Well on the upside, as the GOP continues to try to author something better than ACA... More people are starting to appreciate the benefits of ACA. I love the irony.
CNN GOP Healthcare Effort
RCP Most Americans Support ACA Now.
CNN GOP Healthcare Effort
RCP Most Americans Support ACA Now.
42 comments:
The outlines of a GOP health care plan were made clear by Trump during the campaign. Trumpcare , will cost less than Obamacare, cover more, and will exclude a role for insurance companies. That works for me. Why not just pass it?
--Hiram
Because though it will cost less for tax payers and most of us consumers... There is a small group of people who would pay more or lose insurance...
Same problem that happened when ACA passed. It increased the costs on the majority to help fund the insurance for the small minority.
Choices... Choices...
This reminds me of the famous ACA comment... You will need to pass it to see what is in it...
There is a small group of people who would pay more or lose insurance...
Is that Trump's fault? He made it quite clear what he wanted to do during the campaign, and as I have been reminded many times, he is a legitimate president. So why don't Republicans respect that legitimacy, and do what the people want?
" You will need to pass it to see what is in it..."
In fairness to President Trump, who seems to know virtually nothing about the details of health care policy, I would never dream of proposing such a precondition to his actions. It's enough for him to deliver on his very clear promises. Leave it to the rest of us to work out the details.
--Hiram
It isn't lost on me, by the way, that the American people who were so disturbed by Nancy Pelosi's inability to foresee the future with regard to something has immensely complicated as health care, went on to elect a president who seems remarkably ignorant about America and it's history. Is there a contradiction there?
--Hiram
CNN Kimmel Monologue
So Jerry and I have been discussing ACA's pros/cons over here. Well... To be truthful: I have been discussing the pros/cons and Jerry has been listing the cons...
Jerry left this interesting quote.
"Once again, I have to suggest to you that you pay less attention to the "good intentions" (which must be presumed depending on your degree of belief in the altruism of our elected leaders) of legislation, and what the most likely effect of that legislation will be in the real world. Obamacare intended to increase competition, reduce cost, improve quality and expand "availability." You know as well as I do that would be impossible without radically altering the underlying system. Obamacare did nothing to increase competition and in fact stifled it by requiring expensive "minimum coverages," "must issue" and "pre-existing condition" rules . It created massive subsidies to insurance companies and insurance buyers alike, that inevitably created massive (total) cost increases, and raised premiums for almost everybody, on top of that. The working poor it was supposed to help have been priced out of the market. It did not add anything to the "supply" side of the health care market and in fact reduced it by doctors who refuse to work for the paltry payment schedule of Obamacare or Medicaid policies. There has been quite a growth in cash-only practices, or "co-ops." And there are still, what, 30 million people "uninsured"?
To put it simply, there is no way that a 2500-page bureaucratic nightmare can possibly make the right decisions for 300 million people, most of whom have already made the decisions that suit them. It cannot work; it's only a matter of how long it takes for the crackup to become intolerable, and how long the smarter-than-everybody Democrats keep trying to defend their stupidity." Jerry
With this view in mind... I am curious how the GOP plan compares. From what I understand, their plan will:
- allow companies to charge the elderly and people with pre-existing conditions significantly higher premiums.
- reduce the subsidies that help low income households pay for their health insurance.
- allow companies to sell policies that will not cover certain ailments and treatments that commonly occur. People will buy them because it is what they can afford now.
- what will it do to the one stop market places where people can easily compare coverages, costs, etc?
Jerry,
Do you have any sources to back up all your opinions?
See... This is a source...
Who is still Uninsured and why?
"Conclusion
While millions of people have gained coverage under the ACA provisions that went into effect in 2014, over 28 million nonelderly individuals remained uninsured in 2015. Many of these people are ineligible for ACA coverage, either because of their immigration status or because their state did not expand Medicaid. Others may be eligible but either do not know of the new coverage options, have had difficulty navigating the enrollment process, or opted not to take up coverage. Affordability of coverage, even with the availability of financial assistance, remains a barrier to insurance, with remaining uninsured adults naming cost as an ongoing major reason for not being insured.
