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TripItUp

Was/Is Obamacare effective?

Was/Is Obamacare effective?  

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37 minutes ago, rustycolts said:

I retired 2015.  I had been checking health insurance prices on and off for a couple of years before I retired it was expensive but I still could have afforded it.  To be honest though even if the ACA had not passed I probably would have dropped coverage.  I know I would have felt it was too expensive even then and a waste of money because I rarely go to the doctor.

Edit maybe if we could break the habit of war we could afford reasonable priced health care.  I have posted this before but here is what we have spent on endless wars since 2001.

https://www.nationalpriorities.org/cost-of/

We're getting a little off topic, but I've had similar thoughts about this decision.  My insurance is paid almost entirely by my employer, but if I had a period where I would be uninsured, I think I'd risk it too.  I know there is a chance something catastrophic could happen, but there is a price where the risk is worth taking.  It seems that most people disagree with this logic -- at least, that's generally the advice I hear.

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I'm not undecided. The answer is yes & no. Yes, in that it increased access. No, in that, by June '09, it had no teeth, didn't deal with the costs or layers of profit participation that would make it viable as a step toward national health coverage.

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11 minutes ago, Juxtatarot said:

We're getting a little off topic, but I've had similar thoughts about this decision.  My insurance is paid almost entirely by my employer, but if I had a period where I would be uninsured, I think I'd risk it too.  I know there is a chance something catastrophic could happen, but there is a price where the risk is worth taking.  It seems that most people disagree with this logic -- at least, that's generally the advice I hear.

How about a system where we didn't have to bear that risk at all?

I've been thinking about the expanded social safety net more as we see the U.S. continually slipping down the ranks of nations by level of "happiness." Western European countries where one can't go broke or have to stay in a crappy job because of health care/insurance are by and large more contented with their quality of life than we are here in our highly capitalistic and lightly regulated system. It makes me wonder if the chance to get rich -- or at least pay less in taxes -- is better for us than the chance to minimize risk and pursue things we like to do without worrying if we'll be able to afford the minimum levels of risk mitigation. Money may indeed not make you happy but in this country fear of not having it can dang sure make you unhappy. 

Insurance wise, I've been lucky as crap for most of my working life but I'm still facing a period of gap coverage ahead for my wife and the prospect of it is scary as heck. Things happen.

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During the time of ObamaCare we had record low number of uninsured and the smallest increases in NHE (and premiums) since those were tracked - which was a surprisingly short history.   The rate of deductible increases also declined.   CMS has claimed across multiple administrations that alternate payment model testing has been successful and has expanded some and even implemented a few of these.  While the current administration has been rolling out rules to undo this, the junk plans that dominated the market went away.

However all of that has caveats.

The number of uninsured is well less than planned because Medicaid expansion was left to the states after the supreme court ruling, because sloppy language created gaps within a family, the individual mandate - when it existed was too small, etc.   

The degree to which the smaller increases in NHE can be attributed to the ACA is debatable.  Many believe that a good chunk of that was due to the recession that preceded it.   Others believe that a good chunk of that is because the health care industry has implemented its own set of reforms to preempt any major government imposition (the ACA touched lots of things, but it more aligned the federal government to the industry rather than the other way around.) 

Deductible increases declining  is largely because the ACA imposes a cap at the top.  For most people with ESI where their deductible is not near the top have seen constant cost shifting.

While the APMs exist outside of Medicaid MSO and the ACA plans that mirror them on the exchanges we still largely live in a FFS world.

So the ACA has effectively cut the uninsured rate, but not as much as planned and the changes since have all been pretty much for the worst.  The "cost curve" has "bent downward" a little since passage but costs still go up faster than GDP and more importantly wages.   The ACA has more winners than losers, but some of those losers - those solidly in the middle class in the individual market who don't qualify for subsidies are largely priced out completely.

So selecting "YES" "NO" "Undecided" (as in all three) seems to be the correct answer.

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9 minutes ago, Bottomfeeder Sports said:

So selecting "YES" "NO" "Undecided" (as in all three) seems to be the correct answer.

I knew it...woot!!!  Winning!!!!!

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1 hour ago, timschochet said:

This is one of the very few threads on the first page that actually discusses a political issue. 

:goodposting:

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5 hours ago, Godsbrother said:

For people that could not get insurance due to preexisting conditions before the ACA it was effective.

I hope so, because that achievement came at a cost to others. 

My individual premiums have gone up 3x in the past 5-6 years, while coverage has been reduced by 50 percent and the excessively high deductibles make out-of-pocket costs so high that most plans are reduced to being just catastrophic.

So in terms of a transfer of wealth the ACA may have been successful/effective but hard to say otherwise (not that you said that specifically but to the larger topic).

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1 hour ago, PhantomJB said:

I hope so, because that achievement came at a cost to others. 

