OBAMA/TRUMPCARE MEGATHREAD

[caulfield12]

They've all expressed "concerns" with the bill "as written," but McConnell apparently specifically left things out of the bill. This gives these Senators the cover to offer a specific amendment and then vote for the bill saying "it was the best deal we could get."

 

Word from the House is that House R's will pass whatever the Senate does unchanged, avoiding a potentially messy reconciling of the two bills and then re-votes in both chambers.

 

We're going to get this god-awful bill that blows up a big chunk of our healthcare industry and leaves thousands of dead Americans a year in its wake to fund nearly a trillion dollars in upper class tax cuts. That's where this country's political priorities are these days.

 

The key is a lot of the Medicaid gutting gets pushed way back to 2023-25, giving them plausible political cover to keep their jobs before everyone fully realizes what has been done to them.

 

And, fwiw, while ex presidents rarely engage so publicly on partisan issues, Obama's clearly in the right on this one. He can see a vacuum at the top of the Democratic resistance and realizes temporarily he's best suited to fill it (Sanders/Warren wing notwithstanding).

 

The only good that comes out of all this is single payer/Medicare for all...but God knows how long that takes. 2025? 2029?

 

Finally, the scariest part is that if the economy and stock market keep ascending (unlikely) for another three years, Trump wins pretty easily. Odds of that aren't high, though.

Edited June 22, 2017 by caulfield12

[StrangeSox]

I don't think it would work that way.

 

It works that way in many other sectors of the economy, though. Look how many corporations are registered in Delaware. Look how many credit cards are issued from SD or Delaware because they have the most favorable usury laws.

 

One of the key policy goals of Republicans has been "selling insurance across state lines," which means we'd lose state-by-state regulations as everyone could just base themselves out of the weakest regulatory body and sell insurance nationwide regardless of what IL or TX regulations are.

 

If the states don't need to pay for it, they will regulate the heck out of insurance companies to gain favor with the voters. The citizens benefit by having more of their interests decided by people more familar with their situations. The Federal government doesn't need to make a blanket policy for everyone in the entire US when each state can do it much easier.

 

Again, though, that's not what health economists actually think will happen, and from my own personal example, the position you're taking doesn't even really hold up. I live in Illinois, but my insurance is from BCBS-FL. If Florida takes the waivers and guts their state insurance regulations, I've now lost regulatory protections at the federal level and it's instead controlled by a state I have no ability to vote in.

 

Health care needs do vary somewhat from state to state, but not in a way substantial enough that cutting EHB's really makes much sense. We're talking the most basic of care requirements. What state doesn't need hospitalization, prescription drugs, emergency services? Removing these can be a death sentence to people with pre-existing conditions if nobody decides to offer health plans in that state covering more expensive care or only offers them for outrageous sums of money, tens of thousands yearly. That's the outcome that health economists are projecting from this plan.

[ptatc]

It works that way in many other sectors of the economy, though. Look how many corporations are registered in Delaware. Look how many credit cards are issued from SD or Delaware because they have the most favorable usury laws.

 

One of the key policy goals of Republicans has been "selling insurance across state lines," which means we'd lose state-by-state regulations as everyone could just base themselves out of the weakest regulatory body and sell insurance nationwide regardless of what IL or TX regulations are.

 

 

 

Again, though, that's not what health economists actually think will happen, and from my own personal example, the position you're taking doesn't even really hold up. I live in Illinois, but my insurance is from BCBS-FL. If Florida takes the waivers and guts their state insurance regulations, I've now lost regulatory protections at the federal level and it's instead controlled by a state I have no ability to vote in.

 

Health care needs do vary somewhat from state to state, but not in a way substantial enough that cutting EHB's really makes much sense. We're talking the most basic of care requirements. What state doesn't need hospitalization, prescription drugs, emergency services? Removing these can be a death sentence to people with pre-existing conditions if nobody decides to offer health plans in that state covering more expensive care or only offers them for outrageous sums of money, tens of thousands yearly. That's the outcome that health economists are projecting from this plan.

But then if the coverage changes drastically, the company could shop for a different one. They wouldn't need to use that one. Also, your example is a work insurance. Those who go for a private insurance could have more of a variety to choose from for their situation. If they allow more state regulation of medicare and medicaid (which they already do to an extent) this could change even more.

 

[Soxbadger]

I know it wont happen, but a fair compromise for someone like SS is that they should be able to choose the state they work in.

 

IE IF I work in IL and employer chooses FL, I can choose that my plans be governed by IL Law.

 

If I work in FL and employer chooses IL, I could stay with IL or I could choose FL.

 

That way the employee gets some protection.

[StrangeSox]

I guess I don't see any actual value in allowing insurers that don't cover basic things like inpatient care, outpatient care, or prescription drugs i.e. are useless and are "health insurance" in name only.

