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TGHusker

Repealing the ACA under Trump

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TGHusker    1,335

This is one of the major Trump promises this campaign. He says it will be accomplish during his 1st 100 days. So with that in mind, I thought I'd start this thread for our discussion and to

see if in time Trump and the repub congress are true to their words.

To begin it off, I've copied Steve Forbes' comments below on the subject. My guess is (and only a guess) he might want to be one of the movers and shakers perhaps as a cabinet member to get this done.

 

Original article:

http://www.forbes.com/sites/steveforbes/2016/11/02/with-obamacare-collapsing-what-do-we-do-next/#34a3c00b7b69

 

Summary article:

 

http://www.newsmax.com/StreetTalk/Steve-Forbes-Obamacare-healthcare-insurance/2016/11/10/id/758214/

 

Quoted in part:

Forbes provides seven recommendations on what to do next:

  1. Nationwide shopping for health insurance. “Let scores of companies compete for your business instead of the handful you now have.”
  2. Transparency for prices. “Require hospitals and clinics to post their prices for all treatments, medications and services.”
  3. Transparency of performance. “Require hospitals to post monthly statements on how many patients died from infections contracted after they were admitted.”
  4. Medicare transparency. More information about payments to help root out fraud and abuse.
  5. Equalized tax treatment. If businesses and the self-employed can deduct their premiums, why can’t individuals buying insurance on their own?
  6. Freedom of choice. “Let people choose their own policies, not be required to accept what bureaucrats think they should have.”
  7. No more threatening mandates. “Forcing employers and individuals to purchase insurance is un-American and unconstitutional.” (Chief Justice John Roberts was criticized for ruling the penalty for not buying insurance was a tax whose payment could be shared, effectively giving renewed life to Obamacare.)

 

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In addition, Republicans will have to figure out a way to fund care for “genuinely uninsurable individuals,” he says.

“Otherwise, we’ll continue to be stuck with the take-all-comers mandate for insurers that has led to an enormous gaming of the system: Don’t buy coverage until you’re sick,” he says

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Comfortably Numb    5,061

Obamacare, and healthcare in general definitely needs fixed. I am not aware of Trump's specific plans or if he even has one beyond his "repeal" shtick. But you can't just repeal it without bad consequences. If they figure out a way to make it (insurance and medical care/drugs) affordable and to have it available for everyone, I'm all for it. I will be keeping on eye on this with great interest. Personally, I think allowing purchase across state lines and more competition could be a good thing but I fail to see how that will sufficiently address the costs issue or even how an out of state insurer is going to be able to function in all locations. I have serious doubts this issue will get made acceptably better.

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Comfortably Numb    5,061

With no mandate (as distasteful as that provision is), we fall right back into the same trap of people receiving care and not being able to pay for it. Hell, many people now, with insurance, cannot afford their premiums or the care. The providers pass those unpaid costs on to those who can pay and it exacerbates the rising cost problem. I don't believe the open market idea of competition can begin to fix this problem.

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TAKODA    580

Obamacare, and healthcare in general definitely needs fixed. I am not aware of Trump's specific plans or if he even has one beyond his "repeal" shtick. But you can't just repeal it without bad consequences. If they figure out a way to make it (insurance and medical care/drugs) affordable and to have it available for everyone, I'm all for it. I will be keeping on eye on this with great interest. Personally, I think allowing purchase across state lines and more competition could be a good thing but I fail to see how that will sufficiently address the costs issue or even how an out of state insurer is going to be able to function in all locations. I have serious doubts this issue will get made acceptably better.

 

I agree JJ, this is a huge undertaking and needs to be fixed.

 

I saw that AZ was increasing the cost up 115%. That is not a typo all, 115%.

 

I do not want to emulate Europe but some where rationally would be good.

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zoogs    6,367

But you can't just repeal it without bad consequences.

Look at the Republican platform. Look at the Trump campaign promises. Look at who controls both chamber of Congress and soon to be all three branches of the federal government, as well as a heady majority of state legislatures in the country.

 

I'm afraid I can't see how "just repeal it" is not the path forward right now.

 

I'd be thankful for anyone who can spell this out to me.

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Obamacare, and healthcare in general definitely needs fixed. I am not aware of Trump's specific plans or if he even has one beyond his "repeal" shtick. But you can't just repeal it without bad consequences. If they figure out a way to make it (insurance and medical care/drugs) affordable and to have it available for everyone, I'm all for it. I will be keeping on eye on this with great interest. Personally, I think allowing purchase across state lines and more competition could be a good thing but I fail to see how that will sufficiently address the costs issue or even how an out of state insurer is going to be able to function in all locations. I have serious doubts this issue will get made acceptably better.

 

I agree JJ, this is a huge undertaking and needs to be fixed.

 

I saw that AZ was increasing the cost up 115%. That is not a typo all, 115%.

 

I do not want to emulate Europe but some where rationally would be good.

 

I believe there is a county in AZ that doesn't have any obamacare insurers.

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TAKODA    580

 

 

Obamacare, and healthcare in general definitely needs fixed. I am not aware of Trump's specific plans or if he even has one beyond his "repeal" shtick. But you can't just repeal it without bad consequences. If they figure out a way to make it (insurance and medical care/drugs) affordable and to have it available for everyone, I'm all for it. I will be keeping on eye on this with great interest. Personally, I think allowing purchase across state lines and more competition could be a good thing but I fail to see how that will sufficiently address the costs issue or even how an out of state insurer is going to be able to function in all locations. I have serious doubts this issue will get made acceptably better.

