For shame, Speaker Ryan. For shame!
49
This is the real class warfare. The rich helping themselves.
75
The "standard" package of benefits can and should be changed through regulation, just as they were created by the Obama administration.
6
Ryan must have figured out how to hypnotize the populace into voting Republican in the 2018 midterms, since we're not likely to develop collective amnesia.
34
One more time around the gooseberry bush...
True enough, managing the subsidies was one of the weaknesses of the Obama plan. However the biggest weakness is that it didn't provide any way to get the insurance companies out of the equation. Until we do that, it is a gyp.
True enough, managing the subsidies was one of the weaknesses of the Obama plan. However the biggest weakness is that it didn't provide any way to get the insurance companies out of the equation. Until we do that, it is a gyp.
41
Of course there are some fundamental problems in the author's logic which assumes that the government should use its laws, fines and taxes to make rich people give poor people money (because rich people *should* give poor people money).
However, the biggest problem is the assumption that the tax credit she describes would unfairly favor the elderly and rich.
The purpose of the increased rate for older taxpayers is simple and based on facts: older people have more chronic health conditions, are likely to spend more on healthcare and any insurance that covers those costs will cost more.
However, the biggest problem is the assumption that the tax credit she describes would unfairly favor the elderly and rich.
The purpose of the increased rate for older taxpayers is simple and based on facts: older people have more chronic health conditions, are likely to spend more on healthcare and any insurance that covers those costs will cost more.
8
Sure, let's put more money aside out of our high salaries that are already stretched to the breaking point whether we're married, with kids, without kids, single, young, middle aged, or older. After all, we've all got money trees in our backyards or, if we don't have a backyard we rent space to grow food. It's easy, just plant a dollar and watch it grow.
Why is it so difficult for our elected officials to understand that what Americans need is a health CARE system, not a wealth care system, and not a health insurance system? Having health insurance no longer guarantees us access to the care we need when we need it or close to where we live. We have a jury rigged system that doesn't satisfy the needs of the patients, their families, or physicians. The only people who are happy are the CEOs in the health care industry.
Why is it so difficult for our elected officials to understand that what Americans need is a health CARE system, not a wealth care system, and not a health insurance system? Having health insurance no longer guarantees us access to the care we need when we need it or close to where we live. We have a jury rigged system that doesn't satisfy the needs of the patients, their families, or physicians. The only people who are happy are the CEOs in the health care industry.
127
Hey Trump,
I know you're reading this. You claim you're a good person. What part of taking insurance away from people is good?
That's what this is doing. You're not a good person, and more people will hate you as a result - including many of your supporters who will lose coverage.
I know you're reading this. You claim you're a good person. What part of taking insurance away from people is good?
That's what this is doing. You're not a good person, and more people will hate you as a result - including many of your supporters who will lose coverage.
55
Pigs.
61
What else could you expect from the republicans? The rich will get richer. The republicans keep talking about expanding medical savings accounts -- well, how many can afford to save 20 or 30 thousand dollars a year into their medical savings account? I submit very few middle class individuals. With the cost of medical procedures, one procedure can cost 25 or 30 thousand dollars -- Way to go voters -- you put Trump into office, now you have to live with the consequences. It will be interesting to see what the republicans come up with for a plan -- they are finding it much harder to repeal than they thought, and opposition to it seems to be growing.
What these bozos in Congress should do is come together in a bi-partisian group and come up with a workable compromised plan that will benefit everyone -- but alas they will never do it, and the American citizen will be the ones to suffer.
What these bozos in Congress should do is come together in a bi-partisian group and come up with a workable compromised plan that will benefit everyone -- but alas they will never do it, and the American citizen will be the ones to suffer.
57
"Medicare for all."
That's all there is to say.
That's all there is to say.
101
Once again Republicans prove their motto: We'll make it better to be rich, as if being rich weren't enough in the first place. Not easier to be comfortable, but better to be rich.
32
The rich get richer - the poor get sicker - and we get stuck with the bill.
How do YOU spell GOP?
How do YOU spell GOP?
44
First of all it is NOT the job of government to redistribute wealth. We are a Constitutional Republic and NOT a Democracy. Secondly, health care is NOT a right. Since when does anyone have the right to the labor of another. Lastly, if we had a true free market competition would drive prices down. Forcing people to buy and subsidize insurance of any kind for others is unconstitutional. The Republicans are no better than the Democrats. It matters not which party is in office the end result is always the same, bigger government. Government subsidies benefit "insiders" to the detriment of the rest of the citizenry.
12
May the blood of your fellow citizens fall upon your head, and may their suffering weigh on your conscience for now and eternity. For there will be blood and death as the result of withdrawing medical care from the poor. "Since when does anyone have the right to the labor of another" you ask. Since when does anyone have the right to be alive period? We are all here on the face of this earth together and we had better care for each other. Collecting taxes and using the money for humanitarian purposes is simply an efficient way for the citizens of a nation to care for each other. Private charity, while wonderful, is scattershot and unreliable.
131
That free market didn't do a very good job of keeping down prices before the ACA. That's what made it necessary. But then, if the market were truly free, we could buy our drugs in Canada. But no, that would cut into drug company profits.
Every reasonable government since the ancient Greeks has had to deal with the dilemma of wealth concentration vs. social disorder. Let it go too far in either direction and you get a failed state. It's a balancing act between rights of ownership and keeping a reasonable society.
The government takes and redistributes money to make roads, schools, the police and fire departments, and the military, not to mention the government itself.
Every reasonable government since the ancient Greeks has had to deal with the dilemma of wealth concentration vs. social disorder. Let it go too far in either direction and you get a failed state. It's a balancing act between rights of ownership and keeping a reasonable society.
The government takes and redistributes money to make roads, schools, the police and fire departments, and the military, not to mention the government itself.
78
Or perhaps the federal government might research better more cost effective process for health care and its delivery. Plenty of messes there.
13
If this is such a good plan, the entire Congress should only have access to this plan and no other. They are extremely cavalier with other people's lives, time for then to join the masses.
69
Great idea! Let them test it out for, oh, about ten years or so, and get back to us.
29
I've said it before and I'll say it again: We can rant and rave all we want about how Trump is a nutjob who duped his supporters, but most things that he has done (the Muslim ban, immigration enforcement, relaxing environmental and financial regulations) do not affect them. However, they cannot ignore lower bank accounts and higher bills. We are past the era of "Obamacare" and what healthcare now becomes will be dubbed "Trumpcare." When the rural working-class whites get hit with higher bills and less coverage, Republicans will have nowhere to hide, since they control both the executive and the legislative branches. This, more than anything else, will turn Trump's supporters against him. I wouldn't want to be a Republican headed for Congressional recess next week...
51
It's all about the proliferation of fake news. Whenever consideration is given to let working people keep more of their money (tax cuts) the alt left spins it into stealing from the poor and giving to the rich.
9
All Republican proposals are designed to redirect money from the poor to the rich.
52
What will happen if the do-nothing Congress does nothing for a year or more? Just let Obamacare go on as is.
Enforcement for the young to sign up has ceased. So, the economics will drop further. More insurers drop out.
I worry about the state of healthcare for the poor if no deal is reached.
Enforcement for the young to sign up has ceased. So, the economics will drop further. More insurers drop out.
I worry about the state of healthcare for the poor if no deal is reached.
12
In his ACA Repeal Plan, the House Speaker references the failed history of state high-risk pools. He pushes for them with a new name: 'State Innovation Grants. To rebut critics of this resurrection, PR (love those initials) says, and I quote: "why would anyone allow them to potentially harm the very patients they are intended to help?"
Now he's taking us for naive, stupid, clueless...any other descriptors?
After 4 brain surgeries in 4 years, I count on ACA to live. My next brain scan is in April. Will it be my last -- because I can't afford one next year or because I die without one? Such are the life-or-death decisions those of us living in the Real World must answer.
Now he's taking us for naive, stupid, clueless...any other descriptors?
After 4 brain surgeries in 4 years, I count on ACA to live. My next brain scan is in April. Will it be my last -- because I can't afford one next year or because I die without one? Such are the life-or-death decisions those of us living in the Real World must answer.
59
What about pre-existing conditions?
27
I have an adult daughter with multiple special needs that lives with chronic pain.... she has Medicaid. Tax credits will not help her because she is unable to work & therefore does not pay income tax. Maybe Paul Ryan will be able to take care of her for me? Or maybe the pro-life party could introduce a bill for mercy killing.... because she suffers in pain & the only reason she is able to live somewhat comfortably is through the coordinated effort of her many specialists. Without this care, I shudder to think of what her life will be like.
These people are absolutely heartless.
These people are absolutely heartless.
84
This proposal, if enacted, will disproportionately hurt voters who naively turned to Trump as the savior for their persistent economic struggles. Rational voters, on the other hand, are not at all surprised.
42
Well the Conservative government in the UK have been putting similar legislation in place for years. They try to find as many ways as they can to make the rich richer and the poor poorer! Welcome to a conservative west.
16
Everything which is not a redistribution scheme is "giving money from the poor to the rich"! Come on! Even the NYT should do better! It might be a better idea to wait until real proposals are put forward and then you can start complaining. Insurance companies - the main beneficiaries of Obamacare - are rushing to the exit. Obamacare is not working as it is and needs to be be scrapped or at least changed. Try to leave politics aside for a moment and, who knows, we might come up with something that might work.
11
"Leave politics aside"? Hard to do when Republicans purposely defunded the risk corridors that were meant to stabilize premiums and insulate the insurance companies -- just in time to jack up those premiums before the elections.
Do you think that was a coincidence?
Do you think that was a coincidence?
29
What cannot be lost here is that Congress and the President works for us...the taxpayer!
Anyone that supports this plan needs to be held accountable and voted out of office as soon as possible.
The GOP counts on a public that thrives on low information and apathy. Do not stand by while republicans make decisions that negatively impact this country and help their party.
Anyone that supports this plan needs to be held accountable and voted out of office as soon as possible.
The GOP counts on a public that thrives on low information and apathy. Do not stand by while republicans make decisions that negatively impact this country and help their party.
24
Not to beat a dead horse, but Trump voters in the poorest, least healthy states will get what they voted for if anything resembling this "repeal/replacement" is realized.
I'd like to say, "I feel your pain." but...
I'd like to say, "I feel your pain." but...
17
Repeal and...
Repeal and Reneg
Repeal and Retreat
Repeal and Redistribution
Repeal and Regret
Repeal and Reprehensible
Repeal and Reince
Repeal and Remorse
Repeal and Ryan
Repeal and Republican
Repeal and Run!!!!!!!!
Repeal and Reneg
Repeal and Retreat
Repeal and Redistribution
Repeal and Regret
Repeal and Reprehensible
Repeal and Reince
Repeal and Remorse
Repeal and Ryan
Repeal and Republican
Repeal and Run!!!!!!!!
15
There's a "medicare for all" petition languishing unsigned at whitehouse.gov. I don't understand. Arrest Madonna for terrorism has more signatures.
16
Tax credits. Not refundable tax credits which means - if you don't have a tax bill you don't get anything. Hence the benefits go only to those making enough money to actually have to pay federal income taxes who don't already have medical insurance coverage.
What happens in the end? Simple, the poor people go to the ER for maximum Charge Master fees, no insurance, that makes them bankrupt and passes the cost for unpaid bills to the rest of the population. Full circle back to where we started but giving yet another tax break to the already well to do.
We will continue to ration medical care based on the ability to pay and continue to claim that we have the best medical care on the planet. This is what the Trump supporters wanted - RIGHT?
What happens in the end? Simple, the poor people go to the ER for maximum Charge Master fees, no insurance, that makes them bankrupt and passes the cost for unpaid bills to the rest of the population. Full circle back to where we started but giving yet another tax break to the already well to do.
We will continue to ration medical care based on the ability to pay and continue to claim that we have the best medical care on the planet. This is what the Trump supporters wanted - RIGHT?
25
Every proposal I've seen includes refundable tax credits.
1
One of my greatest joys of the last several years was to assist people in signing up for Obamacare. I will never forget the relief on their faces as they learned they could get medical, and in some cases, dental care.
Low to low-mid-income Americans will bear much of the brunt of Bannon/Trump Care. And, because they are not big GOP donors, their plight, their deaths will not phase the GOP.
Low to low-mid-income Americans will bear much of the brunt of Bannon/Trump Care. And, because they are not big GOP donors, their plight, their deaths will not phase the GOP.
29
What exactly are the problems that the GOP is trying to "Fix"
1) Removal of insurance denial due to preexisting conditions?
2) Funding help for moderate income people who do not have employer subsidized coverage?
3) Floor on coverage to eliminate junk insurance?
4) Allowing dependents under 26 to be on parents policies?
5) Removal of annual & life time caps for insurance payout?
6) Addition of coverage for 20 million citizens?
and how does the GOP plan make America great again?
1) Removal of insurance denial due to preexisting conditions?
2) Funding help for moderate income people who do not have employer subsidized coverage?
3) Floor on coverage to eliminate junk insurance?
4) Allowing dependents under 26 to be on parents policies?
5) Removal of annual & life time caps for insurance payout?
6) Addition of coverage for 20 million citizens?
and how does the GOP plan make America great again?
22
Such a surprise! It's not as if this administration is cutting taxes for the ultra rich or allowing unsafe working conditions to continue or raising taxes on single parent households or running oil pipelines through the lands and watersheds of surviving remnants of Aboriginal Americans.
Uh, I've just received a news update so never mind. I have to go now and write my congress person. Hope it's one that likes poor people.
Uh, I've just received a news update so never mind. I have to go now and write my congress person. Hope it's one that likes poor people.
23
as i see it this plan will increase the premiums of unsubsidized policy holders by reducing the number of younger and medicaid eligible policy buyers. A similar death spiral result can be expected unless insurors have lots of flexibility to price policy holders with existing conditions higher and to reject the most costly of such potential policy buyers.
2
More and more I'm growing convinced that the Republicans introduce policies that hurt the poor not because they themselves despise the poor -- many of them do -- but because their well-off constituents, not all of them billionaires, despise and hate the poor and want to punish them until they disappear.
We are looking at a national failure of conscience, a population that has grown mean, grasping and infuriated with poverty. Policies that could help the poor enrage these people, because they hold two contradictory views of the poor: One, that they could easily overcome their poverty by hard work and diligence as they imagine they themselves did (ignoring the considerable private and public help they received on their way up); and two, that the poor by their continued poverty demonstrate an innate inability to compete and win, and therefore any efforts to help them will only sap their own wealth and turn the poor into competitors for the same resources -- housing in pleasant surroundings, cheap food, decent civil services like police, fire, water and sewerage, and of course superior schools.
These two contradictory impulses reinforce each other, and so can answer any attempt by government to improve their lot, or any attempt by the poor themselves to demand better services and equality before the law. A population so buttressed against any progress at all cannot eliminate the poor nor help them. And so we continue to inevitable destruction.
We are looking at a national failure of conscience, a population that has grown mean, grasping and infuriated with poverty. Policies that could help the poor enrage these people, because they hold two contradictory views of the poor: One, that they could easily overcome their poverty by hard work and diligence as they imagine they themselves did (ignoring the considerable private and public help they received on their way up); and two, that the poor by their continued poverty demonstrate an innate inability to compete and win, and therefore any efforts to help them will only sap their own wealth and turn the poor into competitors for the same resources -- housing in pleasant surroundings, cheap food, decent civil services like police, fire, water and sewerage, and of course superior schools.
These two contradictory impulses reinforce each other, and so can answer any attempt by government to improve their lot, or any attempt by the poor themselves to demand better services and equality before the law. A population so buttressed against any progress at all cannot eliminate the poor nor help them. And so we continue to inevitable destruction.
55
And yet so many of these leaders and their constituents insist they are Christians, followers of He who said, "The poor we always have with us" and "If you would be perfect, give all your worldly goods to the poor and follow me." (Of course though he is thought by many to be the savior of the world and loved by all, we know where those words got him.) the world never changes, does it?
11
There is a 3.8% tax on investment income and a 0.9% tax on income over $250,000. These taxes are used to help pay for subsidies under the ACA. The only goal of the Republican Party is to repeal these taxes. Once that goal is achieved they will enact some useless program that turns the clock back to 2007. The 30 million covered under the ACA will go back to being uninsured.
49
This is completely in step with Trump's plan to give tax breaks to the rich at the expense of the poor and middle-class. We all know that trickle-down economics doesn't work, because the rich invest the savings, while the poor and near-poor tend to spend it. Furthermore, as the article points out, the poor are less likely to have money to sock away in health care savings accounts.
It's not clear what they want to do to Medicare, but it can't be good. Most older people won't be able to afford higher-cost insurance. And prudent people planned their retirement in part on the costs of healthcare and receipt of Social Security benefits.
Disabled people often had little chance to save for retirement, let alone disability, so they too will be on a poor position.
It's not clear what they want to do to Medicare, but it can't be good. Most older people won't be able to afford higher-cost insurance. And prudent people planned their retirement in part on the costs of healthcare and receipt of Social Security benefits.
Disabled people often had little chance to save for retirement, let alone disability, so they too will be on a poor position.
32
So, if I understand correctly, because I pay for my own insurance as a freelance journalist, and my deductible is $500, I can't utilize a Health Savings Account? Why? I have to change to a new policy that has at least a $1,300 deductible?
And what are the target monthly amounts for the tax credits?
And what are the target monthly amounts for the tax credits?
15
The obsession with Ayn Rand thinking amazes me since she was so shallow and trite.
When These Republican Congressional Representatives swear to the Constitution, do they forget the Preamble?
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
The rich get richer and the poor die. The GOP is made up of vile hateful people. I can't even begin to calm down enough to go into all of the reasons this will be a failure.
The only thing they seem to care about is Defense. Police State good. Social Justice bad. Arggh!
When These Republican Congressional Representatives swear to the Constitution, do they forget the Preamble?
“We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”
The rich get richer and the poor die. The GOP is made up of vile hateful people. I can't even begin to calm down enough to go into all of the reasons this will be a failure.
The only thing they seem to care about is Defense. Police State good. Social Justice bad. Arggh!
51
I might add that if you look at history you will find that the poor get poorer no matter which party holds office. Smaller government would benefit all. If either party actually wanted fair taxation we would have a flat tax and everyone would pay at the same percentage - no exemptions. It would pretty much eliminate the IRS (which by the way Constitutionally speaking, the tax on income is unconstitutional).
4
We must, absolutely MUST, start organizing for 2018. I fear it may be our last chance. They have to go!
2
Beautifully written...
But I'm wondering how much the rich really care about Defense now. Are we safer with Trump in the White House? Hardly!
But I'm wondering how much the rich really care about Defense now. Are we safer with Trump in the White House? Hardly!
9
One of the biggest flaws is that people are essentially not risk rated for their lifestyles. People who live outrageous and self destructive lifestyles pay the same rates as people who live prudently.
Doesn't happen for life insurance or car insurance. People on the low end continue to NOT pay their share of the medical expenses while people who work and earn a modest income get penalized by paying disproportionately higher premiums and also paying higher taxes to subsidize those people who don't/won't work as a matter of lifestyle.
Doesn't happen for life insurance or car insurance. People on the low end continue to NOT pay their share of the medical expenses while people who work and earn a modest income get penalized by paying disproportionately higher premiums and also paying higher taxes to subsidize those people who don't/won't work as a matter of lifestyle.
14
This is slightly off-topic of the article but it would be so great if health insurance could help cover the cost of things like healthy groceries - for instance, pasture-raised meats and organic veggies - which really should be considered preventative care. Instead, people who can't afford these foods are feeding themselves and their children sugar, corn, soy, and wheat-laden garbage (subsidized crops turned into cheap "food"), and wondering why they're always sick. But at least their insurance covers doctor's visits and prescriptions! I know at least in (parts if not all of) Ohio, EBT is now accepted at farmers' markets, which is fantastic. But what about those of us who are over the poverty line yet still struggle to afford healthy groceries?
8
Oh, get real. People who work for less than, say, $15 an hour simply don't have the income to pay for health insurance. And those same people are not always living outrageously or self-destructively.
What we need is a true nationalized health care plan. Everyone else has this figured out.
What we need is a true nationalized health care plan. Everyone else has this figured out.
3
Perhaps but I also take care of fair number of people who develop diseases that bear no relation with lifestyle . How do you propose we deal with these people
1
Me being a surgeon I always see financing of health-care in the US taken as a political issue depending on decisions made by them and, ultimately, economists who, in the end most of the time disregard the issue of so many people uncovered by insurance. I wonder, what is it that health professionals have to say? more han anything else because I have the strong conviction that unless these professionals get involved in solving this problem it will be hard to increase coverage and secure health-care to poor people. An internist from Chicago suggested once that this problem could be alleviated if a substantial number of doctors would agree on dedicating 20% of their practice to these uncovered patients by charging less or not charging at all; it would create a trend and other components of the health-care world would likely follow and lessen the burden of the less favored by chance or money. Medicine is not about money-making or at least not all of it. Maybe just up to 80%
21
Your comments are great here. But I think all people should make a little sacrifice, not docs with $300k in student loans and rising insurance premiums.
3
Republicans do not represent working Americans. They don't care about our environment, public education, or healthcare. This is not rocket science. The lives of working Americans will become much more difficult under this administration and congress.
If you are a poor or working class, =>50k a year, and you vote for republicans, you are handing the power to the very people who take the food off your table, and tell you, you need a diet.
I give them credit for the con artist they are, hopefully this will finally teach the working class that they have no friend in a Republican.
If you are a poor or working class, =>50k a year, and you vote for republicans, you are handing the power to the very people who take the food off your table, and tell you, you need a diet.
I give them credit for the con artist they are, hopefully this will finally teach the working class that they have no friend in a Republican.
63
If you don't have the cash to lay out up front, you can't get the savings or tax credits...it's that simple. Having a lower limit on medical deductions would be more beneficial to the poor but still wouldn't encourage anyone to seek our routine care rather than wait for an emergency
22
Another "bait and switch" offering from the GOP. What good does a tax credit do you when you can't find insurance to cover your family year round? I've come to expect the reverse Robin Hood policies but this sinks to an all time low.
33
Is health care beyond life saving emergency care a right or a privilege? Is there a social benefit to assuring basic health care to all? The Republican leadership says, "No".
14
Just enough change to allow Trump to claim credit???
9
If the title of your article turns correct you can start calling President Trump "Hood Robin".
9
This is the Trump crime family running the government right now. I hope they enjoy their largesse. Time will run out for them. His "supporters" will see the light.
6
Or Robin Hoodwink ;)
7
"Republican Health Proposal Would Redirect Money From Poor to Rich"
Well, of course it will, silly.
Well, of course it will, silly.
28
Healthcare is neither rational nor transparent, therefore it does not function. under "market conditions" as the Republicans spout. Ever try to get a straight answer on what a treatment or procedure will cost, even a simple office visit? Even once your EOB arrives you still aren't sure what cost and why, or why insurance covered this last year but not now.
The GOP is inexcusable to tell people to be 'better consumers' when you have to basically sign a blank check just to be seen by medical personnel.
The system needs regulation, ACA was at least a beginning.
The GOP is inexcusable to tell people to be 'better consumers' when you have to basically sign a blank check just to be seen by medical personnel.
The system needs regulation, ACA was at least a beginning.
36
Everyone, including Donald Trump according to his 2000 book, knows that universal coverage is the answer. We can pay for healthcare and get healthcare or we can pay for health insurance and then fight and plead for the benefits we thought we'd paid for. Every retired Republican I know just loves his medicare. It's yours that needs more choice and access to and less actual coverage.
This all just kills me. When did *we* turn into the evil empire?
The one extra kill-me part is the thousands and thousands of struggling people in Kentucky and Kansas who finally got insurance through medicare expansion. They will lose it and suffer without ever knowing that that huge and temporary reprieve from fear of having to see a doctor, or god forbid go to a hospital and lose the house, was Obamacare. I wish every one of them could take back their vote and their MAGA hat for a refund.
This all just kills me. When did *we* turn into the evil empire?
The one extra kill-me part is the thousands and thousands of struggling people in Kentucky and Kansas who finally got insurance through medicare expansion. They will lose it and suffer without ever knowing that that huge and temporary reprieve from fear of having to see a doctor, or god forbid go to a hospital and lose the house, was Obamacare. I wish every one of them could take back their vote and their MAGA hat for a refund.
37
The only reasonable, cost effective approach to healthcare is single payer.
37
GS, you're right, end of argument. I had heart valve surgery in 2015 that was covered by the ACA. The condition was not from "lifestyle" and cost over $300K. There is no way in a hundred lives I could have saved enough thru Ryan's health savings accounts to pay for this or been covered by the right wing's high risk pools (I did not know I even had a cardiac issue). I simply would have gone bankrupt and lost everything I owned. Meanwhile the mean spirited and heartless Paul Ryan, McConnell, and Rand Paul concentrate on this issue of the rich while the executive branch of the government twirls like a piñata at a kid's party.
39
Looking forward to seeing the numbers...how many will lose coverage? Will the plan realize Trump's promise to "cover all American"? What will the costs look like for people with chronic conditions? What will insurance companies say?
6
Chronic conditions will probably only be covered up to a certain lifetime total amount and no coverage for existing conditions if there is a lapse in insurance (pre 2007 rules). The insurance companies who are like United Care (who provides much of the Medicaid coverage currently) - stock prices will continue to fall anticipating decreased demand.
Finally (using Trump's logic): If, under Trump Care, you aren't covered then you must not be American.
Finally (using Trump's logic): If, under Trump Care, you aren't covered then you must not be American.
3
As with just about all Republican healthcare proposals, the likelihood of a massive spike in medical bankruptcies looms large. Another example of that vaunted American exceptionalism.
22
Spike above the 700K bankruptcies due to medical bills we already have annually. And most of those people HAVE insurance. I saw a poster that said Canada had 0 medical bankruptcies per year, UK 0, Australia 0, etc. I had a thrombotic event while insured with the highest level policy GE offered it's employees. It ruined our lives. Our hospitals have become like predatory lenders. I still cry from the shame of having sold my mother's and grandmother's jewelry that should have gone to my daughter.
17
America loses when the middle class loses.
The goal should be to create a powerful middle class that the poor will aspire to, not creating a mediocre lower class at the expense of the middle class.
The goal should be to create a powerful middle class that the poor will aspire to, not creating a mediocre lower class at the expense of the middle class.
15
Trump's a con man. Ryan and his followers are the bait and switch brigade having passed their flim flam/too good to be true qualifying exams blessed by the evangelical clergy for whom clean living and bake sales make medical science and health coverage unnecesssry.
23
The Republicans hated the ACA before it was passed because they knew it would mean people would associate Democrats with health care. They fought government assisted health care for decades. Now they are about to discover that they were right all along. Repealing the ACA and replacing it with something that doesn't provide health care for people who are not working will be very hard for them at the ballot box.
16
How can we vote if we're dead from losing our life-saving ACA?
6
This is exactly what anyone paying ANY attention knew the Republicans would do: take more from the sick, poor and needy (while quoting Bible verses at them, of course), and move more money to the top. What will it take for the Republican base to finally realize they've been played?
27
We need price and quality transparency to create a market in health care. Without transparency, the consumer cannot determine the value of the service: Value = Outcome Quality/Price. Singapore posts prices. Citizens are also responsible for making choices of where they get care. Their healthcare cost as a percentage of GDP is 4%. Socialist Europe is running at 9% and going up. Our Crony Capitalist System, masquerading as a "market" is running at 18%. Lee Kuan Yew saw the problem when he insisted on providers posting prices. Dr. Thomas Sowell discussed the problem that Minister Lee could foresee: "The first thing undermined or destroyed is self-rationing. When you pay the full price of going to a doctor, you go there when you have a broken leg but not when you have the sniffles or a minor skin rash. When the government makes health care “affordable,” you go there for sniffles and a minor skin rash." Some people would call this "common sense," obviously it is in short supply.
