Texas District Court Strikes Down the Entire Affordable Care Act

[David Dennison 18485]

Just now, Kyle said:

Yeah, um, you don't understand the details of how Medicare works.

Yeah, um, I do.

[Anastasis 23328]

Medicare consists of Parts A, B, C and D.

Parts A & B are a FFS system funded by the federal government.  This is the single payer component of Medicare. If I wanted to be a real pedantic prick, I could argue that aspects of the FFS system don't reflect a single payer system since MACs may create regional variability in coverage through LCDs.  But I don't feel like being a pedantic prick right now.  I just finished deboning my deer and about to fire up the grinder.

Part C is a private health plan implementation of Medicare coverage that replaces Parts A and B for individuals who select this coverage (~1/3 of medicare beneficiaries). The most common plans have some premium level, but depending on a range of factors, there may or may not be additional premium costs associated with electing Part C.  Most plans offer a no cost option. UHC, Humana, Anthem, Kaiser, and Aetna all have substantial Part C presence. Part C enrollment has a strong growth rate, and a number of studies have demonstrated greater satisfaction, quality and health outcomes for MA vs. FFS. It is not a single payer system. 

Part D is a prescription drug benefit implemented by private insurers and PBMs.  It is not a single payer system, and there is no analogous A/B FFS option for prescription drug benefits in Medicare.

 

While I would prefer a different approach, if we are going to go the road of M4A (likely) it should look at lot like Part C. At the very least, the private option should be available.  

[David Dennison 18485]

Just now, Anastasis said:

Medicare consists of Parts A, B, C and D.

Parts A & B are a FFS system funded by the federal government.  This is the single payer component of Medicare. If I wanted to be a real pedantic prick, I could argue that aspects of the FFS system don't reflect a single payer system since MACs may create regional variability in coverage through LCDs.  But I don't feel like being a pedantic prick right now.  I just finished deboning my deer and about to fire up the grinder.

Part C is a private health plan implementation of Medicare coverage that replaces Parts A and B for individuals who select this coverage (~1/3 of medicare beneficiaries). The most common plans have some premium level, but depending on a range of factors, there may or may not be additional premium costs associated with electing Part C.  Most plans offer a no cost option. UHC, Humana, Anthem, Kaiser, and Aetna all have substantial Part C presence. Part C enrollment has a strong growth rate, and a number of studies have demonstrated greater satisfaction, quality and health outcomes for MA vs. FFS. It is not a single payer system. 

Part D is a prescription drug benefit implemented by private insurers and PBMs.  It is not a single payer system, and there is no analogous A/B FFS option for prescription drug benefits in Medicare.

 

While I would prefer a different approach, if we are going to go the road of M4A (likely) it should look at lot like Part C. At the very least, the private option should be available.  

How do you pay a Part C premium? Where does it come from and who collects it?

 

[Kyle 207]

5 minutes ago, David Dennison said:

Yeah, um, I do.

Okay. If that makes you feel better keep telling yourself that.

[Anastasis 23328]

Just now, David Dennison said:

How do you pay a Part C premium? Where does it come from and who collects it?

Depends on a variety of factors, including dual eligibility status, the specific coverage selected, and the plans available on a regional basis. 

[Kyle 207]

7 minutes ago, Anastasis said:

Medicare consists of Parts A, B, C and D.

Parts A & B are a FFS system funded by the federal government.  This is the single payer component of Medicare. If I wanted to be a real pedantic prick, I could argue that aspects of the FFS system don't reflect a single payer system since MACs may create regional variability in coverage through LCDs.  But I don't feel like being a pedantic prick right now.  I just finished deboning my deer and about to fire up the grinder.

Part C is a private health plan implementation of Medicare coverage that replaces Parts A and B for individuals who select this coverage (~1/3 of medicare beneficiaries). The most common plans have some premium level, but depending on a range of factors, there may or may not be additional premium costs associated with electing Part C.  Most plans offer a no cost option. UHC, Humana, Anthem, Kaiser, and Aetna all have substantial Part C presence. Part C enrollment has a strong growth rate, and a number of studies have demonstrated greater satisfaction, quality and health outcomes for MA vs. FFS. It is not a single payer system. 

Part D is a prescription drug benefit implemented by private insurers and PBMs.  It is not a single payer system, and there is no analogous A/B FFS option for prescription drug benefits in Medicare.