 

I agree JJ, this is a huge undertaking and needs to be fixed.

I saw that AZ was increasing the cost up 115%. That is not a typo all, 115%.

I do not want to emulate Europe but some where rationally would be good.

I believe there is a county in AZ that doesn't have any obamacare insurers.

Please relay the importance or the significance of that, in your opinion?

 

Wealthy people?

 

The reason why the increase is occurring at 115% is because Obama care in AZ don't have enough participants or?

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Landlord    7,848

I don't know much about how insurance works, but I know as someone who falls in between the gap of Medicaid and being able to afford my own health insurance (I haven't had any for 4-5 years now), I would very much like to not have to pay $1400 in 2018 for not having any insurance next year.

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HuskerNation1    1,069

I really think the focus of Health Care reform needs to focus on the skyrocketing costs across the board. What is causing costs to rise so much? What can be done to lower or stabilize expenses? My parents are not yet on Medicare, and there monthly premiums just went from $1400 to $2500 a month, and this is happening everywhere. A truly competitive market with proper competition will drive down rates, but we currently have 50 state silos of health insurance.

Also, many good doctors are leaving the profession and there needs to be a better system that encourages good doctors to stick around? Lots of problems still exist.

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ColoNoCoHusker    396

An open competitive market only drives the price down when the product or service can be commoditized. The healthcare insurance industry has consolidated massively over the last 45+ years but hospitals and medical centers can't really take the same approach. Overall, commoditizing this sector is nearly impossible where life & death are concerned. What's your life worth or the life of someone about which you care deeply?

 

Even if one were to do some "trust-busting", collusion is built into the structure of the insurance system from the get-go. Everybody knows everyone else's costs are and everyone knows what every center charges and what every policy covers. There is little organic market growth that can occur so the best way to increase revenue is to increase rates/premiums, grow into neighboring segments, or own the entire vertical.

 

Most of the good doctor's that are leaving are doing so because they can make more $ doing something else. If we pay Dr's more to keep them, where does that money come from? Insurance companies are not going to forego record profits...

 

The state of healthcare even prior to ACA is pretty much that of a public utility without any oversight. Having done some work around the core systems for the largest healthcare providers, I personally do not see being able to address the cost problem without destroying the industry and starting over.

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Comfortably Numb    5,061

I don't know much about how insurance works, but I know as someone who falls in between the gap of Medicaid and being able to afford my own health insurance (I haven't had any for 4-5 years now), I would very much like to not have to pay $1400 in 2018 for not having any insurance next year.

Not to be rude, but I would very much like for you to get insurance so, if the unexpected should occur, we don't get stuck with the bill for your healthcare and so you can receive the care you may need.

 

Sorry, but it is bullsh#t that you are in some gap between Medicare and being able to afford insurance. If you do not qualify for medicare, there are subsidies in Obamacare to where you can afford to purchase it. Problem is, "afford" can be a relative term. If you choose to eat out, go to bars or sporting events, buy video games etc., then yes you can afford healthough insurance. But you are probably young and healthy so it seems a reasonable gamble to not pay the $300 or so bucks a month it would likely cost you.

 

$1800 per year penalty. Pffft. I pay $1460 per month (MONTH- I didn't stutter) now for coverage of family of 4, and it is going to around $1850/mo. beginning in January.

 

If your income is such that you really cannot afford $300+/- per month, then you are eligible to get a bunch of premium help from the government. I was about to say go get it, but I guess we're all in limbo now as to what changes may be in store.

 

This year, I have had some issues and my wife just had a surgery with numerous other procedures. The cost of my medical and Rx to date total to date about $75k and my wife's stuff is going to likely be around $80k. And I'm not done for the year. Thinking I should also have a surgery I need since we have already maxed our out of pocket, so another IDK $80-100k. I would be absolutely screwed if I had not spent $18k on insurance. I can't afford the $30k combined it cost me this year either but it sure is better than the $140k to $250k it would've cost without insurance. Believe it or not, we're not even deathbed sickles ready to kick the bucket. Just a couple rather common and routine things.

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Moiraine    5,955

 

I don't know much about how insurance works, but I know as someone who falls in between the gap of Medicaid and being able to afford my own health insurance (I haven't had any for 4-5 years now), I would very much like to not have to pay $1400 in 2018 for not having any insurance next year.

Not to be rude, but I would very much like for you to get insurance so, if the unexpected should occur, we don't get stuck with the bill for your healthcare and so you can receive the care you may need.

 

Sorry, but it is bullsh#t that you are in some gap between Medicare and being able to afford insurance. If you do not qualify for medicare, there are subsidies in Obamacare to where you can afford to purchase it. 4

 

 

 

I don't know if you're saying there's no gap or that you just don't believe he can't afford it.

 

But anyway, I was in that same gap before I graduated. I was going to school full-time and working 20 hours a week at near minimum wage, and in Nebraska the gap is between 100% and 130% poverty level. If I'm remembering correctly, if you are at less than 130% you can't get the ACA subsidies, and if you're at over 100% you don't qualify for medicare. All states qualify to fill this gap if they agree to it, and the federal government pays the vast majority for the subsidies. State government pays a very small part of it (I don't remember what it is but off the top of my head I think 10%). Basically down the line, Republican states refused it and Democratic states accepted it. This part of the ACA was one of the things Obama gave up during the negotiations. He didn't want the gap to exist at all. He gave in so that the ACA would be passed.