Going without coverage can have serious health consequences for the uninsured because they receive less preventive care, and delayed care often results in more serious illness requiring advanced treatment. Being uninsured also can have serious financial consequences. The ACA has provided coverage to millions of people in the United States and has the potential to reach many more. Efforts to both extend eligibility in states that have not expanded Medicaid and reach the remaining uninsured who are eligible for coverage may enroll more people in coverage and ensure that fewer individuals and families will face the health and financial consequences of not having health insurance."
CNN GOP Still Not There
"
What's in the bill?
The GOP health care bill would eliminate Obamacare taxes on the wealthy, insurers and others, and get rid of the individual mandate imposed by Obamacare, officially known as the Affordable Care Act. Instead of the Obamacare subsidies that are tied to income and premiums, the GOP plan would provide Americans with refundable tax credits based mainly on age to purchase health insurance.
The legislation would also allow insurers to charge higher premiums to those in their 50s and early 60s, compared to younger consumers.
The bill would also significantly curtail federal support for Medicaid and allow states to require able-bodied adults to work. After 2020, states that expanded Medicaid would no longer receive enhanced federal funding to cover low-income adults, and those that hadn't expanded would be immediately barred from doing so.
And it would allow states to relax some key Obamacare protections of those with pre-existing conditions, which are among the health reform law's most popular provisions. States could apply for waivers to allow insurers to offer skimpier policies that don't cover the 10 essential health benefits mandated by Obamacare. Also, insurers would be able to charge higher premiums to those with medical issues if they let their coverage lapse. States requesting waivers would have to set up programs -- such as high-risk pools -- to protect insurers from high-cost patients.
However, the GOP bill doesn't touch one another beloved piece of Obamacare -- letting children stay on their parents' insurance plans until the age of 26. "
Just a reminder about the 10 Essential Benefits that Jerry sees as excessive governmental over reach.
"1.Outpatient care—the kind you get without being admitted to a hospital
2.Trips to the emergency room
3.Treatment in the hospital for inpatient care
4.Care before and after your baby is born
5.Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
6.Your prescription drugs
7.Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
8.Your lab tests
9.Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
10.Pediatric services: This includes dental care and vision care for kids"
It does seem odd to me that people who swear it is critical to save the lives of babies balk (ie anti-abortion folks) at helping to fund the Maternity and Pediatric aspects of American Healthcare.
All the while happily collecting FICA from those young working families so old people healthcare is fully funded. And ensuring that heart attacks, strokes, and all the other old people risks are in the policies...
Apparently Religious Conservatives are being consistent... "The lives of those babies are critical... As long as those lives do not cost me any time or money..." :-)
From Jerry:
"I must ask what it is you are defending, and why? You seem a reasonable, logical sort. What about the ACA is worth keeping, that balances out all the pieces that are not?"
What do I like about ACA:
1. The individual mandate - everyone should be required to be insured or have $300,000+ per person in a trust fund. (ie self insured) This avoids the pre existing fraud issue ACA is dealing with now.
2. The 10 essential coverages - they are basic and logical. And yes some people will not use all of them, but then again they may... They just don't know. And even if they have zero chance of being pregnant or having kids, there are other offsetting problems they may have.
3. Limiting the premiums for older people to <3 times that of younger people. This offsets the pregnancy and pediatric coverage issue discussed above.
4. Subsidies based on family income and insurance cost, not on age... Rich old people really don't need subsidies. (ie credits)
What I dislike about ACA:
1. It's being funded by special taxes on the wealthy and medical devices.
2. The current pre-existing condition mandate that allows people to sign up, get that new hip, and then stop paying premiums until they need another hip.
3. Having many unique government run market place systems with all their high setup, marketing and maintenance costs. One system should be able to handle the country... Maybe make it a part of the amazon shopping experience...
I'll give it more thought...
538 GOP Changes
Here's the deal. Obamacare involves a reallocation of costs. Some people will pay more than others. The people who are paying more can always as, "Why us?". The answer is because health care has to be paid for by someone, and by increasing the size of the polls, health care is, or at least should be, less expensive for everyone. Of course, that reasoning doesn't convince everyone, but the underlying forces for it are always present. That's because the cost of health care has always got to fall on someone, and whoever it is, always can claim unfairness, but this time in a context where everyone is paying more.
