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

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Old 12th July 2017, 01:23 PM   #241
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I get really tired of everyone always trying to make every issue a political issue. Some problems in the world aren't innately political. I'm sure if you look hard enough and squint your eyes just right, you can make it out so that every issue has some correlation with whatever political indicator you've decided to use that day. But that doesn't make it the reality.

I don't care what your politics is. ACA is NOT a success. It is failing, and there doesn't look to be a solution in the works. The proposed solutions at the moment are WORSE, no question... but that still doesn't make ACA good. It's not. ACA as it stands right now is NOT sustainable.
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Old 12th July 2017, 01:25 PM   #242
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Originally Posted by Emily's Cat View Post
Yeah, I don't think it's just the current regime. I don't think anyone in politics is willing to touch it. Despite objections to the contrary, most democrat politicians are beholden to corporate interests too.
Of course not, health care costs are to big to do anything to reduce them.
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Old 12th July 2017, 01:44 PM   #243
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Quote:
President Donald Trump lamented that he'll be "very angry" if the Republican effort to repeal Obamaca collapses.

“I will be very angry about it and a lot of people will be very upset,” Trump said on the possibility of the bill to repeal Obamacare failing, adding, “but I’m sitting waiting for that bill to come to my desk. I hope they do it.”

...


“They’ve been promising it for years. They’ve been promising it ever since Obamacare which is failed,” Trump said. “It’s a failed experiment. It is totally gone. It’s out of business and we have to get this done.”

Senate Majority Leader Mitch McConnell is trying to win support from several moderate Republicans and key conservatives in the coming days. He announced Tuesday that the Senate would stay in session through the first two weeks of August, shortening the summer recess considerably.

“He’s got to pull it off. Mitch has to pull it off,” Trump said of the Kentucky Republican. “He’s working very hard. He’s got to pull it off."
http://www.politico.com/story/2017/0...th-care-240465

Trump sounds so pathetically desperate.
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Old 12th July 2017, 02:29 PM   #244
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Originally Posted by Emily's Cat View Post
The gaps are occurring in rural areas, regardless of the politics involved. The relationship at play that is providing your false correlation is that states with larger urban centers and fewer rural areas tend to lean more liberal. The percentage of people in areas without coverage is an effect of rurality rather than politics.
If they're right-wing because they're rural, that might explain their politics. But it's their politics that determine whether their state expands Medicaid and other programs, which in turn has plenty to do with who gets insurance. And there's no particular reason why states, which generally regulate insurance, can't establish coverage regions that would include more than one county, or would create markets that would tie rural counties to the nearest urban center. These problems are manageable, for people who actually want to manage them. The blue states do, the red states don't.
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Old 12th July 2017, 04:27 PM   #245
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Originally Posted by Bob001 View Post
If they're right-wing because they're rural, that might explain their politics. But it's their politics that determine whether their state expands Medicaid and other programs, which in turn has plenty to do with who gets insurance. And there's no particular reason why states, which generally regulate insurance, can't establish coverage regions that would include more than one county, or would create markets that would tie rural counties to the nearest urban center. These problems are manageable, for people who actually want to manage them. The blue states do, the red states don't.
The politics may be part of it. But it isn't the whole story. There were a handful of blue states that did NOT expand Medicaid, and several red states that did. So clearly that's not the only issue.

I suspect that wealth is a much bigger piece of it - although wealth and politics are correlated. Wealthy people tend to be Democrats, poor people tend to be Republicans. I suspect it has a lot to do with how much money you have available to toss in to the community pot - especially when rural poor communities don't have access to many of those community benefits, like subsidized public housing, community health centers, community transit, etc.

Bear in mind that expanding Medicaid didn't all come from federal coffers - the states had to fund some of that as well. That means increased taxes in those states in some form or other. And the federal funds were essentially seed funds - at some point those funds disappear, and the states will need to be able to fund that expansion all on their own. Is it really surprising that several of the poorest states in the union didn't opt to increase their taxes and spending?
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Old 12th July 2017, 07:05 PM   #246
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Originally Posted by Emily's Cat View Post
I get really tired of everyone always trying to make every issue a political issue. Some problems in the world aren't innately political. I'm sure if you look hard enough and squint your eyes just right, you can make it out so that every issue has some correlation with whatever political indicator you've decided to use that day. But that doesn't make it the reality.

