ACA reversal/change?

[Guest]

I think the $10,000 figure is meant to represent the deductible of a high deductible plan, what the consumer would have to pay before insurance kicked in.

It is. We had catastrophic coverage the ACA ruined, unfortunately, and it was perfect for our family. Out of pocket and non emergent expenses were budgeted in and paid for with our health savings account, our monthly cost was less than $80 per family member for this and we had coverage for any emergency service, surgery, or illness event that exceeded about 4,000. Then we decided to go with a different catastrophic option that was less per month, covered events greater than 10,000, and sock more away to pay for the routine medical costs like well babies and allergist appointmenfs.

 

Our state very nearly passed something like this for Medicaid, where each patient would be vouchered annually to cover basic medical costs and could shop around for the best price or provider they wanted, and then a more traditional catastrophic system to pay for long term illlnesses, pre-existing conditions, or emergencies. I don't have the documents with me but the savings was in the 20+% range to our state immediately, on one of our biggest budget line items, with vast improvements to the patient and providers both in terms of quality and reimbursement.

[ChocolateReignRemix]

What has been floated is essentially the government vouchering Medicare instead of administering it, complete with allowing purchasing of insurance across state lines, so the plans can be made genuinely competitive and vary in their coverage with need. Nobody on the left or right wants old people dying in the streets, that's silly. There has also been talk of expanding Medicaid risk pools to cover pre-d siting conditions on a need based, sliding scale, so that those who wouldn't fare well on the normal system can still get covered. It should still be a significant cost reduction even in fully covering a very sick person via taxpayers.

 

There are lots of good ideas that have been floated, assuming the absolute worst and most heartless outcome isn't really reasonable. Republicans get sick and have elderly family too. In our state it has consistently been the republican legislature proposing innovative, cost saving, quality improving medical changes and being blocked because of petty politics. Believe it or not these people exist in more legislatures than my own and even get elected nationally. There have been years of kicking around alternatives and cost benefit analyses for them, so the current congress and president should have a broad swath of options to consider and discuss.

 

The vouchering would be vouchers for private insurance.  When last floated, the voucher amounts were laughable.

 

Regarding the bolded, insurance is state regulated, and it is state laws - not federal - that prevent insurance sales across state lines.  Currently 6 states allow insurers to do so.

 

The thing is, insurers as a whole are not clamoring for this.  Building networks is expensive, and many small markets would simply not be worth the effort.  This idea gets floated constantly but there is no evidence that it would actually lower costs.  For evidence of that position, simply look at the pricing in metro markets where the large insurers are already represented.  Costs in those areas are no consistently cheaper.

 

Forbes covered this pretty well already.

http://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-trump-selling-health-insurance-across-state-lines-wouldnt-lower-costs/#19fff1945f01

[NoPlaceLikeHome]

I understand that we do sometimes use ascribe negative connotations to the word entitled, but entitlement is an accurate and appropriate term here--it means something people have been granted a legal right to.

http://legal-dictionary.thefreedictionary.com/Entitlement

Yes but I heard many on the right use that term to imply that folks are moochers and free loaders:(

[NoPlaceLikeHome]

It is. We had catastrophic coverage the ACA ruined, unfortunately, and it was perfect for our family. Out of pocket and non emergent expenses were budgeted in and paid for with our health savings account, our monthly cost was less than $80 per family member for this and we had coverage for any emergency service, surgery, or illness event that exceeded about 4,000. Then we decided to go with a different catastrophic option that was less per month, covered events greater than 10,000, and sock more away to pay for the routine medical costs like well babies and allergist appointmenfs.

 

Our state very nearly passed something like this for Medicaid, where each patient would be vouchered annually to cover basic medical costs and could shop around for the best price or provider they wanted, and then a more traditional catastrophic system to pay for long term illlnesses, pre-existing conditions, or emergencies. I don't have the documents with me but the savings was in the 20+% range to our state immediately, on one of our biggest budget line items, with vast improvements to the patient and providers both in terms of quality and reimbursement.

Yeah this sounds great if you have the money but many folks and I wager most folks do not have the money and therefore will forgo necessary health care since they cannot afford it. Then they will end up in the hospital costing oodles and oodles of more money.

 

I see many people here who scrounge nickels and dimes just to afford a bus ride and who cannot even afford the bus pass which costs $5 but is allows for cheaper bus rides. This is just one example of many that face the poor everyday.

Edited November 12, 2016 by NoPlaceLikeHome

[Guest]

Yeah this sounds great if you have the many but many folks and I wager most folks do not have the money and therefore will forgo necessary health care since they cannot afford it. Then they will end up in the hospital costing oodles and oodles of more money.

 

I see many people here who scrounge nickels and dimes just to afford a bus ride and who cannot even afford the bus pass which costs $5 but is allows for cheaper bus rides. This is just one example of many that face the poor everyday.

Yes, and it is still cheaper to issue them each checks into a health savings account and let them go spend it on medical services than to try and cover them by Medicaid. Less administrative cost, more competitive service, better quality care. That is precisely what our state was looking at. It was cheaper to give people each 10-15k annually straight into a checking account issuable only to medical services and supplies (including naturopaths and eye/dental care, vitamins, etc) and allow individual appeals and application for catastrophic or ongoing illness coverage beyond that point than to expand Medicaid by the way we ended up doing it (and with much less quality results).

 

In terms of the ACA, if you credited every man, woman, and child in the country with a portion of what was spent setting up the stupid exchange and website and had them go pay for their own care, they'd have had something like 50k each by which to do so before ever touching Medicare and Medicaid spending and regardless of how healthy or sick they were. The current system is that ridiculously inefficient and costly.

