NCPA: 10 necessary changes to repeal/replace with ACA/Obamacare

emilynghiem

Constitutionalist / Universalist
Jan 21, 2010
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National Freedmen's Town District
Repeal and Replace: 10 Necessary Changes

I looked up why Allen West moved to Dallas and found he had taken a leadership role with the National Center for Policy Analysis. I also found this on their website, I thought was interesting and good material to work with. Not only does it briefly summarize the problems, but offers a solution to each. Why can't we address these issues logistically and drop the politics. If people can't agree, why can't we allow people to separate funding, such as checking a box for money to go to health care and giving taxpayers a CHOICE of whether to direct funds to the "free market" system of health savings accounts or whether to direct funds to a singlepayer system through govt by which people could "agree to opt in voluntarily" to mandates thereunder.

============================================================
Monday, January 17, 2011
by NCPA

There are 10 structural flaws in the Affordable Care Act (ACA). Each is so potentially damaging, Congress will have to resort to major corrective action even if the critics of the ACA are not involved. Further, each must be addressed in any new attempt to create workable health care reform.

1. An Impossible Mandate

Problem: The ACA requires individuals to buy a health insurance plan whose cost will grow at twice the rate of growth of their incomes. Not only will health care claim more and more of every family's disposable income, the act takes away many of the tools the private sector now uses to control costs.

Solution: 1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.

2. A Bizarre System of Subsidies

Problem: The ACA offers radically different subsidies to people at the same income level, depending on where they obtain their health insurance - at work, through an exchange or through Medicaid. The subsidies (and the accompanying mandates) will cause millions of employees to lose their employer plans and may cause them to lose their jobs as well. At a minimum, these subsidies will cause a huge, uneconomical restructuring of American industry.

Solution: Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased - preferably in the form of a lump-sum, refundable tax credit.

3. Perverse Incentives for Insurers

Problem: The ACA creates perverse incentives for insurers and employers (worse than under the current system) to attract the healthy and avoid the sick, and to overprovide to the healthy (to encourage them to stay) and underprovide to the sick (to encourage them to leave).

Solution: Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs - ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee.

4. Perverse Incentives for Individuals

Problem: The ACA allows individuals to remain uninsured while they are healthy (paying a small fine or no fine at all) and to enroll in a health plan after they get sick (paying the same premium everyone else is paying). No insurance pool can survive the gaming of the system that is likely to ensue.

Solution: People who remain continuously insured should not be penalized if they have to change insurers; but people who are willfully uninsured should not be able to completely free ride on others by gaming the system.

5. Impossible Expectations/A Tattered Safety Net

Problem: The ACA aims to insure as many as 34 million uninsured people. Economic studies suggest they will try to double their consumption of medical care. Yet the act creates not one new doctor, nurse or paramedical personnel. We can expect as many as 900,000 additional emergency room visits every year - mainly by new enrollees in Medicaid - and 23 million are expected to remain uninsured. Yet, as was the case in Massachusetts, not only is there no mechanism to ensure that funding will be there for safety net institutions that will shoulder the biggest burdens, their "disproportionate share" funds are slated to be cut.

Solution: 1) Liberate the supply side of the market by allowing nurses, paramedics and pharmacists to deliver care they are competent to deliver; 2) allow Medicare and Medicaid to cover walk-in clinics at shopping malls and other unconventional care - paying market prices; 3) free doctors to provide lower-cost, higher-quality services in the manner described below; and 4) redirect unclaimed health insurance tax credits (for people who elect to remain uninsured) to the safety net institutions in the areas where they live - to provide a source of funds in case they cannot pay their own medical bills.

6. Impossible Benefit Cuts for Seniors

Problem: The ACA's cuts in Medicare are draconian. By 2017, seniors in such cities as Dallas, Houston and San Antonio will lose one-third of their benefits. By 2020, Medicare nationwide will pay doctors and hospitals less than what Medicaid pays. Seniors will be lined up behind Medicaid patients at community health centers and safety net hospitals unless this is changed. Either 1) these cuts were never a serious way to fund the ACA, because Congress will cave and restore them, or 2) the elderly and the disabled will be in a separate (and inferior) health care system.

Solution: Many of the cuts to Medicare will have to be restored. However, Medicare cost increases can be slowed by empowering patients and doctors to find efficiencies and eliminate waste in the manner described below.

