The GOP Health Plan -or-If You're Not Wealthy You're Screwed

[BoSoxGal]

Paul Ryan is a terrible human being. I'm not going to wish a crippling chronic illness on him or someone he loves, because he has platinum healthcare so it wouldn't really make him suffer as much as he should.

I have zero sympathy that his father died when he was young. And before you all jump down my throats about that - IDGAF.

FYI, for at least a decade before ACA was passed, it was routine for insurance premiums to rise by double digit percentages every year - I worked in nonprofits where the budget was a conversation all employees were engaged in and we dealt with that problem over and over and over; we often agreed to forego salary increases in favor of our employer paying the increases in full. That isn't a problem created by ACA; what needs to happen is serious regulation of the health insurance industry, beyond just the removal of antitrust exemptions.

Or single payer, and put those greedy fuckers out of business altogether.

[Long Run]

From Charlie Pierce:

Paul Ryan said that insurance cannot work if healthy people have to pay more to subsidize the sick.

This is literally how all insurance works.

Actually it is Pierce who apparently has no idea how insurance works. A healthy person should pay less in premiums than an unhealthy person. This is how auto insurance works (bad drivers pay more). This is how fire insurance works (lower cost houses pay less; houses with better fire safety pay less, etc.). This is how life insurance works (people with a shorter life expectancy pay more). And, when the insurance market is allowed to work, this is how health insurance works -- people with a lower cost expectancy pay less, and this is obviously what Ryan was referring to since one of the major flaws of the ACA was the predicted and inevitable "death spiral" on the exchanges that was caused by making healthy people pay too much for their insurance. The one market reform that has been included in the proposed law is that if a person has insurance and then gets sick, they cannot be excluded or rated based on health issues (they would just be rated on their general demographics). This has long been the law for group plans, but needs to be added to the individual market.

[Scooter]

[Econoline]

one of the major flaws of the ACA was the predicted and inevitable "death spiral" on the exchanges that was caused by making healthy people pay too much for their insurance.

The ACA attempted to address this by (1) making coverage mandatory, so that healthy people would be compelled to get covered and expand the pool, thus reducing premiums for everyone; and (2) providing subsidies based on income, so that fewer people would feel that their premiums were "too much". If it didn't work as written, it could have been fixed by adjusting the amount of the non-coverage penalties, or the amount of the subsidies, or both.

Instead, this particular flaw—if it it was indeed a problem—has been made even worse in Ryan's new bill: people will be able to drop out of the market (or just refuse to get coverage in the first place), wait until they get sick enough to really need insurance coverage, and then get insurance for 30% more (for the first year only) than they would have been paying if they'd kept their insurance the whole time. (In other words, if the period they're not insured is less than 2 months or more than 16 months, someone who is young and healthy could save a lot of money by not buying insurance until they actually need it to pay their medical bills—and nothing would prevent them from doing just that.)



ETA: It's somewhat pointless to argue about this, though...Jim is right: this particular bill is going nowhere. And BTW, I think that Jim's "3 suggestions" could be added to the existing ACA as a reasonable compromise....if only there were any enough reasonable Republicans in Congress.

[Econoline]

[Sue U]

Actually it is Pierce who apparently has no idea how insurance works. A healthy person should pay less in premiums than an unhealthy person. This is how auto insurance works (bad drivers pay more). This is how fire insurance works (lower cost houses pay less; houses with better fire safety pay less, etc.). This is how life insurance works (people with a shorter life expectancy pay more). And, when the insurance market is allowed to work, this is how health insurance works -- people with a lower cost expectancy pay less, and this is obviously what Ryan was referring to since one of the major flaws of the ACA was the predicted and inevitable "death spiral" on the exchanges that was caused by making healthy people pay too much for their insurance.

I call bullshit: In fact, health insurance is NOT and SHOULD NOT BE individually rated according to health status of the insured, as such a rating practice entirely defeats the purpose of group health insurance, which is to spread risk across a community of insureds. In the typical employer-sponsored group health plan -- which existed since long before ACA and is still how most people get their coverage -- all employees are assessed the same premium payment regardless of age or health status. (Similarly, the payroll tax for Medicare is at a uniform percentage rate per employee.) As you yourself note:

The one market reform that has been included in the proposed law is that if a person has insurance and then gets sick, they cannot be excluded or rated based on health issues (they would just be rated on their general demographics). This has long been the law for group plans, but needs to be added to the individual market.

