Priorities for the Democratic National Committee and All Democratic Party Officials
Job # 1 should be to establish and maintain integrity.
Job #2 should be to engage the best available cyber security for communications and web sites.
Job #3 should be to understand the differences between Progressive world views and Conservative world views
Job #4 should be to explain the Democratic messages simply and clearly using the best behavioral science.
Job #5 should be to get all persons eligible to vote registered.
Job #6 should be to get all registered voters to actually vote.
Make sure that your Democratic Party walks the talk. No fake news. No exaggerations. No cute deceptions. No cheap shots. No gloating over Republican circular firing squads. Explanations rather than attacks. Seek first to comprehend.
Job # 1 should be to establish and maintain integrity.
Job #2 should be to engage the best available cyber security for communications and web sites.
Job #3 should be to understand the differences between Progressive world views and Conservative world views
Job #4 should be to explain the Democratic messages simply and clearly using the best behavioral science.
Job #5 should be to get all persons eligible to vote registered.
Job #6 should be to get all registered voters to actually vote.
Make sure that your Democratic Party walks the talk. No fake news. No exaggerations. No cute deceptions. No cheap shots. No gloating over Republican circular firing squads. Explanations rather than attacks. Seek first to comprehend.
Why pay an insurance company at all? You're only introducing more uncertainty into an already complex process. I'd rather see employers pay taxes and government provide health care. Take the burden off both sides. Despite what you might think, socialized medicine is actually a free market argument. Labor would be free to move between employers or become self-employed without the undue burden of medical risk. Meanwhile, businesses could cut the administrative overhead of renegotiating insurance rates ever year. Sorry to HR and insurance employees but your job is redundant in this capacity. We don't even need future automation. You're easily processed out of the job right now.
5
Anatole France: The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.
2
That last paragraph is a joke. If anybody thinks that companies will keep a benefit because it keeps them competitive in the employee marketplace didn't learn anything from our experience with employer sponsored pension plans. Prior to the advent of 401K plans, most large employers had defined pension plans. After 401K plans came into existence, defined pension plans disappeared. The same thing will happen with employer sponsored health insurance plans. Prior to ACA, I recall reading these same employee benefits analysts starting to take bets as to which large employer would be the first to drop health insurance benefits because of the double digit increases in health insurance premiums. I could easily see even larger employers copy the government by providing an employee with a fixed amount of money each year to purchase health insurance in the individual marketplace. And just like the government, the premium support would not be indexed to the inflation rate. Therefore, it would be worth less each year. Don't forget, unless you have health insurance premiums written into your employment contract, it is a totally voluntary benefit provided by your employer and it can be taken away at anytime.
5
Before ERISA was passed in 1974, employees who had defined benefit pension plans had no legal vested rights to their pensions. Many employers had no reserves built up to pay the liability they had to their employees and retirees, and were not legally obligated to pay them. It worked fine as long as the business was thriving and growing, but if the economy or business stumbled, the pension plan was one of the first expenses to go.
When ERISA was passed, the law required employers to segregate pension funds with a trustee, they had ten years to fully fund their pensions, and they had to pay premiums to the PBGC to insure against pension plan failures. That was the beginning of the end of private sector defined benefit plans. Big companies, that had relatively highly paid employees used the pension plans to smooth out earning variability by making larger than necessary contributions during profitable years to reduce their federal tax, and relatively skimpy contributions during lean years. The death knell for defined benefit plans was when the federal government capped contributions.
In 1978, 401(k)s were introduced. Defined benefit pensions were already doomed by then. Even private sector employers who have defined benefit plans have closed them to new hires. Within 10 years, the only newly hired employees who have defined benefit plans will be civil servants. And the government plans have less than 50% of the funds required to pay the prom
When ERISA was passed, the law required employers to segregate pension funds with a trustee, they had ten years to fully fund their pensions, and they had to pay premiums to the PBGC to insure against pension plan failures. That was the beginning of the end of private sector defined benefit plans. Big companies, that had relatively highly paid employees used the pension plans to smooth out earning variability by making larger than necessary contributions during profitable years to reduce their federal tax, and relatively skimpy contributions during lean years. The death knell for defined benefit plans was when the federal government capped contributions.
In 1978, 401(k)s were introduced. Defined benefit pensions were already doomed by then. Even private sector employers who have defined benefit plans have closed them to new hires. Within 10 years, the only newly hired employees who have defined benefit plans will be civil servants. And the government plans have less than 50% of the funds required to pay the prom
All I can say is thank god I got my IUD when I did.
3
Just another case of being shocked (!) by this administration to find gambling going on here.
And while Trump is compromising our healthcare, he wants to drastically increase the military budget and military personnel and their families' healthcare will be funded for life on our dime. Separate not equal.
2
My favorite statement in this review of the Republican healthcare plan, and it's effect on employer offered healthcare is this: "But smaller employers, particularly in certain industries, may choose to cut back."
There is no doubt that most small employers will cut back or end health insurance offerings to their employees. There is no doubt. The A.C.A., flawed as it is, had the intention of bringing healthcare coverage to more, and more and more Americans. It did it by provided extended Medicaid, making workplace healthcare insurance mandatory, and through a variety of carrot/stick approaches.
The Republican healthcare plan is to unwind all of those provisions, and cut 800 billion out of the Medicaid system. How will the destitute elderly afford nursing home care? Don't ask a Republican. They don't care.
These two changes (unwinding A.C.A. mandates and cutting Medicaid) will kill all of the good the A.C.A. did for citizens, except for the very, very rich who get a tax cut out of the deal. It is a shame Republicans are not focused on getting healthcare for all of us, rather than tax cuts for the rich; a shame.
There is no doubt that most small employers will cut back or end health insurance offerings to their employees. There is no doubt. The A.C.A., flawed as it is, had the intention of bringing healthcare coverage to more, and more and more Americans. It did it by provided extended Medicaid, making workplace healthcare insurance mandatory, and through a variety of carrot/stick approaches.
The Republican healthcare plan is to unwind all of those provisions, and cut 800 billion out of the Medicaid system. How will the destitute elderly afford nursing home care? Don't ask a Republican. They don't care.
These two changes (unwinding A.C.A. mandates and cutting Medicaid) will kill all of the good the A.C.A. did for citizens, except for the very, very rich who get a tax cut out of the deal. It is a shame Republicans are not focused on getting healthcare for all of us, rather than tax cuts for the rich; a shame.
10
The destitute elderly are not the ones who are losing Medicaid, it is the able bodied adults who are working fewer that 20 hour per week It is a crime for the taxpayer to be paying $80 billion per year to provide health insurance for the able bodied.
Single payer: Done.
3
Employer based coverage is the big conundrum in our system. Because so many people get their coverage through their employer, not enough are exposed to the individual markets to demand better reforms, and because of the inferiority of most individual market plans to good, large employer group plans, people are extremely risk adverse about transitioning away from employer coverage into those markets, and rightly so. There's also the tax favorability of employer based coverage, which ACA (and to some degree, AHCA) tries to remedy through tax credits for individual market plans, but there is still the matter that the majority of those receiving their coverage through their employer are highly shielded from the real costs of their coverage and therefore have little understanding of what the real costs are. Which leads to shallow observations that health insurance can be purchased by sacrificing a cell phone plan or cable subscription. When people lose their jobs and get the COBRA statement they get a real sticker shock as they realize that coverage they are accustomed to is more like a mortgage or rent payment, and sometimes more.
What is needed is a conferrable system of coverage so the transition is eased (comprehensive single payer for example), with other policies to sooth (i.e. requiring employers to remit the amount of coverage as wages), otherwise employer based coverage will remain a stubborn obstacle in the way of real reforms.
What is needed is a conferrable system of coverage so the transition is eased (comprehensive single payer for example), with other policies to sooth (i.e. requiring employers to remit the amount of coverage as wages), otherwise employer based coverage will remain a stubborn obstacle in the way of real reforms.
5
I am sure that any cost . Will be pass on over Employer cost.
Fake promise alert: Trump's campaign promise to "drain the swamp" was an edited version of his real intention: "drain the swamped". The former isn't happening (witness those currently jumping into the swamp), and the latter is a work in progress (witness those who are currently, or will soon be, swamped).
3
Well, lots of Americans voted for Trump and the Republicans because they wanted 'freedom' and fell for the 'America first' populist slogan. Now you got it and guess what, you are not first in Trump's priorities. Now all of us have to suffer the consequences. Trump just fired Comey. Was he digging a bit too deep? Supposedly on the advice of Sessions. I think the mob is in charge of our Government and we only have ourselves to blame. Well, I blame the red states for unleashing this adminstration on us and pity the democrats living in those states. I used to think I could live anywhere in the US but my choices are severely limited it seems.
15
Perhaps if the Democrats had designed a better plan we wouldn't be in this pickle. ObamaCare is projected to add $1.5 trillion to the deficit in the next ten years. Even with that huge cost, one third of the counties only have one insurer and a second third only have two insurers in 2017. Several insurers have already announced that they are not going to participate in 2018. The only place that ObamaCare is functioning is in high density population centers with populations in excess of 2.5 million. Even markets with one million people are struggling.
The one size fits all federal solution of ObamaCare works, with $1.5 trillion cost only works in big blue cities. It doesn't even work in midsize blue cities. To make it work would take an additional $0.5 trillion at least.
And ask yourself where all of that extra spending went. There were 40 million uninsured in 2010 and there are 30 million uninsured in 2017. The extra money went to the big drug companies who were able to raise their prices to the insured and to the big medical chains who were able to negotiate higher reimbursement rates from the insurance companies after they consolidated the hospitals and providers in the markets.
Big medicine does not deserve the extra $1.5 trillion, much less an additional $0.5 trillion even if they did make big campaign contributions to the Democrats.
The one size fits all federal solution of ObamaCare works, with $1.5 trillion cost only works in big blue cities. It doesn't even work in midsize blue cities. To make it work would take an additional $0.5 trillion at least.
And ask yourself where all of that extra spending went. There were 40 million uninsured in 2010 and there are 30 million uninsured in 2017. The extra money went to the big drug companies who were able to raise their prices to the insured and to the big medical chains who were able to negotiate higher reimbursement rates from the insurance companies after they consolidated the hospitals and providers in the markets.
Big medicine does not deserve the extra $1.5 trillion, much less an additional $0.5 trillion even if they did make big campaign contributions to the Democrats.
Employer-based healthcare is really on the way out. In the past few years, most small companies (under 100 employees) reduced their expenses by having their employees secure comprehensive healthcare through the ACA (Obamacare). I am one of those employees. Now, with the GOP in charge of the Federal Government, they have decided that they must get rid of the ACA and replace it with an"undefined" plan. In fact the only thing we DO know is that the wealthiest tax-payers will receive a tax cut. The rest is TBD. The GOP is so preoccupied with satisfying the needs of their wealthy benefactors that they've totally forgotten the average worker and consumer. The GOP is setting itself up to be the big loser of the 2018 mid-terms... not to mention the 2020 elections.
13
Considering how they're acting, I don't think that they are all that worried about pleasing or not pleasing their constituents or getting voted out of office. They know that no matter what they do, their jobs (and their own fantastic health tax-payer-funded insurance plans) are safe thanks to the American public's propensity to very short memories, gerrymandering, voter intimidation and having unlimited campaign funds. Therefore, with no negative consequences, they are free to inflict as much damage on the "little people" as they like.
8
You lost your employer health insurance because of ObamaCare, and you did not get a commensurate raise in your paycheck. Your employer increased his profit. I lost my employer provided retiree health insurance subsidy because of ObamaCare.
In 2010, 59% of the US population [including spouses and dependents] had employer provided health insurance. In 2015, the percentage was down to 49%.
You blame the GOP It is going to take some real effort to get the US back to a system that is as good as it was when Obama took office.
In 2010, 59% of the US population [including spouses and dependents] had employer provided health insurance. In 2015, the percentage was down to 49%.
You blame the GOP It is going to take some real effort to get the US back to a system that is as good as it was when Obama took office.
All employer health benefits should be taxed as ordinary income and the taxpayer-subsidized health insurance deduction for companies--unfair to self-employed--should be eliminated. Doing both will bring both discipline and reality to the healthcare industry, which includes insurance companies, of course.
5
You have to be kidding... high deductibles notwithstanding, do you have any idea at all how much this would raise the tax bill considering most insurance costs are measured in thousands of dollars a month? That is invisible income that most people can't write a check for to pay the tax man. Sorry dude, but if you're self-employed, you should have a plan for affording insurance. Cost of doing business 101.
2
It is not unfair for an employer to take a tax deduction for the money they pay for employee health coverage, as they do for all other employee compensation. What is unreasonable is that it is not included in employee taxable compensation. If employees realized how much their health insurance was really costing, we would draw closer to a market based, lower cost, medical structure.
I don't understand why red state residents are shouting down their representatives in town halls. These people voted for Trump and the House representatives, what did they expect? Can't people put two and two together?
17
Unfortunately, they decided to check out their representatives REAL agenda AFTER they voted for them, not before.
2
Obviously not every person in red states voted for Trump.
4
It is Democrats who are shouting down their Republican representatives. The Republicans in those Congressional districts want ObamaCare eliminated.
I suspect the primary reason for age discrimination in American business is health care costs for older workers. Insurance companies charge premiums based on their loss experience and a business with 20-somethings is going to have a fraction of the cost of a company with 50+ plus workers.
Early Retirements offers used to be the way to shed older workers. Now it's forced layoffs that disproportionately target older workers. So this is not just about having health care, this is about having a job.
In my 20,000 person Tech company, 1/10th of one percent are over 55. I hope this is an extreme case, but I don't see many of my age peers fairing any better at other companies. Whatever you think about health care policy, know this, it has a lot to do with whether you have a job, now or in the future.
Early Retirements offers used to be the way to shed older workers. Now it's forced layoffs that disproportionately target older workers. So this is not just about having health care, this is about having a job.
In my 20,000 person Tech company, 1/10th of one percent are over 55. I hope this is an extreme case, but I don't see many of my age peers fairing any better at other companies. Whatever you think about health care policy, know this, it has a lot to do with whether you have a job, now or in the future.
16
And the House plan allows discrimination based on age. The insurance companies can non charge 5 X as much. A good policy is about $15,000 so 5 times means $75,000 a ear for insurance.
9
Since the rising cost of health benefits outstrips inflation, I suspect you are right. Health benefits are part of the compensation package for an employee. When the insurance costs rise, so does the compensation. Even if their take-home salary is the same, an older worker gets compensated more than a younger worker due to age. If we were to firmly address ageist policies, we would get rid of taxpayer subsidized, employer-provided health insurance. The worker's total compensation would be determined free of age factors, and the worker would buy insurance on the consumer end. Older workers would presumably be subject to higher insurance costs in the open market, but at least they would have their jobs. Younger workers would not have their compensation fall behind their older coworkers just because they happen to be younger.
