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Millions Flee Obamacare
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Post: #61
RE: Millions Flee Obamacare
(11-11-2016 03:25 PM)Owl 69/70/75 Wrote:  And I would expect a lot of support from republicans and zero from democrats. Democrats are interested in concentrating power in the federal government. Quality of health care is immaterial to them.

If I were Trump and had to get a repeal/replacement through Congress, I'd be very careful about how I'd approach the process given that the Democrats will pull out all the stops to maintain the only real 'achievement' of the Obama administration. He could try and ram it through without them, but to go at it without any Democratic support would mean the GOP would have to either do a partial repeal through the filibuster-proof budget reconciliation process, or pass a full repeal and create a replacement by throwing the filibuster out the window.

He can't do the first since it'll be seen as a cop-out with the regulatory structure essentially staying intact. If he tries going with the second, he runs into a few problems: One, he needs to get basically every Republican senator on board, and it's tough to get fifty-one senators even of the same party to agree. Two, you run the risk of compromising the final bill with such a small room for error. And three, even if you manage to create a viable replacement out of that, Trump loses a lot of political capital and creates the problem Obama had with the GOP and half the nation with Obamacare; political opponents have no problem disowning and trying to undermine a law they have no attachment to. Failure to incorporate any bipartisanship in the legislative process seldom yields sound results.

The best way to deal with stubborn Democrats is to reinstate the effect of the Grassley Amendment by eliminating the illegal Obamacare SHOP exemption for congressional employees. With the stroke of a pen, all the sudden every single one of them is subject to the ACA again after Obama unilaterally created a loophole in 2013 because the GA was so unpopular on Capitol Hill.

The best way Trump could go about that is to sign an EO that closes the loophole on a specific date, creating a mob of angry staffers who would threaten to leave by the busload after it takes effect. In doing so, he gets any lukewarm Republicans to fall in line and then forces Democrats to the table for two reasons. One, members of Congress can't afford to lose entire staff of loyal employees with connections to their district/state for campaigning and constituency services. And two, if they still refused to cooperate they'd get crushed in the forum of public opinion; no American will have sympathy for members of Congress or their well-compensated staff forced to play by the same rules as everybody else.

From there the Democratic Party will be far more willing to compromise even if the GOP has to sweat a little bit too, which is why the deadline would be set well in advance to allow for enough time to craft an effective law. It might take some marginal changes to the final health bill or some extra bridges built in blue states as part of Trump's infrastructure investment plan, but it'll work a lot better in the long run than force-feeding.
11-11-2016 08:22 PM
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Gravy Owl Offline
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Post: #62
RE: Millions Flee Obamacare
(11-11-2016 07:06 PM)GoodOwl Wrote:  HSAs were basically gutted from what they were and intended to be under the restriction imposed upon people by Obamacare.

You are mistaken. I had an HSA before Obamacare and have kept it through Obamacare with no major changes. Contribution limits have been increasing (which is a good thing).

Quote:Think of it this way: what if every legal US citizen and foreign national had an HSA (or actually, Ben Carson's Health Empowerment Accounts were even better) and what if the tax advantages were beefed up even more, and what if the govt helped seed low-income citizens' accounts (this would be the big leap, but would be the coup that would pout the nail in the coffin of the left's dream of govt controlled healthcare)?

I think most on the left would be thrilled to get universal health care, not necessarily government-controlled health care. Some people fail to make that distinction.

I have been really happy with my HSA+HDHP. It provides a cost control by giving patients more incentive to not always choose the most expensive option, while not skimping on preventative care. It might not work as well for people with serious chronic illnesses. Still, I think what you described could be the basis for a good policy. As with anything, the devil is in the details, so it will be interesting to see what emerges.
11-12-2016 12:31 AM
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GoodOwl Offline
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Post: #63
RE: Millions Flee Obamacare
(11-12-2016 12:31 AM)Gravy Owl Wrote:  
(11-11-2016 07:06 PM)GoodOwl Wrote:  HSAs were basically gutted from what they were and intended to be under the restriction imposed upon people by Obamacare.

You are mistaken. I had an HSA before Obamacare and have kept it through Obamacare with no major changes. Contribution limits have been increasing (which is a good thing).

I appreciate your letting me know your experience with them. Most things I've read over the last few years seem to mention that the HSAs were limited under Obamacare. Could there be some state differences/limitations?

(11-11-2016 07:06 PM)GoodOwl Wrote:  Think of it this way: what if every legal US citizen and foreign national had an HSA (or actually, Ben Carson's Health Empowerment Accounts were even better) and what if the tax advantages were beefed up even more, and what if the govt helped seed low-income citizens' accounts (this would be the big leap, but would be the coup that would pout the nail in the coffin of the left's dream of govt controlled healthcare)?