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Moiraine    5,955

I'm okay with the Republicans trying to improve or replace ACA, although I'd have to see their plan.

 

But I wonder what they'll do about women's health. A line I remember clearly from Jeb Bush was that he doesn't know if we need to be spending half a billion $ on women's health care.

 

You know... even though it's women who have babies - for two people, and take birth control - for two people

 

There's that other detail that we spend 600 billion on military. 600 billion on military but 500 million is too much to spend on child bearers.

 

The goal should be to make women less likely to choose abortion, by giving more support for having their baby.

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Comfortably Numb    5,061

I may not be fully informed about the "gap" especially in other states. My exprince and knowledge is in Colorado and it seems like the subsidy is phased in immediately from the point you become ineligible for Medicare or the state care program and I'm pretty sure it phases out at around $50k individual / $90k family income levels. I am speaking completely from my memory of researching it for my emoyees over a year ago. I do know at the time it seemed like at any income level a person could make it work and would be seriously gambling with the health and financial well being if they chose to forego it. I will acknowledge that may not be the case everywhere so I apologize for getting a little preachy.

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dudeguyy    3,490

Wow, this thread is going to be fun. Some very knowledgable folks in here-- I know JJ knows his stuff from personal experience, and it sounds like ColoNoCoHusker does too. Do you work in insurance, man?

I will try to add my opinions as someone who's just starting my first year of schooling for the medical field. A large part of our curriculum is learning about how the insurance industry works and how we are to bill things for patients. I'm kind of apoplectic about the situation right now, because if they do follow through on this promise to repeal and replace as they say, what I'm learning about the ACA is probably going to become irrelevant and I'll have to learn a whole new system. So basically, I may be hosed right now. But, nonetheless, maybe I can actually provide something productive here for other people instead of complaining! :lol:

 

ColoNoCo pretty much laid things out as I see them. Our insurance industry (and healthcare system on the whole) suffered terrible runaway growth over the last few decades:

 

2011_09_13_1.jpg

2013_09_HealthCareCosts3.png

health-care-spending-in-the-united-state\

 

Naturally a more expensive medical system makes it more expensive for insurance companies to cover us. The thing that REALLY sucks about that upward cost growth is that is that it is MUCH easier keep a system affordable BEFORE the cost balloons than deal with it afterward. We would have been much better off had we opted for single-payer or some other type of cost-efficient method long ago rather than utilizing our mix and match grab bag system as long as well have.

 

As to the future? I think he may be right when he said above that it may be necessary to tear the whole damn thing down and start over. Is that realistic? Nah. But it may best address runaway costs. The thing about what we're doing now is that half-measures don't really work. Obvious Obamacare did not get implemented like he wanted to (with a public option)... and costs have been a huge problem. It did offer millions more people coverage and eliminate denial due to preexisting conditions, and those are HUGE steps in the right direction in terms of actual quality of care. So it accomplished 2 of the big 3 of insurance, arguably: improved quality of care and covered more people. It's failing miserably at the third, controlling costs.

 

Those are the three big metrics for insurance efficacy and quality, IMO: quality of care, percentage of people covered, and cost. When Trump says he can improve all three in one fell swoop by simply "removing lines around the states, he's completely ignorant to the reality and completely full of crap. I'm not surprised since he views everything through a simple, transactional lens, but if it was easy to accomplish cover more folks, improve care, and drive down costs, someone would've done it long ago.

 

It will be interesting to see what they do. The thing that always rubbed me the wrong way about Paul Ryan and the GOP writ large criticizing the ACA (though they have a very legitimate beef about costs) is that A) they blocked the public option in the first place and B) they never had a legitimate alternative while the criticized. It's easy to complain and hard to draw up an effective plan for US healthcare. Which one is more important?

 

I also believe that the insurance industry is a unique one where simply open market economic principles don't drive down costs, and ColoNoCo outlined some reasons why quite well above. Bringing down overall healthcare spending requires driving down the very high wages of our medical experts. The entire medical field is going to fight that tooth and nail. So you've got to deal with that resistance as well. As Bnil said, we need to attract the best, but it's hard to do so if we also need to pay them less.

 

Finally, I'm of the mind that moving away from fee-for-service (FFS) payment models for medical experts here-- where they're paid based on the number of procedures you had done, treatments you've had, or examinations you've undergone-- towards a quality-based model-- where they're paid based on how well the patient improves-- is vital. That would end price-gouging patients for ineffective or excessive services to line their pockets. There's been a large push for that within our industry, and it needs to continue-- the industry is still largely FFS. Nowhere does Trump's plan mention that, and it's a big driver that keeps costs high, from what I understand.

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Comfortably Numb    5,061

I'm okay with the Republicans trying to improve or replace ACA, although I'd have to see their plan.But I wonder what they'll do about women's health. A line I remember clearly from Jeb Bush was that he doesn't know if we need to be spending half a billion $ on women's health care.You know... even though it's women who have babies - for two people, and take birth control - for two peopleThere's that other detail that we spend 600 billion on military. 600 billion on military but 500 million is too much to spend on child bearers.The goal should be to make women less likely to choose abortion, by giving more support for having their baby.

