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Policy Analysts From Left, Right, And Center Criticize House GOP Obamacare Replacement

congress-healthcare

While House Republicans move forward with the health insurance reform bill that was introduced yesterday to what now seems like undeserved fanfare, health care policy experts from across the political spectrum are speaking out against it:

They rarely agree on much, but health care experts on the left, right and center of the political spectrum have found consensus on the House GOP’s Obamacare replacement: It won’t work.

While their objections vary depending on their ideological goals, the newly introduced American Health Care Act (AHCA) is facing an unrelenting wave of criticism. Some experts warn that the bill is flawed in ways that could unravel the individual insurance market.

The bill, experts said, falls far short of the goals President Donald Trump laid out: Affordable coverage for everyone; lower deductibles and health care costs; better care; and zero cuts to Medicaid. Instead, the bill is almost certain to reduce overall coverage, result in deductibles increasing, and will phase out Obamacare’s Medicaid expansion.

(…)

Let’s start with the primary objection from the center and left: It’s very likely people will lose insurance coverage if the GOP plan became law, taking full effect in 2020. Possibly a lot of people.

Like any health care bill, including the current system, there are winners and losers within this shift. In general, younger and higher-income people looking for insurance on the individual market are poised to gain. Older, sicker and lower-income patients are the bigger losers.

For one, tax credits to help people buy health insurance in the individual market are less generous than the Affordable Care Act for some of the most vulnerable Americans. Under the ACA, these credits are based on a person’s income and pegged to the cost of plans where the individual lives. Under the House bill, they are based on age and fixed. The bill also removes ACA subsidies that allows some lower-income customers to pay fewer out-of-pocket costs through their plan.

On the other hand, the House’s tax credits are accessible at higher incomes than the ACA’s: In the House bill, it’s up $75,000 for an individual and $150,000 for a family. In the ACA, it’s 400% of the federal poverty level, which is $47,520 for an individual and varies based on family size.

If you’re a 40-year-old making $50,000 you might benefit from the House plan. Under Obamacare, you get nothing to help pay your premium, but you would get $3,000 under the House bill.

And if you’re wealthy, you’re in luck.

The House bill uses the savings from spending less on health coverage to eliminate taxes that pay for Obamacare: About $600 billion over the next 10 years, according to the Committee for a Responsible Federal Budget. Close to half of that revenue comes from surtaxes on high-income Americans. They’re also more likely to benefit from an increased tax deduction on health savings accounts.

(…)

On the right, there’s a more specific concern. The plan still retains the basic structure of the ACA, even as its benefits are less generous: Federal dollars to buy insurance, regulations on what that insurance provides, and a requirement that insurers take on customers with pre-existing conditions. Some have labeled it “Obamacare-lite” or “Obamacare 2.0.”

“House Republican leaders sent a signal loud and clear: liberalism has already won,” Phil Klein, a conservative commentator at the Washington Examiner, wrote.

While moderate Republicans and liberals fret that the Medicaid changes will leave people in the cold, conservatives worry that the bill will encourage states to sign up as many new participants as possible before the expansion ends, who then will be grandfathered in afterwards. It also punts its changes to the ACA’s tax credits to 2020, when the political environment will be anyone’s guess and there could be opportunities to delay or cancel the reforms.

One thing that analysts all agree on, though, is that the plan would do nothing to address rising health care costs:

[E]xperts complain that the GOP plan leaves out the most prominent proposals (especially among conservatives) that might drive costs down. And some of its features could potentially drive prices higher.

One big missing piece is that the bill does not eliminate Obamacare’s “Essential Health Benefits,” a list of 10 broad categories, like mental health or maternity care, that insurance plans were required to cover.

Proponents of the benefits argue they’re needed to keep insurers from cherry picking healthy customers into cheaper low-benefit plans. Critics complain they raise premiums by giving insurers less flexibility to design plans and forcing consumers to buy more comprehensive plans than they need.

The earlier leaked draft of the House GOP plan would have left it to states to decide, but the bill that was introduced left out that provision. This is for procedural reasons: House Republicans concluded that the regulations can’t be changed via the budget reconciliation process they are using to pass their health care bill.

