The Affordable Care Act II - Because Mr. Obama Loves You All

[meazza]

 

 

Damn, that was a perfectly good pair of underwear.

 

:lol:

 

I didn't realize long winded posts full of drivel counts for analysis.

[Meathead]

ive always believed that coverage should be for everybody. when i used to be high earner i believed it, now as a disabled chronically ill man i certainly still believe it

 

whether thats socialized medicine, a market based system, or most realistically a combination, everybody should have access. we are at a point in our human development that we can do it if we just stop the squabbling

 

the don has promised that. will republicans be able to deliver? color me deeply skeptical given their track record

 

the dems had their chance and it looked promising, but the aca is failing in the middle and leaving too many ppl with the terrible choice to pay their mortgage or swallow that huge colonoscopy deductible

 

i would love to see both sides of the aisle finally come together to deliver a usable solution. weve had multiple opportunities to do that, yet it always devolves into a pissing contest with one side working and the other side sabotaging

 

all the while real ppl are really suffering, real ppl are really dying. real ppl facing excruciating choices that seriously threaten their present and their future

 

theres got to be a better way. i pray we are finally ready to deliver one. i am not confident

[Tiberius]

"Death spiral? What death spiral?

 

The report provides a bit of good news for Obamacare supporters and detractors. Despite some instability in Obamacare's marketplaces, the CBO doesn't believe the health care law is facing a dreaded death spiral, in which premiums rise so high that only the sickest patients are motivated to purchase insurance. Nor does the CBO think the GOP plan would result in a death spiral.

 

The report says Obamacare's income-based subsidy structure is protecting enrollees from higher premiums, which comes at a greater expense to the federal government. And the CBO thinks the individual mandate is still enough of an incentive to bring healthy people into the marketplace.

 

The Republican plan's subsidies would also help bring in healthy people to the marketplace, even though they "would be generally less for those receiving subsidies under current law," the CBO said. The bill also includes a $100 billion fund to help states cover vulnerable patients, which the CBO thinks would help insurers keep down premiums."

 

http://www.politico.com/story/2017/03/obamacare-repeal-cbo-uninsured-236016

 

 

So much for that lie peddled here and by GOP politicians

[Meathead]

Sen. Joe Manchin (D-W.Va.), among the most conservative Democrats, who is up for re-election in 2018, said on Monday the bill is “morally wrong.”

"To do what they're doing right now is absolutely unconscionable," Manchin said. “It's just awful … There's got to be a moral compass inside somebody.”

"Can’t sugarcoat it, it doesn't look good, does it?" observed Sen. Bill Cassidy (R-La).

It’s tough to guess how long Republicans can carry the day with a “trust us” argument, with spooked conservatives and moderates both peeling off and many health industries wary of the party’s replacement plans.

Price and others are already attacking the CBO for reviewing just the first part of the replacement plan. But that ignores the fact that the CBO is only supposed to analyze legislation that has been introduced — and not take into account extraneous promises from the White House and GOP leaders about what else may or may not happen down the road.

agreed

based on their history i have very low confidence the republicans will do whats right for all americans on health care

[B-Man]

"The implicit standard in analysis of the health insurance system is that every consumer must have government-selected coverage............But why?"

"This chosen paradigm doesn't take into consideration the most forceful motivation of human behavior, namely, whether a large expenditure of limited resources is in one's economic interest. This standard of 'universal coverage' is as artificial as the government's bloated health care costs. A young person with minimal health expenses is well served not to purchase one of these government-created insurance policies: their yearly medical expenses do not exceed the cost of their premiums and deductibles. With the rate Obamacare costs are skyrocketing, that pool isn't just confined to young people anymore. If an individual or family has to fork out tens of thousands of dollars before seeing health care benefits, what's the point? Why not save that money and when services are needed, pay directly to the care providers?"

Good questions asked by Liz Sheld at PJ Media.