 

While I would prefer a different approach, if we are going to go the road of M4A (likely) it should look at lot like Part C. At the very least, the private option should be available.  

The differences lies more around the MACs and agents of CMS, but of course most of the geniuses on this board don't get much into details or nuance. Too much emoting about national socialists and some kind of -ism fed by daily social media-driven outrage and fake news.

Edited December 16, 2018 by Kyle

[David Dennison 18485]

1 minute ago, Anastasis said:

Depends on a variety of factors, including dual eligibility status, the specific coverage selected, and the plans available on a regional basis. 

I wonder what would happen to Medicare Advantage if the feds removed themselves from equation.

I'm sure it would be fine.

[Anastasis 23328]

3 minutes ago, David Dennison said:

I wonder what would happen to Medicare Advantage if the feds removed themselves from equation.

 I'm sure it would be fine.

I've outlined different ideas about what a better system could look like previously. I like the idea of converting medicare to a catastrophic coverage plan for all Americans.  Let the actuaries figure out where that line is drawn, and fund it with a reasonable payroll deduction. Provide a safety net for those who cannot afford coverage up to the catastrophic limit. Expand broadly tax exempt HSAs. Allow HSA to cover premiums for something analogous to Part C coverage up to the catastrophic limit. The catastrophic backstop would pressure premiums downward. Reform the FDA, require comparative effectiveness studies and cost effectiveness studies for regulatory approval of new drugs and devices. Maybe take a look at reforming the hospital/ER bend over and take this shit in the ass billing games. 

 

But in reality what we are going to do is derp out soundbites like "Medicare for all" and watch the dysfunctional nature of our politics finger itself in the ass. 

[Thetexashammer 1062]

Medicare goes bankrupt in six years.

Your suggestion is similar to what Italy is doing. They are the most indebted, lowest growth country in western europe, and they think they can solve their problem with more government spending. 

There's just this disconnect between facts and what's in people's heads.

Edited December 16, 2018 by Thetexashammer

[Anastasis 23328]

Just now, Thetexashammer said:

Medicare goes bankrupt in six years.

imgur

[Thetexashammer 1062]

2 minutes ago, Anastasis said:

imgur>

Edited December 16, 2018 by Thetexashammer

[David Dennison 18485]

3 minutes ago, Thetexashammer said:

Medicare goes bankrupt in six years.

Your suggestion is similar to what Italy is doing. They are the most indebted, lowest growth country in western europe, and they think they can solve their problem with more government spending. 

There's just this disconnect between facts and what's in people's heads.

Your taxes will go up before Medicare goes bankrupt. If Medicare goes bankrupt, it means this country is no longer a going concern. Same for Social Security.

 

[Henry Hill 3156]

What does “this country is no longer a going concern” mean?

[David Dennison 18485]

14 minutes ago, Henry Hill said:

What does “this country is no longer a going concern” mean?

No more United States of America.

[Serak The Preparer 3421]

3 hours ago, Kyle said:

So, just to be clear, you do not think there were / are problems with the VA? And this is based on a three-year-poll of 5,818 veterans of which 78% were "satisfied" with their coverage, which could be explained by its cost? Dots are starting to connect.

You have complained at various times about intellectual honesty from several posters. Question for you: do you honestly think that David Dennison thinks there were / are no problems with the VA? Are you intentionally distorting his position in order to attack said position?

[Anastasis 23328]

21 minutes ago, Serak The Preparer said:

Are you intentionally distorting his position in order to attack said position?

In the Cloak Room?  

 

[Serak The Preparer 3421]

2 minutes ago, Anastasis said:

In the Cloak Room?  

 

100% agreed with your reaction in general. Would not remark on this except when posters remark on intellectual honesty of others.

[Kyle 207]

28 minutes ago, Serak The Preparer said:

You have complained at various times about intellectual honesty from several posters. Question for you: do you honestly think that David Dennison thinks there were / are no problems with the VA? Are you intentionally distorting his position in order to attack said position?

No and No.

[Smax 3799]

So I hopped on healthcare.gov last night to see prices for a single non smoking 45 year old male in Harris county with no pre existing conditions

 

 

Not too affordable IMO for the crowd this was aimed to help

 

[Anastasis 23328]

15 minutes ago, Smax said:

So I hopped on healthcare.gov last night to see prices for a single non smoking 45 year old male in Harris county with no pre existing conditions

  

 

Not too affordable IMO for the crowd this was aimed to help

  

Those are just stupid plans. Out 10-12k before coverage kicks in, and a 40% coinsurance after deductible is met. 

