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The Republican Obamacare Replacement Bill is out. It is titled "The American Health Care Act" or AHCA. http://www.speaker.gov/press-release/statement-introduction-american-health-care-act The tl;dr summary of the bill: - No more employer or individual mandate That means small businesses with more than 50 employees can requires all of their employees to get individual coverage now and no longer have to provide health benefits. There is a 30% increase in premiums for a year if you go 2 months without insurance to replace the individual mandate. - The range of incomes for subsidies is much larger than Obamacare. You can get credits up to $109,000 in income. Obamacare subsidies ended just below 50k. Though the income range is much larger, the maximum subsidy amounts are much smaller than Obamacare. Anyone who makes less than 75k a year is eligible for a full subsidy. Higher than that and your subsidy is reduced by a % based on your age and income: - Subsidies are now partially age-based. The subsidy maximums are: $2,000 for those under 30 $2,500 for those between 30 and 40 $3,000 for those between 40 and 50 $3,500 for those between 50 and 60 $4,000 for those over 60 Older, richer, and healthier = Probably better off than under Obamacare Younger, poorer, and sicker = Probably worse off than under Obamacare A 28-year old making 25k could get up to 9k in subsidies under Obamacare. He would be capped at 2k under this plan. A 60-year old making 70k would get nothing under Obamacare. He could get a max of 4k under this plan. - Block Grant Medicaid - Medicaid expansion continues for 2 years. Afterwards it ends and if you ever get above the income limits, get employed, or move states you can't get back on. This is a way to kill the Medicaid expansion without throwing millions of people off of it all at once. - Keeping the provision to stay on parent's plan until 26 - Eliminate Medicare excise tax of 0.9% on incomes above 250k - Keeping the Obamacare rules banning denial based on pre-existing conditions. But insurers can charge you more based on your conditions and age. The cap was 2x higher premiums for someone 55+ under Obamacare and you could only charge extra for smoking. The new plan allows up to 5x higher premiums for age and 2x higher cap for pre-existing conditions. - Keep the Obamacare rule banning plans from having a "lifetime benefits" limit. They could impose some form of annual benefit caps though. - Repeal Obamacare medical device tax and tanning tax. - Plans that cover abortion are not eligible for tax credits. - Funding mechanism after the first two years is left to be decided and not spelled out. This is a big gap and something that there will be fights about when the full House and Senate take it up. - Mandatory coverage requirements are repealed. That means it is up to the insurers and individual plans to decide what birth control to cover. The first annual physical of the year and other preventative medicine are no longer free and it is up to the discretion of the insurer how they are handled. Who will benefit? The two groups that come out way ahead in the Republican health plan compared to Obamacare are: - Healthy males who make between 55-75k a year and have less than $200 in average annual out of pocket health expenses - A married couple with no kids who makes 145-150k a year and has no chronic illnesses. The groups that come out the worst compared to Obamacare are: - Anyone covered under the Medicaid expansion - Anyone Medicaid eligible who is single and not disabled - Anyone making less than 49k. - People (especially single women) who are under 35 and sicker than average (more than $1,000 a year in out of pocket health costs) This is just financially and not factoring in the benefits of near universal birth control and preventative care access. quote:This new tax credit structure could also hurt to many low-income Americans, whose subsidies would fall substantially. The Kaiser Family Foundation estimates that that these new tax credits would be anywhere between 31 and 82 percent lower for a 60-year-old who earns $20,000, depending on where that 60-year-old lives. How will it impact premiums? Starting in 2020, under the GOP replacement plan, insurers would no longer be required to offer the “essential health benefits package” — which right now requires that insurers cover maternity services and pediatric care. This addresses a constant Obamacare gripe from Republicans: the health care law mandates a benefit package that’s too big. This drives up premiums, they argue, and scares off some healthy and young enrollees who want to buy a skimpier plan. There is some truth to this argument. Obamacare’s marketplaces have struggled to attract young adults at the level the White House had initially hoped. (The Obama administration originally said it wanted one-third of the marketplace to be people between the ages of 18 and 34, but right now it’s only about a quarter.) The GOP replacement plan makes the individual market more advantageous for healthier people. Some states might choose skimpier benefit packages that would allow insurers to cut certain benefits they no longer want to cover — they could stop covering maternity benefits, for example, to make their plans less attractive to women who plan to become pregnant. This would likely benefit healthy people, who generally want less robust coverage at a cheaper price. But it’ll send the cost of more comprehensive plans — the plans sicker people need — skyrocketing. And it could leave someone who wants, say, health insurance to cover her maternity costs completely out of luck. quote:There are other ways the draft makes insurance better for young people too: by letting insurance plans charge them lower rates. Leon Trotsky 2012 fucked around with this message at 03:38 on Mar 7, 2017 |
# ? Mar 7, 2017 03:22 |
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# ? Apr 29, 2024 16:18 |
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Woot. Thanks Leon. Health insurance lobby Any word on how all this works with reconciliation? Quite a few pieces, like the new mandate, seem blatantly against reconciliation rules.