I don't know what the answers are, but I'm suspicious of mainstream media for obscuring these questions, which were also obscured when Obamacare was passed. Healthy young people who'd been choosing not to buy insurance were needed in the pool, paying premiums, to make it possible for companies to be forced to take in and keep customers with pre-existing conditions. The pro-Obamacare propaganda continually presented insurance coverage as an end in itself, as if the individual is better off with insurance. But really the idea was more that the entire system of financing health care with private insurance companies is better off if more people participate — especially more people who don't have high current expenses — that is, the kind of people who, left to their own devices, are most likely to prefer to use their money to buy something other than insurance they don't think they're going to use.

It's a difficult scheme, and to pull it off, it seems that people need to be fooled. The key to the fooling — I think — is to speak in terms of how many people are "covered," not in terms of how many people are better off.

Right now, it seems that many of the people who have coverage pay a lot of money for something they can't use. If they are not better off in that position, why are we supposed to feel bad if they get a reprieve from needing to pay a lot of money for something that has no value to them? I think the secret answer is: Because insurance companies need that money to keep paying the bills for the customers who do have expensive conditions, the people who are happy to get to pay premiums because they get back more than they put in.

I wish we could speak clearly and honestly about the real problems. I find the complexity — confused by partisan propaganda — horrible. And I am not dealing with a struggle to pay premiums or any serious health problems. I do not see how most people can be expected to engage with these issues other than to gravitate toward the propaganda of one side or the other and be scared.

Edited March 15, 2017 by B-Man

[Magox]

"Death spiral? What death spiral?

 

The report provides a bit of good news for Obamacare supporters and detractors. Despite some instability in Obamacare's marketplaces, the CBO doesn't believe the health care law is facing a dreaded death spiral, in which premiums rise so high that only the sickest patients are motivated to purchase insurance. Nor does the CBO think the GOP plan would result in a death spiral.

 

The report says Obamacare's income-based subsidy structure is protecting enrollees from higher premiums, which comes at a greater expense to the federal government. And the CBO thinks the individual mandate is still enough of an incentive to bring healthy people into the marketplace.

 

 

 

 

So much for that lie peddled here and by GOP politicians

 

 

It's not so black and white as many people paint it to be. Is the ACA in a "death spiral"? Well, yes and no, kinda.

 

It's not as if health insurance is one giant risk pool, there are many many localized individual risk pools throughout the country. Typically urban areas with high populations tend to have a higher proportionate amount of young people insured with the carriers offered in that area, meaning you have healthier risk pools which in turn means lower premiums. Whereas many rural areas tend to skew towards older populations which means unhealthier risk pools and higher premiums. That has always been the case.

 

What is different now under the ACA than pre ACA is with the additional mandates of more coverage via the minimum essential benefits and the perverse incentives that favor older people through their community based rating that disincentivizes younger healthier enrollees, you are seeing a death spiral for people who don't qualify for subsidies. Rates literally went up over 40% in this area this past year.

 

Look at those plans, for $1000 a month, you get a $7000 deductible that doesn't even have a single copay. Now tell me, if the underlying rates are going up 20,30,40,50% a year in these areas and you aren't qualifying for a subsidy, can someone with a $50,000-$80,000 a year income truly afford a $1000 month policies that barely pays for anything?

 

That is a death spiral, because guess what? That individual market which only has one carrier in it, will continue to raise rates because the only ones who will purchase those policies are people who qualify for large subsidies or people who are very dependent on healthcare, meaning sicker individuals.

 

Did you know that 1/3 of all the counties in the US only have one carrier offering policies through the ACA exchange? Why do you think that is? It didn't start off that way. There were more, there were lots of CO ops that were created and they went bankrupt. Why do you think that is, Tiberius? Did they decide that they now hated money and they didn't want to make any more of it?

 

They went bankrupt or made the financial decision to pull out because they were losing money. They couldn't raise the rates high enough to cover their losses. Which is why under the ACA it is virtually a localized monopoly throughout the country of a few various carriers.

 

When Trump says we could allow the ACA to fail on its own, well........ That wouldn't quite happen either. Yes, you would most likely see certain regions within certain states where there would be no carriers. That is the direction we are heading, so in that region, yeah that would happen. But in most areas, you would still see functioning markets. Waiting for the majority of the ACA to implode wouldn't happen in Urban markets. Waiting for it to implode is largely a talking point.