(11-12-2016 12:31 AM)Gravy Owl Wrote:  I think most on the left would be thrilled to get universal health care, not necessarily government-controlled health care. Some people fail to make that distinction.

I have been really happy with my HSA+HDHP. It provides a cost control by giving patients more incentive to not always choose the most expensive option, while not skimping on preventative care. It might not work as well for people with serious chronic illnesses. Still, I think what you described could be the basis for a good policy. As with anything, the devil is in the details, so it will be interesting to see what emerges.

I have previously stated that if instead of the ACA approach, the Democrats had pushed for a universal catastrophic policy for every citizen, that would have been a winner years ago, and much of the anxiety/vitriol towards the ACA would have been neutralized.

i'd agree that the other part of the equation that HSAs appear to better address is the cost/comparative pricing situation. One major thing I believe that keeps driving medical/health prices up is that most do not treat it like a consumer which imo should always be part of the consideration of any decision, medical or otherwise. Although people are in different financial circumstances, removing the appearance of a more normal consumer motive by disconnecting the actual purchase of the actual care from the payment seems to make things more difficult and expensive overall. I'd like to get govt as well as employers out of the picture other than providing tax incentives/credits and I hope that is the direction that the new Admin goes with. Tying health to employment might have worked better in the 1950s, but things are so different for most people nowadays that the model is too archaic and contributes to the problem imo.
(This post was last modified: 11-28-2016 01:48 PM by GoodOwl.)
11-28-2016 01:47 PM
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georgewebb Offline
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Post: #64
RE: Millions Flee Obamacare
(11-12-2016 12:31 AM)Gravy Owl Wrote:  I think most on the left would be thrilled to get universal health care, not necessarily government-controlled health care. Some people fail to make that distinction.

I hear too many people of all political persuasions who don't really want health insurance, in the sense of rational risk-shifting; what they want is health care that "someone else" pays for.
11-28-2016 02:24 PM
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Post: #65
RE: Millions Flee Obamacare
Most people simply don't understand what insurance is. Not anyone on here I don't think, but in the country

Healthcare for the uninsured existed before... it was just Medicaid and not 'insurance'. Dems encouraged states to expand medicaid in order to gain control over it, without having to put that money on their books beyond the few years they fund it before pulling the rug out and hoping the states have fallen on their tax swords to fund it. Unlike the feds, the states can't just print money.

If that is what they wanted to do, they should have expanded Medicare... Medicaid could then have covered copays and deductibles for the poor. They didn't because that would be the largest tax increase in history by far, and they didn't want to own that.

OwlNumbers solution is one way. Another is to allow HSAs and HDCPs, and offer that for the poor. Let the states cover HSA-like expenses... well-checks etc, and let the feds cover catastrophe's. Create a joint group like the former high risk pools for those with chronic or PECs. BUT ALSO charge a copay premium for diseases/injuries of choice... i.e. a 500 OOP max for a broken leg due to tripping over a cat, and a 5,000 OOP max for a broken leg due to skydiving. People who want to skydive can pay a few extra dollars for a 'rider'. Similar things for COPD from smoking. You can quit or pay a higher deductible.

The thing we need to end is people treating their bodies like a playground and then expecting those who act responsibly to cover their expenses.


As to the 'gutted' programs, maybe that is FSAs?
11-28-2016 11:16 PM
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Post: #66
RE: Millions Flee Obamacare
(11-28-2016 02:24 PM)georgewebb Wrote:  
(11-12-2016 12:31 AM)Gravy Owl Wrote:  I think most on the left would be thrilled to get universal health care, not necessarily government-controlled health care. Some people fail to make that distinction.

I hear too many people of all political persuasions who don't really want health insurance, in the sense of rational risk-shifting; what they want is health care that "someone else" pays for.

And that is the exact lie that has been sold to so many. The truth is that services cost money and that the federal government does not create one penny, but, oh, how people fawn over those "federal dollars" as if they were some magical unicorn instead of the hard-earned funds taken from hard-working people.

Much better IMO to leave the money with the people and use govt only to establish and enforce the rules where it may be used: e.g. as in separate, individually-owned (not govt and not corporate) accounts for things like heath insurance, healthcare (which should be properly separated and separately funded IMO), unemployment, retirement, etc...it is the desire to consolidate power and steal wealth by aggregating these dollars that only the individual legal citizens should own instead of the govt or corporations, that is one of the main problems with our system. Chile has some better ideas about how to do this.
11-29-2016 09:13 AM
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GoodOwl Offline
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Post: #67
RE: Millions Flee Obamacare
(11-28-2016 11:16 PM)Hambone10 Wrote:  Most people simply don't understand what insurance is. Not anyone on here I don't think, but in the country

Healthcare for the uninsured existed before... it was just Medicaid and not 'insurance'. Dems encouraged states to expand medicaid in order to gain control over it, without having to put that money on their books beyond the few years they fund it before pulling the rug out and hoping the states have fallen on their tax swords to fund it. Unlike the feds, the states can't just print money.

