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Obamacare repeal/replace (or 2.0, or Obamacare "lite")


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Or whatever it's going to be called. Too early to say for sure on that end ("Trumpcare?")

 

But the critics (of which there are plenty on the right) are correct about one thing- it basically is Obamacare 2.0. The spin machine has already started to work at championing this as some type of free market reform, but in reality, it's basically just Obamacare with some items renamed, and a little tinkering around the edges. The major change is the mandate is being replaced with a quasi-mandate-- i.e., instead of having to purchase insurance or face a penalty, now one can choose not to purchase insurance, but face a 30% increase in premiums once you do buy.

 

So it begs the question, how did we get here? Why didn't the GOP actually have a replacement plan? Well that should be obvious- Obamacare was the GOP plan, i.e. their original alternative to a more nationalized system, so as to keep the $$ flowing to insurance companies.

 

The opposition always had more to do with the fact that Obama passed it than anything else, and in that sense, it was very much the useful boogeyman for the past 8 years, just like Iraq was for the Democrats in the 00s. And had the GOP lost this election, it would've been the gift that kept on giving- all sorts of sh-t could be blamed on Obamacare for years to come. But that didn't happen, and after years of promising a replacement, the GOP had to have known that there was always the risk that they'd be back in power.

 

Going to the policy itself- the main problem with Obamacare was the mandate loophole- a problem I discussed on here years and years ago as the big reason why premiums wouldn't go down (and, of course, I was right). Basically the penalty was never large enough to actually incentivize people to purchase insurance, since you could just wait until you got sick, due to the ban on denying pre-existing conditions. And just like clockwork, that's exactly what happened- no one that was healthy signed up and premiums went through the roof. How this wasn't discussed more when the original plan was passed baffles me to this very day.

 

And this is exactly what's going to happen under the new plan. No one is going to care about a hypothetical 30% increase in a premium when they won't actually need the insurance until 20 or 30 years from now. People in general are pretty irrational and also notoriously bad at long-term planning. So, only sick people will continue to sign up, same as before, and premiums will keep going up.

 

There's only two ways to decrease premiums. Either a) go back to the old system where insurance actually worked like insurance, and insurers could deny people for all sorts of reasons (this ship has probably sailed.. there's no way this is politically viable);

 

or b) we'd have to go to single-payer, or even just nationalize health care altogether. Of course, for this to work without taxes going astronomically up, there'd have to be things like rationing and death panels, and you can forget about anything like that ever passing Congress.

 

So basically, we're just kinda stuck with Obamacare or some version of it; that's about as conservative a plan you can practically get through Congress. And the thing is, behind closed doors, the GOP knew this. So why was this the issue that we had to draw the line in the sand on? There were a lot of other good things that could've flown through in the first 100 days. Infrastructure would've been tough for the Dems to vote against and an easy win. Trade would've been a pretty easy win, and would also have the added benefit of splitting the Dems between the Sanders and Clinton wings. And with a couple wins in their pocket, the GOP may have had the capital to push through some truly fundamental changes that would dramatically benefit the country, like immigration reform or tax reform.

 

But instead, we now have to debate this turd for the next 6 months? The GOP will now be lucky if they can get any major bills through before the midterms. And not only that, the Dems are in the position where they can basically sit on the sidelines, watch Ryan try and whip votes for the bill, and then if it actually passes somehow, blame the increased premiums on the GOP for the midterms.

 

You know what's funny- Trump actually realized this. He mentioned off-the-cuff several times in recent rallies that the easy thing to do would be to just let Obamacare implode and then blame it on the Dems, instead of trying to replace it. His instincts were right. Too bad that's not how it's gonna play out.

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This is going off topic here, so out of respect to the actual topic, I will put this into spoiler tags for people like Tex who want to see my response. Those who don't want to see it, can choose not

...well I guess it doesn't matter. Cancer is generally slow moving and Nuclear war with N Korea will be much quicker.

Because that is the entire fucking point of insurance of any kind. That has always been the case and always be the case. You don't buy insurance after you need it, but before hand in case you ever d

I don't disagree with a lot of your analysis on why the pre-existing conditions ban pretty much sinks private health insurance in the long run, but I will say that I'm not sure how you can call jacking up the price to new customers who have probably sat around for years and even decades until they needed "insurance" a mandate.

 

It seems that the word is just being thrown around for political purposes.

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It's not a mandate in the true sense, since you are not required by law to do something.

 

That's why I called it a quasi-mandate. It's a dis-incentive that, theoretically, is supposed to guide societal behavior towards a desired income. It is undoubtedly less coercive than the original mandate.

 

But that's neither here nor there. My main problem with it is, the mandate has just been swapped out for another mechanism that is unlikely to do anything.

 

The original mandate would've worked if it was sufficiently high enough. Like if the penalty was jail time or something crippling, like a $20,000 fine, then you bet your ass people would've signed up for health insurance. But obviously something like that would never pass. Then again, most things that would actually fix health care won't either.