Totally agree with this. Women do have special healthcare needs and elevated expenses. That is not a place to be looking to save dollars especially considering the massive amounts spent elsewhere in the budget, like military.

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Comfortably Numb    5,061

Excellent post and info dudeguyy.

 

I do have pretty good experience with it, both as a consumer and as an employer who used to select and offer the plans. I also, for some sick and perverted reason, actually read almost the entire ACA bill when it was being implemented.

 

I have wasted many brain cells contemplating how to fix it and I have come up with nothing that doesn't negatively impact at leat one of the 3; quality, availability and cost. Sadly, I am fairly convinced that it cannot be suitably fixed. I hate the word "can't" but it is such a behemoth and a seemingly unfixable problem. I believe the thing that is going to have to give is quality and also to some extent availability. The problem with letting cost run wild is that also affects the amount of people that can be covered so it is always a double loser. I also agree with you that Trump's coverage and competition across state lines is basically a joke. NO way that begins to put a dent in it.

 

The best solution I have come up with is a complete socialistic takeover with single payer....and there goes quality, convenience and some availability. It is just an absolute shitshow.

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Moiraine    5,955

I may not be fully informed about the "gap" especially in other states. My exprince and knowledge is in Colorado and it seems like the subsidy is phased in immediately from the point you become ineligible for Medicare or the state care program and I'm pretty sure it phases out at around $50k individual / $90k family income levels. I am speaking completely from my memory of researching it for my emoyees over a year ago. I do know at the time it seemed like at any income level a person could make it work and would be seriously gambling with the health and financial well being if they chose to forego it. I will acknowledge that may not be the case everywhere so I apologize for getting a little preachy.

I'm no expert either but since Colorado is kind of in the middle politically (or was in 2008), they are likely one of the states that agreed to fill the gap from 100-130% poverty level.

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Comfortably Numb    5,061

I think we are officially light blue considering our last few election cycles. I don't know exactly how the gap may be filled but I don't think it really exists here.

 

There's an OOC beauty in here btw.

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Moiraine    5,955

I think we are officially light blue considering our last few election cycles. I don't know exactly how the gap may be filled but I don't think it really exists here.

 

There's an OOC beauty in here btw.

 

I don't want that filled by Trump.

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Comfortably Numb    5,061

 

I think we are officially light blue considering our last few election cycles. I don't know exactly how the gap may be filled but I don't think it really exists here.There's an OOC beauty in here btw.

I don't want that filled by Trump.
But I bet he'll move on it like a b**ch.

Ha, couldn't resist.

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BIGREDIOWAN    2,129

My guess is they aren't going to completely repeal it and just say, "Everything's back to the way it was, enjoy!" I'm guessing they'll have a "bridge" in place to transition from the affordable care act to whatever plan Trump and the Republicans come up with that'll be a better plan. The costs are out of control, this has to be taken care of and fairly quickly on some level. I think the free enterprise nature of his plan is a good one, hopefully that'll drive prices down similar to auto insurance. More options, means cheaper rates, and you pick and choose what you want/need from those providers. Some folks are only going to have one option this time no matter the cost! That's insane.........

 

Something I've always wondered, and maybe it exists, why isn't there some sort of oversight on the medical field and insurance fields costs? Basically it seems like they can charge whatever they want and we need to pay for it and deal with it as consumers/users. At some point enough is enough on these costs and it's only appears they are gouging the consumer/user and until someone puts a stop to it, it just seems like it'll continue forever.

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Moiraine    5,955

Something I've always wondered, and maybe it exists, why isn't there some sort of oversight on the medical field and insurance fields costs? Basically it seems like they can charge whatever they want and we need to pay for it and deal with it as consumers/users. At some point enough is enough on these costs and it's only appears they are gouging the consumer/user and until someone puts a stop to it, it just seems like it'll continue forever.

My impression, coming from a background of little knowledge, as that the main problem is the prices the drug companies charge. I'm sure the insurance companies are far from guilt-free, but I think the drug companies are the biggest problem.

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Landlord    7,848

JJ, no offense taken, but you have no idea about my finances, my health, or my habits and please don't make the assumption that you do.

 

 

I've tried for the last two years to apply through the marketplace and simple reality is that I make too much for Medicaid but I can't afford insurance. In reality, I can't even afford all of the bills I already have on a monthly basis (eating a diet consisting mostly of ramen, pb&j and frozen pizzas), and the cheapest I can get my healthcare down to is ~$175, which to many doesn't seem like a big deal, but to someone often wondering how I'm going to eat for the next week and how I can ever get Wells Fargo to stop calling me 18 times a day, is a mountain I can't currently climb. Even if I could, the deductible on those plans is $10,000 or greater, so for being a relatively healthy young adult it's really just throwing money away.

 

I wish that wasn't the case. I'm going on my third month with some kind of bronchial infection or something worse that going to a minute clinic and getting a z-pack didn't fix. If anyone thinks they can offer me knowledge that I'm ignorant of, I'd be more than welcoming of that over PM.

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dudeguyy    3,490

JJ, you brought up a good point about subsidies. Not everyone qualifies, but if you do, they're damn well worth it. I remember seeing a tweet recently about guys who were pro-ACA (worked for Obama) who had talked to a women absolutely in tears about this news that broke recently that premiums would go up 25%. She didn't think she could afford it. Turns out, she actually qualified for subsidies and thus her premium went down 1%. People have to understand how to use the system, and the confusing system doesn't lend itself to user-friendliness. Always check subsidies!

