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tommyboy

Obamacare: Obama just straight up lied to you, in your face

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I realize it's all anecdotal, but as a small business owner who has purchased my families insurance for 25+ years, I finally left Blue Cross and will save 7k this year. If anything, the focus on health insurance just made me more diligent in finding a better alternative. I would usually just get a call from my broker during enrollment time and she'd say, the plan is going up again, and because I didn't really feel like dealing with it myself I'd just re-up at whatever cost. This year, I found a new broker and a comparable plan from United Healthcare that saved some real money. Only wish I did it 10 years ago.

So you're saying market competition has been here the entire time? No way! :o

To tell you the truth I have no idea. Every year I asked my broker to find a cheaper plan that fit my criteria and she came back with Blue Cross. I don't have an HR staff and I relied on her to do her job. She either was a bad broker or in bed with Blue Cross at the exclusion of other carriers, I don't know. And to your point, there is market competition now and instead of taking steaming dumps on anything ACA, I would think the self proclaimed party of business would realize that and actually lift a finger to make the law work in that framework. Instead they seem content to prove that the health insurance market shouldn't be a for profit industry which will undoubtedly make it an actual government run plan. Ironic. It is kind of crazy for the right to spend so much time, effort and money trying to destroy a law that should foster continued, maybe even heightened, competition.

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over under on how many hours that page will be viewable until someone deletes it? I say 2 more hours

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over under on how many hours that page will be viewable until someone deletes it? I say 2 more hours

How did you find it? How long has it been like that?

Given the time it's taken them to build a website, I don't think they will be too quick is tearing one down. I'll take the over.

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Just my opinion, Tobias, but Mattyl comes across to me just as credible as you and far less condesending.

:2cents:

Thanks for sharing. Not sure where I was condescending here, since I've admitted i know virtually nothing about this issue. All I know if that if you say someone is lying, you should use their actual statement and relevant data when you try to prove it.

"It sucks for all of us that the guy who appears to be the most prominent expert with respect to this industry is full of ####."

"Just stop digging. You're embarrassing yourself. It was an atrocious argument and you know it. Go back and read the post if you've forgotten how bad it was."

My opinion is you guys are looking at the numbers from different viewpoints and don't see the point the other is making. I don't know who is more right nor due I really care. I just know when

you start stating your opinion about someone as fact as you did above, it comes across as condescending. Mattyl hasn't done that in this thread and appears to have honestly tried to respond to all your arguments. Again, just a third party opinion, so feel free to ignore it if you like.

BOOM! :goodposting:

We all know what Tobias is doing and it isn't working. Mattyl clearly knows what he is talking about whereas Tobias...not so much. We all know which side Tobias is on, and it's preceded with "hard" and ends with "left". So, of course he's going to come in here and try and take Mattyl down to protect the Savior.

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I realize it's all anecdotal, but as a small business owner who has purchased my families insurance for 25+ years, I finally left Blue Cross and will save 7k this year. If anything, the focus on health insurance just made me more diligent in finding a better alternative. I would usually just get a call from my broker during enrollment time and she'd say, the plan is going up again, and because I didn't really feel like dealing with it myself I'd just re-up at whatever cost. This year, I found a new broker and a comparable plan from United Healthcare that saved some real money. Only wish I did it 10 years ago.

So you're saying market competition has been here the entire time? No way! :o

Competition doesn't work if the consumer has no idea of their choices. Whether that is no idea that these choices exist or no idea how to weight them. The exchanges help with the former, the latter remains to be seen.

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I realize it's all anecdotal, but as a small business owner who has purchased my families insurance for 25+ years, I finally left Blue Cross and will save 7k this year. If anything, the focus on health insurance just made me more diligent in finding a better alternative. I would usually just get a call from my broker during enrollment time and she'd say, the plan is going up again, and because I didn't really feel like dealing with it myself I'd just re-up at whatever cost. This year, I found a new broker and a comparable plan from United Healthcare that saved some real money. Only wish I did it 10 years ago.

So you're saying market competition has been here the entire time? No way! :o

Competition doesn't work if the consumer has no idea of their choices. Whether that is no idea that these choices exist or no idea how to weight them. The exchanges help with the former, the latter remains to be seen.

We really need to stop coddling the lazy.

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1) move the age bands from the current 3:1 max to a 5:1 max. This will lower the costs for the younger folks, enticing them to join the pool. The stats are something like a third of people between 21 and 34 are currently uninsured when they currently have the advantage of lower prices. I don't know why people think that adjusting age bands to 3:1 (which will increase the cost to the young) will somehow now get them to enroll. I understand that this will have to increase the rates some for the older folks - which is what the market currently dictates anyway. Older folks have had the advantage of time to put money away for things like this, they can handle it.

Does a 5:1 "age band" put the average rates for older folks above Medicare's cost per enrollee? I don't know. What is the stated reason for this in the ACA? (This is outside of my area of expertise.)

Except I disagree with that last sentence. These "older folks" are living in a much different world than when they were younger.

2) remove at least some of the EHBs. It's beyond stupid to me that a single woman in her 40s has to have "pediatric dental" included on her plan which increases her cost - much like a single male having maternity coverage. These EHBs (the most important of which were already included on the vast majority of individual plans like Rx, ER, lab work) have driven up costs for all, which will adversely affect the number of people who enroll (simple supply and demand).

How are benefits that aren't going to be used "driving up cost for all". Sure the utilization of these benefits spreads the cost of them across the entire risk pool, but covering things that aren't used don't add costs.

Now if more people utilize more expensive care because they are now covered that would add costs right now. But we are going away from utilization based reimbursement of providers so even that may not be true very long.

And "population management" healthcare requires that people have these base levels of coverage in order to coordinate care.

3) allow for higher deductibles than the current maximum (and make is asset based if you want to). The higher the deductible, the lower the premium. The lower the premium the more utilization you'll see as more will be able to afford it. Some people can afford a $6,350 "worse case scenario" currently, some can afford even more and would if it meant 10-20% lower premiums.

