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Old 08-20-2015, 05:27 PM   #61
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I am not sure I follow this concern. Its all about creating unfettered competition across all state lines, and no states should be able to regulate more or less than any other.
As I mentioned in an earlier post, even in a country like Canada that has universal health care each province has a different set of coverages, requirements, etc... Why don't they all agree on a common set of rules and regulations and pricing?

A place to start would be to study what other countries have done, and the reasons they did it. I suspect that when we dig down and understand all the nuances, we will see that it is not so simple. The devil is always in the detail.
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Old 08-20-2015, 05:37 PM   #62
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The ACA, imperfect as it is, is a big step in the right direction. What's proposed by those wanting to repeal it strikes me as a huge step backwards. By the time 2017 rolls around, people won't stand for its replacement by something inferior and I think the politicians know that. What we're seeing now is a lot of blather to get primary votes - nothing more.

I would add that at the rate we're going with mergers in the insurance industry, we may end up with single payer anyway!
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Old 08-20-2015, 06:25 PM   #63
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The problem is that healthcare in the U.S. is treated like any other commodity. We are witnessing the same approach now in public education and to varying degrees, other municipal services like water & public safety.
Can you elaborate on how you think it should be treated?
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Old 08-20-2015, 09:36 PM   #64
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Blather for votes...that about sums it up. Talk is cheap.
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Old 08-21-2015, 08:46 AM   #65
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Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.
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Old 08-21-2015, 08:52 AM   #66
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Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.
You're missing at least one HUGE difference and while DW and I could pass medical underwriting, I would object to their plan as a matter of principle.

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Of course, tax credits won't do much good for people if they can't get coverage because they have cancer or a disability. Obamacare, of course, outright bans insurers from discriminating against people with pre-existing conditions, then makes it up to the companies by requiring every American to get insured, which gives them more healthy (and profitable) customers. Rubio, Walker, and other Republicans would eliminate those rules.
(emphasis added)

Bringing back pre-existing conditions is a dealbreaker in my mind.
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Old 08-21-2015, 08:56 AM   #67
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Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.
Doing away with the individual mandate is a HUGE difference. Without it, younger, healthier people will opt out of buying insurance and cause premiums to rise. Or, they will become free riders who don't buy insurance until they get sick, another bad outcome.
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Old 08-21-2015, 09:03 AM   #68
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Perhaps I am not seeing the difference here between ACA (ObamaCare) and this new GOP proposal. Instead of being required to buy insurance and getting a subsidy if your income is low, you would be able to buy insurance from any state and get a voucher that would be more if your income is low.

What is the difference? Is it that there is no requirement to buy the insurance? Does it do away with the minimum coverages and/or limits on medical underwriting? This seems at most a minimal cosmetic change unless there are other big differences not described.
His plan is not a minimal change at all.
Gives a tax credit based on age alone, without consideration of income or resources:
0-17 $900
18-34 $1,200
35-49 $2,100
50-64 $3,000
Brings back consideration of pre-existing conditions, deletes Medicaid expansion, reopens the Medicare donut hole problem, creates high risk pools, removes requirement for insurance which will drive premiums up, children under 26 no longer able to stay on the parents plan, "lawsuit reform" deprives those injured from getting just compensation.
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Old 08-21-2015, 09:58 AM   #69
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That would be great if that was so. But, it isn't so... at least it hasn't been in most of the across state lines proposals that have been made.

Sure, if every state had to regulate insurance companies the same as others then competition across state lines would be fine (in my opinion).

But, in the actual real world, they don't have to do so. States actually do vary tremendously in their regulations of insurers and in how they handle things like rate increases or other consumer protections. Simply allowing insurers to compete across state lines does not change that.

So, in the actual real world, it would be like what happened with credit card companies. A race by some states to regulate the least so as to bring more insurers to that state.

