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Repealing the ACA under Trump


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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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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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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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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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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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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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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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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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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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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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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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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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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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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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