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Leon Trotsky 2012
Aug 27, 2009

YOU CAN TRUST ME!*


*Israeli Government-affiliated poster
The AHCA also nearly doubles the cap on Health Savings Account contributions. A couple can now contribute a little over 13k per year.

If you are generally healthy and have used up all of your tax-advantaged retirement space, then this is like another 13k a year you can invest or stash tax-free and withdraw with no penalty when you're 65.

That's a significant boost for high-income and generally healthy people.

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Leon Trotsky 2012
Aug 27, 2009

YOU CAN TRUST ME!*


*Israeli Government-affiliated poster

EugeneJ posted:

So if a poor wins the lottery they die

That's very Republican

To be fair, if they win the lottery they can probably afford their own premiums.

Also, you are only banned from Medicaid for a maximum of 10-years! So, don't be an idiot with the money for 10-years and don't get cancer at the same time and you're golden!

No Butt Stuff
Jun 10, 2004

Leon Trotsky 2012 posted:

The AHCA also nearly doubles the cap on Health Savings Account contributions. A couple can now contribute a little over 13k per year.

If you are generally healthy and have used up all of your tax-advantaged retirement space, then this is like another 13k a year you can invest or stash tax-free and withdraw with no penalty when you're 65.

That's a significant boost for high-income and generally healthy people.

Do HSAs have an earnings cap for contributions like 401ks?

Confounding Factor
Jul 4, 2012

by FactsAreUseless

quote:

"Well, we're getting rid of the individual mandate. We're getting rid of those things that people said that they don't want," Chaffetz replied. "Americans have choices, and they've got to make a choice. So rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on that, maybe they should invest in their own health care.

"They've got to make those decisions themselves," Chaffetz added.

Jason Chaffetz is the worst.

Lote
Aug 5, 2001

Place your bets

Leon Trotsky 2012 posted:

Hmmm... the WaPo and Vox seem to disagree

So basically if you look at the bill, it says that the Essential Health Benefits will sunset after Dec 31 2019. So yeah, the New York Times is right this wont be changed...until 4 years from now! :v:

This bill could be a non-starter in red states if it's framed as "The bill removes requirements to cover addiction and mental health services".

Bizarro Watt
May 30, 2010

My responsibility is to follow the Scriptures which call upon us to occupy the land until Jesus returns.

Confounding Factor posted:

Jason Chaffetz is the worst.

Chaffetz sounds like your run of the mill Reddit troll.

I wonder what his favorite sub is.

BarbarianElephant
Feb 12, 2015
The fairy of forgiveness has removed your red text.
A new top-of-the-line iPhone costs about $800. That's about half of one month of premiums for my family's health insurance.

Shimrra Jamaane
Aug 10, 2007

Obscure to all except those well-versed in Yuuzhan Vong lore.

Bizarro Watt posted:

Chaffetz sounds like your run of the mill Reddit troll.

I wonder what his favorite sub is.

It's CoonTown.

Leon Trotsky 2012
Aug 27, 2009

YOU CAN TRUST ME!*


*Israeli Government-affiliated poster

No Butt Stuff posted:

Do HSAs have an earnings cap for contributions like 401ks?

No, you just can't be on Medicare, can't be claimed as a dependent, and have to have a HSA compatible high-deductible plan.

Subvisual Haze
Nov 22, 2003

The building was on fire and it wasn't my fault.

No Butt Stuff posted:

Do HSAs have an earnings cap for contributions like 401ks?

You're thinking of Roth IRAs not 401k. But no, no earnings cap for HSA. Even the Roth IRA earnings limitation is incredibly easy to circumvent (fund a traditional ira, immediately convert it to a Roth IRA, pay no tax because it has no earnings).

Anchor Wanker
May 14, 2015

Leon Trotsky 2012 posted:

Basically, single people making more than 8k and less than 20k without a disability are the ones who are going to get bounced first.

Woop, das me. Hope nothing bad happens to me in the next 4 to 8 years.

No Butt Stuff
Jun 10, 2004

Subvisual Haze posted:

You're thinking of Roth IRAs not 401k. But no, no earnings cap for HSA. Even the Roth IRA earnings limitation is incredibly easy to circumvent (fund a traditional ira, immediately convert it to a Roth IRA, pay no tax because it has no earnings).

I was actually thinking of the Highly Compensated Employee stuff, but apparently that just has to do with employer match rather than employee contributions.

