Magox

It's a political document, nothing more. Basically it is to accentuate their priorities, I would expect the real budget to take not such a blunt approach to it.

I don't believe any rational thinking person would come away with some take that you just did. Before the ACA became law, many insurers were already beginning to cover preventative visits such as mammograms, annual physicals etc. I would expect that most insurers to continue doing so. Here is the beauty, if a particular insurer doesn't offer that service, then some other carrier will and you would have the choice to go with that carrier, specially if they allow carriers to compete across state lines. I think that will be addressed.

They are going back to the drawing board and will go further towards expansion of coverage once it gets to the Senate. Having said that, the "essential health benefits' is one of the most paternalistic overreaches I have ever seen from the US government. How in the hell are you going to mandate that a 62 year old have maternity coverage or a children's dental pediatric plan along with their coverage? It's preposterous.

I don't know why I waste my time with you. But here you go. Example 1 Many of the fracking regulations have been found to already exist at the state level. Example 2 Example 3 There are tons of regulations that are in place at the state level that are not required by the Federal government to come down with additional top down measures that place additional costs and burdens on business that do next to nothing to what is already in place.

The horse trading has begun. Some of the proposals to where they could bridge the gap are here, that's encouraging.

I'm ok with it. Not because I want don't want clean air and water, just that many of the regulations are redundant and often times already have related laws and regulations set at the state level.

I will say this, much like Christianity had to go through major reforms to change their brutal ways from many centuries ago, it is the religion of Islam that needs to take a good look at itself and purge the extremist factions they face today. There needs to be a level of introspection within that religion. I don't believe drawing a moral equivalence between the two paints an accurate depiction of the challenges that the religion of Islam is facing today.

Let's make America white again!!!! White Power!!!

Let's just assume that their baseline numbers are correct and that 24 million people would be losing coverage, which I think is off. I think they overestimate the impact of the mandate, in our MGA's experience if I had to calculate our customers motives for purchasing healthcare through the ACA, most are purchasing it because it is so cheap with the subsidy they receive that it is a virtual no brainer for them. People are getting gold plated low deductible policies in some cases for $0 premiums. Crazy. I would venture to guess that at most a 1/3 that are on the exchange are motivated by the mandate, probably closer to 20%. Which puts that number around 3-4 million. Out of that 24 million the majority of those come off from medicaid. The average medicaid enrollee's health plan costs the government $6000 in premiums. The average advanced tax credit under the ACHA (Ryan's/Price's) plan for those making a little over the medicaid threshold is approximately $3000. So the drop off is profound. That is where the majority of the loss of coverage that is being calculated by the CBO is coming from. That and the over 50's with incomes below $40,000. They also are going to receive a huge premium increase under the ACHA than what they were receiving under the ACA. If they could increase that advanced tax credit number along with designing high deductible plans that are rich with doctor, rx, specialist, diagnostic testing and ER copays, I think they could create plans with premiums on average of only $4000 annually which would come close to enrolling all these people who lost their Medicaid coverage. The design of the plans is going to play a huge role in my opinion in expanding those coverage numbers. Of course that isn't something that the government will decide, that is something that the carriers would have to determine.

This should be the approach.

I was actually going to post virtually this same argument, that even though Democrats took substantial political losses and that the bill they crafted was extremely flawed that at the end of the day, they had won the argument. Which is that in the conscience of the American public, in order for healthcare to be considered a success, overall coverage has got to be at the forefront of any healthcare system. I see it not just with Democrats or independents but many Republicans as well. That's not necessarily true. Every person who doesn't get coverage because of removing the mandate aren't created equally. If you are priced out of coverage because of the bill, then you'd be right, but make no mistake there are plenty of people who can afford it who would rather not obtain insurance.

As soon as the mandate is lifted and/or the word is out that they aren't penalizing those without health insurance, there is a strong argument to be had that Trump owns it. Which this has already begun. LA, I know there are some factions that are suggesting that is the way forward, wherever you heard it from, I've heard the same thing. All I can tell you that there is one common denominator between all those uniformed voices suggesting such a proposal, and that is that they are paid agitators and make a living off of constant opposition and unsound realism.

