Want my support for the ACA? Repeal the mandate.

[Demo_Chris]

Force insurance companies to EARN my business. It's as simple as that.

If it's a good deal, you don't need a mandate, you just need good advertising. And if you try to tell me that other people need my money to cover their healthcare -- whether it benefits me or not -- they what you are really advocating is the worst kind of regressive taxes.

So there it is. Repeal the mandate. Obama has delayed basically everything else, might as well do this as well.

[MADem]

1. Not going to happen. You need to talk with a private insurer to get nationwide coverage. nt

[Demo_Chris]

3. Can't afford that. nt

[steve2470]

5. mind giving us some details ? if not I understand nt

[Demo_Chris]

27. short version: I am ALWAYS away from "home". nt

[VanillaRhapsody]

2. Wow....just wow....what keeps coming out....

[Demo_Chris]

4. Shocking that Heritage Foundation plans might find opposition here? nt

[VanillaRhapsody]

7. Shocking that you think that is a good point of negotiation to get where you want this to go...

[Demo_Chris]

20. Where want it to go is no mandates...

If our party cannot manage single payer or a public option, they can at least give me the option to opt out without penalty. Seems reasonable to me.

[steve2470]

21. sorry, your OP is flamebait during an election year

have a nice evening.

[VanillaRhapsody]

25. ditto!

You are right....time to stop playing these games with them....its an important election year....that needs to be pointed out repeatedly!

[Walk away]

77. If you sign a contract to pay any of your future medical costs in cash or...

be refused care and die in your bed if you come down with something expensive like cancer or learn to set your own bones then....OK!

[Demo_Chris]

88. I invite you to seriously think about your post...

I mean that. Seriously think about what you are saying here.

Assuming the ACA is as wonderful and inexpensive as some claim, there is no reason why ANYONE would refuse to sign up. You couldn't keep them away. The only people who would refuse would be either ignorant (in which case it is inhumane to condemn them) or spiteful-- and even Republicans don't put feelings ahead of their wallets, not once Obama leaves office at any rate.

The argument you are making is that insurance companies NEED the money generated by the mandate to provide care (and profits) for everyone else. But who are we talking about here and how does this work? Who does this mandate impact, and what kind of policies will they purchase to escape the rapidly escalating fines? And be aware, unless the cost outweighs the benefits, there is NO monetary reason for the mandate at all. The POINT is to extract money from those who cannot easily afford insurance and who might make other choices -- such as returning to school, saving for a car or nicer apartment, going to a dentist, buying shoes that fit, paying their power bill, buying food, unimportant stuff like that. You think a 23 year old mom working three part time jobs should be wiped out if she doesn't buy an Obamacare policy at a hundred a month? Even if she selects a fine avoidance plan which covers nothing, do you think she has an extra fifty a month? Obama does, and apparently you do too. Fuck her, right? Let her get another job because the insurance industry needs her money to help lower your insurance premiums.

[Walk away]

94. I doubt if you are a 23 year old mom with three jobs but just in case you are....

I'll explain to you that you can file for an exemption with these forms http://marketplace.cms.gov/getofficialresources/publications-and-articles/hardship-exemption.pdf
and you will very likely get it.

Why don't you get your facts straight before you spout off at everyone who will be paying for your medical care with their tax dollars.

If you are so terribly poor then you qualify for Medicaid, an exemption of extremely low cost coverage. Without the ACA you qualify for nothing.

[Demo_Chris]

98. No, my problem is different, but my position on mandates has nothing to do with ME...

Or so I would like to believe.

[Walk away]

106. Too bad you didn't bother to check your facts before you started...

your thread...unless your real point is to get a lot of attention.

I don't think you will find anyone at DU who would not prefer something more like a single payer system but the ACA is the first step. No one is forcing poor people to pay penalties and OPs like this are not helpful to anyone.

[mythology]

130. Actually no, if there is no mandate and pre-existing conditions have to be covered

the "correct" economic move is to not get insurance until you're on your way to the hospital. Why? Because if they have to insure you, why would you give them money prior to actually needing the service? You wouldn't and then the system would only have those who have on-going needs (ie the most expensive people) which would cause rates to skyrocket.

And shockingly, single payer also has a mandate via taxes. Granted you may not see it because it comes out before you get your check, but it still has to be paid for. That single mom working 3 jobs is going to have to put in money via taxes to pay for that too.

[phleshdef]

24. The ACA went miles beyond the Heritage plan.

They shared like one thing in common, and that was the mandate.

The ACA provides subsidies based on a progressive income scale.

The ACA opens up thousands of free clinics.

The ACA requires large employers to provide insurance.

The ACA regulates the shit out of the insurance companies at a level far above and beyond any regulations they've ever been subjected to.

The ACA also expands Medicaid and buy's Medicare 8 more years of solvency.

The Heritage plan did not do these things.

[area51]

103. Heritage plan

I believe the Heritage plan offered vouchers, so they did offer a form of subsidy.

[phleshdef]

104. It wasn't nearly as generous as the ACA on that front.

[notadmblnd]

6. Are you also against the mandatory requirement for car insurance?

And do you complain about it as loudly as you complain about the ACA?

[BuelahWitch]

8. Because you don't need car insurance if you don't fucking drive!

[steve2470]

11. we all need healthcare....

The ACA is a stepping stone to single payer.

[BuelahWitch]

13. I replied to the above poster who tried to use the tired car insurance analogy

And I'll believe the ACA is a stepping stone to single payer when I see it.

