Obamacare Question

[Childless]

Of course they aren't going to replace it.  The only thing better than the ACA is single payer and they definitely wouldn't do that.  Quite frankly, I don't think any of them thought they'd be in this position.  I'm sure they assumed HRC would win and they planned to spend the next four years doing exactly what they've done the previous eight years, bitch about it without coming up with a solution (something Republicans seem to excel at).  All of a sudden, they're faced with following through on their promise and they have no clue how to replace it.  They're panicking and trying to figure out how to dodge a clusterfuck that will boot them from office in two years without looking like liars.  Good luck assholes!

[formergothardite]

1 hour ago, RoseWilder said:

That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”

Yes they will. No way Trumpcare will be nearly as good as Obamacare. I suspect they are all terrified right now. It is easy to rant about stuff, it is way harder to fix it and they all must know that going back to the old ways of healthcare will just anger folks. 

[GreyhoundFan]

"Another Bogus Obamacare Argument From Donald Trump And Paul Ryan"

Quote

If you’ve heard a Republican talk about the Affordable Care Act lately, then you’ve almost certainly heard that the law is imploding, collapsing, in a death spiral or a combination of the three.

Here, for example, was House Speaker Paul Ryan (R-Wis.) in a Wednesday evening interview with Greta Van Susteren on MSNBC: “Obamacare is collapsing under its own weight.... It’s already going away. Obamacare is leaving.”

President Donald Trump made similar remarks at a Republican Party retreat in Philadelphia on Thursday, when he boasted that acting quickly to repeal the law would do the Democrats a favor because the program was bound to fall apart on its own.

Senate Majority Leader Mitch McConnell (R-Ky.), White House Chief of Staff Reince Priebus ― pretty much every Republican with power in Washington right now ― has said something along these lines.

Of course, Republicans have been predicting Obamacare’s demise since it became law in 2010. But now that Trump is in the White House and the Republicans in Congress are proceeding with their plan to repeal the law, sooner rather than later, the argument has new political value.

If the program’s collapse is imminent, as they say, then there’s no point in worrying about the roughly 20 million people who now get coverage through the program. Because, under this scenario, no matter what Republicans do, those folks are going to end up without decent coverage.

And if the end result of repeal efforts is a disaster ― with millions more uninsured, millions more struggling with less reliable or less comprehensive coverage than they had ― Republicans can always say things would have been awful anyway.

The logic is sound. The premise, that Obamacare is unraveling, is not.

Why (Some) Obamacare Marketplaces Are Struggling

Obamacare’s marketplaces, where people without employer-based insurance can buy private policies, have certainly had some problems. But whether they are modest and fleeting or serious and ongoing, or somewhere in between, depends on whom you ask.

When the law first took full effect, with all the new rules for selling coverage, insurers had to guess at what policies consumers would buy and at what price. It turns out most of them misjudged the market, with some of them misjudging it badly. They ended up attracting fewer healthy people and more unhealthy people than they anticipated, leaving them with premiums too low to cover the big medical bills they were suddenly paying. The insurers lost money, and, by last year, they had enough data to see it wasn’t a fluke.

A few carriers responded by withdrawing plans altogether (although a federal judge recently concluded that one insurer, Aetna, also had other motives). The rest increased premiums, sometimes severely ― creating a bunch of scary headlines and giving Republicans like Ryan and Trump the opportunity to bash the Affordable Care Act as an actuarial apocalypse. Frequently they would say the system was in a “death spiral.”

Many actuaries cringe at such references, because, as Danny Vinik noted recently in Politico, “death spiral” is actually a term they use to describe a very specific set of circumstances that cannot really exist with the Affordable Care Act, at least in its current structure. A death spiral happens when insurers must repeatedly raise premiums in order to cover losses from patients with high medical bills, with each new increase scaring away more healthy customers, thereby creating new losses and forcing the insurers to raise premiums again ― until eventually only very sick people willing to pay astronomical premiums stay with the program.

The Affordable Care Act is not really vulnerable to this because it offers financial assistance in the form of refundable tax credits, limiting what low- and middle-income individuals pay for basic policies no matter how high the premiums go. That basically guarantees that insurers will have a critical mass of healthy people paying premiums. As long as the individual mandate remains in place, imposing financial penalties on people who decline to get coverage, a death spiral is even less likely.

A more realistic possibility is that the market deterioration of the past year continues, with yet more insurers abandoning markets and those remaining raising premiums even further, to the point that only people with subsidies find it attractive. It’d be a lousy deal for the more affluent, and it’d mean higher costs for the government.

