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clockworkjoe posted:what kind of reforms would step 2 entail? Have they given any hints at all? Nothing definitive but HHS and CMS have quite a bit of authority built into statute. Prime example is HHS qualifies what constitutes Essential Health Benefits within the confines of the ACA mandates. Take a look at below and imagine how much Trump/Price can screw it up. If AHCA doesn't pass, I imagine they will take to regulatory fuckery. I'd love to see the Trump administration get weighed down in years of lawsuits over it. https://www.cms.gov/cciio/resources/data-resources/ehb.html
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Mar 15, 2017 00:53
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Badger of Basra posted:I think it's the old saw of insurance across state lines. This would destroy the state exchanges but no one seems to have thought about it that far ahead. Insurance prices cost more in certain places because healthcare costs more in those places; no one is going to offer you cheap insurance premiums that you will use to pay to pay for expensive healthcare. Old Kentucky Shark fucked around with this message at 01:07 on Mar 15, 2017 |
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Mar 15, 2017 01:03
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Old Kentucky Shark posted:It actually wouldn't do anything at all, because insurance companies don't WANT to sell across state lines, and no one can make them. It's currently legal in several states and no one bothers to take advantage of it because it's a stupid, irrational, profitless idea. The point of "selling across state lines" is to effectively ban states from regulating insurers. The goal is for a single state to win a race to the bottom where they don't regulate insurance at all (think Delaware for corporations, South Dakota for credit cards) and the companies all move there. Then they're based in that state and subject to that state's laws, and much less subject to each individual state's laws.
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Mar 15, 2017 01:36
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I take it back, the second step has already started. Price/Verma will allow medicaid expansion states to "experiment" in new ways with what's called a "Waiver" under ACA section 1115. Alabama has already started and now Price/Verma have said fullspeed ahead. This will happen regardless if AHCA fails to pass. Here's a good rundown on what to expect with republican states finding new ways to gently caress over the poor but still get medicaid matching dollars. http://kff.org/health-reform/issue-brief/key-themes-in-section-1115-medicaid-expansion-waivers/ 
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Mar 15, 2017 03:36
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Old Kentucky Shark posted:It actually wouldn't do anything at all, because insurance companies don't WANT to sell across state lines, and no one can make them. It's currently legal in several states and no one bothers to take advantage of it because it's a stupid, irrational, profitless idea. Insurers want a single national standard. Not just in Healthcare, but all types of insurance. Most insurers run multiple systems. For healthcare they run 50 concurrent systems. Well, more than that because many of them also run Medicare Supplement and Medicaid third party administration business. Every year they have lawyers review the changes and updates to the law for 50 states and generate 50 different projects to update 50 different systems. Or however many states they sell in. They would love to get that down to 1 system. They don't sell across state lines now because the current system because the risk of things changing is too high.
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Mar 15, 2017 03:53
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Some of the proposed fixes to AHCA are being revealed: https://secure.politico.com/story/2017/03/obamacare-repeal-republicans-trump-congress-236045 quote:Senators are considering taking whatever the House is able to pass and beefing up tax credits for low-income people to help bring down premiums and increase coverage numbers, multiple Republican sources said. John Thune of South Dakota, the No. 3 GOP senator, is one of the lead proponents of that effort. quote:Also under consideration is injecting billions of dollars into states’ “stabilization” accounts to narrow the coverage gap between Obamacare and the House’s repeal-and-replace bill. Cassidy said he’d want prefunded Health Savings Accounts for low-income people who would otherwise struggle to sock away savings for health care.
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Mar 15, 2017 04:18
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So if you take the House proposal, but put a lot more funding into it, you get Obamacare with a $600 billion tax cut.
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Mar 15, 2017 04:24
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Arglebargle III posted:So if you take the House proposal, but put a lot more funding into it, you get Obamacare with a $600 billion tax cut. No one is talking about keeping the Medicaid expansion which seems like a bigger deal. They do want to add work requirements to it though because of course. In Texas I'm not even sure if you could get on Medicaid if you had actually a full time job (even minimum wage) because the requirements are nuts.
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Mar 15, 2017 04:27
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Xae posted:Insurers want a single national standard. Not just in Healthcare, but all types of insurance. They also don't want to have to deal with pesky state regulations like "you have to cover what you promised to cover" and so forth. Badger of Basra posted:No one is talking about keeping the Medicaid expansion which seems like a bigger deal. They do want to add work requirements to it though because of course. In Texas I'm not even sure if you could get on Medicaid if you had actually a full time job (even minimum wage) because the requirements are nuts. Not just the medicaid expansion. AFAIK they still awnt to convert medicaid to cap-and-cut rather than a need-based program. Arglebargle III posted:So if you take the House proposal, but put a lot more funding into it, you get Obamacare with a $600 billion tax cut. It's not just funding, it's specifically *where* they took that funding from: Medicaid.
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Mar 15, 2017 04:50
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Majorian posted:Now now, hold it there mister...are you telling me that this doesn't scream personality? 
