Trump said that he would fire Price if Price didn’t deliver the votes in the Senate. It was a goofy thing to say because Price has no power in the Senate, but Trump is goofy.
The thing is, his threats tend to mean something about what he’s thinking. If he has decided that Price is somewhat liable for that failure, it puts a black mark on Price, even though Trump is by far more responsible for not even making a modicum of an effort.
Now imagine that the individual markets have mounting problems, after Trump announces that he’s going to let them fail and after there is evidence that there is sabotage coming from HHS (they are under investigation right now by GAO, for example). Trump cares little about the voters but he cares a TON about what the media are saying about him. The media would then start really to hammer that the ACA has all these problems and Trump did it, etc.
Who does Trump blame? He’ll blame Obama, obviously, but he’s blaming Hillary Clinton for Russia AND Jeff Sessions, too. I think he might turn on Price EVEN IF PRICE WAS FOLLOWING HIS ORDERS.
Again, he’s blaming Price for something that is more his fault than Price’s already. That’s his MO.
I think the 5 month kabuki theatre display in both houses of Congress amply demonstrated that Boehner was right on that fundamental assumption.
There’s a good Vox article, which argues that “repeal and replace” sorta made sense from 2010 to 2012, before all of Obamacare benefits kicked in. The Republicans apparently did actually have a consistent r&r plan, ready to go if Romney had won. But five years on, after Obamacare has been working and delivering benefits, that 2010 r&r plan doesn’t work.
“John Boehner told Republicans some inconvenient truths on Obamacare.”
I sure agree with this. I expect it to intensify immediately.
Would you, please? I understand, I think, why Medicare-for-All is problematic, starting with how many people would be thrown out of work all at once if we moved precipitously toward that. People who are employed by the health insurance industry, etc., would find themselves in a tough spot. But what about Medicare buy-in for older Americans?
The problem with most ideas that build on Medicare is that Medicare is fairly expensive coverage to be on, and it excludes a few things that are really important–dental, hearing, vision, and the biggie long-term care.
If we simply say that someone can buy in to Medicare at the price that people 65+ do, then we are saying that the amount of time those folks in general put into working and adding to the trust fund through the payroll tax is unimportant.
If we say that someone can pay more to buy in, then we’re talking steep costs on top of already steep costs.
If we say that someone can pay less to buy in, then we’re talking a big problem with inequity.
From the POV of groups that support Medicare, the answer is to make Medicare more affordable for everyone in it, whether the extant population or any new expanded population. But most of the proposals floating around don’t do that. They just slap a “Medicare” label on something that is a separate system, with usually better benefits.
Sure thing!
First, a little explainer on Medicaid:
Medicaid is paid for with a combination of federal and state funds. States run the program, and have to be in compliance with federal legislation and regulations. For example, the Medicaid statute requires states to pay for nursing home care for eligible individuals.
All states (as far as I know) have “waivers” in place. These waivers allow the states to do things that don’t actually comply with either some of the statutes or some of the regulations. The two most common waiver types you will see are 1915 waivers (often 1915(c)) and 1115 waivers. These are both statutory waiver types, built into the law, that allow workarounds in some circumstances.
1915(c) waivers allow states to use federal Medicaid money to pay for people who would otherwise be in nursing homes. Again, nursing homes are a required expense, but what’s called “Home- and Community-Based Services” are optional for states.
1915 waivers are limited. They must be cost-effective, have very explicit rules, etc. They can do things like extend the income threshold for people who are nursing home eligible, for example. They have been really successful in getting more home care to people who would otherwise be costing much more in a nursing home. Many states have multiple 1915 waiver programs.
The other type of waiver, 1115s, are much broader. Under 1115 waivers, states can basically ask to waive all sorts of parts of the Medicaid program. They can ask to institute work requirements, copays and premiums, drug testing, benefit limits, etc. All that really has to happen is they have to come up with what they want, send it to HHS/CMS, and get approval.
Under Obama’s HHS/CMS, states had to work hard to get these waivers, and show that they weren’t going to be harmful for the recipients.
Essentially, Tom Price and the head of CMS, Seema Verma, have started shopping waivers to states. Verma is calling states, suggesting that they could get various waivers if they only apply. IOW, they are making it open season on Medicaid waivers.
So, we expect a whole lot of shit to hit the fan as states take advantage of these ways to kick people off Medicaid and limit benefits.
HHS/CMS have also already started requiring states to require people to get Medicaid eligibility redeterminations more often, which makes more people churn off the program as they miss deadlines, etc. It hugely increases the burden on the state and the individuals in the program, but if you just want to fuck people over, it’s a good bet.
Thanks for all the informed commentary in this thread.
Watching the discussion makes me eternally grateful to Tommy Douglas, Woodrow Lloyd, and Lester Pearson. Our system isn’t without its problems, but I’ll take our problems over your problems any day of the week and twice on Sunday.
[Quote=jsgoddess]
The problem with most ideas that build on Medicare is that Medicare is fairly expensive coverage to be on, and it excludes a few things that are really important–dental, hearing, vision, and the biggie long-term care.
[/quote]
Just thought I’d drop a note that despite having UHC/single payer, the Ontario health plan also doesn’t include dental or vision and long term care is a bit of a patchwork. (there are some programs for the extremely poor)That slack is taken up by private coverage.
Here, Medicare Part A usually has no premium, but is (I think) $450/month if you are not qualified for premium-free. It has a deductible of $1,316 for each benefit period (not year). Coinsurance for days past 60 in the hospital or nursing facility. No out-of-pocket limit.
