OBAMA/TRUMPCARE MEGATHREAD

[caulfield12]

http://www.cnn.com/2017/01/16/politics/tom...x.html?adkey=bn

 

Price's nomination looks to be in trouble now with all the smoke around his candidacy...but who knows anymore what is disqualifying, if anything, when you control Congress.

[StrangeSox]

Although Trump promised healthcare for everyone at a lower cost, surprise, he was just rambling off whatever popped into his brain that moment.

 

https://twitter.com/jrovner/status/82115077...src=twsrc%5Etfw

[caulfield12]

The Republican members of Congress have to be pretty livid with Trump about now...especially Ryan and Price (well, theoretically the future head of HHS if he survives the nomination process with allegations of "insider trading" hanging over his candidacy).

 

On the other hand, it's giving Rand Paul some "open water" to present his own plan, which definitely has some positive things going for it.

[StrangeSox]

julie rovner ✔ @jrovner

BREAKING: New @cbo estimate of partial ACA repeal (2015 bill): up to 32 million more uninsured, indiv prems double

https://www.cbo.gov/publication/52371

 

In brief, CBO and JCT estimate that enacting that legislation would affect insurance coverage and premiums primarily in these ways:

 

-The number of people who are uninsured would increase by 18 million in the first new plan year following enactment of the bill. Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026.

 

-Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

 

This is just from an analysis of "H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which would repeal portions of the Affordable Care Act (ACA) eliminating, in two steps, the law’s mandate penalties and subsidies but leaving the ACA’s insurance market reforms in place." and not the actual hellscape republican plan.

Edited January 17, 2017 by StrangeSox

[Balta1701]

https://www.cbo.gov/publication/52371

 

 

 

This is just from an analysis of "H.R. 3762, the Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015, which would repeal portions of the Affordable Care Act (ACA) eliminating, in two steps, the law’s mandate penalties and subsidies but leaving the ACA’s insurance market reforms in place." and not the actual hellscape republican plan.

2 points to highlight:

1. The Republicans cannot eliminate the ACAs market reforms (banning preexisting conditions, etc.) without gaining the support of 8 Democrats as those are subject to the filibuster - they were passed when the Democrats had a full 60 seat majority in the Senate. If the Republicans were to remove subsidies without removing those requirements, that is "individual insurance market will collapse" setup because anyone who has a chronic condition and extreme costs would continue purchasing insurance while the correct economic decision for anyone who is generally healthy would be to stay uninsured until a major illness hits.

 

2. Also worth noting that the Republicans added an amendment earlier this year that states the CBO does not have to provide cost estimates for every set of proposed health care tweaks they offer for analysis.

[bmags]

#2 is especially adorable.

[StrangeSox]

Aren't they also/didn't they already change how the CBO scores things so that their plans get better scores via "dynamic scoring" aka "we swear supply side economics will significantly boost both the economy and government revenues this time!"?

[caulfield12]

http://www.vox.com/policy-and-politics/201...are-act-tax-cut

 

The "hidden" reason Republicans are so eager to repeal Obamacare

 

 

 

The two big relevant taxes, according to the TPC’s Howard Gleckman, are “a 0.9 percent payroll surtax on earnings and a 3.8 percent tax on net investment income for individuals with incomes exceeding $200,000 ($250,000 for couples).” That payroll tax hike hits a reasonably broad swath of affluent individuals, but in a relatively minor way. The 3.8 percent tax on net investment income (money made from owning or selling stocks and other financial instruments rather than working), by contrast, is a pretty hefty tax, but one that falls overwhelmingly on the small number of people who have hundreds of thousands of dollars a year in investment income.

 

 

For the bottom 60 percent of the population — that is, households earning less than about $67,000 a year — repeal of the ACA would end up meaning an increase in taxes due to the loss of ACA tax credits.

 

But people in the top 1 percent of the income distribution — those with incomes of over about $430,000 — would see their taxes fall by an average of $25,000 a year.

