Taking a Hatchet to healthcare (Pt. 1)

This will be a multi-parter on the P-Care proposal from Republicans.  I’m busy today.

Section 101: Repeal Obamacare
Standard Republican boilerplate with a lie in the first sentence as healthcare costs as a proportion of GDP actually decreased last year.

Section 201: Adopt Common-Sense Consumer Protections
Reinstate the popular to the employed middle class parts of Obamacare. Keep kids on parents’ insurance until the end of age 26, disallow life time limits. Tweak the age rating bands from a 3:1 ratio (Obamacare law) to 5:1 (pre-Obamacare usual and customary) despite that change having little acturial impact. The 3:1 ratio is roughly equal to the actual expected cost ratio for 21 to 64 year olds.
Guaranteed renewability is the Republican means of dealing with pre-exisiting conditions. However medical underwriting will now be allowed so the incentive will be for insurance companies to go do a very thorough record review to look for application ommissions such as failure to list acne as a pre-exisiting condition to deny cancer claims. It says there will be strong regulation, but really, how stupid are we to expect strong regulation from a Republican bill?
Section 202: Pre-exisiting conditions covered based on continious coverage
Continious coverage is the key here instead of the banning of medical underwriting. Basically, if someone is able to keep covered themselves insured, a new policy can’t be medically underwritten against them, they get general rates. The problem is people who have significant health problems AND significant income variation are highly likely to have months where they can not keep continous coverage. One bad stretch and a person is priced out of health insurance for life (although that life will be fairly short)
Section 203 – Empowering Small business and individuals
Basically allow for small business to pool resources together to reduce acturial variance and TAX CREDITS. Or we could just use the SHOP exchanges to do the same damn thing.

Refundable tax credits to individuals and families up to 300% Federal Poverty line. Obamacare has refundable tax credits up to 400% of FPL. Don’t allow those tax credits to be used for abortion (which basically would mean the individual health insurance market would offer very few if any policies covering abortion). Value of those credits are significantly reduced compared to Obamacare credits. For intsance a single 64 year old at 200% FPL would get a $3,720 Republican credit while s/he gets a $6,100 Obamacare subsidy. Two 64 year old non-smokers at 200% FPL would get $13,000 in subsidies from Obamacare or $8,800 from this Republican bill.

Oh yeah, since the Republicans have re-instated medical underwriting, those 64 year olds have the pre-exisiting condition of being OLD. They won’t get Obamacare rates, their rates for anything that provides decent coverage will destroy their subsidy in three or four months.
The idea behind the Republican bill’s smaller subsidy is that people have too much good insurance as it is, so a smaller subsidy will force more people to get catastrophic coverage only and then pay for day to day expenses out of pocket. The threat of destitution will make people extremely cost sensitive and thus extremely efficient shoppers.
Section 204 — More power to states
States can automatically enroll people into coverage equal to their subsidy value. I don’t have a problem with this. Given subsidy levels, these default plans will have deductibles in the $15,000 to $20,000 range. High risk pools will be formed again and be chronically underfunded. Interstate compacts are allowed (as they are now for regulation and selling of insurance, but the Georgia and Maine examples show that few companies really want to sell across state lines)
Section 205 Expand HSAs and Consumer Directed healthcare
Allow pre-tax dollars to pay for non-prescription and over the counter goods and services. Expand allowable uses of HSA dollars. Either of these proposals is worth talking about as they are fairly small bore.

27 replies
  1. 1
    cleek says:

    sounds like a government takeover of the healthcare industry.

    they should be against it.

  2. 2
    Keith P. says:

    Wasn’t continuing coverage the status quo prior to ACA? I’ve always been able to get new insurance (group) with a pre-existing condition due to proof of prior coverage

  3. 3
    Ruckus says:

    Leave it to rebups to try to fuck over as many people as they can at any one time.
    They must feel they get points for involving as many people as possible using the least amount of legislation. Which they probably do from their rich whore mongers. The result of keeping one’s head up one’s own ass for so long is called shit for brains.

  4. 4
    MikeJ says:

    They know that this is really their last shot at it. This year there are still people who don’t understand what “Obamacare” is. A year from now this bill will be taking stuff that people already have away fro them.

  5. 5
    Richard Mayhew says:

    @Keith P.: In certain situations yes, HIPAA allowed for continous coverage for transitions from the group provided insurance market to the individual underwritten insurance market. But this was limited and had some serious flaws.

