# The Repeal of Obamacare/ACA: Step-bystep, Inch-by-inch **URL:** \ **Category:** The BBQ Pit\ **Created:** [January 2, 2017, 5:06pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146 "2017-01-02T17:06:13Z")\ **Posts on this page:** 20\ **Page:** 77
**Author:** ![suranyi](https://avatars.discourse-cdn.com/v4/letter/s/e36b37/32.png) [@suranyi](https://boards.straightdope.com/u/suranyi)\ **Post date:** [October 13, 2017, 10:39pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1521 "2017-10-13T22:39:03Z")
Just got my notice from Blue Shield of California: If I stick with my current plan, my premium is increasing by 30% next year. ☹ I don’t see anything happening that will provide GOOD insurance at an affordable price anytime soon. ---
**Author:** ![Bone](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bone/32/407_2.png) [@Bone](https://boards.straightdope.com/u/Bone)\ **Post date:** [October 13, 2017, 10:52pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1522 "2017-10-13T22:52:26Z")
> [@Bricker](#): > > That’s not a complete description. States must explicitly allow inter-state insurance business – not simply set up neutral rules that apply to all companies. Yes, I agree. When I said “comply with state’s requirements” I meant even the ones that say whether or not a foreign company can operate. The way around that would be to set up a subsidiary domiciled in the state. The subsidiary would be required to comply with the in state rules. Setting up a subsidiary to do this for large companies is not a significant barrier. > [@Bricker](#): > > Ownership of the companies may extend to out-of-state entities, including parent companies with the same name. Risk pools do not. Overhead, fringe, and G&A costs do not. The direct basis risk pools upon which to base rate and loss experience may not, but premium and loss, overhead, fringe, and other G&A can be pooled across the enterprise with intercompany pooling, cession, and retrocession. For me, I don’t have strong feelings either way. I don’t think interstate insurance sales is a panacea or would even have any significant impact. ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 13, 2017, 11:02pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1523 "2017-10-13T23:02:17Z")
> [@k9bfriender](#): > > Right, and the point is that each state gets to set its own rules as to whether or not it will allow insurance companies to sell across state lines into it. If a state wants to allow it, it can. If a state does not want to allow it, it does not have to. > > This takes that right away from the state to make that determination, and forces it to accept plans from out of state. > Specific to each and every company and subsidiary, no, and I doubt that you have that level of knowledge of the insurance company either. My “confident declaration” is based on more than just seeing the same name. It’s based on seeing how they are owned by companies of the same name. > > As to the basics of the legal framework, sure. They are nearly all owned by a few huge parent companies that have subsidiaries in the states that they cover. > > This means that if they can sell across state lines, then they can shut down their individual subsidies in the different states, and sell plans directly through their parent copr, located in the state with the most lenient laws and regulations towards providers. > I suppose making the risk pool larger would help some of the small states, like wyoming or north dakota. I would have no problem with those states getting together, and allowing insurance to be sold across those lines. The ACA doesn’t have a problem with it either, those states are free to open themselves up that way. So, if this was such a great idea, you would see most of the small states banded together in a single risk pool already. > > If there were a law that prevented states from allowing policies to cross state lines, that would be one thing, and should be looked at if the states want it. There is no such law, the law only respects the states decision as to whether or not to allow such policies. This would get rid of the rights of states to regulate the insurance products sold to their residents. The McCarran-Ferguson Act requires a state affirmatively permit such dealings. So without any California law on the books preventing it, insurance companies from out of state can’t sell in California. Now, you say this is simply respecting California’s rights (although claims above in the thread seemed to suggest that any company could sell anywhere as long as they met the same standards, which is not correct – a Nevada company can offer identical policies to a California one and still not legally operate in California. Do you acknowledge this?) The problem with this is: it’s relatively unique to insurance (and a few other industries). That is, California can’t prevent me from selling furniture or vacuum cleaners even if I am an out of state company, even if they tried to pass a law doing so. This is true for the vast majority of commerce. Why? Because of the dormant Commerce Clause. I’m going to stop here and ask if I need to explain this further, or if you’re familiar enough with the dormant Commerce Clause that the point is clear. ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [October 14, 2017, 12:31am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1524 "2017-10-14T00:31:16Z")
