I wish I lived in the reality where ACA was a total sell-out by the Democrats because if they had only Green Lanterned a little harder obviously single-payer would now be the law of the land. The law as passed was, however, somewhat better before John Roberts took it upon himself to rewrite it back in 2012 - sorry red states, no free money for you! :)
Also, I want a pegasus.
And despite the word “affordable” being in the name - there’s no Constitutional requirement that a bill’s name make sense - it was more about expanding coverage, not controlling costs. Although it has modestly bent the curve on cost growth. Provisions like ACOs and whatnot have been something of a mixed bag so far. Richard Mayhew over at Balloon Juice* is good for anyone wanting to learn a bit about how health insurance plans actually work. The subject is rather in my professional wheelhouse so I suppose I can vouch for him ;)
- I’m sure some posters will object that the site is, overall, hella librul though.
magnet
4203
Yes, a company that wants to operate in a state needs to abide by the laws of each state where it operates. Just like McDonald’s, Hyundai, and Walmart, which are all able to follow their local requirements.
I suppose the alternative is to set up a federal insurance board, which could replace those in individual states. Is that what the GOP means when it trumpets the tenth amendment?
The real reason insurance companies don’t compete everywhere is the same reason cable companies don’t compete everywhere. Setting up payer networks is complicated, and companies don’t have the resources to operate everywhere. Don’t blame the government.
That’s not quite fair to many members of the GOP. They’re fine with Government handouts to the rich ;).
I keed, I keed (mostly). There is an honest discussion regarding whether tax cuts and program changes (including smaller Government) to allow people to help themselves is better than Government programs among chunks of the GOP -and working with programs that can help poorer people - Kasich and the ACA for example. Sometimes the people having that conversation are dishonest about their intentions, but there are honest GOP folks interested in that conversation.
Oghier
4205
Mine is, too! But I think that “buy insurance across state lines” really means “ignore state insurance regulations.” Let’s make every consumer as well protected as those in, say, Mississippi, and everything will be awesome.
JeffL
4206
Man, living here in Iowa (which means we’re lucky enough to get political ads nonstop - who knew Huckabee was still running?) it feels like Sanders has more momentum than Clinton, especially among people who are willing to come home from work, then go back out on a cold 5 degree winter night and drive to the local library or school auditorium, then spend the evening in the caucus process (which for the Dems involves publicly standing in the space for your candidate, after people have tried to get you to vote for their candidate, and then after the people are counted, being subjected to another 30 minutes of people trying to change your mind, then casting your vote again publicly. Oh, and the other party business that goes on. It’s a lot more than dropping by the polling place and running in and quickly casting your vote (in private) and then running on home. You have to really be pretty passionate for your candidate to actually leave the house and spend the evening in the process.
The 538 shows Clinton with an 81% chance of winning the Iowa caucus. But it sure seems like the people here who are most likely to actually bundle up and spend their evening at the caucus are more Sanders supporters. They just seem much more passionate and proactive and enthusiastic; the Clinton supporters come across as more “Yeah, it would be nice if she wins the nomination, and I’m pretty sure she will” but not “driven”.
That, I think, is the most challenging part of polls, etc. to predict a caucus up here. If you call people, ask them poll questions, then ask them if they plan to go to the caucus and vote, I’m guessing you’ll get a lot of people who will say “Sure.” But I suspect the numbers who actually go are a lot less than the polls predict. The number who have shown up for each party in the last caucuses are a really small % of registered voters (and interestingly enough, there are more voters in Iowa registered as Independent than either party - and they aren’t allowed to caucus.)
Oghier
4207
OK, you’re an old-school states’ righter, believing the Federal Government should be paying only for musket balls and expeditions to explore the wildlands beyond the Mississippi river. Everything else should be done by the states.
You mention that states should regulate health insurance, and that it would be cheaper if it could be sold across state lines. Ironically, that policy proposal is popular among GOP candidates as a way to “avoid red tape.” This is shorthand for “don’t let individual states impose regulations on us,” or sometimes, “let us pick whatever state has the least regulations, then sell that plan nationwide, as it’s a lot easier for us to just buy one state legislature.” I’m sure the people of NY, California or Mass would enjoy the same government effectiveness that has made Mississippi such a beacon of good health, right? :)
So, yes, insurance would be cheaper if the federal regulations were curtailed or eliminated, and state regulations could be ignored altogether. We agree on that. I’m not confidant health outcomes would improve.
magnet
4208
If a state can’t regulate what happens inside its borders, it’s pretty much the opposite of “State’s rights”. The GOP proposals are not much different from arguing that if a restaurant is licensed to operate in China, then it should be allowed to operate in Iowa with no additional restrictions.
Rule of law is not a multiple choice problem.
Nesrie
4209
So you’re saying this statement directly from Horizon Blue Cross was just a lie and it never happened?