My individual premiums have gone up 3x in the past 5-6 years, while coverage has been reduced by 50 percent and the excessively high deductibles make out-of-pocket costs so high that most plans are reduced to being just catastrophic.

So in terms of a transfer of wealth the ACA may have been successful/effective but hard to say otherwise (not that you said that specifically but to the larger topic).

Might I ask if this was the group or individual market?

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33 minutes ago, The Commish said:

Might I ask if this was the group or individual market?

Individual

ETA: In addition, the pre-ACA plan was a PPO but now HMO

Edited by PhantomJB

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For me personally it's been a success. I buy through my state marketplace because my employer doesn't offer any coverage.

I've bought individual plans both pre-ACA and post.

Initially, I saw large increases in premium costs. Probably around 20%.

The past three years, my premiums have been flat. My plan added child dental coverage and my deductible actually went down about $200 this year.

I may be unique, though. I believe the price stabilization was a result of my state adding a reinsurance program. I could be wrong, but I thought that reinsurance aspect was part of the original ACA that the Republicans were able to strip out before ACA went live. That may have helped keep initial premiums relatively stable.

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22 minutes ago, PhantomJB said:

Individual

ETA: In addition, the pre-ACA plan was a PPO but now HMO

And what made you have to change?  Or was it the same plan,  but the plan took the opportunity to put the screws to you. The later happened to us and we are on the group market <_<

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I'd like to know what anyone disagrees with among the following claims.

1. The main goals of the ACA were (a) to increase coverage (by getting more people to sign up for insurance by taxing people who don't, by subsidizing low-income earners on the individual market, by expanding medicaid, and by making insurance accessible to those with pre-existing conditions), and (b) to "reduce" (i.e., slow the rate of growth of, or at least the rate of growth of the rate of growth of) overall spending on health care by ... some mechanisms I'm not familiar with.

2. The ACA is an unquestionable success on point (a). This isn't reasonably disputed, is it? Coverage is up; the percentage of uninsured is down.

3. I don't know how the ACA was supposed to reduce total spending on health care. I never thought it had a chance of happening. Sometime after its enactment, I recall reading that the rate of increases in costs was slowing. If true, that would be a partial success (but could also be explained by factors other than the ACA), but I didn't personally try to evaluate whether it was true, and even if it was, it may not have lasted. Basically, I don't know how effective the ACA was on point (b). I suspect it's hard to get a decent answer. Costs were increasing quite a bit before the ACA was passed and before it completely went into affect. I'm not aware of any blip in the trajectory of the curve, either upward or downward, after it went into effect. I mean, I'm sure total costs have gone up because coverage has gone up. But in terms of cost per unit of health care provided ... I have no idea. (In terms of cost per unit of good health outcomes, I assume that's gone up quite a bit because I don't think health outcomes are getting better.)

4. So bottom line, I'm fairly confident that the ACA has been effective in increasing coverage. I'm not at all confident, one way or the other, whether it's been effective or counterproductive at decreasing the rate of increase in healthcare costs per unit of health care provided.

5. I therefore have no strong reason to suspect that it hasn't done more good than harm on the whole, by at least getting more people covered.

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29 minutes ago, The Commish said:

And what made you have to change?  Or was it the same plan,  but the plan took the opportunity to put the screws to you. The later happened to us and we are on the group market <_<

My previous provider was forced to exit the market...which then caused me to choose from a new set of entrants and that's when all the fun began.

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14 minutes ago, Maurile Tremblay said:

I'd like to know what anyone disagrees with among the following claims.

1. The main goals of the ACA were (a) to increase coverage (by getting more people to sign up for insurance by taxing people who don't, by subsidizing low-income earners on the individual market, by expanding medicaid, and by making insurance accessible to those with pre-existing conditions), and (b) to "reduce" (i.e., slow the rate of growth of, or at least the rate of growth of the rate of growth of) overall spending on health care by ... some mechanisms I'm not familiar with.

2. The ACA is an unquestionable success on point (a). This isn't reasonably disputed, is it? Coverage is up; the percentage of uninsured is down.

3. I don't know how the ACA was supposed to reduce total spending on health care. I never thought it had a chance of happening. Sometime after its enactment, I recall reading that the rate of increases in costs was slowing. If true, that would be a partial success (but could also be explained by factors other than the ACA), but I didn't personally try to evaluate whether it was true, and even if it was, it may not have lasted. Basically, I don't know how effective the ACA was on point (b). I suspect it's hard to get a decent answer. Costs were increasing quite a bit before the ACA was passed and before it completely went into affect. I'm not aware of any blip in the trajectory of the curve, either upward or downward, after it went into effect. I mean, I'm sure total costs have gone up because coverage has gone up. But in terms of cost per unit of health care provided ... I have no idea. (In terms of cost per unit of good health outcomes, I assume that's gone up quite a bit because I don't think health outcomes are getting better.)

