Debate Now An Unhappy Birthday for Obamacare?

[Greenbeard]

There is lots of internet traffic out there about how Hawaii's exchange is going to close.

Anyone care to comment ?

I don't know if it is true or not.

"Close" means transition to the federal platform--and it could. I'd personally like to see most of the remaining state-based exchanges move over to the healthcare.gov platform.

Five years ago the debate was whether there should be a single national/federal exchange (the House's preference) or a number of state-based exchanges (the Senate's preference). The Senate won out and the ACA was built around state-based exchanges with a federal exchange created as a fallback.

The argument for a state-based approach was that different states could tailor the design of the exchange concept to their local political preferences, market conditions, etc. Deloitte laid out some of the possibilities for different states:

With dozens of state-based exchanges you not only leave autonomy over these markets in the hands of states, we get a great policy experiment in which we get to see which exchange models work best in which circumstances. Obviously that hasn't panned out to the scale originally envisioned but within the variation that did emerge some early results are available (State-Based Marketplaces Using ‘Clearinghouse’ Plan Management Models Are Associated With Lower Premiums).

In addition to the different models states could adopt and the choice to default to the federal exchanges, the ACA also created the option of regional marketplaces that spanned multiple states--an option that would make sense particularly for some of the smaller states (that don't have the scale to support the operations of their exchanges financially) but that wasn't seriously pursued.

Point being that only a fraction of the state-based variation and experimentation that was allowed under the ACA came to pass. To the extent we've learned much from the experiment, the lesson has been that we're just much better off doing this through the federal government than through the states (which, I'll admit, is the opposite of what I assumed five years ago).

More importantly, HHS has built enough flexibility into the implementation process (e.g., by 1) allowing states like New Mexico to use the shared technical infrastructure of healthcare.gov while still technically operating a state-based exchange, and 2) creating the concept of a "partnership exchange" that's technically a federal exchange but allows states control over certain aspects of the exchange, leaving room for the variation envisioned in the state-based exchange concept) that the lines have been blurred.

All of which is a long-winded way of saying that most of the rationale for independent state-based exchanges no longer exists. The states have proven not very good at it, many don't have the scale to support it, and the federal government's work leaves enough room for state variation and control that you don't need a separately built state exchange.

It was an interesting experiment but the last 5 years have proven that the House was right: the federal government can do this more effectively than the states. Lesson learned! I'd like to see virtually all of the remaining state-based exchanges move over to healthcare.gov.

 

[Sun Devil 92]

Where is that 31 billion coming from ?

If you mean why is creating all those new primary care providers deficit neutral, that would be Title IX of the ACA: Revenue Offset Provisions.

If I read the first page or two correctly, that would be through taxes. Somebody else is funding that 31 billion.

Did I read that correctly ?

BTW: I am not reading a 233 page document. Next time, why not just say what it says so I'll know what you are pointing at.

I'll bump this one forward and ask again....is this saying that 31 billion is coming from new taxes ?

 

[Greenbeard]

I'll bump this one forward and ask again....is this saying that 31 billion is coming from new taxes ?

Just to make sure I'm clear on the formula here: you're going to ask a barrage of questions, I'm going to respond to them very clearly, then you're going to ignore my responses and immediately jump on to something else. Is that what we're going to keep doing here?

Yes, "revenues" means taxes. That's where public spending comes from--even to create new primary care docs!

 

[dblack]

I'll bump this one forward and ask again....is this saying that 31 billion is coming from new taxes ?

Just to make sure I'm clear on the formula here: you're going to ask a barrage of questions, I'm going to respond to them very clearly, then you're going to ignore my responses and immediately jump on to something else. Is that what we're going to keep doing here?

Yes, "revenues" means taxes. That's where public spending comes from--even to create new primary care docs!

Heh... formula? Glass house much?

 

[Sun Devil 92]

I'll bump this one forward and ask again....is this saying that 31 billion is coming from new taxes ?

Just to make sure I'm clear on the formula here: you're going to ask a barrage of questions, I'm going to respond to them very clearly, then you're going to ignore my responses and immediately jump on to something else. Is that what we're going to keep doing here?

Yes, "revenues" means taxes. That's where public spending comes from--even to create new primary care docs!

While I understand your frustration, you should try to understand that some of us really DON'T know how this fits together.

I appreciate the information you have provided so far and I have tried not to ignore the facts you've provided.