The percentage of patient due accounts receivables have doubled to tripled in the past 10 years for a typical practice. Part of this was the economy. Part of it is that high deductible plans are now 20% or so of the market. Collecting this patient AR is expensive.
I'm not terribly against these, especially when linked to HSAs as shown somewhere in this thread. However these savings in premium do come at a cost elsewhere in the system.

4) don't punish a group for not proving medical insurance if they don't want to. For many employees, it will actually benefit them (making them subsidy eligible). It also opens up options for the employees from the 1 or 2 plans their employer offers to all the plans available to them on the exchange.

$2000 to $3000 an employee is not a punishment, it is merely the bill for out sourcing these administrative services. And while that is a bit of a flippant answer, it is largely the reason why not. Something has to pay for the subsidies of these employees.

5) don't make subsidy eligibility solely based on income (and if other coverage is available to you). Make it also based on assets/net worth. I already have a client who retired early who can pretty much dictate his income that he takes from his IRA/401(k) - and he owns a $2M+ farm that he paid for in cash. He's planning on only "paying himself" $40k or so next year so that he qualifies for subsidized coverage. I think we can all agree this isn't right, but should it work will be a trend that continues and grows.

The problem with "need based" programs someone needs to determine the need. Implementing your idea sounds good, but likely too costly in bureaucrats making calls. But I could be convinced otherwise.

6) (and I know this won't go over well here but I'll say it anyway), make maternity an optional rider. Unlike nearly every single other "health insurance claim", maternity is one that is directly dictated by choice and most often planned for (I understand some pregnancies are unexpected). You don't choose to break your arm or get sick, but you do often choose as well as plan to get pregnant. If you want to have a child that is by all means your choice and no one is taking that away, but why should I be part of paying for that $10-15k claim (the average cost to deliver a baby)? If you can't afford that, or simply the additional cost to add a rider to your coverage that would cover that - I'm sorry, you can't afford to raise a child. If that child has an illness or ailment which is unexpected or not planned for, that's what the insurance is there to cover.

No! This should be a shared societal cost for the same reason educating children is shared, because society is benefited by the stability that families provide. That parenting provides. (In general of course). I know we have some guys around here who want to control population growth, but they are currently on the losing side of policy decisions.

.

7) have some additional forms of "medical underwriting". This will get tricky I know, but if it's "ok" to charge a smoker up to 50% more, I fail to see what would be wrong with charging more for other personal choices that have a direct link to medical costs. Maybe the easiest way to do this would be to give "discounts" off the base rate for people who meet requirements rather than giving premium increases for those who do. Example - base rate is $200, but you get a 10% if you can show you don't smoke, with another 5-10% if your BMI is in a certain range, and potentially others. We need to incentiveize the public to lead healthier lives, and there is no better way to do that than with $.

These incentives already exists in "wellness programs" and will only get bigger as healthcare is about managing populations and not responding to incidents. Maybe they aren't on the premium side but they are happening.

8) increase the eligibility for Health Savings Accounts (HSAs). This will have a direct link to reducing bankruptcies from medical claims. Make no mistake about it, many people will have higher OOP maximums on ACA compliant plans than they did on the plans being canceled. Some people simply don't have the savings to meet that new higher OOP max should something occur. Give people the ability to put money away on a tax favored basis to cover that.

HSA's are fine. (Though I'd rather the government partially fund them on the spending side of the ledger than hide the cost on the tax side. I don't like "tax expenditures".)

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We really need to stop coddling the lazy.

Small business owners who aren't well versed in the array of health insurance plans available for their group are lazy? Even those that try by out sourcing to what the expect have some expertise in the field?

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We really need to stop coddling the lazy.

Small business owners who aren't well versed in the array of health insurance plans available for their group are lazy? Even those that try by out sourcing to what the expect have some expertise in the field?

lazy or stupid. take your pick. They probably do lots of comparison shopping for everything else, why don't they for insurance?

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We really need to stop coddling the lazy.

Small business owners who aren't well versed in the array of health insurance plans available for their group are lazy? Even those that try by out sourcing to what the expect have some expertise in the field?

lazy or stupid. take your pick. They probably do lots of comparison shopping for everything else, why don't they for insurance?

Yep, the 11% of Americans who actually own their own business did it by being stupid and lazy. They'd just be better off getting a job somewhere and have their boss take care of it for them.

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1) move the age bands from the current 3:1 max to a 5:1 max. This will lower the costs for the younger folks, enticing them to join the pool. The stats are something like a third of people between 21 and 34 are currently uninsured when they currently have the advantage of lower prices. I don't know why people think that adjusting age bands to 3:1 (which will increase the cost to the young) will somehow now get them to enroll. I understand that this will have to increase the rates some for the older folks - which is what the market currently dictates anyway. Older folks have had the advantage of time to put money away for things like this, they can handle it.

Does a 5:1 "age band" put the average rates for older folks above Medicare's cost per enrollee? I don't know. What is the stated reason for this in the ACA? (This is outside of my area of expertise.)

Except I disagree with that last sentence. These "older folks" are living in a much different world than when they were younger.

I'll see if I can tackle these one at a time.

It may very well put the average rate for older folks toward Medicare, depending on the plan chosen. Now if the plans weren't rated up as high so the 60 could have maternity and juvenile oral care (some of my other points), they likely wouldn't be so high. I'm honestly not sure what the "stated reason" is or if there is one, but the current age bands which could be closer to 7:1 are built around the actual utilization of health care by people of different ages. It cost more to insure the average 64 year old than the average 18 year old, that's obvious. The idea was simply that the younger would subsidize the older (the younger would have to pay more so that the older could pay less).

The last sentence you can disagree with but it's true. The older folks have been apart of the health care market for their entire lives and have for the most part become accustomed to the higher rates older folks are charged. A 5:1 band still helps them by lowering their average cost. A 3:1 band helps them too much, at the detriment to the younger. The older ages have a higher % of insured already, so why are we giving them such a price break to keep them insured?

