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ACA repeal wheels in motion vs The Twilight Zone and railroad switch yards.....
Here's the full paragraph: "Ellis says the new policy doesn't fully rise to the level of declining to enforce the law. 'If the IRS turns a blind eye to people's status, that isn't quite not enforcing it,' he says. "It's more like the IRS wanting to maintain plausible deniability."
The IRS is not now turning a blind eye. It turned that blind eye three years ago, when it failed to reject tax returns with omitted health info. That's what people are missing. The dirty little secret is that the IRS did the same thing under Obama.
"But it makes it clear that following Trump's executive order, the agency's trajectory is towards a less strict enforcement process."
Less strict than what? From the enforcement process under Obama? No. From the new, more strict enforcement the IRS was prepared to implement this year.
The article ends: "Correction: The IRS did not reject silent returns last year, as this story originally indicated." Emphasis in original. Curious how it managed to miss that key point originally. Changes the whole sense of the article.
Let's face it, enforcement was already pretty lax. The ACA itself barred the IRS from going after monies owed: "The only way that the IRS can collect the ACA penalty is if you pay it voluntarily, or if you’re owed a refund."
The only thing I see that's changed from Obama is that the voluntary nature of the filing disclosure is now out in the open. Hence my characterization of the status under Obama as a secret.
In practical terms, that can be a big deal. For example, Congress closed the SS file and suspend loophole only after it was publicized and lots of people started taking advantage of it. But in principle, this tax reporting "change" is simply maintaining the status quo.
"Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of 'insurance for everybody'". Washington Post, Jan 15.
Either his replacement plan was complicated and Trump knew that, or it wasn't complicated, so health care doesn't have to be all that complicated after all.
What? Surely you're not suggesting that he wasn't nearing completion of a replacement plan?
To repeat - this is not a change. Under Obama, the IRS did not require you to check that box. The only thing that's changed is that Trump has effectively publicized this fact.
Had Trump not signed the executive order, then there would have been a change. That change would have been to require people to check the box. The IRS had been planning to add this requirement to your returns for 2016 taxes. Instead, it is making no change.
The Trump administration is taking its first steps to put its imprint on the Affordable Care Act, reversing plans to withhold tax refunds this year from Americans who flout an insurance requirement in the law while proposing a series of rule changes to encourage insurers to remain in ACA marketplaces. The Internal Revenue Service has revoked an Obama-era instruction to taxpayers that was taking effect during the current filing season as a way to further compliance with the ACA’s requirement that most Americans carry health insurance or pay a tax penalty. Under the instruction, the IRS had announced that it would no longer process tax returns for people who fail to send a notice with their returns that they have insurance, are exempt from the requirement or are paying the fine. Instead, the agency said in a statement on Wednesday, tax returns will be processed as always, even for individuals who do not provide the required information. The IRS said the decision, made earlier this month but not previously publicized, was in line with an executive order that President Trump signed hours after his inauguration, giving agencies broad authority to lighten the burden of federal rules under the ACA.
Highlighting a different section of the article: Instead, the agency said in a statement on Wednesday, tax returns will be processed as always ... in line with an executive order that President Trump signed [on January 20th]
No change. The change that would have taken place, according to what you highlighted (the current filing season), was never to have taken place under Obama.
Side note: Health insurers may still issue via mail, the 1095-B form.....proof of health insurance coverage; and line 60 on the 1040 has a check box regarding whether health insurance coverage was in place for the previous 12 months. I don't know what is being done with the data, other than for input in the system.
From a current article in the Wall Street Journal:
"In the House... leaders of two conservative groups have said they can’t support the health-insurance proposal."
“It says millionaires can get just as much of a tax credit and check from the federal government... and we’re going to pay for that by putting a tax on union workers and middle-class workers that happen to have good employer insurance—that dog doesn’t hunt.”
"In the Senate, where Republicans can lose no more than two votes to pass legislation without Democratic support [Senators Rand Paul, Mike Lee and Ted Cruz] said Monday night... that they would oppose any legislative effort that fell short of a full repeal of the 2010 health law."
