Relatively not bad news about Health Care Reform
Via (one of) the brillian Waldmans
I find a very interesting and actually somewhat reassuring article by Caitlin Owens
“Obamacare repeal? More like Obamacare reform”.
I strongly recommend reading the article which considerably reduced my fear and loathing.
To be clear: Republicans will likely call whatever they end up doing Obamacare repeal, especially publicly. And when you end up with something vastly different, what’s the difference?
What they say they won’t get rid of:
Pre-existing condition coverage
Letting children stay on their parents’ plan until age 26
Lifetime caps on coverage
Medicaid expansion (but it will look different)
What they say they will go after:
Essential health benefits (insurers won’t have to cover as many things)
Age rating bands (bigger range of premiums will be allowed)
There’s no step-by-step plan yet — because they had never planned for a President Trump. “We’re in rapid detox of holy crap, we have to actually do this,” the first aide told me.
I love the “holy crap” quote. Now this is only somewhat reassuring for reasons. First, Owens talked to aids. They are people who actually know what is in the ACA, but they have no power. There is no reason to be confident that actual senators will listen to their aids. Second, people talk to reporters for a reason. The apparently very frank statements might be a trial balloon soon to be shot down by enraged conservatives. Third the list of what to keep doesn’t include exchanges, subsidies or a mandate. Even if the claims of the anonymous aids correspond to the decision of a majority of senators, they leave $ 60 billion questions open.
Partly, I love the article, because the anonymous aids confirm that Republicans have been post policy for years. I also liked this quote
Congress tested its repeal strategy last year using “reconciliation,” a procedural tool that prevents legislation from being filibustered in the Senate. Even this repeal bill didn’t get rid of the whole law. But one of the aides said this version of the bill was mostly about “messaging,” and that this time, “We’re not going to use that package. We’re not dumb.”
I am shocked shocked that congress passed a bill which they knew was “dumb” just for messaging.
Repeat of warning: these are anonymous quotes from sources who may have influence but don’t have power and who are motivated by motives.
update: Waldman[n]s think alike.
Are you so sure the messaging isn’t about what they will keep and not about what they passed? Pre existing conditions have always been treated as requiring continuous coverage which isn’t pre existing conditions at all. A third are more radical and want an immediate end. They won’t succeed but will shape it. Not dumb, just zealous.
SadlyObama care is not sustainable and wouldn’t have survived in its current iteration even if Trump had not lost the election. I imagine this fact – the rapidly rising premiums – had more to do with Clinton’s loss than Comey’s letter. Voters to whom this was a major issue are going to pay a lot of attention to how healthcare turns out. One hopes Trump is smart enough to find a solution that works rather than simply turn the issue over to the ideologues.
Wrong, the rising cost of healthcare is not sustainable as discovered by just about every other country on this planet. And you are conflating two different topics in your message here, the PPACA and healthcare.
I’m not sure about the survival of Obamacare. You are extrapolating a trend based on one year. It could just be that the CBO is better at underwriting than the pros. Premiums for 2017 are about what the CBO forecast for 2017.
Also there are simple fixes. I think it would be enough to say that insurance companies can only sell on the individual market if they participate on the exchanges. Now they can choose whether to participate but must charge same for exchange sold and directly sold. To get subsidies policyholders must use the exchanges, so exchange sold insurance insures poorer people who are less healthy.
This is an easily fixable problem with minor reforms. Impossible given GOP obstruction, but not a difficult technical issue.
Yu are fixating on the wrong issue. Healthcare insurance does not control the cost of healthcare. Your solution to healthcare companies selling exclusively on the exchanges does make sense; but, it is minor when compared to what is driving costs.
Umm, why are people suddenly forgetting the amount of Rep Congressman who got tea partied the last six years?
You do not need to be Kreskin to figure out what is going to happen regarding the ACA.
They will repeal it subject to a date in the future(at least one year, probably two). Then they will talk about the “super terrific” new program that the Reps will come up with to replace it.
Like the last 6 years, that program will take a long while to come up with. Personally I think they will repeal it effective in January, 2019, giving them some time to develop the “super terrific replacement, and then promise that the replacement will take place before then.
