What Features Do You Think Are Needed for the ACA Replacement?

[JimBowie1958]

I have read of a number of things people seem to think need keeping from the ACA and more that are needed to make the whole thing be a consumer centered system.

Trump has said he wants a number of features.

First he wants to keep from the ACA the pre-existing condition prohibition, and the 26 year old child ability to remain on his parents insurance.

He also wants to remove all state limits on insurance so that we have true national competition among medical insurance companies.

Now to pay for all that, we had/have the mandatory insurance 'tax' that requires everyone to get insurance and employers to offer insurance to full time employees. Otherwise we will be driving insurance companies out of business.

Perhaps the mandate should include catastrophic coverage policies to let people have a cheap alternative and insurance companies still get the customer base they need to stay in business?

The state insurance pools seemed to allow for the pooling of resources, and might have worked had more healthy people bought in. Should we keep such insurance pools?

Expanded health savings accounts could cover the deductibles, but this doesnt help people who dont have the funds to put money into such an account. What about them?

Decentralize control for Federal government back to states?

What else needs to be a part of the replacement for the ACA?

Medicare expansion? Do we tell people who have it is will no longer be available?

Federal grants of up to $3 billion to help the system get off the ground?

Should we include welfare assistance to those who cannot afford entry level costs? Combine that with a tax deduction for health insurance costs?

JAMA Forum: What Might an ACA Replacement Plan Look Like?

Compare Proposals to Replace The Affordable Care Act

The Project 2017: GOP ACA Replacement They Don't Want You To See

The GOP Obamacare 'Replacement' Has Arrived. Sort Of. | The Huffington Post

 

[JimBowie1958]

Anyone have any other ideas I left out?

 

[EverCurious]

I'd like to see EMTALA repealed personally as that's what drove up medical costs in the first place IMO. Ya know if we could get the cost of care down then we wouldn't even need insurance.

* I'm biased against insurance though, I consider it a waste of money, higher on my list than say rent or leasing cars, even credit cards. We need to stop allowing folks to be so impatient, borrowing money is far too easy these days... ~shrug~

 

[flacaltenn]

Anyone have any other ideas I left out?

The ACA really damaged small business and the self-employed by OUTLAWING group plans thru professional organizations. They need to bring this back. Those people should be allowed to pooled just like a corporation or Union has a private pool... It tossed MILLIONS of doctors, lawyers, veterinarians, restaurant owners, etc into the exchanges.

As for "medicare expansion" -- I think you mean MediCaid expansion --- right? O-Care attempted to "hide the costs" of those marginally UNqualified for MediCaid by enticing them into the exchanges. In a sense letting the POOL premiums rise to accommodate the larger needs of this segment. It was a brilliant way to "redistribute" the costs of those who just didn't qualify for MediCaid. But sinister.

MediCaid needs to be expanded. But only to those who have legitimate financial need.

Remember -- the ACA tore up the whole fucking system to fix the 9 or 10% of the "uninsured". And it only succeeded in shaving a few percent off that number. And they DID IT by sticking them with AWFUL "bronze" level plans that would bankrupt any "working poor" family if they ever needed to have a substantial claim on the junk..

For MediCaid --- the premiums should never be subsidized. It's the DEDUCTIBLES and any large co-pays that should be subsidized. THAT'S when folks incur real costs. And you drive up ANYTHING by subsidizing it --- like premiums. But if give them a market Catastrophic plan and only subsidize the Out of Pocket costs, --- there will be no mechanism for raising costs on such a small fraction of the pool that actually INCURS the costs of services. In most pools, It's 2 to 4% of the pool that causes 60% of the pay-outs...

 

[EverCurious]

^ This.

Though I see ACA, and even whatever the government spits out next, as nothing but a bandaid on the real problem - the cost of care. We need to look at the underlying issues that drive costs up and at least make an effort to get them under control. So far no one is looking into it, they just blow it off as inflation or the "natural rise" but I don't see it that way. What I see is a complete abandonment of respect for the medical profession in society as a whole - and I relate it to the open and vicious hostility toward the idea of becoming wealthy in this nation, the political blame game by the left, and the resulting failure of schools to pay homage to a once noble profession.

