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Tags Affordable Care Act , AHCA , donald trump , health care issues , health insurance issues , obamacare , Trumpcare

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Old 1st July 2017, 10:49 AM   #161
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So Trump's great plan is now to simply repeal the legislation and then replace it at some later date, presumably one of his in 2 weeks time scales. Serious question what would be the consequences of just making the current act null and void?
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Old 1st July 2017, 12:43 PM   #162
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Originally Posted by Darat View Post
So Trump's great plan is now to simply repeal the legislation and then replace it at some later date, presumably one of his in 2 weeks time scales. Serious question what would be the consequences of just making the current act null and void?
Tax cuts for those earning over $200,000 a year. 20 to 30 million Americans lose health insurance. Medicare ends up in a funding crisis in only a couple of years. About a half million Americans in the health care field lose their jobs as the funding dries up.
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Old 1st July 2017, 01:17 PM   #163
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Originally Posted by newyorkguy View Post
Complaint by whom? The post I was responding to said Congress was advised by the actuary industry that the rise was too steep. I think really to vet some of this one would have to go back and read news articles from 2009-2010.
I did find a source for actuaries complaining that the premiums for young people would rise due to the 3 to 1 limit on variations by age. As the penalties for not having insurance are rather low, many young people would just pay the penalty.

Source.
Quote:
The low penalties associated with the individual mandate in the legislation are particularly problematic given the market reform rules that limit premium variations by age. The narrower the allowed premium variation, the stronger the individual mandate needs to be in order to ensure that low- risk individuals obtain and keep coverage. Moving to a narrow limit on premium variations by age, such as the proposed 3-to-1 limit, could result in dramatic premium changes, compared to what individuals face currently. In particular, younger individuals in states that currently allow underwriting and wider premium variations by age could see much higher premiums than they experience currently (and may have chosen to forgo). The premiums for younger and healthier individuals will likely be high compared to the penalty, especially in the early years, but even after they are fully phased in, they are likely to lead many to forgo coverage.
From an actuarial standpoint the penalty should be so large that everyone would buy insurance. This would not look good from a political standpoint. For that reason the penalty started out low and gradually increased to modest. It's still cheeper for most people to pay the penalty instead of buying insurance. Assuming of course that they don't have any serious medical problems.
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Old 1st July 2017, 01:39 PM   #164
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Originally Posted by Kestrel View Post
I did find a source for actuaries complaining that the premiums for young people would rise due to the 3 to 1 limit on variations by age. As the penalties for not having insurance are rather low, many young people would just pay the penalty.

Source.


From an actuarial standpoint the penalty should be so large that everyone would buy insurance. This would not look good from a political standpoint. For that reason the penalty started out low and gradually increased to modest. It's still cheeper for most people to pay the penalty instead of buying insurance. Assuming of course that they don't have any serious medical problems.

It's kind of amazing how many of these sorts of problems would be eliminated by a simple single payer system.

Everyone pays in through their taxes. Coverage comes from that. Everyone gets covered.

The entire country is the pool, and the single payer negotiates the best deals it can get for a pool of over 300,000,000.

Obviously a system like that could never work, though. Nobody has ever made that happen.
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Old 1st July 2017, 02:40 PM   #165
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Originally Posted by quadraginta View Post
It's kind of amazing how many of these sorts of problems would be eliminated by a simple single payer system.

Everyone pays in through their taxes. Coverage comes from that. Everyone gets covered.
That's Socialism - which everyone knows has failed wherever it was tried (and any that haven't yet will eventually - you just wait and see!).

The biggest problem with single payer is the lack of competition. Only the Free Market can deliver a truly efficient solution with the lowest possible cost. That solution may involve even more concentration of wealth by a few, and millions of people dying on the streets, but it will be efficient!*


* defined as:- making the most money for the 1%.
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Old 1st July 2017, 04:37 PM   #166
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Originally Posted by Kestrel View Post
...From an actuarial standpoint the penalty should be so large that everyone would buy insurance. This would not look good from a political standpoint. For that reason the penalty started out low and gradually increased to modest. It's still cheeper for most people to pay the penalty instead of buying insurance. Assuming of course that they don't have any serious medical problems.
I appreciate your linking the 2009 American Academy of Actuaries letter to Senator Harry Reid, who was then Senate majority leader.

I suspect one problem with increasing the penalties was Republican opposition. In fact, a New York Times article from Nov. 7, 2010 (the link I have requires a log-in) reported on Republican intentions to block the new law by blocking funding. One of the strategies they planned was to block IRS appropriations to fund enforcement of penalties.
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Old 1st July 2017, 06:40 PM   #167
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Originally Posted by newyorkguy View Post
Complaint by whom? The post I was responding to said Congress was advised by the actuary industry that the rise was too steep. I think really to vet some of this one would have to go back and read news articles from 2009-2010.
And you might be disappointed by the news articles. Political reporters aren't necessarily health-care wonks. Maybe at the NYT. Even when reporters get into the nitty-gritty, the audience for any one niche in a sprawling bill is limited, because there are so many aspects of the law. Medicare, Medicaid, Part D, pre-existing conditions, age differentials on premiums, income differentials on premiums, deductibles, co-pays, how fast to pull the rug beneath people's feet, keeping "kids" on till age 26, tax credits and it just goes on and on.

The middle-class people reading these stories probably weren't totally engrossed, because the majority of households were able to hang on to at least one full-time job with benefits, but that share is rapidly shrinking.

Obama's most prominent success is not really the nuts and bolts of the ACA. It's the fact that nowadays throwing 20+ million off the health-care rolls is seen as politically risky. So goody, Republicans are having to get informed. It's progress but only of the most painful sort. Because the more the GOP tries to fix the U.S. system, the more obvious it becomes that they really want to break it some more. What's McConnell's big threat to rally his troops? Bipartisanship.

A third of Mitch McConnell and and Rand Paul's constituents are on Medicaid. Add the people already on Medicare, and people working in the health-care industry, and people who get insurance through government jobs, and what you have, massively, is a constituency that is very invested in having an orderly health-care delivery industry, while their 2 Republican senators are absolutely determined to throw the biggest possible wrench in the works.

I'm not oblivious to the fact that amidst all this, actual wealth must be created and maybe these senators think they are addressing that issue.

What am I missing?
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Old 2nd July 2017, 04:11 AM   #168
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Please, please do this.

Quote:
Axios' Jonathan Swan ferreted out the intriguing news that the White House has reached out to former Trump campaign officials in hopes of ginning up repeal-and-replace rallies in Maine to pressure Sen. Susan Collins, and Nevada to try to retrieve Sen. Dean Heller.
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Old 3rd July 2017, 03:27 AM   #169
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Originally Posted by quadraginta View Post
If only it were so simple.

Mrs. qg is on Medicare and has a supplemental Part D policy.

She only needs two drugs to manage her COPD, a Spiriva Handihaler, and a Ventolin inhaler. (Well ... three, counting the oxygen she is hooked up to 24/7) She pretty much has to have these two drugs, or all the supplemental O2 in the world won't keep her out of the emergency room.

Our Part D plan is one of the best bang-for-the-buck plans for those two drugs I can find, using all the different insurance calculators out there.

Just looking at the Spiriva alone, over a year. Jan. is full price, just about, because of the deductible. That's right at $500. Just for one month. After that we get a stretch of months which aren't unmanageably painful, right at $100 per. For a while.

Then, around the Fall of the year, their "donut hole" kicks in. Prices jump back up to around $300 per month or more. We don't get out of the "hole" before the end of the year, when it all starts over again.

That's just for one drug, not coincidentally, I suspect, one of the most commonly prescribed drugs for her condition. COPD patients are enough of a profit target for the pharmaceutical industry that several major news organizations have done specials on the price abuse.

For some of you this may not sound all that bad, But like I said, that's just one drug. And just one of hers.

We are both on fixed incomes. I'm on disability. I can't work at all. She's on SS. She can only get out of bed with great effort. We have a little back-up in the bank, but thanks to things like this it is evaporating rapidly.

We pay 20% of every doctor's appointment, every piece of medical equipment, every everything.

Our income from SS is sufficiently high (just barely)to keep us from being eligible for any other supplemental medical assistance. We just have to get by.