1
A good policy for a 25-40 year old costs the employer about $1500-3000 per year. Double that for family coverage. The same policy for a 50-64 year old is $12000-$15000 per year. Double that if his spouse is also covered.
Under ObamaCare, the rule was the oldest could be charged 3 X the youngest. If that is not discrimination, how is a different factor, that is more in line with actual costs suddenly discriminatory.
Under ObamaCare, the rule was the oldest could be charged 3 X the youngest. If that is not discrimination, how is a different factor, that is more in line with actual costs suddenly discriminatory.
Just skip to the last paragraph. Much speculation, little substance.
"Even if the law changes, coverage by most large employers is likely to remain widespread and robust, particularly if a strong economy prompts them to compete to attract workers. But even in past downturns, health benefits have proved tricky to take away. In the years before the Affordable Care Act, employers had no requirement to offer coverage and few rules about what benefits they should include. Still, in those years, generous employer coverage was the norm for large companies. “It’s not likely they would abandon that approach in a post-A.C.A. environment,” said Tracy Watts, the United States health reform leader at Mercer."
"Even if the law changes, coverage by most large employers is likely to remain widespread and robust, particularly if a strong economy prompts them to compete to attract workers. But even in past downturns, health benefits have proved tricky to take away. In the years before the Affordable Care Act, employers had no requirement to offer coverage and few rules about what benefits they should include. Still, in those years, generous employer coverage was the norm for large companies. “It’s not likely they would abandon that approach in a post-A.C.A. environment,” said Tracy Watts, the United States health reform leader at Mercer."
"Generous"? As a result of ever increasing costs, for years now, companies have been reducing or eliminating coverage so the idea that companies are going out of their way to offer superior healthcare plans to attract better employees is a gross oversimplification of the reality. I know of one very successful Wall Street multi-national who up until a few years ago, paid for, in full, all their U.S. based employees health insurance coverage.
Today, as a cost reducing measure, and although the company still administers and secures the plan from the insurance company at a somewhat reduced rate, employees are now responsible for paying, in full, their own premiums for whatever plan they choose often adding up to several thousand dollars in a year, not a particular advantageous method, I suppose, of attracting employees.
Today, as a cost reducing measure, and although the company still administers and secures the plan from the insurance company at a somewhat reduced rate, employees are now responsible for paying, in full, their own premiums for whatever plan they choose often adding up to several thousand dollars in a year, not a particular advantageous method, I suppose, of attracting employees.
3
They can go back to having skimpy lifetime caps so after a few cancer treatments even when you have been healthy and paid premiums on time for years you would be dropped because you are at the lifetime cap.
3
The longer-term implication no one is talking about yet is how the AHCA is designed specifically to undermine the viability of Medicare. Eight years from now the GOP will be saying Medicare is in crisis and needs to be reformed (i.e. privatized) because this bill cuts the payroll taxes to the wealthy that support Medicare for everyone.
Paul Ryan has been pretty clear that his goal is to get rid of all government health care programs (Medicaid & Medicare). This is his Trojan horse to get there.
Paul Ryan has been pretty clear that his goal is to get rid of all government health care programs (Medicaid & Medicare). This is his Trojan horse to get there.
33
I am in favor of any medical plan passed by congress that includes a provision in which all of congress is required to buy individual insurance at their own expense for themselves, spouse, and children, in their home district. I think we would get quite a good plan.
40
Employers will now be able to provide "lowest common denominator" coverage. What this means is that a corporation can determine which state's standard it will use for all it employees, regardless of what state the employees actually live in and the requirements of that state. So if a corporation has a location in a state that opts out of Obamacare standards (say Mississippi) all that corporation's employees, even those who live in states (say Massachusetts) that have not opted out, will be covered by the same plan. This will clearly make it much easier for employers that self-insure to strip benefits from those employees that live in states that mandate Obamacare standards.
19
Employees have been asked to shoulder more and more of employer health plan costs through premiums and higher ded's, co-pays and total out of pocket caps for at least the last 25 years. Providing health coverage to employees is a very expensive line item for corporations. Would they hesitate to limit coverage or eventually stop the practice to ratchet up bonus pools for Senior executives? Nahhh!
18
Employers clamored to provide health coverage to employees after WW2 because of wage controls that were in place. That was the moment when the US could have had universal coverage, but employers decided to opt us out for their benefit. The notion of the "common good" in our country continues to devolve. Unless we get that core concept reinstated, we will lose our sense of common purpose and end up like the Roman Empire.
23
Trumpcare is not a health care bill, but rather a tax cut bill for the rich, so later they can again reduce taxes via reconciliation.
That is really all that was intended, which is why so many repubs fell in line and didn't need to read the bill at all.
That is really all that was intended, which is why so many repubs fell in line and didn't need to read the bill at all.
23
Misery loves company. My sense is that as the GOP makes healthcare more and more inaccessible even in employer-paid plans, the majority of Americans will loudly demand single-payer healthcare, firing many of those lousy Congressmen along the way.
What's more if we could get our healthcare costs down to say European levels, about $1 trillion would flow into our economy every year. We can educate every child, retrain every worker, build highly productive infrastructure and more.
What's more if we could get our healthcare costs down to say European levels, about $1 trillion would flow into our economy every year. We can educate every child, retrain every worker, build highly productive infrastructure and more.
17
That makes way too much sense for us to ever legitimately implement it.
2
Do single-payer European plans offer unlimited healthcare on demand, and unquestioned universal access to the most expensive medical procedures and devices as American plans do or is there some form of healthcare rationing? I suspect that the British (I'll use them as an example) cannot get an appointment for routine care within 48 hours, cannot schedule nonemergency surgery within one week and are subject to a cost-benefit analysis for high-cost medical procedures and devices. Please correct me if the non-American health plans are cheap yet also provide on - demand every medical procedure a citizen wants. If this is the case, we Americans are missing out.
This GOP Bill has huge repercussions far and wide and no limits in its devastation. Families will go bankrupt and die. Where is the compassion? What happened to Christian teachings? The world is watching in horror and in shock, the blow by blow tragic killing of the once
glorious American democracy by liars, kleptocrats and morally bankrupt oligarchs.
Who will stand up to them and save the American people? Where are the American leaders who will fight for the American people? Where are they?
The Congressmen who voted for this egregious bill are clearly not representing their constituents and should be fired on the spot without pay and health insurance .
It should not take a year and half to do this.
glorious American democracy by liars, kleptocrats and morally bankrupt oligarchs.
Who will stand up to them and save the American people? Where are the American leaders who will fight for the American people? Where are they?
The Congressmen who voted for this egregious bill are clearly not representing their constituents and should be fired on the spot without pay and health insurance .
It should not take a year and half to do this.
20
So we are replacing laws that guarantee good coverage with hopes that employers will be generous. I think a brief glance at what has happened to real wages in recent years will show that is a pipe dream.
39
It's difficult not to see the @GOP as mean spirited and not beholding to Corporations. It baffles me why people vote these politicians in to office when the affects of their law making hurt the people that support them.
21
I agree. It's so counter intuitive. Why would someone vote for something that will to a near certainty cause pain. It's as if these people suddenly secumbed to the Stockholm syndrome!
1
Start taxing the money companies spend on health insurance for employees. That'll level the playing field. And raise money for Medicaid for the working poor.
7
So we can see that Trump and the GOP house members are for equality: their plan screws everyone.
17
As the Republicans work out how to make their health care policies more draconian for everyone, I would appreciate knowing if there is anyone in Washington D.C. who is currently working to figure out a single-payer / universal care / Medicare For All plan that they could present to the American public. Sen. Bernie Sanders campaigned about how important this issue is, but is he working on a plan? I would be very interested to hear any real information about how this could work. Even if the Republicans can not pass their AHCA plan, the ACA is not going to stay stable as it has been undermined by Trump & Co. and the insurance companies are limiting coverage for many people. I am hoping that the NYT would look into reporting about this.
12
NYReader:
Bernie Sanders, John Conyers and other progressives in the House and Senate have already formulated such a bill(single-payer) back a few weeks ago for all in the democratic party to present in a united front and as an alternative to The Republican "Deathcare" plan. The problem is, up to this point, only about 40 % of democrats in the House and only a handful in the Senate have committed to supporting it. I don't recall the NYT reporting on this, as a result, that is why you and others believe nothing has happened. Always remember, for the mainstream media BIG Healthcare and BIG Pharma are BIG advertisers.
When one investigates a little further, it becomes very clear that pretty well all of the group of non-committed members, including senior representatives the likes of Diane Feinstein and Nancy Pelosi, over the course of their careers, have received hundreds of thousands of dollars in campaign contributions from various institutions within the healthcare industry.
I am afraid, for those that think, if elected, the majority of corporately-controlled democrats would automatically start the ball rolling on a single-payer system, think again.
Bernie Sanders, John Conyers and other progressives in the House and Senate have already formulated such a bill(single-payer) back a few weeks ago for all in the democratic party to present in a united front and as an alternative to The Republican "Deathcare" plan. The problem is, up to this point, only about 40 % of democrats in the House and only a handful in the Senate have committed to supporting it. I don't recall the NYT reporting on this, as a result, that is why you and others believe nothing has happened. Always remember, for the mainstream media BIG Healthcare and BIG Pharma are BIG advertisers.
When one investigates a little further, it becomes very clear that pretty well all of the group of non-committed members, including senior representatives the likes of Diane Feinstein and Nancy Pelosi, over the course of their careers, have received hundreds of thousands of dollars in campaign contributions from various institutions within the healthcare industry.
I am afraid, for those that think, if elected, the majority of corporately-controlled democrats would automatically start the ball rolling on a single-payer system, think again.
2
I noticed that Trumpcare drops drug addiction treatment requirement. You would think that a state like West Virginia that has the distinction of leading the nation in number of drug overdose deaths per capita, in fact they are 22% ahead of number two. You would think that their three House Representatives might want to try to save a few lives and maybe even ask for additional funding for drug treatment. You would think that but you would be wrong. These three (Moe, Larry and Curly, I don't mean to insult the Three Stooges.) voted to eliminate coverage! I bet they will vote to spend 27 billion dollars for some idiotic wall to stop drugs from Mexico( zero chance of working) but won't spend spit to reduce the drug demand in their state. Sounds like they are fully qualified to represent their constituents.
19
Just a hunch that those US Reps have received contributions from private prison companies and either have them already operating in their districts or are working tirelessly to get them to locate there.
7
In their rush to crow about passing the bill, many on the right missed these very critical points. Just wait until their employers drop their coverage, because many will.
24
I really don't want to rely on undisclosed decisions by the state, my employer, and the Trump administration to decide what I pay for health insurance.
5
The more health care benefits the GOP takes away whether directly or indirectly, the stronger the case for single payer, Medicare for all, universal health care. Single payer 2019!
25
What are the costs? How will we pay for universal Medicare? I have yet to see anyone address this question in quantified terms. Even the proposed House bill is vague on this matter. If cost analyses are not put on the table, shouting Medicare for All ! makes as much sense as Tippecanoe and Tyler Too !
I have employer-subsidized health insurance. Monday morning I called Intermountain Healthcare, my provider, to make an appointment for a shingles shot. I was placed on hold for 23 minutes. When the human receptionist finally came on the line, she said she was very sorry but my doctor's staff would have to call me back to make the appointment. I then played phone tag with the doctor's staff for nearly 36 hours before I finally realized I could skip the doctor and go to the grocery store pharmacy to get the shot. But the inefficiency and impenetrability of the system, even for those of us privileged to have "good" insurance, boggles the mind. I miss calling the doctor's office, making an appointment in 30 seconds, getting the shot, and being done with it. Single payer, please! The executives of IHC are making money hand over fist while we hapless would-be consumers languish on hold.
28
Is there anything positive in the new Trumpcare bill at all? Other than tax cuts for the wealthy? Seriously.
23
Are these Republican legislators intentionally trying to hurt the poor or are they too stupid to realize the consequences of their policies?
11
Are the Republicans intentionally trying to hurt the employed with insurance middle class?
5
It's intentional. If all the poor folks die due to lack of access to healthcare, the Republicans are confident that the cost of a safety net will go down as well.
And the rich will put more money in their wallets.
And the rich will put more money in their wallets.
6
They are intentionally trying to hurt the poor. From Donald Trump to the Republicans on Capitol Hill -- they know exactly what they are doing -- no doubt about it. I'm wondering when Americans will stand up and say, "Enough!"
10
I work for a large employer in the aerospace industry. I have worked at my current employer for more than 20 years. During that time, I have seen a steady shifting in costs to the employees, and a steady decrease in coverage. The latest has been a shift to the high deductible plans. Employers are not stupid. They don't do it all at once. The do it slowly so that each little change is "I'll live with this" for the employee, but they tend to cover only what they need to, and if they can apply a lifetime maximum that saves them money and affects few, they will over time. If they could exclude preexisting conditions and save money, they would up to the limit where their employees walk because someone else offers better. Things that affect few but are expensive would be the first things to go.
27
I work for a small private liberal arts university. What you have observed is true for us as well: a steady erosion of coverage, a steady increase in premiums, and cost shifting from the university to the employee. The same is true for our retiree health care.
20
i work for one of the largest companies in the world and they have offered great insurance but have always discriminate against pre existing conditions. Prior to Obamacare they just added lifetime caps. You could be healthy for 20 years paying your premiums on time and under the House plan we will go back to lifetime caps which means after a few cancer treatments you are at your employers lifetime cap.
5
Ironically, I teach at a medical program. We already have high premium, high co-pay, high deductible insurance which I am anticipating will become less useful in the next few years.
2
"The possible effects on the employer health system got little attention during congressional debate."
There was a debate? I must have missed it.
There was a debate? I must have missed it.
44
I thought passing ACA was supposed to kill off the employer provided benefit as companies offloaded empolyees to the exchanges. I guess no matter what, it's going to be a catastrophe!
5
Opponents predicted that employers would drop coverage under ACA but it didn't happen because Employers were mandated to offer it. That has been part of the unhappiness with the ACA. It could be fixed but Ryan, the or The Great Mortician, as I call him, can't wait to dismantle increased coverage and then to get his hands on Medicare. If you're young that may not bother you but if you are lucky you might get old. There is no social safety net program that Ryan can't wait to gut or weaken. It gives him joy.
11
Does this mean that We the People can reduce the health benefits or decide not to provide our employees (the Congress) with health insurance? Since our employees think that this is such a great law for We the People; it seems only fair that it be applied to them as well.