[steve2470]

14. ok keep waiting...one day it's coming nt

[Demo_Chris]

15. Only if you believe trillions in subsidies weakens insurance companies. nt

[steve2470]

16. your argument is a libertarian one

SCOTUS disagreed with you. We agree to disagree.

[brush]

74. Pls don't exaggerate . . .

Trillions? Come on, get real.

If the ACA wasn't law the insurance companies would be profiting a whole lot more, but even them it wouldn't trillions.

The ACA is not perfect but it's a Godsend to 5 million people so far who were uninsured before but now they are.

You want those folks to have to go back to enduring ER triage when they get sick or to have free medical exams like they can now under the ACA.

Your post seems to be purposely divisive, especially in 2014, an election year.

[Jesus Malverde]

33. We all need healthcare, we don't all need health insurance.

Young healthy people by and large are better off paying cash for services than expensive premiums for services they don't need.

A doc in the box is enough for a large percentage of the population age 20-40.

If they have a catastrophic event they can declare bankruptcy.

Most young people do not suffer catastrophic illnesses or accidents.

Sick people and older people do need insurance or a means to pay for our extremely expensive healthcare.

[Hekate]

62. It's sufficient for a large percentage of the MALE population age 20-40. WOMEN HAVE BABIES...

...IN THAT EXACT SAME AGE GROUP. WE ARE OVER HALF THE POPULATION.

Jesus (and I don't mean you, Malverde).

[Jesus Malverde]

64. Actually california where I'm from had insurance programs

For women and their children.

They were neither uncovered or denied health care.

Medi-Cal and Presumptive Eligibility
Pregnant women with low incomes can apply for Medi-Cal and, if they're eligible, get coverage back to the date of their application.

Medi-Cal also has a Presumptive Eligibility (PE) program for pregnant women, which provides immediate, temporary, no-cost care while your application for full Medi-Cal coverage is being reviewed. The PE program provides pregnancy-related care, some lab tests and prescription coverage related to pregnancy. (It does not cover labor and delivery or inpatient care.)

Medi-Cal's PE services for low-income pregnant women are provided by specific PE providers, including physicians, certified family nurse practitioners, clinics, certified midwives and hospital outpatient clinics. The PE provider determines if you are eligible for the PE program.

For information about the Medi-Cal PE program for pregnant women, you can contact a PE provider (ask your provider if he or she participates) or contact the perinatal coordinator at your county health department for a list of PE providers in your area. You also may contact the state's PE support line at [phone] or visit www.dhcs.ca.gov/services/medi-cal/eligibility/Pages/PE.aspx.

Access for Infants and Mothers
California's Access for Infants and Mothers (AIM) program provides low-cost, comprehensive health coverage for middle-income pregnant women who do not have health insurance, who are not eligible for Medi-Cal or Medicare Part A and Part B, and who are less than 30 weeks pregnant. The AIM program is also available to women who have private health insurance plans with a maternity-only deductible or copayment greater than $500.

Coverage under the AIM program costs 1.5 percent of your adjusted annual net income and is billed to you over a 12-month period.

The ACA did nothing to fix a problem that did not exist.

[Hekate]

65. Define "we" when you say it. As for me, I am concerned with the other 50 states too, not just Calif

...ornia, which is where I also live. There were plenty of people (women and children people) who were not getting adequate access. It was and is a problem and we have a long way to go.

[Jesus Malverde]

67. Which states did not have insurance for pregnant women?

I suspect even the reddest states had prenatal programs and other healthcare for pregnant women.

Prenatal programs save money in the long run.

The rules for Medicaid eligibility for pregnant women vary by state, but all states must cover pregnant women with incomes under about $20,000 as an individual. Many states cover pregnant women with higher incomes under Medicaid, and some states cover pregnant women through the Children's Health Insurance Program (CHIP).

To learn whether you might be eligible, check with the department in your state that administers Medicaid. Your child will automatically be eligible for Medicaid or CHIP for up to one year if you're enrolled in either program when the baby is born.

http://www.insure.com/articles/healthinsurancefaq/health-insurance-where-can-pregnant-woman-get-maternity-coverage.html

[Ms. Toad]

73. It is not an insurance program - and note the income limit.

Many women are generally uninsurable except through special programs or during limited windows, and if you are, and your income is above the limit for the Medicaid program, you are out of luck. Insurance in my state for people who had pre-existing conditions (depending on age range) ran around $1000 a month. That makes it out of reach for women with incomes anywhere near (but over) $20,000/year.

[CreekDog]

118. so young healthy people are better off paying cash for having a baby

and declaring bankruptcy if they can't afford to.

wow.

i thought your posts were pretty awful before, somehow you made them worse!

[Jesus Malverde]

140. Have you done the math for an individual who doesn't qualify for

the subsidies, has college loans that cannot be resolved through bankruptcy, cant pretend they are children and stay on their parents plan and are suffering from wage pressures? Paying a full nut for insurance might not make economic sense.

Are you looking at this from the individual level or are you looking at this from the perspective of a system. Some think that young healthy people struggling financially should be locked into a broken system paying outsized premiums for services they don't need so that the program works for the older/sick people.

The ACA might not make sense for young people. They might end up paying for 10-15 years of premiums they don't need. It makes a ton of sense for the insurance companies and those people the young will be subsidizing.

Even some of those participating in the ACA will need to declare bankruptcy because they will not be able to afford non covered medical expenses.