4. So bottom line, I'm fairly confident that the ACA has been effective in increasing coverage. I'm not at all confident, one way or the other, whether it's been effective or counterproductive at decreasing the rate of increase in healthcare costs per unit of health care provided.

5. I therefore have no strong reason to suspect that it hasn't done more good than harm on the whole, by at least getting more people covered.

 I think this is probably a fair assessment.  I don't believe a goal was to reduce costs.  There wasn't a single, meaningful aspect of the law put forth that addressed costs IMO, but you say "spending" above and I think there are mechanisms that were put in place to address that yes.  Any of the cost mechanisms that were put in place seemed to be put in place to make things neutral.

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According to healthcare.gov, there were three goals of the ACA.

1. Make "affordable" insurance available to more people.

2. Expand the Medicaid program to cover more people.

3. Support innovative medical care delivery methods designed to lower the costs of health care generally.

https://www.healthcare.gov/glossary/affordable-care-act/

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38 minutes ago, Maurile Tremblay said:

3. I don't know how the ACA was supposed to reduce total spending on health care. I never thought it had a chance of happening. Sometime after its enactment, I recall reading that the rate of increases in costs was slowing. If true, that would be a partial success (but could also be explained by factors other than the ACA), but I didn't personally try to evaluate whether it was true, and even if it was, it may not have lasted. Basically, I don't know how effective the ACA was on point (b). I suspect it's hard to get a decent answer. Costs were increasing quite a bit before the ACA was passed and before it completely went into affect. I'm not aware of any blip in the trajectory of the curve, either upward or downward, after it went into effect. I mean, I'm sure total costs have gone up because coverage has gone up. But in terms of cost per unit of health care provided ... I have no idea. (In terms of cost per unit of good health outcomes, I assume that's gone up quite a bit because I don't think health outcomes are getting better.)

I followed this fairly closely because i had friends in the field and Obama was the first person i ever voted for President who won and i deeply hoped that the transitional figure he had become would pay off with a long honeymoon at the very least. I was satisfied he would not make any significant difference by June of his first year, because that's about when he gave up on single-payer and reversing the price-negotiation protections to pharma that Dubya had snuck in thru the SS Part D bill.

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Obamacare was effective in that it got more people healthcare coverage.  It was ineffective in addressing the cost of coverage, and led to many price increases.  

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11 minutes ago, PhantomJB said:

According to healthcare.gov, there were three goals of the ACA.

1. Make "affordable" insurance available to more people.

2. Expand the Medicaid program to cover more people.

3. Support innovative medical care delivery methods designed to lower the costs of health care generally.

https://www.healthcare.gov/glossary/affordable-care-act/

I think number one was unquestionably obtained, except it came at a high cost to those on the individual market that didn't benefit enough (or at all) from subsidies to make up for the loss of plans that either could exclude people based on health condition and/or exclude paying for various services (this would include over coverage limits).  

Number two was certainly achieved.  Even in states where Medicaid was not expanded the number of people that discovered eligibility for Medicaid went way up.

Number three should probably be broken into two pieces (or mayve three).  The first was better coordination of care via electronic health records.  While this is arguably a greater part of the stimulus package (the HITECH piece)  than ACA, the ACA did cover this.  This was also where most of the $2500 in savings was to come from.   I think that most in the industry are still trying to achieve the promises, the potential  of EHR beyond streamlining coding,  compliance, and charge entry.  

The second component of number three are the alternative payment models.  Basically Medicare changing the way they pay for some things in order to theoretically pay for quality rather than quantity.   In many cases these are structured such that the savings achieved would be shared between the government and the providers.   Again both the Obama and Trump administration have touted success along these lines but there is nothing really "earth shattering" that I am aware of.  Just experiments and trials with some being a modest success.

I guess maybe a third component could be to emphasize preventive care. I think the story here is that "habits are hard to break".   People who now have coverage didn't stop using ERs first, didn't start having regular check ups, etc.   Maybe over time this changes?

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32 minutes ago, PhantomJB said:

According to healthcare.gov, there were three goals of the ACA.

1. Make "affordable" insurance available to more people.

2. Expand the Medicaid program to cover more people.

3. Support innovative medical care delivery methods designed to lower the costs of health care generally.

https://www.healthcare.gov/glossary/affordable-care-act/

I would argue that the goal that made this time different from previous attempts at reform was the 12 years added to Medicare.   I think that, more than the brief Senate super majority created the sense of urgency.

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57 minutes ago, The Commish said:

 I don't believe a goal was to reduce costs.  

This is simply false.

 

The Democrats want everybody to forget about that promise, which is why this new  narrative has been adopted by liberals.

 

There are countless documents and videos(some of which have been provided in this thread) that demonstrate lowering costs for the middle class was the main sales spin the Democrats put on this when the legislation was being pitched.

