The continuous republican attack on the affordable care act...

[b.c.]

... or on RELIABLE coverage, PERIOD.

Today was supposed to be the deadline for public commentary on Trump & Co's. proposed "rule changes" that will facilitate the availability and sales of JUNK policies (a.k.a. "Trumpcare"). Raise your hands if you knew that.

Not that public commentary would've made ANY difference in Republican plans ANYWAY.

From the outset, much had been written of the efforts of Trump and the GOP to undermine the ACA, in spite of their complete FAILURE to come up with a better alternative, and the effect their efforts have had on insurance costs and the stability of the industry:


Number of Americans without health insurance grows in Trump's first year, new figures show - LA Times
GOP Seeks To Eliminate Obamacare’s Individual Mandate | NBC Nightly News - YouTube
Trump administration’s actions raise health insurance premiums, study says | PBS NewsHour
This Is How Much Trump's Obamacare Sabotage Increased Health Insurance Costs | HuffPost
Breast cancer and screening info removed from the government's health department website

Now, as noted in the article linked below:

"The Republican vision for health care no longer has anything to do with repeal and replace. Instead, it's just get rid of Obamacare and all of its consumer protections so that cheap, skimpy insurance plans that don't cover anything can return. The whole idea of actually replacing Obamacare but keeping protections for people with pre-existing conditions is totally out the window with the ascension of Trump.​

Here’s what the GOP has in mind: Weakened protections for people with pre-existing conditions. Skimpier benefits that leave out coverage for important medical needs. Less protection from financial harm due to illness. And a number of actions designed to make the Affordable Care Act's exchanges less stable for the millions of Americans who use them. ​

From the Trump administration sabotage of the open enrollment period last year, to the regulations it has proposed, to new state experiments to limit coverage, the Republicans seem to want nothing more than the return to the bad old days."​

Failing repeal, Republicans intent on dismantling Obamacare without a replacement

These junk plans that are cheaper but reportedly don't cover what many may NEED covering are currently available in some places, for three months. Trump, of course, wants to change that, making them available for a year and renewable.

The Kaiser Family Foundation found the following:

"Out-of-pocket spending in plans the KFF researchers found in Miami, Phoenix, and Houston reached as high as $30,000 for just three months of coverage. ​

The annual limits in out-of-pocket costs imposed by Obamacare in regular insurance are $7,000 for an individual or $14,000 for a family, ​

but these new plans also are allowed to have caps in coverage, something Obamacare did away with...​

And none of the plans that KFF examined cover maternity care, which is also a requirement for Obamacare coverage."​

If you need prescriptions or maternity care, you won’t like Trump’s short-term insurance plans - Vox

Trump & Co........... "Making America great.................................................................. again."

 

[Klingsor]

It's all about choice: you get to choose the shitty, overpriced plan that's best for you.

 

[b.c.]

The Health 202: The health care world slams Trump's proposal for short-term insurance plans - The Washington Post
"The American Medical Association has warned it could “disrupt and destabilize the individual insurance market.” The American Academy of Family Physicians said it would allow insurers to avoid covering “vulnerable, expensive patients.” More than 100 patient groups have signed a letter in opposition."


Junk insurance plan proves Trump doesn't care about your health
https://www.usatoday.com/story/opin...re-your-health-andy-slavitt-column/381588002/
"Republicans in Washington are so far proving they can’t be taken seriously to improve the nation’s health or health care system."

"After first submitting a budget that aims to force austerity on Medicaid and Medicare recipients to pay for last year’s tax cuts that are going largely to corporations and the wealthy, the Trump administration has now followed up with a new plan to allow insurance companies to sell junk health insurance."

"Make no mistake, this is part of the continuing GOP drive to overturn the Affordable Care Act. It has gone from the headlines to the back pages, but to Americans with pre-existing conditions, or those living on the margins, the threat is just as real."

 

[Max_Polo]

This thread could also be titled "the continuous bureaucratic attack on American healthcare."

Health insurance is a disaster for many reasons, not least of which is that we (patients and doctors) do not treat it like insurance - we expect the best quality care to be available regardless of reimbursement, we expect first dollar coverage for many services, etc.

Obamacare is a disaster but the GOP have not proposed anything of value recently in the healthcare space either.

The American Medical Association cares about patients as much as the National Rifle Association cares about responsible, legal, safe gun ownership...both do the bidding of corporate special interests.

Given that there are no easy answers here, and that the thread is clearly intended to be a partisan attack, I would not anticipate anything good to come of this discussion, but these (above) are my $0.02 on the topic.

 

[Klingsor]

This thread could also be titled "the continuous bureaucratic attack on American healthcare."

Can you clarify how things were better before bureaucracy?

Health insurance is a disaster for many reasons, not least of which is that we (patients and doctors) do not treat it like insurance - we expect the best quality care to be available regardless of reimbursement, we expect first dollar coverage for many services, etc.

Perhaps health insurance is, by definition, a disaster.

But aside from that, is our expectation the problem, or our failure to meet it?

 

[Max_Polo]

Can you clarify how things were better before bureaucracy?

Well, bureaucracy impacted healthcare before I was born and has continually since. MIPS, MACRA and all the other government-imposed stupidity have added zero value for patients.

I'd offer that Medicare was the beginning of the corporatization of medicine (and its downward spiral overall) but the political hate mail will fly and it's an academic argument because it's clearly here to stay.

Perhaps health insurance is, by definition, a disaster.

That is correct. Insurance is intended to protect against catastrophic loss. When we use it for routine expenses, the inefficiency of the system (and 20% margin for operations and shareholders) is a larger drag overall.