I skip my doctors' appointments whenever I think I can safely do so. Just to slow down the evaporation of our meager savings. I have more doctors than she does. More meds, too.
Clearly the republican solution to this issue is you both need to just get jobs with better health insurance.
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Old 3rd July 2017, 03:29 AM   #170
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Originally Posted by Emily's Cat View Post
I really wish that politicians would stop trying to design health systems. They don't know anything about how it works. It's almost guaranteed to be a disaster.

You want something better? Commission the NAIC and the AAA to come up with a solution. Then stick with it.
Industries always write the best regulations for them. It is like the futility of regulating the banking industry when it really should be self regulating. They know what they are doing far better than any politician's.

Sounds like having foxes design your hen house.
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Old 3rd July 2017, 03:31 AM   #171
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Originally Posted by Emily's Cat View Post
Those two organizations are pretty much the only ones with sufficient understanding of the current marketplace, the dynamics of insurance, and the impacts that changes to that marketplace (including UHC or single payer) will have. Anyone else is almost guaranteed to create as much havoc as progress.
And as such they have a vested interest in keeping the fundamental marketplace in place. Because changes that are too large are going to destroy their jobs.
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Old 3rd July 2017, 04:15 AM   #172
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Quote:
2. Changing the subsidy to be age-adjusted to reduce the dramatic cliff experienced by older consumers when they hit 400%...
The Trump healthcare proposes going to age-based subsidies rather than income. Here's the argument against it:
Quote:
"This means that Bill Gates would qualify for the largest tax credit simply because he is 61 years old. ... Conversely, a 23-year-old with little income and health problems gets minimal help under Price's plan — despite the fact that they need support much more than Gates does."
Arguments for:
Quote:
One reason for choosing to allocate subsidies by age is practical — it's far easier to administer. In fact, one of the biggest ongoing struggles for the implementation of Obamacare has been coming up with ways to verify applicants' income for the purposes of determining subsidies...Another reason is that adjusting by age could potentially cover more people by more efficiently allocating government spending. In a more market oriented system, insurance is going to be a lot cheaper for younger people. Imagine giving a 30 year-old with a low income the highest tax credit available under the Price plan — $3,000 per year. If, in a market-based system, that 30 year-old could easily find insurance for $100 per month, or $1,200 per year, it means the government is leaving $1,800 in subsidy money on the table that in the age-based system would go toward helping somebody older with more expensive insurance. Link
Under Obamacare subsidies end once people's income reach 400% of the federal poverty level (FPL) which is currently about $98,000 a year. According to Census Bureau statistics that is a) not a lot of people and b) income usually declines once a person reaches their early 50s. Seems to be valid arguments on both sides..

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Old 3rd July 2017, 04:59 AM   #173
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Originally Posted by newyorkguy View Post
The Trump healthcare proposes going to age-based subsidies rather than income. Here's the argument against it:


Arguments for:


Under Obamacare subsidies end once people's income reach 400% of the federal poverty level (FPL) which is currently about $98,000 a year. According to Census Bureau statistics that is a) not a lot of people and b) income usually declines once a person reaches their early 50s. Seems to be valid arguments on both sides..

http://i1336.photobucket.com/albums/...psmnaiehoe.jpg
The $98,000 figure is for a family of 4. 400% of the Federal Poverty Level is just under $48,000 for a one person household. (2016 FPL figures are used for insurance purchased this year). Are these income charts for a household or a person?
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Old 3rd July 2017, 01:47 PM   #174
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This is for individuals, forgot the link. The point still holds. Even for single person households, where 4x the FPL is $48,000, on average people would lose the ACA subsidy from their late 30s to their late 50s which is when earnings are usually at a peak.

