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Trumpcare- Passed the House and onto the Senate; will it pass there? And what will it finally look like? (1 Viewer)

TobiasFunke said:
If you want to go straight to the source there are links to the bill itself and to a Committee-produced summary towards the bottom of the page here.  The latter is obviously a biased source but it's still a fairly dry, facts-only recitation.
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Thanks.  I still don't understand why we can't just go back to the way things were (with some obvious tweaks).  Yes, underwriting with some people paying more than others (with limits), would that be so bad?  I mean we're throwing tens if not hundreds of millions a year into subsidies to help people pay for this coverage, and to reduce their deductibles and out of pockets anyway - I was curious at to how big the individual market would have been pre-ACA if individuals were given that kind of money to pay for coverage.  Yes, people could still be either excluded or priced out of the market (which is the same thing), and for those people just allow them to enroll in Medicaid.  We enrolled an extra ~17m people into Medicaid due to the ACA anyway, what's another 750k?  These politicians have to make this stuff so #######g complicated.

 
Ren Ho3k said:
Why does there have to be a replace part.  Just repeal the ####### thing 
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I suspect this sentiment is pretty strong among core Trump supporters.

The answer of course is that Republicans rightfully fear the repercussions of simply removing the aspects of Obamacare that the public likes, specifically not having to pay more for pre-existing conditions.

 
timschochet said:
I suspect this sentiment is pretty strong among core Trump supporters.

The answer of course is that Republicans rightfully fear the repercussions of simply removing the aspects of Obamacare that the public likes, specifically not having to pay more for pre-existing conditions.
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Well, I think you understand that this helps fewer people than it hurts - rightly or wrongly is for you to decide. 

 
matttyl said:
Thanks.  I still don't understand why we can't just go back to the way things were (with some obvious tweaks).  Yes, underwriting with some people paying more than others (with limits), would that be so bad?  I mean we're throwing tens if not hundreds of millions a year into subsidies to help people pay for this coverage, and to reduce their deductibles and out of pockets anyway - I was curious at to how big the individual market would have been pre-ACA if individuals were given that kind of money to pay for coverage.  Yes, people could still be either excluded or priced out of the market (which is the same thing), and for those people just allow them to enroll in Medicaid.  We enrolled an extra ~17m people into Medicaid due to the ACA anyway, what's another 750k?  These politicians have to make this stuff so #######g complicated.
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Again- and we discussed this when this program was enacted- once you give any kind of benefit to the public, politicians are terrified to take it away.

A little history: in 1964, Ronald Reagan made a political name for himself campaigning against Medicare. During the next 16 years he made lots of arguments against Medicare, many of them valid (at least theoretically), and always vowed to repeal it the moment he became President. Then he got elected President and silence. Because his advisors and the Republicans in Congress were scared of the repercussions- they didn't want to touch it. Same reason the Eisenhower administration didn't touch Social Security.

Now in this case, enough Republicans are opposed to ACA that it's going to be repealed and replaced. But they're terrified to touch the pre-existing condition part of it, so that means that practically speaking they can only tinker with it. Your reasoning, matttyl, seems fine to me, but the politicians won't dare take stuff away.

 
timschochet said:
Here is a list of all the awful things that the new law will do. Granted it's from the Los Angeles Times, so it's got an axe to grind. Still perhaps somebody can rebut these criticisms? 

https://www.google.com/amp/www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-repeal-20170306-story,amp.html
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As we explained earlier, this amounts to an enormous tax cut for the wealthy — at least $346 billion over 10 years, every cent going to taxpayers earning more than $200,000 ($250,000 for couples). The proposal would sharply raise the limits on contributions to tax-advantaged Health Savings Accounts — another gimme for the rich.

I have a hard time believing Trump would do this to us.  We voted him in?

