House passes "repeal and replace"

[Bryan_Ekers]

@Banquet_Bear

How has the House passing “repeal and replace” been a backlash against globalism?

Globalism knows what it did wrong!

[RTFirefly]

@Tee

I supported the ACA, but Shagnasty gave a perfect example of a very real problem. This thread is a kind of logical morass where health coverage is believed equal to health care, but the two are really not interchangeable.

Maybe not, but one of the big contributions of the ACA was to drastically reduce the difference between the two. Essential health benefits, community rating, defining the gold/silver/bronze bands in terms of the percentage of actual value they had to provide, the banning of annual and lifetime limits - these things placed some rather substantial limits on the ability of insurers to not pay for needed health care.

There are obviously specific cases where the ACA doesn’t work as well as it should (big surprise, given GOP blocking of any technical fixes since they want the ACA to fail), but at a global level, the ACA taking effect has meant that there now IS a rough equivalence now between coverage and health care.

The AHCA would of course undo that equivalence.

ETA: That’s also a response to

@D_Anconia

For the last time, health insurance is not health care.

[Tee]

@Banquet_Bear

…in the United States healthcare and health insurance are intrinsically linked: and I see no problem linking them together. If you aren’t covered by decent health insurance, you can’t get decent health care (unless you qualify for medicaid, etc.)

I agree. Insurance is a poor vehicle for public health, it’s just the only one we have at the moment. So there’s the delimma, do we expand the current system via Medicare and Medicaid, or put our resources into developing something like the NHS model, or reduce federal government involvement and let the fifty states devise their own systems.

I’d actually be a proponent of the state model, if I wasn’t already aware that this side of the argument leans libertarian and there’s a lot of complaining about freeloaders, taxes as theft, sheeple who think health care is a right, not a commodity, etc. When this thinking is dressed up for public consumption, it’s about federal government overreach and forcing people to buy insurance, and a curious lack of anything useful in the way of how to help sick people access care that they need. Which is a shame, because there’s no logical reason why the states can’t provide that, or why its so-called proponents didn’t spend the last eight or ten years planning how to do it.

[D_Anconia]

@running_coach

Then expand on it, explain why it’s so critical and actually contribute something to the thread.

No. It’s up to the poster(s) who claim that 24 million!!! people will not have health care should the ACHA become law to back up that claim.

[Ann_Hedonia]

@Shagnasty

Do you realize that the only solid argument that ObamaCare supporters have is that it gave (greatly subsidized) healthcare to a very small minority of the population?

Other than that, there wasn’t much good about it. Health care premiums have skyrocketed as have prescription drug costs. However, the most insidious effect that few people talk about is that high-deductible plans have become the norm under ObamaCare.

For those that don’t speak American, that means that, even if you sign up for an expensive plan, you still can’t go to the doctor without paying for it yourself until you have racked up thousands of dollars in costs (your insurance means little until then). It also resets every year so, God forbid, your little Billy gets into an accident on New Year’s Eve. You could run up a family medical bill of $10,000 or more overnight and still have to pay exorbitant insurance premiums for nothing.

That chilling effect is real. I have a few health conditions but I stopped going to the doctor several years ago once the high deductibles kicked in because of ObamaCare. I would have to pay for it myself even though both me and my employer pay many thousands of dollars a year for my (now almost useless) health insurance. It is simply too expensive now even though I have supposedly good health insurance.

I am fine with helping the lower 10 percent or so help get some form of health insurance but I am not willing to let the mechanism that enables that effectively disable my own. I have no idea why many people are so ideologically tied to ObamaCare. It started out as a Republican idea after all and has only been with us for a few years and has obviously failed miserably by almost every measure except for a small group of poor people that now have greatly subsidized health insurance at the expense of everyone else. That is not a good metric unless you are an illogical bleeding-heart. We can do much better.

I have a full pay ObamaCare plan that has a zero deductible. This myth based on the fact that you can’t get a subsidy for a low or 0 deductible plan. I just had to choose to pay a little more for a plan. And I did choose, there were so many options offered through my state exchange I decided to use a broker.

Even people with the higher deductible plans get over a 50% discount off the billed price of services up until the point that they meet their deductible.

