I’m probably being naive here, but I would hope that given his oath of office he’d enforce the law faithfully. Of course, that’s naive even for normal Presidents these days.
Seniors are another group that will get the royal shaft here and another right-leaning demographic (excepting old guys like me). If the bill passes, the GOP pisses off some of their most loyal voters. If it fails and the ACA is not repealed, they piss off others among their most loyal voters. This is a no-win situation for them.
Messing with the risk corridors is quite justified. No part of the selling of the bill mentioned that if the government failed to enforce the individual mandate that we’d bail out the insurance companies for their losses.
Right, but the only way that that provides financial support for people who require more health care is if you charge young people more than their expected costs, which the ACA does with the 1:3 ratio.
I think naive is putting it mildly to be honest.
He hates anything to do with Obama, the Republican party has been arguing for years how awful Obamacare is, they ran on repealing it because its a disaster, the new head of HHS is Tom Price who has been railing against Obamacare for years. Now you think they are going to do their honest best to run it as well as they can if they can’t get the new bill past both houses? Even if it continuing to run effectively will mean they were wrong the whole time?
I can’t accept that you genuinely believe this. It’s too ridiculous. It’s akin to believing that the pyramids were used for grain storage or something equally preposterous.
In a sense, yes, but in politics it’s easier to recover from something you didn’t do, or tried to do and failed, then actively doing something harmful. Failing to repeal ACA will demotivate some Republican voters, but making progress in tax reform, reducing the size of government, fighting ISIS, and cutting our illegal immigrant population significantly will help a lot with the base.
Passing a bad ACA replacement on the other hand won’t just demotivate Republican voters, it will turn many of them into Democrats. That’s just not good. Some of these people we only just won over. Gotta make it up to them if we fail here, in other policy areas.
This is where accountability comes in. When Obama’s bureaucracy fell down on the job, I hit them hard on this board and talked about it with anyone who would listen. Not just because I don’t like Obama, but because the “deep state” as it is now called is one of my top pet issues. Not in the paranoid, “secret government organizations are watching you” sense, but in the “unelected bureaucracies hold a lot of power and are essentially allowed to fail to do their job and elected officials aren’t held accountable for it.”
If the Trump administration actively sabotages ACA or it fails through negligence, I’ll be saying the same things about Trump. But if things continue pretty much as they are and the exchanges go into a death spiral, that’s the design of the system at fault.
How will you know the difference? You know what the White House will say, but how will you know that they didn’t act with negligence or with malice? Do you think they will put that in a press release?
Did you have this same level of absolute faith in Obama when he began his first term?
In other words, Republicans want Death Panels so as to enrich themselves.
Isn’t that what any sort of insurance based on shared sacrifice is going to do? Sure, the insurance companies want to separate out the young and healthy and give them good rates and they want to separate out the old and unhealthy and deny them insurance altogether.
(Although, I will note the extremes that they went to in order to deny insurance who might have a condition where they would occasionally use it to otherwise healthy young people: When I was in grad school back around 1990, some of the grad students got together to get a supplemental insurance policy to cover us beyond the cap on our grad student insurance, which was something like $25000 or $50000. So, we were just getting a policy that covered us up to $1 million with a $25000 or $50000 deductible. And, when it was my turn to talk to the insurance agent and I told him I had had kidney stones, he said that would be excluded as a pre-existing condition. Then he said, “Just one event, right?” and I said that, no, I had had 3 events over the last 5 years or so. He looked up in his little book and it said “NCA” for no coverage available. He told me the best he could do is write me an accident-only policy. That’s when I realized how totally f-cked up the health insurance market was…When a young healthy adult in his mid-20s could not buy a health insurance policy with a huge deductible to cover catastrophic situations! I mean, it wasn’t just unfair, I think it was totally stupid and illogical even from an actuarial point of view.)
Great for profits though!
(The proposition was that health insurance is more expensive in rural areas than in cities.)
I don’t have a cite - and I’m not sure whether this is, in fact, true, or HOW true - but economies of scale seem like an obvious explanation, right?
In other words, it costs pretty much as much to open and operate a clinic in The City and The Hinterlands, but if the City clinic sees 10 times as many patients, its per-patient costs will probably be lower.
That might be the explanation, but I don’t think it is. Most services cost more in cities. Labor costs more. Rent costs more.
I expect the cost difference is mostly: people in rural areas are in worse health on average, mostly because they are poorer on average. I’m sure there are lots of details, but I bet that’s the dominating effect.
My cite that it IS so isthis 538 article (scroll about halfway down). WHY it is so I don’t know.
Another factor is the lack of competition in rural areas. If there’s only one hospital in a county, any health insurer trying to add that county to its service area pretty much has to deal with that hospital, which gives the hospital more negotiating power. You can’t play them off (“give us a good deal or we’ll restrict our network to your cross-town competitor”) unless there IS a cross-town competitor.
Meanwhile, the hospital doesn’t have a large pool of job applicants to pick from, so they have to spend more money recruiting doctors, med techs, etc., to come work in remote areas far from the amenities of the city. There probably aren’t a lot of local service industries, either: there aren’t three MRI centers within a five-mile radius, but instead the closest one is 100 miles away, which means there is more pressure to acquire one locally even if it won’t be utilized as heavily as one in the city. (Plus, the nearest repairman is five hours away by road, which has to be added into the cost of service calls.)
Also, low population density means there aren’t lots of customers, so fewer insurers are willing to invest the time/energy/$$ in developing a network, marketing a plan, etc. Less competition between insurers means less reason to hold down prices.
Finally, people in rural areas are more likely to be older and poorer than their urban counterparts, which means their health needs are likely to be higher.
A cite: Health Premiums Most Expensive in Rural Areas (about 2015 ACA premiums)
We can do better, absolutely. But your guys want to do worse.
Tell us again why you continue to back them.
That already happened.