The Repeal of Obamacare/ACA: Step-bystep, Inch-by-inch

[Folacin]

@Inbred_Mm_domesticus

Their proposals will lead to people opting to avoid the individual market because it is too expensive to participate. This effectively returns this aspect of the law to pre-ACA days. In the meantime, for the suckers who try to participate, the 30% surcharge they pay for the bottom of the barrel insurance they can afford will go straight to insurer’s profits. Yes, they will eventually cancel their insurance when they realize it doesn’t do anything for them, but in the meantime profit.

Well, the smart, healthy ones won’t sign up until they get sick. Bank the money they would have spent on insurance (or buy an I-phone, I guess), and, in the eventuality that they get sick enough that insurance would be a good idea, the 30% surcharge will be a bargain.

That is the adverse selection that the mandate was (feebly) attempting to prevent. This will be a true death spiral for insurance rates.

[nate]

I can get behind the term “Republicare” that I’ve seen on Reddit. Make them own this shit.

[Skywatcher]

Trump has endorsed Republican legislation to replace Obamacare, saying it had earned support “from everybody”. Not so fast, your Orangeness.

[Frankenstein_Monster]

Assume a 40 year old person can get a Silver plan today for $400 premium/month and $3000 deductible.

With Trumpcare, you get $250/month advanceable tax credit. You’re left with $150/month premium to pay.

With Obamacare, if you make $30k/year (250%FPL) the premium cap (you pay) is $200/month (8%). You pay slightly more under Obamacare than under Trumpcare. If you are completely healthy (no healthcare costs other than premium) then Trumpcare is better.

But if you make only $15k/year (133%FPL) the premium cap is $38/month (3%). And with Cost Sharing Reduction you get $0 deductible. You pay a GREAT deal more under Trumpcare. Thousands of dollars per year at least. Am I getting this right?

So Trumpcare is good if you’re not too poor and completely healthy. Trumpcare is horrible if you’re not very rich and/or not very healthy. And this is with normal insurance, not Medicaid. I wonder how this is going to play out.

[ThelmaLou]

@AngelSoft

Why is it so hard for them to just realize or accept that for people who really need help the most, giving it to them in the way of ‘tax credits’ and ‘health savings accounts’ are useless. …

They realize it. They just don’t give a fuck.

@PastTense

So exactly how do you deal with the problem of healthy people not participating until they get sick?

You pay for the program with taxes like the rest of the civilized world

[My proposed solution is universal Medicare.]

Exactly

[jasg]

We are going to see many articles analyzing the AHCA, but this one from Jonathan Chait is worth a read.

There are some tables from Kaiser Health in the article which compare subsidies. It should play well in rural America - not…

Obamacare concentrates its benefits on people with the most modest incomes. Republicans would spread them much higher up the income ladder. Obamacare ties its subsidy levels to the cost of health insurance in a market. Trumpcare does not. As a result, people in high-cost areas — like rural markets — would have their subsidy cut in half or more. When you combine all these problems — a smaller overall pool of money for subsidies, and targeting the subsidies less efficiently — you have a recipe for massive harm.

[sinjin]

@Bone

The difference being it would be consistent with the constitution as it should be understood. If you don’t find that important that’s not surprising.
You’ve misunderstood. If healthcare for all were to be provided like Medicare that would not be treading new ground. And yes, principles matter to me.

C’mon yourself? I don’t think the ACA is evil in the slightest. I think it’s well intentioned but ultimately poor public policy. But you didn’t answer the question. Would you be okay to be forced to purchase Trump provided goods and services, and if you declined you’d be penalized with a tax? My guess is you’d be opposed, but you seem to avoid answering direct questions for some reason.

Your question is stupid. Insurance companies are not owned by the president. Nothing necessary to human life is owned by Trump. Why are you bringing up this red herring? However I would like medicare for all. I had hoped that that was in the ACA.

[sinjin]

@GrumpyBunny

I’m a healthcare analyst. I live in Massachusetts; I’m originally from Florida. And I agree with you that the ACA didn’t work when it was rolled out nationally.

