Is the ACA Unraveling?

[DemocratSinceBirth]

This is unbelievable.

[quinnox]

1. No, it is getting fixed and adjusted

[warrior1]

2. stop it

[cali]

6. stop what? Stop asking questions? Stop any criticism of the ACA at all?

There are some serious problems facing the ACA and yet there are too many people here who want to shut down rational discussion of the issues.

[geek tragedy]

10. there's rational discussion vs "the sky is falling" nt

[cali]

14. I don't disagree with that, but ANY criticism of the ACA is met with attempts

to shut it down.

[KittyWampus]

25. most of the criticism is bullshit.

[cali]

29. such as? what do you consider bullshit?

Is it bullshit that there's a perception problem? Is it bullshit that the democratic caucus in Congress is fracturing over it? Is it bullshit that there have been problems with the federal website?

whining about criticism and trying to shut it down is a big stinking unhelpful pile of shit.

[geek tragedy]

39. methinks you exaggerate some--there's a lot of criticism, much of it founded.

Some criticisms get shouted down, a few underservedly so.

[Romulox]

3. It doesn't make sense. It's mandatory private insurance ON TOP OF the already broken system. nt

[Jesus Malverde]

48. Absent any price controls, other than the good will of PRIVATE for profit corporations..

All passed on to the now captive consumer.

[Romulox]

56. Who have guaranteed margins under the law, subsidized by the Federal government???

It is a plan only the Heritage Foundation could've come up with. A bizarre mishmash that enshrines for profit greed into out healthcare law without capturing any of the efficiencies of the marketplace. And at the same time, the ACA brings to bear the entire weight of the Federal government into a plan that doesn't guarantee care from everyone.

A bizarre, "third way" Frankenstein's monster...

edit: Edit to make it clear I am agreeing whole-heartedly with Jesus Malverde's extremely well put post.

[tridim]

63. A guaranteed profit margin?

In the ACA?

I think you meant to say a profit CAP, which is not a "guaranteed profit margin". Insurance companies are free to lose customers and profit just like any other business.

[Romulox]

66. They only have to spend 80% on care--a percentage that would invoke a Congressional Hearing if it

were Medicare.

[tridim]

67. Before the ACA they could legally spend 8% on care.

Keep complaining though if it makes you feel better.

[Romulox]

70. Before the ACA I wasn't forced to buy from them. nt

[tridim]

71. If you wanted health insurance, yes, you were forced to buy from them. nt

[Romulox]

72. So, a pointless subthread of what ifs. Mandatory for-profit insurance still is hard to justify. nt

[Hoyt]

79. A good chunk of the 20% is overhead, not profits. Medicare has overhead too, and uses insurance

companies to administer the program. At best, Medicare-for-all premiums MIGHT BE 10% less than the insurance companies are charging (under the Medical Loss Ratio), and then the government would have to spend all the money to administer the program that the private insurance companies are shouldering now.

And Medicare is not so good when you consider there are no caps on out-of-pocket costs, etc. My guess is that most folks who are griping now, would be griping under Medicare-for-all if the savings in premiums weren't a whole lot more.

Truth is, the whole system needs an overhaul including what providers expect to get, and what patients expect. Only then are we truly going to have something approaching affordability.

[Romulox]

80. "administrative costs in Medicare are only about 2 percent of operating expenditures..."

*According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.

*Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.

*Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.


http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

[Hoyt]

86. That doesn't include all administrative costs, and Medicare administration costs

as a percentage look much better because Medicare expenditures per beneficiary are so much greater. Medicare also loses a ton by paying just about any claim, and trying to recoup fraudulent payments after the fact.

Even if you took your 17%, most folks are going to gripe unless premiums are really cheap like less than a dinner and movie. It ain't gonna happen.

Again, Medicare has no cap on out-of-pocket costs, has serious cover gaps, etc.

My point still stands, until providers and patients accept the compromises needed to make health care truly affordable, we will never be happy.

[Jesus Malverde]

64. I've heard this described as a Heritage foundation plan

That "progressives" would be promoting and aligning themselves with it is surprising.

I'm concerned about the expected sacrifice young people are supposed to make to make this plan work. A generation already saddled in debt and facing limited job opportunities.