 

There's absolutely price gouging going on BRI. Look at asshats like that Shkreli dude driving up the cost on a brand name drug used to treat toxic infections and HIV/AIDS from $13.50 a pill to $750 a pill overnight. Some people hail him as some type of capitalist hero. What a piece of crap.

 

One of the major things Dems would like to do would allow the government to bargain for drug prices for EVERYONE (not just those on Medicare/Medicaid). They'd have massive bargaining power compared to what we have now. I believe Trump mentioned that at some point, but it's not in his platform. I doubt they'd pursue it. I believe the Republican line on that situation is that more competition will somehow magically lower drug prices (and medical spending as a whole) in lieu of any kind of government oversight.

 

You kind of posted both sides in your response. The Pubs love competition as a solution, but won't step in with any kind of oversight. The Dems are all about consumer protection and oversight, but aren't winners in the competition department. This is why a sober, non-partisan approach is best.

 

Finally, in regards to the OP and the actual agenda, mandates are not "threatening." You may not agree with them, but they serve a very specific purpose. The mandate that everyone buys insurance is there to push towards universal coverage. Without it, healthy people don't buy in and we can't afford to cover the sick people in need who DO sign up. Mandates allow for the risk pooling that allow large scale coverage to work. Now, if you aren't concerned with universal coverage as as goal, you probably hate a mandate. That is the GOP's position.

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Comfortably Numb    5,061

JJ, no offense taken, but you have no idea about my finances, my health, or my habits and please don't make the assumption that you do.

 

 

I've tried for the last two years to apply through the marketplace and simple reality is that I make too much for Medicaid but I can't afford insurance. In reality, I can't even afford all of the bills I already have on a monthly basis (eating a diet consisting mostly of ramen, pb&j and frozen pizzas), and the cheapest I can get my healthcare down to is ~$175, which to many doesn't seem like a big deal, but to someone often wondering how I'm going to eat for the next week and how I can ever get Wells Fargo to stop calling me 18 times a day, is a mountain I can't currently climb. Even if I could, the deductible on those plans is $10,000 or greater, so for being a relatively healthy young adult it's really just throwing money away.

 

I wish that wasn't the case. I'm going on my third month with some kind of bronchial infection or something worse that going to a minute clinic and getting a z-pack didn't fix. If anyone thinks they can offer me knowledge that I'm ignorant of, I'd be more than welcoming of that over PM.

Sorry LOMS, you're right, I have no specific knowledge of your situation and I shouldn't have acted like I did. I will offer though, purely mathematical, $175/mo is $2100 annual so if your penalty is $1800, doesn't that effectively make your cost only $300 more per year to actually have the insurance? Again, I don't have any direct knowledge of how the penalty really gets applied or the options or conditions where you live and it's been a long time since I've really had to figure out how to get by on limited resources.

 

I hope your condition improves and that you are able to get the care you need.

 

Edit- sorry, I read your post closer and saw the 175 was for a 10k deductible plan. That is what they consider a catastrophe plan and likely would do you no good for day to day medical care. IMO That type of plan would be a waste for you. You already effectively have a catastrophe plan, everyone does, it's called go to the hospital and don't pay your bill. I thought that was one of the things the ACA actually fixed but I guess it didnt.

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Comfortably Numb    5,061

One of the very basic decisions in this deal is,

 

Are you for the mandate that everyone needs and has to have coverage, or do you want to accept that some lives are disposable and refuse medical care to those who can't pay for it? That is the mandate issue in simplistic terms.

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Red Five    3,591

I was hoping this thread would start a good discussion on this topic. I may (or may not) know a thing or 2 about it. Lot of good posts so far.

 

First thing I tell everybody, the ACA's biggest problem was that the word AFFORDABLE is in it. There is noting affordable about healthcare. Its expensive. It sucks, but thats the way it is. Fixing the cost of healthcare isn't just an insurance problem. You have to work with the docs, hospitals, tech companies, drug companies, etc. Problem is there is a large segment of the population that is used to the 80s and 90s when a) companies paid a lot more of the share of premium than they do now and b) benefit plans were made so that it would only cost a $5 copay for an office visit, $10 for a ER visit, and $100 for an inpatient stay.

 

Second, "selling across state lines" is total political BS blustering that means nothing. You live in NJ and want to buy a BCBS Nebraska plan because it is cheap? Then go right ahead, but all of your in-network doctors are in Nebraska. And if BCBS Nebraska were to start selling in NJ, then it would cost just as much (if not more) as your local plans because they would have to negotiate a network in NJ.

 

I will add in more thoughts throughout the day as I have more time...

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ColoNoCoHusker    396

 

Something I've always wondered, and maybe it exists, why isn't there some sort of oversight on the medical field and insurance fields costs? Basically it seems like they can charge whatever they want and we need to pay for it and deal with it as consumers/users. At some point enough is enough on these costs and it's only appears they are gouging the consumer/user and until someone puts a stop to it, it just seems like it'll continue forever.

My impression, coming from a background of little knowledge, as that the main problem is the prices the drug companies charge. I'm sure the insurance companies are far from guilt-free, but I think the drug companies are the biggest problem.

 

 

It's everything. The medical supply manufacturers, distributors, pharma, tech manufacturers, insurance, even hospitals & medical providers. The federal regulations alone are impossibly stringent for good reason. But this means that cost is an afterthought.

