[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.

Last week Rand Paul was on Morning Joe and had this to say about what he wants to replace the ACA:

Rand Paul wrote:

What we really need is to get insurance de-linked from employment and allow me, if I'm an individual employer, a business of one, you need to let me pool together easily with large groups so I’m a pool of thousands if not millions of people so I don't get this problem of jacking up my rates when I get sick

I'm sure you'll all be shocked that the fine journalist minds on Morning Joe didn't respond with "healthcare exchanges are a huge point of the Affordable Care Act, can you elaborate on how your exchanges would be different, and why those differences are extensive enough to warrant a complete appeal and rewrite of the system, rather than more minor reforms?"

Yonder wrote:

Last week Rand Paul was on Morning Joe and had this to say about what he wants to replace the ACA:

Rand Paul wrote:

What we really need is to get insurance de-linked from employment and allow me, if I'm an individual employer, a business of one, you need to let me pool together easily with large groups so I’m a pool of thousands if not millions of people so I don't get this problem of jacking up my rates when I get sick

I'm sure you'll all be shocked that the fine journalist minds on Morning Joe didn't respond with "healthcare exchanges are a huge point of the Affordable Care Act, can you elaborate on how your exchanges would be different, and why those differences are extensive enough to warrant a complete appeal and rewrite of the system, rather than more minor reforms?"

So, Rand, individuals pool together with millions of others.....say....320 million others?

Hello single payer!

So... he wants a union for healthcare users?

I forgot to link to the video.

In his defense he does note that removing the mandate without removing "the feel-good parts" is a recipe for disaster. He also doesn't want to repeal the ACA without replacing it with something else simultaneously. Those are two points, at least, that it seems unclear whether most GOP understands.

Like I said, Morning Joe is a pile of steaming garbage which didn't actually clarify for us what Rand Paul means, but it seems like he wants the ACA marketplace, but doesn't like the lifetime maximums, loss of pre-existing conditions, reproductive health care, etc. Maybe that's not true, but with him describing the market place and seeming dismissive with his term "the feel-good parts" that's what it seems like to me.

Which, to be fair, would still be better than pre-ACA, even if it was worse than ACA. In the next four years "we unraveled less than 8 years of progress" is actually not seeming too horrible.

Part of the problem is that states were allowed to opt-out, which meant that the available pools were smaller than economically feasible in the long run in some cases.

Demosthenes wrote:

So... he wants a union for healthcare users?

Probably. My understanding of libertarianism is they fully support unions just like what you are describing - provided they are not compulsory.

One of the things that I have heard as a Republican ACA reform desire is to transition/supplement the State Exchange options with National Exchange options, where an insurance plan registered in, say, Kansas, could be chosen by anyone in any State.

I know that the the Democratic response to this is that this is an attempt to let all of the insurance plans originate in the bottom rung state that provides the least quality, but if this was combined with the ability for the different States to still apply those restrictions to their Residents (so maybe a CA worker wouldn't be able to choose some of the worst options in the National Exchange, but they could still choose the better ones) wouldn't that resolve most of those concerns?

(And I'm not predicting that that will be what the Republicans propose, I'm asking if there are other criticisms/concerns of the "National Exchange" idea that would remain even with that modification).

I mean, if you allow it over state lines, doesn't it become inter-state business, at which point there should be a *gasp* Federal regulation system instead of 50 state ones?

Yonder wrote:

One of the things that I have heard as a Republican ACA reform desire is to transition/supplement the State Exchange options with National Exchange options, where an insurance plan registered in, say, Kansas, could be chosen by anyone in any State.

I know that the the Democratic response to this is that this is an attempt to let all of the insurance plans originate in the bottom rung state that provides the least quality, but if this was combined with the ability for the different States to still apply those restrictions to their Residents (so maybe a CA worker wouldn't be able to choose some of the worst options in the National Exchange, but they could still choose the better ones) wouldn't that resolve most of those concerns?

(And I'm not predicting that that will be what the Republicans propose, I'm asking if there are other criticisms/concerns of the "National Exchange" idea that would remain even with that modification).

Healthcare pricing is opaque, at best. Allowing states to set their own minimum requirements for healthcare insurance coverage would simply add to that problem.

It would take us back to the pre-ACA days where consumers had to compare apples to oranges and try to pick an insurance plan that offered what they thought was decent coverage for the cost. And we know how that ended: millions of people buying absolutely sh*t insurance because it was cheap and marginally better than having no insurance.