Medicare Part B has a $134/month premium if you’re under $85,000/year, plus $183 deductible. 20% copay with no out-of-pocket limit.
This doesn’t cover most prescriptions, so that’s an extra premium, copay, and coinsurance at American pharma prices.
Private insurance options are Medicare Advantage HMOs/PPOs, where the premiums can be quite a bit higher but may cover drugs and dental or Medigap. The feds actively discourage Medigap. And MA gets overpaid compared to fee-for-service Medicare, so when someone choose the rational choices for themselves, the system suffers.
You can buy long term care insurance, but most people can’t afford it. So people end up on Medicaid once they blow through their savings.
I don’t know how all of that compares to pricing in Canada, but I have my guesses.
Considering there is a very real and frightening possibility Time could get purchased by the aptly-named George Pecker, of National Inquirer fame, something very much the opposite of the above sentiment would happen. ETA: Not that Time is on par with Harper’s or the New Yorker, but still a somewhat iconic publication that really could avoid Peckerization.
A McConnell promise that I’LL BET won’t be kept, now that his parade got rained on?
Yeah all those nasty Mars bases and all those prevert’d pizza vendors.
jsgodess, by “Medigap” do you mean Part F? And if so, do you have any insights as to why the Feds would discourage it? I’ll be switching from employer insurance to Medicare Part B next year (high time, since I’ll be 70½), and my employer will pick up approximately half the cost of their designated Part F option. Even with Part D and dental, this will still be significantly less expensive than any of the available MA plans. So if there’s a rationale behind Part F being discouraged, I’d appreciate knowing what it is.
Thanks in advance — or as my mother (on whom be peace) would say, “thanks till you’re better paid.”
Economists hate first dollar coverage, which is what the most popular Medigap plans offer. (IOW, you pay for the Medigap plan but it covers your cost-sharing.) Economists feel that this will lead to you getting more health care than you need.
Many?Most? health policy people, on the other hand, think that when you add cost-sharing, you get less health care and that some of it might be stuff you need and some might not. So first-dollar coverage gets people to the doctor for necessary care.
The enrollment rules for Medigap are must less encouraging than those for Medicare Advantage. You only have a limited initial enrollment period, people with disabilities are blocked in most states, they can do underwriting after the open enrollment, etc.
I forgot to say, yes, Plan F is the most popular (if I remember correctly) Medigap plan. It historically has had first-dollar coverage, though that is going away soon. I think the second most popular plan, Plan C, also does first-dollar coverage, but may not cover all cost sharing.
jsgoddess, thank you for taking the time to share the explanations you gave above. It clarifies areas of both Medicare and Medicaid about which I needed to learn more. I’m pretty familiar with the big picture stuff in both programs, but not the granular detail you provided. I really appreciate your efforts.
I’m sure it would be the wrong approach to expand Medicare coverage at this time to include such things as dental, vision, long-term care, etc. It would probably be enough of a slog just to get a buy-in for older Americans, say down to age 55. (I believe this was Hillary Clinton’s plan.) But if it could be accomplished, it could be a starting point to address the real issues in our health care mess: Too much profit. Not just drug companies, but investors in all manner of health care-related industries such as hospitals, both for-profits and non-profits, health insurance companies, and even little companies like mine that profit on the fringes of the mess we have (administration of Section 125 cafeteria plans).
Anyway, thank you again. I have a better understanding of the issues because of you.
The big difference between Canada and the US is that elderly folk in Canada don’t have to pay for medical expenses, and if they’re below a certain income level, their meds are paid for as well.
The big expense is housing/senior care, which is not paid for by the Medicare system. Seniors have to pay for that themselves, unless below certain income/asset levels, when social assistance kicks in.
So no premiums, co-pays, and deductibles for Grandad’s medical care.
I tend to agree that McCain is generally a shit, but I do think his No had an important nuance to it.
Murkowski and Collins voted No because they didn’t like the bill and that’s an important point to make.
McCain voted No because he didn’t like the process and I think that was an important point to make too and it was getting lost as the other protest-voters caved one by one.
Has he actually said that? It looked very much like he voted NO because he wasn’t convinced the House won’t pass the skinny repeal (rather than bringing it into conference). If he was opposed to the process, he should have voted NO on the MTP.
Does anyone have a handle on how important it is to the Republican base that the ACA be repealed?
I’ve heard time after time some GOP congresscritter exclaim, “This is a promise we made to our voters! We can’t NOT give it to them!”
But the popularity of the ACA has risen sharply since the election, and I can’t help but think that a lot of people who were proclaiming so loudly that it needed to be repealed were doing so because they believed that it would be replaced by a plan that would get them better insurance at a lower cost. I can’t help but think that some of these people are now saying, “If you can’t give us the great plan you promised, then don’t take away what we have.”
Trump is twittershouting that the Pubs have to try again and keep trying until the ACA is repealed. McConnell said that it was time to move on, but some other GOP congresscritters have been saying they need to give repeal another chance.
If they don’t manage to repeal it, what are estimates of how big the blowback will be at the polls?
Also, I seem to remember that there was a procedural reason why they had to do healthcare before they tackle the budget. I’m thinking (but of course could easily be wrong) that by doing it first they could do it through reconciliation, but if they pass a budget first that’s no longer available to them.
If I’m right, does this mean that farting around with ACA repeal is going to push back dealing with reforming the tax code and setting the budget? If so, how long will they be willing to do so?
I know exactly what you mean!