Comparing the new health insurance proposal vs Obama care - No politics please

Parent Cafe
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@suzyQ7 EMERGENCY care is a right, which is why so many people used to go to ERs for things that could have been treated at doctors offices, if they’d had the right to get care there. However, as you know, ERs only have a duty to stabilize the patient, not to provide comprehensive medical care. I cannot show up at Emergency and ask for my annual mammogram, or my next installment of chemo, or my physical therapy for a previous injury, or even my Rx necessitated by the emergency they treated me for. IMO we should have the right to those kinds of care as well.

You’re correct that hospitals are very much opposed to the new law, and for good reason. A lot of them will go out of business, especially in rural areas. Are you arguing that that’s a good thing?

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IIRC, privately owned hospitals can turn away patients. Public hospitals and emergency receiving facilities cannot. And many rural hospitals are closing labor& delivery and maternity wards http://www.healthline.com/health-news/labor-delivery-rooms-closing-at-rural-hospitals

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I tried reading the proposed replacement plan, but it was too dense (plus, I kept getting mad. What’s with all the language about lottery winners and Medicaid?) I thought that this a pretty good summary of the new proposal from the Kaiser Family Foundation: http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act

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In our state, there are no private hospitals. All are nonprofit and losing money. The ambulances have to take the patients where there is an available bed, not where the patient prefers or has insurance coverage.

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“Can somebody explain to me block grants to states for Medicaid, how they work, and why they are seen as a bad idea? From my reading, I am not clear on why they will provide coverage for fewer people.”

@lasma covered the basics of block grants. Medicaid as it exists is a state/federal program and the amount the states pay versus how much the feds cover varies, it is not a fixed formula. Some states get a significant portion of their medicaid spending from the federal government (Alaska comes to mind), others get half or less from the federal government. Right now if the number of people on medicaid goes up, that formula holds, but with the block grant program the amount the federal government gives will only increase by the inflation rate (for medical care or overall CPI I don’t know), so if you have an influx of people, they would be SOL. The official cutoff for expanded medicaid is 2020, so it wouldn’t happen immediately.

From what I understand, the funding is based on 2016 allocations and it is on a per person basis, so basically they are locked into 2016 levels of payments. So even if they do expand medicaid in the state to get people insurance (let’s say people who have lost their ACA insurance but are eligible), the state likely won’t have extra funds to cover them.

Under the law being proposed, there also are no longer requirements for medicaid plans, expanded or otherwise, the way it was under ACA, they leave it to the states. Which basically means states can change their medicaid plans at will to cover what they wish, so for example to be able to enroll more people into medicaid they could slash spending to things like Nursing homes (senior citizens are huge users of medicaid for things like nursing home care. since many of them are well within the income guidelines for the program), and they could cut what they are willing to pay, which would cause doctors to come out of the program and the like.

Almost all experts expect that millions of those who gained coverage under expanded medicaid will lose those benfits, and some are saying it might be almost the entire 10 million who got coverage this way. Among other things, states that had the most people getting covered by expanded medicaid are also states where the federal government pays a lot of the costs, they are going to be the first victims of this, states that cover more of their costs will be less affected, though still hurt.

The thing about the plan is it is not about health insurance, the way ACA was, the plan being proposed is about access (or so they claim), basically it is supposed to give people access to individual plans by using tax credits (the current range of the credits fyi is 2k-4k a year, depending on age…). The government is not providing insurance through government run exchanges, they are basically giving you some sort of credit as payment (which of course you only can collect at tax time, so you are footing the entire cost of the plan until you file taxes and get your return, which is different than getting insurance with a lower premium each month, this is not the same thing.

I think people when the ‘plan’ actually comes out are going to be in for some rude awakenings. Among other things, they may realize that ACA was not the evil some claim it was, for example they are reporting today that the ‘massive increase’ in premiums for health insurance that some were claiming affected around 3% of Americans, the idea that ACA caused healthcare premiums to soar for employer plans is factually incorrect, the increase in employer plans is less now then it was before ACA (as I posted before, my employer estimated that of the total increase in premiums each year, about 50 bucks the first year was ACA, and after that it was even less), this on a plan that costs total 24k a year. I think they thought they were going to get what they wanted, plans that were affordable, low copays, low deductibles and would keep them from being bankrupted by medical bills, I suspect what they are going to get isn’t going to make them too happy, especially when they find out they will be paying the full cost of a plan for a whole year before seeing any kind of relief, and likely it will be a plan with very high deductibles, copays and exclusions compared to what they had.

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Any and all discussions about public funding or regulation of healthcare are by definition political. I know, I am a Political Scientist :slight_smile:

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@jym626

In some parts of the country, the ACA policies limited which hospitals one could go to with specific ACA policies. AZ had that issue. So does CA.

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Right, thumper. When we have any form of insurance except [that which must not be named], insurers are going to specify which providers we can use, or more accurately, which providers they have contracts with and will thus cover. In some places, this wasn’t a problem, but in others it was, and narrow networks was one of the big complaints about ACA. Insurers did that to keep the premiums down. Americans chronically want everything, but don’t want to pay for any of it. But in states where ACA was embraced, this tended to be less of a problem.