Because:

1.) Politics. The Republicans’ message was so negative and pervasive about this. The end result was many red states going with the party line and declaring, “We ain’t gonna expand no Medicare!” (Never mind the 50% uninsured population, half of whom are asthmatic, have cancer, or are pre-diabetics that make up the state. BTW, uncontrolled chronic health problems are bad for hospitals’ bottom line)

2.) Industry creativity – the pseudo-coverage known as “high deductible plans” do nothing to help anyone’s health, nor does it provide much in the way of coverage or security. And the creative tricks used to reduce coverage of medications used for standard care need to stop, too.Declaring every medication used to treat a condition “non-preferred” is fucking wrong.

And 3.), no one took on the drug companies. The drug companies have been coddled and allowed to run amok, and will never, ever have a conversation about how to combine reasonable pricing and making reasonable profits until America starts to import drugs from India.

To my mind, we need single-payer, universal coverage. Some form of universal coverage has worked in every westernized country, and serves to keep citiziens healthier by treating problems as they come up rather than when they are at the ER.

The infrastructure for single payer already exists with Medicare, which has been successful for fifty years. (Medicare also needs some updating; but that’s another post.)

Negotiations with drug companies so that epi-pens aren’t $600 a pop, and sixty-year-old drugs don’t cost $1200 per month. Import drugs if the pharmaceutical companies won’t negotiate.

Existing insurance companies can process claims (as they do for Medicare) and sell add-on plans to employers, to be employee perqs.

There are dozens of countries we can look at to analyze how to implement this, but I’d suggest one that was analyzed in this Commonwealth Fund report.

I agree with this whole heartedly. What are the chances though?

[Miller]

@Patx2

That’s a very logical argument you make. If they are going to penalize someone, they should give them every opportunity to not have to be penalized. Life changes, circumstances change. The other argument, of course, the one that gets so much attention is what right does the government have to tell anyone they have to have health insurance or pay a penalty anyway?

The problem you got here is that, as I’m sure you’ve noticed, health care isn’t free. So, if we don’t make health insurance mandatory, when someone who doesn’t have insurance gets sick, we got two options:

1. Everyone else pays for their healthcare.

2. We let the fucker die.

Which of these approaches are you advocating?

[JohnT]

Iconic photo of woman deciding between health care and iPhone

[JohnT]

AARP takes strong stand against WealthCare:

AARP Opposes Healthcare Bill

[Chimera]

Januvia (Diabetes drug) in the USA: $450/month
Januvia in Canada: $107/month

That’s a whole lot of extra profit and ‘marketing’.

[snowthx]

In a matter of days we went from “Who knew health insurance was so complicated” to “We’ve solved all the problems with the ACA.” I’m sure the Republicans’ plan is well thought-out since they have had 7 years to study the market here. It all came together over the weekend, I assume. Buh-lieve me, it’s gonna be yuge!

[galen_ubal]

I’m wondering if Trumpcare isn’t supposed to be a failure - that way Republicans think they can shrug, say, “Well, we tried, but government has no place here”, and repeal Obamacare with no replacement.

[elucidator]

Obama didn’t play four dimensional chess, he played four dimensional poker. His wonks were better than theirs.

His wonks said that even with all the poison pills that the Pubbies demanded, the efficiencies gained and the people served would catch up. If ACA could just hold on for a year or two, the ugly shit would wear off, and the efficiencies would begin to be felt. And all those people who couldn’t go to the doctor had to go at least once, to walk out into the parking lot and say “Hey! I like that!” And every one that did that was a solid bet for support.

The Republicans saw a chance to bury health care reform once and for all and nail the coffin shut. Because their wonks told them that’s what would happen. And they believed their wonks because everybody knows liberals are fuzzy thinking do-gooders who have no grasp of reality. Not hard-nosed realists, like they are! Nosir!

You know what? Obama is smarter than me! Wow!

[Saint_Cad]

@JohnT

From ObamaCare to WealthCare, a study in how to openly fuck millons out of their lives to enrich dozens.

With medical coats and insurance costs, that’s how it was before Obamacare, during Obamacare and after Obamacare.

I get that the lefties on the board will use any excuse to bash Trump and Republicans but you forget that under Obamacare BOTH insurance prices and medical costs rose. Sure everyone could get insurance and that was great but let’s not act like it made getting sick any cheaper.

