OBAMA/TRUMPCARE MEGATHREAD

[StrangeSox]

Greg Sargent ✔ @ThePlumLineGS

I've obtained new Kaiser polling:

 

42% of Trump voters say they or their families rely on Medicaid

 

Large majorities of them oppose cuts: https://twitter.com/ThePlumLineGS/status/867385044469506049 …

9:29 AM - 24 May 2017

[caulfield12]

48% of the births in America today rely on some element of Medicaid spending, fwiw.

 

A huge segment of the US population is going to be affected adversely...not only that half, but the other 50% paying insurance premiums will continue to see huge premium increases as a result of people going bankrupt or not being able to pay their hospital bills out of pocket. Those costs will always be passed on to someone in the system.

[illinilaw08]

I kind of agree with this.

 

Doesn't that model ultimately restrict access to healthcare for people? My understanding of the concept of concierge medicine is that you pay an annual fee to your doctor in exchange for certain services. It's basically like paying a retainer to a lawyer. And as you use the services, the doctor eats away at the retainer. That model, it seems to me, would lead to fewer people having access to healthcare, because fewer people would be able to afford to put their doctor on retainer. Health insurance would exist literally for catastrophes.

 

How, under this model, does someone living paycheck to paycheck access a doctor when they get strep throat, or for an annual physical?

[bmags]

Doesn't that model ultimately restrict access to healthcare for people? My understanding of the concept of concierge medicine is that you pay an annual fee to your doctor in exchange for certain services. It's basically like paying a retainer to a lawyer. And as you use the services, the doctor eats away at the retainer. That model, it seems to me, would lead to fewer people having access to healthcare, because fewer people would be able to afford to put their doctor on retainer. Health insurance would exist literally for catastrophes.

 

How, under this model, does someone living paycheck to paycheck access a doctor when they get strep throat, or for an annual physical?

 

Well, you can look at Canada for a model of more limited service but with a 30% private insurance industry still there.

 

I would be supportive of this. It, after all, would not be so different than dental, except people would have the government insurance to fall back on for surgery.

 

Americans consume more healthcare than other nations for often elective things. Concierge could let them pay for more services, but ultimately for most getting insurance for 3-4 scheduled checkups per year plus the governmental insurance.

 

Is that *worse* than what we have now? I'm not so sure. 1 it would encourage some decrease in the use of excess healthcare.

 

We've seen such sluggish growth and some of it has to be due to going to such a service heavy industry like healthcare which has shown very little ability to scale in a way that decreases pricing. (i.e. we are a 2017 hospital, we all have machinery for MRIs and CT scans paid for many times over, we should see competition that decreases the price we ask for these machines, except actually we will charge same amount or increasing amount to hide the costs that we incur from our inefficient health care system)

 

I would be open to it. I think there are better options, but universal, full stop, coverage so that nobody gets bankrupted from pregnancy or disease would be a big step. Would like to see mental health also covered.

[illinilaw08]

Well, you can look at Canada for a model of more limited service but with a 30% private insurance industry still there.

 

I would be supportive of this. It, after all, would not be so different than dental, except people would have the government insurance to fall back on for surgery.

 

Americans consume more healthcare than other nations for often elective things. Concierge could let them pay for more services, but ultimately for most getting insurance for 3-4 scheduled checkups per year plus the governmental insurance.

 

Is that *worse* than what we have now? I'm not so sure. 1 it would encourage some decrease in the use of excess healthcare.

 

We've seen such sluggish growth and some of it has to be due to going to such a service heavy industry like healthcare which has shown very little ability to scale in a way that decreases pricing. (i.e. we are a 2017 hospital, we all have machinery for MRIs and CT scans paid for many times over, we should see competition that decreases the price we ask for these machines, except actually we will charge same amount or increasing amount to hide the costs that we incur from our inefficient health care system)

 

I would be open to it. I think there are better options, but universal, full stop, coverage so that nobody gets bankrupted from pregnancy or disease would be a big step. Would like to see mental health also covered.

 

That makes sense. I read the original post as catastrophe policies were purchased on the private market. If it was catastrophic Medicare for all with a dental like model for ordinary care, that's a much more interesting idea to me.

Edited May 24, 2017 by illinilaw08

[bmags]

That makes sense. I read the original post as catastrophe policies were purchased on the private market. If it was catastrophic Medicare for all with a dental like model for ordinary care, that's a much more interesting idea to me.

 

Yeah, I think one thing is the California bill goes too far imo, it would be incredibly expensive and have an unclear disruption to many people employed by health care.

 

I thought public option would be the only thing politically possible after 2010 but it seems like there is more support even from insurance industry for a form of single payer. I think it needs to be vetted.

[StrangeSox]

Meaghan Smith @MeaghanRSmith

McConnell told Reuters that he does not intend to reach out to any Democrats in order to pass the Senate's version of the health care bill

1:38 PM - 24 May 2017

 

There were something like 160 GOP amendments allowed to the ACA and months and months of working with several of them to craft the bill.