I have hopes that something better will be passed, but I have my doubts that it will actually come about. We have a dysfunctional political society that is filled with political agitators from both sides of the aisle. It's sort of like Hamas. Hamas exists because there is conflict with Israel. Without the conflict, there is no cause and without a cause there is no existence for them. So it is in their benefit to always stir up opposition and hysteria. Same things with talk radio, the media hucksters, mainstream media etc. Without conflict, there is no cause. It benefits CNN to always be opposed to Conservative orthodoxy, it is in the interests of Hannity to always be in opposition to Democrats or Levin, Ingraham, Breitbart and Rush to rail on the so-called establishment at every turn. The environment is toxic. Those that have a real interest in getting things done are in the wrong business. Politics is for actors and provocative demagogues. Exactly!

I saw that and referenced to what "populists" wanted in an earlier post. There is no way that he'd be able to get even 50% of Republicans to get on board with this, the Freedom Caucus would go ape ****, Republican leadership would not usher this in, he'd have to get rid of Tom Price and would need at least 50% of Democrats to go along with it. It's a pipe dream. However, the idea of going in the direction of expanding coverage is not and can be done with the proper concessions. It's not reasonable, because it is not realistic.

I hope so, their goodwill would go a long way with the possibilities of ending the ACA.

Two points that I'd like to make- In regards to waiting for Obamacare to collapse- if you are waiting for this to happen, it won't happen before 2018 midterms. This is their chance to do something about while they have control of the house, senate and presidency. Sure you could wait, but it's a big risk if you are indeed in the camp of wanting to do something about it. I remember, not even one month ago there were calls being made from the right as to why they hadn't moved on the repeal and replace bill. Now that Ryan/Price are moving on it, all of a sudden people are realizing how difficult it is and they want to wait a little while. You can wait, personally I would have liked to have seen tax reform along with infrastructure first and then obamacare. But I get the reasoning why they tackled this first, and to not get into the weeds too much, but health insurers were looking for some guidance because the rate setting process HAS ALREADY BEGUN for next year, the filings have begun, actuaries are looking at the rate proposals and they need to know the rules of the game. So if you want to repeal the ACA this year, you have to do this first. You can learn about that process here. Guys like Cruz, Paul and the freedom caucus are good at opposing but they aren't realists. They don't understand the prospect of actually governing. It's easy to rail on something, it's another to actually put proposals together that can actually get through reconciliation rules and then passed with enough votes to actually become law. My hopes is that I'm wrong about them and that they play a constructive role in wanting to put together a realistic compromise. That's what this is really about, its about people who are sincerely working in good faith to make a bad situation better. If they only propose and are willing to accept their version of what is right, then they aren't a constructive force.

This is suprising

I will say this, Steve King is most certainly someone who ascribes to nativism. That is about as friendly of a way that I can put it.

What a quandary, you have different factions of the GOP all fighting over what should be done. You have the hardliners pure market driven people who are pulling in one direction, then you have the moderate/centrists who want slightly more expanded coverage, then you have the populists, who essentially want entitlements and near universal coverage and then you have GOP leadership Ryan/Price who are stuck in the middle. It's funny watching Laura Ingraham attempt to protect Trump by saying that Ryan is building a "trap" for Trump.

http://www.politico.com/story/2017/03/obamacare-repeal-republicans-trump-congress-236045 All decent proposals. Unlike the ACA, whenever there were concerns with the bill when it was being crafted, they just jammed it in despite the negative analysis. It appears that GOP leadership is looking to improve parts of it based on the negative feedback. That's the way it should be. In the senate, increasing coverage seems to be the predominant priority. The goal should be have expanded coverage, naturally it won't be as much as the ACA because of the mandate but if they can get within 5-8 million people that would be good IF they can bring down premiums substantially lower than under the ACA, while providing more choices and doctors that accept the plans, with some Deficit savings, that in my view would be what success looks like.

Trump is more of a moderate when it comes to healthcare than the hardliners and even more so than GOP leadership. He ran on the promise that he would prioritize overall coverage and lower premiums. I mean the guy advocated for Universal healthcare on more than a few occasions. His core supporters like that, his core supporters are not Cruz sort of supporters. He's not a fiscal hardliner. I do believe he will intervene, and start focusing on getting overall coverage up. Not now, he has to appease the Freedom caucus and get their support. Once he has them locked up with a concession or two, you'll begin to see him moving more in that direction once it goes to the Senate. There are many more moderate/centrists in the Senate that he has to worry about than the fiscal hardliners, even though they will pose a challenge. Rand Paul and Mike Lee I believe will be the most difficult. Cruz I believe will cave because he has a re election coming up and ever since Trump has been elected he has been kinda sucking up to him. He doesn't want to turn away Trump supporters, he still has national ambitions and he was profoundly hurt with his clashes with Trump. My guess is that there will be another concession or two to lock up his support. And if not, then he'll continue to go in the other direction to try to get Manchin's support and that would do it.