I don't care what your politics is. ACA is NOT a success. It is failing, and there doesn't look to be a solution in the works. The proposed solutions at the moment are WORSE, no question... but that still doesn't make ACA good. It's not. ACA as it stands right now is NOT sustainable.
Perhaps it would be sustainable without the sabotage: cutting risk corridor supports to insurance companies, dumping the individual mandate . Maybe the Republicans will be forced into a compromise that fixes ACA rather than eliminates it.
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Old 12th July 2017, 09:30 PM   #247
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Originally Posted by Marcus View Post
Perhaps it would be sustainable without the sabotage: cutting risk corridor supports to insurance companies, dumping the individual mandate . Maybe the Republicans will be forced into a compromise that fixes ACA rather than eliminates it.

Maybe if they started calling it Romneycare.

That should take some of the sting out.
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Old 13th July 2017, 02:57 AM   #248
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Originally Posted by Emily's Cat View Post
The politics may be part of it. But it isn't the whole story. There were a handful of blue states that did NOT expand Medicaid, and several red states that did. So clearly that's not the only issue.
Which blue states did not?

By the map here I see at best purple states choosing not to.

http://www.kff.org/health-reform/sli...sion-decision/

The only states I see Hillary winning that did not expand it are Virginia, and Arizona. Those are not exactly hugely blue states. But I am sure West Virginia is excited about getting its medicaid cut. It was the predictable result of their voting and they are not stupid. The whole rhetoric was that you couldn;t take trump literally, so why would they think they could take him literally when he said there would be no medicaid cuts? These are not stupid people they knew what they were getting.
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Old 13th July 2017, 09:06 AM   #249
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Originally Posted by ponderingturtle View Post
Which blue states did not?

By the map here I see at best purple states choosing not to.

http://www.kff.org/health-reform/sli...sion-decision/

The only states I see Hillary winning that did not expand it are Virginia, and Arizona. Those are not exactly hugely blue states. But I am sure West Virginia is excited about getting its medicaid cut. It was the predictable result of their voting and they are not stupid. The whole rhetoric was that you couldn;t take trump literally, so why would they think they could take him literally when he said there would be no medicaid cuts? These are not stupid people they knew what they were getting.

A bit ironic, since that is a primary source of funding there for treatment for drug dependency and abuse, and one of the GOP's big clarion calls these days is the need to address the opioid abuse epidemic in areas like that.
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Old 13th July 2017, 09:34 AM   #250
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Originally Posted by quadraginta View Post
A bit ironic, since that is a primary source of funding there for treatment for drug dependency and abuse, and one of the GOP's big clarion calls these days is the need to address the opioid abuse epidemic in areas like that.
By stepping up law enforcement. Lock all the addicts up then we can hire the coal miners not locked up as guards. It is so simple.
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Old 13th July 2017, 09:40 AM   #251
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Originally Posted by quadraginta View Post
Maybe if they started calling it Romneycare.

That should take some of the sting out.
Too soon. Romney still has living enemies. "Reagancare" would be better : he's a saint and his enemies are all dead, at least politically.
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Old 13th July 2017, 12:53 PM   #252
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Originally Posted by Marcus View Post
Perhaps it would be sustainable without the sabotage: cutting risk corridor supports to insurance companies, dumping the individual mandate . Maybe the Republicans will be forced into a compromise that fixes ACA rather than eliminates it.
Not really. The risk corridors were always planned to sunset, as was the federal reinsurance. The mandate might have some impact, but it really hasn't been as big a driver of adoption as you might think. At max, it still ends up being equivalent to roughly 2 months of premium on a silver plan, depending where you are and the prevailing prices in that area.

