Well they did take all the teeth out of the mandate, which does spell trouble. If it collapses it will be because of that, not because it did on its own.
I often used a doctor analogy with my family when trying to discuss Trump.
I’m having eye surgery next month. Let’s say that when I went to select my surgeon I couldn’t get my first choice or my second choice. And let’s say I’m not crazy about the only available surgeon, he’s a good enough surgeon and will do a good job on my eyes but he’s an unpleasant person and I really don’t like him.
I might not be happy about this. I wish my surgeon was as nice as the receptionist in his office. Man, I really LIKE her, we hang out and chat all the time. And she seems smart. But what I’m NOT going to do is have her perform my eye surgery.
Now we are seeing what happens when the “outsider who isn’t part of the medical establishment” actually gets in the operating room. “Well, we’ve learned a lot about eye-cutting process. Who knew it could be so complicated? It’s really hard. We tried our best and we came really really close. We almost performed a successful operation. Hooray for us!”
It’s been just delicious listening to them trying to spin this loss. I especially like the dumped boyfriend monologues ---- “That other bill is NO GOOD and will be a disaster and break your heart. Then you’ll come running back in tears begging for our bill. That other bill is bad,u don’t now hats good for you! You’ll come back to me someday, mark my words!”
And can you imagine if the Falcons blamed their SuperBowl loss on the Patriots? “Yeah, we would’ve won the big game but half the guys on the field weren’t on our side!” Its the Patriots fault we lost, not ONE of them tried to help us!" They are a sad vindictive team! I think they might have tried to beat us on purpose. SAD!
Probably too much to hope for but I could go for 4 years of this.
Well, it kind of sucks if the beneficiary’s family has to lose their home and all collective assets before their loved one can get needed care… which is more or less how things are written as I understand it. Experts, please correct me if I’m wrong on that. Also, if said beneficiary had done something like helped a child make a downpayment on a home four years before that sum would be required to be paid back and sent to the beneficiary’s care prior to said person getting their needs covered. Or any other substantial gift given up to five years before, even if at the time everything was fine and no fraud intended. Help your grandkid pay for his needed heart surgery three years ago with a few thousand? Gee, the kid better pay up or now grandpa’s need for a rehab facility won’t be covered. Sucks to be grandpa, too bad, hold a spaghetti dinner.
Look, I get it, for the most part people should use their own resources first but currently there are NO exceptions whatsoever for extenuating circumstances no matter how reasonable.
That’s one of the reasons restructuring everything would be a good idea right now, 'cause otherwise we are going to hurt so very, very much. Get rid of the institutional bias (Medicaid has a mandatory pay for nursing facility care but it’s optional for the cheaper and usually preferable HCBS), support family and paid caregivers, amp up end of life counseling and advance directives, integrate M-aid services into M-are, with sliding scale cost sharing for low-income beneficiaries, etc.
We don’t have to reinvent the wheel, we just have to decide that we are not all tycoons in the making and acknowledge that we are a society.
Well, that’s just crazy talk.
i’m high on life, you bastard!
Nah, can’t be! Here’s what he had to say about that in The Art of the Deal (p.60):
Trump should have told his ghost writer to at least make it sound like Trump wrote that book! That quote is a dead give away.
But… but… but what about poor Sean Spicer!?
Ya THINK?
That “focus on the big picture” stuff may fly when you’re talking to your staff or to a TEAM which has acknowledged you as the leader. Today’s Republican coalition, not so much.
And apropos of that, I’m wondering if we ultimately owe Glenn Beck(!) a debt of gratitude. By encouraging/inspiring the creation and growth of the Tea Party, with his 9/12 movement, he may have turned the GOP into as big a herd of cats as the Dems.
He tweeted the following:
“Watch @JudgeJeanine on @FoxNews tonight at 9:00 P.M.”
Jeanine opens her show with the following sentence:
“Paul Ryan needs to step down as Speaker of the House.”
She then goes to make the argument that, since Trump is so stupid about legislation, Ryan should have protected him more.
The Washington Post asks the musical question, “Why were the Republicans in such a hurry on the health care bill?”