This seems like a pretty simple question.

In the context of what you were presenting....seniors getting more benefits that they were not paying for....I was just curious to know who was.

Was it based on savings from some of the efficiencies you describe or what ?

BTW: If I have time, I need to go back and read a section of this thread where state exchanges were discussed. I must have had the wrong impression, because I thought you were in favor of them.

Then when I posted the information on Hawaii...you seemed to go in another direction.

 

[Greenbeard]

While I understand your frustration, you should try to understand that some of us really DON'T know how this fits together.

If that's really your goal, I think just browsing the table of contents for the ACA to get a sense of its structure would help you. It's broken up into 9 major (complementary) sections, each asking a different question:

Expanding/improving insurance coverage
I. How do we ensure competitive insurance markets and help people outside of employer-based coverage to afford a plan?
II. How do we start modernizing Medicaid, plugging in the gaps that have historically existed in it and using it to support 21st century models of care delivery?

Improving care delivery and health
III. How do we improve the actual delivery of care, fixing the deficiencies that have been driving up costs and impeding quality improvement? [If I haven't been clear, this is my personal favorite.]
IV. How do we encourage and promote health, in part by bringing the nation's public health infrastructure into this millennium?

Misc. to make the above goals work better
V. How do we bolster the health care workforce to make sure it's ready to meet the demands of I-IV?
VI. How do we modernize the fight against fraud and abuse, particularly in the public insurance programs, to make sure the money flowing through them is being better spent?
VII. How do we speed up the FDA approval process for an emerging class of medical therapies?
VIII. How do we address the financial challenge of providing long-term care services for an aging population? [This section was a somewhat ill-advised pet project of Ted Kennedy that was repealed a few years ago.]

Fiscal responsibility
IX. How do we pay for all this?

There's a lot that falls under each of those but that's the gist of what each piece is trying to achieve. And they intersect in a number of ways.

I appreciate the information you have provided so far and I have tried not to ignore the facts you've provided.

This seems like a pretty simple question.

In the context of what you were presenting....seniors getting more benefits that they were not paying for....I was just curious to know who was.

Was it based on savings from some of the efficiencies you describe or what ?

Thanks.

Every dollar of spending in the law (and then some) is paid for, either through raising new revenue or through offsetting it by reducing other spending. For Medicare in particular, the savings thus far have been huge. As I'm sure I've mentioned, Medicare spending on a per capita basis started going down. So I wouldn't worry too much about the new Medicare benefits under the ACA breaking the Medicare bank, it's in much better shape than it was before.

BTW: If I have time, I need to go back and read a section of this thread where state exchanges were discussed. I must have had the wrong impression, because I thought you were in favor of them.

Then when I posted the information on Hawaii...you seemed to go in another direction.

I favor the exchange concept: competitive insurance markets that bring transparency and market dynamics to the insurance sector. I was a fan of leaving the operation of exchanges in the hands of states for the reasons I outlined above: I thought variation and experimentation in their design would be a good thing, as would tailoring their features to local conditions. But disinterest from most states and incompetence from those states that did show interest in designing their own exchanges have convinced me that isn't the way to go.

I'd be perfectly happy to see them all migrate over to healthcare.gov--all the advantages of states having their own infrastructure can be preserved within the context of the federal infrastructure (i.e., variation and experimentation can still exist), and at lower cost and greater operational efficiency. It wasn't clear that would be the case five years ago, but it's pretty clear now. At this point, there's virtually no reason that a state like Hawaii should be trying to fix what it tried to build--they should join healthcare.gov and proceed from there.

The whole thing was a pretty illuminating experiment.

 

[rdean]

Better read this first:

Employers shrug off Obamacare robbing Republicans of a campaign issue US Message Board - Political Discussion Forum

 

[dblack]

spammer's delight

 

[Sun Devil 92]

Republicans can't handle the truth.

Since nobody really knows what the truth is....it is not surprising.

Of course, the left is just as ignorant.

 

[rdean]

Republicans can't handle the truth.

Since nobody really knows what the truth is....it is not surprising.

Of course, the left is just as ignorant.

The only "facts" you should follow are the ones based on numbers and data.

 

[Sun Devil 92]

Republicans can't handle the truth.

Since nobody really knows what the truth is....it is not surprising.

Of course, the left is just as ignorant.

