Trump to gut ACA via executive order

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The ACA was fundamentally flawed and everyone, including the Obama administration knew it. There is no point in using band aids to deal with the flaws. Just repeal it and come up with a structurally sound alternative.

As long as the flawed ACA is allowed to continue with fixes, the less likely that it will really be dealt with in a serious way.

Name the alternative. The ACA was the GOP plan. The GOP has now rejected it because the black guy installed it.

So now what? Can't go back to what was before, and the ACA is now dead. What do you suggest?

Too much to cover in a post but basically:

- We need a public option - not single payer
- Insurance across state lines should be permissible
- People who make lifestyle choices that jeopardize their health pay more eg those who are overweight, smoke, don't go in for medically recommended screenings, etc
- Pharmaceutical prices MUST be negotiated and, if needs be, the option should be available to purchase from a different country eg Canada - but subject to it being from approved sources to deal with quality issues
- States should be allowed maximum latitude to develop their own health financing and delivery mechanisms
- It should be mandatory for every American to have health insurance - the half-assed approach that ACA took with minimal tax penalties was ludicrous
- Primary care specialties have to be incentivized so that more physicians choose that vs the other specialties that are better compensated
- "Medicare for all" has merit but not the way that liberals have promoted it. Phase it for those over 60 initially and then after a certain time span depending on how well it works, consider expanding it to perhaps those over 55.
- Illegals cannot be given free or subsidized medical coverage

There is more and all of the above are just general policy prescriptions which need to be filled out with greater detail.

But let me repeat, it would be utterly futile to continue to try and fix the ACA given its fundamental flaws. And I don't care whether it was based on Republican ideas or not. I am not a supporter of Trump but if both sides are not willing to come to the table to really deal with health care in a realistic way then it is better that it implodes and the outcry that would result will force some thing more effective and structurally sound. Schumer and Pelosi are out of their fricking minds when they start out with the position that there will be no repeal of the ACA but they are only open to "fixing" it which is code for throwing more money at it.

But in the meantime, has why not destabilize the whole insurance markets just for the fun of it.

I am convinced that until politicians from both sides have their backs against the wall nothing will happen. Both sides are too entrenched in their respective ideological positions. What will it take for people to get it into their heads that ACA in its present form will never be viable? It is structurally unsound and the temporary fixes that the Democrats want will just make things worse over time.

What Trump's EO order will do is to accelerate the process of implosion which is hardly desirable but given that neither side wants to address the issue without budging from their respective positions perhaps this will cause enough of a reaction to compel serious discussion and negotiation.

BTW, my background is in health care administration and we knew when ACA was passed that it was a matter of time before it would fall apart.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The ACA was fundamentally flawed and everyone, including the Obama administration knew it. There is no point in using band aids to deal with the flaws. Just repeal it and come up with a structurally sound alternative.

As long as the flawed ACA is allowed to continue with fixes, the less likely that it will really be dealt with in a serious way.

Name the alternative. The ACA was the GOP plan. The GOP has now rejected it because the black guy installed it.

So now what? Can't go back to what was before, and the ACA is now dead. What do you suggest?

Too much to cover in a post but basically:

- We need a public option - not single payer
- Insurance across state lines should be permissible
- People who make lifestyle choices that jeopardize their health pay more eg those who are overweight, smoke, don't go in for medically recommended screenings, etc
- Pharmaceutical prices MUST be negotiated and, if needs be, the option should be available to purchase from a different country eg Canada - but subject to it being from approved sources to deal with quality issues
- States should be allowed maximum latitude to develop their own health financing and delivery mechanisms
- It should be mandatory for every American to have health insurance - the half-assed approach that ACA took with minimal tax penalties was ludicrous
- Primary care specialties have to be incentivized so that more physicians choose that vs the other specialties that are better compensated
- "Medicare for all" has merit but not the way that liberals have promoted it. Phase it for those over 60 initially and then after a certain time span depending on how well it works, consider expanding it to perhaps those over 55.
- Illegals cannot be given free or subsidized medical coverage

There is more and all of the above are just general policy prescriptions which need to be filled out with greater detail.

