Repealing the ACA under Trump

[JJ Husker]

 

https://twitter.com/Acosta/status/839665918754099200

 

the republicans are in control of everything. if they would rather have americans dying for lack of healthcare that is on them. The blood will be on trumps hands in that case.

The sad reality is, Americans will be dying with the replacement plan or with an unmodified Obamacare plan or with a failed ACA. The part that is unquestionable is that Republicans will be responsible for any of those 3 scenarios. They are in control and are responsible for fixing it. The only possible salvation for Republicans is if they fix the ACA or institute a better plan. I've seen nothing to indicate that is even being attempted. I'm not naive enough to think it will be easy but these stupid childish m'fers aren't even trying. Put 10 of them in a room and they wouldn't be able to figure out how to poor piss out of a boot. The best and smartest my ass. There is one problem with the ACA and it's the same problem Obamacare failed to address, runaway costs. When somebody that matters figures that out and quits simply spouting talking points and blowing their base, let me know. Until then I've got to come up with some crime plans that will fund my unaffordable healthcare.

[zoogs]

Of course it's not being attempted. They are not in the least interested in the public welfare. The interests they are answering to should be obvious, and it explains completely all of their political efforts in this area.

[JJ Husker]

Of course it's not being attempted. They are not in the least interested in the public welfare. The interests they are answering to should be obvious, and it explains completely all of their political efforts in this area.

Yes, but let's not pretend the dems didn't do much the same thing when they implemented the ACA. I mean sure at least they showed some interest in trying to cover more of the vulnerable people but nobody, R or D, gives or gave a flying f#ck about creating a sustainable healthcare plan. The fact is it doesnt affect the politicians and both sides simply cater to their fringe bases and the special interests that line their pockets.

 

I know there are no easy answers when it comes to solving healthcare, in fact it may be near impossible without creating other serious problems, but I really wish our government wasn't so broken that they would at least attempt to make it better. I'll give Obama and the dems credit for fixing some of it but none of them have the balls or desire to do what is needed. There's a reason the biggest problem is never mentioned and it is spelled $,$$$,$$$,$$$,$$$.

[zoogs]

I don't think that's true. Changing healthcare has been a Dem priority for a long time. It has also been a Good one, I think. The ACA required compromise and was essentially a conservative approach, because the alternative was doing nothing and that was way more politically viable.

 

Then the ACA was passed and the former status quo interests mobilized. I get that broad spectrum cynicism is popular but it's clearly not a case of neither party caring about healthcare reform. It's a question of priorities: sacrificing so and so to get more people covered, or sacrificing coverage because other things are more important.

 

The fact that Obama spent all his political capital in the ACA is a clear demonstration of where his priorities were.

[JJ Husker]

I don't think that's true. Changing healthcare has been a Dem priority for a long time. It has also been a Good one, I think. The ACA required compromise and was essentially a conservative approach, because the alternative was doing nothing and that was way more politically viable.

Then the ACA was passed and the former status quo interests mobilized. I get that broad spectrum cynicism is popular but it's clearly not a case of neither party caring about healthcare reform. It's a question of priorities: sacrificing so and so to get more people covered, or sacrificing coverage because other things are more important.

The fact that Obama spent all his political capital in the ACA is a clear demonstration of where his priorities were.

You don't think what is true?

I agree with everything you said....

 

I suppose we could think they really tried to create the best plan possible while ignoring addressing the rapidly escalating cost problem. And then maybe assume that was because of compromise and incompetence rather than political expediency, greed and corruption. Maybe I am too cynical but capital hill has more than earned it. Don't be fooled about motivations and simply write off the obvious shortcomings as compromise.

[Saunders]

 

What would yours contain that would trouble them BRB?

Right now there is no motivation built into the system that gives the providers (hospitals/Doctors) a reason to drop their prices. If a patient is told they need a heart surgery, they are scared and sign up for wherever their cardiologist tells them too. The insurance company doesn't have any motivation because if they start losing money, they just raise premiums. If the person qualifies, they just get subsidies from the government. The government has forced everyone to have insurance so their customer base just exploded.

 

This system SUCKS!!!

