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Fri Jul 28, 2017, 07:52 AM

Re: ACA. Now what?

There are serious issues with this law. High (and rising) premiums, astronomical deductibles, docs refusing ACA coverage, etc.

Realistically, how will this be fixed with the Rs in charge?

67 replies, 4722 views

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Reply Re: ACA. Now what? (Original post)
MichMary Jul 2017 OP
Lee-Lee Jul 2017 #1
MichMary Jul 2017 #4
SammyWinstonJack Jul 2017 #15
DemocratSinceBirth Jul 2017 #37
Lee-Lee Jul 2017 #40
DemocratSinceBirth Jul 2017 #41
Lee-Lee Jul 2017 #43
DemocratSinceBirth Jul 2017 #44
Lee-Lee Jul 2017 #48
DemocratSinceBirth Jul 2017 #49
MichMary Jul 2017 #55
DemocratSinceBirth Jul 2017 #57
MichMary Jul 2017 #61
Demsrule86 Jul 2017 #2
MichMary Jul 2017 #5
Dem2 Jul 2017 #11
MichMary Jul 2017 #12
Dem2 Jul 2017 #13
LineLineLineLineLineLineReply ?
MichMary Jul 2017 #14
Dem2 Jul 2017 #16
MichMary Jul 2017 #17
Dem2 Jul 2017 #18
MichMary Jul 2017 #21
better Jul 2017 #31
MichMary Jul 2017 #36
better Jul 2017 #52
MichMary Jul 2017 #54
better Jul 2017 #60
MichMary Jul 2017 #62
Lee-Lee Jul 2017 #45
better Jul 2017 #53
Demsrule86 Jul 2017 #63
Demsrule86 Jul 2017 #64
Cosmocat Jul 2017 #3
MichMary Jul 2017 #6
FSogol Jul 2017 #7
MichMary Jul 2017 #8
FSogol Jul 2017 #9
MichMary Jul 2017 #10
FSogol Jul 2017 #19
MichMary Jul 2017 #22
OnDoutside Jul 2017 #20
spanone Jul 2017 #23
MichMary Jul 2017 #24
spanone Jul 2017 #25
Lee-Lee Jul 2017 #34
beachbum bob Jul 2017 #26
Lint Head Jul 2017 #27
MichMary Jul 2017 #28
SalviaBlue Jul 2017 #58
MichMary Jul 2017 #59
Phoenix61 Jul 2017 #29
edhopper Jul 2017 #30
MichMary Jul 2017 #33
mythology Jul 2017 #42
MichMary Jul 2017 #47
taught_me_patience Jul 2017 #32
MichMary Jul 2017 #35
taught_me_patience Jul 2017 #38
MichMary Jul 2017 #39
edhopper Jul 2017 #50
LexVegas Jul 2017 #46
Deuce Jul 2017 #51
emulatorloo Jul 2017 #56
Demsrule86 Jul 2017 #65
MichMary Jul 2017 #66
Demsrule86 Jul 2017 #67

Response to MichMary (Original post)

Fri Jul 28, 2017, 08:00 AM

1. That's kind of my big fear in this now

 

The mandate may as well be gone for the next 3 years because Drumpf has told the IRS to not enforce it.

There is no financial relief that will come to any insurers that are overloaded.

I'm NC in virtually all of our counties you have only one choice for ACA plans.

If the negative stories keep piling up this could become an issue for the senate races in 2018 and for the Presidnetial is it gets bad enough.

If I thought they were smart enough to do it I would say they staged this whole failure and want it to get worse (with their help all they can) so they can ram through something even way, way worse.

We need to be very aggressive in keeping all the positive ACA stories in the forefront of the public mind.

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Response to Lee-Lee (Reply #1)

Fri Jul 28, 2017, 08:07 AM

4. I've posted my situation before

My dh is retiring later this year, and we need to go to the individual market for the first time. Here (rural Michigan) there were only two plans available. I have two out-of-state docs, and one plan covered neither one, and the other covered only one of them. Silver plan, $1700/month premium, $9000 deductible.

Some people think that because we are even considering this that we can afford it. We will pay, because health insurance is a priority for us, but the $20,000 in premium that the insurance company will rake in will be $20,000 that we will NOT be spending on something else--local restaurants, local yarn store, toy store for grandchild gifts, hotels a few times/year, etc. The $$$ that the insurance companies will take will come out of the pockets of someone else.

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Response to Lee-Lee (Reply #1)

Fri Jul 28, 2017, 08:34 AM

15. Smart? No. Cunning, always.

DUMP will be screaming how it's the Democrats fault, non stop, until the midterm while doing all he can to insure the failure of Obamacare.

