 10, 2017, 04:33:30 PM »
"What comes after the ACA?"

Well, here's a start:

http://fortune.com/2017/03/10/genetic-testing-workplace-wellness-bill/

A new GOP bill working its way thru the house will allow employers to require employees to take a genetic test and give them the results of that test.  They will be allowed to charge a huge penalty on the premiums (like 30%!!) if you don't comply.

Of course, once that genetic data exists, it only takes one law change or one data breach for that info to get out.  Your genetic makeup would no longer be private.

I find it Ironic that the GOP is having employers gather genetic data.  Ironic as in the slogan "Arbeitet macht Frei",  "Work will make you free", which was the slogan on the gate into Dachau.  (A Nazi death camp.)



That makes me fighting mad.

If I were Jewish or "not white" I would find it wise to be fighting mad over such a bill.

And, since my family and I may not be as lily white as we think we are ('cause there's no telling what those ancestors were up to), it's in our own self interest to be fighting mad, anyway. Even if we didn't have a conscience, soul or heart.

And - just a personal observation - the 2nd Amendment doesn't exist just to protect conservatives from tyranny.




Bateaux

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Re: What comes after the ACA?
« Reply #1481 on: March 10, 2017, 04:56:44 PM »
I don't trust our leaders to provide any workable health care plan going forward.   I've met and surpassed my planned FIRE number (1.5 M) needed without health care included.   I'm now working to secure a second FIRE level ( +500K) to pay for expected health care expenses. I estimate that I'll secure that extra amount in about two years.  So new total for FIRE is 2M.  Basically that works out to 20k using the 4% rule for health care alone.  I think many of you should reconsider your FIRE number because of the craziness I'm seeing in Washington.
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Exflyboy

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Re: What comes after the ACA?
« Reply #1482 on: March 10, 2017, 05:31:19 PM »
I don't trust our leaders to provide any workable health care plan going forward.   I've met and surpassed my planned FIRE number (1.5 M) needed without health care included.   I'm now working to secure a second FIRE level ( +500K) to pay for expected health care expenses. I estimate that I'll secure that extra amount in about two years.  So new total for FIRE is 2M.  Basically that works out to 20k using the 4% rule for health care alone.  I think many of you should reconsider your FIRE number because of the craziness I'm seeing in Washington.

And/or be prepared to move out of the US upon RE.

I am thankful we are well beyond our FI requirements like your planning on.

Roland of Gilead

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Re: What comes after the ACA?
« Reply #1483 on: March 10, 2017, 07:21:57 PM »
I don't trust our leaders to provide any workable health care plan going forward.   I've met and surpassed my planned FIRE number (1.5 M) needed without health care included.   I'm now working to secure a second FIRE level ( +500K) to pay for expected health care expenses. I estimate that I'll secure that extra amount in about two years.  So new total for FIRE is 2M.  Basically that works out to 20k using the 4% rule for health care alone.  I think many of you should reconsider your FIRE number because of the craziness I'm seeing in Washington.

I trust in the fact that 90% of the US population can't save $500k, let alone $2M.   Your plan seems to indicate that 90% of the USA are going to go without healthcare.

Bateaux

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Re: What comes after the ACA?
« Reply #1484 on: March 10, 2017, 07:46:39 PM »


I have pretty much lost faith that anything rational will be done to make health care affordable in the US.  Living abroad is also an option.   Last year I'd decided that if the Republicans regained control that I would extend my FIRE date due to health care uncertainty.   I have a good plan with my employer and as much as I desire to FIRE now, I've got to wait this out a bit longer.

« Last Edit: March 10, 2017, 07:50:32 PM by Bateaux »
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jim555

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Re: What comes after the ACA?
« Reply #1485 on: March 11, 2017, 02:39:05 AM »
The NYS Dept of Health has looked at the AHCA.

The Essential Plan is eliminated.
Costs:
2017 240 million
2018 681 million
2019 1,171 million
2020 2,415 million and every year thereafter

1 million will loose healthcare.

That is some plan, costs more, delivers less.

https://www.scribd.com/document/341427078/NYS-Department-of-Health-Aca-Repeal-Analysis#from_embed

Metric Mouse

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Re: What comes after the ACA?
« Reply #1486 on: March 11, 2017, 03:52:55 AM »
The NYS Dept of Health has looked at the AHCA.

The Essential Plan is eliminated.
Costs:
2017 240 million
2018 681 million
2019 1,171 million
2020 2,415 million and every year thereafter

1 million will loose healthcare.