The House GOP bill also balked at an earlier plan to reduce the tax deduction businesses get for providing health care. It was a politically perilous idea, but many policy experts supported the proposal, saying it would help drive down health-care costs and raise wages by reducing the incentive to offer more generous plans.

“This bill misses the mark primarily because it fails to correct the features of Obamacare that drove up health care costs,” Edmund F. Haislmaier, an expert at the conservative Heritage Foundation who advised Trump’s transition team, wrote on Tuesday.

The plan also leaves out Trump’s proposal, backed by many on the left, to empower Medicare to negotiate lower drug prices. The president tweeted on Tuesday he plans to address it in a future bill.

In reality, the plan does very little to deal with the major problems that many people who have bought policies on the exchanges have encountered since the PPACA went into effect. For example, while the plan leaves in place the ban against denying coverage for people with pre-existing conditions, it leaves open the possibility that insurance companies can radically increase premiums for these customers while at the same time taking away the subsidies that were previously supposed to make such policies affordable. Additionally, the replacement for the PPACA’s individual mandate seems guaranteed to increase the cost of insurance in the long-run, especially if younger, healthier people decide not to get insurance at all, something insurance companies count on to keep overall costs and expenditures down. Instead of an insurance mandate that includes a tax penalty, the House bill allows insurance companies to levy a fine equal to 30% of the premium against anyone who goes without insurance for more than two consecutive months. For most health, young people this is likely to be a far higher amount than the penalty under the PPACA would have been. It’s also worth noting that many people end up going without insurance not by choice but because they either cannot afford it, or because they lost their job and aren’t covered by an employer-provided policy anymore. Therefore, the logical choice for most of these people would be to go without health insurance rather than be penalized. To be fair, of course, that choice also exists under the PPACA since the fine for not having insurance is fairly low and, since it’s paid through the income tax process, largely not visible to the individual consumer. Nonetheless, this change is likely to make insurance more expensive in the long run because it means that the pool of insured people will be older and, most likely sicker and more likely to make use of high-cost medical procedures and services.

In addition to these problems, The New York Timereports that other analysts believe that the Republican plans will cause millions of people to lose coverage:

Millions of people who get private health coverage through the Affordable Care Act would be at risk of losing it under the replacement legislation proposed by House Republicans, analysts said Tuesday, with Americans in their 50s and 60s especially likely to find coverage unaffordable.

Starting in 2020, the plan would do away with the current system of providing premium subsidies based on people’s income and the cost of insurance where they live. Instead, it would provide tax credits of $2,000 to $4,000 per year based on their age.

But the credits would not cover nearly as much of the cost of premiums as the current subsidies do, at least for the type of comprehensive coverage that the Affordable Care Act requires, analysts said. For many people, that could mean the difference between keeping coverage under the new system and having to give it up.

“The central issue is the tax credits are not going to be sufficient,” said Dr. J. Mario Molina, the chief executive of Molina Healthcare, an insurer that offers coverage through the Affordable Care Act marketplaces in California, Florida and several other states.

Martha Brawley of Monroe, N.C., said she voted for President Trump in the hope he could make insurance more affordable. But on Tuesday, Ms. Brawley, 55, was feeling increasingly nervous based on what she had heard about the new plan from television news reports. She pays about $260 per month for a Blue Cross plan and receives a subsidy of $724 per month to cover the rest of her premium. Under the House plan, she would receive $3,500 a year in tax credits — $5,188 less than she gets under the Affordable Care Act.

“I’m scared, I’ll tell you that right now, to think about not having insurance at my age,” said Ms. Brawley, who underwent a liver biopsy on Monday after her doctor found that she has an autoimmune liver disease. “If I didn’t have insurance, these doctors wouldn’t see me.”

The Congressional Budget Office has yet to release its official estimates of how many people would lose coverage under the proposal, but a report from Standard & Poor’s estimated that two million to four million people would drop out of the individual insurance market, largely because people in their 50s and early 60s — those too young to qualify for Medicare — would face higher costs. Other analysts, including those at the left-leaning Brookings Institution, have estimated larger coverage losses.