3
Some states like Maryland have medical regulations that DO post medical costs right down to the daily fee for the in-hospital room costs. It changes daily but can't go over a certain fee. We need more states that pass rules like this.
3
Three things about this "Better Way".
(1) If Obama could go back in time, he might consider calling it the Conservative Heritage Foundation Care. Why? The GOP spends a large portion of their repeal effort whining about ObamaCare.
(2) This is still a social program by big government to redistribute money albeit under a less targeted way. The GOP will do just enough to have talking points. The GOP will once again duck for cover behind the ruse of poor people needing to take personal responsibility.
(3) The way the GOP replaces will undoubtedly leave great gaps in coverage. It will be like moving the death panels into the family decision making process. It will be like switching primary care back to the ER where it is extremely costly.
(1) If Obama could go back in time, he might consider calling it the Conservative Heritage Foundation Care. Why? The GOP spends a large portion of their repeal effort whining about ObamaCare.
(2) This is still a social program by big government to redistribute money albeit under a less targeted way. The GOP will do just enough to have talking points. The GOP will once again duck for cover behind the ruse of poor people needing to take personal responsibility.
(3) The way the GOP replaces will undoubtedly leave great gaps in coverage. It will be like moving the death panels into the family decision making process. It will be like switching primary care back to the ER where it is extremely costly.
11
Medicare for all. Medicare for all. Medicare for all.
How much simpler it would be to protect people from birth to death, while all contribute premiums according to income and the budget is supplemented by payroll taxes. Medicare (the real thing, not the W.-era con known as Advantage) works more efficiently that any private insurance ever did, and it treats only the elderly and the disabled. Adding tens of millions of healthy young people who would pay premiums would make Medicare as effective as the single payer systems seen throughout the rest of the developed world. You could fold in Medicaid to allow coverage for medications and dental, give true parity to mental health and drug abuse treatment, and get employers out of the business of acting as an intermediary between patients and insurers. And while you're at it, free medical school tuition in exchange for mandatory service in under-served areas, and a re-balancing of specialties by paying primary care physicians higher fees and surgeons and some over-rated specialties more moderate compensation. But all of this is too sensible and would cut into the profits of large corporations, including hospitals.
Bernie, we need you.
How much simpler it would be to protect people from birth to death, while all contribute premiums according to income and the budget is supplemented by payroll taxes. Medicare (the real thing, not the W.-era con known as Advantage) works more efficiently that any private insurance ever did, and it treats only the elderly and the disabled. Adding tens of millions of healthy young people who would pay premiums would make Medicare as effective as the single payer systems seen throughout the rest of the developed world. You could fold in Medicaid to allow coverage for medications and dental, give true parity to mental health and drug abuse treatment, and get employers out of the business of acting as an intermediary between patients and insurers. And while you're at it, free medical school tuition in exchange for mandatory service in under-served areas, and a re-balancing of specialties by paying primary care physicians higher fees and surgeons and some over-rated specialties more moderate compensation. But all of this is too sensible and would cut into the profits of large corporations, including hospitals.
Bernie, we need you.
52
Brava! This has always been the best solution.
5
Republican's "Better Way" agenda is nothing more than a lot of the same "grand old" policies that didn't work before and won't work now. After reading the policy outline which "empowers Americans and unleash the forces of choice and competition to lower costs and increase quality," I'm deeply concerned. What I hear is Republicans want consumers to put skin in the game so to speak. Choice and competition are not always better and with industries like health where costs are complex and care for chronic conditions are not easily measured people will be forced to choose less expensive but not always superior treatments and care. Health care is not a commodity to be managed the same way the retail industry is managed. As someone with a chronic illness it's difficult enough to manage daily life without worrying if my doctor based on my insurance plan is prescribing the best as opposed to the most cost effective medication, treatment, and tests. Comparing the price of a blender at several stores empowers consumers. Comparing the price of health services empowers insurance companies, not the sick. It's very unsettling when you're relying on the expertise of an industry that is simultaneously calculating your illness into their bottom line. What if I'm too expensive to make the cut like before the ACA? What difficult choices will I have to make yet again to manage an unmanageable illness and a health care system that can always care less
30
Paul Ryan, a millionaire who has no concept of the dire health care needs of even the middle class, much less the poor, is out to abandon in a mindless, selfish way the desperate needs of the American people.
The wealthiest country in the world is the USA yet of the western world, we have the poorest health care situation and are the only country of these that has no real national health insurance. His health plan is as unrealistic as his proposed anti-abortion law which will prove as unenforceable as 1920s
Prohibition. The wealthy will seek abortion in England, France, Italy and Scandinavia where abortion is legal and affordable. The burden of any anti-abortion law will fall on the poor (as Europeans learned long ago). These will suffer but abortion will endure.
The wealthiest country in the world is the USA yet of the western world, we have the poorest health care situation and are the only country of these that has no real national health insurance. His health plan is as unrealistic as his proposed anti-abortion law which will prove as unenforceable as 1920s
Prohibition. The wealthy will seek abortion in England, France, Italy and Scandinavia where abortion is legal and affordable. The burden of any anti-abortion law will fall on the poor (as Europeans learned long ago). These will suffer but abortion will endure.
27
When will Ryan realize that the real challenges to abortion and health care control are not just human? Pig-Human hybrid flesh will become both standard and easily less expensive than traditional transplants. As a result, we need abortion controls on pig no less than on human tissue, or we could eat porkrinds from our own family!
3
That "world's wealthiest country" tag is meaningless hot air. If you aren't front and center among those who make the millions it billions, how do you have a right to share in the profits, so to speak? Do Bill Gates, Warren Buffet, Mark Zuckerberg, Derek Jeter, Magic Johnson, Mitt Romney or my boss owe me (or you) anything? Of course not.
3
That's not the point she was making. She was responding directly to the article on the Republicans' proposal which transfers better access and money to healthcare to the rich from the poor who, by virtue of history and numbers, have been those most uninsured. It's not an issue of the rich giving to the poor. It's our Republican controlled government proposing, as they often do, to give more to the rich and in this case taking it from the poor.
6
Very misleading headline and article.
The proposal, is focused on individuals who do not have access purchase health insurance through their employer. How many "rich" people does that include?
The proposal, is focused on individuals who do not have access purchase health insurance through their employer. How many "rich" people does that include?
4
A lot of wealthy people are not employed, their income derives from investments. So, yes they would benefit fro larger tax credits on their health insurance costs.,
21
This marks the beginning of the end for the GOP. The elements of this "plan" would make cuts to Medicaid and remove subsidies for those (lower income) people that cannot afford the difference between their coverage and the costs of care.
The GOP is taking away healthcare from those that have it and those that need it.
The commitment of the GOP to repeal & replace a working healthcare plan has compromised their ability to think.
Do not underestimate the changes in the GOP solution- the end result is that they are kicking people off of their healthcare.
The GOP is taking away healthcare from those that have it and those that need it.
The commitment of the GOP to repeal & replace a working healthcare plan has compromised their ability to think.
Do not underestimate the changes in the GOP solution- the end result is that they are kicking people off of their healthcare.
28
Incredibly, the only people who really hate Americans having the right to affordable health care are politicians in Washington, who already get government-provided health care for themselves and their family, for life. How convenient!
38
Incredibly, members of congress are required to buy their medical insurance on the DC Obamacare exchange, and at retirement are eligible to purchase the same coverage that any other federal employee is able to buy. How convenient!
4
Scott, I don't believe you, period. Proof, please, esp as the ACA is very new.
3
So the Republican plan rewards older and therefore sicker people while cutting subsidies for relatively healthy poorer people which will result in more of them dropping coverage. Any insurance executive would say that this is exactly what you do NOT want to do because you cannot spread risk around enough to the healthy population. What the Congressional Republicans are doing is assisting Trump in moving us back to the old system whereby more Americans end up in bankruptcy annually due to exorbitant medical bills.
23
c-c-g: I was about to ask this very question - how is this good business? In order to be profitable, insurance companies need a large pool of mostly healthy policy-holders to subsidize the old and sick - this plan seems to incentivize young people to take their chances without insurance.
5
The ACA is not perfect, but I think it would have been far less imperfect had President Obama had a Democratic (i.e. supportive, cooperative, compassionate) congress. His original ideas for the ACA were battered, bent and discarded along the way. What we ended up with was as good as he could get after the Republicans (i.e. vindictive, greedy, cruel to the poor) finished gnawing and slashing.
I have given up any hope that our country will rise above the morass of stupidity and mendacity that it has evolved into. I blame Lee Atwater, Karl Rove and the likes of Rush Limbaugh and Fox News for the hatefulness and divisiveness in our once great (and probably NEVER to be again, despite Trump's one note campaign slogan) country.
I have given up any hope that our country will rise above the morass of stupidity and mendacity that it has evolved into. I blame Lee Atwater, Karl Rove and the likes of Rush Limbaugh and Fox News for the hatefulness and divisiveness in our once great (and probably NEVER to be again, despite Trump's one note campaign slogan) country.
37
Add, lack of a conscience...
4
The whole debate on healthcare is just a reflection of how insane this country is on some issues. On the right, you have politicians arguing against socialized medicine while all municipal employees, on the local, state and federal level ( yes, I know Members of Congress and some of their support staff are on ACA), are basically enjoying a form of socialized, or universal, health care with their gold plated plans paid for by tax dollars. On the left, the liberals have a complete break with reality when they praise ACA without acknowledging that ACA is pretty much unaffordable for the middle class who make just enough to not get a subsidy. President Clinton in a moment of candor said last October that people who make just enough to not get a subsidy are "getting killed". Meanwhile, it's not like we have to reinvent the wheel on this. Every developed country has some form of affordable, universal health care that works by almost every metric many times better than the mess we have in this country. We just need to pick one.
26
As has been stated, Medicare for all. You're right, we already have one that works, not perfectly, but better than any private health care plan for the number of people on it. Let's all get on it.
5
Pick Canada.We can be found,just north of the 49th.
6
One hundred miles south of ya. Finances keep me south of the 49th until Dec of this year. By then I hope a clear decision presents itself.
It is unfortunate for America that Mitch McConnell and Paul Ryan are not as ridiculously stupid as Trump. His bazar behavior makes him an easy mark for blackmail. Should Trump try to put his foot in the door to buck the republican agenda that he ran against, when pre-existing conditions coverage is traded for health savings accounts and social security cuts start to drive seniors into poverty, Trump goes along or his party will seize on any of the numerous issues that could be blown up to impeachable scale at the GOP's whim.
Americans should be less worried about Russians blackmailing Trump and more about the radical republican right making Trump dance to their tune or face the music alone
Americans should be less worried about Russians blackmailing Trump and more about the radical republican right making Trump dance to their tune or face the music alone
10
"Redirect money from poor to rich" it has been going on ever since does not matter who is in the White House. Refresh me which era when Gov made a policy which Redirect money from Rich to Poor?
5
Blue states pay money into Washington every day, that is spent in red states, so every era.
8
Just wanted to thank Ms. Sanger-Katz for these excellent articles, which really do a first-rate job of reporting on these issues.
I've learned a great deal that's been helpful to serving on an health insurances JPA, and in negotiations: again, thanks, and please keep going!
I've learned a great deal that's been helpful to serving on an health insurances JPA, and in negotiations: again, thanks, and please keep going!
10
Any health care plan that depends upon the private, for profit sector to determine prices/costs/premiums is D.O.A. That doesn't mean the Republicans won't be able to go that route but it does mean that going forward, the Republicans own it - own it all.
However, when the facts come out, when the numbers accumulate, the Republican Party will be decimated by voter defections. When it comes to health care, political parties that engage in quid pro quo with the wealthy will not be able to find cover from the number of people who prematurely die each year - first thousands, then over time millions. Any idiot knows that healthcare is not a partisan issue - i.e. it is not just Democrats that need health care.
Republican and Democratic politicians appear to completely misjudge the populist will of the American people. Voting for the lesser of two evils has worked effectively in the past but given the results of this past election, it is clear that going forward that cynical strategy will tear this country apart.
Today, Medicare from cradle to grave is the most expedient and logical way forward but ultimately, universal health care operated and controlled by the non-profit public sector is the medically wise and most cost efficient choice.
However, when the facts come out, when the numbers accumulate, the Republican Party will be decimated by voter defections. When it comes to health care, political parties that engage in quid pro quo with the wealthy will not be able to find cover from the number of people who prematurely die each year - first thousands, then over time millions. Any idiot knows that healthcare is not a partisan issue - i.e. it is not just Democrats that need health care.
Republican and Democratic politicians appear to completely misjudge the populist will of the American people. Voting for the lesser of two evils has worked effectively in the past but given the results of this past election, it is clear that going forward that cynical strategy will tear this country apart.
Today, Medicare from cradle to grave is the most expedient and logical way forward but ultimately, universal health care operated and controlled by the non-profit public sector is the medically wise and most cost efficient choice.
18
Healthcare is important, but Trump supporters are unmoved by it. They might possibly be moved by jobs, but that ain't gonna happen. Automation will make jobs even rarer than now, and no-one in govt has a glimmer of understanding of how to handle mass unemployment. it will require huge govt investment and there is just no money and no direction.
3
Very sick and dead people don't vote, and maybe that's exactly what they want.
2
"Republican Health Proposal Would Redirect Money From Poor to Rich"
Anybody surprised??
Anybody surprised??
9
Anyone surprised?? I am not.
6
Surprise!! or Surprised?
3
You can't use the word "redistribute" when you are talking about your own money. If I don't pay more in Obama taxes, I am keeping my money and it does not go anywhere to "redistribute" back to me. That would be lunacy.
I do agree with others here, that the middle class, just over the income to get a subsidy was paying the whole ride for everyone getting a plan on the exchanges, that is why they had both high premiums AND high deductibles. Plans like that used to be low premiums with a high deductible. And another difference was that you were made to buy a full health plan with stuff in it, instead of buying insurance for the risk of something bad happening and needing a hospital or an emergency room. Other people were given their plan with subsidies, so they were using medical services, and the people who paid the most, had no cash left to go for an appointment. Or there was no doctor who would take what they had, they changed doctors, and found out they did not get to use the insurance because they had a huge deductible first.
I do agree with others here, that the middle class, just over the income to get a subsidy was paying the whole ride for everyone getting a plan on the exchanges, that is why they had both high premiums AND high deductibles. Plans like that used to be low premiums with a high deductible. And another difference was that you were made to buy a full health plan with stuff in it, instead of buying insurance for the risk of something bad happening and needing a hospital or an emergency room. Other people were given their plan with subsidies, so they were using medical services, and the people who paid the most, had no cash left to go for an appointment. Or there was no doctor who would take what they had, they changed doctors, and found out they did not get to use the insurance because they had a huge deductible first.
5
The falsehoods here need to be countered:
(1) "Paying the whole ride": Not getting a subsidy doesn't mean you are paying for the subsidies given to others. The money for subsidies comes from elsewhere, other taxes, not your premium, which is at full market price.
(2) Even if you did pay for subsidies, you would not be paying "the whole ride." (Contributing a portion to another's dinner falls short of paying for their full meal.)
(3) "Other people...were using services [while] people who paid the most, had no cash left to go for an appointment." This makes no sense, given how subsidies are designed. Out-of-pocket premiums payments are targeted at 8-10% of income, with less percentage paid at the bottom). In short, as an upper income earner (far above the median, given you aren't receiving subsidies) you still have more money left over to spend, on everything including healthcare, after subtracting your premium, than people receiving subsidies. If you don't have money left over to cover appointments, chances are very high that your poorer fellows have the same problem, yet worse. (There is a problem with specific income levels where a dollar more income yields a significant reduction, more than a dollar, in subsidies. But that only entails that people earning slightly less have a better situation.)
(4) Income is not desert: Adjunct teachers, and many others, basically subsidize you and your children's costs by receiving less than fair wages. Turnabout is often more than fair.
(1) "Paying the whole ride": Not getting a subsidy doesn't mean you are paying for the subsidies given to others. The money for subsidies comes from elsewhere, other taxes, not your premium, which is at full market price.
(2) Even if you did pay for subsidies, you would not be paying "the whole ride." (Contributing a portion to another's dinner falls short of paying for their full meal.)
(3) "Other people...were using services [while] people who paid the most, had no cash left to go for an appointment." This makes no sense, given how subsidies are designed. Out-of-pocket premiums payments are targeted at 8-10% of income, with less percentage paid at the bottom). In short, as an upper income earner (far above the median, given you aren't receiving subsidies) you still have more money left over to spend, on everything including healthcare, after subtracting your premium, than people receiving subsidies. If you don't have money left over to cover appointments, chances are very high that your poorer fellows have the same problem, yet worse. (There is a problem with specific income levels where a dollar more income yields a significant reduction, more than a dollar, in subsidies. But that only entails that people earning slightly less have a better situation.)
(4) Income is not desert: Adjunct teachers, and many others, basically subsidize you and your children's costs by receiving less than fair wages. Turnabout is often more than fair.
3
Make the plan applicable to both the House and Senate.
Only then can the masses be assured that the Republican plan is "far less expensive and far better" for "everybody" than Obamacare.
Only then can the masses be assured that the Republican plan is "far less expensive and far better" for "everybody" than Obamacare.
12
Well let's face it. Republicans think poor people deserve to be sick.
Whether Republicans think poor people don't "take care of themselves" or whether they think poor people are just plain lazy, or they think poor people are stupid and so what if they're sick, the true nature of Republicans in 2017 is loud and clear.
As a nurse, who has taken care of poor, rich, young, old, very very sick, fairly healthy, whatever - to discriminate against sick people is about as low as they go.
Republicans seem to equate the word Christian with their kind. They are far from any religion at all. The opposite is at work with them. And to think a doctor is at the helm, Tom Price, Secretary of Health and Human Services is a joke. Maybe he should donate some of his $13,000,000 to "the poor" and go do hands on healthcare in the real United States. Go to Bellevue and hand out of few bedpans...to poor people, Dr. Price. Get humane. Get Christian as professed. Bring along Paul Ryan and Mitch McConnell.
Tom Price is the "so-called" - a so-called doctor.
Whether Republicans think poor people don't "take care of themselves" or whether they think poor people are just plain lazy, or they think poor people are stupid and so what if they're sick, the true nature of Republicans in 2017 is loud and clear.
As a nurse, who has taken care of poor, rich, young, old, very very sick, fairly healthy, whatever - to discriminate against sick people is about as low as they go.
Republicans seem to equate the word Christian with their kind. They are far from any religion at all. The opposite is at work with them. And to think a doctor is at the helm, Tom Price, Secretary of Health and Human Services is a joke. Maybe he should donate some of his $13,000,000 to "the poor" and go do hands on healthcare in the real United States. Go to Bellevue and hand out of few bedpans...to poor people, Dr. Price. Get humane. Get Christian as professed. Bring along Paul Ryan and Mitch McConnell.
Tom Price is the "so-called" - a so-called doctor.
33
Trump and the Republicans will do what they have always done.
Roll out some flawed replacement plan that will have less coverage and cover fewer middle class and poor Americans, then announce that the plan is better than Obamacare and the best medical care ever.
As usual. most people will accept the "Con", especially if the Media fact checks it!
Roll out some flawed replacement plan that will have less coverage and cover fewer middle class and poor Americans, then announce that the plan is better than Obamacare and the best medical care ever.
As usual. most people will accept the "Con", especially if the Media fact checks it!
9
I just called Speaker Ryan's office and asked for a single payer health plan. I'm fed up. Whether you "deserve" it or not, I believe all Americans deserve to have healthcare, period. I feel this way because I'm a Christian. But even if I wasn't, there are other arguments for it. Since money talks in this political arena (I actually am currently referring to it as a "circus"), optimizing the health of us all will pay back many fold. It's a smart investment, LOW risk. I am willing to pay for it though I believe this economy has plenty of money already without my contribution.
Healthcare 4 All!
Healthcare 4 All!
Healthcare 4 All!
Healthcare 4 All!
Healthcare 4 All!
Healthcare 4 All!
16
Paul Ryan has shown us his character time and again and he is a shameful person. The best that can be done is for the good people of WI to rise up and ensure that he is removed from office.
He tells everyone about his Christian values but his actions say otherwise.
He tells everyone about his Christian values but his actions say otherwise.
4
Margot Sanger-Katz, my guess is that you have a robust affordable low premium insurance plan. I have no insurance. First time in my life I have been unable to afford insurance. Then with the high deductible I wouldn't be able to pay it would be useless anyway. I am a cancer survivor so I'm pretty much up the creek thanks to obama. I'm open to what the Republicans have to bring to the table.
1
Look up the risk corridor program and note that Republican Jack Kingston of GA and the Labor Dept slipped in section 227 that refused to cover insurance company's losses. On Feb 10, 2017, Moda vs. US Government won a case and 12. 4 million dollars. Justice Thomas C. Wheeler stated, "the Government "made a promise in the risk corridors program that it has yet to fulfill. Today, the court directs the Government to fulfill that promise. After all, 'to say to [Moda], 'The joke is on you. You shouldn't have trusted us,' is hardly worthy of our great government." Another bait and switch tactic used by republicans who want Obama to take the fall for the ACA failure.
3
WealthyCare
WealthyCare because Rich Lives Matter More
WealthyCare because Rich Lives Matter More
16
Just as I predicted. Under the Trump-led Republicans, the poor lose health insurance, Medicare, civil rights, voting rights, and will not see and new job growth. What else can go wrong? (Well, be a member of the LGBT community, that's what else.)
8
Wonderfully clarifying article. Thank you!
As to ...
"... it will be hard for President Trump to honor his promise of coverage that is “far less expensive and far better” than Obamacare... It’s a simpler, potentially cheaper plan than Obamacare,"
But in no way BETTER on a justice as fairness basis, which is the foundation of the democratic Social Contract.
And though it may be less expensive for the tax base as a whole, it will not necessarily be less expensive for any particular less wealthy person, who will still pay for insurance on an actuarial basis, i.e., a basis which includes the profits necessary to support the 5th homes and ski trips for the Barons of the private Insurance Industry, money that the taxpayers would not have to support if we had provably qualitatively better AND less expensive "Medicare for All!"
The one major thing I think this article may have missed is that if this plan is true to its Paul Ryan vision for desiccating Medicare, those tax credits will NOT be indexed fully to medical inflation.
If that's true, then, overtime the value of the credits will be eroded, resulting in a cost shifting to the consumer, which will reinforce the redistribution of the benefits upwards, and the proportionate burden consequences downwards.
Medicare for All!" solves all of these problems of equity, and the Democrats should focus on that message rather than picking nits with a mean-spirited and, objectively, sociopathic Republican proposal.
As to ...
"... it will be hard for President Trump to honor his promise of coverage that is “far less expensive and far better” than Obamacare... It’s a simpler, potentially cheaper plan than Obamacare,"
But in no way BETTER on a justice as fairness basis, which is the foundation of the democratic Social Contract.
And though it may be less expensive for the tax base as a whole, it will not necessarily be less expensive for any particular less wealthy person, who will still pay for insurance on an actuarial basis, i.e., a basis which includes the profits necessary to support the 5th homes and ski trips for the Barons of the private Insurance Industry, money that the taxpayers would not have to support if we had provably qualitatively better AND less expensive "Medicare for All!"
The one major thing I think this article may have missed is that if this plan is true to its Paul Ryan vision for desiccating Medicare, those tax credits will NOT be indexed fully to medical inflation.
If that's true, then, overtime the value of the credits will be eroded, resulting in a cost shifting to the consumer, which will reinforce the redistribution of the benefits upwards, and the proportionate burden consequences downwards.
Medicare for All!" solves all of these problems of equity, and the Democrats should focus on that message rather than picking nits with a mean-spirited and, objectively, sociopathic Republican proposal.
13
If Republicans were truly concerned, they could merely lower Medicare eligibility to 55. The savings alone could be passed on to subsidize a younger and poorer person. It could also act as a stimulus for jobs for older folks, who are viewed unfavorably by prospective employers when looking for work, mostly due to the uncertainty of how they may impact the group and premiums.
20
If we truly can't afford to cover everyone (though we can), shouldnt we cover the young rather than the old? I'm 61, and would love to have medicare for everyone, but how about putting our children first.
2
The Republicans must be truly concerned, as they are talking about RAISING the Medicare age.
3
I agree. And it would free up some full time jobs for younger workers if those over 55 who would have a decent retirement income if they didn't have to pay between $700 and $1000 - or more - a month for insurance. I know many who would leave their full time teaching jobs at 55 and go find one or more less stressful part time jobs if they could go on Medicare and pay around $300-350 a month for Medicare and a Part D supplement.
4
"Redirect money from poor to rich" is not much different from what Obamacare did, forcing working middle class Americans who don't qualify for taxpayer subsidies to pay exorbitant premiums to support the health care industrial complex. The problem is costs, but there is no leadership to address costs.
9
First off, the PPACA contains about fifteen provisions to control costs, starting with capping both a family's out-of-pocket expenses and an insurer's profits.
Second off, "Obamacare," gained health insurance for 20-30 million Americans, and paid for it with taxes on the wealthy.
Ignorant leftism is not leftism.
Second off, "Obamacare," gained health insurance for 20-30 million Americans, and paid for it with taxes on the wealthy.
Ignorant leftism is not leftism.
5
Not equivalent...
It did not redirect money from poor to rich, which has been the outlandish norm for 40+ years!
It did not redirect money from poor to rich, which has been the outlandish norm for 40+ years!
5
no, the problem is complex, and it's everyone's fault including insurance and drug companies and their massive profits, health professionals and poor, short term patient care, and patients and their ridiculous expectations. And last but not least, policy makers and the opportunity the health care mess offers them to redirect their moral agenda to thin the herd.
I pay for universal k-12 education, police and fire protection, roads and bridges, military across the globe, and the salaries of these clowns.
Now I want basic healthcare for all citizens on that list. Single payer.
I pay for universal k-12 education, police and fire protection, roads and bridges, military across the globe, and the salaries of these clowns.
Now I want basic healthcare for all citizens on that list. Single payer.
8
This article is fundamentally wrong - the main goal of Republican's Obamacare replacement is to shift funding from Wealthy (via 3.8% tax on those making over 250K a year) to middle class workers (via capping excluding of tax from employee based healthcare ).
Republicans only care about the 1% - This Replacement laws makes it obvious.
Republicans only care about the 1% - This Replacement laws makes it obvious.
13
I'm having sometrouble... Your first para is supposedly supporting your conclusion?
1
I'm infuriated but not surprised. What I want to know is why people who need assistance most keep voting against their own interest. It's sickening.
22
1. Ignorance--some of it willful.
2. Some not voting on the health care issue, they vote Republican for one or two other reasons.
3. the highly dependent and furious want someone to take care of them and Republicans have been far better in lying o them.
Republicans have Jesus, the flag, phony patriotism and nostalgia on offfer. People with weaker minds, relative emotional weakness, and who are not at all informed are suckers for that stew, always on the stove, simmering
2. Some not voting on the health care issue, they vote Republican for one or two other reasons.
3. the highly dependent and furious want someone to take care of them and Republicans have been far better in lying o them.
Republicans have Jesus, the flag, phony patriotism and nostalgia on offfer. People with weaker minds, relative emotional weakness, and who are not at all informed are suckers for that stew, always on the stove, simmering
12
because they are in denial
4
The ACA did not redistribute wealth from rich to poor Americans. It redistributed wealth from the middle class to low income Americans. I work for a small employer, and our plan was dropped after ACA came into effect. What was previously an affordable, no-deductible plan doubled in price and came with a whopping deductible. Most middle and lower middle class people, even on the exchanges, found themselves with "coverage" that didn't cover anything, because, unless a catastrophic illness befell you, you would never hit the deductible. So yes, people have "coverage" but most people can not afford to use it, because the out of pocket expenses are egregiously high.
