OBAMA/TRUMPCARE MEGATHREAD

[StrangeSox]

New CBO estimate out on the proposal to eliminate the individual mandate as part of the tax cut bill

 

$338B deficit reduction over 10 years but 13M fewer people insured

[Balta1701]

I don't know if this is helpful at all for the folks who got hit by the CSR removal, but just in case it is:

 

Shop around! THIS IS IMPORTANT. The premium hikes due to Donald Trump’s elimination of the CSR subsidy have a very different effect on different plans. You might be able to get a bronze plan for free. You might be able to get a gold plan cheaper than a silver plan. If you’re lazy and just renew your current plan, it could cost you hundreds or thousands of dollars.

 

If you don’t get a subsidy, DON’T SHOP ON THE OBAMACARE EXCHANGE. Premiums have gone up a lot thanks to the CSR business, but if you go to a broker you’ll probably find off-exchange plans that aren’t affected by it. This could save you a ton of money. And if you don’t get a subsidy, there’s really no point to enrolling in Obamacare anyway.

[StrangeSox]

3 Finance Committee members tell me they probably won't reauthorize CHIP funding before it expires bc they spent too much time on repeal

— Alice Ollstein (@AliceOllstein) September 28, 2017

 

Nearly 9 million children in this country rely on CHIP, and it expires this Saturday.

 

They still haven't done anything to renew CHIP, and states are starting to run out of money to keep funding it. Several million children are going to lose health insurance by the end of the year while congress is focused on cutting taxes for the richest of the rich.

[StrangeSox]

As part of getting her to vote "yes" on the tax bill that repealed the individual mandate and blows up individual markets, Susan Collins wanted the Alexander-Murray bill to continue funding the CSR's that Trump stopped paying attached to must-pass bills this year.

 

Shockingly, it won't be. I'm sure the "assurances" she received from McConnell not to gut SS, Medicare and Medicaid in the future are real, though.

 

Looks like no Alexander-Murray health bill attached to CR like Susan Collins wanted... https://t.co/Dpu8wBZYsc

— Erik Wasson (@elwasson) December 4, 2017

 

 

[caulfield12]

Medicare, which specifies reimbursement rates for all the doctors who compete to serve its enrollees, is in fact the most efficient healthcare delivery system in the nation, with the lowest administrative costs. Far from suppressing innovation, Medicare has been a fount of innovation. The program has been a leader in testing new models for healthcare payment and new approaches to, yes, "patient-centered" care.

 

Ryan just wants to cut costs, but his prescriptions, such as they are, won't do that. Medicare and Medicaid can't actually be "reformed" from within; they're both prisoners of overall healthcare costs. That's what needs to be reformed — how we pay doctors and hospitals, how we judge the value of medical outcomes, and how much we allow drug companies to charge patients for their products.

 

None of those factors is on Paul Ryan's agenda. He's just talking about shifting the embedded costs of healthcare from government to individuals, and in a way that will drive costs up, not down. As long as he chooses his interviewers carefully, his lies and misrepresentations aren't going to get the scrutiny they deserve. But since's he's threatening to turn them into policy, it's time they did.

 

 

http://beta.latimes.com/business/hiltzik/l...1208-story.html

[StrangeSox]

Because the Trump administration arbitrarily cut the sign up period in half, today is the last day to purchase coverage for 2018 through the exchanges.

[StrangeSox]

List of words the Trump administration is banning the CDC from using:

 

“diversity”

“fetus"

“transgender”

“vulnerable”

“evidence-based”

“science-based"

“entitlement”

 

Comic book villain levels of evil

[BigSqwert]

List of words the Trump administration is banning the CDC from using:

 

“diversity”

“fetus"

“transgender”

“vulnerable”

“evidence-based”

“science-based"

“entitlement”

 

Comic book villain levels of evil

 

Under his eye

[StrangeSox]

Incidentally, the billionaires' tax cut bill that'll be signed into law soon includes repealing the individual mandate, which is estimated to result in 13M people losing health insurance and untold impacts on the individual market. Truly, a great day for the GOP and for our country.

[Dick Allen]

Incidentally, the billionaires' tax cut bill that'll be signed into law soon includes repealing the individual mandate, which is estimated to result in 13M people losing health insurance and untold impacts on the individual market. Truly, a great day for the GOP and for our country.

Merry Christmas.

