Oh, sure, but come on, people ⌠who needs âcoverageâ when you have access to coverage, amirite?
âtens of millions of Americansâ will be at risk of losing coverage under the proposed legislation
Is that all?
âThe GOP
What are the key protections that will be lost? Would be nice to see some analysis of the bill itself.
Um, everything that the ACA now mandates? The minimum set of protections that states could now decide are no longer required? The loss of subsidies and support? The loss of the requirement to cover preexisting conditions? The massive loss of money over time, as medicaid spending is drastically cut?
It isnât really complicated. Might I suggest you do some research?
Nah, itâs ââaccessâ to health care,â remember? The emergency room is always there. And the free market fairy is going to bring down the cost of everything by a factor of ten once all those terrible, life-saving government regulations are removed.
Graham is trying to end round red states that have embraced ObamaCare and that donât want his help. Not a great way to win the nomination in 2020, Lindsey.
For starters, it: ends the Medicaid expansion, and converts traditional Medicaid from an entitlement to a block grant (transferring funds from the mostly-blue expansion states to the non-expansion red states); eliminates the individual mandate, destroying protections for pre-existing conditions (effectively creating separate, unaffordable âhigh-risk poolsâ for people who most need insurance); defunds Planned Parenthood (because of course); and sets the âprogramâsâ funding to end by 2026.
There are plenty of good sources of info around â Vox has great stuff, and even if you donât have a Twitter account, you can (and should) read the Twitter feeds of Andy Slavitt and Topher Spiro for specs on all health-care issues. For instance, hereâs Slavittâs quick checklist of this billâs âfeaturesâ:
https://twitter.com/ASlavitt/status/908072873964826624
He (twitter.com/ASlavitt), and Spiro (twitter.com/TopherSpiro) have lots more detail. The consensus of all those not on the right is that this thing encompasses the worst features of all the prior awful, failed bills; itâs the combined product of ideology and the GOPâs sheer desperation to have some âaccomplishmentâ to show their base come 2018. Itâs a disgusting piece of work that will literally kill people if it passes.
Which makes (Dr.!) Bill Cassidyâs association with it really, really interesting: heâs the one who oh-so-earnestly vowed to hold any bill to the âJimmy Kimmel testâ and went on the show to bathe in everyoneâs praise. Apparently Kimmel will be addressing the matter on air tonight; looking forward to it.
Thatâs a lot of question marks. Perhaps just dont say anything if you have no clue.
Thanks - v useful, though I wonder if Slavitt is a bit misleading. He says it ends federal protection for pre-existing conditions, but Vox says itâs a waiver system available to states, and that the waiver application must include a description of âhow the state intends to maintain adequate and affordable health insurance coverage for individuals with preexisting conditions.â
Frankly I think I need to do some more reading on it!
It doesnât use the language, âwe eliminate protection for pre-existing conditionsâ (hence my use of âeffectivelyâ), but the description you quote leaves lots of room to define âadequate and affordable.â And without the mandate to push healthy folks into the system, costs inevitably rise for those who do buy insurance. The only remaining options (and states have tried for decades to find solutions) are either to have everyoneâs policies get much more expensive (except for bare-bones âinsuranceâ) or to create high-risk pools for the sicker population, which makes those policies much, much more expensive. (The end of the essential-benefits requirement is also relevant here.) And the preferred âsolutionâ most Republicans are describing is the use of high-risk pools, though theyâre avoiding the term. So yes, except for the most affluent, itâs effectively the end of protections for pre-existing conditions.
(BTW, Slavitt was the guy in charge of the health-care programs in the Obama administration; thereâs nobody better-informed on these issues.)
Donât allow the GOP (Greedy Odious Pricks) to kill the ACA.
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Sens. McCain (AZ), Murkowski (AK), and Collins (ME) really need to hear from you.
ROFL⌠Dear heart, I was answering your question and mocking you at the same time. Everything I wrote was true and you clearly have no answer for it. Better to be thought a fool than to continue posting here and prove it.
He says it ends federal protection for pre-existing conditions
Thatâs probably because it ends federal protection for pre-existing conditions. Funny how that works. A protection that can easily be waived is not, in fact, a protection, by any meaningful definition of that word.
but Vox says itâs a waiver system available to states, and that the waiver application must include a description of âhow the state intends to maintain adequate and affordable health insurance coverage for individuals with preexisting conditions.â
Uh-huh, and had you bothered to read further, you would have seen that the states donât actually have to prove that their alternative makes sense, is workable, and actually works. All they have to do is pinky swear that it will do some good, no, really, we mean it. There are no protections.
Frankly I think I need to do some more reading on it!
