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ACA repeal wheels in motion vs The Twilight Zone and railroad switch yards.....
And I thought hacking one of my accounts, or someone using my SSN and attempting to obtain a Federal tax refund, or that Samsung or Vizio are using my smart TV to spy on me in my home or, well you name your own choice beyond what is already stored at the Utah data site about me and you.
Yes, the below link is Huffington Post and probably not friendly to the Republican party side of life and I have seen a few other similar reports; so use your own judgement about this report. Do you own research and study. This article is a combo of related healthcare reform info. So many potential twists and turns possibly affecting healthcare investments into the future. Don't be concerned about that medical HIPPA document as someone will have your genetic ID stored safe and secure, eh? The data won't be used against me and mine for any healthcare cost structure...will it ???
Wishing I had another 50 years on this rock to discover the outcomes of today's pending events in the many things government. Hope I can recall some this when I return.
As a 62 year old, I along with other pre-Medicare seniors have a very specific question. Even if I can afford premiums which may be higher than what the current exchanges may now have, what will the available plans actually cover, and what will be the deductibles?
With a raft of pre-existing conditions, I'm happy as a clam to have a plan that through a combination of premiums and deductibles caps my out of pocket at about $15K.
I wonder what the future would hold under GOP-Care?
I also am part of an ACA plan. High deductible... first $6500 on me and then shared costs for the next $6500 so I also wondered how I will approach my medical care decisions. I will make it a point to list my medical needs against what is covered as part of my preventative care and get these pre-approved before I step foot in the MD's office.
Medical care is now one of many things in life that need to be price checked.
Anyone have information on the proposed tax credits (deductions) and the possible changes to HSA limits?
Huh, I finished reading Bee's post and then found this in my email (I subscribe to USA Today). No idea how this quickly-fashioned health care replacement will work, but it is a little unsettling. I don't get it. The GOP railed on Obamacare for 6 years. You would think they would have had replacement ideas in hand for almost that time. Now we get something crafted together in a few short weeks. Sad to think we can go back to insurance companies calling all the shots. The below clip is just estimates, but I would think any analysis by the CBO should be taken into consideration before passing.
I'd be more comfortable if congress was getting the same HC as us.
Brought to you by USATODAY.com A lot of people could lose their health insurance The Congressional Budget Office (CBO) released its analysis on the cost and impact of the Republican's proposed legislation, the American Health Care Act, to repeal and overhaul the Affordable Care Act, or Obamacare. It estimates that 14 million Americans could lose their health care coverage in 2018, and 24 million by 2026 . It also found that by 2026, 52 million would be uninsured. The CBO’s analysis could make the controversial legislation even tougher for GOP leaders to push through Congress. No surprise, Democrats are fiercely opposed to the legislation. Need a refresher on the CBO? It’s an independent, non-partisan office that analyzes the budgetary impact of proposed legislation. Because it puts strong importance on objectivity, lawmakers across the aisle trust the CBO’s analysis
I'd be more comfortable if congress was getting the same HC as us.
Define "us". 49% of "us" get our health care through our employer. Some of us get that through large employers who still purchase "traditional" group plans. Others work for small companies that purchase ACA plans for their employees on the SHOP marketplace.
Congress provides its employees (including your Congress critters) health care through SHOP. The only difference is that since the US Government is not exactly a small employer, the ACA had to have an exception written to allow Congress to purchase ACA plans the same as other employers.
PK tonight; no surprises here --- so how did this even come into existence? Laughable except not funny. Obamacare imposes a mandate to induce healthy people to sign up, offers means-tested subsidies to make insurance affordable, and expands Medicaid to take care of people with really low incomes. Trumpcare eliminates the mandate, slashes subsidies overall and redirects them to those who don’t need them, and sharply cuts Medicaid. Of course that leads to a huge drop in coverage.
The great Hiltzik, LATimes: Here’s the good news ...: The repeal would reduce the federal budget deficit by $337 billion over 10 years. Most of that would be the result of a stunning $880-billion reduction in Medicaid outlays, delivered in part by zeroing out the ACA’s Medicaid expansion over time, and in part by converting traditional Medicaid to a block-grant program that would squeeze states more every year. In other words, the reduction in the federal budget would come from throwing the neediest Americans off Medicaid and forcing reduced benefits for those who are left. Another $673 billion in budget reductions would come from reducing and eliminating tax subsidies for individual insurance. That’s another way that the GOP plan would appear to save money, only by imposing more costs on those least able to afford them.
The latter figure is wrong or at least misleading, because tax subsidies would not be eliminated but changed in form.