 

We can say that since Trump brought Christmas back.

[caulfield12]

http://www.cnn.com/2017/12/20/politics/don...care/index.html

 

Trump is also (not so quietly) claiming he killed ObamaCare (and, yet again, a better system is promised)

[StrangeSox]

The cost-curve for health spending has been bent down substantially, which was one of the major goals of the ACA. It's now more inline with GDP growth. Per Kaiser.

 

Edited January 3, 2018 by StrangeSox

[Balta1701]

I find that plot to be almost useless because the health care inflation rate was particularly low for a couple years 2010-2013 or something like that, right after the ACA was passed, but then it returned to well above inflation rates the last couple years.

[StrangeSox]

Andy Slavitt

✔

@ASlavitt

BREAKING NEWS ON CHIP: CBO now says if Congress extends CHIP for 10 years instead of 5, it will not cost the government ANYTHING.

 

It will save $6 billion AND keep 9 million low income kids covered.

 

Congress decides within 9 days.

 

This is not widely known but needs to be.

[caulfield12]

ObamaCare was supposed to slow down costs.

 

While it's hard to isolate the inflationary effect from the substantive policy impact, it seems to be making the argument that it's working fairly well.

 

I heard a GOP Rep arguing that it's Kaiser Permanente who's doing exceedingly well curtailing costs, but that they're not very indicative of the overall/general trends in the health insurance field.

[StrangeSox]

The Trump administration is allowing states to impose work requirements for Medicaid, and Kentucky was the first to jump onboard.

 

Andy Slavitt

✔

@ASlavitt

BREAKING: Kentucky became the first state today to require Medicaid beneficiaries to work or lose access to care.

 

They are also requiring very poor people to pay premiums or lose coverage— for extended periods. The plan is for a national model.

 

Here’s quick highlights.1/

 

Let’s start here in reviewing the new program.

 

There’s a “literacy” provision.

 

If you don’t work enough hours and lose coverage, you can get to see a doctor again if you can pass a state literacy course about health or money. 2/ pic.twitter.com/RooWcagCOL

 

1:52 PM - Jan 12, 2018

 

There is also a 6 month lock out provision— meaning you can’t apply for coverage again for six months if you are removed for not registering annually or if you have a kid or get married and don’t report it.

 

For “certain populations.” 3/

 

But the good news is you get to report this information using KY’s already overloaded Medicaid call centers.

 

Can’t see that being a problem. 4/

 

If you don’t pay your new premiums, you lose coverage & then have a period where you can’t enroll.

 

This will likely be what ends a lot of access. Many families can’t afford school lunch as it is. Or have checking accounts. Or have access to state offices. I could go on... 5/

 

Sorry part timers. If your hours drop under 30/week, you lose coverage. Unless you add another 20 hours of job training, you’re cut off. 5/

 

 

This is just needlessly cruel.

Edited January 12, 2018 by StrangeSox

[StrangeSox]

and if the court tosses a single part of Bevin's proposal, he's just going to end the entire Medicaid expansion.

 

https://twitter.com/RepJohnYarmuth/status/951937566282059776

 

It's such a shame because Kentucky was one of if not the biggest success stories out of the ACA, and the people there really liked Kynect. But then they voted in Bevin who campaigned on ending it all and were shocked and disappointed when he started doing just that.

[Soxbadger]

Maybe next time KY will realize that votes have consequences and that not everyone will look out for their best interest.

[caulfield12]

Once again, poor people either don’t vote or don’t vote in their best interests/get sucked in by identity politics

 

 

Bevin won't admit it, but his plan would force most of those 430,000 people off the federal insurance plan – leaving many of them without a way to pay medical bills.

 

After being asked repeatedly whether those people who earn up to 138 percent of the poverty level would still have health insurance, Bevin said, "They're Kentuckians. They will continue to live in Kentucky if they choose to."

 

While they are Kentuckians, the question is whether they will vote.

 

The Pew Center report used 10 criteria to determine people's financial stability including one that dealt with whether they or anyone in their family received Medicaid, and another that dealt with whether they had trouble paying medical bills in the past year.

 

Of the least secure, 57 percent said they or a family member received Medicaid, and 64 percent said they had had trouble paying medical bills. Only 20 percent of that group were likely to vote in the 2014 election.