 
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matttyl said:
Again, why would it collapse?  No health insurance market ever had a mandate until 2014, and we didn't see collapse then.  So why would we now?  I mean, we're seeing collapse in the current individual ACA market, but that has (or at least has had) a mandate. 
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I didn't say it would. He did. 

 
timschochet said:
But they're terrified to touch the pre-existing condition part of it, so that means that practically speaking they can only tinker with it. Your reasoning, matttyl, seems fine to me, but the politicians won't dare take stuff away.
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How about this (which was in some GOP proposal, but I haven't seen it in this one specifically yet) - you only have a pre-ex waiting period if you were uninsured prior to the coverage going into effect.  So say you've always had coverage and you obtain new coverage via the individual market in this "replaced ACA market" - there is no pre-ex waiting period for you.  If on the other hand you go without coverage for 9 months and only then obtain coverage - you have a 9 month pre-ex waiting period (how long you'd have to wait to get coverage for any pre-exisiting condition) but anything new that comes up would be covered.  That sounds fair, doesn't it?

Does away with a "mandate" penalty - we'll still have guaranteed issue coverage - if people don't go uninsured there will be no pre-ex limitation (so that effectively is your mandate to obtain and keep coverage), and keeps people from gaming the system by only obtaining coverage when they need it.  Anybody opposed to this?  Really interested in the thoughts of @timschochet, @TobiasFunke, and @Henry Ford on this.

 
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matttyl said:
He was quoting the LA Times article Tim linked to.  I'm still trying to find out why that would be the case.  I haven't gotten any answers.
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Haven't you been saying the markets will collapse for 6 years? Is it just the penalty that does that in your mind? Because that's the big difference between the ACA and this that I've seen so far. 

 
matttyl said:
How about this (which was in some GOP proposal, but I haven't seen it in this one specifically yet) - you only have a pre-ex waiting period if you were uninsured prior to the coverage going into effect.  So say you've always had coverage and you obtain new coverage via the individual market in this "replaced ACA market" - there is no pre-ex waiting period for you.  If on the other hand you go without coverage for 9 months and only then obtain coverage - you have a 9 month pre-ex waiting period (how long you'd have to wait to get coverage for any pre-exisiting condition) but anything new that comes up would be covered.  That sounds fair, doesn't it?

Does away with a "mandate" penalty - we'll still have guaranteed issue coverage - if people don't go uninsured there will be no pre-ex limitation (so that effectively is your mandate to obtain and keep coverage), and keeps people from gaming the system by only obtaining coverage when they need it.  Anybody opposed to this?
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On its face it seems like a reasonable idea (there may be problems with it I'm not considering). 

But again I think that in political terms it's unrealistic. You can't charge anybody a cent more for pre-existing conditions ever again. That's the new political reality. 

 
matttyl said:
How about this (which was in some GOP proposal, but I haven't seen it in this one specifically yet) - you only have a pre-ex waiting period if you were uninsured prior to the coverage going into effect.  So say you've always had coverage and you obtain new coverage via the individual market in this "replaced ACA market" - there is no pre-ex waiting period for you.  If on the other hand you go without coverage for 9 months and only then obtain coverage - you have a 9 month pre-ex waiting period (how long you'd have to wait to get coverage for any pre-exisiting condition) but anything new that comes up would be covered.  That sounds fair, doesn't it?

Does away with a "mandate" penalty - we'll still have guaranteed issue coverage - if people don't go uninsured there will be no pre-ex limitation (so that effectively is your mandate to obtain and keep coverage), and keeps people from gaming the system by only obtaining coverage when they need it.  Anybody opposed to this?  Really interested in the thoughts of @timschochet, @TobiasFunke, and @Henry Ford on this.
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I'm way out of my depth here. I've had employer-provided health care my entire adult life and this is one of the political issues I've thankfully never had to deal with professionally either.  When I would challenge you previously it was on data use, not underlying policy. 

The extent of my expertise is knowing that Chaffetz and lots of other Republicans are probably gonna be hearing that "iPhone" line a lot over the next year or two.

 
matttyl said:
How about this (which was in some GOP proposal, but I haven't seen it in this one specifically yet) - you only have a pre-ex waiting period if you were uninsured prior to the coverage going into effect.  So say you've always had coverage and you obtain new coverage via the individual market in this "replaced ACA market" - there is no pre-ex waiting period for you.  If on the other hand you go without coverage for 9 months and only then obtain coverage - you have a 9 month pre-ex waiting period (how long you'd have to wait to get coverage for any pre-exisiting condition) but anything new that comes up would be covered.  That sounds fair, doesn't it?