Edited March 15, 2017 by Magox

[Magox]

 

Sen. Joe Manchin (D-W.Va.), among the most conservative Democrats, who is up for re-election in 2018, said on Monday the bill is “morally wrong.”

"To do what they're doing right now is absolutely unconscionable," Manchin said. “It's just awful … There's got to be a moral compass inside somebody.”

"Can’t sugarcoat it, it doesn't look good, does it?" observed Sen. Bill Cassidy (R-La).

It’s tough to guess how long Republicans can carry the day with a “trust us” argument, with spooked conservatives and moderates both peeling off and many health industries wary of the party’s replacement plans.

Price and others are already attacking the CBO for reviewing just the first part of the replacement plan. But that ignores the fact that the CBO is only supposed to analyze legislation that has been introduced — and not take into account extraneous promises from the White House and GOP leaders about what else may or may not happen down the road.

 

 

Trump is more of a moderate when it comes to healthcare than the hardliners and even more so than GOP leadership. He ran on the promise that he would prioritize overall coverage and lower premiums. I mean the guy advocated for Universal healthcare on more than a few occasions. His core supporters like that, his core supporters are not Cruz sort of supporters. He's not a fiscal hardliner.

 

I do believe he will intervene, and start focusing on getting overall coverage up. Not now, he has to appease the Freedom caucus and get their support. Once he has them locked up with a concession or two, you'll begin to see him moving more in that direction once it goes to the Senate. There are many more moderate/centrists in the Senate that he has to worry about than the fiscal hardliners, even though they will pose a challenge. Rand Paul and Mike Lee I believe will be the most difficult. Cruz I believe will cave because he has a re election coming up and ever since Trump has been elected he has been kinda sucking up to him. He doesn't want to turn away Trump supporters, he still has national ambitions and he was profoundly hurt with his clashes with Trump. My guess is that there will be another concession or two to lock up his support. And if not, then he'll continue to go in the other direction to try to get Manchin's support and that would do it.

[Magox]

Plus, the bill is a far cry from President Donald Trump’s promise to cut costs and provide better coverage, even “insurance for everybody” as he once vowed. The conflicting messages have Republicans wondering what problem they are trying to solve.

“We’ve got to come back to defining what is success. What is the objective we are trying to accomplish here? We saw premiums go up, not down. And that to me is not success,” Sen. Steve Daines (R-Mont.) said of the CBO report. “That’s not acceptable. To me, we’ve got to find a better path forward.”

“Fourteen million people would lose insurance in a year relative to baseline. That’s something that folks are going to be concerned about,” said Sen. Bill Cassidy (R-La.). “Who wants to see 14 million people lose coverage?”

 

 

 

Despite the gripes, GOP leaders refuse to concede their deadline of passing a repeal bill within the next month is unrealistic. It’s a negotiating tactic intended to create urgency, lawmakers said, out of fear the party could dither endlessly without a target date. House GOP leadership will begin whipping the bill this week to get a tentative vote count, and intend to hold a vote next week.

But leaders on both sides of the Capitol now admit that the yawning gap between the House and Senate may require far more intricate negotiations than simply jamming bills through each chamber before the April 8 Easter recess. In the House, for instance, leadership is considering an amendment to allow states to impose work requirements on healthy Medicaid beneficiaries, which could lure conservative votes without repelling moderates.

Senators say they’ve got some ideas of their own, including beefing up the tax credits and helping states deal with the reversal of Obamacare’s Medicaid expansion.

“We’re going to consider trying to work on the coverage numbers and get those better,” said Senate Majority Whip John Cornyn (R-Texas) in an interview. He would not rule out bicameral negotiations between the House and the Senate. “It may be well be this goes back to a conference committee.”

The public sniping has triggered triage at the highest levels of government. Conservatives from both chambers are visiting the White House this week to try to persuade Trump to back their pitch to push the bill further right. Vice President Mike Pence, Health and Human Services Secretary Tom Price, as well as two key House chairmen, Reps. Greg Walden of Oregon and Kevin Brady of Texas, visited the Senate GOP lunch on Tuesday to try and calm nerves over the brutal CBO score, attendees said. They emphasized that Republicans plan to do far more than just the current proposal under consideration.