> [@wolfman](#): > > I’m not in a panic about it yet. I think there is a good chance for a lawsuit against the order, as contrary to existing federal law, getting a temporary stop before it goes into effect. At that point I have no idea what would happen but if it did end up in the supreme court, it is a court with the same general ideological makeup that saved the ACA a few years ago. And they are, of course, partisan, but partisan Pubs, not Trumpnuts. I can’t see that many of them really looking forward to tying their legacy to certifying executive overreach against a congress controlled by their party, by a buffoon, with no respect for the constitution, open contempt for the judiciary, and certain to go down as the most contemptible jackass the White House will ever see. Nah, it’s pretty much over, dude. The insurance companies cannot afford the uncertainty - it’s bad for their business. They will have to start operating under the assumption that the healthcare law is gradually unwinding. The uncertainty alone is enough to get insurers to bail on the markets. Trump is trying to create a death spiral, and he has the power to make that happen. This is perhaps the “flaw” of Obama’s decision to sign this into law without bipartisan support, though it’s an understandable calculus. Obama assumed that once Republicans actually figured out that the law wasn’t nearly as unpopular as they had made it seem, they would be reluctant to pull the plug on it. He didn’t anticipate the bat shittery that would consume the far right. ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [October 14, 2017, 12:41am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1525 "2017-10-14T00:41:22Z")
> [@Bricker](#): > > I’m going to stop here and ask if I need to explain this further, or if you’re familiar enough with the dormant Commerce Clause that the point is clear. I’d like you to explain this further. AFAICT, states can allow insurance companies from other states to offer policies if they want right now. How is implementing “Buying insurance across state lines” going to fix/solve/do anything? ---
**Author:** ![eulalia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eulalia/32/457_2.png) [@eulalia](https://boards.straightdope.com/u/eulalia)\ **Post date:** [October 14, 2017, 12:53am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1526 "2017-10-14T00:53:26Z")
> [@suranyi](#): > > Just got my notice from Blue Shield of California: If I stick with my current plan, my premium is increasing by 30% next year. ☹ > > I don’t see anything happening that will provide GOOD insurance at an affordable price anytime soon. If you are on a silver plan you may be able to switch to a gold one for not much more. Some companies are raising the silver plan premiums more because the tax credits are based on the price of the second lowest cost silver plan. If you’re eligible for the credit it will also go up. Covered California apparently is adding a CSR surcharge to silver plans. > **[Covered California makes Silver Switcharoo official, issues press release to...](https://acasignups.net/17/10/11/covered-california-makes-silver-switcharoo-official-issues-press-release-explain-it)** > > Covered California (CA's ACA exchange) just issued the following press release: Covered California Keeps Premiums Stable by Adding Cost-Sharing Reduction Surcharge Only to Silver Plans to Limit Consumer Impact In the absence of a federal commitment... ---
**Author:** ![Bricker](https://avatars.discourse-cdn.com/v4/letter/b/977dab/32.png) [@Bricker](https://boards.straightdope.com/u/Bricker)\ **Post date:** [October 14, 2017, 1:34am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1527 "2017-10-14T01:34:41Z")
> [@Slash1972](#): > > I’d like you to explain this further. AFAICT, states can allow insurance companies from other states to offer policies if they want right now. How is implementing “Buying insurance across state lines” going to fix/solve/do anything? Yes, right now they can, by taking an affirmative step and passing legislation. When we speak of “implementing ‘Buying insurance across state lines’,” we’re talking about removing the federal law that prohibits it unless a state affirmatively permits it. Right now, I don’t need California’s legislature to act before to sell my furniture in California stores. But I can’t sell my insurance policies. ---
**Author:** ![JackieLikesVariety](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jackielikesvariety/32/296_2.png) [@JackieLikesVariety](https://boards.straightdope.com/u/JackieLikesVariety)\ **Post date:** [October 14, 2017, 1:35am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1528 "2017-10-14T01:35:08Z")
> [@](#): > > don’t see anything happening that will provide GOOD insurance at an affordable price anytime soon. that is the bottom line ---
**Author:** ![Leaper](https://avatars.discourse-cdn.com/v4/letter/l/4bbf92/32.png) [@Leaper](https://boards.straightdope.com/u/Leaper)\ **Post date:** [October 14, 2017, 1:42am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1529 "2017-10-14T01:42:24Z")
> [@asahi](#): > > Nah, it’s pretty much over, dude. The insurance companies cannot afford the uncertainty - it’s bad for their business. They will have to start operating under the assumption that the healthcare law is gradually unwinding. The uncertainty alone is enough to get insurers to bail on the markets. Trump is trying to create a death spiral, and he has the power to make that happen. This is perhaps the “flaw” of Obama’s decision to sign this into law without bipartisan support, though it’s an understandable calculus. Obama assumed that once Republicans actually figured out that the law wasn’t nearly as unpopular as they had made it seem, they would be reluctant to pull the plug on it. He didn’t anticipate the bat shittery that would consume the far right. If this is so, thank you for trying, jsgodess. I’m sorry there was nothing to be done. ---