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Response to Lee-Lee (Reply #1)

Fri Jul 28, 2017, 09:58 AM

37. Chump owns it and if he continues to sabotage it it will inure to his detriment

And since over six in ten Americans loathe him they will be inclined to believe the worst about him anyway.

It would be like leaving your dog with someone for a month and when you come back to get him he's dead because the person didn't feed him.

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Response to DemocratSinceBirth (Reply #37)

Fri Jul 28, 2017, 10:26 AM

40. It's not going to look that way to most Americans

 

Sure, to those of us aware and involved enough we see it for what it is.

Most people are not even remotely as aware or active. How many Democrats are there and what tiny percentage is even active enough to collaborate on forums like this?

More importantly, it won't look like that to the only group that matters- potential swing voters. Potential swing voters are very disconnected from political reality or they wouldn't be wishy washy swing voters.

So to them, lacking the nuanced deep understanding, they will see the plan the Democrats passed and have been rightfully proud of struggling and the GOP and Trump saying "We told you so and tried to do something, not or fault".

And perception is reality.

Like it or not the political reality is the law is our creation, it's our success in getting it passed, and it's been a central point of our party's platform since before it was passed. We own it. We rightfully own all the successes but the reality is in the eyes of all the voters that matter and will be swayed by it we own the failures and problems just as much. And you won't convince them that the GOP or Trump is to blame for the failures while claiming credit for all the successes. It won't fly.

It would be better to just own the problems and say "Look, while not perfect it's still better than before." And run on getting control of Congress to fix what needs fixing.

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Response to Lee-Lee (Reply #40)

Fri Jul 28, 2017, 10:32 AM

41. Trump has an approval rating in the high thirties.

A majority of voters are inclined to believe the worst about him. He has no reservoir of good will. That is why they believe he is Putin's fluffer. It will not be a hard sell to a majority of Americans that Obama Care was working fairly well until Trump and the GOP sabotaged it because they were more concerned in undermining Barack Obama's legacy than making sure Americans have health insurance.

Of course the Deplorables see it differently but they are not even a plurality, much less a majority.

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Response to DemocratSinceBirth (Reply #41)

Fri Jul 28, 2017, 10:54 AM

43. You may be right

 

But I don't share your optimism.

If we keep seeing headlines about rising premiums and more and more insurers leaving the marketplace that will dominate the news cycle. Maybe we can counter with pushing explanations that the GOP is to blame and trumpeting all the success stories to counter it. But if negative. Wes about the ACA continues to dominate the news cycles that leaves us starting in a deficit and having to claw back just to neutral on the issue.

My biggest fear is that we see one of the states that only had one insurer in the marketplace lose that one insurer. It's already come close to happening even before Trumps meddling has had any effect. It's looking like that may happen in Iowa this year.

If that happens it will be a chorus of "we told you so from the very beginning" on the right. And I don't think our more nuanced explanations of why they are to blame will be able to break through all of that noise.

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Response to Lee-Lee (Reply #43)

Fri Jul 28, 2017, 11:01 AM

44. Two competing narratives

Narrative One (The Trump Narrative) Obamacare was flawed from the beginning.

Narrative Two ( The Democratic Narrative) Obamacare was working fairly well until Trump and the GOP sabatogued it.


Those who like Trump will believe Narrative One. Those who dislike Trump will believe Narrative Two. Since more people dislike Trump more people will believe Narrative Two.

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Response to DemocratSinceBirth (Reply #44)

Fri Jul 28, 2017, 11:22 AM

48. The real world isn't as simple as you portray it

 

Not by a long shot.

Most people don't form their opinions based solely on who the person presenting that viewpoint it. That is especially true to the middle of the road swing voters.

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Response to Lee-Lee (Reply #48)

Fri Jul 28, 2017, 11:31 AM

49. There is us and there are them.

A super majority of Americans dislike and disapprove of Trump and will consequently not give him the benefit of the doubt. And in the current situation Trump is on the record as saying he wants Obamacare to fail. Trump is easy to demonize because he is, well, Satanic.

I am more than willing to go into the 018 mid terms with the message we are trying to make health care better and Trump and the GOP are trying to make it worse.

Trumpcare =Deathcare

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Response to DemocratSinceBirth (Reply #49)

Fri Jul 28, 2017, 12:27 PM

55. He also has the Bully Pulpit

He can control the narrative, and Dog-help-us if any rational person ever gets control of him!