But let me repeat, it would be utterly futile to continue to try and fix the ACA given its fundamental flaws. And I don't care whether it was based on Republican ideas or not. I am not a supporter of Trump but if both sides are not willing to come to the table to really deal with health care in a realistic way then it is better that it implodes and the outcry that would result will force some thing more effective and structurally sound. Schumer and Pelosi are out of their fricking minds when they start out with the position that there will be no repeal of the ACA but they are only open to "fixing" it which is code for throwing more money at it.

But in the meantime, has why not destabilize the whole insurance markets just for the fun of it.

I am convinced that until politicians from both sides have their backs against the wall nothing will happen. Both sides are too entrenched in their respective ideological positions. What will it take for people to get it into their heads that ACA in its present form will never be viable? It is structurally unsound and the temporary fixes that the Democrats want will just make things worse over time.

What Trump's EO order will do is to accelerate the process of implosion which is hardly desirable but given that neither side wants to address the issue without budging from their respective positions perhaps this will cause enough of a reaction to compel serious discussion and negotiation.

BTW, my background is in health care administration and we knew when ACA was passed that it was a matter of time before it would fall apart.

My background's also in health policy and administration. Who's "we"?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So Trump has killed the ACA with nothing to replace it.

Yup, millions will lose health insurance, many of them poor Trump voters. And after a few years, we will just hit bottom and when voters revolt we can have a real conversation on what constitutes minimum health care and the merits of single payer.

They're not going to lose health insurance. It sounds like it's only the cost-sharing subsidies that will be impacted, not the premium subsidies. So people with low incomes will still get a free or nearly free insurance plan. They might have to pay more to see the doctor, but the plan itself would still be free.

So you are saying poor people,can afford to pay more to see doctors? And that the next rung up on the economic laddder can pay the higher insurance premiums? Whew. That's a relief. I thought people who were dirt poor might not be able to pay more to see the doctor, gets tests, fill prescriptions, etc. and that the true middle class was strapped enough without a hint GE health insurance premium rise.

Silly me. Such a relief that the government can stop paying billions and it will effect no one. Kinda makes you wonder why we were paying it in the first place.

Sarcasm isn't a good look for you.

Right now we have this ridiculous inequitable system where poor people get free insurance plans AND see the doctor for free, and working class ($50kish) have to pay astronomical premiums they can barely afford and then can't see the doctor anyway because it's not covered. In other words, moderste earners are required to provide FREE care to others that they can't afford for themselves! This way, the pain is spread more evenly, and the real hurt of Ocare is felt. This will force Comgress to act and come uo with a replacement. Otherwise, liberals will continue to be behind the plan, since poor people are taken care of and they (the liberals) have disdain for the working class.

Except poor people will continue to get free care through Medicaid and ACA premium subsidies, and the middle class will get stuck with sharply rising premiums. It makes the problem in the Middle worse.

[Anonymous]

I indirectly administer Medicaid through my job (it's not my primary job, but it's a side effect). The bottom 20-25% won't feel this at all. Maybe more in Medicaid expansion states. Middle class and UMC, whether they buy through the ACA or their employer, are going to get killed on premiums. The exception will be extremely large pools, like Feds. Where there are hundreds of thousands of healthy buyins for some policies.

Taking things away without a plan to replace by EO-- the Climate accords, DACA, the ACA-- isn't legislating. It's going to cause chaos on many levels.

Welcome to Seve Brannon's utopia.

[Anonymous]

Deplorable.

[Anonymous]

Anonymous wrote:I indirectly administer Medicaid through my job (it's not my primary job, but it's a side effect). The bottom 20-25% won't feel this at all. Maybe more in Medicaid expansion states. Middle class and UMC, whether they buy through the ACA or their employer, are going to get killed on premiums. The exception will be extremely large pools, like Feds. Where there are hundreds of thousands of healthy buyins for some policies.

