@thumper1, the thread is about comparing ACA with TrumpCare, not what we want.
If I were Queen, I’d want that which shall remain nameless but that isn’t on the table either. TrumpCare is what’s on the table.
If I were you, I’d tell my kid to get a job with employer insurance. That is the best solution for those who are going to be stuck with TrumpCare.
^^ Easier said than done.
True, but I’d tell them to start looking now.
There is nothing in TrumpCare which addresses any of the issues regarding more networks or more insurance companies entering the marketplace. It’s likely to result in even smaller networks and fewer insurance companies selling individual plans. There is also nothing in the plan capping deductibles or co-pays and it’s taken away the plan level (I believe it’s Silver) that allowed some people, based on income, to have a lower deductible and smaller co-pays. All that is gone now. So, the only good alternative, imo, is to get a job with health insurance benefits - or plan to pay most of your expenses out of pocket.
I also read that there is no opt out of TrumpCare for states who want to create their own health insurance system. All states must go over to using TrumpCare in the individual market. The Committee refused to allow an Amendment allow an opt out to even be voted on.
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.
I’m thankful that both my kids have employers who provide health insurance, but that’s not the way it is for everyone. It’s insensitive to say that, in essence, you get what’s coming to you if you aren’t savvy enough to have a job with health insurance benefits. And what about people like us, where DH is self-employed? Everyone should be able to get affordable health insurance with adequate benefits and networks.
Most jobs in my state are created through entrepreneurship. Having ACA allows people the flexibility to go out on their own, start new businesses, and create jobs. Not having the protections provided by ACA throws up various road blocks to many from pursuing that path. Another way all of us will be hurt.
As proposed (or at least what I have read of the ‘plan’ which right now is not really a plan, it is a bunch of ideas posing as a plan) this is not a replacement for ACA, there will be no health care exchanges, basically this plan is based in the idea that the government will give people tax credits to buy insurance and expects them to go out there in the market and buy an individual plan (it could be family or individual coverage, obviously). They are operating on the idea that with all these people out there willing to buy insurance that companies will compete for the business, compete against each other, and that will lower the cost of coverage, it is the idea that health insurance and medical care is like buying tv sets or cars…Paul Ryan talks about ‘choice’, but how much health coverage can you get for a 5k subsidy (which is roughly what they are talking about?). In the individual market, before ACA, a typical family plan in the nYC area was like 26k, and individual coverage was easily 10k a year for a decent plan.
The difference between this current proposal and ACA is that they don’t require plans to cover anything,there are no miniumums, so what will happen is someone will buy a family plan using the voucher and likely will be buying something that doesn’t cover a lot. When ACA was passed, they talked to people complaining about how expensive the plans were, that they used to have coverage for 70 bucks a month that cost them 400 under ACA…but then when they looked at that 70 buck plan, they found it didn’t cover hospitalization, it didn’t cover catastrophic illness, it basically gave them discounts on routine medical care, and these people when they get sick become a burden on the rest of the system through cost shifting and taxes.
As far as insurers making a windfall, what else is new? Despite all the claims of losing money, if you look at the health insurers their stock prices aren’t exactly penny stocks, and the CEO’s are making many 10’s of million in compensattion (mostly stock based). The reason they put that cap on deducting stock based compensation in ACA was based in this stock based compensation, Most CEO pay comes from stock, and stock prices are driven up when health insurers increase revenue (ie premiums) and cut costs (ie what they will pay). The idea was to discourage health insurance boards from granting benefits based in stock, because stock price and cash salary and bonuses work very differently, and stock oriented management is what leads to at least some of the huge cost increases in premiums (for example, California had a crisis with doctor’s malpractice insurance, they blamed lawsuits, capped awards and pain and suffering amounts…and the premiums still shot up, turned out much of the increase was insurers making money from the premium-payout, not investing the float).
What is worse is what ACA was trying to do was create group pools (the way employer plans or trade association or union plans work), where the young and healthier subsidize the more sick. The plan as it is now described is not a pool, it will be millions of people searching for individual plans, which in a sense are a pool of one, which means people pay through the nose.