The biggest death knells for ACA are:
  • It doesn't do anything about cost
  • large provider groups know insurers have geo-access requirements and have been unwilling to come down on price
  • Most of the new entrants to the marketplace are older and/or sicker than average, definitely higher cost than in the pre-ACA market
  • The youngest and healthiest can stay on their parent's group coverage for a fraction of the price until age 26
  • Essential benefits are extensive and significantly more coverage than previously available which forces prices up
  • How Actuarial Value is defined exacerbates adverse selection impacts

Those aren't any of the things that have been 'sabotaged'. Those are the basic underpinnings of the law.
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Old 13th July 2017, 01:03 PM   #253
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Originally Posted by ponderingturtle View Post
Which blue states did not?

By the map here I see at best purple states choosing not to.

http://www.kff.org/health-reform/sli...sion-decision/

The only states I see Hillary winning that did not expand it are Virginia, and Arizona. Those are not exactly hugely blue states. But I am sure West Virginia is excited about getting its medicaid cut. It was the predictable result of their voting and they are not stupid. The whole rhetoric was that you couldn;t take trump literally, so why would they think they could take him literally when he said there would be no medicaid cuts? These are not stupid people they knew what they were getting.
Maine, Wisconsin, and Virginia have been blue in at least 3 of the past 4 elections. They did NOT expand Medicaid.

Louisiana, Kentucky, and West Virginia have been red in at least 3 of the last 4 elections. They DID expand Medicaid.

Arizona, Arkansas, and Indiana have been red in 3/ of the last elections, and they partially expanded Medicaid.

Iowa, Ohio, and Florida (all swing states) have been 2 out of 4 elections, split blue/red. Ohio expanded, Iowa partially expanded, Florida did not.

ETA: This is from your KFF source, as well as from wikipedia
http://www.kff.org/health-reform/sli...sion-decision/
https://en.wikipedia.org/wiki/Red_st...nd_blue_states
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Old 13th July 2017, 01:16 PM   #254
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Originally Posted by Emily's Cat View Post
Maine, Wisconsin, and Virginia have been blue in at least 3 of the past 4 elections. They did NOT expand Medicaid.

Louisiana, Kentucky, and West Virginia have been red in at least 3 of the last 4 elections. They DID expand Medicaid.

Arizona, Arkansas, and Indiana have been red in 3/ of the last elections, and they partially expanded Medicaid.

Iowa, Ohio, and Florida (all swing states) have been 2 out of 4 elections, split blue/red. Ohio expanded, Iowa partially expanded, Florida did not.

ETA: This is from your KFF source, as well as from wikipedia
http://www.kff.org/health-reform/sli...sion-decision/
https://en.wikipedia.org/wiki/Red_st...nd_blue_states
Those are all swing states, and that is what they get for putting all the republicans in their statehouses. But that for some reason doesn't count them as red states.
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Old 13th July 2017, 02:52 PM   #255
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Originally Posted by Emily's Cat View Post
Not really. The risk corridors were always planned to sunset, as was the federal reinsurance. The mandate might have some impact, but it really hasn't been as big a driver of adoption as you might think. At max, it still ends up being equivalent to roughly 2 months of premium on a silver plan, depending where you are and the prevailing prices in that area.

The biggest death knells for ACA are:
  • It doesn't do anything about cost
  • large provider groups know insurers have geo-access requirements and have been unwilling to come down on price
  • Most of the new entrants to the marketplace are older and/or sicker than average, definitely higher cost than in the pre-ACA market
  • The youngest and healthiest can stay on their parent's group coverage for a fraction of the price until age 26
  • Essential benefits are extensive and significantly more coverage than previously available which forces prices up
  • How Actuarial Value is defined exacerbates adverse selection impacts

Those aren't any of the things that have been 'sabotaged'. Those are the basic underpinnings of the law.
Okay, assuming all these points, what would be the solution then? If we don't want to fix the ACA, and Trumps suggestions are obviously clueless, what does that leave? Back to the bad old days where poor people and people with preexisting conditions weren't covered?
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Old 13th July 2017, 03:52 PM   #256
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Originally Posted by Marcus View Post
Okay, assuming all these points, what would be the solution then? If we don't want to fix the ACA, and Trumps suggestions are obviously clueless, what does that leave? Back to the bad old days where poor people and people with preexisting conditions weren't covered?
Two alternative approaches...

