Anonymous wrote:i hope this turns into such a disaster that single payer is enacted.

increased access to health INSURANCE is useless.....direct cost control is what is necessary. we need to focus on increased access to actual care required.

If you believe that increased access to health insurance is useless, then I infer that you have never lacked health insurance.

i hope this turns into such a disaster that single payer is enacted.

increased access to health INSURANCE is useless.....direct cost control is what is necessary. we need to focus on increased access to actual care required.

Anonymous wrote:Jeff,

Re your 10:35 post, it's not clear that insurance will be affordable even with the subsidies. Less expensive, yes. But genuinely affordable, that's not clear, since the government isn't privy to households' actual cost-of-living expenses. Medicaid expansion isn't happening in all 50 states. Insurance companies have been allowing parents to keep children on their plans until age 26 for years, so not sure how much the ACA is impacting this category. Pre-existing: Yes, that's a great thing. But can states opt out of that, too? They're opting out of the marketplace and Medicaid expansion.

Net-net, with the shifts in the industry, is this a win-win? It's too early to tell. For now, the sum of it remains dispiriting.

I think you are confusing "expanding access for insurance" with "providing coverage to every single individual". Will the subsidies make insurance affordable for everyone? Likely not. As is the case for just about everything else, people have different priorities. Some people will prioritize something ahead of health insurance -- perhaps logically, for example, if they need the money for food, but perhaps illogically. But, I don't think you can argue that access will not be expanded at all through the subsidies.

I don't know how common it was before the ACA for insurance companies to allow children to stay on their parents' coverage. But, I know that the ACA made it universal and it has been one of the most popular facets of Obamacare. Again, it's hard to argue that this has not expanded coverage at all.

Similar to Medicaid expansion. Obviously, it is not expanding coverage in those states that refused to accept it. It is obviously expanding coverage in those states that did.

States cannot opt out of the pre-existing condition prohibition. Amusingly, I've seen a number of Republicans who propose to "repeal and replace" Obamacare state that this is something that would be in the replacement. How they would manage that without an individual mandate remains to be seen.

Also, states cannot opt-out of the exchanges. They can choose not to have their own exchange, but then the Feds build one for them. Every state has an exchange.

I don't think anyone can logically argue that access to insurance is not being expanded. It can be argued that some are receiving less affordable or less convenient access -- and some may be dropping insurance as a result. But, such individuals are not being denied access, they are choosing not to use the access available to them.

It should also be noted that we've seen companies expand access to health insurance as a result of the ACA. For instance, Disney World very publicly announced that it would convert part time workers to full time in order to give them health benefits.

Jeff,

Re your 10:35 post, it's not clear that insurance will be affordable even with the subsidies. Less expensive, yes. But genuinely affordable, that's not clear, since the government isn't privy to households' actual cost-of-living expenses. Medicaid expansion isn't happening in all 50 states. Insurance companies have been allowing parents to keep children on their plans until age 26 for years, so not sure how much the ACA is impacting this category. Pre-existing: Yes, that's a great thing. But can states opt out of that, too? They're opting out of the marketplace and Medicaid expansion.

Net-net, with the shifts in the industry, is this a win-win? It's too early to tell. For now, the sum of it remains dispiriting.

Anonymous wrote:[

It is not the fault of the Supreme Court, it is the fault of the Democrats in Congress who knowingly passed a law that was unconstitutional. The Congress cannot mandate that the States implement programs. It simply doesn't have the authority -- that is settled law. They were warned, and they ignored the warnings, because they needed to use the budget reconciliation process to cram the law through, and that didn't give them time to fix it's many (known) flaws.

Right, the justices of the Supreme Court, the litigants and the many parties who filed the amici briefs all somehow missed this. IF ONLY THEY HAD LISTENED TO YOU!!!

Anonymous wrote:
It is not the fault of the Supreme Court, it is the fault of the Democrats in Congress who knowingly passed a law that was unconstitutional.

Many Republicans declared that the individual mandate was unconstitutional. Yet, it was withheld. By your reasoning, all of those Republicans were knowingly lying.