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# ? Mar 7, 2017 03:26 |
Is this where I wail and gnash my teeth
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# ? Mar 7, 2017 03:27 |
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my only hope is that if this bill passes, it'll trigger a wave once the whites in the midwest realize that the damned Obamacare was actually helping them. but it seems like it might not make it out of the Senate, no? i get that its dumb to hope that Republicans will do anything that's not in their own interest but there are some Senators who are gun-shy on this right?
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# ? Mar 7, 2017 03:27 |
I read somewhere that this new bill will kick 15 million people off health insurance. Is that substantiated?
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# ? Mar 7, 2017 03:29 |
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SKULL.GIF posted:I read somewhere that this new bill will kick 15 million people off health insurance. Is that substantiated? Estimates based off of Medicaid changes and a Kaiser Health study. There is no CBO score out yet for an "official" estimate.
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# ? Mar 7, 2017 03:30 |
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Carlosologist posted:my only hope is that if this bill passes, it'll trigger a wave once the whites in the midwest realize that the damned Obamacare was actually helping them. I have a feeling this is going to be strangled in the crib. If it isn't, they are greatly underestimating the amount of healthy young people that are going to say 'gently caress it' and not get insurance at all. Premiums will probably go through the roof, because the 'increased competition' from allowing cross-state insurance is a loving pipe dream. The best we can hope for is that one group of morons (the Freedom Caucus) sabotages the other group of morons (Paul Ryan et. al) and they can't get anything done. If it goes through, it won't take long for it to cause a real health care crisis. That's without taking the Medicaid changes into account.
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# ? Mar 7, 2017 03:32 |
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Hieronymous Alloy posted:Is this where I wail and gnash my teeth You and me both buddy. AFAIK this is the latest polling on the ACA favorables. http://kff.org/health-reform/poll-finding/kaiser-health-tracking-poll-future-directions-for-the-aca-and-medicaid/ The medicaid bits are truly eye-opening.
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# ? Mar 7, 2017 03:32 |
AbsolutelySane posted:The best we can hope for is that one group of morons (the Freedom Caucus) sabotages the other group of morons (Paul Ryan et. al) and they can't get anything done. If it goes through, it won't take long for it to cause a real health care crisis. That's without taking the Medicaid changes into account. Yeah. The lives of tens of millions of people now depend on the inability of the Republican congress to agree with itself. This is where poo poo really starts to get bad and Trump actually starts creating real honest to god crises that have direct impacts on huge swathes of the country (the immigration EO was relatively small potatoes).
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# ? Mar 7, 2017 03:39 |
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gently caress Baby Boomers
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# ? Mar 7, 2017 03:40 |
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Leon Trotsky 2012 posted:Estimates based off of Medicaid changes and a Kaiser Health study. Commonwealth have a pretty good economic impact brief on a repeal but it doesn't reflect AHCA. http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/repealing-federal-health-reform
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# ? Mar 7, 2017 03:40 |
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The full text of the letter from Portman, Murkowski, Gardner, and Capito was a little hard to google among the news stories. Here's a link, in case it saves someone some time: http://www.portman.senate.gov/public/index.cfm?p=press-releases&id=C6D96A68-A891-4BA1-8AD2-1CE166E0F8EBLeon Trotsky 2012 posted:There is no CBO score out yet for an "official" estimate. Will that be happening? I thought the ACA bill was specifically exempted from them looking at it.