Except that they immediately will “reconcile” a small part of the ACA that pays for 1/3 of the bill by increased taxes on the rich as deficits do not matter now and anyway, they can place the blame for that squarely (Surprise!) on Obamacare and that bad black man who ruined our country by giving illegal immigrants healthcare with our hard earned money.
Strangely enough, they will then delay until after the election in 2018, so they can run on repealing Obamacare(again) without making any changes.
Then, with their backs against the wall their “super terrific” plan will be tort reform, high risk pools, and the selling of worthless insurance across state lines (y’know, “competition”).
And return us to the good old days.
Say we’re talking about inflation rather than healthcare. Take a country that has had years of high inflation. Nothing they try puts a dent into the trend. Then they implement a new monetary policy that results in a few years of low inflation. But along comes a year with inflation that actually exceeded the annual rate seen before the new monetary policy was tried. The likely conclusion is that the short term fix failed and there will be a return to a trend, not that this is a one year blip. (Sure, there are exceptions)
This is the situation we are in now, but the inflation is limited to healthcare costs. We employed a gimmick that gave us a few good years, but 2017 rates seem to indicate that the dragon wasn’t actually slain and is back.
And “you” believe the PPACA controls the increases in the cost of the healthcare industry?
Your last sentence does not make sense at all in light of the fact that there are states that had no such high increases, and that some even had declines.
Once again, you seem to have the desire to smash that square peg into a round hole with a large ideological hammer.
A clever way would be to repeal in two years after a replacement is decided on to allow time to adapt and then never get around to it.
Robert, ther terms have been “Repeal” and “Replace”, and the replace core portions were well defined for years. We are now into the “process” discussion of how to repeal ACA, and it appears it may take the shape of major amendments.
EM may have another approach that could yet resolve for replacing ACA. His description of the “super terrific” plan components may very well be their core. Most conservatives would also like to see the removal of the mandates and their associated penalties.
Finally, this bill will also have some bi-partisan approval to correct the failure(s) of the first version. You folks won the fundamental argument over whether we should/should not have such a program. The implementation of this win was abominably poor. Now let’s make it better.
With this election the Dem party is a regional urban party. It remains to be seen whether they can recover from this result.
“With this election the Dem party is a regional urban party.”
Missed the last couple of decades, huh?
What is important is the cost to the end user. If those go up X%, and that X% is unaffordable to the end user, he/she doesn’t care whether that was due entirely to healthcare providers, insurance providers, or some combination of the two. The effect is the same – treatment foregone, pharmaceuticals not taken, etc. It may matter from the perspective of finding a fix, but if rates rise at X% a year, and that is not affordable to those who need it, then it is failure.
Devolving the decision to the states with more flexibility would allow them to wash their hands of it with less pain but less assertion of power.
Mike, what you are saying is simply false. Premiums are are not spiking. Premiums are exactly what the CBO projected back in 2010. There were some unexpectedly low premiums for the first few years, but now they are back to expected trend. So stop saying something that is false. It just makes you sound stupid.
Yes, insurance may be unaffordable for the relatively few higher income families that don’t get subsidies. But that was always the case, even before Obamacare. I’m guessing that you never had to purchase insurance on the individual market, in which case you are speaking from total ignorance.
Individual insurance was always unaffordable. I know. I’ve been in that market for the last 25 years, long before Obamacare. If you want to fix that problem for those higher income families without subsidies, then you need to expand subsidies to higher income families.
For the 20 million people who now have affordable insurance, Obamacare has been very successful. For the higher income families without subsidies, nothing has changed. It is just as expensive as it always was. You can’t blame that on Obamacare.
I thought that the inflation of anything had something to do with the relative supply and demand of those products and services. Is that still true with the health care, pharma and insurance industries? There must be a real shortage of doctors and drugs for those sky rocketing premiums. Perhaps we could have all the drugs made over seas (all generic brands) like they did with manufacturing? Besides if they can make health care mandatory then they can also make union busting a felony.
I think there is data supporting both sides out there.
