New Health Care Bill

[kannon]

Hello All -

I have been trying to digest the 49 page CBO report on the Senate Healthcare Bill.

For those of us with Medicare rapidly coming up and currently on group policy from our employer, will we see changes in our premiums? deductibles?

For us FIREs I suspect accessibility to health insurance is not an issue, the question now is affordability.

Thanks

Kannon

 

[MichaelB]

The thread was moved to the "Health and ER" forum, where all the other discussions on law have taken place.

For reference, here's the CBO analysis https://www.cbo.gov/publication/52849 and here is the ammended version of the Senate bill (updated 6/26) https://www.budget.senate.gov/imo/media/doc/BetterCareReconcilistionAct.6.26.17.pdf

 

[LRDave]

The last time we tried to discuss this, Porky kilt it. So we best be behavin'......

 

[FIREmenow]

Consider the accuracy of past CBO reports before putting all you faith in that.

With the Senate bill, it has been said elsewhere that premiums will continue to go up for 1-2 years and then drop dramatically.

 

[ShokWaveRider]

It is getting better, but still does not take the biscuits. From our perspective, the Subsidies will still be in place for 2018 and maybe 2019.

But the problem is not solved. I feel for the Medicaid folks and am glad I am not one of them...... at least not yet.

But I do fall into the Subsidies and cost sharing & recipient category. I personally do not think it will work without a mandate. Whether it will pass.... eventually or not is a different story.

There is a lot of talk about letting the states make the decisions. That did not do too well in FLA. They did not expand Medicaid.

The States cannot run deficits, so why would they on their own accord offer better HC to the masses. It needs to be mandated IMHO.

They kicked the ball till after the 4th. I am sure I will get a heart attack from the stress alone by all this waiting and uncertainty. (Tongue in cheek).

How do you think the Insurance companies feel?

 

[MichaelB]

The Senate bill was amended, I linked the new bill in my previous post. There are two changes. One affects the use of stability fund resources, the other allows insurers to impose up to a 6 month waiting period when there is a lapse in continuous coverage.

This post by Timothe Jost at Health Affairs Blog explains in greater detail. http://healthaffairs.org/blog/2017/...ting-period-for-those-who-let-coverage-lapse/

 

[Blue Collar Guy]

I made it through page 1 line 11, I read it twice. Ill wait for it to be republished in words and sentences that i understand.

 

[samclem]

Consider the accuracy of past CBO reports before putting all your faith in that.

+1. There's a good piece on the CBO's unwarranted fascination/faith in the existing mandate here. In a nutshell, the CBO estimates of the future numbers of uninsured in various ACA alternatives appears to be largely unchanged even when varying amounts of subsidies are provided to the poor. Conversely, the CBO appears to be a big believer in the mandates as presently structured, despite the growing evidence that it isn't very effective (and will grow less effective if no change is made to the ACA and premiums continue to rise, increasing the relative financial reward for not buying insurance).

 

[MichaelB]

That didn't take long.

The value of the CBO is not only the projection, it's the framework and methodology they use to analyze proposed legislation, which is applied consistently. It is pointless to discuss only the accuracy of prediction itself and not the identification of key trends and overall impact.

Which alternate source of analysis exists that more accurately projected the trends, impact and enrollment levels of the ACA and is available for either of the bills we have now (House or Senate)?

 

[travelover]

...........Which alternate source of analysis exists that more accurately projected the trends, impact and enrollment levels of the ACA and is available for either of the bills we have now (House or Senate)?

This is the part that confuses me. I can't imagine writing a bill that would affect so many people without a thorough analysis subject to cross examination by experts in all related fields (insurers, providers, experts in global healthcare systems, etc.)

 

[samclem]

That didn't take long.

"What do we do all day?" indeed!

The value of the CBO is not only the projection, it's the framework and methodology they use to analyze proposed legislation, which is applied consistently. It is pointless to discuss only the accuracy of prediction itself and not the identification of key trends and overall impact.

The CBO framework may be consistent, but does it produce valid estimates? In 2013, the CBO predicted there would be 25 million Americans on the Marketplace exchanges by 2017. The real number is 9.5 million. That's well beyond a small rounding error. Their consistent methodology, apparently, stinks. Anyway, can we see this framework that produces these numbers? I'll dig a bit, but I haven't seen details of the method by which they predict if Jim and Sally are going to choose to be insured or just pay the fine. Regardless, we know the fine is staying stable while insurance premiums continue their rapid climb, so we know more Jims and Sallies will be incented to roll the dice if nothing changes.

Which alternate source of analysis exists that more accurately projected the trends, impact and enrollment levels of the ACA and is available for either of the bills we have now (House or Senate)?

A million monkeys throwing darts . . . one will have gotten the right number.

I think one promising way to get real data on what works, how real people react to actual incentives, what unintended consequences await, how to get the discussion moved to reducing health care costs (the real issue, IMO) rather than just accepting terrific price increases that result from throwing money at any problem, etc is to let states have some latitude to try varying approaches. What Texas tries won't match what Massachusetts tries, but 1) each will be a response to local constituents and 2) each state can benefit from the experiences of others. After a bit of turbulence (probably no worse than we just experienced based on the "here it is" plan that was rolled out from on high), we'll have something based on a lot of real data.

 

[explanade]

Both bills would remove about $1 trillion in funding over 10 years and that trillion dollars would go to tax cuts for the highest income households.