The old (ACA) subsidies (refundable tax credits and cost sharing subsidies) do comprise most of a $673B savings, and these forms of subsidies would indeed be eliminated. But the new form of subsidies (tax credits) under AHCA would cost an extra $361B.
If you want to see the loss of coverage breakdown, go to p. 20. 2018 - 14M: 6M individual coverage, 5M Medicaid, 2M through work (all rounded) 2019 - 16M: additional individual and Medicaid losses
During DJT campaign trail, he said everyone will get coverage but at a lower cost. Guess this is far from reality.
Many of my friends who are self-employed, have had hard time getting basic coverage until ACA came along. Now some of them are wondering if the new ACA is enacted, will they be covered at all? Now that CBO has revealed that the new ACA will have 14 millions people losing their coverage in 2018, and the situation worsen in later years. What a mess!
There is no chance Hiltzik did not "go to the source", but you often are now finding things other experts do not, or have missed, so you really should post a comment to that column at the LAT. Seriously.
The repeal would reduce the federal budget deficit by $337 billion over 10 years. Most of that would be the result of a stunning $880-billion reduction in Medicaid outlays
Interesting decision to use the word "most". Gross reductions come also from other spending cuts of $673B (the aforementioned elimination of the ACA form of subsidies), as well as $70B as a side effect of projected employer plan enrollment changes and $6B from repealing a small employer tax credit. We know he's writing about gross (not net) reductions because $880B exceeds the net reduction of $337B.
$880B is indeed more than half of the total $1629B in gross reductions. It's 54%. This use of "most" is the type of writing that some editors would not let slip into a news article. But newspaper editors do tend to give opinion writers a bit more leeway in how they present facts.
I agree with Hiltzik's sentiment, and it's something I've been emphasizing - that those most harmed are the most vulnerable, significantly (or as he put it, stunningly) those on Medicaid. But when he writes headlines with words like "horrific" and "monstrosity", it's pretty clear that his choice of words, let alone figures, is a bit suspect. Readers of the LA Times could already see that headline; it wasn't evident here, especially absent a link to the column.
The House GOP plan would scrap that aid and cap future federal support for Medicaid, delivering $880 billion in savings over the next decade, the budget office estimates. ...
The Medicaid cutbacks, coupled with other cutbacks, would help the GOP legislation reduce federal deficits by $337 billion over the next decade, according to the CBO report.
A little less stunning, a little better presentation that this is but one piece of a bigger picture.
The thing I can never quite understand is why this desire to spend more on the military--devices that take life--but less on saving it
Somebody told me years ago it's better at goosing the economy. Goes like this: Build a highway, hospital or bridge and it stays in place for maybe 50-100 years. No need to keep spending. But if you sit a vehicle out on a battlefield, it may get blown up. If you fire off rockets or mortar shells they're permanently expended and need to be replaced. Toss in a never-ending arms race, one side seeking superiority over the other, and you have a lot of economic stimulus that wouldn't be there with simple infrastructure.
Dark theory I suppose. Grossly oversimplified here. But sense a lot of truth in it.
A minor update on the Medicaid portion of coverage: "Out of the 20 million people who have gained insurance under the law [ACA], about 14.5 million received coverage through Medicaid, 3.3 million of whom were previously eligible."
In round numbers, about 3/4 of the new coverage under the ACA came from expanding Medicaid.
NYTimes cites a KFF page stating that the Medicaid expansion data does not include Louisiana. LA did not expand Medicaid until after the time period covered by the data (Jan-March 2016).
There is a lot of play in most figures, because of large uncertainties (check the size of those error bars), because of different assumptions being made (which are almost never discussed), because frankly people are not 100% rational consumers.
I think most people here realize that there are behavioral patterns that make stock markets less than 100% efficient. IMHO it's even worse with insurance, something people seem to be unable to value correctly. For example, many people pay up for a lower cap on expenses, regardless of how much extra they're paying (e.g. pay $1500 in higher premiums for a $2K reduction in expense cap). That's a bad buy unless you're pretty certain that you'll max out.
What all this means is that articles (and columns) that present their assumptions and sources are much more helpful than those that mostly bemoan how bad things are going to be.
This also means that whenever you read something about how many people are expected to react a certain way, yellow lights should be flashing like mad.
Finally, in addition to all the legitimate uncertainties and unknowns, there is a lot of ambiguity in how terms are being used. Couple that with deliberate spin, which is in ample supply, and you come up with statements like Spicer's claim (noted in the Washington Post fact check linked to above):
"You can’t only have nine-plus million people on the exchange and say in the first year alone [14 million will lose coverage] when there’s no touch to Medicaid or anything else".