No shit, Sherlock.
Itâs a good point - Iâm perhaps a bit more optimistic on how the courts would ultimately define adequate and affordable. it certainly raises uncertainty, but flexibility as well, and could be that the âadequateâ standard is raised over time.
Probably the main reason Iâm not quite so doom and gloom about the change is that I donât think the ACA is a viable long term solution, kicking the responsibility down to the states could mean some genuinely innovative systems are implemented. If there doesnât end up being an amendment to stop it, the possibility of some states implementing a public option (and raising taxes to pay for it as needed) would be a really positive development.
The courts canât write law. There is no mechanism in the law for the process you describe. Do try to keep up.
Probably the main reason Iâm not quite so doom and gloom about the change is that I donât think the ACA is a viable long term solution
Every plan the Republicans have come up with makes things ten times worse. The âdoom and gloomâ is warranted; people will die if this bill passes. The âgenuinely innovative systemsâ all require federal money and would require federal signoff and federal redirection of such things as Medicare, Medicaid, and VA funding, among others. There is zero possibility of âsome states implementing a public option.â
Please stop posting about something you manifestly know nothing about and have done not even the minimal amount of reading on. You continue to expose yourself as a fool with every post.
The reason we needed health-care reform in the first place is that before the federal government got involved, the statesâ complete âflexibilityâ contributed in great part to the crisis the system was in. (And btw, the ACA already gives waivers for states to experiment as long as they meet certain minimum criteria.) No federal program â no human endeavor â is without flaw, and Obamacare, like Social Security and Bushâs Medicare D, has needed adjustments. (Of course, unlike those programs, a significant proportion of the ACAâs problems are the direct result of GOP roadblocks and sabotage at the state and federal level, but they still need to be addressed.) The systems in Switzerland and Germany are quite like the ACA and are very successful, so thereâs no reason the ACA canât be as well â as long as the parties are dealing in good faith, which we clearly donât have now, with just the latest proof the GOP leadershipâs pulling the plug on what was a very promising bipartisan effort. (I strongly suspect thatâs precisely why they pulled the plug on it.)
On your optimism about Graham-Cassidy, thereâs a reason virtually every health-care association (AMA, hospitals, cancer, heart, lung, AARP, and more) opposes it. If you actually think, having heard and read more about it, that the fedsâ throwing it back to the states with far less money (zeroing out entirely by 2026) and far fewer patient protections (the ACAâs full acronym is PPACA, remember) wonât simply send us back to the disastrous system we had before (and worse â theyâre gutting traditional Medicaid as well), thereâs probably nothing more to discuss.
I agree with much of that (except the similarity to the German system, which has a compulsory public option - I think at around 7% of salary which is matched by the employer - with private layered on top. In terms of value for money the German system isnât particularly good, either).
The literal elephant in the room is that to work it requires, as you point out, good faith on both sides to work. In addition, it requires good faith from hospitals, medical supply companies and pharmaceutical/device companies to not price gauge. None of this good faith exists, and most importantly the electorate keeps voting at state and federal level for the party that wants to gut it. The US couldnât be more dissimilar to Germany and Switzerland, and its no surprise their sort of system couldnât work here. The only option as I see it is to put the public into public healthcare provision. The ACA was only ever going to be a sticking plaster once it polarised political opinion.
In terms of federal subsidies, itâs not clear to me why it should be funded federally. 8 years is plenty of time for states to put up their own taxes, in line with the proposed decrease in federal taxes.
Ah, so we just need to get the GOP to sign onto single payer; got it. To address the substance here (and Iâve all but decided youâre sorta trolling, probably from the right faking left, but whatever), the obstacles in the way of reform in this country have always been formidable, which is why itâs taken since Truman to make any real progress. If you think we have trouble emulating Germany but Canada would be a breeze, youâre just not paying attention.
Now, if I were queen of the US, Iâd undo the SCOTUS ruling that allowed GOP-run states to refuse Medicaid expansion (which Cassidy is now amazingly characterizing as having been âpassed by by Obamacareâ) and mandate inclusion of a public option (say, Murphyâs Medicare buy-in, or Schatzâs Medicaid one), which has always seemed to me to be the most likely route to single-payer, without the political uproar and genuine disruption a move straight to SP, even over several years, would cause. But Iâm not queen; if the ACA survives, I expect something like my second âcommandâ to happen, by states or federally. If Graham-Cassidy kills it, that may ultimately cause enough pain that the country will, after many years, if the GOP canât somehow blame the Dems, cry out as one for single-payer. Or not. Either way, itâs not worth the death and destruction it would wreak in the meantime.