But of course middle class fuckers will decide that being able to sock away an additional 6500 in their HSA yearly is worth watching millions die.

Nothus
Feb 22, 2001

Buglord

EugeneJ posted:

So if a poor wins the lottery they die

That's very Republican

It's literally a "gently caress you" clause.

Former Everything
Nov 28, 2007


Is this right?
Remember when Ralph Alvarado wrote his response to Beshear's response to the SOTU and said that Obamacare was a disaster because there was no plan to pay for it

and then the house repubs drew up a plan that literally eliminated the ACA's funding mechanism (excise tax) and omitted any funding structure after the first two years

lol

and then it literally wasn't reported anywhere how much of an idiot Alvarado was?

cool

KillHour
Oct 28, 2007


Anecdotally, if this goes through, I'm cancelling my health insurance as soon as open enrollment comes up. Hope the insurance companies love losing all their healthy customers!

BarbarianElephant
Feb 12, 2015
The fairy of forgiveness has removed your red text.

KillHour posted:

Anecdotally, if this goes through, I'm cancelling my health insurance as soon as open enrollment comes up. Hope the insurance companies love losing all their healthy customers!

Then when you get hit by a car we all get to pay for your bills in the ER, but since you won't be eligible for physical therapy or corrective surgeries, we also get to pay so that your crippled rear end doesn't die of starvation! All win!

Monkey Fracas
Sep 11, 2010

...but then you get to the end and a gorilla starts throwing barrels at you!
Grimey Drawer
How is the "well now insurance companies can charge up to 5X as much based on age" thing going to play with the old farts that vote GOP? Will the increased subsidies for said old farts really cover that gap?

KillHour
Oct 28, 2007


BarbarianElephant posted:

Then when you get hit by a car we all get to pay for your bills in the ER, but since you won't be eligible for physical therapy or corrective surgeries, we also get to pay so that your crippled rear end doesn't die of starvation! All win!

Boy, I hope so!

:toot:

Leon Trotsky 2012
Aug 27, 2009

YOU CAN TRUST ME!*


*Israeli Government-affiliated poster

Monkey Fracas posted:

How is the "well now insurance companies can charge up to 5X as much based on age" thing going to play with the old farts that vote GOP? Will the increased subsidies for said old farts really cover that gap?

No.

The point of that provision is to allow the insurance companies to get more money from people who will be using a lot of services. It will incentivize healthier old people to go for skimpier plans.

Right now, the cost burden of the top 20% of health care users is spread out gradually through the entire population. That means that everyone is paying a little bit extra to discount older and sicker people. This way, the cost is focused much more on older and sicker people to get everyone else a small discount.

The broad themes and goals of the bill are:

- Increase out of pocket costs for most plans. This will incentivize healthier people to get skimpier plans and seek treatment less often.
- Increase costs on those who are likely to use lots of services and use that to give a discount to healthier people.
- The first two points are combined to try to lower monthly expenses for people on individual plans, but greatly increase the upfront cost of using services.
- Provide fixed costs to the government.

Leon Trotsky 2012 fucked around with this message at 17:14 on Mar 7, 2017

esquilax
Jan 3, 2003

nevermind

Yeowch!!! My Balls!!!
May 31, 2006

theres a fwiggin' genocide going on acwass da borda, why dont we do sumfin..? pweeez no votey for joe biden uWu

esquilax posted:

nevermind

Genuinely interested in your thoughts on this one, because I keep trying to figure out who the hell this is supposed to appeal to and not succeeding.

The "murder the poor" provisions are insufficiently tough for the Tea Party caucus but sufficiently there to piss off the people who give a poo poo about them. Insurance companies are given a tax cut as apology for replacing the mandate with a sentence reading "young healthy people, if your insurance ever lapses, don't bother buying it back," which might be the worst imaginable answer.

It is proving a difficult intellectual exercise to find a part of this spacecraft that's good.

Subvisual Haze
Nov 22, 2003

The building was on fire and it wasn't my fault.
The only "goal" I can see this succeeding at is increasing choice of available options on the exchange. Unfortunately said increased options are going to be poo poo plans that don't cover much of anything.

And I guess dumping more of the federal Medicaid costs onto the states, and likely Medicare.

It's amazing how the insurance options for unhealthy low income earners are: get on disability to qualify for Medicare and then never leave it or ????