We're one country. We should have a coherent and consistent national standard for healthcare insurance requirements.

The only thing that gives me a bit of comfort is that the CBO has already published rules saying that it won't count people who buy crappy insurance plans as officially being covered. It will use the ACA as the standard so that Republicans can't claim that people kept their insurance when what actually happened was that they just bought a cheap plan with little coverage and few benefits.

Wouldn't the other issue be that if I got a plan from a state not near me that all the health care providers I would see are out of network, making any coverage that much worse (both in terms of my out of pocket and no negotiated fees between providers and my insurance administrator)?

OGSlinger wrote:

We're one country. We should have a coherent and consistent national standard for healthcare insurance requirements.

The only thing that gives me a bit of comfort is that the CBO has already published rules saying that it won't count people who buy crappy insurance plans as officially being covered. It will use the ACA as the standard so that Republicans can't claim that people kept their insurance when what actually happened was that they just bought a cheap plan with little coverage and few benefits.

If the ACA standard is sufficient then why was there Democrat pushback to letting the Exchanges reach across States?

Garrcia wrote:

Wouldn't the other issue be that if I got a plan from a state not near me that all the health care providers I would see are out of network, making any coverage that much worse (both in terms of my out of pocket and no negotiated fees between providers and my insurance administrator)?

The larger health insurance companies are nationwide though... aren't they? Do any US people here not have Aetna or Blue Cross in their area?

Vaccine skeptic Robert Kennedy Jr. says Trump asked him to lead commission on ‘vaccine safety’

The stunning move would contradict established science, medicine and the government’s position on the issue. It comes after Trump — who has long been critical of vaccines — met at Trump Tower with Kennedy, who has spearheaded efforts to roll back child vaccination laws.

We're so f*cked on so many levels.

Yonder wrote:
Garrcia wrote:

Wouldn't the other issue be that if I got a plan from a state not near me that all the health care providers I would see are out of network, making any coverage that much worse (both in terms of my out of pocket and no negotiated fees between providers and my insurance administrator)?

The larger health insurance companies are nationwide though... aren't they? Do any US people here not have Aetna or Blue Cross in their area?

The issue there is that your in-network options tend to be limited to larger chain practices with all the homegrown independent practices being out-of-network.

Yonder wrote:

If the ACA standard is sufficient then why was there Democrat pushback to letting the Exchanges reach across States?

Because insurance companies are largely regulated by state agencies and selling an insurance plan from one state to a consumer in another state means that the consumer's state regulatory agency would have to then allocate resources to provide oversight of other state's insurance company, which would lead to clashes and confusion between the two regulatory bodies. And none of that would protect the consumer.

Also, the ACA lets insurance companies sell across state lines. Doing so is so complex that no insurance companies have done so.

Under the ACA, companies are allowed to sell across state lines if there is an agreement between the two states. The plans must still meet coverage requirements of the act, which also spells out licensing requirements and how disputes would be addressed.

No state has yet taken advantage of this option and no major insurers have asked for it.

Blumberg said it would be difficult for an insurance company to jump in to another area and establish provider networks, make negotiations and set proper prices without existing consumer data.

Insurance regulators also generally oppose the concept because it would lead to questions over regulatory authority. State regulators don't have the resources to watch other states. A briefing from the National Association of Insurance Commissioners states that allowing insurance to be sold across state lines would make insurers less accountable and prevent regulators from assisting consumers in their states.

Antos said that while reducing regulation is a general conservative principle, this idea is not a good example.

“I have a hard time defending this particular point because I think, in the end, what really drives the cost of healthcare is the cost of the services and the bargaining power of the insurance companies,” he said.

Yonder, an interview I heard today with Sen. Ron Johnson on "Here and Now" about the ACA repeal showed that Republicans strongly want to eradicate the national exchanges, because the ACA has "broken" them, and put back a system of state-based exchanges. I don't see that they want a national exchange.

Yonder wrote:

If the ACA standard is sufficient then why was there Democrat pushback to letting the Exchanges reach across States?