 

We have a wellness program in our company. Within that plan, if an employee needs that heart surgery, the wellness program will look at how much it is going to cost and then find comparable hospitals that will do it for much less. The patient/employee is not forced into using someone they don't want. They can then choose based on the cost. We will totally wave any deductible or co-pay if the employee decides on the lower cost facility. The wellness program also researches the quality of care at the facility so they are not sent to a place that won't do comparable work.

 

Something like this has got to be built into the system for everyone. We have an employee who had a procedure done at an office not physically within the hospital. When they received their bill, the hospital charged them a fee. When asked, the hospital said the doctor who did the procedure had an office within the hospital so they are allowed to charge a fee.....even though the patient never set foot in the hospital.

 

The cost structure and billing is totally screwed up to the point these places can charge whatever they want and get away with it.

 

Our insurance company is trying to get more providers signed onto contracts. What some providers will agree to is to charge insurance customers "medicare plus 100%" So, if a medicare patient would be charged $1000, the insurance patient would get charged $2000. Now, you may scoff at that, but a lot of providers won't do these contracts because they are charging insurance patients sometimes 10-15 times medicare.

 

Hospitals and doctors are NOT going to like being forced to charge less. But, there is no reason why a procedure should cost $80,000 in one place and $15,000 in another without the patient being informed.

 

 

Note: this isn't an argument, just at anecdote.

 

I'm not an expert on the subject, buy my wife is (she oversees the team covering multiple hospitals in billing/insurance/PFS), so take this comment with the "phone game" filter.

 

A big part of the reason that they use tiered pricing, is to cover the people who come in, get procedures done, and never pay. Her group writes off millions each month in bad debt, that will never be recovered. Medicare pays way faster than insurance companies. And cash pay gets an even cheaper rate, with a 20% discount if you pay up front. One of the interesting changes she told me about that her hospital group has done post ACA is set up a charity that people can donate to, and the hospital uses those funds to pay for insurance for patients requesting financial services.

 

Hearing her talk about hoops they have to jump through is mind boggling.

[JJ Husker]

Can somebody tell me if I'm reading this bill correctly as pertains to tax credits?

 

It looks to me like a $2500 yearly tax credit for the tax payer and spouse and $1500 for each child. In my situation (family of four) that would be an $8000 yearly tax credit. That would appear to be a much larger benefit than I currently get from the ACA.

 

I will get around to reading this bill in its entirety, just like I did the ACA but I stumbled across this part and haven't heard anyone talking about it.

[NM11046]

Thanks Sanders - I've taken a bit of a step back because I realized that I'm biased on this debate. But indeed state/national programs have very specific criteria, payment and timing of payment lined up and it makes things easy. There's no debate. The challenge is sometimes there is also no flexibility in diagnosis and coverages.

 

The insurers are the ones I find most distasteful in all of this - their reimbursement dollar negotiation with physician groups and hospitals is shameful. To (as a practitioner) decide you can only take some insurance rather than all is nothing more than a survival tactic. It's also why the ACA was good. Without a requirement of all (young and healthy as well as old and needing more care) having to have insurance there's just no way to insure that the pools have enough in them to cover all. The healthy young folks who choose to gamble and not insure really impact the availability of funds to care for our sicker friends.

 

I can't speak to hospitals making a profit at the cost of the people - that is wrong. But I can say that hospitals profit and doctors profit are not related (or minimally so).

[BigRedBuster]

 

 

What would yours contain that would trouble them BRB?

Right now there is no motivation built into the system that gives the providers (hospitals/Doctors) a reason to drop their prices. If a patient is told they need a heart surgery, they are scared and sign up for wherever their cardiologist tells them too. The insurance company doesn't have any motivation because if they start losing money, they just raise premiums. If the person qualifies, they just get subsidies from the government. The government has forced everyone to have insurance so their customer base just exploded.

 

This system SUCKS!!!

 

We have a wellness program in our company. Within that plan, if an employee needs that heart surgery, the wellness program will look at how much it is going to cost and then find comparable hospitals that will do it for much less. The patient/employee is not forced into using someone they don't want. They can then choose based on the cost. We will totally wave any deductible or co-pay if the employee decides on the lower cost facility. The wellness program also researches the quality of care at the facility so they are not sent to a place that won't do comparable work.

 

Something like this has got to be built into the system for everyone. We have an employee who had a procedure done at an office not physically within the hospital. When they received their bill, the hospital charged them a fee. When asked, the hospital said the doctor who did the procedure had an office within the hospital so they are allowed to charge a fee.....even though the patient never set foot in the hospital.