Spicer is relying on a tendency of people to think of the ACA only as exchanges/mandates in order to spin the figure. In that context, Spicer would be right - you can't lose 14 million in coverage if there are only 9 million total. But the CBO counts Medicaid as insurance also. So it's talking about losing 14 million people (exchange, Medicaid, and employer-based) out of 20 million covered now (and probably more in 2018 if the ACA remains intact).
I like that example because it illustrates ambiguity and spin in one neat package.
Interesting comment section at the end of article and the implication that all of this is setting the stage for tax reform (mostly cuts for the wealthy):
From the comment section this referenced article:
Which raises the question: why are Republicans pushing so hard to get Phase I through right now instead of waiting until the other phases are ready to do and doing the whole thing together, which would make much more policy sense and be far more responsible as a matter of governance?
The answer is that tax reform, with another big tax cut mostly for wealthy people, is up next. Under reconciliation rules, the bill has to be deficit-neutral over the next ten year period or else the provisions expire, as the Bush tax cuts did. Trying to make up for the lost revenue with spending cuts would be very difficult if the tax cuts are compared to today's level of revenues as the baseline.
But Phase I of their health care bill is the part that involves a big tax cut (again for wealthy people) and CBO has already scored it as a deficit reducer over ten years. Once that passes, then Republicans have a new and lower level of revenues to serve as the basis of comparison for their tax reform bill. With this new baseline, they might be able to cobble together enough further spending cuts to meet the deficit-neutral designation.
Pushing through Phase I alone has nothing to do with health care reform; it's about setting the stage for the tax cuts to come in their tax reform bill. It's a shame that more members of the media don't understand the reason for this cynical strategy.
Hi @bee Thank you for the added info...........the comments sections of many articles many times provide other or more useful input for consideration. My take on timing/phasing of changes regarding a new health plan also has a great deal related to coming elections. State elections (state and federal level positions) are not very far into the future for campaign purposes. If cost changes or available decent access are going to be to the downside for individuals; there will be many republicans whose future fate of employment will be on the line. I have not attempted to find any data, but I am inclined to believe that a lot of folks in need of support for healthcare voted Republican tickets in their states. A number of those up for election in the near future are going to have to decide very soon whether to poop or get off the pot; as the saying goes. The Dems looked foolish shuffling ACA in the early days of its life (pre-vote) and the Rubs are following those foot steps, IMHO. In general, the politicians; in the end, don't eat their own. AND YES, I/we do have to follow this area of politics at the time, as changes can affect various investment sectors. Regards, Catch
"The cost of failure on health care? It may be the rest of Trump’s agenda."
"there’s a lot more at stake for President Trump than whether the bill can be saved: Its fate could also determine how much else he can get done"
"Republicans are counting on cuts from former president Barack Obama’s health-care law to make the budget math work on other Trump priorities, particularly major tax reductions."
Note: Well, perhaps my previous remark regarding cynicism was a little optimistic.
“Those trade-offs have bedeviled efforts to expand health insurance coverage for decades”
“It is very hard to maximize health coverage while minimizing the cost to the government and disruptions to current insurance arrangements.”
“Trump’s own ideas about health policy do not seem to grapple seriously with these trade-offs. He repeatedly talks about covering more people at a lower cost but has offered no plan to do so."
Comments
http://www.latimes.com/politics/la-na-pol-obamacare-trump-supporters-20170312-story.html
And I thought hacking one of my accounts, or someone using my SSN and attempting to obtain a Federal tax refund, or that Samsung or Vizio are using my smart TV to spy on me in my home or, well you name your own choice beyond what is already stored at the Utah data site about me and you.
Yes, the below link is Huffington Post and probably not friendly to the Republican party side of life and I have seen a few other similar reports; so use your own judgement about this report. Do you own research and study. This article is a combo of related healthcare reform info. So many potential twists and turns possibly affecting healthcare investments into the future.
Don't be concerned about that medical HIPPA document as someone will have your genetic ID stored safe and secure, eh? The data won't be used against me and mine for any healthcare cost structure...will it ???
http://www.huffingtonpost.com/entry/the-house-bill-that-could-sideline-medical-research_us_58c328d9e4b0c3276fb784d8
Wishing I had another 50 years on this rock to discover the outcomes of today's pending events in the many things government. Hope I can recall some this when I return.
Regards,
Catch
As a 62 year old, I along with other pre-Medicare seniors have a very specific question. Even if I can afford premiums which may be higher than what the current exchanges may now have, what will the available plans actually cover, and what will be the deductibles?
With a raft of pre-existing conditions, I'm happy as a clam to have a plan that through a combination of premiums and deductibles caps my out of pocket at about $15K.
