I’m greatly in favor of it. Medicaid is one of the many programs that’s partially - but far from fully - funded by the Feds and therefore leaves the states in a situation where their spending is under the control of the Feds. They can’t afford to bail out of the whole program, and they can’t afford to spend whatever the Federal government dictates either. (The states administer the program, but they are subject to heavy oversight from relevant federal laws and CMS regulations.)
If it were up to me, I would outlaw this type of power grabbing altogether, but that’s not about to happen anytime soon.
Block granting Medicaid is a huge problem. It is an attempt to cut the program’s funding without just saying “Hey, we’re cutting the fuck out of this program’s funding.”
I believe I heard Paul Ryan saying last night that he’s prepared to offer the health care plan he developed for President Trump to enact ASAP.
Ryan’s plan involves:
a tax credit ($2300 for individuals and $5,700 for families) to purchase insurance,
HSA’s and increasing the amounts one can set aside in an HSA,
the creation of state exchanges where each person in that state can shop for a plan,
auto-enrolling those who don’t register for a plan (I think he misspelled “mandate” here) ,
monitoring insurance companies to ensure they take both sick and well clients equally (weird- I thought citizens would shop for the plan they wanted),
improving Medicaid and paying the bill for the poor ,
blending Medicare and Medicaid together and then having the Feds cover the once-were-on-Medicaid poorest,
and making health care facilities (I guess- maybe he means insurance companies. It’s kind vague to me) publish price lists so consumers can shop around.
He plans to use the CDC to improve health by reducing rates of heart disease, stroke, and diabetes (somehow) and,
giving bonus money to the states that increase immunization rates to 90% (LOL- can’t imagine Trump supporters being big on “forced vaccinations”!).
He also wants to increase the amount the wealthy pay into Medicare,
and somehow ensure that people who use food benefits only buy healthy food.
The final part included a mediation plan to resolve cases of medical error (So no more suing. It’s too expensive. (?))
This is the 2009 plan that Ryan developed following Obama’s election. It’s a whole two pages, so Congress will be able to read it before they pass it! Easy Peasy!
Well. Yes.
Especially for a number of the states that voted overwhelmingly for Trump. But I must admit, I’m looking from an outsider’s perspective - as it seems to be what they want…
It also ignites the death spiral, because you can’t keep the pre-existing clause without the mandate. There just aren’t enough healthy people to pay for the sick ones. It won’t work. But that might get us to universal health care sooner if we can drive all the insurance companies into the ground.
Why would any lawmaker, Rep or Dem possibly vote for block grants to states to fund Medicaid? This is guaranteed to either decrease federal funding for their Medicaid constituents and/or yank away heathcare for hundreds of thousands of them?
What politician in their right mind would vote for this?
In my experience, they won’t be driven into the ground. First, premiums will rise and eventually they will abandon the individual market.
Twenty-three years ago, we enacted reform in Washington State. In 1994 we eliminated the individual mandate. By 1999 all insurers had stopped selling individual policies.
So, let’s do it at the Federal level and see if we get different results… (What is it called when you keeping trying the thing that doesn’t work?)
The mandate is already a paper mandate only. That’s why rates are going up, yet ACA supporters are still optimistic that the law can succeed. But it’s all academic anyway, because no strong mandate is legal according to SCOTUS. Once you get to the point where it’s actually punitive enough, then it would amount to “forcing people to buy health insurance” which was ruled illegal under the commerce clause.
TWo more quick observations about the ACA situation:
“Repeal ACA” is mere semantics. Democrats were not wrong to point out that many parts of ACA were Republican ideas. Republicans couldn’t support it because it also included a lot of stuff they found to be poison pills. So there are two ways to “repeal” ACA. ACtually repeal it and replace it, which is hard, or repeal the offensive ideas, keep the good stuff, make a few modifications, and then call it Trumpcare, even though all that’s technically been done is amending ACA.
I’ve mentioned before that there’s really no mandate, but Republicans can actually do something effective about it by ending the bonus enrollment periods. Sure, without a mandate, people will be tempted to not sign up until they get sick. But if they can only sign up during the enrollment period, that changes things. Most people who get sick in March can’t wait until November to sign up. So limiting signup periods can help. Another option, which Republicans have floated, is to only force insurers to cover preexisting conditions if people have maintained insurance. So those who wait until they get sick are screwed, but they screwed themselves. Also, if the coverage mandates are ended then insurers can offer ultra cheap plans for the healthy that only cover catastrophic expenses. That gets more healthy people in the market and mitigates the damage a little, since instead of being out of the market entirely and trying to buy insurance when they get sick, they’d only be upgrading their insurance when they get sick. Subject to a months-long wait for the next enrollment period.
