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Post by morecoffeeplease on Jun 8, 2017 19:13:59 GMT -6
Actions/facts/ thoughts on the ACA replacement.
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Post by morecoffeeplease on Jun 8, 2017 19:16:18 GMT -6
Paging athn64 and others with Dem Senators. I like Topher's idea.
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athn64
Ruby
Posts: 17,426 Likes: 76,773
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Post by athn64 on Jun 8, 2017 19:16:54 GMT -6
Paging athn64 and others with Dem Senators. I like Topher's idea. This is a good start. thanks.
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kitchen
Gold
Posts: 928 Likes: 4,667
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Post by kitchen on Jun 8, 2017 19:32:02 GMT -6
Repeal and replace!
(with single payer)
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LED
Gold
┌∩┐(◣_◢)┌∩┐
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Post by LED on Jun 8, 2017 19:42:16 GMT -6
How does the per person cap work? What does that mean?
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Post by Deleted on Jun 8, 2017 19:59:28 GMT -6
How does the per person cap work? What does that mean? My understanding is that right now if people are eligible for Medicaid, the fed govt matches the state govt spending whatever it may be. (Not necessarily dollar to dollar but some formula.) This would institute a per capita cap on what the fed govt will contribute (despite the fact that older or disabled people on Medicaid could likely cost more than the per person cap). So then it would be up to the state to make up the difference or adjust their eligibility requirements when they can't afford it.
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Post by Deleted on Jun 8, 2017 20:03:05 GMT -6
I am feeling really depressed about this. I think that lengthening the Medicaid phase-out to 7 years is going to be enough for these "moderate" GOP Senators.
The only hiccup would be that means they need more $ so they'd need to keep some of the taxes for awhile. The Freedom Caucus might not like that but my guess is they'll roll over. The GOP all really want a "win" after all this Russia-Trump stuff.
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Post by morecoffeeplease on Jun 8, 2017 20:15:25 GMT -6
This is terrible, from HuffPo. basically the 7 year timeframe is not entirely legit m.huffpost.com/us/entry/us_5939be88e4b0b13f2c689ede/amp"Portman has described the proposal as offering a “significant glide path,” as if slowing down the withdrawal of federal funds represents a major change to the House bill. But a handful of states have “trigger” provisions in the legislation authorizing Medicaid expansion in which eligibility reverts to pre-expansion levels as soon as they stop receiving that extra money from Washington."
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Post by Cnon on Jun 8, 2017 20:19:29 GMT -6
Repeal and replace! (with single payer) Sounds cool. how are we paying for that; which taxes should be raised?
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athn64
Ruby
Posts: 17,426 Likes: 76,773
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Post by athn64 on Jun 8, 2017 20:23:38 GMT -6
I am feeling really depressed about this. I think that lengthening the Medicaid phase-out to 7 years is going to be enough for these "moderate" GOP Senators. The only hiccup would be that means they need more $ so they'd need to keep some of the taxes for awhile. The Freedom Caucus might not like that but my guess is they'll roll over. The GOP all really want a "win" after all this Russia-Trump stuff. This whole thing is despicable. They don't give a shit about the American people.
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kitchen
Gold
Posts: 928 Likes: 4,667
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Post by kitchen on Jun 8, 2017 20:26:39 GMT -6
Repeal and replace! (with single payer) Sounds cool. how are we paying for that; which taxes should be raised? Combo of tax increases and cost savings from efficiency. Tax increases that are (IMO) obvious: -Tax capital gains as income -increase higher income bracket tax rates, significantly at the highest incomes -Fix estate tax (i.e. no reason why people need to inherit bucket tons of money without paying taxes) Those would be coupled with modest across the board income tax increases. So basically what Bernie said?
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athn64
Ruby
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Post by athn64 on Jun 8, 2017 20:27:49 GMT -6
Honestly, I could afford to pay into single payer if I no longer had to pay over $5000 a year in premiums.
