Obamacare implosion

In the future, when the US is involved in a political debates over internal issues that really are non of your business, please STFU!!!!!!!

For the record, I'll also disagree with Fly on this one. While I seldom agree with the international perspective on internal American politics, I do find it interesting.

Republican senators have come up with an alternative to Obama care. A bit late but...

- We allow small businesses to band together for coverage – like large corporations do – to negotiate a better deal for health coverage.

- We scrap all of ObamaCare’s rating changes and expensive mandates.

- We offer individuals who are uninsured, self-employed, or working at a small business a tax credit for health coverage to help them be able to buy a plan and keep it.

- We reform – but do not expand – the broken Medicaid entitlement. Too often Medicaid proves the axiom that access to a government health care program is not necessarily access to health care.

Because Medicaid often pays providers so little, roughly half of physicians no longer accept Medicaid patients.

Based on the feedback of many governors, we give states dramatically more flexibility to provide their citizens the health care they need, without all the red tape, micromanagement, and uncertainty from Washington.

Taking their ideas one at a time.

We allow small businesses to band together for coverage – like large corporations do – to negotiate a better deal for health coverage.

People have been talking about this forever. Easy to say, harder to put into practice.

- We offer individuals who are uninsured, self-employed, or working at a small business a tax credit for health coverage to help them be able to buy a plan and keep it.

About time. They've been talking about this forever, but never do anything. Hopefully they will this time.

FYI for those outside the US. Corporations who purchase health insurance on behalf of their employees get to do so with pre-Tax dollars. An individual who purchases an identical policy must do so with post-Tax dollars. Depending on the tax rate brackets and which state they live in that means that individuals pay an extra 20-50% more for insurance, solely due to taxes.

Given that the individuals in the lower 50% of the income brackets don't pay any taxes, this won't impact the "not quite poor" uninsured at all. The main impact will be on the self-employed small business owners and those who retired before 65. (Not all of whom are rich. I know several individuals who would have preferred to keep working but wound up retiring early when they were laid off due to this lousy economy.) Not a huge number of people impacted but a nice boost for middle class small business owners and as we've been discussing in another thread, the middle class needs all the help it can get!

- We scrap all of ObamaCare’s rating changes and expensive mandates.

Useless politician blather. Sounds great but no specifics.

- We reform – but do not expand – the broken Medicaid entitlement. Too often Medicaid proves the axiom that access to a government health care program is not necessarily access to health care.

Because Medicaid often pays providers so little, roughly half of physicians no longer accept Medicaid patients.

Based on the feedback of many governors, we give states dramatically more flexibility to provide their citizens the health care they need, without all the red tape, micromanagement, and uncertainty from Washington.

I'll believe this when I see it. They've been talking about it for years but no one does anything.

FYI for those used to single payer. There is no requirement that doctors treat Medicaid patients (the government program for the poor). So for the 20% of the population on Medicaid, they have to find doctors who are willing to accept that form of payment. Good luck, even many doctors who accept Medicaid for existing patients won't do so for new ones.

biochem wrote:

In the future, when the US is involved in a political debates over internal issues that really are non of your business, please STFU!!!!!!!

For the record, I'll also disagree with Fly on this one. While I seldom agree with the international perspective on internal American politics, I do find it interesting.

I find the international perspective interesting and often amusing. I vividly recall listening to the BBC's coverage while traveling in Israel of the tensions between President Reagan and the Sandanista regime. The BBC reporter on the ground was describing US SR-71s making bombing runs n the capital! The European guest workers, especially the Swedes, were all certain it was true. The only other American guest worker was attempting to ingratiate himself by telling the Europeans that the US used NUCLEAR WEAPONS during the invasion of Grenada!!! He was obviously attempting to get laid, LOL.

I would not be angry about the international intrusion into American politics if it had not been successful. A lot of people who would have recognized Obama for what he is iftheinternational support had not granted him an aura of gravitas. Everyone knew that Obama was an imbecile with no private sector experience outside of scooping ice cream at Baskin and Robins. He had no experience in Government except a few years as an Illionoise State legislature. He was given that seat as a reward for his services as a Democrat party poverty pimp. As a legislator, he often voted "PRSENT" rather than for or against legislation. Obama then served only a few years as a US Senator (won the seat only because he illegally accessed the records of his opponents' divorce from Jeri Ryan (aka "Seven of Nine") to embarrass him into withdrawing at the last moment) where Obama was to busy running for President to accomplish anything. While I disagree with the European fetish for electing welfare state nannies to rule them, their
parliamentary systems ensure that their PMs will be competent technocrats with years of experience actually running a government. The Europeans never would allow someone as incompetent as Obama to become THEIR Prime Minister.