Example… PWC has a graph showing healthcare costs trending down here (http://www.pwc.com/us/en/health-industries/health-research-institute/behind-the-numbers.html), but they also state:
A more pessimistic assessment is in the first graph (following some tables) generated by the commonwealth fund at this post by the national conference of state legislators (http://www.ncsl.org/research/health/health-insurance-premiums.aspx)
I honestly don’t have the expertise or time to make an assessment between the first and the second scenarios or other scenarios drawn up by other think tanks. I can only tell you my family’s experience feels more like the second option than the first, and we’ve been lucky to have our health care subsidized by employers during most of my working life. I have had to deal with the open market one year, and it was a kick in the teeth experience. The current system doesn’t feel success to me.
Mike says: “Although next year’s growth rate is the same as last year’s, it still outpaces general economic inflation.”
And that has been the case since way before Obamacare. I have paid 8% to 10% increases year after year in the individual market pre-Obamacare, so why are you complaining about Obamacare, when the increases have been lower.
Mike says: “I can only tell you my family’s experience feels more like the second option than the first, and we’ve been lucky to have our health care subsidized by employers during most of my working life.”
So why the hell are you complaining about Obamacare. It has nothing to do with your employer insurance. Obamacare is for people without employer insurance in the individual market and low income people on Medicaid.
This is what really gripes me about most of the Obamacare critics — they aren’t even in the individual market yet they feel qualified to pontificate on something they have no experience with. Those of us in the individual market can say that Obamacare is a vast improvement over the horrible situation pre-Obamacare.
You missed this quote:
And like most Americans, I am well aware that with a bit of bad luck it can happen again. And I have friends who have had to rely on the open market in the last few years, and a close family member with a pre-existing condition who worries about her insurance running out. Perhaps you should pontificate in their direction as well. They’ll appreciate it even more than I do.
So you were in the market for one year? So how could you possibly compare the conditions pre-Obama and post-Obama? You simply have no idea.
Any family of four making less than $100,000 a year is getting a subsidy for their insurance on the Obamacare exchange.
And your friend with a pre-existing condition would have been flat out of luck before Obamacare. Thanks to Obamacare they never have to worry again about a pre-existing condition making them ineligible for insurance. Do you even know anything about what you are talking about?
Nobody is guaranteed anything if they cannot afford the premiums for a policy.
Your comment inspired me to go look for a calculator that indicates subsidies. According to this (https://www.healthinsurance.org/obamacare/subsidy-calculator/) someone 46 years old, in my zip code making $33K a year would get a $448 annual subsidy. Now add that to whatever you amount of disposable income you figure someone with an income of $33K a year in Long Beach CA is going to have, and you might have $500 a year available for insurance. Say you have a spouse with a pre-existing condition which keeps her from working, and a kid. So… every policy will cover that pre-existing condition, but you need to find a policy that covers your family of 3 at $500 a year (without extra costs like copays and so forth). I’m no expert on the insurance market, and I tried to enter the hypothetical info into a few websites, but each time all I got was a promise of a call back. I suspect there aren’t many options for the family of three and $500 a year to spend. Heck, the co-pays for most insurance policies for people I know are quite a bit more than that.
Now I’ve been lucky in my life, but I know the above situation describes a lot of people.
Mike, just stop. You don’t know what you are talking about. That site you are looking at is just wrong. Did you add family members? You don’t know what you are doing
Go here, the most reliable calculator:
You will find that the annual subsidy is up to $10,400 per year. After subsidy, your family of three will be getting a Silver insurance policy for about $130 per month. If you wanted lower cost, higher deductible insurance, you could get a Bronze plan for close to $0 per month. That’s right free insurance. And because you hypothetical family is below 200% of the poverty level, they also get an additional cost-sharing subsidy that pays for deductibles and co-pays.
Exact number vary by state, but you get the basic idea. You simply don’t know what you are talking about.
So I went to the site you recommended, and entered the figures and got the numbers you stated. So far so good. Butyou cut off this bit:
So this family’s silver plan for $130 comes with a deductible of up to $4,700 a year. Now, remember, we’re talking about a spouse with a pre-existing condition. For just about any pre-existing condition that would necessitate a law like Obamacare disallowing insurance companies from turning away customers, you will end up paying that $4,700 a year.
Now, you mention cost sharing and other subsidies. How high are they? Because the deductibles alone – forget the premiums – are 14% of the family’s pre-tax income, and living in California isn’t cheap.