9
Your experience is not in line with the larger data and your story does not make sense. Aca did not affect businesses that already had insurance for their employees. If your company was suddenly using the marketplace, you were going to lose coverage all together or lose that other coverage. And its really amazing you had such cheap no deductible insurance. When we had that kind of coverage, it cost us 800 per month.
6
Your employer chose to close out your health plan.... that was a decision they made, not an ACA issue. If they told you otherwise, you might want to look into this on your own using reliable information sources. There is so much mis-information floating around about the ACA one can find "facts" to support a certain view no matter true they are. From a perspective of a self-employed person with employees (3 to 4), I was grateful that the ACA gave us access to health care however these proposals are a huge step backward.
6
Members of Congress are getting fairly good health care benefits, as I understand it. Someone should do a comparison of what they get and what they are proposing for the rest of us. It might be enlightening.
12
Members of Congress essentially get the same type of health insurance benefits that people that work for big companies get. That is a choice between a number of insurance plans with the employer (in Congress' case, the federal government) subsidizing a portion of the premiums for the health insurance chosen. I worked as a staffer for a Senator after being in the private sector at a large company and the health benefits I had as a government worker were very similar to the health benefits I had as an employee of a Fortune 500 company. Now that I'm working on my own and paying my health insurance premiums, I sure do miss the subsidy that I got from my employer!
11
Sounds like expanding access to credits to me.
No one should be surprised the Republican Party is abandoning the poor in our country. Keep them poor and pregnant. Shameful
13
Do you have some research information to share?
The repellent Republicans led by the odious Ayn Rand admirer Ryan are completely insane and yet you'd never convince them of that. Why? Because they are true believers, unswerving in their Objectivist philosophy that to the winner, in this case the rich, goes the spoils.
The rich in Ryan's simplistic mind are the rulers of the world, the job creators, the movers and shakers who made America great. Over the backs of the working class and slave labor they did but they manage to leave that out of their "success" stories. They need to be rewarded beyond all sense of proportion for their "good work".
These Republicans who allow an imbecile like Ryan to lead them are the problem. They are the culprits who have kept the poor, middle class and workers down stagnating on the economic ladder for decades. These are all variations of Ronnie Raygun's Supply Side Voodoo Economics. The rich get richer, and through their generosity they will gladly trickle down their wealth onto the Lumpen Proles. Really, this is what Ryan and his clowns sincerely believe. How in heaven's name could someone in the Middle Class be convinced of this rubbish? How could people who voted for Ryan be so deplorable and poorly educated to buy this Republicans snake oil?
So far, millions it seems. President Obama, Hillary and Bernie had and have real solid proposals for the hard working class yet they were rejected in 2016 by some charlatan goof ball.
America, you should be positively ashamed.
DD
Manhattan
The rich in Ryan's simplistic mind are the rulers of the world, the job creators, the movers and shakers who made America great. Over the backs of the working class and slave labor they did but they manage to leave that out of their "success" stories. They need to be rewarded beyond all sense of proportion for their "good work".
These Republicans who allow an imbecile like Ryan to lead them are the problem. They are the culprits who have kept the poor, middle class and workers down stagnating on the economic ladder for decades. These are all variations of Ronnie Raygun's Supply Side Voodoo Economics. The rich get richer, and through their generosity they will gladly trickle down their wealth onto the Lumpen Proles. Really, this is what Ryan and his clowns sincerely believe. How in heaven's name could someone in the Middle Class be convinced of this rubbish? How could people who voted for Ryan be so deplorable and poorly educated to buy this Republicans snake oil?
So far, millions it seems. President Obama, Hillary and Bernie had and have real solid proposals for the hard working class yet they were rejected in 2016 by some charlatan goof ball.
America, you should be positively ashamed.
DD
Manhattan
33
Excellent
5
National strike today. We must reject these bafoonish, boorish, malignant proposals and individuals. Our country is in major trouble.
4
Dear Libby Z:
I agree on a national strike day, and many more to follow. There is going to be a Women's Strike coming up and I hope you will be a part of it.
It is the least we all can do. My wife and I are avid consumers though now retired we tend to more frugal. But since January 20th we have made a commitment to spend as little on trivial things as possible. Consumers have an enormous effect on the economy. While Trump Von Clownstick remains president we need to spend wisely and be as frugal as we can. It will have an impact if we stay together and stay strong.
DD
Manhattan
I agree on a national strike day, and many more to follow. There is going to be a Women's Strike coming up and I hope you will be a part of it.
It is the least we all can do. My wife and I are avid consumers though now retired we tend to more frugal. But since January 20th we have made a commitment to spend as little on trivial things as possible. Consumers have an enormous effect on the economy. While Trump Von Clownstick remains president we need to spend wisely and be as frugal as we can. It will have an impact if we stay together and stay strong.
DD
Manhattan
3
"It would also eliminate incentives for low-income people to avoid earning more (higher earners can face a reduction in benefits)."
Let's see how that scenario looks:
Person who gets by as a low income worker, not making enough, aspires to better income and life. The person is depicted as saying, "Hmm... I think I will DECREASE my income so I can pay less for my insurance premium. That's it! That's how I get ahead in life!"
This is what Republican lawmakers see as the outcome of the ACA, dis-incentivize workers from making more money?!
I guess they didn't notice that that there are MORE jobs than when Obamacare was enacted. A little inconsistency between the facts on the ground and that particular narrative (but, nothing new there, with that bunch).
Let's see how that scenario looks:
Person who gets by as a low income worker, not making enough, aspires to better income and life. The person is depicted as saying, "Hmm... I think I will DECREASE my income so I can pay less for my insurance premium. That's it! That's how I get ahead in life!"
This is what Republican lawmakers see as the outcome of the ACA, dis-incentivize workers from making more money?!
I guess they didn't notice that that there are MORE jobs than when Obamacare was enacted. A little inconsistency between the facts on the ground and that particular narrative (but, nothing new there, with that bunch).
14
Back in the olden days, I used to hear people complain when they got a pay raise because now they would be in a new tax bracket. In very, very simple terms, this meant that instead of making, say, $17,000 a year and paying $3,400 (or 20%, and I'm not taking into account the deductions) in taxes, now they'd be making $34,000 a year and paying $8,500 (or 25%) in taxes. However, in spite of their complaints about the tax bracket, they're still making $11,900 (after taxes, and still not taking deductions into account) more than they used to. And frankly, even with the tax bracket change, I never knew one person who refused to take the raise.
6
Really? I went back to school after losing my job during the obama admin. Even though I now have a BAS I have yet to land a viable job in my field and working as a substitute teacher. I still have no insurance. If I did I wouldn't be able to pay the $1500+ deductible.
1
Please stop the lie that Obamacare extended health coverage to 20 million Americans. Much of that number reflects people who just were already qualified for Medicaid, but had not yet enrolled, and did so primarily to avoid the Obamacare penalty. Others who had lost their employer sponsored plans...due to the Obamacare edicts...had to go through the Obamacare market.
Further, the government's payment to doctors under Medicaid is so low that Medicaid insureds have a hard time finding a doctor who will accept their "insurance" (narrow networks).
The current system, contrary to what you espouse, does not ensure that low and middle income Americans can afford the cost of their premiums. Are you not aware that many cannot afford insurance now, because of Obamacare? That part of the Obamacare scam is that people, who are counted as "insured" for the bragging statistics, have the bronze or silver plans where the deductibles are $6-12,000, making the plan not really health insurance but catastrophic coverage only?
Not to mention the massive increase in premiums ordinary people have faced because of Obamacare, with its forced coverage of items the insured would not have opted for.
Millions of 60-65 year olds are struggling to keep afloat. Then you bring up Tillerson...who, BTW, makes so much that his tax credit would likely be cancelled out under the proposed plan. Further, a final plan is not even in place yet, set for discussion or voting.
Further, the government's payment to doctors under Medicaid is so low that Medicaid insureds have a hard time finding a doctor who will accept their "insurance" (narrow networks).
The current system, contrary to what you espouse, does not ensure that low and middle income Americans can afford the cost of their premiums. Are you not aware that many cannot afford insurance now, because of Obamacare? That part of the Obamacare scam is that people, who are counted as "insured" for the bragging statistics, have the bronze or silver plans where the deductibles are $6-12,000, making the plan not really health insurance but catastrophic coverage only?
Not to mention the massive increase in premiums ordinary people have faced because of Obamacare, with its forced coverage of items the insured would not have opted for.
Millions of 60-65 year olds are struggling to keep afloat. Then you bring up Tillerson...who, BTW, makes so much that his tax credit would likely be cancelled out under the proposed plan. Further, a final plan is not even in place yet, set for discussion or voting.
6
You watch fox too much.
5
Do you have anything constructive to say? Or just liberal bias? I haven't watched one hour total of Fox in 2017. My comments are from my own experience and viewpoint.
2
Lies? You might want to back off your rhetoric here. Absolutely, some people learned they were eligible for Medicaid through the out reach program. By "Much of that number..." it would appear you are implying the majority, however you did leave yourself wiggle room. I think it is weird that you would be critical of people accessing a critical program that clearly saves lives. The vast majority of the 20 million were either newly eligible through the EXPANDED Medicaid program or on the exchange. Here is a link that has indepth information on all of this and more: http://content.healthaffairs.org/content/33/1/78.short I'm one of those 60/65 year olds who uses a plan on the exchange. Our income is too high for any assistance so we pay a hefty premium under a Silver plan; our deductible is HALF of what you claim. The costs of the plans are going to vary from state to state. We live in Washington State where we have a state run exchange and have an insurance commissioner who is aggressive in looking out for the interests of our residents so we maybe in better shape than those who live in states where the legislature is hostile to the ACA. There are a number of areas the ACA could be improved but the proposals the Republicans are working on will not address any of those but will provide some relief for some of us (including me and my wife) but at the expense of those most in need.
2
Margot Sanger-Katz forgets that to be a redistributive law, Obamacare has to affect all the population. This is plain wrong, however; it affects primarily people who have no desirable employer-provided health insurance, which, almost by definition, excludes a lot of very wealthy people; it also doesn't affect people who are on Medicare, which also, by definition, excludes a lot of quite poor people.
Truth is, it transfers wealth from people who are economically unsecure enough to buy their own health insurance - but don't qualify for subsidies - to people who are economically unsecure enough to actually qualify for them, but don't have other health coverage, i.e. through VA. Even worse, such subsidy is essentially a stealth subsidy, since it mandates a common risk pool between people who have to pay their deductable, and people who are very insulated from deductables. It's a bad way outright, since in California a silver plan for a 64-year-old will be substantially more expensive than government Medicare coverage for 65-year-old.
Truth is, it transfers wealth from people who are economically unsecure enough to buy their own health insurance - but don't qualify for subsidies - to people who are economically unsecure enough to actually qualify for them, but don't have other health coverage, i.e. through VA. Even worse, such subsidy is essentially a stealth subsidy, since it mandates a common risk pool between people who have to pay their deductable, and people who are very insulated from deductables. It's a bad way outright, since in California a silver plan for a 64-year-old will be substantially more expensive than government Medicare coverage for 65-year-old.
4
Let's thin the herd.
5
Tax credits are subsidies, if anything, they will make our profligate Healthcare system worse.
4
Self employed tax returns had a place for paying for or partly paying for your health insurance premiums with pre tax dollars. So you had to come up with the money first, but then it was not taxed money you bought your health care with. I think subsidies are too complex. I just don't want to be taxed on my health care dollars, or taxed on the money I pay all my taxes with. Please don't double tax me, bro.
1
All of those union people along with state and federal workers with those big fat pensions atop social security will be in a high bracket for receiving free healthcare. It will be interesting to see this all act out.
1
Wow, I had no idea after working for 33 years and contributing to both my pension and SS that once I retire I will receive a "big fat pension", very nice. Too bad you fell for Reagan and his gift to WS that pensions were bad and 401ks were good. Before the country was duped with trickle down, unions are bad and pensions are worse people who worked most of their lives had a secure retirement. They were not rich, but secure. Now most people don't have "big fat pensions" and I feel sorry that our country has fallen for the lie that Republicons have sold the last 40 years.
8
A retiree's social security payment is reduced for any amount of money they are also receive from a government pension, so there is no windfall. Link to regulations below so you can educate yourself instead of using pejorative terms like "fat pensions."
https://www.ssa.gov/planners/retire/gpo-wep.html
https://www.ssa.gov/planners/retire/gpo-wep.html
3
It's pretty simple: Republicans no longer support healthcare for all, and they haven't for a decade.
They're just trying to figure out how to package their Social Darwinism for the poor in a way that looks better to the middle class while still picking our pockets.
They're just trying to figure out how to package their Social Darwinism for the poor in a way that looks better to the middle class while still picking our pockets.
16
Umm - more than a decade. The "Hillary-hater' machine was created in the '90s as part of the effort to defeat health care reform under Clinton (he had Hillary take the lead on that). [ When it became clear that Hillary was a potential presidential candidate, they Republicans kept it going year after year. and ramped it up with things like the Benghazi hearings, which switched to the email issue. By the time the election rolled around, it had done its job, and vast numbers of people were convinced the issue was the lesser of two evils, rather than between an experienced politicial qualified to be President, and an ignorant and clueless megalomaniac boor totally unqualified to be President.]
7
Two words. Single. Payer.
29
The ONLY sensible alternative. There is no other viable solution. Obamacare, while great for those who couldn't get health insurance due to pre-existing conditions or who received subsidies so they could afford insurance was great. People who didn't get subsidies suffered when premiums went up, they resented Obamacare. Having insurance companies in the mix does not support Healthcare for All. Love to see states adopt a Single Payer alternative as a start, since the federal govt, with the Tea-Taliban Party in charge, will create a dismal replacement.
6
"But it’s far less generous to the poor, and unlikely to provide the health insurance for “everybody” that President Trump envisions."
That won't matter. He will just say we now have "beautiful plans," and his supporters will believe it. He and they will also brand any reports to the contrary as "fake news."
That won't matter. He will just say we now have "beautiful plans," and his supporters will believe it. He and they will also brand any reports to the contrary as "fake news."
13
You fail to mention the "alternative facts"
1
Mixing healthcare either with income or age is a wrong turn to take: as healthcare is vastly superior to only two groups, the rich and the poor, regardless of their health or age.
The rich can go to any provider and pay out of pocket regardless of who and where.
For medicines that can cure any disease they may have hat are unaffordable in America where they are twice as expensive as in other countries or procedures they would be denied by insurance here they can fly to luxury spots and have a vacation while they're at it.
But those who are poor and on Medicaid and QMB's who are over 65, poor or disabled or can get all of this while staying home without spending a dime, or of found to have a health problem sign up for ObamaCare when they discover the problem and while having high deductibles can get "affordable care".
As for the vast majority of Americans and almost all millennials, who only need catastrophic insurance as they have taken care of themselves the Government and insurance companies want us to pay, while insurers and pharmaceutical manufacturers make 98% of their profits without any competition.
So why talk about the poor and rich, and start talking about healthy and well, and about letting competition into the marketplace as medicine is nearing the point where most diseases will be curable and if left alone favors only the rich and poor, until it drives 90% of us into being poor with the cost of medicine, bankrupts America.
The rich can go to any provider and pay out of pocket regardless of who and where.
For medicines that can cure any disease they may have hat are unaffordable in America where they are twice as expensive as in other countries or procedures they would be denied by insurance here they can fly to luxury spots and have a vacation while they're at it.
But those who are poor and on Medicaid and QMB's who are over 65, poor or disabled or can get all of this while staying home without spending a dime, or of found to have a health problem sign up for ObamaCare when they discover the problem and while having high deductibles can get "affordable care".
As for the vast majority of Americans and almost all millennials, who only need catastrophic insurance as they have taken care of themselves the Government and insurance companies want us to pay, while insurers and pharmaceutical manufacturers make 98% of their profits without any competition.
So why talk about the poor and rich, and start talking about healthy and well, and about letting competition into the marketplace as medicine is nearing the point where most diseases will be curable and if left alone favors only the rich and poor, until it drives 90% of us into being poor with the cost of medicine, bankrupts America.
2
I hate to burst your bubble, but medicine isn't "getting to the point where most diseases will be curable". That is simultaneously a gross overestimate of mankind's ability and a gross oversimplification of disease. Medicine IS getting very good at defining the characteristics of lifestyle and circumstance that can trigger disease processes. But realistically, we are discovering insidious new diseases with no known treatments faster than we are curing known diseases.
1
Ivanka Trump can get free contaceptive services through the ACA.
The lack of means-testing for tax credits in this Republican proposal is every bit as stupid, but hardly worse.
And a quick reminder: poor women have had access to contraceptive services through Medicaid for decades before the ACA. They also have the highest rates of unintended pregnancies. Rates of unintended pregnancies dropped in the years before the ACA was implemented. Those declines are attributed to improvements in contraceptives, particularly long-lasting contraceptives.
The lack of means-testing for tax credits in this Republican proposal is every bit as stupid, but hardly worse.
And a quick reminder: poor women have had access to contraceptive services through Medicaid for decades before the ACA. They also have the highest rates of unintended pregnancies. Rates of unintended pregnancies dropped in the years before the ACA was implemented. Those declines are attributed to improvements in contraceptives, particularly long-lasting contraceptives.
2
Actually, if Ivanka was not on the company plan at her fathers business it is not likely she would get free contraceptive services, she would get no subsidy either, she would have to pay for the full plan herself with her own money, before she could walk up to a window and pick up any prescription. It is not FREE when you pay the whole thing yourself, you are basically, pre paying.
2
In certain states, the only people who qualify for Medicaid are people who are on Welfare. The working poor don't qualify. Many of the working poor are not offered insurance through their employers and they don't make enough money to pay for individual or family policies on their own. Since the working poor usually have families to support, with no insurance or Medicaid, their choices regarding birth control are limited to abstinence or OTC spermicides and condoms, the effectiveness of which are questionable at best. So no, poor women everywhere have not always had access to long-lasting, low-cost and effective contraception.
5
Ummm, no: "Plans in the Health Insurance Marketplace must cover contraceptive methods and counseling for all women, as prescribed by a health care provider. Plans must cover these services without charging a copayment or coinsurance when provided by an in-network provider — even if you haven’t met your deductible."
https://www.healthcare.gov/coverage/birth-control-benefits/
As for the working poor who have no insurance or Medicaid, the ACA has a cut-out for just this group, and does not require them to purchase medical insurance. So no joy there. There are also the estimated 11 million undocumented immigrants who are not covered under the ACA.
The WHA amendment to the ACA was driven by politics, not some noble effort to provide affordable access to contraceptive methods for women who otherwise would have been doomed to unwanted pregancies. "Free" stuff is always popular.
https://www.healthcare.gov/coverage/birth-control-benefits/
As for the working poor who have no insurance or Medicaid, the ACA has a cut-out for just this group, and does not require them to purchase medical insurance. So no joy there. There are also the estimated 11 million undocumented immigrants who are not covered under the ACA.
The WHA amendment to the ACA was driven by politics, not some noble effort to provide affordable access to contraceptive methods for women who otherwise would have been doomed to unwanted pregancies. "Free" stuff is always popular.
Clearly the ACA was crafted with precision to provide insurance to poor and low income Americans and those with chronic conditions, through the income-tied subsidies and cost sharing subsidies, the design of the plans and essential benefits, and the Medicaid expansion.
What it did not do was offer much to middle-income Americans who often wound up paying more and getting less. This is why Minnesota stepped in and extended state based subsidies to middle income residents who found they were priced out of the individual insurance market.
The Republicans are banking on the idea that all these middle income people, now not entitled to any subsidy or getting minimal subsidies, will be so much better off on their plan that it will be a win for their party.
What it did not do was offer much to middle-income Americans who often wound up paying more and getting less. This is why Minnesota stepped in and extended state based subsidies to middle income residents who found they were priced out of the individual insurance market.
The Republicans are banking on the idea that all these middle income people, now not entitled to any subsidy or getting minimal subsidies, will be so much better off on their plan that it will be a win for their party.
6
A note about Medicare premiums. If you retired after 2009, Medicare premiums are now means-tested - no flat rate for all. Your premium is based on looking back for three years at your gross income and setting the rate based on those numbers. So actually, people who retired from jobs with lots of benefits accruing at the end of your time on the job (bonuses, raises, stock, etc.) pay more for those three years than someone who retires with a more steady income. That means when a person sells off the stock they were given upon retirement - it counts as income - even if you sell off that stock 5 to 10 years after retirement - and therefor they pay a higher Medicare Premium.
My husband and I have been in that category for the past 6 years - our Medicare premiums are much higher while our income has not really changed (BTW - when you have to begin taking 401K distributions, the same thing happens - your "income on paper" goes up while your actual income is taxed at a much higher rate.) I am NOT complaining. I feel it is only right that my Medicare premiums ($650/month for two of us) are well worth the investment - and am happy that others who might not be able to afford insurance are being covered. A healthy America is the best America.
My husband and I have been in that category for the past 6 years - our Medicare premiums are much higher while our income has not really changed (BTW - when you have to begin taking 401K distributions, the same thing happens - your "income on paper" goes up while your actual income is taxed at a much higher rate.) I am NOT complaining. I feel it is only right that my Medicare premiums ($650/month for two of us) are well worth the investment - and am happy that others who might not be able to afford insurance are being covered. A healthy America is the best America.
9
Shainzona, you and your have the attitude that I associate with America at its best. Inspiring! Thank you.
1
In this economic climate, no one has any incentive (except theoretically on paper) to earn less money just to save on health insurance. People are working two and three jobs just to keep their heads above water, and even then they are drowning.
This is a Republican myth. I'd like them to show me ONE person of limited means who decided to earn less. The only people who can do this trick are people with large incomes who can arrange tax shelters.
I hope low-income Republicans are paying attention. They are going to reap what they sowed (along with the rest of us, unfortunately).
This is a Republican myth. I'd like them to show me ONE person of limited means who decided to earn less. The only people who can do this trick are people with large incomes who can arrange tax shelters.
I hope low-income Republicans are paying attention. They are going to reap what they sowed (along with the rest of us, unfortunately).
17
It is and it isn't a Republican myth. Anyone with income near 400% of the FPL would have a lot of incentive to try to control their AGI to avoid the subsidy cliff.
But the most common way to do it is not to earn less, but to adjust their IRA or other retirement plan contributions, or contribute more to their H.S.A.s There are a lot of deductions that can be used to bring down your AGI without earning less.
But the most common way to do it is not to earn less, but to adjust their IRA or other retirement plan contributions, or contribute more to their H.S.A.s There are a lot of deductions that can be used to bring down your AGI without earning less.
2
If you think there are many people who are at 400% of the FPL and have enough "extra" money to contribute meaningfully to an IRA or other "retirement plan" (especially in places like Wilton, CT where the average household income is $300,000) you are very misinformed, if not completely clueless. HSAs also have contribution limits, so if someone is already at the maximum ($3400 for an individual) that would not work. I would like to see you live as a single working adult in Wilton, CT on $48,000 annual gross income (approx. 400% of FPL) and be able to pay for rent and utilities, food, clothing, a car and gas to get to work, repay student loans, etc. and afford health insurance by "manipulating" your contributions to an IRA or increasing your contributions to an HSA.
2
This is a full-on attack on the poor. We who are not poor must stand with the and resist this heartless shift in policy.
25
Someone should ask Republican leadership how the success of their proposal is to be judged. What objective measures should "evaluators" apply? Right now it appears Republicans will deem it a "success" if more poor people have LESS coverage. Heckuva job, Repubs.
9
The repeal and replace document tries to confuse people because they label the ACA as Obamacare throughout the document.
Anyone else notice that?
Two-thirds of the document trashes the ACA and misrepresents the issues driving the hatred of the current plan and in the barest most obscure way discusses replacement
I couldn't get away with this piece of garbage in middle school
But then again...he loves the uneducated
Anyone else notice that?
Two-thirds of the document trashes the ACA and misrepresents the issues driving the hatred of the current plan and in the barest most obscure way discusses replacement
I couldn't get away with this piece of garbage in middle school
But then again...he loves the uneducated
17
UNIVERSAL HEALTH CARE. Where are the REAL leaders who would do the monumentally obvious, and make UNIVERSAL HEALTH CARE the clearly obvious decision. Get rid of these bought and paid for politicians, and replace them all with REAL leaders who would make sure ALL the PEOPLE were taken care of, not only the disgusting and incompetent executives and rich people who always put profits before people, and the sycophantic press and media who cozy up to the rich to do their bidding in order to get some of the crumbs and leftovers the rich throw to them under the table. We need another election to shake up and get rid of the politicians and academics who survived this last election - it is going to happen...
5
"Obamacare was a redistributive law, transferring money from rich to poor..."
You show a profound lack of understanding what the ACA was designed for.
You are correct that it was a redistributive law.
It transferred money from Federal and State coffers directly to insurance companies while providing very little actual health care.
You show a profound lack of understanding what the ACA was designed for.
You are correct that it was a redistributive law.
It transferred money from Federal and State coffers directly to insurance companies while providing very little actual health care.
4
Designed for? Let us look at what it actually did. Obamacare gave Medicaid (where health insurance is subsidized by "rich" (the more you earn, the more you pay the government) taxpayers) to more people (expanded income requirement for subsidies), offered those specious bronze and silver plans with their high deductibles (and subsidized by the "rich"), penalized high earners with a higher "Medicare" tax which directed money to shore up Obamacare.
No question that it provided very little care. But it punished citizens by financially penalizing them if they did not enroll, and raised drastically the premiums of people who paid for their own non-subsidized insurance, whether thorough work or on their own.
Your conclusion is that it was not designed to help patients at all?
No question that it provided very little care. But it punished citizens by financially penalizing them if they did not enroll, and raised drastically the premiums of people who paid for their own non-subsidized insurance, whether thorough work or on their own.
Your conclusion is that it was not designed to help patients at all?
3
Ok so the rich folks get health insurance they can already afford without any national plan of any sort. And the poor are left to go to the hospital and recieve care hardly anybody without insurance of any kind can't. The Republicans are thinking they're just being fair. And they may be. But to whom..Poor person you can get sick and go to the hospoital and bankrupt the rest of your life . Rich person you can get sick get and cheaper insurance go to the hospital and have it not cost you a dime. There is some sort of twisted version of fair here but I'm not seeing it. I'm sure the insurance companies and the Republicans do.
Is this anything like washing pans at the soup kitchen that are already clean?
Is this anything like washing pans at the soup kitchen that are already clean?
8
The media needs to interview average Trump supporters about how they will feel and what they will do if they lose their ACA benefits. How long can their denial go on before they realize how profoundly they have been duped by the Drumpf.
11
85% of Americans get their health insurance coverage through work policies.
I would be curious to understand the voting statistics of the remaining percentage. Who is against ACA? I would think it would be voters who have employer based coverage but feel that the ACA is threatening their work based policies.
I would be curious to understand the voting statistics of the remaining percentage. Who is against ACA? I would think it would be voters who have employer based coverage but feel that the ACA is threatening their work based policies.
1
It's ironic and near-nauseating how Paul Ryan can proudly claim his Catholicism, yet formulate a means to move what is currently good healthcare coverage from those who need it to those who don't.
The fundamental mission of the Catholic Church has always been to help the poor. Where are you on that Speaker Ryan?
The fundamental mission of the Catholic Church has always been to help the poor. Where are you on that Speaker Ryan?
13
Ahh, but Ryan is "pro life" don't you know.
