806 replies to this topic

[artcinco]

[freedom78]

OK, Art, I"m calling Bullshit.  All you're doing is going from one NR article to the one that pops up below it.  Did the National Review offer you a full scholarship or something?

[artcinco]

^ I was waiting for that! Guilty as charged.

 

It actually is one of the only conservative online places that doesn't insult one's intelligence.

[johnboyx1]

It's the free market at work. Anyone have a problem with that???

[Mr. Roboto]

Medicaid Privatization Gets Messy in Iowa

 

In Iowa about 600,000 people get medical care through Medicaid, the public-health program for the poor and disabled. That includes more than a third of the state’s children. Doctors currently bill Iowa’s Medicaid program directly for their services, but starting next year, the state will move all of its Medicaid patients onto managed-care plans offered by four private insurers. Governor Terry Branstad, a Republican, estimates the switch will save Iowa $51 million in the first six months of 2016, about 1 percent of the state program’s $4.2 billion budget.

It’s been a complicated handoff. The change was originally planned to take effect Jan. 1. With two weeks to go, the federal Centers for Medicare & Medicaid Services, which oversees state programs, deemed Iowa “not yet ready” in a letter to the state on Dec. 17. By mid-December, many of the state’s hospitals and other medical providers—such as clinics, nursing homes, and home health-care services—still hadn’t signed contracts with the Medicaid insurers. That made it impossible for patients to know whether they could keep their existing doctors.

 

“This thing is moving way too fast,” says Scott McIntyre, vice president for communications of the Iowa Hospital Association, which sued in November to block the privatization plan. Three companies that lost bids to administer Medicaid plans have also sued, arguing that the bidding process was unfair.

Amy McCoy, a spokeswoman for the Iowa Department of Human Services, says the change is necessary to contain a state Medicaid budget that’s doubled since 2004. Iowa plans to allow patients to see doctors outside of the managed-care networks for the first three months to smooth the transition. “We wanted to do something more proactive that’s going to be able to have more impact on health outcomes,” she says.

 

The question is whether that impact will be positive or not. Since the 1980s, 39 states have privatized some or all of their Medicaid programs, paying private medical plans a fixed monthly sum to manage care for the poor and disabled. At least 39 million Americans—more than half the total Medicaid population—were enrolled in Medicaid managed-care plans in March 2015, according to data compiled by the Kaiser Family Foundation, a nonprofit focused on health-care policies. Some of the growth comes from the federally financed expansion of Medicaid under the Affordable Care Act. In 2013, Governor Branstad arranged for special permission to use the new funding to buy qualifying residents private insurance through the state Obamacare marketplace, a precursor to moving all of Iowa’s Medicaid beneficiaries to private plans.

 

Nationally, the shift to Medicaid managed care hasn’t been proved to save money, and the approach has a mixed record on how patients fare, according to a 2012 review by the Robert Wood Johnson Foundation. Another study, published this year by authors at the Urban Institute, a liberal think tank, found that for nondisabled adults, managed care is associated with increased likelihood of emergency room visits, trouble seeing specialists, and difficulty getting prescription drugs. “We don’t have as much evidence on what works and what doesn’t work as we would like to have,” says Julia Paradise, associate director at the Kaiser Commission on Medicaid and the Uninsured, a bipartisan policy group convened by the Kaiser Family Foundation.

 

Charles Bruner, executive director of the Child & Family Policy Center in Des Moines, says he’s unsure whether the managed-care plans will be required to cover the early-childhood care and social services his group supports. Such programs can help prevent children from developing chronic illnesses such as obesity or diabetes later, but they don’t offer immediate savings. He fears managed-care companies are going to ask, “Can we get rid of the peanuts on the airplane?” Iowa Department of Human Services spokeswoman McCoy says those worries are misplaced: “The benefits that are offered through our Medicaid program are going to stay the same.”