This WaPo article is one of the clearer explanations of the task Trump is facing.
It explains once again that a successful healthcare plan stands on three legs.
[ol]
[li]Guaranteed issue (pre-existing conditions allowed - as he wants)[/li][li]Community rating (you don’t pay more if you get sick)[/li][li]Everyone must be covered[/li][/ol]
The rest of the industrialized world has figured this out, so the rest of it is just implementation details…
For anything Obamacare got wrong, fix it. Some country in the world has figured it out. Perhaps something like this if we want to invent out own fixes.
[ul]
[li]Mandated insurance too expensive? Allow anyone to buy a barebones, catastrophic policy. If they won’t buy it, apply a tax penalty equal to the barebones premium and throw them in the hell that is Medicaid.[/li]
[li]Too poor to pay taxes? See last word above.[/li]
[li]Premiums too high? Offer sliding tax credits base on income and plan.[/li]
[li]People game the system by buying full coverage only when they get sick? Only allow a change in plans every one year, two years, five years - depending on how comprehensive your plan is.[/li]
[li]The nation is healthier if people get regular checkups? Entice them to buy better plans. Give tax credits on comprehensive plan premiums but not on barebones plans. [/li][/ul]
Yes, I know “Too exepensive, too much taxation” - see “Other countries, non-profit”.
We are too great a country to not be able to figure this out…
At last, we seem to have >50% of the US population thinking of “Do Something!”.
I remember it was always “Socialized Medicine!” “Commie-Pinko Socialized Medicine” whenever someone suggested that a few bottles of antibiotics were cheaper than having TB, Typhoid, Syphilis etc. walking around and spreading it to Important (white, with at least a bit of money) people.
I expect the ACA replacement to be typical Republican ‘reform’: They’ll dump the individual mandate and the heavy insurance regulation, but keep all the popular stuff. Trump already said that there has to be a way to provide for pre-existing conditions, and that he likes the idea of maintaining coverage for students 26 years of age or under on their parent’s plan.
So you’re probably going to get something that looks very similar to the ACA, but without the employer and individual mandates it will blow up the budget. The Republicans will respond that their system will free up insurers and doctors, and cause price reductions that will pay for the thing, or something like that. And that won’t happen.
A similar thing happened with the Savings and Loan industry. The S&L’s were highly regulated in exchange for giving them loan guarantees, and the Republicans came along and cried big government and removed the regulations - but found the loan guarantees were just a little too popular among their constituents. The result was wide-scale fraud and abuse.
Yes, he said that, which ought to infuriate all the rednecks who voted for him on a promise to “repeal the ACA” and replace it “with something terrific”!
Back in the early days of the ACA, someone did a survey where it turned out that many voters (typically of the Fox News watching variety) absolutely hated “Obmacare” but were strongly in favor of a different system called the Affordable Care Act whose basic features were described to them, which turned out to be Obamacare.
Now that they’ve learned that Obamacare and the ACA are the same thing, they hate both of them, but they say they like many of the features. It’s kind of how I like the features of my new car, but I hate the way that things were rigged where I have to pay for it. It makes no sense for anyone to argue that the pre-existing condition loophole was bad, but they don’t like the mandate. That’s not how insurance works. You don’t get to enjoy the “freedom” not to buy fire insurance on your house, but then get to insure it after it’s a smoldering heap of rubble. The idea of the mandate is a small step in taking health insurance out of the realm of classical insurance and something closer to single-payer where the risk pool consists of the entire population, and in return, the program can offer universal and unconditional coverage.
Trump sounds like he’s following the same path as these early conservative pundits who had no idea what they were talking about, and he seems to be on track to both piss off the hardcore Republican base who want to see it repealed just on general principle, and at the same time render it dysfunctional for the people who depend on it.
Yes, there are aspects which are popular, but it’s also pretty expensive and the individual mandate is very unpopular. So it’s going to have to look a lot different once it gets through the GOP shredder and gets rebuilt.
