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Tue Feb 17, 2015, 03:10 AM

ACA 2.0

Reasons we need to retake Congress in 2016 so that the Affordable Care Act can be improved:

1. To put the Affordable back in Affordable Care: Too many plans tack the whole annual out of pocket onto the start of the insurance as massive deductibles, $3000 to $5000 a person. Since these are the plans that the poorest people pick (because they are the only plans they can afford) they do not use their new insurance, except in an emergencies---and sometimes not even then. I see too many people in the office who refuse to get necessary care at the hospital. "I can't afford that $3000 deductible. You'll have to give me something for my ____ (insert stroke, heart attack, concussion) in the office or I am going home without treatment." High deductibles kill. More often, people put off necessary tests---like breast biopsies, because they do not have the cash up front to schedule "elective" procedures. Meaning when they finally get so sick that they have to bite the bullet and go to the hospital, their disease has progressed.

2. To Put the Care back in Affordable Care : Too many insurers have found a sneaky way around the "No exclusion for pre-existing conditions". They refuse to pay for necessary treatments for the most costly pre-existing conditions---in effect denying care to those who need it most. AIDs patients suddenly find that they can not get their meds. Cancer patients can not continue their chemotherapy. The same insurers make most medications available for a reasonable copayment. When insurers choose not to cover the treatments which the sickest people need, they do so in order to discourage the sickest people from signing up for their plans. For those who say "Some insurance is better than none", AIDs patients on Medicaid get good drug coverage. If we force them onto private plans that do not cover their meds, they will not be able to afford their meds.

3. To Force Red States to Act on Affordable Care: The Supreme Court found a nasty loophole. States could choose not to accept billions in federal funds earmarked for their poorest citizens. In effect, some states could decide to let their poorest citizens die---just because. The result has been the closure of rural hospitals in Red States, causing everyone, even those with insurance to be at risk for preventable death. This is a public health disaster. If the states won't take the money, then the feds need to write a new law creating a new program which is federally managed to insure the poor.

Universal health care is a work in progress. The job is not done. To make any progress, Dems will need to control both houses again.

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Response to McCamy Taylor (Original post)

Tue Feb 17, 2015, 03:21 AM

1. When the ACA passed, Democrats controlled both houses. They could have done universal health care

then, but because democrats such as Lieberman, Bayh, both Nelsons and others not only didn't want universal healthcare, they wouldn't even go for Medicare for all. I am pretty skeptical even if Democrats controlled both houses if universal healthcare would be a reality.

Until congressional people are forbidden from taking legal bribes, (lobbyist), I do not see it happening

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Response to still_one (Reply #1)

Tue Feb 17, 2015, 08:31 AM

2. It wasn't the lobbyists


It was the voters. The ACA has never been popular (although elements of it have been.) In fact, nearly all the Dem senators who voted for it have either been voted out, or retired to avoid having to face their electorate.

This was never a good bill. It helped some people, to some extent, but it was supposed to solve the problem of the uninsured, and it didn't. Deductibles and co-pays have kept it out of the hands of those who needed it most.

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Response to YarnAddict (Reply #2)

Tue Feb 17, 2015, 09:38 AM

3. It was the only thing that would have passed at that time, and when you say it has never been

popular, that is because the wing nut states refused to expand Medicaid which would have helped a lot more people.

In addition, those Democrats lost because they ran away from it. A significant number of uninsured people who do not qualify for Medicaid, get can get significant subsidies through the ACA.

It helped more than "some people".

Kids up to 27 can be covered under their parents plan. No more pre-existing conditions, expanded Medicaid, etc.

Because not all the states decided not to jump aboard, that was because of the SC.

I wonder why you ignore the subsidies in your rebuttal. In addition, the number of uninsured has decreased significantly, so I am not sure where you are getting your talking points:


The point I was making, there is no way that single payer or even Medicare for all would have passed. There were enough Democrats not on board with that. The ACA is a step, and it is better than what was before, and it can build to make it better. The same thing happened with Medicare when it first happened, and it got better. For now nothing will happen as long as the republicans control Congress and the state legislatures.

The reason more people are not helped is because the republicans in those states refused to implement it.

and by the way, it was the lobbyists. The Insurance lobby who helped craft the law

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Response to still_one (Reply #3)

Tue Feb 17, 2015, 11:32 AM

4. Believe me, I know about the subsidies


When my son, who works for little of nothing, came off my dh's group insurance, we looked around and found a very basic BC/BS policy that was designed for young healthy adults. Bare bones, basic stuff. A lot that wasn't covered, but the premium was low, and it would keep him (and us) out of the poorhouse if something catastrophic happened--which is highly unlikely. It was about $100/month. It was perfect for what we needed. It was also not ACA compliant.

So, this year he got a different policy, ACA compliant. The premium is now $277/month. He gets a subsidy, but we still pay about $120/month. But it's a relief to know he is covered in case he gets pregnant.

Yes, it was the only thing that could have passed at the time, but it was still a bad bill. As for the uninsured now having coverage, if they can't afford to use it, what good is it?

Expanding Medicaid country-wide may have been a better option for the poor, but there were many of us who were happy with our insurance, and didn't need this bill, and yet, it is affecting us as well.

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Response to still_one (Reply #1)

Tue Feb 17, 2015, 11:41 AM

5. Even when Democrats just barely had nominal control of both houses...

...filibustering Republicans forced plenty of compromises in the ACA. Even then, in most cases, Republicans refused to vote for the bill itself, doing nothing more than allowing a vote to happen, even with their own compromises in it.

Do I think real, full Democratic control, without trying to reach the artificial 60 vote threshold in the Senate, would have produced Medicare for All, or anything else nearly so good?

No. But we would have at least gotten something much better than the ACA we had to settle for -- which never had much hope of being merely better than nothing at all.

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Response to Silent3 (Reply #5)

Tue Feb 17, 2015, 01:03 PM

7. I don't think so. They floated Medicare for those 55 and older at the time, and those

Blue dogs wouldn't go for that, they sure would not have gone for something much better than we got

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Response to McCamy Taylor (Original post)

Tue Feb 17, 2015, 11:48 AM

6. 'fix it later' -- as if. let's be real, there is no intention to fix it, or enact a single payer

dems have patted themselves on the back and moved on , the rest of us take it up the keister.

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