3
The Church wants compassionate, modest healthcare, not the kind of health plans the ACA designed. Hospitalization. Vaccines. Not invitro pregnancy treatments, or other medical preferences that do not concern themselves with life and death. High bloodpressure meds, not free contraceptives. The reason we can't have universal care, is that Americans are not ok with limiting medicine to life and death care for everyone, because then there is massive jealousy when people run out and get private services like they do in UK and Canada.
2
correction - he is 'pro-birth'
after birth, he doesn't care if you die.
the republican obsession over restricting abortion rights is not about 'life', it is about control.
after birth, he doesn't care if you die.
the republican obsession over restricting abortion rights is not about 'life', it is about control.
2
This plan will allow people like me, over 50, married, and employed to accelerate tax deferred savings for healthcare spending in retirement
By my estimates my husband and I would knock $20,000 off our current income for taxes at the country's expense...of course
We didn't vote for him
We didn't ask for this
It is irresponsible
But if you give it to me, I will take it and those dummies in the rust belt can twist in the wind that they voted against the ACA
By my estimates my husband and I would knock $20,000 off our current income for taxes at the country's expense...of course
We didn't vote for him
We didn't ask for this
It is irresponsible
But if you give it to me, I will take it and those dummies in the rust belt can twist in the wind that they voted against the ACA
6
Please, please, please don't blame us in the rust belt. It does not help us solve these monumental problems we have. You and me are a lot alike....I'm married to someone over 50, upper bracket in taxes, and I've seamlessly had employer provided health insurance my whole life. These changes won't hurt me and perhaps will put more money in my pocket. I am frustrated and angry that DT got the White House and the Republican majorities everywhere. I've been living the Scott Walker nightmare for 7 years. I know full well how outside forces (Koch in WI, perhaps Russia nationwide) can swallow something I love and distort it. But let's stick together. I'm a CA native with numerous relatives in CA & NY, and a whole lot of them voted for DT. It wasn't just us in the rust belt, though I was shocked and horrified at 1 am on 11/9 that it was coming down to what happened in WI. Resistance to this (what I call) evil will take us joining forces and standing up together.
15
I wouldn't let my son apply to UW-Madison because of budget cuts. As an out of state student who would pay full tuition it really annoyed me how the republicans have taken over and ruined a great institution. Hope you and indivisible can fight for change...because these decisions will effect the growth and security of your adopted state.
I am hopeful that the folks that didn't want to vote for her will wake up and see that they need to vote for themselves...
I am hopeful that the folks that didn't want to vote for her will wake up and see that they need to vote for themselves...
5
I can't wait to see what all the Trump voters are going to say when they finally figure out they've been duped and these guys are only interested in privatizing every function of government they can and freeing up the private sector from all laws aimed at protecting us so they can plunder it. No wonder Silicon Valley billionaires are building secure bunkers in anticipation of serious civil unrest when the Republican rank and file finally clue in.
9
I am 62, on Social Security making $15,000 a year with pre-existing conditions.
I am currently covered under the ACA. With this Republican proposal, or at least its intent, I am screwed. How many are in a similar position? Millions, I would guess.
One way to begin would be to expand Medicare to those currently between 62 and 65 (you must be 65 plus for coverage). A small band-aid but in a very precise spot.
I am currently covered under the ACA. With this Republican proposal, or at least its intent, I am screwed. How many are in a similar position? Millions, I would guess.
One way to begin would be to expand Medicare to those currently between 62 and 65 (you must be 65 plus for coverage). A small band-aid but in a very precise spot.
9
I would like to see Medicare for all.
4
This FORMER Republican can't wait to vote in 2018. This is not the compassionate conservative and patriotic party I once knew. This is a bunch of blood sucking, greedy, misogamist, bigoted, old white men who all must be replaced. I'll do everything possible to campaign and vote against Republicans in 2018 and beyond. I'm just a tired old working farmer who wants his young family members to enjoy America.
24
Richard, I'm with you. Im also a former republican, voted for them all my life until Trump. Living in WI I've seen first hand how greedy and morally corrupt the republican party has become. They truly serve only the rich; I'll never vote republican again.
13
A plan that diverts resources and health from the poor and health-services deprived to the comfortable and health-services enriched, a plan that good Christian conservatives will applaud, because they believe that Christ tells them that the poor they will always have with them!
3
Yes, a lot of Christian conservatives seem to think that you will always have the poor with you, so why rush to help them?
3
Is anyone surprised? In eight years has it been forgotten that a Republican health plan is based on financial worth not the health of the citizenry.
9
Of course it would: that is what they stand for, and the only mystery is why the masses of people who stand to gain nothing, and lose much, from such policies continue to support this morally bankrupt party. Is it simply for want of other viable choices?
4
The Trump administration is going to be marked by the GOP trying to fine-tune the amount of poor people it can kill off vs. needing people to clean their toilets.
7
Main stream media now needs to compare and contrast Paul Ryan's, his wife's, and his children's health care benefits to those Ryan is offering to low-income families. Is Ryan one of these people who claim to be Christians when in fact their only God is money?
19
We need to stop referring to the Affordable Care Act as Obamacare.
8
Ashish Jha, MD has written about his/family's experiment with a high deductible plan. As a highly experienced physician whose research interests are in health policy and public health, this should have been easy and straightforward, right? After all, he has the medical knowledge, the connections, and the ability to navigate the health care system. In fact, they struggled. One of the statements he made was that it was like having two choices for dining: spending a lot on a fancy meal or eating nothing. The healthcare marketplace in America is not rational. He had difficulty getting information on prices and cost-effectiveness and skipped getting care for a potentially life threatening condition.
I have seen how Medicare has changed the lives of our patients, particularly those who did not have coverage until they aged into the government funded, single payer insurance plan. Ironically, many people thought that Medicare was half a step away from Socialism when it was put into law in the 60s. While the ACA needs work, the idea of proposing to further reduce access to care for Americans makes me frankly ill. Good thing I have health insurance...for now.
Here is a link to Dr. Jha's article about his high deductible experiment:
https://www.statnews.com/2017/02/06/health-insurance-high-deductible-exp...
I have seen how Medicare has changed the lives of our patients, particularly those who did not have coverage until they aged into the government funded, single payer insurance plan. Ironically, many people thought that Medicare was half a step away from Socialism when it was put into law in the 60s. While the ACA needs work, the idea of proposing to further reduce access to care for Americans makes me frankly ill. Good thing I have health insurance...for now.
Here is a link to Dr. Jha's article about his high deductible experiment:
https://www.statnews.com/2017/02/06/health-insurance-high-deductible-exp...
11
A simple solution - Congress should provide all US citizens and legal non-residents the same package of healthcare that Congress members and their families receive, and at the same costs / deductibles. If the Congressional healthcare program is good enough for these so-called "public servants", it should be good enough for the rest of us. Case closed.
31
We do not have a Congressional healthcare program anymore, it was a trade off to get the ACA through Congress. We have to shop through the ACA marketplace just like the rest of the country but Congress covers a part of our insurance just like any employer, the monthly cost is still ridiculous in my opinion though.
4
Amen. I am so sick of the idea that providing healthcare to human beings is an expense. It is not. It is an investment with HUGE benefits, for us all. Please please please call your senators and representative. Say what you wrote here to them.
3
And this is part and parcel why the GOP hates ACA. Suddenly they had to live like the common folk.
1
The issue is the redistribution of wealth from poor people to rich people. It is happening because of two factors: Firstly, there are millions and millions of poor people on America. They are generally uninformed, and generally non-political. Secondly, the people who are rich pay the toll for politicians to run and hold office. Both the wealthy and the politicians pay attention to who's getting what as bills are written. If we can find a way (most democracies in the world do) to get our politicians separated from the wealthy feed train, we might stand a chance of getting laws that work for all of us. That is the only solution.
27
Would love to see the politicians separated from the wealthy feed train and looking out for the well being of ALL Americans. I'd propose no human or business enterprise could contribute to political campaign expenses. Each person running would get the same amount from the government for expenses and could actively campaign for only 90 to maybe 120 days but could have a website with their platforms on it. I'm sick of "pay to play" and endless campaigning. All the politicians only care about getting rich off the backs of the people who bought, oh, excuse me, elected them.
7
The way I understand this proposal, it seems to me that the poor will be left out in the rain. The wealthy can afford to save money in case they become ill, but what about people who, because of low earnings, only manage to survive from day to day? Will there be a cap set on how much care they get? When it is used up, will they be left to die? One Republican rich woman said that she could afford to pay all of her medical bills without having to "purchase insurance that goes to helping people who are too iresponsible to provide for themselves." All right - guess who'll be hollering for help if she gets, Lord preserve, a catastrophic illness! I'm a European, and nowhere on this continent do we have a medical system that is so callous and geared only to the rich as is the American one.
5
Poor people are not giving money to wealthy people, when taxes are cut. If you do not pay more taxes, it is your money and not redistributed at all. See me after class.
It is hardly a surprise that the Republican health care proposal would transfer more money from most of us to the very wealthy. From what I can tell that is really their only governing principle. Reagan paved the road to our growing inequality and they have only doubled down on that since.
I often joke with friends by asking, "Well what did the Republicans do today to give more of my money to the Koch brothers?". Unfortunately it is not really a joke at all.
I often joke with friends by asking, "Well what did the Republicans do today to give more of my money to the Koch brothers?". Unfortunately it is not really a joke at all.
38
Much as I am a fan of ACA and feel it should be tweaked instead of burned down, the Republican plan to turn Medicaid into block grants instead of a Federally administered program dos not necessarily mean that funding will be cut. There are cases where managing Medicaid in different ways has resulted in great improvements in the care of covered populations. For example, Ohio's capitated approach to pediatric beneficiaries was proposed and led by providers, and provided wins for both the State and providers. Today, Medicaid reimbursement is already driving providers into the ditch. The reimbursement is so low that few providers can afford to have more than a token number of Medicaid beneficiaries, if any. A more creative approach is needed. The accept of "reducing cost" can be met by refocusing providers on ensuring health with Medicaid beneficiaries rather than treating illness. Tough order with a population that is already challenges by economic and transportation barriers (ever tried to take a child who is vomiting and has diarrhea to a doctor who is a 40-minute bus ride away?) but it certainly unleashed creativity among providers when the onus is put on them to provide better care and reduce cost.
3
Block grants are too often used as slush funds for states. They can use the money for other purposes, instead of their original intention. See: http://www.slate.com/articles/news_and_politics/moneybox/2016/06/_welfar...
2
But then their residents will not have health care.
This proposal is going to be very hard to evaluate because no one knows what the "free market" is going to produce in the way of coverage, premiums, deductibles, add-ons for pre-existing conditions, etc. The critics of the ACA may be happy to find very low cost plans that turn out to be complete junk when it is time to make a claim.
We will also return to the days where the insurance companies deny claims for some trivial oversight in the 12 page application process.
Some here have proposed that the best option would be to just extend Medicare for all. I agree with this, but I am now afraid that the opposite will occur and that this plan will be extended to "reform" Medicare itself.
We will also return to the days where the insurance companies deny claims for some trivial oversight in the 12 page application process.
Some here have proposed that the best option would be to just extend Medicare for all. I agree with this, but I am now afraid that the opposite will occur and that this plan will be extended to "reform" Medicare itself.
24
What a strange country we now live in.
Every night we are bombarded by advertisements from drug companies, supplemental insurance plans, and the like while most hardworking middle-class Americans agonize over whether they can afford to even see a doctor when they get sick.
Typical of republicans to advance a plan to make it easier for someone like Tillerson to get financial aid, while claiming to level the playing field for all Americans.
Access to basic healthcare should be a Right to all, not a Privilege for a few.
Every night we are bombarded by advertisements from drug companies, supplemental insurance plans, and the like while most hardworking middle-class Americans agonize over whether they can afford to even see a doctor when they get sick.
Typical of republicans to advance a plan to make it easier for someone like Tillerson to get financial aid, while claiming to level the playing field for all Americans.
Access to basic healthcare should be a Right to all, not a Privilege for a few.
75
But a right to healthcare demands that other people have to serve you. How is that your right?
Rights are intangible things you cannot touch. When I exercise my rights, they do not impact your rights nor require you to do anything including surrendering your wallet to a huge bureaucracy.
Perhaps this will set the stage for a one payer system, the expansion of Medicare as advocated by Sen. Sanders. This could happen if the implementation is cruel to too many, and Democrats re-win at least the Senate. At that point Trump may have to rescue his Presidency with a bold and truly populist move, universal healthcare.
21
Interesting that this law would provide a different credit by age. It is insurance companies that set these prices, presumably based on actuarial statistics. Will the law promise to track the average age based gradient in prices among major insurers, or will it set a fixed chart of credits? It seems like prices could be gamed to get more subsidies, but it is hard to forecast exactly how.
I think the only move which could actually reduce medical prices (with U.S. residents paying far higher prices for prescription drugs) would be to allow some foreign competition, and to have more students entering medical school
I think the only move which could actually reduce medical prices (with U.S. residents paying far higher prices for prescription drugs) would be to allow some foreign competition, and to have more students entering medical school
8
Why increase the number of medical students? There is no shortage of physicians, Americans just want Cadillac care at VW prices. It is impossible to have high-access, high-quality, low-cost care. One leg must give--to expect otherwise is either stupid or childish. Keep increasing the number of doctors while lowering their pay and eventually our health care will rival any under-developed nation's. The best minds will have no incentive to work long hours, at high risk of lawsuit, for low pay. It amazes me that people will praise a barely literate athlete/rock-star/actor, happily contributing to multi-million dollar contracts, and then expect their thoracic or neurosurgeon to provide free care. Doctors want to care for their patients AND be paid for their services. What drives up costs? Law suits (plaintiffs, lawyers, and juries), poor personal lifestyle choices (obesity, smoking, alcohol, drugs), and insurance companies. Want to blame someone for costs--look in the mirror, and at your neighbors and friends.
France has been shown to offer high quality care in a universal system. When I lived in Japan, I met with doctors who treated my chronic ear and sinus conditions much more effectively than any ENT (I've seen more than one) has been able to do in the U.S. There I paid about $10 per visit.
Some of what you suggest does drive up costs, but the main cause is our highly greedy form of capitalism. You can make much more money with certain procedures involving high-priced equipment and having "specialists" do the work. Plenty of orthopedic surgeons, fewer people with much knowledge or interest in offering true health care for life.
Some of what you suggest does drive up costs, but the main cause is our highly greedy form of capitalism. You can make much more money with certain procedures involving high-priced equipment and having "specialists" do the work. Plenty of orthopedic surgeons, fewer people with much knowledge or interest in offering true health care for life.
2
Can you explain that Christine?
Seeing just one comment mildly in favor, and dozens sharply against these changes.
And that is also how Bush Jr's brilliant plan to privatize Social Security - only 3 years before his 2008 crash would have decimated it's holdings - was stopped.
Republicans forgot to be careful what they wished for.
In the document, where they keep insisting Obamacare is "unsustainable" - substitute instead "we'll never ask the 1% to give back".
This is about fiscal priorities, nothing else. Republicans want another tax cut for billionaires, and will trade tens of millions of Obamacare-insured Americans for it.
And that is also how Bush Jr's brilliant plan to privatize Social Security - only 3 years before his 2008 crash would have decimated it's holdings - was stopped.
Republicans forgot to be careful what they wished for.
In the document, where they keep insisting Obamacare is "unsustainable" - substitute instead "we'll never ask the 1% to give back".
This is about fiscal priorities, nothing else. Republicans want another tax cut for billionaires, and will trade tens of millions of Obamacare-insured Americans for it.
55
Hmm, tax credits will do absolutely nothing to help an unemployed or underemployed person retain their health care. As an older man who is finding it difficult to find employment, this has me, in Trumps own wording, BIGLY worried.
66
I looked at the linked Republican plan mentioned in the article, and supposedly the tax credits will be refundable for those of us without enough income to pay much or any federal taxes. It would also be payable monthly. I expect that means that the credit would go directly to the insurance company. Supposedly, if there is anything left after the premium is paid, it can be put into an HSA.
But, like you, I'm worried.
But, like you, I'm worried.
1
Hi Anthony,
I hear you. A stake in the heart of both the poor and disappearing middle class. I grew up in a very Italian working class neighborhood in SF in the 50's and 60's and remember that affording good health care was always a priority in the family and the ACA was the first time the government addressed the issue in an even remotely effective way. Be well.
I hear you. A stake in the heart of both the poor and disappearing middle class. I grew up in a very Italian working class neighborhood in SF in the 50's and 60's and remember that affording good health care was always a priority in the family and the ACA was the first time the government addressed the issue in an even remotely effective way. Be well.
1
Half-way through the downloaded document, it is spewing GOP falsehoods about Obamacare and little else. Here is a tidbit evading reporters so far
• funding for state innovation programs— whether it is high-risk pools
There is your 100% predictable, GOP protection for pre-existing conditions. You'll be forced into very costly high-risk pools, and Ryan's tax credit will laugh at you as you cannot afford to keep a policy.
Innovative - right. These people are corrupt.
• funding for state innovation programs— whether it is high-risk pools
There is your 100% predictable, GOP protection for pre-existing conditions. You'll be forced into very costly high-risk pools, and Ryan's tax credit will laugh at you as you cannot afford to keep a policy.
Innovative - right. These people are corrupt.
38
I agree. High risk pools will be a barrier to many who need healthcare, but are not wealthy. I can guarantee that nothing is going to trickle down out of the hands of the wealthy.
4
I looked at it too, and I agree about the nonsense about Obamacare. The constant smokescreen of look at them, look at them, don't look at us, is childish.
I saw the bit about high-risk pools, too. Having had cancer and having a minor heart condition as well, I assume I won't be able to get health insurance, even with the refundable tax credit. No change there, then.
I saw the bit about high-risk pools, too. Having had cancer and having a minor heart condition as well, I assume I won't be able to get health insurance, even with the refundable tax credit. No change there, then.
2
Except those high-risk pools are controlled by the states, and when they run out of funds they simply leave everyone else uncovered. Already been there
2
Welcome to the new, worse America.
32
So the new bill makes health care cost the same for everyone? This sounds like equality to me. I see no reason why someone who has worked hard and is successful should have to pay for their success.
2
But many successful people do not need to access health care through Obamacare or whatever new Republican plan is eventually implemented because they receive it through their employer. Business owners also likely will not be eligible for this plan because they will be purchasing coverage for their businesses, not for themselves on the individual market.
5
And what about someone who has worked hard without achieving financial success?
2
No, it gives people the same amount of tax credit, only varying by age. But if the tax credit is $500 a month, and health insurance costs $1000 a month, low-income people will still be unable to buy it. I know I won't be able to.
2
Now that the Republicans have sent out some trial balloons, the public needs to let our legislators know how we feel about these ideas.
Democrats need to clearly communicate who wins and who loses with these proposed changes, in clear language that is repeated many times in many venues.
Our 45th President made promises. Do these proposed changes honor those promises? Do they help or hurt the constituency that did the most to put him in the White House?
What mother, father, grandmother, grandfather, or human being would want to see people who have insurance lose it because they can't afford it any more? Perhaps in the abstract, that sounds fine to people of a certain mindset, but substitute "my life", "my child", "my parent", "my spouse", "my friend".
Let's listen carefully to who advocates for these changes and hold them accountable for the cruel and inhumane consequences we will witness if these proposals become law.
Democrats need to clearly communicate who wins and who loses with these proposed changes, in clear language that is repeated many times in many venues.
Our 45th President made promises. Do these proposed changes honor those promises? Do they help or hurt the constituency that did the most to put him in the White House?
What mother, father, grandmother, grandfather, or human being would want to see people who have insurance lose it because they can't afford it any more? Perhaps in the abstract, that sounds fine to people of a certain mindset, but substitute "my life", "my child", "my parent", "my spouse", "my friend".
Let's listen carefully to who advocates for these changes and hold them accountable for the cruel and inhumane consequences we will witness if these proposals become law.
35
"What mother, father, grandmother, grandfather, or human being would want to see people who have insurance lose it because they can't afford it any more?"
Sadly, every Trump supporter I know would answer this question with "ME!". They do not believe that everyone "deserves" health care - you have to earn it and if you can't afford it, tough luck.
Sadly, every Trump supporter I know would answer this question with "ME!". They do not believe that everyone "deserves" health care - you have to earn it and if you can't afford it, tough luck.
3
It is time for universal health care. Think how much better every American's life would be not to deal with the stress and worry of paying for medical bills.
Yes, there would be taxes, but if the wealthiest paid their fair share and Congress would stop diverting funds that are supposed to go into a national health care program, like Medicare, it would be paid for.
We are all Americans--we have fire protection, police protection, military protection, all paid through taxes--so why not health protection? All involve protecting life. We should come together as a country and support each other, regardless of party or faith, to have better lives. Universal health care is the way to start.
Yes, there would be taxes, but if the wealthiest paid their fair share and Congress would stop diverting funds that are supposed to go into a national health care program, like Medicare, it would be paid for.
We are all Americans--we have fire protection, police protection, military protection, all paid through taxes--so why not health protection? All involve protecting life. We should come together as a country and support each other, regardless of party or faith, to have better lives. Universal health care is the way to start.
46
Unless and until we create massive demonstrations, universal health care will happen at the same time as the elimination of the electoral college, expanded voting rights, the end of gerrymandered districts and the elimination of lobbyists masquerading as representatives. In other words, it will never happen as long as people write sappy comments pleading with the power structure to willfully give AWAY its power.
19
Why is the wealthiest's "share" a penny more than what their own healthcare costs or if we slide left, any more, dollar for dollar, greater than someone on minimum wage pays? Since when is making the right choices, achieving success and building a fortune seem as a negative.
1
Thank you. I don't think you will find generosity in this administration or congress. They are the "haves" and good old boys & girls who don't want to share. Most of them will call themselves Christians, because it makes them more electable, but I don't know many who know the details of what Jesus did for the poor and ill.
Despite our nation providing all the services mentioned above, the wealthy will hiss the word "socialism" to scare others, while pocketing their profits and sheltering their money from taxes.
Despite our nation providing all the services mentioned above, the wealthy will hiss the word "socialism" to scare others, while pocketing their profits and sheltering their money from taxes.
1
Here we go again . . . plain and simple economic warfare, The Rich v The Rest of Us. This has nothing to do with equitable access to quality healthcare and everything to do with further economic stratification of our society. If the Republicans get their way, and their model of healthcare is instituted, then after the popular uprising, single payer healthcare cannot be more than two or three Presidential/Congressional elections away.
26
Everyone should pay for government.
10
"House Republicans have repeatedly said that they would continue providing some protection for people with pre-existing medical conditions."
They'll be passing out condoms.
They'll be passing out condoms.
19
If you read their document, the protection is in the form of high-risk pools. We all know how well that works.
2
Over half of what we pay in federal income taxes goes to military. With that we do wars on lies like Iraq that cost around A TRILLION. We do coups on libya that ended up arming ISIS. We did a coup on Honduras that resulted in more refugees. So who do we elect a guy running on the hate platform. We have got to be collectively the most stupid people on earth.
42
Agreed. I am astonished humans ever learned to walk upright. One would think that 8 years of republican Bush would have been a life long lesson, but apparently not. They needed a con man huckster narcissist to embarrass the USA and create havoc only its enemies are enjoying.
29
The United States, is the "only"western industrialized country not to have a universal health care plan.I can't for the life of me understand why Americans don't demand,what is a basic right of citizens to health care.Not only do I not understand---I am blown away in disbelieve.I hear this "garbage"all the time about "socialized medicine."Not able to choose your own doctor and long waiting lists before you get treatment.The standard Republican "bull----"How a private,non-government plan works best.Well,America--here is a dose of reality.Many Americans are dying because they have no access to health care---period.You already pay more for health care,with HMO'S than we,as Canadians pay for universal health care.I will cite myself,as an example.In the past two years,I have been battling cancer.I have undergone extensive testing,treatments and hospital care--for over two months.This included chemo.radiation and three operations.Within three weeks of my diagnoses I had begun extensive treatments.Canada's health care is universal and free---paid for by our taxes.The ordinary Canadian can not understand why American's don't demand this basic human right?Oh,and the fact is my bill,for all of my cancer treatments was "ZERO!" In America,I would not be typing this----I WOULD BE DEAD!"
'"
'"
93
You will get responses from those who zero in on "Within three weeks of my diagnosis I had begun extensive treatments" and say "See! Look at those unacceptable wait times! You could have died in those 3 weeks! That would never happen here!"
But the truth is that that does happen here too. I am a cancer survivor. After my diagnosis it was approximately 5 weeks before treatment began. During those 5 weeks my disease was assessed and a treatment plan was developed--the same things that I'm sure happened during your 3 week wait. But I had to wait for a PET scan while my doctor wrangled with my insurance company, which said it wasn't necessary.
After the whole ordeal was over (at least the first round, let's not talk about the 10 years of cascading side effects), I was out of pocket around $300 and that was what I paid for a private room while in the hospital. Why was I so fortunate? I was a union member and my union had negotiated very good health care benefits for its members.
But here in the US we have one party which does not want Americans to have the right to collectively bargain either because it redirects money to those who work f from those who merely invest. So we've got a party which thinks our health care crisis can be solved with tax credits and health savings accounts while at the same time suppressing wages with all of their considerable might.
I can't understand why Americans don't demand these basic human rights either. Thirty-five+ years of misinformation?
But the truth is that that does happen here too. I am a cancer survivor. After my diagnosis it was approximately 5 weeks before treatment began. During those 5 weeks my disease was assessed and a treatment plan was developed--the same things that I'm sure happened during your 3 week wait. But I had to wait for a PET scan while my doctor wrangled with my insurance company, which said it wasn't necessary.
After the whole ordeal was over (at least the first round, let's not talk about the 10 years of cascading side effects), I was out of pocket around $300 and that was what I paid for a private room while in the hospital. Why was I so fortunate? I was a union member and my union had negotiated very good health care benefits for its members.
But here in the US we have one party which does not want Americans to have the right to collectively bargain either because it redirects money to those who work f from those who merely invest. So we've got a party which thinks our health care crisis can be solved with tax credits and health savings accounts while at the same time suppressing wages with all of their considerable might.
I can't understand why Americans don't demand these basic human rights either. Thirty-five+ years of misinformation?
23
I went through a similar experience with cancer in the UK ten years ago. I had successful treatment with zero out-of-pocket costs and excellent medical care. Britain's health care is also universal and paid for out of tax revenues.
People can change jobs, become unemployed, move to another part of the country and still not lose their health care.
People can change jobs, become unemployed, move to another part of the country and still not lose their health care.
4
Basic human rights have nothing to do with demanding other people use their time and skill to take care of you.
For all those Red State, age 40-65+, blue collar white males earning $30k-$99k/yr who voted for Trump and the Republicans, it's time to reap what you sow.
Unfortunately, so too will Americans who do not deserve your punishment.
Unfortunately, so too will Americans who do not deserve your punishment.
50
And let's not forget their families too!
PS- A majority of non-college educated voters of both genders voted for the Huckster in Chief. If this GOP plan passes, the USA will become just like Kansas under Brownback or Texas under Perry - unable to afford K-12 education, healthcare and social services - all so we may have tax cuts for 1% and the most expensive military on the planet Earth. BTW - Please show me again where it says in the Constitution that the US taxpayers have to pay to be the world's policeman.
PS- A majority of non-college educated voters of both genders voted for the Huckster in Chief. If this GOP plan passes, the USA will become just like Kansas under Brownback or Texas under Perry - unable to afford K-12 education, healthcare and social services - all so we may have tax cuts for 1% and the most expensive military on the planet Earth. BTW - Please show me again where it says in the Constitution that the US taxpayers have to pay to be the world's policeman.