While the tax credits in the Republican proposal are the most generous for older people — $4,000 for a 60-year-old compared with $2,000 for a 25-year-old — they end up covering less of an older person’s costs. As soon as next year, the Republican plan would allow insurers to begin charging older individuals much more than younger individuals. Insurers are prohibited today from charging the older person more than three times as much as the youngest, but the Republican plan would allow them to charge five times as much. A 64-year-old could see annual premiums increase by almost 30 percent to $13,100 on average, according to the S.&P. analysis.

For people like Alan Lipsky, a self-employed consultant in Arden, N.C., the Republican plan could have a huge financial impact. Mr. Lipsky, who is 60 and whose wife is in her 50s, receives a tax credit of $2,097 a month for his family of four and pays $66 a month out of his own pocket. His family’s total annual tax credit of $25,164 would be reduced to $11,500 under the new plan, covering less than half of the total cost of his current coverage.

“I don’t think the Affordable Care Act is perfect,” said Mr. Lipsky, whose family deductible is $12,000 per year, “but at least for people like me it gives a baseline, and I’m worried I won’t have that baseline anymore. What they’re talking about is unaffordable for me.”

(…)

The proposal would also eliminate another important element of the subsidies, the financial assistance available for low-income people with their out-of-pocket costs, such as deductibles and co-payments. While many of the plans now sold through the Affordable Care Act marketplaces have large deductibles, the cost-sharing reductions available protect lower-income people from medical bills that could otherwise run into the thousands of dollars. Analysts say the lack of out-of-pocket assistance is likely to make any plan much less attractive to low-income people.

In other words, while the House plan keeps many of the popular elements of the Affordable Care Act, it does so in a manner that seems designed to make sure that the people who benefit from those provisions will either face vastly increased premiums or face losing their insurance entirely, meaning that they will likely get dumped into the Medicaid system at some point, seek bankruptcy protection due to the burden of unpaid medical bills, or simply forgo treatment entirely because they can’t afford it. This would put us back in what would effectively amount to the pre-PPACA health care world on steroids, with millions more people likely going without insurance and all the social costs that come from that, along with the fact that it would do nothing to control rising health care costs. Given that, it’s no wonder that analysts on both sides of the political aisle are speaking out against it.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. michael reynolds says:

    I’ll commit the sin of repeating something I wrote on the other thread: I just looked at the actual numbers and it seems I save about $6,750. Lovely. Nice. Who doesn’t like money? But it means just about nothing to me, while it would buy coverage for a family of four who are now free! Free to get sick and die poor in a cardboard box under a bridge! What a brilliant plan. Genius.

    The only upside is that Paul Ryan is exposed as just what I always said he was: an empty suit, a vacuous pretty boy with stuffing between his muscular ears. The policy wonk of the GOP. Right.

    Highly-rated. Helpful or Unhelpful: Thumb up 43 Thumb down 1

  2. Gromitt Gunn says:

    I realize this may come off as overly cynical, but I can’t help thinking that the idea of people dying off in their 50s and early 60s due to lack of affordable coverage, and thus not living long enough to enroll in Medicare, is considered a feature rather than a problem to a lot of the House GOP caucus.

    Highly-rated. Helpful or Unhelpful: Thumb up 30 Thumb down 2

  3. Daryl's other brother Darryl says:

    I would prefer that these guys just come out and say that they are giving a huge tax cut to their donors, and the rest of you can go suck eggs.
    I thought the orange blob in the white House was supposed to be a straight shooter?

    Like or Dislike: Thumb up 15 Thumb down 2

  4. Jc says:

    @michael reynolds:

    an empty suit

    Exactly. You have 8 years to come up with a replacement saying all along “we have a plan, it will be better, wait and see” and this is what we get? If this is not proof that the GOP is devoid of ideas, I don’t know what is

    Highly-rated. Helpful or Unhelpful: Thumb up 26 Thumb down 3

  5. OzarkHillbilly says:

    So under this plan, if my wife loses her job (and the health insurance that comes with it), I will be unable to obtain insurance and have, at best, 6 months to live. For Republicans I am sure that is just a bonus. But here’s a little news for them: I’m not going out alone.