If that is what they wanted to do, they should have expanded Medicare... Medicaid could then have covered copays and deductibles for the poor. They didn't because that would be the largest tax increase in history by far, and they didn't want to own that.

OwlNumbers solution is one way. Another is to allow HSAs and HDCPs, and offer that for the poor. Let the states cover HSA-like expenses... well-checks etc, and let the feds cover catastrophe's. Create a joint group like the former high risk pools for those with chronic or PECs. BUT ALSO charge a copay premium for diseases/injuries of choice... i.e. a 500 OOP max for a broken leg due to tripping over a cat, and a 5,000 OOP max for a broken leg due to skydiving. People who want to skydive can pay a few extra dollars for a 'rider'. Similar things for COPD from smoking. You can quit or pay a higher deductible.

The thing we need to end is people treating their bodies like a playground and then expecting those who act responsibly to cover their expenses.


As to the 'gutted' programs, maybe that is FSAs?

I want the govt out of American citizens' lives:



11-29-2016 09:16 AM
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Hambone10 Offline
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Post: #68
RE: Millions Flee Obamacare
Actually Good, I don't think my proposal and your desire are that far apart. Obviously NO form of 'mandatory' insurance (even if you can refuse the care) meets your desire, but it still allows much choice.

The problem with the promised 'universal healthcare' is that it doesn't discourage poor choices... it actually somewhat rewards them. Creating a 'hole' in coverage for choice encourages better choices for those who can, but doesn't harm those who can't.
11-30-2016 12:50 PM
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Post: #69
RE: Millions Flee Obamacare
So far Trump or Conway have said that with the new plan (which is almost ready!) no one will lose insurance, everyone with have insurance, it will cost less, and deductibles will be lower. Sounds great! I await the announcement.

Or the Republicans can announce a version of the French system. But since they hate everything French, I guess they'll call it "Freedomcare"... Seriously though, if they propose adopting the French system, I think it would get strong support from the Dems. But we had that debate earlier.

My prediction: They end up quietly moving on to tax cuts. The world did not end with Obamacare like they predicted, and while many people hate this abstract thing called "Obamacare," they like many things like the pre-existing condition protections. And a lot of people in states Trump won would lose insurance with a repeal.

My track record this cycle is terrible, so take it with a grain of salt, but I would not at all be shocked if they end up leaving Obamacare alone, except for maybe some of the fixes where there is bipartisan support...
01-18-2017 02:18 PM
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Post: #70
RE: Millions Flee Obamacare
Still thinking the odds of Obamacare being around in 4 years are pretty good.

https://www.washingtonpost.com/politics/...2fa1d1a1da
01-27-2017 05:52 PM
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Post: #71
RE: Millions Flee Obamacare
(01-27-2017 05:52 PM)JustAnotherAustinOwl Wrote:  Still thinking the odds of Obamacare being around in 4 years are pretty good.

One possibility is that the Republicans will pass a modest reform and assert it is Completely Different than Obamacare.
02-02-2017 01:35 AM
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Post: #72
RE: Millions Flee Obamacare
(02-02-2017 01:35 AM)Gravy Owl Wrote:  
(01-27-2017 05:52 PM)JustAnotherAustinOwl Wrote:  Still thinking the odds of Obamacare being around in 4 years are pretty good.

One possibility is that the Republicans will pass a modest reform and assert it is Completely Different than Obamacare.

And now for something completely different.

https://www.youtube.com/watch?v=K2P86C-1x3o
(This post was last modified: 02-02-2017 01:40 AM by OptimisticOwl.)
02-02-2017 01:39 AM
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Gravy Owl Offline
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Post: #73
RE: Millions Flee Obamacare
02-22-2017 01:33 AM
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JustAnotherAustinOwl Offline
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Post: #74
RE: Millions Flee Obamacare
Who knew health care could be so complicated? No way anyone could have foreseen this.

http://www.cnn.com/2017/02/27/politics/t...mplicated/


Boehner predicting "Repeal and Replace" won't happen....

http://www.politico.com/story/2017/02/jo...ans-235303
02-28-2017 04:17 PM
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RiceLad15 Offline
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Post: #75
RE: Millions Flee Obamacare
(02-28-2017 04:17 PM)JustAnotherAustinOwl Wrote:  Who knew health care could be so complicated? No way anyone could have foreseen this.

http://www.cnn.com/2017/02/27/politics/t...mplicated/


Boehner predicting "Repeal and Replace" won't happen....

http://www.politico.com/story/2017/02/jo...ans-235303

The elected officials who have been bloviating about Obamacare for eight years but in that time have yet to produce and try and market a replacement to it don't have a replacement for it?

