# What Now For the ACA? **URL:** \ **Category:** Great Debates\ **Created:** [November 9, 2016, 3:00pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208 "2016-11-09T15:00:35Z")\ **Posts on this page:** 20\ **Page:** 6
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [November 11, 2016, 8:42am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/101 "2016-11-11T08:42:31Z")
> [@adaher](#): > > For example, get rid of the coverage mandates and substitute selling insurance across state lines. Is that a conservative principle now, the federal government should take away the power of the states to regulate insurance within their own borders? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 11, 2016, 9:10am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/102 "2016-11-11T09:10:23Z")
It’s a confusing issue because while states have sovereignty, the interstate commerce clause exists. The clause was not put in there to be a blank check for Congress to regulate anything related to economics, as Democrats have been using it for, but to insure free trade between the states unless there was a compelling state interest involved. for example, states are allowed to regulate liquor and ban interstate liquor sales. That’s a bit of a relic from prohibition. But health insurance is a perfectly legal product, there’s just no reason for there to be restraint of trade in that industry. So the federal government is perfectly within its powers to let consumers buy out of state insurance, just like they can buy 99% of products out of state, whether or not they meet state standards. And since I mentioned liquor, there’s really no reason any longer for the federal government to allow states to ban competition with state-run liquor shops. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [November 11, 2016, 9:54am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/103 "2016-11-11T09:54:58Z")
> [@adaher](#): > > And since I mentioned liquor, there’s really no reason any longer for the federal government to allow states to ban competition with state-run liquor shops. It’s not up to the federal government. Section 2 of the 21st Amendment added an alcohol exception to the commerce clause. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 11, 2016, 10:20am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/104 "2016-11-11T10:20:59Z")
well, that’s something I didn’t know. Amazing what can be learned at 5 in the morning. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [November 11, 2016, 12:03pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/105 "2016-11-11T12:03:55Z")
> [@adaher](#): > > Like i said, I don’t think this is going to be a straight up repeal and the GOP doesn’t have the votes for it anyway. But they can take it apart piece by piece and substitute GOP ideas as appropriate. For example, get rid of the coverage mandates and substitute selling insurance across state lines. I know we’ve been over this before – there are a lot of mutually dependent interlocking parts. If you remove the coverage mandate, but don’t remove the pre-existing condition requirement, healthy people roll the dice, dropping coverage, knowing if they get a really serious condition they can jump right back into the pool. (Keeping them from doing that is why the mandate got in there.) ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 11, 2016, 12:29pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/106 "2016-11-11T12:29:00Z")
People are already doing that. The mandate isn’t affecting behavior much. In theory, yes the parts are interlocking, but in practice it’s not working that way as of yet. Which is part of why it’s having problems, but it’s not up to Republicans to fix ACA to the Democrats’ preferences. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [November 11, 2016, 12:32pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/107 "2016-11-11T12:32:47Z")
> [@adaher](#): > > People are already doing that. The mandate isn’t affecting behavior much. In theory, yes the parts are interlocking, but in practice it’s not working that way as of yet. Which is part of why it’s having problems, but it’s not up to Republicans to fix ACA to the Democrats’ preferences. Why not? For Social Security, Medicare, and dozens of other major programs, the initial legislation was not perfect, so legislators did their job, tweak things until it they did work pretty well. If something in the ACA isn’t working that way as of yet, why wouldn’t all of Congress want to fix it? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 11, 2016, 12:48pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/108 "2016-11-11T12:48:41Z")
Republicans will fix it, their way. ---
**Author:** ![Bridget\_Burke](https://avatars.discourse-cdn.com/v4/letter/b/7cd45c/32.png) [@Bridget\_Burke](https://boards.straightdope.com/u/Bridget_Burke)\ **Post date:** [November 11, 2016, 1:40pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/109 "2016-11-11T13:40:24Z")
> [@adaher](#): > > Republicans will fix it, their way. Yes, they will have many opportunities to excel in the next two to four years. The whole world is watching. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 11, 2016, 1:42pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/110 "2016-11-11T13:42:02Z")
Now the odds of them actually excelling, the odds seem low, but we saw the Cubs win the World Series and Donald Trump win an election so anything can happen. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [November 11, 2016, 1:47pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/111 "2016-11-11T13:47:11Z")
> [@adaher](#): > > So the federal government is perfectly within its powers to let consumers buy out of state insurance, just like they can buy 99% of products out of state, whether or not they meet state standards. The problem is not that the fed will allow states to accept insurance carriers from out of state, but that republican proposals will require states to accept insurance companies from out of state. Some states have different standards as to what types of health insurance may be offered in their state. Republicans will get rid of the state’s ability to regulate that. Even if a state does not want to have an insurance carrier from out of state with much lower standards, they will have to allow it. For the party of states rights, this is a bit of a contradiction. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 11, 2016, 1:53pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/112 "2016-11-11T13:53:58Z")
It is and isn’t, as I said before. The states are engaged in restraint of trade, which is also against conservative principles. And I’m not sure it really takes away any legitimate state power. Insurance carriers that don’t meet standards will still be out of their state, it’s just that consumers will be able to buy the products. It’s just like going to Canada to buy drugs. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [November 11, 2016, 2:17pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/113 "2016-11-11T14:17:27Z")
