New Health Care Bill

[ERD50]

Quote:

Originally Posted by Ronstar Posts shown above as removed have been removed ....

What does that mean? I don't see any 'posts shown as removed'? I'm guessing that 'removed' is only visible to mod/admins?

-ERD50

[Ronstar]

Quote:

Originally Posted by ERD50 What does that mean? I don't see any 'posts shown as removed'? I'm guessing that 'removed' is only visible to mod/admins? -ERD50

Yes. I've edited my post to make more sense. The point of my post was to notify members that posts containing partisan political comments have been removed, and that our Community Rules prohibit such comments.

We realize that the AHCA is extremely fluid at this point and that don't know what the final product will look like. The mod team has closed past threads where discussions were based on speculation.

However, there is no excuse for partisan political commentary. It's listed as one of the violations in our Community Rules, and posts containing such comments will be deleted since they frequently lead to arguments, personal attacks, and a slew of off-topic comments.

[Fermion]

Is it reasonable to discuss the options we might have available if nothing is done (congress just moves on to other things). It looks to me like that could be a possibility.

The penalty for being uninsured has been removed already right? Does that mean the whole system will still collapse eventually even if it is not repealed and replaced?

I actually don't know how the collapse would work. Here in Washington state we have a couple of counties that do not have any insurance providers signed up for 2018. I think recently they negotiated Premiera Blue Cross to service one of the counties but the other is still up in the air.

[Ronstar]

Quote:

Originally Posted by Fermion Is it reasonable to discuss the options we might have available if nothing is done (congress just moves on to other things). It looks to me like that could be a possibility. The penalty for being uninsured has been removed already right? Does that mean the whole system will still collapse eventually even if it is not repealed and replaced? I actually don't know how the collapse would work. Here in Washington state we have a couple of counties that do not have any insurance providers signed up for 2018. I think recently they negotiated Premiera Blue Cross to service one of the counties but the other is still up in the air.

I think the mod team would find it reasonable to discuss options available if nothing is done - as long as there are no partisan political comments, and as long as the options being discussed aren't based on wild speculation. Keep in mind that some prior threads have been closed when posts started veering toward speculation.

[NomDeER]

Quote:

Originally Posted by Fermion The penalty for being uninsured has been removed already right? Does that mean the whole system will still collapse eventually even if it is not repealed and replaced?

Insurance is still mandated and the law requires a penalty. But Trump has indicated that he may not enforce the penalty. So, there may be fewer healthy people buying insurance. But, the more pressing issue is whether certain subsidies will continue to be funded. There are continued threats to cut off those subsidies. Without a guarantee that the government will pay the insurance companies the promised subsidies, some insurance companies will not offer plans next year. This is probably a bigger concern in areas with more lower-wage workers who aren't on Medicaid, but need the subsidies to use their insurance from the exchanges.

The Senate bill would remove the mandate. I think it will be difficult to make a system work well without a mandate. Especially if the premiums and deductibles would go up and the amount of coverage and the subsidies would go down. (That would be the case for most early retirees under the Senate bill and for many others as well.) A lot of people were complaining about the deductibles and premiums for the bronze plans under the ACA when they actually were receiving essential health benefits. Paying more for less care is not likely to be more popular or more feasible. But, even if there are a lot less people buying insurance, that doesn't mean the exchanges will completely collapse.

But, with Medicaid cuts, it seems that the Senate bill is likely to make it more difficult for people to find insurance and medical care in some areas. When uninsured people go to the ER for medical care, some of those costs get passed on to insured people in the form of premiums. And in poorer, less populated areas, there are fewer paying patients to support a hospital. That's one of the concerns expressed by some Senators from states with more poor people and rural areas.

[candrew]

Quote:

Originally Posted by Ronstar and as long as the options being discussed aren't based on wild speculation.

Here are the facts absent any speculation. All of us pay taxes in one form or another and all of us will eventually die.

When it comes to the dying part, just make sure to do it quickly.

[explanade]

KFF released a report with some astounding premiumnumbers on the Senate bill:

Quote:

On average, Americans between ages 55 and 64 would see a 115 percent increase, more than double their premiums under Obamacare, to buy a comparable plan. Americans with incomes under 200 percent of the federal poverty line (about $24,000 for individuals) would see 177 percent increases in premiums versus just 57 percent for people with higher incomes. The changes, by contrast, would be less sweeping for younger and higher-income customers. Those 18 to 34 years old with incomes over 200 percent of the federal poverty line would see no increase at all in their premiums, according to the report. But those below 200 percent of the federal poverty line would still see increases of 82 percent if they decided to keep a similarly comprehensive plan. The worst hit would be customers who are both 55-64 and have lower incomes: Their premiums would go up by 294 percent, almost a fourfold increase.