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# ? Mar 7, 2017 03:40 |
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Also, the AHCA includes a ban on all federal dollars going to Planned Parenthood and prevents states from using Federal Dollars on payments to Planned Parenthood.
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# ? Mar 7, 2017 03:41 |
Carlosologist posted:whites in the midwest Carlosologist posted:realize I found the porblem
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# ? Mar 7, 2017 03:44 |
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eviltastic posted:
There will be. The re-wrote the bill from the original draft form because the initial CBO score was incredibly bad (up to 20 million losing coverage, increased cost to consumers, and uncertain funding mechanisms.) The big challenges are going to be: - The CBO score - Getting 50 Republicans on board in the Senate - Figuring out how to fund it after the first two years. The CBO literally can't score it right now because they score on 10-year windows and the bill has no funding mechanism after the first two years. That's going to be the huge fight.
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# ? Mar 7, 2017 03:47 |
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Leon Trotsky 2012 posted:There will be. The re-wrote the bill from the original draft form because the initial CBO score was incredibly bad (up to 20 million losing coverage, increased cost to consumers, and uncertain funding mechanisms.) If there's no CBO score, how can it pass reconciliation?
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# ? Mar 7, 2017 03:49 |
Bueno Papi posted:If there's no CBO score, how can it pass reconciliation? The Republicans don't give a poo poo so long as gently caress the poors?
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# ? Mar 7, 2017 03:51 |
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The CEO sweetener is a fascinating exercise because the optics are awful, but it's the only thing they can come up with to try to distract health insurance companies from "we're going to tell anyone who's young and healthy to just not bother buying health insurance." This will be interesting mostly because I'm trying to wrap my head around who exactly this is supposed to appeal to.
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# ? Mar 7, 2017 03:52 |
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Bueno Papi posted:If there's no CBO score, how can it pass reconciliation? They are going to have to define a funding mechanism in the final bill and get a CBO score. They probably have no idea how to do that without either kicking tons of people off or having half the party revolt. That's likely why it wasn't in the committee draft.
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# ? Mar 7, 2017 03:54 |
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I wouldn't even say it was 15 million it's probably going to be higher than that if this get's through (it won't) but if it does then well it's going to be disastrous. They've somehow made it worse than what things were before Obamacare. It's just insane. I don't even know what I am going to do. I've started researching buying drugs from other countries. Thankfully, I am in process right now to get Dual Citizenship with Lithuania. Unless something fucks that up so I'll be able to get the gently caress out of the USA.
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# ? Mar 7, 2017 03:55 |
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Leon Trotsky 2012 posted:They are going to have to define a funding mechanism in the final bill and get a CBO score. Alright, I assume it'll be one of those dynamically scored ones where tax cuts make the economy grow by 1000%. How do republicans plan on making the necessary statutory changes to ACA? I know they can just defund the various parts they don't like but they can't add any statutes like their new mandate.
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# ? Mar 7, 2017 03:56 |
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Not only the millions who will lose insurance, but how many jobs will be lost? There were reports of it being millions also. Thanks for the thread Leon.
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# ? Mar 7, 2017 04:02 |
Confounding Factor posted:Not only the millions who will lose insurance, but how many jobs will be lost? There were reports of it being millions also. I think we should focus on all the kids this will kill. I'm not being hyperbolic. A lot of kids are on Medicaid. Tens of millions. If Medicaid is just a block grant, no longer need-based, then the states can cut those Medicaid services at will. We are talking millions and millions of children who are at risk of losing their medical coverage, many of them desperately ill. You think states are going to cover things like heart transplants for poor kids if they aren't being forced to by the federal government? Spoiler: they won't. This reform is legislative child murder. Mass murder. Class genocide. Hieronymous Alloy fucked around with this message at 04:11 on Mar 7, 2017 |
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# ? Mar 7, 2017 04:06 |
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eviltastic posted:I thought the ACA bill was specifically exempted from them looking at it. If anyone else was thinking the same thing, here is a politifact page explaining why this is wrong.