Another lesson we are learning is that business people don't understand government. Donald Trump is a case in point, a man who seems awed by learning things that literally everyone else in America has known for decades. Surely, he must be the last person in America to figure out that health care policy is complicated. Like most businessmen, Trump is a believer in the virtues of accountability. But what he hasn't learned is that in politics, accountability doesn't mean keep track of costs, it means shifting those costs unto some other constituency, preferably one that doesn't vote, or failing that, one that has already demonstrated a historical tendency to vote for someone else.
--Hiram
From Jerry...
"Your article clearly states the problem. Asked if they would like what the ACA promised, people say yes. Asked if they like what Obamacare has delivered, they will say no. And asking the general public what those actually affected by the hurricane think does not get you the right answer.
That is why Republicans are too stupid to see the clear and sensible path, here. They simply repeal Obamacare for everybody that does NOT already have it, and offer an alternative (such as keeping the plan they like), while those who ARE on Obamacare get to keep the plan THEY like. Nobody loses their insurance, but they gain an option that might (most likely) be better. "
For better or worse, repealing ACA also repeals the funding sources that are currently reducing the health insurance costs for millions of low income Americans via subsidies.
There is no you can have your cake and eat it too.
It's the Republican conundrum. They can't include coverage for pre-existing conditions without finding a way to pay for it. And that's Obamacare.
--Hiram
Except it isn't true. The "Affordable Care Act" is not affordable for most people, and the fact that "poor people" get subsidized by taxpayers does NOT reduce the actual cost of health insurance. And even with the subsidies, the combination of premiums and deductibles make most of the plans unaffordable. It is ridiculous to believe that government can MANDATE free market competition, the only sure way to drive down prices and increase supply.
Maybe you cannot have your cake and eat it, but having Democrats say "let them eat cake" doesn't get cake for anybody. It does, however, suggest a solution.
"It's the Republican conundrum. They can't include coverage for pre-existing conditions without finding a way to pay for it. And that's Obamacare. "
Baloney. It's called "state high risk pools" or "pre-existing condition waivers" or "passing the health care tax deduction to the employee to purchase portable insurance and eliminating the pre-existing condition problem." All of which were options BEFORE Obamacare came along, and could be wholly sufficient after it is gone.
Jerry.
Proof? "even with the subsidies, the combination of premiums and deductibles make most of the plans unaffordable"
Now I agree that ACA plans in rural America for middle class and wealthy people are expensive. Not sure if that is an ACA problem or a population / resource scarcity problem.
As for conundrums, how do you pay for including 26-year-olds on their parents policy, so long as there is no charge to the parents for such coverage? How does the person who breaks an arm and leg and then buys an insurance policy pay for that sizable expense? How does somebody making 24,000/year pay $4500 for a "cheap" Obamacare insurance policy that has a $6000 deductible?
Jerry,
As for separate high risk pools or pushing the water into the big pools. Not sure what the benefit is. It still needs to be funded.
"proof"?? The numbers are readily available.
And since roughly 1/3 of counties (and growing) have only one Obamacare provider available, might we expect prices to rapidly rise? And what about the growing number of counties in which there are ZERO providers? "Unaffordable" certainly includes "not at any price," yes?
So, let things be funded by the best mechanism, as it was before the Wizards of Washington "fixed" what wasn't broken.
I won't try to defend the AHCA. Nobody understood Obamacare when it was passed, and nobody can understand it now well enough to "fix" it. It's like trying to retool a diesel locomotive to run in the Tour de France. Scrap the "ACA" and start over.
You definitely have feelings of nostalgia for pre-ACA. Not sure if many others do.
To me it was / is a non-issue.
It seems you want to toss the baby with the bath water.
The "Affordable Care Act" is not affordable for most people, and the fact that "poor people" get subsidized by taxpayers does NOT reduce the actual cost of health insurance.