1) Fix what we have now. IMO, we would accomplish a lot by doing two things. First, change how the AV requirements are applied with respect to cost. Second address the costs.

Changing the AV requirements is probably going to get really boring for everyone in this thread except me. So feel free to skip.

The current AV is defined as the percentage of incurred costs paid by the insurer. The premiums, are expected to reflect the percentage levels of the AVs. For example, Bronze is at 60%, and Gold is at 80%, so the premiums for Gold plans are expected to be one-third higher than for Bronze plans.

The problem is that the incurred costs for a bronze plan and a gold plan are very different. Bronze plan folks are on the whole healthier and have lower incurred costs. Gold plan folks are on the whole sicker and have higher incurred costs. So for example, the average incurred cost for a Bronze might be $300 PMPM and the average cost for Gold might be $500 PMPM. When we apply the AVs, we see that the Bronze AV ends up at 60% of $300 = $180, and the Gold AV ends up at $400. That means the insurer paid portion of a gold plan's incurred costs is actually 2.22 times the Bronze's.

If the prices were allowed to reflect the underlying incurred costs for each tier of coverage, then the prices in the market place would be more appropriate. Bronze plans would be cheaper by quite a bit, which would appease the young/healthy people who can't get decent coverage for the price they're paying. Gold plans would be more expensive, which would reflect the inherent adverse selection of richer plans.


2) Gradually lower the age of eligibility for Medicare. The benefits would also need to be modified as that age lowers, to ultimately include maternity and pediatrics among other services. This would also have the benefit of allowing a continued private insurance market, in the form of Medicare Supplement and Medicare Advantage. That should help to appease those opposed to universal care, while still providing reasonable coverage for everyone.
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Old 13th July 2017, 08:39 PM   #257
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Originally Posted by Emily's Cat View Post
......
2) Gradually lower the age of eligibility for Medicare. The benefits would also need to be modified as that age lowers, to ultimately include maternity and pediatrics among other services. This would also have the benefit of allowing a continued private insurance market, in the form of Medicare Supplement and Medicare Advantage. That should help to appease those opposed to universal care, while still providing reasonable coverage for everyone.
Why gradually? Many people have suggested lowering the age to 55, or even 50, and charging an appropriate, income-based premium for voluntary enrollees, which would drop to current levels when people reach 65. It would essentially be an age-based public option that would take care of people who lose their jobs at an age when it will be hard to find a new one, and also gives people an incentive to retire early if they can afford it and are just working to keep their benefits.
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Old 13th July 2017, 10:12 PM   #258
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Originally Posted by Arcade22 View Post
http://www.politico.com/story/2017/0...th-care-240465

Trump sounds so pathetically desperate.
He is also saying, loud and clear, that he will sign anything no matter how bad it is for the average American.
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Old 14th July 2017, 06:08 PM   #259
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This is quite the letter Insurers have jointly issued on the Cruz amendment.
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Old 14th July 2017, 08:11 PM   #260
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Originally Posted by Emily's Cat View Post
Two alternative approaches...

1) Fix what we have now. IMO, we would accomplish a lot by doing two things. First, change how the AV requirements are applied with respect to cost. Second address the costs.

Changing the AV requirements is probably going to get really boring for everyone in this thread except me. So feel free to skip.

The current AV is defined as the percentage of incurred costs paid by the insurer. The premiums, are expected to reflect the percentage levels of the AVs. For example, Bronze is at 60%, and Gold is at 80%, so the premiums for Gold plans are expected to be one-third higher than for Bronze plans.

The problem is that the incurred costs for a bronze plan and a gold plan are very different. Bronze plan folks are on the whole healthier and have lower incurred costs. Gold plan folks are on the whole sicker and have higher incurred costs. So for example, the average incurred cost for a Bronze might be $300 PMPM and the average cost for Gold might be $500 PMPM. When we apply the AVs, we see that the Bronze AV ends up at 60% of $300 = $180, and the Gold AV ends up at $400. That means the insurer paid portion of a gold plan's incurred costs is actually 2.22 times the Bronze's.