 

 

 

But the most immediate concern is ensuring a repeal bill can pass the House.

“The worst thing we can do is do a half-assed job,” said Rep. Ted Yoho (R-Fla.), a member of the House Freedom Caucus who says he will not support the current bill. “If we don’t deliver on what we were told to do, we won’t get voted back in. Nor do I feel we deserve to be back in.”

White House advisers on Monday were readying a major push to give the far right some sort of “significant” concession, skittish that House whips couldn’t pass the bill without more conservative support. One idea being considered: Phasing out the Medicaid expansion in early 2018 instead of Dec. 31, 2019.

House GOP leaders, however, are pushing back against the idea because, as Rep. Charlie Dent (R-Pa.) said, it “would cost a lot of votes.”

A quicker phaseout would also be frowned upon by the Senate, where more than a dozen senators are worried about how low-income people and elderly constituents will be treated by the House proposal. They could lose coverage altogether or see their premiums skyrocket.

Senators are considering taking whatever the House is able to pass and beefing up tax credits for low-income people to help bring down premiums and increase coverage numbers, multiple Republican sources said. John Thune of South Dakota, the No. 3 GOP senator, is one of the lead proponents of that effort.

 

 

Also under consideration is injecting billions of dollars into states’ “stabilization” accounts to narrow the coverage gap between Obamacare and the House’s repeal-and-replace bill. Cassidy said he’d want prefunded Health Savings Accounts for low-income people who would otherwise struggle to sock away savings for health care.

Some of those proposals could be paid for by slashing tax credits for wealthier Americans. But several sources said it might require using some of the $377 billion in savings from the bill to help prop up coverage for people who would lose it. Those savings are one of the few bright spots from the CBO score, but paying for more generous tax credits and stabilization accounts would cut into the bill’s deficit reduction and turn off undecided conservatives.

That’s unlikely to go over well in the House, which is generally more conservative than the Senate. And the House would have to vote on any changes made by the Senate.

 

 

http://www.politico.com/story/2017/03/obamacare-repeal-republicans-trump-congress-236045

 

All decent proposals. Unlike the ACA, whenever there were concerns with the bill when it was being crafted, they just jammed it in despite the negative analysis. It appears that GOP leadership is looking to improve parts of it based on the negative feedback. That's the way it should be. In the senate, increasing coverage seems to be the predominant priority.

 

The goal should be have expanded coverage, naturally it won't be as much as the ACA because of the mandate but if they can get within 5-8 million people that would be good IF they can bring down premiums substantially lower than under the ACA, while providing more choices and doctors that accept the plans, with some Deficit savings, that in my view would be what success looks like.

Edited March 15, 2017 by Magox

[Tiberius]

It's not so black and white as many people paint it to be. Is the ACA in a "death spiral"? Well, yes and no, kinda.

 

It's not as if health insurance is one giant risk pool, there are many many localized individual risk pools throughout the country. Typically urban areas with high populations tend to have a higher proportionate amount of young people insured with the carriers offered in that area, meaning you have healthier risk pools which in turn means lower premiums. Whereas many rural areas tend to skew towards older populations which means unhealthier risk pools and higher premiums. That has always been the case.

 

What is different now under the ACA than pre ACA is with the additional mandates of more coverage via the minimum essential benefits and the perverse incentives that favor older people through their community based rating that disincentivizes younger healthier enrollees, you are seeing a death spiral for people who don't qualify for subsidies. Rates literally went up over 40% in this area this past year.

 

Look at those plans, for $1000 a month, you get a $7000 deductible that doesn't even have a single copay. Now tell me, if the underlying rates are going up 20,30,40,50% a year in these areas and you aren't qualifying for a subsidy, can someone with a $50,000-$80,000 a year income truly afford a $1000 month policies that barely pays for anything?

