[Discussion] Health Policies and ACA Reform/Repeal

The existing health thread is for discussion on how changes to current policy will/have personally affected you or those you know. This thread is for more general discussion of the subject.

There's not going to be a lifeline from Democrats before the 2018 elections, no way, no how.

Little-noticed House Republican bill would let employers demand workers’ genetic test results

A little-noticed bill moving through Congress would allow companies to require employees to undergo genetic testing or risk paying a penalty of thousands of dollars, and would let employers see that genetic and other health information.
Employers got virtually everything they wanted for their workplace wellness programs during the Obama administration. The ACA allowed them to charge employees 30 percent, and possibly 50 percent, more for health insurance if they declined to participate in the "voluntary" programs, which typically include cholesterol and other screenings; health questionnaires that ask about personal habits, including plans to get pregnant; and sometimes weight loss and smoking cessation classes. And in rules that Obama's Equal Employment Opportunity Commission issued last year, a workplace wellness program counts as "voluntary" even if workers have to pay thousands of dollars more in premiums and deductibles if they don't participate.
As long as employers make providing genetic information "voluntary," they can ask employees for it. Under the House bill, none of the protections for health and genetic information provided by GINA or the disabilities law would apply to workplace wellness programs as long as they complied with the ACA's very limited requirements for the programs. As a result, employers could demand that employees undergo genetic testing and health screenings.
If an employer has a wellness program but does not sponsor health insurance, rather than increasing insurance premiums, the employer could dock the paychecks of workers who don't participate.

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farley3k wrote:

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Sort of reminds me of Nero's death scene in Star Trek.

Yonder wrote:
Paleocon wrote:

The question is what does Bannon gain from humiliating Ryan? My guess is a lot.

There is every indication that Trump judges people almost solely based on their perceived strength. Ryan being humiliated will severely lower Trump's esteem of him (or maintain its already low state) and make Trump unlikely to listen to Ryan and that helps Bannon in the future on any and every issue where Ryan would give the President different advice or ideas.

This makes me think that when/if Congress decides to impeach the Trump Administration, I think that they will also make sure Bannon burns.

Yonder wrote:
Jolly Bill wrote:

Ryan's plan is already being attacked from both sides, which leads me to think he tried to split the difference without really understanding how to pull everyone in (a process that takes months and months, normally) and just got it out there as his one and only shot at it.

It's really hard to see how it is possible for Ryan to pass a healthcare plan now. His one and only shot was to come out with a legitimately good healthcare plan that the Democrats would vote for. The Republicans chose not to do that. Without a legitimately good plan (almost?) no Democrats will vote for it. That means that Ryan is going to need a huge majority of Republicans to vote for it, and the Republican party is, if not irreconcilably split on how to handle healthcare, is still very, very ,very split on how to handle it.

Now we're early on, so maybe they'll go back to the drawing board and come back with something that isn't a pile of murderous garbage, but... it's sort of seeming like that's not going to happen..

This is why I was talking in my post about some imminent threat to the GOP lurking in the next 1-2 months that is forcing Ryan's hand. This was a terrible attempt and I can't imagine anything that would have resulting in this becoming the bill Ryan hangs his Speakership on unless he ran out of time against a clock we're not seeing. I'm just assuming that clock is a potential Trump impeachment / investigation.

Edit: Anything that would have been progressive enough to draw Democratic votes would have lost too many Republicans to pass the bill and lost him the Speakership anyway.

I mean, he's already stuck between older voters who will drop him if they go back to double or triple their insurance rates from the last couple of years and the Kochs and Devos and such who reaaaaaaaaaaally need that couple million back for some reason (along with all the organizations/groups they're astroturfing that cost more than what they'd save, but it's really the principle of the matter, I guess).

Lexi Alexander wrote:

In 1934 Germany this was called Information for Genetic and Racial Hygiene

https://twitter.com/Lexialex/status/...

I think this might be one of the best summaries I've seen of the Republican view toward healthcare.

“The bottom line is, some insurers, hospitals, and other providers may not appreciate our decision to repeal the individual and employer mandate penalties, because that could lead to less people paying for coverage. But we refuse to force individuals and families to purchase expensive insurance they don’t want, don’t need, and cannot afford,” a spokeswoman for the House Ways and Means Committee said.