If the prices were allowed to reflect the underlying incurred costs for each tier of coverage, then the prices in the market place would be more appropriate. Bronze plans would be cheaper by quite a bit, which would appease the young/healthy people who can't get decent coverage for the price they're paying. Gold plans would be more expensive, which would reflect the inherent adverse selection of richer plans.


2) Gradually lower the age of eligibility for Medicare. The benefits would also need to be modified as that age lowers, to ultimately include maternity and pediatrics among other services. This would also have the benefit of allowing a continued private insurance market, in the form of Medicare Supplement and Medicare Advantage. That should help to appease those opposed to universal care, while still providing reasonable coverage for everyone.
Sounds simple and from what I can tell, effective. And the people I know love their Medicare!

Chances of the Republicans in Congress instituting these ideas: zero.
Chances of the Republicans in Congress seeking instead to deceptively severely limit and eventually eliminate Medicare: 70%.
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Old 16th July 2017, 09:10 AM   #261
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Another downside to cuts in health care coverage:
Quote:
We like to think that tuberculosis is a public health issue exclusive to the developing world, but the disease has begun to resurface as a major concern in certain parts of the United States, too.
http://www.slate.com/articles/health...re_likely.html
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Old 16th July 2017, 09:26 AM   #262
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I don't understand why the news media can't just come out and say it, the GOP cannot deliver on replacing the ACA because they've been lying about actually having a replacement all this time.

The media will report everything but like, 'can't get both the moderates and the far right in the party together'. That is not the problem. Or, 'they are trying to please the base'. That is also not the problem. Or, 'they had 7 years to get a plan together and didn't do it.' That last one is as far as the news media wants to go when it comes to stating the truth.

On the other side the news media has repeated the Democratic message, it's a tax cut and the GOP wants to get rid of the Medicaid expansion. But that still side-steps the one unstated fact:

The truth is, the GOP promised a magical health care bill and it has always been and continues to be a big lie. I wish the media would at least mention that truth.



As I post this I am reminded of the latest GOP talking point, the ACA only impacts 10% of the population. If that is the case, why all the fuss about the things the ACA mandated insurers cover?
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Old 16th July 2017, 02:39 PM   #263
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For me, I am amazed by the public spectacle of the GOP pressing forward with a plan that is overwhelmingly opposed and hated by the vast majority of the public, the medical community, the health insurance businesses, many or most State governors (including many Republicans), and, in fact, a singnificant number of GOP Senators (who have to be unhappily recruited one by one by threats or "brides"). A plan that will take away access to health insurance for 10s of millions and raise premiums on many of the ill and elderly. Doesn't the Republican leadership feel at least a bit embarrassed by their obvious desperation to pass this stinking heap of legislation that is going to be a disaster for so many, with the only possible goals to repudiate Obama and funding tax cuts to the wealthiest?
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Old 16th July 2017, 03:01 PM   #264
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Originally Posted by Emily's Cat View Post
...Bronze plans would be cheaper by quite a bit, which would appease the young/healthy people who can't get decent coverage for the price they're paying. Gold plans would be more expensive, which would reflect the inherent adverse selection of richer plans...
But doesn't that run counter to one of the fundamentals of ACA? If you decrease the amount the younger people are paying, then you have to increase the amount older people are paying until their premiums begin to get prohibitively expensive. Which sounds pretty much like where we were pre-ACA.


Originally Posted by Emily's Cat View Post
Gradually lower the age of eligibility for Medicare. The benefits would also need to be modified as that age lowers, to ultimately include maternity and pediatrics among other services...
Realistically, I think expanding Medicare has virtually no chance to survive a Republican Congress. They're going in the opposite direction: they want to restrict Medicare eligibility.
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Old 16th July 2017, 04:13 PM   #265
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Originally Posted by newyorkguy View Post
But doesn't that run counter to one of the fundamentals of ACA? If you decrease the amount the younger people are paying, then you have to increase the amount older people are paying until their premiums begin to get prohibitively expensive. Which sounds pretty much like where we were pre-ACA.




Realistically, I think expanding Medicare has virtually no chance to survive a Republican Congress. They're going in the opposite direction: they want to restrict Medicare eligibility.