And while we are at, let’s get rid of all those perks our employees have. Most of us understand that they probably have the best health insurance and retirement benefits of all American workers. We know that they are receiving exuberant salaries. However, we have yet to see much that improves the daily lives of ordinary Americans. According to the Center for Public Integrity our employees also have “many less-publicized perks that come along with the job.” Some of which our employees have a lifetime to enjoy; even if they no longer are our employees!
See: www.publicintegrity.org/2011/11/23/7495/congressional-perks-lawmakers-mo...
And while we are at, let’s get rid of all those perks our employees have. Most of us understand that they probably have the best health insurance and retirement benefits of all American workers. We know that they are receiving exuberant salaries. However, we have yet to see much that improves the daily lives of ordinary Americans. According to the Center for Public Integrity our employees also have “many less-publicized perks that come along with the job.” Some of which our employees have a lifetime to enjoy; even if they no longer are our employees!
See: www.publicintegrity.org/2011/11/23/7495/congressional-perks-lawmakers-mo...
11
Perhaps our president's question about why the Civil War was fought should be answered by suggesting that he read Lincoln's Gettysburg Address (it's short--he should be able to handle it). It ends with "of the people, by the people, for the people." Not just some people--THE people. That's us!
5
I think it's too long for him. He only likes single pages with bullet points. Perhaps someone could read it to him. They could also read the Bill of Rights to him while they are at it. In two sessions perhaps.
3
This issue received little attention during congressional debate because there was NO congressional debate of this bill....
10
perhaps the debate they are referring to was the negotiations between those on the far right and the extremist far right.
there were 20 Republican congresspeople who voted no or did not vote. so there is a sliver of hope for bipartisan action on the things that matter to the citizens of our country
there were 20 Republican congresspeople who voted no or did not vote. so there is a sliver of hope for bipartisan action on the things that matter to the citizens of our country
Why do I get the feeling that there is some backroom cabal who have concluded that single payer is the endgame in all of this, and factions are just trying to gain momentary advantage for various special interests along the way?
Now it's obvious that in their adversarial partisan positioning, even the GOP is boxing in the options to wean the economy of off private employer sponsored health insurance.
I can't stand how circuitous the money polluted political system has made this process. Nobody can have a freaking direct conversation in public any more, it's useless. Burn it to the ground.
Now it's obvious that in their adversarial partisan positioning, even the GOP is boxing in the options to wean the economy of off private employer sponsored health insurance.
I can't stand how circuitous the money polluted political system has made this process. Nobody can have a freaking direct conversation in public any more, it's useless. Burn it to the ground.
4
That would be nice but that cabal doesn't exist. The GOP are the real elitists. They really feel only the "good" and the "real Americans" matter. To them that is the people with money who vote for them. Everyone else? They don't count. They're hoping all the poor, disabled and frail elderly will die soon. Really, I am not kidding.
2
Democrats need only to hammer home one message to turn the 2018 elections to their favor. One message that help bring millions to vote who passively sat on the sidelines last time:
"Vote like your life depended on it - because it will"
"Vote like your life depended on it - because it will"
20
The Republican Congress, in its lack of infinite wisdom, passed a deeply flawed bill that not only doesn’t improve Obamacare but also manages to find even more ways to gut health care for millions of Americans. It was a spineless move meant to put the onus on the Senate while taking ‘credit’ for repealing the ACA. Now, while the GOP literally dances in the aisles, even those who thought they were ‘safe’ such as those with employer provided health benefits, will began to see the folly of the whole thing. As an American I am deeply ashamed of what passes for 'progress' in Congress.
18
I would like to see government refund all the taxes they collect and get out of individual lives. The best way to drain the swamp.
1
Move to a deserted island and you will get your wish (no government, no taxes). Never mind that with climate change, you will have to swim to your outbuildings in a few years.
4
There are a few countries in the Middle East or Africa where (income) taxes are pretty low or 0. Of course, there also is less protection for having body parts chopped off if you are in the wrong place or belong to the wrong group of people. But that's surely better than having to pay taxes!?
2
Start with Congress first!
5
It is long past time for universal health care, paid for by ALL citizens and businesses and corporations, to provide good health care to ALL Americans.
Enough with these ridiculously ineffective, mean-spirited, tugs of war between the rich and the not-rich, the old v young, the white v minority, the cities v rural towns, the employed and unemployed, the healthy and sick, the liberals v conservatives. We will ALL save money if we ALL pay to cover ALL of us and get rid and/or control the thousands of for-profit middle men in the health, insurance, and pharmaceutical industries who are bleeding us to death. It is time to stand up and tell this horror of a "government" that THE PEOPLE--THE PEOPLE WHO THEY SHOULD BE SERVING--want good and affordable health care, schools, universities, housing, transportation, and security. These are the things a government must provide to everyone, not just to the richest and most powerful among us. Trump and the Republicans have forgotten this, if they ever knew it. It is time to get rid of the lot of them and start over.
Enough with these ridiculously ineffective, mean-spirited, tugs of war between the rich and the not-rich, the old v young, the white v minority, the cities v rural towns, the employed and unemployed, the healthy and sick, the liberals v conservatives. We will ALL save money if we ALL pay to cover ALL of us and get rid and/or control the thousands of for-profit middle men in the health, insurance, and pharmaceutical industries who are bleeding us to death. It is time to stand up and tell this horror of a "government" that THE PEOPLE--THE PEOPLE WHO THEY SHOULD BE SERVING--want good and affordable health care, schools, universities, housing, transportation, and security. These are the things a government must provide to everyone, not just to the richest and most powerful among us. Trump and the Republicans have forgotten this, if they ever knew it. It is time to get rid of the lot of them and start over.
19
HR676. Can't find the flaw
If you were well informed as to the true components of the ACA you understood that the ACA helped to strengthen the employer based healthcare model and provided greater protection for those that receive insurance from their employers.
If you were a person who simply hated the ACA because President Obama was the force behind it, then you may not have known but you will, possibly know soon. Also if you or members of your family rely on Medicare or Medicaid in any form or fashion, you may soon realize that Trumpcare is just step one on block granting Medicaid and voucherizing Medicare. Maybe wen Grandma has no place to live and be cared for you will finally realize the harm you have done to yourself (and the rest of us).
If you were a person who simply hated the ACA because President Obama was the force behind it, then you may not have known but you will, possibly know soon. Also if you or members of your family rely on Medicare or Medicaid in any form or fashion, you may soon realize that Trumpcare is just step one on block granting Medicaid and voucherizing Medicare. Maybe wen Grandma has no place to live and be cared for you will finally realize the harm you have done to yourself (and the rest of us).
24
Once again, it's all about weakening the people.
17
How any person who is not a multi millionaire can vote Republican is beyond my logic.
35
From Obama Care to Trump Don't Care.
35
In the years before the Affordable Care Act, employers had no requirement to offer coverage and few rules about what benefits they should include.
The trend then, was that many employers stopped offering coverage, and those that did, offered skimpier coverage. Republicans want to return to a version of that on steroids.
As someone who has been an unsubsidized individual buyer for over 20 years, I've been constantly gouged (slightly less so under the ACA) and IGNORED
(we're only a small percentage of the individual market) who cares if we get screwed? No one. No Democrat or Republican. I have no sympathy for people who voted for Republicans and will lose their coverage or have it weakened by the AHCA:employer based or individual. Maybe people will finally wake up and demand a single payer system, or at least a plan that combines both single payer and private insurance. Other countries regulate how much health care providers are paid. Until we do that too, people will continue to be priced out of getting healthcare.
The trend then, was that many employers stopped offering coverage, and those that did, offered skimpier coverage. Republicans want to return to a version of that on steroids.
As someone who has been an unsubsidized individual buyer for over 20 years, I've been constantly gouged (slightly less so under the ACA) and IGNORED
(we're only a small percentage of the individual market) who cares if we get screwed? No one. No Democrat or Republican. I have no sympathy for people who voted for Republicans and will lose their coverage or have it weakened by the AHCA:employer based or individual. Maybe people will finally wake up and demand a single payer system, or at least a plan that combines both single payer and private insurance. Other countries regulate how much health care providers are paid. Until we do that too, people will continue to be priced out of getting healthcare.
30
It's not healthcare providers that are running up the price of healthcare. Look at the salaries and perks of the insurance CEO's and the $$$ that insurance companies make by denying care to citizens.
1
Trumpcare medical insurance is nothing but the Republican government controlled "REAL DEATH PANEL".
36
I think the best way to insure this new health care adjustment to the Affordable Healthcare Act or entire new bill is the best possible coverage for everyone, is to make it mandatory that every member of Congress (while serving in government)and their families to be covered under it, too.
8
Unfortunately only Congress can do that. Hypocrites that they are, that won't happen.
4
Although some conservatives are seeing the writing on the wall, it appears the GOP in all their ideological purity are paving the way for an all-government run single payer health care system for the USA. Their so-called plans will cause a partial collapse of what we have now, with rural hospitals and nursing homes going under, more medical bill bankruptcies and millions without coverage. There will be a political solution to what the GOP is inflicting on this country.
6
I think the best way to insure this new health care adjustment to the Affordable Healthcare Act or entire new bill, is to make it mandatory that every member of Congress (while serving in government)and their families to be covered under it, too.
5
If TrumpCare becomes law, one can envision the return to the pre-ACA era of junk insurance policies that offer super affordable premiums, little to no practical coverage and deductibles so high that few if any would be able to reach them before declaring bankruptcy. A return to the wild west of health care coverage for many Americans where only the wealthy and healthy survive is in the hands of a duplicitous Republican controlled Congress and the petulant little boy sitting behind the adult desk in the Oval Office.
12
Jeff in Chicago:
And in a cost death spiral, with providers fleeing the networks in droves, and the liberals unwilling to do anything meaningful about it -- how is the ACA actually any better for people who are actually responsible enough to pay for their own unsubsidized health insurance?
Remember, liberal unicorns aside, at the end of the day, SOMEBODY has to pay for health care.
It seems to me that BOTH sides of the aisle are grimly clinging to their talking points while the system fails. This will have serious impacts on families as the ACA unravels. Why is it that (via lack of action) the left is so unconcerned about this?
It's hypocritical, and I'm not fooled.
Meanwhile, we need to get to single payer ASAP, with the caveat that we need to actually define what the coverage should be, and of course HOW WE ARE GOING TO PAY FOR IT.
And in a cost death spiral, with providers fleeing the networks in droves, and the liberals unwilling to do anything meaningful about it -- how is the ACA actually any better for people who are actually responsible enough to pay for their own unsubsidized health insurance?
Remember, liberal unicorns aside, at the end of the day, SOMEBODY has to pay for health care.
It seems to me that BOTH sides of the aisle are grimly clinging to their talking points while the system fails. This will have serious impacts on families as the ACA unravels. Why is it that (via lack of action) the left is so unconcerned about this?
It's hypocritical, and I'm not fooled.
Meanwhile, we need to get to single payer ASAP, with the caveat that we need to actually define what the coverage should be, and of course HOW WE ARE GOING TO PAY FOR IT.
1
I have a good benefits at work. Years ago the conservatives I worked with were spreading right wing conspiracy rumors that we'd lose our medical coverage if Obamacare was passed. Those rumors were false of course. Those fellow employees went on to vote for Trump who will now try to weaken their benefits significantly.
9
Well, if you retire early soon and are forced to buy your own health insurance, THEN you'll get to see just how bad the ACA is.
Hint: narrow provider networks which are worsening, insurers leaving the ACA state pools in droves, and a rapidly escalating cost death spiral aren't signs of success for the ACA, (except for those who don't pay for their own coverage, of course).
Funny how the liberals ONLY seem to want to talk about those who don't pay their way when discussing the "success" of the ACA.
Hint: narrow provider networks which are worsening, insurers leaving the ACA state pools in droves, and a rapidly escalating cost death spiral aren't signs of success for the ACA, (except for those who don't pay for their own coverage, of course).
Funny how the liberals ONLY seem to want to talk about those who don't pay their way when discussing the "success" of the ACA.
1
"The possible effects on the employer health system got little attention during congressional debate." Oops, I must have missed that debate.
6
Welcome to the Republican Party, ordinary Americans. Republicans did their best to weaken and block the passage of a healthcare system while Obama was President; they told you that healthcare under Obama was failing (though millions more Americans gained health coverage); they told you they would fix healthcare if elected; they won office based on lies, distortions and empty promises; in office, they pass legislation to cut healthcare -- not just "Obamacare" but to also weaken the healthcare coverage that many Americans get through their employers, and also they propose to cut Medicaid coverage for children with disabilities.
Republicans promised to help ordinary Americans, but none of these Republican actions actually does so. These Republican actions harm ordinary Americans.
Who do Republicans care about? How about...
*Companies that don't want to pay for good coverage for their employees.
*Very rich people that can afford to pay for their own health coverage and specialty healthcare, and who don't want to pay their fair share of taxes to contribute to systems that help ordinary Americans.
*People who hold a "no government" ideology.
*Those who value a "traditional values" ideology (construed broadly) more than they value the day-to-day interests of ordinary Americans.
So why would an ordinary American vote for Republicans? Maybe they fall into the last two bullet points above. See also "lies, distortions and empty promises" above.
Republicans promised to help ordinary Americans, but none of these Republican actions actually does so. These Republican actions harm ordinary Americans.
Who do Republicans care about? How about...
*Companies that don't want to pay for good coverage for their employees.
*Very rich people that can afford to pay for their own health coverage and specialty healthcare, and who don't want to pay their fair share of taxes to contribute to systems that help ordinary Americans.
*People who hold a "no government" ideology.
*Those who value a "traditional values" ideology (construed broadly) more than they value the day-to-day interests of ordinary Americans.
So why would an ordinary American vote for Republicans? Maybe they fall into the last two bullet points above. See also "lies, distortions and empty promises" above.
5
Hey Has anyone looked to see what kind of Health Insurance plan is offered to the employees of the Trump Companies?
23
Well I think we are all relieved that with the new Republican plan healthcare companies are receiving a $400 million dollar tax cut on their CEO pay. Their pain was keeping me awake at night! I mean, if you're paying your guy $17 million a year, (Aetna) you deserve a break!
20
And I'm quite sure that the first group who will suddenly begin paying, oh say 50%, will be federal employees enrolled thru the Federal Employees Health Benefit plans. Just as federal employees who began work at the end of 2015 found they were paying in 5 times the amount for their pension coverage as had previous federal employees, just as whenever a Republican 'administration' wishes to punish employees it's always the civil servants who get it first.