But aside from that, is our expectation the problem, or our failure to meet it?

Both, but more the former given the economic issue with first dollar coverage.

Then, there's the whole issue of "you get what you pay for." Doctors, hospitals and others are paid based on volume. If I get $80 for every patient I see, the way to make more money is to see more patients. So, shorter visits, more attention to a government-subsidized and now essentially mandated computer record, less attention to the patient...but I make more money. It's ridiculous to expect any other outcome until we start to pay for the end result (healthy patients) rather than the process.

ETA - to clarify, I've bailed from that stupidity, but most patients and doctors are stuck in a system where volume matters, quality does not, and service sucks.

 

[Klingsor]

I'd offer that Medicare was the beginning of the corporatization of medicine (and its downward spiral overall) but the political hate mail will fly and it's an academic argument because it's clearly here to stay.

Because people like it. Maybe that's significant.

. . . most patients and doctors are stuck in a system where volume matters, quality does not, and service sucks.

Anecdotally, I was happy with the service that saved my life. But I agree that quality should matter more than volume.

 

[Max_Polo]

Anecdotally, I was happy with the service that saved my life. But I agree that quality should matter more than volume.

I don't mean to say that doctors driven by volume-based reimbursement are not conscientious or caring. And we do generally end up with good outcomes for acute illnesses. But we don't do prevention well and the "system" should be paid for the outcomes that matter to patients.

 

[Bigbailey12]

This thread could also be titled "the continuous bureaucratic attack on American healthcare."

Health insurance is a disaster for many reasons, not least of which is that we (patients and doctors) do not treat it like insurance - we expect the best quality care to be available regardless of reimbursement, we expect first dollar coverage for many services, etc.

Obamacare is a disaster but the GOP have not proposed anything of value recently in the healthcare space either.

The American Medical Association cares about patients as much as the National Rifle Association cares about responsible, legal, safe gun ownership...both do the bidding of corporate special interests.

Given that there are no easy answers here, and that the thread is clearly intended to be a partisan attack, I would not anticipate anything good to come of this discussion, but these (above) are my $0.02 on the topic.

You are 100% right that Obamacare act is a disaster. The cutoff in Ct for subsidized healthcare is $98,400. If you make $98,401, for a family of four is over 1700. per month outstanding incentive to go to the unemployment line get it for free

 

[Klingsor]

You are 100% right that Obamacare act is a disaster. The cutoff in Ct for subsidized healthcare is $98,400. If you make $98,401, for a family of four is over 1700. per month outstanding incentive to go to the unemployment line get it for free

So people will choose to be unemployed instead of earning $98,000 a year?

*Which* people?

 

[Max_Polo]

So people will choose to be unemployed instead of earning $98,000 a year?

Of course not. Or at least not any sane ones. But some might not work so hard to advance, get a graduate degree or work overtime to go from $90,000 to $100,000.

 

[Bigbailey12]

So people will choose to be unemployed instead of earning $98,000 a year?

*Which* people?

It provides incententive to make less money if you are on the border of subsidized or not. People can’t afford insurance that takes two weeks of your paycheck just for insurance

 

[Bigbailey12]

It is a shitshow

 

[Bigbailey12]

That is for the bronze plan with a 12000 $ deductible

 

[Bigbailey12]

The point is if you are on the bubble would you accept a raise?

 

[keenobserver]

Of course not. Or at least not any sane ones. But some might not work so hard to advance, get a graduate degree or work overtime to go from $90,000 to $100,000.

And somehow looking out for one's own financial self interest is bad when it involves working people? I know many people who when in the income restricted part of their Social Security or Railroad Retirement turn down money making work because the penalty of making more than a set amount undermines the value of their work. I've know wealthy professionals who delay December billings until January to stay in a lower tax bracket. I don't see anything wrong with that - at any income level.

 

[Max_Polo]

And somehow looking out for one's own financial self interest is bad when it involves working people? I know many people who when in the income restricted part of their Social Security or Railroad Retirement turn down money making work because the penalty of making more than a set amount undermines the value of their work. I've know wealthy professionals who delay December billings until January to stay in a lower tax bracket. I don't see anything wrong with that - at any income level.

Anything that discourages productivity and achievement cannot be good, right? Delaying billings into January is fine, but not effective if each year is repeated.

 

[keenobserver]

Anything that discourages productivity and achievement cannot be good, right? Delaying billings into January is fine, but not effective if each year is repeated.

In general I agree with the sentiment of impeding productivity, but that isn't the issue here. One could argue the higher taxes / insurance premiums / payback penalty is the threat to productivity, not a decision not to do more work to earn more just for the sake of earning. We're almost saying the same thing from slightly different viewpoints.

 

[b.c.]

Can you clarify how things were better before bureaucracy?

Perhaps health insurance is, by definition, a disaster.

But aside from that, is our expectation the problem, or our failure to meet it?

Or the UNWILLINGNESS to meet it because of their own political/ideological goals and connections/panderings to special interest groups, and those dark money/state behind the scene MOVERS who dictate policy making in ways that best serve THEMSELVES.

We keep hearing how the ACA is such a disaster, yet in THREE attempts to replace it (ALLEGEDLY) they haven't come up with better. That, in spite of the fact that many other nations have somehow figured out how to provide some form of universal healthcare to their citizenry.

The fact is, those currently in control of Congress, the Oval Office, and their defenders, supporters et al, WANT health insurance to fail.

One way to ease Obamacare premium costs: Fix the rebate formula

 

[b.c.]

Continuing Sabotage of Americans' Healthcare, Trump Proposes Allowing Insurers to Offer 'Junk Plans'