[ChocolateReignRemix]

Yes, and it is still cheaper to issue them each checks into a health savings account and let them go spend it on medical services than to try and cover them by Medicaid. Less administrative cost, more competitive service, better quality care. That is precisely what our state was looking at. It was cheaper to give people each 10-15k annually straight into a checking account issuable only to medical services and supplies (including naturopaths and eye/dental care, vitamins, etc) and allow individual appeals and application for catastrophic or ongoing illness coverage beyond that point than to expand Medicaid by the way we ended up doing it (and with much less quality results).

 

In terms of the ACA, if you credited every man, woman, and child in the country with a portion of what was spent setting up the stupid exchange and website and had them go pay for their own care, they'd have had something like 50k each by which to do so before ever touching Medicare and Medicaid spending and regardless of how healthy or sick they were. The current system is that ridiculously inefficient and costly.

 

The second bolded makes me question your first bolded.

 

Using 20,000,000 as the number of people now covered under the ACA, allotting $50k/person comes to $1,000,041,214,000.  Pretty sure that isn't the cost of the ACA yearly.

 

(Actually I know it isn't, and I even know where your fictitious $50k/person number comes from.)

[Guest]

Update from WSJ interview - the president elect signaled he will keep portions of the ACA.

 

I'd guess this would be the Medicaid expansion, and the changes will be enacted upon the remaining market segment. Looking forward to more details coming out in the next few weeks.

 

ETA - http://www.wsj.com/articles/donald-trump-willing-to-keep-parts-of-health-law-1478895339

 

Looks like it wasn't the Medicaid expansion but the expanded age coverage and pre-existing condition provisions.

Edited November 11, 2016 by Arctic Mama

[MaeFlowers]

Only dealing with how to pay or who pays won't help everyone. It may help this or that individual but society will still be paying the high cost. We need to deal with the actual cost of care not just how to pay for it.

 

I took my son to a local provider rather than the ER for his stitches to save money. 40 minutes and some thread, a needle, rubbing alcohol, cotton and bandage cost over $1000. It would easily been over twice maybe 3 times that at the ER. Both ER's in our state have groups of doctors that are separate from the hospital and choose the rate they charge. They are monopolies since private doctors can't work there. It is billed separately from the hospital so I could see that the doctor cost 3x's as much as the hospital (including payment for building, cleaning, nursing staff, equipment), the separate x-ray technician bill, EKG bill. You would think the doctor would be the cheapest bill since he didn't do much compared to all the technicians, didn't have to pay for equipment, or deal with the room before or after, scheduling, nursing, etc. They are a monopoly and are gouging big time but if we only focus on who pays then we aren't dealing with the root of the problem which is doctors using state governments to prop up monopolies or pharmaceutical companies charging obscene amounts because they can per government enforcement. When deregulation is spoken of it is never dealing with enforced monopolies, only payment procedures. Also the fact that people can't shop around because you aren't allowed to see the cost before you are treated (fought this battle a lot) doesn't help.

I've always wondered about this. It seems to me that if fair rates were charged, people would be more likely to pay. If the hospital would charge $12 for a $6 test rather than $800 for that test, wouldn't there be fewer problems with non-payment and bankruptcies? I really don't understand the logic but I also don't understand the overhead.

 

 

The difference between self-pay and negotiated rates through insurance companies baffles me, too. Why is the price different for everyone? Should a cast or a test or a surgery not cost the same regardless of who is buying?

[TechWife]

What has been floated is essentially the government vouchering Medicare instead of administering it, complete with allowing purchasing of insurance across state lines, so the plans can be made genuinely competitive and vary in their coverage with need. Nobody on the left or right wants old people dying in the streets, that's silly. There has also been talk of expanding Medicaid risk pools to cover pre-d siting conditions on a need based, sliding scale, so that those who wouldn't fare well on the normal system can still get covered. It should still be a significant cost reduction even in fully covering a very sick person via taxpayers.

 

There are lots of good ideas that have been floated, assuming the absolute worst and most heartless outcome isn't really reasonable. Republicans get sick and have elderly family too. In our state it has consistently been the republican legislature proposing innovative, cost saving, quality improving medical changes and being blocked because of petty politics. Believe it or not these people exist in more legislatures than my own and even get elected nationally. There have been years of kicking around alternatives and cost benefit analyses for them, so the current congress and president should have a broad swath of options to consider and discuss.

 

Well, I am in charge of my mother's finances. As I said, she has a limited income. I have to plan for the worst case scenario. 

 

How will allowing insurance companies to cross state lines lower costs? They will all just go to the states where they have the fewest restrictions on how they do business and expose the entire nation to those scenarios. They will figure out how to maximize their profits by minimizing covered services, increasing fees to policy holders and decreasing their operating expenses. 

 

Medicaid expansion hasn't worked. In fact, our Republican governor refused federal funds to do just that in our state. Other states have done the same thing. Our republican legislators, both at the state and federal level, vote for policies that benefit insurance companies. The fact that some of them improve care for patients is secondary. 

 

I never said people want the elderly dying in the streets. That isn't my fear at all. Instead, it's whether or not the medication my mom takes for her TIA's will be covered, or will she eventually stroke and end up unable to feed herself, talk, walk, etc.. I worry about whether or not her pain medication will be covered (it exceeds $300 per month without Medicare Part D "extra help"). Without it, she has pain to the point of crying when she walks. You see, I'm not worrying about some theoretical problem that may or may not ever occur. I am worried about very real, practical concerns. I am worried about my mother.   