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kitchen
Gold
Posts: 928 Likes: 4,667
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Post by kitchen on Jun 8, 2017 20:32:31 GMT -6
Honestly, I could afford to pay into single payer if I no longer had to pay over $5000 a year in premiums. Yup.
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LED
Gold
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Post by LED on Jun 8, 2017 20:39:54 GMT -6
I've been taking a tiny bit of solace in the fact that they haven't really been attacking Medicare too much. But now everything I'm seeing about dual eligibles has me freaking out again.
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kitchen
Gold
Posts: 928 Likes: 4,667
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Post by kitchen on Jun 8, 2017 20:47:23 GMT -6
I'm having a lot of angst about the following: I believe that saving the ACA is incredibly important. I also believe that the ACA is a shitty solution. I wonder if things have to get worse before they get better? It fucking sucks that so many people will die while bankrupting their families in the meantime? That feels like such a cynical analysis though. Surely 21st century America is better than that?
Blergh.
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mowkey
Bronze
Posts: 145 Likes: 923
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Post by mowkey on Jun 8, 2017 20:50:06 GMT -6
I dont know why they can't start with pricing schedules a la Medicare/Medicaid. Please don't tell me a vaginal delivery and 2 day hospital stay should be billed at $25k-$40k. Medicaid pays something like $9k-$18k. Even though ultimately the insurance companies don't pay $40k why conflate it? Just set the prices and raise them on a fixed schedule. Same with Rx. If Merck doesn't like it they can fuck off.
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Post by Deleted on Jun 8, 2017 21:07:03 GMT -6
Honestly, I could afford to pay into single payer if I no longer had to pay over $5000 a year in premiums. Not being snarky, but won't you be paying that 5k in taxes vs premiums?
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athn64
Ruby
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Post by athn64 on Jun 8, 2017 21:13:21 GMT -6
Honestly, I could afford to pay into single payer if I no longer had to pay over $5000 a year in premiums. Not being snarky, but won't you be paying that 5k in taxes vs premiums? No. If you look at the tax increase, it'd be about 2.2% of our income. Currently, with the added deductable and other costs, we pay over 10%.
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mowkey
Bronze
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Post by mowkey on Jun 8, 2017 21:19:38 GMT -6
Also what we pay in coinsurance and deductibles. Only big health things I've ever had (thankfully) are my kids. I work for a huge global company with average to better insurance and I had to pay thousands for both my pregnancies. My husband needs a scope done but it's $4000 out of pocket for his insurance.
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Post by Deleted on Jun 8, 2017 21:29:26 GMT -6
Also what we pay in coinsurance and deductibles. Only big health things I've ever had (thankfully) are my kids. I work for a huge global company with average to better insurance and I had to pay thousands for both my pregnancies. My husband needs a scope done but it's $4000 out of pocket for his insurance. I've met my family 10-13k deductible the past 3 years due to unfortunate circumstances (baby, child needed tonsils out, another baby). My husband needs surgery but the 5k is a reason we are trying to it off as long as we can. We want another baby, but we can't do the 13k. We have paid roughly $700-$875 a month for the privilege of paying that high deductible. We have spent almost $48k in the past 4 years on health and dental deductibles. This can not continue. The current system is going to crush the middle class.
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Post by Deleted on Jun 8, 2017 22:51:21 GMT -6
I dont know why they can't start with pricing schedules a la Medicare/Medicaid. Please don't tell me a vaginal delivery and 2 day hospital stay should be billed at $25k-$40k. Medicaid pays something like $9k-$18k. Even though ultimately the insurance companies don't pay $40k why conflate it? Just set the prices and raise them on a fixed schedule. Same with Rx. If Merck doesn't like it they can fuck off. What pricing schedules do you mean? There is already a few schedule for Medicare and Medicaid (varies by state). Hospitals are paid about 35 cents for every dollar billed to Medicare and 11 cents for every dollar billed to Medicaid (in my state). Also, most hospitals have a limit on how much they can raise prices per year because it is in their contracts with insurance companies and they have to charge the same across the board. There can certainly be more done on that front, but charges don't really affect the cost curve like they do in a "regular" industry.