 

That is a death spiral, because guess what? That individual market which only has one carrier in it, will continue to raise rates because the only ones who will purchase those policies are people who qualify for large subsidies or people who are very dependent on healthcare, meaning sicker individuals.

 

Did you know that 1/3 of all the counties in the US only have one carrier offering policies through the ACA exchange? Why do you think that is? It didn't start off that way. There were more, there were lots of CO ops that were created and they went bankrupt. Why do you think that is, Tiberius? Did they decide that they now hated money and they didn't want to make any more of it?

 

They went bankrupt or made the financial decision to pull out because they were losing money. They couldn't raise the rates high enough to cover their losses. Which is why under the ACA it is virtually a localized monopoly throughout the country of a few various carriers.

 

When Trump says we could allow the ACA to fail on its own, well........ That wouldn't quite happen either. Yes, you would most likely see certain regions within certain states where there would be no carriers. That is the direction we are heading, so in that region, yeah that would happen. But in most areas, you would still see functioning markets. Waiting for the majority of the ACA to implode wouldn't happen in Urban markets. Waiting for it to implode is largely a talking point.

So changes are needed, and will always be needed because health care, insurance, technology and demographics are always changing. But there is no working with these Republicans. They just see anyone with less than a couple million dollars as animals. They are just using the facts you pointed out to try and trash the whole system and leave the animals to fend for themselves

[DC Tom]

So changes are needed, and will always be needed because health care, insurance, technology and demographics are always changing. But there is no working with these Republicans. They just see anyone with less than a couple million dollars as animals. They are just using the facts you pointed out to try and trash the whole system and leave the animals to fend for themselves

[This is an automated response.]

 

 

Created by DC Tom-bot, beta version 0.7.

[keepthefaith]

So changes are needed, and will always be needed because health care, insurance, technology and demographics are always changing. But there is no working with these Republicans. They just see anyone with less than a couple million dollars as animals. They are just using the facts you pointed out to try and trash the whole system and leave the animals to fend for themselves.

 

It's no surprise that you would respond to an informative and well crafted post with your typical serving of poop.

[Tiberius]

[This is an automated response.]

 

 

Created by DC Tom-bot, beta version 0.7.

The garbage man is at work!

It's no surprise that you would respond to an informative and well crafted post with your typical serving of poop.

 

How would you be able to tell what's informative from what's poop? You are no where near intelligent enough to do that

[B-Man]

 

It's no surprise that you would respond to an informative and well crafted post with your typical serving of poop.

 

No surprise whatsoever........one has to admire Magox's patience, he posts a substantive reply and what does Gator come back with ?

 

Republicans view people as animals.............................amazingly simplistic, even for him

[Tiberius]

No surprise whatsoever........one has to admire Magox's patience, he posts a substantive reply and what does Gator come back with ?

 

Republicans view people as animals.............................amazingly simplistic, even for him

It's true. A propagandist like you can't agree of course, it goes against what you do. You are an amoral scum bag

[DC Tom]

It's true. A propagandist like you can't agree of course, it goes against what you do. You are an amoral scum bag

[This is an automated response.]

 

 

Created by DC Tom-bot, beta version 0.7.

[Tiberius]

[This is an automated response.]

 

 

Created by DC Tom-bot, beta version 0.7.

The GOP sees you as an animal, too. A useful one though, like a pig that will be bacon

[Magox]

What a quandary, you have different factions of the GOP all fighting over what should be done. You have the hardliners pure market driven people who are pulling in one direction, then you have the moderate/centrists who want slightly more expanded coverage, then you have the populists, who essentially want entitlements and near universal coverage and then you have GOP leadership Ryan/Price who are stuck in the middle.

 

It's funny watching Laura Ingraham attempt to protect Trump by saying that Ryan is building a "trap" for Trump.

 

Former senator Judd Gregg (R-N.H.), who was a key player in the battle over the Affordable Care Act in 2010, said of the current situation: “The Republicans are in an impossible position.”“Most of the people who are in opposition to this have never governed, don’t know how to govern and don’t want to govern,” Gregg said. “Unfortunately, Republicans now control the government and have to learn how to govern. The Laura Ingrahams of the world, who make their money agitating, aren’t functional in a situation where the president has to govern.”