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Response to MichMary (Reply #55)

Fri Jul 28, 2017, 12:52 PM

57. Its like being Charlie Mansons foxtrot instructor

It’s like being Charlie Manson’s foxtrot instructor. You go out there, you teach him a few moves, and you think, ‘Hey, look at that, he can learn the foxtrot.’ And the next thing you know, he’s trying to put a pen in your eye, because he’s Charlie Manson.


-Mike Murphy

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Response to DemocratSinceBirth (Reply #57)

Fri Jul 28, 2017, 01:21 PM

61. That made me LOL! n/t

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Response to MichMary (Original post)

Fri Jul 28, 2017, 08:02 AM

2. Now we have to mobilize to save it. We must hold rallies and contact congressional

members. And no talk of single payer please. They already used that against us last night...medicare for all or a public option. And let's not put anything named 'single payer though' until the ACA is out of danger. Millions are depending on us.

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Response to Demsrule86 (Reply #2)

Fri Jul 28, 2017, 08:09 AM

5. But, what will be done

to address unaffordable premiums, deductibles, lack of choice of docs? Yeah, single payer isn't going to happen for a long, long time. In the meantime there are lots of people who are going to be hurt by the inadequacies of the ACA.

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Response to MichMary (Reply #5)

Fri Jul 28, 2017, 08:26 AM

11. You sound like the right-wing guy I was arguing with last night

I guess we don't have those issues in my area but I know they do in some areas but I wish you wouldn't make broad statements that make it sound like it applies generally, it's how our opponents talk.

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Response to Dem2 (Reply #11)

Fri Jul 28, 2017, 08:30 AM

12. I am speaking from my own experience

I'm glad things are working out for you, but there are others of us for whom that isn't the case. Guess we should just be ignored . . .

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Response to MichMary (Reply #12)

Fri Jul 28, 2017, 08:31 AM

13. I guess I should just be ignored?

?

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Response to Dem2 (Reply #13)

Fri Jul 28, 2017, 08:33 AM

14. ?

Sounds like you are saying that because the law works for some the rest of us should sit down and shut up.

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Response to MichMary (Reply #14)

Fri Jul 28, 2017, 08:34 AM

16. I was just hoping that you wouldn't use the same language as the right wing guy I was arguing with

It does work for tens of millions of us, the majority in fact. I was just asking 4 a more reasonable language that sounded less broad.

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Response to Dem2 (Reply #16)

Fri Jul 28, 2017, 08:37 AM

17. My post above:

My dh is retiring later this year, and we need to go to the individual market for the first time. Here (rural Michigan) there were only two plans available. I have two out-of-state docs, and one plan covered neither one, and the other covered only one of them. Silver plan, $1700/month premium, $9000 deductible.

Some people think that because we are even considering this that we can afford it. We will pay, because health insurance is a priority for us, but the $20,000 in premium that the insurance company will rake in will be $20,000 that we will NOT be spending on something else--local restaurants, local yarn store, toy store for grandchild gifts, hotels a few times/year, etc. The $$$ that the insurance companies will take will come out of the pockets of someone else.


I guess I don't know if this is "less broad." It's my own personal experience. My life. My health. My finances.

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Response to MichMary (Reply #17)

Fri Jul 28, 2017, 08:43 AM

18. That sucks

I hope something is done to improve the situation going forward. If that was offered to me, I would go to the insurance company and tell them that they either fix this or I will dedicate my life to destroying them and their whole business model. I hope there is another alternative that you can find to this situation. I do not also know if the situation is any better or worse than before the ACA.

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Response to Dem2 (Reply #18)

Fri Jul 28, 2017, 08:58 AM

21. Thank you for understanding

It DOES suck. This has been a mixed bag. I have a pre-existing condition, and if not for the ACA dh would have to work til I become Medicare eligible. But . . .

As it is, we want to keep both of the docs, so we will pay out-of-pocket for the surgeon who isn't covered, (right now just watchful waiting,) and hope that by the time I need the surgery, he will accept whatever plan we have, or that changes will be made to the overall plan. The insurance agent even talked to us about moving to an area where we will have greater choices (!) but who does that?

The trouble is that there is nothing we can do about it. Nothing any of us as individuals can do. If I got the CEO of BC/BS on the phone and gave him a piece of my mind, he would know that he can laugh in my face. The choice is to go without insurance, pay the fine, and accept the risk of being bankrupted, or pay their exorbitant premiums/co-pays/deductibles.

The ACA has done wonderful things for some, but not so much for others. It has also been the best thing that ever happened for insurance companies.

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Response to MichMary (Reply #21)

Fri Jul 28, 2017, 09:43 AM

31. I share Dem2's concern with your choice of language.

I think we can all agree that there are still massive problems with the healthcare system in this country, but I also think it can be safely said that you are indeed playing into the hands of the ACA's opponents by regarding the problems you outline as "inadequacies of the ACA".