The only "facts" you should follow are the ones based on numbers and data.

Numbers and data can be construed to mean just about anything you want.

There are people who get paid good money to torture data to say what they want.

The first "facts" you need are the expectations and pre-set report card that will be used to make future analysis.

With this in hand, you can evaluate data more intelligently and in context.

 

[Sun Devil 92]

I should point out that the lack of common metrics is the biggest issue to a reasonable discussion on Obamacare.

What I hear constantly is the right and the left arguing against the metrics they respectively chose to highlite.

Obamacare was supposed to save everyone 2500/year. How ? I don't ever recall how, exactly that was supposed to happen. The way it was presented, we would have 2500/year more to spend. Someone recently told me that the saving were in the "reduced increases" (that was a good one) I would see...meaning I had no way of knowing just what my increases were with or without since one would never be generated. So, as I explained, such a claim in that regard was total bullcrap.

We were told we could keep our doctors. Do we know how many people really lost their doctors...and why ?

So, the unhappy birthday in my estimation is simply the polling numbers which easily can and could be swayed by a good disinformation campaign.

 

[candycorn]

I should point out that the lack of common metrics is the biggest issue to a reasonable discussion on Obamacare.

What I hear constantly is the right and the left arguing against the metrics they respectively chose to highlite.

Obamacare was supposed to save everyone 2500/year. How ? I don't ever recall how, exactly that was supposed to happen. The way it was presented, we would have 2500/year more to spend. Someone recently told me that the saving were in the "reduced increases" (that was a good one) I would see...meaning I had no way of knowing just what my increases were with or without since one would never be generated. So, as I explained, such a claim in that regard was total bullcrap.

We were told we could keep our doctors. Do we know how many people really lost their doctors...and why ?

So, the unhappy birthday in my estimation is simply the polling numbers which easily can and could be swayed by a good disinformation campaign.

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it. Meaning that if your plan was a junk plan deemed only to pay for emergency room visits and a once a year check-up, you would have to be upgraded. And yes, those with the junk plans lost their insurance that they probably paid very little for. The insurance that meets the minimum standards of the ACA is slightly more expensive in most areas and still more expensive in some. That was the group who was most "affected" by the measure passing. In a lot of those cases--people who had junk policies--they didn't qualify for the subsidy either.

The largest group that was affected was that the uninsured are now insured or are paying a penalty. This will reduce the tax burden we pay for county hospitals over time because there will be a reduction in visits since these people are now insured. Overall, the cost for the user will be lowered as well since pill therapy can be utilized instead of much more costly emergency services.

As for losing doctors, this will likely be a short-term issue as the dust settles. You'll probably lose physicians who were not all that dedicated now that there will be a slightly different element of the population visiting the hospitals.

The overwhelming majority of the nation was in no way effected since most get their insurance through their employer and the plans offered far exceeded the ACA minimums.

Anyone who says otherwise is unaware of the facts.

 

[dblack]

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it.

He should have been prosecuted for it. The bill was passed on false pretense. Representatives are informed by the opinions of their constituencies, and their constituencies opinions were based on this and many other flat out lies about the nature of the proposed law. Democracy isn't valid when it's based on a deception.

 

[candycorn]

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it.

He should have been prosecuted for it. The bill was passed on false pretense. Representatives are informed by the opinions of their constituencies, and their constituencies opinions were based on this and many other flat out lies about the nature of the proposed law. Democracy isn't valid when it's based on a deception.

Just out of curiosity, how much jail time would you give BHO for that?

 

[dblack]

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it.

He should have been prosecuted for it. The bill was passed on false pretense. Representatives are informed by the opinions of their constituencies, and their constituencies opinions were based on this and many other flat out lies about the nature of the proposed law. Democracy isn't valid when it's based on a deception.

Just out of curiosity, how much jail time would you give BHO for that?

I dunno. Six months? What do you think? We need to quit tolerating this kind of behavior from our leaders. Honestly, don't you think it's kind of pathetic that we accept it so casually? How can democracy work if we don't know what proposed laws will do until after they're passed? If we can't count on our leaders to be honest about what they're writing into law?

The most important thing that needs to happen is that laws passed under false pretense need to be struck down by the Court on that basis alone. This is what I found so depressingly cynical about Roberts decision on the mandate. He basically acknowledged that Congress and the President had lied all along and that the mandate was, after all their denials, a tax.