  6. 6
    Ash Can says:

    So the basic idea is to trim existing Obamacare provisions so that more people die. How very…Republican.

  7. 7
    Roger Moore says:

    @MikeJ:

    They know that this is really their last shot at it.

    It’s their last shot at making political hay out of it, at least; their only chance of actually repealing Obamacare was to take over Congress and the White House in 2012. Neither this bill nor any other bill that tries to overturn Obamacare has a chance of becoming law as long as Obama is in office, and by the time he’s out it will be too late.

  8. 8
    OGLiberal says:

    OK, so it’s sounds like they took the ACA and tweaked it so that it benefits less people. But it’s still government inserting itself into the private coverage market. I can see this getting the Brooks/Morning Joe crowd all warm and fuzzy – so they can say, “See, there are sensible Republicans who are looking for solutions!” But can’t see the TP/wingnut arm of the party liking this any better than the ACA. The only positive I can see it having for them is that it isn’t the product of the ni-CLANG! in the White House.

    And since these just look like tweaks on current ACA provisions, why repeal the ACA and replace? Why not just try to tweak the individual parts of the ACA that this “replacement” seeks to do? Because “repeal” is all the crazies care about. And if repeal were ever to happen – it won’t – even the sensible, moderate, Morning Joe Republicans who put this together know that the “replace” part of the plan will be quickly forgotten and we’ll be back to everybody getting screwed, but with the poors and the blahs getting screwed more than anybody, which will make the baggers happy because at least there will some undeserving person getting screwed more than they are.

    I see it also has the ambulance chaser provision in there. Because that’s the only thing making US healthcare expensive….poor, lazy blahs hiring greedy Jewish guys to get them money they don’t deserve so they can’t take the settlement dollars, but iPhones, and spend their days playing xBox and smoking weed. Fix that and you’ve fixed everything!

  9. 9
    Fair Economist says:

    What’s interesting about the proposal is that, horrible as it is, it’s still a whole lot better than the pre-Obamacare situation. It makes it clear that all the complaints about Obamacare not going far enough, or even actually being bad, are off-base. Obamacare was a huge step forward and a major improvement to the US health system.

  10. 10
    lgerard says:

    I have never understood this concept of “buying insurance across state lines”. This is like saying you could solve the housing problem in NYC by allowing people to buy housing in Mississippi.

    By buying insurance, you are buying access to the local health care community and infrastructure. Leaving aside the large disparities in the cost of living among states, that community in a state like Massachusetts is simply better then that of Mississippi.

    Ironically, Ocare increases the chances of large insurance companies expanding to new states as the exchanges dramatically lower the cost of entry into new markets.

  11. 11
    NonyNony says:

    @Fair Economist:

    It makes it clear that all the complaints about Obamacare not going far enough, or even actually being bad, are off-base.

    The trick is that some outcomes of the ACA are really goddamn popular. Like forcing insurance companies to let your kids stay on until they (hopefully) have a job that provides insurance. And the elimination of “lifetime limit” caps on crappy policies. And forcing insurance companies to take people with pre-existing conditions. These things are really freaking popular and nobody is going to be happy with someone saying they want to take them away.

    And the small business like the carrots that the ACA put in to get them to offer insurance – especially since the owners of those small businesses want good insurance for themselves. So you can’t really get rid of that either.

    Basically what a lot of folks in Red State Country seem to want is something that does all of the good stuff that the ACA does without the tax penalty if they don’t have insurance. And also not proposed and signed by Obama through a Democratic Congress. They want a Republican Congress to put something that is the same (but without the penalty for no insurance) in front of a Republican President and have him sign it.

    This will, of course, NEVER HAPPEN IN A MILLION YEARS. But this is because what those folks actually WANT from their government is not what they say they want nor is it what they vote for. And that’s a big problem, but it’s been a big problem for as long as I’ve been politically aware and the ACA is not really anything more than an example of that problem in action.

  12. 12
    Mike in NC says:

    Summary of GOP Sections 101-205: Be Careful & Don’t Ever Get Sick!

  13. 13
    chopper says:

    Pre-exisiting conditions covered based on continious coverage

    ah yes, the Fuck the Underemployed Act of 2014. it’s a good one.

    seriously, how many people out there are working shitty jobs with no health insurance because it’s all they can get? all of those people would be fucked under this plan.

  14. 14
    Another Holocene Human says:

    202 is the money part of this proposal. Basically, setting one set of middle class people up to shoot the other. FYIGM writ large. (Note I don’t say working class–they’re beneath the GOP’s contempt. The only poor people they pitch to are Bible fantasists who will jump on their olden days/get off my lawn talk and never notice who picks their pocket… I mean, they’re church members so the sucker to skeptic ratio has already been … enriched.)