    Highly-rated. Helpful or Unhelpful: Thumb up 32 Thumb down 0

  6. DrDaveT says:

    Proponents of the benefits argue they’re needed to keep insurers from cherry picking healthy customers into cheaper low-benefit plans. Critics complain they raise premiums by giving insurers less flexibility to design plans and forcing consumers to buy more comprehensive plans than they need.

    …and people who can read and think point out that these two groups are saying exactly the same thing with different emphasis. “Forcing consumers to buy more comprehensive plans than they need” is exactly the same thing as “preventing cherry-picking” is exactly the same thing as “ensuring robust risk pools”. People who want to be able to buy a plan tailored exactly to their personal risk level are (1) wealthy, and (2) healthy. They should overpay for health insurance for exactly the same reason that childless couples should pay School Tax.

    Edmund F. Haislmaier, an expert at the conservative Heritage Foundation

    Oxymoron alert. Unless they meant that he’s an expert in rent extraction; I guess HF does have those.

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  7. DrDaveT says:

    I once heard a prominent health analyst give the plenary talk at an Operations Research / Management Science conference. It was pretty eye-opening when he laid out the statistics relating income and health, and essentially characterized the decision problem as “How many people are you willing to kill in order to pay $X lower taxes?”.

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  8. Tyrell says:

    What is needed is a basic, free, no frills plan and work from there, with options available for a cost. That would not be hard to do; just use medicare as the base. There are optional coverages I would pay more for, and some that I don’t need. One thing that needs to be done now is to drop the ridiculous mandate – penalty. A person should not have to answer to the IRS if they can’t afford health insurance. And those who are financially able to handle medical costs personally without insurance should not have to pay the fine either
    “Don’t mess with the IRS: they are cracking down this year, they can garnish your wages, put a levy on your bank accounts, and even your home or business could be up for grabs !”

    Like or Dislike: Thumb up 2 Thumb down 13

  9. CSK says:

    Being he poor excuse for a human being that I am, I’m really, really enjoying the frenzied efforts on the part of the avid Trumpkins to make this palatable to the base.

    Like or Dislike: Thumb up 7 Thumb down 0

  10. OzarkHillbilly says:

    @Tyrell:

    And those who are financially able to handle medical costs personally without insurance should not have to pay the fine either

    BWAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA ….. gasp ….. wheeze……

    You haven’t been in the hospital lately, have you? And just exactly how does one decide one can pay out of pocket for all healthcare? What is the minimum dollar limit? Do you have even the slightest clue what one week in ICU costs?

    Here’s a proposal for you: Anyone who wants to self insure can. BUT…. They have to have a readable chip embedded under their skin with up to date banking info and hospitals are allowed to kick their unconscious bodies to the curb when they run out of funds. No ifs, ands or buts.

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  11. Slugger says:

    I am in comfortable financial circumstances. I buy my healthcare with my own money, and I subsidize others in two ways. I get taxed to provide coverage for some. Indirectly, when an uninsured person uses the healthcare system this overhead is passed on to me. Now, I understand some uninsured might drop dead without ever interacting with the health care system, and this would save money. However, for others lack of care might translate into high costs. Lack of education might worsen chronic conditions like diabetes and asthma with increased crises leading to the emergency room. A young woman without health care might have less birth control and produce more kids that wind up in the neonatal ICU for half a million bucks which will be passed on to us paying customers.
    Is it possible that not having comprehensive coverage of the whole population is actually more expensive?

    Highly-rated. Helpful or Unhelpful: Thumb up 28 Thumb down 0

  12. Scott says:

    Back in 2008, TR Reid did a documentary, Sick Around the World, about 5 different systems that are successfully providing universal healthcare. Did the US want to do that? No, we’re too exceptional to copy anything that works.

    Even the conservative Avik Roy, who can’t stand the ACA, admires some of them, particularly the Swiss system. I looked that up and they have 99.5% coverage.

    Seems to me if a country as similar to us as Canada can have one, then we could also.

