As Obamacare goes into effect, new criticisms leveled

[WhoWee]

How does the new system work? Are all required to get health insurance? What happens to those people who are unemployed/underemployed and do not have enough money to buy insurance?

Where do you want to start? It's phased-in over several years. The taxes start ahead of the benefits. The Obama Administration has granted over 200 waivers to companies thus far - so NO - everyone won't have to follow the rules. We have a few other threads running with a lot of posts. You might want to read through them as well.

This link will give you an idea of the problem with this legislation - not a lot of clarity.
http://docs.house.gov/rules/health/111_ahcaa.pdf

 

[Zefram]

I guess none of us know.

If you want a basic introduction to the law, KFF has lots of materials for you. Also note that the legislation linked to in the post above is not the law in question.

 

[WhoWee]

If you want a basic introduction to the law, KFF has lots of materials for you. Also note that the legislation linked to in the post above is not the law in question.

Kaiser has published some good information. As for the link - think of it as research notes.

 

[nismaratwork]

I'm going to pipe up and say, I think it does no harm to see both sides (and they are SIDES) of this debate, but beyond that there is no substitute for a truly neutral and knowledgeable party. I'm not that party, but there isn't a lot of neutral going around right now, and it's a HUGE bill so if you do find that person or group... please share?

 

[nismaratwork]

I feel the criticism is warranted. If it weren't, why were over 200 waivers to Obamacare granted (primarily to politically well-connected unions)? And, why were shady procedural tactics (threatened reconciliation) and blatant buy-offs (Cornhusker kick-back) used to secure passage? In my opinion, from this legislative disaster recovery will be exceedingly slow.

You feel this is somehow different from the way that other legislation is produced?

 

[nismaratwork]

Reconciliation has traditionally only been used for passing budgets (which the Democrats refused to do last year). Granted, buy-offs have gone on forever, but you have to admit that a buy-off exempting a state from parts of the legislation itself is pretty blatant.

Oh, it's so blatant I don't recall if it even made it into the final bill! Still, I think the lesson we can take from this has less to do about this bill, than it does with what a concentration of Washington wheeling and dealing looks like. Normally we get ONE bridge to nowhere, or some pork... here we had a HUGE trough, so we had some big old hogs!

As for reconciliation, you could be right, I certainly don't know. I'll tell you what, unless someone else has evidence to the contrary, I'll take your word for it.

 

[Zefram]

Oh, it's so blatant I don't recall if it even made it into the final bill!

The permanently increased FMAP for Nebraska didn't make it into the law. It was removed, ironically perhaps, using reconciliation.

 

[nismaratwork]

The permanently increased FMAP for Nebraska didn't make it into the law. It was removed, ironically perhaps, using reconciliation.

I'd call that irony! Thanks for the information Zefram.

 

[mheslep]

Yes, reconciliation (only 51 votes needed for cloture - instead of 60) had traditionally been used only for passing budgets. The Democrats had threatened to use it to block Bush judicial appointees (the nuclear option), but McCain and others thwarted that effort.

Right, the Democrats, in the minority then in 2005, were using the filibuster in the Senate to block Bush judicial appointees when the majority Republicans threatened the "nuclear option" to stop the filibusters by changing Senate rules when McCain stepped in.

 

[mugaliens]

If for no other reason than to eliminate the pork and complexity, I vote for a do-over. The bill is about 999 pages too long, and about 1,000% too expensive.

Apparently, Econ wasn't a required course in law school. Apparently, neither was preventative medicine, health ed, or P.E. You can't fix America's health problems by bankrupting the country.

Life just doesn't work that way.

 

[WhoWee]

More health care waivers approved.

http://thehill.com/blogs/healthwatc...-more-than-50-denied-waiver-requests-hhs-says

"The latest round of approvals bumped the number of waivers from 222 to 729. However, the number of individuals covered by the waivers rose from 1.5 million to just 2.1 million. HHS said it was anticipating the bump because plans were required to file the waiver request before the plan year starts — Jan. 1 for many.

Republicans on the powerful House Energy and Commerce Committee last week asked HHS to disclosed detailed information on waiver requests. HHS said Wednesday night that the waiver process has been transparent. "

 

[mheslep]

Testimony couple days ago from the Medicare actuary and Rep McClintock

McCLINTOCK: True or false: The two principal promises that were made in support of Obamacare were one, that it would hold costs down. True or false?