The entire idea of the ACA was to get more people insured. By far the age bracket with the highest % of uninsured is the young (18-30ish). If we're trying to get these young "invincibles" insured, we need to make is financially feasible for them.

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2) remove at least some of the EHBs. It's beyond stupid to me that a single woman in her 40s has to have "pediatric dental" included on her plan which increases her cost - much like a single male having maternity coverage. These EHBs (the most important of which were already included on the vast majority of individual plans like Rx, ER, lab work) have driven up costs for all, which will adversely affect the number of people who enroll (simple supply and demand).

How are benefits that aren't going to be used "driving up cost for all". Sure the utilization of these benefits spreads the cost of them across the entire risk pool, but covering things that aren't used don't add costs.

Now if more people utilize more expensive care because they are now covered that would add costs right now. But we are going away from utilization based reimbursement of providers so even that may not be true very long.

And "population management" healthcare requires that people have these base levels of coverage in order to coordinate care.

The last few days I've been running quotes for people on ACA plans for 1/1/14. For some reason one particular carrier, that I won't name, doesn't have pediatric dental imbedded already and has it as a "stand alone" that you must then include on the plan separately to be ACA compliant. I ran a quote for a single 28 year old female (who wants a plan that will cover maternity, that's a separate issue). I told her that she has to have the pediatric dental rider included on her plan, that it was a rider we had to include. She asked how much. I said an extra $6.80 I believe. She tells me that she doesn't have a kid yet, so why does she need to have dental care for it. I had no answer.

It's not a huge additional cost, and she'll pay it. I'm just not sure why it's "essential" for a plan covering a single 28 year old to have pediatric dental at all. It increased her cost about 3%, so again, not huge. But that extra couple of bucks per month might be the difference between some other 28 year old not buying a plan and going uninsured rather than buying one (again, supply and demand). The lower cost we make these plans, the higher utilization we'll see, and that's the goal here. If we do the same for some other EHBs (especially maternity and drug and alcohol rehab which personally I don't think belong on "health insurance plans") we could lower everyone's cost by 30% or more. The lower these prices are, the more utilization we'll have.

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3) allow for higher deductibles than the current maximum (and make is asset based if you want to). The higher the deductible, the lower the premium. The lower the premium the more utilization you'll see as more will be able to afford it. Some people can afford a $6,350 "worse case scenario" currently, some can afford even more and would if it meant 10-20% lower premiums.

The percentage of patient due accounts receivables have doubled to tripled in the past 10 years for a typical practice. Part of this was the economy. Part of it is that high deductible plans are now 20% or so of the market. Collecting this patient AR is expensive.
I'm not terribly against these, especially when linked to HSAs as shown somewhere in this thread. However these savings in premium do come at a cost elsewhere in the system.

Got any proof of that? I did say you could make it asset based if you really wanted to. I myself have an "HDHP" or high deductible health plan, combined with an HSA. My HSA currently has enough to cover a full year's deductible and OOP.

If you want to you could "force" the HSA on the insured, so instead of paying $200 to the insurance company, he pays $150 to the insurance company for the higher deductible plan and $50 to his HSA (which is his money). Healthy people will jump all over that, and those are the people you need in the pool to make this thing work.

My point #1 helped keep the young in the pool, this one helps keep the healthy in the pool. We need both those groups in the pool for this to work.

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1) move the age bands from the current 3:1 max to a 5:1 max. This will lower the costs for the younger folks, enticing them to join the pool. The stats are something like a third of people between 21 and 34 are currently uninsured when they currently have the advantage of lower prices. I don't know why people think that adjusting age bands to 3:1 (which will increase the cost to the young) will somehow now get them to enroll. I understand that this will have to increase the rates some for the older folks - which is what the market currently dictates anyway. Older folks have had the advantage of time to put money away for things like this, they can handle it.

Does a 5:1 "age band" put the average rates for older folks above Medicare's cost per enrollee? I don't know. What is the stated reason for this in the ACA? (This is outside of my area of expertise.)

Except I disagree with that last sentence. These "older folks" are living in a much different world than when they were younger.

I'll see if I can tackle these one at a time.

It may very well put the average rate for older folks toward Medicare, depending on the plan chosen. Now if the plans weren't rated up as high so the 60 could have maternity and juvenile oral care (some of my other points), they likely wouldn't be so high. I'm honestly not sure what the "stated reason" is or if there is one, but the current age bands which could be closer to 7:1 are built around the actual utilization of health care by people of different ages. It cost more to insure the average 64 year old than the average 18 year old, that's obvious. The idea was simply that the younger would subsidize the older (the younger would have to pay more so that the older could pay less).

The last sentence you can disagree with but it's true. The older folks have been apart of the health care market for their entire lives and have for the most part become accustomed to the higher rates older folks are charged. A 5:1 band still helps them by lowering their average cost. A 3:1 band helps them too much, at the detriment to the younger. The older ages have a higher % of insured already, so why are we giving them such a price break to keep them insured?

The entire idea of the ACA was to get more people insured. By far the age bracket with the highest % of uninsured is the young (18-30ish). If we're trying to get these young "invincibles" insured, we need to make is financially feasible for them.

I have no expertise here, but how is this analysis wrong?

Overall, we find that loosening the rate bands from 3:1 to 5:1 would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers, once subsidies are taken into account. This is not only the case for all likely purchasers, but also for two populations of particular concern: the 10 million 21-27 year olds who are currently uninsured and the 3 million who currently have nongroup coverage.

The vast majority of these young adults will be protected by Medicaid/CHIP, subsidies provided through the exchanges, or by their parents’ employer-based coverage. By contrast, looser rate bands would significantly increase out-of-pocket rates paid by the oldest purchasers, who lack a parental option and are substantially less likely to be eligible for subsidies

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4) don't punish a group for not proving medical insurance if they don't want to. For many employees, it will actually benefit them (making them subsidy eligible). It also opens up options for the employees from the 1 or 2 plans their employer offers to all the plans available to them on the exchange.