Average household size per the 2010 census is 2.58 persons. Link Here's a chart showing median household income by age:
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Old 4th July 2017, 01:25 PM   #175
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Quote:
3. changing the age scale to be 5:1 instead of 3:1 to allow for lower rates for younger people.
This part of ACA was aimed at spreading costs more equitably. It was not a popular choice among actuaries or insurers for the reason that, coupled with low penalties for failure to buy coverage, it might mean many younger healthier persons would conclude it would be cheaper to pay the penalty rather than buy a healthcare plan. The American Academy of Actuaries advised Senator Harry Reid:
Quote:
The premiums for younger and healthier individuals will likely be high compared to the penalty, especially in the early years, but even after they are fully phased in, they are likely to lead many to forgo coverage. Link
The National Association of Insurance and Financial Advisors said:
Quote:
One provision in the Patient Protection and Affordable Care Act (ACA) compresses the permitted age band rating to a 3:1 ratio. While the goal of this provision is to attempt to spread health care costs more equitably over the age spectrum [a recent study] concluded that premiums could increase by as much as 42 percent for individuals between 21-29 years of age due to age band constriction. Link
The 3:1 ratio remained in the legislation yet some studies found the uninsured rate among younger Americans did go down. A study by the Urban Institute found:
Quote:
[Figures] show that among adults ages 19 to 34, who had relatively a high uninsured rate of 30 percent in 2010, nearly 8.7 million people gained coverage from 2010 to 2015 (a 41.5 percent reduction in the uninsured). Link.
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Old 4th July 2017, 03:42 PM   #176
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The penalties haven't really had time to work, eventually they would be so high that it would make more sense for the young people to buy in.
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Old 4th July 2017, 04:46 PM   #177
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The fallacy is, young people don't need healthcare. ACA is aimed at providing people with primary care, the goal being to keep people healthy, not just provide treatment for people who are seriously ill. This is one of the reasons most medical associations are on board. The best path to good health is to start seeing a primary care physician when you are young. By the time you reach the age where you're at increased risk the doctor has a good history on you and they can often spot problems long before they become serious ones. In the long run, that's cheaper for everybody. Which was the whole idea behind ACA; but we don't see the forest for the trees.

Plus young people do need healthcare. They get sick, they break limbs, get pregnant etc.
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Old 4th July 2017, 06:10 PM   #178
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It's not so much that young people don't need healthcare as that being young changes the risk/reward equation. The 3 to 1 ratio means that younger people are subsidizing older people. Which in my view is not a bad thing because those young people will also get old, at which point they would benefit from this system.
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Old 4th July 2017, 06:31 PM   #179
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Originally Posted by Marcus View Post
It's not so much that young people don't need healthcare as that being young changes the risk/reward equation. The 3 to 1 ratio means that younger people are subsidizing older people. Which in my view is not a bad thing because those young people will also get old, at which point they would benefit from this system.
I'm a very good driver. I don't balk at my insurance premiums because those 19 yr olds get in more accidents.

People can frame heath insurance in a dozen ways. When someone wants a tax cut for the wealthy or ignorantly believes the ACA's regulation of health insurance is akin to a government takeover of health care, it's very easy to frame the problem in a way that causes people to reject the ACA.
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Old 4th July 2017, 06:46 PM   #180
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Originally Posted by Skeptic Ginger View Post
I'm a very good driver. I don't balk at my insurance premiums because those 19 yr olds get in more accidents.

People can frame heath insurance in a dozen ways. When someone wants a tax cut for the wealthy or ignorantly believes the ACA's regulation of health insurance is akin to a government takeover of health care, it's very easy to frame the problem in a way that causes people to reject the ACA.
That's actually an argument that we should subsidize the high car insurance premiums paid by 19 year olds. At least I think we don't do that now, I do know their premiums are very high.
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Old 4th July 2017, 07:21 PM   #181
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Originally Posted by Marcus View Post
That's actually an argument that we should subsidize the high car insurance premiums paid by 19 year olds. At least I think we don't do that now, I do know their premiums are very high.
No, it's an argument that no one blinks at paying car, house and fire insurance. It's just that single payer medical insurance or government health insurance is a change in the norm for the US and it takes a great effort to make such a change.

We can see from the countries with single payer or national health insurance policies that ALL people benefit from such a system, it is more efficient.

My health insurance costs more than a young healthy person and my car insurance costs less. There is nothing wrong with that, within a reasonable range for everyone (people with DUIs excepted). I have no issue with a surcharge for smokers.

Obesity and drug addiction need careful scientific research before such surcharges are added to those policies but those details are beside the point.

