It absolutely fascinates me how much latitude a President has to work around the laws that are on the books. No wonder they keep getting sued for over stepping their authority.
The irony of course is that the Conservatives vilified Obama and accused him of playing emperor when he took these types of actions, while the Liberals cheered Obama. Now the shoe is on the other foot and the Conservatives are cheering on Emperor Trump while the Liberal gnash their teeth.
The first and second links discuss potential actions that Trump may take to allow people to buy less inclusive, and likely less expensive plans. This sounds great until one understands the likely negative impacts it will have on the rest of the system.
The 3rd link discusses Trump's effort to make it harder for poor women to get and stay on birth control. I of course think this is the height of stupidity since unintended pregnancies and the costs of/to the children are one of our country's biggest problems and shames. Long term reversible birth control should be free to every man and woman in the USA.
Thoughts?
VOX How Trump is Planning to Gut ACA
CNN Association Health Plans
Hill Trump Weakens Birth Control Mandate
Vice What Trump Has Signed
The irony of course is that the Conservatives vilified Obama and accused him of playing emperor when he took these types of actions, while the Liberals cheered Obama. Now the shoe is on the other foot and the Conservatives are cheering on Emperor Trump while the Liberal gnash their teeth.
The first and second links discuss potential actions that Trump may take to allow people to buy less inclusive, and likely less expensive plans. This sounds great until one understands the likely negative impacts it will have on the rest of the system.
The 3rd link discusses Trump's effort to make it harder for poor women to get and stay on birth control. I of course think this is the height of stupidity since unintended pregnancies and the costs of/to the children are one of our country's biggest problems and shames. Long term reversible birth control should be free to every man and woman in the USA.
Thoughts?
VOX How Trump is Planning to Gut ACA
CNN Association Health Plans
Hill Trump Weakens Birth Control Mandate
Vice What Trump Has Signed
59 comments:
I have always supported Trump's campaign promise to make health care better cheaper and to cover more people. If there are executive orders that can be issued within the existing legal framework, I am all for them. This is what his supporters expected of Trump; that he would bring the imaginative solutions that characterized his business career to Washington. It's why we sent America's leading health care expert to the White House.
--Hiram
Why be such a piker, with "free birth control"? Let's just mandate sterilization for all the "undesirables."?
Why be such a piker, with "free birth control"?
Speaking for myself, I am acutely aware that health insurance is not free. For those who have their health insurance that their place of work, it's part of the compensation package. It is a very expensive benefit. And obviously, those who receive health insurance under Obamacare are very aware that it's not free.
--Hiram
Jerry,
Because free does not equal mandating. It just allows poor women/men the same freedom to choose as wealthier women/men. The poor women/men would not need to choose between food or birth control.
Now I would happily mandate sterilation for our friend Angel Adams for the good of her children. Whereas you would???
Well, I'm just glad to see you've come around to the point I made a few days ago about how Trump's actions in managing the ACA are going to hurt many folks.
Sean,
The challenge though is that it is also going to help many folks...
Currently the young and healthy are paying a lot of extra money to keep the pool filled. And for those who do not qualify for subsidies this a huge burden.
Sure, but those same people aren't going to be young and healthy forever.
You are correct. And as they age their premiums will increase accordingly.
I hope they save some money from those lower premiums...
"And as they age their premiums will increase accordingly."
Leaving them out of luck, under GOP health plans!
Or, these young and eventually old folks could buy into an HSA, solving both problems, if government would get out of the way and allow it.
And my point on sterilization is that, people now choose to engage in unprotected sex and the "begetting" that follows. That contraception is free or nearly so doesn't enter into that choice. If you don't want them having unprotected sex, you have to stop them from having unprotected sex or offer them some incentive/disincentive to do so. The disincentive cold be required work and child support, or at least no additional welfare. The incentive might be a job or education that would lift you out of poverty. You want people to make good choices, either give them good choices or mandate that they make the "choices" you want.
How is the government getting in the way of HSAs?
Jerry,
Per our previous discussions, you are in denial regarding the high cost of high quality birth control in the USA and how much of a burden it is for poor women to stay protected against unintentional pregnancies. Which of course is kind of ironic since you often state you want to support the poor and give them equal access to good things.