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# ? Mar 7, 2017 04:07 |
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Hieronymous Alloy posted:I think we should focus on all the kids this will kill. Weirdly Medicaid covers some transplant services the kicker though is that they often don't cover the anti rejection drugs. Yeah this is gonna kill thousands of children .
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# ? Mar 7, 2017 04:13 |
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Hieronymous Alloy posted:I think we should focus on all the kids this will kill. The CHIP program covers kids. Block granting Medicaid won't hurt kids the most. It will hurt them, but they will be spared the first and second rounds of eligibility tightening. The people who will get hurt the most are people who are single, not disabled, and poor (but not completely destitute) Basically, single people making more than 8k and less than 20k without a disability are the ones who are going to get bounced first.
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# ? Mar 7, 2017 04:14 |
Hollismason posted:Weirdly Medicaid covers some transplant services the kicker though is that they often don't cover the anti rejection drugs. Current Medicaid must cover transplant services for children, under the EPSDT mandate. Block grant though? All those federal need-based requirements go POOF and when the smoke clears, dead children everywhere, dead of preventable conditions, because gently caress poors Leon Trotsky 2012 posted:The CHIP program covers kids. Sure, but that's just what's easiest to cut. There are already plenty of attempts to cut children's services in conservative states, because children's services are where most of the money is -- if you want to cut medicaid, you have to cut kids, one way or another. Due to the current federal limitations most current cuts are done via "prior authorization" requirements, which are allowed. But there really won't be any reason to not just cut out the middleman. That's the thing -- in conservative states that did not expand Medicaid, funding has still not recovered from the cuts in 2008. Lots of places in this country are *already* past the "first and second rounds" of tightening. Hieronymous Alloy fucked around with this message at 04:18 on Mar 7, 2017 |
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# ? Mar 7, 2017 04:15 |
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Hieronymous Alloy posted:I think we should focus on all the kids this will kill. And if it is block granted, it just means that Republican governors will use it to plug budget gaps under the guise of using it for meidcal programs, so it will kill kids by making sure rich people get tax breaks.
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# ? Mar 7, 2017 04:17 |
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Hieronymous Alloy posted:I think we should focus on all the kids this will kill. Children are in most states the smallest part of their medicaid outlays. The fastest growing medicaid outlay after CLA's is payments to LTC facilities. In some states, especially in those that haven't expanded medicaid, it is the largest outlay. The whole LTC industry depends on medicaid and likewise all those patients.
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# ? Mar 7, 2017 04:19 |
Bueno Papi posted:Children are in most states the smallest part of their medicaid outlays. The fastest growing medicaid outlay after CLA's is payments to LTC facilities. In some states, especially in those that haven't expanded medicaid, it is the largest outlay. The whole LTC industry depends on medicaid and likewise all those patients. Ok, fair enough. I'm going by what I've picked up at the local level, not detailed study of the national numbers. I know that in my state 46% of the children in the state are on Medicaid, so, yeah . . . I'm not speaking hypothetically, I've already seen numerous attempts to cut children's services in my state (disguised as prior authorization requirements, usually). Long term care is the other side of the coin certainly. All those nursing home residents? Turn 'em out in the street. Gonna be like walking dead out there, but with Alzheimer's patients. Hieronymous Alloy fucked around with this message at 04:24 on Mar 7, 2017 |
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# ? Mar 7, 2017 04:21 |
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Hieronymous Alloy posted:Current Medicaid must cover transplant services for children, under the EPSDT mandate. Most of the money isn't in children's services in Medicaid. It is in chronic diseases and disabilities among older and impovrished adults. Diabetes complications, heart disease, renal failure, cornea and other ocular surgeries, cancer, and alcohol-related illnesses. Chip is about 1.5 billion a year. Total Medicaid spending is around 545 billion a year. About half of all Medicaid enrollees are 18 or under, but they actually only account for about 17% of the budget. The top 10% of Health Care users require 80% of the budget. This group is overwhelmingly middle-aged and older with chronic problems. Kids are the most cost-effective Medicaid enrollees.