Unaffordable premiums, deductibles, and lack of choice of docs are, as I am sure we can all agree here, real problems. But they are not, in fact, inadequacies of the ACA.

They are inadequacies of a for-profit healthcare system.

The ACA was unable to fix those problems because of the inadequacy of our government.
And our government is inadequate for solving such problems because it is at the near-complete mercy of Capitalism.

It is precisely because so many people placed the blame for these problems on the ACA, rather than on the death grip that the forces of unrestrained capitalism have on our government, that we are where we are. Our opposition are masters of deflection. We would do well to be dramatically more cautious to properly identify the actual root causes of the problems we face, and fervently reject their attempts at misdirection, rather than allow them to co-opt us into using their deliberately misleading language.

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Response to better (Reply #31)

Fri Jul 28, 2017, 09:58 AM

36. Well,

I kind of like capitalism. Investment in dh's 401k plan has created a nice little nest egg that means we will have a retirement that my parents (who didn't trust the stock market) could have only dreamed of.

Insurance companies are out of control, and regulating them like a utility would probably improve things. Meanwhile, thinking the ACA is perfect as is isn't productive to the current situation. Real people are in a bad situation, and the problems need to be solved.

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Response to MichMary (Reply #36)

Fri Jul 28, 2017, 11:57 AM

52. I kinda like capitalism too, within certain constraints.

The problem is that capitalism is far too unconstrained in places where it needs to be, like healthcare.

I'm not trying to suggest that the ACA is perfect. I am merely pointing out that some of the most significant problems related to the ACA aren't actually problems with the law itself, but rather problems with aspects of the healthcare system itself, that the law cannot regulate.

It's not just (or possibly even primarily) the insurance companies that are out of control. There is, of course, the issue of ridiculous salary and benefit packages for the upper management of the insurance companies, and the profit motive of the insurance companies themselves, though to be fair, the ACA actually does do something to address that, in the form of the 80/20 rule that requires that 80% of premiums go to the actual provisioning of healthcare services.

The real underlying problem is the outrageously inflated cost of healthcare services. Unfortunately, Congress does not have the authority to regulate the cost of healthcare services, which is where we come up against the inadequacies of our government itself.

Let's compare the US with, say, The United Kingdom. The UK has a both a single payer system and a nationalized healthcare delivery system, as well as private insurance, doctors, practices and hospitals. In 2012, the average cost of a C-Section in the US was $15,041. The cost in the UK was $4,435. Even without delving into the separate issue of healthcare cost inflation, it's pretty easy from just these figures to illustrate that if the cost of services covered by insurance is outrageously high, so too will be the cost of the insurance that covers them, even with protections like the 80/20 rule.

Ergo, the root of the problem lies not just in the insurance industry, but rather in the profit motive being applied to healthcare, as that drives the cost of the service, which in turn drives the cost of insurance. A true nationalized health service would dramatically lower the cost of services by removing the profit motive from the root level of the equation, and would thereby lower the cost of insurance to cover those services. Single payer would still lower costs by virtue of bargaining power, but less so than a nationalized system, in that we would still be insuring services that include substantial markups.

Capitalism is fine and well in many sectors of the economy, but there are some sectors from which the profit motive should rightly be excluded in favor of overriding public interests like universal access to basic necessary medical care.

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Response to better (Reply #52)

Fri Jul 28, 2017, 12:25 PM

54. I really don't know why services are so high here

compared to the UK.

Just take some of the equipment. Every hospital (including small, rural hospitals) has an MRI scanner, CT scanner, mammography equipment, lots of other things that I've probably never even heard of. If you need a CT scan, you can probably get that within days for non-emergency situations, immediately for things like a brain bleed (for instance.) One of the criticisms I've heard about other countries' healthcare is that you often have to wait months or even years for tests we take for granted will be available to us on a timely basis. Maybe their hospitals aren't all as well equipped as ours are.

So, in addition to the equipment, you need trained staff to operate it, with adequate compensation. Each of those people probably needs costly malpractice insurance, etc. The costs add up. Does this contribute to the cost differential?

Are MDs, RNs, docs, lab techs, etc. as well-compensated as our medical people?

I have also read a lot of true horror stories about the care that patients receive in GB. In general, I think our hospitals do a good job with patient care. I wouldn't be willing to sacrifice that level of care for national healthcare. (Just to be clear, I'm not sure that would be the case. Just saying that should be a factor we take into consideration before we adopt another country's plan.)