 

I agree, there are a broad swath of options to consider. Privatization of Medicare should not be one of them. I don't trust Republicans to do anything that isn't in the best interests of the insurance companies that are lobbying them. 

 

Changes in policy affect real people. It isn't about the people though, it's about profits. If it were about people, this would have been fixed a long time ago. 

[Guest]

They will probably leave Medicare as is with no modifications, which is definitely a possibility given the broad task of reform and complexity set before congress and the next president. Any solution to the fiscal problems of healthcare will have to drive down cost for consumers either through changes to the tax code, service pricing, or market conditions. Whatever we see will address one and likely all of those. If the solutions that improve the the broader consumer pools are also applicable to Medicare I'd expect to see them replicated there, but I really doubt it will be the first area tinkered with, since the ACA succeeded in making bigger healthcare problems than Medicare for the country to tackle first.

 

I'm excited to see what can be come up with.

 

Edited to remove stuff that could be misconstrued as snark.

Edited November 12, 2016 by Arctic Mama

[TechWife]

 since the ACA succeeded in making bigger healthcare problems than Medicare for the country to tackle first.

 

 

 

Yes, and ACA is what provides the "extra help" that pays for my mom's medications. ACA has not been a disaster for everyone - real people had real problems that they are now getting help with whereas they didn't have that help prior to ACA. 

[Lanny]

Congressmen do have staffers to read and dissect these things for them so I am not buying that they did not read it since at the very least their staff read it and advised them on it.

 

Secondly, the Republicans made many, many amendments to the law and helped squash the public option being offered as a choice on the healthcare markets. Let us not forget that the whole mandate thing was a conservative idea supported by republicans until Obama proposed going with it as a conciliatory gesture.

 

Third, I really think using the term entitlement has negative connotations since it implies that folks feel "entitled" to healthcare instead of people actually deserving health care as a human being.

 

My 2 cents.

 

I have always heard that none of the U.S. Senators or Congress persons said that they had read it, or claimed that they had read it, in it's entirety.  Possibly some of them had staffers who actually did that. I hope so! But, Staffers are not elected by the people. Senators and Congress persons are the ones we elect.

 

I believe the term entitlement is ALWAYS the word that is used, by Senators, by Congressmen, by the President, and by the Media, to describe the government programs that are the fastest growing part of the budget of the Federal Government, and which have severe problems within each program. Social Security Retirement, Social Security Disability, Medicare, etc.  They need to be tweaked, but that is the political "kiss of death" for politicians and the vast majority of them do not want to try it. The term "Entitlements" in Washington DC is used for a number of programs that have been in place for many years and it has *nothing* to do with ACA/ObamaCare.  

 

However, the subsidies *must* be included in the Federal Budget. Without the subsidies, the program would collapse even sooner.  As Gruber said, "it only passed because of the stupidity of the American people".  What a horrible thing for him to have said, but it is true, if no Senators and no Congress people actually read the entire 3000 pages before they voted to pass it. 

 

There is IMO a *HUGE* need to provide good health care to everyone. How that will be done and what it will end up  costing remains to be seen. As Bill Clinton said a few weeks ago, about the ACA/ObamaCare, "It's a crazy system. The premiums are doubling and the coverage is being cut in half".  That really doesn't help a lot of people who cannot afford the increasing premiums and the Deductibles, before they have any coverage.

 

VERY COMPLICATED PROBLEMS 

[rebereid]

Unfortunately, I am afraid that they will repeal before taking the time to come up with a real plan of how to replace in order to gain favor with their constituencies so that we will still end up with a bigger mess that will take longer to sort out. If there had been any real details on a workable plan by the GOP (much less the president-elect) to replace it at any point since it was implemented, I haven't heard them.

 

 

I have similar concerns. Actually, Republicans at congress did issue some opinions at the end of June this year. 

 

http://abetterway.speaker.gov/?page=health-care

 

I read the healthcare proposals (it's a 37 page document and you can download the pdf) and am mulling through thoughts on it. I like the emphasis on the parts of ACA that did work, i.e., that pre-existing conditions should always be covered and insurance companies would not be able to turn people away. It's a start at least. It sounds like Reps now understand that that is something no one wants to see go away agin.

[purplejackmama]

Yes, and ACA is what provides the "extra help" that pays for my mom's medications. ACA has not been a disaster for everyone - real people had real problems that they are now getting help with whereas they didn't have that help prior to ACA.

I'm glad your mom was helped. Our premiums have doubled and our deductible almost troubled. My family is struggling. I know from talking to others, we aren't alone.

[Lanny]

I'm glad your mom was helped. Our premiums have doubled and our deductible almost troubled. My family is struggling. I know from talking to others, we aren't alone.

 

Your family is one of the families Bill Clinton was describing, 3 or 4 weeks ago, when he said something like (these are possibly not his exact words or in his original sequence, but it is very close):  "It's a a crazy system. People are having their Premiums doubled and their Coverage cut in half. People are bustin it 60 hours a week".

 

For Bill Clinton to have said that, publicly, before a big crowd, there are probably millions of families in your shoes.  Many millions?