7
This is no surprise. The effect on the individual will be horrible. So it will be with acute care facilities. Significantly worse health care coverage will lead to rising costs as Emergency Rooms/hospital clinics provide care for those with no coverage either as a substitute for primary care or catastrophic care made so because of delay. It is the most expensive, lowest quality, and least efficient care. Those w/o coverage will not be able to pay, and hospitals will face rising "uncompensated" care. Struggling intercity hospitals will need federal bail outs. The cost increase curve which Obama care bent toward zero wil now continue to rise as a % of GDP. Ugly truth is that neither physicians nor politicians take any responsibility for the problem.
10
Millions of lives destroyed or ended for high end tax cut. Will voters ever wise up?
19
Part of me wants to ask 62,000,000 folks, "How does it feel" to vote for someone who knows nothing about the job? The other part-of-me wants to respond: "Next time you need a Dentist- call your Mechanic." Perhaps that could be an attack ad against House Republicans too.
31
It's all gonna work out, though -- women who will no longer be able to find an OB-GYN will be directed to call a dentist.
2
As if things weren't bad enough....
6
Why has it taken so long for this issue to be discussed? Every media outlet has relentlessly focused on Medicaid- ignoring the real elephant. Anyone with employer-provided health insurance should be terrified, come October's Open Enrollment period if the Senate doesn't work some type of magic on the House Death-Care policy.
Anyone working for the same employer over 15 years, has seen their traditional 3-Choice-Cafeteria-Plan (Great-Good-Alright) Morph into the *Okay-Mediocre-Abysmal* If nothing changes with the Republican Death Plan, employers will have no incentive to offer anything above what is mandated by the market and will reduce company contributions even further than they already have.
It is time those who falsely believe (or hope) they will be saved by their Company Insurance; wake up. Republicans will be coming after you too.
Anyone working for the same employer over 15 years, has seen their traditional 3-Choice-Cafeteria-Plan (Great-Good-Alright) Morph into the *Okay-Mediocre-Abysmal* If nothing changes with the Republican Death Plan, employers will have no incentive to offer anything above what is mandated by the market and will reduce company contributions even further than they already have.
It is time those who falsely believe (or hope) they will be saved by their Company Insurance; wake up. Republicans will be coming after you too.
23
As a small business owner during the past 25 years we have always had health insurance for our employees, I'm more concerned with health insurance companies jacking up premiums & enacting new restrictions regarding pre-existing conditions in the new policies offered to small businesses if the AHCA is enacted.
15
I am sick of ACA being referred to by career politicians as an "entitlement plan."
It's not like McConnell, Ryan, and Trump are somehow paying for it.
Taxpayers are. (Just like we pay $3 mill. every time DT goes to Florida)
And taxpayers have made it VERY clear- that the richest nation on earth should poudl provide comprehensive, affordable care to its citizens.
Rs should be looking how to make to make ACA better, not how to kill it.
Wake up America.
You pay THEM. you pay for THEIR health care.
And they are playing stupid games with YOUR money.
It's not like McConnell, Ryan, and Trump are somehow paying for it.
Taxpayers are. (Just like we pay $3 mill. every time DT goes to Florida)
And taxpayers have made it VERY clear- that the richest nation on earth should poudl provide comprehensive, affordable care to its citizens.
Rs should be looking how to make to make ACA better, not how to kill it.
Wake up America.
You pay THEM. you pay for THEIR health care.
And they are playing stupid games with YOUR money.
38
Although private employers get some tax benefit from the cost of providing health coverage for employees, they offer it as both an incentive for attracting employees, or as an investment in employee stability to avoid them quitting due to illness or injury...or both. The employment/health care connection makes no sense otherwise, but contributes to the complicated have and have not world of health care. I did not believe ACA was the solution to a bad situation, failing to address costs, failing to have pools of insured large enough to cost healthy people unfairly or cover sick people sufficiently, when we needed a single, universal system. Medicare appears cost-effective only because doctors and hospitals use it as a loss-leader and offset the fee limits with what they charge the insured and non-insured patients. If we had a single-payer, universal basic coverage, and allowed Part B,C,D for anyone or any employer to add to that, and negotiated pricing and provided true cost of care so everyone can know what things cost, I would be happy to see ACA go. That is not what is in AHCA, and rather than fix what was wrong with ACA, we are now going backwards to health care rationing and law of the jungle. If you don't think employers will use changes to cut their cost of health care, you are a fool.
18
When the press was breathlessly spending segment after segment repeating the drama after drama of how the poor old and sick were going to be hurt, you would have thought that this little bit of news that could hurt those of us in the middle, would have been at least shared in one ,maybe even two, of the segments that repeated the same things over and over and over... As is usual, those of us in the middle don't count to the press, the government, television news... Only the extremes get reported so that you keep eyes glued to the drama and make your money. I am getting tired of you all.
5
Good. A plan that hurts only the more vulnerable, less powerful in our society while protecting those with good jobs would be even less moral than the current one. This package of changes to Obamacare cannot be allowed to pass the senate. Impact on the fully employed means more of us have skin in the game.
8
Why are the Republican's having a secret Healthcare debate, not including Democrats and not being open about it with various Medical experts and groups?
How about doing it right rather then just doing it.
How about doing it right rather then just doing it.
8
If you're a worker over age 50, this should send chills up your spine. If your employer gets hit with a bigger bill for your insurance, why would they keep you? Americans are waking up. . . be careful how hard you push Republicans and greedy insurance companies!
29
They don't really want to keep us and our high salaries any way. And forget entrepreneurship, how will you get affordable insurance at age 50-64 to be self employed? 50 is not "elderly"!
4
A consequence of thereplacement for Obamacare will be many employers not providing insurance. In addition to the obvious savings of not paying for employee insurance, there will be another competitive reason to drop health insurance coverage after both employer and individual mandates are gone. Consider two fast food firms trying to hire minimum wage workers. One employer offers the minimum wage plus some (probably meager) health insurance, that requires some partial payments from the employee. The other employer offers the minimum wage and can tell the prospective employee that since there is no health insurance the employee will not have any premium taken from their pay and that will significantly increase their take-home pay. In this way the employer not providing health insurance actually has an easier time attracting low wage workers.
The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded. Sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently in every developed country all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA being the only exception.."
http://seekingalpha.com/article/1647632
The reason that no nation, including the wealthiest can allow markets to set the prices of medical care indefinitely is that demand for medical care is inelastic. Demand for a good or service is inelastic if a percentage increase in price results in a smaller percentage decrease in the quantity demanded. Sellers facing inelastic demand will continuously raise prices until prices reach the elastic portion of the demand curve. Consequently in every developed country all goods or services with inelastic demand have their prices regulated by government. Medical care in the USA being the only exception.."
http://seekingalpha.com/article/1647632
12
This is actually a good thing. Employers should not be in the insurance business. Let them pay their workers competitively and then everyone can buy their own policies on an exchange. We would probably see better options for everyone and we would increase the mobility of our labor force. If everyone was in the same pool the system would undoubtedly be improved.
1
Your comment really doesn't make sense, as employers aren't "in the insurance business" by helping their employees get insurance coverage. Nor do you provide any basis for the belief that workers would see better options. Your position is a bit like arguing that people will be better off because the insurance market will function like the market for cell phone, internet, and cable service, and everyone is happy with that, right?
5
You obviously have never been an employer. I like healthy employees and I work very hard to make sure they receive excellent benefits. Not only is it the moral thing to do, it increases my ability to compete with larger employers.The Republican's proposed changes are disastrous and do absolutely nothing to move this country to a single payor system. So please do not try to pretend that there is anything good about this proposed law. There isn't.
19
Yes, employers shouldn't be in the health care business. Instead we should have single-payer, Medicare for all.
18
We the people are the employers of the congress.
Under this new law we could stop paying their health insurance.
Under this new law we could stop paying their health insurance.
23
The GOP extolls the free market, and yet they do nothing to bring the fair market to bear. Price transparency, comprehensible billing, measures to facilitate "shopping around", price discrimination, and other inefficiencies are left in place. The "free market" is the GOP's euphemism for allowing businesses to do as they please without regard for the greater good.
20
People who break the law and go to prison have their health care taken care of, dental and eyes too. We should be able to provide citizens who obey the law with better coverage, not less. Keep Obamacare and let people have the option of buying into Medicare at an earlier age.
35
The AHCA has "the potential to weaken rules against capping worker’s benefits or limiting how much employees can be asked to pay in deductibles or co-payments." This will be yet another sad outcome to the GOP's heartless efforts but it doesn't worry me personally because I belong to a union and my health benefits are a negotiated issue. Yet another ironic outcome for those most supportive of Trump is that even those who already have health benefits in "right to work" states may have their benefits severely curtailed or eliminated. Is this what they thought making America great again would look like ?
17
Anyone else find it offensive that all of our politicians on the federal, state and city levels receive completely free health care on our dime? What hubris for our politicians to believe that we should pay for their health care while we are left scraping by in this utter disaster of shock and awe capitalism they call a health system.
That Americans aren't in the streets demanding free health care for all is a true testament to how much we've been brainwashed into thinking we don't deserve this fundamental right provided by every other developed nation (but somehow a right only afforded to our politicians?). Instead, we sit around parsing the details of these ridiculous attempts to provide substandard care at usurious prices to our people while our leaders take our tax money and help themselves to free health care. Where else in the developed world would people stand for this?
That Americans aren't in the streets demanding free health care for all is a true testament to how much we've been brainwashed into thinking we don't deserve this fundamental right provided by every other developed nation (but somehow a right only afforded to our politicians?). Instead, we sit around parsing the details of these ridiculous attempts to provide substandard care at usurious prices to our people while our leaders take our tax money and help themselves to free health care. Where else in the developed world would people stand for this?
100
In the USA we have attempted to deal with the combination of inelastic demand and unregulated medical care prices in various ways. One method of keeping medical care expense as a percent of GDP to "only" double that of other developed countries was to have a significant portion of the population uninsured and denied medical care in some circumstances. The existence of large numbers of uninsured (conscripts in the war against rising medical costs) did moderate the growth in health care costs.
As long as medical prices are set by market forces, the inelasticity of demand will force market prices inexorably higher. In a "mixed system" with both free-market and controlled health care prices like the USA, prices inexorably are driven upwards to the market level as long as demand is inelastic. Prices such as payments from Medicare that are "controlled" have to be increased continuously with legislation such as the "doctor-fix" to stay competitive with market prices. Medical prices can only be effectively controlled either by direct price controls as in Japan or with systems where everyone gets care for "free" from the government. In those countries only the wealthy can chose not to use the government paid health services that they have already paid for with their taxes and patronize the small market-priced sector. In those countries, forgoing the government priced system is not an option for almost all doctors, as it is in the USA..."
http://seekingalpha.com/article/1647632
As long as medical prices are set by market forces, the inelasticity of demand will force market prices inexorably higher. In a "mixed system" with both free-market and controlled health care prices like the USA, prices inexorably are driven upwards to the market level as long as demand is inelastic. Prices such as payments from Medicare that are "controlled" have to be increased continuously with legislation such as the "doctor-fix" to stay competitive with market prices. Medical prices can only be effectively controlled either by direct price controls as in Japan or with systems where everyone gets care for "free" from the government. In those countries only the wealthy can chose not to use the government paid health services that they have already paid for with their taxes and patronize the small market-priced sector. In those countries, forgoing the government priced system is not an option for almost all doctors, as it is in the USA..."
http://seekingalpha.com/article/1647632
2
Totally agree. And can you even understand how 13 white old entitled men are on this committee??? No one representing any other class? Make America old white men again?
10
Don't forget the loyal right-wing contingent in the military. 20 years of employment = a lifetime of health care coverage.
Good. The indifferent who think they only come for OTHERS will learn a bitter lesson.
Bravo!
Bravo!
12
Tying health insurance to employment enslaves us all.
How many people would quit their jobs if it weren't attached to insurance?
This hurts innovation and risking new business ideas.
In other words, keeps us down.
How many people would quit their jobs if it weren't attached to insurance?
This hurts innovation and risking new business ideas.
In other words, keeps us down.
30
I had a health event when I was young, and could never leave the public sector because the precondition would have kept me uninsured.
15
I'm actually calling it quits after ten years of running my own consulting business. I'm the only employee and so can't qualify for group coverage. All insurers in MN have cancelled individual market plans that provide a nationwide network, meaning my cancer-survivor spouse can no longer go to her medical team at MD Anderson in Texas for follow up care (unless we sell our house to pay for the out of network coverage).
I need to go work for someone else and hope they offer a decent plan.
I need to go work for someone else and hope they offer a decent plan.
15
". . The possible effects on the employer health system got little attention during congressional debate."
What debate? The House passed this ASAP so that the CBO couldn't get a word in before the vote. And, the President hasn't a clue as to what's in the bill.
What debate? The House passed this ASAP so that the CBO couldn't get a word in before the vote. And, the President hasn't a clue as to what's in the bill.
29
I'm not sleeping nights because of this president and his family of thieves
13
Neither am I. I worry about my future, as I approach retirement. I have worked hard to pay off my bills, my home, and save for retirement - and it all may be for nothing, if I have no access to affordable healthcare. Trump is a con man - always was - always will be. We need to follow his $$$ to Russia and impeach him. This man and his family are robbing us blind and his "policies" will bankrupt all of us while he and his ilk walk away with smirks on their faces and $$$$ in the pockets.
5
The ACA required that employers provide both break time and a place (NOT a bathroom) for mothers to express breast milk, and it made free breast pumps available. The AHCA (or any Republican-sponsored effort) will likely affect employed mothers who are breastfeeding their babies. Will the old men on the Hill advocate for new moms in the workplace? I'm not holding my breath.
13
This may come as a shock to the ultra left, but very few employers are financially able to provide appropriate facilities for mothers to breastfeed their children, nor can the have cradles and playpens in the office. Sorry if that sounds harsh...
Very few employers have offices and break rooms? Appropriate facilities for expressing breast milk requires a quiet private space and a corner of a refrigerator. Also employers can not allow employees a 15 min break after 2 hours of working, nor can they provide a half hour for lunch?
2
Break rooms have gone the way of the five o'clock whistle as have breaks. Most people eat lunch at their desks. The tech companies appear to provide good benefits but they are actually designed to keep employees on campus.
Why are people not more angry?! The GOP has completely lied to the American public about why they want to repeal the ACA. They want tax breaks for themselves and for the people that finance their campaigns, that's it. This bill has nothing to do with improving healthcare, it's just a cynical attack on the legacy of Obama and it comes at the expense of our and our loved ones health.
58
More than a cynical attack! It's craftily constructed to give tax breaks to the wealthy, while denying benefits to the elderly, the poor, women, those who work multiple part-time jobs, and anyone with a "pre-existing condition". And they had the gaul to make it a Rose Garden celebratory photo-op.
10
Why do the Republicans want to gut the Affordable Care Act? Is it indifference to the suffering of the sick and injured, cluelessness about how insurance works, the touching but unjustified faith that the unregulated marketplace always works to help ordinary people, or the desire to give yet another tax break to the wealthy?