The Affordable Care Act (ACA) removes the pre-existing condition exclusion starting on January 1, 2014 for both new employer-based health insurance plans and new Individual health insurance plans. Health insurance companies cannot charge higher premiums for current and past health problems, gender and a person’s occupation. Also, insurers cannot refuse to sell coverage or renew coverage because of a pre-existing medical condition.
I can find many more. Jan 1 2014 has a lot of sources to back it. What source are you using?
CraigM
4210
Emphasis mine.
This is a big deal here. For you to view that system as not only viable, but preferable, is absolutely mind boggling to me. If you have any sort of preexisting conditions you were living on a razors edge before. Lose your job? Better find a new one quick. Want to start your own company? Hahahahaha, sucks to be you, good luck getting your asthma meds covered when you buy your plan. What about people who worked but did not have employer coverage? SOL for you sonny.
There are a bunch of holes in that system. If you are dealing with long term medical treatment, you are basically tied to your job. If anything changes, or some misfortune befalls you, you could be in a real hole. This change in preexisting coverage is reason enough to support the ACA.
Oghier
4211
Yep. That’s my point. You can’t advocate for state’s rights and the GOP idea of selling health insurance across state lines, which eliminates the ability of states to regulate health insurance. Well, you can, but it requires either tremendous skill at handling cognitive dissonance or utter ignorance of the details.
Oghier
4212
Yep. Before the ACA, I knew people who stayed in jobs they hated solely because of a medical condition that made leaving that job impossible. Now, you have the mobility to go work for a start-up, or start one yourself, even if you’ve been diagnosed with something.
Or I guess Oghier and CraigM could say what I’m trying to say but, like, civilly. That works too.
Well Trump just got some more twitter fodder to use against Cruz.
"Earlier this year, when asked about the political clout of Goldman Sachs in particular, he replied, “Like many other players on Wall Street and big business, they seek out and get special favors from government.”
So how much does this hurt Cruz?
The concept is that if there is a good insurance plan offered in Kansas City, KS, you can let the residents of Kansas City, MO buy it without the need for a separate corporate entity in MO. In the future, if an insurance company already had a fair number of customer in Missouri it would then being encourage to expand operations in the rest of Missouri and maybe eventually start operating in St. Louis. The article is probably right regulatory compliance probably costs less than setting up a good network, but it is still expensive. States would be free to opt in or opt out of being part of a regional system. It certainly isn’t a magic bullet.
But I was really talking about was more the concept of states acting as laboratories for health care. Much like they do for homelessness, law enforcement, drug treatment, education and bunch of other social areas. If Mass system produces good results more states will start adopting it, I know Hawaii was looking at. We already require employers to provide insurance for full-time workers.
The per capita income of #50 Mississippi is 1/2 of that of #1 Maryland. So yes health in Mississippi is almost certainly going to be worse than that of the DC suburbs. Specifying a minimum standard for what is adequate insurance that is uniform across the country means it is going to be unaffordable for many people in many regions. The ACA standards for what is good insurance make sense for Washington DC, not for the rest of the country.
wahoo
4216
I am using US Dept of Labor rules and explanation. This page is archived and accessible from the current DOL HIPAA rules. Govt could be wrong. http://www.dol.gov/ebsa/newsroom/fshipaaDec04.html
Current briefing. http://www.dol.gov/ebsa/newsroom/fshipaa.html
. http://www.dol.gov/ebsa/newsroom/fshipaaDec04.html
ShivaX
4217
Sure, but the reality is that a state would change it’s laws to have no regulations or oversight or value as well as a bunch of legal protections/loopholes for the insurance companies and then every single insurance provider would just move there. Then every state’s laws are meaningless because everyone is now “in” Alabama. Alabama makes a bunch of money, everyone gets shit healthcare. We’ve already seen it with banking and Delaware.
Alstein
4218
Most State governments can only be trusted to screw over their citizens- we need a federal government to keep them honest. I’d be ok with getting rid of states entirely and abolishing the 10th Amendment these days.
As fucked up as the government in is Hawaii, it’s still nowhere near as screwed as the Federal government. I do volunteer work for both state parks and the national parks. The state bureaucracy is maddening, but the regulations for the National Park Service are mind-numbing. It takes years to do anything.
magnet
4220
It’s true that HIPAA first introduced the idea of guaranteed coverage regardless of pre-existing conditions, but it was subject to certain conditions that are described above.
But the more important point, arguably, is that HIPAA didn’t really do anything to control premiums for people with pre-existing conditions. So even if you met the HIPAA requirements for guaranteed coverage, there was nothing preventing the insurance company from tripling your premium if they learned you had (say) a cancer diagnosis. Especially if you were in the individual insurance market, without the bargaining power of a large employer to help you. Unaffordable insurance is hardly better than no insurance at all.
ACA not only put an end to exclusion based on pre-existing conditions, it also eliminated the effect of catastrophic pre-existing conditions on the premiums that could be charged. Insurance companies can’t even require a medical exam before enrollment. For people in the individual market with pre-existing conditions, that’s a huge improvement.
The Official Donald Trump Jam:
