ConnorEl
Well-known member
if the penalty for not being enrolled is close enough to the cost of the least expensive plan and if you are getting subsidies to pay for that plan I think you would enroll, or stay enrolled.
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What happens to the people who get fired or can't afford the premiums? Remember, the GOP doesn't want to have subsidies. Also remember in the House bill (and likely in the Senate bill) many basic services for plans are not included. Hell, even covering visits to the ER (which is a top reason for young people to have insurance) isn't even covered.
The plan the House put forth is like buying a chassis for a car with the doors, windows, hood, seats and more as options. Of course their "coverage" is cheaper, but it doesn't cover anything.
ConnorEl
Well-known member
See my last 3 posts, two on last page.
I said congress could make the exchanges better, more viable, if they wanted to. Of course for reasons mostly smacking of hyper-partisanship they do not want to do this.
I said congress could make the exchanges better, more viable, if they wanted to. Of course for reasons mostly smacking of hyper-partisanship they do not want to do this.
A good start. I do think we need pay docs differently for this thing to work.
No one is objecting to special enrollment periods which includes loss of coverage, ie you get fired. And the house bill does include subsidies, albeit for some they will go down vs. today (and some will go up), but they certainly exist. And the bill does allow require EHBs but it allows states apply for a waiver to redefine essential health benefits in 2020.
A lot to not like about it but not sure your post is terribly accurate.
What's not accurate? If your objection is to one word, give me a break.
Here’s a rundown of what they are:
http://www.nbcnews.com/health/health-care/gop-health-care-debate-what-are-essential-benefits-n737646
Outpatient care — This covers most scheduled doctor visits, such as to check a rash, or a non-emergency stomach ache. Insurance companies negotiate deals for these and often designate "networks" of doctors and clinics with approved charges. Individuals who walk in without coverage pay much, much more.
Emergency room trips — Insurance policies cover both the ER visit and ambulance trips. Otherwise people can get socked with bills totaling tens of thousands of dollars, perhaps incurred while they were unconscious.
In-hospital care — All care people get as hospital patients, such as surgery. Some conservatives argue that people should be able to choose to opt out of this type of coverage and pay lower premiums. Most health policy experts say this is a gamble. “One answer is because someday you may be sick and that’s the way that insurance works,” says David Cutler, a Harvard University economics professor who helped design the Affordable Care Act.
Pregnancy, maternity and newborn care — This one’s controversial to some, who ask why men should pay for a service they’ll never use. “It is true that women get pregnant but men kind of help them get pregnant,” Cutler said. Pre-ACA, 62 percent of people with non-group policies had no maternity benefit.
Mental health and substance abuse disorder services — This particular benefit has gotten some attention with the ongoing opioid epidemic. Before the ACA, 18 percent of non-group policies left off mental health benefits.
Prescription drugs — Insurance companies usually negotiate discounts. Out of pocket costs for many drugs can be much higher than what an insurer pays for them.
Rehabilitative services and habilitative services. These include help recovering from an injury or illness, but also treatment for kids with autism or cerebral palsy.
Lab tests
Preventive services — This includes vaccines, cancer screenings such as mammograms and colonoscopies and, controversially, coverage of birth control.
Pediatric services — Including dental and vision care for childre
Here’s a rundown of what they are:
http://www.nbcnews.com/health/health-care/gop-health-care-debate-what-are-essential-benefits-n737646
Outpatient care — This covers most scheduled doctor visits, such as to check a rash, or a non-emergency stomach ache. Insurance companies negotiate deals for these and often designate "networks" of doctors and clinics with approved charges. Individuals who walk in without coverage pay much, much more.
Emergency room trips — Insurance policies cover both the ER visit and ambulance trips. Otherwise people can get socked with bills totaling tens of thousands of dollars, perhaps incurred while they were unconscious.
In-hospital care — All care people get as hospital patients, such as surgery. Some conservatives argue that people should be able to choose to opt out of this type of coverage and pay lower premiums. Most health policy experts say this is a gamble. “One answer is because someday you may be sick and that’s the way that insurance works,” says David Cutler, a Harvard University economics professor who helped design the Affordable Care Act.
Pregnancy, maternity and newborn care — This one’s controversial to some, who ask why men should pay for a service they’ll never use. “It is true that women get pregnant but men kind of help them get pregnant,” Cutler said. Pre-ACA, 62 percent of people with non-group policies had no maternity benefit.
Mental health and substance abuse disorder services — This particular benefit has gotten some attention with the ongoing opioid epidemic. Before the ACA, 18 percent of non-group policies left off mental health benefits.
Prescription drugs — Insurance companies usually negotiate discounts. Out of pocket costs for many drugs can be much higher than what an insurer pays for them.
