The US Healthcare Mass Debate

[Tero]

The let's give them something for a while but be vague about it and scrap the rules plan
http://thehill.com/policy/healthcare/35 ... epeal-bill

[Tero]

Fuzzy block grants direct some money to states. Only to 2026.

Cassidy-Graham cuts health coverage in two ways: first, by undoing the ACA’s major coverage expansions through a block grant, and second, by radically restructuring and cutting the entire Medicaid program. The bill would eliminate the ACA’s Medicaid expansion and marketplace subsidies starting in 2020, offering in their place only a smaller, temporary block grant that states could use for health coverage or any other health care purposes, with no guarantee of coverage or financial assistance for individuals.

According to the bill’s sponsors, this block grant would give states “flexibility,” allowing them to maintain the coverage available under the ACA if they wanted to do so while enabling other states to experiment with alternative approaches. But in reality, states wouldn’t be able to maintain their coverage gains under the ACA. Instead, Cassidy-Graham, like the earlier House and Senate repeal-and-replace bills, would cause many millions of people to lose coverage.

First and foremost, this is because the block grant funding would be insufficient to maintain coverage levels equivalent to the ACA. The block grant would provide $243 billion less between 2020 and 2026 than projected federal spending for the Medicaid expansion and marketplace subsidies under current law. In 2026, block grant funding would be at least $41 billion (17 percent) below projected levels under the ACA. These figures do not include the cuts resulting from the bill’s Medicaid per capita cap, discussed below, which would cut Medicaid funding outside of the ACA’s Medicaid expansion by an estimated $39 billion in 2026.

These estimates understate the actual cuts to federal funding for health coverage in another way as well. Under current law, federal funding for the Medicaid expansion and marketplace subsidies automatically adjusts to account for enrollment increases due to recessions or for higher costs due to public health emergencies, new breakthrough treatments, demographic changes, or other cost pressures. In contrast, the Cassidy-Graham block grant amounts would be fixed — they wouldn’t adjust for the higher costs states would face due to these factors. Faced with a recession, for example, states would have to either dramatically increase their own spending on health care or, as is far more likely, deny help to people losing their jobs and their health insurance.

Like the earlier version of the Cassidy-Graham plan, the revised plan would disproportionately harm certain states. The block grant would not only cut overall funding for the Medicaid expansion and marketplace subsidies but also, starting in 2021, redistribute the reduced federal funding across states, based on their share of low-income residents rather than their actual spending needs. In general, over time, the plan would punish states that have adopted the Medicaid expansion or been more successful at enrolling low- and moderate-income people in marketplace coverage under the ACA. It would impose less damaging cuts, or even raise funding initially, for states that have rejected the Medicaid expansion or enrolled few low-income residents in marketplace coverage. (These states would still see large cuts in the long run and during recessions or when faced with other anticipated increases in health care costs or need.)

In 2026, the 20 states facing the largest funding cuts in percentage terms would be Alaska, California, Connecticut, Delaware, the District of Columbia, Hawaii, Kentucky, Louisiana, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, North Dakota, Oregon, Rhode Island, Vermont, and Washington. These states’ block grant funding would be anywhere from 35 percent to nearly 60 percent below what they would receive in federal Medicaid expansion and/or marketplace subsidy funding under current law.

The Cassidy-Graham bill would lead to large coverage losses for another reason as well. Under current law, moderate-income consumers in the individual market are guaranteed tax credits to help them pay for meaningful coverage meeting certain standards, and low-income adults in expansion states are guaranteed the ability to enroll in Medicaid, which provides a comprehensive array of benefits and financial protection. Cassidy-Graham would eliminate these guarantees and allow states to spend their federal block grant on virtually any health care purpose, not just for health coverage.

Facing federal funding cuts and exposed to enormous risk, most if not all states would have to use the bill’s so-called “flexibility” to eliminate or cut coverage and financial assistance for low- and moderate-income people. In particular, many states would likely do one or more of the following: cap enrollment; offer very limited benefits; charge unaffordable premiums, deductibles, or copayments; redirect federal funding from providing coverage to other purposes, like reimbursing hospitals for uncompensated care; and limit assistance to fixed dollar amounts that put coverage out of reach for most low- and moderate-income people. As a result, many millions of people would lose coverage.

Block Grant Funding Would End After 2026

https://www.cbpp.org/research/health/li ... -uninsured

[Forty Two]

Repeal.

Just repeal it.

[JimC]

...and let the poor suffer their ill-health as they so richly deserve to...

[Scot Dutchy]

When health care is such a big political football no solution will be found especially in a country with such a massive wealth difference.

[Forty Two]

...and let the poor suffer their ill-health as they so richly deserve to...

How would repealing Obamacare do that? Children are covered under SCHIP and the poor are covered under Medicaid. Were you under the impression that Obamacare covered poor people who didn't have available health insurance?