    Like or Dislike: Thumb up 11 Thumb down 0

  13. @Tyrell:

    What is needed is a basic, free, no frills plan and work from there, with options available for a cost.

    What kind of “frills” do you mean? Cancer? Massive heart attack? Freak accident?

    Isn’t part of the problem, ultimately, that none of us knows for sure what coverage we are going to need.

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  14. gVOR08 says:

    Low income people who don’t vote get screwed and mid and upper class people who do vote get a break. Morally repugnant, but politically kind of clever. Right in the Republican wheelhouse. If they get away with it.

    Like or Dislike: Thumb up 8 Thumb down 0

  15. gVOR08 says:

    @Scott:

    Seems to me if a country as similar to us as Canada can have one (a universal health care system), then we could also.

    We certainly could, except, as I’m sure you know, for one very large difference between us and Canada. They don’t have the Republican Party.

    Like or Dislike: Thumb up 14 Thumb down 0

  16. Tyrell says:

    @OzarkHillbilly: There are multi-millionaires who could pay for a month hospital stay with their pocket change. Maybe not a lot but some. Think back to someone like Hughes. He not only took residence of one hotel floor, but he bought the hotel itself. We are talking about industrial, finance, and land barons, some entertainers, and some pro athletes. Buffett comes to mind, among others.

    Like or Dislike: Thumb up 0 Thumb down 2

  17. Scott says:

    @gVOR08: Yes, I was speaking rationally which apparently is in short supply in political circles.

    Like or Dislike: Thumb up 0 Thumb down 0

  18. Monala says:

    @Tyrell: I made this comment on the other thread about the new Republican plan:

    I notice that the parts of Obamacare that this plan would keep are the parts that benefit affluent people. After all, if you’re part of the top 10% but not the top 1%, you (or your kids) could still have a pre-existing condition that insurers might want to deny, or a devastating illness or injury that costs more to cover than some annual or lifetime insurance cap. And since you’re not in that 1%, that could bankrupt you without ACA-type protections. So of course those parts are retained, and so what if poor people get screwed over…

    The 1% are the very few who could self-fund a serious medical crisis. (And seriously, if that’s the case, a $695 tax penalty for not having insurance under the ACA is nothing).

    But even upper income people who are not in the 1% would quickly blow through their funds when dealing with something like cancer.

    Like or Dislike: Thumb up 8 Thumb down 0

  19. @Tyrell: Well, moguls are fine regardless of public policy.

    But how is that a helpful observation? We cannot base general public policy off of the fact the mega-rich don’t need insurance.

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  20. michael reynolds says:

    @Tyrell:

    The percentage of people who could self-pay in the worst sort of circumstances is probably less than half a percent. Effectively no one. So that’s just a fantasy. Because if you end up burning through your money to save your kid or your wife or yourself you end up back on the taxpayer.

    Which is one of the many reasons we needed just about every part of Obamacare. And why the GOP is so morally repugnant. And why they are enabled by people like you who don’t know enough to know how little you understand.

    These are people who have no problem giving me an irrelevant tax cut and letting you die. That’s your team. Those are the people you support. My sense of you as a human being, Tyrell, is that you are not enough of an aszhole to be a Republican.

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  21. Kari Q says:

    @Tyrell:

    It’s foolish to exempt those individuals from taxation for multiple reasons, but the simplest ones are practical: everyone supports higher taxes for billionaires (except some billionaires) so it’s politically popilar; and they never even notice the additional taxes. Their lives change not at all because of the extra taxes they pay to help provide health care to those who can’t afford it.

    Like or Dislike: Thumb up 2 Thumb down 0

  22. Kari Q says:

    @Steven L. Taylor:

    Fortunately, Republicans have addressed the critical issue of lottery winners receiving subsidized health care.

    Like or Dislike: Thumb up 5 Thumb down 0

  23. Terrye Cravens says:

    They had years to come up with something and this is the best the GOP could do. Ridiculous.

    Like or Dislike: Thumb up 4 Thumb down 0

  24. Gustopher says:

    Paul Ryan really has crafted an impressive plan — is there anyone who has any knowledge of health care in this country who is in favor of it?