FOSTER: I would say false, more so than true.

McCLINTOCK: The other promise… was the promise that if you like your plan, you can keep it. True or false?

FOSTER: Not true in all cases.

http://www.youtube.com/watch?v=XC9rhGWJA2w&feature=player_embedded

Its over! Repeal and replace the thing already.

 

[nismaratwork]

When it comes down to it, just scrap it all, along with entitlements. Cut down the population, lower the deficit... win win.

I'm not trying to be sarcastic either... we don't need so many people, and I, and those I care about have money now. So... cut 'em all loose, but I sure hope hat you have something in the bank.

I'm amazed that anyone on the pro-universal health-care side actually WANTS to pass anything at this point... don't want it? don't have it! When your cystic fibrosis starts to act up, well... genetics. Cancer bad? Well, let's see the color of your money.

Really... who's lives are you trying to save?... gulls who are moved by the kind of rhetoric quotes in this thread, and espoused by others?

USA... a train wreck in slow motion where the passengers are too busy talking to get off the train. It's going to be interesting to watch it happen... train wrecks always are.

 

[WhoWee]

When it comes down to it, just scrap it all, along with entitlements. Cut down the population, lower the deficit... win win.

I'm not trying to be sarcastic either... we don't need so many people, and I, and those I care about have money now. So... cut 'em all loose, but I sure hope hat you have something in the bank.

I'm amazed that anyone on the pro-universal health-care side actually WANTS to pass anything at this point... don't want it? don't have it! When your cystic fibrosis starts to act up, well... genetics. Cancer bad? Well, let's see the color of your money.

Really... who's lives are you trying to save?... gulls who are moved by the kind of rhetoric quotes in this thread, and espoused by others?

USA... a train wreck in slow motion where the passengers are too busy talking to get off the train. It's going to be interesting to watch it happen... train wrecks always are.

Is this a new kind of scare tactic?

 

[nismaratwork]

Is this a new kind of scare tactic?

Nope, just something a comedian pointed out: we have all of these "liberals" trying to FORCE unwanted health care on people. OK, cut it.

Seriously, let's try it Rand Paul's way and see what happens, I'm a naturalized citizen with more than one citizenship; this isn't my grave.

I see what doctors are doing in the USA, changing who they take as patients, what they prescribe, and sometimes they move their practices abroad! Your system is terribly broken, and if the best solution right now is nothing... do it.

So... no... not a scare tactic... this is like trying to convince a Jehova's witness to get a transplant if they're set against it. At some point, if they want to die so badly... die already.

 

[PhilKravitz]

Federal government future expect liabilities minus future expect revenues equals 202 trillion dollars. So no need to change anything. Just wait and change will come due to reality.

 

[nismaratwork]

Federal government future expect liabilities minus future expect revenues equals 202 trillion dollars. So no need to change anything. Just wait and change will come due to reality.

Huh?

 

[CAC1001]

Nope, just something a comedian pointed out: we have all of these "liberals" trying to FORCE unwanted health care on people. OK, cut it.

Seriously, let's try it Rand Paul's way and see what happens, I'm a naturalized citizen with more than one citizenship; this isn't my grave.

I see what doctors are doing in the USA, changing who they take as patients, what they prescribe, and sometimes they move their practices abroad! Your system is terribly broken, and if the best solution right now is nothing... do it.

So... no... not a scare tactic... this is like trying to convince a Jehova's witness to get a transplant if they're set against it. At some point, if they want to die so badly... die already.

No one is saying we should do "nothing" about America's healthcare system. It obviously needs reform. But the Democratic party's argument that we had to do "something," and hence Obamacare, well Obamacare was the totally wrong way to go about it and was done in the name of ideology by the Democrats.

 

[WhoWee]

This is something I've touched on in previous posts/threads but we don't yet have all of the details. The Class Act is Title VIII of the healthcare law. The Senate passed it 12/24/09, House approved 3/21/10, and President Obama signed it into law on 3/23/10. Now, the Secretary of Health and Human Services is expected to set benefits by October 2012?

http://www.whitehouse.gov/health-care-meeting/proposal/titleviii
"Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)
Establishing a Voluntary, Self-Funding Long-Term Insurance Choice for American Families
The Act provides Americans with a new option to finance long-term services and care in the event of a disability."

