Healthcare

[IrishLax]

Changes made last night to healthcare bill:

https://www.nytimes.com/interactive/2017/03/20/us/changes-to-republican-health-plan.html?_r=0

Soooo even worse? Am I reading changes rights?

 

[BleedBlueGold]

Soooo even worse? Am I reading changes rights?

Work requirements to get Medicaid for some people? Seems worse.
Block grants? Definitely worse.
I don't see the point regarding dis-allowing tax money to be rolled into HSA. I like the increased contribution limits on HSAs, but that will only effect a small number of upper-middle to upper class citizens with more disposable incomes.
I don't understand the charging 5x more for older Americans. Need to do more reading, I guess.

Overall, I still think it's a bad plan. And I read today that they're trying to push some of it down to the Senate in order to skip the CBO re-eval of the new plan. Seems shady.

 

[Veritate Duce Progredi]

Changes made last night to healthcare bill:

https://www.nytimes.com/interactive/2017/03/20/us/changes-to-republican-health-plan.html?_r=0

Not a fan after a cursory read. I hope they are unable to replace the ACA until they come up with a true plan. I'm failing to see how this will fix anything.

As BBG says above, I do like the increased limits for HSA but that is a pittance compared to the rest. I only like it because I've been using mine as a savings vehicle primed for conversion down the road. I'm guessing less than 1% of Americans do something similar.

Everything else proposed is awful.

 

[BleedBlueGold]

Not a fan after a cursory read. I hope they are unable to replace the ACA until they come up with a true plan. I'm failing to see how this will fix anything.

As BBG says above, I do like the increased limits for HSA but that is a pittance compared to the rest. I only like it because I've been using mine as a savings vehicle primed for conversion down the road. I'm guessing less than 1% of Americans do something similar.

Everything else proposed is awful.

HSAs are brilliant and more people should take advantage of them. But when nearly 70% of Americans have less than $1,000 in their regular savings accounts, it's hard to imagine HSAs being the golden goose of healthcare. They're only useful for people who have disposable incomes.

Curious what you will be converting to. HSA to IRA? Or Roth?

 

[Veritate Duce Progredi]

HSAs are brilliant and more people should take advantage of them. But when nearly 70% of Americans have less than $1,000 in their regular savings accounts, it's hard to imagine HSAs being the golden goose of healthcare. They're only useful for people who have disposable incomes.

Curious what you will be converting to. HSA to IRA? Or Roth?

There was a podcast/article from a blogger called MadFIentist describing the virtues of an HSA. I have a pre-existing Roth that I put money in from time to time (don't max it out) because I have other retirement accounts. The HSA is further security in case we run into some high premiums but if we don't use it, it'll just continue to grow (i have all of my money in Vanguard funds).

I misspoke about the conversion. I had to pull out my cheat sheet I made for all my accounts. There is an ability to convert an HSA to IRA one time but that's not how I intend to use it. It's simply a savings vehicle. I'm still paying most medical expenses out of pocket and saving receipts so I can pull from the account before 65 should I have a need. (assuming I have enough receipts to cover what I pull).

My employer also contributes $500 per annum so it further incentivized this path for me. My family is covered through my wife's employer. That may not always be the case, eventually I may move away from it when a high-deductible plan no longer makes sense. At that point, the money can continue to grow as a taxable retirement account at 65 (pull before 65 and incur a 20%? penalty).

As to your bolded statement above, agreed. I'm only happy because n=1, it's not going to fix jacksh!t for anyone who isn't already making enough to be looking for additional ways to sock away money.

 

[Legacy]

HSAs are brilliant and more people should take advantage of them. But when nearly 70% of Americans have less than $1,000 in their regular savings accounts, it's hard to imagine HSAs being the golden goose of healthcare. They're only useful for people who have disposable incomes.

6 in 10 Americans don't have $500 in savings (CNN Money)
20% of the people would put a medical bill of $500 on their credit card.
Almost half of the adults surveyed reported they or a family member faced a major financial expenditure in the past year.

I posted the facts (#148) on Texas, their working poor, their Medicaid and ability to access healthcare through the ACA exchange, because Texas requirements and restrictions is what the Congress would like to achieve.

Texas and Medicaid
-- Some Texans do qualify for Medicaid and CHIP programs in Texas - 4.7 million - second only to California
-- However, Texas sets very low limits on Medicaid qualification for adults.
-- To qualify for Medicaid in Texas, adults with dependent children must make less than 18% of the federal poverty level (FPL), which amounts to less than $3,600 per year
-- Adults without children are not eligible for Medicaid in Texas unless they are disabled

The Working Poor in Texas
-- 84% of the uninsured in Texas have one or more adults in the family working
-- 33% of uninsured Texans fall below the Federal Poverty Limit of $15,000 (if you are paid $7.50 per hour, work 40 hours per week for 52 weeks a year, your income is just over $17,000

Hospitals will bear the burden for uncompensated care, as they are in Texas to the tune of $5.5 billion last year. Providers will not see patients until they present to the ER, the most expensive area to address health care problems. They would then be discharged with prescriptions that they cannot afford to fill. Those are some of the reasons why every major health-related group and almost every health insurance company has come out against Trumpcare.