9
The states that benefited from Obama's economic policies (quantitative easing/stock market rise, Wall street profit surge) voted for Hilary Clinton. The states that did not voted for Trump. No democrat has figured out waht to do about the job destruction caused by Bill Clinton's NAFTA. NAFTA was a Republican idea. In fact all the legislation Clinton got past were based on republican ideas. You can scold the Trump low income voters but why? Hilary Clinton had no solutions for their problems. Yes, it would be better to vote democratic because the Dems are committed to preserving our measly safety net (including Obamacare) But that's about all the party DNC stood for. They had no solution for the economic ills brought on by their enthusiasm for globalization, including NAFTA.
1
Health Savings Accounts are a wonderful deal---for the affluent.
You still have to pay normal insurance premiums AND pay 1/12 of your annual deductible every month.
Sure, you get to keep the money if you don't use it for health-related expenses, but if it's a struggle simply to pay for insurance, how are you going to pay that extra couple of hundred dollars per month?
And hello, why do we even have four-figure deductibles in the first place? The excuse is that high deductibles keep people from running to the doctor for every little thing, but the REAL result is that people avoid going to the doctor at all, even for potentially serious things.
Health Savings Accounts are just another Republican mechanism for making the rich and healthy even richer while neglecting the real needs of the non-rich and unhealthy.
You still have to pay normal insurance premiums AND pay 1/12 of your annual deductible every month.
Sure, you get to keep the money if you don't use it for health-related expenses, but if it's a struggle simply to pay for insurance, how are you going to pay that extra couple of hundred dollars per month?
And hello, why do we even have four-figure deductibles in the first place? The excuse is that high deductibles keep people from running to the doctor for every little thing, but the REAL result is that people avoid going to the doctor at all, even for potentially serious things.
Health Savings Accounts are just another Republican mechanism for making the rich and healthy even richer while neglecting the real needs of the non-rich and unhealthy.
42
Historically the Republicans Party had no problems with national health care. A similar plan was even offered by Richard Nixon. The crux of the matter is not the provisions of the plan which can always be modified. No, it is the funding mechanism: The Republicans just don't want the rich to pay for it. They prefer to let it be like Medicare where there is an upper limit on contributions and exemptions allowed that enables the rich to avoid their fair share of the cost.
30
Republicans believe in the market where supply and demand will work. They dont' see need for modification given the recent warpage of the system. The confusion is perhaps in part the 50's 60's and 70's as it did better than now where their are billions of people, globalization and mega mongo corporations taking place of thousands of people have their own biz. The health care market (its hardly even a "market" !) is even more messed up than having 1-3% own/control 90%. So applying some capitalistic purity wand to this monster will not help. We need a complete redo- even the rich often don't get good medical care !! So you know its real bad..
9
OK, Republican Congresspersons, cut Medicaid and then YOU come over here and take care of my 90-year-old blind, practically paralyzed mother.
34
If adopted, this might be the poison pill that kills re-election of Republican majorities in Congress.
24
Let us pray and get active!
5
One can only hope!
1
Not mentioned. The proposal does not allow the credits to be used for insurance plans that cover abortions.
18
Didn't know there were insurance plans that cover abortions. Must be something only the rich get on their plans
1
Sicker people will take insurance young people will not. Premiums will skyrocket deductibles will be high and people will just go to the hospital. Hospitals will have to assume cost.
10
And don't forget that the hospitals will have you sign before treatment, and if you can't pay, or your condition is chronic, boom, your home gets taken, now you're homeless too.
18
What makes you think those hospitals are going to stay open? Or keep their emergency rooms open? Negative income never has a successful outcome.
1
Healthcare is a right! Trickle-Up Medicine is abhorent to any civilized society!
18
What else should we expect from the Republican Party - take from the poor and give to the rich. That's been the story of income inequality for years. That's why I say, the GOP Health Care Proposal is "die, serfs!".
36
Speaker Paul Ryan has been trying to "explain"--actually, lie is a much better phrase--about has plan since before his failed VP run of 2012. ACA keeps insurance r company Administrative Expenses--Profit and Executive r B onuses--to 20%. But with vouchers, the sky's the limit, just like before President Obama signed Affordable Health Care into law--in 2010. Ironically, with lots and lots of promises, the GOP hasn't been able to improve upon it.
They state that you don't have to buy what you don't want, or even buy into it at all. So, what happens when you get sick? Pre-existing conditions might make Ryan's vouchers worthless. You don't buy auto insurance AG+FTER an accident! Or home-owners AFTER a fire. And remember, in those "good old days"--for all you GOPpers--many things were not even covered by some plans, including maternity and pre-natal for young women.
Lastly, ACA--derisively called "Obamacare"--was promoted on the ultra-conservative, GOP Camper, Heritage Foundation. And then, Mitch McConnell signed a version into law, in Massachusetts.
https://thetruthoncommonsense.com
They state that you don't have to buy what you don't want, or even buy into it at all. So, what happens when you get sick? Pre-existing conditions might make Ryan's vouchers worthless. You don't buy auto insurance AG+FTER an accident! Or home-owners AFTER a fire. And remember, in those "good old days"--for all you GOPpers--many things were not even covered by some plans, including maternity and pre-natal for young women.
Lastly, ACA--derisively called "Obamacare"--was promoted on the ultra-conservative, GOP Camper, Heritage Foundation. And then, Mitch McConnell signed a version into law, in Massachusetts.
https://thetruthoncommonsense.com
24
Mitt Romney a Repub signed
1
Speaker Ryan has once again come up with the Soylent Green Plan. He's an abysmal human being. And he sounds like a broken record. Whatever Congressional District he represents should be immediately excised from the Union. He's a disgrace to all of us.
Thank goodness he's so ineffectual.
Thank goodness he's so ineffectual.
30
Republicans love talking about tax credits as a way to pay for medical bills. What good are tax credits going to do for most Americans?
27
Do the Republicans have ANY plans that aren't about directing money to the rich? That's pretty much their entire agenda.
34
I'm so disgusted by the Republican Party and the damage they seem delighted to inflict upon the most vulnerable citizens....for the benefit of those who have the most. It's appalling and all of us have an obligation to fight back.
41
We can't win until we figure out what to do about the "hate and ignorance" vote. And their plan, in addition to more money for the wealthy, also involves working very hard to keep as many Americans scared and stupid as possible.
2
If you think Trump's "repeal and replace" Obamacare plan favors the wealthy, just wait until you see his "tax reform" plans...
29
The plan is ridiculous, dangerous, backwards-going.
I ask you to look at the economic reasoning of the line I quote at the end. We are now, with House Republicans, apparently in the same surreal, alternative facts world of the President.
It takes us back to the horrible, horrible old system of pre-existing-condition-screened insurance with state-run high-risk pools to try and cover some people with pre-existing conditions. The high-risk-pools had numerous problems: closed, waiting lists, low maximum coverage limits, premiums up to $25,000 a year per person. They also often had serious eligibility problems, so that a person who never tried to game the system, and had continuously maintained health insurance prior to needing the pool could be ineligible when they needed it.
The plan has some funding for the state high risk pools with "State Innovation Grants". Now, no mention of a dollar amount on the grant here, but a recent Economist article calculated in a recent Ryan plan, only < 1/4 of the needed funds were supplied for the high risk pools.
Now I quote the plan for the economic argument that the new pools will be OK:
"Some may suggest State Innovation Grants would lead to enrollment caps or waiting lists – like certain high risk pools functioned prior to Obamacare. This is false. These new and innovative State Innovation Grants are designed to help vulnerable patients. Why would anyone allow them to potentially harm the very patients they are intended to help?"
I ask you to look at the economic reasoning of the line I quote at the end. We are now, with House Republicans, apparently in the same surreal, alternative facts world of the President.
It takes us back to the horrible, horrible old system of pre-existing-condition-screened insurance with state-run high-risk pools to try and cover some people with pre-existing conditions. The high-risk-pools had numerous problems: closed, waiting lists, low maximum coverage limits, premiums up to $25,000 a year per person. They also often had serious eligibility problems, so that a person who never tried to game the system, and had continuously maintained health insurance prior to needing the pool could be ineligible when they needed it.
The plan has some funding for the state high risk pools with "State Innovation Grants". Now, no mention of a dollar amount on the grant here, but a recent Economist article calculated in a recent Ryan plan, only < 1/4 of the needed funds were supplied for the high risk pools.
Now I quote the plan for the economic argument that the new pools will be OK:
"Some may suggest State Innovation Grants would lead to enrollment caps or waiting lists – like certain high risk pools functioned prior to Obamacare. This is false. These new and innovative State Innovation Grants are designed to help vulnerable patients. Why would anyone allow them to potentially harm the very patients they are intended to help?"
9
For anyone interested, here is the Economist article I referenced on Ryan's version of the plan having < 1/4 of the needed funding http://www.economist.com/news/united-states/21715731-without-plenty-cash... .
(The Economist worked with Minnesota as a case of a working high risk pool. To have high-risk-pools like Minnesota's in all states, the Economist estimated $11 billion a year was needed, but Ryan's plan offered only $2.5 billion a year. )
Also, I point anyone interested to this excellent NY Times article:
https://www.nytimes.com/2017/01/22/business/president-donald-trump-healt...
on the old pre-existing-condition-screened system with (generally unreliable) high-risk-pools that was the norm in most states prior to ObamaCare.
(The Economist worked with Minnesota as a case of a working high risk pool. To have high-risk-pools like Minnesota's in all states, the Economist estimated $11 billion a year was needed, but Ryan's plan offered only $2.5 billion a year. )
Also, I point anyone interested to this excellent NY Times article:
https://www.nytimes.com/2017/01/22/business/president-donald-trump-healt...
on the old pre-existing-condition-screened system with (generally unreliable) high-risk-pools that was the norm in most states prior to ObamaCare.
7
Medical expense remains the top cause of bankruptcy in this country, and this plan will do nothing to change that. The ACA was based on a Heritage Foundation plan and modeled after Romney's Massachusetts plan, so it is already a conservative idea which fails to address the root problems of cost control and universal access in order to preserve a corporate, profit-motivated model. Without a radical shift to a single-payer, cost-controlled system that covers everyone, these problems will never be fixed.
42
I expected the R's to cut Medicaid funding, especially for the states who opted to expand eligibility and cover more people with the ACA. The rest of the whitepaper is just a repeat of the Speaker of the House's long term goal, which has been to "block grant" Medicaid and transfer greater responsibility for program costs to participants, without commensurate controls for reducing; unnecessary procedures, grossly over priced drugs and exorbitant medical devices. These issues and a host of other systemic problems are not fixable by a single individual and require national leadership. This trend will continue for Medicare also, as the cost of that program is ballooning, and the less creative way to deal with a problem is just to make it someone elses concern by passing the buck. If you apply this template to many of the current administration's pronouncements, you will find it fits.
18
let's be brutally honest here: for fifty two years,
the Republicans have been determined to make
the poor in this country less healthy. this new
so called plan assumes that poor, or for that
matter middle class people, can save enough
money to fund these phantom medical health
accounts. an average week in the hospital would
wipe out most of these accounts and leave
people with no choice but to borrow from
retirement savings or hit up relatives, who are
probably no better off than they are.
in 2008, I had a medical emergency and required
surgery. without my medicaid and eventually
when I turned 65,medicare,I would not have been
able to afford the surgery and the follow up
treatment. I am fine now, thanks entirely to these
programs.
Republicans will gut these programs for no other reason than their near pathological need to please the most radical right and misinformed
supporters among their constituents and give
more money to their wealthy contributors.
I have always favored rational discussion with
our Republican friends and not simply hurling
condescending insults at them,but they need to
realize how devastating the gutting of these
programs would be to the poor and elderly.
the Republicans have been determined to make
the poor in this country less healthy. this new
so called plan assumes that poor, or for that
matter middle class people, can save enough
money to fund these phantom medical health
accounts. an average week in the hospital would
wipe out most of these accounts and leave
people with no choice but to borrow from
retirement savings or hit up relatives, who are
probably no better off than they are.
in 2008, I had a medical emergency and required
surgery. without my medicaid and eventually
when I turned 65,medicare,I would not have been
able to afford the surgery and the follow up
treatment. I am fine now, thanks entirely to these
programs.
Republicans will gut these programs for no other reason than their near pathological need to please the most radical right and misinformed
supporters among their constituents and give
more money to their wealthy contributors.
I have always favored rational discussion with
our Republican friends and not simply hurling
condescending insults at them,but they need to
realize how devastating the gutting of these
programs would be to the poor and elderly.
75
I think the Republicans would just as soon snail-mail a bullet to each poor person for when a serious medical condition arises.
13
Seriously? This is it? THE plan? What is it about Americans that makes them turn in the face of a single-payer healthcare system?
It doesn't have to be "socialist" (a.k.a. my much beloved NHS in the UK - despite the Tory government flying in the face of facts and trying to model it on a US-based privatized insurance model), it could take a leaf out of the Swiss Assurance Maladie - Government mandated, but privately run - even Paul Krugman has waxed-lyrically about this model, to which I participated while a Swiss resident.
The United States - a nation which promotes the right to bear arms, but not affordable healthcare. Really?
It doesn't have to be "socialist" (a.k.a. my much beloved NHS in the UK - despite the Tory government flying in the face of facts and trying to model it on a US-based privatized insurance model), it could take a leaf out of the Swiss Assurance Maladie - Government mandated, but privately run - even Paul Krugman has waxed-lyrically about this model, to which I participated while a Swiss resident.
The United States - a nation which promotes the right to bear arms, but not affordable healthcare. Really?
70
There is no free lunch. Less is not more. One cannot put fewer taxpayer dollars into health care subsidies and obtain greater coverage of the population; not without instituting other unprecedented constraints on rising health care costs.
Market forces alone are radically ineffective in highwayman conditions: Your money or your life. Premiums and deductibles are adjustable, but, gouging and scams aside, they are based in a ruthlessly calculable tradeoff grounded in actual payout costs. Wish away, but one cannot lower both premiums and deductibles without reducing the profitability of issuing insurance, reducing coverage, or reducing the underlying cost of health care. Any Republican plan will be playing on that same hard field as the ACA. There's no magic here. Look for the winners and losers. And a predictable lack of seriousness.
Market forces alone are radically ineffective in highwayman conditions: Your money or your life. Premiums and deductibles are adjustable, but, gouging and scams aside, they are based in a ruthlessly calculable tradeoff grounded in actual payout costs. Wish away, but one cannot lower both premiums and deductibles without reducing the profitability of issuing insurance, reducing coverage, or reducing the underlying cost of health care. Any Republican plan will be playing on that same hard field as the ACA. There's no magic here. Look for the winners and losers. And a predictable lack of seriousness.
28
I still don't understand the Republican obsession with the ACA. What do they stand to gain from changing it, depriving thousands if not millions of healthcare coverage, and undermining the financial systems of many hospitals and medical centers? Even the insurance companies seem uneasy about the unforeseeable consequences. Is it just that the conservatives fear that we'll spiral into godless Communism like the Canadians and Europe and--well, the rest of the civilized world?
41
I am not a Christian. But have always believed in loving your neighbor as yourself, in helping those less fortunate. Through the method of give a man a fish and he eats for a day, but teach a man to fish and he eats for a lifetime, and teaches his community how to fish. Paul Ryan seems to think that starving a murdering those who earn less than him, and the world will be better place. I think this is a bad plan, it will not surprise when those whose children might have been saved were it not for Ryan's paw on the scale, decide to burn his house and this country to the ground.
18
How will hospitals view a plan that offers less to the poor? Will we again see increasess in ER visits? Will older adults, who may benefit more in terms of tax credits, also be subject to premiums that are even higher than under the ACA?
10
Shocked! Shocked that Republicans will take money - and healthcare - from the poor to give to the rich!
Of course all the time piously bragging what wonderful Christians they are.
Don't you just wish sometime that the Jesus - that they SAY they believe in - would come down and justly smite these big hypocrites?
Of course all the time piously bragging what wonderful Christians they are.
Don't you just wish sometime that the Jesus - that they SAY they believe in - would come down and justly smite these big hypocrites?
65
Or at least drive them from the temples!
14
Single payer. Its not perfect, of course. No solution is. But right now there is an entire (substantial) "cottage" industry whose sole purpose is to represent health care providers negotiate out-of-network claims that insurers request because the patient (you and I) was inadvertently referred. This is just nuts. Don't get lost in the details. we need single payer!
29
Yes, if the Republicans want to replace the ACA with a plan that's ready to go, Medicare for all is it.
15
Republican health care proposals...because the poor have it too good, and the wealthy don't have it good enough.
68
Rex Tillerson getting tax credits under this proposal is as stupid as Mark Zuckerburg's wife getting free contraceptive services under the ACA.
8
Hugh, it is not. If you're only considering the cost then providing free contraception saves health care dollars. This is because the cost of pregnancy and delivery is much more costly. You might say that Mrs. Zuckerburg could afford the all the obstetrical and pediatric care required. That's true. It still saves money overall and for the vast majority it is just not worth it to means test all those who would choose contraception.
15
Although there's an argument to be said that equal healthcare opportunities and care should be available to all - regardless of income. Or is that a bit too socialist?
8
When the ACA was enacted I ended up paying more on our family's insurance; it wasn't fun but I felt it was the one option given to us to move this country toward something greater.
I fear my extra dollars (north of $250/month extra) will, under the Republicans, will still be used, but not to provide health care to someone less fortunate than my family, but rather to some pharmaceutical CEO or other gazillionaire.
It would be the worst if both situations.
Parting thought.... why do billionaires only want to be richer?
I fear my extra dollars (north of $250/month extra) will, under the Republicans, will still be used, but not to provide health care to someone less fortunate than my family, but rather to some pharmaceutical CEO or other gazillionaire.
It would be the worst if both situations.
Parting thought.... why do billionaires only want to be richer?
80
"why do billionaires only want to be richer?" ... that is the defining question of our times.
18
Why do billionaires only want to be richer? Greed can reduce brain size. Lots of greed can leave you with only mush in your head with room for terror and no room for sympathy for, much less empathy with, your fellow beings
19
This reminds me of an interview of a woman from Kentucky who, thanks to the ACA, had health care insurance for the first time in her life. Yet she was convinced by the right to vote for a Republican governor who initially campaigned to abolish Obamacare. If she hasn’t lost her health care insurance already, she’ll get her wish soon enough. God forgive me, but I’m getting tired of donating money and voting for the benefit of those less well off than me while those I hoped to help actually vote to make me better off at their expense. After this last election I’m beginning to think that I should just worry about taking care of my own. Hopefully I’ll return to my progressive roots for the next election, but I wonder how much enthusiasm I’ll have for it.
61
Trump and republicans are still fooling us about health insurance. This MAGA "plan" is just subterfuge. Republicans had many years (since 2009) to devise a viable plan... and all they have is this "We've-put-something-together-so-tell-us-if-you-like-it" Plan.
They gave no details about how their "plan" works (it's described briefly in the 1st-half of this article: www.nytimes.com/2017/02/16/us/politics/affordable-care-act-congress.html ).
The plan requires us to save / deposit our own money into a special "savings account"... until we might need it. So let's all start saving for the $50,000 that a heart attack costs.... or the $300,000 we may need for cancer therapy. The most wonderful GREATEST part: we get tax deductions for whatever we save! AMAZING!!
That's their full (fool) plan -- we save our own money (in basically a bank account) and we get tax deductions. We'll pay FULL COST for healthcare out of our own pockets. It's not an insurance plan... it's a savings plan ! !! !
Yes, save away America. The Rebubs have it under control.
If you can only save $2600 a year... they'll light a candle for ya, 'cus that's all the "health care" you can afford. Tough luck!
Repub idea of universal healthcare : "If you expected healthcare, you shouldda been born rich!"
drip...
drip...
drip...
They gave no details about how their "plan" works (it's described briefly in the 1st-half of this article: www.nytimes.com/2017/02/16/us/politics/affordable-care-act-congress.html ).
The plan requires us to save / deposit our own money into a special "savings account"... until we might need it. So let's all start saving for the $50,000 that a heart attack costs.... or the $300,000 we may need for cancer therapy. The most wonderful GREATEST part: we get tax deductions for whatever we save! AMAZING!!
That's their full (fool) plan -- we save our own money (in basically a bank account) and we get tax deductions. We'll pay FULL COST for healthcare out of our own pockets. It's not an insurance plan... it's a savings plan ! !! !
Yes, save away America. The Rebubs have it under control.
If you can only save $2600 a year... they'll light a candle for ya, 'cus that's all the "health care" you can afford. Tough luck!
Repub idea of universal healthcare : "If you expected healthcare, you shouldda been born rich!"
drip...
drip...
drip...
30
Yes, and our health accounts will likely be managed by Goldman Sachs or Wells Fargo, allowing us perhaps 1.5% on our money. No thanks.
3
Ok, I get trying to widen the pool. Why is it that these insurance companies split their pools between employer-based insurance and the exchanges? Ah, different product manager?
If the pool mix is one of the problems, then combine the pools. Single-payer.
Also all with employer-based insurance, you are not immune. The GOP wants to cut the tax credits your company gets to supply your insurance. Beware.
If the pool mix is one of the problems, then combine the pools. Single-payer.
Also all with employer-based insurance, you are not immune. The GOP wants to cut the tax credits your company gets to supply your insurance. Beware.
8
Great article about nothing but suppositions, biased opinions and fake news.
But keep the ball rolling NYT your readers need something to compalain about.
But keep the ball rolling NYT your readers need something to compalain about.
1
How many times do I have to say it? They are unable to govern. They can destroy. They can block. They can lie. They can stonewall.
But they cannot create.
They cannot do good things.
They cannot govern.
End of story.
But they cannot create.
They cannot do good things.
They cannot govern.
End of story.
68
Alas, with just a low six-figure salary, you might have to limit trips to Europe to just two annually and own a condo in a neighborhood where you must mingle with people who ride the subway! And now the paper of record dismisses your plight. The agonies of the forgotten top 20%.
20
What I find most interesting in this story, is that Republicans seem to have found a way to undo large parts of Obamacare without having to worry about a Senate filibuster. 51 votes will do it. They have 52.
Remember back in 2009-10, when Democrats had a big majority in the Senate, 60-40? Enough to pass something even with no Republican votes, provided they all stuck together. Yet they wasted a year and a half, in a futile attempt to get Republican support, meanwhile giving the one or two most conservative Democrats veto power over the final legislation ...
Us liberals can talk all we want about Republican "disfunction." Yet when it comes to helping the wealthy, Republicans have a laser focus. In health care and tax reform, you can bet they will enact huge wealth redistribution schemes to benefit the donor class.
Wouldn't it be great if Democrats had that same degree of focus? If they did, we would have had universal guaranteed health care long ago.
Remember back in 2009-10, when Democrats had a big majority in the Senate, 60-40? Enough to pass something even with no Republican votes, provided they all stuck together. Yet they wasted a year and a half, in a futile attempt to get Republican support, meanwhile giving the one or two most conservative Democrats veto power over the final legislation ...
Us liberals can talk all we want about Republican "disfunction." Yet when it comes to helping the wealthy, Republicans have a laser focus. In health care and tax reform, you can bet they will enact huge wealth redistribution schemes to benefit the donor class.
Wouldn't it be great if Democrats had that same degree of focus? If they did, we would have had universal guaranteed health care long ago.
29
Yeah I remember 2009-10, when they could've accomplished so much, and missed their chance. I recall thinking that Obama was wasting precious time trying so hard to do things in the spirit of bipartisanship, when all the while the republicans were basically spitting in his face. What a wasted opportunity.
They could've steamrolled their policies through and never looked back.
We need more people like Sanders and Warren who will fight for us, not do the bidding of their corporate overlords while lining their pockets.
They could've steamrolled their policies through and never looked back.
We need more people like Sanders and Warren who will fight for us, not do the bidding of their corporate overlords while lining their pockets.
Is this a surprise? It's called "Trickle-Down Healthcare."
17
It makes me sad that this plan would benefit me by allowing me another tax loophole to save more money through my health saving plan, while stripping the most vulnerable among us of health insurance. I don't need the Republicans to change the ACA to benefit me. I need them to help my less fortunate fellow Americans. And ironically, a lot of them are Trump supporters.
19
Your comment is welcome...other than Warren Buffett, it is long overdue for the well off to speak up and tell the Republican Party that they don't need any more tax breaks...that we want a stable nation where ALL of our citizens lives are valued.
7
A variation of their previous de facto criminal plan of be rich, don't get sick and/or don't have a bad life event and put big phrama/hmos before sick Americans.
9
Tell me again why rich person is going to pay the same as a poor person? What was that? Speak up so we can all hear you!
12
HSA's are a pain. Not quite 60, really, do I want more paperwork, another separate checkbook/checking account, all the tax and record keeping busy work that it takes to fund, hold and use an HSA?
At this age/stage, I'm trying to simplify all of my life, especially my financials, and healthcare.
This is not a step in that direction.
At this age/stage, I'm trying to simplify all of my life, especially my financials, and healthcare.
This is not a step in that direction.
20
Funny how when Ocare resulted in millions of Americans being forced to purchase expensive, high-deductible individual-market health insurance under draconian tax penalties, losing the insurance and the doctors Obama had promised they could keep, the "consumer advocates" and the press never spoke up.
You didn't care about us then.
Why should we care about you now?
You didn't care about us then.
Why should we care about you now?
5
And now you're going to be happier? Good luck with that and please don't show up in the ER with no coverage and expect medical personnel who care.
10
This was not the experience of many people. I had private insurance and during the same period my insurance increased 30% per year on average, not to be blamed on Obamacare.
6
Bless you sir! In a few sentences you have shined the light of truth.
Wouldn't it be nice if Republicans would surprise us at least every once in a while and do something generous, or kind, or even practical. Do they enjoy being considered the Scrooge McDucks of the world?
18
It might get confusing from here on in, but rest assured, now that the Republicans are in charge "If you like your current illness, you can keep remaining ill."
25
Thanks for the chuckle; I feel my health improving already.
Maybe we should all join Laugh Clubs and and either laugh ourselves to death or gain peace of mind from it.
Maybe we should all join Laugh Clubs and and either laugh ourselves to death or gain peace of mind from it.
1
With this new program, low-income Americans will lose out once again to the uber wealthy. And yet a vast number of them will continue to vote straight down the Republican ticket -- assuming they choose to vote at all.
If only we could inform these Americans that they're being hoodwinked into voting against their own interests, but sadly they hold steadfastly to the belief that their elected Republican officials really do care about them.
If only we could inform these Americans that they're being hoodwinked into voting against their own interests, but sadly they hold steadfastly to the belief that their elected Republican officials really do care about them.
12
Perhaps these low-income Americans deserve to suffer for their choices.
1
Really? They deserve to; "suffer." How Christian-unlike.
1
And where will the euthanasia centers be located? Oh, that's right, we must suffer for our sins, so no pain relief.
1
Please keep reporting on this. It is very important for people to understand what they are offering. It is a plan that will significantly hurt the middle and lower income people and that is not what the people want. People need to understand what is being proposed and to get on the phones and tell their reps it is unacceptable.
16
These people have no shame.
12
People over 50 years old like myself and spouse will make out like bandits with this plan. I can double the amount in my HSA and make catchup payments and then do the same with the 401K...and so can the hubby and the fact that it is all in my name wont cause any problems...right?.
Conservatively I think I could shield another $15-20K per year!
So this little plan is going to cost a fortune, it is completely unethical and will bankrupt the country.
Sad.
Conservatively I think I could shield another $15-20K per year!
So this little plan is going to cost a fortune, it is completely unethical and will bankrupt the country.
Sad.
15
I am shocked by this news.