7. Impossible Burden for the States

Problem: Even as the ACA requires people to obtain insurance and fines them if they do not, the states will receive no additional help if the estimated 10 million currently Medicaid-eligible people decide to enroll. Although there is substantial help for the newly eligible enrollees, the states will still face a multibillion dollar, unfunded liability the states cannot afford.

Solution: States need the opportunity and flexibility to manage their own health programs - without federal interference. Ideally, they should receive a block grant with each state's proportion determined by its percent of the nation's poverty population.

8. Lack of Portability

Problem: The single biggest health insurance problem for most Americans is the lack of portability. If history is a guide, 80% of the 78 million baby boomers will retire before they become eligible for Medicare. Two-thirds of them have no promise of postretirement health care from an employer. If they have above-average incomes, they will receive little or no tax relief when they try to purchase insurance in the newly created health insurance exchange. To make matters worse, the ACA appears to encourage employers to drop the postretirement health plans that are now in place.

Solution: 1) Allow employers to do something they are now barred from doing: purchase personally-owned, portable health insurance for their employees. Such insurance should travel with the individual - from job to job and in and out of the labor market; 2) Give retirees the same tax relief now available only to employees; and 3) Allow employers and employees to save for postretirement care in tax-free accounts.

9. Over-Regulated Patients

Problem: The ACA forces people to spend their premium dollars on first-dollar coverage for a long list of diagnostic tests. Yet if everyone in America takes advantage of all of the free preventative care the ACA promises, family doctors will be spending all their time delivering care to basically healthy people - with no time to do anything else. At the same time, the ACA encourages the healthy to over consume care, it leaves chronic patients trapped in a third-party payment system that is fragmented, uncoordinated, wasteful and designed for everyone other than the patient.

Solution: 1) Instead of dictating deductibles and copayments, give patients greater freedom to save for their own small dollar expenses in health savings accounts, which they own and control; and let them make their own consumption decisions. 2) Allow the chronically ill access to special health accounts, following the example of Medicaid's highly successful Cash and Counseling program, which allows home-bound, low-income disabled patients to control their own budgets and hire and fire those who provide them with services.

10. Over-Regulated Doctors

Problem: The people in the best position to find ways to reduce costs and increase quality are the nation's 778,000 doctors. Yet today they are trapped in a payment system virtually dictated by Medicare. The ACA promises to make this problem worse by encouraging even more unhealthy government intervention into the practice of medicine.

Solution: Providers should be free to repackage and reprice their services under Medicare. As long as their proposals reduce costs and raise quality, Medicare should encourage resourceful, innovative attempts to create a better health care system.
 
Monday, January 17, 2011

Let us know when you catch up to June, 2016.
 
Monday, January 17, 2011

Let us know when you catch up to June, 2016.

Well, Arianrhod how many of these points have been addressed and corrected?

As far as I know, Obama delayed the employer mandate but refused to delay the individual mandate.
He added exemptions for certain unions and was criticized for that.

Nobody from either party has come forward and pushed to correct the problems with the mandate,
although the singlepayer/universal care activists on the left oppose the mandates for channeling money to corporate insurance interests and away from health care; and the free market/right to life activists on the right oppose paying into such a system that doesn't represent their principles or beliefs but violates them.

At this point, I am also giving up on finding legal help to make such arguments,
and plan to write out a proposed solution myself, to separate the funding options by party.
And asking Senator Ted Cruz, Congresswoman Sheila Jackson Lee, and Governor Greg Abbott
to call a Constitutional Convention for party leaders, members and officials in Texas to write this up formally.

I'm sick of the pressure of having to pay for a bunch of nonsense I can't afford
because people in Washington passed something that doesn't affect them,
so they have zero motivation to fix or change it. Only people affected do,
and we're not in charge of this bill that we didn't write, or vote on, that affects us as taxpayers.

You can criticize the critics all you want, but who is correcting anything?
I will try it myself. And ask Texas officials to help set up legislative teams to put this in proper format.
Sick of it!
 
Nobody from either party has come forward and pushed to correct the problems with the mandate,

So what's your solution?

Please tell me you're too smart to say "THERE WAS NOTHING WRONG WITH IT BEFORE AND WE SHOULD JUST GO BACK TO WHAT IT USED TO BE whatever that was because we really weren't paying attention before 2014."
 
Nobody from either party has come forward and pushed to correct the problems with the mandate,

So what's your solution?