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Response to MichMary (Reply #54)

Fri Jul 28, 2017, 01:20 PM

60. I can only speak with authority to my own experience

which outside the US, is limited to Italy, where even as a visitor, I received very prompt and very good care. I have friends in GB whose experiences with the NHS are actually pretty comparable to my experiences here.

Now the point you raise about delays is an interesting and somewhat complicated one, that invites discussion about the difference between socialized medicine and single payer, and why a combination of the two may be the best solution.

In an exclusively socialized medicine system, the government actually directly employs the providers. The VA is a good example. In such a system, there is a direct correlation between the staffing and funding of the providers, the workload, and the backlog. In a single-payer system, the marketplace is completely open to everyone who participates in the single-payer system. Thus, there are multiple options for services, which naturally helps increase the likelihood of being able to obtain services in a timely manner. Thus, it is my estimation that the best outcome would likely be achieved by a combination of a nationalized system, private practice, and single payer. That would ensure that there are cost-controlled options available for all routine, non-time-critical services and that everyone's insurance would cover services in the private sector should one elect to use them.

As for pay, no, practitioners in the UK are not paid quite as much as they are here, but they still make a respectable living. In the US, the average salaries for GP's and specialists are $161k and $230k, respectively. In the UK, they are $118k and $150k. One should bear in mind, however, that those are averages, and 'specialists' is a pretty broad category.

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Response to better (Reply #60)

Fri Jul 28, 2017, 01:37 PM

62. Interesting

I kind of winced when you mentioned the VA, because there have been a lot of problems with vets getting sub-standard care, long waiting lists, etc. People I know here who utilize the VA system have to drive quite a distance, just to see a doc. As an example of government-run healthcare, I doubt that you could convince many people that's the way to go.

I don't know how a combination system would work and still provide superior care to everyone. Some would be able to afford the private practice system, and would obviously receive top-notch care, as they do with concierge care. Others, obviously those in poverty, would be relegated to the VA-like system. Outcomes would be different, and it just wouldn't be right. The lives/health of the 1% are no more valuable than anyone else's.

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Response to better (Reply #31)

Fri Jul 28, 2017, 11:07 AM

45. Calling a person who is sharing their real personal problems out for their language

 

Is a pretty shitty way to respond to someone who is concerned about real life problems that affect them.

Just because their real life experience plays into critics of the program doesn't mean they shouldn't talk about it or be honest about it. If it's their real life and their real struggle then they have the right to talk about it and they shouldn't be attacked or criticized for speaking up about it just because it's inconvenient to our side.

If their premiums are high and unaffordable attacking them or having "concern for their language" when they simply state the facts is just trying to shut up voices with experiences you don't like.

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Response to Lee-Lee (Reply #45)

Fri Jul 28, 2017, 12:17 PM

53. I'm not criticizing speaking up about it.

Nor am I trying to shut anyone up.
I've got a wife with epilepsy and a daughter with PTSD.
These issues are pretty important to me too.

But it being true that premiums are too high does not mean that it is true that the insurance companies or the ACA are the actual root cause of that fact. The problem of high premiums cannot be solved by addressing the ACA and/or the insurance companies, because neither are where the problem originates.

It's important for us to speak up about these problems, but it is of least equal importance for us to accurately recognize what the root cause of these problems is. What I'm saying, perhaps poorly, is that correctly naming the problem and focusing on it rather than the distractions from it is what we should do next.

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Response to MichMary (Reply #5)

Fri Jul 28, 2017, 04:15 PM

63. Nothing will ever be perfect, but I have heard the Dems come up with some ideas.

I don't know if the GOP would go for it, a public option would work for those areas who don't have good coverage...the uncertainty has hurt the markets too...and Trump withhold insurance money too...we can find ways. Also, what you describe is not just the ACA, employer insurance have high deductibles and the premiums are climbing too. I have an 8000 dollar deductible and pay juar over 400. a month. Unless I go to the hospital, I don't make my deductible...and my plan pays nothing until I do...not even a prescription.

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Response to MichMary (Reply #5)

Sat Jul 29, 2017, 09:47 AM

64. That is what I mean by saving it...force the GOP to help fix it.

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Response to MichMary (Original post)

Fri Jul 28, 2017, 08:06 AM

3. This isn't over

They are sick, depraved people.

The moment they left the senate floor the scurried back into their cock roach hotel and started trying to figure something else out.

Even if they can't out and out legislate the end of ACA, they will continue to sabotage it in every possible way, purposefully hurt millions of americans out of mean spirited, hatefulness.

Nothing "we can do" unless this country rings the bell in a B I G way November 2018.