Or maybe Republicans have a way to cover everyone with affordable and also medically effective insurance? If so, I wish they'd let the country in on it.
Or maybe Republicans have a way to cover everyone with affordable and also medically effective insurance? If so, I wish they'd let the country in on it.
7
What is the benefit of being a citizen of this country? My family has been here since before the Revolution and now I can't say that we have advanced all that much since 1723 when they came here from Wales. If they had stayed back home, they'd have a national health care program--same for my Dutch, German, Scottish and Italian ancestors. So besides making fancy bombs, what do my tax dollars get me? Not the best infrastructure, not money poured into alternative energy sources--see what the Germans accomplished on that front and I am earning half of what I made in 1994 and I am now in my 50s.
So I am beginning to think it may be time to call it a day. Australia maybe? At least they got rid of guns.
So I am beginning to think it may be time to call it a day. Australia maybe? At least they got rid of guns.
67
You get the benefit of being free. Free to sacrifice your health and life for corporate profits and further enrichment of the rich. Why have all of the modern democracies rejected this except for the greatest democracy of all, the U.S.?
19
My family came to the US for a better life and that's a good reason to leave as well.
"Whether those changes happen depends on how the Trump administration, states and employers act."
And whether the Senate passes a bill similar to the House's and then President Trump signs it.
As much as I hate the House bill I think it gives Ryan, et al. far too much credit to keep making it seem as though their bill is already the law of the land.
And whether the Senate passes a bill similar to the House's and then President Trump signs it.
As much as I hate the House bill I think it gives Ryan, et al. far too much credit to keep making it seem as though their bill is already the law of the land.
6
Certainly Trump's victory party and photo op at the White House created the optics Republicans wanted: the AHCA is a done deal, even though (oops!) it's not.
3
"The employer health benefit system existed long before the Affordable Care Act..."
Maybe the best thing is to get rid of mandated employer-provided health care.
Maybe the best thing is to get rid of mandated employer-provided health care.
3
Employers provide insurance voluntarily. There was never a mandate prior to the ACA.
8
From Wikipedia: https://en.wikipedia.org/wiki/Health_insurance_in_the_United_States
Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II.[19] The labor market was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers.[19]
And now, because of short sightedness and a refusal to look at what socialized medicine has achieved, Americans are paying more than any other country for the least amount of health care.
Employer-sponsored health insurance plans dramatically expanded as a direct result of wage controls imposed by the federal government during World War II.[19] The labor market was tight because of the increased demand for goods and decreased supply of workers during the war. Federally imposed wage and price controls prohibited manufacturers and other employers from raising wages enough to attract workers. When the War Labor Board declared that fringe benefits, such as sick leave and health insurance, did not count as wages for the purpose of wage controls, employers responded with significantly increased offers of fringe benefits, especially health care coverage, to attract workers.[19]
And now, because of short sightedness and a refusal to look at what socialized medicine has achieved, Americans are paying more than any other country for the least amount of health care.
3
Insurance cost is largely based on the size of the pool. If you're an employee of a large company the size pool is large and healthy people balance out the less healthy. If you're an employee of a small company, not such much. If you're a pool of one i.e. the individual market you're on you own. Artificially constraining the pool by state or county, which is how individual tends to work, doesn't help. What we need is one pool for everyone in the country. Employers could still contribute to their employees' insurance if they wished. This would also help reduce the cost because insurance companies would be forced to compete with each other. Not quite single payer but it's a step in the right direction and the best we're likely to get until the Democrats have complete control, with a filibuster-proof majority in the Senate.
12
You avoided the most nefarious aspect of this bill -- and one in which all insured people will be affected. The new bill will end the requirement for all insurance coverage to provide preventive care at no cost to the insured.
Every single one of us is benefiting from that now. Do you think they will continue to do that after they are no longer required to?
I don't think so.
Every single one of us is benefiting from that now. Do you think they will continue to do that after they are no longer required to?
I don't think so.
73
Perhaps if members of congress had to enroll in Trumpcare they'd propose a better solution. Take away their Tricare for life and see what happens. Exactly how much are we spending on their health care?
33
Members of Congress do not have Tricare for life. They have Obamacare plus, which allows subsidies at higher levels than other Obamacare enrollees.
5
Contrary to popular belief, Congressional members do not receive free health care. As it does for other federal employees who purchase their insurance through the Federal Employees Health Benefits Program, the federal government provides a subsidy equivalent to 72 percent of the weighted average of all FEHBP premiums. So members of congress and their staff pay approximately 28 percent of their annual healthcare premiums through pre-tax payroll deductions. And I believe they are eligible for the subsidies only if they purchase "gold tier" plans through the ACA exchanges...
Mea culpa, thank you DC and Marcus for enlightening me. Now I'm only slightly annoyed rather than thoroughly annoyed. I'll fact check my "facts" in the future!
Marcus, you must know my younger sister Faustina?
Marcus, you must know my younger sister Faustina?
I suggest everyone print the text of this article and read it at the next Republican town hall and solicit a response with audience reaction.
15
Single payer will address coverage for all and rein in health care costs driven up by insurance company administration and redundant drug R&D. Read Warren Buffet's article in yesterday's NYT.
10
"Single payer will address coverage for all and rein in health care costs..."
Of course it will...just look at Medicare...
Of course it will...just look at Medicare...
3
Medicare does not allow negotiation for drug prices, which is a major flaw that true single payer would correct (saving billions annually in the process).
4
Republicans always want to do the most harm to the poor and needy. As a result next on the republican pecking order are working class folks. Followed by working class families and lastly the middle class. The only winners of the AHCA are going to be the wealthiest and corporations who typically care about profits. Republicans are not patriotic and definitely lack empathy for anyone who's not one of their own. I dare anyone to prove how the AHCA will make America great again when half the population will not be able to maintain their health because thy can't afford health insurance.
16
if you lead an unhealty life style health insurance will do little to improve it. So stating "not able to maintain their health" is misleading. But like all democrats that what they love doing.
1
Jason's comments are incoherent at best, and clearly disingenuous. Lack of access to health care DOES effect people's ability to maintain good health regardless of their 'lifestyle.' Jason seems to believe that those misfortunate enough to have medical issues are invariably responsible for those issues, a callous and ignorant perspective.
The issue is that INSURANCE IS THE WRONG MODEL TO USE for providing health care in this country.
Jason better hope that, should Trumpcare pass, he is never in the situation of having him or his loved ones struck with a chronic illness. We are all just one diagnosis away from financial disaster. If annual and lifetime limits come back even more of us will suffer, and tens of thousands will die so that the top tenth of one percent can have their tax breaks.
SAD ;)
The issue is that INSURANCE IS THE WRONG MODEL TO USE for providing health care in this country.
Jason better hope that, should Trumpcare pass, he is never in the situation of having him or his loved ones struck with a chronic illness. We are all just one diagnosis away from financial disaster. If annual and lifetime limits come back even more of us will suffer, and tens of thousands will die so that the top tenth of one percent can have their tax breaks.
SAD ;)
5
As a REAL scientist I can tell you that we have only limited control of our health regardless of our politics (which you clearly display). Genetics and environment play a big factor. You can inherit genes that make you prone to a particular disease (e.g., breast cancer), or just be born with it (e.g., juvenile diabetes, heart defects). You can also be exposed to environmental toxins (e.g., lead in the water), which is now more likely since the administration is lowering all kinds of standards. Access to regular and routine medical care can provide early detection and treatment so those afflicted are "able to maintain their health".
Don't fool yourself Jason, no matter how well you take care of yourself bad things can still happen to you and those you care for, while some folks who live like there is no tomorrow live to 100!
Don't fool yourself Jason, no matter how well you take care of yourself bad things can still happen to you and those you care for, while some folks who live like there is no tomorrow live to 100!
19
Ending employer provided healthcare programs might be the best thing that could happen at this point. If half of all Americans get health coverage through work imagine how those voices might be shaping this discussion, for the better, if the playing field were level.
7
When one adds up all the what if’s of the ACA, AHCA, Medicaid, and now Employers health coverage, all I can see is a disastrous health care calamity about to unfold. The AHCA will get major revisions by the Senate and will take weeks if not months to get it passed, then back to the House where it will not likely pass. In the meantime the Government is not making any attempt to make even minimal repairs to the ACA to keep premiums down and insurance companies from bailing out altogether. Employer plans will continue to weaken as they observe the inaction of Congress. And Medicaid Expansion is in limbo waiting for something to happen, which when it does, most likely it will be bad news for the needy.
The only health insurance program that is safe (for the time being) is Medicare. And Republicans know that old people vote. All of them! Odd too, Medicare is the closest we have to a “single payer: insurance program and functions quite well. I know I’ve be on it for nine years.
The only health insurance program that is safe (for the time being) is Medicare. And Republicans know that old people vote. All of them! Odd too, Medicare is the closest we have to a “single payer: insurance program and functions quite well. I know I’ve be on it for nine years.
18
"Medicare is the closest we have to a “single payer: insurance program and functions quite well."
Agreed.
Agreed.
4
Under the ACA, buying in the individual market is regarded, fairly or unfairly, as the least desirable way of obtaining coverage.
1
Enabling further age discrimination in the workplace is what this is all about. Companies that are pressured by their insurers to not hire or get rid of older workers. in order to lower premiums, will do it.
27
Exactly. You said it.
5
Health benefits are a part of the employee's compensation, albeit a tax-free one largely hidden to the employees' direct view. Let us say two employees perform the same job with the same take-home salary. One is older and the other is younger. Since the older employee's health benefits cost more than a younger employer's benefits, their total compensation is actually higher than the younger employee. This is indeed ageist. The younger employee is not paid as much as the older employee by virtue of his/her younger age. Is this fair? Shouldn't their total compensation be equal to prevent age-based discrimination? That could possibly entail giving the younger a greater take-home amount.
The same situation exists for a single employee compared to an employee with dependents. Why should the employee with a spouse and children get a more expensive benefits package? Should the employees get the same compensation? Equal pay for equal work and all that?
The hidden nature of employer-provided health benefits results in compensation inequities.
The same situation exists for a single employee compared to an employee with dependents. Why should the employee with a spouse and children get a more expensive benefits package? Should the employees get the same compensation? Equal pay for equal work and all that?
The hidden nature of employer-provided health benefits results in compensation inequities.
The easy way for Republicans to avoid election blowback in 2018 is to keep Obamacare benefits until the end of 2018 -- after they've kept control of Congress. Then, a big "surprise" as benefits fall and consumer costs rise in 2019.
7
Won't work. Republicans own it all now.
1
An interesting way to analyse the impact of a policy of eliminating virtually all limits on companies' ability to cease offering medical insurance coverage or to decrease benefits and raise effective premia massively: simply assume away the problem. Consult spokesmen for employee associations:" don't worrry companies wouldn't do that". Refer to previous experience: "they didn't cancel coverage before so they won't now" (ignoring the fact that they HAVE been gradually quitting covering employees). Absolutely no analysis of what could be done if they DO exit.
9
Exactly. If the assumption is that employers won't take those steps, and the policy is based on hoping they don't, then why not just keep the regulation that doesn't allow them to do so? Just think what happens when we "hope" they don't limit coverage, then the company has a bad year for stockholders and an activist investor comes in and insists that they cut insurance coverage costs. The board will have to do so because it's allowed. I love how republicans don't want rules to guide good corporate behavior because they say they are not needed, but then are angry if the regulation exists!
5
Both employers and employees would contribute far less than they do now if a Medicare type plan for people under 65 was implemented. These people and employers would contribute more to Medicare for employees who, by definition, have an income (and typically far greater than retirees). Overhead would be less. Private insurers would still make money managing Medicare Advantage and Supplemental Plans. Risk would be shared over 300 million people rather than across the covered lives of one company or one insurer. Makes great economic sense. But the question is whether or not the political cowards will see the light.
29
Employer-provided insurance is no panacea, even if the AHCA doesn't pass or employers leave things as they are. As a public employee I currently pay about $6000 a year in premiums for myself and my wife. We have a $2500 deductible and 10% copayments up to $1000. And due to the fact that virtually every specialist we're sent to see is not an employee of our HMO, they are not bound by the reimbursement limits the HMO imposes and come after us for any portion of their bill not paid by our insurance. And none of those costs count toward our deductible or copayments. So even with what we hear people call "Cadillac health insurance" our total expenditures easily run $10,000 to $15,000 a year. And neither of us has any serious health issues. We have friends in Canada and Germany and they are completely astounded Americans have not taken to the streets by now to demand a better system.
29
Miniver Cheevy, born too late,
Scratched his head and kept on thinking;
Miniver coughed, and called it fate,
And kept on drinking.
And he kept on drinking because that was all he could do to ease the pain. What is the point of improving health care, improving drugs, doing medical research and making discoveries if whatever results from it will beyond the reach of those who need it unless they are very rich? Unless that is exactly the point the GOP is driving us to with the full cooperation of Trump, and the entire health care industry in America. Only the very rich will be able to receive care for their ailments. The rest of us will return to patent medicine, snake oil, and prayer. One thing the 1% better be aware of is this: certain illnesses like Ebola, measles, etc., do not care what socioeconomic class you are from. Rub shoulders or walk into the breath of someone with certain illnesses and you will probably contract them and possibly die. Therefore, no matter what the GOP and their corporate masters claim to the contrary, it is in everyone's best interests to have a good public health system and that includes access to health care when and where it's needed, not at the whim of an insurance company, state, or politician.
Scratched his head and kept on thinking;
Miniver coughed, and called it fate,
And kept on drinking.
And he kept on drinking because that was all he could do to ease the pain. What is the point of improving health care, improving drugs, doing medical research and making discoveries if whatever results from it will beyond the reach of those who need it unless they are very rich? Unless that is exactly the point the GOP is driving us to with the full cooperation of Trump, and the entire health care industry in America. Only the very rich will be able to receive care for their ailments. The rest of us will return to patent medicine, snake oil, and prayer. One thing the 1% better be aware of is this: certain illnesses like Ebola, measles, etc., do not care what socioeconomic class you are from. Rub shoulders or walk into the breath of someone with certain illnesses and you will probably contract them and possibly die. Therefore, no matter what the GOP and their corporate masters claim to the contrary, it is in everyone's best interests to have a good public health system and that includes access to health care when and where it's needed, not at the whim of an insurance company, state, or politician.
8
Can someone finally shout the truth, This bill isn't about healthcare at all; it's about granting a $1 trillion tax cut to the rich.