 

The cost structure and billing is totally screwed up to the point these places can charge whatever they want and get away with it.

 

Our insurance company is trying to get more providers signed onto contracts. What some providers will agree to is to charge insurance customers "medicare plus 100%" So, if a medicare patient would be charged $1000, the insurance patient would get charged $2000. Now, you may scoff at that, but a lot of providers won't do these contracts because they are charging insurance patients sometimes 10-15 times medicare.

 

Hospitals and doctors are NOT going to like being forced to charge less. But, there is no reason why a procedure should cost $80,000 in one place and $15,000 in another without the patient being informed.

 

 

Note: this isn't an argument, just at anecdote.

 

I'm not an expert on the subject, buy my wife is (she oversees the team covering multiple hospitals in billing/insurance/PFS), so take this comment with the "phone game" filter.

 

A big part of the reason that they use tiered pricing, is to cover the people who come in, get procedures done, and never pay. Her group writes off millions each month in bad debt, that will never be recovered. Medicare pays way faster than insurance companies. And cash pay gets an even cheaper rate, with a 20% discount if you pay up front. One of the interesting changes she told me about that her hospital group has done post ACA is set up a charity that people can donate to, and the hospital uses those funds to pay for insurance for patients requesting financial services.

 

Hearing her talk about hoops they have to jump through is mind boggling.

 

I used to work in healthcare and I would completely agree with your/your wife's assessment. That's why even as a fiscal conservative, I was for some type of plan that gets more and more people covered some how. We (meaning people who have insurance) are already paying for these people. The problem is that it's happening at an extremely expensive rate.

 

I used to work in the lab at Iowa Lutheran Hospital in Des Moines. I would be called all the time to the emergency room to draw blood on patients for stuff that other people just go to their local doctor or health clinic for. The reason why these people go to the ER is that the ER can not turn them away. So, the hospital foots the bill and has to recoup those funds some how.

 

If everyone has access to the doctor or health clinic, that patient gets treated much cheaper.

 

Now to the billing issue. Part of the problem at least that our local hospital has is their billing takes forever. I will go into the Dr. office (associated with the hospital) for something and sometimes I won't get a bill for 6 months. I'll pay my bill whenever I get it. Problem is, they can't get it out in a reasonable amount of time.

[BigRedBuster]

Thanks Sanders - I've taken a bit of a step back because I realized that I'm biased on this debate. But indeed state/national programs have very specific criteria, payment and timing of payment lined up and it makes things easy. There's no debate. The challenge is sometimes there is also no flexibility in diagnosis and coverages.

 

The insurers are the ones I find most distasteful in all of this - their reimbursement dollar negotiation with physician groups and hospitals is shameful. To (as a practitioner) decide you can only take some insurance rather than all is nothing more than a survival tactic. It's also why the ACA was good. Without a requirement of all (young and healthy as well as old and needing more care) having to have insurance there's just no way to insure that the pools have enough in them to cover all. The healthy young folks who choose to gamble and not insure really impact the availability of funds to care for our sicker friends.

 

I can't speak to hospitals making a profit at the cost of the people - that is wrong. But I can say that hospitals profit and doctors profit are not related (or minimally so).

So....you're upset that an insurance company is refusing to pay whatever a Dr. or Hospital wants?

[Saunders]

 

 

 

What would yours contain that would trouble them BRB?

Right now there is no motivation built into the system that gives the providers (hospitals/Doctors) a reason to drop their prices. If a patient is told they need a heart surgery, they are scared and sign up for wherever their cardiologist tells them too. The insurance company doesn't have any motivation because if they start losing money, they just raise premiums. If the person qualifies, they just get subsidies from the government. The government has forced everyone to have insurance so their customer base just exploded.

 

This system SUCKS!!!

 

We have a wellness program in our company. Within that plan, if an employee needs that heart surgery, the wellness program will look at how much it is going to cost and then find comparable hospitals that will do it for much less. The patient/employee is not forced into using someone they don't want. They can then choose based on the cost. We will totally wave any deductible or co-pay if the employee decides on the lower cost facility. The wellness program also researches the quality of care at the facility so they are not sent to a place that won't do comparable work.

