Repealing the ACA under Trump

[BigRedBuster]

Aren't you proposing a punishment the other way? It's just not a punishment when they possibly are sick and needing the insurance?

Otherwise, how do you enforce a mandate?

[zoogs]

The mandate's advantage is that people are required to pay in. You could see it as punishment, or just as enforcement of our need to have everybody paying in one way or another.

 

This isn't the same realm of "punishment" as we're going to screw you over and leave you with zero options -- i.e, you cannot get insurance for six months now that you need it. I'm not bothered at all by enforcing people to pay in. I'm bothered by the latter.

 

As of right now, I know people who don't buy coverage because they know they can buy it if they get sick. I know specifically one who all of a sudden went out and bought a policy right when his wife started having some major health problems.

 

Yes. And I think the clear and straightforward solution [within the ACA framework] is to raise the mandate penalty. That way, fewer people will choose to do this. And those who do will be paying into the system anyway.

 

If this guy couldn't do that, then what happens to him? We live him and his wife behind because hey, they had choices but made the wrong ones, and failed life?

 

I mean, I feel like that's explicitly the goal of legislation such as this. Create a world where such people are simply left behind to die because at that point there are no options. I'm sure there are some benefits to the rest of us.

[JJ Husker]

 

ED, I replied in greater detail outlining my objection to this system.

 

Why can't we just not have a conniption over the concept of a government mandate? The Republicans are so "Big Government" averse they'd rather institute a cruel punishment. This isn't preservation of choice, not really -- you can "choose", but if you choose the wrong way we're going to punish you for it. How else do you call a scenario where someone opts to exercise that hard-fought-for Republican freedom not to buy health insurance, then they get sick, and then they're barred from re-entering the marketplace for six months by Republican policy?

 

 

There's not only a way in hell, there's a way in the real world this thing can pass. We're on its doorstep.

 

Yeah, I saw your greater detail after I posted.

 

I don't necessarily disagree with you but also let's not act the ACA doesn't do the same thing.

The fine or penalty for not having coverage under the ACA is woefully inadequate. People can game the system now by choosing to not have coverage. And then if they have a problem and want to become insured they cannot acquire a plan until the next open enrollment period. Insurers can deny coverage for pre-existing conditions and they can charge whatever inflated premium they want today to let people into a plan outside of the open enrollment period. So let's not portray this aspect of the repub plan as being any more cruel than what exists today.

[BigRedBuster]

I said the way the Repubs are proposing to do it is pathetic.

 

I'm trying to figure out how you have a mandate and enforce the penalty.

 

Let's say you take the guy who I described above. He chooses to not buy insurance. HIs wife gets sick so then he needs it so he going and buys a policy.

 

Do you assess the penalty at the time he tries to now go buy insurance?

[zoogs]

Am I misunderstanding the ACA? How does something like what BRB described work if this is the case?

 

My understanding has been that the mandate is enforced through the IRS.

[Ratt Mhule]

I don't mean to sound like a dick or anything but what is calling your representatives going to do? They don't give a crap about what the people want. The Republicans holding off on this bill are doing so because it doesn't go far enough for them, not because they care that people will lose healthcare.

[JJ Husker]

Am I misunderstanding the ACA? How does something like what BRB described work if this is the case?

 

My understanding has been that the mandate is enforced through the IRS.

It is but you still cannot get back into the marketplace if you have a period of non-credible coverage.

 

I almost found out the hard way exactly how it works. I lost my coverage in 2016 for about 5 months because of a payment mixup. If I would not have gotten that straightened out, I would not have been able to get back into a marketplace plan. That means they could have charged me through the ass and denied coverage of preexisting conditions. Once your outside the open enrollment period they can basically do whatever they want. In that aspect, I don't see any difference between this provision in the repub plan and what currently exists in the ACA.

[zoogs]

I don't mean to sound like a dick or anything but what is calling your representatives going to do? They don't give a crap about what the people want. The Republicans holding off on this bill are doing so because it doesn't go far enough for them, not because they care that people will lose healthcare.

 

I don't think this is true. Concerted public pressure matters. In particular, you'll be talking to office staff and hopefully there's some cumulative trickling up of your concerns. At the very least you can collectively signal what is strongly intolerable. In the absence of which they'll know there's no political will to oppose them.