Anonymous wrote:
It is not the fault of the Supreme Court, it is the fault of the Democrats in Congress who knowingly passed a law that was unconstitutional. The Congress cannot mandate that the States implement programs. It simply doesn't have the authority -- that is settled law. They were warned, and they ignored the warnings, because they needed to use the budget reconciliation process to cram the law through, and that didn't give them time to fix it's many (known) flaws.

This is a novel view of the legal history of the ACA. From here (see p. 4; NFIB vs. Sebelius was the ACA case)

http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8347.pdf

The Supreme Court has long recognized that Congress may attach conditions to the federal funds that it disburses to states under its spending power to ensure that funds are spent according to Congress’ vision of the general welfare. This power has been interpreted broadly to allow Congress to achieve policy objectives that it could not attain by legislating directly through its enumerated powers. While such conditions can be viewed as extending into areas traditionally encompassed by the states’ general police power to regulate the public’s health, safety and welfare, at the same time, “states have traditionally been considered by courts to be [sovereign governments and therefore] relatively resistant to such coercion.”

Prior to NFIB v. Sebelius, the Court upheld Congress’ power to fix the terms on which it disburses federal money to states as long as the condition satisfies four factors: it must be (1) related to the general welfare, (2) stated unambiguously, (3) clearly related to the program’s purpose, and (4) not otherwise unconstitutional. In only two earlier cases, one in the 1930s, and another in the 1980s, the Court noted as an aside that there possibly could be a future case in which a financial inducement offered by Congress could pass the point at which permissible pressure on states to legislate according to Congress’ policy objectives crosses the line and becomes unconstitutional coercion.

In NFIB v. Sebelius, the Court for the first time found that a federal condition on a grant to states was unconstitutionally coercive.

Well, since this is no longer a discussion of the rates on the DC exchange, but of the ACA in general, I'll move it to the Political forum.

Anonymous wrote:If you really look at that map, it's not purely political whether the states challenge or accept the law. In fact, few outside of CA and the northeast accept the law entirely.

It's not a question of "challenge or accept" the law. It's a question of participating in the Medicaid expansion, or not participating in the Medicaid expansion.

Here are the states, by whether the governors are Republicans or Democrats.

http://commons.wikimedia.org/wiki/File:United_States_Governors_map.svg

Here are the states, by whether or not they're participating in the Medicaid expansion.

http://www.advisory.com/Daily-Briefing/Resources/Primers/MedicaidMap#lightbox/2/

Anonymous wrote:

Anonymous wrote:9:49 ACA expanded Medicaid coverage. But it's state by state, and there are reports that millions will not be eligible.

Yes, millions will not be eligible. But that is not the fault of the ACA. It's the fault of the Supreme Court.

Before the ACA, states were required to provide Medicaid coverage to

1. pregnant women and children under age 6 with family incomes at or below 133% of the federal poverty level (FPL)
2. children ages 6 through 18 with family incomes at or below 100% federal poverty level
3. parents and caretaker relatives who meet the financial eligibility requirements for the former AFDC (cash assistance) program
4. elderly people and people with disabilities who qualify for Supplemental Security Income (SSI) benefits based on their low income and resources

They were not required to provide Medicaid coverage to non-disabled, non-pregnant adults without children. Medicaid eligibility for working parents was also very limited.

Under the ACA, states would have been required to also provide Medicaid coverage to every non-pregnant, non-disabled adult under 65 with an income at or below 138% of the federal poverty level, starting in 2014. The federal government would have paid for almost all of this coverage, from 100% in 2014-2016 decreasing to 90% in 2020 and thereafter.

The Supreme Court found this requirement unconstitutional.

Now it is up to the states to decide whether or not to accept the Medicaid expansion. Not surprisingly, this decision has gone according to party lines. States with governors from the party that opposes the ACA have not accepted the Medicaid expansion. Therefore, people who live in those states, who would have been covered under the Medicaid expansion in the ACA, will now not be covered.

Lots and lots and lots of detail here: http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8347.pdf

It is not the fault of the Supreme Court, it is the fault of the Democrats in Congress who knowingly passed a law that was unconstitutional. The Congress cannot mandate that the States implement programs. It simply doesn't have the authority -- that is settled law. They were warned, and they ignored the warnings, because they needed to use the budget reconciliation process to cram the law through, and that didn't give them time to fix it's many (known) flaws.