[Romulox]

68. I don't think it's even logical to believe that younger people *could* bail out this system.

It's odd to think that a generation of young already saddled with unprecedented inequality, debt, and downward pressure on wages could bail out this bizarre system we have it. Set aside issues of fairness. How is it even mathematically possible that there are enough affluent "bros" out there to shoulder 10% increases in the cost of insurance per year?

With what money? Made from which jobs?


Again, another very well put post.

[Demo_Chris]

83. They can't, and they wont...

Until the penalties get so abusive they are forced to do so.

They won't get anything for their money because they won't be able to afford the deductibles. Or college, or electricity, or their own apartment. According to many here, they should just be more "responsible" with their $9 an hour paycheck.

[leftstreet]

4. It was shitty legislation. It can only get better n/t

[scheming daemons]

5. geezus... trash thread

No. Not even close.

Like another poster said... Stop it.

[DemocratSinceBirth]

13. Medicine 101

Ignoring a problem doesn't make it disappear...

[scheming daemons]

24. "is it unraveling?" isn't reasoned discussion. it is mindless hysteria.

[AgingAmerican]

60. It's a question

The reaction to the question is hysteria.

[geek tragedy]

7. Jeebus man, don't panic.

Yes, this is a politically toxic moment, but the only thing to fear is panic itself.

[pinto]

8. No. It isn't. One overlooked aspect of the 1 year extension is the requirement for ins. companies

to inform policy holders of their options. Including ACA. No more bait 'n switch.

[Whisp]

15. I don't see that as a reason to lose your freakin mind over.

Some of the reactional threads here are hilarious.

[AgingAmerican]

62. And some of the reactions to the reaction

...are funnier.

[HijackedLabel]

9. No.

When you itemize the ACA, people support it wholeheartedly.

It's the 'Obama' part no one likes.

That and the media sensationalism that amplifies every MINOR problem with the law.

[Demeter]

16. Honey, they haven't even started talking about the Major problems with the law

It's not going to get better. Fixing the minor problems won't make any improvement in this fundamentally flawed law. It was designed on a faulty premise. Several, actually.

[DemocratSinceBirth]

17. The plan was well intentioned but...

The plan was well intentioned but it looks like "we" don't know what we are doing.

[HijackedLabel]

18. Working just fine here in a state that expanded Medicaid and set up its own exchange.

Many members of my family are getting Medicaid or getting plans as cheap as $20 a month after subsidies.

I'm sorry some people think they are getting a raw deal, but their whiny bullshit is what's undermining the law for me and my family.

[Demeter]

27. Medicaid is NOT Obamacare

People have been shut out of Medicaid for decades (generations, even) who qualified based on income, because the State govts. and the Feds were too damn cheap to pay as needed.

Breaking down the Medicaid quota system is very nice, but that isn't Obamacare. And when that lovely federal money goes away (very soon) it will be business as usual for Medicaid. Medicaid reform would have been useful, but it hasn't happened.

[HijackedLabel]

28. Obamacare expanded Medicaid.

And should be counted in the enrollment numbers.

As the President said, they are Americans too.

[Demeter]

40. Medicaid is Medicaid, an entirely separate and unequal program

It has the virtues of

1. actually being functional

2. actually being funded out of general revenues

BUT it is of limited access, limited care, and when you die, your estate is forfeit to the govt. to repay the cost of your medical care.

The fact that the ACA ALSO expanded Medicaid (and not in a sustainable fashion) does not mean the two are equal and alike.

If you are going to make points in an argument, it helps to have a few hard, knobby facts on your side. Emotion will not cut it.

[Puzzledtraveller]

35. I'm a Medicaid caseworker and the conflation of the two irritates me to no end.

You are spot on too. Medicaid is a seperate issue that they enticed some states with and repulsed others no thanks in part to the SCOTUS. However, seperate Medicaid reform would have been great and would maybe have allowed more people to be covered in all states.

[Jesus Malverde]

55. The subsides as I understand it are actually tax credits...nt

[Demo_Chris]

84. Yep. That's what's so alarming, and the defenders REFUSE to see it. nt

[cali]

19. but that is not the general perception of the ACA

and minor problems have a way of adding up. There are real and serious problems with the ACA that need fixing sooner rather than later.

[HijackedLabel]

21. You can't make fixes when there's an entire political party,

whose sole mission is to repeal the law using any minor problem as an excuse.

