Trump just called for full repeal of ACA

[Greenbeard]

1) Medicaid is a state program, and the way it's run is different in every states, so we have 50 versions of "Medicaid." Results in the Medicaid program in Oregon may be better or worse than the results in Tennessee or KY or Texas or California.

More to the point, even Oregon's Medicaid program in 2008 is not Oregon's Medicaid program in 2017. The state overhauled the program in 2012, to impressive effect.

2015: Oregon Medicaid reforms meet savings goals as more enroll

A 21% decline occurred in emergency department visits for patients served by Oregon's coordinated-care organizations since the 2011 baseline, the state reported. Also reported—a 9.3% decline in hospital admissions related to short-term diabetes complications, and a 48% decrease in hospital admissions for chronic obstructive pulmonary disease. . .

The effort to get enrollees connected to a patient-centered medical home could be partially responsible for the care improvements. CCOs also have been motivated to improve care by receiving incentive payments if they meet or exceed 17 performance-measure targets, such as controlling diabetes and hypertension. Some argue that the CCOs have been given the freedom to be innovative and they've risen to the challenge.

2016: Oregonians use ER less, docs more after Medicaid expansion

After expanding Medicaid, residents of Oregon are largely able to find a doctor and have dropped ER visits, despite a more than 50% increase in the number of people using the program, according to a new analysis by the state.

The report (PDF) is on the state's Coordinated Care Organization (CCO) program, which manages care for a majority of Medicaid beneficiaries. The program was established under a 2012 Medicaid waiver. There are 16 of the organizations throughout the state.

Each year, the state withholds a portion of total monthly payments given to CCOs and they only receive the withheld funds if they meet 17 different measures, such as access to care and visits to the emergency room use.

For 2015, CCOs received a combined total of $168 million in incentive payments, up from $128 million in 2014.

Key findings of the report include:

• 83.8% of Medicaid beneficiaries were able to receive appointments and care when they needed it, up slightly from 83% in 2014.
• 43.1 enrollees visited an emergency department per 1,000 member months compared with 47.3 in 2014.
• 8.6% of adult Medicaid beneficiaries were readmitted to a hospital within 30 days of discharge, down from 11.4%.

The drop in ER use is especially surprising. In 2008, the state used a lottery to expand its Medicaid program for low-income adults and studies of that expansion showed an uptick in ER use.

Lori Coyner, the state's Medicaid director says the financial incentive strategy that CCOs operate under is responsible for their success.

 

[year2late]

The current regulations cause more problems than they fix. Some of those regulations need to go. Not all, of course.

Which ones?

Many regulations exist because the hierarchy at the insurance company would allow you to die rather than cover a very expensive curable illness if they could get away with it......

 

[Perotista]

How stupid is he? That would throw 32 million off health insurance.

https://twitter.com/realDonaldTrump...or-32-million-people-to-lose-health-coverage/



For more in-depth views on this: https://www.washingtonpost.com/blog...-lose-health-coverage/?utm_term=.00df2992dade

This probably would have worked through 2015 when over 50% of all Americans opposed Obamacare. Not today. According to RCP averages 48.3% of Americans now favor the ACA vs. 42.5% against.

https://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html

I think Americans have finally become used to it. Instead of going off into the unknown with repeal and replace or just plain repeal, the ACA has become part of America's normal routine. Whether they like it or not, they are comfortable with it when compared to destroying their routine with something completely unknown and not understood or nothing in this case. Something is always better than nothing.

The ACA might be heading toward the scrap heap of history on its own accord as more and more insurance companies pull out. But even so, it is something still around and functionable which as I stated, beats nothing. I personally think it is time for the Republicans to forget about repeal only or about repeal and replace until next year or the year after. Dire consequences awaits those who tell the electorate to stick it where the sun doesn't shine. Just ask the Democrats of 2010.

 

[JasperL]

More to the point, even Oregon's Medicaid program in 2008 is not Oregon's Medicaid program in 2017. The state overhauled the program in 2012, to impressive effect.

2015: Oregon Medicaid reforms meet savings goals as more enroll

2016: Oregonians use ER less, docs more after Medicaid expansion

I'm just responding to say I appreciate the wealth of great info you post on healthcare on DP, and your excellent explanations. Have no idea how or where or why you come across all this, but it's a big help keeping up with what's going on. It's a good example of why expertise can never be overrated eace

 

[KevinKohler]

LOL....this is the equivalent to the "turn it off and turn it back on" solution to computer problems.

Except....that usually works....

 

[MTAtech]

How exactly would that "throw 32 million off health insurance"?

The link to the CBO analysis is right in the article.

We can estimate the impact of repealing those things. Indeed, the Congressional Budget Office has already done so, when it analyzed a previous version of a GOP repeal bill over a year ago. And that analysis found that repealing those things would result in 32 million people losing coverage by 2026, 19 million of them people who would lose Medicaid coverage.

