ACA, do we want it gone?

[Tim]

@Bmac,
“How can we consider ourselves a great and humane country if we don’t care for all our citizens?”

With all due respect, quoting you out of context is not fair. That is the most blatant argument for pure unadulterated socialism I have ever seen. Equal results are the foundation of your logic. I apologize, it’s one solution. I simply disagree with the solution of wealth redistribution to be “great and humane”.

[Lordosis]

G wrote:

“Would the 3.8% tax on cap gains go too?”

I laughed out loud at that one.

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Just like fat cells once created they never go away.

[spiritrider]

Emilyjane wrote:

As a 62 year old retired physician, hx of breast cancer, it is terrifying that the administration wants to get rid of pre-existing condition coverage.

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The problem isn't with covering pre-existing conditions. It is the vast numbers of people who are gaming the system by not getting coverage until they need it, including coverage for pre-existing conditions. The mandate never had any practical effect on this.

The way pre-existing conditions were treated before ACA (except for some states) was criminal. The two biggest problems were the ability for insurers drastically raise rates or deny renewal.

A middle ground could exist where individual would have to pay more for new coverage with pre-existing conditions (maybe 2X), but renewal was guaranteed. This would provide more incentive for people obtain coverage before they absolutely needed it and if they don't their loss. To my knowledge they have not proposed getting rid of coverage for pre-existing conditions, just the current free-for-all coverage.

The ACA was a delusion that everybody would obtain coverage and have the young people subsidize the old. The bottom line is understanding how insurance works. For any insurance system to be workable it has to have sound actuarial basis and a sufficient pool of healthy people paying for a smaller number of intermittent unhealthy people.

[burritos]

wideopenspaces wrote:

I don’t. It allowed a lot more people to get insurance, it covers pre existing conditions and covered mental health. A lot of my patients have benefited from it.

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Is it insurance? I think it's more like groupon for medical care.

[IntensiveCareBear]

I try not to fuss over things which I have no control. ACA and anything else they come up with is just tilting to socialized medicine. It is not "if" but when.

...We all know it's "your body, your responsibility" at the end of the day. The answer was, and is, better health and nutritional education.

Health care costs too much because people expect too much. Many expect too much because their insurance costs so much. For others, it is entitlement or boredom or weakness or who knows what that drives them to seek excess care or workups. Everyone wants the million dollar workup, and nobody wants to pay for it. Most cannot pay, yet still feel entitled.

Docs and hospitals clearly don't help since they are driven for profits... more diagnoses and more meds and tests means more income. Consider how you treat patients at a charity or mission clinic versus how you treat them in the hospital office... night and day difference. Docs want the million dollar workup since their private practice or hospital RVU bean counters are promising them more gold pieces for doing it.

If the patients are educated and self pay, they are logical and frugal. If the docs and hospitals are ethical and not in so much debt and not so afraid of malpractice... they don't over-diagnose and over-test so badly. But that is just not reality. It hasn't been for awhile.

The moral of the story is take care of your body, learn how to have it run optimally, and spend your health care money (shouldn't need to spend much!) like it is really your own money. "Health is the first wealth." There are ways to live free in an unfree world. I'm just glad the tax penalty for not carrying health insurance is gone; that was a crock. GL

[Hatton]

My problem with the ACA is that it really does not help the middle class.  The truly poor can get medicaid.  The next rung of people get an ACA subsidy then the next rung is hosed.  If you look at the premiums and deductibles even I a relatively healthy near-retiree cringe at the cost.  The entire health care system is out of control.  Actually look at some EOBs.

[Larry Ragman]

There are two different issues being conflated here. The first is whether or not the courts will find it unconstitutional. If they do (and they might based on sebilius, the legislative intent, and the new position taken by the Administration) then all the features should go, including coverage for existing conditions, coverage for children until age 26, NIIT, etc. Why? The law says in plain text several times that each part, including the mandate, is unseverable. Chief Justice Roberts sided with the liberal justices by declaring the mandate a tax. Now that it is not, there is no precedent for Congress requiring citizens to purchase a private good.

The second issue is the merits of the features listed above, plus Medicaid expansion. I suspect some states will keep them, some not. It is much less clear to me that Congress will pass a new law, but I suspect yes. The Republicans will not want to defend killing the law with no replacement for the popular features. Nothing will change immediately because the policies and state Medicaid coverage already exist. And nothing prevents the insurance companies from offering the policies as is, though the cost likely goes up.

[Dreamgiver]

How about the 2.9% medicare surtax on income above FICA limits, would that go away too?

[Larry Ragman]

Yes, if the law is struck down in its entirety, which is what the district court did. Currently on appeal to the 5th circuit court of appeals

[Larry Ragman]

Although isn’t it 3.8% NIIT and 0.9 Medicare surtax?

[spiritrider]

Larry Ragman wrote:

Although isn’t it 3.8% NIIT and 0.9 Medicare surtax?

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Correct. While there is a Social Security maximum wage base (2019 = $132,900), the 1.45% employee/employer FICA taxes and 2.9% SE taxes have been unlimited since 1994.

[adventure]

spiritrider wrote:

We can debate what that replacement might look like, but I’m guessing we would have as much trouble coming to a consensus as the politicians do. We all come from our own set of life experiences and biases.

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I agree. This will be tough. Sure, all the politicians will "build something better", but that's the tricky bit (and getting consensus too!).

[scottvoiers]

Some of the comments in here are unreal, especially coming from physicians. Vouching for coverage for pre-existing conditions? Do you realize that by definition, insurance cannot possibly cover pre-existing? If you want that so badly, just call it what it is; fleecing the American people to cover the health expenses of complete strangers. This is what charity, church, and community organizations are for. Not the federal government.

[SWEng]

scottvoiers wrote:

Some of the comments in here are unreal, especially coming from physicians. Vouching for coverage for pre-existing conditions? Do you realize that by definition, insurance cannot possibly cover pre-existing? If you want that so badly, just call it what it is; fleecing the American people to cover the health expenses of complete strangers. This is what charity, church, and community organizations are for. Not the federal government.

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No, this is unreal. Do you realize that by definition insurance companies pool clients' risks?

[Anne]

By definition, someone using a non-dictionary definition of a word to support their opinion, is called an opinion.

My opinion, as a physician, is that being diagnosed with type 1 diabetes as a 7 yr old makes life difficult enough, it shouldn't also screw you over in terms of getting insurance coverage the rest of your life.

My opinion is also that the role of government is to ensure a safe and functioning society for its citizens.

Healthcare is a mess, that's for sure. I'm not sure what the right answer is. But if this were a MC quiz, I know I could rule out "C: rely on church and charity" before considering the other options