The reason they lied about it is because tax increases are unpopular with many voters. The did it specifically to deceive voters who would oppose the law if they admitted it a was a tax. If any merchant sold a product or service based on such a false claim, they'd be compelled to return the purchase price, at the very least, if not prosecuted and punished for committing fraud.

 

[Sun Devil 92]

I should point out that the lack of common metrics is the biggest issue to a reasonable discussion on Obamacare.

What I hear constantly is the right and the left arguing against the metrics they respectively chose to highlite.

Obamacare was supposed to save everyone 2500/year. How ? I don't ever recall how, exactly that was supposed to happen. The way it was presented, we would have 2500/year more to spend. Someone recently told me that the saving were in the "reduced increases" (that was a good one) I would see...meaning I had no way of knowing just what my increases were with or without since one would never be generated. So, as I explained, such a claim in that regard was total bullcrap.

We were told we could keep our doctors. Do we know how many people really lost their doctors...and why ?

So, the unhappy birthday in my estimation is simply the polling numbers which easily can and could be swayed by a good disinformation campaign.

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it. Meaning that if your plan was a junk plan deemed only to pay for emergency room visits and a once a year check-up, you would have to be upgraded. And yes, those with the junk plans lost their insurance that they probably paid very little for. The insurance that meets the minimum standards of the ACA is slightly more expensive in most areas and still more expensive in some. That was the group who was most "affected" by the measure passing. In a lot of those cases--people who had junk policies--they didn't qualify for the subsidy either.

The largest group that was affected was that the uninsured are now insured or are paying a penalty. This will reduce the tax burden we pay for county hospitals over time because there will be a reduction in visits since these people are now insured. Overall, the cost for the user will be lowered as well since pill therapy can be utilized instead of much more costly emergency services.

As for losing doctors, this will likely be a short-term issue as the dust settles. You'll probably lose physicians who were not all that dedicated now that there will be a slightly different element of the population visiting the hospitals.

The overwhelming majority of the nation was in no way effected since most get their insurance through their employer and the plans offered far exceeded the ACA minimums.

Anyone who says otherwise is unaware of the facts.

I am not sure why all this is in here if you were responding to my post which was that we need a set of common metrics.

 

[candycorn]

I should point out that the lack of common metrics is the biggest issue to a reasonable discussion on Obamacare.

What I hear constantly is the right and the left arguing against the metrics they respectively chose to highlite.

Obamacare was supposed to save everyone 2500/year. How ? I don't ever recall how, exactly that was supposed to happen. The way it was presented, we would have 2500/year more to spend. Someone recently told me that the saving were in the "reduced increases" (that was a good one) I would see...meaning I had no way of knowing just what my increases were with or without since one would never be generated. So, as I explained, such a claim in that regard was total bullcrap.

We were told we could keep our doctors. Do we know how many people really lost their doctors...and why ?

So, the unhappy birthday in my estimation is simply the polling numbers which easily can and could be swayed by a good disinformation campaign.

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it. Meaning that if your plan was a junk plan deemed only to pay for emergency room visits and a once a year check-up, you would have to be upgraded. And yes, those with the junk plans lost their insurance that they probably paid very little for. The insurance that meets the minimum standards of the ACA is slightly more expensive in most areas and still more expensive in some. That was the group who was most "affected" by the measure passing. In a lot of those cases--people who had junk policies--they didn't qualify for the subsidy either.

The largest group that was affected was that the uninsured are now insured or are paying a penalty. This will reduce the tax burden we pay for county hospitals over time because there will be a reduction in visits since these people are now insured. Overall, the cost for the user will be lowered as well since pill therapy can be utilized instead of much more costly emergency services.

As for losing doctors, this will likely be a short-term issue as the dust settles. You'll probably lose physicians who were not all that dedicated now that there will be a slightly different element of the population visiting the hospitals.

The overwhelming majority of the nation was in no way effected since most get their insurance through their employer and the plans offered far exceeded the ACA minimums.

Anyone who says otherwise is unaware of the facts.

I am not sure why all this is in here if you were responding to my post which was that we need a set of common metrics.

Well, you stated that "we were told we could keep our doctor". That was incorrect. Physicians can change their mind on insurance every other day if they wish.

 

[Sun Devil 92]

I should point out that the lack of common metrics is the biggest issue to a reasonable discussion on Obamacare.