    Is there some tiny group of Softer Social Darwinists somewhere saying “what we need to do is let the poor die, because they are lazy otherwise they would be rich. But the people who aren’t quite rich enough, but are almost there, well, let’s give them a small boost… I mean, we’re Social Darwinists, but were not heartless…”?

    It retains the framework of Obamacare, but hangs such meager pickings on this framework that it won’t be effective, and rebrands it as the Great Republican Solution. Who wants that?

    Like or Dislike: Thumb up 2 Thumb down 0

  25. An Interested Party says:

    I imagine that Steve Bannon is sitting somewhere with his slovenly unshaven face, grinning from ear to ear now that his mortal enemy, Paul Ryan, has been completely exposed as a total fraud…and to think that at one point this government moocher was being touted as the great Republican wunderkind…ack, McCarthy, Walker, Ryan…what is it with Wisconsin Republican slimeballs…

    Like or Dislike: Thumb up 5 Thumb down 0

  26. DrDaveT says:

    @Slugger:

    Is it possible that not having comprehensive coverage of the whole population is actually more expensive?

    Of course.

    Public health is infrastructure. We have a Public Health Service because, once upon a time, rich people were dying left and right of tuberculosis and they finally — it took a long time — realized that this was because poor people lived in crappy conditions that bred tuberculosis. Forking over a bit of cash to improve the lot of the poor magically made rich people healthier. Who could have guessed?

    The idea that everyone should be able to use highways for free, or go to school for free, but that healthcare should be a la carte for those who can afford it is an unfortunate accident of history and almost too stupid for words. Which makes it a core Republican value these days.

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  27. An Interested Party says:

    Great editorial about how this shitty bill exposes the values of Democrats and Republicans…

    Like or Dislike: Thumb up 3 Thumb down 0

  28. JohnMcC says:

    @Tyrell: “What is needed is a basic, free, no frills plan…with options available….” Wow, sounds almost exactly like my Medicare (which is not free but wonderfully cheap) and the supplemental market which is vigorous and competitive and also wonderfully cheap.

    Tyrell! You’re a genius! Medicare for everyone! What a concept!

    Like or Dislike: Thumb up 13 Thumb down 0

  29. Scott O says:

    Martha Brawley of Monroe, N.C., said she voted for President Trump in the hope he could make insurance more affordable. But on Tuesday, Ms. Brawley, 55, was feeling increasingly nervous based on what she had heard about the new plan from television news reports

    Don’t worry Martha Brawley of Monroe. N.C. It says right in the bill that “This Act may be cited as the ‘‘World’s Greatest Healthcare Plan of 2017’’. ”

    Just what you wanted.

    Like or Dislike: Thumb up 8 Thumb down 0

  30. David M says:

    @Scott O:

    said she voted for President Trump in the hope he could make insurance more affordable

    I will never understand this, it makes even less sense than MAGA.

    Like or Dislike: Thumb up 6 Thumb down 0

  31. SC_Birdflyte says:

    @Slugger: Exactly. That’s the basic idea behind any system of insurance: price it to cover everyone and everyone pays.

    Like or Dislike: Thumb up 1 Thumb down 0

  32. KM says:

    @David M:

    But, but, but, he’s the Dealmaker!! He’ll go in and boss them around and score us a sweet deal where bloodwork is always $5 and the doctor won’t cost more then $25 no matter what’s wrong with me!! He wrote the Art of the Deal and is a businessman so of course he’s gonna lower the costs evil Obama imposed on me!

    In all seriousness, though, that’s really how some people think. That because Trump has owned a business, he’s somehow intrinsically better at this kind of thing then a politician. “Common sense” will kick in and a “real person” would do a better job. Nevermind the man’s never payed a copay in his life let alone full medical prices, has never seen an EOB, has never argued over a charge and probably has concierge doctors on call, he’s a businessman so naturally he’ll get the job done because he has “real world experience”.

    Like or Dislike: Thumb up 2 Thumb down 0

  33. Just 'nutha ig'nint cracker says:

    @DrDaveT:

    “How many people are you willing to kill in order to pay $X lower taxes?”.