74 Percent. Your Health Care Premium Could Go Up That Much - NBC News

[NomDeER]

Quote:

Originally Posted by explanade KFF released a report with some astounding premiumnumbers on the Senate bill: 74 Percent. Your Health Care Premium Could Go Up That Much - NBC News

This is what makes it impossible for me to say I'm going to ER this year. I think I could do it under the current law. But, if the Senate bill becomes law, I don't think ER is a realistic possibility for me. It's stressful. Not knowing what is going to happen with health insurance is genuinely bad for my health.

[samclem]

A significant limitation in both the CBO and KFF numbers: The are treating the Senate plan as a standalone entity (which is all that they can do). The proponents of the Senate plan (like the House plan before it) make clear that this is the first of multiple steps--it is all that can be accomplished >under the reconciliation rules<. It is part one. Under reconcilliation it is not possible to accomplish many of the reforms that will reduce underlying health care costs which are the true driver of higher premiums.

"What are you doing?"
"I'm jacking up the car to change our tire. It's flat."
'"But now things are worse than before! We can't move at all with that jack under there. At least before we could crunch along slowly on the rim."
"That wouldn't have been possible for much longer. When I get the new tire and wheel on, things will be much better."
"Better! All my studies show me that jacking up the car will make us go slower."
"That's true, but ultimately irrelevant."

[MBSC]

Quote:

Originally Posted by Fermion Here in Washington state we have a couple of counties that do not have any insurance providers signed up for 2018. I think recently they negotiated Premiera Blue Cross to service one of the counties but the other is still up in the air.

Both counties now have plans for 2018.

Quote:

Molina and BridgeSpan will offer plans inside the Exchange, Washington Healthplanfinder, ensuring that people who buy their own health insurance in Klickitat County can get premium subsidies, if they qualify. BridgeSpan also will offer plans outside of the Exchange in Klickitat County. Last week, we announced that Premera Blue Cross (Premera) would remain in Grays Harbor County, selling plans inside the Exchange. I’m very grateful to Molina, BridgeSpan and Premera for the work they did to re-evaluate their coverage areas and for thinking seriously about the impact these decisions would have on consumers. Every county needs coverage and today, we have that. Reference: Klickitat County will have two insurers in 2018 - State of Reform | State of Reform

[Gumby]

I have read about flaws in the CBO scoring methodology, but I'm not sure that is an absolute bar to using their results. Even a flawed methodology, so long as it is consistent, can show the relative benefits of two different bills. It is the same as unemployment numbers; it doesn't matter if you think U3 or U6 is the proper number to use, it is the trend of both of them over time that is more important.

At least, that's how it looks from here. I could easily be wrong.

[scrabbler1]

The individual mandate is the "price" we as a society pay so that the exclusion for pre-existing conditions can be eliminated. Otherwise, the healthy people opt out while premiums and/or deductible+copays rise for everyone else (read: sicker people).


Back in my days working in the actuarial field (auto insurance), I worked on several pricings of state law changes which strengthened the mandate to buy auto insurance. From my research back then, I saw that states which implemented more effective measures such as (a) linking insurance cancelation reports with the state DMVs, and (b) the requirement to show proof of insurance when pulled over by the cops for any reason, not just after an accident, were able to reduce the uninsured motorists populations (which reduced UM rates) much more than relatively ineffective measures.


The more effective the individual mandate, the more people will buy HI and avoid the unwanted outcomes such as "free riders" and adverse selection. Repealing or even weakening the individual mandate just because "people don't like it" is terrible policy.

[MichaelB]

Quote:

Originally Posted by Gumby I have read about flaws in the CBO scoring methodology, but I'm not sure that is an absolute bar to using their results. Even a flawed methodology, so long as it is consistent, can show the relative benefits of two different bills. It is the same as unemployment numbers; it doesn't matter if you think U3 or U6 is the proper number to use, it is the trend of both of them over time that is more important. At least, that's how it looks from here. I could easily be wrong.

To quote George E. P. Box, “Essentially, all models are wrong, but some are useful”.