[StrangeSox]

New CBO score out

 

2018: 14 million more would be uninsured than ACA

 

2020: 19 million more

 

2026: 23 million more

 

Edited May 24, 2017 by StrangeSox

[StrangeSox]

Pre-existing condition protections destroyed for 1/6 of the population

 

[StrangeSox]

People in states who chose to eliminate Essential Health Benefits coverage would have their premiums drop but would likely end up paying more overall since their insurance will be pretty useless.

 

More money for worse care.

 

[bmags]

Bill is great if you can guarantee you will be healthy and can guarantee you can live in a state that won't waive benefits.

 

 

[StrangeSox]

People needing maternity care could incur thousands of extra dollars of health care expenses

 

[StrangeSox]

Bill is great if you can guarantee you will be healthy and can guarantee you can live in a state that won't waive benefits.

 

Or have an employer hq'd in a state that won't waive benefits (I've got BCBS, but through a state other than IL)

 

Republicans throwing a party to celebrate this bill passing one house of congress may not have been the brightest idea ever

 

Edited May 24, 2017 by StrangeSox

[bmags]

Holy crap I didn't think about that. My wife had BCBS through Tennessee because her company was in Nashville.

[bmags]

SO basically argument in waiver states:

You can be charged based on health status if you do not have continuous coverage (when you lost and reapplied, health is a factor).

 

Creates incentive for healthy to drop and reapply for coverage to pay lower premiums.

 

Healthier people paying less puts pressure to raise premiums on those with CONTINUOUS in the community rating groups, pricing out those with pre existing conditions. Those people cannot shop around, as soon as they drop they'd be at the whims of being charged for their medical status.

 

Pretty brutal.

[StrangeSox]

CBO estimates that in states requesting AHCA waivers, premiums for low-income elderly enrollees would go up 800 percent. That is not a typo.

3:47 PM - 24 May 2017

 

 

 

 

Just remember, this bill is really just a tax cut for the wealthy disguised as a healthcare bill. That's their main motivation, and they don't care how many Americans it kills to get there.

 

 

CBO: "a few million of those [who DO remain insured] would use tax credits to purchase policies that would not cover major medical risks"

3:35 PM - 24 May 2017

 

So this bill saves a little bit more money, and 1 million fewer people will lose insurance, but the actual effects are even more brutal than the first time around, and much of the "insurance" people will have will be functionally useless.

Edited May 24, 2017 by StrangeSox

[bmags]

The CBO also makes clear that it is paying for the tax cuts that fund non-coverage provisions with 880 million dollars worth of cuts to medicaid.

[RockRaines]

My favorite argument is that 20 year olds dont need insurance. Has anyone BEEN to a doctor on a college campus? Its full as f***.

[StrangeSox]

Kicking 14 million people off of health insurance in an election year so you can give the wealthy a tax cut seems like a bad idea to me.

[bmags]

Among other bizarre things this doesn't do just based on previous GOP history, it did not fix the Medicaid cliff, where making enough to leave medicaid is extremely disincentivized compared to ACA

[Quin]

My favorite argument is that 20 year olds dont need insurance. Has anyone BEEN to a doctor on a college campus? Its full as f***.

 

I developed epilepsy at 19 and have subsequently racked up thousands in ER bills that boil down to them giving me water.

[StrangeSox]

Kicking 14 million people off of health insurance in an election year so you can give the wealthy a tax cut seems like a bad idea to me.

 

 

Nate Silver ✔ @NateSilver538

AHCA is $874 billion in tax cuts and $119 billion in deficit reduction, financed by a net $993 billion reduction in spending on health care.

4:00 PM - 24 May 2017

 

 

Gentlemen, to evil!

[StrangeSox]

I developed epilepsy at 19 and have subsequently racked up thousands in ER bills that boil down to them giving me water.

 

The GOP wants you to be bankrupted or dead so that some millionaire can afford a new Ferrari or two.

[StrangeSox]

Holy crap I didn't think about that. My wife had BCBS through Tennessee because her company was in Nashville.

 

This confirms that thought:

 

For the large-group market, which generally consists of employers with more than 50 employees, current regulations allow employers to choose the EHB benchmark plan of any state in which they operate. Because of those regulations, a large employer operating in multiple states, including one that elected an EHB waiver, could base all of the plans it offers on the EHB requirements in a state with the waiver. That decision could allow annual and lifetime limits on benefits not included in the state’s EHBs. However, large employers already have considerable flexibility in the range of the benefits they include in their plans, so CBO and JCT expect that their benefit offerings would probably not be noticeably affected by the actions of states.

 

Seems like there's a lot resting on that "probably" in the last sentence, though. Would depend heavily on the employer and what their typical worker looks like. I have to imagine that for most people with employer-based health care coverages, we'd be seeing the return of lifetime caps.

Edited May 24, 2017 by StrangeSox

[greg775]

There's so much outrage today about this new health care plan. Look, it hasn't passed yet. If it's not reviewed closely and rejected by the House then that is as bad as Trump proposing it. Just reject it if it's so bad. Why would it pass into law?