 

[usmbguest5318]

I always have to chuckle when I see people talk about tax breaks to help poor people afford things.

• Look at what the poverty level income is. (Remember those are gross income figures)
• Look at the tax tables to see about how much poor people have to pay in taxes. (Remember, those are taxable income figures; income after all deductions from income.)

Now tell me how much of tax cut can you give them that's going to allow them to afford health insurance? I don't care how much of a tax break you give a poor person. They still ain't affording a damned thing. The tax cut may bring them closer to affording something, but "close to affording" is still not affording. You can't buy something you almost have the money to buy.

 

[fncceo]

How about no features at all. If you want health care, pay for it.

 

[Disir]

Medicaid expansion. Immediately. Some of these people at the very bottom cannot jump through hoops to get what they need. That is going to save a lot of cash in other arenas that people don't take into consideration.

 

[Mac1958]

The replacement should ignore politics (hee hee) and expand the current and successful Medicare/Medicare Advantage/Medicare Supplement system to all. That would:

• Rid us of this absolutely fucking absurd, INEFFICIENT, seven-headed hydra of a delivery/payment "system" (Individual, Group, VA, Medicare, Medicaid, Worker's Comp, Indigent)
• Provide fundamental preventive and diagnostic care for all, so that we can catch problems earlier instead of later and save a great deal of money in the long run
  
• Take a massive cost monkey off the backs of American business by making these plans personal and portable
  
• Take a massive cost monkey off the backs of American insurers by ridding them of the low-end service administration
• Maintain free market competition and innovation through Medicare Advantage and Medicare Supplements
• Open up massive new markets for American insurers
• Create a massive new preventive/diagnostic care center industry so that GP's are not overwhelmed
• Take advantage of an already-functioning and scalable system instead of going back to the fucking drawing board
  
• Make America's seamless, symbiotic, public/private health system the model for the world instead of following others' flawed systems

Just kidding! Our "leaders" don't have the BALLS.
.

 

[martybegan]

The replacement should ignore politics (hee hee) and expand the current and successful Medicare/Medicare Advantage/Medicare Supplement system to all. That would:

• Rid us of this absolutely fucking absurd, seven-headed hydra of a delivery/payment "system" (Individual, Group, VA, Medicare, Medicaid, Worker's Comp, Indigent)
• Provide fundamental preventive and diagnostic care for all, so that we can catch problems earlier instead of later and save a great deal of money in the long run
  
• Take a massive cost monkey off the backs of American business by making these plans personal and portable
  
• Take a massive cost monkey off the backs of American insurers by ridding them of the low-end service administration
• Maintain free market competition and innovation through Medicare Advantage and Medicare Supplements
• Open up massive new markets for American insurers
• Create a massive new preventive/diagnostic care center industry so that GP's are not overwhelmed
• Take advantage of an already-functioning and scalable system instead of going back to the fucking drawing board
  
• Make America's seamless, symbiotic, public/private health system the model for the world instead of following others' flawed systems

Just kidding! Our "leaders" don't have the BALLS.
.

The thing is if you let my company drop my health care, they won't raise my salary to compensate if they are not forced to do so.

Sounds like "single payer but we are not calling it that"

No thank you.

 

[Mac1958]

The replacement should ignore politics (hee hee) and expand the current and successful Medicare/Medicare Advantage/Medicare Supplement system to all. That would:

• Rid us of this absolutely fucking absurd, seven-headed hydra of a delivery/payment "system" (Individual, Group, VA, Medicare, Medicaid, Worker's Comp, Indigent)
• Provide fundamental preventive and diagnostic care for all, so that we can catch problems earlier instead of later and save a great deal of money in the long run
  
• Take a massive cost monkey off the backs of American business by making these plans personal and portable
  
• Take a massive cost monkey off the backs of American insurers by ridding them of the low-end service administration
• Maintain free market competition and innovation through Medicare Advantage and Medicare Supplements
• Open up massive new markets for American insurers
• Create a massive new preventive/diagnostic care center industry so that GP's are not overwhelmed
• Take advantage of an already-functioning and scalable system instead of going back to the fucking drawing board
  
• Make America's seamless, symbiotic, public/private health system the model for the world instead of following others' flawed systems

Just kidding! Our "leaders" don't have the BALLS.
.