The biggest problem with the ACA is that it doesn't deliver health care it delivers expensive insurance, with guaranteed profits for privately owned corporations.

You know the anthem blue cross ACA plan in Alameda has 4 doctors...only two of which are board certified. 4 doctors for the whole county. Id say people are being pushed into paying full price for premiums and getting a plan that is no way comparable to the plans offered through employers. A similar blue cross plan for Alameda offered through an employer would have access to many many more doctors. All of them board certified.

[lumberjack_jeff]

136. "If they have a catastrophic event they can declare bankruptcy."

Your solution is exactly the same as the problem statement.

Health care is expensive because those who experienced catastrophic events either died or didn't pay.

[phleshdef]

19. A vast majority of working people don't have the option to not drive.

That really is a powerless comeback.

[BuelahWitch]

31. I didn't drive till I was 24

Started working at 17. I found ways to get where I wanted to go. It's still a *choice*. ACA is NOT a choice. So yes, the car insurance analogy is fucking stupid.

[VanillaRhapsody]

34. I was 25 so freaking what! My grandmother NEVER learned to drive

she begged me to learn...she told me not being able to drive was like not being able to read!
So its a lousy "choice" unless you live in a highly urban area. In fact she would say its "fucking stupid"

[phleshdef]

37. You're own personal anecdotes don't really count.

You can't deny that driving to work is a necessity for a huge number of Americans that have to get to a job.

But even so, lets go with your premise. You can opt out of car insurance by not driving and instead use public transportation or car pooling or whatever. Well, even in that case, someone is still having to pay insurance for the vehicle being used. But yea, lets say, not driving is the opt out, for argument sake.

The ACA mandate gives everyone a way to opt out too... pay the damn tax. Its completely fair. Hospitals HAVE to treat you if you end up in the ER. Unless we want to give hospitals the choice to turn you away after you've just been pulled of out the wreckage of a car accident, unconscious and bleeding internally, unless they can find an insurance card on you, then we have to continue requiring them to treat people (as we should). That also means though that every person who is not somehow insured is a liability on the system. So those who are financially able should have to pay into the system somehow. The mandate + tax fine opt out does achieve that.

[BuelahWitch]

109. Analogy still doesn't fit

If I don't drive, I don't have the IRS (or the state) coming after me forcing me to pay a fine for car insurance. Wait till people are losing their tax refunds because of this fucking thing. For some people it's the one chance they have to get a little ahead of the game. Then the screaming will start.

[phleshdef]

111. Well you can choose not to drive but you can't choose to not be an ER liability.

Given that's the nature of things, the fine is perfectly justifiable.

[HockeyMom]

86. Mass transit in NYC

How many people living in Manhattan drive or own a car? Even after moving to Queens, you can still get around with mass transit, or old fashioned walking.

[phleshdef]

112. Most of the country is nothing like NYC or LA or Chicago in terms of public transportation.

[HockeyMom]

116. I now live in Naples, Florida

Ever heard of it? I see many people, including very OLD people, WALKING, or riding bikes, down the roads to work or wherever. My husband rides his bike to work, 10 miles round trip, a few times a week. He is 65. No MASS TRANSIT does not have to equal CARS.

[phleshdef]

119. 90% of Americans drive to work.

http://www.brookings.edu/blogs/brookings-now/posts/2013/10/ninety-percent-of-americans-drive-to-work

[Chan790]

127. The ACA shouldn't be a choice.

Don't be a leech on society, sign up for health insurance.

I favor harsher penalties for people who refuse to meet the mandate and can afford to buy insurance. Needless to say, I support the mandate too.

[BuelahWitch]

131. Harsher penalties? Like what?

Throw them in jail? Beat them in the town square? I think you better read over your .sig line, that certainly doesn't sound like an "anti-fascist" sentiment.
BTW, how do you know I'm not already signed up? Or did it just make you feel better to call me names?

[Chan790]

132. Bigger fines.

It's currently the larger of 1% or $95. I'd like to see it increased to 1% or the lowest yearly premium available through your local exchange. That way people can't actually save money through from avoidance...same rule that there is no compliance mechanism to enforce the penalty other than deduction from tax return.

I didn't mean you, I meant as a general commentary. We've gone about this the wrong way...rather than just trying to convince people that it's good for them, we should also be convincing people that not signing up makes one a deadbeat. The people I've met who've refused to sign up out of some misguided principle are the same people who would take the insinuation they're a deadbeat badly.

[jmowreader]

114. Try living in a rural area if you don't fucking drive!

[otohara]

137. But We All Get Old

I no longer feel alone in this disability category, because everyone of my peers are now complain about one thing or another.

[pipoman]

9. One has a choice about owning a car...

[VanillaRhapsody]

30. not everyone....

find a job in a rural area without one!

[Demo_Chris]

12. No, insurance is the price of owning and operating a dangerous machine. nt

[Xithras]

113. There is no mandatory requirement for car insurance.

There isn't a federal law requiring it.

No U.S. states require it for vehicles operated on private roadways.

Two U.S. states still have no laws requiring it at all.

Many U.S. states have laws allowing people to opt out if they chose. Here in California, a lot of people with good credit scores simply get surety bonds or deposit accounts instead of insurance. It does mean that you're responsible for fixing your own car if you get in an accident, but it eliminates the monthly payout to the auto insurer, which many see as "burning money". The bond issuers want money as well, but it's nearly always cheaper than insurance. The truly wealthy don't need either of those, but can simply drop $35k in to a deposit account and file it with the DMV. That demonstrates "financial responsibility" under state law, and removes the requirement that they buy anything at all.