Concerned Citizen
Jul 22, 2007
Ramrod XTreme

Leon Trotsky 2012 posted:

Those funding details and additional regulations are apparently coming. There's 2 more bills to come to complete the reform package.

https://twitter.com/realDonaldTrump/status/839108868584124417?ref_src=twsrc%5Etfw

i'm guessing these don't qualify for reconciliation and thus are DOA?

Pollyanna
Mar 5, 2005

Milk's on them.


Is this insanity going to pass, are we in for a huge blow to healthcare across the country, and will the GOP suffer any blowback from this?

Yeowch!!! My Balls!!!
May 31, 2006

theres a fwiggin' genocide going on acwass da borda, why dont we do sumfin..? pweeez no votey for joe biden uWu

Pollyanna posted:

Is this insanity going to pass, are we in for a huge blow to healthcare across the country, and will the GOP suffer any blowback from this?

We're probably in for some kind of blow to healthcare across the country, but the bill as is is going to provoke some internal Republican rebellions from a few different directions.

Concerned Citizen
Jul 22, 2007
Ramrod XTreme

Pollyanna posted:

Is this insanity going to pass, are we in for a huge blow to healthcare across the country, and will the GOP suffer any blowback from this?

it's not looking too good for the bill at the moment. they clearly do not have 50 votes in the senate. remains to be seen if they can work out a compromise.

Oxxidation
Jul 22, 2007

Concerned Citizen posted:

it's not looking too good for the bill at the moment. they clearly do not have 50 votes in the senate. remains to be seen if they can work out a compromise.

The Kochs are also opposing it full-force because it's not a full repeal. Americans for Prosperity is openly threatening GOP congressmen who vote for it.

Hollismason
Jun 30, 2007

Witchfinder General

Yeah the Koch brothers are wanting a full repeal so I don't think this is going to pass at all.

What are they doing with the budget reconciliation process?

suburban virgin
Jul 26, 2007
Highly qualified lurker.

Leon Trotsky 2012 posted:

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.

I think this point is right at the heart of what's gone rotten in American healthcare, not just in Medicaid but generally. Too much time and effort being spent in the healthcare sector extracting every possible dollar from the old and insured (or Medicaid protected) and not enough keeping the population healthy throughout the majority of their lives. Naturally you're going to spend more on healthcare for the old and sick, that's just how people work, but a rational system would put a lot of resources into extending the healthy portion of peoples lives to save money later. It's a uniquely free-market issue where the healthcare industry wants to keep old, sick, brain-dead people alive on machine assistance and painkillers for as long as possible, but kicks young people out of the clinic to die of a treatable infection.

I don't think you're going to get single-payer or socialized medicine in the U.S. The population, the industry, the entrenched powers just won't accept it without guillotines. But maybe some kind of insurance system than incentivizes health rather than sickness might be possible. Maybe some system where you can sign up to a low-cost insurance plan that covers all the expected healthcare complications of life, but with some contractual commitments. First that you'll look after yourself, and second that you'll agree to have the good grace to request the machines be switched off rather than sit rotting mindless in a hospital bed for the last eighteen months of your life.

Of course that's only one lovely nugget of the stinking edifice of American healthcare, and does lean a little far in blaming the victim without addressing the corruption in the industry itself, but it's something we're going to have to face as expensive technologies for extending sick life become the norm.

Yeowch!!! My Balls!!!
May 31, 2006

theres a fwiggin' genocide going on acwass da borda, why dont we do sumfin..? pweeez no votey for joe biden uWu

suburban virgin posted:

I think this point is right at the heart of what's gone rotten in American healthcare, not just in Medicaid but generally. Too much time and effort being spent in the healthcare sector extracting every possible dollar from the old and insured (or Medicaid protected) and not enough keeping the population healthy throughout the majority of their lives. Naturally you're going to spend more on healthcare for the old and sick, that's just how people work, but a rational system would put a lot of resources into extending the healthy portion of peoples lives to save money later. It's a uniquely free-market issue where the healthcare industry wants to keep old, sick, brain-dead people alive on machine assistance and painkillers for as long as possible, but kicks young people out of the clinic to die of a treatable infection.

I don't think you're going to get single-payer or socialized medicine in the U.S. The population, the industry, the entrenched powers just won't accept it without guillotines. But maybe some kind of insurance system than incentivizes health rather than sickness might be possible. Maybe some system where you can sign up to a low-cost insurance plan that covers all the expected healthcare complications of life, but with some contractual commitments. First that you'll look after yourself, and second that you'll agree to have the good grace to request the machines be switched off rather than sit rotting mindless in a hospital bed for the last eighteen months of your life.