Trumpcare is a budgetary technique that passes along the burden of managing health care for those who cannot afford insurance to the states, many of which are facing some severe budget shortfalls as well as to hospitals. Hospitals will pass along some of the costs of uncompensated care to those with employer-provided insurance. There are ways to pay for basic health care and preventative care to lessen these burdens on all.

These are reasons why every health group has opposed this bill as written.
Health Groups Denounce G.O.P. Bill as Its Backers Scramble (NY Times)

 

[BleedBlueGold]

6 in 10 Americans don't have $500 in savings (CNN Money)
20% of the people would put a medical bill of $500 on their credit card.
Almost half of the adults surveyed reported they or a family member faced a major financial expenditure in the past year.

I posted the facts on Texas, their working poor, their Medicaid and ability to access healthcare through the ACA exchange, because Texas requirements and restrictions is what the Congress would like to achieve.



Hospitals will bear the burden for uncompensated care, as they are in Texas to the tune of $5.5 billion last year. Providers will not see patients until they present to the ER, the most expensive area to address health care problems. They would then be discharged with prescriptions that they cannot afford to fill. Those are some of the reasons why every major health-related group and almost every health insurance company has come out against Trumpcare.

Trumpcare is a budgetary technique that passes along the burden of managing health care for those who cannot afford insurance to the states, many of which are facing some severe budget shortfalls as well as to hospitals. Hospitals will pass along some of the costs of uncompensated care to those with employer-provided insurance. There are ways to pay for basic health care and preventative care to lessen these burdens on all.

These are reasons why every health group has opposed this bill as written.
Health Groups Denounce G.O.P. Bill as Its Backers Scramble (NY Times)

Not sure why you felt the need to repost...

I agree Trumpcare is garbage.

 

[MJ12666]

Editorial: The American Health Care Act's hidden costs will hurt everyone (Modern Healthcare)

By Merrill Goozner | March 18, 2017

Making strictly a financial analysis comment and not a moral argument, the article's conclusions are flawed in that it only takes into account the current additional costs of not treating ailments early because of a lack of insurance; but ignore the possible financial benefit that would be realized based on a reduction in the lifespan of these same individuals. Not treating their condition early will probably shorten their lifespan considerably and therefore result in significant savings on healthcare spending in later years. If you are doing a cost analysis these saving need to be taken into consideration as healthcare costs rise significantly as the patient ages.

 

[BleedBlueGold]

Making strictly a financial analysis comment and not a moral argument, the article's conclusions are flawed in that it only takes into account the current additional costs of not treating ailments early because of a lack of insurance; but ignore the possible financial benefit that would be realized based on a reduction in the lifespan of these same individuals. Not treating their condition early will probably shorten their lifespan considerably and therefore result in significant savings on healthcare spending in later years. If you are doing a cost analysis these saving need to be taken into consideration as healthcare costs rise significantly as the patient ages.

I know you're just pointing out a legitimate fact here, but seriously...?

People will die because they don't see a doctor soon enough because they can't get healthcare and you're pointing out the financial benefit of no longer having to pay their healthcare in their later years?

Did I miss something?

 

[Legacy]

Making strictly a financial analysis comment and not a moral argument, the article's conclusions are flawed in that it only takes into account the current additional costs of not treating ailments early because of a lack of insurance; but ignore the possible financial benefit that would be realized based on a reduction in the lifespan of these same individuals. Not treating their condition early will probably shorten their lifespan considerably and therefore result in significant savings on healthcare spending in later years. If you are doing a cost analysis these saving need to be taken into consideration as healthcare costs rise significantly as the patient ages.

Do you have anything that shows "a possible financial benefit that would be realized based on a reduction in the lifespan of these same individuals." (on Medicaid)?

i would think that poverty, poor nutrition, lack affordability of medications, lack of preventative care without early intervention, the prevalence of untreated chronic diseases would be predictive indicators in decreased life expectancy, especially combined with the age factor.

This references some studies that may be relevant and is a very fair article:
Is Medicaid Bad for Your Health? (FactCheck.org)

Obama’s Council of Economic Advisers points to the 2014 Massachusetts study and the 2012 Medicaid study to claim that the risk of death will be lower in states that have adopted the ACA expansion. The Massachusetts study found a 2.9 percent reduction in mortality rates for Massachusetts counties from the four years before the 2006 health care overhaul to the three years after, as compared with other states’ counties. The 2012 Medicaid study examined five-year periods before and after state Medicaid expansions from 1997 through 2007 and found a 6.1 percent reduction in adults’ mortality rates in those states, compared with adults in neighboring, nonexpanding states.
The CEA report says that because there are uncertainties with this type of data and “in the interest of being conservative,” it uses the smaller effect found in the Massachusetts study to estimate “5,200 fewer people would die each year” if all states expanded Medicaid and that 5,000 fewer deaths per year will occur in states that have expanded the insurance program.
That Massachusetts study said it found an “absolute decrease of 8.2 deaths per 100,000 adults” and that the changes it found were “larger in counties with lower household incomes and higher prereform uninsured rates.”