The answer (I’ve inserted two line breaks into the original wall o’ text):
These people call themselves responsible leaders? How do they look at themselves in the mirror? If, indeed, their reflections are visible.
There are in fact exceptions for extenuating circumstances, although these vary somewhat from state to state.
The spousal impoverishment rules, for example, are designed to allow a spouse not entering a nursing home to preserve sufficient income and assets to prevent their own impoverishment when their husband or wife needs extensive care. In their case, a jointly-owned home is considered an exempt asset, and its value is NOT required to be used to pay the nursing home (some states have limits on the amount of equity that can be shielded, but it is everywhere substantial if there is a spouse or dependent child residing there).
Each state also has its own rules on considering undue hardship and extenuating circumstances. In Kansas, for example, an individual has the burden of showing “by clear and convincing evidence” that the transfer was not an illegitimate attempt to shield assets, but it can be done. Chipping in a few thousand for a grandchild’s heart surgery would probably be ok; giving many thousands towards somebody’s down payment would be more problematical. I could construct a scenario in which Pops reasonably expected he had sufficient assets to give the down payment and still retain enough to pay his own way, but then suffered catastrophic losses that rendered his plans worthless; that might be enough to convince the regulators not to assess a penalty. If Pops gave away his last bit of savings to buy his kid a house, though, he isn’t going to get taxpayer-funded nursing home care for months or years, unless Child coughs up the money or Pops proves he’s done everything he can to compel Child and still faces life-threatening hardship.
My favorite irony about all this is that people who will argue to the figurative death against abortion (and I’d be flabbergasted if there’s a single member of the House Freedom Caucus who wouldn’t) were just fine with guaranteed deaths due to cutting funding for emergency room care. They probably figure that those deaths would be mostly Democrats…yet another way to keep the godless votes out of their sacred election process.
After all, only the ‘elect’ are ‘saved.’
I believe Bayard was being facetious.
Keeping Obamacare for now probably helps Trump. It’s a mess and the Democrats own it. Had it been overturned, the media would surely blow those adversely affected out of proportion.
Sure a few Republicans like it…they are getting their pockets, er campaigns stuffed by groups that are for it.
Trump can say he tried, but I think he knew it would not happen yet.
This is a second term type of change…once you do not need to be re-elected.
Yeah, I’ll take their being ‘pro-life’ seriously when they have the same passion about protecting lives of the already-born as they seem to have for the ‘unborn.’
It could use some tweaking. (And that’s been one of the problems of the GOP’s scorched-earth opposition to Obamacare: the sorts of tweaks you’d normally do to a new program once it was running and you could see what worked well and what needed fixing, have not been possible thanks to the GOP.)
But on the whole it’s in pretty good shape.
First, most of the people benefiting from Obamacare are doing so because of the Medicaid expansion. That’s inherently stable if nothing’s done to it.
Second, the main symptom of the supposed death spiral of Obamacare is that there are a lot of counties where there’s only one insurer in the Exchanges. That’s unfortunate, because it means the only choices consumers have are between the different products of a single insurer.
BUT:
- Going from several insurers to one insurer in an Exchange doesn’t mean the next step is from one to zero. If you’re the sole insurer in an Exchange, you can price your products as needed to be profitable. Why should you drop out?
And:
- That insurer is still required under the law to refund excess profits: the insurers are required to pay out at least 85% to medical caregivers (doctors, hospitals, etc.) of what they collect in premiums, and if they fall short, they’ve got to rebate the difference to their customers. So there’s a limit to the extent to which the sole insurer can gouge its customers.
Obviously, IF the Trump Administration decides not to enforce the individual mandate, sooner or later you would get the death spiral of too few young, healthy people subsidizing too many old, sick people. As with everything I’ve said above, I’ll yield to **jsgoddess **who is our resident expert, but AFAIK there’s only hints of this starting to happen so far.
But barring Trump Administration sabotage, Obamacare is in decent shape. It’s not a mess.
We won’t really know the exact status of ACA until the insurers actually start charging prices commensurate with what they are spending on benefits. Most insurers are losing money by keeping rates artificially low.