 

A buddy is a programmer for a medical device manufacturer. For the typical devices he works on, 20 hours of coding requires nearly 140 hours of testing. If he does a full month of coding, it generates a year's worth of testing effort. They bring it down with around the clock automation, parallel testing, etc but it blows back up with more coders on the project. This is for mid-range devices that are at most medical centers. Ironically, the hardest part is finding a company that can provide circuit boards that will last the life of the machine. They ended up in-sourcing this a couple years ago.

 

Another company out here builds custom surgical tools for surgeons. They are very expensive but will last several lifetimes and are custom fit for the Dr. They help avoid hand/muscle fatigue and prevent complications being high precision instruments. These instruments are manufactured to stricter tolerances than the "off-the-shelf" counterparts. Even so insurance companies stopped covering surgeries where the surgeon used these instruments since they were "custom". The solution ended up requiring the Doctors to purchase the instruments through the hospital or insurance company to be covered. If you are a neurosurgeon who does surgery at 3 hospitals, you have to purchase 3 sets. As a hospital, do you want to purchase custom instruments for every surgeon? So most Doctors looked at purchasing them through the insurance company. The markup was something like 125%. It's a no-win.

 

My point with the above is how efficiency really is not a factor and there is no motivation for any segment to work with another segment. It really the definition of a broken system.

 

EDIT: As far as costs, most fee schedules for most procedures are based on the Medicare fee schedules. However, this whole system is broken. Different shops have different costs but everyone knows nobody charges less than X... Competition has nothing to do with it when everyone knows the consumer has no other option...

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dudeguyy    3,490

I was hoping this thread would start a good discussion on this topic. I may (or may not) know a thing or 2 about it. Lot of good posts so far.

 

First thing I tell everybody, the ACA's biggest problem was that the word AFFORDABLE is in it. There is noting affordable about healthcare. Its expensive. It sucks, but thats the way it is. Fixing the cost of healthcare isn't just an insurance problem. You have to work with the docs, hospitals, tech companies, drug companies, etc. Problem is there is a large segment of the population that is used to the 80s and 90s when a) companies paid a lot more of the share of premium than they do now and b) benefit plans were made so that it would only cost a $5 copay for an office visit, $10 for a ER visit, and $100 for an inpatient stay.

 

Second, "selling across state lines" is total political BS blustering that means nothing. You live in NJ and want to buy a BCBS Nebraska plan because it is cheap? Then go right ahead, but all of your in-network doctors are in Nebraska. And if BCBS Nebraska were to start selling in NJ, then it would cost just as much (if not more) as your local plans because they would have to negotiate a network in NJ.

 

I will add in more thoughts throughout the day as I have more time...

 

Ahh, you brought up another good point I had run across but had forgotten.

 

Another reason I'm not entirely convinced eliminating "the lines around the states" is the panacea some make it out to be is that competition is not always good for quality. In fact, price and quality are often inversely related.

 

Let's say we do allow selling across state lines. People want their costs to go down, right? So if they do, presumably, you're getting worse coverage that your less likely to use. I'm not even sure all insurance companies would offer high-end plans if the federal regulations are gutted. So then you have companies competing to offer cheaper and cheaper plans (that also become more and more useless to the average American).

 

I worry about a race to the bottom where insurance companies see who can offer the absolute cheapest plans that offer the lowest quality care and people flock to them. Then there's a very small pool of healthy folks for companies covering the sick people who actually USE their insurance, they can't be profitable, and they run into problems staying solvent.

 

Basically, I'm worried this deregulation would end risk-pooling and I'm not sure what effect that would have on the insurance climate as a whole.

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knapplc    19,301

President-elect Trump willing to keep parts of ObamaCare

President-elect Donald Trump said that, after conferring with President Barack Obama, he would consider leaving in place certain parts of the Affordable Care Act, an indication of possible compromise after a campaign in which he pledged repeatedly to repeal the 2010 health law.

In his first interview since his election earlier this week, Mr. Trump said one priority was moving “quickly” on the president’s signature health initiative, which he argued has become so unworkable and expensive that “you can’t use it.”

Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the health law after the president asked him to reconsider repealing it during their meeting at the White House on Thursday

Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.

“I like those very much,” Mr. Trump said in the interview.

 

 

 

This is sounding less like a repeal and more like a tweak. Which is what everyone except Barack Obama has been saying for a while now.

 

I wonder how the base will react if it isn't, in fact, repealed? Since that's been the mantra and the goal of the 50+ attempts to repeal it since its inception.

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cornstar    134

 

But you can't just repeal it without bad consequences.

Look at the Republican platform. Look at the Trump campaign promises. Look at who controls both chamber of Congress and soon to be all three branches of the federal government, as well as a heady majority of state legislatures in the country.

 

I'm afraid I can't see how "just repeal it" is not the path forward right now.

 

I'd be thankful for anyone who can spell this out to me.

Sorry If this has already been asked, but can it be repealed without a super majority in the Senate?

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cornstar    134

I'm okay with the Republicans trying to improve or replace ACA, although I'd have to see their plan.

 

But I wonder what they'll do about women's health. A line I remember clearly from Jeb Bush was that he doesn't know if we need to be spending half a billion $ on women's health care.

