Making the Affordable Care Act go away without a plan…

Healthcare, Observations on life, Politics 9 comments

at the expense of the middle class

9 comments

  2. Perhaps if you explain how the plan is being taken from all but the sicker population, it would help me understand. I have never been involved with ACA since I was on Medicare when all this came about. I understand much of the flap is over subsidies added in 2021.

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    1. Not sure that’s exactly it. What I said was as the cost of ACA insurance rises – the insureds portion – only the sicker people, those needing Medical care will choose to pay higher costs because they know they will use the coverage. Others will not insure. This concentrates high cost users thus starting a spiral of ever higher increasing premiums. Adverse selection. You need a good mix of risks to make insurance viable. As far as the administration is concerned it’s a good way to undermine the ACA and put the blame on insurance companies.

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      1. “Perhaps if you explain how the plan is being taken from all but the sicker population”

        No plan is being taken away from anyone.

        Instead, we are returning to Health Reform/Obamacare/Patient Protection and Affordable Care Act of 2010 (PPACA) design for public exchange coverage with the taxpayer subsidies AS ORIGINALLY DESIGNED.

        What this confirms is what we have always known. Americans want the best health coverage YOUR money will buy. If YOU are not paying for their coverage, as Dick notes, they will waive coverage unless they are relatively confident their costs (or at least their risk of financial loss) will far exceed their premium/contribution.

        What we are talking about is not “the cost of ACA insurance rising”, but the elimination of the extra, super duper, American Rescue Act of 2021 dollop of additional, beyond PPACA subsidies.

        What Dick is confirming is that Health Reform public exchange coverage, as designed by President Obama and the Democrats in the PPACA was always going to be a failure – it promised Americans a lot of stuff (reductions in cost, keep your doctor, keep your plan, and most importantly OTHERS WILL PAY) without any specific revenue generators to cover the cost of those promises!

        Medicare is part of the problem and has been for 40+ years since the introduction of something called Diagnostic Related Groups and Resource Based Relative Value Schedules. Those standards have eroded Medicare reimbursement rates, what is called Medicare Allowable, so that, in 2025, those reimbursement rates are noticeably less than the actual cost to deliver services (about 15% lower than the actual cost, on average). So, to stay in business, providers must charge most everyone else more than the actual cost. In fact, according to a number of Rand studies, employer sponsored plan charges are 250+% of the Medicare Allowable, and ~325% more than Medicaid Allowable.

        “As far as the administration is concerned it’s a good way to undermine the ACA and put the blame on insurance companies.”

        Baloney. The American Rescue Act of 2021, the law that gave us the super duper added dollop of subsidies for those enrolled in Public Exchange coverage, and PPACA itself are SOLELY Democratic designs. No republican voted for either bill. The fault lies solely on the decisions of prior Democratic administrations. Insurers have been integral to PPACA operations from the very first day.

        The PPACA was doomed to ultimate failure on the day it was passed by the Senate – December 24, 2009. It relies on taxpayers picking up the cost to expand access to Medicaid. It relies on taxpayers subsidizing public exchange coverage. However, there was no specific provision in PPACA that generated revenue to cover the added costs.

        So, from day 1, PPACA and the American Rescue Act of 2021 were nothing but Democratic vote buying efforts, using deficit spending, so that they didn’t have to explain the added cost to any current taxpayer.

        Only because no current taxpayer is footing the bill today … that’s the reason why Americans say they like Health Reform.

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      2. It is not bologna at all Jack. The administration knows what will happen when the extra subsidies are gone and that is the end of ACA.

        How and why they or should they have been implemented is not the immediate issue.

        They now present an opportunity to undermine ACA as I said. Its ideology in action pure and simple. Just like replacing it with HSA payments is the ideology of Project 2025.

        Anyone with health insurance experience knew Obamacare could not meet its promises for cost savings, except perhaps for those directly benefiting by going from nothing to coverage. It did however, get millions insured.