**Author:** ![ThelmaLou](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/thelmalou/32/390_2.png) [@ThelmaLou](https://boards.straightdope.com/u/ThelmaLou)\ **Post date:** [October 14, 2017, 1:55am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1530 "2017-10-14T01:55:49Z")
> [@asahi](#): > > …This is perhaps the “flaw” of Obama’s decision to sign this into law without bipartisan support… You say that like there was an ice cube’s chance in hell that he could have gotten Republican support. > [@](#): > > Obama assumed that once Republicans actually figured out that the law wasn’t nearly as unpopular as they had made it seem, they would be reluctant to pull the plug on it. He didn’t anticipate the bat shittery that would consume the far right. Obama’s biggest flaw/mistake was assuming that the Republicans would ultimately 1) over look how much they hated him, 2) be reasonable and 3) give a shit about the well-being of the citizens of this country, particularly the poor and middle class. In fairness, I don’t think any of us foresaw the level of \*batshittery \*that we are now watching unfold. And also, in fairness, when it came down to the nut cutting, Congress couldn’t do the deed… it’s Trump who wants credit for that accomplishment. ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [October 14, 2017, 2:41am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1531 "2017-10-14T02:41:03Z")
> [@ThelmaLou](#): > > You say that like there was an ice cube’s chance in hell that he could have gotten Republican support. Obama’s biggest flaw/mistake was assuming that the Republicans would ultimately 1) over look how much they hated him, 2) be reasonable and 3) give a shit about the well-being of the citizens of this country, particularly the poor and middle class. In fairness, I don’t think any of us foresaw the level of \*batshittery \*that we are now watching unfold. And also, in fairness, when it came down to the nut cutting, Congress couldn’t do the deed… it’s Trump who wants credit for that accomplishment. Don’t misunderstand me - I was saying that sarcastically. I won’t go into how ACA was basically in many ways a compromise with those who demanded a public option and we settled for Heritage Foundation/Romney-care. The ACA was Vichy-care. The Dems could have gone full-on Bernie-care back in 2009. ---
**Author:** ![fervour](https://avatars.discourse-cdn.com/v4/letter/f/ce7236/32.png) [@fervour](https://boards.straightdope.com/u/fervour)\ **Post date:** [October 14, 2017, 2:57am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1532 "2017-10-14T02:57:56Z")
Anyone arguing that Blue Cross/Blue Shield are entirely unaffiliated across states is wrong. I don’t know what their legal arrangements are, but in March 2017, I broke my wrist in Philadelphia, PA . I have BC/BS of Alabama. My hospital paperwork said I had BC/BS of PA. I pointed out that I did not have BC/BS PA. The hospital administrators said something like, “that’s just the way we fill it out. . .” Clearly the various BC/BS in each state have some sort of reciprocal agreements. I paid $150 for my ER visit in PA, and I believe it was another $150 for the outpatient surgery two days later to screw my wrist back together. The hospital and the two different state’s BC/BS’s worked out the rest of the payments. ---
**Author:** ![The\_Other\_Waldo\_Pepper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/the_other_waldo_pepper/32/12370_2.png) [@The\_Other\_Waldo\_Pepper](https://boards.straightdope.com/u/The_Other_Waldo_Pepper)\ **Post date:** [October 14, 2017, 4:16am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1533 "2017-10-14T04:16:49Z")
> [@asahi](#): > > Don’t misunderstand me - I was saying that sarcastically. I won’t go into how ACA was basically in many ways a compromise with those who demanded a public option and we settled for Heritage Foundation/Romney-care. The ACA was Vichy-care. The Dems could have gone full-on Bernie-care back in 2009. Could they have sold that with an If-You-Like-Your-Plan-You-Can-Keep-It pitch? ---
**Author:** ![wolfman](https://avatars.discourse-cdn.com/v4/letter/w/a8b319/32.png) [@wolfman](https://boards.straightdope.com/u/wolfman)\ **Post date:** [October 14, 2017, 4:36am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1534 "2017-10-14T04:36:57Z")
> [@asahi](#): > > Nah, it’s pretty much over, dude. The insurance companies cannot afford the uncertainty - it’s bad for their business. They will have to start operating under the assumption that the healthcare law is gradually unwinding. The uncertainty alone is enough to get insurers to bail on the markets. Trump is trying to create a death spiral, and he has the power to make that happen. This is perhaps the “flaw” of Obama’s decision to sign this into law without bipartisan support, though it’s an understandable calculus. Obama assumed that once Republicans actually figured out that the law wasn’t nearly as unpopular as they had made it seem, they would be reluctant to pull the plug on it. He didn’t anticipate the bat shittery that would consume the far right. Paul floated this a few months ago to prove his _Bone Fides_ to his sucker donors, and clueless Trump bit hard. And the uncertainty is obviously of no benefit to anyone, but if this order being allowed to stand, it is the death of the GOP, and therefore it will not. It it crafted with so many outs that the Buffoon doesn’t understand. It’s just a Mexican standoff to see who blinks first. ---