 

 

Edited by TripItUp

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1 hour ago, TripItUp said:
1 hour ago, The Commish said:

 I don't believe a goal was to reduce costs.  

This is simply false.

 

The Democrats want everybody to forget about that promise, which is why this new  narrative has been adopted by liberals.

 

There are countless documents and videos(some of which have been provided in this thread) that demonstrate lowering costs for the middle class was the main sales spin the Democrats put on this when the legislation was being pitched.

I am talking about goals and you are talking about what was used to sell it.  Which would you like to discuss?  I don't disagree that cost was used to sell it.  You continue to be all over the place.  BFS gave a pretty good interpretation around the "cost" portion up above...maybe read that?

And if I'm being honest, there is nothing in this thread that isn't in the Obamacare thread.  It's well documented with all the various participant positions...might want to check it out if this is a genuine interest of yours.

And why are you selectively picking only portions of my posts and responding as if that was the whole thought?

Lots of red flags in your posts here, but I'm trying to give you the benefit of the doubt.

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1 hour ago, TripItUp said:

This is simply false.

 

The Democrats want everybody to forget about that promise, which is why this new  narrative has been adopted by liberals.

 

There are countless documents and videos(some of which have been provided in this thread) that demonstrate lowering costs for the middle class was the main sales spin the Democrats put on this when the legislation was being pitched.

 

 

Why would "we" forget when the average family of four saved between 2010 and 2017 $4000 on their premiums?   The cost curve bent downwards during this period.   That is not spin.   Attributing this all to the ACA like the link does (and to be honest the link does have other issues) would probably be spin but I think that is less spin than arguing that things have changes such that the ACA has sent premiums skyrocketing,   Because except for those in the individual market in that window where subsidies aren't available and premiums eat up too large of a chunk of their income this isn't true (in aggregate).  Premiums (and cost sharing) for most people have continued on a slightly better trajectory than prior to the ACA. 

Now if you want to argue that these savings came from some other source then there are certainly cases to be made (I already have listed a couple).  If you want to argue "slightly better trajectory" isn't exactly all that big of deal then you miss Obama's base belief-

Quote

This metaphor has been used before, but this -- the ship of state is an ocean liner; it's not a speed boat. And so the way we are constantly thinking about this issue of how to bring about the changes that the American people need is to -- is to say, if we can move this big battleship a few degrees in a different direction, we may not see all the consequences of that change a week from now or three months from now, but 10 years from now, or 20 years from now, our kids will be able to look back and say that was when we started getting serious about clean energy, that's when health care started to become more efficient and affordable, that's when we became serious about raising our standards in education.

But I don't see any reason that democrats need to be ashamed by this metric.  Sure it would be better if there was a bright line, black and white, instant gratification, unambiguous  case to be made, but those seldom exist for democrats.   This is politics, even if the reality is the ACA is a trivial component of the rate of increase reductions own the success and claim the need to build on those successes.  There is no serious alternative on the other side that would achieve democrats' goals.

Edited by Bottomfeeder Sports
Striked out the text as I was mixing two different thoughts. Whether or not the individual market skyrocket isn't dependent on income once subsidies are out of the picture.

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2 hours ago, dschuler said:

Obamacare was effective in that it got more people healthcare coverage.  It was ineffective in addressing the cost of coverage, and led to many price increases.  

Which do you think the American people care more about?

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31 minutes ago, Bottomfeeder Sports said:

There is no serious alternative on the other side that would achieve democrats' goals.

I agree with this.  

The goal(in my opinion) should always have been to lower costs for the taxpayers and neither side can figure it out, which is absolutely ridiculous and somewhat maddening.

Republicans are as much to blame as the Democrats and neither side should be getting a free pass on this.   

Edited by TripItUp

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Any analysis of the effectiveness of Obamacare is incomplete without also evaluating the political capital spent and the resulting opportunity costs. What has been gained in health care needs to be weighed against the lack of legislation on things like cap-and-trade and potential Paris ratification for climate change. Obama's "pen and a phone" turned out not to be as effective as he claimed.

Other major pieces of his legislative agenda — on climate change, on immigration, on civil rights — stalled or died at different stages, and the administration turned to the exercise of executive power to achieve its goals.

On Capitol Hill, many Democratic lawmakers, aides and consultants wondered — openly and not — about the political costs of the dogged pursuit of health-care reform. The costs were to be measured not only in congressional seats but in policy priorities.

The GOP leveraged Obamacare into massive political gains, and they didn’t end with the profound Democratic losses in the 2010 midterms. 

https://www.washingtonpost.com/graphics/national/obama-legacy/obamacare.html

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From the same WaPo article.

A June 2016 survey from the Kaiser Family Foundation found that 29 percent of Americans say that Obamacare has hurt their family, compared to 18 percent who say it has helped. Most cited increased costs; others pointed to new difficulties in accessing care.

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1 hour ago, TripItUp said:

Which do you think the American people care more about?

