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Coach Power'T's Thread for Knowledge Absorption.


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Knapp, Zoogs, ZRod, NUance, BRB or whoever...

 

Will one of you guys please give me an unbiased outline of the pros and cons of what Obamacare does. You can keep it short, but I'd like some of the lesser known stuff put in it. Why would one disapprove of it from an educated standpoint and why would someone approve of it from an educational standpoint. Taking party affiliation out of it.

 

I'll admit. I know far less than what I need to know and I'm also to lazy to research it for myself and would rather find out through genuine non agenda driven discussion. This is not a troll attempt to start dissension

 

Thanks.

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When you say "educational standpoint". Do you mean as a teacher? Or, did you mean "educated standpoint"?

 

I can only give you my opinion without going and digging for articles myself.

 

Pros:

 

1) Insurance has been made available to more people.

2) Insurance companies can not deny you because of preexisting conditions.

3) A market place was set up where an individual can go to one spot and shop for insurance.

 

Those are all very good things that should be high priority in any new healthcare policy.

 

Cons:

 

1) It does nothing to bring down actual costs to obtain services. Meaning, you might have insurance, but, the insurance company is still paying WAY too much for a particular procedure and they just pass those costs on to you in premiums (or, gets subsidized by the government). No incentive to bring down costs.

2) their is one hell of a lot of reporting that is now required by employers that shouldn't have anything to do with hiring someone to do a job.

3) Insurance companies are pulling out of individual state markets which leaves states with only one option on the exchange or none at all.

4) Even though insurance was available to more people (good thing) premiums went way up for others.

5) There is a mandate to have insurance but no way of policing it. Many people game the system.

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Well, you didn't ask me but I'll give ya my 2 cents on Obamacare.

 

The Good;

It made healthcare more affordable for the poorest and most needy. Expanded medicare and provided assistance for low income.

Eliminated pre-existing conditions exclusions.

Let children stay on their parents plan until age 26.

Attempted to implement some escalation controls on providers and insurers by requiring certain amounts of revenue must be directed to patient care.

 

The Bad;

The penalty for not having coverage is not stiff enough to insure everyone participates. Some people don't want any mandate and some want it more forceful. The thinking on this typically falls along party or ideological lines but not always. I tend to be fairly conservative but I can see how healthcare is different from other free market goods and I understand the necessity of pooling risk.

 

The Ugly;

It basically ignored the real basic issue of our healthcare problem; rapidly escalating provider costs and the resultant increasing insurance premiums. They named it the Affordable Care Act (ACA) when a more accurate name would've been the More Affordable Care for the Poor and Still Rapidly Escalating Costs for Others Act.

It caused large one time premium increases for many to help cover the increased exposure of insurers due to the items mentioned above in the good.

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Good questions! I'll start. The ACA is an effort to expand health insurance coverage and has resulted in a significant reduction in the number of Americans uninsured. According to Wikipedia, health care spending increases have slowed since its implementation and the CBO also reports that it will reduce the budget deficit, while repeal would increase it.

 

One of the most popular ways it expands coverage is by requiring insurers to cover people with pre-existing conditions. This is provided for by the individual mandate, which 'requires' (with a soft tax punishment) people to buy insurance. These provisions work in concert. Thus, everyone cannot wait until they are sick to get on guaranteed insurance, which would collapse the market. That would be like waiting until you crash your car to buy auto insurance and then forcing insurers to cover that. There are two strong criticisms of the mandate, from opposite camps: one, that it doesn't go far enough to compel people to buy insurance, and two, that it exists at all. But overall, the mandate, working in concert with the pre-existing conditions requirement, form one of the central planks of the ACA effort to make sure everyone gets covered.

 

One of its most effective elements has been Medicaid expansion to simply put more lower-income people on health insurance. However, states are not required to implement this (which would have been funded by the federal government, albeit I believe temporarily) and as of last fall 19 states still had not. What this means in those states is that low-income families caught in the gap (sans Medicaid expansion) are pushed onto the healthcare exchanges instead. Like the above, there are at least two camps: those who feel expansion didn't go far enough or that it shouldn't have been optional and those who don't want the federal government involved at all.