Fundamentally what this boils down to is the government backing out of health insurance. The multi state plan is based in the idea of competition across state lines, but most states have the same insurers, you see blue cross in its various forms, Aetna, United Health care and its plans, maybe 1 or 2 others…so where is the competition? I love when lawmakers point out that a health care plan in let’s say Arkansas is cheaper than let’s say NJ, but they leave out that is because doctors and hospitals in that state are cheaper due to cost of living, cost of operating…so does that mean someone in Maine buys an arkansas plan then travels there? Will doctors in NJ take the same rate of payment as doctors in Arkansas? What makes this worse is the GOP has zero federal regulation of health insurance, if we allow cross state plans, what will happen? All the insurance companies will go to state(s) that have the least regulation, likely someplace desperate for the jobs , much like they did with pollution before the EPA, compete to the bottom on what companies will be required to do…and think about what that could mean, back to the days before ACA where insurers dropped people who came down with cancer or heart disease, and state regulators said “I’m sorry, there is nothing we can do, we don’t dare challenge them because they will leave the state”.
One thing I do know, I think a lot of people are going to wake up in the next year or so and look back and say “I don’t think ACA was so bad”. The 10 million who got coverage under medicaid in the next 3 years likely will see them removed from the rolls, given they plan on limiting medicaid payments to the states, and states, especially the ones where a lot of people gained coverage, don’t have the budgets to take up the slack. News media and the like interviewed people who were against ACA about what they wanted in health care, and they said they wanted a plan with low premiums, low deductibles and co pays and affordable medicine, and I suspect they are going to find that whatever finally gets through will be the opposite, they might find ‘afffordable’ premiums but find things like 14k deductibles (catastrophic coverage), and large copays for what is covered, or insurance that subsidizes office visits but when you get really sick, doesn’t cover anything.
In the end I wonder if Boehner will be right, that with the civil war brewing between factions of the GOP (for example, the NJ congressional republicans are balking at the medicaid aspects of the plan), between the tea party who want the government out of it entirely, those proposing the current plan and those who think the current plan is too limited, and what we will end up with is a modified ACA because that is all they can pass…but who knows?
The real problem with this plan is it doesn’t attact the whole issue of healthcare, not surprising. For example, how we get healthcare, we are at a phase of technology when a lot of diagnosis could be done by AI based systems, but I doubt the AMA would like that too much, likewise a lot of health care now done by doctors could be done by NP’s and medical techs, doesn 't take a guy with an MD to treat poison ivy. The country is great at bringing in foreign trained workers in the tech fields to lower compensation costs, why couldn’t we import foreign born doctors who meet US qualifications, they likely would be a lot cheaper? Yes, to a certain extent I am being sardonic, I don’t necessarily say flood the market with cheaper cost foreign born doctors, I don’t like them doing that in other areas, but the point is that there are so many entrenched interests, so many ‘fat bellies to feed’ in my dad’s words, that it is going to be difficult to develop an overall health plan that works, and that is what needs to be done, attacking one side won’t work IMO.
@Knitkneelionmom Under ACA, Medicaid pays the states a specific amount per enrollee. The states must cover everyone enrolled, and they must provide the federally mandated benefits.
With block grants, the feds would send a lump sum and tell the states it’s up to them how to administer it. Three problems with that: First, a state might decide to change who qualifies, or for how much coverage. For example, they could decide to reduce the income requirement, or the reinstate the pregnancy/disability/dependent child requirements, both of which would reduce the number of people covered. They could reinstate annual caps, or exclude preventive care. They could do anything they want.The working poor would be especially decimated by this.
Second, the block grants would increase over time, but not by as much as health care costs increase. In that case, states would either have to cover the difference, or cut enrollees or benefits. This would accomplish the goal of kicking people off Medicaid without the bad optics of actually passing a law to kick people off Medicaid. It would just happen naturally as health care economics evolve.
And third, if the Medicaid population grows, say, in the event of a recession, there would not be additional funds to cover them. They’re just SOL.
@shellfell The big question underlying all of this is this: Should healthcare be a right? IMO a critical mass is now saying Yes. That’s new.
