Just found out that I will be forced on the exchanges after next year- my exemption runs out.
On some level, this will likely get worse, no matter what. People live longer, and require more magic healthcare to keep them going.
Used to be, you got cancer? Sorry dude, hope you had a good run. There wasn’t any expensive treatment for it. You just died. Now there are all kinds of amazing treatments for all sorts of things that used to be terminal or chronic. There weren’t things like replacing your joints with titanium joints. I mean, christ, a few weeks back some retired soldier had a double arm transplant. Ignoring the fact that a few decades ago, that guy would have just died on the field when his arms and legs got blown off, the fact that we can freaking transplant entire arms, and have them work? That shit is a amazing.
But the result of this is gonna be that it costs more. I don’t see how it could be otherwise.
Here’s an interesting thing that might spark discussion which isn’t about how Trump is going to end the world.
So I found this:
http://paulryan.house.gov/healthcare/
This is Ryan’s plan from 2009, prior to passage of the ACA. What I am struck with, is how it seems like it basically is the ACA.
From the short summary:
Creating Affordable and Accessible Health Insurance Options
Our health care system should be easier to navigate and provide integrated care in a more equitable manner. A vibrant
market for health insurance that is consistent and fair will allow all Americans access to health coverage. The Patient’s
Choice Act of 2009 would encourage states to establish rational and reasonable consumer protections, including the
following:
• Creates State Health Insurance Exchanges to give Americans a one‐stop marketplace to compare different
health insurance policies and select the one that meets their unique needs
• Gives Americans the same standard health benefits as Members of Congress, so all Americans have a wide range
of choices
• Protects the most vulnerable Americans to ensure that no individual would be turned down by a participating
Exchange insurers based on age or health
• Creates a non‐profit, independent board to risk adjust among participating insurance companies to penalize
companies that “cherry pick” health patients and reward insurers that encourage prevention/wellness and cover
patients with pre‐existing conditions
• Helps States expand coverage through auto‐enrollment at state and medical points of service, for individuals
who do not select a plan at the beginning of the year
• Gives states the ability to band together in regional pooling arrangements, as well as the creation of robust high
risk pools, reinsurance markets, or risk adjustment mechanisms to cover those deemed ‘uninsurable’
Equalizes the Tax Treatment of Health Care, Empowering All Americans with Real Access to Coverage
Economic analysts across the political divide agree that the tax code is stacked in favor of the wealthy and those who get
their health coverage through their employers, discriminating against the self‐employed, the unemployed, and small
businesses. The Patients’ Choice Act of 2009 would restore fairness in the tax code and give every American, regardless
of employment status, the ability to purchase health insurance by:
• Providing an advanceable and refundable tax credit of $2,300 per individual or $5,700 per family
• Improving the operation of Health Savings Accounts [HSAs] by allowing health insurance premiums to be paid
with HSAs without a tax penalty
• Allowing preventative services to be covered by High Deductible Health Plans
• Increasing the amount of money an HSA owner may annually contribute to their account
Modernizing the Medicaid Benefit and Protecting Medicare Beneficiary Choice
The health security for low‐income families and American seniors is threatened by the outdated formulas and exploding
costs of Medicaid and Medicare. These vital programs require significant reforms to better balance value for those
beneficiaries in greatest need and protection for U.S. taxpayers. The Patients’ Choice Act would make important
improvements to both programs without limiting eligibility or benefits by:
• Integrating low‐income families with dependent children into higher‐quality private plans through direct
assistance
• Removing the stigma of Medicaid and providing access to the same coverage options available to all Americans
• Realigning responsibility between federal and state governments in order to better coordinate benefits by
requiring the Medicare program to assume Medicaid responsibility of premiums, cost‐sharing, and deductibles
for low‐income seniors
• Rebalancing long‐term care services to ensure choice between institutionalized and home‐based care
• Empowering Medicare beneficiaries with more choices and more power by reforming Medicare Advantage
• Allowing for the creation of Medicare Accountable Care Organizations that would improve payment to
physicians, hospitals, pharmacists, and nurses for demonstrable improvements in quality and patient satisfaction
while reducing costs
• Requiring wealthy Medicare beneficiaries to contribute a little more for their care under Medicare Part D
Ensuring Compensation for Injured Patients
Our current legal system does a poor job at compensating patients for medical mistakes in a fair and efficient manner.
Instead of nurturing an environment where medical professionals can openly learn from their mistakes, our legal system
often forces doctors and patients into contentious courtroom disputes. The Patients’ Choice Act would reform this
broken system that helps drive health care costs out of control by:
• Encouraging states to adopt a number of legal alternatives entirely run by the state that would include the
establishment of expert medical panels to resolve disputes, creation of health courts, or a combination of both
Am I alone in seeing this as extremely similar to what eventually passed as the ACA?
It goes back further than that. For instance:
The rating on that statement was “half-true” in the sense that the plan was much like the ACA but only had the support of a “strong roster” of Republicans rather than an outright majority. I think the point remains, though, that the Republican party had strong support for something much like that ACA back in the 90s (and maybe even before). That Ryan would have been in a similar position makes sense, at least until the politics of supporting a plan put forward by Democrats came into play.
Which isn’t a surprise, really. The ACA doesn’t do much to help the majority of individuals, since most already had insurance through employers. The insurance/provider industry had to make some concessions, like pre-existing conditions coverage and the covered-until-age-26 clause, but in return their position in the health care market is solidified (as opposed to weakened by public alternatives). There are no real cost reduction measures or incentives to provide better care (just more of it). Seems perfectly logical to me that the Republican party would have been happy to support a plan that props up big business at the expense of the end product.