 

You know... even though it's women who have babies - for two people, and take birth control - for two people

 

There's that other detail that we spend 600 billion on military. 600 billion on military but 500 million is too much to spend on child bearers.

 

The goal should be to make women less likely to choose abortion, by giving more support for having their baby.

Very good post!

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zoogs    6,367

^I'm glad you think so, too! :D

 

Without a supermajority, the Democrats retain filibuster power. However, it can be undermined to smithereens anyway. As far as I can see, it's really at the President's -- and Congress's -- discretion.

 

The optimist in me thinks that Trump will smell a branding opportunity, pass single-payer, and call it TrumpCare. He'd have to fight Paul Ryan on that, but on this regard, Ryan is the true believer.

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dudeguyy    3,490

I feel like the GOP would be OK with it if they could be the ones to say they fixed it and claim it as their own. Which is kind of ridiculous given the screams for blood every time the ACA is brought up. But if it brings along a more sustainable healthcare system, I'm all for it.

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Moiraine    5,955

I feel like the GOP would be OK with it if they could be the ones to say they fixed it and claim it as their own. Which is kind of ridiculous given the screams for blood every time the ACA is brought up. But if it brings along a more sustainable healthcare system, I'm all for it.

Again, agree completely with you. I've never felt the GOP was truly against all of Obama's policies. They just said no because they were coming from a Democrat.

 

Sad thing is if the Democrats try to work with the Republicans in the House/Senate, they will never get credit for it.

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cornstar    134

^I'm glad you think so, too! :D

 

Without a supermajority, the Democrats retain filibuster power. However, it can be undermined to smithereens anyway. As far as I can see, it's really at the President's -- and Congress's -- discretion.

 

The optimist in me thinks that Trump will smell a branding opportunity, pass single-payer, and call it TrumpCare. He'd have to fight Paul Ryan on that, but on this regard, Ryan is the true believer.

Thanks. I'm not unreasonable, I want this country fixed. I hope The Donald can do it, but I'm very cautious.

 

I agree with Dudeguy's last post, too.

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knapplc    19,301

This country will not be fixed while half the people feel they or someone they love will be imminently persecuted. Electing a candidate whose platform contained explicit persecution is not a step toward healing, and certainly not in good faith.

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BIGREDIOWAN    2,129

Let's not spin off into that realm about how unethical Trump is in this thread. There are about 10 others people can do that in. Let's keep this one about the topic at hand please.

 

I like that he's showing just in a few days here he's open to listening and working with folks to try and get the healthcare part right. I know some folks that are dealing with these increases and it's not easy and we have to get this under control.

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zoogs    6,367

After meeting with Obama, Trump has signaled his willingness to keep two parts of the ACA that he likes very much. What does that mean?

 

Trump's about to find out.

 

So how do you prevent that kind of gaming of the system by consumers? Well, that’s easy. You require that everyone buy at least some minimal level of insurance at the beginning of every year, so they can’t buy insurance only after they get sick. Let’s call that an” individual mandate.”

I think this presents a great (if fragile) opportunity for the Republican establishment to find out just how much Americans really want to lose the ACA.

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dudeguyy    3,490

What may happen if you repeal without replacing

 

 

Republicans say they plan to repeal Obamacare through reconciliation, a budget process that requires just 51 Senate votes and guarantees that Democrats can't stand in the way. But the GOP can't eliminate the entire law through reconciliation — just the parts tied to federal funding.

 

So lawmakers could nix the law's mandate requiring most Americans to buy insurance and the subsidies to help them afford it, but likely couldn't toss the ban on discriminating against people with pre-existing conditions — a policy that Republicans, including Trump, have talked about keeping in some form.

That could leave behind an unworkable coverage system in which insurers must cover everyone regardless of medical condition, while two key policies meant to attract healthier customers — the mandate and subsidies — are eliminated. And insurers would have no guarantee that Congress would come up with a viable replacement.

Iowa Insurance Commissioner Nick Gerhart, a Republican appointee, cautioned last week against repealing the law without a replacement, writing that it would have "devastating consequences in the disruption to people's care."

-----

Insurers could flee the marketplaces even sooner if Republicans strip away funding for the cost-sharing subsidies insurers provide to low-income customers. House Republicans successfully challenged the legality of that federal spending in court, but the Obama administration is appealing the ruling. Trump could drop that federal appeal on his first day in office, which would mean insurers still have to provide the subsidies but without federal funding. But because of a clause in their exchange contracts, insurers could immediately cut off coverage if the federal government no longer provided cost-sharing subsidies.

States might still be able to compel or persuade insurers to stay in the market for a short period.

 

I think this article presumes that "getting rid of the lines around the states" is not a viable future for our insurance system. I hope they're working on something very real right now, because slapping together generic conservative ideas for insurance is not going to cut it as a replacement for what we have now.

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Kiyoat Husker    1,508

I'm not very knowledgeable about the specifics of healthcare, but if, as some of you have said, the industry costs ballooning out of control is the real issue, then wouldn't heavy regulation of the industry be the answer?

 

I know that one of the objectives of the Trump presidency (and a conservative objective) is DE-regulation in general. However, hasn't a gradual increase in deregulation throughout the 80's and 90's put us in the position we are in right now? With large corporate interests served, and the income-gap widening.

