Repealing the ACA under Trump

[BigRedBuster]

BRB, I'm not opposed to a demonstrably superior approach than how Obamacare tackles this problem. I'd encourage you to keep fleshing out your idea. I'm certainly not shocked or offended by it. I'm simply trying to poke holes into it.

 

Tbh, I don't understand how you can have such a dim view of the ACA while having an apparently positive view of your idea. How does guaranteed Medicare when you need it address the issue of healthy people opting out of the insurance markets? How does your second prong, indeed, reconcile with your first? Do away with the pre-existing conditions mandate, but then impose a soft "costly customer" mandate for insurance companies? .... not to mention, the 'cost of providing healthcare' issue about which you frequently criticize Obamacare doesn't appear to be even touched here.

 

But perhaps I'm missing your point.

(in my opinion) The difference between my idea and the ACA is that the ACA is forcing these people into a system (insurance companies) where the insurance companies still need to make a profit. If they don't, they cease to exist. Fact of life. So, by forcing these people into the insurance market place, insurance companies are jacking up premiums to everyone else to astronomical levels which doesn't work for everyone else.

 

 

Off the top of my head, if we flood Medicare with all of these unhealthy people, who ends up paying for it?

 

1) Taxes would have to go up, no?

 

2) One of the reasons that group/individual premiums are high is that Medicare reimbursement to docs is lower than group/individual rates. So if more people switch to Medicare the docs will raise prices on the group/individual business to make up the shortfall.

 

This is where I would like to see data. Right now we are subsidizing a lot of people to buy really expensive healthcare insurance. That is extremely expensive and already costing tax payers. Part of this cost is the profit insurance companies are putting into their prices.

 

So......what I would like to see is if by doing what I propose, is that cheaper than subsidizing these people in the insurance market.

 

I would guess that a lot of these people can't work because of their condition which causes them to be low income and qualify for subsidies. So.......let's take the insurance out of the equation and pay for the actual cost of the healthcare instead of paying really expensive premiums to the insurance companies.

 

Hey....I'm throwing out the idea because I'm tired of the same ol' same ol' bickering going back and forth that isn't getting anywhere.

[RedDenver]

The problem is that insurance companies take these people in and cover the cost by drastically increasing the premiums on healthy people.

Yes, that's the entire idea of having insurance. Imagine if people complained about their homeowner's insurance like this: Those people that got hit by tornadoes are drastically increasing the premiums on the people who didn't.

 

You get insurance not because you are healthy - it's because you want to share the risk of health costs with a large group for whom the average paid will be less than the risks of not being in the group.

 

In other words, your insurance premiums cover the RISK of getting hit by a tornado or a health problem, so it makes no sense to separate out the groups because EVERYONE is at risk.

 

And yes, your premiums are ridiculous. If you really are paying $30k/year, then it might make more sense to put that money in the bank and pay straight out of pocket.

[Danny Bateman]

 

I'm so sick and tired of these two groups in Washington acting like children and not addressing the problems. So, I'm throwing out an idea that came to me. I would love to see what the cost to tax payers would be compared to the current ACA system.

 

Two major issues exist.

 

a) We need to mandate preexisting conditions can not be used as an excuse to lose coverage. However, that is a huge expense for insurance companies which drive up premiums.

 

b) Nobody is addressing the cost issues in the system.

 

So, if we are stuck with dealing with insurance premiums instead of actual cost of healthcare, here's what I would like to see studied.

 

How about if we do away with the mandate to insurance companies that they are required to insure people with preexisting conditions. Along with that, allow those people to sign up for medicare. So, if you can't get coverage because of a preexisting condition, then you are allowed to be covered under medicare prior to being 65 years old.

 

One thing that comes to mind is that....well....then all the insurance companies would do is drop anyone who is costing them money. So, I would put in a system where they are required to document why they can not cover this person. If they do not meet certain criteria for that category, then the insurance company is required to cover them.

And then, to help minimize costs, the government could create a public option available to healthy people too. Assuming it is relatively inexpensive, it could jump start some competition in the market places.

 

Democrats tried that in 2009. It was called the public option. Joe Lieberman killed it.