You could use the decrease in mortality to begin calculation of financial benefits to a society for possible benefits for not providing some affordable health insurance to quantify an increase in mortality without health insurance. But you would also need to factor in the costs of increased times missed from work, decreased productivity, increased costs for society to provide expensive care, etc. You could look at the non-expansion states and compare savings and costs to the expansion states not only for health indicators but for increasing mortality of Medicaid patients. You probably want to think of factors as lack of job mobility and earnings potential as well as residence in high crime areas, which increases expensive trauma care, in decreased life expectancy.

But, overall, addressing those factors above of decreased life expectancy would improve health and productivity for America, by increasing productive life expectancy and savings and in relieving burdens that would be passed along to families for healthcare both in direct costs and in direct care for aging parents.

 

[MJ12666]

Do you have anything that shows "a possible financial benefit that would be realized based on a reduction in the lifespan of these same individuals." (on Medicaid)?

i would think that poverty, poor nutrition, lack affordability of medications, lack of preventative care without early intervention, the prevalence of untreated chronic diseases would be predictive indicators in decreased life expectancy, especially combined with the age factor.

This references some studies that may be relevant:
Is Medicaid Bad for Your Health? (FactCheck.org)



You could use the decrease in mortality to begin calculation of financial benefits to a society for possible benefits for not providing some affordable health insurance to quantify an increase in mortality without health insurance. But you would also need to factor in the costs of increased times missed from work, decreased productivity, increased costs for society to provide expensive care, etc. You could look at the non-expansion states and compare savings and costs to the expansion states not only for health indicators but for increasing mortality of Medicaid patients.

This is my point. In doing a financial analysis you would need to estimate the cost savings of these individuals dying earlier than if they received treatment that prolonged their lives. It is a fact that as people age their healthcare costs increase with age. It is impossible for them to go down. By treating them early and prolonging their lives you most likely have a net increase in society's healthcare costs per individual on average. Again I am not advocating this only stating that by not taking this into account the study is flawed; and therefore so is any conclusion that relies on the study.

 

[IrishLax]

This is my point. In doing a financial analysis you would need to estimate the cost savings of these individuals dying earlier than if they received treatment that prolonged their lives. It is a fact that as people age their healthcare costs increase with age. It is impossible for them to go down. By treating them early and prolonging their lives you most likely have a net increase in society's healthcare costs per individual on average. Again I am not advocating this only stating that by not taking this into account the study is flawed; and therefore so is any conclusion that relies on the study.

All of this was clear and irrefutable from your original post. Not sure how anyone even argues with the obviously correct logic. Hypothetically, the most "affordable" healthcare for a society would be one where everyone dies as early as possible incurring the fewest expenses... but obviously that system would also be an abject failure.

 

[IrishLax]

You Are About To Be One Dumb Accident Away From Bankruptcy, If You Aren't Already

Thought this article was a great illustration of how stupid some people are about the ACA and the facts of current "affordable" plans on the exchanges. The entire premise of the headline is that "things are good now, but watchout when GOP plan passes!" Which is (somewhat) true, but not as the author laughably frames his scary pre-ACA scenario:

There are some nights when it keeps me up in a panicked haze. What if I get hit by a car while I’m running? What if I take a spill on my bike and tear some ligaments or, worse, have to take an ambulance to the hospital from some far flung road outside the city where I live? An x-ray? I’m eating lentils for weeks. Extensive bloodwork? Not going home for Thanksgiving this year. Cancer? My only recourse would be Chapter 7 bankruptcy and America’s most effective health care plan: a GoFundMe campaign. Sure, I have health insurance for now, but these grim financial hypotheticals are the things that keep you up at night when (Republican) lawmakers have spent nearly a decade telling you they are going to diminish your access to health care.

There have been many stories in the last year about the truly heinous toll repealing ACA would have on citizens and the unnecessary deaths that would follow. I won’t pretend my situation is anything like that of the tens of thousands of American families faced with life-threatening diseases and crushing, ruinous debt from medical bills. But I can tell you how a small and dumb accident can put a regular dude on the financial ropes in America.

In late 2009 I fell down some steps in my apartment and tore my knee open. I was 24, broke (but gainfully employed), and uninsured. I took a cab to the ER, where the very nice nurse who stitched up my wound—I needed over 50 stitches and local anesthetic, which, it turns out, is very expensive!—specified the hours she worked and told me to come in then so I would not have to pay even more money to have the stitches removed. The ER bill from the stitches—stitches, we’re not talking about chemo or open-heart surgery—nearly bankrupted me. I haggled with the hospital’s billing department for months to reduce the tab to a palatable number, which was still north of $2,000. This, I know, is miniscule in the scheme of things. But I was living paycheck-to-paycheck, saddled with student loans, and, as a recent college grad, had little-to-no savings. $2,000 was not an insignificant chunk of change. I suspect many Americans would say the same thing about $2,000.