 

Something like this has got to be built into the system for everyone. We have an employee who had a procedure done at an office not physically within the hospital. When they received their bill, the hospital charged them a fee. When asked, the hospital said the doctor who did the procedure had an office within the hospital so they are allowed to charge a fee.....even though the patient never set foot in the hospital.

 

The cost structure and billing is totally screwed up to the point these places can charge whatever they want and get away with it.

 

Our insurance company is trying to get more providers signed onto contracts. What some providers will agree to is to charge insurance customers "medicare plus 100%" So, if a medicare patient would be charged $1000, the insurance patient would get charged $2000. Now, you may scoff at that, but a lot of providers won't do these contracts because they are charging insurance patients sometimes 10-15 times medicare.

 

Hospitals and doctors are NOT going to like being forced to charge less. But, there is no reason why a procedure should cost $80,000 in one place and $15,000 in another without the patient being informed.

 

 

Note: this isn't an argument, just at anecdote.

 

I'm not an expert on the subject, buy my wife is (she oversees the team covering multiple hospitals in billing/insurance/PFS), so take this comment with the "phone game" filter.

 

A big part of the reason that they use tiered pricing, is to cover the people who come in, get procedures done, and never pay. Her group writes off millions each month in bad debt, that will never be recovered. Medicare pays way faster than insurance companies. And cash pay gets an even cheaper rate, with a 20% discount if you pay up front. One of the interesting changes she told me about that her hospital group has done post ACA is set up a charity that people can donate to, and the hospital uses those funds to pay for insurance for patients requesting financial services.

 

Hearing her talk about hoops they have to jump through is mind boggling.

 

I used to work in healthcare and I would completely agree with your/your wife's assessment. That's why even as a fiscal conservative, I was for some type of plan that gets more and more people covered some how. We (meaning people who have insurance) are already paying for these people. The problem is that it's happening at an extremely expensive rate.

 

I used to work in the lab at Iowa Lutheran Hospital in Des Moines. I would be called all the time to the emergency room to draw blood on patients for stuff that other people just go to their local doctor or health clinic for. The reason why these people go to the ER is that the ER can not turn them away. So, the hospital foots the bill and has to recoup those funds some how.

 

If everyone has access to the doctor or health clinic, that patient gets treated much cheaper.

 

Now to the billing issue. Part of the problem at least that our local hospital has is their billing takes forever. I will go into the Dr. office (associated with the hospital) for something and sometimes I won't get a bill for 6 months. I'll pay my bill whenever I get it. Problem is, they can't get it out in a reasonable amount of time.

 

Agree 100%.

[RedDenver]

I don't think that's true. Changing healthcare has been a Dem priority for a long time. It has also been a Good one, I think. The ACA required compromise and was essentially a conservative approach, because the alternative was doing nothing and that was way more politically viable.

Except that that no Republicans voted for the ACA, so making it a conservative approach made no sense. The Dems had the votes to get ACA with a public option passed but went with a more conservative plan anyway.

[NM11046]

 

Thanks Sanders - I've taken a bit of a step back because I realized that I'm biased on this debate. But indeed state/national programs have very specific criteria, payment and timing of payment lined up and it makes things easy. There's no debate. The challenge is sometimes there is also no flexibility in diagnosis and coverages.

 

The insurers are the ones I find most distasteful in all of this - their reimbursement dollar negotiation with physician groups and hospitals is shameful. To (as a practitioner) decide you can only take some insurance rather than all is nothing more than a survival tactic. It's also why the ACA was good. Without a requirement of all (young and healthy as well as old and needing more care) having to have insurance there's just no way to insure that the pools have enough in them to cover all. The healthy young folks who choose to gamble and not insure really impact the availability of funds to care for our sicker friends.

 

I can't speak to hospitals making a profit at the cost of the people - that is wrong. But I can say that hospitals profit and doctors profit are not related (or minimally so).

So....you're upset that an insurance company is refusing to pay whatever a Dr. or Hospital wants?

 

Not necessarily - I'm upset by the fact that an insurance company who is willing to pay more will get a contract. What physician organization or hospital will turn away more money for a procedure or coded office visit? It's coming from the Ins figures not demands from the doctors.