    I can’t speak for you, but, alas, I live in a country where I personally know people who would answer that question. The are called “Republicans.”

    Like or Dislike: Thumb up 8 Thumb down 0

  34. Just 'nutha ig'nint cracker says:

    @Monala:

    The 1% are the very few who could self-fund a serious medical crisis. (And seriously, if that’s the case, a $695 tax penalty for not having insurance under the ACA is nothing).

    On the other hand, why would people at that level of wealth expose themselves to the financial risk of a serious medical crisis when medical insurance would be relatively cheap–compared to the cost of, say, cancer (which could easily outstrip even 20 or 30 years of premium payments)?

    Like or Dislike: Thumb up 3 Thumb down 0

  35. Just 'nutha ig'nint cracker says:

    @DrDaveT: Fair enough, but the real trigger was that tuberculosis was communicable. If they had been able to figure our a way to effectively quarantine the poor without the public health system doing it…

    Like or Dislike: Thumb up 3 Thumb down 0

  36. Pch101 says:

    Republicans think that the solution to everything involves tax cuts, tax credits and what they perceive to be market competition:

    -This plan reduces taxes for the affluent. Check.
    -This plan is centered around the use of tax credits, the magic elixir for all Republican problems. Check.
    -This plan involves giving money to large corporations. Check.

    I can understand why sensible people who understand healthcare economics know that it’s a joke. but I’m genuinely surprised that there are so many Republicans who are so quick to criticize it.

    Like or Dislike: Thumb up 6 Thumb down 0

  37. Tyrell says:

    @JohnMcC: That has been my idea for quite a while: offer Medicare to all who want it. That would have saved the expense and troubles of the Federal Obamacare website. People could have gone to the Medicare site and signed up in minutes.
    Then they offer more plans and options: Dental, vision, orthodontics, cosmetic surgeries, low or no deductible, specialist cost same as regular doctor, gym memberships, and other. This would bring in more companies and more money. Young people would like the new options. Also, change the IRS deduction rule: make it a straight deduction, not that ridiculous percentage of income which most people can never meet.
    As it stands now, the sand is running out of the hour glass, the shot clock is counting down, and the gate is getting ready to close: The Obama Care is collapsing and some people are going to find out the hard way – literally as they are walking out of the hospital and try to settle up. All the big companies are almost gone: AETNA, HUMANA, BCBS. Just where is the money coming from ? My understanding was that tax money could not be used; it is supposed to be self funding, with all those young, working people paying for it ? Well, it seems a lot of different taxes are being used for that. See: Align America, “Obama Care funding: where it comes from
    and where it goes”. One tax is on the higher end insurance companies. Another is on medical devices. Another is on “tanning” services.
    “Obama Care is repealing itself”

    Like or Dislike: Thumb up 0 Thumb down 3

  38. @Tyrell:

    That has been my idea for quite a while: offer Medicare to all who want it.

    So, to be clear, you support the adoption of single-payer system?

    Like or Dislike: Thumb up 12 Thumb down 0

  39. pylon says:

    @Tyrell:

    That has been my idea for quite a while: offer Medicare to all who want it. That would have saved the expense and troubles of the Federal Obamacare website. People could have gone to the Medicare site and signed up in minutes.
    Then they offer more plans and options: Dental, vision, orthodontics, cosmetic surgeries, low or no deductible, specialist cost same as regular doctor, gym memberships, and other. This would bring in more companies and more money.

    So, just like Canada, eh?

    Like or Dislike: Thumb up 11 Thumb down 0

  40. @pylon: Indeed.

    Like or Dislike: Thumb up 4 Thumb down 0

  41. Tyrell says:

    @Steven L. Taylor: I don’t have a problem as long as there are options available. My plan was switched from HUMANA to UHC. The plan itself is still about the same, except now I get many more choices on gym membership, which I still have not used yet. Options special packages such as dental, vision, orthodontics, low or no deductible, and cosmetic surgery will appeal to a lot of people and bring more money in. I don’t think that people have a preference as far as the basic hospital coverage goes except for the deductibles and co-payments. The supplemental plans are where the sweets are. And right now I can afford to pay a little more for the supplement plan I chose.
    Medicare itself can seem confusing and overwhelming at first. For several months I was receiving mail every day about this or that plan b, plan c, and so on. All that mail filled up two file crates. Also lots of phone calls. I did not make it to any of the information meetings. Everyone who reaches 65 needs to make sure they sign up, or they will have to pay a lot more later on. I know one person who found that out the hard way.