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# ? Mar 7, 2017 04:24 |
Leon Trotsky 2012 posted:Kids are the most cost-effective Medicaid enrollees. Especially when you consider the lifetime savings gained from investing in children's care (as things like ABA therapy demonstrate). I'm not claiming that Republican legislatures will be rational. I'm just saying I've seen repeated attempts to cut children's services and I expect those attempts to be accelerated dramatically once federal oversight requirements are removed. Covering ABA therapy saves hundreds of millions over the long term, but the only reason my state covers it is because of the federal guidance requiring it issued year before last. Remove that requirement and that coverage is going to vanish as quickly as it appeared -- and that's just one treatment for one condition.
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# ? Mar 7, 2017 04:27 |
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Sorry if this was asked - any experts want to weigh in on probability of Republicans success with repeal and replace?
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# ? Mar 7, 2017 04:28 |
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Hieronymous Alloy posted:Ok, fair enough. I'm going by what I've picked up at the local level, not detailed study of the national numbers. I know that in my state 46% of the children in the state are on Medicaid, so, yeah . . . I'm not speaking hypothetically, I've already seen numerous attempts to cut children's services in my state (disguised as prior authorization requirements, usually). Absolutely the way it's gonna go. Mark Blyth put it well when he said the Boomers are scavenging every dollar they can from the young and poor to protect their status. Making children healthy is a super efficient use of healthcare dollars but the Boomers want that money to afford a third knee replacement.
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# ? Mar 7, 2017 04:30 |
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two year window on funding and two year window on Medicaid = they'll try a full repeal after the midterms betcha Ryan will try moving Medicare to block grants after 2018, too
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# ? Mar 7, 2017 04:33 |
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FuturePastNow posted:two year window on funding and two year window on Medicaid = they'll try a full repeal after the midterms Trump is not going to let Paul Ryan jeopardize his re-election.
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# ? Mar 7, 2017 04:37 |
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So medicaid is probably getting constricted and exchange plans are going to become more expensive and useless. Well, it sounds like the community health center I work at is going to become even more swarmed with patients in the near future. Patients who will be even less likely to have a primary exchange insurance to reimburse at least some of the costs to our program. Hopefully they can propose even more inane eligibility requirements for the 340B drug program, just to make my work a perfect hell.
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# ? Mar 7, 2017 04:41 |
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Mokelumne Trekka posted:Sorry if this was asked - any experts want to weigh in on probability of Republicans success with repeal and replace? Gonna have to see how it shakes out. It's a real compromise bill, republican idea of a compromise, and there's quite a few republicans who won't accept anything short of a full repeal. Then there are four republican senators who won't accept rolling back the medicaid expansion. On top of ~7 republican governors who don't want it cut as well. Opposing is an army of Koch purchased lobbyists and media campaign staff that are rolling out as we speak.
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# ? Mar 7, 2017 04:45 |
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Mokelumne Trekka posted:Sorry if this was asked - any experts want to weigh in on probability of Republicans success with repeal and replace? Pretty low would be my guess. There's already howling from the Koch lobbyists and Freedom Caucus nuts that it doesn't salt the Earth enough. On the flip side a couple moderate Republicans in the senate have already expressed dissatisfaction with anything that will increase number of uninsured. I also would have put the odds of Donald Trump becoming president at "pretty low" though, so God only knows.
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# ? Mar 7, 2017 04:47 |
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# ? Apr 29, 2024 16:18 |
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Medicaid is the main insurance for people who are on SSI and sometimes SSDI. So what you're going to have is this large swathe of people lose their health insurance and have reduced services because of these block grants. I think people forget that as well. Either that or you'll have more restrictions on income etc.. for people on SSI and SSDI.
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# ? Mar 7, 2017 04:50 |