 

In my world at least the decisions aren't made by doctors trying to charge more for an office visit or blood draw. It's decided by the insurance contracts which determine how many patients in a plan they get who are healthy vs. unhealthy - that's why some plans in the past have been dropped by a PHO, they are full of high risk patients and they put a PHO in the hole. Then you have to count on the more healthy (typically commercial) plans where you've got healthy pts and the pool can cover the mess.

 

I'm not sure I'm communicating any of this clearly here - admittedly I've got a bunch of work in front of me and I'm tuning in and out - so apologies in advance if this doesn't read clearly.

[Danny Bateman]

 

I don't think that's true. Changing healthcare has been a Dem priority for a long time. It has also been a Good one, I think. The ACA required compromise and was essentially a conservative approach, because the alternative was doing nothing and that was way more politically viable.

Except that that no Republicans voted for the ACA, so making it a conservative approach made no sense. The Dems had the votes to get ACA with a public option passed but went with a more conservative plan anyway.

 

 

They did NOT have the votes to get the public option. Joe Lieberman voted against it because he represented a state that is heavily reliant on the insurance industry for their economy. He singlehandedly killed the public option because it needed only 1 more vote.

 

I have to agree with Zoogs and disagree with El D regarding the rollout of these bills. The incompetence and tone deafness of the GOP is astounding. While the ACA of course wasn't perfect and didn't work for everyone, they at least had the foresight to work with major insurers, healthcare organizations, hospitals and the like to craft a bill they supported.

 

Compare that to the GOP, who put together this flaming pile of crap in secrecy and was immediately hit with heavy criticism from both the Dems, conservative organizations, and major healthcare organizations/providers. They're criticizing the bill because they weren't consulted, and because frankly, it's not a very good bill.

 

El D, one more question. Where are you reading about the $1500 credit per child? I haven't seen anything about that at all and I'm genuinely pretty curious.

[Danny Bateman]

Remarkable, breath-taking hypocrisy from the GOP on healthcare - then vs. now:

 

 

Republicans, at the time, felt like the process was moving much too quickly. “Congress is moving fast to rush through a health care overhaul that lacks a key ingredient: the full participation of you, the American people,” said Rep. Paul Ryan.

Democrats moved with more information than Republicans have now, but also with less than you’d want for a legislature overhauling the American health care system. And much of the debate in 2009 — just as is true in 2017 — revolved around scores from the Congressional Budget Office.

At the June 23 Energy and Commerce health subcommittee hearing, Rep. Michael Burgess (R-TX) pressed on the issue. “Mr. Chairman, will you commit that we will at least have a CBO score on the bill that we will mark up?” he asked.

Burgess now chairs the Energy and Commerce health subcommittee, where he is currently marking up the American Health Care Act without a CBO score.

The CBO released preliminary estimates for the bill before markup but not a final score. “Those figures do not represent a formal or complete cost estimate for the coverage provisions of the draft legislation,” then-Congressional Budget Office Director Doug Elmendorf cautioned.

Rep. Dave Camp, who then served as the Republican ranking member on Ways and Means, was not pleased.

“We cannot afford to guess when it comes to health care,” he said at his opening statementfor the Ways and Means markup in 2009. “This is not some think-tank experiment; these are people’s lives, people’s jobs we are talking about … his committee has no business marking up a bill of which CBO cannot tell us its cost or impacts.”

 

Sad but not surprising to see all of these officials do the same thing they decried in 2009, arguably to a much worse degree.

 

If you want the participation of the American people, you don't craft your legislation in hidden, off limits rooms in secrecy around Capital Hill, bar other reps from entering, and run away when you're found out.

 

Something very significant I've noticed since I started keying in to politics before the campaigns - there's a remarkable tendency to allow equal deference to both sides in the name of remaining "neutral" and "balanced". It's not fair to excessively criticize one side or the other, since they're all the same anyway right? The Dems had their chance with ACA, now we owe it to the GOP to see what they can do because it's their turn.

 

Bull. This is a garbage bill and a garbage approach to making a healthcare system that works for everyone. They want to lower costs by ripping healthcare away from the poor, hammering the oldest and sickest among us, and offering huge tax breaks to the wealthiest people in the country.

 

Paul Ryan is a two-faced Ayn-Rand reading POS and I don't trust him or the Turtle McConnell to fix healthcare. They just want to appease the far-right conservatives and their donors and get re-elected.