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dudeguyy    3,490

I mean, the correct answer is probably... :dunno

 

Everyone has a different approach they think is best. A lot of it depends on your goals. If you strictly want to get lower premiums, taking away the ACA would likely do so. I personally very much doubt turning things over to the private sector and the insurance companies themselves will fix the long-term health of the system. Insurance premiums were already going up before the ACA.

 

percentageincreasekff.png

 

The thing about simply tearing up the ACA and going back to the old way is that that neither helps everyone get coverage or ensures quality. If you're not a fan of pushing for universal coverage, the former point is probably fine with you. But if we push massive deregulation in the name of competition, you're going to remove a lot of safeguards that were put in place to ensure the quality of our coverage. I worry about a race to the bottom where we get cheaper and cheaper plans that offer increasingly poor coverage. Now, a good deregulation advocate would say that people would have the ability to find the level of coverage they want and pay for that. People could get crappy plans with very cheap premiums or pony up the dough for good plans with very expensive premiums.

 

Call me naive, but I'm not convinced the deregulated free market would offer good comprehensive coverage for those who need it most. Those who need the most medical care and thus more comprehensive coverage often have less access to resource they need to afford it-- I'm talking about the elderly and lower socioeconomic folks with poor health. Speaking of the elderly, Trump is apparently adopting Paul Ryan's plan for Medicare phaseout after explicitly campaigning on not changing Medicare-- another broken campaign promise:

 

http://talkingpointsmemo.com/edblog/trump-comes-out-for-medicare-phaseout

 

 

Rambling, I know. But I tend to agree more regulation is needed. The majority of countries that have achieved universal coverage have done so with at least some form of government support, be it single-payer, a multi-payer system like France where you government provides basic healthcare and you can purchase better supplemental plans if you so choose, or a mandate like we have here where we require folks to attain coverage or face a fine.

 

Tearing up ACA without a viable alternative accomplishes none of these. In short, I'm afraid the path they're on now will take coverage away from those who need it most and degrade coverage quality in the name of driving down prices for those who can afford it.

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dudeguyy    3,490

While You Were Sleeping, Senators Took the First Step Toward Obamacare Repeal

 

The Senate took a meaningful step toward repealing Obamacare in the early hours of Thursday morning, with Republicans voting nearly unanimously to approve a budget that would kill the health-care law. Going into the session, there was a sense that Democrats might be able to use the vote — and their freedom to offer politically dangerous amendments — to split the GOP over when and how they hoped to enact the repeal. After all, several Republican senators have lately voiced doubts over the party’s apparent strategy of repeal and delay, and the turmoil has only been deepened by Donald Trump’s recent announcements that Obamacare repeal must be accompanied by a full replacement with some yet-to-be-determined-but-definitely-terrific GOP plan. The logistics of doing what the president-elect and the handful of wavering Republican senators want are, to say the least, daunting.

 

But when it came to cast the key vote last night, party unity held: 51 of 52 Senate Republicans voted for the repeal budget (only Rand Paul bucked party discipline, reflecting his opposition to repealing Obamacare without a replacement plan being in place). No Democrats crossed the line to vote for it, though Dianne Feinstein was absent following surgery.

Over the course of the evening, 17 amendments were brought to the floor. Most were offered by Democrats, seeking to highlight popular aspects of Obamacare that would be lost in repeal. All the amendments were, in turn, defeated. The Republicans senators who were expected to offer an amendment to put off the deadline for passing the actual repeal — in the form of a budget-reconciliation bill — from late January to early March announced they were backing off, based on assurances from leadership that the deadlines could be adjusted later. Which is to say, for the moment, the party managed to paper over substantive disagreements by kicking key questions down the road.

So did Democrats get anything of value from this truncated exercise? Perhaps so. Republican senators are now on record as having rejected opportunities to keep Medicare, Medicaid, and the children’s health program CHIP off the cutting-room floor; to make it possible to import prescription drugs from Canada; to prevent erosion of women’s health services and support for rural hospitals; and perhaps most tellingly, to protect Medicaid funding for the 32 states that accepted the option of expanding that program under the Affordable Care Act.

Now it gets kicked to the House. The article mentions it's getting passed there unless the Freedom Caucus rebels wanting immediate replacement before repeal. Doubt it.
It should be noted that Democrats proposed a ton of amendments trying to protect different programs and ideas that would provide better care for people and were denied.
The GOP will sink or swim on their own with whatever they come up with.

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knapplc    19,301

The country will wake up one day from this Republican bender with one hell of a hangover.

 

The problem is, the Democrats aren't exactly inspiring with their plans for the country, either. We so, so desperately need an unaffiliated leader to emerge who isn't beholden to either of these archaic parties.

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zoogs    6,367

knapplc for president :)

 

I'm serious. Better that than Zuckerberg 2020, which I think builds off the same sentiments but is frightening in its own way.

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dudeguyy    3,490

As long as we're tossing celebrities out there, I'd support either Bill Gates or Elon Musk in 2020.

 

I don't know why people keep bringing up Kanye.

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zoogs    6,367

Elon Musk was actually born in Africa :o :o :o :o :o

 

I think people mention Kanye because he actually has ambitions. I think Zuck does, too. But I feel all these people are a little too disconnected from the actual everyman, nonpolitician appeal they will attempt to channel. I'd support Gates, but he seems like the kind of guy who would never get into politics.

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Landlord    7,848

Mike McHargue is who I'd argue would be the greatest candidate for the Presidency.

 

Mark Cuban could actually be a really good President, I think.

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