I'm not as politically savvy as some people. I have some questions for people who might be more in the know than myself. Obamacare did not get repealed. The American Healthcare Act, known as Trumpcare, did not replace it. Now, when Obamacare was voted on by Congress, not a single Republican in Congress voted for it, but since Congress was Democrat majority, and all Democrats voted for it, Obamacare passed. This time around, though, if I heard right, even though Congress is now majority Republican I thought I read or heard somewhere that for Trumpcare to pass at least a few Democrats had to vote for it, which, of course, none did. Why did some Democrats have to vote for Trumpcare in order for it to pass but no Republican votes were needed to pass Obamacare?
If I'm not mistaken there is a subset of the Repubs called the 'Freedom Caucus' who are being the holdouts. But maybe I have that backwards.
Yeah, I found that out, but what I want to know is if all Republicans had voted for it, would Democrat votes still have been needed for it to pass, and, if so, why?
The republicans fall 8 seats (i think) short of a fillibuster-proof Senate. So, with dissenting Republicans, some Dem votes would have been critical. I think. Things are better in the House at 237 Rep vs 193. The bill need 60% in the house. I think.
House only requires simple majority. Too many Repubs were against it. Felt too much like Obamacare lite without actual repeal. Can pass Senate with simple majority if using reconciliation process, which means revenue only issues. It will take them a year to get back to it. It the meantime, the Obamacare exchanges will collapse and the trump admin will help it do so.
I don't know much about the insurance industry. If the Obamacare exchanges collapse, as you claim, what does that mean for people who have to buy health insurance??
Group/employer sponsored plans.... not much change Individual plans? Most likely doomed See Christian medishare...
Well, take this Christian medishare out of the equation for a moment, as I'm sure it wouldn't necessarily be a good fit for everybody. If individual plans disappear, how are people supposed to get insurance? Not everybody has a job that offers insurance or pays any share of the insurance if they do "offer" insurance. I'm sure you realize the requirement to have insurance was going to be removed via Trumpcare, but it never passed, and wasn't even put to a vote. How is it fair to penalize people with the tax penalty if they can't even find health insurance after individual plans disappear (I'm assuming that's what you meant by "doomed")? Can't Congress at least repeal the mandate even if they can't come to an agreement on anything else about Trumpcare or is it ALL portions have to be passed together or none at all?
In what history of ever, did Congress ever kill its own cash cow by imposing less taxes? 0:0 In order to overhaul the healthcare system, the entire insurance system would need to be overhauled. Because as it stands now, you have government mandates for insurance (car and homeowner's for example) that rides on the back of for-profit insurance companies, who are more interested in catering to their bottom line and shareholders, than catering to their customers. Which is why Geico, State Farm, Progressive and Allstate have millions in advertising budget and are rolling in money, funded by insurance premiums, which aren't spend to cover people but to grow those businesses and increase their profit margins. It's a vicious cycle, really, and the only losers are the insurance customers who keep paying more money for less coverage all the time. Now with Obamacare, you have the same mandatory laws riding on for-profit health insurance companies, which is why Blue Cross, United Healthcare etc. now provide less coverage for higher premiums and why so many people who were insured with these companies before, now can't afford it any longer. The reason medishare works is because it's handled by nonprofits. As I believe it should be done. It's also driven by members who decide what to pay for and what not to pay for. Everything goes into a big bag and is distributed from there based on need. Pretty straightforward, really. If insurance is mandatory by law, then I think all insurance companies should be nonprofit organizations. Period. That prevents insurance from being a for-profit business model that sucks funds out of people's pockets and gives those funds to stockholders and pays CEOs millions of dollars in salary and runs huge ad campaigns. Which is no bueno. Or, repeal those mandatory laws, make it all voluntary, and let the free market compete and give people lots of options, which will drive prices down. Let people decide if they want to buy insurance, or save money and pay for expenses out of their own pockets by negotiating services and prices with hospitals and clinics themselves. If you have coverage, then your insurance companies do the negotiating. If you don't have coverage, you would have to handle that part of it your own self. Either have a free insurance and healthcare market, or don't. Either let it all function in a free economy and make it voluntary, or don't. Right now we have it both ways and it's a huge mess. Of course these for-profit insurance companies have powerful lobbyists who pay big bucks to make sure the rules don't change. Why would they, like Congress, kill their own cash cow? They won't, until they're forced to by law. Just scrap the whole federally mandated insurance cluster, and let the states handle it. That makes everything smaller and actually easier to govern, and the residents in each state will have a lot more pull by not having to appeal to the federal government, which can hardly agree on anything, as it stands. Which is why Congress consistently locks horns and has to shut down the federal government, because nobody wants to compromise and do what's best for the people they have been elected to represent.