124
The Repubs seem commited to not only gut the system set up for independant working folks and the poor,but to undermine the system set up for those working for private companies.In what dystopian upside down world do the members of the Failure and Ignorance Party reside that they view this as an improvement.It is way past time to cut benefits and wages for these idealogical idiots and make them live under the failures they prescibe for the rest of the country.
6
Please call this what it is: Trumpcare. This is not an American health care plan. After 8 yrs of people disparaging "Obamacare", then it is only fair that this mess should be called Trumpcare. His name should be glued and stapled to this anti American act also known as the make the rich richer act.
26
Although I agree with your sentiments, I do not agree with the name. I see no reason to think that Trump actually cares about anything other than his own pocketbook. Plus, the die hard Trump supporters out there might see the name as a positive. Call it the latest Republican health care plan.
4
With all due respect to the Willis Towers Watson survey, the response to a non-dependent question on lifetime maximums or any other plan design feature is meaningless and they and Ms. Sanger-Katz should know better. When faced with rising costs consultants offer a menu of cost savings options which would include, among other things, imposing a lifetime limit. (Why do you think these limits were so popular prior to ACA?) Only time will tell if benefits that are not mandated will find themselves on the cutting block when faced with bottom line realities. The same fate for the end of coverage for pre-existing conditions may well be in the cards. Come on Willis TW, you should be more professional in your surveys and conclusions. Embarrassing.
4
Federal policy is now designed to promote fraud on everyone not in the 0.1%. This is what you get when the President is a real estate grifter, Congress is filled with Ayn Rand acolytes, and both are allied with Russia which is free to hack our democracy and bribe politicians through shell corporations. Our new world post-Citizens United.
Resist.
Resist.
25
who is this 0.1% percent the left shouts so much about?
Did you know bernie IS the 0.1%? That is fact.
Did you know bernie IS the 0.1%? That is fact.
3
According to CNN Money, the two states in which the level on income inequality between the top 1% and other 99% is the greatest are New York and Connecticut... Are those considered GOP strongholds?
Jason, we all have Google, and we all know that Bernie and most of the rest of the Senate are in the 1%, which is roughly $389,000 and above. "The left" keeps talking about this because the numbers of those in this income category have risen, as have those below the poverty line, while the percentage within the middle class have been steadily declining. As Bernie says, this is a rigged system, in which tax laws and other subsidies help these people more than those below that line. That Bernie's income places him in this group has not meant he has supported the system. Like others (Warren Buffett, Bill Gates) he decries the system which makes his tax burden proportionately small. That is fact.
http://www.epi.org/publication/income-inequality-in-the-us/#epi-toc-3
http://www.epi.org/publication/income-inequality-in-the-us/#epi-toc-3
What the do they want?
No health insurance, except for the rich? Is that the eventual goal?
No health insurance, except for the rich? Is that the eventual goal?
10
The logic becomes clearer when you remember that the actual purpose is to free up enough tax receipts to give the ultra-rich a big, fat tax cut.
20
This entire bill is a slapdash, miserly, piece of vindictiveness with no purpose other than to dismantle any accomplishments of Barack Obama.
30
Have you read the bill in its entirety?
Informative article in so many ways to the point that I think it's exceptional.
Last week's House bill was insidious for multiple reasons (very much including a # of the details & conclusions covered in this piece); the GOP's and Administration's response to that was to try and change the subject from what dominated initial publicity - pre-existing conditions - except they had to parse words and flat-out lie to have any shot at success (even temporal); however, I don't want ANYONE to lose sight of what's at stake here and that's to recognize that the ENTIRE bill is insidious - people change jobs and discover that their employer's insurance plan is across the board inferior to what they previously had (and the issue of employers being forced to increase employee contributions to premiums that were going up annually pre-dates ACA by at least 8-10 years). Stuff like that.
It's should already be obvious that Jimmy Kimmel's comments struck a monumental chord with people - here's a guy who makes $millions per year and he is more than capable of paying the costs of making his baby healthy, so he uses his position and influence to get to the heart of the matter. God Bless him.
Last week's House bill was insidious for multiple reasons (very much including a # of the details & conclusions covered in this piece); the GOP's and Administration's response to that was to try and change the subject from what dominated initial publicity - pre-existing conditions - except they had to parse words and flat-out lie to have any shot at success (even temporal); however, I don't want ANYONE to lose sight of what's at stake here and that's to recognize that the ENTIRE bill is insidious - people change jobs and discover that their employer's insurance plan is across the board inferior to what they previously had (and the issue of employers being forced to increase employee contributions to premiums that were going up annually pre-dates ACA by at least 8-10 years). Stuff like that.
It's should already be obvious that Jimmy Kimmel's comments struck a monumental chord with people - here's a guy who makes $millions per year and he is more than capable of paying the costs of making his baby healthy, so he uses his position and influence to get to the heart of the matter. God Bless him.
20
I love this sentence in the article: "The possible effects on the employer health system got little attention during congressional debate." And why do you think that was? Because media like the NYT gave NO COVERAGE to this issue. There were Congressmen talking about it -- including on MSNBC -- but nobody in the media picked up on it. Nor did the media make it clear that the problems with the previous version of AHCA were all contained in the new version, and then some. Instead, the media solely focused on the pre-existing conditions issue, which played into the GOP narrative that coverage for pre-existing conditions was guaranteed (never mind that the coverage might be unaffordable for most). Really, really sloppy journalism on this issue. I expect more from the NYT.
7
Medicare for ALL : 2018. Keep it simple, keep it strong. Please proceed, GOP. Your pandering to your masters will be your downfall. Finally.
15
Any calculation of policy trade offs excusing how few people would be affected by loss of this or that coverage in any given year or lifetime is simply restating the actuarial fact that relatively few people need a major payout from health insurance in any given year or lifetime. Beware that in such trade off discussions, what is being considered is offering people affordable health insurance only so long as they don't actually need it. Yes, that's fine revenue stream for insurance companies if they are not actually required to provide the nominal product: insurance.
3
The employer mandate was established to try to get large enough groups to allow for employers to negotiate for lower premiums and better coverage for their employees, while including many of the young and healthy working people into the portfolios of the insurance companies to provide that all important profit to induce them to take on so many older and/or less healthy people in the exchanges.
Want to get rid of the need to induce insurance companies? Get rid of them. As long as the private insurance industry is involved, their never ending greed for more and more profit will be a driving factor in the cost and coverages available - through employers or to individuals.
Their profit provides no heath care. It is gained after they have paid for all their buildings and the operation of them, all their employees and their benefits, all their advertising and marketing, all that stuff they send to you that you throw in the trash, all those ads on TV, all the costs of billing you and processing the payments, all the costs of processing claims and keeping track of how much of your deductible/co-payments you've used this year, all the CEO and executive pay and benefits and Golden parachutes and Board members and entertainment budgets and gifts to doctors and hospitals and clinics...
After all that, not one dollar of which provides health care, THEN they need to make a profit - all reflected in your premiums.
Medicare for everyone. Sightly higher taxes. No premiums for anyone.
Want to get rid of the need to induce insurance companies? Get rid of them. As long as the private insurance industry is involved, their never ending greed for more and more profit will be a driving factor in the cost and coverages available - through employers or to individuals.
Their profit provides no heath care. It is gained after they have paid for all their buildings and the operation of them, all their employees and their benefits, all their advertising and marketing, all that stuff they send to you that you throw in the trash, all those ads on TV, all the costs of billing you and processing the payments, all the costs of processing claims and keeping track of how much of your deductible/co-payments you've used this year, all the CEO and executive pay and benefits and Golden parachutes and Board members and entertainment budgets and gifts to doctors and hospitals and clinics...
After all that, not one dollar of which provides health care, THEN they need to make a profit - all reflected in your premiums.
Medicare for everyone. Sightly higher taxes. No premiums for anyone.
18
This pernicious bill is about removing everyone's access to reliable, affordable medical coverage - not just an unlucky few.
Yes, it specifically targets those who are sicker or poorer than many of us. That's heinous enough. But don't think you and your family are immune from this insanity, which would create a situation far worse than pre-ACA.
Our neighbors to the north and south have universal health coverage. Maybe someday we'll join the modern world.
Yes, it specifically targets those who are sicker or poorer than many of us. That's heinous enough. But don't think you and your family are immune from this insanity, which would create a situation far worse than pre-ACA.
Our neighbors to the north and south have universal health coverage. Maybe someday we'll join the modern world.
8
I found this article interesting but missing a few points, typically employers in a strong economy with low unemployment maintain healthy benefits because they are competing for a smaller pool or available employees as well as balancing retention of existing employees. Smaller employers also swim at in the same pool and would be unlikely to change existing benefits.
1
These sorts of changes are painful but acceptable if, and only if, insurance companies become the price regulated entities that they deserve to be. They obviously have considerable market power. And the market for health care services falls well short of mutually beneficial "voluntary" exchanges between service providers and consumers. Insurance companies must be prevented from profiting, just like other industries in similarly flawed markets.
3
Anyone who has or contracts a serious illness will requiring extensive or not so extensive treatment can run into lifetime limits especially with the high costs and the unbundling of costs to maximize profits. Given how health insurance companies have structured insurance and how narrow the networks are, the costs in terms of stress, money, and the time spent trying to ensure that everything is covered, I fail to see why Americans should be forced to participate in such a rigged system. If Congress and the CEOs who head these companies had to deal with them they'd reform it instantly.
When profits are the main purpose of a company, especially one that is in the health field, patients lose. We've seen it with pharmaceuticals, hospitals, health and dental insurance, medical devices, and other aspects of health care. I'd rather pay more in taxes so that when someone is in need of care they can get it rather than limp along until the need is so urgent it cannot be denied. No one in a country as rich as ours should be forced to choose between medical care, needed medications, and paying a premium plus a co-pay, a deductible, and having to beg for care.
When profits are the main purpose of a company, especially one that is in the health field, patients lose. We've seen it with pharmaceuticals, hospitals, health and dental insurance, medical devices, and other aspects of health care. I'd rather pay more in taxes so that when someone is in need of care they can get it rather than limp along until the need is so urgent it cannot be denied. No one in a country as rich as ours should be forced to choose between medical care, needed medications, and paying a premium plus a co-pay, a deductible, and having to beg for care.
16
It's naive to assume that even large corporations would continue to follow their pre-ACA approaches to employee health insurance. Costs have risen since then, and a repeal/rollback would roil the waters significantly, providing the perfect excuse for cutbacks.
19
Imagine for a minute, this all white, male Republican group managing to get 50 votes + Pence to pass the bill of their dreams. Soaring premiums, Medicaid all but gone, hospitals, especially rural, closing, medical bankruptcies common again. One sixth of the economy in shambles, chaos in insurance markets.
All this for a giant tax cut for those with the most who need it the least.
Finally, I hope it will become crystal clear, especially to Trump voters, that the GOP exists mainly to cut taxes. All else, health care, infrastructure, safety nets, carry little weight. They need to please the people who fund them.
But in that scenario, I think they'll find out the majority in this country do not support their dislike for all things government. The next election, 2018, will hopefully make that clear to them.
All this for a giant tax cut for those with the most who need it the least.
Finally, I hope it will become crystal clear, especially to Trump voters, that the GOP exists mainly to cut taxes. All else, health care, infrastructure, safety nets, carry little weight. They need to please the people who fund them.
But in that scenario, I think they'll find out the majority in this country do not support their dislike for all things government. The next election, 2018, will hopefully make that clear to them.
25
I'm surprised Larry Levitt is saying that lifetime limits affect very few people. Look how expensive treatment of breast cancer is! Look at all of the stories of people with children born prematurely and spending weeks/months in NICU. These stories aren't uncommon. And with lifetime limits not being adjusted for inflation, a Raise the Caps Coalition found that a 1988 lifetime limit of $1 million would be adjusted to $3.6 million in 2007. It's 2017. I think one might argue that lifetime limits will affect MANY people in 2017 unless those caps are majorly adjusted. $1 million doesn't get you much in healthcare these days. And it most certainly won't get my husband a stem cell transplant, should his leukemia return.
53
I couldn't agree more. I was diagnosed with a familial (inherited) cardiac condition in 2003. I managed it medically for 13 years before suddenly becoming very ill. One cardiac arrest, 3 ablations, one left ventricle assist device implant and one heart transplant later our bills totaled over $3 million - all within a 9 month span. Our insurance - through my wife's employer - is very good, but now there is the possibility that either yearly or lifetime benefit caps could return. In addition to the pre-existing condition concerns with the bill, this is an overlooked aspect of the changes being made that could have a significant impact on many people. Even selling our home and using all of our retirement savings, there is no way we could have paid for this.
37
Why are Health Care Costs "skyrocketing". Is there some underlying cause other than Greed? The Insurance Companies will write this bill for the Senate. The bought off men of the Committee are owned by Insurance Companies and all rabid opponents of any subsidized health care. The American Public is doomed but after all they put these self centered Thieves in Office. This is all about further undeserved Tax Cuts for the 1%.
23
If I was a small employer I would drop health insurance to save money. That should be expected since America got into the health insurance business. Another entitlement program that will be abused; just give it time.
Absolutely! The nerve of people thinking they're entitled to healthy lives. What do they think we are in America? A first-world country?
8
The Trump era all but codifies the plan to demonize the victim. The love of money is the root of all evil, indeed.
13
Remember when most large employers offered pensions? Expect health care to go the same way, with "personal responsibility" being the watch word while the CEO still gets unlimited coverage.
85
None of this is a surprise but the GOP should come right out and say that they are making all these changes to help corporations and wealthy people like themselves, rather than flat out lying by saying this is to benefit average Americans.
12
If they did not lie even their base would not vote for them. It is why they have spent lavishly on creating and maintaining their propaganda networks
4
The calculus on health care should be "how many lives can we prolong or save"? But the GOP seems to think that the question is "how much money can we withhold to collapse they system?"
10
I think it is so sad that so many of the detractors of ACA who voted Mr. Trump will now suffer the consequences of their choice. I think it it so much sadder that those who did not vote for him will now suffer the consequences of their choice, as well. The cruelty of AHCA, particularly after years of Obamacare in place, is horrifying coming from our leadership. They will eventually succeed in hurting many. At the next Rose Garden celebration, I hope they enjoy their cake. It's so sad.
15
I agree with your second sentence, not the first. If the US is going to try to be a democracy, citizens need to start acting like responsible voters.
4
Ms. Sanger-Katz, your article alludes to ways employers could avoid covering high risk/cost employees under AHCA. But, you quote representatives of large employers (Willis Towers Watson, Mercer and ERISA) who say "employers" are unlikely to do that. In counterpoint to your large employer sources, AHCA may well undo key protections in Obamacare for the 60% of employees in the U.S. who work in small businesses that tend to insure their health coverage.
