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ACA Running Thread

It's a giant business sector being propped up by government subsidy, of course everyone involved is trying to squeeze out the maximum amount of profits. It's not a matter of bad people, it's just capitalism - the commercialization of human survival.

Can someone get this cat a hat with a point that shines.
 
1. Thanks for the socialism, California. See how that worked out.
2. Why did she take her sick family to a bunch of public places?

To get the medicine she desperately needed.
 
some doc probably rolled their eyes and proscribed antibiotics for a viral infection because she insisted on it
 
I mean most likely it was Strep? Which brings up all kind of questions, her kid shouldn’t go to school that day or the next day. There is like a laundry list of antibiotics that could treat strep. I can’t think of an off brand antibiotic that will cost anything close to what she paid.
 
Medicare For All gaining steam. Would relegate private insurance to Med-sup policies. Article is silent on the provider response
https://www.yahoo.com/finance/news/medicare-could-eliminate-600-billion-120006771.html

Medicare For All is a simpler, more elegant solution than Obamacare, which compromised heavily to keep private insurance existing and providers happy. The problem Medicare For All solves is provider price gouging by setting prices at the government level by administering health care. Of course, the government is then in the health care business. Another way to end provider gouging is a medical usury law that is pegged to Medicare rates. This solves the cost problem, and keeps government out of health care.
 
 
Im working in Canada this week and I haven't seen any sick people laying aboot :cool: or any lines of sick people needing operations outside of the hospitals and clinics. Everyone seems happy and healthy and business is good here. :noidea:
 
How’d you get into Canada?


latest
 
Im working in Canada this week and I haven't seen any sick people laying aboot :cool: or any lines of sick people needing operations outside of the hospitals and clinics. Everyone seems happy and healthy and business is good here. :noidea:

Hopefully you’re up there getting baked with the natives.
 
I had to fill out all the Obamacare forms manually this year for our company. The directions were..........not easy to understand. You can see why businesses revolted.
 
Nice piece in the NEJM about building on the ACA to get to true universal coverage. Likely behind a paywall for most of you, so I'll paste the full text.

https://www.nejm.org/doi/full/10.1056/NEJMp1901532

For decades leading up to enactment of the Affordable Care Act (ACA), the United States failed to reduce the percentage of Americans who lacked health insurance coverage. Since the ACA’s passage, the percentage of U.S. residents without coverage has fallen by almost half, from 16% to approximately 9%. Yet more needs to be done if we are to achieve universal coverage.


Uninsured Nonelderly People in the United States by Program Eligibility Status, 2017.
The bar graph, which draws on estimates by researchers at the Urban Institute, shows which groups remained uninsured in 2017.1 In our view, these estimates make clear that achieving universal coverage within the framework created by the ACA requires four basic steps: implementing the ACA’s Medicaid expansion in all states, increasing and expanding financial assistance to people who purchase coverage through the health insurance marketplace to make coverage more attractive, ensuring that people actually enroll in the affordable coverage for which they are eligible, and addressing coverage for undocumented immigrants.

Policymakers can tackle each of these steps and thereby finish the job of ensuring universal coverage by building on the ACA. The framework presented here has many elements in common with proposals put forward by others, including teams at the Urban Institute and the Center for American Progress.2,3 The similarities among these proposals reflect the fact that each seeks to fill the same gaps in the U.S. health insurance system.

For people who are concerned about the fiscal cost, political feasibility, or disruption associated with a single-payer approach to providing universal coverage, this framework may be viewed as an alternative. Or it can be seen as a stepping stone to such a system. Although we see these four steps as an integrated whole, policymakers could expand coverage by enacting only some of these proposals, and states could implement some without federal action.

The first step — ensuring that all states expand Medicaid coverage to people with incomes below 138% of the federal poverty level, the standard set in the ACA — can be achieved with a combination of carrots and sticks.4 The stick is a reduction in the base federal matching rate for Medicaid spending in states that continue to refuse to implement the Medicaid expansion. The carrot is an increase in the matching rate for states that expand Medicaid coverage. These changes need not be particularly large to be effective; for example, increasing expansion states’ base federal matching rate by about 2 percentage points (or reducing nonexpansion states’ base federal matching rate by the same amount) would make expansion effectively free for a typical state. The small size of these adjustments would insulate this approach from being judged unconstitutionally coercive. The Supreme Court struck down the approach taken in the ACA, which conditioned the entirety of each state’s Medicaid funding on its willingness to expand coverage. Here, the vast majority of Medicaid funding would be unaffected. The small size of the adjustments would also limit unintended consequences for Medicaid beneficiaries if, contrary to our expectations, some states continued to resist expansion. States would also need to be barred from implementing Medicaid-eligibility restrictions such as work requirements, substantial premiums, and limits on retroactive coverage of services delivered before formal Medicaid enrollment.

The second step involves increasing and expanding eligibility for the subsidies available through the ACA’s health insurance marketplaces to encourage more people to take up coverage. This step includes increased tax credits to offset insurance premiums, higher cost-sharing subsidies to offset out-of-pocket costs, and extension of subsidies to people with incomes exceeding 400% of the federal poverty level, the current income limit on eligibility for marketplace assistance. Extensions along these lines are essential for achieving universal coverage, given that people who were eligible for subsidies but did not buy coverage accounted for fully one quarter of the nonelderly uninsured population in 2017, and some people with incomes above the current income-eligibility threshold also face burdensome premiums.