Please tell me you're too smart to say "THERE WAS NOTHING WRONG WITH IT BEFORE AND WE SHOULD JUST GO BACK TO WHAT IT USED TO BE whatever that was because we really weren't paying attention before 2014."

That's it!
To allow taxpayers to separate funding so they can redirect their taxes
to go to the programs that match their beliefs. I recommend coordinating
this by state and by party. I am willing to work with TX legislators and Governor
to create a pilot model in Texas, and if it works, share that with other states.

The same way you check a box on your tax return if you want money to
go to the campaign funds, people can check a box and opt into the health
care mandates of their choosing. I recommend dividing it by party lines, since
clearly people do not agree on beliefs about health care, same sex benefits, etc.
Then it is between people and their states to use the party system to democratically
allow people to organize their resources and representation under the policies they believe in.

So this solution will separate funding on any other related conflicts,
if it's done by party and people can choose which policy they believe in supporting.

More details below, of some things I would suggest to make this work.

The main idea is to recognize that making the mandates optional would
allow constitutional free choice of beliefs. Even the federal reserve is optional to use;
you are not penalized if you use independent currency instead of federal notes.
Only when you pay taxes to govt are you required to use that system.

Likewise nobody should be penalized for believing in supporting charities,
free market or other means of providing health care besides the federal govt.

=================================================================

People who are free market, prolife and want to fund health care savings accounts
can organize that through the GOP networks, set up a collective and the money
for health care will pay for those programs that those members/voters agree on
a system how to set up and manage. I recommend it being an offshoot of the
current system of organizing by party, by district/state all the way to national.

People who are prochoice and want singlepayer to cover everyone from
same sex couples to immigrants can fund a collective plan through the
Democratic networks and fund/manage how they want to cover everyone
they promise health care coverage to. I recommend taking on prison reform,
adopting units or setting up schools and managing enrollees from prisons
or immigration application that way. Cover health care and education
with the money currently wasted on a failed criminal justice system.
 
^So you lot don't get to start any opportunistic Wars for No Damn Reason? That would be a good start.
 
Repeal and Replace: 10 Necessary Changes

I looked up why Allen West moved to Dallas and found he had taken a leadership role with the National Center for Policy Analysis. I also found this on their website, I thought was interesting and good material to work with. Not only does it briefly summarize the problems, but offers a solution to each. Why can't we address these issues logistically and drop the politics. If people can't agree, why can't we allow people to separate funding, such as checking a box for money to go to health care and giving taxpayers a CHOICE of whether to direct funds to the "free market" system of health savings accounts or whether to direct funds to a singlepayer system through govt by which people could "agree to opt in voluntarily" to mandates thereunder.

============================================================
Monday, January 17, 2011
by NCPA

There are 10 structural flaws in the Affordable Care Act (ACA). Each is so potentially damaging, Congress will have to resort to major corrective action even if the critics of the ACA are not involved. Further, each must be addressed in any new attempt to create workable health care reform.

1. An Impossible Mandate

Problem: The ACA requires individuals to buy a health insurance plan whose cost will grow at twice the rate of growth of their incomes. Not only will health care claim more and more of every family's disposable income, the act takes away many of the tools the private sector now uses to control costs.

Solution: 1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.

2. A Bizarre System of Subsidies

Problem: The ACA offers radically different subsidies to people at the same income level, depending on where they obtain their health insurance - at work, through an exchange or through Medicaid. The subsidies (and the accompanying mandates) will cause millions of employees to lose their employer plans and may cause them to lose their jobs as well. At a minimum, these subsidies will cause a huge, uneconomical restructuring of American industry.

Solution: Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased - preferably in the form of a lump-sum, refundable tax credit.

3. Perverse Incentives for Insurers

Problem: The ACA creates perverse incentives for insurers and employers (worse than under the current system) to attract the healthy and avoid the sick, and to overprovide to the healthy (to encourage them to stay) and underprovide to the sick (to encourage them to leave).

Solution: Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs - ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee.

4. Perverse Incentives for Individuals

Problem: The ACA allows individuals to remain uninsured while they are healthy (paying a small fine or no fine at all) and to enroll in a health plan after they get sick (paying the same premium everyone else is paying). No insurance pool can survive the gaming of the system that is likely to ensue.

Solution: People who remain continuously insured should not be penalized if they have to change insurers; but people who are willfully uninsured should not be able to completely free ride on others by gaming the system.