Does away with a "mandate" penalty - we'll still have guaranteed issue coverage - if people don't go uninsured there will be no pre-ex limitation (so that effectively is your mandate to obtain and keep coverage), and keeps people from gaming the system by only obtaining coverage when they need it.  Anybody opposed to this?  Really interested in the thoughts of @timschochet, @TobiasFunke, and @Henry Ford on this.
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I think you'd like to go back to exactly what the rule was before the ACA.  

It's more important to me that people with pre-existing conditions have affordable policies and can't be turned down than how many months someone has to wait.  But I would feel significantly better about a "waiting period" if there are exclusions to the waiting period for certain qualifying life events, as we've previously discussed in this topic. 

 
Henry Ford said:
Haven't you been saying the markets will collapse for 6 years? Is it just the penalty that does that in your mind? Because that's the big difference between the ACA and this that I've seen so far. 
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I've been saying that the ACA market won't survive and will collapse pretty much since 2013 (which I I think when I found FBG).  I said it would happen after the federal subsidies to the carriers stop, which was at the end of 2016.  At that time we saw a 25.6% increase in average unsubsidized premiums, numerous carriers leave the individual markets (Aetna, Humana, Cigna and United among many smaller ones) and worst of all a decrease in the size of the individual market itself.  The penalty may have helped keep it together a bit - but it was the overall change to the market itself (guaranteed issue on an individual basis, community rating, an individual's ability to obtain coverage almost whenever they need to, or at least "reset" their coverage every year) which brought about the current collapsing. 

 
matttyl said:
How about this (which was in some GOP proposal, but I haven't seen it in this one specifically yet) - you only have a pre-ex waiting period if you were uninsured prior to the coverage going into effect.  So say you've always had coverage and you obtain new coverage via the individual market in this "replaced ACA market" - there is no pre-ex waiting period for you.  If on the other hand you go without coverage for 9 months and only then obtain coverage - you have a 9 month pre-ex waiting period (how long you'd have to wait to get coverage for any pre-exisiting condition) but anything new that comes up would be covered.  That sounds fair, doesn't it?

Does away with a "mandate" penalty - we'll still have guaranteed issue coverage - if people don't go uninsured there will be no pre-ex limitation (so that effectively is your mandate to obtain and keep coverage), and keeps people from gaming the system by only obtaining coverage when they need it.  Anybody opposed to this?  Really interested in the thoughts of @timschochet, @TobiasFunke, and @Henry Ford on this.
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I'd be opposed to it.  I want everyone to have health care, even people that make poor decisions.

 
timschochet said:
On its face it seems like a reasonable idea (there may be problems with it I'm not considering). 

But again I think that in political terms it's unrealistic. You can't charge anybody a cent more for pre-existing conditions ever again. That's the new political reality. 
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What I described isn't doing that, at least in premiums (which is what I take from you saying you can't charge more for a pre-ex).  You'll still pay the same as everyone else.  If you're just now jumping in for whatever reason, though, you may not have coverage for a pre-ex.  Medicare part D does a similar thing where if you don't obtain it when you're initially eligible and obtain it later, you'll pay a penalty. 

 
matttyl said:
I've been saying that the ACA market won't survive and will collapse pretty much since 2013 (which I I think when I found FBG).  I said it would happen after the federal subsidies to the carriers stop, which was at the end of 2016.  At that time we saw a 25.6% increase in average unsubsidized premiums, numerous carriers leave the individual markets (Aetna, Humana, Cigna and United among many smaller ones) and worst of all a decrease in the size of the individual market itself.  The penalty may have helped keep it together a bit - but it was the overall change to the market itself (guaranteed issue on an individual basis, community rating, an individual's ability to obtain coverage almost whenever they need to, or at least "reset" their coverage every year) which brought about the current collapsing. 
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So why would it not collapse under the GOP plan?

 
matttyl said:
What I described is pretty close to what it was like pre-ACA.  It's really not that bad (unless obviously you had a very significant pre-ex condition). 
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That's why I said that.  And the really bad part was the ability to heavily charge people with pre existing conditions and deny policies outright.  As I also said. 