That is what our pre-ACA health care system looked like: Falling down the steps can put you on the verge of financial ruin. And I’m one of the lucky ones. I did not have to deal with complicated surgeries, exorbitant prescriptions, or a protracted battle with an illness that necessitates impossibly expensive treatment. I’m just a lanky klutz who is always in a hurry. I literally fell down some steps.

This is where someone—Jason Chaffetz or some other freedom-and-liberty obsessed Republican, perhaps—might tell me to be smarter about my finances. That I had choices that led to my burdensome medical costs. That I should have made different choices to make sure I could afford a freak visit to the emergency room. Or that I did have the choice to purchase health coverage (which would have been so comically bad it probably would have only marginally reduced my hospital bill anyway).

After that, I got insured on what lawmakers and deep-pocketed health care lobbyists like to call the free market. And you know what? It’s not as magical as the GOP would have you believe. It was lousy, expensive, and the only thing it ensured was that my parents wouldn’t go bankrupt if I got hit by a garbage truck. I had a $7,000 deductible and a $239 monthly premium for catastrophic insurance. Shopping for plans, it seemed like no matter what I picked, I was fucked either way. The one I ended up with disincentivized going to the doctor and disincentivized preventative care. I once got a free flu shot out of pity from a Duane Reade pharmacist because they didn’t take my shitty catastrophic plan. It was bad and expensive coverage. Get ready for more of that.

Holy fuck is that dumb. Literally nothing about his scenario is different under the ACA vs GOP proposed plan, because the only thing that would possibly affect that bottom line cost would be if he was on his parent's plan (and the GOP plan is keeping that provision).

Most of the cheap ACA plans are exactly as he described the one he purchased before the ACA... high deductible, premiums in the hundreds of dollars a month. In fact, being on an average ACA exchange plan would cost him more in a year than what he paid out of pocket for the stitches uninsured. And the pre-ACA plan he purchased in 2010 is more affordable than current plans with similar levels of coverage.

As the article goes on, he basically backs off his initial crap and acknowledges much of this... but he knew he couldn't get published on that kind of site without an alarmist headline and warped anecdote that doesn't jibe with reality. The ACA is flawed, and the proposed Republican plan is worse. But none of that affects his hypothetical out-of-pocket expense paying for stitches. People need to cut the bullshit and start dealing in facts.

 

[kmoose]

Holy fuck is that dumb. Literally nothing about his scenario is different under the ACA vs GOP proposed plan, because the only thing that would possibly affect that bottom line cost would be if he was on his parent's plan (and the GOP plan is keeping that provision).

Most of the cheap ACA plans are exactly as he described the one he purchased before the ACA... high deductible, premiums in the hundreds of dollars a month. In fact, being on an average ACA exchange plan would cost him more in a year than what he paid out of pocket for the stitches uninsured. And the pre-ACA plan he purchased in 2010 is more affordable than current plans with similar levels of coverage.

As the article goes on, he basically backs off his initial crap and acknowledges much of this... but he knew he couldn't get published on that kind of site without an alarmist headline and warped anecdote that doesn't jibe with reality. The ACA is flawed, and the proposed Republican plan is worse. But none of that affects his hypothetical out-of-pocket expense paying for stitches. People need to cut the bullshit and start dealing in facts.

Not to mention........... I've lived paycheck to paycheck before. $2000+ is not an insignificant amount of money. HOWEVER........... I think there are like 3 hospitals in America where you CANNOT make regular $20 a month payments until your bill is paid off. Hospitals are NOTORIOUS for allowing people to make as little a payment a month as they can possibly scrape together, as long as they keep making those payments. So his "financial ruin" bullshit is just that.............. bullshit.

 

[Legacy]

Patients' Perspectives on Health Care in the United States
A Look at Seven States & the Nation

February 2016 Publisher: NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health Publication: Public Opinion Poll Series
Editor(s): NPR/Robert Wood Johnson Foundation/Harvard School

The Patients’ Perspectives on Health Care survey series seeks to illuminate the self-reported experiences
today of health care consumers across the country and in seven states: Florida, Kansas, New Jersey, Ohio,
Oregon, Texas and Wisconsin. These locations were not picked at random; rather, they were selected to
represent a geographically diverse group of states that have (NJ, OH, OR) and have not (FL, KS, TX)
expanded Medicaid, as well as the only state in the nation that did not have to, since Wisconsin’s preACA
eligibility criteria already matched those passed by national health reform.
All participants – both those sampled in the seven states and across the nation – were asked to share their
personal experiences and opinions. Thus, comparisons between any state and the nation contrast the views
of a representative sample of that state’s residents to a representative sample of residents across the
country asked about their perceptions of their own state. Although there are many differences among the
views and experiences of people across states, this report only highlights such differences when they are
statistically significant from the national sample. It summarizes the survey’s state and national findings as
they pertain to six main questions:
1. What is the overall picture in the United States – what has changed in the past two years, and how
do adults in the U.S. rate their health care and costs at the state and personal levels?
2. How do adults in the U.S. rate the quality of their health care?
3. How do adults in the U.S. perceive the cost of their health care?
4. Do adults in the U.S. face barriers to accessing health care?
5. How do adults in the U.S. experience health care at different sites, including doctor’s offices,
hospitals, emergency rooms, urgent care centers and retail or drug store mini-clinics?
6. What do adults in the U.S. think of national health reform?