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Response to Cosmocat (Reply #3)

Fri Jul 28, 2017, 08:12 AM

6. In practical terms,

what will improve the ACA to lower premiums and deductibles, and to provide more options? Infusions of $$$ to insurance companies isn't going to be part of the equation, not as long as the GOP is in charge. Expanding subsidies to higher income people? Also not going to happen. I'm asking about real, practical, possible solutions.

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Response to MichMary (Original post)

Fri Jul 28, 2017, 08:12 AM

7. Nothing will get fixed with the Repubs in charge. n/t

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Response to FSogol (Reply #7)

Fri Jul 28, 2017, 08:15 AM

8. But--

then they will be able to blame the D's (and the three R "no" votes) for things they warned about. This could end up being a political disaster for our side. And in the meantime, REAL PEOPLE will be hurt more and more.

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Response to MichMary (Reply #8)

Fri Jul 28, 2017, 08:17 AM

9. Nonsense. They have been sabotaging the ACA and refusing to allow the Democrats to make minor tweaks

They'll own the whole debacle.

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Response to FSogol (Reply #9)

Fri Jul 28, 2017, 08:23 AM

10. What "minor tweaks" will improve the ACA?

Seems to me that whatever solves some of the problems will have to be pretty major, and will probably be non-starters, even among some of the conserva-Dems.

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Response to MichMary (Reply #10)

Fri Jul 28, 2017, 08:49 AM

19. Unlike you, I don't see the ACA as a failure, I see it as a success and a early step toward single

payer. See all the grassroots people fighting for the ACA? See all the stories about how removing pre-existing conditions and lifetime limits saved people? It hasn't been given proper time to stabilize insurance markets. It will improve over time, if the GOP would stop tried to f' it up.

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Response to FSogol (Reply #19)

Fri Jul 28, 2017, 09:02 AM

22. I have posted in this thread

about my premium and deductible and choices. How much are you paying in premium? What's your deductible? Have you lost your doctor?

If this will improve "over time," how long will that take?

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Response to MichMary (Original post)

Fri Jul 28, 2017, 08:56 AM

20. What it needs is a group in the Republican side to realise, that if they do nothing, they will swing

regardless. From the noises coming from the more moderate Reps, they seem open to fixing what's wrong with the ACA and parking it as an issue. If that group are genuine, the Democratic Party should talk. Make Obamacare permanent and workable (get the exchanges working/lower drug costs etc), and then in a few years extend it further.

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Response to MichMary (Original post)

Fri Jul 28, 2017, 09:02 AM

23. it's THE LAW. trump needs to uphold the law.

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Response to spanone (Reply #23)

Fri Jul 28, 2017, 09:04 AM

24. As it stands?

With astronomical premiums? With deductibles that cause people to choose not to seek treatment?

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Response to MichMary (Reply #24)

Fri Jul 28, 2017, 09:10 AM

25. it needs fixes, but it's the law.

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Response to spanone (Reply #23)

Fri Jul 28, 2017, 09:48 AM

34. Problem is with any law there is wide discretion on how it is implemented and enforced

 

There are wide ranges of how any law can be implemented enforced, based on who is making those decisions.

Look at a simple law like a speed limit. It's the law. But a police department and individual officers have wide discretion on how they enforce it.

They can put up signs then never run radar or write tickets because they choose to put effort into other enforcement. Then some people follow the law and some don't. And just ticket people for excess speed after an accident.

They can do what most police departments do and enforce more serious violations like ignoring a few miles over and doing tickets or warnings as the degree of violation increases, like only giving tickets for 10 over.

Or they can have a constant presence of officers doing stops for every motorist even 1 mile over the speed limit and maxing them out with every ticket and fine they can.

Each of those methods can be considered "enforcing the law". And if you want to be a hardliner than the last version is the most true version of upholding the law.

Just like that, the way the ACA is written the executive branch has a HUGE amount of discretion on how the ACA is implemented and enforced, from choosing not to go after people who don't pay the tax penalty for not having coverage to minor rulings on what insurance companies must cover. They can be following the law and still mke decisions at every step that harm the system.

The precedent is long set that the executive to exercise discretion on a number of things. Heck, just look at DACA. Immigration law didn't change at all there, President Obama just used his power as the Chief Executive to direct that there would be no priority in enforcement against a certain class of undocumented immigrants. Trump can just the same direct that there is no priority for enforcing any parts of the ACA.

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Response to MichMary (Original post)

Fri Jul 28, 2017, 09:12 AM

26. nothing until 2018 and this time none of the

 

bullcrap about "lesser of 2 evils"...