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Here’s an article talking about it.

https://mobile.nytimes.com/2017/03/07/health/risk-of-losing-health-insurance-in-republican-plan.html

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“The get-a-different-job approach may work for the individual, but it’s not a solution. It just kicks the problem to someone else, the person who replaces me at my old job.”

No it’s not but it’s what I would tell my kid to do asap if he had a job that didn’t offer health insurance.

I don’t believe they will start taxing employees health insurance benefits because that is why they are doing the tax credit in TrumpCare, so people purchasing individual policies get a tax break, too. That is their stated reason for it and why it is not a subsidy. They only kept the Cadillac Tax - which has been pushed back until 2025 in the TrumpCare bill - because the bill cannot add to the deficit In the long term ( i.e. 10 years) so the tax gets to be counted in the bill even though it doesn’t go into effect for 8 years - and likely really never will now.

They can’t get rid of pre- existing conditions (yet) because that cannot be done under a reconciliation bill - which only needs 51 votes in the Senate to pass instead of 60.

Anyway, it is what it is and people are just going to have to find a way to live with it. There is no other plan. It’s already passed in the both House committees.

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@lasma:
Yep, hospitals are part of the networks in any insurance plan if you want to go in network (you would have to be crazy to go out of network, there literally is no price protection there). The only exception is a true emergency situation, if you have a life threatening situation then I believe plans cover you as if you went to an in network hospital ER, you usually have to notify them and then once stable if you need hospitalization you are supposed to go to a hospital in network (doesn’t always work that way, thought).

It is correct that ER’s are there to stablize you, not give primary treatement, the problem is that still covers a lot. Childbirth for example is covered by that, and that is a pretty expensive thing, injuries are covered, or even if you are sick with a sore throat or the like, the ER has to treat you, even though many of those are ‘routine care’. Obviously, someone without insurance coming to an er with a heart attack is going to be expensive, but a lot of the cost of ER’s is stuff that if someone had insurance, would be handled by doctor’s offices and the like at a lot less cost (I don’t have a breakdown on that). My local ER is interesting, it is not owned by the hospital, a group of doctor’s bought it and I have to admit it is well run. I asked them why someone would want to run an ER in this day and age, that it must be money losing, but what they told me was because in my area a large percentage of people have good health insurance coverage, so they don’t have that large an amount of cases with people without insurance (and I am sure they cover that by cost shifting to the people with insurance).

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Not sure what “[that which must not be named]” is supposed to be, but there do not seem to be any insurers which cover all providers. Even with government insurers (traditional) Medicare and Medicaid, there are providers who do not accept them.

http://kff.org/medicare/issue-brief/primary-care-physicians-accepting-medicare-a-snapshot/ indicates that 72% of physicians accept new Medicare patients, and 45% accept new Medicaid patients. An additional 21% will accept Medicare from existing patients, and an additional 22% will accept Medicaid from existing patients.

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The docs around here often only accept patients “by referral” from a doctor they like and trust so they will get compliant patients who will pay their bills and not need an interpreter that the doc has to pay for our of his/her own funds and is NOT reimbursed for!

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Here’s another article and video:

http://talkingpointsmemo.com/livewire/omb-director-mulvaney-insurance-isnt-the-goal

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@ucbalumnus :
The cost of employer sponsored health care has dampened both employment and more critically, raises,with the cost of health insurance premiums soaring for most of the last 30 years, that extra cost has taken away from both employment and wages. As opposed to places that have single payer or non employer based healthcare, US companies are at a disadvantage. One of the problems is that employers complain about the cost of health insurance premiums, but then they fight to have it covered by employers, in large part because they see it as a way to attract employees, but more importantly, if the plan is any good, retaining employees afraid of a new company either having worse benefits or none at all…

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Ucb, it’s true that Medicare/Medicaid is not accepted by all providers – now. But if Medicare were the only insurance company, I bet that would change in a hurry. :slight_smile:

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Employers like offering employees health care because employers don’t have to pay any taxes on the cost of their share of the premium. It is much cheaper for them then raising people’s salaries.

If business did not want this expense they would be the first ones knocking down the doors of Congress to get employers out of providing health insurance.

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emilybee- That is so incorrect. ^^^ Health care is an extremely high expense for employers and they don’t like anything about it! Trust me on this. It is a necessary evil and most larger corporations are basically self-insured and all the medical costs come back to them. What employees think is the “insurer” is really a company (like Blue Cross or Aetna) that is just administering the plan for the employer. The economies of scale make it possible to provide better coverage to the employees, of course, than could be obtained by each one individually.

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Oh my God, I can’t imagine how fast our companies would love to ditch our health care if they thought they could get away with it. As if they would actually raise our salaries by a commensurate amount…ain’t gonna happen.

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My small business employer likes offering benefits for the same reason employers liked it during WWII. It helps to attract and retain employees. We have a fantastic package (which will definitely be subject to the Cadillac tax if it ever happens, which I doubt), and our turnover is extremely low. My bosses don’t like administering and paying for all that insurance, but I don’t think they’d want to give up the competitive advantage it gives them in the labor market.