And personally I don't care if people choose to have sex. What I care about is making it as easy as possible for all adults to avoid unintended pregnancies / babies when they simply are not ready or willing to be a fully engaged and capable parent.
So I want to promote every citizen who is sexually active to be on a high quality long acting birth control until they are ready and truly wanting to conceive a child... It seems that making it free with few barriers to access is an excellent way to accomplish that goal.
By the way, you never said what you think we should do about our friend Angel?
Not that I am thinking it will help, but here are a couple of related articles.
NPR How Birth Control Saves Tax Payers Money
And it looks like they only consider the costs of delivery... Not the potential 18 years of welfare costs, school costs, prison costs, etc.
The Atlantic Social and Economic Benefits of BC
Sean,
As I often say... I do not know what the best answer is on healthcare.
Is it good to overcharge the young in order to under charge the older folks?
Is it good to way over tax the successful folks to give the unsuccessful people free or reduced cost services?
As always I would prefer that our society strongly push unsuccessful people to change, improve and work to become successful people. This just letting them pass through school and become a burden on our society is not good for them or our country.
Is it good to overcharge the young in order to under charge the older folks?
Yes. In the same way it's good to charge old folks for planned and foreseeable health care events like pregnancy benefits.
Is it good to way over tax the successful folks to give the unsuccessful people free or reduced cost services?
Yes, it is. Should successful people be treated better? Should they get discounts at movies? Should they get free popcorn? What other perks should successful people get?
--Hiram
Hiram,
The younger people's premiums would account for those pregnancy costs within that population's premiums. No need for older people to pay more.
And it isn't the successful folks who are getting a discount at the movie, the free popcorn and the other perks... Remember that right now they are paying full price for the movie, popcorn, perks...
AND they are paying for unsuccessful folks to get a discount at the movie, the free popcorn and the other perks...
In essence our society is saying that if you learn, work, save, invest, get/stay married and live a fiscally conservative life... You will have to pay full price and pay extra to cover the bills of those who made different choices.
"The younger people's premiums would account for those pregnancy costs within that population's premiums. No need for older people to pay more."
Segregating people into small, little pools is how we got ourselves into this mess. If you're going to segregate all the 55-64 people into one pool or all the sick people into one pool, they're not going to be able to afford insurance. We need to have as large a pool as possible in order to spread the risk.
Does that mean that young people pay a bit more now? Yep. But it also means that we're promising to them that they won't have to go broke when they get older or get into a car accident or get cancer in order to fund their medical treatment.
I am not promoting small pools with questionable policies / coverage that won't cover the expenses of the insured adequately like Jerry does.
I am just saying that maybe the 1 to 3 young vs old premium ratio is too small... Maybe the old folks should pay 5 times what the young do?
And please remember that "this mess" is more about poverty than about healthcare. The folks with good educations, marriages, financial / personal habits, etc usually have great healthcare.
The only problem in the past was the pre-existing condition issue, and hopefully that has been fixed for people who get and stay insured.
And hopefully we find some way to stop free loaders who do not pay insurance premiums from gaming that system.
Regarding the ratios...
Typically the goal would be to keep the costs manageable and age appropriate for young people when their incomes are lower and life costs are high.
Then the older folks who make and have more could pay a higher and age appropriate rate since they should have more income and resources.
Unfortunately this does not work out very well when people don't continuously learn / improve, don't save, don't invest, etc. At that point they are like young irresponsible people in an old persons body.
Remember that saying I love.
"Not all old people are wise"
"And please remember that "this mess" is more about poverty than about healthcare. "
No, it isn't. The fact that families who are making more than the subsidy level (~$90K for a family of 4) are having a difficult time paying for health insurance demonstrate that.
"The only problem in the past was the pre-existing condition issue, and hopefully that has been fixed for people who get and stay insured. "
That was the only problem? You're crazy!
CNN Trump Promises Great Coverage
Regarding the premium variations by age... I remember talking to a friend of mine who is a part owner in an engineering consulting / contracting business... They are big enough to be self insured, hire a management firm and reinsure the big events just like my firm. We were surprised at first because their premiums were much lower than the ones for my company...