I'm honestly not sure what you mean by this, or at what point in the process it happened. Can you give a cite for me? I know a lot of stuff went into the ACA because Democrats worked for a year to get Republicans on board; other stuff went in because Health Care providers got in and said "don't screw us!"; and some price controls were dropped in exchange for pharma support. So perhaps it had less to do with standard party politics and more to do with Republican/special interest influence? There's often a give-and-take in these things that puts one side in odd positions when viewed out of context. (For example, Sen. Johnson strongly opined that Republicans wanted to *fix* Obamacare, not eradicate it. My thought was, if that's what they wanted to do, they could have improved it periodically as the Act intended starting six years ago! But that's where we are today...).

I am referring to the plan to "sell insurance across State lines" which was mentioned by Trump several times prior to the election, and has been a GOP policy desire for some time according to this New York Times article.

The pure idea doesn't involved the ACA, because it's a Republican idea and thus requires the ACA is burned down to the ground, but I would imagine it could be implemented as a "National Exchange" sort of thing, either in a reformed ACA if the Republicans don't destroy it because they can't come up with a replacement (and that actually stops them) so they decide to "completely remake and repair it" or some new TrumpCare system that is pretty similar to the ACA because the name is 90% of what America doesn't like about it.

Yonder wrote:

The larger health insurance companies are nationwide though... aren't they? Do any US people here not have Aetna or Blue Cross in their area?

Blue Cross isn't a great example. They are an association of many different companies. Aetna, UnitedHealthCare, Cigna, and others are national. As you stated other than a race to the state with the bottom rung requirements and regulation I don't see how selling cross state lines would offer much benefit to the insurance companies and even less benefit to consumers. I'm not even sure what the in-network expectations would be if you live in Texas and buy an Ohio based plan - would be you basically be permanently out of network?

I work for Aetna and this is my personal opinion.

Tanglebones wrote:

Vaccine skeptic Robert Kennedy Jr. says Trump asked him to lead commission on ‘vaccine safety’

The stunning move would contradict established science, medicine and the government’s position on the issue. It comes after Trump — who has long been critical of vaccines — met at Trump Tower with Kennedy, who has spearheaded efforts to roll back child vaccination laws.

We're so f*cked on so many levels.

Yeah, this is beyond distressing.

Last week the House voted on a package of rules governing the 115th Congress.

Buried in the rules was a passage that bars the nonpartisan Congressional Budget Office from analyzing whether any bill, joint resolution or amendment repealing Obamacare would increase federal spending over the next decade.

Part of the challenge lies in the potential cost of repeal. Estimates vary wildly on how much an ObamaCare repeal would add to the deficit. It hinges on who you talk to and what metric they use. Various figures range from $350 billion to $1 trillion to $9 trillion over a longer period.

But one thing is clear: Republicans already prepped a provision to ignore internal congressional budgetary rules if the repeal is successful and explodes the federal deficit.

Efforts to defang the House’s quasi-official ethics watchdog office scored most of the attention early this week as the GOP advanced a “rules” package to govern the body during this Congress. But Republicans tucked a provision into the plan which bars the Congressional Budget Office (CBO) from counting a dramatic spike in deficit spending spurred by an ObamaCare repeal. Language in the resolution bars the CBO from tallying the cost of any ObamaCare repeal bill that bloats deficit spending by more than $5 billion over the next decade and $20 billion over the next four decades.

So they are systematically dismantling any measure of accountability. See my earlier comment about not even pretending to be the good guys anymore.

Wait; they can't count things more than $5b? How strange that this thing they started looking at is actually three things that cost $4.5b each!

TheHarpoMarxist wrote:
Tanglebones wrote:

Vaccine skeptic Robert Kennedy Jr. says Trump asked him to lead commission on ‘vaccine safety’

The stunning move would contradict established science, medicine and the government’s position on the issue. It comes after Trump — who has long been critical of vaccines — met at Trump Tower with Kennedy, who has spearheaded efforts to roll back child vaccination laws.

We're so f*cked on so many levels.

Yeah, this is beyond distressing.

Make Smallpox/Polio/Et Al Great Again!

Spoiler:

We're all going to die!

Yonder, I think the problem Dems have with a national, non-Federal (private) marketplace is that it would move the states towards greater deregulation of insurance policies, because companies will base in the low-regulation states to reduce costs and liabilities, and they will lobby other states to match those regimes so as to make it easier to cross state lines. Basically, it comes down to how much you trust your insurer. If you think that they will reduce your costs and increase your services because you pulled the law off their back, then you're good with the GOP plan. If, on the other hand, you are an *actual* capitalist and keep thinking "all the market will bear" is more likely, then you're going to oppose it.