Marketplace subsidies would also need to be extended to workers who are currently ineligible because they are offered coverage at work that is considered “affordable” under the ACA’s standards but still imposes onerous premiums. This group accounted for roughly one tenth of the uninsured population in 2017. In addition to increasing coverage, this change would reduce premium and out-of-pocket costs for many currently insured low- and moderate-income workers who face burdensome costs.

Even after these two steps are undertaken, some people would remain uninsured. Some would be eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but would not enroll in these programs. Though technically uninsured, they are financially protected against the costs of a serious illness because such coverage is generally retroactive. Even so, policymakers can streamline enrollment procedures to encourage more people to enroll before the onset of illness.

For higher-income people, however, a different approach is needed. Thus, the third step covers anyone who is not eligible for Medicaid or CHIP and who does not have other coverage. They would be automatically enrolled in a “backstop” insurance plan, which could be either public or private. Health care providers would submit claims to the backstop plan whenever people in this group used health care services. On each year’s income tax return, people who lacked coverage other than the backstop plan for at least 1 month during the year would pay a premium for the backstop plan for each month they lacked other coverage, whether or not they actually used the backstop coverage. The premium would be reduced by the amount of any tax credit for which they were eligible. The expansion of marketplace subsidies described above would help make automatic enrollment in the backstop plan palatable by reducing these net premiums.

In combination, these steps would expand coverage to all legal U.S. residents. However, they would not reach the one sixth of the population who were undocumented immigrants and therefore ineligible for both Medicaid and marketplace subsidies. The final step to universal coverage would be to ensure this group access to insurance programs. This goal can be achieved by creating a path to citizenship or in other ways. Expanding insurance coverage is far from the only rationale for reforming immigration policy, but without some such reform, genuinely universal coverage is impossible.

How much this approach would cost the federal government depends on parameters we have not fully specified — notably, the size of the marketplace-subsidy expansions. However, we anticipate that legislation in line with this framework would have federal costs broadly similar to those of the ACA’s coverage expansions, as such legislation would drive the uninsured rate from about half its pre-ACA level to zero. These costs could be covered by measures similar to those that paid for the ACA, which included reforms to Medicare payments and revenue increases.

Policies aimed at reducing the unit prices of health care services, such as introducing a public plan that would pay the lower prices currently paid by public programs and that would compete with private plans, could also help to finance this agenda. Policies that successfully reduced health care prices would reduce the cost of providing marketplace subsidies and, if applied to the employer-sponsored insurance market, would also reduce the revenue lost to the tax exclusion for employer-sponsored coverage.

In addition to expanding coverage, the proposals discussed above — notably those to expand marketplace subsidies and reduce the unit prices of health care services — would reduce premiums and out-of-pocket costs for many people who already have coverage. These reforms could be combined with other reforms to improve coverage for people who are already insured. The additional reforms could include implementation of rules to eliminate surprise out-of-network bills, lowered caps on annual out-of-pocket spending, and expansion of the list of services that insurers must cover without cost sharing to cost-effective services that pose little risk of overuse, such as generic drugs that treat chronic conditions.5

Nearly 9 years after the ACA became law, proposals to expand insurance coverage are again a major topic of public debate. The approach described here provides a blueprint for achieving the widely shared goal of universal coverage at a manageable fiscal cost and with minimal disruption for the hundreds of millions of Americans who are already insured.

nejmp1901532_f1.jpeg
 
In our view, these estimates make clear that achieving universal coverage within the framework created by the ACA requires four basic steps: implementing the ACA’s Medicaid expansion in all states, increasing and expanding financial assistance to people who purchase coverage through the health insurance marketplace to make coverage more attractive, ensuring that people actually enroll in the affordable coverage for which they are eligible, and addressing coverage for undocumented immigrants.

Yep.

Just skimming the rest, it seems pretty sensible.

And a most "Republican" way to get to universal coverage. Unfortunately, these further reforms seem to have no chance of being implemented with Trump in the WH or Republicans in charge of either branch of congress.
 
Instead, Trump and his administration, unsuccessful at legislative undoing of the ACA (representing the best effort to date to positively reform health care) when controlling congress, are upping the effort to do so judicially.

With. No. Replacement.

And with NO hope to offer an actually better replacement.

If the ACA gets utterly overturned by the courts (I hope this is not really very likely) it will cause incredible chaos, disruption, pain and misery to individuals, both that receive and deliver, and institutions that deliver health care. And Pubs will try to blame Obama, Dems, the ACA. But the truth is it will be entirely on the Pubs, who chose what they hoped would be a politically advantageous position of intransigent and irrational (other than from some cynical and selfish political angle) opposition. Because they decided to say, "fuck you" to Americans or the idea of doing anything good in order to dishonestly portray Obama and the ACA (a freaking Republican plan) as some reckless/harmful/dangerous scheme.

Republicans, IMO, deserve to suffer a loss of power for a long time for the way they refused to work at all with Obama to do almost anything necessary or good. Unfortunately, their choice to do so actually seemed to pay off. But I hope they are increasingly exposed and put out of power for a long, long time.

How in the word can we get our government to better function? For folks on "both" sides to be willing to work together on common problems in an effective manner? Jesus.

Republicans have led the way to the insanely dysfunctional governing we now suffer with.
 
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The NEJM note above is a reasonable approach but lacks cost controls which is ultimately what we need to help create a stable market.

I'd add that we index provider comp for ACA plans to some % of Medicare to make coverage more affordable and also require providers to be in value based contracts with some risk component for these populations. In the same vein, I'd require selection of a Primary Care doc and also publish cost/quality metrics for primary care and create tiered primary care to drive people to the best, most effective primary care in the market.

Next week we will tackle big pharma!
 
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