What I hear constantly is the right and the left arguing against the metrics they respectively chose to highlite.

Obamacare was supposed to save everyone 2500/year. How ? I don't ever recall how, exactly that was supposed to happen. The way it was presented, we would have 2500/year more to spend. Someone recently told me that the saving were in the "reduced increases" (that was a good one) I would see...meaning I had no way of knowing just what my increases were with or without since one would never be generated. So, as I explained, such a claim in that regard was total bullcrap.

We were told we could keep our doctors. Do we know how many people really lost their doctors...and why ?

So, the unhappy birthday in my estimation is simply the polling numbers which easily can and could be swayed by a good disinformation campaign.

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it. Meaning that if your plan was a junk plan deemed only to pay for emergency room visits and a once a year check-up, you would have to be upgraded. And yes, those with the junk plans lost their insurance that they probably paid very little for. The insurance that meets the minimum standards of the ACA is slightly more expensive in most areas and still more expensive in some. That was the group who was most "affected" by the measure passing. In a lot of those cases--people who had junk policies--they didn't qualify for the subsidy either.

The largest group that was affected was that the uninsured are now insured or are paying a penalty. This will reduce the tax burden we pay for county hospitals over time because there will be a reduction in visits since these people are now insured. Overall, the cost for the user will be lowered as well since pill therapy can be utilized instead of much more costly emergency services.

As for losing doctors, this will likely be a short-term issue as the dust settles. You'll probably lose physicians who were not all that dedicated now that there will be a slightly different element of the population visiting the hospitals.

The overwhelming majority of the nation was in no way effected since most get their insurance through their employer and the plans offered far exceeded the ACA minimums.

Anyone who says otherwise is unaware of the facts.

I am not sure why all this is in here if you were responding to my post which was that we need a set of common metrics.

Well, you stated that "we were told we could keep our doctor". That was incorrect. Physicians can change their mind on insurance every other day if they wish.

Right.

 

[candycorn]

I should point out that the lack of common metrics is the biggest issue to a reasonable discussion on Obamacare.

What I hear constantly is the right and the left arguing against the metrics they respectively chose to highlite.

Obamacare was supposed to save everyone 2500/year. How ? I don't ever recall how, exactly that was supposed to happen. The way it was presented, we would have 2500/year more to spend. Someone recently told me that the saving were in the "reduced increases" (that was a good one) I would see...meaning I had no way of knowing just what my increases were with or without since one would never be generated. So, as I explained, such a claim in that regard was total bullcrap.

We were told we could keep our doctors. Do we know how many people really lost their doctors...and why ?

So, the unhappy birthday in my estimation is simply the polling numbers which easily can and could be swayed by a good disinformation campaign.

The President actually said this:

If you like your healthcare plan, you can keep it.

Most of us who understood the bill knew that the asterisk was "if the plan met the minimum standards for the ACA. But since the President didn't verbalize the asterisk...he rightly got criticized for it. Meaning that if your plan was a junk plan deemed only to pay for emergency room visits and a once a year check-up, you would have to be upgraded. And yes, those with the junk plans lost their insurance that they probably paid very little for. The insurance that meets the minimum standards of the ACA is slightly more expensive in most areas and still more expensive in some. That was the group who was most "affected" by the measure passing. In a lot of those cases--people who had junk policies--they didn't qualify for the subsidy either.

The largest group that was affected was that the uninsured are now insured or are paying a penalty. This will reduce the tax burden we pay for county hospitals over time because there will be a reduction in visits since these people are now insured. Overall, the cost for the user will be lowered as well since pill therapy can be utilized instead of much more costly emergency services.

As for losing doctors, this will likely be a short-term issue as the dust settles. You'll probably lose physicians who were not all that dedicated now that there will be a slightly different element of the population visiting the hospitals.

The overwhelming majority of the nation was in no way effected since most get their insurance through their employer and the plans offered far exceeded the ACA minimums.

Anyone who says otherwise is unaware of the facts.

I am not sure why all this is in here if you were responding to my post which was that we need a set of common metrics.

Well, you stated that "we were told we could keep our doctor". That was incorrect. Physicians can change their mind on insurance every other day if they wish.

Right.

Well, the context was framed in the healthcare plan. You know this. Anyone who is over the age of 18 knows that a doctor can take your particular insurance or not on any given day of the week. If you were "fooled" by that....that is unfortunate.