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Repealing the ACA under Trump


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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 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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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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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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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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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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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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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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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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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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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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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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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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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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