**Author:** ![Merneith](https://avatars.discourse-cdn.com/v4/letter/m/57b2e6/32.png) [@Merneith](https://boards.straightdope.com/u/Merneith)\ **Post date:** [October 14, 2017, 5:02am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1535 "2017-10-14T05:02:22Z")
Donald’s already shot the hostage. He’s already blinked. Now he’s trying to get the Democrats to negotiate the hostage’s death? ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [October 14, 2017, 10:26am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1536 "2017-10-14T10:26:59Z")
> [@asahi](#): > > Don’t misunderstand me - I was saying that sarcastically. I won’t go into how ACA was basically in many ways a compromise with those who demanded a public option and we settled for Heritage Foundation/Romney-care. The ACA was Vichy-care. The Dems could have gone full-on Bernie-care back in 2009. This would be assuming some hypothetical Democratic Party that didn’t exist in 2009. It was hard enough to get 60 Senate votes for something as radical (compared to the status quo) as the ACA, during that 14-week interval when there were 60 Dems in the Senate. And it only passed the House by 220-215. Getting the ACA through Congress, even as Democratic a Congress as we had in 2009-2010, was about as heavy a lift as it gets. There were not 60 and 218 votes for an ACA with a public option, let alone single-payer. The Democratic Party has moved considerably on this issue - mostly just this year, when defending the ACA finally became a political winner. If the Dems get control of Congress in 2018 or 2020, they can pass a public option, assuming they either repeal the filibuster, or can shoehorn the public option into a reconciliation bill. But single payer? Despite a surprising number of Senators coming out in favor of it, even the Dem party as a whole isn’t there yet, and probably won’t be in 2021, either. ---
**Author:** ![RTFirefly](https://avatars.discourse-cdn.com/v4/letter/r/c77e96/32.png) [@RTFirefly](https://boards.straightdope.com/u/RTFirefly)\ **Post date:** [October 14, 2017, 10:40am UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1537 "2017-10-14T10:40:26Z")
> [@Merneith](#): > > Donald’s already shot the hostage. He’s already blinked. Now he’s trying to get the Democrats to negotiate the hostage’s death? Nah, the bullet hasn’t got there yet. So it’s more like “what will you give me in return for deflecting the bullet?” This is going to be tough. People got loud about the repeal attempts, and forestalled them (just barely). People are going to have to put pressure on GOP Congresscritters to make the ACA tamper-proof: fund the CSR subsidies for a period of several years beginning in 2019 (I assume we’ve already missed the boat on 2018) so that the insurance companies don’t just throw in the towel; do the same with funding for advertising, outreach, and enrollment assistance; write the enrollment periods into the law, things like that. Because the Dems can’t block Trump’s ACA sabotage by themselves, and the GOP won’t help unless they feel the heat from their constituents. ---
**Author:** ![Merneith](https://avatars.discourse-cdn.com/v4/letter/m/57b2e6/32.png) [@Merneith](https://boards.straightdope.com/u/Merneith)\ **Post date:** [October 14, 2017, 12:38pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1538 "2017-10-14T12:38:37Z")
Screw that. The GOP isn’t going to save Obamacare (as delicious as that would be). Forget pleading with them. Take all the energy and anger focus it on the next election. ---
**Author:** ![Kinthalis](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kinthalis/32/16084_2.png) [@Kinthalis](https://boards.straightdope.com/u/Kinthalis)\ **Post date:** [October 14, 2017, 12:48pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1539 "2017-10-14T12:48:25Z")
Man this couldn’t come at a worse time for me. Trying to find a new job, COBRA is a ridiculous $1,500 a month, even with my old job’s income I couldn’t possible afford that! Obama care is my only hope of not losing coverage for my family, and the best plan I can afford, still expects me to pay the first $2,000 worth of doctor’s bills by myself before it kicks in. I hate the party of fuck you I got mine. May these fuckers face punishment for their greed in some other life. ---
**Author:** ![enipla](https://avatars.discourse-cdn.com/v4/letter/e/54ee81/32.png) [@enipla](https://boards.straightdope.com/u/enipla)\ **Post date:** [October 14, 2017, 1:33pm UTC](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146/1540 "2017-10-14T13:33:39Z")
Three hurricanes a massacre in Las Vegas, tragic fires in California. And what does Trump concentrate on? Taking health care away because of that uppity black man. I’d like to know who the asshole is that suggested this latest EO to him. [Previous page](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146.md?page=76) [Next page](https://boards.straightdope.com/t/the-repeal-of-obamacare-aca-step-bystep-inch-by-inch/776146.md?page=78)