Taking things away without a plan to replace by EO-- the Climate accords, DACA, the ACA-- isn't legislating. It's going to cause chaos on many levels.

Welcome to Seve Brannon's utopia.

This is bad policy on so many levels. Millions of people are going to forego needed medical care. But hey-Trump and his family are going to get a huge tax cut!

[Anonymous]

Health insurance should have NEVER been privatized. It is a public good. I hope to God we see a single-payer federal system in place in my lifetime.

[Anonymous]

Anonymous wrote:Health insurance should have NEVER been privatized. It is a public good. I hope to God we see a single-payer federal system in place in my lifetime.

We may. But the period of time between now and then will be hell on earth for tens of millions of Americans.

[Anonymous]

I feel for the millions of people - our most vulnerable people - who will be devastated by this move. It's reckless and vengeful and entirely about an F-U to Obama rather than any thoughtful move to improve insurance and medical care in this country.

Aside from those who are ill and those people who will get sick or have children or have conditions that will be undesirable for insurers to cover (e.g., asthma, diabetes, hypertension, etc), women will also suffer. Maternity coverage is very expensive ....

Really sad for working and middle class Americans who will be most hurt by this. Really angry that the GOP and the POTUS care more about sticking it to the past president out of spite than the well being of citizens.

[Anonymous]

Anonymous wrote:I indirectly administer Medicaid through my job (it's not my primary job, but it's a side effect). The bottom 20-25% won't feel this at all. Maybe more in Medicaid expansion states. Middle class and UMC, whether they buy through the ACA or their employer, are going to get killed on premiums. The exception will be extremely large pools, like Feds. Where there are hundreds of thousands of healthy buyins for some policies.

Taking things away without a plan to replace by EO-- the Climate accords, DACA, the ACA-- isn't legislating. It's going to cause chaos on many levels.

Welcome to Seve Brannon's utopia.

Not sure about this. Subsidies and reimbursements are stopping effective immediately. That most definitely affects the bottom 25%.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Going forward, it's TrumpCare.

If it isn't covered and you thought it was, that's on Trump.
If it is more expensive, then it's on Trump.
If you have caps, its on Trump.
If pre-existing isn't covered, it's on Trump.

yep. AGREE!

Disagree. Why would Obama design a health care plan that requires a Republican president to prop it up, lest it fall apart? If it can't stand on its own, it's fundamentally flawed, and the person who designed and pushed it is to blame.

[Anonymous]

The middle class who do not get the subsidies are already being killed on this.

[Anonymous]

This EO is great. States can still regulate insurance so blue states will most likely keep Obama regulations. It WILL hurt red states and maybe that's what's needed for their populations to rethink who they support.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The ACA was fundamentally flawed and everyone, including the Obama administration knew it. There is no point in using band aids to deal with the flaws. Just repeal it and come up with a structurally sound alternative.

As long as the flawed ACA is allowed to continue with fixes, the less likely that it will really be dealt with in a serious way.

Name the alternative. The ACA was the GOP plan. The GOP has now rejected it because the black guy installed it.

So now what? Can't go back to what was before, and the ACA is now dead. What do you suggest?

DP. Maybe if the Demcratic president hadn't championed a GOP plan, we wouldn't be in this mess.

[Anonymous]

Anonymous wrote:This EO is great. States can still regulate insurance so blue states will most likely keep Obama regulations. It WILL hurt red states and maybe that's what's needed for their populations to rethink who they support.

This is a good point. Individual states have their own regulations in regards to what insurance companies need to provide. The blue states most likely will require broader coverage than the red states, and the state insurance commissioners usually have to agree with an increase in the premiums. Additionally, it's the red states that have more unhealthy people, hence, the premiums in the red states will be higher since there is more risk.