    Like or Dislike: Thumb up 1 Thumb down 0

  42. DrDaveT says:

    @Just ‘nutha ig’nint cracker:

    Fair enough, but the real trigger was that tuberculosis was communicable. If they had been able to figure our a way to effectively quarantine the poor without the public health system doing it…

    Oh, absolutely. Tuberculosis was the AIDS of its day — a long-incubation communicable disease that could easily kill you. Throw in typhus and diphtheria and influenza and all of the other dangerous communicable diseases of the day, and the value of public health became obvious even to the Scrooges of the day.

    We’ve been riding those coattails ever since. Modern Americans expect to be germ-free at no cost to themselves, without having to pay for an FDA or EPA or PHS or vaccinations or mosquito-elimination campaigns or what have you. We panic at the first mention of Ebola or Dengue or Zika, but scream bloody murder at the thought of spending money to do the things that are effective in preventing their spread. Except for building walls and keeping out brown people; for that we’ll open the check book as fast as you like.

    Like or Dislike: Thumb up 7 Thumb down 0

  43. Daryl's other brother Darryl says:

    @Steven L. Taylor:

    So, to be clear, you support the adoption of single-payer system?

    Yes…at the very same time that he supports people who will never, ever, pass it.

    Like or Dislike: Thumb up 5 Thumb down 0

  44. Just 'nutha ig'nint cracker says:

    @Daryl’s other brother Darryl: Yeah… That’s one of the problems all right.

    Like or Dislike: Thumb up 1 Thumb down 0

  45. David M says:

    Seriously though, is there any part of this bill that is even an improvement over Obamacare? There has to be some GOP policy included in the bill that won’t be a complete disaster, right?

    Like or Dislike: Thumb up 2 Thumb down 0

  46. Pch101 says:

    @David M:

    Seriously though, is there any part of this bill that is even an improvement over Obamacare?

    The plan has tax credits. Republicans lovvvvvvvvvvvvve tax credits.

    Apparently, there is nothing that tax credits can’t fix. I’m surprised that they haven’t used tax credits to cure cancer, make pigs fly and bring peace to the Middle East.

    Like or Dislike: Thumb up 3 Thumb down 0

  47. Mr. Bluster says:

    @Scott O:..“This Act may be cited as the ‘‘World’s Greatest Healthcare Plan of 2017’’. ”

    What’s in a name?
    The White House doesn’t want the GOP Obamacare replacement branded ‘Trumpcare’
    How about we brand it PUDCARE!

    The Trump team, however, has pushed back on the name. White House counselor Kellyanne Conway pushed for the use of the official name instead of Trumpcare during an interview with Fox News on Wednesday.
    “I’ll call it Trumpcare if you want to, but I didn’t hear President Trump say to any of us, ‘Hey, I want my name on that,'” Conway said. “We’re happy it is the American Health Care Act. This is serious stuff. This isn’t branding according to someone’s name.”
    http://finance.yahoo.com/news/white-house-doesnt-want-gop-231823096.html

    Like or Dislike: Thumb up 1 Thumb down 0

  48. al-Alameda says:

    I’d brand it “TrumpDoesntCare”

    They’re also proposing to radically change Medicaid funding which will also very likely reduce care for millions of the neediest Americans.

    This is potentially the most radical administration in in nearly a century.

    Like or Dislike: Thumb up 0 Thumb down 0

  49. Tony W says:

    @Tyrell:

    And those who are financially able to handle medical costs personally without insurance should not have to pay the fine either

    I know exactly zero people who are financially able to handle medical costs personally without insurance.

    Perhaps Mr. Trump can, but nobody with a net worth under $10-15 million can really make that guarantee.

    Like or Dislike: Thumb up 0 Thumb down 0