I carried a $35k bond on my cars for years without insurance. It cost me about $1000 a year (which was cheaper than insurance, considering the fact that I had two teenagers in the house and both my wife and I had points), and I only stopped doing it when my finances got hit and my FICO score dropped, which tripled the surety percentage the bondholder wanted.

[Hoyt]

10. Why, so you can game the system and buy in when you need it? Sign up with a not-for-profit, or do

what it takes to get on Medicaid. Insurance companies will definitely "earn you business" when you get sick. You are just stirring a pot that is already frothing over.

[Demo_Chris]

18. In theory you can do that anyway. Mandates do nothing to prevent this. nt

[Hoyt]

22. Good, I see you've figured out how to game the system and let others pay to help it work.

How 1%er sounding.

It's not close to perfect, but it is what we have for the moment. Why don't you try to make it better, rather than help it fail?

[Demo_Chris]

40. I AM trying to make it better...

So far you haven't offered anything more than blind partisan defense of a bad system. You like insurance companies so much? Fine, keep 'em, but don't force me to give them my money.

[Hoyt]

46. I like what we have now considering things. And a mandate is the only way to make it work

until something better is enacted simply because of folks like you who would game the system for their own personal advantage, not to mention post crud like this that plays into the hands of Republicons.

[brush]

75. So you have no insurance at all?

Are you telling us if you get sick or have a serious accident you depend on going to the ER?

Pls be clear.

Is that what you are saying?

Everyone else pays for your ER dependence?

[Demo_Chris]

89. If you support the ACA and its subsidies you already endorse this...

You just prefer that insurance companies collect some money for themselves off the top. I'm sure you are also in favor of repealing Medicaid, correct? If not, then stop trying to use right wing talking points.

[brush]

108. Seems you're the one with the right wing talking points

Last edited Tue Mar 25, 2014, 12:53 AM - Edit history (4)

And furthermore, as the ACA calls for, I'm in favor of Medicaid expansion. Got that?

And where do you think we live, in a socialist country (not that there's everything wrong with that)? We live in the most cut throat capitalist country of them all so to expect us to go from insurance companies having free reign to make as much profit as they can to making nothing, well, that's totally fantasy land thinking. At least with the ACA they can only make so much, and that figure includes all their administrative costs as well.

Perhaps instead of running down 4-year-old established law, work to improve it and move the country towards single-payer (most on this site would of course prefer that but some understand that the ACA is a move away from insurance companies gaming for unlimited profits and towards maybe Medicare for all.

Is that what you're trying to say? The only thing I get through your unclear posts is that you're against insurance companies and would rather have no coverage than the ACA.

If that's not correct please be clear and state what your position is instead of what it is not.

And as far as repug talking points, you do know that they are the ones constantly running down the ACA (them and now you, that is)?

[Chan790]

128. ...applause.

[phleshdef]

29. They require the financially able to pay a tax/fine when they don't have insurance.

The revenue from this tax/fine is put back into the risk pool in various ways, thus preventing the people who meet this criteria from completely avoiding contributing to their own risk toward the health care financing mechanisms that we have in place.

[pipoman]

17. It is simple outsourcing

Healthcare should be administered by the government. ..single payer. ..i view this much like the for profit jail system.

[Hoyt]

26. You mean like Medicare, and Medicaid that rely heavily on insurance companies and

private doctors, hospitals, and other providers at the moment?

[HockeyMom]

83. Only Medicare Parts C and D

Part A is free. Part B is $104 a month and is not run through insurance companies. You are thinking of Medicare Advantage Plans ("what Medicare doesn't pay&quot and that is not mandatory. Part A by itself satisfied the mandate.

I don't like insurance companies myself, so I did not choose Medicare Advantage. Deductible for Part A is $1,500 and for Part B is $150.

What insurance plan even comes close to that? I had a $3,500 a year deductble where I used to work. Unless you are VERY SICK every year, you would pay out of pocket for just about any medical expense.

Personally, I think the ACA has the insurance companies licking their lips over this mandate. Look at all the profits they can now make.

[Hoyt]

84. Well, unless you have a supplemental, there is no out-of-pocket cap on traditional Medicare. And

Insurance companies do administer traditional Medicare -- they just don't take any risk. Every claim by a doctor or hospital goes through a subsidiary of an insurance company. If you have a question about your claim, you call an insurance company that handles that for the government. So, yes, they are involved, just not quite to the extent of Medicare Advantage Plans (that 30% of Medicare beneficiaries voluntarily select).

It appears you are in NY; therefore, your Part B claims are -- or will be -- handled by Empire or NGS, subsidiaries of BCBS and/or Wellpoint (which are insurance companies).

[Nye Bevan]

23. New York tried a system where insurers were required to accept anyone who applied

and there was no mandate. The result was a "death spiral" where sick people signed up, healthy people did not, which caused premiums to increase, so even fewer healthy people signed up, and premiums rose to thousands of dollars per month for family coverage:

April 2009

New York County

Monthly family premium rates for Point of Service Plans (POS)

$4450 – Aetna Health. Inc.
$3776 – Atlantis Health Plan, Inc.
$4066 – Empire BlueCross BlueShield HMO
$6824 – GHI HMO Select, Inc.
$4187 – Health Insurance Plan of Greater New York, Inc.
$3816 – Health Net of New York, Inc.
$3500 – Managed Health, Inc.
$4208 – Oxford Health Plans (NY), Inc.

http://pnhp.org/blog/2009/04/28/new-york-hmopos-death-spiral/

A mandate is essential to prevent such a death spiral. (Of course, as we all know here on DU, single payer would be even better).