I wonder what the future would hold under GOP-Care?
Medical care is now one of many things in life that need to be price checked.
Anyone have information on the proposed tax credits (deductions) and the possible changes to HSA limits?
I'd be more comfortable if congress was getting the same HC as us.
https://pbs.twimg.com/media/C60jd_ZVoAA1R4P.jpg
Congress provides its employees (including your Congress critters) health care through SHOP. The only difference is that since the US Government is not exactly a small employer, the ACA had to have an exception written to allow Congress to purchase ACA plans the same as other employers.
Washington Post blog, Jan 4, 2017, "Fox News host propagates Obamacare congressional exemption myth".
Obamacare imposes a mandate to induce healthy people to sign up, offers means-tested subsidies to make insurance affordable, and expands Medicaid to take care of people with really low incomes. Trumpcare eliminates the mandate, slashes subsidies overall and redirects them to those who don’t need them, and sharply cuts Medicaid. Of course that leads to a huge drop in coverage.
The great Hiltzik, LATimes:
Here’s the good news ...: The repeal would reduce the federal budget deficit by $337 billion over 10 years. Most of that would be the result of a stunning $880-billion reduction in Medicaid outlays, delivered in part by zeroing out the ACA’s Medicaid expansion over time, and in part by converting traditional Medicaid to a block-grant program that would squeeze states more every year.
In other words, the reduction in the federal budget would come from throwing the neediest Americans off Medicaid and forcing reduced benefits for those who are left.
Another $673 billion in budget reductions would come from reducing and eliminating tax subsidies for individual insurance. That’s another way that the GOP plan would appear to save money, only by imposing more costs on those least able to afford them.
The old (ACA) subsidies (refundable tax credits and cost sharing subsidies) do comprise most of a $673B savings, and these forms of subsidies would indeed be eliminated. But the new form of subsidies (tax credits) under AHCA would cost an extra $361B.
As always, the best thing to do is go to the source. 37 pages. I'm just skimming it now.
https://www.cbo.gov/sites/default/files/115th-congress-2017-2018/costestimate/americanhealthcareact_0.pdf
If you want to see the loss of coverage breakdown, go to p. 20.
2018 - 14M: 6M individual coverage, 5M Medicaid, 2M through work (all rounded)
2019 - 16M: additional individual and Medicaid losses
More detailed 2020 and 2026 figures are there.
Many of my friends who are self-employed, have had hard time getting basic coverage until ACA came along. Now some of them are wondering if the new ACA is enacted, will they be covered at all? Now that CBO has revealed that the new ACA will have 14 millions people losing their coverage in 2018, and the situation worsen in later years. What a mess!
Interesting decision to use the word "most". Gross reductions come also from other spending cuts of $673B (the aforementioned elimination of the ACA form of subsidies), as well as $70B as a side effect of projected employer plan enrollment changes and $6B from repealing a small employer tax credit. We know he's writing about gross (not net) reductions because $880B exceeds the net reduction of $337B.
$880B is indeed more than half of the total $1629B in gross reductions. It's 54%. This use of "most" is the type of writing that some editors would not let slip into a news article. But newspaper editors do tend to give opinion writers a bit more leeway in how they present facts.
I agree with Hiltzik's sentiment, and it's something I've been emphasizing - that those most harmed are the most vulnerable, significantly (or as he put it, stunningly) those on Medicaid. But when he writes headlines with words like "horrific" and "monstrosity", it's pretty clear that his choice of words, let alone figures, is a bit suspect. Readers of the LA Times could already see that headline; it wasn't evident here, especially absent a link to the column.
Here's how the LATimes reported the same facts: A little less stunning, a little better presentation that this is but one piece of a bigger picture.
https://ww2.kqed.org/arts/2017/01/19/report-trump-administration-plans-to-privatize-cpb-cut-nea/
Everyone attempting 'balance' mentions the savings, which are trivial in the scheme of things.
Now here's redistribution:
http://www.vox.com/2017/3/13/14914062/republican-health-care-plan-cbo-redistribution-poor-medicaid
Build a highway, hospital or bridge and it stays in place for maybe 50-100 years. No need to keep spending. But if you sit a vehicle out on a battlefield, it may get blown up. If you fire off rockets or mortar shells they're permanently expended and need to be replaced. Toss in a never-ending arms race, one side seeking superiority over the other, and you have a lot of economic stimulus that wouldn't be there with simple infrastructure.
Dark theory I suppose. Grossly oversimplified here. But sense a lot of truth in it.
https://www.nytimes.com/2017/03/13/us/politics/fact-check-trump-obamacare-health-care.html
(NYTimes fact check column)
In round numbers, about 3/4 of the new coverage under the ACA came from expanding Medicaid.