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Mar 15, 2017 09:02
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evilweasel posted:The point of "selling across state lines" is to effectively ban states from regulating insurers. The goal is for a single state to win a race to the bottom where they don't regulate insurance at all (think Delaware for corporations, South Dakota for credit cards) and the companies all move there. Then they're based in that state and subject to that state's laws, and much less subject to each individual state's laws. The Republicans are all for State's rights when States want to do something hateful. Not so much when they wish to regulate their own affairs.
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Mar 15, 2017 11:38
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Xae posted:Insurers want a single national standard. Not just in Healthcare, but all types of insurance. The carrier I work for operates in a handful of states. Putting together a competitive provider network in that state is a much bigger hurdle than state regulations. Good luck getting the same or better deals at major hospital systems when you have no market share. I haven't met another Actuary that thought "selling across state lines" was a good idea for anyone, insurers included.
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Mar 15, 2017 15:21
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Reik posted:The carrier I work for operates in a handful of states. Putting together a competitive provider network in that state is a much bigger hurdle than state regulations. Good luck getting the same or better deals at major hospital systems when you have no market share. I haven't met another Actuary that thought "selling across state lines" was a good idea for anyone, insurers included. I would expect that local companies would be bought out or just technically change their official state of business to [Delaware] or wherever has the lowest regulations.
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Mar 15, 2017 15:26
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Reik posted:The carrier I work for operates in a handful of states. Putting together a competitive provider network in that state is a much bigger hurdle than state regulations. Good luck getting the same or better deals at major hospital systems when you have no market share. I haven't met another Actuary that thought "selling across state lines" was a good idea for anyone, insurers included. You don't necessarily make it a single joint plan across all states. You just reincorporate each state insurance thing in whatever state offers you the lowest regulations, so you have Aetna New York* (*incorporated in and subject to North Dakota insurance regulations). From there, maybe you start merging them, but that's not necessary for the plan to gut state regulations to work. This is not a plan for a more efficient health care market. It's a ploy to evade regulation, dressed up as a ploy for a more efficient health care market. It's a "free market" of regulation! The market decides what regulations it wishes to be subject to!
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Mar 15, 2017 15:29
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Ryan has smelled Trump's imminent "this stupid idea is all Ryan's fault and it's all his fault it sucks" plan: https://twitter.com/BraddJaffy/status/841994819396370432
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Mar 15, 2017 15:44
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Reik posted:The carrier I work for operates in a handful of states. Putting together a competitive provider network in that state is a much bigger hurdle than state regulations. Good luck getting the same or better deals at major hospital systems when you have no market share. I haven't met another Actuary that thought "selling across state lines" was a good idea for anyone, insurers included. I agree that assembling the network is much harder and more expensive, but the cost of running the separate systems does add up. But it is maybe a percent or two at most. We're still talking about billions of dollars across the industry, but it wouldn't suddenly make healthcare affordable. National networks and whatnot already exist for the large carriers. If I really wanted to I could already see a doctor in another state. It isn't so much about the doctors as it is about the states laws governing how the claims have to be handled. Having 50 different sets of laws covering the same thing just doesn't make sense. At the same time the GOP plan is guaranteed to gently caress consumers by creating a regulatory race to the bottom. A single Federal set of regulations with strong consumer protection would be a good middle ground that I think the carriers would accept. But I think it is also incredibly unlikely to happen.
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Mar 15, 2017 15:46
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Spaced God posted:The fact that we're discussing how much a fictional character makes and will lose under AHCA is what's wrong with politics tbh. https://twitter.com/cushbomb/status/830520490947117056
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Mar 15, 2017 15:49
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evilweasel posted:Ryan has smelled Trump's imminent "this stupid idea is all Ryan's fault and it's all his fault it sucks" plan: Paul Ryan, suicide bomber
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Mar 15, 2017 16:28
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evilweasel posted:Ryan has smelled Trump's imminent "this stupid idea is all Ryan's fault and it's all his fault it sucks" plan: Ahhh yessss the Kiss of Judas Tear yourselves apart you depraved jackals Hieronymous Alloy posted:I would expect that local companies would be bought out or just technically change their official state of business to [Delaware] or wherever has the lowest regulations. B-b-but then states couldn't dictate their own laws for medical care!  BIG GOVERNMENT!!! STATES RIGHTS!!!
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Mar 15, 2017 16:43
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evilweasel posted:You don't necessarily make it a single joint plan across all states. You just reincorporate each state insurance thing in whatever state offers you the lowest regulations, so you have Aetna New York* (*incorporated in and subject to North Dakota insurance regulations). From there, maybe you start merging them, but that's not necessary for the plan to gut state regulations to work. The thing is, nobody that I have talked to in insurance even thinks it's a good idea for insurers. The state regulators aren't going to be happy if all of the insurance companies in their state try to use loopholes to avoid their regulation, and they'll start putting in stuff like "any policy issued to someone who is a legal resident of this state is subject to our state regulations regardless of where the plan originates" and then we're back to an even more complicated regulation system. We might save a little right when everyone decides to originate their plans in Puerto Rico or wherever there's no state premium tax, but it's a cat and mouse game.