Then we compared the demographics. His firm employs a lot of young men who are often single. Whereas my company has a very diverse work force, if not a little old.
Is it unfair that our premiums are higher or is it just logical?
Sean,
Yes it may be that I am crazy... Now who are these $90,000 families who are having a hard time paying for health insurance? Using my family's total premium (mine, companies & out of pocket) of $25,000 / year, I do see that it would be painful if one was self employed. However it should be achievable.
Based on my self employed friends, I am guessing they did not have this problem before ACA drove up the costs up in rural areas.
It goes back to the tradeoffs you want to make. Yes, you can charge people individually based on what their actuarial risk is -- which means old and sick people are going to pay a lot more. So much more, in fact, that many of them won't be able to afford it regardless of how virtuous they are. Or, you can choose a different route where you ask those who are currently young and/or healthy to pay a little more now in return for the promise that they will receive those protections when their time comes.
And I would probably be angry that $25,000 of my compensation goes to health costs every year, however with a wife who has neck/disk issues and 3 daughters who have dealt with various miscellaneous issues... I am guessing we incur an average of about $15,000 in costs/year over the past decades.
And the balance of the premium goes to people who are not as lucky as me and my family.
"Based on my self employed friends, I am guessing they did not have this problem before ACA drove up the costs up in rural areas."
Well, you just said if they're above the limit, it shouldn't be a problem. If it's below the limit, they are getting a subsidy. So what is it? Do you know what you're talking about?
I am happy to discuss different routes. As long as people are willing to discuss the pros and cons of each route.
As I noted above, I work for a diverse company... I already pay more for the older and less healthy folks.
The challenge is how to set up the system to strongly pressure participants to make healthy choices. And giving away free and reduced cost coverage with no conditions is surely not the way to make America healthier.
Below seems to describe the problem.
Premium Hikes
ACA drove up premiums excessively without giving them any advantage... Likely to help fund others.
"Below seems to describe the problem."
At 11:53 this morning, you said "However it should be achievable." regarding such a scenario.
Is it a problem now? I can't follow what your complaints are.
Sean,
Why are you arguing against the fact that ACA drove up the costs of coverage in rural America to irrational levels?
ACA may have accomplished good things for many low income folks, but it is crushing people like those in the link. I have friends who used to be happily insured in 2008 and now have dropped their coverage because of what ACA did to their premiums.
Now if they could get great insurance like I have for ~$4,500 per head, they probably wouldn't mind... But that is not the case with ACA in their areas.
"Why are you arguing against the fact that ACA drove up the costs of coverage in rural America to irrational levels?"
I'm not arguing that premium costs aren't high. (In fact, if you go back to my health care plan, I have a specific point designed to address this specific scenario.)
*YOU* are the one who argued at 11:53 this morning that premium costs for someone who made too much to qualify for the subsidies was "achievable".
I'm glad that now you're recognizing it is a problem.
But it also shows that your point about the problems with our health care system being "more about poverty" just ain't true.
Actually I argued that premiums were okay for most successful people until ACA arbitrarily raised their premiums.
Personally I think you are intentionally missing my point, my self employed friends were okay with their health insurance / care situation back in 2008. They paid a reasonable amount to get insurance that did something for them. Post ACA now they pay a lot more for even higher deductibles and they are not impressed...
The Liberal answer of course is to just give out bigger subsidies to more people.
Which of course is just doubling down on making people even less personally responsible for their own health and healthcare. And passing the burden on to unrelated citizens.
OK, so which of the essential health benefits should be removed?
Maybe the bolded ones... They seem pretty silly for a bunch of single farmers...
Every health plan must cover the following services:
Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (like surgery and overnight stays)
Pregnancy, maternity, and newborn care (both before and after birth)
Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
Prescription drugs
Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)
Many of these folks were happy just having low premium high deductible plans in case they got cancer or something. Unfortunately as the article noted, these did not meet the ACA rules.
My friends have to absorb $10,000+ equipment repair surprises at times... Big healthcare bills would not blow their budget.
Many of these folks were happy just having low premium high deductible plans in case they got cancer or something
They knew they could stick us with the bills. Freedom isn't free. Neither is health care. And somehow, as with the Las Vegas shooter, the rest of us end up picking the costs of someone else's freedom.