Edited December 16, 2018 by Anastasis

[RayDog 682]

I saw a report that total healthcare costs are now 3.5 trillion dollars or over $10,700 per person. The present system is untenable as we could be looking at 6 trillion a year in 10 years.

It is clear that we must make substantial changes to get costs under control.

[David Dennison 18485]

25 minutes ago, Smax said:

So I hopped on healthcare.gov last night to see prices for a single non smoking 45 year old male in Harris county with no pre existing conditions

 

 

Not too affordable IMO for the crowd this was aimed to help

 

What did you put in as his income?

[TwiceHorn 31085]

51 minutes ago, Anastasis said:

Those are just stupid plans. Out 10-12k before coverage kicks in, and a 40% coinsurance after deductible is met. 

ACA is full of stupid plans then. It apparently helps the lower end folks substantially and buttfucks self employed people. 

[Foosters 17688]

14 hours ago, Thetexashammer said:

Medicare goes bankrupt in six years.

Your suggestion is similar to what Italy is doing. They are the most indebted, lowest growth country in western europe, and they think they can solve their problem with more government spending. 

There's just this disconnect between facts and what's in people's heads.

Your worried about the debt? Man, you're going to be disappointed when you learn what your party has been up to.

[David Dennison 18485]

59 minutes ago, Anastasis said:

Those are just stupid plans. Out 10-12k before coverage kicks in, and a 40% coinsurance after deductible is met. 

There are four pages of plans. Some are like that. A few aren't. 

Also, if you make too much to qualify for a tax credit, you can always shop around for insurance outside of healthcare.gov. 

[TwiceHorn 31085]

Just now, David Dennison said:

There are four pages of plans. Some are like that. A few aren't. 

Also, if you make too much to qualify for a tax credit, you can always shop around for insurance outside of healthcare.gov. 

Which is virtually nonexistent. And incur the rax penalty. 

[Keef 754]

The fact that we largely have to obtain health insurance in this country through our employer is dumb and an unintended quirk caused by the tax code. 

[David Dennison 18485]

6 minutes ago, TwiceHorn said:

Which is virtually nonexistent. And incur the rax penalty. 

Go without. Problem solved.

[David Dennison 18485]

7 minutes ago, Keef said:

The fact that we largely have to obtain health insurance in this country through our employer is dumb and an unintended quirk caused by the tax code. 

It is dumb and I'm not sure which quirk you're talking about, but from a historical perspective, employer based health insurance is largely a result of wage controls implemented during WWII.

[Keef 754]

13 minutes ago, David Dennison said:

It is dumb and I'm not sure which quirk you're talking about, but from a historical perspective, employer based health insurance is largely a result of wage controls implemented during WWII.

Employer comp for health insurance premiums is tax free. I think this also dates back to WWII. 

[NotActuallyALonghorn 4965]

14 hours ago, TwiceHorn said:

ACA is full of stupid plans then. It apparently helps the lower end folks substantially and buttfucks self employed people. 

It also keeps lots of people from trying to start their own businesses when they are already employed with health coverage.

[Fozzz 152]

Market based health insurance is a scam.  There is no way to make it work unless you are fine throwing the old and those with preexisting conditions to the wolves.  

[Al Bundy's Napoleon Hand 13530]

20 hours ago, TwiceHorn said:

ACA is full of stupid plans then. It apparently helps the lower end folks substantially and buttfucks self employed people. 

My friend who is a self-employed architect was paying 68 dollars a month meeting certain requirements (keeping blood pressure under control for one) a couple of years ago. I'm sure it's gone up since. My first year purchasing insurance through Obamacare I was paying 101 dollars a month for a Blue Cross/Blue Sheild of Texas silver plan. 

 

Of course anecdotal evidence adds virtually nothing to understanding the ACA, which had they kept the Public Option would have been essentially a hybrid/compromise between the Clinton Universal Healthcare Initiative and the Republican counterproposal, but since the discussion is obviously going there, figured I throw it in.