[Cha]

28. Thanks for the reality of the Mandate, Nye.

[phleshdef]

32. And even single payer would have a mandate, it would just be tax based instead of premium based.

[VanillaRhapsody]

35. Libertarians...pffffffttttttt!!

[Jesus Malverde]

39. Single payer would bring with it the ability to negotiate rates with the healthcare industry

With real leverage. The purchasing power of a government should not be underestimated. It is however anathema to our "free market".

Socialized medicine is only good for Veterans.

[phleshdef]

45. I don't know any DUer that doesn't want single payer.

Of course its the better way to go... but I'm just making the point that any attempt at a universal system has a mandate of some sort. We might not call it a mandate when its tax based, instead we might call it an extension of the Medicare tax. But "having to pay" is "having to pay". Theres better plans for the way things work beyond "having to pay", but its still the same principle at its core.

[Jesus Malverde]

48. NOT having to pay a middleman for administration and profit is a huge win

A middleman who doesn't deliver a single dollar of healthcare.

With socialized medicine you don't pay the middleman and those expenses are not included.

Paying for actual healthcare is much more satisfying than paying for administration.

I agree with you that under single payer the mandate would be there in the form of a government expense like funding the military or other government roles.

[phleshdef]

49. Yea that goes without saying.

But we have to still work with the political climate we have while we strive to create the political climate we want.

[Jesus Malverde]

51. I think ACA actually codifies the broken system into our government rather than give

hope for change in the future.

The private insurance system was headed for collapse before this law came into effect. The law takes a broken, failing system, describes it as fixed, and sets it up as an improved model.

The insurers are now too big to fail as it were.

It's like, how could we pay for the healthcare if the insurers went out of business. Only they know how to code procedures and handle money, we're helpless without them.

[phleshdef]

52. "The private insurance system was headed for collapse before this law came into effect"

Um, no, they weren't.

[HockeyMom]

82. I worked for a public school district

that dumped the insurance company and self-insured. Don't religious organizations do this too?

[TheKentuckian]

61. If the government is a criminal cartel that gets over by denying care then we should replace it.

So, I think the argument is moot.

It is also moot because you'd have to go far out of your way to make such a "mandate" to come out of post tax dollars.

It is also invalid because we would get actual care instead of an admission pass (plus ca$h on delivery) to access to care.

All mandates are not created equal, just because one scheme is sensible doesn't mean any possible permutation is and vice versa.

I'm fine with shared responsibility to accomplish large aims but we have a system to do that called levying taxes. The thing is a perversion and a very dangerous precedent.

The current structure dictates entering into a contract with a private, for profit, and predatory cartel as a condition of being alive paid with after tax dollars. Seems utterly fucked up. The government uses tax money to hire vendors all day, everyday so such a bizarre arrangement isn't required in any way.

No, it must be like this to work some mishmash scheme out and then only with the often criminal Supreme Court stepping in and pulling a Matrix like edit/delete job on clearly and repeatedly expressed legislative intent and somehow redefined the penalty as a tax to keep it from going down even as they gutted one of the legs of the stool.

This mandate is bad law and stupid governance despite being the foundation of a law that will help a lot of people. This is not the way to execute the aim.

[Demo_Chris]

41. New York didn't have a federal subsidy...

I am not calling for the repeal of the ACA, just the removal of the truly sick and twisted portion. You want my business? Make me an offer too good to pass up.

[Amonester]

66. But Single-Payer would need a raise in taxes.

Saying this while living in a Single-Payer system.

What many fail to mention is, a Single-Payer system needs income taxes to Pay.

In my province, Healthcare payments account for half of the total provincial budget!

Workers are MANDATED to pay their taxes (some up to 50% or more of their income).

And we have sales taxes on products AND services also, with partial refunds for the needy.

Mandate.Tax.Mandate.Tax. All in all, exchange one another. All the same.

[Donald Ian Rankin]

120. Taxes are much more progressive (in the technical sense) than insurance fees.

Taxes are paid disproportionately by the rich.

Health insurance subsidies have something of the same effect, but not to nearly the same extent.

[Jesus Malverde]

36. One of my biggest problems with the ACA is that it brings millions of customers to the insurers

But leverages none of that to negotiate better rates for services from the pharmaceutical/healthcare industry.

Single payer systems and programs like medicaid bring with them purchasing power and the ability to set rates for services. With the ACA each of these millions of consumers is treated individually and none of the purchasing power is aggregated.

[Hoyt]

42. DELETE. Sorry got posted twice.

[Jesus Malverde]

47. Under the ACA insurance companies are guaranteed

20% of their income for administration and profits.

It's not really an incentive to keep costs down.

[Hoyt]

50. I think competition adds that incentive. If another insurer thinks they can handle the population

of patients cheaper, they'll put a plan on the exchange to attract folks who want a lower premium. Right now, a number of insurers are holding back because of the risk.

BTW, that risk is another reason Congress wasn't too keen on a public option (beyond Medicaid for the poorest uninsured). Congress was not going to appropriate funding for benefits and the systems needed to run it all of the sudden.