 

I like the idea of Insurance companies being permitted to sell their policies across state lines. However, the COL can vary, wildly, between places in the USA. Things that cost 1X in a low cost COL area (Texas, Florida, etc.) might cost 2 or 3 times that, in a high COL area like California, New York, Washington, DC; Boston, etc.  So, my idea is that the insurance companies could be permitted to sell the same insurance policy in 50 states and in DC, but to adjust the Premiums for each state, to pay for the costs in different areas.   I don't think it would fly for people in low COL areas to pay the same rates as people  in    high COL areas, but that may be the end result.

 

The other option I see is for a Single Payer system run by the U.S. Government, but look at the problems in the V.A. system and they are only trying to cover a small percentage of the U.S. population in their facilities.

 

I've read that Ryan and Trump would like to start with keeping the Pre Existing Coverage exclusion OUT of any new or modified plan, and also they want to keep the provision that allows people up to 26 years of age to be considered children and covered on their parents policies.  Those are 2 very popular features of the ACA/ObamaCare.

 

Programs like Medicare and Medicaid, which so many millions of Americans rely on, have been in financial trouble for many years. Medicare will have severe financial problems in about 10 years? Social Security Disability?   Those programs must be fixed, so they will survive, but it is not "PC" to talk about actually trying to fix them. 

 

These are just the tip of the iceberg of the problems that need to be fixed, for our children and grandchildren to have a good life. Very complex problems.  After that, they can begin to work on the Military, which is getting replacement parts for many aircraft (fixed and rotary wing) from museums, the Infrastructure, and then tackling the National Debt. There are many HUGE problems.  

[ktgrok]

The problem with keeping pre existing conditions coverage is that if you drop the mandate requiring every one have insurance you will have healthy young people skipping it leaving the pool of insured as those who are sicker and more expensive. Which will increase premiums.

[Guest]

The problem with keeping pre existing conditions coverage is that if you drop the mandate requiring every one have insurance you will have healthy young people skipping it leaving the pool of insured as those who are sicker and more expensive. Which will increase premiums.

Yes. A high risk pool, whereby coverage can be obtained but it costs more. That's the likely outcome. Applying specific subsidies and laws governing ceilings on that is probably going to happen if it is maintained, to help control costs. There are three different paths I've seen for managing this.

Edited November 12, 2016 by Arctic Mama

[need2read]

Does anyone have any idea what making insurance companies not for profit or turning them into co-ops would do?

Generally, I'm not big on govt involvement in business but when something like insurance is law, and generally unaffordable to the public, I don't see why we don't force their hand.

 

As a aside...both Trump and Pence have said that coverage for preexisting conditions should continue. Trump also has said that pharmaceutical companies should be taken to task over prices. I don't know if they are blowing smoke. I guess we can only wait and see.

They go out of business. Maine had a non-profit co-op that started right after the ACA took effect. The first year their premiums were ok, the next year they went up a lot and then they stopped taking new customers and eventually closed down because they were not taking in enough to pay out claims.

 

 

Sent from my iPhone using Tapatalk

[NoPlaceLikeHome]

Yes. A high risk pool, whereby coverage can be obtained but it costs more. That's the likely outcome. Applying specific subsidies and laws governing ceilings on that is probably going to happen if it is maintained, to help control costs. There are three different paths I've seen for managing this.

I am unsure what you mean in reference to ceilings. If you are referring to the lifetime caps on how much an insurance company will pay out for a person's care that was outlawed by Obamacare, then I hope they do not repeal that measure since I have taken care of many folks who easily exceeded lifetime caps that used to be in effect frequently prior to Obamacare.

[Guest]

I am unsure what you mean in reference to ceilings. If you are referring to the lifetime caps on how much an insurance company will pay out for a person's care that was outlawed by Obamacare, then I hope they do not repeal that measure since I have taken care of many folks who easily exceeded lifetime caps that used to be in effect frequently prior to Obamacare.

No, the opposite. I was referring to caps on the monthly charge for these individuals whereby subsidies would kick in on a sliding scale so they wouldn't be subject to insurance costs that grew above a certain percent of net income, even if they did go up a bit compared to a low risk pool.

[maize]

Your family is one of the families Bill Clinton was describing, 3 or 4 weeks ago, when he said something like (these are possibly not his exact words or in his original sequence, but it is very close): "It's a a crazy system. People are having their Premiums doubled and their Coverage cut in half. People are bustin it 60 hours a week".

 

For Bill Clinton to have said that, publicly, before a big crowd, there are probably millions of families in your shoes. Many millions?

 

I like the idea of Insurance companies being permitted to sell their policies across state lines. However, the COL can vary, wildly, between places in the USA. Things that cost 1X in a low cost COL area (Texas, Florida, etc.) might cost 2 or 3 times that, in a high COL area like California, New York, Washington, DC; Boston, etc. So, my idea is that the insurance companies could be permitted to sell the same insurance policy in 50 states and in DC, but to adjust the Premiums for each state, to pay for the costs in different areas. I don't think it would fly for people in low COL areas to pay the same rates as people in high COL areas, but that may be the end result.

 

The other option I see is for a Single Payer system run by the U.S. Government, but look at the problems in the V.A. system and they are only trying to cover a small percentage of the U.S. population in their facilities.

 

I've read that Ryan and Trump would like to start with keeping the Pre Existing Coverage exclusion OUT of any new or modified plan, and also they want to keep the provision that allows people up to 26 years of age to be considered children and covered on their parents policies. Those are 2 very popular features of the ACA/ObamaCare.

 

Programs like Medicare and Medicaid, which so many millions of Americans rely on, have been in financial trouble for many years. Medicare will have severe financial problems in about 10 years? Social Security Disability? Those programs must be fixed, so they will survive, but it is not "PC" to talk about actually trying to fix them.