Depends on if they were previously covered or not.  Middle class and above were hit hard under Obamacare, while lower income families did better.  

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1 hour ago, PhantomJB said:

From the same WaPo article.

A June 2016 survey from the Kaiser Family Foundation found that 29 percent of Americans say that Obamacare has hurt their family, compared to 18 percent who say it has helped. Most cited increased costs; others pointed to new difficulties in accessing care.

I guess that means that most people don’t know, which is surely right.

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15 hours ago, dschuler said:

Depends on if they were previously covered or not.  Middle class and above were hit hard under Obamacare, while lower income families did better.  

let me rephrase the question, which issue do the most Americans care about(and it's not remotely close)

Edited by TripItUp

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1 hour ago, PhantomJB said:

Any analysis of the effectiveness of Obamacare is incomplete without also evaluating the political capital spent and the resulting opportunity costs. What has been gained in health care needs to be weighed against the lack of legislation on things like cap-and-trade and potential Paris ratification for climate change. Obama's "pen and a phone" turned out not to be as effective as he claimed.

Other major pieces of his legislative agenda — on climate change, on immigration, on civil rights — stalled or died at different stages, and the administration turned to the exercise of executive power to achieve its goals.

On Capitol Hill, many Democratic lawmakers, aides and consultants wondered — openly and not — about the political costs of the dogged pursuit of health-care reform. The costs were to be measured not only in congressional seats but in policy priorities.

The GOP leveraged Obamacare into massive political gains, and they didn’t end with the profound Democratic losses in the 2010 midterms. 

https://www.washingtonpost.com/graphics/national/obama-legacy/obamacare.html

:goodposting:

 

I'm actually shocked this is up for debate...but here we are.

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4 minutes ago, TripItUp said:

let me rephrase the question, which issue do the most Americans care about it.(and it's not remotely close)

How much they pay for coverage, which was a good reason Trump was elected?  The idea that a middle class family is okay with paying thousands of dollars for something extra to provide for a low income family is nothing more than a pipe dream.

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28 minutes ago, Juxtatarot said:

I guess that means that most people don’t know, which is surely right.

No. That is not "surely right." Of course you could have done the research for the benefit of the group instead of guessing but I will do it for you.

Overall, half of the public (52 percent) says they have not been directly impacted by the health care law, however more say they have been hurt by the law than say they have been helped (28 percent compared to 18 percent).

From the same poll (for consistency sake):

After the close of the ACA’s third open enrollment period on January 31st, Americans’ opinion of the health care law is tilting negative, with 41 percent saying they have a favorable view and 47 percent saying they have an unfavorable view.

https://www.kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-march-2016/

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51 minutes ago, TripItUp said:

let me rephrase the question, which issue do the most Americans care about it.(and it's not remotely close)

Cost...which moves us to now.  What will be done?  Under POTUS?  Gutting ACA and making it worse while offering no alternative.  Democratic candidates offering solutions.

 

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On ‎11‎/‎5‎/‎2019 at 6:41 AM, The Commish said:

First, It was primarily sold as an expansion of insurance coverage I know because I was really negative about how light it was on cost reduction measures.  It's the primary reason I didn't believe it would work.  There was plenty in the bill that attempted to keep costs neutral.  Very little direct mandate to reduce costs.  The philosophy was that over time if we change the way we approach healthcare, costs would go down on their own.  I didn't buy it then and I don't buy it now.  There is no question that the bill, as written, was beginning to bend the cost curve a little bit, but not nearly to the levels we need.  And I don't think we'd have gotten to where we need to be cost wise with the original legislation.  It's all but guaranteed that we aren't going to get there now with the changes this administration has instituted....it's gone from bad to worse.

 

On this, we probably agree more than you realize except for the last part.  The decisions made by this administration to attack the current system with absolutely no alternative has made a bad move significantly worse and is pushing us towards government run healthcare.  I've always been a proponent of a public option policy where the government is allowed into the individual market to compete with everyone else.  They can prove to me that they can do what they say they can in real time and not touch my insurance at all.

 

You asked if it was effective not if it was a success.  I don't think I am going out on a limb here and saying people answered the question you asked.  The primary goal of this initiative was to expand insurance coverage and medicaid while remaining as revenue neutral as possible.  It did that.  You can argue that you don't think that should be the goal (I know I did).  You can argue it was way too expensive for the little expansion that occurred (I did that too).  Yes, there were promises that the average household would save $2500.  That wasn't the goal.  Yes, there were promises that you could keep your doctor.  That wasn't the goal either.  Again, you can go back to the Obamacare thread and see the discussion unfold in real time as many pointed out there were no real cost reduction portions of the bill and you can read how unhappy many of us were with that fact.

But he didn't get the answer he wanted so blames it on liberal members of the forum.