The thing is if you let my company drop my health care, they won't raise my salary to compensate if they are not forced to do so.

Sounds like "single payer but we are not calling it that"

No thank you.

We can identify a problem and just give up and throw the whole thing out, or we can work on addressing the problem. That would need to be addressed.

I gave 8 pretty strong positives there. What are your thoughts on them?
.

 

[martybegan]

The replacement should ignore politics (hee hee) and expand the current and successful Medicare/Medicare Advantage/Medicare Supplement system to all. That would:

• Rid us of this absolutely fucking absurd, seven-headed hydra of a delivery/payment "system" (Individual, Group, VA, Medicare, Medicaid, Worker's Comp, Indigent)
• Provide fundamental preventive and diagnostic care for all, so that we can catch problems earlier instead of later and save a great deal of money in the long run
  
• Take a massive cost monkey off the backs of American business by making these plans personal and portable
  
• Take a massive cost monkey off the backs of American insurers by ridding them of the low-end service administration
• Maintain free market competition and innovation through Medicare Advantage and Medicare Supplements
• Open up massive new markets for American insurers
• Create a massive new preventive/diagnostic care center industry so that GP's are not overwhelmed
• Take advantage of an already-functioning and scalable system instead of going back to the fucking drawing board
  
• Make America's seamless, symbiotic, public/private health system the model for the world instead of following others' flawed systems

Just kidding! Our "leaders" don't have the BALLS.
.

The thing is if you let my company drop my health care, they won't raise my salary to compensate if they are not forced to do so.

Sounds like "single payer but we are not calling it that"

No thank you.

We can identify a problem and just give up and throw the whole thing out, or we can work on addressing the problem. That would need to be addressed.

I gave 8 pretty strong positives there. What are your thoughts on them?
.

it all boils down to government running health care at the federal level. If you make it go between States, the States are out of it, and the feds have to run it. I see it as a giant DMV that we all have to be part of. By expanding medicare you just give companies an excuse to dump medical coverage and not compensate us for the loss. You can say "well work somewhere else" but what if a whole industry or sector does it at the same time?

Sooner or later the costs will continue to go up, and then the government will be faced with the issues seen in actual single payer systems, cut services, cut payment to doctors, or raise taxes to pay for it.

 

[JimBowie1958]

I always have to chuckle when I see people talk about tax breaks to help poor people afford things.

• Look at what the poverty level income is. (Remember those are gross income figures)
• Look at the tax tables to see about how much poor people have to pay in taxes. (Remember, those are taxable income figures; income after all deductions from income.)

Now tell me how much of tax cut can you give them that's going to allow them to afford health insurance? I don't care how much of a tax break you give a poor person. They still ain't affording a damned thing. The tax cut may bring them closer to affording something, but "close to affording" is still not affording. You can't buy something you almost have the money to buy.

I always have to chuckle when people dont read the entire OP and then shoot from the lip.

Did you miss this selection on the poll?

Tax deductions combined with welfare assistance to allow poor to afford minimum insurance

 

[Frankeneinstein]

I have read of a number of things people seem to think need keeping from the ACA and more that are needed to make the whole thing be a consumer centered system.

Trump has said he wants a number of features.

First he wants to keep from the ACA the pre-existing condition prohibition, and the 26 year old child ability to remain on his parents insurance.

He also wants to remove all state limits on insurance so that we have true national competition among medical insurance companies.

Now to pay for all that, we had/have the mandatory insurance 'tax' that requires everyone to get insurance and employers to offer insurance to full time employees. Otherwise we will be driving insurance companies out of business.

Perhaps the mandate should include catastrophic coverage policies to let people have a cheap alternative and insurance companies still get the customer base they need to stay in business?

The state insurance pools seemed to allow for the pooling of resources, and might have worked had more healthy people bought in. Should we keep such insurance pools?