        There is no way to cover all Americans without using other people’s (taxpayer) money in some way, you know that well. Just as taxpayer money subsidizes our Medicare Part B premiums.

        All this with no workable viable alternative on the horizon.

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      3. “It is not bologna at all Jack. The administration knows what will happen when the extra subsidies are gone and that is the end of ACA.”

        PPACA Public Exchanges survived from 2014/2015 – 2021 without the extra, super duper, unnecessary, unfunded dollop of subsidies. If they can’t survive without them after 2025, all that confirms is that PPACA is a faulty design and should be eliminated. The fact that the Republicans and Democrats can’t agree, which is NOTHING NEW, means the only option is to continue the status quo.

        “How and why they or should they have been implemented is not the immediate issue.” I agree., However, had there been bipartisan agreement in 2009/2010, instead of President Obama shoving it down Republican’s throats, we would not be where we are today.

        “They now present an opportunity to undermine ACA as I said.” The ACA remains as it was prior to 2022. The ACA is undermining itself. Whether or not that was part of Project 2025, the fact is that the elimination of the super duper subsidies was a Democrat design. Why aren’t you blaming Democrats?

        “Anyone with health insurance experience knew Obamacare could not meet its promises for cost savings” Absolutely, I announced to my family at our 2009 Christmas Eve gathering that PPACA was crap and that it would ultimately fail.

        “There is no way to cover all Americans without using other people’s (taxpayer) money in some way” I don’t look at auto insurance as using other people’s money. That’s because insurance companies can underwrite risks and I don’t end up paying more than I should.

        “All this with no workable viable alternative on the horizon.Why can’t it survive after 2025?” Ask the Democrats why they didn’t make it indefinite if it was so essential to the maintenance of PPACA?

        Clearly, it was never part of PPACA, and was never needed for COVID, either. It was all about buying votes and sending the bill to people too young to vote and generations unborn.

        Notice that the Democrats DID NOT say who they would tax to extend the subsidies – they didn’t suggest that the folks in the public exchange should pay more, did they? No, they are still buying votes.

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      4. Here’s a final comment.

        Question: Why isn’t a risk pool of the 22+ Million Americans in the Public Exchange large enough to be self sustaining?

        Answer: The vast majority of those in the public exchanges ARE NOT in the public exchange insurance risk pool. Who is in the pool? Who is getting soaked? Who is drowning in debt? It is taxpayers, but not today’s taxpayers … it is tomorrow’s taxpayers who will someday have to shoulder the cost of all of the deficit spending by Obama, Trump 1, Biden and Trump 2.

        That is, it is the money of those who are funding the subsidies (future taxpayers) who are actually in the risk pool. They get to pay and THEY GET NOTHING! Vote buying, pure and simple.

        If it were today’s taxpayers, a bill that increased taxes surely wouldn’t get any Republican votes and most Democrats wouldn’t vote for it either – it would be an obvious tax increase that doesn’t benefit those paying the taxes, the 325 MM Americans who do not have public exchange coverage. That would cost current office holders votes. It would crap all over Democrat’s goal of leveraging health care costs to win the midterms and win control over the House – deja vu 2008.

        Not a chance that Democrats would make overt what today is covert, clandestine and surreptitious.

        In fact, if Republicans were smart, they would give the Democrats another vote on a bill that asks everyone in the public exchange to simply pay an added per capita fee to fund a stop loss coverage (for the bad risks in the pool). That would lower the cost of the basic coverage so that limiting PPACA subsidies to pre-2022 levels would result in coverage just as affordable as it was pre-COVID.

        Then, if you limited eligible expenses under stop loss to Medicare Affordable, that would be a per capita monthly cost of perhaps as much as $50, or $600 a year. Interestingly, limiting eligible expenses would surreptitiously shift more cost to current taxpayers who have employer-sponsored coverage … but, the D’s wouldn’t go for that because the incidence (not the impact) would be on public exchange participants.

        There is no chance the Democrats will require the 22+ million in exchange coverage to act as its own risk pool. Maybe the Republicans would?

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