[freedom78]

So it looks like Congressional Republicans used the reconciliation process to pass their ACA repeal, which was of course vetoed, thus bypassing the possibility of a Senate Dem filibuster.

 

 

 

 

 

I'll patiently wait for anyone from that side of the aisle to decry the hypocrisy.

[artcinco]

Point taken but wasn't Obamacare passed with Reconciliation?

[freedom78]

Yes, that's why it's hypocritical. 

[artcinco]

#Fairness. ;-)

[Mr. Roboto]

A draft House Republican repeal bill would dismantle the Obamacare subsidies and scrap its Medicaid expansion, according to a copy of the proposal obtained by POLITICO.

 

The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020.

 

The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare “Cadillac tax” that Republicans have fought to repeal.

 

Speaker Paul Ryan said last week that Republicans would introduce repeal legislation after recess. But the GOP has been deeply divided about how much of the law to scrap, and how much to “repair,” and the heated town halls back home during the weeklong recess aren’t making it any easier for them.

 

The key House committees declined to comment on specifics of a draft that will change as the bill moves through the committees. The speaker's office deferred to the House committees.

 

In place of the Obamacare subsidies, the House bill starting in 2020 would give tax credits — based on age instead of income. For a person under age 30, the credit would be $2,000. That amount would double for beneficiaries over the age of 60, according to the proposal. A related document notes that HHS Secretary Tom Price wants the subsidies to be slightly less generous for most age groups.

 

The Republican plan would also eliminate Obamacare’s Medicaid expansion in 2020. States could still cover those people if they chose but they’d get a lot less federal money to do so. And instead of the current open-ended federal entitlement, states would get capped payments to states based on the number of Medicaid enrollees.

 

Another key piece of the Republican proposal: $100 billion in “state innovation grants” to help subsidize extremely expensive enrollees. That aims to address at least a portion of the “pre-existing condition” population, though without the same broad protections as in the Affordable Care Act.

 

It also would eliminate Planned Parenthood funding, which could be an obstacle if the bill gets to the Senate. And it leaves decisions about mandatory or essential benefits to the states.

 

According to the document, there’s only one single revenue generator to pay for the new tax credits and grants. Republicans are proposing to cap the tax exemption for employer sponsored insurance at the 90th percentile of current premiums. That means benefits above that level would be taxed.

 

And while health care economists on both sides of the aisle favor tax-limits along those lines, politically it’s a hard sell. Both businesses and unions fought the Obamacare counterpart, dubbed the Cadillac tax.

 

The document is more detailed than the general powerpoint House leaders circulated before the recess. Lawmakers are still in disagreement about several key issues, including Medicaid and the size and form of subsidies. Discussions within the House, and between House leaders and the White House about the final proposal are ongoing. President Donald Trump, who gives a major speech to Congress on Tuesday night, has said he expects a plan will emerge in early to mid March.

 

The exact details of any legislation will also be shaped by findings from the CBO about how much it will cost and what it will do to the federal deficit.

 

But the draft shows that Republicans are sticking closely to previous plans floated by Ryan and Price in crafting their Obamacare repeal package.

 

“Obamacare has failed," said HHS spokesperson Caitlin Oakley. "We welcome any and all efforts to repeal and replace it with real solutions that put patients first and back in charge of their health care rather than government bureaucrats in Washington, D.C.”

 

Other changes proposed by Republicans align with previous ideas for strengthening the individual insurance market, which has been unstable under Obamacare with rising premiums and dwindling competition. For example, the legislation would allow insurers to charge older customers up to five times as much as their younger counterparts. Currently, they can only charge them three times as much in premiums. The insurers have been pushing for that change.

 

The proposal also includes penalties for individuals who fail to maintain coverage continuously. If their coverage lapses and they decide to re-enroll, they would have to pay a 30 percent boost in premiums for a year. Like the unpopular individual mandate, that penalty is designed to discourage individuals from waiting until they get sick to get coverage.