 

And for the true elite in the top 0.1 percent — people like designated White House senior adviser Jared Kushner, Treasury Secretary Steve Mnuchin, Education Secretary Betsy DeVos, Commerce Secretary Wilbur Ross, and many major campaign donors — the tax cut is truly enormous. Households with incomes of more than $1.9 million would get an extra $165,000 a year in take-home pay. That’s obviously more than enough money to make these hyper-elite families come out ahead regardless of what happens to health insurance markets.

 

By contrast, upper-middle-class families would get an extra $110 a year in after-tax income. That’s nice, but it isn’t going to replace a health insurance plan.

 

 

 

 

Phil Klein, a top conservative health policy journalist, has urged Republicans to solve their overpromising problem by “stating a simple truth, which goes something like this: ‘We don't believe that it is the job of the federal government to guarantee that everybody has health insurance.’”

Edited January 18, 2017 by caulfield12

[GoSox05]

This is how American health care kills people

 

 

 

[Balta1701]

So, last night theRapist president signed executive orders with a couple parts. First it directs the government to find any excuse to avoid charging the fee associated with the individual mandate as possible. Basically, that on its own should, if followed by the IRS and associated agencies, make it easier for healthy people to avoid buying insurance without paying the penalty tax on the individual market. This of course has the potential to, on its own, raise prices for everyone else on the individual market because the group that must stay insured due to actually being sick is the most expensive group and the group that would leave and then only buy insurance if they get sick is the most profitable group.

 

If that part of the EO is followed, there will be a grad student like me 7 years ago, somewhere in this country, who will wind up dead because of it within 2-3 years.

 

The third part grants much more latitude to states to apply for work waiver requirements and things like that in order to qualify for the medicaid expansion. If this actually sets up an excuse for large states like Texas to expand medicaid coverage when they weren't going to do so on principle with that icky president, should medicaid coverage still exist, this would be a generally good thing.

[Chisoxfn]

So, last night theRapist president signed executive orders with a couple parts. First it directs the government to find any excuse to avoid charging the fee associated with the individual mandate as possible. Basically, that on its own should, if followed by the IRS and associated agencies, make it easier for healthy people to avoid buying insurance without paying the penalty tax on the individual market. This of course has the potential to, on its own, raise prices for everyone else on the individual market because the group that must stay insured due to actually being sick is the most expensive group and the group that would leave and then only buy insurance if they get sick is the most profitable group.

 

If that part of the EO is followed, there will be a grad student like me 7 years ago, somewhere in this country, who will wind up dead because of it within 2-3 years.

 

The third part grants much more latitude to states to apply for work waiver requirements and things like that in order to qualify for the medicaid expansion. If this actually sets up an excuse for large states like Texas to expand medicaid coverage when they weren't going to do so on principle with that icky president, should medicaid coverage still exist, this would be a generally good thing.

I'm interested in the middle part...why would a grad student like you end up dead because of this clause? Trying to better understand, becuase even when the system was broken, wasn't there the ability to go to free health clinics or in an emergency just go to an emergency room. Not saying it was a good answer, can then such person is saddled with debt, but I thought people could still get treatment at certain types of hospitals regardless.

 

Remember, I am pro healthcare for all, just trying to understand.

[StrangeSox]

Cassidy-Collins release a one page summary of their "Repeal and Replace" bill they put forward

 

http://www.cassidy.senate.gov/imo/media/do...17)%20(002).pdf

Edited January 23, 2017 by StrangeSox

[caulfield12]

I'm interested in the middle part...why would a grad student like you end up dead because of this clause? Trying to better understand, becuase even when the system was broken, wasn't there the ability to go to free health clinics or in an emergency just go to an emergency room. Not saying it was a good answer, can then such person is saddled with debt, but I thought people could still get treatment at certain types of hospitals regardless.

 

Remember, I am pro healthcare for all, just trying to understand.

 

There are a not insignificant number of people with ACA plans where the deductible is set at $4000-$6000. That doesn't make sense. That's basically catastrophic insurance, but it's going to expose families to either financial ruin or not seeking urgent care that could be life saving in that $1000-$3000 range (because it would all end up out of pocket), which covers quite a bit of threatening eventualities.