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Post by Deleted on Jun 8, 2017 22:59:23 GMT -6
I'm pretty upset by all this.
The ACA is not perfect, but it is something that needs to be fixed, not canned. It has a lot of important parts and the basis is solid. Sure I would prefer single payer, but that seems like such a long shot in our country. So, finding a way to get insurance companies to provide coverage through exchanges is a really good solution. I'm in a state where the exchanges are working reasonably well (sure there are some issues) and I've seen many patients getting life saving care on ACA plans and Medicaid. I just hate to think what will happen if this passes.
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Post by oreobitsy on Jun 8, 2017 23:29:31 GMT -6
I dont know why they can't start with pricing schedules a la Medicare/Medicaid. Please don't tell me a vaginal delivery and 2 day hospital stay should be billed at $25k-$40k. Medicaid pays something like $9k-$18k. Even though ultimately the insurance companies don't pay $40k why conflate it? Just set the prices and raise them on a fixed schedule. Same with Rx. If Merck doesn't like it they can fuck off. What pricing schedules do you mean? There is already a few schedule for Medicare and Medicaid (varies by state). Hospitals are paid about 35 cents for every dollar billed to Medicare and 11 cents for every dollar billed to Medicaid (in my state). Also, most hospitals have a limit on how much they can raise prices per year because it is in their contracts with insurance companies and they have to charge the same across the board. There can certainly be more done on that front, but charges don't really affect the cost curve like they do in a "regular" industry. Thanks for explaining this, @juliagulia. I wish I understood the various ways insurance/Medicaid/Medicare/no insurance all work currently, but it is like my krytonite. I have a child who had a major medical diagnosis two years ago. When I see the breakdown of discounts or costs on bills, it can be really frustrating to see how arbitrary the discounts look on bills.
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mowkey
Bronze
Posts: 145 Likes: 923
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Post by mowkey on Jun 9, 2017 5:49:34 GMT -6
I dont know why they can't start with pricing schedules a la Medicare/Medicaid. Please don't tell me a vaginal delivery and 2 day hospital stay should be billed at $25k-$40k. Medicaid pays something like $9k-$18k. Even though ultimately the insurance companies don't pay $40k why conflate it? Just set the prices and raise them on a fixed schedule. Same with Rx. If Merck doesn't like it they can fuck off. What pricing schedules do you mean? There is already a few schedule for Medicare and Medicaid (varies by state). Hospitals are paid about 35 cents for every dollar billed to Medicare and 11 cents for every dollar billed to Medicaid (in my state). Also, most hospitals have a limit on how much they can raise prices per year because it is in their contracts with insurance companies and they have to charge the same across the board. There can certainly be more done on that front, but charges don't really affect the cost curve like they do in a "regular" industry. I think I kinda meant since the pricing is there for medicare/medicaid, why isn't that the pricing across the board? I think I read somewhere that the cost of pregnancy/delivery in the US has tripled since the late 90's. Whether they are actually collecting more or just billing more I don't know.
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danib
Sapphire
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Post by danib on Jun 9, 2017 5:57:30 GMT -6
Not being snarky, but won't you be paying that 5k in taxes vs premiums? No. If you look at the tax increase, it'd be about 2.2% of our income. Currently, with the added deductable and other costs, we pay over 10%. Yes, it's not just your premiums, but your deductables etc as well. @kokopelli Im Canadian so I suppose biased here. But my most recent (high risk) pregnancy required 27 ultrasounds, monthly bloodwork, bi-weekly doctor visits, 6 non-stress tests, vaginal delivery with epidural, and a 6 day hospital stay for me and babe (including baby needing blood work, EKG and ultrasound, and 2 days under the lights for jaundice). It cost me nothing. Zero dollars. Our system isn't perfect, but it's worth it when you need it.