That's a pretty safe bet.

Anything which might actually improve healthcare access for Americans has virtually no chance to survive a Republican Congress.

I think this would be true even if the solution was 100% free of cost to the government.

It is unquestionably true if there is any additional cost at all.
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Old 16th July 2017, 04:41 PM   #266
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Originally Posted by Giordano View Post
For me, I am amazed by the public spectacle of the GOP pressing forward with a plan that is overwhelmingly opposed and hated by the vast majority of the public, the medical community, the health insurance businesses, many or most State governors (including many Republicans), and, in fact, a singnificant number of GOP Senators (who have to be unhappily recruited one by one by threats or "brides"). A plan that will take away access to health insurance for 10s of millions and raise premiums on many of the ill and elderly. Doesn't the Republican leadership feel at least a bit embarrassed by their obvious desperation to pass this stinking heap of legislation that is going to be a disaster for so many, with the only possible goals to repudiate Obama and funding tax cuts to the wealthiest?
I'm not sure the GOP "leadership" sees anything from a non-swamp perspective. The perceptions being reported back by Republican congress-critters whose July 4th break was ruined by the matter are a challenge to be managed. They are not something that needs to be taken account of in any other sense.

Obama was the porch-light which kept the GOP swarm together, but with that extinguished they revert to a disparate bunch of bugs heading into the night on their own peculiar pursuits.
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Old 16th July 2017, 07:04 PM   #267
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Another opinion about ACA from Amy Davidson Sorkin, a staff writer at The New Yorker magazine:

Quote:
One of Obamacare’s innovations was to expand Medicaid eligibility to include people slightly above the poverty level. The federal government now pays the states a percentage of what it costs them to care for eligible residents: if a state spends more, it gets more, within certain parameters...many middle-class families rely on the A.C.A.’s essential health benefits, which include substance-abuse treatment, to deal with dependency issues.

Before Obamacare, when people who had insurance developed a serious health condition, they often discovered that it wasn’t covered by their policy, or that there were so many co-payments, deductibles, mysterious charges, and caps—including lifetime caps—that their coverage amounted to little more than a discount coupon on something that remained unaffordable. People found themselves without coverage for hospitalization, prescription drugs, and pediatric and chronic-disease care. A key contribution of the Affordable Care Act was to define each of those services, and some others, as “essential health benefits”—services that a plan had to cover in order to call itself a plan.

McConnell, Speaker of the House Paul Ryan, and others have brushed off concerns from constituents who say that Obamacare has saved their lives by claiming that the program has already “collapsed.” This is not true; the exchanges are under pressure, largely because of the uncertainties that the Republicans have introduced, but the percentage of Americans who are uninsured has fallen from sixteen per cent to nine per cent. The rate of personal bankruptcy, often attributable to medical costs, has also fallen. Link
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Old 17th July 2017, 12:21 PM   #268
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Originally Posted by Arcade22 View Post
http://www.politico.com/story/2017/0...th-care-240465

Trump sounds so pathetically desperate.

And that he has absolutely no idea what he's talking about, what is in the bill, and what a bill even is. His comments are always generic and void of any details. "they're working very hard, it's a great thing, whatever it is"
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Old 17th July 2017, 01:56 PM   #269
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Kasich spokesman: Pence’s healthcare claims ‘false’
The false assertion:
Quote:
“I know Gov. Kasich isn’t with us, but I suspect that he’s very troubled to know that in Ohio alone, nearly 60,000 disabled citizens are stuck on waiting lists, leaving them without the care they need for months or even years,” Pence said in a speech Friday at the National Governors Association summer meeting in Providence, R.I.
VP Pence made a fake news claim today and has been called on it by multiple sources including GOP governor Kasich.
Quote:
Ohio Gov. John Kasich's (R) office has flatly rejected Vice President Pence's claim that nearly 60,000 disabled Ohioans are on waiting lists for Medicaid’s home and community-based services.
Not to mention all the GOP bill would so is make said waiting lists longer.
Quote:
According to the Post, waiting lists for such Medicaid services are common and are typically longer in states that did not take ObamaCare's Medicaid expansion than in those that did.