We do have a framework - benefits will depend on a person's degree of impairment (min $50/day) expected to average $75/day. Individuals will pay premiums for at least 5 years before they qualify - a 5 year waiting period. We still don't know if this will be classified a "Partnership" plan (insurance term) with the Government - but should be with the various carriers (per state regulations).

Nursing home care is very expensive and a drain on Medicaid. LTC (Long Term Care) typically requires medical underwriting and is designed to protect retirement assets (as well as the house).

 

[nismaratwork]

No one is saying we should do "nothing" about America's healthcare system. It obviously needs reform. But the Democratic party's argument that we had to do "something," and hence Obamacare, well Obamacare was the totally wrong way to go about it and was done in the name of ideology by the Democrats.

Someone is; I am. Send it back to the states, if they can afford it, and if not... not.

 

[Al68]

Someone is; I am. Send it back to the states, if they can afford it, and if not... not.

Or we could fix the problem with each state prohibiting out of state insurance policies. The federal government has no constitutional authority to force people to buy insurance, but they do have the power to regulate interstate commerce, so they could simply pass a law preempting state prohibitions on interstate policies, after repealing Obamacare.

That would immediately and drastically improve competition. And an even bigger advantage to consumers is that it would provide an incentive for states to stop screwing over consumers with their regulations, since a consumer can simply buy a policy not subject to them from another state.

 

[WhoWee]

Or we could fix the problem with each state prohibiting out of state insurance policies. The federal government has no constitutional authority to force people to buy insurance, but they do have the power to regulate interstate commerce, so they could simply pass a law preempting state prohibitions on interstate policies, after repealing Obamacare.

That would immediately and drastically improve competition. And an even bigger advantage to consumers is that it would provide an incentive for states to stop screwing over consumers with their regulations, since a consumer can simply buy a policy not subject to them from another state.

I think it would be more productive if the states worked to agree on a reasonable standard for policies to be sold (and used) across state lines. The best way to turn away a bad idea is to have a good idea.

 

[mugaliens]

One of the brightest ladies of my high school, a current PhD, came at me with a simple objection to my complaints. When I got what she was getting at, and replied with 53 objections to her points which she claimed did not exist in the health care plan at all, yet in the first 49 pages of a 1,000 page document, she gave up, dissed me from FB, and I haven't heard from her since.

So much for Valedictorians with respect to being able to read government documentation.

I'm retired. She's not. Somehow, I "evolved" between then and now, or I would have been one of the V's.

Still, the documents rest on their own case. I rest on mine.

 

[Zefram]

Or we could fix the problem with each state prohibiting out of state insurance policies. The federal government has no constitutional authority to force people to buy insurance, but they do have the power to regulate interstate commerce, so they could simply pass a law preempting state prohibitions on interstate policies, after repealing Obamacare.

That would immediately and drastically improve competition. And an even bigger advantage to consumers is that it would provide an incentive for states to stop screwing over consumers with their regulations, since a consumer can simply buy a policy not subject to them from another state.

These are two very distinct points. If the goal here is primarily deregulation (and given the way these proposals tend to be structured, it generally is), that's one thing. Creating a competitive pressure for insurers to locate in states that have few (or offer to shed existing) consumer protections and encouraging insurers to "separate the wheat from the chaff," so to speak, in interactions with those who benefit to varying degrees from consumer protections is, I think, a bad idea.

The question of attempting to increase consumer choice of insurance policies--decoupled from the notion of deregulating them--is a different story. But it's a more complicated story. There are multiple ways to try and do that without granting states the authority to deregulate each other's insurance markets. As I believe WhoWee is alluding to, states can voluntarily enter into compacts with each other in which ground rules are set. Then insurance policies can be sold across their state lines but without initiating a regulatory race to the bottom.

Another option that will be implemented in a few years is the creation of national plans--insurance policies that can be sold in multiple states but must conform to national standards. Yet another option, in which certain states are currently said to have a very serious interest (Utah is the one that comes to mind immediately), is for states to build multi-state health insurance exchanges. That is, when they construct the new markets for individual insurance policies required by the ACA that market would serve more than one state.