Also, the CBO estimated a public option would come in at 7 to 8% less than private insurance (mainly by paying providers less). Somehow, I bet folks will still be griping if rheir premium were $460, rather than $500.

[Jesus Malverde]

53. The financial incentive is to charge as much as possible.

It's like a waiter whose tip is based off your total bill. He wants you to spend and eat more because he will make more.

The 20% for admin and profits grows with the pool and increases.

Lets say they insure 5 customers for $20 each they get to keep $20 for admin and profits.

Lets say they insure 5 customers for $40 dollars each suddenly they get $40 for admin and profits while serving the same 5 people.

Thats the economics of the system we've built, I don't think it incentivizes reduced premiums it almost guarantees they will go up.

[Hoyt]

54. No it does not guarantee premiums will go up. Another insurer, such as a hospital not-for-profit

will offer an exchange plan that undercuts the high premium plan. And the high premium plan will be quite noticeable on the exchange.

If plan A has a monthly premium of $500 because management thinks like you, and plan B with same services, etc., is $350,which one are you going to select now that you can move freely with no preexisting condition exclusions? Pretty soon, Plan A will be forced to lower premiums or exit the market. And, Plans are going to be jockying for insureds so that they will be selected when government gets smart and selects preferred plans.

As a matter of fact, if they were trying to increase benefits to game the medical liss ratio, the poster's insurance company would not have given him the run around on expensive meds that started all this ACA, Obama bashing. They would have said, "heck here's more than you need, would you like a nurse to come by daily and give you each pill with a cold glass of juice."

YlYlso, your "waiter" example doesn't capture the dynamics of the issue.

[Jesus Malverde]

55. I don't think we've seen the dynamic on the exchanges you

describe. I hope we do.

[Hoyt]

56. Not yet, many insurers are holding back until the risks are better known.

But, I'll guarantee if folks aren't selecting a given insurer's plabs, the insurer will change things pretty quickly or just get out.

[Hoyt]

42. "We are not going to put your drug on our formulary at that price" is pretty strong.

Well, until unhappy patients pitch a fit because they are too good to use a generic to keep costs down.

I do agree single payer, or small number of payers, might be in a better position to negotiate. But private insurers are not without negotiating leverage. Heck, under Medicare, it Medicare Advantage insurers that are negotiating drugs, not CMS.

[SheilaT]

38. So you want to be free not to have coverage?

Okay then. Go without. So then you have a heart attack, or an aortic ambulism, or get type 2 diabetes, or some nasty cancer. And now you have no coverage. You will spend the entire rest of your life (if you're lucky you'll die quickly and your heirs will have this problem) paying the bills for this medical catastrophe.

[Jesus Malverde]

44. No he will limp along until the next open enrollment and get insurance.

Lemme guess everyone without homeowner insurance will also be robbed and all those without flood instance will be flooded.

Insurance is a game of playing risk, some need it more than others. Age, genetics, and environment all play a part.

When people are uninsured, when they get sick, they get creative.

My friend who got a brain tumor went to India and paid cash for the surgery. His care was as good as one would get from the American for profit healthcare industry only paid a fraction of what you would pay in the US.

BTW why wish the worst on anyone unless your trying to SCARE them. (I like how you condemn the heirs too)

[lostincalifornia]

60. He did NOT wish any ill on the OP. He just stated the possible risks. If someone wants to take

those risks that is there choice.

Most people cannot do what your friend did and catch a plane to India for an operation, and possible follow-up treatment.

This is the way things are today. If someone wants to take their chances that is their choice, and if everything goes fine then they win, otherwise they lose, and they will pay the price.

[Demo_Chris]

90. Scary! Far better I buy a plan that does NOT cover me...

That way my family can get a head start on that financial ruin.

[lostincalifornia]

57. won't happen, and they do need a mandate at least the way it exists today

[lostincalifornia]

58. Are you against the Social Security and Medicare mandate?

[Demo_Chris]

91. Am I paying the government, or paying a corporation. Get it now?

[lostincalifornia]

97. Usually the government will subcontract to private insurance. They do it now for Medicare

Supplemental

but regardless, that is not how it is today, maybe one day. You have a choice, either you meet one of the exceptions to be excluded from the mandate, such as if 8% of your income exceeds the premium for the Bronze plan, or you don't participate, and may be subject to a penalty through your taxes.

However, if your income is low enough, and you qualify for expanded Medicaid, you pay nothing. If you do not qualify for Medicaid, and your income is low enough, you most likely will have a substantial subsidy from the government which means you will be paying considerably less.

Compared to what was before, it is far better, but until we elect people who change it to single payer that's the way it is

[jmowreader]

59. Without the mandate, the whole rest of the system is unaffordable to the insurers

If you could just go down and buy insurance any ol' time you felt like it, like the "drop the mandate" people want, no one would ever buy insurance until they got sick...and then they'd drop it as soon as they got better. Which would totally fuck up the system: the insurance companies (all of them, in any insurance line) are betting their risk pool won't file claims, and the risk pool is betting that they will.

And yes, other people need your money to cover their healthcare. Or their house fires. Or their traffic accidents. Because, DemoChris, that is how insurance works.

[lostincalifornia]

63. exactly, it spreads the risk. We don't have single payer, and this is what we have, so that is what

we deal with for now.