The point is, get over the hurdle of people believing because some people need more medical care than others we can't change to single payer or national health insurance and regulation of the health care industry. Yes we can and we'll all be better off if we do. All the research results support that conclusion.

After that, the rest are just negotiable details.

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Old 5th July 2017, 04:23 PM   #182
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Originally Posted by Kestrel View Post
When the ACA was being designed they brought in lots of experts. It hasn't been a disaster despite the Republican claims that it has.
Have you been paying attention to the number of carriers exiting markets, the counties with zero coverage available, and the rate hikes coming down for 2018? What does it take for you to see it as a disaster?
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Old 5th July 2017, 04:27 PM   #183
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Originally Posted by newyorkguy View Post
No.2, changing the subsidy to age-adjusted to avoid older consumers paying 400% of...the cost of the basic premium?

First of all what I'm seeing is the difference in costs -- between a 21-year-old and someone age 64 -- is actually about 300% or, as I find it more often expressed, 3x. This is a chart from ValuePenguin:

http://i1336.photobucket.com/albums/...psiownzoj0.jpg

The ACA planners said this was done in order to allow insurers to consider age when determining premium cost. The reason for that seems obvious. However, individual states can set their own regulations. Most use the federal guidelines (above) but a few don't. New York and Vermont do not allow age to be a consideration in computing premium costs. Massachusetts does but only allows a 2x rise.

I can agree that seeing the premium cost more than double between age 40 and 60 seems extreme. I presume the thinking is, medical requirements rise with age and so does (normally) income. I would want to know the history though and without searching a news archive it is a little hard to find. What was the original proposal? Was it changed? ACA went through a long hearing process and was amended dozens of times in order to try and gain some Republican support. What was the Republican position vs. the Democrats?
The SUBSIDY produces a cliff. A 20 yo who moves from 399% of FPL to 401% of FPL sees only a very marginal difference in their premium costs due to the loss of the subsidy. A 60 yo moving in those same brackets sees a dramatic increase in their premiums once that subsidy is taken away. The subsidy is tied to a % of income, but the premiums aren't. What ends up happening is that a low-income older family gets a substantially large subsidy that disappears when they cross the line.
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Old 5th July 2017, 04:30 PM   #184
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Originally Posted by newyorkguy View Post
FPL meaning federal poverty level. Income for a family of four at 4x the FPL would be about $98,000. Link Not having employer-based healthcare coverage is a big part of the problem. A survey done last year by the Commonwealth Fund found:


But the message being replied to was not about income-based subsidies, it was about the way ACA lets premiums rise as one ages. Removing limits on income-based subsidies is not one of the points that was listed that actuaries recommended
I think you misunderstood.

Originally Posted by Emily's Cat
American Association of Actuaries, Society of Actuaries, Blue Cross Blue Shield Association Actuarial Committee. Suggestions included:
  1. increasing the penalty for mandatory coverage,
  2. changing the subsidy to be age-adjusted to reduce the dramatic cliff experienced by older consumers when they hit 400%,
  3. changing the age scale to be 5:1 instead of 3:1 to allow for lower rates for younger people,
  4. removing the minimum FPL requirement for individual market that excluded people with incomes under 133%FPL and allow for less disruptive transitioning between Medicaid and Individual markets,
  5. revisions to the risk adjustment methodology to even out the disparate preference for older/sicker individuals over younger/healthier ones and create a more stable environment,
  6. creation of an invisible high risk pool to mitigate the impact from sicker than average new entrants
and a few others I don't recall.
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Old 5th July 2017, 04:35 PM   #185
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Originally Posted by newyorkguy View Post
The Trump healthcare proposes going to age-based subsidies rather than income. Here's the argument against it:
That's a bad argument. It isn't recommending that it be ONLY age-adjusted subsidies, but that it be both age and income adjusted. Thus a low income older person would receive a larger subsidy than a younger low income person... but high income person would receive no subsidy at all.
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Old 5th July 2017, 04:37 PM   #186
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Originally Posted by newyorkguy View Post
The 3:1 ratio remained in the legislation yet some studies found the uninsured rate among younger Americans did go down. A study by the Urban Institute found:
A very large portion of those got coverage to age 26 on their parent's plan, rather than purchasing their own.
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Old 5th July 2017, 04:39 PM   #187
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Originally Posted by newyorkguy View Post
The fallacy is, young people don't need healthcare. ACA is aimed at providing people with primary care, the goal being to keep people healthy, not just provide treatment for people who are seriously ill. This is one of the reasons most medical associations are on board. The best path to good health is to start seeing a primary care physician when you are young. By the time you reach the age where you're at increased risk the doctor has a good history on you and they can often spot problems long before they become serious ones. In the long run, that's cheaper for everybody. Which was the whole idea behind ACA; but we don't see the forest for the trees.