@Old_Joe Well, the old thought; "that they don't eat their own".............. One must suspect that with the 2018 elections just down the road, a lot of folks are going to have to "poop or get off the pot" with whether to stay on the ship or other, eh?
NYPOST is owned by the FOX news owner Murdoch family. So always read their opinion with a grain of salt. Even Obama agreed that his ACA plan needs changes. But since last 8 years, GOP is more interested in killing it without any specific alternative GOP option on the table. I think majority working class Americans do not understand the differences between the Obama care or GOP care options. Their main concerns are the coverage and cost. At present the majority know the details on Obama Care but GOP Care option details are in thin air. Trump voters hope that the GOP Care plan will have better coverage and costs less. So we all are waiting to see their final bill. But I doubt that Trump has any magic wand that he can produce a better ACA option other than a voucher!!!!
"Republican legislative leaders in Indiana are warning that repealing the Affordable Care Act could unravel a program for poor residents that Vice President Mike Pence implemented as governor, a conservative blueprint for expanding Medicaid under the federal law.
Indiana House Speaker Brian Bosma and GOP Senate leader David Long both said this week that tens of thousands of poor people could lose their insurance if Republicans in Washington enact some of the ideas they're discussing for repealing President Barack Obama's signature health care law.
"It's reality hitting home," Long, a Republican from Fort Wayne, said Wednesday. "... The issue of the working poor is real. It's not going to be easy."
Like many articles on the ACA, this one tends to muddy what has changed and why. It states that the ACA is doing all these wonderful things, but buries many paragraphs down that much the improvement in coverage and cost is due to its changes to single payer systems - Medicare and Medicaid (state/federal system).
Not that these are bad things or that they should be minimized. But little of the improvement is coming from what people think of as the ACA - the "three legged stool" of subsidies, mandates, and guarantee issue (no preexisting conditions), as well as health exchanges.
The column observes there are: "north of 20 million people getting coverage through either the Medicaid expansion or the health-care exchanges", while later acknowledging that "Most of the ACA’s coverage gains have come through the Medicaid expansion."
It states that the ACA "appears to be accomplishing one of its important goals of 'bending the health-care cost curve.'" The column it cites in support starts its explanation by saying that "One factor is the ACA’s cuts in payments to Medicare providers and health plans. Another is the recession and slow recovery, which reduced demand for health care by weakening incomes."
That column goes on to state that "The ACA itself has contributed to these structural changes [that slowed rise in costs] by introducing incentives to improve efficiency and quality." To back this up, it cites a Commonwealth Fund column. There you find that it is again the Medicare changes that get the credit: "A number of ACA reforms, particularly related to Medicare, have likely contributed to the slowdown in health care spending growth by tightening provider payment rates and introducing incentives to reduce excess costs."
Is the ACA helping? Yes. Are any alternate proposals better? Not that I can see, at least to the extent that we are able to actually see alternate proposals. But it looks like one could jettison the entire three legged stool and still preserve most (not all) of the coverage improvements (Medicaid) and virtually all of the cost containment measures (Medicare). At least based on this article and its citations.
Note: I am not advocating that. Rather the opposite. But IMHO it is important to understand what is doing what in order to have a, well, healthy discussion.
However thorough he was, he may not even have it all correct or complete. 8M exchanges, 15M Medicaid, according to this volunteer as of a few weeks ago, whom for some reason I thought you followed or had cited:
I don't know if anyone here has been to one of these town hall meetings to discuss the ACA with your local representatives. But if you have, you soon realize it's about a lot more than just numbers. I went to one, and heard the stories from people who know firsthand either they or their kids wouldn't be alive today were it not for the law. It changes the equation once you meet these people face to face and listen to them.
I do indeed cite acasignups.net - Charles Gaba is about the most meticulous person I've seen tracking all this stuff.
I also cite MW ("most: (1) greatest in quantity ...; (2) the majority of; [e.g.] most people"). 2/3 > 1/2 > 1/3 .
These are definitions of an adjective. When "most" is used as an adverb (as I did in the first sentence), MW defines it to mean "to the greatest or highest degree —often used with an adjective or adverb to form the superlative."