But let’s cut to the chase because this back and forth is wearing me out. Personally, I don’t see how this hypothetical family does it. But I’m willing to accept your assurance that it happens. Fine. Let’s say they’re making ends meet somehow. But now assume the 33K a year paycheck increase at 3% a year, other costs increase at the same rate, but healthcare costs increase at 8% from today’s level for a few years. How many years out do you go before you do conclude that it is unaffordable? Because the pre-existing condition requirement becomes completely irrelevant to people who cannot afford a policy at all.
And to be clear, I don’t blame Obamacare for this. I am merely pointing out that it isn’t solving the biggest problem with the healthcare system in the US.
Mike, your average family employer plan that you enjoy is about $16,000 per year. Your hypothetical family is getting insurance for something like zero to $1600 per year. So without Obamacare they would be paying $16,000 or going without. And you say that Obamacare is a failure. You want to go back to that — $16,000 or nothing. What kind of monster are you?
Hey, the subsidies could be made better, but going back to pre-Obamacare is a horrible thought. You simply have proved over and over again that you are completely ignorant of the facts about Obamacare. It’s one thing to be ignorant, but to be obstinate in your ignorance is unforgivable.
$1600 a year is the cost of the $130 a month premiums plus the copay if the copay if the copay is $40. The copay is up to $4600 according to the website you sent me to, and for a pre-existing condition that is at all serious, you can expect to spend the whole $4600. So the cost of actually having healthcare is $6,160 less other subsidies which you said exist but haven’t shown evidence for.
So basically, if they are going to pay for healthcare, their total budget for everything else is $26,840. So fine. Let’s say they are living happily in Long Beach, CA, covering their healthcare needs and living on $26,840. I’ve been very lucky and never had to make ends meet like that, so I can only say it seems hard to me. But, as I stated above, I will grant you that is possible since you say so, but again, as I stated before, I have a question. If the family’s income continues to grow at the rate of inflation, but their healthcare costs rise at 8% a year, how long before you believe this family cannot pay to keep the person with pre-existing conditions alive? Because once they cannot afford to pay for that, the guarantee of coverage for pre-existing conditions becomes worthless to them.
To make it simple… that amounts to reducing their annual living expenses budget by a bit over $300 a year in current dollars. I can’t imagine the 26840 budget is leaving much slack. So again, how many years in a row can you do that before the family is no longer able to afford healthcare?
Nice try but you have no chance to convince Mike that healthcare in the US is very expensive and that Obamacare had nothing to do with that.
Let him go back to his rac.., err, country of origin data.
” we’ve been lucky to have our health care subsidized by employers during most of my working life. ” -Mike-
And thus the futility of taking to Mike about healthcare. Yep, employers give employees health insurance out of the goodness of their hearts as opposed to part of compensation.
Employers started giving health insurance to employees because of a government-imposed wage freeze.
I get so tired of this anecdotal bs.
Here is another.
My wife and my insurance comes through her employer, a large corp with over 200,000 employees.
Between the company and ourselves, our premium per year is a little north of $18,000 (W-2 forms show employer contributions in a separate box). Deductible is $3200 per individual, with a max out of pocket of $5900 per person, or $6400 for both of us.
And if this appears high, you can check and see the non-anecdotal amounts in the annual Kaiser survey here:
Healthcare in the US is expensive. Obamacare had nothing to do with that.
Oh, and our healthcare subsidy is a little north of $4000 a year.
Boy. Even when EMichael agrees with me he has to act as if he doesn’t. It seems we are both saying healthcare in the US is expensive, that the expense wasn’t caused by Obamacare, but that Obamacare isn’t solving the cost problem either. You’d think some people are simply trying to disagree for the sake of disagreeing.
“An ounce of prevention is worth a pound of cure”.
Thing is you have to pay for the prevention up front. The ACA is at least part of the reason that healthcare costs have slowed in the US over the past couple of years.
So you saying it is not helping to solve the cost problem is wrong. Stone, cold wrong.
I would be much, much more accurate in saying that employer provided insurance is causing the cost problem. And if I wanted to get really accurate, I can say that providers are causing the cost problem.