 

Republicans have vowed to dismantle Obamacare ever since it passed with only Democratic votes in 2010. But reaching agreement on what should come next has proven difficult since they gained full control of Congress and the White House.

 

Recent polling has shown that Obamacare is increasingly popular. Supporters of the health care law have been turning out by the hundreds at town hall meetings across the country to demand that Republicans answer questions about what’s going to happen to the 20 million individual who have gained coverage under Obamacare.

 

According to the latest Kaiser Family Foundation tracking poll, released Friday morning, the public now views the Affordable Care Act more favorably than it has since the summer of its enactment. Some 48 percent view the law favorably — up from 43 percent in December. About 42 percent have an unfavorable view of the ACA — down from 46 percent in December. The pollsters say Independents are mostly responsible for the shift. A separate poll by the Pew Research Center found 54 percent approve of the health care law — the highest scores for Obamacare in the poll's history. Meanwhile, 43 percent said they disapprove. 

[freedom78]

So, in answer the to obvious question of "how will you both cover more people AND lower costs", the answer is "WE WON'T!"  They're gutting medicaid (i.e. fewer people covered) and planning to price gouge seniors. 

[Mr. Roboto]

I'm seeing a lot of these stories, and I just don't understand. ACA saved your life, but you still voted for the people who promised to take it away from you. These people are filling town halls now too. 

 

****

 

This Trump voter is torn between support for the president and an Obamacare plan that saved her life

 

Kathy Watson was anxious about her health coverage even before she woke up gasping for breath last month and drove herself to the emergency room with a flare-up in her heart condition.

 

After struggling for years without insurance, the 55-year-old former small-business owner — who has battled diabetes, high blood pressure and two cancers —  credits Obamacare with saving her life.

 

Watson also voted for Donald Trump, believing the businessman would bring change. She dismissed his campaign pledges to scrap the Affordable Care Act as bluster.

 

Now, as she watches the new president push to kill the law that provided her with a critical lifeline, Watson finds herself among many Trump supporters who must reconcile their votes with worries about the future of their healthcare.

 

Watson, a proud, salty woman who was uninsurable a few years ago, isn’t ready to renounce Trump. But she’s increasingly frustrated by his vague promises to replace Obamacare with something better.

 

“I’ve been through enough,” Watson said recently, sitting on the patio outside her mobile home, down a sandy road in a rural corner of northern Florida. “I don’t want to go back.”

 

As one of millions of Americans who depend on the healthcare law’s protections, Watson embodies the political challenge Republicans face as they scramble to fulfill their pledge to repeal Obamacare without harming people like Watson, who helped fuel Trump’s unexpected victory. 

 

Her story is also a cautionary tale for GOP leaders, whose promise to cut healthcare costs by scaling back insurance rules threatens to reopen the gaps that once left nearly 50 million Americans without coverage. 

 

Watson knows those gaps better than anyone.

 

Like some 150 million Americans, she for years had a health plan offered by an employer, in her case, a mobile home manufacturer where her husband worked.

 

But in 2001, Watson’s husband had to quit after he was injured. The law office where she worked as a paralegal, like many small businesses, didn’t offer a health plan.

 

“That’s when my nightmare began,” she said.

 

For a while, the couple scraped together the money to keep his plan, an option known as COBRA coverage. After 18 months, the plan offered under the Consolidated Omnibus Budget Reconciliation Act expired.

 

Watson tried to buy a health plan on her own. But before Obamacare, insurers routinely screened out sick and potentially costly customers. Trump has voiced support for keeping that protection, but other Republican plans would allow insurers in some cases to charge sick patients more.

 

Watson had unusually high white blood cell counts and years earlier had part of her colon removed. “Nobody was going to go near me with a 10-foot pole,” she said.

 

Watson next tried to get a health plan by starting her own business. Insurers were sometimes willing to cover a group of employees, which are a better risk than a single person.