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Response to MichMary (Original post)

Fri Jul 28, 2017, 09:13 AM

27. Mitch McConnell in his speech last night said that

They probably had to work with Democrats now. That they need to see what the Democrats ideas are. He said it kind of sarcastically but I think he means it. And if he does Obamacare can be fixed to work or we could have single-payer or Medicare for all.

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Response to Lint Head (Reply #27)

Fri Jul 28, 2017, 09:17 AM

28. I hope that happens

Both sides need to come together. I doubt that there will be any single-payer any time soon, but fixes need to be made.

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Response to MichMary (Reply #28)

Fri Jul 28, 2017, 12:55 PM

58. The republicans have no intention of ever doing anything to help the American people.

They are there to serve their corporate donors.

Their job is to help insurance companies get richer.

We "came together" and allowed the Cons to weaken ACA when it was being written as law. It was necessary and we got some good things but we still have for profit healthcare.

Between 2010 and 2015 the top 70 healthcare insurance executives took in $9.8 Billion in personal income. That is where your premiums and deductibles are going.

We need to do away with this immoral system.

Cons will never fix anything. They are there to destroy our government. Their corporate donors don't want a functioning government that provides for the general welfare of the people of this country. They want to extract our wealth with as few regulations as possible.

You will be squeezed as long as they have the power to do it.

My situation is very much like yours. I don't like it, but if we did not have ACA our premiums would be higher, as would our deductibles. We could be dropped for pre-existing conditions. We would have caps on coverage. We would not have basic preventative care covered, etc. etc. etc.

If we had ACA in the decade prior to Obama's presidency my sister would probably be alive. She had no insurance, no money and cancer. She had to be treated (not treated) by the County Indigent Services. She did not get the treatment she needed in a timely manner. She died at 54.


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Response to SalviaBlue (Reply #58)

Fri Jul 28, 2017, 01:20 PM

59. When the ACA was being written

the problem was the Conserva-Dems. They are the ones who made the demands. (Think Bart Stupak of Michigan.)

The Republicans weren't going to support anything, so the Dems had to do it all without them. Their conservative members had to be arm twisted into supporting what we ended up with.

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Response to MichMary (Original post)

Fri Jul 28, 2017, 09:30 AM

29. We could make a very strong case for universal health care

But, we need to have a a real plan, not just a slogan. IMHO, the biggest problem with the ACA is it is corporate welfare. As long as health care is seen as an industry and not a right maximizing profit will rule. Utilities are seen as a right and are regulated yet still make a profit. We need to work, starting yesterday, with getting people to see health care as a right, just like electricity and water. If Twitler can get people to believe a lie by repeating it enough, surely we can get people to believe the truth the same way. Look at the campaign to get people to stop smoking, shifting cultural beliefs is possible. It just takes strong, concerted effort.

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Response to MichMary (Original post)

Fri Jul 28, 2017, 09:35 AM

30. Let's look at some facts

and not spout RW hyperbole.

https://www.nytimes.com/2016/10/26/upshot/rising-obamacare-rates-what-you-need-to-know.html

https://www.nytimes.com/interactive/2017/03/09/us/politics/who-is-really-affected-by-rising-obamacare-premiums.html

But 85 percent of the people buying insurance through the marketplaces receive federal subsidies, which generally shield them from premium increases.


These groups account for 3 percent of all Americans.


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Response to edhopper (Reply #30)

Fri Jul 28, 2017, 09:48 AM

33. Read the second article

(Couldn't read the first you linked because article #2 took me to the limit for free articles.)

My dh and I are among the 15% who don't receive subsidies. We are NOT wealthy. One income family, he is paid fairly well, and we have a nice little nest egg, and pension. We are solidly middle class. I posted above about the quote that we got for the individual market. You can look through my posts here and see what our quote was. And the limitations on our doctor choices. That isn't "RW hyperbole." It is FACT. Here is another fact: In order to pay that crushing premium there is a lot we won't be doing. When we go out for a nice dinner and leave a waitress a 20% (or more) tip, that $$ goes directly into her pocket. Well, that is something we will give up. We love to read. Probably won't be spending a lot at our local bookstore. Or yarn store. May not do some traveling. Hotels, restaurants, etc. won't be seeing our money.

These are "choices" we will be forced to make, and they will impact others.

Ignoring us, or the rest of the 15%, isn't going to help the Dem party, at all. Fixes need to happen.

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Response to MichMary (Reply #33)

Fri Jul 28, 2017, 10:36 AM

42. If he's retiring, then his estimated income will drop

 

Subsidy eligibility is expressly one of the life events that qualifies for enrolling outside of the open enrollment period. It's highly unlikely you would have a $1,700 a month policy with a $9,000 deductible.