Screw over the many to give "choice" to the few. I guess that's freedom? A million people are thrilled to have healthcare, a thousand people are ticked off they had to buy it because they'll "never need it", then we'd better make sure those thousand people are happy, who cares if it wrecks things for the million happy people?

Kehama wrote:

I think this might be one of the best summaries I've seen of the Republican view toward healthcare.

“The bottom line is, some insurers, hospitals, and other providers may not appreciate our decision to repeal the individual and employer mandate penalties, because that could lead to less people paying for coverage. But we refuse to force individuals and families to purchase expensive insurance they don’t want, don’t need, and cannot afford,” a spokeswoman for the House Ways and Means Committee said.

Screw over the many to give "choice" to the few. I guess that's freedom? A million people are thrilled to have healthcare, a thousand people are ticked off they had to buy it because they'll "never need it", then we'd better make sure those thousand people are happy, who cares if it wrecks things for the million happy people?

I wouldn't say that's the view. That's the intellectual fig leaf. The view is that making some people pay for other people is wrong. This has nothing to do with freedom. It's about what they think a society should do in order to work together for each other's benefit.

We shouldn't fall for the bait of thinking this is about those thousand ticked off people, making us look like the anti-freedom side (which, sadly, our intellectual fig leaves often do) and buying into their ideas about the happy and the ticked off.

For us, this is about the people with the capacity to pay who are getting the huge tax cut that is the other part of this new health (no)plan. If some happy people have to pay more but some ticked off people have to pay less because we build this program around the people with the capacity to pay being the ones who actually pay whether that's through premiums or taxes or whatever, our concern is with building a health care insurance law that works in accordance with our ideas that it's capacity to pay that is the guiding issue, full stop.

White House analysis of Obamacare repeal sees even deeper insurance losses than CBO

The White House's own internal analysis of the GOP plan to repeal and replace Obamacare show even steeper coverage losses than the projections by the Congressional Budget Office, according to a document viewed by POLITICO on Monday.

The executive branch analysis forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimate — a finding that undermines White House efforts to discredit the forecasts from the nonpartisan CBO.

The analysis found that under the American Health Care Act the coverage losses would include 17 million for Medicaid, six million in the individual market and three million in employer-based plans.

A total of 54 million individuals would be uninsured in 2026 under the GOP plan, according to the White House analysis. That’s nearly double the number projected under current law.

White House spokesmen did not respond to requests for comment Monday evening.

Kehama wrote:

I think this might be one of the best summaries I've seen of the Republican view toward healthcare.

“The bottom line is, some insurers, hospitals, and other providers may not appreciate our decision to repeal the individual and employer mandate penalties, because that could lead to less people paying for coverage. But we refuse to force individuals and families to purchase expensive insurance they don’t want, don’t need, and cannot afford,” a spokeswoman for the House Ways and Means Committee said.

Screw over the many to give "choice" to the few. I guess that's freedom? A million people are thrilled to have healthcare, a thousand people are ticked off they had to buy it because they'll "never need it", then we'd better make sure those thousand people are happy, who cares if it wrecks things for the million happy people?

I think the problem for the summary is that, cannily, Obama and the other Democrat legislators who crafted this bill, with the help of Republicans (whoever is coming to the comment box right now, reminder, that actually happened before they all walked away at the last second and the bill was passed without them)... really set up the Republicans to fail if they repealed this.

By drawing the individual mandate from the Heritage Foundation's rather conservative plans, what else could they really do but strip it and claim "freedom"?

I mean, the individual mandate is all about a requirement that an individual's purchasing or not of health insurance doesn't affect YOUR costs. By requiring everyone able to get coverage, they cannot drive up the price of YOUR treatment at a hospital when they stiff the bill (which would have (and will again!) caused the hospital to raise the price of your procedure (along with just about everyone else's)).

It is, plain and simple, a requirement that you cannot harm me. Literally the only thing they (ideally) think government should be about other than some war-time stuff as needed.

But, having been included in Obamacare, it's liberal, has to go.

Except that's the linchpin, without it, you can't pay for literally the entire rest of the bill which is far too popular in practice (if not in name) to entirely kill (not that that's stopping Ryan, who seems to have decided his time with "the poors" that made him realize how hard it can be for those just making ends meet seems to have worn off with some fresh cash from his corporate overlords).

