Coach Power'T's Thread for Knowledge Absorption.

[RedDenver]

Plenty of us also (myself included) take the hit and don't buy insurance because we can't afford it, and even if we could the stuff within availability is essentially worthless. As far as I understand, the IRS also doesn't have any legal ability to enforce those penalties other than ask if they can please have your money.

FYI the Supreme Court ruled that the penalty is a tax and can be collected, so I'm pretty sure the IRS can enforce the penalty just like any other tax. And there are some really strong additional penalties for not paying your taxes on time. Consult a lawyer before not paying that penalty.

 

[RedDenver]

Landlord, your's is a perfect illustration of the fundamental problem with Obamacare and demonstrates it well. Actually, the only people who benefitted from Obamacare (it applies to each and every person in the country so don't get confused if you think you have some other policy, program or option - they are all regulated, constructed, priced and dictated by the Affordable Care Act (Obama/Pelosi, etall Care).

The prices (premiums and copays and deductibles) for virtually all policies and coverages have doubled in just eight years since Obamacare was passed (quite literally voted on by every Democrat without being able to read it or know what was in it).

I was going to read this until I got to the bolded. That's a lie told by the right. The ACA was debated for months.

 

[Nebfanatic]

El Diaco brings it up over and over again. No matter what legislation is put into place it won't have a real impact unless it addresses healthcare costs. I was watching a documentary about people who travel specificly for cheaper healthcare and was astounded by one country in particular. Thailand is a country with great facilities and doctors and offer procedures at typically 1/10th of what it would cost in the US. How is this possible? There are many things that effect this such as difference in currency strengths and economies but the majority of it comes down to the simple fact that healthcare in the US is being ridiculously overcharged. What can we do to reign this in when as ED points out, the alternative to not getting care is suffering and death? This allows hospitals and companies to charge absurd prices because of course people would rather pay than to suffer or die. It's not a legitimate alternative. We can't boycott the healthcare system

 

[Danny Bateman]

Premiums ARE rising. That has been the case for a very, very long time. The ACA slowed the rate of premium growth. They are increasing much slower than they did under W.

But yes, in order to address the root of the problem, we'll have to find a way to drive down the actual costs hospitals and providers charge for services. Steps have been made in this direction, but more needs done. The problem is that is an incredible lift politically, and it's going to take a very, very determined effort to get it done. The ACA didn't do enough. The BCRA didn't even try. Trump seems to have eschewed that goal in favor of juicing Big Pharma and insurer profits. Maybe he thinks that is better for the economy? Maybe he doesn't care? The point is whoever ultimately set us in the right direction has a LOT of incredibly difficult work cut out for them.

 

[knapplc]

Knapp

Dude. We've met. You know that I don't know sh#t from shinola!

There are some really good answers here. I'll give a decent (researched) answer when I have time. I respect the straight up request for info, and while I generally know stuff, most of my info comes from google and engaged discernment. I won't pretend to be an expert on Obamacare, or Trumpcare, so don't expect much.

I will tell you that Obamacare (the ACA) was never meant to be anything more than a first step, and it was always known to be flawed, and (like El D & BRB say all the time) it was never meant to be a fix for the biggest problem in the healthcare world which is rampant out-of-control costs, but it was always going to be better than the current problem.

The ACA is like an unguided rocket - a bottle rocket without a bottle - that shot off generally in the direction we wanted, but wasn't properly guided and wasn't the best solution.

I can tell you, off the top of my head, that Trumpcare (or whatever they're calling it) isn't a better solution, and in almost every way is worse than Obamacare.

tldr; Thanks for asking me by name. I don't have the answer you deserve yet.

Why hasn't anyone talked about Medicare in this thread? That's the most important thing about Obamacare!

 

[Red Five]

One other thing the ACA did was to basically put a cap on insurance company earnings. For individual and small business plans (<100 employees), 80% of the premium must be used on heath care claims (and something called "quality improvements") and the remaining 20% can be for admin, profit, and marketing. For large group plans (>100 employees) 85% of the premium must be used on claims. If the actual claims end up only being 70% of the premium, then the insurance company must pay back the remainder to the people its covering.

http://www.kff.org/health-reform/fact-sheet/explaining-health-care-reform-medical-loss-ratio-mlr/

 

[Danny Bateman]

One other thing the ACA did was to basically put a cap on insurance company earnings. For individual and small business plans (<100 employees), 80% of the premium must be used on heath care claims (and something called "quality improvements") and the remaining 20% can be for admin, profit, and marketing. For large group plans (>100 employees) 85% of the premium must be used on claims. If the actual claims end up only being 70% of the premium, then the insurance company must pay back the remainder to the people its covering.

http://www.kff.org/health-reform/fact-sheet/explaining-health-care-reform-medical-loss-ratio-mlr/

This just reminded me of another way in which the ACA absolutely and undeniably improved healthcare:

The elimination of annual and lifetime caps or limits. Used to be that your insurance company could pick whatever point they wanted in a given year or over the course of your life to decide that was enough and they weren't going to pay for any more care. If something got too expensive, they bailed out and their policy holder was SOL.