--Hiram
Hiram,
What am I missing here? How is having a high deductible plan "sticking us with the bills"?
My company is self insured up to some large deductible per person and then reinsurance takes over... I don't see anyone defaulting on payments to the hospitals in this system? Or transferring their debts to us tax payers.
Where as with ACA and Medicaid a huge amount of expense is being "stuck with us", the tax payers.
"Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)"
This is quite possibly one of the most ridiculous suggestions you've made, to remove this as an essential health benefit.
I won't go into how stupid it is, because you will likely not understand.
Moose
Well, maybe I will...
John, you're going to have to explain why you don't think the mind is as important as the hand.
You don't think mental health is important to single farmers? I don't even know how to respond to that except with ridicule.
Moose
"Maybe the bolded ones... They seem pretty silly for a bunch of single farmers..."
Again, you say you don't want specialized pools for different groups but you just build your list of essential health services based on single farmers. You clearly have no idea how health policy actually works, so I should really stop engaging with you on this topic.
Sean,
You asked me which ones I would remove and I gave you some answers.
Now I understand that "YOU" want everyone covered for "EVERYTHING", but what if that is not what the customer wants? And if it drives up the cost of the product to where people can not afford it?
Moose,
Since I suffer from anxiety and have been on paxil since 2004, I agree that mental health is important. However how one pays for that counseling and/or medication is a different topic.
In my case I could probably get off my 30 mg a day if I made different life choices, but this is so simple and I love my diet mountain dew... :-)
Please remember that it really is not necessary for insurance to cover all the little stuff that often fall under the deductibles.
Or maybe we should put marriage counseling coverage into "healthcare"...
"Now I understand that "YOU" want everyone covered for "EVERYTHING""
How many times do I need to ask you to stop doing this?
Not all, or maybe very few, mental health problems are caused by behavior.
You seem rather ignorant about mental health issues.
The brain/mind, as part of the body, can also break down like any other part of the body that you seem to have no trouble covering under basic health insurance.
One would think that the stigma of mental health would have disappeared by now, but some people just refuse to use their brains to understand it.
Moose
Sean,
Paraphrasing is supposed to be a good way to clarify misunderstandings... If you disagree with my summary:
- What are you willing to leave out of healthcare insurance?
- Who are willing to let not have it and for what reason?
Moose,
There are true mental disorders out there... But should people be forced to pay premiums to get coverage they do not want? That is the big question here...
Here are some stats
If you're uncertain about my position, ask. Do not make declarative statements. I have asked you to do this on numerous occasions. I do not appreciate it at all.
My positions on your questions are rather clear. I have not suggested any expansion of covered health benefits beyond the ACA guidelines and I have made clear how I would expand coverage by tweaking the ACA on several occasions.
I'm sorry but the jump from a fully functioning ACA with your improvement ideas in place to, Medicaid expanded in all states, people were all enrolled, taxes raised to fund it all, etc...
"Now I understand that "YOU" want everyone covered for "EVERYTHING"
seems to be a pretty small hop.
Do you disagree? If so, what is your rationale?
Which citizens would not be covered for what?
There are lots of things that you're not entitled to under the ACA: weight-loss surgery, cosmetic surgery, fertility treatments, alternative medicine as a few examples. Your insurance company has the right to make formulary lists for prescription medications or not to cover experimental treatments. That's just the start of it, but you get the idea (I hope). The ACA is not everything for everyone. If we expanded coverage along the lines I propose, we would have something for everyone, that's true.
You love to take a dump on everyone's else ideas about health care without offering concrete ideas of your own. Your party proposes policies that would leave millions more people uninsured. That would produce bad outcomes in health -- and over the long run, in our budget.
"But should people be forced to pay premiums to get coverage they do not want?"
Yes. It's called Single Payer.
Moose
Sean,
That was a good answer, however it seems that some treatments and drugs are limited... Not that the conditions can not be treated. To me it seems infertility is the only true healthcare issue that will not be treated at this time.