It was the best we could do at the time. Believe me on this, given our druthers we would have made health care a lot more affordable for most people but we just didn't have the support to do that. I am not too impressed by complaints by Republicans that Obamacare lacks features they opposed giving it.
--Hiram
Yes, I have "nostalgia." My health insurance costs doubled and my health care was a lower quality after ACA. If I have to toss the baby out with the "bath water," it's worth doing, because right now the baby is drowning in an ocean of good intentions and terrible reality.
And we don't have to go back to pre-ACA, though that would be a terrific improvement. We can repeal the ACA and put in place what we SHOULD have done, to make insurance more affordable, so more people could be covered.
And since roughly 1/3 of counties (and growing) have only one Obamacare provider available,
The problem with the localization of Obamacare Republicans favor is that many areas just aren't big enough to sustain even one provider, if that. It's hard to be competitive when there are no competitors.
The lack of understanding on this issue is one of the things I don't understand about this. Republicans do after all, support selling health insurance across state lines. That would pretty much solve the competition problem, if they were required to sell health insurance across state lines. But that isn't what they have in mind. The other thing to do would be to allow health insurance to be sold nationally. I actually favor that, but Republicans when they figure out exactly what they are saying, don't.
--Hiram
Hiram, "providers" refers in this case to INSURANCE providers, not health care providers. And remember Obamacare is about everybody having health insurance, while doing nothing to help them get actual health care.
Insurance can be sold anywhere in the state, and selling it across state lines would be even better because statewide insurance regulations that drive up prices would be eliminated. It's one of the best ideas the GOP has, since it is Constitutional and O'care is not.
"Believe me on this, given our druthers we would have made health care a lot more affordable for most people..."
Sorry, I cannot believe that. It defies the laws of economics, of human nature, and defies simple common sense. Government either tries price controls, which do not work, or they try rationing, which makes the "product" less available.
"What do I like about ACA:
1. The individual mandate -..."
And yet last year there were 6.5 million people who were uninsured, because they chose to pay the penalty rather than buy something they did not want or believe they needed, and could not afford.
This whole notion that somehow "we" are responsible for some individual's expenses, of any stripe, are simply wrong and leads us to all sorts of silly things like the individual mandate. When argued before the SCOTUS, the question was, if government can require you to buy health insurance that you don't want and can't afford, what else can they force you to buy against your will?
ACA should have been great for competition then...
Government took a lot of money from the Peters and gave it to the Pauls so they can pay for market based healthcare.
The only price controls exist within Medicare and Medicaid.
The only real constraints were the 10 essential benefits, and pre-existing condition and old people can not be forced to pay more than 3 times what normal people pay.
VOX High Risk Pools Explained
VOX No CBO score update yet
Sounds like they think they have the votes in the House, though I have no idea how they are going to get 60 votes in the Senate.
"The only price controls exist within Medicare and Medicaid."
Simply not true. The IPAB sets reimbursement schedules for Obamacare policies if costs get "too high," and insurance companies are forced onto "fee-for-service" schedules that limit reimbursements and lead to lower quality of care.
"Sounds like they think they have the votes in the House, though I have no idea how they are going to get 60 votes in the Senate."
I know an easy way to get a repeal past the Senate. A) Since Obamacare as a whole has "budgetary impact" it can be repealed as a whole via reconciliation and 51 votes. Add to it a simple "if you like your Obamacare plan you can keep your Obamacare plan" and you eliminate the (largely phony, IMHO) argument that people "will lose their insurance." THEN you remove Congress' (illegal) exemption from Obamacare, and the "replacement" bill sails through the Senate with 60 votes or more.
CNN ACHA vs ACA
Here is a much more detailed explanation.
ACA Facts Cost Management
"From 2014–2017, any year in which the Medicare per capita growth rate exceeds the average growth in the consumer price index (CPI) and medical care CPI, the IPAB will be required to recommend Medicare spending reductions. For determination years 2018 and after, the target is pegged to per capita GDP growth plus one percentage point. The IPAB recommendations will become law unless Congress passes an alternative proposal with the same budgetary savings. The board’s mandate also includes recommendations on private health spending. While not binding, these recommendations could reduce increases in private health spending."
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