As usual, the "states rights" argument is used as a means to deregulate a market.

Senate votes at 1:30 AM to begin repeal process. Amendments to protect things like pre-existing condition protections are rejected. No plan to replace any provisions exists.

Tanglebones wrote:

Senate votes at 1:30 AM to begin repeal process. Amendments to protect things like pre-existing condition protections are rejected. No plan to replace any provisions exists.

Nothing says confidence in the popularity of your actions like doing it when most of the country is asleep.

Starting to think the "leak" was another cleverly timed bit of bullsh*t that failed on its timing and came out a day early.

This is the "burn the bridges" preparation of the battlefield. Republicans know that the only thing that people like less than Obamacare is losing any of the healthcare they *have* got. That means that there is a natural groundswell, already seen in polls, that works against tearing the ACA to pieces, because every Republican alternative that's been mooted has offered less benefits for most people. That in turn means that if they decide to take months or years to work on a replacement, with it being constantly compared to the ACA, it will be easy for Dems to argue that they should just work together to *fix* it, and peel off Senators and Reps to support that. The more the changes are in the press, the less people will like them.

So they are burning that bridge by asserting that they will simply tear it all down and deal with the results later. This has several effects. One, it removes the possibility for wavering Republicans to work with Democrats, because Democrats have come out fully against the "kill now, replace at leisure" approach. It frames the issue as "us vs. them" again, which makes the Republicans close ranks. Secondly, it puts the blame on Dems if they "obstruct" even obviously worse plans. And because of that, it increases the chances that some Dems will decide they are better off working for *any* replacement, even one that means a step backwards. Lastly, it signals their intent to fight to the last ditch, because they have nothing left to lose after eliminating the compromise-and-fix option.

I guess things could work out differently, but this midnight vote is McConnells attempt to prepare the battlefield for what's coming. It signals that they *know* that they can't offer even the benefits of the current ACA, much less the promised improvements, so they are preparing to put Democrats in the line of fire for the substandard replacement they eventually come up with. Early days, but that's how it is looking right now.

Demosthenes wrote:
Tanglebones wrote:

Senate votes at 1:30 AM to begin repeal process. Amendments to protect things like pre-existing condition protections are rejected. No plan to replace any provisions exists.

Nothing says confidence in the popularity of your actions like doing it when most of the country is asleep.

Starting to think the "leak" was another cleverly timed bit of bullsh*t that failed on its timing and came out a day early.

I've wondered the same thing about that leak.

The late time for that vote I think was more the 'fault' of the Democrats and their push of this particular vote-a-rama

Robear wrote:

So they are burning that bridge by asserting that they will simply tear it all down and deal with the results later. This has several effects. One, it removes the possibility for wavering Republicans to work with Democrats, because Democrats have come out fully against the "kill now, replace at leisure" approach. It frames the issue as "us vs. them" again, which makes the Republicans close ranks. Secondly, it puts the blame on Dems if they "obstruct" even obviously worse plans. And because of that, it increases the chances that some Dems will decide they are better off working for *any* replacement, even one that means a step backwards. Lastly, it signals their intent to fight to the last ditch, because they have nothing left to lose after eliminating the compromise-and-fix option.

I guess things could work out differently, but this midnight vote is McConnells attempt to prepare the battlefield for what's coming. It signals that they *know* that they can't offer even the benefits of the current ACA, much less the promised improvements, so they are preparing to put Democrats in the line of fire for the substandard replacement they eventually come up with. Early days, but that's how it is looking right now.

Good luck with that, Mitch. Democrats can't do sh*t about this - Republicans control both chambers and the White House. Republicans are going to *OWN* the repercussions of repeal, and when the effects of their no-doubt less comprehensive replacement (or worse, the vacuum of an utter lack of any kind of replacement) start to be felt, they'll be standing there with their dicks in their hands.

For the last 8 years, Republicans have been complaining about the parts of the ACA that deserved complaining about. Not enough coverage, high premiums and lack of competition in the marketplaces for less populated areas. Here's the thing. Every one of those things is likely to be worse under the Republican's replacement plan. They have dug their own grave, here.

If you'd like to contact your representatives in Congress, https://www.callmycongress.com is a good resource.

Dimmerswitch wrote:

If you'd like to contact your representatives in Congress, https://www.callmycongress.com is a good resource.

I like what i've been seeing on my FB feed. People saying that since he wont divest that calling Trump Tower is fair game!