 

These are just the tip of the iceberg of the problems that need to be fixed, for our children and grandchildren to have a good life. Very complex problems. After that, they can begin to work on the Military, which is getting replacement parts for many aircraft (fixed and rotary wing) from museums, the Infrastructure, and then tackling the National Debt. There are many HUGE problems.

Medicare is managed by the government and works fairly well, that is a better example of what single payer could look like than the VA, which is really a different model entirely.

 

Medicare does not, to my knowledge, own or operate facilities of its own.

[TechWife]

Medicare is managed by the government and works fairly well, that is a better example of what single payer could look like than the VA, which is really a different model entirely.

 

Medicare does not, to my knowledge, own or operate facilities of its own.

 

Agree. The VA system is not an example of single payer, it is an organization unlike any other in the nation. 

 

You are correct, Medicare does not own or operate any facilities. 

[Carol in Cal.]

The problem with keeping pre existing conditions coverage is that if you drop the mandate requiring every one have insurance you will have healthy young people skipping it leaving the pool of insured as those who are sicker and more expensive. Which will increase premiums.

AKA the adverse selection death spiral.

But the solution to that is to keep premiums reasonably low, or at least to have a catastrophic care insurance option that is low cost.  Because really, who doesn't want health insurance?  Answer:  No one, but if it's that or rent you do tend to lean toward rent.

[Lanny]

I believe these issues, ACA/ObamaCare, Medicare, etc., are going to get some very serious study and ideas now.  ACA/ObamaCare will collapse, if it is not changed, very soon.  That is probably what the designers of it intended to happen.   One possibility is to change ACA/ObamaCare so it can survive.  Another possibility for them to look at is to put everyone with Pre Existing diseases that are incredibly expensive into a " Very High Risk" pool, and have the government pay for them, to keep the rates and deductibles lower for the people who are not (at this time ) Very High Risk. It will be interesting, to see how it plays out.  Many complex and costly issues.

[Ravin]

If Medicaid covered all children, and anyone under 50 who makes under the median income and either has no employer health insurance benefit or has a pre-existing condition which makes private insurance prohibitively expensive, Medicare covered everyone 50 and over, and VA health care was expanded to all veterans, with a simplified, streamlined "here's my DD2-14" qualification process instead of the mess of hoop jumping we have now, the pool of people left without health care would be quite small.  Most of those left would do just fine with a catastrophic plan and HSA. This is particularly true in places like Arizona where more providers than not accept Medicaid, and Medicare providers are not hard to find.

[QueenCat]

I believe these issues, ACA/ObamaCare, Medicare, etc., are going to get some very serious study and ideas now.  ACA/ObamaCare will collapse, if it is not changed, very soon.  That is probably what the designers of it intended to happen.   One possibility is to change ACA/ObamaCare so it can survive.  Another possibility for them to look at is to put everyone with Pre Existing diseases that are incredibly expensive into a " Very High Risk" pool, and have the government pay for them, to keep the rates and deductibles lower for the people who are not (at this time ) Very High Risk. It will be interesting, to see how it plays out.  Many complex and costly issues.

 

Not all pre-existing conditions need to be lumped high risk though........ I have asthma. I take my meds and have a flair up once every five years BUT was uninsurable for private plans before ACA due to pre-existing conditions. Thankfully, group coverage is not an issue as long as you have continuing coverage. It's crazy for people like me to be considered high risk. Why should I have a super high deductible? Insane.

[QueenCat]

If Medicaid covered all children, and anyone under 50 who makes under the median income and either has no employer health insurance benefit or has a pre-existing condition which makes private insurance prohibitively expensive, Medicare covered everyone 50 and over, and VA health care was expanded to all veterans, with a simplified, streamlined "here's my DD2-14" qualification process instead of the mess of hoop jumping we have now, the pool of people left without health care would be quite small.  Most of those left would do just fine with a catastrophic plan and HSA. This is particularly true in places like Arizona where more providers than not accept Medicaid, and Medicare providers are not hard to find.

 

The veteran in this family would prefer Medicare. No way we'd want the VA to be his coverage.

[mommytobees]

Medicare is managed by the government and works fairly well, that is a better example of what single payer could look like than the VA, which is really a different model entirely.

 

Medicare does not, to my knowledge, own or operate facilities of its own.

 

DOD is a better example and it does work.

 

Are there problems, yes! I got into a nasty fight with the naval hospital in VA when they told me that they wouldn't release a baby without feeding them formula if the mother's milk hadn't come in within 3 days (my milk came in on day 5 with both kids). 

 

But, overall, DOD works. 

 

Kris

[mommytobees]

The veteran in this family would prefer Medicare. No way we'd want the VA to be his coverage.

 

I think comparing Single-payer healthcare system with VA is a bad example. VA has many problems and most of their problems should never have happened. They were allowed to happen due to politics and other issues. 

 

If you look at Tricare and the DOD medical system, you'd see a better pattern of workable solution.

 

Why not expand Medicaid to cover everyone who is a citizen? Period. With no exception. Get rid of the health insurance business for US citizens. Have supplemental plans to cover non-citizens, people in the US covered by visas. 

That isn't going to solve the problem for illegal aliens, who still need healthcare and have to have it, but it will change the dynamics quite a bit.

 

Kris

[purplejackmama]

I think comparing Single-payer healthcare system with VA is a bad example. VA has many problems and most of their problems should never have happened. They were allowed to happen due to politics and other issues.