Of course that's only one lovely nugget of the stinking edifice of American healthcare, and does lean a little far in blaming the victim without addressing the corruption in the industry itself, but it's something we're going to have to face as expensive technologies for extending sick life become the norm.

It's called the capitation model. It's only ~minor~ problem is that it requires insurers and providers, two entities whose incentives are the polar opposites of each others', to play nice.

Works like this: Insurers give providers a big sack of money, a big sack of patients, and say "this is for them. if you take care of them for cheaper you make more. if they get sicker you make less." Suddenly, providers have an incentive to try for preventative care as opposed to treating everything as a loss-leader on when your heart/hips/knees finally go and they can soak you for everything you've got. Elegant free market solution to the problem, right?

Yeah, well, understandably, insurers have every incentive here to make the sack as tiny as possible and the patients as high-risk as possible, whereas the providers want it the other way around, and neither side has any reason to trust the other side's numbers in this negotiation. So you only really see it being rolled out where a hospital owns an insurance company or an insurance company owns a hospital, with all the accompanying inefficiencies: hospital-owned capitation models don't have profitable insurance divisions and insurance-owned capitation models don't have profitable hospitals.

Outcomes are measurably better, of course, but nobody's pay is measured in human quality of life.

JesusSinfulHands
Oct 24, 2007
Sartre and Russell are my heroes

Leon Trotsky 2012 posted:

Those funding details and additional regulations are apparently coming. There's 2 more bills to come to complete the reform package.

https://twitter.com/realDonaldTrump/status/839108868584124417?ref_src=twsrc%5Etfw

Ahahaha. What happened to "I've got a great healthcare bill that's going to lower costs and increase coverage, and we're going to pass it in the first month of my administration"?

You need 60 votes in the Senate to pass allowing interstate sales of health insurance, and good luck getting 8 Democrats to go along with your agenda.

Nothus
Feb 22, 2001

Buglord

Leon Trotsky 2012 posted:


- Increase out of pocket costs for most plans. This will incentivize healthier people to get skimpier plans and seek treatment less often.
- Increase costs on those who are likely to use lots of services and use that to give a discount to healthier people.
- The first two points are combined to try to lower monthly expenses for people on individual plans, but greatly increase the upfront cost of using services.
- Provide fixed costs to the government.

So now healthcare is being driven by the same shortsighted ignorance used by people who buy cars based solely on the monthly payment. Also discouraging people from actually using the care they pay for. :thumbsup:

ded redd
Aug 1, 2010

https://twitter.com/KFILE/status/839149818496839680

Guys, I think... I think Pence is a dumb.

Electric Phantasm
Apr 7, 2011

YOSPOS

Is it a possible for ACA to get repealed and not have replacement?

Discendo Vox
Mar 21, 2013

We don't need to have that dialogue because it's obvious, trivial, and has already been had a thousand times.

JesusSinfulHands posted:

You need 60 votes in the Senate to pass allowing interstate sales of health insurance, and good luck getting 8 Democrats to go along with your agenda.

Why do they need 60 votes?

Zikan
Feb 29, 2004

Discendo Vox posted:

Why do they need 60 votes?

filibuster

Concerned Citizen
Jul 22, 2007
Ramrod XTreme

Discendo Vox posted:

Why do they need 60 votes?

the senate can only pass 1 reconciliation bill a year. a part b and part c bill requires 60 votes.

ihatepants
Nov 5, 2011

Let the burning of pants commence. These things drive me nuts.



Concerned Citizen posted:

the senate can only pass 1 reconciliation bill a year. a part b and part c bill requires 60 votes.

Does this mean that they can just add the part b and part c bill as reconciliation next year and the year after?

No Butt Stuff
Jun 10, 2004

No guarantee they'll control the Senate for part C.

And it's gonna be hard to get a partial law passed, even with the GOP because who is going to vote for something that if not completed (and honestly even if completed) is going to alienate old people and tons of others for insurance company money. Some, but surely not a majority.

I hope.

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Discendo Vox
Mar 21, 2013

We don't need to have that dialogue because it's obvious, trivial, and has already been had a thousand times.

Concerned Citizen posted:

the senate can only pass 1 reconciliation bill a year. a part b and part c bill requires 60 votes.

Zikan posted:

filibuster

I'm genuinely pretty ignorant of Senate rules at this point, but aren't the Republicans now in a position to undo that 60 vote "requirement"?

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