NYTimes cites a KFF page stating that the Medicaid expansion data does not include Louisiana. LA did not expand Medicaid until after the time period covered by the data (Jan-March 2016).
http://www.latimes.com/business/hiltzik/la-fi-hiltzik-gop-healthcare-20170314-story.html
and some countering facts to the usual WH bullshit
https://www.washingtonpost.com/news/fact-checker/wp/2017/03/14/fact-checking-the-white-houses-rhetoric-on-the-cbo-report
I think most people here realize that there are behavioral patterns that make stock markets less than 100% efficient. IMHO it's even worse with insurance, something people seem to be unable to value correctly. For example, many people pay up for a lower cap on expenses, regardless of how much extra they're paying (e.g. pay $1500 in higher premiums for a $2K reduction in expense cap). That's a bad buy unless you're pretty certain that you'll max out.
What all this means is that articles (and columns) that present their assumptions and sources are much more helpful than those that mostly bemoan how bad things are going to be.
@davidrmoran sent me a link that's worth sharing (if I've made him a bit gun shy, I apologize) that does this. It's a column, but one that lays out the perspectives, facts, and viewpoints clearly and calmly:
http://www.slate.com/blogs/moneybox/2017/03/14/conservatives_can_t_debunk_the_cbo_s_blockbuster_report.html
This also means that whenever you read something about how many people are expected to react a certain way, yellow lights should be flashing like mad.
Finally, in addition to all the legitimate uncertainties and unknowns, there is a lot of ambiguity in how terms are being used. Couple that with deliberate spin, which is in ample supply, and you come up with statements like Spicer's claim (noted in the Washington Post fact check linked to above):
"You can’t only have nine-plus million people on the exchange and say in the first year alone [14 million will lose coverage] when there’s no touch to Medicaid or anything else".
Spicer is relying on a tendency of people to think of the ACA only as exchanges/mandates in order to spin the figure. In that context, Spicer would be right - you can't lose 14 million in coverage if there are only 9 million total. But the CBO counts Medicaid as insurance also. So it's talking about losing 14 million people (exchange, Medicaid, and employer-based) out of 20 million covered now (and probably more in 2018 if the ACA remains intact).
I like that example because it illustrates ambiguity and spin in one neat package.
More official bullshit here, with a nice parsing in response:
https://www.washingtonpost.com/news/fact-checker/wp/2017/03/15/mulvaneys-suggestion-that-a-person-making-one-fifth-his-pay-couldnt-afford-a-doctor/
From the comment section this referenced article:
Thank you for the added info...........the comments sections of many articles many times provide other or more useful input for consideration.
My take on timing/phasing of changes regarding a new health plan also has a great deal related to coming elections. State elections (state and federal level positions) are not very far into the future for campaign purposes. If cost changes or available decent access are going to be to the downside for individuals; there will be many republicans whose future fate of employment will be on the line. I have not attempted to find any data, but I am inclined to believe that a lot of folks in need of support for healthcare voted Republican tickets in their states.
A number of those up for election in the near future are going to have to decide very soon whether to poop or get off the pot; as the saying goes.
The Dems looked foolish shuffling ACA in the early days of its life (pre-vote) and the Rubs are following those foot steps, IMHO.
In general, the politicians; in the end, don't eat their own.
AND YES, I/we do have to follow this area of politics at the time, as changes can affect various investment sectors.
Regards,
Catch
@bee- I'm afraid that that level of cynicism and deviousness is reserved for politicians only.
"The cost of failure on health care? It may be the rest of Trump’s agenda."
"there’s a lot more at stake for President Trump than whether the bill can be saved: Its fate could also determine how much else he can get done"
"Republicans are counting on cuts from former president Barack Obama’s health-care law to make the budget math work on other Trump priorities, particularly major tax reductions."
Note: Well, perhaps my previous remark regarding cynicism was a little optimistic.
http://www.vox.com/policy-and-politics/2017/3/15/14908524/obamacare-lessons-ahca-gop
“Those trade-offs have bedeviled efforts to expand health insurance coverage for decades”
“It is very hard to maximize health coverage while minimizing the cost to the government and disruptions to current insurance arrangements.”
“Trump’s own ideas about health policy do not seem to grapple seriously with these trade-offs. He repeatedly talks about covering more people at a lower cost but has offered no plan to do so."
====================================================================================
TRUMP: “Nobody knew that health care could be so complicated.”
Gee, it sure seems like some people knew that.
Note: davidmoran's "Vox" article is one of the best general overviews that I've seen.