 

If you look at Tricare and the DOD medical system, you'd see a better pattern of workable solution.

 

Why not expand Medicaid to cover everyone who is a citizen? Period. With no exception. Get rid of the health insurance business for US citizens. Have supplemental plans to cover non-citizens, people in the US covered by visas.

That isn't going to solve the problem for illegal aliens, who still need healthcare and have to have it, but it will change the dynamics quite a bit.

 

Kris

How much does it cost to cover everyone with Medicaid?

[StephanieZ]

I just thought I'd update this since I'd chimed in earlier with my experience as an employer and user of the ACA. 

Recap: Our personal family-of-5 coverage had gone up from 1850/mo last year to 2500+/mo this year. (Yoikes!)

 

We decided to check the "SHOP Exchange" on the ACA. It's a marketplace for very small (under 50 employees) businesses to buy group health insurance. We had wanted to use it from the get-go in 2014, but it wasn't ready on time, so it didn't launch until the following year. As a result, we'd actually cancelled our group health insurance plan at work to allow our staff and ourselves to be eligible for the subsidies on the ACA (and given them raises to cover their premiums). We were very happy with the ACA for 2 years, less so last year with premium increases, and pretty shocked at 2017 pricing (more than double our 2014 pricing . . . )

 

So, anyway, we have launched a SHOP ACA plan for our employees (and ourselves)!!! Our family pricing came down to 1800/mo for a bit better but generally comparable plan as would have been 2500+ on the individual exchange. Our employee pricing is also generally pretty decent. Runs about 350-400/mo per employee, depending on their age/etc. (One over 50 is more like 600/mo)

 

We'll be paying 75% of that (so around 300/mo per employee); the employees 25% (around 90/mo for the 20-somethings, 145 for the 50+ year old). Because we are a (relatively) low wage and tiny employer, our business will get a federal gov't subsidy back of about 45% of the part we pay towards our employee premiums (not our own or our immediate family, though, sensibly).

 

So, that brings our true employer cost down to more around 150-170 per employee (as high as 250 or so for our oldest staff member). 

 

 

Employees could add their dependents to the plan if they choose, at their cost (pre-tax). They can also choose from 3 different "silver level" plans, although there's not a lot of choice in there as they are all the same company. 

 

The plans are very good from the most reputable company in our region. (Freedom to use any provider, small co-pays, moderate deductible, etc, very few exclusions on what they cover for mental health/infertility/etc)

 

So, as a business, after all the tax/etc stuff washes out along with our personal family savings of the reduced premiums, we'll likely be spending maybe an extra 700-800/mo or so to cover the 8 other FT employees, or a bit less if they don't all accept the coverage. Employees are all coming out a good bit better. Most were already covered on ACA plans (I'd walked them all through it 3 years ago.) But the newer employees didn't get walked through signing up for ACA, and at least one is uninsured, so this will be very good for her. Another team member will be happy to have this option to her spouse's work insurance, since that plan (big state employee plan) is going bankrupt in our state and is getting really crappy and expensive. 

 

Using the SHOP exchange was at least 5000 times easier than "olden days" shopping for coverage for a small group. Now, the pricing is purely based on ages and zip codes, that's it! No 10 page medical history forms, no messing up your plan pricing by having one sick or old person. The subsidies make it feasible to offer the insurance without making a big cut in wages. As it is, though, it's still a big added payroll expense, and we'll likely hold wages steady during our annual age review this winter due to that. 

 

You do have a lot of data to put into the system (SSNs, birth dates, hire dates, etc, as well as all that for each dependent), but I think it'll be pretty plug-and-play now that it's all official and launched. 

 

SO, I sure hope the ACA Employer SHOP exchange thing stays put. 

 

Or, just maybe, the "Excellent" "Super" "Fantastic" very, very, very "Great" but thus far super-secret health care plan that will soon be unveiled will be even greater!! Won't that be fabulous!! I just can't wait!!

 

 

 

 

 

 

 

 

 

Edited November 15, 2016 by StephanieZ

[mommytobees]

How much does it cost to cover everyone with Medicaid?

 

That I don't know..... LOL, I can dream, but don't have time to actually research the idea!

 

Kris

[purplejackmama]

That I don't know..... LOL, I can dream, but don't have time to actually research the idea!

 

Kris

Me either :)

[Lanny]

Not all pre-existing conditions need to be lumped high risk though........ I have asthma. I take my meds and have a flair up once every five years BUT was uninsurable for private plans before ACA due to pre-existing conditions. Thankfully, group coverage is not an issue as long as you have continuing coverage. It's crazy for people like me to be considered high risk. Why should I have a super high deductible? Insane.

 

I wouldn't think you would be in the "very high risk" group.  I see those as people with chronic problems that cost in the hundreds of thousands of dollars per year, or millions of dollars per year.

 

Everything I am reading and seeing on the TV news from the USA is that whatever changes are made,  Pre Existing problems will be covered and "children" up to the age of 26 will be covered. Those are very popular with everyone.  

 

I have P.T.S.D. so I would have been excluded from getting insurance,  when "Pre Existing" conditions were excluded.  

[redheadmom]

AKA the adverse selection death spiral.

But the solution to that is to keep premiums reasonably low, or at least to have a catastrophic care insurance option that is low cost. Because really, who doesn't want health insurance? Answer: No one, but if it's that or rent you do tend to lean toward rent.

To answer your question...No I don't want health insurance. I want health care.

 

One of the things I have seen with ACA is that insurance is more affordable, but getting actual health/medical isn't affordable. So you can pay your premium but not have any money to go to the dr.