 

Edited March 15, 2017 by Magox

[Meathead]

 

Trump is more of a moderate when it comes to healthcare than the hardliners and even more so than GOP leadership. He ran on the promise that he would prioritize overall coverage and lower premiums. I mean the guy advocated for Universal healthcare on more than a few occasions. His core supporters like that, his core supporters are not Cruz sort of supporters. He's not a fiscal hardliner.

 

I do believe he will intervene, and start focusing on getting overall coverage up. Not now, he has to appease the Freedom caucus and get their support. Once he has them locked up with a concession or two, you'll begin to see him moving more in that direction once it goes to the Senate. There are many more moderate/centrists in the Senate that he has to worry about than the fiscal hardliners, even though they will pose a challenge. Rand Paul and Mike Lee I believe will be the most difficult. Cruz I believe will cave because he has a re election coming up and ever since Trump has been elected he has been kinda sucking up to him. He doesn't want to turn away Trump supporters, he still has national ambitions and he was profoundly hurt with his clashes with Trump. My guess is that there will be another concession or two to lock up his support. And if not, then he'll continue to go in the other direction to try to get Manchin's support and that would do it.

 

i hope youre right

 

i just dont trust the don, i think hes a low character individual who will do whats best for the don. that makes him entirely unpredictable. it could go the way you aptly described, or he could suddenly change course and go full republican on health care and start funneling more money to the one percent at the expense of the rest

 

i sure hope he comes through as you suggest. i remain unconfident

 

 

 

 

http://www.politico.com/story/2017/03/obamacare-repeal-republicans-trump-congress-236045

 

All decent proposals. Unlike the ACA, whenever there were concerns with the bill when it was being crafted, they just jammed it in despite the negative analysis. It appears that GOP leadership is looking to improve parts of it based on the negative feedback. That's the way it should be. In the senate, increasing coverage seems to be the predominant priority.

 

The goal should be have expanded coverage, naturally it won't be as much as the ACA because of the mandate but if they can get within 5-8 million people that would be good IF they can bring down premiums substantially lower than under the ACA, while providing more choices and doctors that accept the plans, with some Deficit savings, that in my view would be what success looks like.

 

thats a great article. i thought i read all the ones on politico, i musta missed it or it came out after i was perusing the lists

 

in any event, that actually makes me a little more confident. they (republicans) appear to be seriously considering the fallout if they do what they normally do and prioritize getting more money to ppl that already have a lot, which disgusts me when talking about health care. the moderates appear (for once!) to have a real voice this time, most likely due to the razor thin margin they have in the senate, not to mention the short cycle they have until midterms where they could get punished for any carelessness to the ppl they would be pushing out of health care

 

i am afraid to get my hopes up hoping the republicans have finally changed their spots on health care. they have been completely intransigent on this topic for as long as i can remember, its hard to imagine they may actually reverse all that and do the right thing for non-wealthy americans

the republicans are asking us to trust them, they will fix this in later stages. i find very little in recent history to give them the benefit of the doubt on this. but i will keep my fingers crossed, again

[Magox]

This is suprising

 

The new survey — conducted in the days following release of the bill by House GOP leaders — underscores the political thicket that President Donald Trump and congressional Republicans face in taking on the issue. While Americans are open to the GOP proposal, there is pessimism that rolling back Obamacare will improve quality, price and coverage.

Overall, 46 percent of voters approve of the GOP health care proposal, more than the 35 percent who disapprove. Nineteen percent of voters say they don’t have an opinion of the bill. But any support is shallow: Only 4-in-10 voters say they either “strongly approve” or “strongly disapprove” of the bill, with strong disapproval (22 percent) slightly outpacing strong approval (18 percent).

"Given the wave of criticism from both parties following the rollout of the bill, this is a relatively strong starting point for GOP leaders and the White House," said Kyle Dropp, Morning Consult’s co-founder and chief research officer. "However, it will be important to track how public opinion stands up as more information is released in the coming weeks."

 

[GG]

Are there any actuaries on this board?

 

Low probability is my guess