That is some plan, costs more, delivers less.

https://www.scribd.com/document/341427078/NYS-Department-of-Health-Aca-Repeal-Analysis#from_embed

How does this plan cost more? It doesn't 'cost more', it simply costs NYS more, and the federal government less.  New York has to pay more to get the same coverage for its persons from 0%-100% FPL. Basically this is the cost of replacing the money that the U.S. government gives New York State every year for Medicaid enrollees. This in no way shows that the AHCA costs 'more', it simply reflects the costs being shifted around. I mean, the report literally says this:

Quote
Over $4.5 billion in costs would be shifted to states, counties, and safety net hospitals over the next four years
Give me one fine day of plain sailing weather and I can mess up anything.

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brooklynguy

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Re: What comes after the ACA?
« Reply #1487 on: March 11, 2017, 05:16:08 AM »
The Essential Plan is eliminated.

I would be interested to learn how they reached this conclusion.  As discussed in the other "end of Obamacare" thread, I still don't see how the bill accomplishes the elimination of the ACA's Basic Health Program option.

jim555

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Re: What comes after the ACA?
« Reply #1488 on: March 11, 2017, 08:03:17 AM »
I was reading an article that in order to go through reconciliation a bill can be blocked by on the grounds that it something "merely incidental" to the federal budget.  The 30% penalty paid to insurance companies is incidental to the federal budget and should be grounds for a Democratic objection to the Senate parliamentarian.

The Repubs could overide the parliamentarian's ruling.  Death spiral guaranteed without any penalty in place.  (I thing death spiral happens even with the 30% penalty.)

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Re: What comes after the ACA?
« Reply #1489 on: March 11, 2017, 08:11:41 AM »
"What comes after the ACA?"



I find it Ironic that the GOP is having employers gather genetic data.  Ironic as in the slogan "Arbeitet macht Frei",  "Work will make you free", which was the slogan on the gate into Dachau.  (A Nazi death camp.)




Just for accuracy (not because I have any problem with your message, but because holocaust deniers tend to feed off inaccuracies), the picture you showed is of Auschwitz-Birkenau, which was an extermination camp, rather than of Dachau, which was a concentration camp and many people died there but was not an extermination camp.
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jim555

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Re: What comes after the ACA?
« Reply #1490 on: March 12, 2017, 10:48:17 AM »
The states that get hit hardest with Trumpcare are all red states.  Delicious irony.
They can go back to how things were before when no one had health insurance. 
http://www.cbpp.org/blog/house-gop-plan-would-make-health-insurance-far-less-affordable-in-high-cost-states

sol

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Re: What comes after the ACA?
« Reply #1491 on: March 12, 2017, 11:45:37 AM »
The states that get hit hardest with Trumpcare are all red states.  Delicious irony.

And the converse is also true.  The premium subsidy map published earlier in this thread suggested that the two states that would see the most benefit under the GOP plan are New York and Washington, because they are liberal states with healthy individual markets and reasonable premiums, so they currently receive very little support from the ACA and the GOP plan would actually result in even lower costs to consumers in these liberal states, for all but the very poorest folks.

But that's not really a surprise.  The whole point of the GOP plan is to make things better for rich folks (like people in New York and Washington and Massachusetts, apparently) and worse for poor folks.
« Last Edit: March 12, 2017, 11:52:08 AM by sol »

Metric Mouse

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Re: What comes after the ACA?
« Reply #1492 on: March 12, 2017, 01:01:49 PM »
It's almost silly for me to care anymore.  I guess this new healthcare is going to pass, it doesn't affect me one way or the other to be honest.  I have a feeling my taxes will drop and, as long as I remain gainfully employed (snicker, got a guaranteed job but enjoy thinking about what lies on the other side from time to time), I'll be OK.  More than OK now that I'm saving even more of my paycheck.  So frustrating that I wanted better for my fellow man, women, and children, but what can you do?  When they say they don't want your help, you eventually take them at their word.
Do we really think that this will pass? I  guess I see too much obstruction from the Democrats and too much division in the Republican party for this to slide though. I've got a terrible track record with reading this stuff though; and consistently wrong goddamn always since last November.
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jim555

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Re: What comes after the ACA?
« Reply #1493 on: March 12, 2017, 01:06:46 PM »
The states that get hit hardest with Trumpcare are all red states.  Delicious irony.

And the converse is also true.  The premium subsidy map published earlier in this thread suggested that the two states that would see the most benefit under the GOP plan are New York and Washington, because they are liberal states with healthy individual markets and reasonable premiums, so they currently receive very little support from the ACA and the GOP plan would actually result in even lower costs to consumers in these liberal states, for all but the very poorest folks.

But that's not really a surprise.  The whole point of the GOP plan is to make things better for rich folks (like people in New York and Washington and Massachusetts, apparently) and worse for poor folks.
NY, VT and MA have either no age rating or limited age rating so a 60 yo will benefit a great deal from the new scheme.  I would think these states might adjust the age rating ratios to be more fair to the younger group.