[running_coach]

@D_Anconia

No. It’s up to the poster(s) who claim that 24 million!!! people will not have health care should the ACHA become law to back up that claim.

Gladly.

[D_Anconia]

@running_coach

Gladly.

Where in that link does it say that people will lose health care?

[running_coach]

@D_Anconia

Where in that link does it say that people will lose health care?

24 million.
It’s the American Health Care Act.

[Bricker]

@running_coach

24 million.
It’s the American Health Care Act.

But it doesn’t say that 24 million will lose health care.

It says that it estimates that in 2026, 24 million fewer people will be covered than would be covered by the current law.

Incidentally, the estimate comes from the CBO, which estimated when the law was passed that in 2016 there would be 23 million getting policies through the exchanges; the actual number in 2016 was less than 11 million.

So (1) the 24 million is the estimated difference is covered people by 2026, not the number of currently insured that will lose coverage now, and
(2) the estimate comes from the same team that estimated current coverage would be 23 million and its only 11 million.

Right?

[running_coach]

@Bricker

But it doesn’t say that 24 million will lose health care.

It says that it estimates that in 2026, 24 million fewer people will be covered than would be covered by the current law.

Incidentally, the estimate comes from the CBO, which estimated when the law was passed that in 2016 there would be 23 million getting policies through the exchanges; the actual number in 2016 was less than 11 million.

**So (1) the 24 million is the estimated difference is covered people by 2026, not the number of currently insured that will lose coverage now, and
(2) the estimate comes from the same team that estimated current coverage would be 23 million and its only 11 million.
**
Right?

This shit again? It’s been covered and you left out critical numbers.

The Congressional Budget Office (CBO), a nonpartisan agency of Congress, made official projections of the Affordable Care Act’s impact on insurance coverage rates and the costs of providing subsidies to consumers purchasing health plans in the insurance marketplaces. This analysis finds that the CBO overestimated marketplace enrollment by 30 percent and marketplace costs by 28 percent, while it underestimated Medicaid enrollment by about 14 percent. Nonetheless, the CBO’s projections were closer to realized experience than were those of many other prominent forecasters. Moreover, had the CBO correctly anticipated income levels and health care prices in 2014, its estimate of marketplace enrollment would have been within 18 percent of actual experience. Given the likelihood of additional reforms to national health policy in future years, it is reassuring that, despite the many unforeseen factors surrounding the law’s rollout and participation in its reforms, the CBO’s forecast was reasonably accurate.

[Ravenman]

@D_Anconia

Where in that link does it say that people will lose health care?

The first full sentence in the link. It is hard to miss:
“CBO and JCT estimate that enacting the American Health Care Act would reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.”

But I know what game you are playing: that health insurance isn’t exactly the same as health care. I acknowledge that there is not a provision of AHCA that makes it a crime for a minimum wage earning single mother to pay $250,000 for heart surgery on her infant to correct a congenital defect.

Happy?

[elucidator]

…the CBO’s forecast was reasonably accurate.

And where, pray, does the CBO estimate the devastation to our country by its impact on the crucial importance of Federalist theory?

[Bricker]

@Ravenman

The first full sentence in the link. It is hard to miss:
“CBO and JCT estimate that enacting the American Health Care Act would reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.”

But I know what game you are playing: that health insurance isn’t exactly the same as health care. I acknowledge that there is not a provision of AHCA that makes it a crime for a minimum wage earning single mother to pay $250,000 for heart surgery on her infant to correct a congenital defect.

Happy?

No, I think he’s pointing out that there’s a difference between, “Right now, X people have health care, and if this law passes that number will be x-24,000,000,” and what the report actually says: “We estimate that in 2026, X people will have health care, but if this law passes we estimate it will be X-24,000,000.”

[Bricker]

@running_coach

This shit again? It’s been covered and you left out critical numbers.

What were the critical numbers that I left out? The Commonwealth Fund think that the CBO’s estimate was reasonably accurate. I don’t. I say that being wrong by 12 million and 50% is not reasonably accurate. Your link explains lots of reasons that the CBO’s mistakes were understandable. But nothing in the Commonwealth Fund link explains why I should NOW assume that their current estimate is accurate.