 

In 2003, Watson opened a debt-collection service for small companies. Business was good, she said, and she hired three employees. But she still couldn’t convince an insurer to sell her a plan.

 

By then, Watson and her husband were getting increasingly desperate. He still had high medical bills from his injury. Watson was feeling increasingly ill herself, with periodic fevers and swollen glands that made it hard to work.

 

A local doctor helped with basic medical care in exchange for her help collecting his bills.

 

But Watson couldn’t afford more extensive medical tests to find out what was making her sick until 2009, when she was diagnosed with a non-Hodgkin’s lymphoma, a form of blood cancer.

 

“We went through everything we had,” Watson said, including selling off her retirement accounts and mortgaging their home. Friends helped her navigate hospitals where one noted that Watson often was treated like a “second-class citizen” because she lacked insurance. Watson’s aging parents helped with many medical bills. 

 

For a short time, Watson thought she’d found relief when an insurance company agreed to provide coverage. But when she tried to use the plan, she discovered it didn’t cover major medical costs, a trap many consumers fell into when insurers were subject to less oversight. Insurers now must cover a basic set of benefits, though GOP leaders are calling for such mandates to be scaled back.

 

Watson estimates she and her husband ultimately ran up more than $100,000 in medical debt.

 

“Kathy is a smart person, but she sure didn’t have the luck of the Irish,” said Anne Lebrecht, Watson’s 74-year-old mother.

 

Passage of the Affordable Care Act finally offered some relief, thanks to a small temporary program created in 2011 for people like Watson who had been denied coverage.

 

She was able to get on a plan that ultimately cost $363 a month and is now cancer free.

 

“I would have lost everything without that,” Watson said.

 

Before Obamacare, many states ran similar programs, known as high-risk pools. Republicans are now exploring ways to reopen them.

 

But many of these state plans ended up being very expensive because they covered only sick patients. Many had to cap enrollment.

 

The Obamacare plan that helped Watson stopped enrolling people because of costs in early 2013.

 

By then, Watson was well enough to get a job at a company that trained customer support staff for DirecTV. It offered a health plan for $123.50 a month.

 

“It was good coverage,” Watson said.

 

She quit the job at the end of last year after hurting herself working in her yard. This time, thanks to Obamacare, there was no gap for her to fall into.

 

After seeing a television ad by Florida Blue, the state’s largest insurer, Watson called the company, and in less than half an hour, she enrolled in an HMO plan, despite her long medical history.

 

The plan normally cost $664 a month. But because Obamacare offers subsidies to help low- and moderate-income Americans afford premiums and deductibles, Watson pays nothing.

 

“I still can’t believe I can get this coverage,” she said.

 

Today, Watson is upbeat, despite dealing with two failing valves in her heart as well as chronic arthritis and diabetes. She’s taking classes to get a real estate license so she can go back to work and get off government-subsidized insurance.

 

But Watson is getting irritated by what she hears from the new president. “I’ll give it a little more time,” she said. “But I’m not really sure about Trump anymore.”

 

She said she’s ready to go to Washington to tell lawmakers not to roll back Obamacare.

 

“Walk a mile in my shoes,” Watson said. “I never thought I’d have to go through all of this. I was working for an attorney. I was making good money. … I’m not here to get something for nothing. I just want to be healthy, pay my bills and go about my life.

 

http://www.chicagotr...0224-story.html

[Mr. Roboto]

So, in answer the to obvious question of "how will you both cover more people AND lower costs", the answer is "WE WON'T!"  They're gutting medicaid (i.e. fewer people covered) and planning to price gouge seniors. 

 

 

[Its Cousin]

Probably shouldn't put this out there, but the ACA might have saved my life. And, its repeal might kill me... a CT scan found an 11mm tumor in my lung. Without the provisions of the ACA, my future is bleak.

[freedom78]

Wow...is this ongoing? 

 

The ACA has problems --- some big ones --- but covering an extra 20 million people isn't one of them.