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I don't think you can fault the GOP here because they inherited this mess. The best thing to do would be to get rid of it altogether, but they can't do that without looking like the bad guys for taking people's insurance away.

 

As Carrie said you need to have premium from healthy folks to fund the claims for sick folks, otherwise there's no way to manage the cost, and I don't see any way Obama/Trump/whatevercare can accomplish this.

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They really should have ignored the press and gone with repeal and delay. Change the status quo first, and then they could fight over the details. They let the Democrats and press bait them from that plan, and now it doesn't look like anything will get done.

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It's been a really stupid ride. They had things t felt they could have fixed about the ACA. Instead it was a poorly thought out concept and full of dumb. The Texas GOP funded commercials with no real substantive policies concerning their plan. It just said basically "You'll have health care. Don't freak out." Then the CBO sent out it's thoughts on the matter and people really freaked out.

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I don't think you can fault the GOP here because they inherited this mess.

 

Ha! They had 7 years to plan for this moment and they blew it. Trumpcare is dead. ACA stands.

Well aware of that sweetie, but there's nothing they can do. The proverbial cat is out of the bag and ****ing the dog. There's nothing that can be done to fix it.

 

Or do you have a plan to pay for this mess? Things cost money.

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They really should have ignored the press and gone with repeal and delay. Change the status quo first, and then they could fight over the details. They let the Democrats and press bait them from that plan, and now it doesn't look like anything will get done.

 

The problem is, that wouldn't have passed through the senate. It probably wouldn't have even made it past the house- the final offer had moved closer to that, and there still weren't the votes.

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What got me is that if you asked someone what they thought about Obamacare in my neck of the woods they were all "NO WAY JOSE! The worst conceived concept ever." But switch and ask about ACA and it was all "It's good. I like it. I use it." I'm still trying to figure out the part about it collapsing on itself. Rates did go up this year and probably will with our aging population with all it's fatty health issues and the exchanges had fewer options but people were still buying. A lot went with the high deductible plan and health savings accounts are increasing (uhm, hello tax benefit).

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The problem is, that wouldn't have passed through the senate. It probably wouldn't have even made it past the house- the final offer had moved closer to that, and there still weren't the votes.

 

It's where they should have started, and they should have set things up to ram through in the first week. If they'd kept it simple like the bill passed last session, they wouldn't have had to deal with the contra-momentum.

 

We'll see how it goes from here. I suspect that this isn't really the end of the discussion. Really, the biggest obstacle is that huge Medicare expansion. It's just a entitlement expansion and really does a large chunk of the actual covering that the Democrats boast about. The number of people actually covered by what we think of as Obamacare who didn't already have insurance is surprisingly small.

 

 

 

Rates did go up this year and probably will with our aging population with all it's fatty health issues

 

That's not why rates are going up. Seniors are on Medicare anyway. Rates are going up because insurance companies are losing billions of dollars on these policies.

 

 

 

but people were still buying.

 

A lot of healthy people aren't. That's the problem.

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The whole idea was that everyone would buy and rates would remain low because the young invincible crowd would pay the same as a 55-year-old smoker with high blood pressure, an enlarged heart, and in remission from cancer twice. Otherwise the price skyrockets because you've got the whole no preexisting conditions thing.

 

It was essentially a tax on the young, but they didn't play ball.

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And that's why the whole thing is a joke. It's not about giving people health insurance, it's about pretending to for political reasons. It's not real insurance. The premiums and deductibles are too high and both will only increase over time because they can't force young people to sign up.

 

On top of that many procedures aren't covered. Doctor may want to do a test to properly diagnose a patient only to find out that ACA won't cover it.

 

Again, the whole thing is a joke and should probably go away. We simply can't pay for it.

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The problem is, that wouldn't have passed through the senate. It probably wouldn't have even made it past the house- the final offer had moved closer to that, and there still weren't the votes.

It's where they should have started, and they should have set things up to ram through in the first week. If they'd kept it simple like the bill passed last session, they wouldn't have had to deal with the contra-momentum.

 

I don't think it would've mattered if they started there. Sure, it was easy to keep it simple last session, because it wasn't going to actually happen and so it was a more symbolic vote than anything else. But once play-time was over and it was time to actually do it, the GOP straight up didn't have the balls. And why? Well, for the reasons I already went over. Because then they would've 'owned' what happened afterwards and too many people had already started benefiting from Obamacare. Once a benefit is granted, it is practically impossible to ever take away. The GOP would've had to replace it with something, and the problem there is that there really isn't a more conservative plan for coverage than Obamacare. And why? Because Obamacare itself was the GOP alternative for coverage without a national health care system. This is why I advised strongly against putting this issue at the top of the agenda. There was no way for the GOP to come out of this minefield with a win. Something like infrastructure at the top would've been much easier to get consensus on, and would've generated capital for what a lot of Republicans really want- tax reform. Now that ship has probably sailed.