[Fiveyearlurker]

@galen_ubal

I’m wondering if Trumpcare isn’t supposed to be a failure - that way Republicans think they can shrug, say, “Well, we tried, but government has no place here”, and repeal Obamacare with no replacement.

I’m not sure that it’s a matter of “supposed” to rather than just that the GOP backed themselves into a corner when, for seven years, they talked about their better plan that would replace Obamacare (which obviously didn’t exist). They never thought they would have the opportunity to get rid of Obamacare, and now they can’t agree on what to actually do. So, they put out the best bill that can actually get any GOP support at all, and blame Obamacare’s entrenchment of dependency on the government when it can’t pass, and say it is now impossible to unravel. Thanks Obama!

[Evil_Economist]

@Saint_Cad

I get that the lefties on the board will use any excuse to bash Trump and Republicans but you forget that under Obamacare BOTH insurance prices and medical costs rose. Sure everyone could get insurance and that was great but let’s not act like it made getting sick any cheaper.

The average employer-sponsored family premium has gone up by $4,154 under Obama, from 2008, before he took office, to 2014, according to the Kaiser Family Foundation’s annual employer survey conducted with the Health Research & Educational Trust. The catch? That’s relatively slow growth for premiums. The RNC may cast it as bad news, but it’s an improvement compared with the growth in premiums before Obama took office.
Under Bush, the average family premiums (including both what employers and employees pay) went up $4,677 in his last six years in office, from 2002 to 2008, an increase of 58 percent. That $4,154 growth under Obama is a 33 percent increase. If we look at Bush’s first six years, the discrepancy gets even bigger: From 2000, the year before Bush was first inaugurated, to 2006, the average family premium went up $5,042, or an increase of 78 percent. (See Exhibit 1.11 on page 31 of the KFF report for these numbers.)

[Ann_Hedonia]

@JohnT

Iconic photo of woman deciding between health care and iPhone

I would need to buy a new iPhone once a month in order to wastefully spend the money I use for my insurance premiums. And it would need to be a really good iPhone, too-- a 7Plus with lots of memory.

Of course the new plan sucks, the good plan that conservatives worked on for years and years was compromised when the Democrats coopted it and called it ObamaCare.

I think the new plan might cause a cascading disaster through the insurance and health care industry. Ill be able to keep my insurance as I have a full pay zero deductible ACA plan ( a lot of posters here are disingenuous when they complain about the deductibles on ACA plans, if you don’t qualify for subsidies there are lots of plan options. I selected the no deductible plan for this year because I’ll have to have cataract surgery twice.)

But my insurer is a start-up company that was formed post-ACA to handle the new business generated by the ACA. I selected the plan because it was better and cheaper than the standard plans, which I also looked at - I had lots of choices under ACA.

But what’s going to happen if a large percentage of their subscribers drop coverage at the same time when if they stop getting those government subsidies that make it affordable for them? That’s potentially going to leave a lot of doctors and hospitals in the lurch for payments on services they’ve already provided - if my insurer is like most businesses they’re counting on this month’s premiums to pay the bills that came in last month.

They could always sue the patients since everyone has to sign that piece of paper promising to pay if their insurer doesn’t. But good luck getting blood from a stone, this could cause a crisis that spirals through the health care industry. I’m thinking the most noxious part of the new plan, the tax breaks for high paid (500,000+ a year) health insurance execs is some sort of bribe to get these guys to shut up about how toxic the plan will be for the health care industry.

[Saint_Cad]

@Evil_Economist

[INDENT]The average employer-sponsored family premium has gone up by $4,154 under Obama, from 2008, before he took office, to 2014, according to the Kaiser Family Foundation’s annual employer survey conducted with the Health Research & Educational Trust. The catch? That’s relatively slow growth for premiums. The RNC may cast it as bad news, but it’s an improvement compared with the growth in premiums before Obama took office.

Yes that the the Dem standard argument. The claim was rates would go down. When the facts showed that the growth rate decreased but that insurance premiums still went up, the Dems moved the goalposts.

So did Obamacare reduce health cost/insurance premiums as promised? No it did not. Again not saying there weren’t good points about Obamacare but don’t act like it solved all of the problems.