But also pretty much everyone has to make financial choices. I can't spend as much as I'd like on fun stuff because I have a mortgage and student loans etc.

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Response to mythology (Reply #42)

Fri Jul 28, 2017, 11:21 AM

47. You are just wrong

With the withdrawals from the 401k, no 401k deduction, etc. income won't go down, and certainly not to the levels that would qualify us for a subsidy. Here is a chart that shows subsidy amounts by income levels. I'm not sure what year this is from, but there is no way that this is up to date.

http://www.financialsamurai.com/subsidy-amounts-by-income-limits-for-the-affordable-care-act-obamacare/

Yes, we all have to make financial choices, but to have to spend more than $20,000/year is ridiculous. Furthermore, as I pointed out upthread, when we "decide" not to go out for dinner, wait staff won't be getting a 20% tip. Who do you think could use our $$$ more--an insurance CEO, or a single mom trying to put food on the table?

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Response to MichMary (Original post)

Fri Jul 28, 2017, 09:44 AM

32. Work with Republicans to come up with

 

Ideas to get more younger people signing up. Something simple like moving the cost ratio from current 3-1 to 4-1 would make it cheaper for younger people to sign up.

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Response to taught_me_patience (Reply #32)

Fri Jul 28, 2017, 09:52 AM

35. I wouldn't mind seeing

a more "cafeteria-style" plan. Let young people choose limited coverage, high deductible, low cost plans that will entice them to get into (and stay in) the ACA.

My dh has suggested expanding the risk pool. For instance, if BC/BS would include ALL covered individuals within a state in that state's risk pool, including all group insurance participants, it would drive the costs of the individual plans way down, while only increasing the cost of the group insurance by a small amount.

I haven't seen either party come up with either of these suggestions.

I personally think working together is a good thing. More people, more ideas. That's never a wrong way to go.

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Response to MichMary (Reply #35)

Fri Jul 28, 2017, 10:00 AM

38. Another simple fix would be to force insurers into the individual market

 

by making it a requirement to participate if they want to offer group plans within a state. That way, you don't get companies like Cigna dropping out of the California individual insurance market for no reason.

Another fix might be to create larger, regional, pools with a group of states to spread the cost more.

I like your HSA idea... unfortunately Democrats don't seem to be proposing any ideas to improve the ACA.

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Response to taught_me_patience (Reply #38)

Fri Jul 28, 2017, 10:05 AM

39. +1!!

These are the kind of suggestions I was looking for when I first posted this.

The ACA was a one-size-fits-all solution for a country that is definitely not one size!

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Response to taught_me_patience (Reply #32)

Fri Jul 28, 2017, 11:33 AM

50. In 8 years

when have the Republicans shown anywhere they are willing to work with Dems to fix the ACA to make insurance more affordable and available.

They ONLY thing they care about is the tax on the wealthy.

They will do nothing if that tax stays.

Without that tax the ACA and Medicaid expansion are gone.

Where is thei pipe dream of the Republicans doing something good for the American people coming from?

Can you show me the last time they did that and not just work in favor of their corporate masters?

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Response to MichMary (Original post)

Fri Jul 28, 2017, 11:10 AM

46. You haz a sad, huh?

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Response to MichMary (Original post)

Fri Jul 28, 2017, 12:29 PM

56. Please keep in mind that Democrats have plans to fix the ACA but MCConnell completely shut them out

of the health care debate. I will remind you HRC planned to both improve the ACA and add a Public Option.

I think the conventional wisdom in the Senate >today< among moderate Republicans is that now Trumpcare has gone down in flames Dems will be brought on board in future efforts to improve healthcare law.

We will see of course if that happens.

But what we really need to do is get out the vote in 2018. If Dems can take control of Congresd they will be in a much better position to improve Obamacare.

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Response to MichMary (Original post)

Sat Jul 29, 2017, 09:47 AM

65. They own it now. McConnell already said it had to be fixed if not repealed.

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Response to Demsrule86 (Reply #65)

Sat Jul 29, 2017, 10:41 AM

66. But, how?

Seriously, what fixes could satisfy enough Reps and Senators to get the votes to pass? They are a mess, with the "Freedom Caucus'" rabid base demanding complete repeal, and the moderates understanding that there is a real need for a medical safety net. The D's, likewise, have absolutes that will prohibit them from compromising.

Personally, I think they should get them all in a big room, lock the doors, and not let them out til they hammer this out.

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Response to MichMary (Reply #66)

Sat Jul 29, 2017, 12:09 PM

67. Stabilize the markets...that sort of thing.

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