$2000 to $3000 an employee is not a punishment, it is merely the bill for out sourcing these administrative services. And while that is a bit of a flippant answer, it is largely the reason why not. Something has to pay for the subsidies of these employees.

I've got a client who owns 3 higher end salons/spas. Because it's common ownership, they all count as one and he has over 50 employees. In fact he's got closer to 80, many part time - but when you do the calculation he'll need to start offering coverage. It will be very expensive for him to do so, and will force him to cut jobs to get under the 50 threshold (that's his plan at the moment).

So either he buys new coverage at a new inflated price which the company doesn't have the money to do, he cuts jobs to get under the limit, or he pays a large fine which he still can't do financially to that level. $2k x 50 employees is $100k a year.

Without the penalty, no jobs lost - and each and every employee can go on the exchange and get their choice of plan and potentially qualify for a subsidy.

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2) remove at least some of the EHBs. It's beyond stupid to me that a single woman in her 40s has to have "pediatric dental" included on her plan which increases her cost - much like a single male having maternity coverage. These EHBs (the most important of which were already included on the vast majority of individual plans like Rx, ER, lab work) have driven up costs for all, which will adversely affect the number of people who enroll (simple supply and demand).

How are benefits that aren't going to be used "driving up cost for all". Sure the utilization of these benefits spreads the cost of them across the entire risk pool, but covering things that aren't used don't add costs.

Now if more people utilize more expensive care because they are now covered that would add costs right now. But we are going away from utilization based reimbursement of providers so even that may not be true very long.

And "population management" healthcare requires that people have these base levels of coverage in order to coordinate care.

The last few days I've been running quotes for people on ACA plans for 1/1/14. For some reason one particular carrier, that I won't name, doesn't have pediatric dental imbedded already and has it as a "stand alone" that you must then include on the plan separately to be ACA compliant. I ran a quote for a single 28 year old female (who wants a plan that will cover maternity, that's a separate issue). I told her that she has to have the pediatric dental rider included on her plan, that it was a rider we had to include. She asked how much. I said an extra $6.80 I believe. She tells me that she doesn't have a kid yet, so why does she need to have dental care for it. I had no answer.

It's not a huge additional cost, and she'll pay it. I'm just not sure why it's "essential" for a plan covering a single 28 year old to have pediatric dental at all. It increased her cost about 3%, so again, not huge. But that extra couple of bucks per month might be the difference between some other 28 year old not buying a plan and going uninsured rather than buying one (again, supply and demand). The lower cost we make these plans, the higher utilization we'll see, and that's the goal here. If we do the same for some other EHBs (especially maternity and drug and alcohol rehab which personally I don't think belong on "health insurance plans") we could lower everyone's cost by 30% or more. The lower these prices are, the more utilization we'll have.

First where is the language either in the law or in the regulatory items that make the "Deamonte Driver" provisions required for those 19 and up? I don't think it exists.

And how do you care for patients from "soup to nuts" (which is what is coming) if mental health and drug rehab etc. is carved out? This just doesn't work. No one calls it "global capititation" any more, but that is what is coming and you just can't start carving out segments of care that need to be managed.

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I have no expertise here, but how is this analysis wrong?

Overall, we find that loosening the rate bands from 3:1 to 5:1 would have very little impact on out-of-pocket rates paid by the youngest nongroup purchasers, once subsidies are taken into account. This is not only the case for all likely purchasers, but also for two populations of particular concern: the 10 million 21-27 year olds who are currently uninsured and the 3 million who currently have nongroup coverage.

The vast majority of these young adults will be protected by Medicaid/CHIP, subsidies provided through the exchanges, or by their parents’ employer-based coverage. By contrast, looser rate bands would significantly increase out-of-pocket rates paid by the oldest purchasers, who lack a parental option and are substantially less likely to be eligible for subsidies

For those who don't understand what we mean by "age bands", it's the maximum difference in premium from the youngest to the oldest. So if a 21 year old cost $150 for a certain plan, the exact same plan for a 64 year old can't be more than $450 (3:1). What I'm saying is we should loosen that to something closer to 5:1 (in today's market we can see up to an including 7:1). At 5:1, my same example would have the 21 year old paying $100 and the 65 year old paying $500. Together the insurance company still gets $600 for the pair, so there is the same amount of money in the pool. Also in my example it's a 33% reduction in premium for the 21 year old for only a 11.1% increase for the 64 year old. Understand these aren't actual rates, but the ratios are correct - typical unsubsidized ACA rates are much higher.

If the ACA is here to get more people insured, I don't think the extra $50 is going to prevent many 64 year olds from obtaining coverage while the $50 lower cost for the 21 year olds will result in far more jumping in sooner (which the ACA will need).

I bolded that part of your quote because mathematically it can't be correct. They then say "once subsidies are taken into account" that the cost will be the same, but they go on to point out that we have 10m 21-27 year olds who are current uninsured, with another 3m on individual plans. That's 13m people between only 21-27 - and we saw a study released yesterday that only an estimated 17m Americans total will get subsidies the first year. So how are 13m of the 17m all between the ages of 21 and 27?! They obviously aren't all going to get subsidies, and I'm afraid that those who don't, won't jump in the pool to the detriment of the pool itself which will now be older without them.

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And right below the above is this gem...

Same Coverage Choices as Members of Congress

Every member of Congress will be required to purchase their insurance from the new health insurance exchange.

http://www.whitehouse.gov/health-care-meeting/proposal/titlei/congress

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First where is the language either in the law or in the regulatory items that make the "Deamonte Driver" provisions required for those 19 and up? I don't think it exists.