5. Impossible Expectations/A Tattered Safety Net

Problem: The ACA aims to insure as many as 34 million uninsured people. Economic studies suggest they will try to double their consumption of medical care. Yet the act creates not one new doctor, nurse or paramedical personnel. We can expect as many as 900,000 additional emergency room visits every year - mainly by new enrollees in Medicaid - and 23 million are expected to remain uninsured. Yet, as was the case in Massachusetts, not only is there no mechanism to ensure that funding will be there for safety net institutions that will shoulder the biggest burdens, their "disproportionate share" funds are slated to be cut.

Solution: 1) Liberate the supply side of the market by allowing nurses, paramedics and pharmacists to deliver care they are competent to deliver; 2) allow Medicare and Medicaid to cover walk-in clinics at shopping malls and other unconventional care - paying market prices; 3) free doctors to provide lower-cost, higher-quality services in the manner described below; and 4) redirect unclaimed health insurance tax credits (for people who elect to remain uninsured) to the safety net institutions in the areas where they live - to provide a source of funds in case they cannot pay their own medical bills.

6. Impossible Benefit Cuts for Seniors

Problem: The ACA's cuts in Medicare are draconian. By 2017, seniors in such cities as Dallas, Houston and San Antonio will lose one-third of their benefits. By 2020, Medicare nationwide will pay doctors and hospitals less than what Medicaid pays. Seniors will be lined up behind Medicaid patients at community health centers and safety net hospitals unless this is changed. Either 1) these cuts were never a serious way to fund the ACA, because Congress will cave and restore them, or 2) the elderly and the disabled will be in a separate (and inferior) health care system.

Solution: Many of the cuts to Medicare will have to be restored. However, Medicare cost increases can be slowed by empowering patients and doctors to find efficiencies and eliminate waste in the manner described below.

7. Impossible Burden for the States

Problem: Even as the ACA requires people to obtain insurance and fines them if they do not, the states will receive no additional help if the estimated 10 million currently Medicaid-eligible people decide to enroll. Although there is substantial help for the newly eligible enrollees, the states will still face a multibillion dollar, unfunded liability the states cannot afford.

Solution: States need the opportunity and flexibility to manage their own health programs - without federal interference. Ideally, they should receive a block grant with each state's proportion determined by its percent of the nation's poverty population.

8. Lack of Portability

Problem: The single biggest health insurance problem for most Americans is the lack of portability. If history is a guide, 80% of the 78 million baby boomers will retire before they become eligible for Medicare. Two-thirds of them have no promise of postretirement health care from an employer. If they have above-average incomes, they will receive little or no tax relief when they try to purchase insurance in the newly created health insurance exchange. To make matters worse, the ACA appears to encourage employers to drop the postretirement health plans that are now in place.

Solution: 1) Allow employers to do something they are now barred from doing: purchase personally-owned, portable health insurance for their employees. Such insurance should travel with the individual - from job to job and in and out of the labor market; 2) Give retirees the same tax relief now available only to employees; and 3) Allow employers and employees to save for postretirement care in tax-free accounts.

9. Over-Regulated Patients

Problem: The ACA forces people to spend their premium dollars on first-dollar coverage for a long list of diagnostic tests. Yet if everyone in America takes advantage of all of the free preventative care the ACA promises, family doctors will be spending all their time delivering care to basically healthy people - with no time to do anything else. At the same time, the ACA encourages the healthy to over consume care, it leaves chronic patients trapped in a third-party payment system that is fragmented, uncoordinated, wasteful and designed for everyone other than the patient.

Solution: 1) Instead of dictating deductibles and copayments, give patients greater freedom to save for their own small dollar expenses in health savings accounts, which they own and control; and let them make their own consumption decisions. 2) Allow the chronically ill access to special health accounts, following the example of Medicaid's highly successful Cash and Counseling program, which allows home-bound, low-income disabled patients to control their own budgets and hire and fire those who provide them with services.

10. Over-Regulated Doctors

Problem: The people in the best position to find ways to reduce costs and increase quality are the nation's 778,000 doctors. Yet today they are trapped in a payment system virtually dictated by Medicare. The ACA promises to make this problem worse by encouraging even more unhealthy government intervention into the practice of medicine.

Solution: Providers should be free to repackage and reprice their services under Medicare. As long as their proposals reduce costs and raise quality, Medicare should encourage resourceful, innovative attempts to create a better health care system.

These were problems before.