Web MD ACA and Weight Mgmt
Boston Reproductive Services
BR 5 Things ACA will not cover
As for dumping on ACA... As I have said many times, I am fine with ACA and your improvement ideas.
My primary gripes with ACA are:
- It is mostly funded on the backs of a small group of citizens.
- It does little to nothing to strongly pressure people to make healthier life choices or encourage them to strive to become independent productive citizens. (ie it is just more feed in the trough)
"Not that the conditions can not be treated. "
Why would you limit the conditions that could be treated?
"I am fine with ACA"
You sure complain about it a lot. You proposed neutering its EHBs above in this thread. So, no, I don't think you're "fine" with it.
Trump is just making things even worse. His decision to end cost-sharing payments has the following disastrous effects:
* Increases the budged deficit by $6 billion in 2018 and $194 billion over the next 10 years
* Average silver-level marketplace premium increases 20% in 2018, and by over 25% in 2020 and thereafter.
* Will cause insurers to leave the exchanges.
* Will increase the number of uninsured by 1 million in 2018.
CBO: Effects on ending the CSR payments
Let's be clear: when Donald Trump said he would provide better and more affordable coverage to the American people, he lied.
His purposeful sabotage of the ACA will have horrible effects on people's lives. He owns it now, and it's all on him and his party that is allowing him to do it.
Sean,
First of all you asked me which EHBs may be negotiable to lower premiums in rural America. I just answered your question.
Related to that, one would limit the conditions that would be treated if the person paying the bill was willing to bear the risk of that decision. My 2002 Suburban no longer has comp or collision coverage on it, I chose to lower my premiums somewhat by doing this. I now bear the responsible for fixing it if I roll it on an icy road.
If someone does not want pregnancy or pediatrician coverage because they don't have sex. That is at least worth discussing.
As for "better and more affordable", I am thinking the people who can reduce their premiums by not paying for extra coverage they do not need would agree with Trump.
Page 7 discusses the deficit impact and it is interesting.
Of course this implies that Trump's actions don't force the hand of Congress to actually deal with health care in a non-partisan manner. Please note that Trump loves to raise the stakes to press people to take action.
"If someone does not want pregnancy or pediatrician coverage because they don't have sex. That is at least worth discussing."
If someone who bypasses pediatric coverage has a baby born with a congenital heart defect, policymakers aren't going to let that kid die because of the parent's decision. This ain't Galt Gulch, and all such a policy would do is bring back the free-rider problem.
"Of course this implies that Trump's actions don't force the hand of Congress to actually deal with health care in a non-partisan manner."
A few things here. First, here were already the Alexander-Murray negotiations in the Senate on shoring up the ACA. This move was not necessary, and in fact, is counter-productive to moving those talks forward. Democrats have less incentive now to make concessions because they know that if no bill is passed, Republicans are going to have accept the consequences for Trump's actions -- 20%+ premium hikes, more uninsured, higher deficits, and less competition on the exchanges.
The pressure is now on Congressional Republicans to do something to prevent that from occurring. And the sad reality is that the ACA without the CSRs is *still better* than any of the GOP proposals from earlier this year, which would have kicked tens of millions off of their insurance. So this move ain't going to bring Democrats towards the AHCA, BCRA, or Graham-Cassidy bills.
If Republicans need Democratic votes to pass something to bypass the problem Trump has created, the price has just gone up, not down. The "Great Negotiator" has botched another one.
It should also be pointed out that the President in "raising the stakes" is literally putting his own citizens' lives and futures at risk to achieve a domestic political goal. In strategic terms, he's taking hostages and then shooting them -- just like he did with DACA.
There's also another problem: most people agree that continuing the CSR payments was going to be a part of the Alexander-Murray framework. What assurance is there that Trump would be willing to accept that?
Right on schedule:
POLITICO: Trump opposes bipartisan Obamacare rescue plan
This is on Republicans now. Best of luck!
Now let's think of this in practical terms.
Republican voters supposedly:
- support people paying their own bills
- are against tax dollars being given to individuals and companies
- are for lower taxes
- are against government mandating what citizens must do
With that in mind, I can see some lukewarm GOP voters being upset. However I can see a lot of my friends being over joyed to be able to buy something that is more aligned to their needs and budget.
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