Unlike group health, the ACA individual market currently allows a 3:1 premium differential based on age and additional premium charges based on tobacco use. And compared to group coverage, the costs are astronomical (I pay well over $23,000/yr to cover my family of four with a "silver" plan that still has significant deductibles and co-pays before any benefit kicks in). From a risk standpoint, there is absolutely no reason that "individual" coverage cannot be aggregated into a "group" coverage model.

The Republicans will never be able to fix the problems of the ACA without both fundamentally restructuring the entire health insurance market, which is far too fragmented, and controlling the cost drivers for healthcare -- neither of which appear to be anywhere in the alleged "thinking" behind "repeal and replace."

[Long Run]

I call bullshit: In fact, health insurance is NOT and SHOULD NOT BE individually rated according to health status of the insured,

? Before ACA, the individual market rated by the demographic and health of the insured. The ACA turned that on its head which is the main reason the Exchanges are failing. If I am sick and then ask for insurance, I should get rejected or thrown into the high cost pool. Most people would say that is fair. On the other hand, if I dutifully buy health insurance and then get sick, I should be treated on a par with others in the risk pool.

In the group market, ratings factor in demographic information and always have. If my group has a lot of expected high cost individuals, then my group rate is higher, and vice versa. Again, ACA warped this by making healthy groups pay more, but as you note even the ACA allowed age bands in a anti-incentive manner (generally forcing groups to seek out lower and worse coverage options). Instead of having transparent and clear subsidies for higher cost groups and individuals, it has a myriad of hidden subsidies, which has led to the ever more costly policies.

[Scooter]

[rubato]

" ....
I have zero sympathy that his father died when he was young. ... " .

For some people suffering is a way to learn compassion and empathy. For others it is an excuse to be a psychopath .

Don't apologize. If losing his father taught him to be kind to other people he would deserve compassion. It didn't, he doesn't

yrs,
rubato

[rubato]

I call bullshit: In fact, health insurance is NOT and SHOULD NOT BE individually rated according to health status of the insured,

? Before ACA, the individual market rated by the demographic and health of the insured. The ACA turned that on its head which is the main reason the Exchanges are failing. If I am sick and then ask for insurance, I should get rejected or thrown into the high cost pool. Most people would say that is fair. On the other hand, if I dutifully buy health insurance and then get sick, I should be treated on a par with others in the risk pool.

In the group market, ratings factor in demographic information and always have. If my group has a lot of expected high cost individuals, then my group rate is higher, and vice versa. Again, ACA warped this by making healthy groups pay more, but as you note even the ACA allowed age bands in a anti-incentive manner (generally forcing groups to seek out lower and worse coverage options). Instead of having transparent and clear subsidies for higher cost groups and individuals, it has a myriad of hidden subsidies, which has led to the ever more costly policies.

Your argument disappears when the ACA is continued. If EVERYONE is required to have insurance there is no one buying insurance after they are sick.

I have seen no evidence that the exchanges are failing overall. I have seen evidence that Aetna abandoned several markets to try to get by anti-trust scrutiny in a merger they were pursuing.


yrs,
rubato

[Burning Petard]

Please note that the Obama Plan that is about to implode was sabotaged from the very beginning. Only 2/3's of the states fully participated. The others opted out of crucial parts of the program so it was never fully implemented.

One writer in the media pointed out that the Whitehouse is strongly objecting to calling the new program Trumpcare, and that is exactly why it should be called Trumpcare. The president promised us his plan would be wonderful. Keep reminding all those voters who protested the traditional political elite of both parties had abandoned them, just what The President is doing for them now and in the immediate future before the next election cycle.

snailgate

[rubato]

".... The one market reform that has been included in the proposed law is that if a person has insurance and then gets sick, they cannot be excluded or rated based on health issues (they would just be rated on their general demographics). This has long been the law for group plans, but needs to be added to the individual market.

This is what happens, automatically, over time as the ACA is in place.

Otherwise you are saying that all of the people with pre-existing conditions, like being older, like being born with a defective heart valve, like coming down with cancer due to a workplace chemical exposure, who are not in the top 5% in income should be excluded from HC and allowed to die. And in fact this would mean the entire family of the sick person would often be cut off. This is known as the "let them die" approach.




yrs,
rubato

[BoSoxGal]

ACA is not about to implode, in fact it is functioning as designed and functioning well in the states that followed the law in full to include Medicaid expansion. NPR had a great interview with MIT economist Jonathan Gruber just the other day explaining just this - and here is one from last October on Breitbart:

http://www.breitbart.com/video/2016/10/ ... e-penalty/

ACA is totally fixable, but fixing healthcare and providing access to Americans IS NOT the Republican agenda - their agenda is to let people die, by the many thousands every year, for lack of access to affordable healthcare. Those people, and their families, are only pocket change votes compared to the big money interests. It is sickening. Period. If there is a hell, I hope they all go there - and I'm pretty sure they will.