The challenge to the CBO estimates is a red herring. Their modeling assumptions and methodology are plainly described for all to see, but what is being challenged are the conclusions.

There is no credible alternate source of analysis. What would be helpful would be an explanation of what specifically is flawed about the CBO methodology. So far there has been no case to be found that shows a different course and outcome for either of these two bills.

Getting back to the bill itself. It makes sense to assume there will be a significant reduction in people with comprehensive insurance coverage, because funding is reduced, across the board. If the insurance companies are not required to offer guaranteed access to comprehensive coverage, people will be left out. If the price for coverage varies more due to age or health, some will try to game the system while others fall out. If one objective of the bill is to reduce price of insurance without touching the cost, there is no other way than to exclude the more costly users. This is what these bills are designed do.

Quote:

Originally Posted by samclem A significant limitation in both the CBO and KFF numbers: The are treating the Senate plan as a standalone entity (which is all that they can do).

That’s right. It’s the only thing CBO and KFF should consider. Same for us. Nothing else matters until it makes that big step from someone’s idea to likely law.

[ERD50]

Quote:

Originally Posted by Gumby I have read about flaws in the CBO scoring methodology, but I'm not sure that is an absolute bar to using their results. Even a flawed methodology, so long as it is consistent, can show the relative benefits of two different bills. It is the same as unemployment numbers; it doesn't matter if you think U3 or U6 is the proper number to use, it is the trend of both of them over time that is more important. At least, that's how it looks from here. I could easily be wrong.

I think that view could make sense if it was also something consistent being analyzed (like your unemployment example). But the CBO gets different bills to evaluate, each with different conditions. So we don't have an opportunity to characterize and adjust for any systemic errors; the errors could vary in amount and direction with each new bill.

IIRC, they are only allowed to look out 10 years, and I think the ACA was written such that it started bringing in revenue for three years before most of the expenditures were being made. So the CBO had to evaluate it for 7 years expenses on 10 years earnings, which would not be the case on-going. That's not really valid, but it is what they are required to do (and I meant this as a general example, it's possible my numbers are off specifically, but that's the point I was trying to make).

edit to clarify: From the above, I'm not saying the CBO #'s should be ignored are are not of some value, I'm just saying the 'consistency' argument doesn't seem to hold.

-ERD50

[HGTVfan]

The thing I am looking at in both the Senate and House versions of the bill is that older people will pay up to 5x what younger people pay (compared to 3x today).

Although I believe that most parts of the Senate and House versions would not take effect until 2020, I wonder about the 5x change. Does anyone know?

I will be on Medicare (thankfully) in late 2019 so I'm just wondering if the 5x provision is proposed to be in effect in 2018 and 2019.

[ShokWaveRider]

I am not sure why the ACA cannot be updated and/or Fixed/Renamed AHCA. Call it a Repeal if you like to make people happy. It would make life so much easier.

[ivinsfan]

I'm disheartened by the fact that all these projections seem to assume that the cost of HI will just continue on an endless upward spiral, that's what making the number of potential uninsured so large. If HI costs your entire income and then some, you won't have HI, that's a given. Giving someone health insurance provided by the government because no one can individually afford it doesn't seem sustainable in the long run.

It just seems hopeless when the consumer is just supposed to pay more every year and the insurance and providers aren't held to a standard of controlling costs.

[Blue Collar Guy]

I never remember hearing years ago so much about health insurance. Now I hear about it everyday. I used to hear about nuclear threats, inflation, crime in the cities. Everyday its the leading story. Its almost like a fascination. I for one have tuned it out for the most part. When things get finalized, I will see where I fit in the master plan. Maybe I will pay more, maybe I will pay less, maybe I wont have any coverage. We made it this far, Ill manage to finish this game of life somehow, no matter what the latest mandate is.

[LARS]

A long (very) analysis of CBO report on Senate Bill. I post link only for those that want to delve deeper into the weeds and have the free time to indulge their angst on the topic...


Reading the CBO Report on the Better Health Care Reconciliation Act (BCRA) | naked capitalism

[explanade]

Here's an explanation of CBO scoring:

Data Dive: Republican healthcare plan, by the numbers | Reuters

Defenders of the bills are saying this is just one part of their health care plan. HHS is promising that in their rule making, they will make things better. First they reject the CBO conclusions but in any event, they will use the executive branch to implement the laws for better results.

Or something like that.