 

[KevinKohler]

People used to have $20 co-pays and $500 deductibles as a regular thing.

Sigh.







I remember those. Now my co-pay is 60, and I avoid the Dr, because 60 bucks = a fun time with the wife and kids, or a new ceiling fan, or lumber to add new steps and an addition to my back patio, etc.

 

[MTAtech]

From what Ive heard ( in our highly secretive Conservative circles....no Liberals allowed ) is the strategy would be to repeal and then focus on replacing in a piece meal fashion

Thats only if the Senate cant get it done, and there's no reason to assume they cannot considering ObamaCare's current death spiral

Go ahead and do that but don't expect to be popular. The insurance markets would immediately be disrupted. 19-26 year olds will immediately be off their parents' plan. Millions will thrown off Medicaid, etc.

Can't imagine how any thinking people would even consider causing such cruelty and havoc -- but again, they are conservatives.

 

[CriticalThought]

If the GOP were to repeal without a replacement they would forever lose the title of "fiscal conservative" because that would be equivalent to burning over 130 billion dollars.

 

[KevinKohler]

Which ones?

Many regulations exist because the hierarchy at the insurance company would allow you to die rather than cover a very expensive curable illness if they could get away with it......

Right. And so....to make that better.....we're going to force all Americans to buy into that scam, thereby guarenteeing them custom....



Instead of simply addressing the actual problem, which is out of control healthcare COSTS.

 

[Oreo]

It won't make it any worse.

Yes it would, as I explained congress has to deliver new health legislation to insurers by (I believe) June 21st each year for them to write policies acccording to the legislation to start January 1, 2018.

Therefore if you just repeal Obamacare--no written legislation, will be available for January 1, 2018--meaning every health insurance policy could be cancelled. Right now all health care insurance policies in this country are written to fit the mandates that were legislated under Obamacare, not limited to individual insurance but corporations and other employers that pay for their employees health insurance, are all under the mandates of Obamacare.

So just repealing Obamacare would affect everyone that has a medical insurance policy.

 

[ajn678]

Massively superior? Superior from the insurance company's perspective. Those plans had lifetime caps for coverage -- which means once your reach that limit, you are on your own. The ACA eliminated lifetime caps as well as discrimination for those with preexisting conditions. It was also possible for ins cos to sell junk plans -- plans that excluded hospital care, the reason one needs insurance.

There are still many plans that exclude hospital care. Usually the bronze plans.

 

[JasperL]

There are still many plans that exclude hospital care. Usually the bronze plans.

False!

All plans offered in the Marketplace cover the same set of essential health benefits.

Every health plan must cover the following services:

Ambulatory patient services (outpatient care you get without being admitted to a hospital)
Emergency services
Hospitalization (like surgery and overnight stays)
...

Goodness, spend 5 seconds with Google before making statements that are that obviously wrong.

 

[ajn678]

False!



Goodness, spend 5 seconds with Google before making statements that are that obviously wrong.

Goodness, marketplace plans do not account for plans you get through your employee. Would you like me to screenshot the plans that my employee offers? The bronze plan covers 0% for hospital visits. Most people are still covered through the employee, which are usually the people that are hit the hardest with the ACA.

 

[MTAtech]

Massively superior? Superior from the insurance company's perspective. Those plans had lifetime caps for coverage -- which means once your reach that limit, you are on your own. The ACA eliminated lifetime caps as well as discrimination for those with preexisting conditions. It was also possible for ins cos to sell junk plans -- plans that excluded hospital care, the reason one needs insurance.

There are still many plans that exclude hospital care. Usually the bronze plans.

Please see the list of required coverage:
https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

Hospitalization is a requirement

 

[ajn678]

Please see the list of required coverage:
https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

Hospitalization is a requirement

Read the post above you. You people really need to stop talking about things you are clueless about.

 

[Anthony60]

If the GOP were to repeal without a replacement they would forever lose the title of "fiscal conservative" because that would be equivalent to burning over 130 billion dollars.

Probably a total BS number, but if it's the cost of freedom, then so be it.

 

[Oreo]

President Trump is correct. This debacle is beyond fixable. While I personally favor repeal, repeal and replace later is the next best option.

Or they could just sign on to the Democrat plan.

You can't leave millions of people that were forced onto Obamacare without medical insurance overnight. Many of them have planned surgeries or are sick now receiving treatments for their conditions.

They had to have the legislation complete and into the hands of the insurers by June 21 (deadline passed) so insurers could write their new policies to start on January 1, 2018. Just repealing it would mean that no one would have insurance on January 1st , 2018, including employer based health care plans.

Trump is a dufuss and it's clear he was never competent nor qualified to be POTUS.