Ohio was among a number of Republican-controlled states that took the ACA's Medicaid expansion, which dramatically expanded the number of people who qualify for the program.

Senate GOP leaders' healthcare bill – the Better Care Reconciliation Act – calls for deep cuts to Medicaid, prompting some more moderate Republican members to voice misgivings about the measure.

VP Pence spreading ‘fake news’ about Ohio
Quote:
About a week after the White House spread misinformation about Ohio’s Medicaid program, Vice President Mike Pence falsely said Friday that 60,000 Ohioans are going without care because of the state’s Medicaid expansion.

That prompted Kasich’s press secretary, Jon Keeling, to tweet: “That’s what we call #fakenews.” Keeling included a link to The Dispatch’s Capital Insider column from last Sunday citing state Medicaid data to refute an article cited by the White House. In what “the West Wing is reading,” the inaccurate piece said that after expanding Medicaid, Ohio “rolled back eligibility for some 34,000 seniors and individuals with disabilities as a cost-cutting measure.”

Medicaid officials also said there was no truth to a separate claim about recipients of Ohio’s Medicaid expansion “being put ahead of 60,000 disabled Ohioans who rely on Medicaid but are currently on a waiting list.”...

Pence spokesman Marc Lotter said the vice president’s source was a Wall Street Journal editorial July 7 slamming Kasich, even questioning whether he was still a Republican because of his stance on Medicaid. The editorial said, “Nearly 60,000 disabled Ohioans are on waiting lists that last for months or years to receive supplemental state services.”

Those Ohioans, however, are on a list seeking Medicaid waivers, mostly for home- and community-based services for the developmentally disabled. The number of people who can be served via the waivers is restricted, according to the Americans with Disabilities Act Participatory Action Research Consortium. ...

But Kaiser itself analyzed the data and concluded “there does not appear to be a relationship between a state’s Medicaid expansion status and changes in its ... waiver waiting list.” Kaiser noted that about 40 percent did not qualify for a waiver when they signed up for one, while as many as 90 percent of those with certain types of disabilities already are getting some form of non-waiver Medicaid help.

The foundation also learned that waiting lists in non-expansion states are often longer than those in expansion states.
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Old 17th July 2017, 02:32 PM   #270
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Originally Posted by Bob001 View Post
Why gradually? Many people have suggested lowering the age to 55, or even 50, and charging an appropriate, income-based premium for voluntary enrollees, which would drop to current levels when people reach 65. It would essentially be an age-based public option that would take care of people who lose their jobs at an age when it will be hard to find a new one, and also gives people an incentive to retire early if they can afford it and are just working to keep their benefits.
Gradually because if you drop it from 65 to 0 in one year, you'll wreck the economy. Phasing it in over the space of about 10 years seems reasonable. It might be feasible to do it faster, but the tax impact would be pretty intense, and you risk a lot of other disruption with unemployment etc. A planned phase in would make it more sustainable, and also more palatable.
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Old 17th July 2017, 02:36 PM   #271
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Originally Posted by newyorkguy View Post
But doesn't that run counter to one of the fundamentals of ACA? If you decrease the amount the younger people are paying, then you have to increase the amount older people are paying until their premiums begin to get prohibitively expensive. Which sounds pretty much like where we were pre-ACA.
Your choice - make it so expensive relative to use that young people don't buy coverage at all... or increase the amount old people are paying so it's more representative of their actual costs and offset with subsidies where appropriate.

Originally Posted by newyorkguy View Post
Realistically, I think expanding Medicare has virtually no chance to survive a Republican Congress. They're going in the opposite direction: they want to restrict Medicare eligibility.
It doesn't have a chance of making it through ANY congress. It's not like it's a new idea.

Also, Medicare and Medicaid are completely separate programs, funded in completely separate ways. They don't really belong in the same sentence there - it's entirely possible to expand Medicare AND ALSO restrict Medicaid eligibility.
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Old 17th July 2017, 03:06 PM   #272
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These numbers are staggering:

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Old 17th July 2017, 03:09 PM   #273
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Expand Medicare?
Originally Posted by Emily's Cat View Post
...It doesn't have a chance of making it through ANY congress. It's not like it's a new idea...