This would represent a major failure of the law, and Gail Wilensky, a well-respected health economist who was director of Medicare and Medicaid in the George H.W. Bush administration, is among those who thinks it’s a very real possibility, given the state of the exchanges right now.

“They are clearly still in churn and unstable as of now, the fourth year of enrollment,” Wilensky told The Huffington Post. “Little insurer choice and unaffordable premiums would be ― and sometimes is now ― the outcome.”

Why The Markets May Be Stronger Going Forward

But even the pessimistic experts agree that it’s too early to know whether that’s going to happen ― or, for that matter, where.

A key point the Republicans never mention is that Obamacare isn’t one program. It’s 51 programs, one for each state plus the District of Columbia. In states like Arizona and Tennessee, premiums spiked and insurer choice dwindled this year. But in states like California and Michigan, the markets are operating smoothly and most consumers shopping on the exchanges still have a wide variety of options.

“[Critics] use the most problematic of the 51 markets ― and even specific instances within given markets, such as particular insurance companies or counties ― as evidence that all the exchanges are in trouble,” says Paul Hughes-Cromwick, a health economist at the nonprofit Altarum Institute research group. “We believe the individual market does, in fact, need some help, but it is neither about to collapse nor do its problems mean that Obamacare … is ‘collapsing under its own weight.’” Hughes-Cromwick went on to call such arguments “absurd.”

In December, the White House Council of Economic Advisers published a report arguing that this year’s increases were largely a one-time correction. It noted, among other things, that this was the first year that insurers had a full year’s worth of data, based on claims that beneficiaries filed, on which to base premiums. This was also the year when a program designed to cover unexpected insurer losses during the early years of operation expired. (A second such program never paid out most of its money, because Republicans insisted on defunding it.)

Meanwhile, for all the talk about high premiums, they are right about where the Congressional Budget Office originally expected them to be. And, as a recent Urban Institute report showed, premiums are roughly on par or even a little cheaper than the premiums for employer insurance, once you adjust for the different levels of benefits. 

Enrollment this year looks like it will be roughly even with last year’s enrollment or maybe even a little higher. If the marketplaces were crumbling, enrollment would be starting to fall. And just last month, S&P Global Ratings projected stronger insurer performance next year ― and even stronger performance the year after that.  

As Paul Ginsburg, a prominent health economist at the University of Southern California, said, predictions of an imminent Obamacare collapse are “totally at odds with the recent analysis from S&P, which shows the exchanges stabilizing, with insurers having experienced improved results in 2016.”

Why The Real Threat To The Marketplaces May Be Trump

David Anderson, who until recently was an analyst at the UPMC Health Plan in Pennsylvania and is now an analyst at Duke University’s Margolis Center for Health Policy, agrees. “The Affordable Care Act is fundamentally stable in most states. Enrollment has been increasing and insurers are projecting better results. Insurers with effective strategies tailored to local demand for high-quality, low-cost health care have been able to show profitability on the exchanges.”

Uwe Reinhardt, a health economist at Princeton University, concurs. “The exchanges are not collapsing on their own weight,” he said. Jon Kingsdale, former director of the Massachusetts exchange and now a director at the Wakely Consulting Group, feels the same way. “With national enrollment increasing each year since 2014 ― and a full decade of market stability under much the same reforms in Massachusetts  ― there is little evidence for [Ryan’s] contention,” Kingsdale said.

Of course, Kingsdale noted, making the argument that Obamacare is already collapsing “does offer an obvious political advantage: Republicans can blame what they do in 2017 to destroy coverage for millions of Americans on the ACA itself.” Republicans could accomplish this legislatively or maybe even through executive authority, by refusing to apply the mandate penalty or other elements of the law they don’t like.

It’s worth mentioning that even if Obamacare markets were imploding, not just in some states but all states, and even if that implosion meant there were  no insurers left ― in other words, even if you imagine a scenario much worse than any expert takes seriously ― that would account for only a portion of the people getting health insurance through the program.

At least half and probably more of the newly insured are getting coverage through Medicaid, a program that the government operates and that won’t be going anywhere ― unless, of course, Republicans decide to get rid of it.

Even though Ryan and his ilk will be responsible for the mess they are creating, I agree with the author that they'll just blame it on Obama and their idiot followers will believe them.