 

Another issue being addressed is transparency. When possible, you should be able to keep your own doctor from previous plans. You especially should be told the cost for any test or procedure at 3-4 competing health centers and hospitals so you can make a determination of quality vs. cost, and the hospitals should be forced to compete with each other on pricing...rather than just dumping a completely unexpected bill on a patient when it's too late for them to make an informed decision.

[StrangeSox]

I'm interested in the middle part...why would a grad student like you end up dead because of this clause? Trying to better understand, becuase even when the system was broken, wasn't there the ability to go to free health clinics or in an emergency just go to an emergency room. Not saying it was a good answer, can then such person is saddled with debt, but I thought people could still get treatment at certain types of hospitals regardless.

 

Remember, I am pro healthcare for all, just trying to understand.

 

Free health clinics, where they're even available, and emergency rooms are very poor ways to treat any sort of chronic illness. I don't know the particulars of Balta's situation, but that was one of the problems that the ACA was attempting to fix.

[caulfield12]

ACA was also causing numerous issues with rural health care...let's see the GOP fix for that.

[Chisoxfn]

Free health clinics, where they're even available, and emergency rooms are very poor ways to treat any sort of chronic illness. I don't know the particulars of Balta's situation, but that was one of the problems that the ACA was attempting to fix.

I was more curious about where Balta was going with the story. I have said on numerous occasions, that I think every citizen should have good health coverage. Period. We live in the best country on this planet and with that, we should be able to consistently provide citizens with the best medical coverage to ensure everyone how the choice to see doctors, manage their conditions, etc. I also think that if you don't do those things, you increase risk for terrible epidemics (because the rich aren't immune to disease, superbugs, etc) and on top of that, by ignoring certain issues, you end up having people admitted to ERs where the expenses end up being far greater then if you just treated people.

 

I do think we need to do things about the ridiculous cost of healthcare and pharma stuff. That said, it isn't an easy answer. I think the ACA did many good things, but in general, I still think we are a far ways from being where we should. I am blessed that for the time being, my wife & I make nice livings, etc. and can afford the deductibles we have (our out of pocket family max is like 15K so if something happened to all of us, it would set us back a pretty penny) but even just giving birth cost of $5K (out of pocket) and I wouldn't call that anything overly unusual.

 

I fundamentally have no idea how healthcare and child costs can be so freaking expensive and as I mention, luckily I have the income levels that I do, but I have a hard time comprehending how someone who makes the average living in this country, can afford this stuff, while saving for retirement, etc. At the very least, I don't understand why we cap things like daycare costs from a tax perspective, etc.

[Iwritecode]

I fundamentally have no idea how healthcare and child costs can be so freaking expensive

 

Because the free market doesn't work in healthcare. Most people have absolutely no idea if their doctor is overcharging them for the care they are providing or not and have almost no way to comparison shop. So doctors are free to charge essentially whatever they want.

 

Another issue being addressed is transparency. When possible, you should be able to keep your own doctor from previous plans. You especially should be told the cost for any test or procedure at 3-4 competing health centers and hospitals so you can make a determination of quality vs. cost, and the hospitals should be forced to compete with each other on pricing...rather than just dumping a completely unexpected bill on a patient when it's too late for them to make an informed decision.

 

This would be a good start.

 

[StrangeSox]

Often times for the most expensive procedures, there isn't actually time to "price shop" because it's an emergency situation and even if you could, there are very strong emotional incentives against choosing the cheapest option when it comes to your own life and well-being. Market forces don't work in health care for a variety of reasons.

[Iwritecode]

Often times for the most expensive procedures, there isn't actually time to "price shop" because it's an emergency situation and even if you could, there are very strong emotional incentives against choosing the cheapest option when it comes to your own life and well-being. Market forces don't work in health care for a variety of reasons.

 

Exactly. So maybe we should be trying to figure out why healthcare costs so much in this country instead of blaming the insurance companies who are more or less the middlemen and have no control over those costs.

 

Although at this point I fear it's akin to trying to get the toothpaste back in the tube. I doubt many doctors are going to want to give up their 6 and 7 figure incomes.

Edited January 23, 2017 by Iwritecode

[Jenksismyhero]

Exactly. So maybe we should be trying to figure out why healthcare costs so much in this country instead of blaming the insurance companies who are more or less the middlemen and have no control over those costs.