Expanded health savings accounts could cover the deductibles, but this doesnt help people who dont have the funds to put money into such an account. What about them?

Decentralize control for Federal government back to states?

What else needs to be a part of the replacement for the ACA?

Medicare expansion? Do we tell people who have it is will no longer be available?

Federal grants of up to $3 billion to help the system get off the ground?

Should we include welfare assistance to those who cannot afford entry level costs? Combine that with a tax deduction for health insurance costs?

JAMA Forum: What Might an ACA Replacement Plan Look Like?

Compare Proposals to Replace The Affordable Care Act

The Project 2017: GOP ACA Replacement They Don't Want You To See

The GOP Obamacare 'Replacement' Has Arrived. Sort Of. | The Huffington Post

I know this isn't going to go over well with some here but...I believe in the end we will end up with a single payer system...there is no other or cheaper way to provide health care for everyone, that aside, there is no reason going to the doctor should be anymore complicated than needing a ride there, over billing is now the norm for doing business and even if that could somehow be fixed healthcare should never be an act of doing business.

 

[aris2chat]

I have read of a number of things people seem to think need keeping from the ACA and more that are needed to make the whole thing be a consumer centered system.

Trump has said he wants a number of features.

First he wants to keep from the ACA the pre-existing condition prohibition, and the 26 year old child ability to remain on his parents insurance.

He also wants to remove all state limits on insurance so that we have true national competition among medical insurance companies.

Now to pay for all that, we had/have the mandatory insurance 'tax' that requires everyone to get insurance and employers to offer insurance to full time employees. Otherwise we will be driving insurance companies out of business.

Perhaps the mandate should include catastrophic coverage policies to let people have a cheap alternative and insurance companies still get the customer base they need to stay in business?

The state insurance pools seemed to allow for the pooling of resources, and might have worked had more healthy people bought in. Should we keep such insurance pools?

Expanded health savings accounts could cover the deductibles, but this doesnt help people who dont have the funds to put money into such an account. What about them?

Decentralize control for Federal government back to states?

What else needs to be a part of the replacement for the ACA?

Medicare expansion? Do we tell people who have it is will no longer be available?

Federal grants of up to $3 billion to help the system get off the ground?

Should we include welfare assistance to those who cannot afford entry level costs? Combine that with a tax deduction for health insurance costs?

JAMA Forum: What Might an ACA Replacement Plan Look Like?

Compare Proposals to Replace The Affordable Care Act

The Project 2017: GOP ACA Replacement They Don't Want You To See

The GOP Obamacare 'Replacement' Has Arrived. Sort Of. | The Huffington Post

The ability to shop for health care, which will in turn lower deductable

Shopping insurance in other states

States will use money in ways that will provide the most coverage for least money for their lower class.

 

[JimBowie1958]

I know this isn't going to go over well with some here but...I believe in the end we will end up with a single payer system...there is no other or cheaper way to provide health care for everyone, that aside, there is no reason going to the doctor should be anymore complicated than needing a ride there, over billing is now the norm for doing business and even if that could somehow be fixed healthcare should never be an act of doing business.

I think that an expansion of Medicaid to help all poor people can accomplish this without the Draconian theft of choice from everyone else that a single payer system would implement.

 

[JimBowie1958]

The ability to shop for health care, which will in turn lower deductable
Shopping insurance in other states
States will use money in ways that will provide the most coverage for least money for their lower class.

You sound like one of those heartless Republicans!

roflmao

 

[blastoff]

I'd start with as little government involvement as possible.

 

[aris2chat]

The ability to shop for health care, which will in turn lower deductable
Shopping insurance in other states
States will use money in ways that will provide the most coverage for least money for their lower class.

You sound like one of those heartless Republicans!

roflmao

depends on the issue

more of a conservative libertarian.

Considering the size of the US and diversity of the population, most issues should be state determination.

The needs of Iowa are not the same as California.

States need to pick up more so the fed can downsize and decrease the debt

 

[WorldWatcher]

>

States can already allow interstate insurance.

http://www.ncsl.org/research/health/out-of-state-health-insurance-purchases.aspx