Republicans won't come together on a health care bill. John Boehner stated in February--that the repeal & replace rhetoric was nothing more than overly optimistic happy talk for the campaign season.
Report: John Boehner says Obamacare won't be repealed and replaced - CBS News

 

[jghiretire]

Here'e the health care conundrum as I see it.

The ACA was way oversold and they didn't need to do it because the controlled everything back then. They would have been better off with a little more under sell, but that's not the way politics works. Everything for everybody and somebody else (The evil KOCH BROTHERS!) pay for it. I get that.

But all the lying and dissembling came back to haunt them in a big way.

The GOP,on the other hand, boxed themselves in a corner by saying how bad it sucks for 6 years, even though it's pretty much a GOP kind of plan. Now,they look like complete idiots because they have nothing to put forth .

The other problem is getting the insurance and big pharma lobbyists out of our politics. They basically have carte blanche to charge whatever they want. I believe the US pays the most for our medication. Yes I know research and all that but maybe they could make a billion less in profit??

 

[JasperL]

Goodness, marketplace plans do not account for plans you get through your employee. Would you like me to screenshot the plans that my employee offers? The bronze plan covers 0% for hospital visits. Most people are still covered through the employee, which are usually the people that are hit the hardest with the ACA.

I'm not understanding or misunderstood your comment, so I apologize. The only "bronze" plan I know of are those sold on the exchange and every plan sold on the exchange must cover hospitalization and all the other EHBs. Individual plans and small group plans sold on or off the exchange must all cover EHBs.

I think you're saying your (presumably large employer) plan doesn't cover hospitalization, and if so you've taught me something. I didn't think it was possible to call it health insurance post ACA without hospitalization, but I learned the ACA didn't impose ANY EHB mandates on large employers.

I feel bad for you that your employer is offering that kind of plan, but you can't blame that on Obama or the ACA - that's just a cheap-ass employer who is exploiting a kind of loophole in the ACA.

 

[jghiretire]

Thanks to Obama's ACA, almost one-fourth (74.5 million people) of the country is now on Medicaid. Even some so-called Republicans now seem to think that's a good idea. I wouldn't worry about ACA repeal or poor people losing their medical insurance until the entire country's broke and we become a banana republic like Venezuela.

No worries - with Trump in charge we're on our way already!!

 

[Henrin]

The other problem is getting the insurance and big pharma lobbyists out of our politics. They basically have carte blanche to charge whatever they want. I believe the US pays the most for our medication. Yes I know research and all that but maybe they could make a billion less in profit??

Did you ever look up the profit margins of those companies? Insurance companies before the ACA had pretty average profit margins, but these pharmaceutical companies get crazy profit margins reaching on average 18%. What really sucks however is that to get in the industry it costs hundreds of millions of dollars to just comply with the regulations alone. I know you guys hate deregulation and all of that, but seriously, the cost of regulation compliance is a serious problem with the industry.

 

[upsideguy]

President Trump is correct. This debacle is beyond fixable. While I personally favor repeal, repeal and replace later is the next best option.

Or they could just sign on to the Democrat plan.

It is actually very fixable.....

1. Increase mandates so the buy/pay the fine option weighs more favorably to the buy
2. Reinstate risk corridors to shore up insurance participation
3. Offer a public option to expand coverage areas so that private insurance participation is not as big a deal.
4. More states open exchanges
5. Lower Medicare eligibility age to 55 to lower the demographic of medicare and ease the burden on private insurance carriers. The 55-64 crowd is the most expensive for private insurance to cover; but would actually enhance (lower the overall costs) on the medicare system.

 

[jghiretire]

So then the Union isn't worth its weight nor the cost they are taking from the miners paychecks? That is bs and you know it. Mining jobs are coming back if you paid any attention to the BLS data

Why would mining jobs come back when natural gas is cheaper??

 

[ajn678]

I'm not understanding or misunderstood your comment, so I apologize. The only "bronze" plan I know of are those sold on the exchange and every plan sold on the exchange must cover hospitalization and all the other EHBs. Individual plans and small group plans sold on or off the exchange must all cover EHBs.

I think you're saying your (presumably large employer) plan doesn't cover hospitalization, and if so you've taught me something. I didn't think it was possible to call it health insurance post ACA without hospitalization, but I learned the ACA didn't impose ANY EHB mandates on large employers.

I feel bad for you that your employer is offering that kind of plan, but you can't blame that on Obama or the ACA - that's just a cheap-ass employer who is exploiting a kind of loophole in the ACA.

Yea, thankfully I can afford the non **** plans, but they certainly do still exist. Plans that are not on the marketplace are not held to the same requirements, and oftentimes this means that people can have insurance that they think covers "catastrophic" care, when it doesn't cover it at all.