 

Of the next least secure group, 25 percent answered "yes" to the Medicaid question. Forty-three percent said they had trouble with medical bills, with 29 percent of them saying they were likely to vote.

 

By contrast, few in the top two groups received Medicaid or had trouble paying bills. Sixty-three percent of the most secure said they were likely to vote in the 2014 election and 51 percent of the second most financially secure group were likely to vote.

 

So, Bevin may be betting with the odds. But if 430,000 longshots come in, they could reshape politics in Kentucky.

 

https://www.courier-journal.com/story/news/...-vote/30668543/

 

 

Steve Beshear, fwiw, would be a legit VP candidate...term limited out as governor

Edited January 12, 2018 by caulfield12

[StrangeSox]

Anthem is now requiring policy holders in several states to diagnose themselves to determine the "most appropriate" health care provider in an immediate care scenario, and if you guess wrong, you're stuck paying the bill. American health care is such a disaster.

 

An ER visit, a $12,000 bill — and a health insurer that wouldn’t pay

 

Brittany Cloyd was doubled over in pain when she arrived at Frankfort Regional Medical Center’s emergency room on July 21, 2017.

 

“They got me a wheelchair and wheeled me back to a room immediately,” said Cloyd, 27, who lives in Kentucky.

 

Cloyd came in after a night of worsening fever and a increasing pain on the right side of her stomach. She called her mother, a former nurse, who thought it sounded like appendicitis and told Cloyd to go to the hospital immediately.

 

The doctors in the emergency room did multiple tests including a CT scan and ultrasound. They determined that Cloyd had ovarian cysts, not appendicitis. They gave her pain medications that helped her feel better, and an order to follow up with a gynecologist.

 

A few weeks later, Cloyd received something else: a $12,596 hospital bill her insurance denied — leaving her on the hook for all of it.

 

“We have a mortgage, we have bills, we have student loans,” says Cloyd, who works for the Kentucky government and has a 7-year-old daughter. “There is absolutely no way I could pay a $12,000 bill. I don’t even have $1,000 sitting around.”

 

Cloyd has her health insurance coverage through her husband’s job. His company uses Anthem, one of the country’s largest health insurance plans. In recent years, Anthem has begun denying coverage for emergency room visits that it deems “inappropriate” because they aren’t, in the insurance plan’s view, true emergencies.

 

The problem: These denials are made after patients visit the ER, sometimes based on the diagnosis after seeing a doctor, not on the symptoms that sent them, like in Cloyd’s case.

 

The policy has so far rolled out in four states: Georgia, Indiana, Missouri, and Kentucky.

 

“We cannot approve benefits for your recent visit to the emergency room (ER) for pelvic pain,” the letter that Cloyd received from Anthem stated, which she shared with Vox. “Emergency room services can be approved ... when a health problem is recent and severe enough that it needs immediate care.”

 

The Anthem letter goes on to list “stroke, heart attack, and severe bleeding” as examples of medical conditions for which ER use would be acceptable.

 

Anthem’s new policy mirrors similar recent developments in state Medicaid programs, which increasingly ask enrollees to pay a higher price for emergency room trips that the state determines to be non-urgent.

 

Indiana implemented this type of policy in 2015, and the Trump administration recently approved a request from Kentucky to do the same. Beginning in July, Kentucky will charge Medicaid enrollees $20 for their first “inappropriate” emergency room visit, $50 for their second, and $75 for their third.

 

All of these policies suggest a new and controversial strategy for reining in health care costs: asking patients to play a larger role in assessing their own medical condition — or pay a steep price.

 

[caulfield12]

Trump unaware of what UK NHS protest was actually about (wanted more funding, not cuts)

https://uk.news.yahoo.com/donald-trump-hit-...-155040357.html

 

 

AMA/Physicians protest harmful Anthem emergency care coverage policy (this is what happens when insurance companies and not doctors set policies)

 

The AMA has asked Anthem to immediately rescind the policy in states where it has been put into effect and halt implementation in all other states.

 

“Physicians know that patients and caregivers should never second guess their instincts that emergency care is needed, nor should they be expected to self-diagnose to determine whether, for example, chest pain is a heart attack or indigestion,” AMA Executive Vice President and CEO James L. Madara, MD, wrote in a letter to Anthem President and CEO Joseph Swedish. “Anthem’s policy requires that they diagnose their acute symptoms at a critical and emotional moment, when time could be of the essence. The impact of this policy is that very ill and vulnerable patients will not seek needed emergency medical care while, bluntly, their conditions worsen or they die.”