Lewis, I agree that it is about a lot more than numbers. Nevertheless, numbers cannot be left out. If the ACA helped only a single person and it cost $100M, we would be saying it was not cost-effective and would discard it. That's a reductio ad absurdum argument, but effective in pointing out that it's not solely about people.
As I keep saying, anecdotes are just that. You need the numbers to back them up. Even lifesaving stories do not suffice if they are few and far between. I'm not trying to be callous here, just realistic. You have the numbers to make a good case (even for a minority of ACA beneficiaries), but you don't get a pass with stories alone.
For example, the ACA impaired my choice of treatments for a life threatening illness. But that's just one story, which means nothing. (More important to me is that I'm still here, doing fine, thank you.)
If you want the "most" bang for the buck, single payer is the way to go. Instead of 20% overhead (as allowed by the ACA for insurance companies), you get the overhead down to 2%. You reduce the paperwork nightmare that healthcare providers have to deal with. Isn't that something "most" of the people in Congress are in favor of? Or is it just government regulation that's the bugaboo, but having to deal with a gazillion private insurers is hunky-dory?
One thing I'm not saying is that ACA precludes single payer systems. It explicitly enables them at the state level. Not the best alternative, as they may fail in small markets (e.g. Vermont). But states like NY and California could make them work.
@MSF We are in agreement. Numbers still matter, but so do the stories. They both matter. And you are right--single payer is the way to go, but politically would be a truly dramatic fight to realize on a federal level. I don't think we get to single payer in this country in our lifetime without a massive groundswell of social unrest. The irony is the Republicans may incite that unrest by killing the ACA. I'm glad to hear your health has improved.
MSF...glad you're doing better, but I noted your comment as to how the ACA "impaired your choice of treatments" for a serious condition. Without being overly specific, can you describe what and how this happened? Other than drugs outside of a specific carrier's formulary, I hadn't heard of prior authorizations for procedures being an issue.
Narrow networks. Choice of treatment was affected by quality of doctors and facilities available, and my insurer's network offered what appeared to be better quality for one treatment than another.
It was different when I was on a group plan with a traditional wide network. Even the majors, e.g. BC/BS, have crafted narrow networks for ACA. That's what keeps the plans "affordable."
Where I live, all ACA plans are HMOs or EPOs. No option to go out of network.
Thanks for the kind thoughts (and to Lewis as well).
Even Accounting major graduate has trouble to understand his/her health care insurance policy. So the common street people just took Trumps words by its face value i.e. their next Health Care policy will cost less and will cover more with all other Obama Care options. During the election all Republican politicians agreed (by not disagreed) and the main question is "do they can produce such better (for the consumer) ACA replacement plan with their magic wand? My common sense says No. In short the common, majority US citizens who trusted Trump & Republicans are screwed!!!
I and many others well know what 'most' means, both arithmetically and in the dictionary --- so odd that you would explain it and then elaborate, as if needed --- and I bet if I posted here that 'most of my investments were in equities', few would ever think I meant 15/23rds, or anything close to it. Idiom and usage. As an editor I often flag it.
Comments
'more like the IRS wanting to maintain plausible deniability'
https://reason.com/blog/2017/02/14/irs-blow-to-obamacare-individual-mandate
so looks effectively like what I wrote, but maybe it will turn out somewhat different.
The IRS is not now turning a blind eye. It turned that blind eye three years ago, when it failed to reject tax returns with omitted health info. That's what people are missing. The dirty little secret is that the IRS did the same thing under Obama.
"But it makes it clear that following Trump's executive order, the agency's trajectory is towards a less strict enforcement process."
Less strict than what? From the enforcement process under Obama? No. From the new, more strict enforcement the IRS was prepared to implement this year.
The article ends: "Correction: The IRS did not reject silent returns last year, as this story originally indicated." Emphasis in original. Curious how it managed to miss that key point originally. Changes the whole sense of the article.
Let's face it, enforcement was already pretty lax. The ACA itself barred the IRS from going after monies owed: "The only way that the IRS can collect the ACA penalty is if you pay it voluntarily, or if you’re owed a refund."