 

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I feel like this is asking people to play Russian roulette with their health and their lives. 5/6, you win a no-consequence exercise of your glorious right to not buy health insurance! Yes! You stuck it to the government. 1/6, you're dead in the water.

I can agree that the ACA was inadequate -- it still left millions uninsured -- but we should be moving away from roulette scenarios. It *seemed* to me that relative to the ACA, this increased the incentive to not buy insurance (no tax penalty!) and simultaneously increased the stick (you might get REALLY screwed if you don't!) in order to still encourage people to buy. If this is not in fact true, then you're absolutely right, ED: this is a much softer distinction from the IM than I had portrayed it.

I think it's hard to have complete sanity without universal coverage. The mandate is still giving people a "slightly cheaper way out" with this roulette-like stick for people who end up on the wrong end of it. Just cover everybody, all the time.

[BigRedBuster]

Am I misunderstanding the ACA? How does something like what BRB described work if this is the case?

 

My understanding has been that the mandate is enforced through the IRS.

 

 

If that's how it is supposed to work, it's not working.

 

Two things at work here.

 

1) The penalty isn't big enough to make people care. It is cheaper to not pay premiums and just pay the penalty if it ever was enforced.

 

2) It isn't enforced.

 

So...to fix it, let's realize that health care premiums are skyrocketing for a lot of people even if the ACA is kept in tact. So, the penalty is going to have to be enormous to make them choose premiums over the penalty.

[BigRedBuster]

I've written emails and letters to my congressmen and all I ever get back is some form letter that has nothing to do with what I said in my original letter to them.

 

My only hope is that somewhere some staff person is keeping a running tally of "for" or "against" whatever regulation I wrote about.

[JJ Husker]

I don't mean to sound like a dick or anything but what is calling your representatives going to do? They don't give a crap about what the people want. The Republicans holding off on this bill are doing so because it doesn't go far enough for them, not because they care that people will lose healthcare.

Yeah, irony of ironies. I believe there are a couple who are opposing it for the right reasons (like the Nevada guy) but, you're right, most of them standing in opposition, it is because it doesn't go far enough for them. If it only sucked worse, then they could support it.

 

I agree that they don't really care about what the people want but they do care about reelection so if any of them who have contested election coming up get inundated with calls, it may make a difference.

[zoogs]

I'm basically thinking you & ED are right. Specifically, if the time between open enrollment -- which is from end of January to November -- is a no man's land, that's somewhere between similar and worse than a 6-month delay.

 

Regarding communications, calling is probably best. I remember reading some takes from former staffers about this post-election But yeah, it might be minor, but I think the office can be made to feel the heat. More importantly, they know when that fire is lacking.

[NM11046]

I don't mean to sound like a dick or anything but what is calling your representatives going to do? They don't give a crap about what the people want. The Republicans holding off on this bill are doing so because it doesn't go far enough for them, not because they care that people will lose healthcare.

Guess it depends on your representatives. They log calls. The numbers do matter when it comes to evaluating if they want to risk losing their seat to vote with the party. It reinforces their decision to stand strong if that's what their constituents want. Sure, it's not going to sway the Mitch Mcconnells of the world, but the Collins, the Murkowskis' the Hellers - they have to pay attention to that.

 

The volume of calls, faxes, emails, town hall and protests is what made the initial pass through the house slow down, that made people hesitant.

 

And ultimately - it can't hurt can it.

[NM11046]

I've written emails and letters to my congressmen and all I ever get back is some form letter that has nothing to do with what I said in my original letter to them.

 

My only hope is that somewhere some staff person is keeping a running tally of "for" or "against" whatever regulation I wrote about.

They do keep a count- a couple started posting again today how many constituent calls/emails etc they've received for and against.

[zoogs]

I think another factor to all this is determination. The GOP is clearly feeling the heat. However, what remains to be seen is how determined they are to push on in spite of it. They might be happy to pay the political costs for what they feel is fundamentally a significant accomplishment.

 

The Democrats were on the hotseat during ACA implementation. Nevertheless, they persisted. And I thank them for it. This time around -- not so much.