 

As one House member himself admitted:

 

Rep. Joe Barton (R-TX) admitted as much as he left the meeting Friday. Reporters asked why, after Republicans held dozens of nearly-unanimous votes to repeal Obamacare under President Obama, they were getting cold feet now that they control the levers of power.

 

“Sometimes you’re playing Fantasy Football and sometimes you’re in the real game,” he said. “We knew the president, if we could get a repeal bill to his desk, would almost certainly veto it. This time we knew if it got to the president’s desk it would be signed.”

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A lot of young people don't buy. Who needs health insurance when you're in your late 20s? They need coverage for what? ingesting foreign things, over drinking and doing dumb acts that break their arms?

Well that's the problem. That's why Obamacare didn't decrease rising premiums, why the GOP replacement, "Obamacare lite" wouldn't have decreased rising premiums, and why premiums are going to just keep going up next year, and the year after that, and so on.

 

So when you said "people are still buying," exactly who are you talking about here?

 

Because it's pretty obvious that people aren't buying and just willing to pay the penalty. The loophole I identified years ago when it originally passed. Why I knew the plan wouldn't end up working, and lo and behold, I was right.

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I don't think it would've mattered if they started there.

 

Maybe it wouldn't have. But slowly ripping the Band-Aid off hair by hair was just about the worst way to do it. If it had all happened immediately and they set a clock for the future, then it all might have been feasible during the confusion and chaos of the transition. Letting it all hang out there where the conservative wing hates it for being Obamacare Lite and the moderate wing runs in panic from pulling back the Medicaid expansion and any bad press on government requirements for what's in the insurance pretty much guaranteed that nothing could get done.

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It doesn't matter what they do. If you took the dollars and cents it would not pay for it. If I paid Krawlie 30 cents and ho only had 25 he would stil be 5 cents short. Then I would frick all his beer and he would be super mad. Then the Asians would want revenge for Vietnam

 

fuck you Vietnam.

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Well Poe, that brings up an interesting point- I do wonder what would've happened if they had just put a straight repeal bill on the floor on day 1.

 

Maybe it passes, maybe it doesn't.. it probably dies in the senate regardless. But that's pretty much the only way Ryan could come out of this with some strength. Put that bill out, draw the line in the sand, and see if the Freedom Caucus has the balls to vote no. By the time Trump finally put his foot down on a 'take it or leave it' offer, it was just too late. Ryan had been waffling on it, delaying the vote, and giving in to the Freedom Caucus bit by bit... they knew they had the upper hand and no matter what Trump said, it was gonna be their way or the highway. Ryan knew that too and figured he'd rather try and save at least little face by pulling the vote. It was a game of chicken and Ryan lost.

 

I feel for Ryan in a way, because he's a good guy and I like him.. but he's gonna be the fall guy for this and when you saw his face in the interviews, he knows it too. Unfortunately Ryan, at the end of the day, wasn't the guy that was gonna get through a bill. We needed a pit bull in there and Ryan just wasn't it.

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Should have been single-payer from Day One.

 

Well, I think there is merit to that position... but you have your own party to thank for that one. When the Dems had total control of government, the most liberal plan that could get through was an old GOP plan from the 90s.

 

Forget single-payer. Actually forget even a public option. Just Obamacare passed by the narrowest of margins and required all sorts of shenanigans to get it through (remember the Cornhusker kickback?)

 

The fact of the matter is, the employer/insurance model is so entrenched in our health care system by this point, that Obamacare, or something like it, is realistically all we're gonna get, and it ain't going anywhere. If the window was ever open for some type of government-run, universal coverage system, that window probably closed some 50 years ago. And funny enough, it was actually Democrats that helped close it the first time too.

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I think, ultimately, either by design or incompetence Obamacare is opening the window back up. Democrats have successfully exploded the insurance model in the long run. If Republicans are too timid to kill it, then we've got a permanent dysfunctional system with rapidly rising premiums going forward.

 

The only part of Obamacare that really "works" as a matter of insuring more people is the Medicaid expansion, which is just raw government entitlement expansion. It's not exactly single payer, but it's close enough.

 

Fast forward a few years with the private insurance market pricing out anyone not on their employer's plan, and with employers dropping out too, and the calls for single payer, or at least universal Medicaid, as the only way to fix all this mess that they created will get louder and more mainstream.

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But there was a stick to get the young people to buy. You're restating things I already know about. There's a tax penalty at the end of the year when you file that increased the more years you didn't buy insurance. Eventually kids (Ha! I say kids but really late twenty and thirty year year old non-hypocondriacs) were like I can either pay the tax and it's cheaper or had gotten pregnant and therefore were choosing not to marry and getting health benefits that way.

 

The biggest thing is to go single payer but when people see how much your medicaid deductions will be I think there will be a real freak out.

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