  15. 15
    Another Holocene Human says:

    @NonyNony: You’re overthinking. They’re spite voters who (like with same sex marriage) fear a loss of status if their access to healthcare is less special (lines to see the doctor!!!!111). They thought fearmongering about the tax penalties would be an effective way to roll the demographic who benefits from the law the most.

    The noise has led a lot of busy, “low info” people to be confused about what affordability means and to be unaware that if they truly don’t have affordable coverage, they’re exempt. But that’s okay–a lot of us are going to spend this year working to get Medicaid expanded. Your political enemies don’t always hand you a gift like this. Life is good.

  16. 16
    BGK says:

    HSAs are like a magic incantation to these clowns. What good is a tax-free savings account for medical expenses if I lack the fscking cash dollars to fund the account???

    Also too, when the agents from the company that does our insurance plan came onsite during open enrollment, a couple of the usual suspects in the office made cracks about the premium increases being due to “Obamacare.” The agent made it clear that our premium increase was about half what it would’ve been without the medical loss ratio caps of the ACA. Kind of shut the clowns down pretty quickly.

  17. 17
    Xantar says:

    The problem is people who have significant health problems AND significant income variation are highly likely to have months where they can not keep continous coverage. One bad stretch and a person is priced out of health insurance for life (although that life will be fairly short)

    Feature, not bug? Paging Alan Grayson…

  18. 18
    burnspbesq says:

    As long as Harry Reid is Senate Majority Leader, the chances of this bill getting a vote in the Senate are zero.

    Elections have consequences. There’s one coming up. Do what needs to be done.

  19. 19
    gnomedad says:

    healthcare costs as a proportion of GDP actually decreased last year.

    Well, yeah, Death Panels, duh.

  20. 20
    David M says:

    This proposal on it’s own is truly awful, and yet it’s being hailed as progress for the GOP. Talk about the soft bigotry of low expectations.

  21. 21
    rikyrah says:

    I truly appreciate all your healthcare posts. You are bringing the truth and telling it like it is.

  22. 22
    danielx says:

    I suppose they’ve realized that now ACA is in effect, just repealing it won’t do because there are already large numbers of people who have been helped by it. They’ve got to replace it with something and figure that if they rain down enough bullshit about “choice” and so forth that somebody (or enough somebodies) will buy into it.

  23. 23
    RaflW says:

    @top

    The threat of destitution will make people extremely cost sensitive and thus extremely efficient shoppers.

    The threat of destitution will make people extremely cost sensitive and thus extremely efficient shoppers vulnerable and angry and yet strangely listless. They will hate insurance companies but somehow not be able to blame Republicans.

    Or perhaps that’s how the ‘thinking’ goes.

  24. 24
    Keith says:

    @OGLiberal: I wouldn’t be surprised to see a Boehner bifurcation of Part (Repeal) from Part 2 (Replace) if only so he can have at least one more repeal Obamacare vote in 2014.

    @Fair Economist: I disagree that the complaints about “not far enough” were misplaced, in truth they remain perfectly valid. That does not mean ACA did not take significant steps forward; the Medicaid-CHIP expansions alone, especially as originally designed before SCOTUS scuttled auto-State roll out, were wonderful and a boon for many who most needed help. But, it does not go far enough: lack of public option, a clearer path to true Single Payer, or to true nationally recognized insurance – live in MD, travel to FL and get really sick (say on cruise ship) and you may be in for sticker shock.

  25. 25
    johnny aquitard says:

    @NonyNony:

    Basically what a lot of folks in Red State Country seem to want is something that does all of the good stuff that the ACA does without the tax penalty if they don’t have insurance.

    IOW, what they’ve always wanted. They want to get the good stuff that results from paying taxes but they want the blue states to pay the taxes for it.

  26. 26
    johnny aquitard says:

    @BGK:

    What good is a tax-free savings account for medical expenses if I lack the fscking cash dollars to fund the account???

    I don’t believe they can’t know this. So why do they keep pushing HSAs?

    One, it totally benefits rich people. They *can* afford to fund a HSA that will cover their health care. And, as usual with these gooper tax reduction schemes, they will reap the most benefit in tax savings.

    Second, they hope it will create a pool of money the size that social security has, except this time the money boys behind the GOP will get to play with it.

  27. 27

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