The only thing I see that's changed from Obama is that the voluntary nature of the filing disclosure is now out in the open. Hence my characterization of the status under Obama as a secret.
In practical terms, that can be a big deal. For example, Congress closed the SS file and suspend loophole only after it was publicized and lots of people started taking advantage of it. But in principle, this tax reporting "change" is simply maintaining the status quo.
http://thehill.com/policy/healthcare/321318-trump-nobody-knew-that-healthcare-could-be-so-complicated
"Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of 'insurance for everybody'". Washington Post, Jan 15.
Either his replacement plan was complicated and Trump knew that, or it wasn't complicated, so health care doesn't have to be all that complicated after all.
What? Surely you're not suggesting that he wasn't nearing completion of a replacement plan?
Had Trump not signed the executive order, then there would have been a change. That change would have been to require people to check the box. The IRS had been planning to add this requirement to your returns for 2016 taxes. Instead, it is making no change.
The Trump administration is taking its first steps to put its imprint on the Affordable Care Act, reversing plans to withhold tax refunds this year from Americans who flout an insurance requirement in the law while proposing a series of rule changes to encourage insurers to remain in ACA marketplaces.
The Internal Revenue Service has revoked an Obama-era instruction to taxpayers that was taking effect during the current filing season as a way to further compliance with the ACA’s requirement that most Americans carry health insurance or pay a tax penalty. Under the instruction, the IRS had announced that it would no longer process tax returns for people who fail to send a notice with their returns that they have insurance, are exempt from the requirement or are paying the fine.
Instead, the agency said in a statement on Wednesday, tax returns will be processed as always, even for individuals who do not provide the required information. The IRS said the decision, made earlier this month but not previously publicized, was in line with an executive order that President Trump signed hours after his inauguration, giving agencies broad authority to lighten the burden of federal rules under the ACA.
Instead, the agency said in a statement on Wednesday, tax returns will be processed as always ... in line with an executive order that President Trump signed [on January 20th]
No change. The change that would have taken place, according to what you highlighted (the current filing season), was never to have taken place under Obama.
IRS definition:
From a current article in the Wall Street Journal:
"In the House... leaders of two conservative groups have said they can’t support the health-insurance proposal."
“It says millionaires can get just as much of a tax credit and check from the federal government... and we’re going to pay for that by putting a tax on union workers and middle-class workers that happen to have good employer insurance—that dog doesn’t hunt.”
"In the Senate, where Republicans can lose no more than two votes to pass legislation without Democratic support [Senators Rand Paul, Mike Lee and Ted Cruz] said Monday night... that they would oppose any legislative effort that fell short of a full repeal of the 2010 health law."
Well, the old thought; "that they don't eat their own"..............
One must suspect that with the 2018 elections just down the road, a lot of folks are going to have to "poop or get off the pot" with whether to stay on the ship or other, eh?
http://www.vox.com/policy-and-politics/2017/2/27/14745210/obamacare-enrollees-repeal-plans
Even Obama agreed that his ACA plan needs changes. But since last 8 years, GOP is more interested in killing it without any specific alternative GOP option on the table.
I think majority working class Americans do not understand the differences between the Obama care or GOP care options. Their main concerns are the coverage and cost. At present the majority know the details on Obama Care but GOP Care option details are in thin air. Trump voters hope that the GOP Care plan will have better coverage and costs less. So we all are waiting to see their final bill. But I doubt that Trump has any magic wand that he can produce a better ACA option other than a voucher!!!!
Tried to order one of those yesterday. Was advised by Amazon that the item was out of stock with no info on future availability.
Republicans in Pence's Indiana warn of health repeal fallout
"Republican legislative leaders in Indiana are warning that repealing the Affordable Care Act could unravel a program for poor residents that Vice President Mike Pence implemented as governor, a conservative blueprint for expanding Medicaid under the federal law.
Indiana House Speaker Brian Bosma and GOP Senate leader David Long both said this week that tens of thousands of poor people could lose their insurance if Republicans in Washington enact some of the ideas they're discussing for repealing President Barack Obama's signature health care law.