While these data are from 2012, companies with less than 20 employees, people who are self employed or sole proprietors (nonemployer businesses) make up almost 98% of the businesses, with companies of 20 employees or less comprising almost 90% of that http://sbecouncil.org/about-us/facts-and-data/ Given that only companies that employ 50 people or more are required to provide health insurance, working for an employer who provides healthcare appears to be a minority of the workforce. Many smaller companies do, but they are not required to. Add to that the fact that many large employers will not offer full time employment to employees, in order to avoid having to provide health insurance or other FTE benefits
So “finding an employer who provides healthcare” is no easy task, @emilybee
@emilybee:
I would agree, but employer health care is likely to become a minefield soon, too. Most people with employer based health care already are facing skyrocketing premiums, higher and higher deductibles and copays and the like, insurance companies refusing to cover things they are supposed to and making the person fight them (I can’t think of the last time I had any kind of claim that was significant where I didn’t have to fight over things like lab tests, MRI’s and so forth with the insurance company). Worse, if they do decide to tax employer paid benefits and have us pay our share of premiums after tax, it will be a huge tax hit on people with employer based plans (I have heard talk they will tax employer based payments above the voucher amount, so if your employer is paying 18k and the voucher is 5k, you would owe taxes on the 13k…I haven’t seen that introduced though, but it has been talked about). Not to mention I suspect with the quality of the plans people can afford with vouchers being what they are, that young person who either doesn’t get insurance or gets a high deductible catastrophe plan,the person without insurance, will be shifted to everyone else when they can’t pay. If as some experts have said, the plans the vouchers will cover will have something like 14k deductibles/year, a lot of people are going to be getting buried by medical bills again, and those losses will hurt people with employer plans.
Employer paid medical insurance is also a significant extra cost to hiring an employee. Such cost to the employer is also not as visible to the employee as wages and salaries. This probably reduces employment generally.
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.
And not everyone wants to work for someone else. Most for this country’s employers are small businesses and many are self employed. By choice.
@thumper1:
You are correct in your analysis, there is nothing to stop health insurers from pulling out of the individual market. By doing what you said, requiring them to offer individual plans if they want to offer employer plans, would be an incentive (obviously) not to drop the plans. The other thing they could do (but won’t) is require that health insurers create pools that merge together their corporate plans and the individual plans into one big risk pool. The insurers would fight that tooth and nail, because corporate plans are their bread and butter, and they know that the individual plans likely would end up being less profitable (due to the fact that as has been proven with ACA, that a lot of the people who go for individual plans are sicker than the general population). This would mean less profits, because the likely losses on the individual plans would take out of their profits in the very lucrative corporate market.
The reality is that any plan that comes out likely will take away any federal regulation of health insurance (which Jeff Sessions among others has claimed was illegal, that insurance regulations were ‘up to the state’, but Scotus ruled a long time that insurance by its very nature was national, not to mention that if they do the cross state plans that is interstate commerce), but my bet would be that any federal plan will be “we will subsidize it through fixed tax subsidies, but after that, you are on your own”
It is certainly going to deter people from going on their own if they can’t get affordable health coverage.
Oh definitely. Repealing ACA will depress entrepreneurship.
"Should healthcare be a right? "
It is already a right, folks. A hospital cannot refuse to treat you, its just that those of us with insurance are the ones paying the hospitals. Under Obama Care, hospitals fared well because they were actually getting paid by new enrollees in the ACA. Under this new plan, less people will be covered, the same people will go to the hospitals, so the hospitals will be left holding the bag once again. That’s why they are against this.
I didn’t read all the pages of this thread, but has anyone definitively established whether pre-existing conditions remain covered if your insurance lapses? I have seen some talk, on Twitter, that if you let your coverage lapse (and are then subject to the 30% increase in premium), that the pre-existing condition protection disappears. And I’ve tried to read the bill, but it’s essentially impossible unless you sit side-by-side with the ACA, as it’s full of things like "delete section 501©, (d), replace with “except in the case of lightning strike.”
So it’s not understandable to a layperson in a lot of places.
Actually everyone ends up paying for those who can’t pay in the form of higher costs, taxes, and other non-transparent ways. Because it is covered differently doesn’t mean the cost disappears–spend sone time in an ER and see the folks camped there waiting endlessly for care. There are folks who come for “tune ups” or because they ran out of medicine or don’t have a regular MD or provider.