I was informed today by a large carrier that for all OFF exchange plans, you must either have a plan with pediatric dental embedded, or have the stand alone rider included on a plan that doesn't have it embedded. I'm not sure where or even if it is in the law, but apparently carriers are forcing it upon everyone OFF exchange because they believe it is. This carrier is not alone...

http://www.flapsblog.net/2013/01/obamacare-in-dentistry-california-and.html

https://www.hsaforamerica.com/hsablog/pediatric-dental-aca/

Is pediatric dental coverage mandatory?

if an individual or small group chooses to purchase health coverage outside of the exchange and from a private insurer, the dental coverage MUST be purchased along with it.

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4) don't punish a group for not proving medical insurance if they don't want to. For many employees, it will actually benefit them (making them subsidy eligible). It also opens up options for the employees from the 1 or 2 plans their employer offers to all the plans available to them on the exchange.

$2000 to $3000 an employee is not a punishment, it is merely the bill for out sourcing these administrative services. And while that is a bit of a flippant answer, it is largely the reason why not. Something has to pay for the subsidies of these employees.

I've got a client who owns 3 higher end salons/spas. Because it's common ownership, they all count as one and he has over 50 employees. In fact he's got closer to 80, many part time - but when you do the calculation he'll need to start offering coverage. It will be very expensive for him to do so, and will force him to cut jobs to get under the 50 threshold (that's his plan at the moment).

So either he buys new coverage at a new inflated price which the company doesn't have the money to do, he cuts jobs to get under the limit, or he pays a large fine which he still can't do financially to that level. $2k x 50 employees is $100k a year.

Without the penalty, no jobs lost - and each and every employee can go on the exchange and get their choice of plan and potentially qualify for a subsidy.

And who would be paying for those subsidies under this plan?

So you are suggestion that this business owner choosing for his business to remain static and never again grow ever? And having thresholds in business where it is extra expensive to add that next customer (maybe another employee, maybe a bigger building, another machine, etc.) so this isn't really any different. Should I expect him (and others in his shoes) to like it? No of course not. But he shouldn't gain a competitive advantage by shifting the cost of his employee's healthcare to tax payers. And we can't afford to have to many of them be "free riders" any longer.

Oh, and your $100K would be for 80 full time employees? Correct? The first 30 are free? Or do I have that wrong?

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I bolded that part of your quote because mathematically it can't be correct. They then say "once subsidies are taken into account" that the cost will be the same, but they go on to point out that we have 10m 21-27 year olds who are current uninsured, with another 3m on individual plans. That's 13m people between only 21-27 - and we saw a study released yesterday that only an estimated 17m Americans total will get subsidies the first year. So how are 13m of the 17m all between the ages of 21 and 27?! They obviously aren't all going to get subsidies, and I'm afraid that those who don't, won't jump in the pool to the detriment of the pool itself which will now be older without them.

As I pointed out last night you used the KFF's 17 million as a numerator and then coming up with your own denominator to promote that the "promise" was a lie, Yet using the KFF's population as the denominator things lined up just fine.

Now this study does not say that most of the 13 million would be getting subsidies. It says most will be getting either Medicaid/CHIP coverage or be covered by their parents plans or be eligible for subsidies.

So at the end of this, no you don't have anything to suggest that this is wrong. Right?

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First where is the language either in the law or in the regulatory items that make the "Deamonte Driver" provisions required for those 19 and up? I don't think it exists.

I was informed today by a large carrier that for all OFF exchange plans, you must either have a plan with pediatric dental embedded, or have the stand alone rider included on a plan that doesn't have it embedded. I'm not sure where or even if it is in the law, but apparently carriers are forcing it upon everyone OFF exchange because they believe it is. This carrier is not alone...

http://www.flapsblog.net/2013/01/obamacare-in-dentistry-california-and.html

https://www.hsaforamerica.com/hsablog/pediatric-dental-aca/

Is pediatric dental coverage mandatory?

if an individual or small group chooses to purchase health coverage outside of the exchange and from a private insurer, the dental coverage MUST be purchased along with it.

"California and Washington Mandate Pediatric Dentistry in Health Exchanges"

Technically these are state regulations and/or interpetations.

The second site's is being blocked because it lands at different site than the link says so I don't know what it says, but I trust it is talking about the interpretation that items sold in the federal exchange need to only offer it while those plans outside it must include it (which could include states running their own). But even still the relevant part is still-

Is dental coverage required as of Jan. 1, 2014, under the ACA?

Yes, for children but not adults. After Jan. 1, 2014, all individual and small group market plans – both inside and outside the exchange – must be certified as "qualified health plans" except for stand-alone dental plans. QHPs must provide all "essential health benefits". Pediatric oral health services are included in the 10-category EHB package and must be offered.

Are pediatric plans one and the same as adult plans?

Edited by Bottomfeeder Sports

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By the way. Notice how the ADA described the ACA?

The "Patient Protection and Affordable Care Act," shorthanded as the ACA and as this series of reports will refer to it, has the potential to reshape health care in America. Expansion of medical insurance coverage, a move toward more integrated care delivery and significant changes in the financing of health care are among the expectations of ACA legislators and regulators.

Most of the focus of this thread is on the "expansion of medical insurance coverage" while wondering out loud why it doesn't address "a move toward more integrated care delivery and significant changes in the financing of health care". Which is really what is important.

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Had an interesting three hours this afternoon.

Spent it with a software programming company my son has worked at the past two years.

He's in Week 2 of a furlough because the software company has yet to see it's two Navy contracts with a 10/1 renewal date get renewed due to the shut down. Although it's just a matter of 5-10 days now as they get their back log unjammed of yearly contract renewals.

They programmed a real-time system that tracks the readiness of military aircraft (there was no such thing when 9/11 went down) and the other project is "Sim Navy", yes, just like the game, but this baby is real and highly classified. Both contracts are well into the 7-figure range.

I was there to scope a job for my website upgrade for my business.

At the end of the meeting, I asked them their opinion about the Obamacare website.

They basically said they were stunned that something so bad would actually be launched.