I agree this could be fixed by having minimum standards that would have to be met...but that isn't what is being proposed.
Of course that situation does not exist today, but I thought this post was about coming up with alternatives. That would be the best case solution from my perspective.
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Old 08-21-2015, 09:58 AM   #70
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Can you elaborate on how you think it should be treated?
IMO, access to routine, quality healthcare should be treated as a basic human right and not based predominately upon a person's ability to pay.
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Old 08-21-2015, 10:02 AM   #71
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IMO, access to routine, quality healthcare should be treated as a basic human right and not based predominately upon a person's ability to pay.
I don't see that in the bill of rights
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Old 08-21-2015, 10:12 AM   #72
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Best to stay on topic, which is about specific proposals to replace the ACA.
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Old 08-21-2015, 10:18 AM   #73
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Best to stay on topic, which is about specific proposals to replace the ACA.
agreed - I'm interested in what they are going to do with the 40% "Cadillac" tax - which is the primary funding mechanism for the ACA

also, ACA reporting is about to hit employers and will be particularly onerous for them

these two things could push major legislation
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Old 08-21-2015, 10:32 AM   #74
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To clarify, the thread topic is current proposals that have been made and, if enacted, will impact us. The discussion - how these might affect us and what options we have - is interesting and relevant.

There have been many previous threads on what we dislike about the ACA. Most lead to the type of heated discussion that is not related to FIRE or our forum, so let's please stay away from that.
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Beginning of a GOP alternative to Obamacare?
Old 08-21-2015, 10:56 AM   #75
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Beginning of a GOP alternative to Obamacare?

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agreed - I'm interested in what they are going to do with the 40% "Cadillac" tax - which is the primary funding mechanism for the ACA

also, ACA reporting is about to hit employers and will be particularly onerous for them

these two things could push major legislation
Editing to add: I know this not on topic. I just wanted to share what my employer is doing to avoid the Cadillac tax due to ACA, which I thought might be interesting to others. No responses necessary.

I'm not sure this is true. My employer is going from an HRA to an HSA next year - which I'm happy about - in order to avoid the "Cadillac" tax.

I would assume this would be true for most employers. I'm skeptical many will pay the additional tax, since human nature indicates we are all well conditioned to minimize our taxes. Companies aren't exempt from that condition.
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Old 08-21-2015, 11:25 AM   #76
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Of course that situation does not exist today, but I thought this post was about coming up with alternatives. That would be the best case solution from my perspective.
Well, we were discussing the specific alternatives suggested. Those alternatives that let insurers sell across state lines don't set up minimum regulatory standards. That is the point. They allow exactly the problem situation...insurers running to the state with the least regulation.
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Old 08-21-2015, 11:55 AM   #77
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Those alternatives that let insurers sell across state lines don't set up minimum regulatory standards. That is the point.
It is (part) of the point.

One problem with "minimum regulatory standards" is that they grow and grow over time (rarely going down).

And one big reason they grow is that interest groups (they're all "special") have a incentive to get get their treatments into the minimum standard. Everyone should have dental - says the dentist. Then the orthodontists make their case and get their services included. Same with chiropractors, acupuncturists, herbalists, homeopathy, and on and on. This is a form of regulatory capture where the various provides are have huge interest in getting their noses under then tent.

And while there's some case for each incremental "improvement" to the standard, after a while, costs end up higher than we can really afford.
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Old 08-21-2015, 12:00 PM   #78
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Well, we were discussing the specific alternatives suggested.
Sorry, I didn't realize we had to stick just to Walker/Rubio proposals. Thanks for being a moderator
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Old 08-21-2015, 12:13 PM   #79
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Sorry, I didn't realize we had to stick just to Walker/Rubio proposals. Thanks for being a moderator
Sorry. Not trying to be a moderator. "We" was an inartful meant to refer to
what I thought was what you and I were discussing which was the current proposals that had been made. I think that you and I are in agreement that selling across state laws with consistent regulations could be workable.

mpeirce -- yes I agree that regulatory standards can be problematical. At the same time, having no minimum standards ends up with every insurer wanting to go to the state with the least regulation where they can raise rates with impunity and there are no consumer protections. I am on view that the "cure" for the problems of bad regulation isn't no regulation. It is better regulation.
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Old 08-21-2015, 12:38 PM   #80
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mpeirce -- yes I agree that regulatory standards can be problematical. At the same time, having no minimum standards ends up with every insurer wanting to go to the state with the least regulation where they can raise rates with impunity and there are no consumer protections. I am on view that the "cure" for the problems of bad regulation isn't no regulation. It is better regulation.
Keeping on topic, Rubio's proposal allows states to opt out of the existing mandates.

That coupled with cross state insurance means some will have relaxed standards, while others won't. Then people can choose which plans from which states they want.

The system would then benefit from market feedback on what bundles of coverage people actually value and are willing or not willing to pay for. That seems better than some "smart person" in Washington telling us all what is best for us.
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