Like was mentioned many times, Obamacare was at least a start.  Lets work together to make it better, but no we have to try and blow it up because a D passed it.  When that failed, due to many realizing people with pre-existing conditions would no longer be covered, the people in power punted and just blame away.

I wonder how those that oppose Obamacare would feel if they had a pre-existing condition or a family member that kept them from being insured, would it change their mind that this is an important feature?

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1 hour ago, yak651 said:

Like was mentioned many times, Obamacare was at least a start.  Lets work together to make it better, but no we have to try and blow it up because a D passed it.  When that failed, due to many realizing people with pre-existing conditions would no longer be covered, the people in power punted and just blame away.

The GOP has not punted.   They've made lots of changes over the years and even goaded the Obama administration into some (Grandmother plans for example).  Here is a list of changes through 2016 including "the many changes the [Obama] administration has made without legal authority".

Here is a "top five" list for the Trump administration, including one that could arguably be said to have backfired in that cutting off a subsidy resulted in more subsidies being paid out.  What is that saying about "death by a thousand cuts"?

And then Texas vs the United States  appeal is expected any day now.   And would likely be on its way to the Supreme Court either way.   The argument seems pretty stupid here to me "the ACA's requirement to buy a product  was legal because the individual mandate was a tax, zeroing out that tax now means the ACA which is effectively no longer requiring the purchase is now illegal", but it seems to have a real enough shot of prevailing from the articles about it.  But then again the GOP doesn't seem worried based on article after article that there is no effort to have something ready in case that during the spring of the 2020 election the Supreme Court is throws out the entire ACA and the chaos that would cause.  So :shrug: 

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1 hour ago, yak651 said:

But he didn't get the answer he wanted so blames it on liberal members of the forum.

Like was mentioned many times, Obamacare was at least a start.  Lets work together to make it better, but no we have to try and blow it up because a D passed it.  When that failed, due to many realizing people with pre-existing conditions would no longer be covered, the people in power punted and just blame away.

I wonder how those that oppose Obamacare would feel if they had a pre-existing condition or a family member that kept them from being insured, would it change their mind that this is an important feature?

Keep in mind that pre-existing conditions were always covered as long as you had continuous coverage.  Back when insurance was cheap, this wasn't a big issue.  Pre-existing condition coverage is now a very important feature since rates have sky rocketed and many have to play the game bouncing on and off coverage.  Right now if you are 50 and make $42,000 ($33,600 after taxes), you get no subsidy, but your insurance will cost $950 x 12 = $11,400 and your out of pocket max is around $7000 for $18,400 spent.  Essentially 55% of you take home will go to "affordable" insurance.  Many of those with pre-existing conditions would have much preferred the old system where they had coverage they could afford to the new system where they are guaranteed access to coverage they can't afford.

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6 minutes ago, BassNBrew said:

Keep in mind that pre-existing conditions were always covered as long as you had continuous coverage.  Back when insurance was cheap, this wasn't a big issue.  Pre-existing condition coverage is now a very important feature since rates have sky rocketed and many have to play the game bouncing on and off coverage.  Right now if you are 50 and make $42,000 ($33,600 after taxes), you get no subsidy, but your insurance will cost $950 x 12 = $11,400 and your out of pocket max is around $7000 for $18,400 spent.  Essentially 55% of you take home will go to "affordable" insurance.  Many of those with pre-existing conditions would have much preferred the old system where they had coverage they could afford to the new system where they are guaranteed access to coverage they can't afford.

Wasn't this happening though...that they were not able to afford it...at least beginning to, where those with ongoing issues were beginning to be charged more because they were using their insurance year after year to treat conditions they will always have?  I thought part of the "problem" was being able to charge significantly higher premiums as well...not just simple access to health coverage, though that was an issue too.  I might be remembering that wrong.

Edited by The Commish

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29 minutes ago, BassNBrew said:

Keep in mind that pre-existing conditions were always covered as long as you had continuous coverage.  Back when insurance was cheap, this wasn't a big issue.  Pre-existing condition coverage is now a very important feature since rates have sky rocketed and many have to play the game bouncing on and off coverage.  Right now if you are 50 and make $42,000 ($33,600 after taxes), you get no subsidy, but your insurance will cost $950 x 12 = $11,400 and your out of pocket max is around $7000 for $18,400 spent.  Essentially 55% of you take home will go to "affordable" insurance.  Many of those with pre-existing conditions would have much preferred the old system where they had coverage they could afford to the new system where they are guaranteed access to coverage they can't afford.

But if you switched jobs you wouldn't, correct?  If I'm wrong I apologize, but that's how I understood it.  And during the time of Obamacare how many people were out of work due to the collapse of the economy that would not be covered when they found a new job.

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2 minutes ago, yak651 said:

But if you switched jobs you wouldn't, correct?  If I'm wrong I apologize, but that's how I understood it.  And during the time of Obamacare how many people were out of work due to the collapse of the economy that would not be covered when they found a new job.