2
American healthcare policy is now being crafted by Republicans who do not recognize health care coverage as a basic human right. It's curious to watch them work against the best interest of all Americans. I have lost my trust in the Republican Congress, they are raising the frustration and anger of citizens of all ages. They are playing with our lives in the most reckless ways!
And they refuse to consider the ideas and concerns of ALL AMERICANS.
And they refuse to consider the ideas and concerns of ALL AMERICANS.
18
Well, maybe this will become an extended "teachable moment" for Trump voters who have relied on Obamacare, even unwittingly. But, maybe that's too optimistic. I think they'd take a bullet for their Lord of Darkness, in thanks for him "telling it like it is".
10
OK, Indivisibles everywhere:
This is a HUGE mobilizing issue.
Got our marching orders.
They can't get away with this.
No way, no how, no where.
This is a HUGE mobilizing issue.
Got our marching orders.
They can't get away with this.
No way, no how, no where.
9
Maybe at some points the poor , like in West Virginia , which represents the majority of the electorate in this country, will understand that voting for the republicans isn't in their best interest.
Until then , they'll keep suffering from self inflicting wounds.
Until then , they'll keep suffering from self inflicting wounds.
17
Hello red states: welcome to reality.
15
Hot diggity dog!
How do you like the proposal, low income trump supporters on the ACA?
I recommend you start eating that elitist liberal health food, and losing those extra pounds, because they just sold you up the river.
Sorry to the decent folks, as you do not deserve this.
How do you like the proposal, low income trump supporters on the ACA?
I recommend you start eating that elitist liberal health food, and losing those extra pounds, because they just sold you up the river.
Sorry to the decent folks, as you do not deserve this.
14
I knew it - I knew it --- the Rich are going to eat the Poor.
12
The poor will eat each other. The rich can afford better. "Let them eat cake".
2
Ayn Rand fanboy resurfaces. There should be no pretense that this will be fair or helpful to the poor, who deserve whatever befalls them (losers).
Congress best remember that extreme income inequality is unhealthy for an economy -see Piketty- and we are heading now into unfettered, pedal to the metal vulture capitalism.
Denying the weakest while making sure Goldman's hitting new highs is frankly obscene, and is not going to end well.
Congress best remember that extreme income inequality is unhealthy for an economy -see Piketty- and we are heading now into unfettered, pedal to the metal vulture capitalism.
Denying the weakest while making sure Goldman's hitting new highs is frankly obscene, and is not going to end well.
14
Our politics may now be "fact-free," making any GOP sham proposal politically passable. But insurance underwriting is not fact-free. Gouging opportunities aside, it's one of the most fact-based industries there is. Watch to see insurers resist any plan the retains the "candy" of no annual or lifetime caps, no exclusion based on preexisting conditions, and other such provisions that guarantee to put the individual market back in the death spiral of rapidly escalating premiums and fewer and sicker covereds it was entering before the ACA.
9
Republicans ARE the Death Panels!
GOP to Americans: DROP DEAD! They're nothing but power mad, greedy, cynical, cold blooded killers, willing to put millions of Americans at risk in service of their wretched, soulless ideology.
Republicans have done NOTHING to benefit the well-being of average Americans, but they do a great many things to our detriment.
So why are people stupid enough, brainwashed enough, to keep voting for these evil fascists?
GOP to Americans: DROP DEAD! They're nothing but power mad, greedy, cynical, cold blooded killers, willing to put millions of Americans at risk in service of their wretched, soulless ideology.
Republicans have done NOTHING to benefit the well-being of average Americans, but they do a great many things to our detriment.
So why are people stupid enough, brainwashed enough, to keep voting for these evil fascists?
16
The Republican party is the party of Hood Robin, taking money from the poor to give to the rich. AKA as Poor Robbin'
9
How nice of them to shovel this manure in front of us right before they go home for recess. We'll be able to tell them just what we think of the stench.
12
Where will they be holding their strategy meetings while on recess?
How is a person going to pay for the premiums with after-the-fact tax credits?
10
You get to claim the credit in advance presumably when you pay your premium. (I guess in that case, the insurance co. gets part of the premium from Uncle Sam.)
1
Another one of PDT's lies, he doesn't care about the poor people and neither to the fat old cat Republicans. The Republicans must be licking their chops as this is another great loop hole to keep their money free from taxes. Just wait for the poor to get poorer and then there will be a revolution, they really can't get any poorer. To coin PDT's saying "so sad."
9
I'm ready to march against this travesty. Just tell me and millions of others where to show up. And we're not radicals. We're just average Americans who demand fairness and are tired of giving gifts to the rich like our President, who pays no federal taxes. We've now had enough.
10
Elimination of the obscene price gouging should be incorporated in there some where. Oh, that's right I forgot about the fact that our laws are bought and paid for by the special interests.
8
This rich man could use something for a change. But seriously, please, stop crying...
Well, duhhhhhh . . .
Everything's "spout up" for the Republicans who promote privatizing everything so that only the luckiest poor will see anything -- support, healthcare, education -- actually "trickle down."
I mean, how will the least fortunate appreciate what they do have if they're given a leg up?
And how will the most fortunate be able to be feel good about their greed if they can't lord it over the poor.
Everything's "spout up" for the Republicans who promote privatizing everything so that only the luckiest poor will see anything -- support, healthcare, education -- actually "trickle down."
I mean, how will the least fortunate appreciate what they do have if they're given a leg up?
And how will the most fortunate be able to be feel good about their greed if they can't lord it over the poor.
4
Tax credits! Great! Not a problem at all for folks wbo can't afford insurance.
7
This is not a surprise--Ryan has discussed this many times. The big question is what Trump will do. He has said many times that the GOP/Trump replacement for Obamacare will be better than Obamacare, and the positive features of Obamacare will be kept. Of coruse, this could be the classic "bait and switch" routine we find on used car sales centers. Judging from what the world has seen of Trump, we should not be surprised that US healthcare will be much, much worse, and very, very soon.
9
Better for whom?
Where is the proof? Why is NY Times not telling us the truth? How about you post the full plan so we can decide for ourselves? NO, never mind, don't do that. Keep feeding the sheep this.
1
Look harder. The NYT has a link to the full plan (such as it is) in the other article announcing it.
7
I am shocked, shocked I tell you. Of course this is what the GOP will do. That is what they always do. The really shocking part is why so many Americans thought they wouldn't touch the ACA. I hope, hope they make these "patriots" pay for their treachery with their jobs next year.
8
Surprise, Surprise, Surprise !!!!!
5
I have always wondered this and never seen it commented on - how do tax credits help people too poor to pay taxes? And how do you incentivize savings for healthcare for people who can't pay both the rent and their food bills?
10
Bingo!
Simpler than it sounds; tax credits will be useless to low income people.
What helped them in ACA were the low-income subsidies, which are on death watch.
Simpler than it sounds; tax credits will be useless to low income people.
What helped them in ACA were the low-income subsidies, which are on death watch.
2
I'd like to see the Times report on what Republicans hope to accomplish with these changes. When the ACA was being debated, the whole idea revolved around the goal of increasing access to health insurance and thus health care by uninsured Americans. That was the game-changer. The details were debated, but that was the goal. And it worked, to the tune of around 20 million people obtaining coverage.
So NY Times: Please report substantially on what the goals are, and let's hear those goals in terms of the health care consumer. Is the goal more people covered? Lower out of pocket cost? What, exactly? I suspect the Republicans aren't looking at their plan through the eyes of the consumer. They seem more interested in the ideology of government interference in a free market, or just getting rid of ACA because it was passed by Democrats. But we really need to know what they're trying to accomplish.
So NY Times: Please report substantially on what the goals are, and let's hear those goals in terms of the health care consumer. Is the goal more people covered? Lower out of pocket cost? What, exactly? I suspect the Republicans aren't looking at their plan through the eyes of the consumer. They seem more interested in the ideology of government interference in a free market, or just getting rid of ACA because it was passed by Democrats. But we really need to know what they're trying to accomplish.
10
Tax credits are a sham, meant to seem like something good is being done but like all tax credits, only those making enough money to a. Pay taxes and b. Itemize deductions, will benefit. And those two things do not describe or apply to unemployed auto workers from Ohio. Trump/GOP fail.
13
Part of Trump's plan to put people back to work: emergency room doctors.
9
Smoke and mirrors from Ryan and his mentor, Ayn Rand!
This administration and the Koch brothers sock puppets in Congress are truly evil and they are out to destroy democracy and install fascism!
Republicans want to test people on unemployment insurance for drugs when the people we should be testing are in Congress!
This administration and the Koch brothers sock puppets in Congress are truly evil and they are out to destroy democracy and install fascism!
Republicans want to test people on unemployment insurance for drugs when the people we should be testing are in Congress!
10
How substantial of a tax credit are we talking? If it's comparable to what lower income folks are already getting to help pay for Obamacare, it doesn't seem like it would hurt the poor. And I imagine you could use any excess for a HSA. But I guess if it's that substantial for everyone it wouldn't really be cheaper?
And if you don't make enough to pay taxes, do you just get a check instead?
And if you don't make enough to pay taxes, do you just get a check instead?
2
No, a Credit is not cash. If you're low income and pay little or no taxes, you get nothing. And no bank will let you deposit a credit. You are SOL.
Getting money to the rich? What's wrong with that? It's been the policy of many of our tax laws and leaders BOTH Republican and Democrat. The latter raises taxes for the crumbs they hand out. The former just tries to bankrupt the whole social system by deprivation. Feed the rich, starve the poor, until there are poor no more. Nobody is going to deprive the FILTHY rich of anything! Nothing new there. Move on!
7
Every 1st World country but America figured out how to handle health care about 50 years ago.
10
I would like to add something worthy of the comments I've just read, but I am really just left without words with respect to this article. What runs in these people's veins, ice water? The absence of empathy, and the shameless nonchalance about that on the part of the GOP, continues to astonish daily. I wonder if we can find torches and pitchforks on Amazon.
8
From the SSA: "Medicare is our country’s health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare, too, including those with disabilities and those who have permanent kidney failure."
Please re-check the facts of your article. Why would anyone of Rex Tillerson's age would be getting a tax credit for government-provided Mecdicare benefits?
Please re-check the facts of your article. Why would anyone of Rex Tillerson's age would be getting a tax credit for government-provided Mecdicare benefits?
It would be an automatic credit with no income test.
4
You can have Medicare as a secondary only if you keep working full time past the age of 65. Therefore, anybody who keeps working past 65 would still get a tax credit, regardless of income.
1
Paul Ryan's autobiography: "At Least I Shrugged"
13
Paul Ryan's code talk about consumer choice in health care, really means that we'll all get to choose which conditions we can't afford to cover! Ryan and his Republican cohorts have no intention to make health insurance better and more affordable, that is unless your idea of better involves pay a whole heck of a lot more for way less coverage.
8
Whatever the GOP ends up calling their health care plan, the Democrats need to come up with a derogatory slogan, e.g. DonT.Care, that will be a counter to the "Obamacare" slur that was rammed down everyone's throat in place of the ACA. Democrats need to message it, and message it hard.
13
I submit
1. DonnyCare
2. Don'tCare
1. DonnyCare
2. Don'tCare
4
3. Care-Less Care
4. Trump n'Care (sounds vaguely Scottish too)
5. OYO Care (On Your Own Care)
4. Trump n'Care (sounds vaguely Scottish too)
5. OYO Care (On Your Own Care)
1
Wow!! the 10% of the population that owns 98% of the wealth are really having to work hard to steal the 2% that the rest of us have. They are getting lower and lower in their digging, soon they will have it all.
9
The wiz kid from Janesville WI, Paul Ryan, who the Republicans keep describing him as the "smartest guy" doesn't seem understand tax credits and savings account do nothing if you can't afford the insurance premiums. 2+2 doesn't equal 5 no matter how hard Ryan tries to pretend it does. The ACA needed fine tuning and has some holes that need plugging but repealing the law -no. Unless it is replaced by a complete expansion for Medicare for all.
10
The class war is coming and not a day too soon.
7
"Republican Health Proposal Would Redirect Money From Poor to Rich"
Isn't that the reason for the existence of the Republican Party? Their guiding principle?
Isn't that the reason for the existence of the Republican Party? Their guiding principle?
12
Please go to your nearest emergency room on a weekend night and take note of who comes in for care. You will see some accident victims, but mostly you will see the poor, both young and old, people with severe chronic conditions, AND the young who have means but NO health insurance. So if you want to know why your insurance premiums are going up, it's because people with health insurance are paying for people without it who go to the emergency room when they need care, especially people who are young and healthy until they have a critical medical need.
The only way to fix the system is to draw, or force, young healthy people into it, thus, spreading the cost of care. It is ensuring failure of any health care system to make it cover pre-existing conditions for everyone at low premiums, while leaving healthy young people out, until they need critical care. Essentially everyone gets coverage, but young healthy people don't have to pay for it until the last minute, only when they need it most and it's expensive, but everyone else shares the cost the whole time.
This is exactly why insurers are pulling out of the ACA. You can't make money only insuring people with critical, expensive health care needs. It's a loser, just like you and me when someone without insurance goes to the emergency room.
The only way to fix the system is to draw, or force, young healthy people into it, thus, spreading the cost of care. It is ensuring failure of any health care system to make it cover pre-existing conditions for everyone at low premiums, while leaving healthy young people out, until they need critical care. Essentially everyone gets coverage, but young healthy people don't have to pay for it until the last minute, only when they need it most and it's expensive, but everyone else shares the cost the whole time.
This is exactly why insurers are pulling out of the ACA. You can't make money only insuring people with critical, expensive health care needs. It's a loser, just like you and me when someone without insurance goes to the emergency room.
4
Ironically, Congress may find come 2018 that these "reforms" disproportionately affect GOP voters in swing states who are now able to afford insurance because of ACA...
5
My guess is the republicans will not pull the plug on folks until the day after the 2018 Congressional Race, thus assuring more people voting against their own interests more BIGLY.
2
Most policies initiated by the GOP have as their primary objective the making of the rich being richer and the poor being poorer. Yet these cowards and hypocrites have the unwavering support of the charlatan Christians
6
Young people as a group, being both less able to afford insurance and less likely to need it than older people, are less likely to buy it. Yet without these young and healthy customers, for-profit health insurance cannot work. Hence the mandate and subsidies of Obamacare.
Let the Republicans remove these basic foundations of the Affordable Care Act and watch the health insurance ponzi scheme fall apart.
Let the Republicans remove these basic foundations of the Affordable Care Act and watch the health insurance ponzi scheme fall apart.
2
"...the current system is set up to ensure that low and middle-income Americans can afford the cost of their premiums. The Republican plan would not do that, and would result in many more low-income people losing out on coverage..."
Two things that stand out to me...
1) So basically, this plan is set up to help older Americans, you know, the ones who are more likely to vote, and vote repubican?
2) And, are we going back to being the only major industrialized country that can't figure out how to provide access to health care for all, including the middle class and poor? To quote our so-called president: "Sad"
Two things that stand out to me...
1) So basically, this plan is set up to help older Americans, you know, the ones who are more likely to vote, and vote repubican?
2) And, are we going back to being the only major industrialized country that can't figure out how to provide access to health care for all, including the middle class and poor? To quote our so-called president: "Sad"
6
I think that people are out of step with what government provides or what it used to provide. Large numbers of people who were on ACA voted Trump because they hate the government interfering in their lives. And who could ever forget the poster from the 2012 election - "Get your filthy government hands of my Medicare". Hate to say it, but Trump and the Republicans did not lie on this on this. They promised to get rid of ACA and they're going to do it. Obviously the people benefiting from it are going to suffer but if more of those people had not voted for Trump, they would not have put everyone who cannot afford decent healthcare in this position.
8
Republicans never disappoint when you think they won't go there they do. Their greed and callousness knows no boundaries.
When someone tells me they voted republican I think they are racist, misogynistic, greedy, self absorbed and ill informed...Every time.
When someone tells me they voted republican I think they are racist, misogynistic, greedy, self absorbed and ill informed...Every time.
6
So The Times is presenting Health Savings Accounts as a poor-to-rich transfer, because the people who use them are disproportionately richer. Well, yes, generally the poor can't take $2500/year, especially when you don't see the results immediately. But they would save money if they could. Especially since it comes out a paycheck at a time, but you can use it all at once. But 401K's are used disproportionately by the rich. And mortgage deductions. You could say that about many things. Are those taking from the poor to the rich?
And on that matter, you didn't even bother to say how much the increase in HSA accounts was proposed to be. Shame on you for bad reporting and bad analysis.
And on that matter, you didn't even bother to say how much the increase in HSA accounts was proposed to be. Shame on you for bad reporting and bad analysis.
3
Shocked, just shocked, that the GOPers' plan favours the rich.
4
I saw the headline and thought "Yaaay, why am I not surprised...."
My answer came promptly "Because that's the general republican agenda, neatly put into one vapidly poignant, headline, right there..."
Oh, the voices in my head...
My answer came promptly "Because that's the general republican agenda, neatly put into one vapidly poignant, headline, right there..."
Oh, the voices in my head...
3
Why don't the people who voted for Trump understand that he and his party just don't give a darn about them. I just shook my head viewing bits and pieces of his press conference today. This person doesn't have a clue, and certainly the mental stability and mindset to be a leader. To quote Bette Davis in All aboutEve, "fasten your set belts it's going to be a bumpy night." Let's hope a short night.
4
Why do the Republican'ts hate this country and the poor and what's left of the middle class so much as per their actions not words?! Why do they like to hurt others so much?! What kind of evil is this?! Hey Republican'ts, ever hear of "Let 'em eat cake?!" And Bastille Day!? American Spring 2017!
4
It all comes down to cruelty. That, in a nutshell, is what the Republican party is all about. You can parse it a million ways, but at the center it is about mean-spirited indifference to whether the rest of us live or die.
10
Is anyone surprised?
1
So much hype served up as a plan - I'm surprised anyone could find anything at all concrete in this contorted marshmallow of a "republican" advertisement. Clearly not to be trusted.
6
"but it would change who benefits most from that support."
Poor and middle class trump supporters are so caught up in the lies and his blaming of the media they don't see that laws like this will bite them the hardest. I remember when the ACA was made available, the state of Kentucky signed more than a half million people to their rolls, I wonder how many of those folks voted to slash their own throats?
Poor and middle class trump supporters are so caught up in the lies and his blaming of the media they don't see that laws like this will bite them the hardest. I remember when the ACA was made available, the state of Kentucky signed more than a half million people to their rolls, I wonder how many of those folks voted to slash their own throats?
7
"Those rules... and those requiring companies to charge the same prices to healthy and sick Americans, would stay on the books, because they can’t be easily changed through the budget process. Changing those rules could make insurance cheaper but would rankle many consumer advocates..."
Rankle consumer advocates? Is that the worst that changing those rules will do? How about return America to the bad old days when sick or potentially sick people couldn't obtain affordable health coverage. Do you think that's why it will "rankle" consumer advocates?
Rankle consumer advocates? Is that the worst that changing those rules will do? How about return America to the bad old days when sick or potentially sick people couldn't obtain affordable health coverage. Do you think that's why it will "rankle" consumer advocates?
6
How can the Republicans keep ignoring the fact that any plans they propose must at least follow some basic insurance principles or they will fail, miserably.
4
Trump plan: take two aspirin, and get lost.
7
Maybe if enough people are forced off their meds, there will be a violent revolution, and Paul Ryan will be its first martyr. Oh, wait, I'm dreaming—the mentally are usually way too tired, sad, confused and self-blaming for that sort of thing.
5
Cruel unkind plan from cruel unkind men.
10
We should seize all assets owned by health corporation CEOs to sell and pay for single payer.
6
Republicans were elected to repeal "Obamacare." Bernie, single payer, was not elected.
Clinton, improve ACA, was not elected.
How many people did not vote?
How many people who voted for republicans thought ACA was not Obamacare?
How many people who voted for republicans wanted Obamacare repealed and replaced?
Elections matter.
Obamacare is over.
What's next? We'll find out over the next two years.
How many people will vote in 2018?
Elections matter.
Clinton, improve ACA, was not elected.
How many people did not vote?
How many people who voted for republicans thought ACA was not Obamacare?
How many people who voted for republicans wanted Obamacare repealed and replaced?
Elections matter.
Obamacare is over.
What's next? We'll find out over the next two years.
How many people will vote in 2018?
Elections matter.
8
Education matters. Our democratic system can't function with such a large segment of low-information voters. Our Presidential election goes to the most extreme marketing focused on those who can't tell good from bad.
5
Transferring money from those who don't have it and need it more to those who have it and don't have as much a need for it? Bet no one saw that coming. Shameful is as shameless does.
7
Tax credits are not very helpful if you don't earn a lot of money and therefore don't pay much in taxes. You'll still be poor and uninsured but with a slightly smaller tax bill.
7
Exactamente
It's becoming something of a truism, but...if Paul Ryan and his republican colleagues are for something, then I know it is bad for the men and women in this country who are just struggling to get by.
8
Of course GOP will shift money from the poor to the rich. It has always been their policy. I am amazed how many poor people vote for GOP despite that, and get surprised every time They do what they have always been doing???
10
How dose this reform in any way whatsoever work best for the people? The people meaning all, everyone of us Americans not just a portion. This is NOT better than "ACA". It will not help all Americans. When implementing change it should be done in the manner that equally helps all. Not just a portion. This reform can not be real. It would create so many issues on so many levels. Trump cares so much about this country then he should resign, with his digtny. He is going to make America.......dead man's land.
5
So Democrats support a Centrist, market-based solution that works ( particularly in places where it is implemented properly, and where the Republicans do not actively try to sabotage it). In exchange, Republicans are prepared to dismantle Medicaid. Next time, it's medicare-for-all or the Democrats shouldn't touch it.
5
Obamacare, like the failed Hillarycare scheme that preceded it, was designed to redistribute money from the haves to the have-nots. Is it any wonder then that dumping Obamacare would reverse that redistribution to at least some degree?
3
Is there any reason to be surprised at this news??!! Of course Ryan et al. would go this direction, Just as they will for any policy change that will benefit the rich and leave the rest of the American people in the dust. Those who supported Trump and will now suffer the economic consequences should have known better -- those of us who did not support fascist and pro-plutocrat government will suffer as well. Perhaps those who supported Trump thought that was a good idea--now we will all be in the same lifeboat!!
7
Should this ridiculous plan go into place we will again see a huge swath of U.S. citizens filing for medical bankruptcy; more doing without vital medical care; people having to choose between paying for treatment or maybe buying groceries or making a car payment--all these disgraceful for this supposedly great nation.
What a joke we truly are, lead unwillingly into the abyss by Trump, Ryan, McConnell and the do-nothing, know-nothing GOP. Tell them all to give up their government funded health care, paychecks and retirement pensions all paid for by us!
What a joke we truly are, lead unwillingly into the abyss by Trump, Ryan, McConnell and the do-nothing, know-nothing GOP. Tell them all to give up their government funded health care, paychecks and retirement pensions all paid for by us!
10
Well, I hear that health care is free to all....in Mexico.
Perhaps that's their plan, to have the US's poor immigrate to Mexico for improved health care services!
Perhaps that's their plan, to have the US's poor immigrate to Mexico for improved health care services!
1
What a good idea.
We can solve the whole problem of low-income people who can't afford unregulated exorbitant corporate US health care with GOP eugenics:
Just make sure the proles have to work 3 jobs for starvation wages, then deny them affordable healthcare so they'll all just burn out & die.
Problem solved.
We can solve the whole problem of low-income people who can't afford unregulated exorbitant corporate US health care with GOP eugenics:
Just make sure the proles have to work 3 jobs for starvation wages, then deny them affordable healthcare so they'll all just burn out & die.
Problem solved.
8
Republicans do not really incentivize making health care "better" for for patients, doctors, et.al. They do care about the fact they made "repealing Obamacare" a repeated line in the sand to their voters, and delivering a version of "reform" that heeds to conservative ideological principles regardless of what its outcomes may be. Which means they will be more or less forced to do some sort of "repeal" regardless. Unfortunately for Republicans, the Democrats co-opted the Conservative-Universal plan through the expansion of mostly existing institutions. There is not a Republican plan to the right of ACA that will deliver the quality, and expanse of coverage and the results of this new plan (which is still just a re-hash of Republican health care talking points with light "specifics" of Past Days) will largely be a pullback on coverage for middle, working class and poor Americans. I honestly think the best medicine to break less well off conservative voters of their Republican "illness" is to let this thing pass as proposed. Let the living on the edge "white working class" Trump/Republican voters feel the results of their votes, personally. Let the media follow closely a group of these voters under the change and report as intently on the changes to their access to health care as they did for those on the "losing" end of ACA
The other option is that less "safe" Republicans will force a "repeal" that looks more like "modifications" on the edges, conservatives be damned.
The other option is that less "safe" Republicans will force a "repeal" that looks more like "modifications" on the edges, conservatives be damned.
Forget about from rich to poor. Like the ACA, and like the majority of government, this bill takes from the young (rich or poor) and gives to the elderly (rich or poor). Meet the new boss...
Partly so. I've been quite happy to pay into SS so that my elders in-need could live with a modicum of dignity. This is called compassion for your fellow citizens. With means testing, wealthy elders receive less SS, so your simple scheme doesn't hold water.
We must sometimes make sacrifices for our communities, and our nation is better when that happens.
This is indicative of a society in which I want to live.
Clearly the Republicans hope to divide and conquer by pitting the nouveau libertarian youth against "old people"; don' fall for it, it's fake compassionate conservatism.
We must sometimes make sacrifices for our communities, and our nation is better when that happens.
This is indicative of a society in which I want to live.
Clearly the Republicans hope to divide and conquer by pitting the nouveau libertarian youth against "old people"; don' fall for it, it's fake compassionate conservatism.
1
Giving less equals taking?
People with money got tired of paying the bills for others. Let them keep their own money, if they want to be charitable they will be.
1
My only hope is that these monsters will all be voted out of office and all these terrible, terrible decisions will be appealed. Americans deserve better.
9
I'm trying really, really hard to try to understand how so many of these so-called "leaders" stridently call themselves Christians. This is the antithesis of Christian values. Shame.
4
They keep forgetting that we don't have the creamy government healthcare program that they receive for 3 days of work a week.
1
Umm, we don't know what "President Trump envisions." We only know what HE SAYS he envisions.
1
The easiest way of streamlining health care coverage would be to eliminate all below the poverty line, or perhaps all below a certain line above the poverty line, as we all know that coverage should go to those who can pay for it, don't we?
This is the plan? After seven years of attacking the ACA, and voting to repeal it dozens of times, this is the GOP plan. Tax credits and health savings accounts? No mandate. Less for the poor. More for those who don't need more?
Clearly, the Pubs aren't serious. They never are when it comes to fairness.
Clearly, the Pubs aren't serious. They never are when it comes to fairness.
3
Deplorable!
6
So here it is, blue collar Trump voters. Your anointed savior wants you to take a huge portion of your meager income and sock it away to pay for your own healthcare. My, how innovative and generous he is. Employers are off the hook. Billionaires are off the hook. Wall Street is off the hook. As usual, they get to make their fortunes off your backs and leave you all to fend for yourselves. Don't worry, you'll be able to deduct all that money you'll need to sock away for healthcare from your taxes. What's that, you don't make enough for it to really impact your taxes much? You say you actually need that money now for housing, education and just plain living? Well, I'm sure if you vote for Mr. Trump again in 2020 he'll fix all that right up for you. After all, he is the genius savior of the working man and woman. That's exactly what you voted for, right?
15
I am now beyond disgust with Ryan and band. I have moved to despising all of them. Rise up now people - before it's too late. You can guarantee the details of the plan will be even worse.