[Scooter]

[Scooter]

There is a certain irony in this:

[BoSoxGal]

Hope all those fuckers are calling and writing to their Congresspeople!

[Econoline]

[rubato]

First the CBO says the bill will take HC away from tens of millions of people and now the OMB (White House) agrees with them:


http://www.politico.com/story/2017/03/o ... use-236019

White House analysis of Obamacare repeal sees even deeper insurance losses than CBO

The executive branch analysis forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimates.

By Paul Demko

03/13/17 09:38 PM EDT

A White House analysis of the GOP plan to repeal and replace Obamacare shows even steeper coverage losses than the projections by the Congressional Budget Office, according to a document viewed by POLITICO on Monday.

The preliminary analysis from the Office of Management and Budget forecast that 26 million people would lose coverage over the next decade, versus the 24 million CBO estimates. The White House has made efforts to discredit the forecasts from the nonpartisan CBO.

White House officials late Monday night disputed that the document is an analysis of the bill’s coverage effects. Instead, they say it was an attempt by the OMB to predict what CBO’s scorekeepers would conclude about the GOP repeal plan.
170313_paul_ryan_kevin_mccarthy_ap_1160.jpg

Congress
GOP scrambles after scorching health bill appraisal

By Kyle Cheney, Burgess Everett and Rachael Bade

“This is not an analysis of the bill in any way whatsoever,” White House Communications Director Michael Dubke told POLITICO. “This is OMB trying to project what CBO’s score will be using CBO’s methodology.”

According to documents viewed by POLITICO, the OMB analysis intended to assess the coverage and spending outcomes of the legislation.

The analysis found that under the American Health Care Act, the coverage losses would include 17 million for Medicaid, 6 million in the individual market and 3 million in employer-based plans.

A total of 54 million individuals would be uninsured in 2026 under the GOP plan, according to this White House analysis. That’s nearly double the number projected under current law.

The White House and congressional Republicans have aggressively sought to undercut the CBO projection by pointing to how far off its coverage estimates for the Affordable Care Act ultimately proved. The nonpartisan budget office predicted that 21 million individuals would gain coverage through the exchange markets in 2016, but only about half that many actually enrolled.

Last week, several Republican senators, expressing doubt about CBO estimates, said OMB was expected to issue its own estimates of the plan.

“We disagree strenuously with the report that was put out,” Health and Human Services Secretary Tom Price told reporters Monday about the CBO after leaving a Cabinet meeting with President Donald Trump at the White House. “It’s just not believable is what we would suggest.” Price, while serving as the House Budget Committee chairman, had a role in appointing the current head of the CBO, a conservative economist.

The House bill was already under attack from very conservative members who wanted it to go further as well as moderates worried about coverage erosion, particularly in Medicaid. The CBO number made the task of passing it even more challenging.

Josh Dawsey contributed to this report.

yrs,
rubato

[Burning Petard]

Long Run is correct..

"Actually it is Pierce who apparently has no idea how insurance works. A healthy person should pay less in premiums than an unhealthy person. This is how auto insurance works (bad drivers pay more). This is how fire insurance works (lower cost houses pay less; houses with better fire safety pay less, etc.). This is how life insurance works (people with a shorter life expectancy pay more). And, when the insurance market is allowed to work, this is how health insurance works -- people with a lower cost expectancy pay less, and this is obviously what Ryan was referring to since one of the major flaws of the ACA was the predicted and inevitable "death spiral" on the exchanges that was caused by making healthy people pay too much for their insurance."

The pitch about pooling risk is what the insurance company spouts when sucking money from those who are unlikely to submit a claim. Meanwhile their actuaries are tediously examining the pool(s) of actual and potential customers to set rates so the amount collected from each individual is most likely to always exceed the amount paid out to that same individual in claims. Wise 'risk managers' from outside the insurance companies go through the same exercise to determine if it is prudent to 'self-insure'.

Trumphcare restores health insurance to the way it is supposed to work--provide comfortable profit to insurance companies.

snailgate

[Econoline]

Is the Republican health plan designed to fail?
.
There’s a theory going around Washington that Republicans don’t want their health bill to pass.

---

Updated by Ezra Klein | @ezraklein | Mar 10, 2017, 1:10pm EST

There is a line worth noting in David Brooks’s column today: “The Republican plan will fuel cynicism. It’s being pushed through in an elitist, anti-democratic, middle of the night rush. It seems purposely designed to fail.”