I suspect that all of the public support and illegal campaign contributions thatrolledinwhenthe Obama campaign disable the location identifier on their credit card processing soft wear to evade US election laws were motivated not by a belief that Obama would be a good President for the US but a disaster. This was their way of giving the US both middle index fingers extended.

I'm not going to argue this point with you, history has shown that it goes nowhere.

As I recall you have been asked several times by multiple people in the past to either show proof or keep quiet about the accusations of illegal campaign contributions and a rant on that subject caused you to be banned. I respectfully suggest that we all just not discuss that topic and avoid the flame war.

namelessfly wrote:I suspect that all of the public support and illegal campaign contributions thatrolledinwhenthe Obama campaign disable the location identifier on their credit card processing soft wear to evade US election laws were motivated not by a belief that Obama would be a good President for the US but a disaster. This was their way of giving the US both middle index fingers extended.

Obamacare seems to be getting worse and worse as more provisions kick in.

So far..

85% covered pre-Obamacare

1. Medicaid eligible. Those already on medicaid neutral. The newly eligible for medicaid is a mixed bag. Obama expanded medicaid eligibility with the Federal government to pay for it until 2017 then drop the Federal % until the states pay for 100% of it in 2020. Needless to say not all states took them up on it not wanting to be stuck with a big burden on their state budget in 2020. So some of these newly eligible have medicaid coverage (if they can find a doctor who will take it) some won't. And if they don't get the coverage they still can't afford insurance and are still uninsured.


2. Medicare - net losers. Some of the money that would have gone to them was diverted to Obamacare particularly those who use the Medicare Advantage program.

3. Those with group policies from employers/unions (55% Americans) - net losers and about to get a LOT worse. Rates have been steadily increasing as insurance companies modify policies to comply with Obamacare mandates. In 2018 the "Cadillac tax" kicks in. It was sold to the American public and to congress who didn't actually read the bill as a tax on a small number of extraordinarily generous healthcare plans given to CEOs and the like. Actually it will hit a fairly large section of the middle class. Basically it will impact what those of you in single payer countries describe as good insurance. Every dollar above the threshold is taxed 40% At least 1 in 4 employers will be hit. So those employers are for the most part planning on cutting benefits to reduce the plans down below the threshold.

4. People with private insurance - these include early retirees not yet eligible for Medicare, the self employed, those whose employers didn't offer insurance but who bought their own. HUGE losers. These guys have been hammered and hammered again. Their rates have skyrocketed even for those who qualified for subsidies. Especially since Federal funding for the "loss leader" plans some of the insurance companies have been selling is disappearing.

Then there is the network problem. FYI for those outside the US. US insurance plans typically contain in network and out of network options. In network doctors, hospitals etc have a negotiated fee structure with the insurance companies and visits to them are covered by the insurance plan. Out of network doctors, hospitals etc are covered in a limited manner if at all. They are considerably more expensive (i.e. unaffordable for the most part). Good insurance plans have a wide network. Wide networks are those those which have large numbers of doctors covered both locally where the client lives and around the country in case of travel. There is considerable state by state variance but in many many cases Obamacare plans have narrow networks. This is particularly problematic for those who have multiple serious medical problems. For example if one has both heart problems and cancer, the narrow networks mean that the insurance plan with the oncologist in network won't necessarily have the cardiologist in network and vice versa, requiring these seriously ill patients to switch to a new doctor. Assuming that one can find an in network doctor willing to accept new patients.

Many of those who could afford only catastrophic plans can't afford the new Obamacare plans and are now uninsured.

Some states such as Oregon had subsidized high risk pools for those private insurance buyers who needed expensive medical care on a routine basis. Those plans have now been superseded by Obamacare and patients in them are now paying skyrocketing premiums for worse care.

The 15 % uninsured

1. Young adults eligible to be on their parents policies until age 26 - net winners.

2. Uninsurable that were not previously covered by high risk pools etc - net winners though not as big as they expected to be. Rates are significantly higher than they were promised, policies are worse and networks are narrow, limiting care.

3. The not quite poor, those who make to much money to qualify for Medicaid but too little to afford policies without Obamacare subsidies - mixed bag, some of these individuals are now insured. Some still can't afford the policies even with the subsidies and now must pay a I don't have insurance fine which makes them even worse off then they were before.

4. Illegal immigrants still aren't covered and still show up in the ER at taxpayer expense. Huge financial burden for states in the southwest. No change from before Obamacare.

5. Those whose hours were cut to 29 hour/week so their employers won't have to paid health insurance. Huge losers not only can they still not afford health insurance but they now are making even less money than before.

Biochem, you've been reading far right wing sites again haven't you.

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Annachie wrote:Biochem, you've been reading far right wing sites again haven't you.