[JoyfulSel]

28 minutes ago, GreyhoundFan said:

"Another Bogus Obamacare Argument From Donald Trump And Paul Ryan"

Even though Ryan and his ilk will be responsible for the mess they are creating, I agree with the author that they'll just blame it on Obama and their idiot followers will believe them.

Thank you so so much for this article. I turned 19 in 2011 and lost my insurance from Medicaid. In 2013, my family and I signed up for Obamacare so I have been following the markets (NJ specifically, obviously) since the beginning. My state offered insurance through 3 different companies then, and the plans were "okay." I didn't feel like they offered the coverage that we thought was good enough for the prices. Now as the years have gone by and we signed up each December, the plans and pricing have become so much more  competitive. Insurance companies have come and gone, that is true, but the mainstays have improved and varied their plans to slide right into the plans/companies that have left.

Premiums, at least as far as I have seen studying them from bronze to platinum options, have remained fairly steady across the board in my state each year. There hasn't been insane spikes in the plans, and companies have done so well, imo, with offering competitive "Silver-plated" plans. Those offer the most tax breaks, but give you a great balance between your monthly premium and deductibles/out-of-pocket-maximums. At the beginning, it was indeed hard for companies to know what people would purchase so it was a shot in the dark with that, as the article points out. But as data is now so much more available, the plans are so much more tailored towards what people can afford and what they believe is great coverage for themselves and their families. I have helped a couple of families find their insurance through the ACA website and they have all been satisfied, so this nonsense of crumbling markets and angry consumers is a load of bull. Ryan is speaking out of his ass because he doesn't care about 20 million people finally having health insurance that is actually affordable and covers more than plans have EVER covered. This all makes me sick, to hear the lies that spew out of his and other Republican's asses. Classic case of using small sample sizes to strike down something that is a huge and comprehensive measure. Sigh.

[Dark Matters]

What the Republicans plan to replace Obamacare with: nothing much.  Hope the Trumphumpers have fun trying to cover their medical expenses now.

 

http://www.politico.com/story/2017/02/house-republicans-obamacare-repeal-package-235343

Exclusive: Leaked GOP Obamacare replacement shrinks subsidies, Medicaid expansion

The replacement would be paid for by limiting tax breaks on generous health plans people get at work.

A draft House Republican repeal bill would dismantle the Obamacare subsidies and scrap its Medicaid expansion, according to a copy of the proposal obtained by POLITICO.

The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020.

The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare “Cadillac tax” that Republicans have fought to repeal.

Speaker Paul Ryan said last week that Republicans would introduce repeal legislation after recess. But the GOP has been deeply divided about how much of the law to scrap, and how much to “repair,” and the heated town halls back home during the weeklong recess aren’t making it any easier for them.

The key House committees declined to comment on specifics of a draft that will change as the bill moves through the committees. The speaker's office deferred to the House committees.

In place of the Obamacare subsidies, the House bill starting in 2020 would give tax credits — based on age instead of income. For a person under age 30, the credit would be $2,000. That amount would double for beneficiaries over the age of 60, according to the proposal. A related document notes that HHS Secretary Tom Price wants the subsidies to be slightly less generous for most age groups.

The Republican plan would also eliminate Obamacare’s Medicaid expansion in 2020. States could still cover those people if they chose but they’d get a lot less federal money to do so. And instead of the current open-ended federal entitlement, states would get capped payments to states based on the number of Medicaid enrollees.

Another key piece of the Republican proposal: $100 billion in “state innovation grants” to help subsidize extremely expensive enrollees. That aims to address at least a portion of the “pre-existing condition” population, though without the same broad protections as in the Affordable Care Act.

It also would eliminate Planned Parenthood funding, which could be an obstacle if the bill gets to the Senate. And it leaves decisions about mandatory or essential benefits to the states.

[PsyD2013]

Rick Shitstain on the ACA.  http://www.dailykos.com/stories/2017/2/27/1638203/-Rick-Santorum-calls-millions-of-Americans-with-pre-existing-conditions-crooks-and-grifters

[GreyhoundFan]

20 minutes ago, PsyD2013 said:

Rick Shitstain on the ACA.  http://www.dailykos.com/stories/2017/2/27/1638203/-Rick-Santorum-calls-millions-of-Americans-with-pre-existing-conditions-crooks-and-grifters

Fuck you, Sandscrotum. People with pre-existing conditions didn't ask to be sick. I should know, I have a chronic illness. He needs to be shipped off the the uncharted desert isle with Agent Orange, his adult spawn, Rancid Penis, Bannon, Pence, Spicey, Kellyanne, Miller, Ryan, McConnell, Chappass, Betsy Wetsy, Sessions, and the rest of their sycophants. Said isle needs to be blissfully free of medical care, so they can spend the rest of their lives contemplating healthcare. Boy, that list is getting longer daily.