The ACA banned those limits, which is an absolute godsend for those with very expensive or chronic conditions that require insurers to cover a lot of costs. Under the ACA, insurers cannot impose annual or lifetime limits on treatments that fall under the law's definition of Essential Health Benefits (EHBs).

EHBs as defined by Healthcare.gov:

A set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. Some plans cover more services.

The waivers in the Senate bill would allow states to create their own definition of EHBs, which is a very short walk to re-imposing annual/lifetime limits. This could lead us back to a situation where people once again have to fear their healthcare getting cut off.

 

[BigRedBuster]

Since this thread is about healthcare, I found this tweet and link interesting.

 

[Red Five]

'Nothing thing that reading LOMS post brought up...

The ACA changed underwriting standards for both Individual and Small Group (<50 or <100 depending of the state).

For Small Group, Insurance Companies must "community rate" them, meaning the employees are not individually underwritten, then making the variance between small group premiums smaller.

For Individual, the elimination of pre-ex has been mentioned. But also Insurance Companies are only able to use your age, location, and tobacco use when coming up with your premium. And the ACA limits the difference in premiums to be 3-1, so all else being equal (location, plan design, tobacco use), older people (the people who use most of the care) are only able to be charged 3x as much as young people. This helps the older, sicker population but costs the younger, healthier population because their premiums are subsidizing the older population.

The new R bill wants to change this to 5-1 rating bands (most expensive premium can be 5x more than the cheapest), which hurts older people and helps younger.

 

[ZRod]

So, JJ or BRB, from a buisness owner's perspective what are some of the draw backs of Obamacare? I know we said somethinf to the effect of more paper work or increased cost to small buisnesses.

 

[TGHusker]

I asked a similar question in a different thread as Coach T - glad he started this thread. So related: Here was my question:

What are the Advantages of a one payer system over a truly free market solution to health care? And Visa Versa - market solution over a one payer? My thinking is that is the ultimate debate long term- are we going to solve this healthcare issue via a govt system or the market?

 

[BigRedBuster]

I asked a similar question in a different thread as Coach T - glad he started this thread. So related: Here was my question:

What are the Advantages of a one payer system over a truly free market solution to health care? And Visa Versa - market solution over a one payer? My thinking is that is the ultimate debate long term- are we going to solve this healthcare issue via a govt system or the market?

TGH.....

just my personal view point. Healthcare is something that is way way different than any other type of market. It's not like someone can choose to not participate in the market if they think it's too expensive or just not interested. It's a system that every one of us needs. I have also never had any "free market healthcare" advocate explain to me how everyone has access to healthcare in a purely free market system.

I'm typically a pro-business/pro-capitalist type person. However, I just don't see how healthcare can fall into that. If you have a heart attack and need heart surgery, are you going to go do research to decide what hospital is cheapest? If you need an MRI, do you research to figure out where it's cheapest? No, your Dr. says you need an MRI, he sends you to a different office to do it and it's done. You in turn get a bill 10x more expensive than if you would have gone to Germany to have it (including airfare) and nobody questions it because your insurance just pays it and figures it into your astronomical premiums you pay each month......along with a nice profit.

 

[NM11046]

I asked a similar question in a different thread as Coach T - glad he started this thread. So related: Here was my question:

What are the Advantages of a one payer system over a truly free market solution to health care? And Visa Versa - market solution over a one payer? My thinking is that is the ultimate debate long term- are we going to solve this healthcare issue via a govt system or the market?

Not necessarily the free market answers, and I completely know that Vox is viewed as a liberal source, but this ironically just came up in my feed, and the article seems well written and easy (for simpletons like myself) to understand. Klein is typically pretty balanced.

i really don't know why the US has stayed away from the VAT. There was recently a great NPR story about that if anybody is interested.

 

[Mierin]

My mom (a business owner) loves the ACA, but she has less than 5 full time employees 3 of those were uninsurable before the ACA. I get the impression JJ and BRB have "big" small businesses.

 

[Scratchtown]

Knapp

Dude. We've met. You know that I don't know sh#t from shinola!

There are some really good answers here. I'll give a decent (researched) answer when I have time. I respect the straight up request for info, and while I generally know stuff, most of my info comes from google and engaged discernment. I won't pretend to be an expert on Obamacare, or Trumpcare, so don't expect much.

I will tell you that Obamacare (the ACA) was never meant to be anything more than a first step, and it was always known to be flawed, and (like El D & BRB say all the time) it was never meant to be a fix for the biggest problem in the healthcare world which is rampant out-of-control costs, but it was always going to be better than the current problem.

The ACA is like an unguided rocket - a bottle rocket without a bottle - that shot off generally in the direction we wanted, but wasn't properly guided and wasn't the best solution.

I can tell you, off the top of my head, that Trumpcare (or whatever they're calling it) isn't a better solution, and in almost every way is worse than Obamacare.

tldr; Thanks for asking me by name. I don't have the answer you deserve yet.

Why hasn't anyone talked about Medicare in this thread? That's the most important thing about Obamacare!

I had to make sure that I included the village elder.