There are some things we can do to make health care delivery better and cheaper for all. Expand more the pool of people to be insured. Bring more competition and transparency into the market place. Bring more Lean thinking into health care to lower cost and improve quality through wider use of best practices and standardization. Remove more waste, fraud and abuses with greater penalties for crimes like Medicare fraud, VA fraud, Planned Parent Hood fraud and drug price gouging. Also people should be able to custom select the coverages they need and want to pay for on their policies rather than the one size fits all plans we get to pick from now. Encourage people to take more responsibility for their health with healthier life style living rewards…
Any chance you could add up the “fraud and abuse” totals of Medicare, VA and Planned Parenthood so you comment has some basis in reality?
Just as a idea, total government spending on Planned Parenthood (Federal, state and local) amounts to less than .2% of US healthcare spending.
So if all of it is fraud the savings are meaningless.
Mike: ” So the cost of actually having healthcare is $6,160 less other subsidies which you said exist but haven’t shown evidence for.”
Okay, now I know you are just maliciously trolling. I pointed out the cost-sharing subsidy and now you claim you won’t believe it until I provide proof for you? Just how lazy are you? If you are so lazy and ignorant about the facts, why do you insist on commenting on a subject you know nothing about and refuse to make any effort to learn.
In the example you gave, the person with the pre-existing condition with the high medical expenses would be limited to spending $2250 out of pocket for deductibles and co-pays. Obamacare would pick up the rest with cost-sharing subsidies.
As to risings costs, no, they don’t pay $300 a year more. Assuming their income remains the same, then their subsidy goes up each year because the subsidy is based on spending a fixed percentage of income for healthcare. As premiums go up, their subsidy goes up so that they don’t pay any more.
Now don’t you feel dumb. Once again you have demonstrated that your beliefs about Obamacare are simply due to ignorance. The fact of the matter is that as a result of Obamacare, over 20 million people now have health insurance who didn’t before. Yes, it could be better, and Democrats have proposed many improvements, but that will never happen because ignorant fools like you are convinced it is terrible and failing. Talk to the 20 million who now have health insurance who didn’t before.
Emichael I don’t like talking to you because #1 you are so rude and #2 you are usually wrong. Now that I got that out of the way lets look at what you just said. Total government spending amounts on Planned Parent Hood (Federal, state and local) amounts to amounts to less than 20% of US Health care spending. So if all the fraud and abuse does add up to 20% of the budget you say that it is meaningless and should not be saved. You truly are a lunatic. First unnecessary abortions that take place at PPH are wrong and immoral. PPH should never be profiting from doing abortions as some directors get rich scheme. Then we get into the Medicaid claims and billing fraud, the SSDI claim fraud, the VA waiting list fraud and the drug company gouging fraud and you can easily see millions of dollars just in fraud alone being wasted. We have not even talked about doing anything more efficiently yet like interstate competition or customizing health plans…What planet are you on?
POINT 2 %!, not 20%.
The idea that someone could misread that shows a level of ignorance beyond belief or an our of control ideology. In your case I think you hit the Daily Double.
EM I think everybody knows that my 20% is far more accurate than your .2% for government waste fraud and abuse. People also know that unemployment numbers are rigged as are the inflation numbers of less than 2%. If you do not include the inflation for health care cost, energy cost, food cost, and education cost then what the hell are you measuring for? These are the real costs of living items that most Americans struggle with but some how the SSA and government always conflates and distorts reality to fit their political agenda. This is what you and many others are again mis reading and yes many young people are rightfully pissed…The DNC is toast for now but Chuck Schumer should not become their default leader. Go see todays WallStreetonParade.com for more that story…
No, some people deal with facts.
PP receives roughly $525 million a year form all government sources.
The US spends $3 Trillion a year on healthcare.
Do the math, you total ah you.
Or you can actually present a real number or two based in reality. But you can’t.
Cause you are clueless.
EM although it only took a minute to find a treasure trove of data on health care waste fraud and abuse in the US by googling it. I found on CMS.org report the center for Medicare and Medicaid services reports that for FY 2015 $547.3B was spent. Of that $$29.12B was paid for improper payments or 9.78% . Where did you get your number?