Color me surprised.
02-28-2017 04:31 PM
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Post: #76
RE: Millions Flee Obamacare
They have a plan now. Thoughts?

I'm still confused why, if the ACA is a "complete disaster" why they don't just repeal it. Seems like there are a lot of parts they are keeping. Why keep it if it's a "complete disaster"?

Of course, it may not pass because the Freedom Caucus thinks it's just Obamacare 2.0 with less generous subsidies. Which brings us back to why don't they just repeal it altogether? While I think *that* would be a complete disaster, at least they would be true to their beliefs.
03-07-2017 10:35 AM
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Post: #77
RE: Millions Flee Obamacare
(03-07-2017 10:35 AM)JustAnotherAustinOwl Wrote:  They have a plan now. Thoughts?

I'm still confused why, if the ACA is a "complete disaster" why they don't just repeal it. Seems like there are a lot of parts they are keeping. Why keep it if it's a "complete disaster"?

Of course, it may not pass because the Freedom Caucus thinks it's just Obamacare 2.0 with less generous subsidies. Which brings us back to why don't they just repeal it altogether? While I think *that* would be a complete disaster, at least they would be true to their beliefs.

I want someone to explain to me what the benefits of this plan are, over Obamacare. It seems like it would just exacerbate the insurance cost problem by no incentivizing healthy people to get insurance before they are sick since you would only pay a slight surcharge (30%) in insurance rates if you saved money by not having insurance and waiting until you were sick to get it.

It seems like all it did was get rid of the mandate so that Reps could say they got rid of the mandate.

Am I missing something on cost controls?
03-07-2017 10:49 AM
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Post: #78
RE: Millions Flee Obamacare
(03-07-2017 10:49 AM)RiceLad15 Wrote:  
(03-07-2017 10:35 AM)JustAnotherAustinOwl Wrote:  They have a plan now. Thoughts?

I'm still confused why, if the ACA is a "complete disaster" why they don't just repeal it. Seems like there are a lot of parts they are keeping. Why keep it if it's a "complete disaster"?

Of course, it may not pass because the Freedom Caucus thinks it's just Obamacare 2.0 with less generous subsidies. Which brings us back to why don't they just repeal it altogether? While I think *that* would be a complete disaster, at least they would be true to their beliefs.

I want someone to explain to me what the benefits of this plan are, over Obamacare. It seems like it would just exacerbate the insurance cost problem by no incentivizing healthy people to get insurance before they are sick since you would only pay a slight surcharge (30%) in insurance rates if you saved money by not having insurance and waiting until you were sick to get it.

It seems like all it did was get rid of the mandate so that Reps could say they got rid of the mandate.

Am I missing something on cost controls?

Tang will not like that this is from Vox, but this is a pretty good summary:

http://www.vox.com/policy-and-politics/2...eplacement

Also points out how the GOP is using the exact same legislative tactics they've been complaining about for years about the original ACA. If anything, more so.

I think it comes down to the fact that they didn't expect to have to govern any time soon. "Repeal and replace" was just a slogan. GOP governors seem very concerned about their constituents losing insurance, whereas reps who either don't think their constituents will lose insurance or that those that will don't vote for them anyway, don't care...
03-07-2017 11:19 AM
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Post: #79
RE: Millions Flee Obamacare
From Forbes:

House GOP's Obamacare Replacement Will Make Coverage Unaffordable For Millions -- Otherwise, It's Great

https://www.forbes.com/sites/theapotheca...e4d04237fd


"The CBO is likely to score the AHCA as covering around 20 million fewer Americans than Obamacare. There are flaws in the way the CBO models health reform legislation, but the AHCA itself contains enough flaws that there can be little doubt that the plan will price millions out of the health insurance market.

Expanding subsidies for high earners, and cutting health coverage off from the working poor: it sounds like a left-wing caricature of mustache-twirling, top-hatted Republican fat cats."

[Just in case there was any doubt of that caricature: They included a tax break for the poor oppressed insurance execs making over $500k a year.... https://www.buzzfeed.com/paulmcleod/the-...wmvbERNRl]
03-07-2017 12:06 PM
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Post: #80
RE: Millions Flee Obamacare
CBO: 24 million will lose health coverage under Trumpcare.

https://www.washingtonpost.com/powerpost...78326e8884
03-13-2017 06:23 PM
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