"It's reality hitting home," Long, a Republican from Fort Wayne, said Wednesday. "... The issue of the working poor is real. It's not going to be easy."
https://www.washingtonpost.com/posteverything/wp/2017/03/06/heres-why-republicans-are-finding-it-so-hard-to-come-up-with-a-replacement-for-obamacare/
Not that these are bad things or that they should be minimized. But little of the improvement is coming from what people think of as the ACA - the "three legged stool" of subsidies, mandates, and guarantee issue (no preexisting conditions), as well as health exchanges.
The column observes there are: "north of 20 million people getting coverage through either the Medicaid expansion or the health-care exchanges", while later acknowledging that "Most of the ACA’s coverage gains have come through the Medicaid expansion."
It states that the ACA "appears to be accomplishing one of its important goals of 'bending the health-care cost curve.'" The column it cites in support starts its explanation by saying that "One factor is the ACA’s cuts in payments to Medicare providers and health plans. Another is the recession and slow recovery, which reduced demand for health care by weakening incomes."
That column goes on to state that "The ACA itself has contributed to these structural changes [that slowed rise in costs] by introducing incentives to improve efficiency and quality." To back this up, it cites a Commonwealth Fund column. There you find that it is again the Medicare changes that get the credit: "A number of ACA reforms, particularly related to Medicare, have likely contributed to the slowdown in health care spending growth by tightening provider payment rates and introducing incentives to reduce excess costs."
Is the ACA helping? Yes. Are any alternate proposals better? Not that I can see, at least to the extent that we are able to actually see alternate proposals. But it looks like one could jettison the entire three legged stool and still preserve most (not all) of the coverage improvements (Medicaid) and virtually all of the cost containment measures (Medicare). At least based on this article and its citations.
Note: I am not advocating that. Rather the opposite. But IMHO it is important to understand what is doing what in order to have a, well, healthy discussion.
8M exchanges, 15M Medicaid, according to this volunteer as of a few weeks ago, whom for some reason I thought you followed or had cited:
http://acasignups.net/
So sort of an odd definition of "most", at like 2/3rds.
I think Utah and some other places may have rocketed since Feb 22.
I also cite MW ("most: (1) greatest in quantity ...; (2) the majority of; [e.g.] most people"). 2/3 > 1/2 > 1/3 .
These are definitions of an adjective. When "most" is used as an adverb (as I did in the first sentence), MW defines it to mean "to the greatest or highest degree —often used with an adjective or adverb to form the superlative."
Lewis, I agree that it is about a lot more than numbers. Nevertheless, numbers cannot be left out. If the ACA helped only a single person and it cost $100M, we would be saying it was not cost-effective and would discard it. That's a reductio ad absurdum argument, but effective in pointing out that it's not solely about people.
As I keep saying, anecdotes are just that. You need the numbers to back them up. Even lifesaving stories do not suffice if they are few and far between. I'm not trying to be callous here, just realistic. You have the numbers to make a good case (even for a minority of ACA beneficiaries), but you don't get a pass with stories alone.
For example, the ACA impaired my choice of treatments for a life threatening illness. But that's just one story, which means nothing. (More important to me is that I'm still here, doing fine, thank you.)
If you want the "most" bang for the buck, single payer is the way to go. Instead of 20% overhead (as allowed by the ACA for insurance companies), you get the overhead down to 2%. You reduce the paperwork nightmare that healthcare providers have to deal with. Isn't that something "most" of the people in Congress are in favor of? Or is it just government regulation that's the bugaboo, but having to deal with a gazillion private insurers is hunky-dory?
One thing I'm not saying is that ACA precludes single payer systems. It explicitly enables them at the state level. Not the best alternative, as they may fail in small markets (e.g. Vermont). But states like NY and California could make them work.
It was different when I was on a group plan with a traditional wide network. Even the majors, e.g. BC/BS, have crafted narrow networks for ACA. That's what keeps the plans "affordable."
Where I live, all ACA plans are HMOs or EPOs. No option to go out of network.
Thanks for the kind thoughts (and to Lewis as well).