[Soxbadger]

1.) A President doesn't pass laws and he can't "regulate" premiums a giant system with millions of factors. No one is arguing to the contrary. For your premium control idea, it would have been interesting to see what would have happened had President Obama interfered with the free market and skewed the supply and demand to an even greater extent but he didn't do that. He did promise lesser premiums for families though. That didn't happen either. Now it's the next administration's problem.

 

2.) Are you questioning the validity of the existence of the healthcare field? Smoke more weed Turtle!

 

1) I am not even sure how to answer this as the only relevant part is "free market." The problem with applying free market principals to insurance, is that insurance is already regulated and there is nothing close to a "free market" for insurance. And while I am likely the most adamant supporter of "free market" on this board, even I have to concede that something like "health insurance" shouldnt be guided by those ideas.

 

That being said, do I believe if all regulations on insurance were removed that it could result in lower premiums? Absolutely, I think that if you removed the barriers of entry that you would get much more competitive rates. The problem is that is insurance really worth anything if the company who insures you does not have the reserves to pay out claims.

 

I get where you think you are going with this, but I also believe that congress could have written a bill that would have ensured 1) Health Insurance providers can make a reasonable return and 2) people would not have to experience abnormal premium increase.

 

2) Dont worry Chibiusa, its okay to admit you were wrong and that I asked a question. Tell tale sign of someone stuck in a corner is trying to answer a question with a question. That being said, I do think as a society people have to ask what rights do people have to health care. Do all people in the US deserve some sort of guaranteed minimum level of healthcare?

 

Its a straightforward question Chibiusa, either you believe people do or they dont. It has nothing to do with the healthcare field, no part of my statements have said that doctors income should be capped, that you cant have specialists who make millions a year etc. Insurance companies are doctors. Insurance companies are piles of money attempting to make more piles of money. I know you will never answer the question.

[Soxbadger]

SB are you saying that health insurance companies want people to not be healthy? Are you saying the AHCA helps the health insurance industry? Are you opposed to the government giving them a bunch of money? I don't get your point. It seems like you're just trying to be righteous.

 

While the Obama administration was driving the distance between the 1% and 99% the insurance companies were living it up. Check out the stock charts of Aetna, Cigna, Humana. Every single one of their stocks are 4-5x the price they were when Obama went into office. If you're against the evil insurance companies or whatever you're trying to project with your cheap questioning, why support the ACA? The ACA couldn't have made it easier for them. They were swimming in money from 2010 on. I bought Aetna's stock shortly after the ACA went into effect and when I sold it I doubled my money. Those evil 1%er's who owned Aetna did thing because of the legislation the Obama admin put forward.

 

 

I actually have no idea what you are talking about here. I havent said anything about ACA or AHCA. It is a simple fundamental question. Do we believe that people should be guaranteed a minimum level of healthcare?

 

The point about getting rich is that the govt can easily restrict premiums and could also review health insurance companies profit/losses to make sure that all parties benefit from the bargain.

 

People's health is not a normal market.

[ptatc]

I know it wont happen, but a fair compromise for someone like SS is that they should be able to choose the state they work in.

 

IE IF I work in IL and employer chooses FL, I can choose that my plans be governed by IL Law.

 

If I work in FL and employer chooses IL, I could stay with IL or I could choose FL.

 

That way the employee gets some protection.

That would a good regulation to allow the states and the individual to have a say in their individual coverage.

 

In my personal example, my insurance is through the state. My daughter is going to school in Colorado. We are in a tiered insurance program and being out of state she cannot get Tier 1 coverage even if the provider is covered as Tier 1.

[illinilaw08]

SB are you saying that health insurance companies want people to not be healthy? Are you saying the AHCA helps the health insurance industry? Are you opposed to the government giving them a bunch of money? I don't get your point. It seems like you're just trying to be righteous.

 

While the Obama administration was driving the distance between the 1% and 99% the insurance companies were living it up. Check out the stock charts of Aetna, Cigna, Humana. Every single one of their stocks are 4-5x the price they were when Obamacare was signed into effect. If you're against the evil insurance companies or whatever you're trying to project with your cheap questioning, why support the ACA? The ACA couldn't have made it easier for them. They were swimming in money from 2010 on. I bought Aetna's stock shortly after the ACA went into effect and when I sold it I doubled my money. Those evil 1%er's who owned Aetna did the same thing because of the legislation the Obama admin put forward.

 

The ACA is one of the bigger examples of wealth distribution from the government. They literally taxed the wealthy to subsidize health insurance for the poor. If you are worried about the widening income gap, the ACA took steps to shrink that gap. The AHCA and whatever they are calling the Senate bill end those taxes on the wealthy...