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Re: What comes after the ACA?
« Reply #1494 on: March 12, 2017, 01:23:26 PM »
It's almost silly for me to care anymore.  I guess this new healthcare is going to pass, it doesn't affect me one way or the other to be honest.  I have a feeling my taxes will drop and, as long as I remain gainfully employed (snicker, got a guaranteed job but enjoy thinking about what lies on the other side from time to time), I'll be OK.  More than OK now that I'm saving even more of my paycheck.  So frustrating that I wanted better for my fellow man, women, and children, but what can you do?  When they say they don't want your help, you eventually take them at their word.
Do we really think that this will pass? I  guess I see too much obstruction from the Democrats and too much division in the Republican party for this to slide though. I've got a terrible track record with reading this stuff though; and consistently wrong goddamn always since last November.

I'm with you.  This version won't pass.
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Paul der Krake

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Re: What comes after the ACA?
« Reply #1495 on: March 12, 2017, 02:54:14 PM »
It's almost silly for me to care anymore.  I guess this new healthcare is going to pass, it doesn't affect me one way or the other to be honest.  I have a feeling my taxes will drop and, as long as I remain gainfully employed (snicker, got a guaranteed job but enjoy thinking about what lies on the other side from time to time), I'll be OK.  More than OK now that I'm saving even more of my paycheck.  So frustrating that I wanted better for my fellow man, women, and children, but what can you do?  When they say they don't want your help, you eventually take them at their word.
That's pretty much my position now. I feel bad for caring so little, but if middle America insists on voting against their own interests over and over again, there's no helping it.

jim555

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Re: What comes after the ACA?
« Reply #1496 on: March 12, 2017, 04:50:40 PM »
Makes me sick when Chuck Todd is throwing softballs to Price and Price is lying his ass off without being challenged.  Outrageous lies like more people will be covered with the new plan.  Then on the news tonight they are repeating the lies as fact.

Metric Mouse

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Re: What comes after the ACA?
« Reply #1497 on: March 12, 2017, 05:15:45 PM »
It's almost silly for me to care anymore.  I guess this new healthcare is going to pass, it doesn't affect me one way or the other to be honest.  I have a feeling my taxes will drop and, as long as I remain gainfully employed (snicker, got a guaranteed job but enjoy thinking about what lies on the other side from time to time), I'll be OK.  More than OK now that I'm saving even more of my paycheck.  So frustrating that I wanted better for my fellow man, women, and children, but what can you do?  When they say they don't want your help, you eventually take them at their word.
That's pretty much my position now. I feel bad for caring so little, but if middle America insists on voting against their own interests over and over again, there's no helping it.
I  guess if enoigh of the  poor people in the country vote that the rich shouldn't pay for their health insurance, who are we to argue?
Give me one fine day of plain sailing weather and I can mess up anything.

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jim555

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Re: What comes after the ACA?
« Reply #1498 on: March 12, 2017, 06:26:26 PM »
It's almost silly for me to care anymore.  I guess this new healthcare is going to pass, it doesn't affect me one way or the other to be honest.  I have a feeling my taxes will drop and, as long as I remain gainfully employed (snicker, got a guaranteed job but enjoy thinking about what lies on the other side from time to time), I'll be OK.  More than OK now that I'm saving even more of my paycheck.  So frustrating that I wanted better for my fellow man, women, and children, but what can you do?  When they say they don't want your help, you eventually take them at their word.
That's pretty much my position now. I feel bad for caring so little, but if middle America insists on voting against their own interests over and over again, there's no helping it.
I  guess if enoigh of the  poor people in the country vote that the rich shouldn't pay for their health insurance, who are we to argue?
Darwin awards in action.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #1499 on: March 12, 2017, 06:31:01 PM »
It's almost silly for me to care anymore.  I guess this new healthcare is going to pass, it doesn't affect me one way or the other to be honest.  I have a feeling my taxes will drop and, as long as I remain gainfully employed (snicker, got a guaranteed job but enjoy thinking about what lies on the other side from time to time), I'll be OK.  More than OK now that I'm saving even more of my paycheck.  So frustrating that I wanted better for my fellow man, women, and children, but what can you do?  When they say they don't want your help, you eventually take them at their word.
That's pretty much my position now. I feel bad for caring so little, but if middle America insists on voting against their own interests over and over again, there's no helping it.
I  guess if enoigh of the  poor people in the country vote that the rich shouldn't pay for their health insurance, who are we to argue?
Darwin awards in action.

I sincerely want to help, but maybe I take my taxes elsewhere.  Darwin can run the show in the U.S., I would prefer to live in a country where the already rich don't openly steal from the already struggling and poor.
Transitioning to FIRE'd albeit somewhat cautiously...