Obamacare made them worse.

Hospitals get paid if you don't come back (so they don't let you back...) great system.
 
^So you lot don't get to start any opportunistic Wars for No Damn Reason? That would be a good start.
Dear Arianrhod
I'm not sure what lot you are addressing? At the time of the genocide against Iraq that started with sanctions killing 5000 children and infants per month, I was active with the peace and justice movement publishing and independent newspaper on this subject.

I am TOTALLY for collecting back trillions in tax dollars credit and reimbursements misspent on illicit unauthorized war contracts, and using that money owed to taxpayers to rebuild and expand hospitals and health care in both countries . Are
You with this idea? I have pitched it to the Green and Occupy activists sick of paying corporate welfare so there isn't money for "free health care" that could be supported through medical education programs as part of the course credits internships and residency requirements to pay back loans. There were peace and justice activists who agreed with this idea, but we are at the grassroots level like KPFT public radio and not the rich Democrats at the top of the elitist echelons like the Clinton and Obama supporters.

If you are in with this idea, I can try again to get the Greens behind it since that's who developed the idea of independent currency I propose to use to issue notes against the debts caused by contested war spending, and invest that capital and labor into building sustainable residential campuses combining housing education health and social services.

I don't think I'm of the lot you are complaining about but on the cutting edge:
http://www.houstonprogressive.org
Earned Amnesty
music video for Sustainable Campus converting sweatshop labor to workstudy jobs
 
^So you lot don't get to start any opportunistic Wars for No Damn Reason? That would be a good start.
Dear Arianrhod
I'm not sure what lot you are addressing? At the time of the genocide against Iraq that started with sanctions killing 5000 children and infants per month, I was active with the peace and justice movement publishing and independent newspaper on this subject.

I am TOTALLY for collecting back trillions in tax dollars credit and reimbursements misspent on illicit unauthorized war contracts, and using that money owed to taxpayers to rebuild and expand hospitals and health care in both countries . Are
You with this idea? I have pitched it to the Green and Occupy activists sick of paying corporate welfare so there isn't money for "free health care" that could be supported through medical education programs as part of the course credits internships and residency requirements to pay back loans. There were peace and justice activists who agreed with this idea, but we are at the grassroots level like KPFT public radio and not the rich Democrats at the top of the elitist echelons like the Clinton and Obama supporters.

If you are in with this idea, I can try again to get the Greens behind it since that's who developed the idea of independent currency I propose to use to issue notes against the debts caused by contested war spending, and invest that capital and labor into building sustainable residential campuses combining housing education health and social services.

I don't think I'm of the lot you are complaining about but on the cutting edge:
http://www.houstonprogressive.org
Earned Amnesty
music video for Sustainable Campus converting sweatshop labor to workstudy jobs
 
Item one on the list is bullshit. Reframing the mandate as a 'generous tax subsidy' will fool some of the people ...
 
Nobody from either party has come forward and pushed to correct the problems with the mandate,

So what's your solution?

Please tell me you're too smart to say "THERE WAS NOTHING WRONG WITH IT BEFORE AND WE SHOULD JUST GO BACK TO WHAT IT USED TO BE whatever that was because we really weren't paying attention before 2014."

That's it!
To allow taxpayers to separate funding so they can redirect their taxes
to go to the programs that match their beliefs. I recommend coordinating
this by state and by party. I am willing to work with TX legislators and Governor
to create a pilot model in Texas, and if it works, share that with other states.

The same way you check a box on your tax return if you want money to
go to the campaign funds, people can check a box and opt into the health
care mandates of their choosing. I recommend dividing it by party lines, since
clearly people do not agree on beliefs about health care, same sex benefits, etc.
Then it is between people and their states to use the party system to democratically
allow people to organize their resources and representation under the policies they believe in.

So this solution will separate funding on any other related conflicts,
if it's done by party and people can choose which policy they believe in supporting.

More details below, of some things I would suggest to make this work.

The main idea is to recognize that making the mandates optional would
allow constitutional free choice of beliefs. Even the federal reserve is optional to use;
you are not penalized if you use independent currency instead of federal notes.
Only when you pay taxes to govt are you required to use that system.

Likewise nobody should be penalized for believing in supporting charities,
free market or other means of providing health care besides the federal govt.

