by "Textured Soy Protein" (texturedsoyprotein)
Published 03/28/2017 at 16:07
by "Textured Soy Protein" (texturedsoyprotein)
Published 03/28/2017 at 16:07
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STARS: 3
Political content in this post. So have a Ferrari 250 GT Berlinetta Lusso!
Whatever your personal feelings on Obamacare, the reality is, it’s now going to be with us for a while longer. We can either work on ways to improve coverage for people, or not.
Here are a couple of articles that are interesting.
First off, the Kansas state legislature just voted to expand Medicaid . Their governor has threatened to veto it, but maybe he won’t.
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For those of you unfamiliar with Medicaid, each state runs an insurance program for low-income people, and is reimbursed on a per-person basis by the federal government.
Obamacare did two things to get more people covered by health insurance:
Created marketplaces in which individuals could buy plans from private insurance companies at reduced rates, with lower-income individuals able to get subsidies applied directly to their out-of-pocket premium costs.
Provided the ability for states to raise the bar for how much money people can make and still qualify for Medicaid programs, the cost of which the federal government would cover, for the most part (eventually after a few years the federal government would cover 90% of costs of the expansion). Many, but not all, states expanded Medicaid. In states that did not expand medicaid, there are people who make too much money to get Medicaid, but not enough money to get the subsidized rates in the health insurance exchanges .
Now that the AHCA is dead in the water and the Republicans have no other immediate fix in the works, several states, even particularly red ones, are starting to say, “ hey, maybe we should take that federal money to expand Medicaid .”
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Here’s another whopper for you: Republicans often cite the large, and increasing, deductibles and other out-of-pocket costs that people get stuck with in plans they purchase through the health insurance exchanges. Section 1402 of the Affordable Care Act is supposed to provide for a bunch of waivers for these costs , but...
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The provision lays out a set of formulas that, in essence, requires insurance companies to waive some of the deductibles and other co-payments for lower-income families. Under 1402, the government is required to reimburse insurers for the cost of these waivers. About 7 million Americans benefit.
However, in 2014, Republicans in the House of Representatives sued the Obama administration, claiming that because Congress had not specifically appropriated this reimbursement money, the government could not dispense it. In May 2016, U.S. District Judge Rosemary Collyer (a George W. Bush appointee) enjoined Health and Human Services from continuing the payments.
The Obama administration, of course, appealed the ruling. But the case is on hold — and the funds remain frozen — pending a decision by the Trump administration on whether to proceed with the appeal.
That’s right, Republicans in the House of Representatives are the reason why those 7 million people’s out-of-pocket costs are out of control.
Another problem with the exchanges that the Republicans like to point out is that in many areas, health insurers have left the exchanges because they haven’t been making money selling plans in them, and people are left with maybe 1 or 2 insurers to choose from. Well guess what? This is also their fault!
Section 1342 promised to reimburse insurers who experienced extraordinary losses in the early years of the exchanges, when predictions about costs and revenue had to be made with no history to draw on. This program, called “risk corridors,” was derailed by a provision that Sen. Marco Rubio (R-Fla.) slipped into a broader spending bill in 2015. That, too, has caused insurers to flee.
Personally, I hate health insurance companies, but the reality is, we need to structure our healthcare laws to encourage the health insurance companies to behave in a way that benefits as many people as possible.
The fact is, the original language of the Affordable Care Act did things to try and stabilize the problems that exist now, and those problems exist because Republicans have invalidated those parts of the ACA.
If they want to fix those problems, all they have to do is reverse their earlier actions, un-block those parts of the ACA, and let the law do what it tried to in the first place.
"facw" (facw)
03/28/2017 at 16:17, STARS: 0
Good points, though on the issue of Medicaid expansion, the ACA made that mandatory, but then the courts struck down that section of the bill. Which is why we have this weird hole where you can make too much for Medicaid (and too much can be $0 in some states), but not enough to qualify for ACA subsidies. The super easy fix would be to just say that you qualify for subsidies if you can’t get Medicaid but of course the GOP won’t pass that.
"ESSSIX GmbH - Accountant/Wagon Thumper" (thedlo)
03/28/2017 at 16:18, STARS: 3
Ideally removing the profit motive should greatly affect the costs of insurance.