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Actually no. The far right wing websites are too busy comparing Obamacare to Nazi Germany (it gets convoluted, though humorous at times) to pay much attention to the fiscal realities.





I know many in single payer countries think of Obamacare as single payer lite, but it's not. It's a Frankenstein monster which seems to be combining the worst of the US system with the worst of single payer and winding up in a huge mess.

I've actually been reading a great deal of business news, regular news etc and those stores correspond well with my personal experience and the personal experiences of those I know.

Obamacare has a huge number of mandates and compliance requirements, those drive costs up which is in part why the costs to EVERYONE are increasing and policies are becoming less generous in the areas in which they legally can. Generally deductibles have gone up significantly. Businesses are putting this information in stockholder reports which is why it is hitting the business news.

Obamacare also had temporary incentives to insurance companies (primarily impacting those buying on the individual market). Insurance companies responded by issuing loss leader policies reasoning that once they got people signed up, they would stay signed up even when the inevitable rate increases came. Those rate increases are now here. People knew they would be coming in theory but with the kick the can down the road and worry about it tomorrow mentality, it got ignored. The reality is not good. Without incentives plan costs are higher, deductibles are higher and networks are narrower.

Networks aren't something you have to worry about in single payer counties but here they are a big deal. The first thing you check when considering a new insurance policies is if your families' doctors are in network or not. And unless you want to switch doctors you do your absolute best to ensure that your doctors are in network. This tends not to be a big problem for healthy people. Generally, they have pediatrician for the kids and another doctor or two for mom & dad. So only they only need to find a plan that accepts those 2-3 doctors. For those with health problems start adding in the specialists, now they need to find 5-10 doctors. And with narrow network plans that becomes a big challenge. Plan A may have the oncologist in network. Plan B may have the cardiologist in network. So do you want to switch your cardiologist or your oncologist? For the most part the narrow network issue is affecting the individual market a great deal more than the employer insurance market (but those with employer insurance are worried that they might be next). Note because insurance is at the state level. Each of the 50 states has different policies available and state by state variance on this issue is considerable.

The next big issue is the Cadillac tax. That kicks in in 2018 but companies are having to put it in their forward looking plans NOW when reporting to stockholders so it is making all of the business news. Most companies are proposing to reduce health benefits to below Cadillac level in those forward looking plans. Some companies are reporting that they are starting Cadillac driven benefit reductions now rather than wait until 2018.

The unions are turning purple. Good healthcare is important to their members and they have spent a lot of time and energy over the years negotiating good health insurances packages. That effort is now up in smoke. Almost all of the union negotiated health packages fall into the Cadillac category and will be heavily taxed if they are not reduced. Many companies/cities/states etc can barely afford the healthcare now. They won't be able to continue it when the Cadillac tax kicks in. With the presidential race on they have been all over the Democratic primary complaining about it (with good reason, they got stabbed in the back by their so-called allies in the Obama administration).

Obamacare is, indeed, not single payer lite. If only...

What it is is an extremely imperfect at best marginal improvement on the complete cluster-fuck that pre-dated it but which did nothing to resolve the fundamental problem with the system... the reliance on the private sector to provide health insurance.


The private sector is great at providing a lot of things, health insurance however could be literally used as the textbook example of what not to use a free market to address in a society. All the market incentives that make the private sector pretty good at providing things like cars and computers and produce and clothing are ass backwards in the health insurance market. Obamacare partially mitigates that, but will never completely address it as it's structured now.


They *should* have instituted single payer, but of course the GOP makes that a practical impossibility so long as they have the votes to either prevent house approval or sustain a filibuster in the Senate...which they did.

Respectfully, it is possible most of us simply do not understand our situation in the USA. Constitutionally the Federal govment has no legal moral ethical or political mandate to provide ANY national health care. None what so ever. None.

Are we understanding this fact? No where in the Constitution does it talk about national health care. No where. It also says quite plainly in the 10 amendment not to do it. Any failed or some what other situations are extremely non legal.

How illegal? About as much as possible. Way above State or Federal law. Way above any court judgements. The only way to change our illegal situation is to pass a Constitutional amendment allowing national health care. Do we understand?

Respectfully. No possible argument can beat this fact.

HB of CJ wrote:Respectfully, it is possible most of us simply do not understand our situation in the USA. Constitutionally the Federal govment has no legal moral ethical or political mandate to provide ANY national health care. None what so ever. None

Except that thing established by Article One of said Constitution where people get to vote for their Congress and then said Congress gets to make laws to run the nation with... yeah, none whatsoever.

It also says quite plainly in the 10 amendment not to do it.

Is that so? I must have missed the text in the 10th that said "the Federal government shall not provide health insurance coverage to its citizens." Maybe you could point out where it "quite plainly" says that?


(As for what it does say, see first half of my reply)