Anonymous wrote:I know several families who currently have health insurance, they're self-insured, and who will save money under ACA because of their states' ACA offerings. (NJ, PA, MI). That's great, but it doesn't address the uninsured issue, does it?

Also, why did it take FOUR YEARS for this to come together? The President signed this into law in March 2010.

The whole thing, from the delays and the website that doesn't work to the Tea Party lunatics, is just so dispiriting.

As has been pointed out several times in this thread, the ACA helps with the uninsured through at least four ways:

1) expanded Medicaid coverage;
2) allowing children to stay on their parents' plans until age 26;
3) eliminating pre-existing conditions as a reason to deny coverage; and
4) providing subsidies to the poor to make insurance affordable.

Part of the problem with the Federal exchanges is that some states waited until the last minute to inform the government that they would rely on a federal exchange. Collecting requirements is normally the first step of a software development project. In this case, requirements were continually changing. This led to a shortened development cycle that did not allow for extensive testing. I assume that a thorough post-mortum will identify a number of other problems as well -- some of them likely inexcusable -- so I am not trying to suggest there aren't real problems. But, any major software project is difficult and -- as I've been posting in the political forum -- fairly common in the private sector as well. It's pretty clear that the state exchanges are doing a whole lot better. While even most of those launched with bugs, most are now working well.

Anonymous wrote:

Anonymous wrote:

ITA it doesn't solve the uninsured problem. Many people will not find plans for under $750 and just pay the fine instead or lie on their taxes (whaaaat people lie on their taxes?!?)

Yes, it doesn't solve the uninsured problem. But it reduces the uninsured problem.

Also,

1. If you cannot find health insurance that costs less than 8.5% of your income, you are exempt from the requirement to have health insurance.
2. the ACA provides subsidies for health insurance for people with household incomes up to 400% of the poverty level. The poverty level for a 2-person household is $15,510. So if you are in a 2-person household, and you're buying insurance on the exchange, you get a subsidy to pay for your health insurance if your household income is under $62,040.

Actually there is no proof yet that it will reduce the uninsured yet either! Only in theory!

I know of people BECOMING uninsured as a direct result of the ACA (Mom getting kicked off husband's plan, companies dropping coverage all together, etc)

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:What problems will ACA solve?

Access to health insurance. The ACA will reduce the number of people who don't have health insurance.

That has yet to be seen. First of all, you have to be able to actually enroll, which is difficult to impossible at this point. How many younger healthier people will just opt to pay the fine? Second, many folks with non- ACA compliant individual plans have had their insurance canceled, only to find that the plans on the exchanges are much more expensive and/or have much higher deductibles. Not to mention all of the folks who have their hours reduced below 30 hours, and dumped off their employers plan, and/or their employer has under 50 employees, and their insurance was non-ACA compliant, so they just stopped covering their employees altogether.

My understanding is that the "affordable" (subsidized) premium numbers being cited have high co-pays, which are not subsidized. That's going to be a shocker for some low-income folks when they actually try to go to the doctor.

At the end of the day, there very well could be fewer insured people in the US when this is done.

Yes, that's true. The future hasn't happened yet. It is too early to say that the ACA is a success. It is also too early to say that the ACA is a failure.

If you really look at that map, it's not purely political whether the states challenge or accept the law. In fact, few outside of CA and the northeast accept the law entirely.

Anonymous wrote:

ITA it doesn't solve the uninsured problem. Many people will not find plans for under $750 and just pay the fine instead or lie on their taxes (whaaaat people lie on their taxes?!?)

Yes, it doesn't solve the uninsured problem. But it reduces the uninsured problem.

Also,

1. If you cannot find health insurance that costs less than 8.5% of your income, you are exempt from the requirement to have health insurance.
2. the ACA provides subsidies for health insurance for people with household incomes up to 400% of the poverty level. The poverty level for a 2-person household is $15,510. So if you are in a 2-person household, and you're buying insurance on the exchange, you get a subsidy to pay for your health insurance if your household income is under $62,040.