Smaller employers are more likely to not offer/drop coverage under AHCA provisions that no longer require them to offer coverage and that offer tax credits to people with jobs that pay above the minimum wage. And, small employers may push higher risk/cost employees into the private insurance market (or to be uninsured) in states that opt for the waivers which eliminate caps on out-of-pocket expenses, eliminate the requirement to cover minimum essential benefits, and require employers to pay at least 50% of the cost of coverage.
Many small employers will use insured or partly insured products. Their insurers will medically underwrite each employee/family and provide premium quotes to the employer with and without the higher risk/cost employees. To keep their premium low(er), the employer may eliminate annual/lifetime limits and set co-insurance at a level that will make coverage unaffordable to their higher risk/cost employees, who will be informed that they can enroll in the state high risk pool.
Smaller employers are more likely to not offer/drop coverage under AHCA provisions that no longer require them to offer coverage and that offer tax credits to people with jobs that pay above the minimum wage. And, small employers may push higher risk/cost employees into the private insurance market (or to be uninsured) in states that opt for the waivers which eliminate caps on out-of-pocket expenses, eliminate the requirement to cover minimum essential benefits, and require employers to pay at least 50% of the cost of coverage.
Many small employers will use insured or partly insured products. Their insurers will medically underwrite each employee/family and provide premium quotes to the employer with and without the higher risk/cost employees. To keep their premium low(er), the employer may eliminate annual/lifetime limits and set co-insurance at a level that will make coverage unaffordable to their higher risk/cost employees, who will be informed that they can enroll in the state high risk pool.
12
Employer-sponsored, tax-subsidized health coverage is responsible for much of the out-of-control costs and unfairness in the American health insurance marketplace today. This subsidy has led to an overly complex, inefficient, and expensive marketplace. I understand that businesses don’t want to give up their tax write-offs and unions will oppose changes. But the fact is Americans who are self-employed, employed by small businesses, retired-early, or lost their job are at a serious disadvantage. In a country, as rich as ours, we are derelict for pushing these folks into a separate and unfair system and for continuing to subsidize an employer-based system that benefits the health care industry at the expense of middle America.
29
Which is why we need single payer.
The profit based heatlh care system in this county is primarily concerned with their bottom line and will do just about anything to achieve it at the expense of the insured. The repeal sends a green light to the industry that ‘paying more less’ is the norm. This will be especially true when the insurance companies are in control and have fewer health care restriction policies to be concerned with.
The same will be true with many companies/corporations; their loyalty is to their bottom line, the almighty dollar and pacifying their stock holders. In their minds the employees are a secondary concern if they are that lucky and are already accustomed to receiving reduced benefits. Remember that once upon a time traditional pension plans were the norm and now they are virtually non-existent thanks to the bottom line and Wall Street.
This only opens the door for many companies to transfer the financial liability of providing health care to the employee. It’s a win win for them. Millions upon millions will be affected and this is OK with the GOP and President………it is more sad than shameful for the richest country in the world.
Eliminate the profit based health care system in this country and then maybe we’ll see a health care system that works for everyone.
The same will be true with many companies/corporations; their loyalty is to their bottom line, the almighty dollar and pacifying their stock holders. In their minds the employees are a secondary concern if they are that lucky and are already accustomed to receiving reduced benefits. Remember that once upon a time traditional pension plans were the norm and now they are virtually non-existent thanks to the bottom line and Wall Street.
This only opens the door for many companies to transfer the financial liability of providing health care to the employee. It’s a win win for them. Millions upon millions will be affected and this is OK with the GOP and President………it is more sad than shameful for the richest country in the world.
Eliminate the profit based health care system in this country and then maybe we’ll see a health care system that works for everyone.
16
Warren Buffett, at his recent Omaha "Woodstock for Capitalists", told CEOs they should be less concerned about tax cuts and more concerned about the spiraling cost of employer health insurance. While corporate taxes have been reduced by half since the 1960s, health care costs have increased by over 3 times, with profound effects on corporate bottom lines and global labor competitiveness.
Given that other developed countries have better health outcomes, with half or less the cost, the business community has much to gain in getting behind something like Medicare for All, especially with the quality and cost advantages of managed care, which the Clintons proposed back in the 1990s.
Employer insurance will surely move back toward mini-med plans for large sector of the economy like retail and commercial real estate, which are immense competitive pressure from on-line sales and distribution.
Or we can just watch medical bankruptcies and ER primary care explode again, while small town hospitals disappear.
Given that other developed countries have better health outcomes, with half or less the cost, the business community has much to gain in getting behind something like Medicare for All, especially with the quality and cost advantages of managed care, which the Clintons proposed back in the 1990s.
Employer insurance will surely move back toward mini-med plans for large sector of the economy like retail and commercial real estate, which are immense competitive pressure from on-line sales and distribution.
Or we can just watch medical bankruptcies and ER primary care explode again, while small town hospitals disappear.
51
Companies will not work to change the US medical system. They'll just speed up the move of jobs out of the US to countries in which they don't have to worry about health care coverage for employees. And the wage per hour will be less.
I keep saying the CEOs of large companies have no loyalty to the US (or any country for that matter.) they just look at ALL countries and look for the lowest cost employee (and health care).
I keep saying the CEOs of large companies have no loyalty to the US (or any country for that matter.) they just look at ALL countries and look for the lowest cost employee (and health care).
1
And what of the growing "gig" economy? Or, more honestly, an economy where you're on your own for employment stability and benefits.
Fewer and fewer Americans each year are covered by employer heath insurance plans. Without a solid marketplace for purchasing individual insurance plans, and basic protections and regulations to be sure these plans are fair and affordable, we may soon find that even more of us are left without options.
Fewer and fewer Americans each year are covered by employer heath insurance plans. Without a solid marketplace for purchasing individual insurance plans, and basic protections and regulations to be sure these plans are fair and affordable, we may soon find that even more of us are left without options.
51
Elizabeth
Good point. That would leave those that might lose employer coverage with Trump-no-care. A very good reason to contact your Senator, because you never know ahead of time what the bean counters at your company are doing.
Good point. That would leave those that might lose employer coverage with Trump-no-care. A very good reason to contact your Senator, because you never know ahead of time what the bean counters at your company are doing.
12
Someone please explain to me why you are treated as a second class citizen if you choose to work for yourself as an independent contractor - as I do as a Realtor - or start your own business, as my husband did, versus becoming an employee? If you work for an employer, you most likely have some health coverage...if not, you are entirely on your own. How is that okay in a country that supposedly encourages entrepreneurism?
115
If you are a fortunate employee, you receive health care through your employer. If you are your own employer, you provide health insurance just as they do.
Happy to have helped!
Happy to have helped!
2
Sharon, I'm a self-employed single parent. 15 years ago when I started my business, my biggest concern was medical insurance. Each year, my insurance increases. Now I'm certain that it's about to soar. It's terrifying.
And it does make me think that the country really isn't supportive of entrepreneurs. The facts confirm that.
And it does make me think that the country really isn't supportive of entrepreneurs. The facts confirm that.
7
It's not. We need single payer.
2
I have one question: Although we spend more than 2 x's what other countries spend on health care (and we have poorer outcomes), how is it that EVERY OTHER INDUSTRIALIZED COUNTRY provides universal health care?
Why does the US fail when ALL other countries succeed?
Why does the US fail when ALL other countries succeed?
107
The US is not a democracy it is not a socialist or communist country. It is a constitutional republic.
And if we did have universal health care where would the money come from?
And if we did have universal health care where would the money come from?
Well, we DO have "universal health care"-- for those 65 years and older and it's called "Medicare". It works very well indeed and is easily paid for by a variety of taxes, including some on Medicare recipients themselves, as well as federal subsidies. Its administrative costs run about 2 percent of expenditures (try that against private medical, or other, insurance policies): the money that "comes from" these sources is peanuts compared to the monies that would be needed to cover this population under any sort of private insurance. OK?
28
I'm sure the GOP answer would be "American Exceptionalism". We are better than those other countries, even if we aren't.
3
Among the many catastrophic thoughts running through my head in the wee hours of November 9th, prominently among them was, "Well, there goes Obamacare." I realized the serious issues with O'Care that needed to be addressed; the new political order would revert to destroying the ACA, however. And its replacement would be a reversion pre-ACA. In my wildest dreams I didn't imagine what the House did last week.
These men (they are really all men) believe if you get sick or hurt it's your own fault and you should pay the price for it. That theme underlies the tax cut bill that passed last week. Now we have to wait and see what 13 men (yes, again all men) in the Senate come up with as a "compromise".
I'm reminded of my first engineering job out of college when I happily looked over my new insurance plan. This was, of course, a first for me and I was more than a little confused about how it all worked. One thing I came to understand was my plan paid for a routine physical once every two years...even though my gynecologist at the time recommended a routine exam and PAP every year.
I also think back to a young woman I knew at another job who had the misfortune to lose her son to cancer. In the final months of his ordeal, she was faced with a dilemma: if he lived much longer his lifetime limit would be reached and he'd no longer have insurance.
Anyone who thinks this debate only affects those on the individual market is kidding themselves.
These men (they are really all men) believe if you get sick or hurt it's your own fault and you should pay the price for it. That theme underlies the tax cut bill that passed last week. Now we have to wait and see what 13 men (yes, again all men) in the Senate come up with as a "compromise".
I'm reminded of my first engineering job out of college when I happily looked over my new insurance plan. This was, of course, a first for me and I was more than a little confused about how it all worked. One thing I came to understand was my plan paid for a routine physical once every two years...even though my gynecologist at the time recommended a routine exam and PAP every year.
I also think back to a young woman I knew at another job who had the misfortune to lose her son to cancer. In the final months of his ordeal, she was faced with a dilemma: if he lived much longer his lifetime limit would be reached and he'd no longer have insurance.
Anyone who thinks this debate only affects those on the individual market is kidding themselves.
177
NO! These men believe if you are not serving in Congress or the White House with your gold plated medical insurance plan, if you get sick or hurt it is your fault.
Some animals are just more equal than others -- like pigs, hogs and swine, See Animal Farm by George Orwell for an explanation of how this works.
Some animals are just more equal than others -- like pigs, hogs and swine, See Animal Farm by George Orwell for an explanation of how this works.
I own a national consumer healthcare advocacy. I can tell you first hand that the majority of Americans who stand to be endangered by this reckless legislation, nearly half of the population or more, have no idea how it would impact their lives.
Congress should be concerned with strict regulations for the insurance companies to control skyrocketing premiums, out of pocket costs and improper (often illegal) claim denials. They should be passing laws to make healthcare providers bill patients correctly, without an estimated 50% - 80% billing error rate that costs patients tens of billions of dollars annually. Congress should be reeling in pharmaceutical and medical device companies that price gouge those with chronic conditions and the elderly.
Instead, the GOP in the House delivers a bill that delivers huge tax breaks for the wealthy to satisfy the mystery Super Pacs that line their campaign war chests with dark money.
Our Founding Fathers are turning over in their graves as if they were on spits.
Congress should be concerned with strict regulations for the insurance companies to control skyrocketing premiums, out of pocket costs and improper (often illegal) claim denials. They should be passing laws to make healthcare providers bill patients correctly, without an estimated 50% - 80% billing error rate that costs patients tens of billions of dollars annually. Congress should be reeling in pharmaceutical and medical device companies that price gouge those with chronic conditions and the elderly.
Instead, the GOP in the House delivers a bill that delivers huge tax breaks for the wealthy to satisfy the mystery Super Pacs that line their campaign war chests with dark money.
Our Founding Fathers are turning over in their graves as if they were on spits.
232
And, Trumpcare will do nothing to rein in health costs. Plus, we all will be paying increased premiums due to insurance companies "uncertainty" factor. We always do.
4
You own Exhale Healthcare Advocates. Your rates are right up there and wouldn't be affordable to anyone who is not making a pretty good salary. If your company is so concerned about patients and cost, why are your rates so high?
2
There is no reason our affluent country should be relying on employers to provide insurance to some when we could set up a single payer system to cover all. Yes, it would require raising taxes but that is the only way to make sure that every citizen in the USA has a basic level of insurance. A single payer system would eliminate the profits of insurance companies and begin to lower the growth of medical costs.
68
We already pay double the costs of other countries--why is the US the only failure in providing universal health care? Our health care system now is cited as a major factor in our poorer outcomes.
We pay double and get less than other countries. Tweaking either the ACA or Trumpcare won't change this.
We pay double and get less than other countries. Tweaking either the ACA or Trumpcare won't change this.
12
No thanks.
Ive been under universal health care. There is long wait times for an appointment. Youre assigned a clinic that you must go to and a Dr.
There is no second opinion. You dont have control of anything. If you dont agree with the Drs assessment youre out of luck.
Ask yourself why do Canadians come to the US for treatment?
In other countries where universal health care exist people still get private insurance. Ask yourself why?
The VA is a disaster. Ive worked in the hospital and seen many VA patients come into the ER because they were turned away from the VA.
Universal a fairy tell that is a horrible system.
Ive been under universal health care. There is long wait times for an appointment. Youre assigned a clinic that you must go to and a Dr.
There is no second opinion. You dont have control of anything. If you dont agree with the Drs assessment youre out of luck.
Ask yourself why do Canadians come to the US for treatment?
In other countries where universal health care exist people still get private insurance. Ask yourself why?
The VA is a disaster. Ive worked in the hospital and seen many VA patients come into the ER because they were turned away from the VA.
Universal a fairy tell that is a horrible system.
Your post reflects an opinion not shared by most citizens under universal health care in researched reports. The VA isn't functioning well but perhaps that is because it has to compete with better funded care supported by for profit health insurance companies and Medicaid.
5
Since 1984 the company my wife and I founded has offered health insurance to our employees. We were paying a modest monthly premium yet surprisingly not all of our 4 employees at the time signed up. 33 years later we have 16 full time employees and everyone has coverage through our plan or through a family member. All of this coverage is provided through small employers. Today our premium is a crushing $11,000 a month and the minimum impact of TrumpCare will be an immediate increase of that monthly payment of $2000 per month to cover our highly skilled and valued workers over 50. At some point the benefit offered is outweighed by the staggering effect on our cash flow and the distinct and very real competitive disadvantage we incur by continuing to provide this benefit. We are seriously considering dropping coverage altogether, giving our employees the 15% of premium they pay plus a raise and telling them to find coverage in the individual market. Several will take the raise and their chances. We have offered this benefit as much because it is the right thing to do rather than a way to attract employees. There is no mystery here, other than the irrationality of the Administration and Majority in Congress; fewer insured means higher costs, higher premiums and the simple math of a market driven death spiral, a real one, not the one the the Trump administration will manufacture if it doesn't get its way.
86
Would the raise offered plus taxes you pay on the raise be equal to your current insurance costs or would you be saving money after cutting off insurance?