> [@adaher](#): > > It is and isn’t, as I said before. The states are engaged in restraint of trade, which is also against conservative principles. And I’m not sure it really takes away any legitimate state power. Insurance carriers that don’t meet standards will still be out of their state, it’s just that consumers will be able to buy the products. It’s just like going to Canada to buy drugs. More like going to Ethiopia to buy drugs. If insurance is sold across state lines, there is no reason for any insurance carrier to respect any state’s requirements. They will just move to a state with lesser requirements, and keep their customers in the state that has protections. It will be a race to the bottom, where pretty much all carriers operate out of the states that have the least requirements, and states will compete and lower their requirements to try to get the business. Now, if the Feds just allow it, and still allow the states to have requirements, that is one thing, states can still regulate the industry in their state if that is what their citizens want. If the fed requires it, then it does not matter what the people of the state want, they will get the insurance based on the state with the least protections. Do you think that the feds should also encourage bootlegging of cigs and liquor and gas and other state taxed products across state lines, regardless of how the state feels about it? ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [November 11, 2016, 2:22pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/114 "2016-11-11T14:22:04Z")
Watching the current batch of Republicans try to fix health care is like watching howler monkeys tinker with a nuclear reactor. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 11, 2016, 2:33pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/115 "2016-11-11T14:33:42Z")
> [@Fotheringay-Phipps](#): > > I wouldn’t go that far. There are winners and losers in every change, and I’m sure there will be winners and losers from any “repeal and replace” bill. But there will be some reforms - laws that did not exist pre-ACA - and some elements of the ACA itself will be maintained. Trump’s proposal is to replace it with HSAs. We already had HSAs prior to Obamacare - I have to admit they were one of a very few good ideas the GOP has had about healthcare - and most “Obamacare” plans were HSA-based already. So how that serves as a “replacement” is beyond me. > [@adaher](#): > > It is and isn’t, as I said before. The states are engaged in restraint of trade, which is also against conservative principles. And I’m not sure it really takes away any legitimate state power. Insurance carriers that don’t meet standards will still be out of their state, it’s just that consumers will be able to buy the products. It’s just like going to Canada to buy drugs. This is utter nonsense. No state is engaged in restraint of trade. Every insurer is free to sell health insurance in every state. They merely have to tailor their offerings to comply with the law of the state they want to sell in. It’s more like Arby’s claiming that its Virginia restaurants are only subject to Delaware health codes, because that’s where they’re headquartered. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 11, 2016, 2:50pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/116 "2016-11-11T14:50:30Z")
> [@Really\_Not\_All\_That\_Bright](#): > > Trump’s proposal is to replace it with HSAs. We already had HSAs prior to Obamacare - I have to admit they were one of a very few good ideas the GOP has had about healthcare - and most “Obamacare” plans were HSA-based already. > > So how that serves as a “replacement” is beyond me. Firstly, I think they can change the rules on HSAs, e.g. to allow it even not in conjunction with HDHPs as is currently the case. But more to the point, even if the entirety of “Trump’s proposal” is to replace it with HSAs (IDK), as a general rule the relationship between a candidate’s proposals and what he does after the election is pretty loose, and I imagine that will be even more so in the case of Trump. And in addition, Trump is not synonymous with the Republicans in congress, who will have their own ideas. (Much as happened with the ACA itself.) ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 11, 2016, 2:56pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/117 "2016-11-11T14:56:42Z")
It’s [pretty much](https://assets.donaldjtrump.com/_landings/contract/O-TRU-102316-Contractv02.pdf) the entirety of the proposal. There’s a slightly longer version [here](https://assets.donaldjtrump.com/HCReformPaper.pdf) which doesn’t make any more sense, and doesn’t mention detaching HSAs from HDHPs. From the short version: [QUOTE=Racist Sunrise] **Repeal and Replace Obamacare Act** Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications. [/QUOTE] ---
**Author:** ![akrako1](https://avatars.discourse-cdn.com/v4/letter/a/c77e96/32.png) [@akrako1](https://boards.straightdope.com/u/akrako1)\ **Post date:** [November 11, 2016, 7:47pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/118 "2016-11-11T19:47:22Z")
while i doubt this will happen, there is _some_ chance the Republicans will recognize reality. Remember, they HAD to trash absolutely everything Obama did. He could never have one ‘win’ to use to woo voters. Now remember that Obama-care is essentially Romney-care, a Republican idea - and nothing even close to true socialized medicine. Can the Republicans now change their position to reflect reality, and not pure partisanship? Most polls show the American public actually likes the ACA when polled the ‘right’ way - about the actual issues: preexisting conditions, children on until 25 - y’know, the stuff that most Americans promptly forgot was part of the ACA. So… we could have the insurance companies leaning on the administration to keep it in place, plus a fairly large public outcry to keep it once people see it won’t be replaced, plus the fact that Trump doesn’t give two sh\*ts about the ‘size’ of the government and ‘individual liberty’ - and there is some chance they’d keep it. But i doubt it. ---
**Author:** ![usedtobe](https://avatars.discourse-cdn.com/v4/letter/u/ec9cab/32.png) [@usedtobe](https://boards.straightdope.com/u/usedtobe)\ **Post date:** [November 11, 2016, 8:15pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/119 "2016-11-11T20:15:22Z")
Need we point out that, until VERY recently, Banking could not be done across State lines? (my understanding of it was (hicksville, Midwest) that the good, God-Fearing WASPs which ran the place feared that the big (“Jew-Owned”) NYC banks would come in and “steal” the money of the Widows and Orphans\*) - - kids: there used to be a quaint concept of “protecting” those who were not Men - the poor widows (who had lost their Men) and orphans (who didn’t even have a Woman to care for them). For Investments, the Utilities were viewed as Rock Solid, and thus Safe for the “Widows and Orphans” who could not afford ANY Risk. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [November 11, 2016, 8:39pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/120 "2016-11-11T20:39:25Z")
“… lets states manage Medicaid funds.” Does this make any one else as nervous as fuck? [Previous page](https://boards.straightdope.com/t/what-now-for-the-aca/771208.md?page=5) [Next page](https://boards.straightdope.com/t/what-now-for-the-aca/771208.md?page=7)