Either way though, it's now a perfect trap for them to just walk right into, and even now, as more and more information is coming out about how this will not only screw over MILLIONS of people in this country, but it'll cost the government more than just leaving it be would have... so they have to deal with deficits rising, the national debt rising, all under their watch.

Demosthenes wrote:

I think the problem for the summary is that, cannily, Obama and the other Democrat legislators who crafted this bill, with the help of Republicans (whoever is coming to the comment box right now, reminder, that actually happened before they all walked away at the last second and the bill was passed without them)... really set up the Republicans to fail if they repealed this.

I think it was set up this way so Obama wouldn't have to go back on a campaign promise. Or go back on the lesser of two campaign promises--Obama actually knocked Hillary during the campaign over the Individual Mandate.

By drawing the individual mandate from the Heritage Foundation's rather conservative plans, what else could they really do but strip it and claim "freedom"?

I mean, the individual mandate is all about a requirement that an individual's purchasing or not of health insurance doesn't affect YOUR costs. By requiring everyone able to get coverage, they cannot drive up the price of YOUR treatment at a hospital when they stiff the bill (which would have (and will again!) caused the hospital to raise the price of your procedure (along with just about everyone else's)).

It is, plain and simple, a requirement that you cannot harm me. Literally the only thing they (ideally) think government should be about other than some war-time stuff as needed.

Except it doesn't. Number one, if a person is so judgement proof they don't fear walking away from an emergency room bill, how could they afford to purchase insurance without the subsidies anyway? With health insurance they don't drive up the price of your treatment, but they do drive up the cost of your taxes that then go to giving them subsidies--either way money is being moved around from somebody in the economy to someone else. It's not a free lunch, but it is a less chaotic system. Even people who could pay for an emergency room bill but don't can still opt for the tax penalty over the insurance premium.

But, having been included in Obamacare, it's liberal, has to go.

Except that's the linchpin, without it, you can't pay for literally the entire rest of the bill which is far too popular in practice (if not in name) to entirely kill (not that that's stopping Ryan, who seems to have decided his time with "the poors" that made him realize how hard it can be for those just making ends meet seems to have worn off with some fresh cash from his corporate overlords).

Obamacare included lots of non-Individual Mandate taxes. I'd really like to see just how important the Individual Mandate is to Obamacare, including to the Medicaid expansion. I can't help but think the Individual Mandate is not nearly as essential as it's continually made out to be. It's the huge tax cut Ryan is pushing that will be fatal (literally). The one I think they're trying to offset with stuff like gutting Medicaid and the subsidies that make insurance affordable for so many.

Either way though, it's now a perfect trap for them to just walk right into, and even now, as more and more information is coming out about how this will not only screw over MILLIONS of people in this country, but it'll cost the government more than just leaving it be would have... so they have to deal with deficits rising, the national debt rising, all under their watch.

Yeah, they promised some great plan, and instead of the exchanges, it'll be their high risk pools that will collapse:

America’s experience with state high-risk pools has been almost universally grim. Before the ACA’s enactment, 35 states had such arrangements. They were chronically underfunded and for enrollees they were expensive, with deductibles as high as $10,000 and premiums as high as double those for healthy individuals. Every state excluded coverage for as long as a year for the very conditions that made their users uninsurable on the open market. They typically imposed benefit limits too low to pay for treatment, time limits for enrollees, and waiting lists.

Either Paul Ryan is full of it or he has no idea what he's talking about

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Ryan and other Republicans say they’re committed. Their plan includes a provision that if you let your coverage lapse for a couple of months, you’ll face a one-year 30% rate hike when you buy insurance again.

Jonathan Skinner, an economics professor at Dartmouth College, called this “exactly the wrong way to structure something that you want people to buy.” By effectively penalizing people for returning to the risk pool, he said, the Republican plan creates an incentive for healthy people not to buy insurance.

“It’s like a perfect storm of disincentives,” Skinner said

Any idea what the legality would be of all of the blue States pulling together to make their own healthcare (so that the poorer blue states get a leg up)?

It seems like the sort of situation that the Constitution or subsequent case law may have vetoed as being harmful to the Union.

Yonder wrote:

Any idea what the legality would be of all of the blue States pulling together to make their own healthcare (so that the poorer blue states get a leg up)?

It seems like the sort of situation that the Constitution or subsequent case law may have vetoed as being harmful to the Union.

