The idea for state exchanges was not a bad one – if the states actually were sincere about implementing them within a framework of national coverage standards.
As it turned out, though, giving states this concession only provided Republicans another way to sabotage the ACA through inaction. The same people also failed to push back against proposed rate hikes, failed to publicize open enrollment periods, and failed to promote the benefits of coverage.
I understand that insurance regulation is a state responsibility/power, but is there not an inherent difference between a state-based marketplace in Wyoming (pop 600k) and one in Florida (pop 20million). California, New York, Texas, Florida, Ohio, Illinois, Pennsylvania, etc… are larger than many countries, but we also have some very small states.
and yes, agreed that States had the power to sabotage the whole thing, and that R states did so with varying degrees of enthusiasm.
Poor Paul. He tries over and over again to get rid of the poor, sick and needy and he fails every time. Those pesky people with a modicum of conscience and decency keep getting in his way. Presumably he does know that even clean living people like himself can fall victim to a horrible disease and who die terrible deaths even with the best care.
Certainly glad to see Rachel’s show last night didn’t wipe AHCA off the airwaves and ruin everyone’s life.
(I agree that health care is the best way to win seats in 2018 and it needs to stay front and center, just being snarky regarding last night’s freak out. ) 
Keep calm and resist.
And you can choose not to have any insurance and die a slow painful death.
Free choice death panel.
What’s not to like ?
“But the structural issues pushing them out are largely untouched by the Republican legislation”
Of course, because it’s a tax cut bill for the 1%, not real health legislation.
Not to mention once the Medicaid payments dry up in those rural red states , the Hospitals close because they can’t support all the indigent care and the counties sure as shit don’t want to pick up the tab
The Dem talking points practically write themselves:
“GOP Washington Insiders Hate Rural America!”
“GOP Establishment Wants You to Move to East Coast or City!”
*"Sell Your Guns to Pay for TrumpCare!"
I think the difference lies in the unique challenges each state poses. In sparsely populated areas where a lot of people are low-income or do not have employer-based plans, providing access becomes a challenge.
There are deeper problems in those ares as well, which are harder to address. Many of these isolated rural areas are not attractive to degreed healthcare professionals. Yes, many offer lower housing costs, but they may also lack the educational offerings for their children, cultural amenities, nightlife, transit services, etc. And some of these areas are not very welcoming to ethnic and racial minorities, and our healthcare workforce is becoming increasingly diverse.
Senator Bernie Sanders insisted on funding for community health centers in the ACA, and IIRC about $9 billion was appropriated for that. That there is a recognition that the private sector marketplace alone does not provide enough incentives to develop robust provider networks in isolated rural communities.
But …But …socialism.
Remember that argument?
What if this entire fiasco isn’t about getting a bill passed, but rather is just to continually undermine the ACA until it truly does collapse. They they will have no choice but to “repeal & replace it.” Right after their I-told-you-so dance, of course.
Yep. And get your grubby commie government hands off my Medicare.
I get your point from a health care delivery standpoint, although some institutions like Intermountain Healthcare in Utah and the Billings Clinic in MT are excellent, but I don’t understand why we would expect a small insurance market to have a similar experience to a very large one.
This is precisely why government involvement is so essential to the health care sector.
You are asking the wrong person. I’ve worked on Medicaid and related issues in the past, but I’ve never worked in marketing or network design.
It’s not a side issue it’s the primary feature.
Well that is interesting Paul. If you were running on this legislation in last falls election why was it not made public so that the voters could make a judgement on just how many people they were willing to through off their health insurance in order to have your smirking face on their TV’s and in the newspapers every day telling them how merciful you are.
Get serious. You did not have this plan last fall and if you had you still would not have run on it because had you done so you and your sorry Republican colleagues would be sitting at home telling yourselves that kicking 24 million people off their health insurance policy was really a kind thing to do.
Your are a poor excuse for a human being.
I think the problem of establishing a strong insurance network parallels the problem of establishing a strong provider network.
Republican toads. All of them!
I guess this is the reason the GOPrs want people to be able to purchase across state lines, right? Because a policy in Alaska will still cost as much as one in New Hampshire, right?
(or is it that insurers will flock to buy the legislature in South Dumbfuckato so they can screw everyone in all 50 states equally?)
My father-in-law lives in a small, poor, rural county (yes, it went overwhelmingly for Dump), but the only primary care provider is Indian. When he first got there, it was all the talk in the churches and cafeterias, “are you going to Dr. Currybreath I don’t see how you can stand to let him touch you”. 6 months on, his waiting room was filled and the talk was about how good he was.