When changes have to be made legislatively, it's not going to happen.

People need to suck it up and defend what we have in the moment.

[cali]

32. If, as you claim, it's not possible to make fixes, than we're really fucked.

And trying to silence people sucks ass.

[Whisp]

11. No it isn't. Calm down.

We have been through these things too many times - this jumping up and down with asshairs on fire.

Calm down.

[SidDithers]

61. "asshairs on fire" might be my new favourite sky-is-falling phrase...

Sid

[snooper2]

12. not unless our new kitten got a hold of it

Damn cat is a fucking terror!


My cat Samy who is about to turn 15 looks at it and says, "really"? You just chased your own ass around the living room for 10 minutes

[badtoworse]

20. The short answer seems to be Yes.

[Demeter]

30. The more detailed answer looks rather like Napoleon's march on Russia

[Demo_Chris]

87. I was thinking Stalingrad for the Germans. nt

[Demeter]

90. Same scenario, same results, different century

[Puzzledtraveller]

22. It's Nth Dimensional Chess.

I forget what dimensions we are on. I believe we crossed over into String Theory.

[SammyWinstonJack]

69. ...

[Rex]

23. What makes you say that?

nt.

[TwilightGardener]

26. It's already been partially implemented, and the exchanges are only six weeks old.

So, no, I don't think so. You just have to tune out the GOP/Media screeching sky-is-falling noises. They WANT everyone swept up in hysteria and doom. Resist it.

[Whisp]

31. that is what is is: GOP hysteria swallowed up whole without question

by the perpertually disappointed.

tired act, same actors.

[cali]

34. way to stick your head in the sand. Public perception is a real phenomenon

with real ramifications- whether it's GOP hysteria or not.

[Demeter]

41. Furthermore, not all people are fooled by the PR

Take cali, Tansy Gold over in the Economy group, and me, for starters...we have been doing the research. You are welcome to view it all. Links in our journals.

[TwilightGardener]

47. It's not sticking your head in sand to look past the screech monkeys.

The White House and Democrats need to fix the fixable problems, and come out swinging in defense. Many people will (and have already) benefitted from the ACA, and to go backwards with some sort of repeal or unwinding of the law will fuck up the system and hurt people far more than letting the ACA go forward with adjustments. Republicans actually know that--that's why they weren't all-in for Cruz's jackassed shutdown. They'd rather try to force chickenshit Dems to help them undermine it in the guise of "helping".

[TwilightGardener]

43. I don't know that any other program has ever come under such intense

negative scrutiny and opposition, it's almost impossible to avoid letting it affect your own thoughts and feelings. When you hear 24/7 that it's the biggest catastrophe to ever have happened in the United States (and really, they are saying just that on righty blogs), you have to remind yourself that it's CHANGES TO HEALTH INSURANCE COVERAGE, and not much more than that. Republicans have mastered hissy fits, Democrats are spineless, and the volume gets turned up to eleven and everyone panics.

[DemocratSinceBirth]

45. It doesn't matter who is causing the hysteria.

People are hysterical, if the polls are to be believed, and they are blaming us as in Democrats.

[TwilightGardener]

49. Most people are not directly, negatively affected. Most people have

coverage thru employers, Tricare, Medicare, etc. That's why Dems need to keep perspective, keep control of messaging, and ride out the intial storm.

[FarCenter]

52. "not directly" is the key phrase

But the taxes on medical devices, drug companies, insurance companies, Cadillac plans, etc. will all feed through to higher employee contributions, more limited network options, and higher out of pocket costs.

[TwilightGardener]

53. There's a lot of moving parts you've just introduced there, so I would need to see

how it all shakes out, probably won't know for a few years.

[FarCenter]

58. Affordable Care Act Tax Provisions

http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

[Laelth]

33. No. It's the law, and it's not going anywhere.

Remember Truman.

No apologizing for the ACA!