In other words, the CBO’s first estimate was for 23 million in 2016, and the actual number is less than 11 million. Why, specifically, should their current estimate be treated as gospel?

[running_coach]

@Bricker

What were the critical numbers that I left out? The Commonwealth Fund think that the CBO’s estimate was reasonably accurate. I don’t. I say that being wrong by 12 million and 50% is not reasonably accurate. Your link explains lots of reasons that the CBO’s mistakes were understandable. But nothing in the Commonwealth Fund link explains why I should NOW assume that their current estimate is accurate.

In other words, the CBO’s first estimate was for 23 million in 2016, and the actual number is less than 11 million. Why, specifically, should their current estimate be treated as gospel?

Medicaid numbers.

Read the whole cite. Not only are various changes that were made discussed but several other forecasting groups are examined and compared to the CBO.

[elucidator]

Only eleven million people at risk of being sick and miserable? Well, shit, sign me up!

[Ravenman]

@Bricker

No, I think he’s pointing out that there’s a difference between, “Right now, X people have health care, and if this law passes that number will be x-24,000,000,” and what the report actually says: “We estimate that in 2026, X people will have health care, but if this law passes we estimate it will be X-24,000,000.”

The CBO estimate also reads, “CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

You seem to imply that the CBO estimate relies on sort of a double estimate: How many will be insured in 2026 under current law? And how many fewer would be insured in 2026 under this change to law?

In fact, CBO estimates that the impact of AHCA would be immediate.

But as an aside, where are the conservatives who are actually presenting formal estimates of enrollments going up under AHCA? As it is, we have this quibbling of whether 24 million would lose coverage, or maybe it won’t be quite that bad, like maybe only 15 million. If the general goal of conservatives is to make health care more affordable - and I will take conservatives at their word on that - why can’t they actually make a analytical case that more people will be able to buy insurance under this plan as compared to the ACA? That’s Trump’s stated goal, BTW.

[Okrahoma]

@Ravenman

The CBO estimate also reads, “CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

So it’s not that insurance will be taken away from people. Or that they would “lose” insurance like so many posters claim in this thread.

No, apparently CBO estimates that a lot of people will choose (may I emphasize this word) not to buy insurance because they will be allowed not to and will not be penalized for doing that.

What a freaking revelation. If you don’t force people to buy insurance, some will choose not to buy it. Amazing. But what happened to the “millions of people will LOSE their insurance” claim? Do you think “choosing not to buy insurance” is equivalent to “losing your insurance”?

[Bricker]

@running_coach

Medicaid numbers.

Read the whole cite. Not only are various changes that were made discussed but several other forecasting groups are examined and compared to the CBO.

I did read the whole cite.

Please explain why you feel the Medicaid numbers make the CBO’s 11 milliion vs. 23 million prediction more accurate. Please explain why “other forecasting groups” are relevant to making the CBO’s 11 milliion vs. 23 million prediction more accurate.

It seems to me that the best we can say is that other forecasting groups were even less accurate. And that the CBO was more accurate about the Medicaid predictions.

Is that your point?

[Bricker]

@Ravenman

The CBO estimate also reads, “CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”

You seem to imply that the CBO estimate relies on sort of a double estimate: How many will be insured in 2026 under current law? And how many fewer would be insured in 2026 under this change to law?

Suggestion: stop trying to address what I “seem to imply,” and just address stuff I actually say.

I said nothing about any “double estimate.” I pointed out that the CBO made an estimate when the law passed that 23 million people would be covered in 2016. And that the actual figure was less than 11 million.

But as an aside, where are the conservatives who are actually presenting formal estimates of enrollments going up under AHCA? As it is, we have this quibbling of whether 24 million would lose coverage, or maybe it won’t be quite that bad, like maybe only 15 million.

The other aspect of the quibbling is around the word “lose.”

Right now, 11 million are covered. The CBO estimates that with no mandate, not so many people will choose to buy. But that’s not really “losing,” to say nothing of harsher words like “forced off.”

If the general goal of conservatives is to make health care more affordable - and I will take conservatives at their word on that - why can’t they actually make a analytical case that more people will be able to buy insurance under this plan as compared to the ACA? That’s Trump’s stated goal, BTW.

I didn’t vote for Trump. Why should I defend Trump’s stated goal?