Plus young people do need healthcare. They get sick, they break limbs, get pregnant etc.
Medical associations are on board because ACA requires all preventive care to be at no cost to the insured individual, which means people go to the doctor more, which means doctors make more money.

ETA: Also because more people covered is better overall.

ETA2: But NOT because ACA has some great goal to provide primary care. It doesn't. Primary care is in there, but primary care was already in everything in the individual market (aside from critical illness and short-term policies, neither of which were removed by ACA, and both of which are regulated differently as they aren't considered comprehensive medical coverage in the first place).
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Old 5th July 2017, 04:43 PM   #188
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Originally Posted by Skeptic Ginger View Post
No, it's an argument that no one blinks at paying car, house and fire insurance.
All of which are risk adjusted. Car insurance varies by age, driving history, type of car, and location - the higher your risk of an accident, the higher your premium. House and fire are similar. They take into account the age the house was built, the location, the topology and terrain, the types of dangers in the area etc. Fire insurance in CA is much higher than in WA. Homeowners insurance in WA varies significantly depending on whether you're on a hillside or not.
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Old 5th July 2017, 05:08 PM   #189
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Originally Posted by Emily's Cat View Post
Medical associations are on board because ACA requires all preventive care to be at no cost to the insured individual, which means people go to the doctor more, which means doctors make more money...
You're seriously arguing the only reason medical associations support ACA is so doctors can make more money?
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Old 5th July 2017, 05:20 PM   #190
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Originally Posted by newyorkguy View Post
You're seriously arguing the only reason medical associations support ACA is so doctors can make more money?
Did you just not read anything beyond that spot? Or did you just not understand the whole "and because more people covered is better overall" part? Or did that sentiment weaken your outrage? Some other reason for ignoring the part of my post that would prevent you from inserting that pesky "only" in there... like nobody else can read?
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Old 5th July 2017, 05:23 PM   #191
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Quote:
[Dr. Jay Shannon, CEO of the Cook County Health & Hospital System] in his speech to a rally in front of Stroger Hospital, noted that the county has cut its subsidy to the health system by 75 percent in recent years, with payments dropping from $481 million in 2009 to a projected $115 million this year—"in large part due to the new revenues available as a result of implementation of the ACA."

Should the ACA be repealed without an adequate replacement, he said, "patients will go back to the days of choosing food for their families or the medications to stabilize their health. These are not choices that any human being should have to make, no less a human being living in the richest nation in the world." Link

The above is from an article in Crain's Chicago Business. On a PBS news report they interviewed low-income patients in Chicago with diabetes who have, for the first time, regular access to a primary care physician and their health has improved at the same time the cost of treating them has fallen. This is from the report:
Quote:
The health law also shifted the business model for U.S. hospitals. It offered them financial incentives to move away from expensive E.R. visits to primary care and managing chronic conditions.