The point here is that opening up health insurance markets across state lines need not go hand-in-hand with the shedding of consumer protections. But you still have to consider the larger question of what you mean by competition. Simply having more insurers serving a given market doesn't necessarily mean health plans get cheaper for the simple reason that those prices aren't set entirely (and, in some markets, even predominately) by insurers. Your premiums reflect a number of things but one of them is certainly the actual dollar amount negotiated for a given claim. If your beef is that there isn't competition to bring down the price of care (as it's ultimately filtered back into your insurance premiums), say because a single hospital chain dominates in your area, increasing competition among payers when the problem actually lies on the provider side may well prove to be counterproductive. That's where the story gets complicated.

 

[Al68]

There are multiple ways to try and do that without granting states the authority to deregulate each other's insurance markets.

What are you referring to? Are people within a state that state's "insurance market"? Does my ability to buy other products from another state constitute the other state deregulating my state's market? Or is it simply an option for consumers to avoid state regulations they determine to be bad ones.

Is it really not obvious why something gets very expensive when government forcefully replaces the decisions of consumers with its own?

The point here is that opening up health insurance markets across state lines need not go hand-in-hand with the shedding of consumer protections.

What "consumer protections" are you referring to? The advantage to being able to buy insurance from other states is that a consumer can avoid the states with burdensome regulations. The cost of regulation would be obvious in the price differences between the states.

Better yet would be a complete prohibition on any state trying to control the contents of a private agreement between private parties. Imagine that. What an extreme and radical notion.

 

[Al68]

I think it would be more productive if the states worked to agree on a reasonable standard for policies to be sold (and used) across state lines. The best way to turn away a bad idea is to have a good idea.

Then what of the consumers that don't consider that standard so reasonable? That's not much better than Obamacare.

How about both the federal government and the states refrain from interfering in private contracts? Or at least give consumers the option of picking a state that does.

 

[WhoWee]

Then what of the consumers that don't consider that standard so reasonable? That's not much better than Obamacare.

How about both the federal government and the states refrain from interfering in private contracts? Or at least give consumers the option of picking a state that does.

The state regulators are closer to the consumers - they hear the problems and deal with insurance issues on a daily basis. I trust the 50 experienced insurance regulators to establish a reasonable set of regulations more than an isolated group of self serving Washington bureaucrats.

 

[Al68]

The state regulators are closer to the consumers - they hear the problems and deal with insurance issues on a daily basis. I trust the 50 experienced insurance regulators to establish a reasonable set of regulations more than an isolated group of self serving Washington bureaucrats.

I agree. My point was that some states are better than others, and would be even more so if consumers were free to choose between them, without some "standard" applying to them all.

 

[WhoWee]

I agree. My point was that some states are better than others, and would be even more so if consumers were free to choose between them, without some "standard" applying to them all.

Insurance regulations are similar to building codes. Some regulations might be more applicable to one region than an another - but everyone can build to the highest standard. If everyone agrees to the same (higher) standards, then all of the (qualified) insurance companies will be able to compete nationwide.

 

[mheslep]

We don't shed all consumer protections in the property and hazzard insurance markets when they operate across the states; I fail to see why that most be so with health insurance.

 

[PhilKravitz]

How about we limit government medical care to a life time cap of $50,000 per person.

 

[WhoWee]

How about we limit government medical care to a life time cap of $50,000 per person.

What would that accomplish? I'll assume you know $50k is a very small amount of medical coverage. In insurance terms, a $50k cash indemnity plan is best sold to someone that doesn't really need coverage - a very healthy 22 year old male that wants to tell his parents he has coverage.

 

[PhilKravitz]

What would that accomplish?.

Lower government spending.

 

[Al68]

Insurance regulations are similar to building codes. Some regulations might be more applicable to one region than an another - but everyone can build to the highest standard. If everyone agrees to the same (higher) standards, then all of the (qualified) insurance companies will be able to compete nationwide.

But unless they are free to offer a non-standard product, it's not really free competition in the sense that the product offered is tailored to consumers instead of government standards.

I have no interest in buying the type of medical insurance that would meet any standard likely to be "agreed on" by third parties. It's my place, not government's, to "agree on" the type of insurance I will buy.

 

[PhilKravitz]

Obamacare is a new tax on the healthy young to pay for medicaid that was bankrupt. It is just a new tax. Nothing more.

So, no freedom for you. You will buy the "insurance" that looks like medicaid for the poor and looks like tax to the working well.