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Mar 15, 2017 17:17
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http://money.cnn.com/2017/03/15/news/economy/medicaid-premiums-work-trump/index.htmlquote:One of the most controversial measures would be adding a work requirement, with the goal of helping them rise out of poverty, Price and Verma said. My god Republicans are so loving dumb.
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Mar 15, 2017 18:49
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Confounding Factor posted:http://money.cnn.com/2017/03/15/news/economy/medicaid-premiums-work-trump/index.html To be clear what's going on here is that the Trump Administration will grant waivers for states to impose work requirements. It's going to be a state level thing if that's wise politics or not but I suspect in most red states it'll be good politics.
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Mar 15, 2017 18:51
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Reik posted:The state regulators aren't going to be happy if all of the insurance companies in their state try to use loopholes to avoid their regulation, and they'll start putting in stuff like "any policy issued to someone who is a legal resident of this state is subject to our state regulations regardless of where the plan originates" and then we're back to an even more complicated regulation system. Maybe I've misunderstood, and I'd be happy to be corrected, but my understanding is that the goal of the whole sell-insurance-across-state-lines thing would be to have the federal government forbid states from having these kinds of regulations.
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Mar 15, 2017 19:28
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quote:Maybe I've misunderstood, and I'd be happy to be corrected, but my understanding is that the goal of the whole sell-insurance-across-state-lines thing would be to have the federal government forbid states from having these kinds of regulations. Probably true, but still hilarious in how it's effectively the government saying "in the name of states' rights, we forbid the states from exercising any rights that exceed that other state's decisions!"
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Mar 15, 2017 19:44
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"If you want your medicine Grandma you better get to work in the fields"
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Mar 15, 2017 20:11
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Sir Kodiak posted:Maybe I've misunderstood, and I'd be happy to be corrected, but my understanding is that the goal of the whole sell-insurance-across-state-lines thing would be to have the federal government forbid states from having these kinds of regulations. I think that's what they would like to do, but I just don't see it happening. Most of these individual policies are on HMO plans now, and HMOs have their own set of regulations that are different than a traditional insurance policy. It would be a huge mess that accomplishes nothing.
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Mar 15, 2017 20:11
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Republicans basically want black people and the poors to pick cotton in order to get healthcare.
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Mar 15, 2017 20:12
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Hollismason posted:Republicans basically want black people and the poors to pick cotton in order to get healthcare. No, just the first part.
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Mar 15, 2017 20:21
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BarbarianElephant posted:No, just the first part. C'mon now, I doubt they'd mind a few poor browns and coffee's out there too.
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Mar 15, 2017 20:24
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"Speaker Ryan, would you say "Work Equals Freedom" under your proposed AHCA? And would you print that on the healthcare forms, or would you use the original German?"
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Mar 15, 2017 20:34
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Isn't the phrase " Work will set you Free" or am I wrong
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Mar 15, 2017 20:57
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Reik posted:I think that's what they would like to do, but I just don't see it happening. Most of these individual policies are on HMO plans now, and HMOs have their own set of regulations that are different than a traditional insurance policy. It would be a huge mess that accomplishes nothing. I wouldn't be at all surprised if a Republican healthcare proposal was a huge mess that accomplishes nothing, just wanted to clarify my understanding of what they were trying to propose.
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Mar 15, 2017 21:07
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Hollismason posted:Isn't the phrase " Work will set you Free" or am I wrong Yeah, Arbeit macht frei - work will make you free The one that blew me away was on the gates of Buchenwald (which I hadn't seen on any other camp gates) that said Jedem das Seine or "To each what he deserves." Both pretty dark, but goddrat. Also, watch Night Will Fall, it's incredible.
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Mar 15, 2017 21:18
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JCT study says AHCA will deplete the Medicare Part A trustfund by 2025. A full three years earlier than ACA. http://kff.org/medicare/issue-brief/what-are-the-implications-for-medicare-of-the-american-health-care-act/ 
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Mar 16, 2017 05:28
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DandyLion posted:C'mon now, I doubt they'd mind a few poor browns and coffee's out there too. They meant like this: Hollismason posted:Republicans basically want black people and the poors to pick cotton
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Mar 16, 2017 07:24
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Barbe Rouge posted:Paul Ryan, suicide bomber Perhaps he really was Muslim all the time.
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Mar 16, 2017 08:03
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Republicans basically want black people.
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Mar 16, 2017 19:30
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bill going well imo https://twitter.com/pdmcleod/status/842150087950237696
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Mar 16, 2017 19:48
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Does cutting NASA's budget show a commitment to NASA?
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Mar 16, 2017 20:22
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Kekekela posted:Does cutting NASA's budget show a commitment to NASA? commitment to ending their climate science research, yeah
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Mar 16, 2017 20:34
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