Edited December 17, 2018 by Al Bundy's Napoleon Hand

[ChickenSandwich 9795]

1 hour ago, Al Bundy's Napoleon Hand said:

My friend who is a self-employed architect was paying 68 dollars a month meeting certain requirements (keeping blood pressure under control for one) a couple of years ago. I'm sure it's gone up since. My first year purchasing insurance through Obamacare I was paying 101 dollars a month for a Blue Cross/Blue Sheild of Texas silver plan. 

 

Of course anecdotal evidence adds virtually nothing to understanding the ACA, which had they kept the Public Option would have been essentially a hybrid/compromise between the Clinton Universal Healthcare Initiative and the Republican counterproposal, but since the discussion is obviously going there, figured I throw it in.

Lol. Were You claiming a negative income?  I’ve seen over a 500%increase in premiums with a drop in overall coverage

[Al Bundy's Napoleon Hand 13530]

What the hell would the premium I was paying the first year under Obamacare have to do with a zillion percent increase? 

[DanRydell 799]

This is going to be appealed, right? How is requiring basic health coverage different from requiring basic auto coverage? They have a huge, throbbing, hardon for that. Financial responsibility and all.

There is no federal law requiring basic auto coverage. Those are state laws.

[Anastasis 23328]

 

1 hour ago, Al Bundy's Napoleon Hand said:

What the hell would the premium I was paying the first year under Obamacare have to do with a zillion percent increase? 

The markets were horribly mispriced the first years, esp 2014-2015. Premiums were way off based on projections that a viable risk pool would emerge. As we know, that was not the case.  ACA had a bunch of flaws, but one of the fundamental ones was the mandate. The penalty was not anywhere near high enough to drive the intended behaviors.  Insurers eventually collected enough data to correctly price the markets, then you see skyrocketing premiums and some of the big players just decide to withdrawal from the markets all together leaving a bunch of medicaid-style narrow network offering. 

[Lidig8r 1846]

Thoughts and musing on the decision and the manner in which it could affect mental health providers and the private equity firms which are heavily invested in the mental health field.

https://dadsjourneywithed.blogspot.com/2018/12/obamacare-struck-down-what-you-need-to.html

[Asithappens 974]

Good. (not really)

Let the Repubs own this and the resulting mess. 

[lemonlime 5503]

23 hours ago, TwiceHorn said:

ACA is full of stupid plans then. It apparently helps the lower end folks substantially and buttfucks self employed people. 

Huh?  How would the self-employed afford insurance without the ACA?  You know private plans were even less affordable pre-ACA?  At least private plans that actually covered jack shit and didn't leave people applying for medical bankruptcy once they got sick.

I'm not a big fan of the ACA because it doesn't do much of anything to control health care costs.  But the idea that there was somehow better, more affordable insurance, with stagnant costs pre-ACA is a myth,   at least for the vast majority of the country. 

And the Trump Republicans are acting like this doesn't affect actual people, and if they just lie that everyone now has cheap coverage people will believe them.  Meanwhile, I have a good friend whose child who just graduated from college, with a genetic condition requiring expensive medical treatment, which makes all but uninsurable on a pre-ACA market.  She gets to worry if she has to sell her house next year to buy insurance for him so that he can live.

[Keef 754]

9 hours ago, NotActuallyALonghorn said:

It also keeps lots of people from trying to start their own businesses when they are already employed with health coverage.

Not really. People just join a PEO like TriNet. 

[Al Bundy's Napoleon Hand 13530]

That was the whole point of the risk corridors the Republican Congress defunded in violation of the law. Buttress smaller insurance companies and co-ops the first few years against losses until they were able to find their price point and gain a foothold in the market. Instead, the GOP, who has had multiple opportunities spanning multiple administrations for a quarter century to come up with their own plan that they won't turn around and oppose once Dems acquiesce to it, intentionally crushed competition in what was already a tepid attempt aat reform so they could have their "See? Government can't do anything right!"

 

I pointed out on the Shag, providing 5 or 6 links, that the growth of healthcare costs slowed after the passage of the ACA- a NET positive for the country- but would be surprised if that continued due to Republican sabotage, and that was before Trump was publicly gloating over sabotaging it. Well, here we are

.

[horn4life 3749]

Ultimately this is gonna be a giant FU to the elected GOP,  Simply because the American voter for years has heard how the GOP has a better plan.  Imagine the GOP actually putting forward an even rudimentary healtcare plan where the math remotely worked?  You can't, because like me, you have been waiting over 20 years for this wonderful secret plan to be unveiled.