 

A serious remaining failure of the ACA is the amount of people that are still left uninsured. From the left, this has led to vocal pushes to either tweak the ACA (increasing the mandate penalty, Medicaid expansion, etc) or to forge ahead with single payer / Medicaid for all. From the right, this has given them the rhetorical ammo to push for total repeal. [Disclaimer: I now heavily fall in the 'single payer' camp although I am happy to fight for just preserving the ACA, given the alternative.]

 

I'm going to mention premium prices and the "one-time" premium spike of 2016 as well as the precariousness of the current exchanges to political uncertainty (e.g, an administration can certainly try to sabotage the ACA through neglect if not active efforts, and this one appears to be doing at least one of those) without delving into them. It's another big topic and I'm sure others (such as JJ/ED and BRB) will chime in. This is a worthy area for further reading, especially for me.

 

Overall, it was sweeping and significant legislation. The central philosophy underlying it is that healthcare is a human right. The ideas used to implement it borrow heavily from market-conscious conservative approaches. In this way it kind of leaves everyone ticked, but it was a major makeover from the status quo and is now proving awfully hard to toss aside.

 

Apologies in advance for the incompleteness / possible lack of rigor here. Hopefully this is all big picture enough to not require more detailed sourcing yet. I'm by far not the most well-read on this, either (go back to a few years ago in any ACA discussion here! I think I prefaced every post with such a qualifier) so I'd definitely welcome any corrections to anything I've said. A large part of my reading/understanding of this topic has developed from 2015 onwards, when it became clear that it was going to be a key consequence of the 2016 election. To be fair, this was also true in 2012 -- I just paid less attention in general back then.

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I'd also add as a positive; that there is no lifetime cap.

 

So for instance if you have cancer, or a chronic condition where meds are ongoing you won't have limitations on what will be paid for as you grow older. This is HUGE for many americans (for instance someone w/CF could potentially get to the point where they need a lung transplant, find a suitable donor and then not have enough coverage to have the surgery because they've used it all staying alive to find the donor)

 

Edit: and another - basic routine care is a basic expectation for coverage. So annual physicals, women's annual exams etc. are covered at no cost (or very little) to the patient.

 

This sort of proactive focus on preventative care has shown to actually lower long term costs for emergent issues. So while it increases healthcare "costs" under the Obama plan, the long term benefit is that people will be less sick in the long run.

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I'd also add as a positive; that there is no lifetime cap.

 

So for instance if you have cancer, or a chronic condition where meds are ongoing you won't have limitations on what will be paid for as you grow older. This is HUGE for many americans (for instance someone w/CF could potentially get to the point where they need a lung transplant, find a suitable donor and then not have enough coverage to have the surgery because they've used it all staying alive to find the donor)

 

Edit: and another - basic routine care is a basic expectation for coverage. So annual physicals, women's annual exams etc. are covered at no cost (or very little) to the patient.

 

This sort of proactive focus on preventative care has shown to actually lower long term costs for emergent issues. So while it increases healthcare "costs" under the Obama plan, the long term benefit is that people will be less sick in the long run.

Yes, 2 more good positives there.

Removing the lifetime cap and the essential basic coverages were definitely both good things.

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Knapp, Zoogs, ZRod, NUance, BRB or whoever...

 

 

I don't know much about Obamacare. So I just gave you a +1 instead.

 

Great thread, btw! Somebody should have made this thread a couple years ago. :lol:

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Something to keep in mind is that it's actually the Patient Protection and Affordable Care Act, but the Patient Protection often gets dropped in discussion. The PP has many of the features that people generally like because it's basically about protecting the patients from the insurance providers.

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Adding 2 cents. I don't know all the details but I believe they made it so insurance companies can't charge a woman more just because she's a woman.

 

Maybe instead of doing that they should charge a man half the cost of giving birth to his child. I don't know.