[Cartmann99]

1 hour ago, GreyhoundFan said:

Fuck you, Sandscrotum. People with pre-existing conditions didn't ask to be sick. I should know, I have a chronic illness. He needs to be shipped off the the uncharted desert isle with Agent Orange, his adult spawn, Rancid Penis, Bannon, Pence, Spicey, Kellyanne, Miller, Ryan, McConnell, Chappass, Betsy Wetsy, Sessions, and the rest of their sycophants. Said isle needs to be blissfully free of medical care, so they can spend the rest of their lives contemplating healthcare. Boy, that list is getting longer daily.

I have a big list of folks to add to your list. I also want that isle to have no televisions, no radios, no internet, and no cellphone reception, so we never hear another peep from any of them.

Edited to add:

I totally forgot that Santorum's youngest daughter has a serious genetic disorder. He wrote a book about her.

https://www.amazon.com/Bellas-Gift-Little-Transformed-Inspired/dp/1501222112

Since he's pro-life, what would he suggest a non-millionaire family do, if they have a special needs child like Bella to care for?

[Penny]

I have 3 autoimmune diseases. I too did not ask for it either. I would love to give my diseases to Sanscrotum and his cronies. Then take away any meds that would help them. Put them on a ship far out to sea and leave them.

[candygirl200413]

I'm still surprised he says this when he has a extremely special needs daughter. But why would he care about other people?! he is just a heartless shit stain!

[fraurosena]

When I read things like this, it makes me glad not to be American. One of my sons has multiple autoimmune disorders. He would be seriously fucked if he were an American. 

Why don't you just send the whole GOP to that island? Saves space in writing out all their names...

[JMarie]

I was flipping between Fox News and MSNBC.  Sean Hannity and Lawrence O'Donnell.  Hannity had these guys on https://www.facebook.com/pg/AtlasMD/services/?ref=page_internal  Direct care physicians, who seemed to have the answer to America's health care problem.  24/7 access to the doctors, free tests, steeply discounted meds.  Sounds too good to be true?  From reading reviews on their FB page, they recommend that their patients still get health insurance for hospitalizations - though I wonder if they even have admitting privileges to any local hospital (maybe they don't, and that's how they're always available?).  My dad is on several of the medicines they offer in their office, and I checked what his copays were compared to the list.  CVS is a lot cheaper for the same dosages and same number of pills.  I also wonder how cheap the medicines are that aren't filled in the office.  Would they be paying full price for them, if the deductible hadn't been met for their insurance?  http://atlas.md/wichita/content/upload/files/Atlas-Pricing.pdf

Yeah, it seemed like a really great idea, until you actually look at what's offered.  Seems typical for Fox.

[PsyD2013]

I have an autoimmune disease and the thought not having access to affordable healthcare and the medication that allows me to live a normal life terrifies me.  I could not afford the medication out of pocket because it costs more than my house payment.  To RDick Shitstain, you sanctimonious asshole,  I am not lazy.  I worked my ass off to complete my doctoral studies with ZERO debt.  I work 50-60 hours a week helping children and their families with autism, intellectual disabilities, and mental health conditions have a better quality of life.  

[clueliss]

This is the hands health care reform is in folks.  Congressman Dumbass from KS 1st district (otherwise known as Western KS) has said the poor don't want health care.  And - said Congressman Dumbass is an OB.  

 

http://www.kansascity.com/news/politics-government/article137189318.html

Quote

BY BRYAN LOWRY

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U.S. Rep. Roger Marshall is facing a backlash for saying in an interview published last week that the poor do not want health care.

Marshall, a Great Bend obstetrician, was elected to the U.S. House last year after ousting former U.S. Rep. Tim Huelskamp in the Republican primary for Kansas’ 1st congressional district, which covers the western half of the state.

The health care website Stat highlighted Marshall’s role in Republican efforts to repeal the Affordable Care Act in a profile published last week. During that interview, Marshall criticized Medicaid expansion, something that was enabled by the program.

“Just like Jesus said, ‘The poor will always be with us.’ … There is a group of people that just don’t want health care and aren’t going to take care of themselves,” Marshall is quoted as saying.