[StrangeSox]

The ACA has a mechanism requiring insurance companies to spend at least 80% of premiums collected on health care costs. The Republican bills both remove this provision.

 

Rabbit, you're right that this bill was ultimately good for the insurance industry. There has been plenty of criticism of the ACA from the left since the start. However, many still feel that it was better than the status quo ante and that this new bill will harm millions.

[ptatc]

I guess I don't see any actual value in allowing insurers that don't cover basic things like inpatient care, outpatient care, or prescription drugs i.e. are useless and are "health insurance" in name only.

These fields are far to general to be a coverage issue. Is that inpatient orthopedic care, mental, neurologic, emergency etc.? There is no "basic" care for inpatient or outpatient.

[illinilaw08]

That would a good regulation to allow the states and the individual to have a say in their individual coverage.

 

In my personal example, my insurance is through the state. My daughter is going to school in Colorado. We are in a tiered insurance program and being out of state she cannot get Tier 1 coverage even if the provider is covered as Tier 1.

 

Wouldn't less state control, and more national control, help with this issue?

 

For me, the biggest issue here is that regulations should have the goal of helping the insured access and afford healthcare. Allowing states to opt out of covering "essential health benefits" and to sell insurance across state lines might lead to more affordable health insurance generally, but if the affordable health insurance doesn't cover anything, it only benefits those who never have to use the insurance.

[ptatc]

The ACA has a mechanism requiring insurance companies to spend at least 80% of premiums collected on health care costs. The Republican bills both remove this provision.

 

Rabbit, you're right that this bill was ultimately good for the insurance industry. There has been plenty of criticism of the ACA from the left since the start. However, many still feel that it was better than the status quo ante and that this new bill will harm millions.

i really disliked ACA and how difficult it made life in the clinic. However, I do like the fact that it changed the status quo and now they are trying something else. Maybe this will work more efficiently and it will be better.

[Soxbadger]

That would a good regulation to allow the states and the individual to have a say in their individual coverage.

 

In my personal example, my insurance is through the state. My daughter is going to school in Colorado. We are in a tiered insurance program and being out of state she cannot get Tier 1 coverage even if the provider is covered as Tier 1.

 

That's why there has to be some sort of "fairness" involved. Most people do not really have much choice when it comes to health insurance and while the ideas of marketplace etc are good in theory, they still had/have problems.

 

Ultimately the problem is that insurance companies have far more money then regular people. And regular people are too fractured to get together to change things. Even if 99% of American's agree on healthcare, it doesnt matter because there are other issues involved when we vote and so we end up picking people who are going to do whats best for them, not necessarily what is best for everyone else.

 

I really do believe that there is a workable solution, I just dont think its possible with our current style of govt. I think the best hope is that at some point Democrat and Republican parties splinter.

[StrangeSox]

These fields are far to general to be a coverage issue. Is that inpatient orthopedic care, mental, neurologic, emergency etc.? There is no "basic" care for inpatient or outpatient.

Emergency care is actually another one of the ehb's this bill will allow states to opt out of. So is mental health coverage. And maternity coverage. And preventative care.

 

I'm sure the actual regs get detailed on what specifically is required, but what you're advocating is that states should get the ability to drop these requirements, period. Why? Who benefits from this?

Edited June 22, 2017 by StrangeSox

[illinilaw08]

Maybe in theory. It was supposed to do a lot of things in theory. Could you provide backing on how the wage gape was lessened by the ACA? I am not a proponent of the AHCA - just a realist on the ACA.

 

I'm not sure how to explain this better. People earning over $200k annually had an additional tax imposed on their income. That revenue was used to fund the subsidies in the ACA for low wage earners. Therefore, the ACA transferred wealth from high earners directly to lower earners, which redistributes wealth from the 1% to lower earners.

 

From the Economist:

 

http://www.economist.com/blogs/democracyin...-and-inequality

[StrangeSox]

i really disliked ACA and how difficult it made life in the clinic. However, I do like the fact that it changed the status quo and now they are trying something else. Maybe this will work more efficiently and it will be better.

They aren't really trying something else. They're gutting ACA and giving tax cuts to the wealthy. They're gutting Medicaid.

 

No health care economist or independent review seems to think this will make anything better, either. Tens of millions will lose insurance as premiums continue to rise and coverage gets worse.

[ptatc]

That's why there has to be some sort of "fairness" involved. Most people do not really have much choice when it comes to health insurance and while the ideas of marketplace etc are good in theory, they still had/have problems.

 

Ultimately the problem is that insurance companies have far more money then regular people. And regular people are too fractured to get together to change things. Even if 99% of American's agree on healthcare, it doesnt matter because there are other issues involved when we vote and so we end up picking people who are going to do whats best for them, not necessarily what is best for everyone else.