 

Dr. Madara’s letter goes on to note that the policy also serves to reduce the value of health insurance purchased from Anthem, as once covered care for an emergency medical condition now “leaves patients potentially holding the bag for the cost of that care.”

 

The prudent layperson standard

 

The AMA, the American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) also suggest that the new policy may violate the “prudent layperson standard” which has been codified into state and federal laws—including the Affordable Care Act (ACA). The standard defines an emergency medical condition as one that manifests itself “by acute symptoms of sufficient severity” that a prudent layperson could reasonably expect that the absence of immediate medical attention could place their health in serious jeopardy. Anthem’s retrospective review appears to be inconsistent with such a standard.

 

"This new policy will mean that patients experiencing emergencies will not go to the ER because of fear of a bill, and could die as a result," ACEP President Rebecca Parker, MD, said in a news release. "Health plans have a long history of not paying for emergency care. Now, they are trying to roll over federal law that emergency physicians fought for to protect patients from this 'profits first, people last' behavior by insurers.”

Edited February 5, 2018 by caulfield12

[StrangeSox]

It's a shame Roberts unilaterally rewrote the Medicaid portion of the law with little or no legal basis. Millions have gone without health insurance because of that.

 

 

[StrangeSox]

 

[caulfield12]

https://finance.yahoo.com/news/trumpcare-will-hurt-people-next-year-201655059.html

TrumpCare will hurt these people next year...and now the blame gets tossed back to the other side, like a political football

 

Bill Luffman, 61, is a tobacco consultant in State Road, North Carolina, whose premiums have soared since the ACA went into effect. But he doubts the Trump proposals will help him. The premium on a Blue Cross/Blue Shield policy covering him and his wife, Joan, rose from $689 a month in 2015 to $2,347 per month in 2017. He paid. But when Blue Cross hiked it to near $2,500 per month for 2018, he applied for a federal waiver letting him buy a cheap policy with limited coverage, because the cost of health insurance was well over 25% of his income. He got the waiver and now pays $1,350 for a policy that covers catastrophic care, but little else.

Luffman rides motorcycles, and doesn’t want a policy that could expose him to open-ended medical costs. So he won’t go without insurance or buy a plan with a low payout cap. And he doesn’t trust Blue Cross, the only insurer in the area, to offer a better-value plan if it can force people into expensive plans. “I think what Blue Cross will do is parlay this into an all-or-nothing situation,” he says. “Without a mandate, they could say, ‘there’s no mandate, either go uninsured or pay us four grand a month.’ Everything about it just really makes me angry.” He hopes to stick with his catastrophic plan — assuming it remains available — until he turns 65 and qualifies for Medicare.

Only a few insurers have so far proposed rate changes for individual plans for 2019. In Oregon, at least three insurers are planning to roll back rates, with six others proposing increases ranging from 9% to 16%. In Maryland, Vermont and Virginia, insurers have proposed rate hikes ranging from 8% to 91%. Those are only proposals, and state officials typically negotiate rate hikes lower. Still, double-digit premium increases seem likely in at least some areas.

[greg775]

I think we should have a discussion of medical horror stories and elderly assisted care living horror stories. I am a hater of our current healthcare system, so much I only want Bernie to win so we can get everything for free in the future. My contention is the insurance companies, even if you get the max coverage at work, don't pay squat and they are putting any middle class person who needs work done on the streets, in the poorhouse.

 

Latest story: A woman I know lost 40 pounds and her blood pressure went back to normal so they took her off the pills. The doctor office said "feel free to come in and get BP readings the next month and see if your readings remain good." She gets a bill today. 60 bucks each time she went in for a one minute blood pressure reading from the nurse. Appalling. America ... land of the way too expensive education system; land of the ripoff health care system!!! Land of the ripoff daycare system (TOO EXPENSIVE!) and land of the ripoff assisted living home system (TOO EXPENSIVE!). What happens is the elderly person gets to stay in assisted living til their funds run out, their savings run out, the $$ they were gonna give to their kids upon death runs out, and the person is kicked to the curb. People like Trump don't care; it's gonna take somebody like Bernie, folks.

Edited June 7, 2018 by greg775