The "Skinny" on the Skinny Healthcare Repeal

Discussion in 'Politics, Religion, Social Issues' started by samcraig, Jul 27, 2017.

  1. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

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    #2
    Without the mandate (which is necessary), the rest collapses in a short amount of time.
     
  2. samcraig thread starter macrumors P6

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    #3
    I'm torn because I think the mandate would need to be truly enforceable and the penalty high enough that it makes sense to get insurance vs pay the penalty. But that really means that plans need to be affordable enough where it's a very simple choice.
     
  3. vipergts2207 macrumors 65816

    vipergts2207

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    #4
    What a country we live in. Initially Republicans promise to implement "fantastic" heathcare with lower premiums. In reality, Republicans may end up passing something that increases healthcare premiums by 20% and potentially crashes the health care system and one fifth of our economy.
     
  4. Rhonindk macrumors 68020

    Rhonindk

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    #5
    Does anyone know what is really in "skinny"? Seeing a lot of "it might be ..." but nothing factual.

    Was just watching Schumer and he is still stuck on "won't help on anything but fix" couched into another seemingly endless variation speech.

    Update: hearing 16 million from CBO would drop? Dems are claiming 20% raise in premiums? What a mess.
     
  5. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

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    The mandate is necessary unless you begin to HEAVILY regulate insurance companies and instill price controls. You cannot ask insurance companies to cover more, keep costs low, and not help them offset it with healthy people in the insurance pool. The penalty for violating the mandate need to be 110% the cost of the cheapest plans yearly premiums.
     
  6. zin macrumors 6502

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    #7
    Nobody should be forced to buy a service from a private company.

    P.S. it's a tax, not a penalty.
     
  7. samcraig thread starter macrumors P6

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    Context matters. I was referring to how the ACA was set up. And a tax can be a penalty.
     
  8. BoxerGT2.5 macrumors 68000

    BoxerGT2.5

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    #9
    Try to get a mortgage without proof of home owners insurance.
     
  9. rjohnstone macrumors 68040

    rjohnstone

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    This was one of my issues with the mandate.
    It was doomed to fail based on the fact that the penalty was capped at such a low level.
    Granted they did that because they knew full well that even with subsidies, some low income families would still choose the low cost penalty over the higher costs insurance plans. Bankrupting low income families with IRS fines would really look bad.
    But the biggest failure of the ACA is it did nothing to control the actual costs of healthcare.
    I'm not against a government offering, however the current law is really unsustainable as written.
    Subsidies were scheduled to scale back and place the financial burden back to the states. Something most states simply cannot afford.
    The CBO has so far been proven to be wrong in their scoring of the ACA.
    They over estimated the participation level of people buying insurance through the exchanges (CBO predicted 23 million, actual is 10.3 million as of 2016). A lot more people simply chose the penalty rather than buy insurance.
    They underestimated Medicaid participation (CBO predicted 10 million, actual as of 2016 is 14.4 million). Medicaid expansion is the part that the states are now on the hook for fully funding as fed subsides trail off.
    A repeal would largely only impact those under Medicaid subsidies according to CBO estimates. But the reality is, states are already worried about future funding of Medicaid at ACA levels.
     
  10. Eraserhead macrumors G4

    Eraserhead

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    #11
    I'm forced to buy buildings insurance and car insurance.
     
  11. oneMadRssn macrumors 68040

    oneMadRssn

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    CBO predicted 23 million by 2026. CBO was only wrong to the extent they were too conservative. We're ahead of schedule.

    I can't find this in the original CBO score of the ACA. Cite?

    The ACA can certainly be improved (increase penalty, increase subsidies, lower bar to subsidy eligibility), but it is overall stable and doing exactly what it was designed to do. Indeed, Trump's own appointee to the Center for Medicare and Medicaid Services put out a report last month that concluded:
    upload_2017-7-27_15-40-19.png
    https://www.cms.gov/CCIIO/Programs-...ds/Summary-Reinsurance-Payments-Risk-2016.pdf

    The “risk score” is a measure of the health status of enrollees. If the exchanges were unstable or unsustainable, the risk scores would be rising fast. They’re not, according to Trump’s own government.

    I would love to have a policy argument about what we can do to make healthcare better, but we have to start from a realistic understanding of the present situation. The ACA is not unsustainable, doomed, or anything like it. The ACA is stable, enrollment is doing a tad worse now that Trump has cut all marketing and community outreach, and it certainly has room for improvement.
     