One Section

Serious Financial Problems
More than a quarter (26%) of adults in the U.S. says health care costs have caused a serious financial
problem for them as individuals or for their family (Table 1). Setting up a payment plan with a hospital or
health care professional was the most common consequence of these serious financial problems,
experienced by more than two in five (44%) patients who struggle with health care costs. The second
most common consequence of large medical bills in the U.S. was spending all or most of one’s personal
savings (42%). Adults in Kansas (36%) are significantly more likely than adults across the nation (26%)
to report having serious financial problems resulting from health care costs.

TABLE 1.
Percent of adults in the U.S. who say their health care costs over the past two years
caused a very or somewhat serious problem for their personal or their family’s overall financial
situation and for whom the following happened because of large medical bills (Q20, 21 a-g).
-- Health care costs caused a serious financial problem 26%
-- Set up a payment plan with a hospital or health care professional 44%
-- Spent all or most of their personal savings 42%
-- Contacted by bill collectors 39%
-- Unable to pay for basic necessities like food, heat or housing 27%
-- Taken on credit card debt that may be difficult to pay off 23%
-- Taken out a loan that may be hard to pay back 19%
-- Declared bankruptcy 7%

Also,
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey
Jan 05, 2016

From Intro:

Previous Kaiser surveys have found that about a quarter of people say they or someone in their household had problems paying medical bills in the past year, and a 2014 Kaiser report provided a qualitative look at some of the circumstances and consequences of unpaid medical bills through interviews with people who had sought credit counseling for medical debt.1 But to date, there has been little research providing a quantitative look at the causes of medical bill problems and the impacts they have on people’s families, their finances, and their access to health care.

To fill this gap, the Kaiser Family Foundation and The New York Times conducted an in-depth survey with 1,204 adults ages 18-642 who report that they or someone in their household had problems paying or an inability to pay medical bills in the previous 12 months. To provide context, we also conducted a shorter companion survey with 1,371 adults ages 18-64 who do not report having medical bill problems.

Section 3: Consequences of Medical Bill Problems
THE IMPACT OF MEDICAL BILLS ON FAMILIES

Excerpt:

SACRIFICES MADE TO PAY MEDICAL BILLS
Even among those with health insurance, people who’ve faced medical bill problems report making various sacrifices in order to pay these bills, including significant changes to their employment, financial situation, or lifestyle. Overall, about seven in ten report cutting back or delaying vacations or major household purchases (72 percent) as well as reducing spending on food, clothing and basic household items (70 percent). About six in ten (59 percent) say they used up all or most of their savings in order to pay medical bills. Substantial shares say that someone in their household took on an extra job or worked more hours (41 percent), borrowed money from family and friends (37 percent), or increased their credit card debt (34 percent). Roughly a quarter (26 percent) say they took money out of a retirement, college, or other long-term savings account. Smaller – but not inconsequential – shares say they changed their living situation (17 percent), took out another type of loan (15 percent), borrowed from a payday lender (13 percent), or sought the aid of a charity or non-profit (12 percent) in order to pay medical bills. Very few (2 percent) report taking out a second mortgage on their home.

These sacrifices are reported by people in all walks of life, and not just the uninsured or those with precarious financial situations. In fact, people who have problems paying medical bills despite having health insurance are more likely than the uninsured with medical bill problems to say they’ve put off vacations or major household purchases (77 percent versus 64 percent), cut back spending on food, clothing, or basic household items (75 percent versus 62 percent), used up all or most of their savings (63 percent versus 51 percent), increased their credit card debt (38 percent versus 24 percent), or taken money out of long-term savings (31 percent versus 17 percent) in order to pay medical bills. The opposite is true in one case; the uninsured with medical bill problems are more likely than those with insurance to say they had to change their living situation in order to pay these bills (23 percent versus 14 percent).

 

[BleedBlueGold]

Thought this was interesting:

http://www.vox.com/policy-and-politics/2017/3/20/14950990/republican-replacement-plan-calculator

 

[IrishLax]

Thought this was interesting:

http://www.vox.com/policy-and-politics/2017/3/20/14950990/republican-replacement-plan-calculator

Very interesting. Everyone at my age making more than like $29k/year is better off (cost wise) under the GOP plan. Old people pay their fair share... which of course Vox phrases as "hurting old people"... rhetoric is a funny thing looking at my phrasing versus theirs.

The primary beneficiary of the ACA is the poorest of the poor and unemployed whose healthcare cost is effectively subsidized by those who can afford it.

 

[BleedBlueGold]

Very interesting. Everyone at my age making more than like $29k/year is better off (cost wise) under the GOP plan. Old people pay their fair share... which of course Vox phrases as "hurting old people"... rhetoric is a funny thing looking at my phrasing versus theirs.