It's not so black and white as many people paint it to be. Is the ACA in a "death spiral"? Well, yes and no, kinda. It's not as if health insurance is one giant risk pool, there are many many localized individual risk pools throughout the country. Typically urban areas with high populations tend to have a higher proportionate amount of young people insured with the carriers offered in that area, meaning you have healthier risk pools which in turn means lower premiums. Whereas many rural areas tend to skew towards older populations which means unhealthier risk pools and higher premiums. That has always been the case. What is different now under the ACA than pre ACA is with the additional mandates of more coverage via the minimum essential benefits and the perverse incentives that favor older people through their community based rating that disincentivizes younger healthier enrollees, you are seeing a death spiral for people who don't qualify for subsidies. Rates literally went up over 40% in this area this past year. Look at those plans, for $1000 a month, you get a $7000 deductible that doesn't even have a single copay. Now tell me, if the underlying rates are going up 20,30,40,50% a year in these areas and you aren't qualifying for a subsidy, can someone with a $50,000-$80,000 a year income truly afford a $1000 month policies that barely pays for anything? That is a death spiral, because guess what? That individual market which only has one carrier in it, will continue to raise rates because the only ones who will purchase those policies are people who qualify for large subsidies or people who are very dependent on healthcare, meaning sicker individuals. Did you know that 1/3 of all the counties in the US only have one carrier offering policies through the ACA exchange? Why do you think that is? It didn't start off that way. There were more, there were lots of CO ops that were created and they went bankrupt. Why do you think that is, Tiberius? Did they decide that they now hated money and they didn't want to make any more of it? They went bankrupt or made the financial decision to pull out because they were losing money. They couldn't raise the rates high enough to cover their losses. Which is why under the ACA it is virtually a localized monopoly throughout the country of a few various carriers. When Trump says we could allow the ACA to fail on its own, well........ That wouldn't quite happen either. Yes, you would most likely see certain regions within certain states where there would be no carriers. That is the direction we are heading, so in that region, yeah that would happen. But in most areas, you would still see functioning markets. Waiting for the majority of the ACA to implode wouldn't happen in Urban markets. Waiting for it to implode is largely a talking point.

There is a philosophical debate to be had, whether it is a right to have health insurance or a privilege? Admittedly, my views has slightly moderated over the years, I suppose that is because I've seen the good that expanded coverage has done in an up close personal manner and rather than debating philosophies there are many real life instances that it has helped. That in no way shape or form implies that I'm for the ACA or the structure of it or the inequities it has caused for many middle class families who have been priced out of the market, but that doesn't negate the benefits of expanded coverage. I'm not in the "it is a right" to have health insurance but I'm also not on completely market based philosophy either. Too many people who don't earn enough cannot afford health insurance and I do believe that our government can help bridge the divide in that aspect. In regards to the car insurance being analogous to health insurance is absurd. Car insurance is there primarily for reasons pertaining to liability. If you have a car and it is being financed, you have an obligation to have it insured to protect the guarantor of your loan. Also, you have an obligation to those that you could do bodily harm to behind the vehicle that you are driving. These are protections not for you but for them. Whereas health insurance is for you, not for the well-being of others. In regards to coercing people to buy a product from a private company, that just seems crazy to me. If I don't want to buy a product, I shouldn't have to. Period

Enough will fall in line as long as they get a concession or two to point to their base flank. The article that I posted up above mentions Sanford's sentiments:

This is an area where the Moderate/centrists will have to compromise with the Freedom Caucus. which is something that I thought we'd see - Post #3655 But if they are to do this, then there will have to be additional tax credits for those that would lose their coverage to get Moderate/Centrist support. It's a two way street. Not everyone will be able to get what they want, there will have to be some give and take or we'll end up keeping what we currently have.