 

 

As far as the medicaid expansion, the states that didn't accept it didn't accept it purely for political reasons. I once calculates that, tops, expanding it in Nebraska would have cost Nebraskans an average of 8 cents per year. For about 1 year while I was in college I was in that gap because I was at a minimum wage job working 20 hours/week. So I was too poor to get the subsidies. If Nebraska had accepted federal help I would have been eligible. Originally this was going to be a requirement but the GOP got their way and it became optional.

 

Which is why it's infuriating that they aren't even discussing their plans with the Democrats. The Democrats conceded plenty when the ACA was passed.

 

 

The negative - people have talked about already. But things that are cheap elsewhere cost a lot here. Insurance companies can't continue to take a loss or they'll go out of business. The drug companies and probably hospitals need to stop overcharging their customers in the U.S.

 

The ACA was like putting a bandaid on a knife wound.

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So let me riddle this - I recognize that premiums went up for some folks and that stung and resulted in some of the immediate push back on why it is terrible ... are there other reasons that the GOP and some of the population feel that the negatives are significant with the ACA?

 

There's a significant deficit in the general population on understanding of how we need healthy as well as sick insured and paying in order to help all covered in the long run - is it more than that?

 

(yes, I understand that controlling costs is a big part of the part that needs fixing - sadly I don't hear that a lot outside of a few on this board)

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Knapp, Zoogs, ZRod, NUance, BRB or whoever...

 

Will one of you guys please give me an unbiased outline of the pros and cons of what Obamacare does. You can keep it short, but I'd like some of the lesser known stuff put in it. Why would one disapprove of it from an educated standpoint and why would someone approve of it from an educational standpoint. Taking party affiliation out of it.

 

I'll admit. I know far less than what I need to know and I'm also to lazy to research it for myself and would rather find out through genuine non agenda driven discussion. This is not a troll attempt to start dissension

 

Thanks.

You and I are in the same boat here Coach. I'm pretty ignorant about healthcare in general. Just last night I stayed up reading and trying to understand why insurance companies are leaving the exchanges. This is great topic to start!

 

I wouldn't worry bout bias sources so much as just getting as much info as you can to contrast and draw conclusions from.

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A few things that haven't been mentioned...

 

Obamacare means different things to different poeple. Sometimes it just references the individual exchange plans that were set up as part of the ACA. Sometimes it refers to the entire ACA law. So it can get tricky to know what the heck people are talking about when you hear Obamacare without asking followup questions.

 

Case in point, when you read/hear that Obamacare plans are going up X% over last year, 98% of the time that refers to the individual exchange plans. I believe that less than 10% of the US population is on these plans.

 

If you are on a large group plan (think >100 employees), then there was very little change when the ACA went into effect. There were a few things that the govt mandated get covered for these plans, but most large group plans were already covering those, and the costs were minimal to meet the govt standards. Also, many of the largest companies self insure (meaning the employer takes the risk and just uses an insurance company to administer the claims), so they are not subject to some of the laws.

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So let me riddle this - I recognize that premiums went up for some folks and that stung and resulted in some of the immediate push back on why it is terrible ... are there other reasons that the GOP and some of the population feel that the negatives are significant with the ACA?

 

There's a significant deficit in the general population on understanding of how we need healthy as well as sick insured and paying in order to help all covered in the long run - is it more than that?

 

(yes, I understand that controlling costs is a big part of the part that needs fixing - sadly I don't hear that a lot outside of a few on this board)

My guess on why some (usually ultra conservative repubs) are against Obamacare. And I am being serious.

1- The name. They were brainwashed by far right radio and media that Obama was bad thus "Obamacare" must be evil incarnate.

2- The mandate. It smells of socialism and some people don't like the government telling them what they must do even if it's for their own good or the collective good.

3- The people who are most opposed to it just plain don't understand the issues of healthcare. I want to say they're stupid but it's more a matter of being willfully uninformed or misinformed.

 

There's a lot of off shoots to those 3 things but I think the majority who support Trump or the recent GOP efforts fall solidly in this description of opposition.

 

I would not say I'm opposed to the ACA, I'm just frustrated that neither party has, or is, addressing the most dire problem. I may bag on Obamacare from time to time because of that but it was and is good legislation. It just needs to be tweaked and added to. It does not need to be repealed or replaced.

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