The primary beneficiary of the ACA is the poorest of the poor and unemployed whose healthcare cost is effectively subsidized by those who can afford it.

Yea I basically had the same thoughts.

High-five to myself for lower premiums and a higher cap on HSAs, while at the same time feeling terrible that those who need help the most are going to struggle even more so under this plan. "Older people paying their fair share" is just a legitimate mathematical fact, but in most cases, they are the people who can least afford it. That's a big reason why healthcare is such a complicated issue.

If this passes (and I don't see how it will with so many R's opposing it at the moment), a couple years after implementation, a big chunk of Trump's voting base is going to be hurting badly.

 

[woolybug25]

Yea I basically had the same thoughts.

High-five to myself for lower premiums and a higher cap on HSAs, while at the same time feeling terrible that those who need help the most are going to struggle even more so under this plan. "Older people paying their fair share" is just a legitimate mathematical fact, but in most cases, they are the people who can least afford it. That's a big reason why healthcare is such a complicated issue.

If this passes (and I don't see how it will with so many R's opposing it at the moment), a couple years after implementation, a big chunk of Trump's voting base is going to be hurting badly.

They wont care... cuz Mexicans...

 

[kmoose]

Very interesting. Everyone at my age making more than like $29k/year is better off (cost wise) under the GOP plan. Old people pay their fair share... which of course Vox phrases as "hurting old people"... rhetoric is a funny thing looking at my phrasing versus theirs.

The primary beneficiary of the ACA is the poorest of the poor and unemployed whose healthcare cost is effectively subsidized by those who can afford it.

I would have thought that most liberals would be up in arms about this:

Their health CARE is not subsidized by those who can afford it. Their health INSURANCE is subsidized by those who can afford it. It's like the most obvious form of "taking care of the 1%(insurance companies)" in the history of taking care of the 1%. The ACA is literally taking your, my, and everyone else's tax dollars and paying insurance companies with it. The insurance companies then jack up the deductibles so that they are guaranteed to come out ahead. The ACA doesn't do a single thing to change the cost structure of health care. It just shifts those costs away from the poor. That's good for the poor, and it's not a bad thing. But if you aren't going to reform the cost of goods and services, then it's nothing more than robbing Peter to pay Paul.

****I AM NOT MAKING ANY CLAIMS THAT THE GOP PLAN DOES ANYTHING DIFFERENT OR BETTER. I'M STRICTLY COMMENTING ON THE IDEA THAT ACA MEANS MORE, OR BETTER, HEALTH CARE FOR POOR PEOPLE****

 

[BleedBlueGold]

I would have thought that most liberals would be up in arms about this:

Their health CARE is not subsidized by those who can afford it. Their health INSURANCE is subsidized by those who can afford it. It's like the most obvious form of "taking care of the 1%(insurance companies)" in the history of taking care of the 1%. The ACA is literally taking your, my, and everyone else's tax dollars and paying insurance companies with it. The insurance companies then jack up the deductibles so that they are guaranteed to come out ahead. The ACA doesn't do a single thing to change the cost structure of health care. It just shifts those costs away from the poor. That's good for the poor, and it's not a bad thing. But if you aren't going to reform the cost of goods and services, then it's nothing more than robbing Peter to pay Paul.

****I AM NOT MAKING ANY CLAIMS THAT THE GOP PLAN DOES ANYTHING DIFFERENT OR BETTER. I'M STRICTLY COMMENTING ON THE IDEA THAT ACA MEANS MORE, OR BETTER, HEALTH CARE FOR POOR PEOPLE****

Any liberal who has a basic understanding of the ACA will point out the same gripe you did. People who put the ACA on a pedestal and think it's flawless are uninformed or being disingenuous. I credit Obama for trying, but it's intellectually dishonest to ignore the fact he received millions of dollars from the insurance lobbies. I highly doubt this was done on accident.

 

[Legacy]

Originally Posted by kmoose; View Post
I would have thought that most liberals would be up in arms about this:

Their health CARE is not subsidized by those who can afford it. Their health INSURANCE is subsidized by those who can afford it. It's like the most obvious form of "taking care of the 1%(insurance companies)" in the history of taking care of the 1%. The ACA is literally taking your, my, and everyone else's tax dollars and paying insurance companies with it. The insurance companies then jack up the deductibles so that they are guaranteed to come out ahead. The ACA doesn't do a single thing to change the cost structure of health care. It just shifts those costs away from the poor. That's good for the poor, and it's not a bad thing. But if you aren't going to reform the cost of goods and services, then it's nothing more than robbing Peter to pay Paul.

If you are saying that a health care system which combines profit and non-profit elements has not been changed, you are certainly correct. What CMS changes have done along with the ACA is change the reimbursement structure of health care, which has moved the responsibility of managing patient healthcare to providers with Value-Based Purchasing. That has been one of the major elements that have controlled costs.

This is my biggest worry about Price. Value-Based Purchasing is one of the few concepts that's shown some actual ability to control costs in health care.