 
fatguyinalittlecoat said:
I'd be opposed to it.  I want everyone to have health care, even people that make poor decisions.
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That idea doesn't really take it away, though.  You can still get it at any time, but if you're coming from no coverage (or a break in coverage of longer than lets say 63 days for instance) then you won't have coverage for what you already have (pre-ex) but you would have coverage for anything new.  That no coverage for anything you have, though, would be limited to the shorter of 12 months or however long you've been without coverage.

 
matttyl said:
How about this (which was in some GOP proposal, but I haven't seen it in this one specifically yet) - you only have a pre-ex waiting period if you were uninsured prior to the coverage going into effect.  So say you've always had coverage and you obtain new coverage via the individual market in this "replaced ACA market" - there is no pre-ex waiting period for you.  If on the other hand you go without coverage for 9 months and only then obtain coverage - you have a 9 month pre-ex waiting period (how long you'd have to wait to get coverage for any pre-exisiting condition) but anything new that comes up would be covered.  That sounds fair, doesn't it?

Does away with a "mandate" penalty - we'll still have guaranteed issue coverage - if people don't go uninsured there will be no pre-ex limitation (so that effectively is your mandate to obtain and keep coverage), and keeps people from gaming the system by only obtaining coverage when they need it.  Anybody opposed to this?  Really interested in the thoughts of @timschochet, @TobiasFunke, and @Henry Ford on this.
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Isn't the mandate the part that pays for the guaranteed coverage?

 
Henry Ford said:
That's why I said that.  And the really bad part was the ability to heavily charge people with pre existing conditions and deny policies outright.  As I also said. 
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Why not simply make those people eligible for Medicaid?  Why couldn't we have done that from the start?

 
The repeal and replace is total garbage.  Won't help, might hurt (based on what I've read).  Fix the underlying issue or the whole thing implodes anyway.  

 
matttyl said:
Why not simply make those people eligible for Medicaid?  Why couldn't we have done that from the start?
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Because instead they created "High Risk Pools." 

I'll do you one better - put people who get denied by two insurance companies (or have premium offers in excess of X% of the base rate) on Medicare, which has premiums and copays and everything. 

 
matuski said:
Isn't the mandate the part that pays for the guaranteed coverage?
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Not really.  I think there is a lot of confusion about what the mandate is and isn't.  It doesn't really "pay" for anything.  It's just a "cattle prod" to make sure people remain in the pool.  I mean the penalties in total got about $3b in 2015 - but the cost of guaranteed coverage in these newly created individual markets is hundreds of millions a year.

 
matttyl said:
That idea doesn't really take it away, though.  You can still get it at any time, but if you're coming from no coverage (or a break in coverage of longer than lets say 63 days for instance) then you won't have coverage for what you already have (pre-ex) but you would have coverage for anything new.  That no coverage for anything you have, though, would be limited to the shorter of 12 months or however long you've been without coverage.
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Maybe I'm confused.  Let's say I am uninsured and I get cancer. My treatments will cost hundreds of thousands of dollars.  I just wait a year as my cancer progresses and then I can get coverage, now that my health is much worse?

 
matttyl said:
I did?  When you say "it", do you mean the current ACA pools, or the new GOP plan?
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I feel like I'm taking crazy pills. 

Dr. Oadi and I were conversing about the LA Times article on the plan saying that the insurance market would collapse under the GOP plan.  You asked why I thought it would collapse. I didn't. 

 
fatguyinalittlecoat said:
Maybe I'm confused.  Let's say I am uninsured and I get cancer. My treatments will cost hundreds of thousands of dollars.  I just wait a year as my cancer progresses and then I can get coverage, now that my health is much worse?
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Yes, but think of all the savings for people who have had continuous health coverage. 

 
fatguyinalittlecoat said:
Maybe I'm confused.  Let's say I am uninsured and I get cancer. My treatments will cost hundreds of thousands of dollars.  I just wait a year as my cancer progresses and then I can get coverage, now that my health is much worse?
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Depends on how long you've been uninsured (and also probably why you were uninsured). 