4
If, as stated by Kaiser, lifetime limits affect very few people, then why would its presence be a significant driver in health care costs, up or down? The nature of insurance is to pool risk. Couldn't the cost for the few with chronic or catastrophic health care costs be spread among all who are covered? Sounds like a red herring.
19
Because little to none of the policies in Obamacare or Trumpcare tackle the runaway inflation in medical costs --- roughly twice non-medical inflation --- employers will feel pressure to cope with it by limiting benefits, requiring employees to pay more of tne premiums, or by increasing out-of-pocket costs.
I will note that the median family income in the US is about $50K and the maximum out-of-pocket ($14,300) for a family under Obamacare is over a quarter of the median.
As long as policy focuses on how to shift the costs and not on the costs themselves, they will continue to rise.
I will note that the median family income in the US is about $50K and the maximum out-of-pocket ($14,300) for a family under Obamacare is over a quarter of the median.
As long as policy focuses on how to shift the costs and not on the costs themselves, they will continue to rise.
19
One of the most significant weaknesses in ACA was directly caused by the mandate continuing employer coverage. It is obvious why ACA required employers to offer insurance; had half the country lost their highly-prized insurance, ACA would have been so deeply unpopular and so thoroughly lack public support it could not have been passed. The weakness caused was unbalanced risk pools in the individual market. People healthy enough to work did not sign up for ACA, leaving the risk pools dominated by the unhealthy with pre-existing conditions. The individual market quickly became unaffordable for those in it. There are many questionable aspects about AHCA, but it's promotion of part of the population losing its employer-based coverage is not one of them. If anything, pushing some healthy people toward the public markets will give the public markets a chance to succeed.
Your argument ignores those people who work for organizations that do not provide health insurance, such as employers of fewer than 50 people.
8
Joe From Boston, My response was apparently approved but has not posted. Here it goes and with a little bit more than the first time around (just in case my first one appears):
Yet my argument addresses all other types of organizations that are mandated to provide coverage.
People commonly say Obamacare has problems that should be fixed. They prefer to advocate for fixing over a repeal. I happen to agree. What my comment does, however, is actually identify what one of those problems is, why the problem exists, and why a fix historically has and would be difficult to do. Simply put, people don't want to face the fact the actual and specific fix is something they don't want.
Yet my argument addresses all other types of organizations that are mandated to provide coverage.
People commonly say Obamacare has problems that should be fixed. They prefer to advocate for fixing over a repeal. I happen to agree. What my comment does, however, is actually identify what one of those problems is, why the problem exists, and why a fix historically has and would be difficult to do. Simply put, people don't want to face the fact the actual and specific fix is something they don't want.
Jow From Boston, Yet my argument takes into account all other types of employers that are mandated to provide coverage.
The ACA was never about the benefits that highly profitable companies provide to their well paid white collar employees. Why we are the only country who feels that it's the employer's responsibility to provide healthcare insurance at all is a debate for another day.
The ACA was always about the Americans who don't earn enough to afford their company's insurance or whose employer was neither large enough nor profitable enough to offer affordable employer sponsored health insurance. Hence the Affordable in ACA.
As someone who works at he intersection of large HR departments and employer sponsored health insurance enrollment processes, I agree that there will probably not be a lot of changes to the large employer, white collar employee health insurance offerings. Other than the impossible reporting requirements (research IRS 1094/1095 C really it's lots of fun), there were not many changes when ACA went into effect.
But it's not this part of the employer sponsored health insurance space that has the problems. The small to medium sized businesses will most definitely reduce their health insurance offerings if allowed to. What is also possible is more smaller employers being incentivized by insurance carriers to increase initial enrollment waiting periods to 90 days thereby insuring a 90 day gap and immediately making anyone with a pre existing condition eligible for the premium penalty.
The ACA was always about the Americans who don't earn enough to afford their company's insurance or whose employer was neither large enough nor profitable enough to offer affordable employer sponsored health insurance. Hence the Affordable in ACA.
As someone who works at he intersection of large HR departments and employer sponsored health insurance enrollment processes, I agree that there will probably not be a lot of changes to the large employer, white collar employee health insurance offerings. Other than the impossible reporting requirements (research IRS 1094/1095 C really it's lots of fun), there were not many changes when ACA went into effect.
But it's not this part of the employer sponsored health insurance space that has the problems. The small to medium sized businesses will most definitely reduce their health insurance offerings if allowed to. What is also possible is more smaller employers being incentivized by insurance carriers to increase initial enrollment waiting periods to 90 days thereby insuring a 90 day gap and immediately making anyone with a pre existing condition eligible for the premium penalty.
39
I deal with employer health benefits each year. Even though we have over 1,000 employees and our claims history is good we have to change every year to avoid a bait and switch 20-30% increase for the same health coverage. Its been this way for years. I'm sure there are a lot of good people who go to work everyday in the insurance sector determined to do the right thing. As for my experience, I've learned to never trust the insurance companies.
100
Democrats were accused of creating death panels during creation of the Affordable Care Act. Republicans can now be tagged with creating a "death bill" that ensures that no government or insurance company need pay for heart and other organ transplants, paraplegic care, long term care of patients disabled as a result of auto accidents, birth defects, debilitating chronic illnesses and a thousand other conditions currently required to be covered by insurance or under medicaid. Under the Republican plan are these patients are expected to declare bankrupcty and to proceed to an uncertain fate and death as the care they need to stay alive will be denied them by for-profit hospitals everywhere? How many Trump voters will be affected by the death bill? Most.
75
Employer funded health care was never a right. It was a benefit to lure good job candidates to choose a company based on the benefits they offered. This premise has been severely eroded over the past 20 years with employers share of funding dropping every year.
Under Trumpcare employers will likely opt to provide a taxable stipend to employees at a fraction of the cost they were paying while the employer will get a tax deduction. Anyone on an employer funded plan is going to learn that their complacency on the health care issue will cost them dearly.
The young think they are invincible and don't need health care until of course they do in which case it will be like trying to buy flood insurance when your home is under 20 feet of water.
The GOP with its Trumpcare plan has put the entire country on the edge of losing their health care, not just the people on the current ACA plans.
Under Trumpcare employers will likely opt to provide a taxable stipend to employees at a fraction of the cost they were paying while the employer will get a tax deduction. Anyone on an employer funded plan is going to learn that their complacency on the health care issue will cost them dearly.
The young think they are invincible and don't need health care until of course they do in which case it will be like trying to buy flood insurance when your home is under 20 feet of water.
The GOP with its Trumpcare plan has put the entire country on the edge of losing their health care, not just the people on the current ACA plans.
120
I guess we will just have to deal with physicians directly. What a concept.
1
Yes, when the ambulance deposits you in the ER following your massive heart attack you can negotiate to obtain the best cardiologist at the lowest price.
2
One thing is for sure, mess with employer coverage and you will wake the sleeping giant at last, perhaps that's what it really will take to get the mass of middle class out of their complacency with this system.
"The possible effects on the employer health system got little attention during congressional debate." What debate? There never was any true debate or study of this bill, as shown by the fact that Ryan and company rammed the bill through the House without benefit of CBO scoring or hearings.
Each and every Representative who voted for this heinous excuse for legislation should lose their jobs - and their health insurance.
Each and every Representative who voted for this heinous excuse for legislation should lose their jobs - and their health insurance.
246
Furthermore, they should not be eligible for unemployment benefits on the grounds that receiving them will lead to lying in a hammock instead of searching for a job. Ask any person who receives unemployment benefits about lying in a hammock all day long and they'll tell you exactly how relaxed they weren't. In present day America losing a job can presage losing one's health and life. Only the GOP and its followers don't want to own up to that fact because they believe that it could never happen to anyone who plans their life well. Planning and living are two different things as we all discover when the unexpected occurs or when our plans don't work because life happens.
9
I second the motion!
1
Those who voted for a candidate in 2016 who supported a Republican party platform simply because they "always vote Republican" may soon regret their votes. The radical Republican agenda does affect the lives of many voters who thought they were safe because they were not the "others" their party targets.
While the shiny objects of division politics were waved before them, the actual laws this Republican Congress was willing and able to pass reflects a far more radical agenda. Many of the elected officials who refuse to answer questions in public from voters do so because their votes are for their party, not for their country or for their voters. The recently passed House health bill is a good example of the process and the results of Republican-control.
Those of us who live in states with Republican-controlled governments understand their priorities and look for the laws passed without public comments or unrelated items attached to must pass bills. If a voter thought they were safe with their employer-based health care under a Republican bill, they are clearly wrong. And if a "middle class taxpayer" thinks tax reform benefits them, there is a Republican Health care bill that proves them wrong.
While the shiny objects of division politics were waved before them, the actual laws this Republican Congress was willing and able to pass reflects a far more radical agenda. Many of the elected officials who refuse to answer questions in public from voters do so because their votes are for their party, not for their country or for their voters. The recently passed House health bill is a good example of the process and the results of Republican-control.
Those of us who live in states with Republican-controlled governments understand their priorities and look for the laws passed without public comments or unrelated items attached to must pass bills. If a voter thought they were safe with their employer-based health care under a Republican bill, they are clearly wrong. And if a "middle class taxpayer" thinks tax reform benefits them, there is a Republican Health care bill that proves them wrong.
194
Also the Trump tax attack on the middle class and public school districts and local government.
3
@Lynda
Well said. The ruse is that middle class Republican voters think that Republican tax and deregulate policies benefit them by saving them tax dollars and other costs. The reality is that the few hundred bucks they might save a year in their taxes (under most Republican tax plans) doesn't compensate for the "non-tax" expenses they are burdened with as a result. Looking at state taxes that were cut which led to reduced higher ed funding. Those cuts were directly turned into "fees" which resulted in much higher out of pocket tuition costs (as one of the drivers of high tuition increases). Back in the "bad ole' days" of higher state taxes, state college tuition could be paid for by a summer job. Now, dual loans from parents and students are required to fund tuition that costs thousands of dollars a semester.
The resistance to single payer/universal health care is another example. By saving on the feared tax to fund that sort of system, individuals instead pay extremely high premiums coupled with high out of pocket costs, and still face exclusions and limits on care (which will be exacerbated under TrumpCare). Almost all estimates of a national system estimate a tax burden that would be less than the current premium + deductible currently paid, while delivering *more care*.
Middle class Republican voters are dupes for the wealthy, they prefer to think of themselves as in the same interest class and vote accordingly, but the math hasn't worked in their favor, almost never.
Well said. The ruse is that middle class Republican voters think that Republican tax and deregulate policies benefit them by saving them tax dollars and other costs. The reality is that the few hundred bucks they might save a year in their taxes (under most Republican tax plans) doesn't compensate for the "non-tax" expenses they are burdened with as a result. Looking at state taxes that were cut which led to reduced higher ed funding. Those cuts were directly turned into "fees" which resulted in much higher out of pocket tuition costs (as one of the drivers of high tuition increases). Back in the "bad ole' days" of higher state taxes, state college tuition could be paid for by a summer job. Now, dual loans from parents and students are required to fund tuition that costs thousands of dollars a semester.
The resistance to single payer/universal health care is another example. By saving on the feared tax to fund that sort of system, individuals instead pay extremely high premiums coupled with high out of pocket costs, and still face exclusions and limits on care (which will be exacerbated under TrumpCare). Almost all estimates of a national system estimate a tax burden that would be less than the current premium + deductible currently paid, while delivering *more care*.
Middle class Republican voters are dupes for the wealthy, they prefer to think of themselves as in the same interest class and vote accordingly, but the math hasn't worked in their favor, almost never.
Welcome back to the era of medical bankruptcies. Under no circumstances can a market based medical insurance model help the average consumer. There is nothing built into the current Republican plan that is designed to reduce cost to the insured, or expense for the service or product provider. The only way to reduce your premiums is to cut back on the leverage of coverage you have.
60
It is naive to think companies, now given a green light to reduce or restrict benefits, will not do so. Provisions protecting employees were included in the ACA because not all employers provided these essential benefits or had unworkable restrictions. If the new Trump-Republican health care bill, or really any version of it, passes we will ALL see reduced benefits in the years to come, with women bearing the brunt of reductions.
126
The business model of the health insurance industry:
The more health services they provide to their customers, the less money they make.
The more health services they provide to their customers, the less money they make.
85
Prime directive for Republican politicians: Do not allow Americans to get accustomed to a new program of support from their government. It does not matter that the support is for people's health, which is essential to life, liberty, and the pursuit of happiness.
125
Employer insurance was already weakened by Hobby Lobby which meant employers could limit health coverage for women or anyone else depending on the boss's religious views even if those beliefs were based on fake science like claiming a contraceptive was an abortificient even if medical science said it was not. Many employers now almost force their workers into wellness programs where they can penalize and identify those with higher health risks. Republicans just tried to force everyone into genetic testing which would identify those with predispositions towards certain diseases or conditions. They want to force recipients in some government safety net programs to take drug tests which further stigmatizes and penalizes them for being poor.
Back to the days of junk insurance and throwing out the sickest people. This is an expansion of a profit-based tyranny over the bodies of Americans, first women, then the poor, then all workers.
Back to the days of junk insurance and throwing out the sickest people. This is an expansion of a profit-based tyranny over the bodies of Americans, first women, then the poor, then all workers.
289
I was hoping that somebody would have asked Gorsuch how he would have opined (he wrote a separate concurring opinion) if the Green family were Christian Scientists and believed that only prayers (no doctors, no medicines, no hospitals) are the appropriate care to provide for the sick.
Would he be willing to let an employer say to the employees "I do not believe in modern medicine, so you get a policy that only covers prayer"?
Would he be willing to let an employer say to the employees "I do not believe in modern medicine, so you get a policy that only covers prayer"?
10
GOP health policy is the new Eugenics.
7
This is just another step in the now longer journey to universal coverage; no amount of spin, us/them, black/white, freedom/slavery is gonna save the cost of this fiasco falling where it will.
The biggest problem with employer provided health insurance is that it is too easy to become stuck in a job that is not a good fit just to keep the insurance.
And if the pre-existing condition ban is overturned, then many will literally have no choice but to stay with a particular employer.
If we cannot get to Medicare for all yet, then the next best thing is to establish a system in which health insurance is bought either individually or through associations for a lifetime, which could give bargaining leverage with providers and drug companies.
A reasonable method would be to offer catastrophic insurance with some form of HSA. The HSA would be the vehicle for low income support as opposed to Medicaid.
This is not a new proposal, but one that seems to be overlooked. I think eventually, the best way to provide such coverage is to have the government provide the catastrophic insurance paid with an increase in payroll taxes. That would provide the young and healthy plus the old and sick that insurance needs to keep premiums down. That would be virtually 100% participation.