They said from what they had read, the structure of the site was flawed in so many ways, that if they ever get it fixed, it's functionality will still be very poor at best from problems associated with tryingto merge data from so many different systems that all the different states and counties use, most of which are 10-15 years old.

They work with the Navy. Very strict guidelines that have to be followed. Several hundred items/regulations that have to be accounted for programming wise and that the Obamacare site probably had a thousand or two of these items and the job should have been scoped out at four, and better yet, five years to just roll out phase one.

They were stunned at the cost of it also, citing that Apple spent $170 million to build it's platform that works on all the Iphones out in the world today. He said they'd gladly take $300 million and live with all the bad publicity. LOL.

Edited by Getzlaf15

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And right below the above is this gem...

Same Coverage Choices as Members of Congress

Every member of Congress will be required to purchase their insurance from the new health insurance exchange.

http://www.whitehouse.gov/health-care-meeting/proposal/titlei/congress

Both are still there....I'm sorta surprised.

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Probably shouldn't be mentioning a highly classified project here....just sayin

Edited by Slapdash
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Probably shouldn't be mentioning a highly classified project here....just sayin

Why do you hate America's war on terror?!?!?!

/Tim

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I bolded that part of your quote because mathematically it can't be correct. They then say "once subsidies are taken into account" that the cost will be the same, but they go on to point out that we have 10m 21-27 year olds who are current uninsured, with another 3m on individual plans. That's 13m people between only 21-27 - and we saw a study released yesterday that only an estimated 17m Americans total will get subsidies the first year. So how are 13m of the 17m all between the ages of 21 and 27?! They obviously aren't all going to get subsidies, and I'm afraid that those who don't, won't jump in the pool to the detriment of the pool itself which will now be older without them.

As I pointed out last night you used the KFF's 17 million as a numerator and then coming up with your own denominator to promote that the "promise" was a lie, Yet using the KFF's population as the denominator things lined up just fine.

Now this study does not say that most of the 13 million would be getting subsidies. It says most will be getting either Medicaid/CHIP coverage or be covered by their parents plans or be eligible for subsidies.

So at the end of this, no you don't have anything to suggest that this is wrong. Right?

To be fair to this there are two obvious counter points (after sleeping on it) to the study-

  • The first is that only 23 (I think) states extended Medicaid so all of the studies that didn't account for this will have the numbers off.
  • The second is that in weighing the costs and benefits of various ideas I'm not certain of the cost that shifting people to Medicaid or their parent's plans that could be participating in the market would create.

The ACA is a complicated piece of legislation which is why I'd like to hear the though process in going into this to understand all of the competing concerns before concluding that this is a good or bad idea. Despite my finding a rebuttal to the idea that it will make a big difference in the numbers, I haven't made that call on this item. I don't have the expertise to know how to pick apart either your argument or the study I posted which is why I was hoping you could at least counter "my rebuttal" with something that would make me think rather than something that at most took two seconds to brush off.

Edited by Bottomfeeder Sports

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They were stunned at the cost of it also, citing that Apple spent $170 million to build it's platform that works on all the Iphones out in the world today. He said they'd gladly take $300 million and live with all the bad publicity. LOL.

Building your own closed system where you control everything at your own pace is pretty easier relative to the demands here. If $170 million is our baseline then anything less than 10s of billions is going to be a deal. (I'm just weighing the relative projects scopes utilizing the information listed in the rest of your post, not arguing the dollars.)

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:lmao:

BTW, liberals, if you don't like it, change the channel.

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I bolded that part of your quote because mathematically it can't be correct. They then say "once subsidies are taken into account" that the cost will be the same, but they go on to point out that we have 10m 21-27 year olds who are current uninsured, with another 3m on individual plans. That's 13m people between only 21-27 - and we saw a study released yesterday that only an estimated 17m Americans total will get subsidies the first year. So how are 13m of the 17m all between the ages of 21 and 27?! They obviously aren't all going to get subsidies, and I'm afraid that those who don't, won't jump in the pool to the detriment of the pool itself which will now be older without them.

As I pointed out last night you used the KFF's 17 million as a numerator and then coming up with your own denominator to promote that the "promise" was a lie, Yet using the KFF's population as the denominator things lined up just fine.

Now this study does not say that most of the 13 million would be getting subsidies. It says most will be getting either Medicaid/CHIP coverage or be covered by their parents plans or be eligible for subsidies.

So at the end of this, no you don't have anything to suggest that this is wrong. Right?

I'm just stating that not all of those between 21-27 who will get premium increases due to the new age bands will have those covered by a subsidy, that's all. And even if "most" will be getting coverage through Medicaid/CHIP (paid by someone else) or coverage through their parents (paid by someone else) or getting a subsidy (paid by someone else) - is that really what we want? Call me conservative, but I'd rather people purchase and own something of their own rather than relying on the help of others.

Also, CHIP is for those 18 or under, so not the age range we're talking about here.

Am I the only one who doesn't want to coddle kids all the way until they are 27 by allowing them to stay on mommy's plan? Seriously, at 27 I had a degree, owned a car outright, had already bought and sold my first residence, was about to purchase my first actual single family home, and had been employed by the same place for 6 years. I totally understand that not everyone will be in the same situation, but at some point you need to be off on your own and taking care of yourself. Also, just because they can be covered under their parents plan doesn't mean the rate to do so will be any less. It's the same inflated rate that's now being passed to the parents (who may ask for the child to fund it, who may not want to at the higher rates).

Age bands will also help more than just those between 21 and 27. Go back to your link and see all the ages under the 2.0 "premium ratio" (half way between the current minimum 1.0 and the current maximum 3.0). It will help people all the way up to around 50. If you look at the uninsured population based on age, you see that insurance coverage tends to increase with age. It's not just those from 21 to 27 who are currently uninsured. We have a large chunk of people in their late 20s and early 30s who are uninsured (semi-young invincibles) while we see a much higher % of coverage for those in their 50s to mid 60s when medicare takes over.