Take it from the top: Obamacare is a mandate for people to buy health insurance. I.e., it legally obligates every American to have health insurance. Before Obamacare, and after, 85+% of all Americans were covered under some sort of group health plan, primarily through employers of one or more family members. Then a certain percentage of the remainder were covered by Medicaid (poor) and Medicare (old). The uninsured at the time Obamacare passed were mostly young, single and high income - more than 1/2 of the unininsured population made the median income in the country, about $55,000 per year, at the time. Earning that amount of money means you can afford health insurance, or you could at the time. Now, though, insurance rates have tripled on the private market, so if such a person is not covered on a group plan, the "affordable health care act" made it about 3 times more expensive for those uninsured to buy insurance.

About 1/4 of the "uninsured" population at the time were illegal aliens. And, most of the remaining quarter were people who were already eligible for either a group plan, or government benefit of some kind, but for whatever reason had not signed up for it.

That's the reality. This whole Obamacare thing was a solution to a non-existent problem that was blown out of proportion for political purposes (the purpose is to take us one step closer to single payer medicine). That's why it was so hard for the Democrats to ram it through, even when they controlled the white house and both houses of congress. It wasn't something that was in high demand. The media and the Democrats made it seem like it was in demand, because of course if you ask anyone if everyone should get healthcare, then the answer is, of course, yes! Everyone should get healthcare! But, if you look at the details of exactly what the coverage problem was in 2009 and 2010 -- it wasn't a problem which Obamacare solved.

That's why, even with a law mandating by law that everyone be covered by insurance, we still have like 35 million uninsured people. Are they "the poor?" Who are they, JimC? If they're "the poor" then how come they aren't covered? We had Obamacare passed in 2010. Didn't it cover "the poor?"

Of course the poor are covered, and the 35 million aren't poor. What that 35 million is breaks down to: (a) people who make plenty of money to buy insurance, but don't want to spend the large amounts of money on insurance, (b) illegal aliens, and (c) people who are eligible for insurance programs but inexplicably have not signed up (the wacko and idiot percentage).

It is a complete myth that "the poor" in the US were left without care. Even before the vaunted Obamacare, it was not true.

[Tero]

We don't give a fuck about healthcare. It's about spending and campaign promises!
http://www.desmoinesregister.com/story/ ... 685674001/

[Forty Two]

We don't give a fuck about healthcare. It's about spending and campaign promises!
http://www.desmoinesregister.com/story/ ... 685674001/

Anyone who supports Obamacare does not give a fuck about healthcare.

[Tero]

Plenty of people 55-65 now get a benefit:
The study finds that on average nationwide, a 60-year-old making $25,000 per year would have to pay as much as $16,174 more per year for health insurance. That is a result of the possible elimination of two kinds of ObamaCare subsidies, which help people afford their premiums and out of pocket costs

States would affect that a small amount but nothing like ACA

http://thehill.com/policy/healthcare/35 ... are-repeal

[Tero]

WASHINGTON — Senator John McCain of Arizona announced on Friday that he would oppose the latest proposal to repeal the Affordable Care Act, leaving Republican leaders with little hope of succeeding in their last-ditch attempt to dismantle the health law and fulfill their longstanding promise to conservative voters.
For Mr. McCain, it was a slightly less dramatic reprisal of his middle-of-the-night thumbs-down that killed the last repeal effort in July. This time, the senator, battling brain cancer and confronting his best friend in the Senate, Lindsey Graham of South Carolina, issued a statement saying that he could not “in good conscience” support the proposal by Senators Graham and Bill Cassidy of Louisiana.
“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” Mr. McCain said. “Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”

[Tero]

Taking out the subsidies of ACA, which some people do not get, new GOP bill will raise premiums:
http://www.actuary.org/files/publicatio ... 092217.pdf

Unless the funds allocated in the proposal are used to create stable markets by maintaining a level playing field for insurers and achieving a balanced risk pool, GCHJ would likely lead to higher individual market premiums, lower enrollment, eroded protections for those with preexisting conditions, lower insurer participation, and more unstable markets than under current law.

[Tero]

Kimmel factor
http://thehill.com/policy/healthcare/35 ... l-stumbles

[Tero]

Even Cruz is against the bill now
http://www.politico.com/story/2017/09/2 ... eal-243067

[Tero]

Trump MAGAts useless:

Nearly a year later, the consensus among Republican lawmakers, aides and strategists is that the job of dismantling ObamaCare turned out to be a lot tougher than they ever expected.

“I think they confused sloganeering with planning and they fell more in love with the slogan than actual governing,” said John Weaver, a Republican strategist.

“We never repealed an entitlement program in this country. Why they thought this would be something simple, easy or even appropriate is beyond me,” he added.
(The Hill)

[Tero]

Give more free goodies to 3 states to buy votes of senators?

The revised bill includes provisions that would steer more federal funding to Alaska, Arizona and Kentucky. All three are home states of senators representing pivotal GOP swing votes who either have opposed or expressed concerns with the bill — John McCain, Rand Paul and Lisa Murkowski. However, Democrats said Senate Republicans are using misleading numbers to obscure massive funding cuts still in the Graham-Cassidy plan.