Are the projections of millions of fewer people being covered, for whatever reason, really that surprising with less funding?

It wouldn't be just people on Medicaid who would be affected. Subsidies are less, both from direct subsidies to people buying insurance and also the cost sharing payments given to insurers in certain markets.

The people who support these bills should defend their positions, i.e. that govt. shouldn't be paying for health care or what some people call a "new entitlement" instead of blaming the messenger, in this case the CBO, for forecasting that cutting spending on Medicaid and other programs will reduce the numbers of people covered.

[mod edit]

 

[samclem]

This is the part that confuses me. I can't imagine writing a bill that would affect so many people without a thorough analysis subject to cross examination by experts in all related fields (insurers, providers, experts in global healthcare systems, etc.)

I'd >guess< the best analysis would come from the insurance companies--they've certainly got a lot riding on the outcome and know something about risks., costs, and the effects of pricing. But, obviously, many of them guessed wrong on the ACA, too (and, to be fair, the "truth changed" regarding the risk corridors, enforcement of the mandate, etc along the way. It's probably too much to ask them to also forecast those items that occurred in the courts and the halls of DC).

 

[explanade]

I'd >guess< the best analysis would come from the insurance companies--they've certainly got a lot riding on the outcome and know something about risks., costs, and the effects of pricing. But, obviously, many of them guessed wrong on the ACA, too (and, to be fair, the "truth changed" regarding the risk corridors, enforcement of the mandate, etc along the way. It's probably too much to ask them to also forecast those items that occurred in the courts and the halls of DC).

Most of them are not losing money. In fact the claim that the insurers are abandoning the exchanges is not true:

https://www.vox.com/health-care/2017/6/23/15856322/republicans-marketplaces-collapse-repeal

Of course some insurers like Aetna withdrew out of some exchanges because a merger was denied.

Do they want the ACA replaced with one of these plans? Maybe, though they will have fewer people enrolled if they pass one of these bills.

 

[explanade]

Side by side comparison of the ACA, the House bill and the Senate bill on various different categories:

https://www.axios.com/how-the-gop-health-bills-would-change-obamacare-2449051356.html

 

[samclem]

The people who support these bills should defend their positions, i.e. that govt. shouldn't be paying for health care or what some people call a "new entitlement" instead of blaming the messenger, in this case the CBO, for forecasting that cutting spending on Medicaid and other programs will reduce the numbers of people covered.

I'm not blaming "the messenger." I'm blaming "the analysts" at CBO for producing bogus, inaccurate analysis in the past. And, by extension, I'm wondering why anyone places much faith in their recent work. Fool us once . . .
You believe that cutting health insurance subsidies for the poor will have a big impact on the number of poor who buy insurance. That might be true. But, the CBO disagrees with you, they think it hardly matters at all. Per their recent estimates, a bill which spends $616 billion additional in subsidies and assistance to get low income people covered by insurance will result in zero additional coverage for that extra money. More here. (previously posted link)

Now, don't shoot the messenger.

 

[Ronstar]

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[explanade]

I'm not blaming "the messenger." I'm blaming "the analysts" at CBO for producing bogus, inaccurate analysis in the past. And, by extension, I'm wondering why anyone places much faith in their recent work. Fool us once . . .
You believe that cutting health insurance subsidies for the poor will have a big impact on the number of poor who buy insurance. That might be true. But, the CBO disagrees with you, they think it hardly matters at all. Per their recent estimates, a bill which spends $616 billion additional in subsidies and assistance to get low income people covered by insurance will result in zero additional coverage for that extra money. More here. (previously posted link)

Now, don't shoot the messenger.

I can't open that link.

Is Forbes a neutral source? Malcolm Forbes Jr. isn't exactly impartial on health care or a lot of other policies.

Is the CBO still staffed by the same people whom you claim made "bogus" analysis in the past?

 

[samclem]

I can't open that link.

Is Forbes a neutral source? Malcolm Forbes Jr. isn't exactly impartial on health care or a lot of other policies.

If you'd rather read the article than criticize Malcom Forbes, you can try to Googify "CBO Predictions About The Senate Health Care Bill Are Deeply Flawed" "Forbes" and "Avik Roy."

The Forbes article quotes the CBO spending numbers for each bill and the CBO estimate of the uninsured for each bill. I'm sure there's some room for interpretation when "counting" for each category, but the numbers are from the CBO (with links to their reports), not something Malcom Forbes wrote on a napkin.

Is the CBO still staffed by the same people whom you claim made "bogus" analysis in the past?

What is this? Do you know if the staff of this nonpartisan office has changed appreciably? Or, do you now want to make the case that the CBO people who made the wildly inaccurate estimates in 2013 have been replaced recently by highly competent analysts? 4 years is not likely to produce much turnover in an organization filled with GS employees.

 

[gcgang]

https://www.theatlantic.com/magazin...american-health-care-killed-my-father/307617/

Above is a link to an article that I read in 2009 that IMO does the best job of explaining Americas healthcare problems and offers a hopeful solution. Basically, it says that government is not good at controlling costs, or improving quality, and that the way to better, more affordable healthcare is to empower us, the consumer. Make costs transparent. Provide mandatory catastrophic insurance for everyone, based on age. Vested HSAs for other expenses. Much more that I'm not adequately summarizing.

Very long article, triggered by the negligent hospital care that killed the author's father, but I still recall it all these years later.

None of the plans enacted or proposed do these things.

 

[ERD50]

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]

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]

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]

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.