Even if we had Single Payer, the only way that works is if everyone pays increased taxes for it. In addition, take Medicare which is a single payer system. We pay taxes for basic Medicare throughout our working careers, and even then people still have to pay something for it, about 100 bucks a month. However, that only covers the basic. To get the complete coverage most people need supplemental coverage, and the only way that works is having enough people sign-up for it so it combines the risk pool with healthy verses those who are not

[Demo_Chris]

70. But who would fund single payer? Would it be Gilligan or would it be Mr Howell? The ACA...

Leaves Gilligan stuck footing the bill so the Professor and 'All the rest' can enjoy reduced rates.

[lostincalifornia]

80. taxpayers of course

[Demo_Chris]

92. Which taxpayers. Don't try to dodge this.

[lostincalifornia]

96. I am not dodging, all tax payers, including corporations. That is how single payer runs

[Demo_Chris]

99. You are still evading. Who pays what percentage? You think single payer is regressive? nt

[lostincalifornia]

100. WHAT!! I am not legislator, and if you expect a complete plan with details, ask your representative

This is just a forum to discuss ideas, not ACCUSE someone of evading something because complete details are not expressed

Have a good day, lets end this now

[CreekDog]

133. why is *your* support so important? are you so important that we should change a law for you?

[Demo_Chris]

69. Mandates or the lack do not impact Waiting Periods....

And yes, it is possible that other OLDER people need healthy younger and poorer people's money to subsidize their health insurance. Rather than a single payer or public option system funded by progressive taxation, we were handed this REGRESSIVE system in which society's hardest pressed are forced to foot the bill -- and if they have one of these hyper narrow catastrophic policies, foot the hill woth a plan that doesn't do shit for them if they need it.

[PeaceNikki]

107. This.

[nationalize the fed]

68. Olbermann agrees

Last edited Mon Mar 24, 2014, 04:46 AM - Edit history (1)

Soon after this rant, Olbermann had to find other employment

Edit: That may have been censored. Repeated "errors". Copies made so if it's censored it will be replaced.

Here's a short clip from that rant

[Demo_Chris]

71. I am in good company then. nt

[TreasonousBastard]

72. The ACA doesn't need your support...

just your money. As has been amply demonstrated, even in this thread, it only works if everyone signs up and, since too many people tend to be cheap or stupid, signing up has to be mandatory.

As much as you hate insurance companies, we're still stuck with them for now. Somebody has to review claims, and that will be the same people who have been reviewing claims for years. Like it or not.

[Recursion]

76. Insurance mandates date back to 1791. They're one of the oldest ideas in the country.

This isn't some new tyranny. This is a very old method the country has used (generally successfully) to address market failures.

[alc]

78. the ACA is the mandate

It's an attempt at universal coverage by forcing everyone to buy insurance. They want to provide a government service (i.e. insurance) without a tax and the associated government responsibility/accountability by having us work directly with the insurers. It's a terrible idea, but it's the core of the ACA.

I think the mandate is a terrible precedent and a dangerous expansion of government power. Yes, I've heard all the arguments about how they've mandated private stuff before and I still think this is an expansion. I've also heard that health care is a serious problem that's so different than anything else that this isn't a precedent they can use again. SS is on track to have problems in 20-30 years. How about we just mandate that everyone get a personal private retirement account to take care of their old age just like they get a personal private insurance policy for their health care? The ACA mandate sounds like the perfect precedent for that.

[Erich Bloodaxe BSN]

79. Bleah.

Why not 'Add a Public Option'?

Why should (private) insurance companies have ANY chance at your business, if you'd rather they didn't?

[BenzoDia]

81. Other countries employ mandates to get their citizens to get covered privately or pubically.

They do it b/c it's effective.

[JoePhilly]

85. So don't get insurance, problem solved.

[Lars39]

87. "How do I qualify for an exemption from the fee for not having health coverage?"

https://www.healthcare.gov/exemptions/

Exemptions from the payment

Under certain circumstances, you won’t have to make the individual responsibility payment. This is called an “exemption.”

You may qualify for an exemption if:

You’re uninsured for less than 3 months of the year
The lowest-priced coverage available to you would cost more than 8% of your household income
You don’t have to file a tax return because your income is too low (Learn about the filing limit.)
You’re a member of a federally recognized tribe or eligible for services through an Indian Health Services provider
You’re a member of a recognized health care sharing ministry
You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare
You’re incarcerated, and not awaiting the disposition of charges against you
You’re not lawfully present in the U.S.

Hardship exemptions

If you have any of the circumstances below that affect your ability to purchase health insurance coverage, you may qualify for a “hardship” exemption:

You were homeless.
You were evicted in the past 6 months or were facing eviction or foreclosure.
You received a shut-off notice from a utility company.
You recently experienced domestic violence.
You recently experienced the death of a close family member.
You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.
You filed for bankruptcy in the last 6 months.
You had medical expenses you couldn’t pay in the last 24 months.
You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.
You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, you do not have the pay the penalty for the child.
As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a time period when you weren’t enrolled in a QHP through the Marketplace.
You were determined ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act.
Your individual insurance plan was cancelled and you believe other Marketplace plans are unaffordable.
You experienced another hardship in obtaining health insurance.
*********************************************************

More info at link: https://www.healthcare.gov/exemptions/

[Jesus Malverde]

95. My Fave - "You’re not lawfully present in the U.S. "

[ProfessorGAC]

93. Are You Sure You Thought This Through?

Advertising is not known to make people buy things they don't want or plan to get. It influences choices when a decision to buy is made.