  12. rjohnstone macrumors 68040

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    Technically you're not.
    You can by a car without insuring it and you can buy a home or building without insuring it.
    Now registering your car would require having insurance or in some states a cash bond in the event of an accident.
    Since driving is a privilege, making insurance mandatory for driving on public roads is reasonable. It's not required if you're on private property.
    Buying a home or building only requires insurance of you're financing it. Pay cash and no insurance is required.
    The bank is imposing the requirement, not the government. They want to protect their investment, because that's exactly what it is to them since they hold the title until full payment is made.
     
  13. Eraserhead macrumors G4

    Eraserhead

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    #14
    To have a decent live if you aren't rich requires car ownership and home ownership with a mortgage.

    And really even if you rent you merely pay buildings insurance indirectly.
     
  14. rjohnstone macrumors 68040

    rjohnstone

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    #15
  15. zin macrumors 6502

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    #16
    Third-party car insurance is compulsory here but I'm not aware that buildings insurance is. Unless it's stipulated in the contract from another company, which is not what we're discussing.

    Again, nobody should be forced to buy something from a private company. You should be free to not buy car insurance. If you get into trouble with your car and your home gets seized to pay for your damages, that was your choice not to buy the insurance. Freedom.

    Same goes for health insurance. IF the insurance is affordable and there is a genuine choice in buying/not buying it, then you should have the freedom to do so.
     
  16. rjohnstone macrumors 68040

    rjohnstone

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    But again... the car insurance is mandated by state laws (New Hampshire and VA do not require it).
    30 states offer the option of a bond in place of car insurance.
    It's not a federal law to have it.

    Home/building insurance is not mandated by law at all. It's a requirement set by the lender.

    That insurance doesn't cover you or any of your losses and the landlord will seek damages from YOU if you're at fault.
    Very few places require renters insurance (which covers YOUR loses and damage to the rental if is your fault).

    The gist of it is the ACA made it mandatory to purchase a product from a non-government entity or pay a penalty.
     
  17. oneMadRssn macrumors 68040

    oneMadRssn

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    #18
    I can't speak as to VA, but NH has a different law that says you are per se financially liable for any harm you cause in a car accident. This, in effect, is why almost everyone who owns their cars still choose to have car insurance.

    Also, would the ACA be any better if the mandate was structured differently? Let's take the 21 drinking age as an example. 21 isn't federal law, but states lose federal highway funding if they don't make their state laws say 21. Would it have been better if the government said it would take away all federal medical funding if states didn't pass a state law imposing a health insurance penalty?

    All of this seems like a distinction without a difference. If the federal government wants something done, it has several ways of doing it. Taxation is one, incentives to the states is another, commerce clause is another, etc.
     
  18. rjohnstone macrumors 68040

    rjohnstone

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    The commerce clause is the reasons you can't shop for insurance across state lines.
    The moment that happens, insurance companies will fall under federal laws instead of state laws.
    While the parent companies for most are national, the actual insuring subsidiary is operated at the state level as an independent entity.
     
  19. BoxerGT2.5, Jul 27, 2017
    Last edited: Jul 27, 2017

    BoxerGT2.5 macrumors 68000

    BoxerGT2.5

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    #20
    So let me get this straight, you want ER's to let patients die on the table when they've made a choice (exercise their freedom) to not buy insurance. Hospitals aren't going to go around seizing property.
     
  20. oneMadRssn macrumors 68040

    oneMadRssn

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    #21
    Ok. So what?
     
  21. MadeTheSwitch macrumors 6502a

    MadeTheSwitch

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    How many people buy a car and only drive it on private property? Precious few I would say. The average person drives their car on public roads.

    That's not freedom. That's freedumb. Kind of silly to be upset about forced insurance paying while being okay with forced home seizure. Really, which one of those two things is the greater impact?
     
  22. samcraig thread starter macrumors P6

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    #23
    It's just about required in an all cash buy. Unless you really want to run the risk (and I'm talking about title insurance) that the title is free and clear. It's a huge gamble for a purchase of that magnitude. But you're right - by law they aren't required to buy it.

    The mandate as we know was very weak. Low penalty - and the only way to collect on those opting out if they didn't pay the penalty was to take money out of taxes. But the issue there is - that only works if there's a tax credit to take out from. It would be interesting (I'm sure it's somewhere) on the total amount paid last year vs amount uncollected vs amount uncollected by received via tax withholdings.
     
  23. zin macrumors 6502

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    #24
    And why should people not have the freedom to make that choice? Because you say so? If somebody makes that choice to not buy the insurance, they do so knowing full well that it might come back to bite them. You don't have a right to force them to buy the insurance from a private company just because you think it'd be stupid not to buy it.
     
  24. MadeTheSwitch macrumors 6502a

    MadeTheSwitch

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    #25
    You haven't answered my basic question. Why is forcing one thing bad, but forcing another thing is acceptable?
     

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