Before the Affordable Care Act, hospitals had little incentive to reduce E.R. visits, especially from Medicare patients who generate a lot of revenue. At the University of Chicago Medicine, an academic medical center, Dr. Kenneth Polonsky says that if those incentives are rescinded and patients forgo preventive care, they will clog up already strained emergency rooms. "We will go back to a very frustrating time, where people had limited options for health care because of inability to get health insurance." PBS link
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Old 5th July 2017, 05:30 PM   #192
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Originally Posted by Emily's Cat View Post
Did you just not read anything beyond that spot?...
Give me a few minutes and I'll go back and edit my post, too.
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Old 6th July 2017, 04:57 AM   #193
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Originally Posted by Emily's Cat View Post
Have you been paying attention to the number of carriers exiting markets, the counties with zero coverage available, and the rate hikes coming down for 2018? What does it take for you to see it as a disaster?
And fortunately with the new republican fixes those counties will have no health care providers so they won't need coverage.
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Old 6th July 2017, 07:13 AM   #194
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4. removing the minimum FPL requirement for individual market that excluded people with incomes under 133%FPL and allow for less disruptive transitioning between Medicaid and Individual markets
I'm not really finding much about this and I'm really not too clear on what is meant anyway. I did find this on a Kaiser website from last year:
Quote:
In states that decide to expand Medicaid, tax credit eligibility effectively ranges from 138% to 400% of the poverty level (because almost all people with incomes below 138% of poverty are eligible for Medicaid and therefore are not eligible for subsidized Marketplace coverage). Link
I don't understand what the recommendation is. Kaiser says almost all persons with income of 138% of the federal poverty level are not eligible for subsidized marketplace coverage. Why should the provision be changed?
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Old 6th July 2017, 09:46 AM   #195
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Originally Posted by Emily's Cat View Post
Have you been paying attention to the number of carriers exiting markets, the counties with zero coverage available, and the rate hikes coming down for 2018? What does it take for you to see it as a disaster?
There are 3,007 counties in the US. 42 of them have no coverage available. This is a problem but far from a disaster.

Yes rate hikes are coming. Part of that is simply insurance companies hedging their bets in an uncertain regulatory environment. If they set premiums too high insurance companies may have to issue a refund due to the Medical Cost Ratio rule. If premiums are too low the company loses money.

The ACA program that allowed insurance companies to share the risk with the government has been defunded by Congress.

If we want to curtail costs, there are plenty of opportunities. But with the GOP in charge of Congress and an clueless idiot in the White House can anything be accomplished?
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Old 6th July 2017, 09:53 AM   #196
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Originally Posted by Emily's Cat View Post
The SUBSIDY produces a cliff. A 20 yo who moves from 399% of FPL to 401% of FPL sees only a very marginal difference in their premium costs due to the loss of the subsidy. A 60 yo moving in those same brackets sees a dramatic increase in their premiums once that subsidy is taken away. The subsidy is tied to a % of income, but the premiums aren't. What ends up happening is that a low-income older family gets a substantially large subsidy that disappears when they cross the line.
An easy solution is to taper the subsides off and eliminate the cliff. But that isn't about to happen because the current debate isn't about fixing health care and insurance. It's about giving the wealth people of America a big *********** tax cut.
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Old 6th July 2017, 09:56 AM   #197
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Originally Posted by newyorkguy View Post
I'm not really finding much about this and I'm really not too clear on what is meant anyway. I did find this on a Kaiser website from last year:


I don't understand what the recommendation is. Kaiser says almost all persons with income of 138% of the federal poverty level are not eligible for subsidized marketplace coverage. Why should the provision be changed?
It could be that if you are eligible for Medicaid you are not eligible for subsidies. If your state didn't expand Medicaid and your income is over FPL you can get coverage from the exchange.
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Old 6th July 2017, 10:01 AM   #198
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Originally Posted by Kestrel View Post
An easy solution is to taper the subsides off and eliminate the cliff. But that isn't about to happen because the current debate isn't about fixing health care and insurance. It's about giving the wealth people of America a big *********** tax cut.
That is what people voted for after all.
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Old 6th July 2017, 01:25 PM   #199
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Originally Posted by ponderingturtle View Post
That is what people voted for after all.

I think most Trump supporters voted for an improved health care system with better coverage and lower premiums.

That was what he promised them.

Giving the wealthy a big tax cut wasn't a prominent part of Republican campaign rhetoric.
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Old 6th July 2017, 01:32 PM   #200
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So Republicans main argument is that Premiums have risen after Obamacare was enacted, despite the fact that they would've risen even if it wasn't enacted? Or that Obamacare didn't insure everyone, even-though it wasn't supposed to, so it's better to just stop trying to give Americans healthcare and return poor Americans their hard-fought freedom of living without healthcare insurance?

I didn't expect intellectually dishonest talking points from Republicans at all.
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