Of course, providers -- especially non-hospitalists -- are often pretty hostile to VBP. You're asking an industry oriented around maximizing the volume of high-margin care to completely pivot and reorient around minimizing the volume of low-impact care. This is an industry that has literally built -- from which facilities they open and where they open them, to coding conventions, to physician culture -- around the former and now you're telling them "we're shifting to VBP with downside risk; all of you are going to completely restructure your health systems and half of you are still going to lose."

If VBP works right, it should increase physician flexibility -- at bottom, VBP is about giving providers a flat rate and saying "go do health care" and leaving the rest up to them. But it can be difficult to implement quality controls (e.g. ensuring hospitals don't start dumping patients, preventing improper transfers, determining actual measurements of quality) that don't interfere with that relationship. I agree with providers who have pushed for improvements in these controls and mitigation of risk while those controls mature.

Price seems to run with the other crowd, though, that's hostile to VBP full-stop. To me, that's fine, but then what's your strategy for reducing the cost of care? Cutting Medicaid and Medicare aren't cost-control strategies, they're budgeting strategies. All that does is shift more of the cost down to the states and to hospitals. You've still got sick patients who need the same amount of care today that they did yesterday. Block granting and privatization are theoretically great, but as long as you still have a system without meaningful ability to negotiate pricing or reduce volume, you're not going to capture a whole lot of efficiencies the states and fed haven't already. We've just shifted deck chairs around -- although this time, the red ones.

EDIT: I probably should clarify -- this is my biggest concern about Price, as opposed to a hypothetical generic, Trump-approvable HHS nominee. Concerns about the overall reform plan (in its current nascent state) are a whole other kettle of fish.

Or, as NOLA says,

...as long as you still have a system without meaningful ability to negotiate pricing or reduce volume, you're not going to capture a whole lot of efficiencies the states and fed haven't already.

The ACA is only one part of the healthcare system and has had positive impacts on Medicare finances and improved the Medicare Hospital Trust Fund finances (see post 103). It has elements that are flawed and have needed improvements, but Congress has refused to act on a comprehensive health plan, moving towards that system "without meaningful ability to negotiate pricing or reduce volume".

So, Americans are stuck with unjustifiable cost increases. (You can see the discussion in posts 100-103)

 

[Legacy]

Prior to Trumpcare, which worsens the impacts the CBO cost scoring addressed in January (Ryan's plan), one conclusion was,

How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums (Congressional Budget Office)

-- Premiums in the nongroup market (for individual policies purchased through the marketplaces or directly from insurers) would increase by 20 percent to 25 percent—relative to projections under current law—in the first new plan year following enactment. The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.

With Trumpcare, the CBO estimates the effect on premiums will be:

Effects on Premiums
The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.
Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund (which CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees with very high claims); the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees. By 2026, average premiums for single policyholders in the nongroup market under the legislation would be roughly 10 percent lower than under current law, CBO and JCT estimate.
Although average premiums would increase prior to 2020 and decrease starting in 2020, CBO and JCT estimate that changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules. Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.

However, they caution this estimate has some degree of Uncertainity.

Uncertainty Surrounding the Estimates
The ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by the legislation are all difficult to predict, so the estimates in this report are uncertain. But CBO and JCT have endeavored to develop estimates that are in the middle of the distribution of potential outcomes.

As examples of federal agencies change in response, let's say that the Justice Dept allows the top six health insurance companies to merge, creating three and limiting competition in the marketplace, or it does not aggressively pursue and prosecute health care fraud, which consumes 3-10% of health care spending. Those are examples of a federal agency outside of HHS....

 

[MJ12666]

I would have thought that most liberals would be up in arms about this:

Their health CARE is not subsidized by those who can afford it. Their health INSURANCE is subsidized by those who can afford it. It's like the most obvious form of "taking care of the 1%(insurance companies)" in the history of taking care of the 1%. The ACA is literally taking your, my, and everyone else's tax dollars and paying insurance companies with it. The insurance companies then jack up the deductibles so that they are guaranteed to come out ahead. The ACA doesn't do a single thing to change the cost structure of health care. It just shifts those costs away from the poor. That's good for the poor, and it's not a bad thing. But if you aren't going to reform the cost of goods and services, then it's nothing more than robbing Peter to pay Paul.

****I AM NOT MAKING ANY CLAIMS THAT THE GOP PLAN DOES ANYTHING DIFFERENT OR BETTER. I'M STRICTLY COMMENTING ON THE IDEA THAT ACA MEANS MORE, OR BETTER, HEALTH CARE FOR POOR PEOPLE****

This is 100% correct. Somehow either by design or coincidence health insurance has be synonymous with healthcare. Which it is not. Insurance is nothing more then a financial derivative that can be used to reduce one's exposure to financial catastrophe related to the potential treatment of a future medical condition. Health insurance has never cured anyone. Neither the ACA or the current proposal addresses the actual cost of healthcare. In order to do so the government would need to actually step in and implement price controls not only on prescription pharmaceuticals but also on the prices charged by healthcare provides and related facilities. That would really be the only way to actually control healthcare costs.