 

It somewhat defeats the purpose.

[Laura Corin]

Why not expand Medicaid to cover everyone who is a citizen? Period. With no exception. Get rid of the health insurance business for US citizens. Have supplemental plans to cover non-citizens, people in the US covered by visas. 

That isn't going to solve the problem for illegal aliens, who still need healthcare and have to have it, but it will change the dynamics quite a bit.

 

Kris

 

You would probably want to add in a residency requirement for US citizens.  As Minniewannabe demonstrated, otherwise you will get American citizens with little actual connection to the US (and who don't pay taxes in the US due to bi-lateral agreements) who will just get on a plane for the 'free' healthcare.  There are an awful lot of dual US citizens around the world, my sons for example: both have US citizenship but were not born in the US, have never lived there, and their father hasn't lived there in over 20 years.

[Lanny]

You would probably want to add in a residency requirement for US citizens.  As Minniewannabe demonstrated, otherwise you will get American citizens with little actual connection to the US (and who don't pay taxes in the US due to bi-lateral agreements) who will just get on a plane for the 'free' healthcare.  There are an awful lot of dual US citizens around the world, my sons for example: both have US citizenship but were not born in the US, have never lived there, and their father hasn't lived there in over 20 years.

 

I do not believe they would discriminate against people who are U.S. Citizens. That would create two (2) classes of U.S. Citizens.  That would imply that your sons or my DD, when they meet the age requirements, would not be eligible to be President of the United States.  Along the same lines, people who are in the United States legally, as Permanent Residents", would be covered.  I doubt that Illegal Aliens. or people in the USA on temporary Visas (Tourist, Student, etc.) would be covered.   

[Laura Corin]

I do not believe they would discriminate against people who are U.S. Citizens. That would create two (2) classes of U.S. Citizens. That would imply that your sons or my DD, when they meet the age requirements, would not be eligible to be President of the United States. Along the same lines, people who are in the United States legally, as Permanent Residents", would be covered. I doubt that Illegal Aliens. or people in the USA on temporary Visas (Tourist, Student, etc.) would be covered.

I think a new healthcare plan is a bit different from eligibility to be President. Including all the dual citizens who are not resident in healthcare would bankrupt the system in six months.

[chiguirre]

You would probably want to add in a residency requirement for US citizens.  As Minniewannabe demonstrated, otherwise you will get American citizens with little actual connection to the US (and who don't pay taxes in the US due to bi-lateral agreements) who will just get on a plane for the 'free' healthcare.  There are an awful lot of dual US citizens around the world, my sons for example: both have US citizenship but were not born in the US, have never lived there, and their father hasn't lived there in over 20 years.

 

I don't agree. American citizens who live abroad mostly have health insurance where they live. For most issues, good health care is available even in developing countries if you live in a city. It's a pain to get on a plane, stay with relatives or get a short term apartment, be sick where you don't have a support system. I could only see people doing that if the only place they could be treated is in the US. But, those tend to be experimental procedures that aren't covered by our current American health plans (things like cancer drug trials, for example). And, of course, any emergency has to be treated where you are.

 

Would your husband really get on a plane to come to the US where he hasn't lived for 20 years to get a tonsillectomy? first line chemo? hip replacement? Or would he prefer to stay at home in the UK and use the NHS.

 

My personal experience of healthcare in pre-disaster Venezuela is that it was completely fine for routine issues. You would only go to the US for experimental treatment or surgeries that were rare enough that only a global medical center had enough experience to do them. Even if you live in the US, you would probably have to move to access these specialized treatments.

[Laura Corin]

I don't agree. American citizens who live abroad mostly have health insurance where they live. For most issues, good health care is available even in developing countries if you live in a city. It's a pain to get on a plane, stay with relatives or get a short term apartment, be sick where you don't have a support system. I could only see people doing that if the only place they could be treated is in the US. But, those tend to be experimental procedures that aren't covered by our current American health plans (things like cancer drug trials, for example). And, of course, any emergency has to be treated where you are.

 

Would your husband really get on a plane to come to the US where he hasn't lived for 20 years to get a tonsillectomy? first line chemo? hip replacement? Or would he prefer to stay at home in the UK and use the NHS.

 

My personal experience of healthcare in pre-disaster Venezuela is that it was completely fine for routine issues. You would only go to the US for experimental treatment or surgeries that were rare enough that only a global medical center had enough experience to do them. Even if you live in the US, you would probably have to move to access these specialized treatments.

 

I agree that few middle-class expats would get on a plane.  But there are many American (and British) dual citizens who are not in easy circumstances with good access to health care - there would be a strong incentive to get together a plane fare to arrive in the US after a dire diagnosis, rather than suffering at home.

 

[chiguirre]

I agree that few middle-class expats would get on a plane.  But there are many American (and British) dual citizens who are not in easy circumstances with good access to health care - there would be a strong incentive to get together a plane fare to arrive in the US after a dire diagnosis, rather than suffering at home.

 

 

How many people with American passports (and all their tax documentation in order--you have to file every year if you're American) live in poverty in third world countries? They'd be better off scraping up the airfare and moving long before they got sick. I don't know about the UK, are there many people with the right of abode living in poverty abroad?

[mommytobees]

You would probably want to add in a residency requirement for US citizens.  As Minniewannabe demonstrated, otherwise you will get American citizens with little actual connection to the US (and who don't pay taxes in the US due to bi-lateral agreements) who will just get on a plane for the 'free' healthcare.  There are an awful lot of dual US citizens around the world, my sons for example: both have US citizenship but were not born in the US, have never lived there, and their father hasn't lived there in over 20 years.