Advertising isn't going to make anybody get insurance, nor is a good deal, because it can't be a better deal than zero if one is convinced they're healthy and won't need it.

The issue is to broaden the base so that there is enough total money to amortize and distribute the costs of medical care across a larger population.

People who don't want it aren't helping the system broaden the cash flow to pay for the greater number of covered folks and there is no way to "convince" them of a good deal, if the alternative is to spend nothing.

[bluestate10]

123. I doubt it. No system is free of some type of mandate. Single Payer has

a mandate called income taxation.

[Gravitycollapse]

101. Nope. Get on board and learn to live with it.

[peace13]

102. If you are willing to sign a waiver refusing all uninsured hospitalizations or emergency services....

that you can not pay for at the time of service then I could go with that. However, this will result in many people dying unnecessarily.

The problem is that people who have been in the system for years have been paying huge premiums because uninsured folks receive services and are unable to pay the bill. Those insured pick up the tab. At some point....NOW....people can no longer absorb the free loading in the system.

Single payer is the answer but until then....folks are going to have to pay their share. I am guessing that you do not drive in many states because folks are mandated to buy car insurance. If you do then you have already compromised your argument.

Why do you think that others should continue to pay for the emergencies and lack of planning of others when affordable insurance is offered?

[theboss]

105. Without the mandate, there is no ACA

So...that's a problem.

[Orsino]

110. How about expanding Medicare further? Might that get your support? n/t

[AceWheeler]

115. Do you know why the mandate is there?

And do you know why and how the insurance industry changed over the past 40 years such that it resulted in such things as denial for pre-existing conditions?

The answer is two-fold. Insurance companies are for profit. Ideally, they insure people who don't really need the insurance.

Second, it has to do with risk pools. To increase profits, insurance companies proceeded to work in the direction of reducing risk in the risk pools.

In order to return to the large risk pools that previously funded insurance, the mandate is necessary. That's all there is to it. Without the mandate, the use of private insurance companies with large enough risk pools to allow insuring more people becomes impossible. Which, by the way, is why so many of us want a Medicare type program, rather than the ACA. The Medicare risk pool is everyone who pays taxes.

Finally, ALL insurance involves people paying for other people. That's what a risk pool is all about.

[DrDan]

117. do you have life insurance? not mandatory, is it.

How about renters insurance? mandatory?

personal property insurance? mandatory?

[bluestate10]

124. You are using a red herring argument.

If a person dies and don't have life insurance their family gets screwed, not the public at large as would happen if a person free loads on the health care system. If a person dies and don't have family to foot funeral bills, the state buries the person in a pauper's grave but own any worldly assets of that person. If a person doesn't have renter's insurance and a fire happens the person loses all burned possessions and if found to have started the fire, gets sued by the landlord, again, the general public is not dragged in to pick up expenses (court costs and Lawyers are paid for by litigants). If a person doesn't have personal property insurance that person is the only person that lose, unless the damaged or stolen personal property injures a person, in that event the uninsured person gets sued, the public doesn't get involved in footing expenses.

[Demo_Chris]

122. The mandate is there to force people, who would not otherwise buy, to purchase their product...

More, it forces them to buy it at ANY price these ghouls set. You have no choice. No matter how much it costs or how little it covers, no matter if it never covers anything at all, even if you know going in that the shit they are selling is completely worthless to you. Thanks to the ACA you have to buy their product. If not, come 2016 you will be paying a minimum fine of $700 per person for the year.

Our party is the one FORCING people to do business with the most despised companies in America. We own the entire mess. It better work.

[bluestate10]

121. Your position is fucking ridiculous.

Last edited Mon Mar 24, 2014, 09:25 PM - Edit history (1)

The mandate is critical to survival of affordable health care. The beloved Single Payer is a system that induces forced participation via taxation. No health care system works without some aspect that citizens can't avoid.

[Sheepshank]

125. Not only ACA, but universal and social health care all require a pool of everyone to pay

payments are either premiums to insurance companies or taxes paid to the gv't...either way it relies on a verybig pool. your model is NOT sustainable.

http://www.upworthy.com/theres-one-thing-obama-did-that-annoyed-almost-everyone-heres-why-its-kind-of-important?c=bl3

[Gidney N Cloyd]

129. Well, and succinctly, put.

[Sarah Ibarruri]

126. My grandma spoke Galician. She used to say, "qui tardi piacchi" meaning...

"You're clucking a little late!" That's an old country reference to when the cook ran after the chickens and the chicks were pretty silent, yet when had one in his hand, only then did that one cluck.

Well, you're clucking a little late. What did you do in the beginning of the discussion about insuring everyone, to make your wishes magically appear? Or are you only now clucking?

[zipplewrath]

134. PO + Mandate

They never should have disconnected the PO and the Mandate. They very early on let it be known that the PO was negotiable. But the Mandate got in very early and was left alone. The two should have been connected solidly. Without one, you don't get the other. It could even have been "restricted" to certain income classes and ended up being a back door for medicaid for all those folks the states aren't currently covering.

[lumberjack_jeff]

135. Universal=mandatory. The mandate isn't one of the top 10 flaws with the system. n/t

[pampango]

138. Repub_Chris: GOP Readies New Votes On Health Law Mandate Repeal ...

http://www.kaiserhealthnews.org/daily-reports/2014/february/24/cap-hill-watch-reform-politics-votes.aspx

[Demo_Chris]

139. The GOP is playing political theater. I don't care what they pretend to do, I care what's right. nt