Yeah, I suppose it's just wishful thinking on my part for Congress to just repeal the health insurance mandate thing. Obviously, I don't relish the idea of paying the tax penalty and that's why I would love to see it go bye-bye. I have health insurance through my job but my wife doesn't. And, with all the bills we have, we just can't afford to get insurance, even government subsidized insurance through the state insurance exchanges, for her until we pay enough of our debt down. It's kind of frustrating and annoying. Add on the tax penalty thing and I'm pretty livid about it all. I kind of resent President Obama for leaving this crap pile of a legacy for us to either live with forever or endure the cluster-you know what that the dismantling of it will become. Honestly, government has no business trying to take over healthcare. They screw it up, just like anything else they touch.
Congress doesn't care about you. Government doesn't care about you. It exists only to take your money. By executive Order, Trump has or will order the IRS to not enforce the penalty, so the mandate stays in place, but the penalty will not be enforced.
Of course part of the issue is when you are legally required to have a "qualifying plan" and the government gets to define what is included in a "qualifying plan" it can only drive the price up. Much of what is considered "insurance" in the healthcare context is anything but insurance, it covers entirely predictable events like routine doctor's visits. These things aren't risk events at all and to include them in an "insurance" policy makes a mockery of the word "insurance". To compare the health "insurance" marketplace to motor insurance, imagine what it would do to your motor insurance premiums if you expected your insurance company to pay for routine servicing, oil changes, headlight bulbs, new tires, and the like. Then imagine what would happen if the government decided that you had to have a policy that covered the cost of putting gas in the tank. Suddenly your $500 premium became a $5000 premium. It might work out well for you if you're the kind of person who drives 50,000 miles a year but wouldn't be so good if you only drive to the local shops. Essentially what Obamacare seems to have done is driven the price of insurance through the roof, then fiddled with tax credits to hand out money like candy to make the newly unaffordable insurance at least somewhat more affordable. On a more positive note, for 2016 I had a bewildering array of options to choose from - so many in fact that I had to ask for some help from a friend who is an insurance broker. This year I had four. Sadly the best like-for-like comparison meant the price went up by nearly 70%.
Isn't there something about insurance not being allowed to compete across state lines? I may have misunderstood that though.
Insurance carriers cannot sell policies across state lines. So, in other words, you have each state regulating what can or cannot be or what has to be or what rates to charge for an insurance policy. ONe of the proposed changes is to allow competition across state lines.
That would seem to be a self-evident way to increase pools of people and decrease risk and drive costs a bit downward.
I completely agree with you. Health maintenance should require a different program than medical insurance, which really should only be needed (like car insurance) for expensive events like accidents, surgeries, or major illness. I actually read today about a primary care doc who offers memberships to patients by way of reasonable monthly payments. That covers office visits, e-mail exchanges, prescription call-ins, home visits, and other such things. That's a great business model for primary care, I think. For those of us who take preventative care seriously, and who really only go to the doctor for annual checkups and minor health problems, something like that is a great option, plus some form of catastrophic insurance for the big stuff, and le voila, done. People who are responsible with self-healthcare and who use medical services judiciously shouldn't be in the same insurance pool with people who run to the doctor's office or (worse) the emergency room every time they have a stuffy nose or stub their toe. That's nonsense.
Health maintenance as a separate option would make a lot of sense. It would provide for people who do have ongoing medical bills that they may find hard to afford and that aren't covered as "risk events" by insurance, and let them pay in instalments. At the same time it lets those who don't have ongoing costs to simply opt out of the plan and pay for services as and when they are used. If I go to the doctor with a headache only to be told to take an aspirin and lie down I expect to get a bill. If it turns out that my headache is caused by brain cancer I'd really like someone else to foot the bill to treat it. Of course part of the problem is the way insurance companies drive prices up. I remember back in (I think) 2011 when we needed to take my wife to the ER. The total bill was something like $800 but it came with a $200 discount for payment within 14 days. The prescription was going to cost $70-some but as soon as I mentioned the magic C-word (cash, for anyone wondering) the pharmacist went away and within seconds came back with a bill for $30-some instead. In other words going through insurance more than doubled the price. If we could get rid of that everybody (except insurance companies, obviously) would be much better off. The problem is that insurance companies have no real incentive to keep prices down because they can cover them with increased premiums (even more so when insurance is mandatory), providers have no incentive to keep prices down because the insurance company pays the bill, and even individuals have little incentive to keep the price down because to a large extent they aren't paying it either. What is really needed is a system whereby people pay to see the doctor, which encourages people to figure whether they really need to see the doctor at all. At the same time it needs to provide for people who genuinely struggle to pay the doctor, yet without creating a system whereby the less well-off can trot to the doctor with every little bump and sniffle knowing Someone Else gets stuck with the tab.
It looks like you'd end up in a means-test system, but even that is going to get bulky with administrative issues. It might be nice to say have a $5000 amount (random number) that can be used for doctor visits throughout the year. If it gets drawn down to 0, then you start paying. But then you'd have to trust the billing is appropriate and as you mentioned, there does not seem to be any incentive for anyone to actually nail down costs.
You would think, but the USA hasn't really embraced free market capitalism in health care since the price/wage controls of the New Deal and post WWII used "benefits" as a way to circumvent wage freezes as tax free benefits.