 

Although at this point I fear it's akin to trying to get the toothpaste back in the tube. I doubt many doctors are going to want to give up their 6 and 7 figure incomes.

 

They set the price though, so I wouldn't call them middle men without control.

[caulfield12]

Often times for the most expensive procedures, there isn't actually time to "price shop" because it's an emergency situation and even if you could, there are very strong emotional incentives against choosing the cheapest option when it comes to your own life and well-being. Market forces don't work in health care for a variety of reasons.

 

More in terms of the costs of getting diagnostic tests done, pretty wild variations and fairly arbitrary in terms of willingness to adjust if you try to dispute the charges.

 

And yeah, emergency situations...no time, but aftercare, inpatient vs. outpatient, there should at least be more options available. In theory, that competition should help to improve costs and force the lower quality providers out of the market.

 

A good example was raised today. In those state reimbursements, they can hold back 2% for state population wellness...let's say, HIV and AIDS prevention in Louisiana, which has huge problems with this particular issue. Every state is better positioned to determine on a local level how best to allocate those funds. Iowa or Wisconsin might use it more for elderly/senior care programs due to aging populations, for another example. As long as the revenues provided states are the same or higher than under ACA, the argument that Washington can better administer the program doesn't hold up.

 

That said, we won't have "replace" fully functioning until 2020, an election year. And we won't know how the insurance markets and pools will react until at least 2018/19. We do know that a lot of insurers opted out because the Medicaid reimbursements were too low...it went from 23 to 5. Arizona, obviously an aging state with numerous retirees, saw over 100% premium hikes in the last year, and had some counties that almost ended up with nobody willing to cover from an insurance pool standpoint.

[StrangeSox]

Courts block $37b Aetna-Humana merger

 

http://www.usatoday.com/story/money/2017/0...erger/96948570/

[caulfield12]

Courts block $37b Aetna-Humana merger

 

http://www.usatoday.com/story/money/2017/0...erger/96948570/

 

Two victories today. That and the Texas ID/voter suppression ruling.

[Balta1701]

I was more curious about where Balta was going with the story. I have said on numerous occasions, that I think every citizen should have good health coverage. Period. We live in the best country on this planet and with that, we should be able to consistently provide citizens with the best medical coverage to ensure everyone how the choice to see doctors, manage their conditions, etc. I also think that if you don't do those things, you increase risk for terrible epidemics (because the rich aren't immune to disease, superbugs, etc) and on top of that, by ignoring certain issues, you end up having people admitted to ERs where the expenses end up being far greater then if you just treated people.

 

I do think we need to do things about the ridiculous cost of healthcare and pharma stuff. That said, it isn't an easy answer. I think the ACA did many good things, but in general, I still think we are a far ways from being where we should. I am blessed that for the time being, my wife & I make nice livings, etc. and can afford the deductibles we have (our out of pocket family max is like 15K so if something happened to all of us, it would set us back a pretty penny) but even just giving birth cost of $5K (out of pocket) and I wouldn't call that anything overly unusual.

 

I fundamentally have no idea how healthcare and child costs can be so freaking expensive and as I mention, luckily I have the income levels that I do, but I have a hard time comprehending how someone who makes the average living in this country, can afford this stuff, while saving for retirement, etc. At the very least, I don't understand why we cap things like daycare costs from a tax perspective, etc.

The basic problem is - if you're ignoring a chronic condition because you cannot afford insurance due to the chronic condition, and that condition becomes acute - you've been ignoring the condition already. So the pain is worse today, it's been bad 2 months ago and you got through it, you may as well ignore it again. Then oops, that's the time it turns fatal. There was...a period of a couple years where I was thinking that was going to be the end result, prior to graduating.

 

The other way that works, and it works just as well, is putting off preventative things like going to the hospital if you get the flu because you skipped the flu shot. That's one you can find plenty of stories of in the pre-ACA days. "it's just the flu, I can get over it".

[StrangeSox]

Someone leaked audio of the recent Republican meetings to the press.

 

Behind closed doors, Republican lawmakers fret about how to repeal Obamacare