What the ACA allowed, which is crushing the market itself, is for someone to be uninsured and get cancer and ONLY THEN obtain coverage to pay for it.  As you may know from the main ACA thread, I'm an agent.  I actually sold a policy to a woman who was 7 months pregnant (she did a justice of the peace ceremony/marriage to create her own "qualifying event") so she could get coverage for the delivery - so she had the baby, kept the policy for another month or two then dropped it (she did, though, keep it for her child to cover all the immunizations and such).  If we're going to have a "community rated guaranteed issue" situation, everyone has to be in all the time with no "gaming" of the system.  Otherwise it collapses, which we're seeing now. 

 
Henry Ford said:
I feel like I'm taking crazy pills. 

Dr. Oadi and I were conversing about the LA Times article on the plan saying that the insurance market would collapse under the GOP plan.  You asked why I thought it would collapse. I didn't. 
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Oh, ok.  I guess I misunderstood what you meant when you said "You think when it collapses the GOP is going to suddenly say "whelp, never mind, let's go Medicare For All."  You were just joking.

Well, Henry, this isn't a joking matter.  :P

 
matttyl said:
Oh, ok.  I guess I misunderstood what you meant when you said "You think when it collapses the GOP is going to suddenly say "whelp, never mind, let's go Medicare For All."  You were just joking.

Well, Henry, this isn't a joking matter.  :P
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You laugh or you cry, matttyl.

 
shader said:
There's the issue
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Shh.  If you keep bringing that up maybe we'll find out an actual solution instead of all this political back and forth BS.  And yes, I fully agree with you and have been saying that for years now.

 
As I see it, Republicans will never vote to give people with pre-existing conditions Medicare because it would be the beginning of the end for private insurance. Medicare is consistently the highest rated insurance in the country.  If we could get it by having insurance companies deny us, we all would.  And Medicare for all would be right around the corner. 

 
I haven't been keeping up with the potential outcomes as much as I should so I'm hoping to lean on those of you who are better versed.  I have a 9 year old with a rare blood disorder whose annual medical costs run over $300K.  How effed am I?  

 
Henry Ford said:
As I see it, Republicans will never vote to give people with pre-existing conditions Medicare because it would be the beginning of the end for private insurance. Medicare is consistently the highest rated insurance in the country.  If we could get it by having insurance companies deny us, we all would.  And Medicare for all would be right around the corner. 
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This is spot on and why the Democrats rejected Obama's proposal for the public option.  Costs and politicians making sure they keep the industry happy are the significant factors that have to be addressed in any solution.  Any solution without those things being addressed in a significant manner are DOA.  In short, we won't ever do this thing correctly because it's not politically expedient to do so :kicksrock:  

 
Henry Ford said:
As I see it, Republicans will never vote to give people with pre-existing conditions Medicare because it would be the beginning of the end for private insurance. Medicare is consistently the highest rated insurance in the country.  If we could get it by having insurance companies deny us, we all would.  And Medicare for all would be right around the corner. 
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Getting the high cost people out of the private insurance pools would be the beginning of the end for private insurance?  And maybe I typed wrong, but my idea was to put these folks onto Medicaid, not Medicare (until they are 65). 

 
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Captain Cranks said:
I haven't been keeping up with the potential outcomes as much as I should so I'm hoping to lean on those of you who are better versed.  I have a 9 year old with a rare blood disorder whose annual medical costs run over $300K.  How effed am I? 
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First off, very sorry to hear this. 

Where is your (actually their) coverage today?

 
Captain Cranks said:
I haven't been keeping up with the potential outcomes as much as I should so I'm hoping to lean on those of you who are better versed.  I have a 9 year old with a rare blood disorder whose annual medical costs run over $300K.  How effed am I?  
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I don't think the House proposal does anything to eff you other than the unknowns at this point - what her insurance will cost, for instance. It's just too soon to know what this would do to premiums for young people with expensive pre existing conditions. But it keeps the ban on annual and lifetime benefit caps. 

 
matttyl said:
Getting the high cost people out of the private insurance pools would be the beginning of the end for private insurance?
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Giving an option for people to get Medicare would be the end for fully private insurance.  Because if you want to, you can get an insurance company to deny you.  It isn't hard. 

 
matttyl said:
First off, very sorry to hear this. 

Where is your (actually their) coverage today?
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I live in Florida.  We had decent insurance for a family of 4 with Aetna for about $1,000/mth last year.  My wife and I split so I'm not exactly sure how much our current policy is, but it's comparable.    

 
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