Massachusetts did their own version of the ACA before the ACA. I wonder if this will serve as a blueprint for other states to do the same.

Grassley On Obamacare Repeal: We Don’t Want To Miss This Chance

Sen. Chuck Grassley says the replacement bill for the Affordable Care Act by House Republicans will have to be rewritten. Yesterday the non-partisan Congressional Budget Office released a report that found some 24 million people who currently have health insurance would not be covered by 2026 under the GOP proposal.

"The House Budget Committee's going to have to go back to the drawing board and come up with something that’s going to be more realistic as far as I can tell," says Iowa's senior senator. "Maybe they can get the votes to go ahead, but in the United States Senate, if they don't do something in the House, it's going to be difficult to get that bill through the Senate."

Every time I hear politicians argue that "the decision should be left to the states" I quake with fear because I live in Alabama. The only public assistance my politicians will okay are tax incentives to auto manufacturers. If it has to do with some sort of social aid for the poor, they want to just leave that up non-profits like the Jimmy Hale Mission or churches. If I ever lose my job I'm pretty much screwed. We opted out of the medicaid expansion, state assistance programs have been cut to the bone, and the state overrode local attempts to raise the minimum wage in cities.

I really wonder how Republicans can keep claiming that this new proposed bill is for the better? I can't help but think this is like going back to pre-seat belt law days and having people say "At least all these people dying in car crashes aren't forced to wear seat belts! They have freedom!"

Kehama wrote:

I think this might be one of the best summaries I've seen of the Republican view toward healthcare.

“The government should have no role at all in health care and private markets should sort it all out, even if it means lots of people die and only the rich will have access to quality coverage."

There. I FTFY.

Kehama wrote:

I really wonder how Republicans can keep claiming that this new proposed bill is for the better?

Because this is the new Republican party. Justifying a stupid position with mental gymnastics and tortured logic has given way to simply ignoring reality and saying whatever you want. This is Trump's gift to the party: he has taught them that the party faithful don't care about evidence or proof if you say something confidently enough.

I was going to complain that this was overly harsh but it really isn't.

It also has to do with the fact that anything Republicans do is good and everything Democrats do is bad. It doesn't even matter if it is the same thing! It is partisanship so embedded I think they don't even see it.

Breitbart News Leads The Charge Against GOP Health Care Bill

CNN anchor Chris Cuomo said Tuesday morning that newly leaked audio of House Speaker Paul Ryan could damage congressional Republicans’ ability to pass a health care bill “more than anything that’s happened thus far.”

On the recording from a private conference call in October, Ryan is heard telling House Republicans that he couldn’t defend then-GOP presidential nominee Donald Trump at that moment or “in the future.” His comments came amid a scandal over the now-president bragging on tape about groping women.

The never-before-heard recording didn’t come to light through a liberal or mainstream news site. Rather, the right-wing, nationalist Breitbart News published it Monday night.

That Breitbart would drop this 5-month-old recording now ― as Ryan and the Trump administration make their case for a health care bill to repeal and “replace” Obamacare ― may appear surprising. After all, the site vigorously supported Trump’s candidacy and its former chairman, Steve Bannon, is chief strategist in the White House.

But Breitbart News emerged as a force in Washington through its sustained attacks on Republican establishment.

Quintin_Stone wrote:
Kehama wrote:

I really wonder how Republicans can keep claiming that this new proposed bill is for the better?

Because this is the new Republican party. Justifying a stupid position with mental gymnastics and tortured logic has given way to simply ignoring reality and saying whatever you want. This is Trump's gift to the party: he has taught them that the party faithful don't care about evidence or proof if you say something confidently enough.

I think in order to truly understand the Republican thinking around health care, one has to start from the position of market fundamentalism. That is, you have to reject any possible social or budget policy direction that doesn't at its core start from the position that the market will always find the most beneficial outcome and that nothing else will ever arrive at anything other than tragic and catastrophic failure.

To the market fundamentalist, the market will magically arrive at an equilibrium point in which medicine is available, affordable, and rapidly innovative once you remove all of the "impediments" to reaching that equilibrium. And according to them, these "impediments" include pubic funding of any kind that necessarily create "market distortions". If you pay for a child's rare cancer treatment or polio immunizations, you inflate the price of medical services such that they become unaffordable to get you femur set after a car accident.