If you switched jobs with no gaps in coverage HIPAA protected you.  If you lost your job then you also had some protections.  Once you had a plan your insurance company also had to continue offering to keep you in it as long as it was offering plans.  

However, the insurance companies had an endless bag of tricks to keep the sick out of the pools.   One was to retroactively cancel your policy if they could find a mistake on your application.  Not talking fraud or misrepresentation but an innocent mistake.  This practice was called rescission and there were hearing on it 2009 where one horror story after another was presented.  Another trick was to offer a new plan to healthy members of a pool to sell them cheap plans and quarantine the sick into their own pools.   They also could exclude covering certain things or have annual and/or lifetime limits.  Etc.  Etc.

So while the statements that there were protections is true, it is false to argue that there were not big issues for the sick in the individual market.  That being said there were those where the pre ACA individual market worked better for them than the post ACA version.

 

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39 minutes ago, The Commish said:

Wasn't this happening though...that they were not able to afford it...at least beginning to, where those with ongoing issues were beginning to be charged more because they were using their insurance year after year to treat conditions they will always have?  I thought part of the "problem" was being able to charge significantly higher premiums as well...not just simple access to health coverage, though that was an issue too.  I might be remembering that wrong.

In 2008, 2009 it wasn't that one side of the aisle was arguing for the need to reform the individual market and the other side argued it was unnecessary.   The debate was on how to reform it.  The GOP using broad brush strokes wanted to address cost through tort reform and through making coverage more market based by removing overburdening state regulations (selling across state lines).  The democrats instead wanted to strengthen regulations and force most everyone into the pools.  

I think that the GOP has since come around to the idea that state level tort reform largely failed and has replaced that idea with "high risk pools" but otherwise have the same idea.   I think democrats have since added the need for reinsurance (which is sort of the same as "high risk pools") and a public plan.   For some democrats that public plan is an option, for others that public plan replaces all other plans with various positions in between.

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2 hours ago, The Commish said:

Wasn't this happening though...that they were not able to afford it...at least beginning to, where those with ongoing issues were beginning to be charged more because they were using their insurance year after year to treat conditions they will always have?  I thought part of the "problem" was being able to charge significantly higher premiums as well...not just simple access to health coverage, though that was an issue too.  I might be remembering that wrong.

BFS covered it very well. If you stayed in your group you were fine (and avoided the dirty tricks). 

Decoupling insurance from employment is needed to fix this. 45% are getting govt insurance and 45% are in employer clean pools getting taxpayer assisted insurance. 

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I was at a small meeting (about 15 to 20 of us) with my freshmen Republican House member this morning.   It was basically a meet and greet where he "press the flesh" before and after, introduced himself a bit, talked about the differences between state legislature and DC, and then asked if anyone had any questions.  All of the questions concerned healthcare one way or another.   I agreed at times and disagreed at others (eg. on the virtues of skinny plans for part time workers).  

He said for example that there is a consensus in DC to prevent pharmaceutical companies from paying other companies to not make generic versions when drugs came off of patent.  That it was extremely frustrating that things where there is strong bipartisan support is just not worked on.  That there were several of these.   I agree it is frustrating.

Something else he said where you may be surprised that I agree is that it was a mistake to have the ACA pools at the "community"  (county) level.   That the GOP wanted to have the pools national (across state lines), but he and others try to at least return to "state level".   I'm pretty sure in the other thread that I have argued several times that in many counties it simply didn't make sense to divide the pools up with competing companies as the pools were too small to begin with.  While I never made this particular argument I agree that "state level" pools would be better (and I agree that national level pools - or even pool would be better yet - no I didn't ask.)     But I agree that for most of the half of country's counties that only have one offering is because they are too small to be their own pools.  Or a failing in the ACA design that makes affordability too vulnerable to a few sick people in small pools.  That being said I don't buy his theory ("too proud to admit a mistake") on why democrats won't change this.

Anyway, just figured I'd share.   I'm new to the area so I haven't formed opinions on the mostly GOP leaders that represent me yet.  Seemed like a nice enough guy and his assistant was great, but then again he is just a freshmen in DC ;) .  

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On 11/4/2019 at 3:41 PM, timschochet said:

Here's my argument as per the other thread: the most important thing that Obamacare did was make it so that people with pre-existing conditions pay the same price as everybody else. That's a revolutionary change in health insurance. I was against Obamacare at the time because I believed that it was an unsustainable change- I still do. It would inevitably lead to socialized health care, though the transition might take decades. That remains my firm belief as well.

Once this change was made, it was permanent. The main reason that Republicans in 2017 could not come up with a way to repeal and replace Obamacare was that they pledged to the public that they would continue to protect pre-existing conditions. And that destroyed whatever kind of market based argument they could make, since an insurance company in a free market cannot operate under such a restriction.