=================================================================

People who are free market, prolife and want to fund health care savings accounts
can organize that through the GOP networks, set up a collective and the money
for health care will pay for those programs that those members/voters agree on
a system how to set up and manage. I recommend it being an offshoot of the
current system of organizing by party, by district/state all the way to national.

People who are prochoice and want singlepayer to cover everyone from
same sex couples to immigrants can fund a collective plan through the
Democratic networks and fund/manage how they want to cover everyone
they promise health care coverage to. I recommend taking on prison reform,
adopting units or setting up schools and managing enrollees from prisons
or immigration application that way. Cover health care and education
with the money currently wasted on a failed criminal justice system.

You are wasting your electronic breath.

There are those who can't see what a mess this is.

And they'll never be able to fund what you describe because they need the money of others to make their dreams work (wet dreams at that...and they certainly don't have the money themselves...otherwise they would not need subsidies for the ridiculous insurance Obamacare offers).
 
If NCPA wants to fix health policy, they should learn something about health policy. Most of this stuff is muddled nonsense.

1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.
People who remain continuously insured should not be penalized if they have to change insurers; but people who are willfully uninsured should not be able to completely free ride on others by gaming the system.

So to recap here: we don't like the individual mandate, but we also don't like free riders so we'll come up with a way to penalize people who don't maintain coverage continuously. Super.

And throw in some "generous tax subsidies" to help people buy insurance. Sounds like they've got the makings of a plan here!

Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs - ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee.

This already exists.

Solution: 1) Liberate the supply side of the market by allowing nurses, paramedics and pharmacists to deliver care they are competent to deliver; 2) allow Medicare and Medicaid to cover walk-in clinics at shopping malls and other unconventional care - paying market prices; 3) free doctors to provide lower-cost, higher-quality services in the manner described below; and 4) redirect unclaimed health insurance tax credits (for people who elect to remain uninsured) to the safety net institutions in the areas where they live - to provide a source of funds in case they cannot pay their own medical bills.

Again, already the case. Isn't there a thread in the forum right now complaining (or maybe lauding, I can't remember) that more NPs and PAs are practicing to the top of their licenses and providing primary care? Medicare and Medicaid already do reimburse retail clinics. The safety net is enjoying a big influx of dollars to support it--that's part of the Medicaid expansion was for.

Many of the cuts to Medicare will have to be restored. However, Medicare cost increases can be slowed by empowering patients and doctors to find efficiencies and eliminate waste in the manner described below.

So it's now almost 2017. No Medicare beneficiary has lost a single benefit, Medicare Advantage is more popular now than ever (despite claims the ACA would destroy it), and Medicare is more efficient now than ever--it even saw declines in per capita costs!

Even as the ACA requires people to obtain insurance and fines them if they do not, the states will receive no additional help if the estimated 10 million currently Medicaid-eligible people decide to enroll. . .States need the opportunity and flexibility to manage their own health programs - without federal interference. Ideally, they should receive a block grant with each state's proportion determined by its percent of the nation's poverty population.

States actually get lots of help for people who decide to enroll in Medicaid. Federal matching funds for every dollar they have to spend on such people, in fact. The point of a block grant is to eliminate that open-ended federal commitment to helping states support such costs. In other words, under a block grant the state would receive no additional help at all if additional people sign up for Medicaid. Impressively disingenuous framing, though!

Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased - preferably in the form of a lump-sum, refundable tax credit.
Allow employers to do something they are now barred from doing: purchase personally-owned, portable health insurance for their employees. Such insurance should travel with the individual - from job to job and in and out of the labor market;

Under our employer-based system, lots of employers (particularly big ones) choose to self-insure. For all intents and purposes, that employer is the employee's insurance company (even if the employee has a membership card from an actual health insurer). That's why they can't take their plan with them when they leave. Is NPCA proposing to dismantle the existing employer-based system and ask 150+ million people to start over? After the uproar when ~1% of that number had to go find new plans a couple years ago?

Sounds like yes, since equalizing the tax treatment of employer-provided and individual insurance would have a similar effect. Pro tip: if we're going to push people into buying their own coverage independent of their employer, they're probably going to be expecting to be able to keep enjoying the consumer protections they're used to in the employer space--so might want to go easy on that ACA repeal.

Instead of dictating deductibles and copayments, give patients greater freedom to save for their own small dollar expenses in health savings accounts, which they own and control; and let them make their own consumption decisions.

Not sure why the right still hasn't gotten this memo, but HSAs are a thing that already exists. You can go open one today!