As such, the ultimate goal is to pull all the stops, weather the "adjustment period" in which folks necessarily die to bring the market to "equilibrium", and enjoy the utopia of the perfection the "market" will spawn.

I honestly wish I was exaggerating.

I am not.

Don't forget the idea that companies are only beholden to shareholders, and their only obligation is to raise the stock price, courtesy of another Republican economist, Milton Friedman. His paper in the early 70's moved the focus of business from a balancing of worker's needs (including retirement and health care and employment stability) with quality products and profits over decades, to one of continual share growth at the expense of all else.

That definitely contributed to the rise of today's Market Maoists.

Woman dies from seizure 6 months after government cut Medicaid benefits and sent her back to work

Amy Schnelle, a former factory worker, received disability benefits for several years and had been seizure-free since 2015 thanks to powerful drugs paid for by her Medicaid coverage, reported WATE-TV.

But the Social Security Administration sent the 31-year-old Schnelle a notice in September that she was healthy enough to go back to work, but she was unable to afford the $1,200 monthly costs for the drugs she needed to avoid life-threatening seizures.

But she *chose* not to afford those medicines. She could have put all her iPhone money into a Health Savings Account, but chose to die instead. When will people learn that being irresponsible has consequences?

(Disclaimer: Sarcasm)

farley3k wrote:

Breitbart News Leads The Charge Against GOP Health Care Bill

CNN anchor Chris Cuomo said Tuesday morning that newly leaked audio of House Speaker Paul Ryan could damage congressional Republicans’ ability to pass a health care bill “more than anything that’s happened thus far.”

On the recording from a private conference call in October, Ryan is heard telling House Republicans that he couldn’t defend then-GOP presidential nominee Donald Trump at that moment or “in the future.” His comments came amid a scandal over the now-president bragging on tape about groping women.

The never-before-heard recording didn’t come to light through a liberal or mainstream news site. Rather, the right-wing, nationalist Breitbart News published it Monday night.

That Breitbart would drop this 5-month-old recording now ― as Ryan and the Trump administration make their case for a health care bill to repeal and “replace” Obamacare ― may appear surprising. After all, the site vigorously supported Trump’s candidacy and its former chairman, Steve Bannon, is chief strategist in the White House.

But Breitbart News emerged as a force in Washington through its sustained attacks on Republican establishment.

Very confused why an audio file that suggests Ryan had a temporary lapse of faith in the Republican party matters so much NOW? Like, yeah, 5 months ago, Ryan wasn't sure if he could defend or support Trump.

And since then he's done sh*t to oppose him.

Like he's suggested a couple of times, well, that's not right... but then continues working with him no problem, doesn't even actually call Trump out as unacceptable or anything, just says the situation is unfortunate and that's it.

Like, are they looking for 100% always devoted to Trump purity at this point?

God damn, even in victory, Republicans manage to turn Sith on each other and start eating each other alive for a liiiiiiiiittle more personal power.

Fragile honor among thieves...

When you have a Democrat in power the Republicans are very, very good at presenting a solid wall of opposition but once they gained power all those factions fell to attacking each other. You can no longer win just by not doing anything so now they have to pursue a vision beyond "Anything but what Obama wants" so now all the in-fighting comes out as they try to figure out what they actually want.

In writing that, the Democrats are also really, really good at fighting each other over what the party should be but not quite as good at presenting a completely united front. Again, just one of the problems with a 2 party system. We're trying to cram 20 different visions for this country into just two buckets.

Kehama wrote:

We're trying to cram 20 different visions for this country into just two buckets.

The real issue is that the Republican bucket pretty much only contains the visions of white Christians, most rich people, and most businesses. The Democratic bucket holds everyone else's.

Which is also why the Democratic party has a lot harder time throwing up a solid wall of opposition or having everyone repeat the same key messages or talking points like Republicans do.

OG_slinger wrote:
Kehama wrote:

We're trying to cram 20 different visions for this country into just two buckets.

The real issue is that the Republican bucket pretty much only contains the visions of white Christians, most rich people, and most businesses. The Democratic bucket holds everyone else's.

Which is also why the Democratic party has a lot harder time throwing up a solid wall of opposition or having everyone repeat the same key messages or talking points like Republicans do.

It honestly wouldn't be that big of a deal if "Moderate Republicans" that left the party actually left the f*cking party instead of "but her email-ing" us to catastrophe.