Quietly, the idea that the House bill is designed to fail is percolating around Washington. I’ve heard it from a half-dozen people now. The law’s construction is shoddy. The outreach has been nonexistent. The hypocritical, hyper-accelerated process is baffling. Nothing about it makes sense.

But if you flip the intention — if you assume Republican leaders want to see a repeal-and-replace bill die in the Senate so they can say they tried and move on to tax reform — all of a sudden, it makes much more sense. It explains why more time wasn’t spent getting the bill right. It explains why they’re going so fast. It explains why they don’t care what the Congressional Budget Office says. It explains why they aren’t doing the outreach that would normally buffer them from this backlash.

Why would they want their own bill to fail? Well, consider the predicament they’re in. Republicans have spent seven years promising to repeal and replace Obamacare. They won election after election atop that vow. But now that they have the power to make good, they’ve run into three problems.

First, Obamacare has become popular. Second, they don’t have an alternative plan that would make good on their promise to provide more people with more generous health care at lower cost. Third, implementing a repeal-and-replace plan — with all the complexity and disruption that entails — will drown the rest of the GOP’s agenda, and perhaps its congressional majority.

Arguably, the best outcome for Republicans is to try to replace Obamacare and fail. And if you believe that’s what they’re doing, much else falls into place.

Take the GOP effort to discredit the Congressional Budget Office’s analysis rather than working with the agency to build a better bill. For that play to work, they need credible, independent validators of their ideas. In 2009, when Democrats wanted to argue that the CBO was underestimating the savings from delivery-system reforms, they pointed to work by Harvard’s David Cutler, among others. The key to their argument was that top health experts disagreed with the CBO, and they made lengthy, plausible arguments explaining why. That’s what this looks like when you’re really trying.

The House GOP isn’t really trying. The conservative intellectual apparatus is overwhelmingly against Ryancare — when you’ve lost Cato and Heritage and AEI and Yuval Levin and Avik Roy and Philip Klein, then discrediting CBO doesn’t come off as CBO is wrong, and here’s a persuasive argument for why; it comes off as we’re wrong, and we’re trying to make sure as few people as possible know it. It’s a flashing signal of weakness.

Nor is it just the conservative intellectual apparatus that is panning Ryancare. It’s also the health care industry. So far, the American Medical Association, the American Hospital Association, the American Nurses Association, AARP, and a host of others have come out against the bill. This is important, because every House member has doctors and nurses and hospitals in their district. It’s a decision that scares legislators rather than comforts them.

Paul Ryan isn’t an amateur. He is, arguably, the most skilled policy entrepreneur of his generation. He is known for winning support from political actors and policy validators who normally reject his brand of conservatism. The backing he’s built for past proposals comes from painstaking work talking to allies, working on plans with them, preparing them for what he’ll release, hearing out their concerns, constructing processes where they feel heard, and so on. He’s good at this kind of thing. But he didn’t put in the work here. And there are consequences to that.

Imagine you’re a backbench Republican House member. You’re a conservative. You didn’t see this bill until Monday. All the think tanks you normally rely on — all the think tanks you normally agree with! — hate it. The hospitals hate it. The doctors hate it. The major conservative activist groups hate it. Your leadership appears afraid of CBO’s analysis — even though they appointed the director of the CBO! Wouldn’t this look a bit weird to you? You want to be a good soldier, of course. Paul Ryan says this is your only chance to repeal and replace Obamacare, and Obamacare is terrible. But you’ve got to be a bit antsy. How much would it take to shake you?

That’s the context in which to read this piece by Yuval Levin, a conservative intellectual who is among the party’s most influential voices on policy. “I suspect that in a week's time its authors will look back fondly on that difficult start as the glorious interlude before the Congressional Budget Office had scored the proposal,” he writes. With a beginning this rocky, it may not take much to scare Republican legislators who are already pretty anxious.

So do I think the GOP plan is built to fail? I don’t. Washington is always more Veep than House of Cards. But I do think Republicans went into this process believing that failure was likely, and so tried to hedge against the consequences by putting hard boundaries around the process. They decided that if they were going to fail at this, they were going to fail fast, over the course of a month or two, not waste a year on the project.

But that decision — and the push for secrecy and mania for speed that have accompanied it — has left Republicans in an indefensible position, and with a very weak bill. In some ways, the scariest outcome for Republicans now isn’t that they fail, as expected, but that they unexpectedly succeed, and have to implement a bill no one really believes will work.