 

I really do believe that there is a workable solution, I just dont think its possible with our current style of govt. I think the best hope is that at some point Democrat and Republican parties splinter.

I agree with the voting and the politicians.

 

The primary issue in my mind is that what is the basic level of care that is affordable to people? How much will the federal or state government need to subsidize the care?

 

There is nothing wrong with insurance companies making money. That is why they got into the business. They make far more money in their investments than they do in premiums. The bigger issue is how does the industry reconcile the cost of care and the cost of insurance. There isn't a single correct answer. cost of care is high due to many reasons including high medical malpractice insurance, lack of insurance payments, capitated contracts and massive amounts of insurance fraud. The increased paperwork at my clinic decreases the productivity which increases the cost of care. Insurance companies have issues when the economies have downturns.

 

It's a complicated mess and at least there are efforts to change it.

[ptatc]

They aren't really trying something else. They're gutting ACA and giving tax cuts to the wealthy. They're gutting Medicaid.

 

No health care economist or independent review seems to think this will make anything better, either. Tens of millions will lose insurance as premiums continue to rise and coverage gets worse.

They really didn't have insurance to begin with because the deductibles were so high, it was practically useless. And are they giving tax cuts to the wealthy or just decreasing the taxes to prior levels before they were raised on the wealthy for this program?

[StrangeSox]

They really didn't have insurance to begin with because the deductibles were so high, it was practically useless. And are they giving tax cuts to the wealthy or just decreasing the taxes to prior levels before they were raised on the wealthy for this program?

You just restated "giving tax cuts to the wealthy." You could rephrase anything as "decreasing taxes to prior levels" that way.

 

And yes, these people really do have insurance. Some have high deductibles, some don't. People also benefited beyond simply having coverage or not--we all likely benefited from the removal of lifetime and annual caps, for instance, which this bill restores. My brother benefited from the increase in parental insurance to 26 years. Many people have benefited from the requirements to cover pre existing conditions. Rural hospitals were given a lifeline and will likely have waves of closures thanks to this law.

Edited June 22, 2017 by StrangeSox

[ptatc]

You just restated "giving tax cuts to the wealthy." You could rephrase anything as "decreasing taxes to prior levels" that way.

Alright let me rephrase it this way.

 

Are the tax cuts to which you are referring ONLY the ones tied to funding ACA or are the cuts different than that?

[StrangeSox]

It's a trillion dollars in tax cuts for the wealthy so they can gut Medicaid. That's the policy choice being made here.

 

It also adjusts the baseline for when they move on to tax"reform" next so they can make even deeper upper class tax cuts.

[ptatc]

It's a trillion dollars in tax cuts for the wealthy so they can gut Medicaid. That's the policy choice being made here.

 

It also adjusts the baseline for when they move on to tax"reform" next so they can make even deeper upper class tax cuts.

Let me ask it again as I'm not familiar with the amounts of money in each tax.

 

Was this just the tax to pay for ACA or does it go above and beyond that?

[illinilaw08]

I don't buy into the theory that higher taxes is good for the greater economy. Employers were put in a tough position. Employers cut back on full time jobs. Obamacare is primarily high deductible plans so if you are in fact a poor person you really don't have any coverage at all with a high deductible ACA plan. Don't you think the subsidies for the poor are offset by the significant rises in premiums? They're saving money here so they can pay more here. Seems like the only winner there is the insurance provider. Looking at the whole picture, it doesn't seem to be a net positive.

 

That part isn't relevant to the conversation though. You specifically stated that the ACA widened the gap between the haves and the have nots. That is absolutely not what happened. People who earned income over $200k annually - note that isn't business with revenues of over $200k, but individuals earning over $200k annually - had an additional tax that paid for subsidies on healthcare for the poor. Therefore, the ACA took wealth from high earners, and transferred that wealth to lower earners.

 

As someone who has demanded citations, perhaps you can give me a source that shows that the people who received subsidies for their healthcare ended up paying more in premiums than they would have paid prior to the ACA.*

 

* Also note that you are ignoring the other benefits in the law. Essential health benefits that had to be covered, guaranteed coverage for pre-existing conditions, a cap on premiums that could be charged to the 55-64 age group that had not yet reached Medicare eligibility. You are making a lot of leaps in logic and in math to get to the conclusion that the ACA was not a net positive.

[illinilaw08]

Let me ask it again as I'm not familiar with the amounts of money in each tax.

 

Was this just the tax to pay for ACA or does it go above and beyond that?

 

3.8% tax on net investment income if your modified AGI is over $200k.

 

0.9% tax on wages over $200k for Medicare.

 

http://blog.taxact.com/tax-law-changes-for-higher-income/

 

https://www.thestreet.com/story/11709964/1/...me-earners.html