8
So they're repealing the Affordable Care Act and replacing it with an Unaffordable Care Act? So much for the self employed working class guy like me.
7
I would just like someone to show me where the constitution says the federal government shall provide health insurance to people, or that we have a right to health insurance, or to force someone else to pay for our healthcare?
2
Health care, as we know it today, did not exist when the constitution was written. The Founding Fathers did not have crystal balls. I wonder what they would have written if they could foresee the treatments available to people today.
3
Bingo. And I'm sick of being called unfeeling if I don't want to pay even higher taxes for people, many of whom should lose weight to contribute towards their own better health. Let them take responsibility.
1
Darwin.
3
Just want to be sure I have this right even though I know I do. It preserves the worst of Obamacare, adds a lot more bad, and guts all of the good and great things about Obamacare that redeemed those unpleasant things?
2
Paul Ryan is working so hard to help the rich at the expense of the middle class he deserves a very special golden parachute when he goes to the private sector. Is there anything at all he has ever done that is even remotely decent?
3
Nothing new...
Finally a plan with common sense. Through Block Grants States will no longer fully subsidize people on Medicaid ensuring everyone has skin in the game. And as an added benefit it will reduce the pressure on State Budgets from the open-ended costs of Medicaid. i.e. instead of giving Medicaid recipients free 24 X 7 home care coverage they will have to scramble for coverage like everyone else. And since Medicaid will no longer provide such free benefits people will no longer game the system by transferring assets to their children in order to qualify for Medicaid.
1
Many republican voters like the ACA but hate Obamacare. When will someone break the news to them that the two are the same? Odds are they'll call it fake news.
3
'Republican plan redistributes wealth from the poor to the rich.'
I'm shocked, I tell you. Absolutely shocked! Why, that would be unheard of!
I'm shocked, I tell you. Absolutely shocked! Why, that would be unheard of!
4
Well, after 7 endless years, it's -- potentially, finally -- a GOP proposal that can be reviewed, scored & hotly debated. At first blush, it sounds like another Paul Ryan/GOP horror show. Eager to see what the CBO has to say about it. Let the fireworks begin.
4
An interesting question to ask, is how GOP congressional seats will keep being filled after they've thrown a bulk of their voting base off either medicaid or the fragile free market exchange.
I don't need a tax credit for my health insurance now (although I guess I'll take it) but how about those people that need that tax credit? This is pretty mind boggling.
The HSA portion of this plan is laughable. How many people participate in 401ks?
I don't need a tax credit for my health insurance now (although I guess I'll take it) but how about those people that need that tax credit? This is pretty mind boggling.
The HSA portion of this plan is laughable. How many people participate in 401ks?
2
Democratic Party, can you please drop your side social issues and focus on healthcare and wages? There are enough low income people that if you can unite them around a simple redistribution program, you can win. You need to get voters registered, get them to the polls, drive a very simple message that fits on a bumper sticker, and bring a real class consciousness to the country. The upper class, aided by social conservatives, is winning.
(I'm in the upper class).
(I'm in the upper class).
1
The wealthy are not against income redistribution, as long as it goes in their direction. Good job Republicans in your scenarios the little guy gets smashed, you guys still don't get it, the little guys will do anything for you if only you take care of them.
4
A health plan that provides less coverage for less cost is not necessarily "cheaper." In terms of value delivered, to individuals or to the nation's health as a whole, it can easily be more expensive, a "bad deal." You'd think Americans had never seen this classic con before. Of course, this is America: There's a sucker born every minute.
What the Republicans seem to be offering on Medicaid is akin to their proposals to "save Social Security and Medicare for future generations" simply by reducing Social Security and Medicare payouts to future generations, as if by budgetary fiat the human needs of future generations might be proportionally lessened. The only thing "saved" is the necessity of taxing those with means to care for the needs of those without.
The telling moment will be when the Republican sham proposals attain sufficient specificity that every American can calculate how they and their families will fare under Trumpcare compared to Obamacare. It is critical that the media and health advocacy groups provide online means by which individuals can make these estimates for themselves, for surely Trump's HHS will not, at least not truthfully.
We can expect the moment it becomes obvious that the GOP "solution" to the premiums and high deductibles of ACA Bronze plans is barebones catastrophic coverage with perhaps marginally lower premiums but even higher deductibles, a maze of fine print exclusions, and none of the no-additional charge preventative care of ACA plans.
What the Republicans seem to be offering on Medicaid is akin to their proposals to "save Social Security and Medicare for future generations" simply by reducing Social Security and Medicare payouts to future generations, as if by budgetary fiat the human needs of future generations might be proportionally lessened. The only thing "saved" is the necessity of taxing those with means to care for the needs of those without.
The telling moment will be when the Republican sham proposals attain sufficient specificity that every American can calculate how they and their families will fare under Trumpcare compared to Obamacare. It is critical that the media and health advocacy groups provide online means by which individuals can make these estimates for themselves, for surely Trump's HHS will not, at least not truthfully.
We can expect the moment it becomes obvious that the GOP "solution" to the premiums and high deductibles of ACA Bronze plans is barebones catastrophic coverage with perhaps marginally lower premiums but even higher deductibles, a maze of fine print exclusions, and none of the no-additional charge preventative care of ACA plans.
7
The Republican plan does attempt to address complaints from middle-class, healthy families and individuals that insurance has gotten more costly. But it does so at the expense of those with pre-existing and chronic conditions.
If Republicans are going to make HSA's an integral part of an Obamacare replacement, they need to eliminate the maximum deductible for a plan set by the IRS so that one can make tax-deferred contributions to an HSA. Few people realize that many Obamacare high deductible plans have deductibles greater than the maximum allowed by the IRS, and therefore prohibit tax-deferred contributions to an HSA.
There will likely be a debate on how to provide access to insurance for those with chronic conditions. It sounds as if Republicans would like to shift this burden to the states, providing some Federal assistance through a bloc grant. However, it is unlikely the grants will come close to what would be required to align overall costs in a high-risk pool with those of existing Obamacare plans.
Given I have a pre-existing condition, I'm already planning on being uninsured for the three or four year interim period until I qualify for Medicare at age 65.
If Republicans are going to make HSA's an integral part of an Obamacare replacement, they need to eliminate the maximum deductible for a plan set by the IRS so that one can make tax-deferred contributions to an HSA. Few people realize that many Obamacare high deductible plans have deductibles greater than the maximum allowed by the IRS, and therefore prohibit tax-deferred contributions to an HSA.
There will likely be a debate on how to provide access to insurance for those with chronic conditions. It sounds as if Republicans would like to shift this burden to the states, providing some Federal assistance through a bloc grant. However, it is unlikely the grants will come close to what would be required to align overall costs in a high-risk pool with those of existing Obamacare plans.
Given I have a pre-existing condition, I'm already planning on being uninsured for the three or four year interim period until I qualify for Medicare at age 65.
3
It's a fantasy to think that people who living paycheck to paycheck are going to out money in a Health Savings Account. Medicare expansion is the most sensible financial course, but is not viable politically because of the big contributions from pharma and insurers. Medicare has low overhead because it does not duplicate ridiculously high salaries paid to senior managers of insurance companies and does not spend on marketing. Opponents will label this "socialized" medicine but many of them went to public schools under a "socialized" education system and collect their social security payments each month. Good luck to anybody looking for a "rational actor" in this mess.
45
The Republican strategy is to end redistribution of wealth to assure all of having some basic needs provided whether they had the resources to satisfy those needs or not. People are entitled to all the benefits available in society which they have the resources to acquire, not people are entitle to acquire the services that they need to live long and healthy lives. Given that most Republicans are going to find that tax credits and health savings and a fixed subsidy will still make any serious ailment drain their resources, I wonder how long this plan will survive. My guess is that it will tickle the major contributors but not the voters upon who the Republicans depend.
13
Nonsense. We are all entitled to police and emergency care based on where we live, not on how much we can afford. Same for roads, water quality, clean air, etc. Its is clearly a benefit to the country to provide a similar base-line of security for healthcare. The era prior to Obamacare clearly demonstrated the market-driven healthcare does not work. Healthcare is an inelastic need, like food and water.
28
Yes, but all are free to drive their Lincolns and Jaguars on the wonderful roads we all pay for. Why should the wealthy pay more? Ha Ha Ha!
1
I agree with you, Brian. In my awkward way I was saying that:
taxes are being used to assure that all receive health care according to need but that Republicans object to the redistribution of wealth that the taxes represent because society does not owe anyone health care for which they cannot pay unless they will die as a result. Even many Republicans who like and depend upon Medicare would like to see it limited to just deserving people and not given to undeserving people.
taxes are being used to assure that all receive health care according to need but that Republicans object to the redistribution of wealth that the taxes represent because society does not owe anyone health care for which they cannot pay unless they will die as a result. Even many Republicans who like and depend upon Medicare would like to see it limited to just deserving people and not given to undeserving people.
"But it’s far less generous to the poor, and unlikely to provide the health insurance for “everybody” that President Trump envisions."
Trump sees everyone as winners and losers, and losers aren't worth anything to him. So, anyone who is poor is a loser and therefore not part of the "everybody" who will be provided with health insurance.
Trump sees everyone as winners and losers, and losers aren't worth anything to him. So, anyone who is poor is a loser and therefore not part of the "everybody" who will be provided with health insurance.
38
The so-called Christian GOP members have clearly not read the Gospel of Matthew or they have conveniently forgotten its core message. The only thing these people are interested in doing is expanding their financial portfolio. They castigated Hillary Clinton for her "basket of deplorables" comment, yet they seek to place millions of Americans with pre-existing health conditions in a pool of the infirmed. Shame, shame, shame. We need to turn out en masses to oppose this compassionless legislation. Not one step back folks.
65
I am constantly amazed by our unwillingness to even consider the obvious solution of expanding Medicare to cover everyone, with the cost covered by a combination of increased payroll and income taxes.
113
Well, that depends on how much taxes would have to be increased, doesn't it? I believe they have done the calculation in Congress, and concluded that if they raised taxes that much, they'd all be voted out of office.
6
It is the right solution. Unfortunately, there is so much money (big pharma, insurers etc) fighting it. In addition, it would be tagged as the dreaded "Socialized Medicine," which will make people run screaming in the opposite direction.
14
The history of the U.S. is to eliminate every unworkable alternative until they are left with an acceptable and workable one, which tends to be the one that offers equivalent well being to all.
2
It is the Ayn Rand philosophy. Self sustainability. Unfettered self-interest. If you can't pick yourself up by those bootstraps, then too bad for you. That makes you immoral, and useless to society. Ayn Rand would step over a disabled person if he was laying on the street.
Republicans aren't going to fix the health care plan but will instead find ways to shift money upwards to the people who have plenty already. As usual, low income people will suffer. Needlessly. It is cruel.
This change to our health care system has been Speaker Ryan's consummate dream. It will be a nightmare for the poor and lower middle class.
It's why Democrats feared this election. This was inevitable.
The cruelty is positively abysmal.
Republicans aren't going to fix the health care plan but will instead find ways to shift money upwards to the people who have plenty already. As usual, low income people will suffer. Needlessly. It is cruel.
This change to our health care system has been Speaker Ryan's consummate dream. It will be a nightmare for the poor and lower middle class.
It's why Democrats feared this election. This was inevitable.
The cruelty is positively abysmal.
184
Cruelty? Perhaps. But, by and large, they voted for it. What role do they play in their own victimization?
1
Ayn Rand was real quick to sign herself up for Social Security and Medicare, programs she abhorred.
7
Why step over a person when you could stomp on them instead? That's the real agenda here.
1
This is not a replacement plan. It is just a smoke and mirrors proposal to justify cutting the taxes that support health coverage for low income people and to subsidize (with inadequate tax credits) coverage for higher income people.
A number of the components in "A Better Way" have been tried for decades before Obamacare and failed to solve our health care/health coverage problem. High risk pools covered less than 10% of those with pre-existing conditions. HSAs have been used only by wealthier people who could afford to stash cash to get tax deductions.
Eliminating the mandate will result in fewer healthy people in the risk pool, therefore higher premiums and fewer insurers participating.
Many people with pre-existing conditions will not maintain continuous coverage, therefore will lose the right to coverage.
Tax credits of $1,200 to $3,000 will only cover a fraction of the cost of coverage.
There is no mention of how or why insurers will continue to cover children up to age 26 on parents' plans when they are not receiving subsidies.
Selling plans across state lines just means healthy people will buy plans with very skinny coverage and premiums will skyrocket for sick people.
Insurers will be allowed to offer plans with higher deductibles and without controls on premiums.
Enrollment periods will be shortened - fewer young, healthy people will enroll and premiums will increase rapidly
Clearly, the new Repeal and Replace Plan will not solve our problems.
A number of the components in "A Better Way" have been tried for decades before Obamacare and failed to solve our health care/health coverage problem. High risk pools covered less than 10% of those with pre-existing conditions. HSAs have been used only by wealthier people who could afford to stash cash to get tax deductions.
Eliminating the mandate will result in fewer healthy people in the risk pool, therefore higher premiums and fewer insurers participating.
Many people with pre-existing conditions will not maintain continuous coverage, therefore will lose the right to coverage.
Tax credits of $1,200 to $3,000 will only cover a fraction of the cost of coverage.
There is no mention of how or why insurers will continue to cover children up to age 26 on parents' plans when they are not receiving subsidies.
Selling plans across state lines just means healthy people will buy plans with very skinny coverage and premiums will skyrocket for sick people.
Insurers will be allowed to offer plans with higher deductibles and without controls on premiums.
Enrollment periods will be shortened - fewer young, healthy people will enroll and premiums will increase rapidly
Clearly, the new Repeal and Replace Plan will not solve our problems.
54
"Selling plans across state lines" is nonsense. In the first place, any insurance company can sell insurance in any state they want to--so long as it meets the state's requirements (as well as those set by the federal government). If people think that the insurance policies in some other state are better than what is available in their state, they should lobby their state to allow the insurance company offering that policy to sell that same one to them. Interesting that Republicans, who are always bleating about states' rights seem to forget all about them when it comes to health insurance or gun permits. With regard to health insurance, companies could seek out the state with the least strict requirements for what insurance would cover and then market really poor policies to people who would have no realistic idea of what they were actually purchasing. (I did insurance administration for a company and know exactly how little almost anyone really understands their insurance policies--including often the people who work for the insurance companies.) Of course, it's likely most insurance companies wouldn't be interested in selling across state lines anyhow, not in these days of "network" health care providers. The insurance companies are not going to want or to be able to create a roster of "in-network" providers all over the place simply to get a relatively small number of purchasers.
12
Clearly they'd like to sell insurance from the Cayman Islands or the Bahamas, where there will be no customer service 800 number to call if you are denied.
My parents were members of "The Greatest Generation," who taught their children that we are our brother's (and sister's) keeper. As such and as part of a household with a comfortable income, I am ashamed and horrified that others who "have" are so begrudging of those who "have not."
A regressive plan like this (and like the proposed changes to the tax code) will cause untold harm to the people who can least afford it, for the benefit of those least need it. Unfortunately, by the time those on the losing side in that equation realize the impact of these changes, it will be too late. The damage will have been done, and will take years to repair.
I am truly glad that my parents didn't see this. They wouldn't recognize their country.
A regressive plan like this (and like the proposed changes to the tax code) will cause untold harm to the people who can least afford it, for the benefit of those least need it. Unfortunately, by the time those on the losing side in that equation realize the impact of these changes, it will be too late. The damage will have been done, and will take years to repair.
I am truly glad that my parents didn't see this. They wouldn't recognize their country.
234
Your parents sound like they were really good decent people who cared for other's and taught their children to do the same. Our "President" should take a few lessons. Sorry for your loss.
1
I feel the same way Anne Marie,
My parents and grandparents would shake their heads in disbelief that the Republicans have no shame!
My parents and grandparents would shake their heads in disbelief that the Republicans have no shame!
1
As usual, Republicans are pointedly not trying to help people, but rather making policy from the bottom line. With Trumpty-DumptyCare, the usual suspects will reap all of the benefits and the poor, unhappy people who voted for him will be less happy. But hopelessness is unattractive and we'll never see their faces or hear their stories except through the "fake news" of the lying mainstream media, right?
Regrets for my cynicism, but it is only exceeded by that of the Republicans who have so little concern for people with disabilities, poor children, low income working Americans, single mothers and other dirt, but are obsessed with the rights of the unborn at all times. Oh, and yes, tax credits for gun purchases should be right up there on their agenda! Why stop with this kind of "reform"?
Regrets for my cynicism, but it is only exceeded by that of the Republicans who have so little concern for people with disabilities, poor children, low income working Americans, single mothers and other dirt, but are obsessed with the rights of the unborn at all times. Oh, and yes, tax credits for gun purchases should be right up there on their agenda! Why stop with this kind of "reform"?
51
The devil is in the details. Maybe literally.
I read one statistic that put the average employer healthcare premium for a family at about $15.7K in 2012 (at 3% annual increase that would be about 17.7K in 2016.)
That is about 34% of the median gross US income. Before taxes.
Just how much of a credit is Paul Ryan looking at? Half the people in the nation would be looking at either unachievable deductibles or premiums that exceed total rent and food and transportation.
We have two options. Spend the money to cover everyone and cut the overall costs, or let some people have the care they want, and let others suffer or die. There is a really crass and nasty calculus in the assumption that the ones who die wouldn't have voted Republican anyway.
I read one statistic that put the average employer healthcare premium for a family at about $15.7K in 2012 (at 3% annual increase that would be about 17.7K in 2016.)
That is about 34% of the median gross US income. Before taxes.
Just how much of a credit is Paul Ryan looking at? Half the people in the nation would be looking at either unachievable deductibles or premiums that exceed total rent and food and transportation.
We have two options. Spend the money to cover everyone and cut the overall costs, or let some people have the care they want, and let others suffer or die. There is a really crass and nasty calculus in the assumption that the ones who die wouldn't have voted Republican anyway.
170
Actually the ones who do most of the dying will be Republicans. The poor ones in the red states. It's mostly the liberals in the blue and purple states who go to the gym and eat lean protein and veggies.
31
Your figures are correct. These numbers are for family units where one or more members has full time gainful employment. Those who don't have anybody who is employed full time are sicker as a group and considerably more expensive to insure.
2
And that's why I sleep better at night - the suckers will suffer the most.
Congress should be subject to the same law they propose for others when it comes to health care Insurance. Only then will they understand one disease can wipe out 40 years of savings for retirement. The only solution is to recognize health care as a right not a privilege for those who can afford it. Nationalized healthcare is the only answer. Anything else is a detour from the inevitable.
203
wise comments
1
Why can't the rest of us have access to the same coverage that the members of Congress enjoy?
4
Why is Congress given such rich health plans? Are they sickly? I propose that they be given a choice of an HMO or a network of providers like most of us have. When they live with any problems- paperwork, changes in doctors, limited hospitals, catastrophic illnesses- perhaps they'll see the wisdom in a more charitable distribution of providers. If they really pay attention, they might consider the role of insurance at all. Single payer nationwide healthcare gives everybody basic care and costs less. They could elect more expensive treatment, but on their own dime. Then look at prescription costs.
1
There is only one solution Medicare for all. Focus on how we can reduce costs to make it affordable and sustainable.
Elimination of insurance profit and costs, drug prices at European levels are a great start.
I would fund it by contributions from employer and employee supplemented by a financial transaction and border tax.
By the way beware of Paul Ryan, he is going to let Trump run up the National debt by reducing taxes and infrastructure spending in the hope it will be paid for by pie in the sky economic growth which will not happen. Then Ryan will use this as a pretext to cut existing Medicare, Medicaid, Social Security, this is his real objective
Elimination of insurance profit and costs, drug prices at European levels are a great start.
I would fund it by contributions from employer and employee supplemented by a financial transaction and border tax.
By the way beware of Paul Ryan, he is going to let Trump run up the National debt by reducing taxes and infrastructure spending in the hope it will be paid for by pie in the sky economic growth which will not happen. Then Ryan will use this as a pretext to cut existing Medicare, Medicaid, Social Security, this is his real objective
159
Ryan is going to start this process by using the chaos associated with the Debt Ceiling (that needs to be raised in March or April) to start justifying the changes to Medicare and Social Security that he wants to make. Medicare vouchers that don't get raised by more than the cost of living each year will hold down costs in two ways. Few would be able to afford a health care insurance policy with the voucher that actually paid for health care. They will end up with catastrophic care policies only which cover their last health crisis. They won't get the regular health care they need and they'll die much younger than they otherwise would have. In both ways costs are kept down because the vouchers will overall be far less than what we pay for actual care today and Insurers will make money off only issuing catastrophic care policies. Earlier deaths will obviously curtail the cost to Social Security, which from Ryan's perspective, will be a win-win for him.
We should be wondering what is wrong with Ryan that he could be so evil.
We should be wondering what is wrong with Ryan that he could be so evil.
31
Yes, he is a real weasel. Probably another who has never held a real job or done any physical labor in his life.
2
One problem for Obamacare now is that younger, healthier people are staying out of the exchanges and, in some cases, going without health insurance. This proposal would accelerate that, which means that the mandate would have to get stricter or the guaranteed issuance part of the law would have to go away. But the last two proposals are politically fraught, and Republicans' willingness to attempt them diminishes as their party continues to lose credibility and popularity thanks to Trump. So this proposal, though misguided, seems to me like they're spinning their wheels. They don't know what to do, so they reflexively pick something cruel and punishing for the poor and the young.
23
So, reading the proposal, I see the part about zeroing out the penalties for not getting insurance, but I don't see anything about guaranteed issuance (I also searched for "pre-existing conditions"). If they require health insurers to insure everyone, they don't penalize people for not getting insured, and then they make it harder for young people to get health insurance, then they will break the US insurance system. This plan is farcical.
More likely, after they've pushed through most of this, they're going to try to market a guaranteed issuance repeal through high-risk pools, and they'll face serious push-back.
More likely, after they've pushed through most of this, they're going to try to market a guaranteed issuance repeal through high-risk pools, and they'll face serious push-back.
24
This idea that somehow premiums are going to go down is completely ludicrous. They have gone nowhere but up in the past 25 years and will continue to do so. Aetna will pay 1 billion and Cigna will pay 1.85 billion now that there merger deals have blown up. Where does anyone think this money will come from? Premiums go up, patient copays and out of pocket responsibilities go up, payments to physicians go down and these for profit companies pocket the difference. The CEOs of these publicly traded companies make in excess of 10 million dollars per year. It cannot be that the rest of the civilized world is wrong.
112
Setting aside the inequity of the tax treatment, how does this plan encourage participation and therefore keep insurers in the marketplace? If companies like Humana and United Healthcare keep bailing out, the ability of people like me to buy insurance without underwriting will be sorely constricted.
27
In a related article, House Republicans were given a packet of talking points for when they are home for the Presidents’ Day recess. Tom Price urged lawmakers, “Let’s not miss this opportunity. Let’s go shoulder to shoulder, arm to arm.”
I say, let's not let them use their power to bully us into this proposal. Let's stand up for the poor and working class. Let's go meet our representatives with our own talking points, shoulder to shoulder, arm to arm. http://healthaffairs.org/.../obama-administration-lays.../
I say, let's not let them use their power to bully us into this proposal. Let's stand up for the poor and working class. Let's go meet our representatives with our own talking points, shoulder to shoulder, arm to arm. http://healthaffairs.org/.../obama-administration-lays.../
68
And when people go out to meet their representatives do not forget to remind them that we, the people, the taxpayers pay for 72% of their healthcare.
Let them repeal and replace their own gov't funded healthcare and leave ours alone!!
Let them repeal and replace their own gov't funded healthcare and leave ours alone!!
1
The Republican agenda is the dark money agenda. There's no daylight between the smirking grifters of the Heritage Foundation, and this powerful, and powerfully unethical, Congressional majority. This is government of the billionaires, by the billionaires, for the billionaires.
It's a monstrous assault on constitutional order, democratic governance, and our most fundamental traditions and principles. What the Republicans are waging is in effect (and in principle as well, although only behind closed doors) a legislative coup d'etat designed to transform our beloved country from one of the world's oldest constitutional republics, a representative democracy which has over more than two centuries slowly progressed toward a more perfect union, into a tax-and-regulation free zone structured to benefit the super-rich.
Republicans intend to privilege the already-privileged, codifying their wealth and guaranteeing their insulation from any civic obligations, while the rest of us are left to struggle for scraps.
It is a travesty and a tragedy.
It's a monstrous assault on constitutional order, democratic governance, and our most fundamental traditions and principles. What the Republicans are waging is in effect (and in principle as well, although only behind closed doors) a legislative coup d'etat designed to transform our beloved country from one of the world's oldest constitutional republics, a representative democracy which has over more than two centuries slowly progressed toward a more perfect union, into a tax-and-regulation free zone structured to benefit the super-rich.
Republicans intend to privilege the already-privileged, codifying their wealth and guaranteeing their insulation from any civic obligations, while the rest of us are left to struggle for scraps.
It is a travesty and a tragedy.
239
But it is what our fellow citizens have voted for. Yes, yes, gerrymandering and voter suppression have played a role, but let's not forget who voted in the legislators who did the gerrymandering and put into place laws that support voter suppression.
1
A step beyond the reduction of taxes from the rich and instead payment of taxes to the rich. It's hard to understand these actions as anything but government for the already comfortable by the already comfortable.
111
Redirect money from the poor to the rich. Isn't that the whole point of the Republican party these days? We will see if the losers in this deal understand what hit them. If they don't -- well the billionaires will be really happy.
256
The article mentions, but does not delve into one significant benefit of the Republican plan. Tax-free healthcare savings accounts would be a tremendous boon to those unfortunate families living paycheck to paycheck. It would provide them with a compelling incentive to live more frugally, with the alternative being staying healthy, or not getting healthcare and possibly dying. As our Great Leader says, it will be beautiful.
18
HSAs are fairly ineffective though and many people don't understand how to use them. I recall before the implementation of the ACA trying to use one and it being not the most straight forward exercise. Do you think the poorest people will utilize HSAs to their benefit in the wake of a reduction in benefits? Let's think about how well 401ks have benefitted a majority of Americans. You have to use them to benefit from them and have excess income to invest in them. Is this a real option?
Additionally, healthcare costs if you're self employed are already tax deductible.
Additionally, healthcare costs if you're self employed are already tax deductible.
41
People living paycheck to paycheck, by stipulation, lack the money to save, and so a fortiori to put into a health savings account. The assertion that HSAs are great for people living from paycheck to paycheck makes no sense.
58
I suspect (but could be wrong) that Spengler's post was snark.
4
"Now we have the outline of that plan, and it looks as if it would redirect federal support away from poorer Americans and toward people who are wealthier."
A Republican plan? Really? I'm shocked! Well, except that the raison d'être of the Republican party is to make sure the poor get as little as possible and the rich get to keep as much as possible, up to and including dynastic wealth (such an American concept for these patriots to embrace, isn't it?).
A Republican plan? Really? I'm shocked! Well, except that the raison d'être of the Republican party is to make sure the poor get as little as possible and the rich get to keep as much as possible, up to and including dynastic wealth (such an American concept for these patriots to embrace, isn't it?).
99
"Hyde restrictions for federal funding of abortions are included during the transition period." page 11.
Does this mean they plan on nixing federal funding for women's private healthcare decision (aka abortions) once the transition period is over? Republicans have got to stop stripping women of their right to privacy.
Does this mean they plan on nixing federal funding for women's private healthcare decision (aka abortions) once the transition period is over? Republicans have got to stop stripping women of their right to privacy.
67
"The credit is not available to be used for plans that cover abortion" page 12. Unfortunately it seems the answer to your question is yes.