The very, very best thing that can happen for the GOP is that the Appeals Court overturns the decision and the Supreme Court declines to hear the case.  Past that ALL scenarios are bad for the GOP:

Option 1:Simply BECAUSE of the current court ruling and the POTENTIAL of no healthcare plan at all, the Dems move forward with legislation. Since there is certainly no protection for pre-existing conditions if the ruling prevails, the GOP will need to show concern as well. While the GOP ran a lying campaign of "protecting pre-existing conditions" the exact opposite has ALWAYS been the case legislatively. They are gonna be caught in their own vice of lies,  The Dems will have control of the House and it will be very hard to vote against the bills likely pushed by Dems to protect the Obamacare mandate of on pre-existing illness exclusions to access to coverage.  So Dems push forward a bill. House Pubs vote in unison against a bill protecting pre-existing conditions? If they want to be re-elected in 2020? Suburban GOP will vote with the Dems here, or just decide not to run for re-election. So some bill passes the house to protect healthcare. Vote moves to Senate facing VERY unfavorable map in 2020.  You think McConnell will prevent a vote here? He's up for reelction you know. See Option 2

Option 2:  Something passes the house, in a barely bipartisan manner and McConnell refuses to allow a vote.  Pressure builds, the GOP is exposed even further on it's actual views regarding providing affordable health care. WIPEOUT in 2020 at both the State and Federal level.

Option 3: I got this off watching FOX News and Mike Huckabee, the GOP insists on punting to the States and rejecting ANY national legislation.  Pressure builds, the GOP is exposed even further on it's actual views regarding providing affordable health care. WIPEOUT in 2020 at both the State and Federal level. This might be the best case scenario of kicking the can down the road for the GOP. You think the Dems are stupid enough to go this route with control of the House? No fucking way.

So like I said the very best scenario of the GOP is for the Appeals Court to overturn the Ruling and the Supremes deciding not to hear the case. Past that ALL scenarios are not good for the GOP because then they would actually have to act if upheld.

[Horn Dog 9579]

10 hours ago, horn4life said:

So like I said the very best scenario of the GOP is for the Appeals Court to overturn the Ruling and the Supremes deciding not to hear the case. Past that ALL scenarios are not good for the GOP because then they would actually have to act if upheld.

Yup.  If Im in charge of the dems I would stop defending the case and refuse to file repeal.  I would state that it is the Trump Administration’s duty to defend this case and since they refuse we will no longer take that burden.  Let it crash, just like the Repubs want.  Let all the poor rural whites lose there health care.  Let all the olds and obese Fox viewers with preexistibg conditions lose their health care, as they voted for.  Let the repubs own it and all the consequences.  

[Anastasis 23328]

36 minutes ago, Horn Dog said:

Let all the poor rural whites lose there health care.  Let all the olds and obese Fox viewers with preexisting conditions lose their health care, as they voted for.

The former are largely on Medicaid. The latter primarily Medicare. People getting insurance on the exchanges are primarily late 30s-late 50s, self-employed or their employer doesn't offer an insurance benefit, with poor health, incomes under the subsidy cap. 

Edited December 18, 2018 by Anastasis

[Satchel 6908]

Had Republicans not spent all of their time blowing up the state exchanges and doing everything they could to undermine a bill that was passed after 14 bipartisan congressional round tables, 13 public hearings and included 160 Republican amendments, the state of American health care delivery and its associated costs would be much different today..

[ChickenSandwich 9795]

22 hours ago, lemonlime said:

Huh?  How would the self-employed afford insurance without the ACA?  You know private plans were even less affordable pre-ACA?  At least private plans that actually covered jack shit and didn't leave people applying for medical bankruptcy once they got sick.

 

This is 1 million % False 

[Judge Roybeanbag 11771]

28 minutes ago, ChickenSandwich said:

This is 1 million % False 

Show your work.  

[TwiceHorn 31085]

36 minutes ago, ChickenSandwich said:

This is 1 million % False 

It is a bit harder to compare. But I had a colleague pre-aca that was a 1099 and had coverage for himself and his son at substantially less than what we paid the first year of ACA and premiums have doubled since then, for plans that cover nothing until the deductible is met. Hell, the COBRA at my last w2 job was about the same as obamacare in the first year. 

 

I don't object to the catastrophic nature of aca plans, but I do object to paying five figures annually for it. And in five? years we have not once met the deductible.