Rehabilitative services and habilitative services. These include help recovering from an injury or illness, but also treatment for kids with autism or cerebral palsy.
Lab tests
Preventive services — This includes vaccines, cancer screenings such as mammograms and colonoscopies and, controversially, coverage of birth control.
Pediatric services — Including dental and vision care for childre
ConnorEl
Well-known member
Plenty of movement in that direction built into the ACA. See my post top of last page--link to nejm article.
Yes, payment for services (not just to docs) needs to change from where we've been.
rj, that link is almost three months old and references "one proposal".
ONW
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At least it references an actual proposal.
Much, if not all of that, is in the bill. As shown here, on May 4 after the bill was passed:
https://thinkprogress.org/house-rep...e-health-insurance-from-millions-7eabb99d5251
"Since then, the legislation has been tweaked to allow states to opt out of Obamacare’s essential health benefits mandate, which requires health plans to cover some pretty basic services: things like hospitalizations, emergency room visits, prescriptions, and maternity care."
Exactly how valuable is insurance that doesn't cover the part in red? This is what I posted. No matter what CH wants to say, the new policies are dramatically less coverage than under ACA. Those will still have coverage will be at much greater health and financial risks.
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States have to apply for a waiver to change the EHBs. The law actually includes them. Saying the law doesn't is just not correct, as is saying the law doesn't include subsidies. My sense is most states wont opt out of the EHBs. A small handful may and we will need to see how the opt out rules work and what ones they wont offer. Most Americans will continue to have access to them (remember EHBs don't apply to most of the group market yet they are included there). I have no issues with EHBs. Just separating hyperbole from fact. There is simply too much hyperbole on both sides of this issue.
Or at least this is what I read in the Onion.
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I think for govt funded business we need to mandate different reimbursement models. Pay Medicare b y 10%, or whatever.
MACRA (which had bi-partisan support) is a good move in that direction, at least for Medicare.
ConnorEl
Well-known member
As I've said elsewhere on this thread, providers of care (individual and institutional) need to be incentivized to provide better quality care more efficiently (or...value). Not merely to do more stuff.
Health insurance can be made less expensive by lessening its benefits or by broadening the pool of participants to include more lower utilizers. Since I favor a healthcare system that we all (as reasonably able) pay into and that is there throughout our lives to reasonably facilitate the meeting of our needs as they arise (primary and preventive, acute, and long-term), I favor by far the latter approach rather than the former. Pubs seem to favor the former.
Health insurance can be made less expensive by lessening its benefits or by broadening the pool of participants to include more lower utilizers. Since I favor a healthcare system that we all (as reasonably able) pay into and that is there throughout our lives to reasonably facilitate the meeting of our needs as they arise (primary and preventive, acute, and long-term), I favor by far the latter approach rather than the former. Pubs seem to favor the former.
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Well said. Getting more into the pool will help as will changing how we pay docs. The group pool is large and well rounded risk wise yet still has significant trends. Paying for performance is a move we need to accelerate.
bcobbdeacs
Well-known member
Define performance
This is especially true if the states where you provide service are able to opt out of covering the most expensive parts of risk.
dartsndeacs
THE quintessential dwarf
I was taking half the American population and dividing by total profits for overall profitability in the industry. I think you stated above that the ACA previously was losing money.
Gooner
Pit League Fantasy Football Commissioner
Transparency is critical in passing health care legislation. Just ask these Republicans.
1. Senate Majority Leader Mitch McConnell, then the minority leader, in a press gaggle, Dec. 18, 2009: “This massive piece of legislation that seeks to restructure one sixth of our economy is being written behind closed doors without input from anyone in an effort to jam it past not just the Senate but the American people before Christmas.”
2. VP Mike Pence to the Washington Times, Oct. 19, 2009: "They've gone from regular order to smoke-filled rooms so there's no real way of knowing when (the final bills) are going to emerge."
3. Sen. Mike Enzi (R-Wyo.) at a committee mark-up, June 17, 2009: "The fundamental flaws in this bill are the direct consequence of how the bill was put together. The bill was drafted exclusively by Democratic staff, who excluded Republicans from the process of preparing the actual legislation."
4. House Speaker Paul Ryan, then a House member from Wisconsin, to MSNBC, July 29, 2009: “I don’t think we should pass bills that we haven’t read and we don’t know what they cost. You rush this thing through before anyone knows what it is, that’s not good democracy, that’s not doing work for our constituents.”
