Well, it’s sounding more and more like ACA will be repealed very quickly with a replacement plan to follow later. Of course that approach leaves open the very real possibility that an agreement can’t be reached on a replacement and there is no replacement plan. That would put us back to 2007, which I thought wasn’t exactly the good old days vis a vie health care issues/insurance.
I’m becoming less optimistic that the health care system will improve for the average American - whether they are covered by the ACA or not. Afraid we will go back to if you have money (and a lot of it) your health care will be taken care of. The rest of us…not so much. Hope I’m wrong
You may be right. And the new leadership may be a wildcard.
But the saving grace hopefully will be that more than 100 million Americans have pre-existing conditions. And will be very upset if they are negatively impacted if that provision is struck from law.
I am not sure how many are of voting age, but probably a large percentage of them. To put it in perspective slightly over 120 million voted in the election this year.
@MaineLonghorn’s comment may be prescient, as that was the response the president-elect gave about abortion rights (push it back to the states). I sincerely hope not. The uncertainty is unnerving for so many.
I agree. If, in the process of transitioning to a universal healthcare system we significantly lower the pay for doctors, while keeping the workload the same (or, more likely, increasing it temporarily because more people will become insured), I feel many people will be turned away from the field.
The US produces the best quality doctors in the world, with the most lifesaving discoveries and groundbreaking treatments. I can’t help but think part or most of that is because we offer top notch incentives for doctors. The question is, how do we strike a balance between top notch quality and maximum coverage…
The incentives to go into medical practice are not so great these days. $300,000 in medical school debt (if your family is not wealthy and generous) is not a good incentive, and can be a disincentive for physicians to go into primary care.
^ That’s just one side of the story though. Physicians are also paid $189k/year (average; with surgeons and specialists making far more than that). Medical school bills can be paid relatively quickly with that level of pay.
In Europe, you may have substantially lower student debt, but your peak career salary will also be substantially lower.
Pushing health care coverage decisions to the state level doesn’t inspire my confidence in having pre-existing conditions covered, or maybe even kids up to 26. It’s even more a dollars and cents decision there, and the number of those with pre-exist conditions is spread out so not nearly as much a block to give input at state level.
Not so fast. When people talk about selling insurance across state lines, this is what they want to prevent: state regulations. Let’s say California passes a law requiring insurers to offer the same price to everyone of the same age, as the ACA mandates. But let’s say also that Congress passes a law allowing insurers to sell across state lines, as many in Congress are advocating.
FangCo bases itself in Idaho, and creates California policies with California doctors and hospitals to sell to Californians. FangCo does not have to follow California law, because it is an Idaho company, but it can sell to Californians, thanks to the new across-state-lines rules. So FangCo only sells insurance to healthy people. All the healthy Californians who want insurance buy it from FangCo, leaving the sick people to try to scramble to find California-based insurers. Result: Californians who don’t need healthcare can buy insurance cheaply, and Californians who do need healthcare can’t afford it.
This would be a good way to deal with the doctor shortage-- the people who have insurance wouldn’t see doctors because they are healthy and don’t need medical care, and the people who didn’t have insurance wouldn’t see doctors because they couldn’t afford it. Success!
@“Cardinal Fang” - BINGO you’ve got it
Although it does take some work for an insurer to build a network in a different state. There have to be enough potential customers to justify spending the time/$ to do that. So I’m not sure how many states will be fertile grounds for selling into except those with larger populations of healthy people.
Btw, we could be having a similar discussion about Medicare if the block grant proposal gains traction
Any insurer would have to follow the laws of the state they are operating in. What allowing insurers to sell across state lines would do would be to cut out state insurance boards that act to keep out competition. If this passed, most insurance companies would locate to a handful of states much like credit card companies incorporate mostly in Delaware or South Dakota.
States used to have laws on interest charged by banks doing business in their states but once they were allowed to incorporate anywhere they wanted and do business in all 50 states, they all incorporated in SDak which had no cap. It did not matter what a state’s law was.
So all the insurance companies will just incorporate in states which have the fewest regulations - like the the ones which don’t have a regulation on covering pre existing conditions. They can all have lousy networks and lousy coverage and no one will be able to stop them or purchase anything better because insurance companies goals are to maximize profits, nothing else.
The entire purpose of allowing insurers to sell across state lines is for them to be able to evade state laws. It’s not to allow an Idaho-based insurer to sell in California. The Congresspeople who advocate selling across lines don’t want insurers who sell to Californians to have to obey California law. They want to get rid of the ACA’s mandates, and then have a race to the bottom.
States can already make interstate compacts allowing an insurer in one state to sell to customers in another state. No insurance companies are pushing for this under Obamacare, because they’d still have to follow the ACA’s rules.