3
It actually says that credits cannot be used toward plans that cover abortion, so I believe it goes beyond the transition period.
3
I suggest that readers study the document. It's long on criticisms of the Affordable Care Act and speaks wishfully instead of proposing an actual plan with targets, goals, and costs. What Ms. Sanger-Katz describes is only one way that the proposal might be implemented. If the devil is in the details, the devil in this document is nowhere in sight.
50
The news that the Republican plan would redistribute money from the poor to the rich is the flip side of one of the unsung benefits of the ACA. Under the ACA and Obama's tax policy, the share of national income of the bottom fifth of the income distribution rose by 18 percent while the share of the top 1 percent fell by 7 percent. That was really good news. If continued and improved, the ACA might allow low and middle class families to keep up with medical expenses, maybe even build savings. Then the Republican Congress comes along and slams them back down again with unaffordable insurance premiums, and useless HSAs. Congress is moving in exactly the wrong direction. They should be improving the ACA by linking out-of-pocket expenses to income, not eliminating premium subsidies.
http://healthaffairs.org/blog/2016/12/15/obama-administration-lays-out-i...
http://healthaffairs.org/blog/2016/12/15/obama-administration-lays-out-i...
160
"it looks as if it would redirect federal support away from poorer Americans and toward people who are wealthier."
What else is new? If anything is a mantra of the Republican Congress and Donald Trump's presidency, it is this unrelenting barrage of programs - from the proposed personal income tax reform to the health care program - that will benefit the wealthy and hurt lower income people.
Throw in the proposed Wall Street Reforms, drastic reductions corporate income tax rates, the demise of the estate tax, the destruction of the consumer protections instituted during the Obama Presidency, and you have an unparalleled thrust to move more money to the wealthy -precisely the people who have benefited the most over the past 15 years.
As if they need more money.
One wonders what the poor white workers who gave Trump the Presidency were thinking. It was all there before them if they cared to look.
What else is new? If anything is a mantra of the Republican Congress and Donald Trump's presidency, it is this unrelenting barrage of programs - from the proposed personal income tax reform to the health care program - that will benefit the wealthy and hurt lower income people.
Throw in the proposed Wall Street Reforms, drastic reductions corporate income tax rates, the demise of the estate tax, the destruction of the consumer protections instituted during the Obama Presidency, and you have an unparalleled thrust to move more money to the wealthy -precisely the people who have benefited the most over the past 15 years.
As if they need more money.
One wonders what the poor white workers who gave Trump the Presidency were thinking. It was all there before them if they cared to look.
204
The fact that so many voters could elect a gov't whose policies are going to be so anti-citizenry and pro-plutocracy is the best indicator that our educational system needs repair. But what will fix it is not more privatized charter schools but more civics and history taught in public schools whose local boards have often distorted or dropped those subjects.
48
@jay: >>> "is the best indicator that our educational system needs repair"
Fully AGREE. Explains the horrid state of our country: from the so-called presidency, republican politicians, political divide, and free-grab-for-all!
We must teach analytical skills, the ability to read and comprehend, to think about things (even if it was not said/written... to read between the lines). And to understand when an issue (or a question) has been ignored but instead a "poke" was used to distract the reader/viewer.
Politicians, especially republicans, now regularly ignore direct questions posed to them and instead blabber about nonsense. We see this regularly with Trump. Yet so many voters couldn't see that about him.
Fully AGREE. Explains the horrid state of our country: from the so-called presidency, republican politicians, political divide, and free-grab-for-all!
We must teach analytical skills, the ability to read and comprehend, to think about things (even if it was not said/written... to read between the lines). And to understand when an issue (or a question) has been ignored but instead a "poke" was used to distract the reader/viewer.
Politicians, especially republicans, now regularly ignore direct questions posed to them and instead blabber about nonsense. We see this regularly with Trump. Yet so many voters couldn't see that about him.
4
You think Wall Street will be reformed under the cabinet he's putting in office? NOT! Couldn't agree with you more.
My husband was in banking before retirement and said the loans banks made were once grounds for being fired. I understand banking reforms are going by the wayside .
My husband was in banking before retirement and said the loans banks made were once grounds for being fired. I understand banking reforms are going by the wayside .
Boil away all the irrelevancies, and it's easy to see that Republican plan has two critical elements. They intend to:
1. Guarantee coverage to the wealthy while denying it to the poor.
2. Punish the states with accessible Medicaid programs (ie. the ones with Democrat-controlled governments) by providing them with less funding.
Is anybody surprised?
1. Guarantee coverage to the wealthy while denying it to the poor.
2. Punish the states with accessible Medicaid programs (ie. the ones with Democrat-controlled governments) by providing them with less funding.
Is anybody surprised?
437
Well i get that except a whole lot of Republican red states gave in and took the medicare. Most of the blue states are pretty well off and growing. Think state of WA, CA, NV which is the fastest growing states currently. In fact all three are working on their own plans to provide care for residents. Republican voters will be the hardest hit. They voted that way to get jobs, meaning they need jobs or better jobs.
2
Yes - all those who voted for Trump for other reasons, and expected that his promise to repeal Obamacare was just campaign rhetoric.
Tax credits are meaningful only if one owes enough taxes to make use of them. What Trump supporters think they will get is insurance that is better in every way - cheaper, great coverage, and choice - but that is not the real world. Let the fun begin.
323
@Anne-Marie Hislop
Correct. And the fundamental difference between ACA tax subsidies and the likely Republican tax credit is how they are disbursed. ACA tax subsidies are paid "up front" directly to the insurer and therefore lowering the out of pocket cost of the premium to the insured. Republican tax credits may only be refundable at the end of the year, requiring the insured to pay the full cost of premiums during the year to qualify for the credit. And the credit can only knock off other taxes potentially, which could still mean many people are getting insurance "tax credits" while still not seeing a lowered cost or dime in their pockets, depending on their tax situation..
Correct. And the fundamental difference between ACA tax subsidies and the likely Republican tax credit is how they are disbursed. ACA tax subsidies are paid "up front" directly to the insurer and therefore lowering the out of pocket cost of the premium to the insured. Republican tax credits may only be refundable at the end of the year, requiring the insured to pay the full cost of premiums during the year to qualify for the credit. And the credit can only knock off other taxes potentially, which could still mean many people are getting insurance "tax credits" while still not seeing a lowered cost or dime in their pockets, depending on their tax situation..
2
The key here is to make this a "refundable" credit. That is, the credit is not a function of the amount of taxes you owe. A current example of a refundable credit is the Earned Income Credit.
1
It depends on whether the tax credit is "refundable" or not. If it's "refundable", then it is a credit you get regardless of whether you pay taxes or not.
But it's a cumbersome way to do it. Direct subsidies are cheaper and easier to implement. My guess is that the Republicans want to do it through tax credits (whether "refundable" or not) because then they can say that they "lowered taxes".
But it's a cumbersome way to do it. Direct subsidies are cheaper and easier to implement. My guess is that the Republicans want to do it through tax credits (whether "refundable" or not) because then they can say that they "lowered taxes".
No mention of the "mandate." Will people still be required to buy insurance? If not, The structure of this plan where young people get a lower tax credit and therefore insurance becomes more expensive will not work. They will opt out of buying insurance and once again we will have the younger healthier people opting out of the plan and pushing premiums up for everybody else. The mandate is a necessary piece of the affordable healthcare puzzle.
71
It's worth remembering that Mr. Trump said, early in his campaign, that of course the mandate would be necessary. Like anyone with any sense, he saw that the risk pool had to include more than the sickest part of the population if a plan was going to work. He's also, previously, had the sense to see that some restrictions on guns are necessary, and enough respect for human rights to see that women's control of their own bodies needs to be protected from religiously-based laws in our secular nation. He's reneged on all of these positions.
10
There is no mention of any mandate because this is not a true health insurance plan.
The plan basically says: you save your own money in a "special account" (a tax-advantaged / glorified bank account). So whatever you save, you get a tax deduction on it. You pay all of your healthcare costs out of this account.
That's it. It's really a savings account with tax-deductions... we will pay FULL COST for healthcare. It's not a health insurance plan... it's a health savings plan. No insurance policy to buy. The "insurance" is whatever we've saved in our account.
So if someone's child gets cancer... make sure they've saved the $300,000 it costs for treatment. They'll be paying for it all using their own money (but of course, AMAZINGLY (and Thanks To The Repubs! - sarcasm!), they'll get that MAGA tax-deduction).
Sound ridiculous? It is!
drip...
drip...
drip... dripping away....
The plan basically says: you save your own money in a "special account" (a tax-advantaged / glorified bank account). So whatever you save, you get a tax deduction on it. You pay all of your healthcare costs out of this account.
That's it. It's really a savings account with tax-deductions... we will pay FULL COST for healthcare. It's not a health insurance plan... it's a health savings plan. No insurance policy to buy. The "insurance" is whatever we've saved in our account.
So if someone's child gets cancer... make sure they've saved the $300,000 it costs for treatment. They'll be paying for it all using their own money (but of course, AMAZINGLY (and Thanks To The Repubs! - sarcasm!), they'll get that MAGA tax-deduction).
Sound ridiculous? It is!
drip...
drip...
drip... dripping away....
3
@ Sheri Kocen
There is no repeal of the mandate in this plan, unless Republicans can secure a 60+ vote majority in the Senate. There are also no changes to the coverage mandates without that same margin. What Republicans may be hoping is that if they can push through the tax/funding changes under reconciliation (as a "repeal"/"replace" act) that they will make the markets untenable for lower income/younger people who are not going to get the subsidies needed to purchase the more comprehensive and expensive plans mandated by ACA - which if more younger/healthier insureds leave the markets the costs will still rise for unhealthy/sicker even with the proposed more "generous" credits based on age. They likely believe if they can produce enough dissatisfaction and turbulence in the markets that they can pin on the remainders of the ACA mandates that this will force the Democrats to "negotiate" - i.e. eliminate most, if not all, coverage mandates, among other "concessions, and therefore the Republicans can try to play both sides (they "Repealed" (points from the base), they "reformed" enough to claim a not total reversion to the "old" system, but "perfection" will be blocked until "obstructionist Democrats" play ball.
Democrats will need to be very assertive and broad reaching that *any* adverse changes to health care after January 20, 2017 will be the result of Republican "reforms" and not the mandate to repeal what is left of the good of ACA.
There is no repeal of the mandate in this plan, unless Republicans can secure a 60+ vote majority in the Senate. There are also no changes to the coverage mandates without that same margin. What Republicans may be hoping is that if they can push through the tax/funding changes under reconciliation (as a "repeal"/"replace" act) that they will make the markets untenable for lower income/younger people who are not going to get the subsidies needed to purchase the more comprehensive and expensive plans mandated by ACA - which if more younger/healthier insureds leave the markets the costs will still rise for unhealthy/sicker even with the proposed more "generous" credits based on age. They likely believe if they can produce enough dissatisfaction and turbulence in the markets that they can pin on the remainders of the ACA mandates that this will force the Democrats to "negotiate" - i.e. eliminate most, if not all, coverage mandates, among other "concessions, and therefore the Republicans can try to play both sides (they "Repealed" (points from the base), they "reformed" enough to claim a not total reversion to the "old" system, but "perfection" will be blocked until "obstructionist Democrats" play ball.
Democrats will need to be very assertive and broad reaching that *any* adverse changes to health care after January 20, 2017 will be the result of Republican "reforms" and not the mandate to repeal what is left of the good of ACA.
3
I question how Republicans can be perceived as anything but evil at this point. Their policies and proposals are rolling back protection after protection. They want to rewind to the wild west where oversight was non-existent and quality of life was anything but. It makes me sad that they can look themselves in the mirror and think they are doing anything good for the American or global populations.
458
You echo my feelings completely. In my view, these Republicans are soulless and devoid of morals. I'm sure when they do look in the mirror they see no reflection. It's unfortunate that they have been able to dupe so many of the people they will actually be hurting into voting for them.
114
The Republicans are a party of reactionaries now. They are reacting to the progressive policies of the Obama years in financial regulation, health care, enforcing overtime regulations, minimum wage laws, and worker, environmental, drug and food safety, and environmental protections They respond to the Koch brothers and to industry lobbyists. They also have a built-in House majority because of gerrymandering. And now they have a president who will choose Supreme Court and Federal judges to interpret the laws in their terms. The 2016 elections will be remembered for the consequences, and not only in a president with a major personality disorder.
47
Republican simply don't have the same narrative. For them, ACA was unfair and a waste of public money. They'd rather have a global taxation system (incl health care benefits and mandates) that's flat across the board where people paya flat % of their income or consumption and everyone receives the same benefit. They will argue that introducing different tiers of benefits causes distortion and is unfair tonhonest hard working people who are just above the qualifying limit.
4
I finally reached Medicare age last fall, after over 20 years of an individual health insurance policy. In the eight years before the ACA, my premiums tripled. With my Exchange policy, though I still had a $3,000 annual deductible (so as always, I paid for all my own health care every year -- except a flu shot! and a mammogram!), at least I qualified for a subsidy that kept my premium about the same and shielded me from further double-digit annual premium increases. Now I feel like I've safely made it onto the shore of a semblance of single payer coverage, while out at sea is a sinking ship full of desperate, terrified passengers. (Yes, I know Ryan and the Republicans have their sights on Medicare next -- but I'm now in a constituency far larger and more powerful than the puny, dismissable individual market.) The rest of the developed countries must just shake their heads in disbelief that this cruel, heartless, life-destroying for-profit system continues, in "the greatest country in the world."
642
Kristi, good post. I want to caution that if and when the Republicans come after Medicare they will probably not do anything about people already on Medicare, but will "sacrifice the unborn" in the hopes that we who are on Medicare will not care.
6
I'm looking forward to turning 65 way, way more than I ever looked forward to turning 16 (driving), or 21 (clubbing). Is this a great country or what, that being old has become a medical security goal post. Sarcasm.
6
I'm only 51, no where near retirement, and I am just about to join AARP. We need a unified voice for the constituency to be able to protect the program.
Congratulations for making it to our single payer system. Please keep your voice loud and strong for those of us who aren't there yet.
Congratulations for making it to our single payer system. Please keep your voice loud and strong for those of us who aren't there yet.
4
It is disingenous to call households with incomes between $80K and $200K 'rich'. Yes, economists will say they are in the top 20%, the 'affluent sector', but everyone knows that in expensive areas of the country they are not living in great luxury.
46
Yes but that is irrelevant. Regardless of where you are living, if you are in the top 20% of income earners then you are. I have lived in Manhattan and LA. Nobody is forcing anyone to drink $5 cups of coffee or $15 artisanal cocktails. I never knew anyone in either of those cities that ever ate a meal at home, in fact it was considered "quaint" to do so. This is not how the average person lives at all.
5
Jonathan:
" It is disingenuous to call households with incomes between $80K and $200K 'rich'. "
Huh?
You need to get out of the Upper West Side of.Manhattan more often. Social Security Administration says that the median household income in 2015 was $48,098. The national average wage for an American worker was $21.84.
The HHS states that the 2016 poverty level was $15,930 for a 2 person household,and $28,410 for a 4 person household. Nearly 14.5 percent of US citizens lived beneath the poverty level in 2014. 33% of American children live below the definition of poverty.
There were 323 million Americans in 2013. NYC accounted for 8.4 million,or about 0.03% of the US population. I agree that it is tough to be married and have 2 kids in NYC on an income of $80K. $80K/year goes much,much further in 80% of the nation. And..outside of San Francisco and Manhattan the VAST majority of American families would faint with joy if the suddenly earned $200K/year.
You have a very,very narrow "world-view".
" It is disingenuous to call households with incomes between $80K and $200K 'rich'. "
Huh?
You need to get out of the Upper West Side of.Manhattan more often. Social Security Administration says that the median household income in 2015 was $48,098. The national average wage for an American worker was $21.84.
The HHS states that the 2016 poverty level was $15,930 for a 2 person household,and $28,410 for a 4 person household. Nearly 14.5 percent of US citizens lived beneath the poverty level in 2014. 33% of American children live below the definition of poverty.
There were 323 million Americans in 2013. NYC accounted for 8.4 million,or about 0.03% of the US population. I agree that it is tough to be married and have 2 kids in NYC on an income of $80K. $80K/year goes much,much further in 80% of the nation. And..outside of San Francisco and Manhattan the VAST majority of American families would faint with joy if the suddenly earned $200K/year.
You have a very,very narrow "world-view".
9
Sorry, but over 90 percent of Americans don't live in NYC or San Fran.
4
Re:
"It would change how tax credits are distributed by giving all Americans not covered through work a flat credit by age, regardless of income.
"That means that the biggest financial benefits would go to older Americans, like, say, Secretary of State Rex Tillerson. If he didn’t have a job in the Trump cabinet and access to government coverage, a 64-year-old multimillionaire like him would get the same amount of financial assistance as someone his age, living in poverty, and he would get substantially more money than a poor, young person."
This is crazy.
Hhow much more regressive could this be?
A tax credit? How will this help folks whose insurance premiums and other health care costs exceed their income? (Of course, most of those are still paying into Social Security and Medicare, but we don't "count" those as taxes.)
A flat credit by age, rather than income? That's nuts in itself, but if the tax going to be age-based, the the credit should more generous for young people, not the reverse. Not only do we need to invest in young people, but this population--on average much healthier and thus intensive users of health care than their elders--needs to be in the insurance pool to make the system work.
And the slashing of Medicaid is unconscionable.
I didn't expect much of the Republicans, and they've still managed to disappoint me.
"It would change how tax credits are distributed by giving all Americans not covered through work a flat credit by age, regardless of income.
"That means that the biggest financial benefits would go to older Americans, like, say, Secretary of State Rex Tillerson. If he didn’t have a job in the Trump cabinet and access to government coverage, a 64-year-old multimillionaire like him would get the same amount of financial assistance as someone his age, living in poverty, and he would get substantially more money than a poor, young person."
This is crazy.
Hhow much more regressive could this be?
A tax credit? How will this help folks whose insurance premiums and other health care costs exceed their income? (Of course, most of those are still paying into Social Security and Medicare, but we don't "count" those as taxes.)
A flat credit by age, rather than income? That's nuts in itself, but if the tax going to be age-based, the the credit should more generous for young people, not the reverse. Not only do we need to invest in young people, but this population--on average much healthier and thus intensive users of health care than their elders--needs to be in the insurance pool to make the system work.
And the slashing of Medicaid is unconscionable.
I didn't expect much of the Republicans, and they've still managed to disappoint me.
268
The credit has to be generous for old people, too. Young people need it because they're poor. Old people need it because they have higher health care costs. Everyone needs it!
4
@vkt
Yes, what is not also mentioned is the method of the tax credit. Under ACA, the tax credit for the subsidies was applied directly to the insurance premium as money not exiting the wallet of the insured. The insured instead just received a lower out of pocket premium expense. Under the Republican plan, will this instead be converted to a "refundable" tax credit, meaning insureds are expected to pay the full cost of their premiums, only to receive the credit at the end of the year as applied to their taxable income, which depending on the individual's taxable situation, may just apply against other taxes owed and would likely not equal into the form of a check for insurance premiums paid. That's a YUUUGE difference and one that needs to be understood. Many middle class, working poor and poor could not afford to pay the full freight of the premium on the expectation of lessening their taxes owed at the end of the year, or even if it was a fully refundable amount, to budget that monthly premium to a yearly check (especially if the credit != premium).
Yes, what is not also mentioned is the method of the tax credit. Under ACA, the tax credit for the subsidies was applied directly to the insurance premium as money not exiting the wallet of the insured. The insured instead just received a lower out of pocket premium expense. Under the Republican plan, will this instead be converted to a "refundable" tax credit, meaning insureds are expected to pay the full cost of their premiums, only to receive the credit at the end of the year as applied to their taxable income, which depending on the individual's taxable situation, may just apply against other taxes owed and would likely not equal into the form of a check for insurance premiums paid. That's a YUUUGE difference and one that needs to be understood. Many middle class, working poor and poor could not afford to pay the full freight of the premium on the expectation of lessening their taxes owed at the end of the year, or even if it was a fully refundable amount, to budget that monthly premium to a yearly check (especially if the credit != premium).
7
Liberals/Democrats should support the Republican Health Proposal. It will help decrease the excess population America has. Therefore, this proposal will advance liberal causes such as raising wages and reducing human impact on the environment simultaneously. Last thing we need is more poor people lowering wages and polluting our environment.
23
Poor people, if they drive, are more likely to drive older, more polluting cars. They're more likely to by processed foods made by agribusiness and less likely to buy environmentally friendly organic products. They're more likely to smoke, and they're more likely to be obese, so they're even more expensive. Without them, there will be more incentive to develop better technological solutions to clean our houses, cut our grass, and mind our children (iNanny, perhaps?).
3
@m. Gessberwitz
Not all, in fact the opposite. Care to take a glance at the results of nations with high poverty and low government services? The poor don't "disappear" and die off nicely, and nothing close to the First World Middle Class exists at all in these nations. The poor don't "die" as a group from the lack of health care access. What they do, particularly in societies with low education/high fundamentalist religiosity/low access to health care and other advanced services, is overproduce beyond their capacity which stresses even the least generous societies in terms of crime, disease, and resource usage/degradation. The expanse of the poor usually threatens the less wealthy that cannot afford to wall themselves, or privately protect themselves through various means.
What I can't understand is that empiric evidence shows that the average living standards for the average human increases the more that governments are designed for citizen needs and access to advanced services increases, including in particular US history. And that societies with less extremes of poverty and wealth also have stronger middle classes, while societies with more extreme poverty have smaller or no middle classes. The average conservative in America is not a rich person. So why are they so intent on continuing to degrade the very system and social fabric that led to the apparent comfort of the American middle class to discard the systems that created it?
Not all, in fact the opposite. Care to take a glance at the results of nations with high poverty and low government services? The poor don't "disappear" and die off nicely, and nothing close to the First World Middle Class exists at all in these nations. The poor don't "die" as a group from the lack of health care access. What they do, particularly in societies with low education/high fundamentalist religiosity/low access to health care and other advanced services, is overproduce beyond their capacity which stresses even the least generous societies in terms of crime, disease, and resource usage/degradation. The expanse of the poor usually threatens the less wealthy that cannot afford to wall themselves, or privately protect themselves through various means.
What I can't understand is that empiric evidence shows that the average living standards for the average human increases the more that governments are designed for citizen needs and access to advanced services increases, including in particular US history. And that societies with less extremes of poverty and wealth also have stronger middle classes, while societies with more extreme poverty have smaller or no middle classes. The average conservative in America is not a rich person. So why are they so intent on continuing to degrade the very system and social fabric that led to the apparent comfort of the American middle class to discard the systems that created it?
1
M. Gessbergwitz :I agree-just send them poor people to a camp.Gas them and have a sale on dog food. Paul Ryans proposals seem to owe a lot to Jonathan Swifts' "A Modest Proposal" .I suppose the satire would be wasted on the Republican Congress.
http://art-bin.com/art/omodest.html
http://art-bin.com/art/omodest.html
6
Worth noting that the press's (including the NYT) rollover on renaming the ACA with the Republican's slur as Obamacare was part of the destruction of this crucial piece of the American safety net.
Lots of sins to go around particularly when the Trumpista gullibles didn't know they were one and the same.
Important that the same folks learn that EPA isn't just about snail darters but about the bass and trout and stripers, the deer and other critters that are part of outdoor sport.
Lots of sins to go around particularly when the Trumpista gullibles didn't know they were one and the same.
Important that the same folks learn that EPA isn't just about snail darters but about the bass and trout and stripers, the deer and other critters that are part of outdoor sport.
104
That's a red herring. Romneycare didn't mind being called Romneycare and ACA proponents themselves endorsed the nickname Obamacare (check out Obamacare facts.com). Besides, who cares?
3
All we can hope is that once the American public realizes they have been duped they will rise up, unfortunately Trump's beloved poorly educated will need to be hit over the head several more times.
353
Oh you mean to the point of unconsciousness?
27
Hope they have medical insurance!
hot on the head all the way to 2024
I fail to understand: Paul Ryan presents himself as a faithful Catholic, but his policies again and again show a preferential option for the rich rather than for the poor.
623
Catholics support Trump because sex obsession and abortions trumps all else with the majority of Catholics cleric and they communicate this to the laity. 52% of Catholics voted for Trump. They care most about abortion and planned parenthood being shut down. I'm not sure what they think about the folks at the Spanish language mass almost every parish now has on Sunday.
133
If only Catholics cared as much about child sexual abuse at the hands of their priests as they do about abortion. Many Catholics and US citizens in general believe the abortion rate is high and increasing while the facts or just the reverse. We should all work to reduce abortion and provide needed contraception and sex education something planned parenthood does--another case where the Catholic church has it's head in the sand. Again abortion in our country is legal while sexual abuse of children is not. Why are these priests not locked up rather than covered up.
42
Ryan would say his policies prefer no one, which is to say they prefer poor people a lot less than Obama's policies. But no need to vilify him or the Republicans on this particular point. it's a matter of political philosophy, not morals.
"The plan includes additional features that redistribute resources from the poor to the rich."
This is the definition of the modern Republican Party.
This is the definition of the modern Republican Party.
721
Right now resources are being redistributed from irresponsible people to responsible people. Stop the subsidies and make everyone pay their fair share. You might find that if everyone has skin in the game costs will go down. i.e. no longer will Medicaid patients take an ambulance to the ER for a checkup if they have a co-pay.
2
john Smith's comment is just so silly. He actually believes we have a huge problem of people taking an ambulance to the ER for a check up and then Medicaid picking up the tab.
Also calling working people who just don't make enough money to buy health insurance irresponsible is irresponsible.
Also calling working people who just don't make enough money to buy health insurance irresponsible is irresponsible.
8
Ahh, and here we taxpayers so generously continue to pay Republicans health benefits and retirement for life, yes?
4
So out of step with the needs of the American people of all socioeconomic backgrounds, Capitol Hill has morphed into a pitch blackened Ivory Tower.
The President, who has never seen an actual medical bill or EOB (Explanation of Benefits) from an insurer in his life is just like the rest of the GOP leadership -- completely out of step with the wants, needs and desires of the people.
Over 70% of healthcare decisions in the household are made by women. We protect the welfare our families with a ferocity that doesn't seem to cross the mind of politicians looking to roll back the ACA, dismantle Medicaid and harm Medicare.
I hope Congress and Trump are ready for a deluge of endless backlash from tens of millions of Americans. As a woman and the head of a national consumer healthcare advocacy, I can assure them they haven't even begun to see us fight.
The President, who has never seen an actual medical bill or EOB (Explanation of Benefits) from an insurer in his life is just like the rest of the GOP leadership -- completely out of step with the wants, needs and desires of the people.
Over 70% of healthcare decisions in the household are made by women. We protect the welfare our families with a ferocity that doesn't seem to cross the mind of politicians looking to roll back the ACA, dismantle Medicaid and harm Medicare.
I hope Congress and Trump are ready for a deluge of endless backlash from tens of millions of Americans. As a woman and the head of a national consumer healthcare advocacy, I can assure them they haven't even begun to see us fight.
765
53% of White women voted for Trump along with 63% of white men. These well to do folks couldn't care less about the poorer Americans, as to health care.
3
Yesssss!
Sarah O'Leary, all they see women as is a group to ignore, call names, restrict rights, and to claim as hysterical. We have no idea what we're doing, saying, or deciding in their eyes. Of course when they need us we're the best, most wonderful people in the world.
The GOP thus cunningly converted a left-right convergence point of national consensus on this absolutely basic step forward in insuring more Americans into an ugly mud-wrestling match, the kind that they relish (and can win).
All of which is to lament that the New York Times continues to casually use this loaded term.