5. Sen. Lindsey Graham in a floor speech, Dec. 19, 2009: “Here’s what they did to get that one vote: They had a deal cooked up that no one knew about but the two people talkin’. There was no input from anybody other than the majority leader and the senator from Nebraska. And after that meeting was over, they come up with a 380 page amendment to a 2000 page bill, they file it yesterday, we hear about it for the first time yesterday… And this is a transparent new way of doing business? You cook up a deal in a backroom that is essentially sleazy in my view to allow one state to be held harmless for Medicare enrollees to get that vote.”
6. Sen. Orrin Hatch (R-Utah) statement, Dec. 19, 2009: "After weeks of back-room dealing and clandestine negotiations behind closed doors of the Capitol, the Reid amendment is a classic grab bag of special deals to buy votes at the expense of American taxpayers."
7. Sen. Lamar Alexander, (R-Tenn.) to the New York Times, Dec. 21, 2009: “It’s obvious why the majority has cooked up this amendment in secret, has introduced it in the middle of a snowstorm, has scheduled the Senate to come in session at midnight, has scheduled a vote for 1 a.m., is insisting that it be passed before Christmas — because they don’t want the American people to know what’s in it.”
8. Sen. Jerry Moran (R-Kansas), then a House member, on Twitter, Jan. 12, 2010: "After all the backroom deals and secret meetings, only 36% of Americans approve of Pres Obama’s handling of health care."
9. Rep. Jeff Fortenberry (R-Neb.) on Twitter, Jan. 13, 2010: "House and Senate leadership now meeting behind closed doors. Health care reform must not be finalized in dark..."
10. Sen. Richard Burr (R-N.C.) on Twitter, Jan. 13, 2010: "Join our effort to stop closed door health care negotiations by signing the petition."
11. Health and Human Services Secretary Tom Price, then a House member from Georgia, on Twitter, Jan. 14, 2010: "With Democrats discussing health care in secret, they're sacrificing the trust of the American people."
1. Senate Majority Leader Mitch McConnell, then the minority leader, in a press gaggle, Dec. 18, 2009: “This massive piece of legislation that seeks to restructure one sixth of our economy is being written behind closed doors without input from anyone in an effort to jam it past not just the Senate but the American people before Christmas.”
2. VP Mike Pence to the Washington Times, Oct. 19, 2009: "They've gone from regular order to smoke-filled rooms so there's no real way of knowing when (the final bills) are going to emerge."
3. Sen. Mike Enzi (R-Wyo.) at a committee mark-up, June 17, 2009: "The fundamental flaws in this bill are the direct consequence of how the bill was put together. The bill was drafted exclusively by Democratic staff, who excluded Republicans from the process of preparing the actual legislation."
4. House Speaker Paul Ryan, then a House member from Wisconsin, to MSNBC, July 29, 2009: “I don’t think we should pass bills that we haven’t read and we don’t know what they cost. You rush this thing through before anyone knows what it is, that’s not good democracy, that’s not doing work for our constituents.”
5. Sen. Lindsey Graham in a floor speech, Dec. 19, 2009: “Here’s what they did to get that one vote: They had a deal cooked up that no one knew about but the two people talkin’. There was no input from anybody other than the majority leader and the senator from Nebraska. And after that meeting was over, they come up with a 380 page amendment to a 2000 page bill, they file it yesterday, we hear about it for the first time yesterday… And this is a transparent new way of doing business? You cook up a deal in a backroom that is essentially sleazy in my view to allow one state to be held harmless for Medicare enrollees to get that vote.”
6. Sen. Orrin Hatch (R-Utah) statement, Dec. 19, 2009: "After weeks of back-room dealing and clandestine negotiations behind closed doors of the Capitol, the Reid amendment is a classic grab bag of special deals to buy votes at the expense of American taxpayers."
7. Sen. Lamar Alexander, (R-Tenn.) to the New York Times, Dec. 21, 2009: “It’s obvious why the majority has cooked up this amendment in secret, has introduced it in the middle of a snowstorm, has scheduled the Senate to come in session at midnight, has scheduled a vote for 1 a.m., is insisting that it be passed before Christmas — because they don’t want the American people to know what’s in it.”
8. Sen. Jerry Moran (R-Kansas), then a House member, on Twitter, Jan. 12, 2010: "After all the backroom deals and secret meetings, only 36% of Americans approve of Pres Obama’s handling of health care."
9. Rep. Jeff Fortenberry (R-Neb.) on Twitter, Jan. 13, 2010: "House and Senate leadership now meeting behind closed doors. Health care reform must not be finalized in dark..."
10. Sen. Richard Burr (R-N.C.) on Twitter, Jan. 13, 2010: "Join our effort to stop closed door health care negotiations by signing the petition."
11. Health and Human Services Secretary Tom Price, then a House member from Georgia, on Twitter, Jan. 14, 2010: "With Democrats discussing health care in secret, they're sacrificing the trust of the American people."