"For Sweden" (rallybeetle)
03/28/2017 at 16:21, STARS: 0
The ACA tries to make Healthcare a national concern, and Medicare and the VA, IHS, etc. In Sweden (tips fedora), much of the work is at the county (analogous to state) level.
"Neil drives a beetle and a fancy beetle" (1500sand535)
03/28/2017 at 16:24, STARS: 0
Americans too often live unhealthily, delay treatment, seek urgent care/emergency care, and then want over diagnosis and treatment.
Whatever system will help people be proactive about their health is a good one, and Obamacare is meant to do that.
Obamacare, single payer, whatever you want to call our old system; lots of us are paying for everyone else(or an older version of ourselves, or an unexpectedly injured version of ourselves) and the sooner we realize we are all in the ship together, the sooner better solutions can be better crafted.
"facw" (facw)
03/28/2017 at 16:25, STARS: 2
That approach would work poorly here, because many of our states are shitty and corrupt.
"For Sweden" (rallybeetle)
03/28/2017 at 16:26, STARS: 1
Chicago isn’t a state though
"Textured Soy Protein" (texturedsoyprotein)
03/28/2017 at 16:27, STARS: 1
Well, the reason the courts invalidated the required Medicaid expansion is because a bunch of states sued to remove it , because the federal government would eventually “only” pay for 90% of the costs of the expansion, and they didn’t want to be stuck paying the 10%. Which, I get their point, but it’s unfortunate that it was blocked.
At this point, it’s very unlikely that a GOP-controlled Congress would vote to spend more money on anything related to healthcare, but states can opt in to the Medicaid expansion.
"Textured Soy Protein" (texturedsoyprotein)
03/28/2017 at 16:29, STARS: 1
The GOP wanted to convert the federal per-person Medicaid reimbursements to block grants where the states would receive a fixed amount of money and be left to figure out how to cover their costs.
The GOP argued that the states would somehow magically use this newfound flexibility to spend less money while providing better coverage. But usually when the GOP at the federal level wants to reduce spending on state-run programs they do it because they know the states will spend less money regardless of whether they achieve a better result. They just want the government to spend less money.
"Textured Soy Protein" (texturedsoyprotein)
03/28/2017 at 16:32, STARS: 1
I agree: in an ideal world we would not have for-profit companies responsible for our healthcare costs.
Unfortunately, they’re so ingrained in our health system that it would be impossible to get rid of them. In theory we could pass a law that said “all health insurance companies are now non-profits,” but then what about all the people who own stock in those companies, and all the other ways they’re tied into the economy at large?
The best we can hope to accomplish is set up ways to get the insurers to do what we want, and to control costs of pharmaceuticals, devices, supplies, and services.
"Neil drives a beetle and a fancy beetle" (1500sand535)
03/28/2017 at 16:32, STARS: 1
Just a tangent to this. One of the things that shows why profit and medicine tend not to go hand in hand together is that lots of hospitals ask for feedback about patient satisfaction and it has bad effects on pain medication use. Because doctors have found that patients are way more satisfied if they’re not in pain, so doctors subject to hospitals that use that metric tend to administer and prescribe way more pain medication because they are told “it’s your job not necessarily to just treat people’s medical problems but make them happy;” and pain pills do that.
"For Sweden" (rallybeetle)
03/28/2017 at 16:33, STARS: 0
This plan would also allow blue states to have a healthcare system largely immune from the ravings of New York born-and-raised presidents.
"Textured Soy Protein" (texturedsoyprotein)
03/28/2017 at 16:38, STARS: 5
In theory, sure. In reality, the only way they’d have full state control is if the block grants went through. But the block grants wouldn’t keep up with inflation, and the blue states wouldn’t have enough money to pay for their utopian Swedish Bernie Sanders healthcare.
I met a guy in St. Martin who when he heard my American accent started asking me about Trump. He talked about how since St. Martin is part of France, all the government assistance available for things like healthcare and unemployment. “How come America, the richest country in the world, doesn’t have these things?”
The best non-preachy explanation I could come up with was that in America, there’s a lot of people who really don’t want the government to do stuff, and they vote for politicians who will make the government do less stuff.