[Danny Bateman]

CBO assessment of GOP skinny repeal plan:

 

16M uninsured next year, 18M insured thereafter. 20% increase in premiums.

 

 

[Danny Bateman]

So... meeting at Ted Cruz's house?

 

[zoogs]

Right now we are subsidizing a lot of people to buy really expensive healthcare insurance. That is extremely expensive and already costing tax payers. Part of this cost is the profit insurance companies are putting into their prices

 

So......what I would like to see is if by doing what I propose, is that cheaper than subsidizing these people in the insurance market.

It sounds like you're taking large numbers of people out of the insurance market, acknowledging that the result will be the remaining people in the market will be expensive for the insurance companies (to put it mildly!) ... and then instituting some requirement that they be covered anyway (an awful like the individual mandate, except they can document their way out of it). To me, that sounds like a market that will utterly collapse.

 

The people you are taking out of the insurance market: some of them will free to be without insurance, and the others will then buy insurance once they're sick. Under your proposal, instead of going to the marketplace, that insurance will be Medicare: 'a single-payer, national social insurance program administered by the U.S. federal government' (1).

 

I guess what I'm wondering is how any insurance marketplace exists at all, and who would be on it.

 

Is this proposal ultimately Medicare-for-all? That *would* be subsidizing everyone, with the argument that it'd be cheaper. It sounds like there's no way this wouldn't devolve into that.

[Danny Bateman]

Reading BRB's post, he's certainly got a novel approach. This is more of a big government approach, though, as there are a couple of pieces of it that would need the heft of the federal government to get done.

 

A) Rework the pre-existing condition language so they can opt-in to Medicare if denied by insurers due to their condition.

 

B) Force insurers to comply with his document guidelines so we can hold them accountable if they just start chucking people off their rolls to drive up profits.

 

Bear in mind, though, that people with pre-existing conditions, as well as the elderly, are oftentimes the most expensive consumer of healthcare. Shifting all (or even most) of the pre-existing conditions folks over into the risk pool where the elderly already reside is going to drastically increase the cost of Medicare. Medicare had a budget of $721B in FY2017, roughly twice that of Medicaid.

 

In that way, I'm not sure you'd be alleviating the burden on taxpayers as much as shifting the dollars elsewhere. You'd also have to think about the practical realities of getting broad coalition behind such a system. I know it's a hypothetical. but if the GOP has had such an aversion to the expansion of Medicaid, I'd have to think we'd find ourselves in the same boat if we start talking about expanding a pool that is already twice as expensive. They'd have a heart attack.

[Red Five]

7 years!!!! And they write the bill over lunch before voting on it that night

 

[Fru]

How much more proof does one need that the GOP cannot govern?

[mrandyk]

How much more proof does one need that the GOP cannot govern?

Seriously. Full control of the government for 6 months and nothing but regression to show for it.

[zoogs]

It's not that they can't. It's that their objectives and priorities are so heinous as to make this very, very difficult for them.

 

If they were trying to accomplish different things (like, not removal of healthcare for the sake of upwards wealth transfer) and still getting stonewalled, then we might shift the blame. But that's not the reality.

 

It was always going to be this hard, given what they want to do.

[Danny Bateman]

[Danny Bateman]

The nerve of these people is effing outstanding! They release their healthcare bill that they've talked about for 7 years two hours before the vote, and refuse to give colleagues more time to read it. They reply with snark.

 

He's currently holding the floor droning on about tort reform and telling stories and refusing to yield for questions.

 

They're so damn ashamed of their bill they won't answer questions about it.

I hope and pray people will remember who pulled this crap.

 

[zoogs]

Is that Sasse? Nice, starring role for the Senator from Nebraska.

[zoogs]

Erstwhile anti-Trump stallion Lindsey Graham is very, very condemning of the so-called 'Skinny Repeal.' It's a 'disaster', he says.

 

Remember that as he votes for it.

 

But it's only a vehicle, of course. A vehicle towards his healthcare vision of, wait for it ...

 

Don't take my word for all this. Here's some RedState blogger tearing his hair out: http://www.redstate.com/patterico/2017/07/27/hey-lindsey-graham-gop-owns-whatever-happens-health-care-now/