If the idea of the ACA is to get to semi universal coverage, we need to take steps to get those currently uninsured covered, and hopefully covered by something that they themselves can afford to purchase.

Edited by matttyl

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Is dental coverage required as of Jan. 1, 2014, under the ACA?

Yes, for children but not adults. After Jan. 1, 2014, all individual and small group market plans – both inside and outside the exchange – must be certified as "qualified health plans" except for stand-alone dental plans. QHPs must provide all "essential health benefits". Pediatric oral health services are included in the 10-category EHB package and must be offered.

Are pediatric plans one and the same as adult plans?

No, they are not. They are different. Starting in 2014, all plans offered to both individuals and small groups need to be QHPs (need to meet standards). Having pediatric oral is a standard EHB and must be included on all plans.

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By the way. Notice how the ADA described the ACA?

The "Patient Protection and Affordable Care Act," shorthanded as the ACA and as this series of reports will refer to it, has the potential to reshape health care in America. Expansion of medical insurance coverage, a move toward more integrated care delivery and significant changes in the financing of health care are among the expectations of ACA legislators and regulators.

Most of the focus of this thread is on the "expansion of medical insurance coverage" while wondering out loud why it doesn't address "a move toward more integrated care delivery and significant changes in the financing of health care". Which is really what is important.

Notice which one they listed first? Expansion of insurance coverage. Those are the things I'm trying to "tweak" in the current ACA structure to improve upon that promise - as Tim requested yesterday.

The 2nd part could have been done without canceling million's of peoples insurance, or really changing much of anything on the insurance side of the equation.

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5) don't make subsidy eligibility solely based on income (and if other coverage is available to you). Make it also based on assets/net worth. I already have a client who retired early who can pretty much dictate his income that he takes from his IRA/401(k) - and he owns a $2M+ farm that he paid for in cash. He's planning on only "paying himself" $40k or so next year so that he qualifies for subsidized coverage. I think we can all agree this isn't right, but should it work will be a trend that continues and grows.

The problem with "need based" programs someone needs to determine the need. Implementing your idea sounds good, but likely too costly in bureaucrats making calls. But I could be convinced otherwise.

Medicaid is asset based for their LTC benefits. Why can't we do the same here?

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Caught the first half hour of the today show on NBC this morning and not one mention of the ACA. Not even anything about the hearing yesterday. Strange.

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6) (and I know this won't go over well here but I'll say it anyway), make maternity an optional rider. Unlike nearly every single other "health insurance claim", maternity is one that is directly dictated by choice and most often planned for (I understand some pregnancies are unexpected). You don't choose to break your arm or get sick, but you do often choose as well as plan to get pregnant. If you want to have a child that is by all means your choice and no one is taking that away, but why should I be part of paying for that $10-15k claim (the average cost to deliver a baby)? If you can't afford that, or simply the additional cost to add a rider to your coverage that would cover that - I'm sorry, you can't afford to raise a child. If that child has an illness or ailment which is unexpected or not planned for, that's what the insurance is there to cover.

No! This should be a shared societal cost for the same reason educating children is shared, because society is benefited by the stability that families provide. That parenting provides. (In general of course). I know we have some guys around here who want to control population growth, but they are currently on the losing side of policy decisions.

This wouldn't "control population growth" at all. I said above that if you want to have a child that is your decision, no one is taking that away from you. If you want to make that personal choice you still can, you just need to have a bit more skin in the game to do it. I just personally don't think insurance is there to cover the "known expenses", it's there for the unexpected. How does maternity coverage = parenting anyway?! Like I said above, if you're not financially well equipped enough to pay a $10k maternity claim yourself, then you are not financially well equipped enough to raise that child.

If nothing else have it as a covered expense for deliveries that cost more than say $7,500. Have a separate maternity deductible. It's still covered, after a point.

Being able to buy "guaranteed issue" hurricane coverage for your house in New Orleans when there is a storm brewing in the Gulf of Mexico would be crazy, right? How is this different? Why should you be able to buy coverage for a situation you know is coming?

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7) have some additional forms of "medical underwriting". This will get tricky I know, but if it's "ok" to charge a smoker up to 50% more, I fail to see what would be wrong with charging more for other personal choices that have a direct link to medical costs. Maybe the easiest way to do this would be to give "discounts" off the base rate for people who meet requirements rather than giving premium increases for those who do. Example - base rate is $200, but you get a 10% if you can show you don't smoke, with another 5-10% if your BMI is in a certain range, and potentially others. We need to incentiveize the public to lead healthier lives, and there is no better way to do that than with $.

These incentives already exists in "wellness programs" and will only get bigger as healthcare is about managing populations and not responding to incidents. Maybe they aren't on the premium side but they are happening.

These "incentives" don't directly affect John Q. Public's wallet. That's what we need. We need to be able to show an actual dollar amount for making certain lifestyle decision. The average person isn't getting any direct premium relief from "wellness programs" and you know it.

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8) increase the eligibility for Health Savings Accounts (HSAs). This will have a direct link to reducing bankruptcies from medical claims. Make no mistake about it, many people will have higher OOP maximums on ACA compliant plans than they did on the plans being canceled. Some people simply don't have the savings to meet that new higher OOP max should something occur. Give people the ability to put money away on a tax favored basis to cover that.

HSA's are fine. (Though I'd rather the government partially fund them on the spending side of the ledger than hide the cost on the tax side. I don't like "tax expenditures".)

Wait, you want the government to directly fund your health savings account?! How many more subsidies do you want?! Where is that money going to come from?

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Caught the first half hour of the today show on NBC this morning and not one mention of the ACA. Not even anything about the hearing yesterday. Strange.

The major media outlets have been getting "training" from the administration on how to cover the story.

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8) increase the eligibility for Health Savings Accounts (HSAs). This will have a direct link to reducing bankruptcies from medical claims. Make no mistake about it, many people will have higher OOP maximums on ACA compliant plans than they did on the plans being canceled. Some people simply don't have the savings to meet that new higher OOP max should something occur. Give people the ability to put money away on a tax favored basis to cover that.