 

Good point! I'm not exactly sure how Canada/Australia/UK do it, but that's my generic basis. I wrote a paper on the Aussie version several years ago, but didn't focus on WHO gets what.

 

You have to pay into it to get it.

 

 

Off Topic, but are your boys keeping their US citizenship as adults? I thought everyone had to pay taxes to the US? (there was all that hoopla about renouncing US citizenship because of it)

 

Kris

[mommytobees]

I do not believe they would discriminate against people who are U.S. Citizens. That would create two (2) classes of U.S. Citizens.  That would imply that your sons or my DD, when they meet the age requirements, would not be eligible to be President of the United States.  Along the same lines, people who are in the United States legally, as Permanent Residents", would be covered.  I doubt that Illegal Aliens. or people in the USA on temporary Visas (Tourist, Student, etc.) would be covered.   

 

To some degree, illegal aliens and temp visa people would have to get healthcare. We don't have the ocean of cushion that Oz has, I'm not sure how Canada does it or the UK, but with Mexico to the south of us and all of South America, we do NOT want unvaccinated children here in the US. (Now, I'm trying to tread carefully and not step into immigration politics--where I am NOT a Trump supporter.....) We have illegal aliens and I don't think that is going to change much. We do NOT want to have unvaccinated and not-treated (TB, HIV, a number of others...) illegal aliens living amongst us.

 

We are already paying for this....and I pray that Trump isn't able to change that. THAT would be a healthcare nightmare.

 

Kris

[StephanieZ]

I do not believe they would discriminate against people who are U.S. Citizens. That would create two (2) classes of U.S. Citizens.  That would imply that your sons or my DD, when they meet the age requirements, would not be eligible to be President of the United States.  Along the same lines, people who are in the United States legally, as Permanent Residents", would be covered.  I doubt that Illegal Aliens. or people in the USA on temporary Visas (Tourist, Student, etc.) would be covered.   

 

FYI, your kids ARE eligible to be President.

 

The "natural born citizen" phrase means that, at the time of their birth, they were born into automatic citizenship. Thus, any child born to a US citizen abroad (or in Hawaii) is a "natural born citizen". This is a nearly universal agreement among constitutional scholars. 

 

See: Ted Cruz. Born in Canada. 

 

And, yes, indeed, this means all that craziness about where Obama was born was *always* irrelevant.

 

Are you shocked? Yes, I was, too. 

[maize]

FYI, your kids ARE eligible to be President.

 

The "natural born citizen" phrase means that, at the time of their birth, they were born into automatic citizenship. Thus, any child born to a US citizen abroad (or in Hawaii) is a "natural born citizen". This is a nearly universal agreement among constitutional scholars.

 

See: Ted Cruz. Born in Canada.

 

And, yes, indeed, this means all that craziness about where Obama was born was *always* irrelevant.

 

Are you shocked? Yes, I was, too.

I think Lanny knows this, he was concerned that creating two types of citizens (with residents being eligible for health care and non residents not eligible) could translate to wider differentiation between resident and non-resident citizens.

 

ETA I don't think this fear is justified, I think if a resident requirement were implemented for healthcare access it would not impact other established citizen right.

Edited November 15, 2016 by maize

[Ravin]

I think comparing Single-payer healthcare system with VA is a bad example. VA has many problems and most of their problems should never have happened. They were allowed to happen due to politics and other issues. 

 

If you look at Tricare and the DOD medical system, you'd see a better pattern of workable solution.

 

Why not expand Medicaid to cover everyone who is a citizen? Period. With no exception. Get rid of the health insurance business for US citizens. Have supplemental plans to cover non-citizens, people in the US covered by visas. 

That isn't going to solve the problem for illegal aliens, who still need healthcare and have to have it, but it will change the dynamics quite a bit.

 

Kris

 

One of the problems with Medicaid is that it varies DRASTICALLY from state to state. From personal and family experience, Arizona is pretty great. Texas, not so much.

[maize]

One of the problems with Medicaid is that it varies DRASTICALLY from state to state. From personal and family experience, Arizona is pretty great. Texas, not so much.

This is one of the difficulties with fixing the healthcare system in the US--as I understand things, it is states that currently hold most of the regulatory and administrative power in this domain.

[Ravin]

As far as the undocumented and vaccinations goes, limit coverage for noncitizen adults to basic public health and emergency care--vaccinations, STD treatment, other contagious illness etc.. Basically, to stabilize emergency cases and to protect the public at large. Probably also maternity care if the mother is going to give birth here, because the baby will be a citizen and deserves a decent start in life.

 

Children should get basic healthcare coverage whether documented or not.

 

Of course, my inclination would be to throw out the whole immigration system and start from scratch, too, so...

[maize]

From a humane perspective, I could never justify refusing healthcare to anyone regardless of immigration status.

[mommytobees]

One of the problems with Medicaid is that it varies DRASTICALLY from state to state. From personal and family experience, Arizona is pretty great. Texas, not so much.

 

That is SO true. I think I'm more Federalizing what we have NOT making it state run. Medicaid is an example because it is already in place...but not really what I would want to use (because of the state issues). Honestly, I'd like to just take Tricare/CHAMPUS (NOT the currently run individual regions), but the overall plan and expand that to everyone....but most people don't even know _what_ I'm talking about let alone know the details.

 

Kris