So was it effective? Of course it was effective. It changed our health insurance situation, permanently.

....in the individual market.  That had always been the case in the large group market, which is by far where most people get their private insurance from. 

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On 11/5/2019 at 2:37 PM, PhantomJB said:

Individual

ETA: In addition, the pre-ACA plan was a PPO but now HMO

This is HUGE.  It can not be stressed enough.  This alone makes the average ACA (Individual market) policy sold today much weaker than the average individual market policy sold before the ACA.  I mentioned this in the ACA thread, and even started a thread about it specifically looking for some information - but exactly a year ago today I was on day #9 of an 11 day stay at Children's National Hospital in Washington DC with my (at the time) 3 year old.  This was our 4th hospital stay in a 2 month window, but first there.  The prior 3 were all at a specific children's hospital here in Virginia.  He ended up being diagnosed with pseudotumor (horrible name for what really is high pressure of his spinal fluid in his head, there is/was no tumor involved), also called idiopathic inter-cranial hypertension.  I believe actually today or tomorrow will be the one year anniversary of what can only be described as brain surgery to install a shunt in his head, which acts as a "pressure relief valve" and removes some fluid when his pressure gets too high and funnels it into his abdominal cavity where it's reabsorbed into the body.  The (pretty much world renowned) pediatric neurosurgeon that performed the surgery said that he'd never seen this diagnosis in a 3 year old boy in his nearly 4 decades of practicing medicine - it was that rare of a situation. 

My son's coverage, thank God, was through my wife's large employer, and it had a PPO (nationwide) network.  So we didn't see a single out of network doctor or facility in that horrible two month time-frame which included numerous facilities for various tests and procedures.  Had we had him covered by an individual policy, from the ONLY carrier participating in our county, which ONLY offered an HMO network - the entire stay at Children's national in DC wouldn't have been covered as the HMO network was, and still is, Virginia only.  Once we crossed the Potomac river on our drive into DC, anywhere we went and anyone we saw would have been out of network.  Now many some FBGs could have afforded an 11 day hospital stay in what was pretty much an ICU situation, ending with a brain surgery, with the change they find in their couch cushions....but I could not.  I would be completely bankrupt today if we had an ACA (Obamacare) individual policy for him. 

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On 11/6/2019 at 12:45 PM, BassNBrew said:

BFS covered it very well. If you stayed in your group you were fine (and avoided the dirty tricks). 

Decoupling insurance from employment is needed to fix this. 45% are getting govt insurance and 45% are in employer clean pools getting taxpayer assisted insurance. 

The uninsured rate would triple (at least) overnight if you did this.  What I mean is that there is a huge chunk of the population who ONLY have health insurance today because it's through their employer.  If you cut that off, many wouldn't take the needed steps to replace it. 

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On 11/6/2019 at 10:44 AM, yak651 said:

But if you switched jobs you wouldn't, correct?  If I'm wrong I apologize, but that's how I understood it.  And during the time of Obamacare how many people were out of work due to the collapse of the economy that would not be covered when they found a new job.

Covered a bit above, but just to add:  Pre ACA we already had COBRA and HIPAA.  With COBRA, you had the right to remain on your old employer policy for up to 18 months.  That was also an "individual right", meaning if you had a family of 4 on your old employer group plan and left there and 3 of you were healthy and one wasn't - 3 of you could go to the individual market (if needed) and the last could remain on COBRA (this could help if that 4th person had already hit their deductible or max OOP for the year).  If you were actually "switching jobs", then you'd most likely go from one group plan to another and there would be no gap in coverage, at least one large enough that 18 months of COBRA couldn't handle for you.  If you did need to go to the individual market, as mentioned above, that's where HIPAA came in to protect you from being declined or having your pre-exisiting conditions not covered. 

Above, "rescission" was mentioned, something I've looked into a lot (I'm a health insurance agent).  It's not the "boogy man" many would like to make it out to be.  Generally speaking, and depending on how you count them, we had about 10-14m people on individual policies each year in the years leading up to the ACA.  The number show that something between 20-30k policies total were canceled from this practice in the entire 5 years leading up to the passing an implementation of the ACA.  So we're already talking about small fractions of one percent of the market - many if not most of which were because an individual simply lied on their application.  If they put down that they weighed 220 when they really weigh 300 - I'm sorry, but that's insurance fraud.  Same idea if they said they don't smoke, but actually do. 

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On November 5, 2019 at 6:16 PM, TripItUp said:

I agree with this.  

The goal(in my opinion) should always have been to lower costs for the taxpayers and neither side can figure it out, which is absolutely ridiculous and somewhat maddening.

Republicans are as much to blame as the Democrats and neither side should be getting a free pass on this.   

I always thought the goal of Obamacare was to take from the rich and give to the poor to obtain the vote of the poor.   The biggest problem with healthcare is the price gouging by the health care and insurance industries and that is a D and R problem. 

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