But when you look at the actual points of Ryan’s plan… what exactly is the difference between it and the ACA?
It honestly looks like it’s virually identical on the major points.
And to be clear, this is essentially what is being proposed as the “replacement” for the ACA by the repeal/replace folks. So it seems like it’s talking about replacing the ACA with… the ACA? But presumably called “Republican awesome-care” or whatever.
Does anyone see what major changes would exist?
Isn’t the major change with Ryan’s (and pretty much every Republican’s) plan switching Medicaid to a block grant? And, maybe, allowing inter-state insurance sale. I can’t remember if that’s a feature of that specific plan, but it almost always is whenever Republicans feel they have to propose something on healthcare reform.
Well, at first glance:
No mention of a mandate (Ryan does support community rating, so I’m not sure how he would avoid adverse selection).
No progressive subsidy for health care, just a fixed tax credit.
No Medicaid expansion.
… but yeah, the principle is basically the same.
One of the major differences is proposals to buy across states. Which I don’t know if shows in that proposal, as much as it was a talking point from Ryan at other points. The main counter argument is that this would effectively tend towards health care standards being lowered, as insurance companies would be able to pick states with the lowest standards of care, and price things to ensure that the market goes there.
Much like how we see see corporations set up ‘headquarters’ in some areas for reasons other than business. Like setting up in a certain Texas district for purposes of filing lawsuits, or Delaware or Nevada for tax shelter purposes.
Or banks in states with looser usury laws. It’s a certainty that this would happen, although it’s not necessarily lowest standards of care — more like regulations most conducive to profit.
You know what the current GOP gets us? Fucking DDoS attacks on a state-run insurance exchange that helps the uninsured get fucking health insurance.
I’m sorry, but whether or not you agree with the ACA as policy, this is just utterly despicable. Actively trying to keep people from getting health insurance to make a Democratic initiative look bad. Nice.
Whether or not they directly committed or commissioned the attacks, the party’s sustained insanity is damn well responsible for it.
Sorry, Republicans. Your ideology is broken. Die off and/or move to fucking Somalia so the rest of us can have our country back, please.
I’m just done with this shit.
Let’s dispense with the notion that you currently cannot buy insurance across state lines. You can. My own policy is sold by BCBS Michigan, and I live in Illinois.
The question is whether Illinois standards should apply to my policy. Republicans would generally prefer to ignore those standards, substituting the (likely) lower standards of the issuing state. Democrats generally think a state should be allowed to regulate the policies sold to its residents, just like they can regulate pretty much everything else that is sold to its residents.
Interesting thing about the “buy insurance across state lines” thing, is that it essentially represents an erosion of states rights, suggesting that the federal government mandate insurance regulations rather than allowing states to decide such things on their own.
Most Americans are just getting such sticker shock at how much they’re paying for shit coverage right now- that the system is going to death spiral without change.
My $260/mo non-ACA plan that expires next year would be $500/mo in the exchange. I’m changing my tax return and looking for any loopholes to avoid paying that- it’s worse than having no insurance.
Basically, the GOP turned Obamacare into a demon, and so they can’t do anything but slay the demon. Rather than tweak and adjust it to fix the problems they’ve found like a responsible party would do, they have insisted that it be repealed and found the problems only because they wanted reasons for repeal not because they were interested in helping anyone. They want it to be a wedge issue like abortion that they can grandstand about to get votes and donations.
Most non-elderly Americans still receive their insurance through their employers. And the group trying to get out of paying for health insurance premiums will likely still show up at an Emergency Room and expect to be treated whether they can pay or not when they need it. They just don’t equate others paying for that visit as… a problem.
If you think $500/mo is acceptable for a single 40-yr old to pay for shit insurance than you have a problem.
If you think a million dollar emergency bill is unheard of, you have a problem. And that problem is people who refuse to pay insurance premiums just shrug when they make others pay their bill.
On a more serious note, if you set-up a system where the sick or concerned are the only ones in the market and the healthy and generally young are giving the market the finger, you’re going to wind up with a pool of individuals that are not profitable for the insurance companies. They’re either going to exit that market or raise prices. They don’t have a choice. They have to keep the doors open just like any other company. Those with challenged incomes. well expanding Medicaid is supposed to try and help with that but we know how some groups feel about government spending and programs.
Do you have a car? I do.
Do you pay car insurance? I do, even though I’ve only used it once in the past 20 years.
The average cost to repair a car is $2000-$3000. A typical car insurance premium is $1000-$2000 / yr.
The average hospital bill is $10,000.
Now do the the math.
So average hospital bill is 5 times car insurance, average health insurance (which is inferior to car insurance too) is 12 times car insurance (using my own costs).
It’s shit math. I want the insurance industry to death spiral now because then the government will have to come up with a real fix. The current problems with the ACA make it too unacceptable for much of America unless they benefit from it, or are bay area Liberals who make enough that it isn’t a problem.
At least in NC, the system is failing- somewhat due to a lack of Medicaid expansion, but largely due to monopoly and lack of cost control. They’ve passed all the costs onto people like myself.
I don’t mind paying taxes or paying a bit extra to support a working system, but not over half my bill going to that and a good chunk more going to corporate profit. The whole point it was supposed to be affordable healthcare, and $500/mo to someone making barely over the subsidy threshhold is not affordable. I know I’m feeling the pain worse than just about anyone- folks making less get subsidies, folks making more it’s a lower part of their income, but I’m going to be getting enogh pain next year that I’d be much better off not getting insurance period.
Imagine paying $1,513 a month for 3 people for shit insurance. I can remember (back in the cave man days) when I was in my early 20’s working for the government and I paid $30 a month for better insurance than I have now.