Providers should be free to repackage and reprice their services under Medicare.

Providers used to bill Medicare at prices the provider determined. It was extremely inflationary.

As long as their proposals reduce costs and raise quality, Medicare should encourage resourceful, innovative attempts to create a better health care system.

This is already happening.
 
And throw in some "generous tax subsidies" to help people buy insurance. Sounds like they've got the makings of a plan here!

Same shit, different party. Neither established party is going to deny the insurance industry their funnel of public dollars.
 
1. An Impossible Mandate

Problem: The ACA requires individuals to buy a health insurance plan whose cost will grow at twice the rate of growth of their incomes. Not only will health care claim more and more of every family's disposable income, the act takes away many of the tools the private sector now uses to control costs.

Solution: 1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.

1). That IS NOT a viable solution - people will simply forgo insurance until they need it. The mandate is a necessary trade off for giving people improved access to insurance coverage. You can have the very popular no pre-existing conditions discrimination OR you can have no mandate. But you can't have both. Obama was theoretically against mandate but when rubber got to meet the road it was understood that it is a required element of the puzzle.

2). Will result in the return of the dreaded fine print. Shopping for policy on even terms will become near impossible again. Maternity insurance coverage will cease to exist entirely because again, people will only elect it when they get pregnant.

3) Wtf is "generous tax subsidy"? If you have low-to-midle income you already aren't paying much in terms of federal income taxes, crediting that amount towards insurance is both insufficient subsidy at those incomes and also has a problem of happening only when tax-returns are filed, not when the insurance bill is due (monthly)
 
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2. A Bizarre System of Subsidies

Problem: The ACA offers radically different subsidies to people at the same income level, depending on where they obtain their health insurance - at work, through an exchange or through Medicaid. The subsidies (and the accompanying mandates) will cause millions of employees to lose their employer plans and may cause them to lose their jobs as well. At a minimum, these subsidies will cause a huge, uneconomical restructuring of American industry.

Solution: Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased - preferably in the form of a lump-sum, refundable tax credit.

WTF? This one is straight up crazy nonsense.

Medicaid is for people making 0-130% of poverty level. What "tax relief" can possibly cover their healthcare insurance? And even if some sort of negative tax-rate scheme is involved how do we give EQUAL credit to those that can afford insurance? At that point government is paying for everyone's insurance.
 
3. Perverse Incentives for Insurers

Problem: The ACA creates perverse incentives for insurers and employers (worse than under the current system) to attract the healthy and avoid the sick, and to overprovide to the healthy (to encourage them to stay) and underprovide to the sick (to encourage them to leave).

Again, wtf?

ACA very specifically makes it ILLEGAL to discriminate based on pre-existing conditions or kick people off for being sick, so none of this makes any sense at all. How much more incentive to cover sick people can there possibly be??
 
These were problems before.

Obamacare made them worse.

Hospitals get paid if you don't come back (so they don't let you back...) great system.

Hospitals now get paid based on outcomes, not procedures. You really think that is a bad idea?

And that part about hospitals not letting people comeback? Pure BS. That would be ILLEGAL.
 
These were problems before.

Obamacare made them worse.

Hospitals get paid if you don't come back (so they don't let you back...) great system.

Hospitals now get paid based on outcomes, not procedures. You really think that is a bad idea?

And that part about hospitals not letting people comeback? Pure BS. That would be ILLEGAL.

Clearly he doesn't understand hospital procedure, where the goal is to fix the problem the first time, provide the patient with an information packet upon discharge explaining how to avoid the problem in the future, consults with a social worker who ensures that the patient has support at home - a family member, a visiting nurse in the case of chronic conditions, etc.

In his imagination, the ambulance pulls up at the ER and armed guards say "Oh, this guy? He was here last week. He's not allowed back in!"

Amazing dystopian fantasy lives these RWNJs live...
 
These were problems before.

Obamacare made them worse.

Hospitals get paid if you don't come back (so they don't let you back...) great system.

Hospitals now get paid based on outcomes, not procedures. You really think that is a bad idea?

And that part about hospitals not letting people comeback? Pure BS. That would be ILLEGAL.

You apparently have no clue how hospitals can work.

They can prevent you from coming back.

I know far to many people who work in the system to know that your pipe dream is just that.

Our costs are still holding steady at about 8,500 per person per year.

If you fixed anything, we'd see it going down.

But you old onto your myth and Obama doll.
 

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