I've seen it happen time after time. When the Democratic candidate allows himself to be put on the defensive and starts apologizing for the New Deal and the fair Deal, and says he really doesn't believe in them, he is sure to lose. The people don't want a phony Democrat. If it's a choice between a genuine Republican, and a Republican in Democratic clothing, the people will choose the genuine article, every time; that is, they will take a Republican before they will a phony Democrat, and I don't want any phony Democratic candidates in this campaign.

http://en.wikiquote.org/wiki/Harry_S._Truman

-Laelth

[FarCenter]

36. Why is Obama taking so much heat for ACA? It was designed by the House and Senate.

Back in 2009 we controlled both houses of Congress. ACA is the result of years of Democratic planning to revise health care. It was rushed into law while we had control of both houses, partly as a tribute to the late Senator Kennedy.

I doubt that Obama had much idea of what was going on. In the White House, health care policy was mainly under the control of some ex-Clinton administration types.

[Lifelong Dem]

37. Not even close to unraveling

Never even crossed my mind. A lot of people are saving money with ACA.

Here are a few of the many.

http://queenofspainblog.com/2013/11/13/we-just-enrolled-in-obamacare/

http://www.huffingtonpost.com/2013/10/05/i-am-obamacare-_n_4046470.html

http://www.lohud.com/article/20131112/NEWS02/311120064/Affordable-Care-Act-profile-Self-employed-couple-find-400-savings?odyssey=mod|newswell|text|News|p&nclick_check=1

[Pretzel_Warrior]

38. No. Get a grip.

[Tarheel_Dem]

42. Jane Hamsher? Is that you?

[Whisp]

46. ah ha! It's coming to that time of pre-midterms again, isn't it?

[Tarheel_Dem]

50. You know it! $$$$$$$$

$$$$$$$$------>>>>>

[RandiFan1290]

44. He has to save 2014!!!!

Remember when he extended the tax cuts for the rich to help win the 2010 election?

Thank god it passed!!!!

[lostincalifornia]

51. no, the MSM in this country has been unraveling for some time now, and have reached a stage where

they are essentially useless.

When chuck toad said that it wasn't his job to question false statements made by republicans about the ACA, that said everything

[factsarenotfair]

78. Worse than useless.

Actually damaging and discouraging.

[Orrex]

54. Holy shit you're right!

I was outside during my lunch break, and I swear that the sky was falling!

[lapfog_1]

57. We aren't getting single payer

it's not going to happen... at least not in my life time. (i'm feeling old today).

So let's hope the ACA works well enough.

If all it takes is this tweak to make it perceived to be working for 3 million Americans... and if it works well for 37 Million more (like the uninsured from before or students who can stay on their parents health care or the 1 Million additional people who can get Medicaid)...

All that has to happen is for those Americans to show their appreciation by VOTING "D" next November.

[ljm2002]

59. Not yet, no...

...but I sure am tired of Obama capitulating under pressure.

[NCTraveler]

65. It is not unraveling.

They are panicking and attempting to fix an extremely flawed piece of legislation.

[winter is coming]

73. No, but that will probably be the meme for the next week.

Media types talk about it as if it's going up like the Hindenburg. Real people I talk to or overhear talk about it like a minor fenderbender -- a nuisance, but not a calamity.

[LittleBlue]

74. Bernie was right on this one

Outside of a few provisions like raising Medicaid eligibility and ending discrimination on pre-existing conditions, this was dogshit legislation.

It will end up hurting us.

We need government-run healthcare, not a reconfigured profit scheme.

[WinkyDink]

75. I hope not! Americans will need coverage when they get sick from China-processed "U.S." chickens!

[gcomeau]

76. No. Get a grip. -nt

[Yo_Mama_Been_Loggin]

77. No

The media isn't doing its job.

[WorseBeforeBetter]

81. Insurers cancelling some policies effective January 1st...

and the so-called government IT experts saying today that the website may not be ready by 12/15. Gaps in coverage, cancer patients starting over with new doctors... yep, unfuckingbelievable.

[CJCRANE]

82. Constant hysteria. The level of hysteria seems to remain constant whatever the issue.

In fact it seems more chronic than the justified anxiety about the government shutdown and possible debt ceiling breach leading to a global economic crisis several weeks ago.

[spanone]

85. the m$m would have you believe....

[libdem4life]

88. I am a major supporter, but it reminds me of finding an old jigsaw puzzle,

seeing the great cover on the box top, dumping out the pieces and digging through the pile to find the corners, then the edges, start little side groupings by matching colors or faces or objects, then pray that all of the rest of the pieces are there to finish it.

[gulliver]

89. No, but people with backbone are getting more lonely. nt