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amylou
Bronze
Posts: 239 Likes: 897
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Post by amylou on Jun 9, 2017 6:26:32 GMT -6
Yes, we need to look at the rising cost of insurance, but what I think is often left out of the conversations is the rising cost heath care itself. For example, when I got my itemized bill after my daughters birth there was a charge for $200 for ibuprofen. Things like the outrageous cost of Epipens now also come to mind. It not only drugs cost that seems outrageously inflated it is also the cost of some procedures and other healthcare services. This article is a little older but made a few interesting points: www.forbes.com/sites/chrisconover/2012/12/22/the-cost-of-health-care-1958-vs-2012/#128ab6594910Obviously advances in technology and convenience drive up the price as well, but that does not explain why the cost of healthcare quadrupled.
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Post by dreadpirateroberts on Jun 9, 2017 6:31:42 GMT -6
What pricing schedules do you mean? There is already a few schedule for Medicare and Medicaid (varies by state). Hospitals are paid about 35 cents for every dollar billed to Medicare and 11 cents for every dollar billed to Medicaid (in my state). Also, most hospitals have a limit on how much they can raise prices per year because it is in their contracts with insurance companies and they have to charge the same across the board. There can certainly be more done on that front, but charges don't really affect the cost curve like they do in a "regular" industry. I think I kinda meant since the pricing is there for medicare/medicaid, why isn't that the pricing across the board? I think I read somewhere that the cost of pregnancy/delivery in the US has tripled since the late 90's. Whether they are actually collecting more or just billing more I don't know. Yeah I don't really understand why different people/insurance are charged different amounts. I mean when I go to target it doesn't cost different depending on which credit card I use. I know insurance companies negotiate for the cost but I think that's so stupid. It should be one price whether your insurance or Medicare/Medicaid is paying or you are paying OOP.
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Post by Deleted on Jun 9, 2017 6:43:38 GMT -6
I would speculate that part of the reason healthcare costs have spiked is because the inclusion of preexisting conditions and 100% covered preventative care. Insurance companies have to recoup those costs somewhere.
Also go ask your local hospital/Dr office how much they had to spend on electronic medical records and implementation. It is shocking how many millions hospitals have to spend on it. Most hospitals are non profit but they still should be breaking even or making a profit to reinvest in new equipment. EMR added to the payroll and budget but aren't necessarily brining in any more money.
Also why can we not drop the 26 year old provision that adds a huge cost? Fix the college education system (which would benefit more than healthcare) and focus on a strong economy where people have jobs that pay more than minimum wage. Spending money on social and economic problems have more benefits than simply spending money on healthcare.
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Post by Deleted on Jun 9, 2017 6:58:05 GMT -6
I think I kinda meant since the pricing is there for medicare/medicaid, why isn't that the pricing across the board? I think I read somewhere that the cost of pregnancy/delivery in the US has tripled since the late 90's. Whether they are actually collecting more or just billing more I don't know. Yeah I don't really understand why different people/insurance are charged different amounts. I mean when I go to target it doesn't cost different depending on which credit card I use. I know insurance companies negotiate for the cost but I think that's so stupid. It should be one price whether your insurance or Medicare/Medicaid is paying or you are paying OOP. Not only do insurance companies negotiate but physicians can't compare what they get paid by who. So it is all secret. There needs to be transparency
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Post by Deleted on Jun 9, 2017 7:14:47 GMT -6
I think I kinda meant since the pricing is there for medicare/medicaid, why isn't that the pricing across the board? I think I read somewhere that the cost of pregnancy/delivery in the US has tripled since the late 90's. Whether they are actually collecting more or just billing more I don't know. Yeah I don't really understand why different people/insurance are charged different amounts. I mean when I go to target it doesn't cost different depending on which credit card I use. I know insurance companies negotiate for the cost but I think that's so stupid. It should be one price whether your insurance or Medicare/Medicaid is paying or you are paying OOP. Just to be clear pricing/charges is the same across the board (for each provider), but payment is what differs between payors. I have a tl;dr in my head on quick and dirty provider financing if people are interested. I just need to get to work and put my feet up first. 😉
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