HSA's are fine. (Though I'd rather the government partially fund them on the spending side of the ledger than hide the cost on the tax side. I don't like "tax expenditures".)

Wait, you want the government to directly fund your health savings account?! How many more subsidies do you want?! Where is that money going to come from?

Money comes from the same place rather it is via a tax break or direct spending.

But we get it, you don't want the government to help pay for health care.

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Money comes from the same place rather it is via a tax break or direct spending.

But we get it, you don't want the government to help pay for health care.

People will view the "direct spending" as their own money, money they put there themselves. The "tax break" is just money they didn't have to send to the government.

I don't want the government to help pay for health care for those who have the ability to pay for it themselves. If we can do things to lower the costs of ACA plans (which I've outlined above) more people will be able to afford them without government assistance. If we tweak subsidy eligibility, we can actually get the subsidies to those who need it - not give them to those who've found a "loophole".

And the more government "helps pay" for health care, the closer and closer we get to single payer. Unfortunately, that might be better than what we have in front of us.

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Caught the first half hour of the today show on NBC this morning and not one mention of the ACA. Not even anything about the hearing yesterday. Strange.

The major media outlets have been getting "training" from the administration on how to cover the story.

I think you mean how NOT to cover the story. FOX is the only major network giving this major coverage, and while their agenda is usually clear, in this case, it is perfectly justified, given what a disaster the ACA has been so far. It shows just how in the tank certain networks are for the president that they are barely mentioning this.

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Just finished signing up for an account and selecting my plan with the new provider at work. Took 5 minutes total with no glitches. Score another one for the private sector.

Also, why does health insurance for myself cost X, but health insurance for me and my spouse cost 3X? Why not 2X? :confused:

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8) increase the eligibility for Health Savings Accounts (HSAs). This will have a direct link to reducing bankruptcies from medical claims. Make no mistake about it, many people will have higher OOP maximums on ACA compliant plans than they did on the plans being canceled. Some people simply don't have the savings to meet that new higher OOP max should something occur. Give people the ability to put money away on a tax favored basis to cover that.

HSA's are fine. (Though I'd rather the government partially fund them on the spending side of the ledger than hide the cost on the tax side. I don't like "tax expenditures".)

Wait, you want the government to directly fund your health savings account?! How many more subsidies do you want?! Where is that money going to come from?

Money comes from the same place rather it is via a tax break or direct spending.

But we get it, you don't want the government to help pay for health care.

In the monster health care reform thread from several years ago, a bunch of us sort of agreed on a fed govt supplied HDHP plan for all Americans + some nominal HSA funding to cover basic care.

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It astounds me that the marriage penalty still exists. It astounds me even more that we keep creating new ones.

NEW YORK (CNNMoney)
There's a lot to recommend marriage. But if you're trying to score the biggest break on the new Obamacare insurance exchanges, it could make sense to say "I don't."

That's because unmarried couples may end up paying less for subsidized insurance than if they were married.

A primary reason are the federal poverty levels, which are used to determine the new subsidies to pay for premiums.

This "marriage penalty," as some conservative critics are calling it, is hardly unique to federal health reform.

"Any [federal benefit] structured based on poverty will have that effect," said Gary Claxton, a vice president of the Kaiser Family Foundation.

That includes Medicaid and various benefits administered through the tax code.

To qualify for one of Obamacare's premium tax credits -- as the main health insurance subsidy is known -- your income must be between poverty level and four times that amount for your household size. The higher up that scale you go, the smaller the subsidy.

The marriage penalty results largely from the fact that the combined salaries of couples can push them out of the range of eligibility faster than if they were unmarried and their paychecks were treated separately.

Here's why: The federal poverty level of a two-person household ($15,510) is less than double that of a one-person household ($11,490).

Take a couple who combined make $40,000 and don't have access to employer-sponsored insurance. Both partners are 35, each makes $20,000 and they don't have kids.

They will pay nearly $1,300 less for two silver-level plans in the exchanges after accounting for federal subsidies than if they were married, according to the Kaiser Family Foundation's health insurance subsidy calculator.

And that holds true whether they live in New York City, Las Vegas, Louisville, or Lawrence, Kansas.

Couples, of course, don't usually make the exact same salaries. Say one partner in the couple making $40,000 brings in $29,000, and the other brings in $11,000.

As an unmarried couple they could pay much less for their coverage than if they take a walk down the aisle. The higher earner would pay close to $1,000 less for a silver plan and $625 less for a bronze plan. And the partner making $11,000 would qualify for Medicaid if they live in a state that has expanded eligibility for the program.

As a result, the partner on Medicaid would pay very little for that coverage since there's almost no cost-sharing of expenses involved, Claxton said.

But if they didn't live in a state with expanded Medicaid, the calculation is different.

Say that same unmarried $40,000 couple live in Kansas.

The $29,000 earner would pay $957 less for a silver plan than if she had applied for premium tax credits as part of a married couple.

But here's the rub: The $11,000 earner would not qualify for Medicaid or a subsidy on the exchange.

So, in that instance, if health coverage for both partners is important, they might be better off getting married and applying for subsidized coverage as a couple, even if it costs more.

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Money comes from the same place rather it is via a tax break or direct spending.

But we get it, you don't want the government to help pay for health care.

People will view the "direct spending" as their own money, money they put there themselves. The "tax break" is just money they didn't have to send to the government.

I don't want the government to help pay for health care for those who have the ability to pay for it themselves. If we can do things to lower the costs of ACA plans (which I've outlined above) more people will be able to afford them without government assistance. If we tweak subsidy eligibility, we can actually get the subsidies to those who need it - not give them to those who've found a "loophole".

And the more government "helps pay" for health care, the closer and closer we get to single payer. Unfortunately, that might be better than what we have in front of us.

People view it differently, but it isn't really different.

I am fine with single payer though.

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