“You mean rich people?”
Then I explained that there are lots of poor people who vote this way because the politicians tell them that if the government does less stuff, and charges less taxes on rich people and for-profit companies, the for-profit companies will give them more stuff.
He was like, “man, those people are stupid!”
"For Sweden" (rallybeetle)
03/28/2017 at 16:45, STARS: 0
Should have asked him about Marine Le Pen
"LongbowMkII" (longbowmkii)
03/28/2017 at 16:58, STARS: 0
Single payer would be best but it would have such an impact on so many facets of our economy that I doubt more than a couple dozen congresspeople would honestly pursue it.
Fact is that many national systems such as NHS arose before massive private corporations became entrenched.
"Highlander-Datsuns are Forever" (jamesbowland)
03/28/2017 at 17:03, STARS: 2
I’m healthy and don’t have much in the way of actual medical costs on an annual basis, yet my insurance costs for a high deductible plan are ridiculous. My out of pocket for my family is approaching $500/month and my companies contribution is >$1300/month. So we are spending about $22,000/year for a 3000/6000 deductible plan. Meanwhile all our health car expenses are paid for through my HSA, which I put money into. Fuck this in the eye, this is so unfair, why can’t we have single payer, based on a % of income (like medicare) then do a flat rate for doctors visits and prescriptions? This would eliminate the insurance companies and leave the decisions to our health care providers. % income would also be fair to lower income folks and spread the burden to the higher income individuals.
Thank you rant over.
"Textured Soy Protein" (texturedsoyprotein)
03/28/2017 at 17:09, STARS: 0
There are lots of avenues to improve the current system in meaningful ways.
Here’s one idea: deductibles that keep going up are awful , so how to get rid of them?
At my current employer, the company only offers health plans with deductibles. You have 2 options:
$1500 deductible ($3000 if you have dependents) and a health reimbursement account that can be used to pay towards your deductible and coinsurance. You have to spend the money by the end of the year or lose it, and can be or a
$3000 deductible ($6000 with dependents) with a health savings account that you can use for any medical, dental or vision expenses; you can add additional money from pre-tax payroll deductions, and you can save the money indefinitely.
The company contributes $1000 to the HRA for an individual or $2000 for a family, but in the higher-deductible HSA plan, only $750 for an individual or $1250 for other coverage.
The HSA has much more flexibility than the HRA, but it’s stuck to a higher deductible, and the premium costs aren’t significantly lower, so the costs to the employee are a bunch higher.
What if there was a way to encourage insurers to quit sticking people with such high deductibles? It could be a combination on legislative caps on the size of deductibles, and tax credits or other financial incentives to lower deductibles.
Similarly, there could be financial incentives offered to employers who make contributions to HSAs on behalf of their employees.
Figure out a way to pay for them while keeping a balanced budget, and you’ve improved the quality care for who knows how many people.
But these aren’t the kind of solutions our politicians are working on.
"Textured Soy Protein" (texturedsoyprotein)
03/28/2017 at 17:13, STARS: 0
Since it would be practically impossible to get rid of insurers, instead we have to look at ways to control costs.
Because you’re absolutely right: you and your employer are spending a giant pile of money and basically all you have to show for it is that when you go to the doctor, you’re charged the insurance-negotiated price, instead of the ridiculously inflated “come in off the street with no insurance” price.
Personally I think we need a law that says the highest price any provider or manufacturer can charge anyone, regardless of insurance, is the price as negotiated by Medicaid/Medicare.
Effectively that would remove the “benefit” that insurance companies say you get from being in their network but stuck with a deductible you’re unlikely to ever fulfill. In which case they’d have to come up with something better to offer you in exchange for the giant pile of money they’re getting.
"gmporschenut also a fan of hondas" (gmporschenut)
03/30/2017 at 00:06, STARS: 0
The downside is in the US states can’t carry debt to the extent the federal government can. It would lead to states cutting services/care. “Sorry abouy that operation hope you can wait till feb 2.”
"For Sweden" (rallybeetle)
03/30/2017 at 00:29, STARS: 0
they have to pay their bills waaaaaaaaaaaaaaaa