I remember on a business trip to Ireland a few years ago. I picked up an eye infection on the flight over. When I got to the hotel I asked it they could recommend a doctor and they arranged an appointment. Went right over and the doctor examined me and gave me a prescription.. The doctor's visit was $20. I was surprised and asked if that was because of her association with the hotel. She said no it was the government mandated fee.

 

[BleedBlueGold]

This is 100% correct. Somehow either by design or coincidence health insurance has be synonymous with healthcare. Which it is not. Insurance is nothing more then a financial derivative that can be used to reduce one's exposure to financial catastrophe related to the potential treatment of a future medical condition. Health insurance has never cured anyone. Neither the ACA or the current proposal addresses the actual cost of healthcare. In order to do so the government would need to actually step in and implement price controls not only on prescription pharmaceuticals but also on the prices charged by healthcare provides and related facilities. That would really be the only way to actually control healthcare costs.

I remember on a business trip to Ireland a few years ago. I picked up an eye infection on the flight over. When I got to the hotel I asked it they could recommend a doctor and they arranged an appointment. Went right over and the doctor examined me and gave me a prescription.. The doctor's visit was $20. I was surprised and asked if that was because of her association with the hotel. She said no it was the government mandated fee.

They can start by easing off the FDA and opening borders. Big Pharma lobby has that on lock down and Congress needs to grow a pair and do the right thing. (Looking at you, Cory Booker.)

 

[Veritate Duce Progredi]

They can start by easing off the FDA and opening borders. Big Pharma lobby has that on lock down and Congress needs to grow a pair and do the right thing. (Looking at you, Cory Booker.)

Yes, they could also aggressively pursue tort reform but it won't happen.

 

[wizards8507]

Wooooo Freedom Caucus now saying 25 "No" votes for the AHCA. It's going down.

 

[Veritate Duce Progredi]

Wooooo Freedom Caucus now saying 25 "No" votes for the AHCA. It's going down.

Thank God, now maybe we can start making sensible changes to the ACA while leaving the framework in place. At least until Donald Trump finds the best words to create a new plan that doesn't read like dogsh!t.

 

[Legacy]

13 less-noticed CBO findings on the ACA repeal bill

By Harris Meyer | March 14, 2017

Everyone reported the top-line numbers from Monday's analysis of the House Republicans' American Health Care Act, a bill to repeal and replace the Affordable Care Act.

The nonpartisan Congressional Budget Office and the Joint Committee on Taxation estimated the bill would drive up the number of uninsured Americans by 24 million over the next decade and reduce the federal deficit by $337 billion.

But here are 13 other findings that should be of high interest to healthcare industry groups.

1. Medicare spending on disproportionate-share payments to hospitals would increase by $43 billion from 2018 to 2026 due to a significant rise in the uninsured population.

2. Medicaid disproportionate-share payments to hospitals would increase by $31 billion over 10 years.

3. Total federal Medicaid payments to states would decline by $880 billion, or 25%, by 2026.

4. Under the AHCA's per-enrollee cap on federal Medicaid payments, states' actual per-capita costs would grow annually 0.7 percentage points faster than federal payments from 2017 to 2026. States have the option of spending more of their own money to maintain spending levels or cutting benefits or provider payments.

5. Five million fewer low-income adults would be enrolled in the ACA's Medicaid expansion programs by 2026.

6. By 2026, Medicaid expansion states would have only 5% of expansion enrollees left for whom they would receive enhanced federal matching payments.

7. Consumers would have a harder time comparison-shopping for health plans because the ACA's minimum actuarial-value requirement would be repealed and insurers could sell subsidized plans outside the ACA exchanges.

8. The repeal of the actuarial-value requirement would prompt many insurers to offer plans with higher deductibles and cost-sharing. That and the loss of ACA cost-sharing subsidies in 2020 would significantly increase out-of-pocket costs for lower-income enrollees.

9. About 7 million fewer people would have employer-based coverage by 2026. With the employer and individual mandate penalties gone, fewer employers would offer benefits and fewer employees would take it up. And the new premium tax credits for higher-income workers would prompt some employers to send their workers to buy coverage in the individual market.

10. By 2026, individual-market premiums would be 20% to 25% lower for a 21-year-old, 8% to 10% lower for a 40-year-old and 20% to 25% higher for a 64-year-old.

11. The one-year, 30% premium penalty for buying insurance after a coverage gap would lead to about 2 million fewer people buying coverage after 2018. Those who pay the penalty would likely be sicker people.

12. By 2026, the average premium tax credit to help people buy coverage would be about 50% less than under the ACA.

13. About 52 million Americans, or 19% of the non-elderly population, would be uninsured in 2026, up from 10% under the ACA. People aged 50-64 with incomes under 200% of the federal poverty level would make up a larger share of the uninsured.

 

[BleedBlueGold]

More amendments last night: https://www.forbes.com/sites/anthon...e-rich-reduced-medicaid-funding/#5abfcb86b7d6

Trying to get those far-right no voters to switch...