Then why'd you suggest it?

Originally Posted by Emily's Cat View Post
...Gradually lower the age of eligibility for Medicare. The benefits would also need to be modified as that age lowers, to ultimately include maternity and pediatrics among other services....
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Old 17th July 2017, 05:11 PM   #274
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Originally Posted by Emily's Cat View Post
Your choice - make it so expensive relative to use that young people don't buy coverage at all... or increase the amount old people are paying so it's more representative of their actual costs and offset with subsidies where appropriate.
c) ramp up the penalties to the the point that young people will be forced to buy coverage. Emphasize that, despite appearances, they themselves will actually get old some day, thus balancing the equation.
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Old 17th July 2017, 06:33 PM   #275
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Current version of the health care bill is officially dead:

New GOP health bill lacks the votes to pass

Quote:
GOP Sens. Jerry Moran (Kansas) and Mike Lee (Utah) announced on Monday night they will not support taking up a bill repealing and replacing ObamaCare, effectively blocking the legislation.

Their decision means Republicans in the Senate are well short of having the support to pass their legislation, and raises serious questions about whether President Trump will reach his goal of ending ObamaCare.

Moran and Lee both said the bill failed to do enough to lower premiums.

"This closed-door process has yielded the [bill], which fails to repeal the Affordable Care Act or address healthcare’s rising costs. For the same reasons I could not support the previous version of this bill, I cannot support this one," Moran said in a statement.

Highlighting the challenges faced by Majority Leader Mitch McConnell (R-Ky.), Lee argued the measure is not conservative enough, tugging in the opposite direction from moderates.
“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations," the Utah Republican said in a statement.

Lee added on Twitter that he and Moran will not support proceeding to "this version" of the Senate GOP legislation, known as the Better Care Reconciliation Act.

Lee warned that a controversial amendment from Sen. Ted Cruz (R-Texas) included in the bill does not go far enough. That amendment allows insurers to sell plans without ObamaCare's pre-existing condition protections if they also sell plans that have them.
So what happens now? Any chance of some kind of bipartisan reform?



Why are you laughing?
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Old 17th July 2017, 06:44 PM   #276
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Originally Posted by Puppycow View Post
Current version of the health care bill is officially dead:

New GOP health bill lacks the votes to pass



So what happens now? Any chance of some kind of bipartisan reform?



Why are you laughing?
I think Democrats would be on board with attempting a bipartisan reform. Unfortunately, I think any invitation would not be sincere. I believe that the GOP would let the Democrats in, tell them what the GOP bill will be and then cry partisanship when the Democrats decline it because the GOP did not actually try to compromise at all. See past attempts for Democrats to compromise with Republicans for verification of this kind of behavior.
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Old 17th July 2017, 06:49 PM   #277
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Originally Posted by Puppycow View Post
Current version of the health care bill is officially dead:

New GOP health bill lacks the votes to pass



So what happens now? Any chance of some kind of bipartisan reform?



Why are you laughing?
I really can't see any path for bipartisan reform here. The two parties' desires seem too sharply opposed. I'd really like to hear from some of the forum Republicans on this. Were any of you in favor of the bill? Did it meet the expectations you had when you voted last election?
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Old 17th July 2017, 08:34 PM   #278
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Originally Posted by Civet View Post
I really can't see any path for bipartisan reform here. The two parties' desires seem too sharply opposed. I'd really like to hear from some of the forum Republicans on this. Were any of you in favor of the bill? Did it meet the expectations you had when you voted last election?
The GOP can't ditch all of its extremists in order to find common ground with Democrats: Paul Ryan is one of them, after all.
It would probably be easier to let the Democrats draft the reform, and see how many Republicans are willing to go along.
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Old 17th July 2017, 08:44 PM   #279
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Democrats would not support any repeal. Obamacare can hang in there till single payer is passed. The gift to insurance companies will then end, as well as 20 dollar ibuprofen pills. And 20 dollar disposable exam pants.
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Old 17th July 2017, 09:15 PM   #280
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Can you do a full repeal under budget reconciliation?
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