With the benefit of hindsight, let’s say you could go back to 2009: If you could make 5 changes to ACA, what would they be?
My choice would be:
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No individual mandate.
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Have a public health insurance option.
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Have stiff penalties for those who can afford to pay medical bills but don’t.
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Have stiff penalties for those file frivolous malpractice lawsuits.
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Force hospitals to publish all their prices and not deviate from them.
Go universal. Go single payer. Give the govt some clout to negotiate with providers. Gravy train stops HERE, motherfuckers!
Yeah, health care reform was going to incur massive public ire no matter what. If you’re going to take a huge hit in the polls, might as well go big or go home.
The ire was going to be manufactured by an opposition dedicated to opposition as a goal in itself, yes. Picking their own damn proposal in the hopes they might actually support it was naive in hindsight. So yes, go with single payer right up front (by simply eliminating the minimum age for Medicare with a graduated tax structure to fund it), and let the rent-seeking parasites now bloating the system find ways to contribute to society instead somehow.
Velocity, without an individual mandate, how would you stop people from waiting until they were sick to buy insurance?
They shouldn’t wait.
But a very good public option could have forced insurance companies to go significantly cheaper and better, and maybe people wouldn’t wait.
Why shouldn’t they wait? you remove the mandate and it would be incredibly stupid to buy insurance when you are healthy.
It wouldn’t be. Buying insurance could save you from bankruptcy in a huge injury/accident.
You get in an accident and you buy insurance that day, no mandate = no reason to buy until you need it.
So if you have a huge injury/accident, you buy it.
If you like your plan, you can keep it.
That’s preexisting.
Well, “…Exchange established by the State or HHS” just to squelch the current King/Halbig horse shit, though I’m sure that there would still be another anti-ACA lawsuit percolating somewhere.
Beyond that, my next biggest change wouldn’t be to the law itself so much as to the process & timeline of its passage: For the love of God, get the bill passed before Scott Brown weasels his way into the Senate. If that had happened just a few months earlier, some of the sloppier drafting language could’ve been improved, which would have enhanced the possibility of my first suggestion taking place.
Next three? Public option, Medicare buy-in, & a MUCH SHORTER implementation timeline (as in, say, having the coverage expansion begin in 2011 or 2012 instead of 2014).
Note that my proposals are made under the auspices of things which were politically possible at the time. In my ideal world, and, Hell, given the conservative smear campaign over the past five years, single-payer should’ve been the goal from the get-go. Easy enough to accomplish, too; just remove the eligibility age for Medicare & tinker with the financing mechanisms of it all.
It’s harder for conservatives to rail against Medicare-for-all, given that all Americans already know what Medicare is in the first place & love for the program is downright ubiquitous.
So you’d keep the disqualification for pre-existing conditions that we used to have? The one that kept people from changing jobs, or ever getting insured? How is that a good thing?
Surprisingly I agree with 3/5 of you recommendations and only disagree with one, and am unsure about one.
As other have said, the mandate is required to guarantee insurance for those with pre-existing conditions. Since this, in my view, is the fundamental purpose of the ACA you can’t get rid of the mandate without scrapping the whole system. So while ideally it would be nice to not have to have the mandate, I don’t see how it can be avoided without the whole thing collapsing.
As for your third suggestions I am unsure what issue you are trying to address. As it stands now hospitals come after you for your last penny on any bills you owe, and I don’t see this changing particularly under the ACA, so I’m not sure what would be different under your version. Please enlighten me.
So I wold probably your changes 1 and 3 with,
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Having the plan be built around a federal exchange and federal subsidies, with the option of expanded exchanges by states if they chose, rather than the current system of assuming that states would be the primary implementers of the program.
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A more robust grandfather clause for old health plans that will allow them to gradually come up to code, rather than a sudden shock of rising premiums.
Ever hear of HIPAA? Portability protection was in place prior to PPACA. It could stand to be made more robust, but its not like this was some new idea.
My top 5 changes to PPACA circa 2009
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Equalize tax treatment of individually purchased plans as compared to employer purchased plans.
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Implement punitive damages cap.
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Permit purchase of policies across state borders.
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Define Unemployment as a qualifying event for a special enrollment period (eliminating requirement to purchase and exhaust COBRA benefits)
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Require all recommended neo-natal testing be covered at 100% as preventative care measure, with treatments covered. Covered conditions are those in accordance with recommendations of the HHS’ Discretionary Advisory Committee on Heritable Disorders in Newborns and Children.
Missing the point. The ability of insurance companies to deny coverage of pre-existing conditions would often keep people from going to a new employer, or be entrepreneurs, since their or their family member’s conditions would no longer be covered.
You can’t deny coverage for preexisting conditions under ACA, and changing that is not one of your changes.
Can’t buy these two. If someone commits medical malpractice you deserve to be compensated fairly as determined by the courts. To permit policies across state borders would mean that all insurers would instantly flock to the state most willing to insist on the lowest level of regulation. No, I do NOT want my health insurance to be regulated by Mississippi.
My preference:
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Expand Medicare for all.
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Provide abortions with no co-pay and bar states from their sham abortion clinic regulations that are intended to shut them down.
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Allow Medicare to bargain with the drug companies over price.
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Reform the patent laws whereby drug companies can extend patents merely by discovering a new use for their drug.
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Not part of the law but FUCKING SELL THE LAW AND FIGHT THE LIES THAT WILL BE SPREAD AGAINST IT.