“Just, like, homeless people. … I think just morally, spiritually, socially, (some people) just don’t want health care,” Marshall continued. “The Medicaid population, which is (on) a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising.

“And I’m not judging, I’m just saying socially that’s where they are. So there’s a group of people that even with unlimited access to health care are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought (into) the ER.”

Marshall’s interview has begun to receive national attention, with MSNBC’s Joe Scarborough reading the quote on Wednesday morning’s episode of “Morning Joe” before his co-host Mika Brzezinski cut him off, saying, “Oh my — just stop!”

Scarborough said on the show that he was “absolutely floored” by Marshall’s comments.

“For somebody to talk about Jesus and the poor that way is a complete twisting of everything that the Gospel is about. Everything! Read the Gospel. Read the Sermon on the Mount. … I mean, Jesus was pretty clear,” Scarborough said.

Marshall’s office did not immediately comment on the uproar over his comments.

Kansas Medicaid advocates say Marshall’s comments display a misunderstanding of the program, which provides medical coverage for low-income families and disabled Kansans.

“The folks that are on Medicaid, they’re people with significant disabilities, children and pregnant women and older Kansans who all want health care, and the state has a basic consensus that they deserve it, that they have that right,” said Sean Gatewood, co-administrator of the KanCare Advocates Network, a group that represents people enrolled in the state’s Medicaid program.

“I can’t understand how a physician would not already have a fundamental understanding of that issue, but it doesn’t feel like he does,” Gatewood said.

As of this year, 19 states have not expanded their programs to provide insurance to people in the coverage gap — people who make too much to receive Medicaid but too little to buy their insurance through the federal health care exchange. Neither Kansas nor Missouri has expanded its program.

David Jordan, the executive director of the Alliance for a Healthy Kansas, a group that wants to expand the Medicaid program in Kansas, called Marshall’s comments disheartening.

Jordan said many of the people on Medicaid and in the coverage gap work multiple jobs.

“These are people who are out there, working hard, paying their bills, and to have their elected member of Congress pointing their finger at them I’m sure is disappointing,” Jordan said.

He said Marshall oversimplifies the problem of health care accessibility. Some people on Medicaid, particularly in rural areas like western Kansas, have trouble finding doctors who accept Medicaid, he said.

Denise Cyzman, executive director for the Kansas Association for the Medically Underserved, said many communities in Kansas, including Great Bend, have no dentists who accept Medicaid.

Cyzman said her organization’s 44 clinics throughout the state provided treatment to 77,000 Medicaid recipients in 2015 and to 262,000 people total, including people who fall in the coverage gap and who lack any insurance.

“These are people who are very interested in accessing health care,” she said. “To put the onus back on the individuals saying they don’t want access to health care … is not at all representative of our experience.”

Jordan said federal data show that about 97 percent of children enrolled in Medicaid saw a primary care doctor in 2012.

“To say that nobody on Medicaid benefits … is not supported,” Jordan said.

Read more here: http://www.kansascity.com/news/politics-government/article137189318.html#storylink=cpy

4

 

[JMarie]

15 hours ago, JMarie said:

I was flipping between Fox News and MSNBC.  Sean Hannity and Lawrence O'Donnell.  Hannity had these guys on https://www.facebook.com/pg/AtlasMD/services/?ref=page_internal  Direct care physicians, who seemed to have the answer to America's health care problem.  24/7 access to the doctors, free tests, steeply discounted meds.  Sounds too good to be true?  From reading reviews on their FB page, they recommend that their patients still get health insurance for hospitalizations - though I wonder if they even have admitting privileges to any local hospital (maybe they don't, and that's how they're always available?).  My dad is on several of the medicines they offer in their office, and I checked what his copays were compared to the list.  CVS is a lot cheaper for the same dosages and same number of pills.  I also wonder how cheap the medicines are that aren't filled in the office.  Would they be paying full price for them, if the deductible hadn't been met for their insurance?  http://atlas.md/wichita/content/upload/files/Atlas-Pricing.pdf

Yeah, it seemed like a really great idea, until you actually look at what's offered.  Seems typical for Fox.

I've been looking over the list of medicines offered by the office.  There's one antibiotic, one sleep med, and one diabetes med.  So I guess you're on your own if that antibiotic isn't indicated for your specific infection (or you're allergic to sulfa, like I am), Ambien doesn't knock you out, or you need insulin.

[Ali]

You are also out of luck if your infection is resistant to that particular antibiotic.`