I keep reading that the tax plans will eliminate the individual mandate.
My question is, does that eliminate the federal and state exchanges? Will we be able to just go to an insurance provider and get coverage if we are not able to get insurance through an employer or will the exchanges still be there? I haven't seen any details about this.
Please don't let this become political.
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In comment 13693120 BobOnLI said:
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Because there will be few healthy people in the pool.
you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance.
BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
who doesn't need healthcare? If someone is uninsured and doesn't pay their hospital bills guess who ends up paying them?
Imagine how many people would sign up if they weren't able to go to the hospital without insurance??
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Because there will be few healthy people in the pool.
you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance.
BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
- Allowing individuals to buy insurance across state lines
- Tort reform
- Legislation that prevents drug manufactures from charging US citizens 54% more for drugs than what they charge the rest of the world for the same
- Etc…..
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In comment 13693240 njm said:
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Thanks. If they repeal the mandate these plans make a lot of sense and it wouldn't affect the deficit so it could be included. But I doubt anyone down there is thinking about such things.
Allowing non-compliant plans would mean reapealing the entire ACA.
OK. Another result of Justice Roberts defining the penalty as a tax. Who knew?
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Will insurers begin to offer plans that would not be currently ACA compliant? Catastrophic plans that would give a target market, perhaps males between 28 and 45 who don't get employer based insurance and have something (assets) to lose if they have an unexpected major problem. A huge deductible, say $10,000., but they get the benefits of the insurance plans rate schedule. Face it, for anyone who's not broke the rates charged by hospitals to those without coverage is more of an incentive to get insurance than any fine currently in place under the ACA.
BTW, didn't Vermont try single payer only to drop is rather quickly because the results were not pretty?
Well, they didn't repeal ACA, so the minimal plans probably would still be disallowed.
VT couldn't get single payer off the ground. It was hard to do. The feds could do it pretty easily.
If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions.
Insurance companies will be required to cover people regardless of pre-existing conditions, and the mandate will be removed?
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If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions.
Insurance companies will be required to cover people regardless of pre-existing conditions, and the mandate will be removed?
For people that buy their policies, yes. Read the whole discussion including what Jim in Fairfax wrote.
BTW, didn't Vermont try single payer only to drop is rather quickly because the results were not pretty?
The kind of plans you're talking about were heavily featured in "The Rainmaker."
Boy have we lost a lot of good posters.
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In comment 13693120 BobOnLI said:
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Because there will be few healthy people in the pool.
you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance.
BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
Nope, I don't like it either. I think the bigger issue with the ACA, is that it did nothing to address the rising cost of healthcare and to make it more affordable. Sure, it includes tax payer subsidies to some, but that’s robbing Peter to pay Paul and just throwing money at a problem without trying to fix it. There were a lot of things that could have been done and should have been looked at to bring the costs down, but weren’t:
- Allowing individuals to buy insurance across state lines
- Tort reform
- Legislation that prevents drug manufactures from charging US citizens 54% more for drugs than what they charge the rest of the world for the same
- Etc…..
The usual shibboleths.
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In comment 13693297 njm said:
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If plans have to remain ACA compliant nobody will lose coverage for preexisting conditions.
Insurance companies will be required to cover people regardless of pre-existing conditions, and the mandate will be removed?
For people that buy their policies, yes. Read the whole discussion including what Jim in Fairfax wrote.
Thanks, I see it.
That's what I was thinking, just untenable under those circumstances.
A) the relative judiciousness of "sell across state lines" has been exposed time and time again and it's largely cited by those unable or unwilling to grasp the intricacies wedded to something as complicated as our system of insurance.
It could theoretically work with extremely stringent federal guidlines, but we know that is despised by a powerful group. As it stands, it is guaranteed to be a race to the bottom as states deregulate companies like crazy to milk local economic benefits. Like what happened with credit card companies leading to, among other things, usurious rates.
B) The VA is not single payer. The latter uses private providers - the gov't foots the bill. The VA is owned and run by Uncle Sam and most providers are gov't employees. (It's also unbelievably overwhelmed, but that's another discussion).
I am not a single payer advocate, but it's useful for the non-lazy among us to get their facts straight lest they diminish the conversation with red herrings & erroneous information.
BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
Like car insurance and homeowner's insurance?
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In comment 13693292 EricJ said:
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In comment 13693120 BobOnLI said:
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Because there will be few healthy people in the pool.
you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance.
BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
who doesn't need healthcare? If someone is uninsured and doesn't pay their hospital bills guess who ends up paying them?
Imagine how many people would sign up if they weren't able to go to the hospital without insurance??
so let's do that. Then you take your tax break and go out to a fancy dinner. Only the kitchen worker who is cutting up your food has been feeling really sick for the past couple of weeks but can't afford to see a doctor. Turns out he has hepatitis, and now you got it. Good thing you can afford insurance.
A) the relative judiciousness of "sell across state lines" has been exposed time and time again and it's largely cited by those unable or unwilling to grasp the intricacies wedded to something as complicated as our system of insurance.
It could theoretically work with extremely stringent federal guidlines, but we know that is despised by a powerful group. As it stands, it is guaranteed to be a race to the bottom as states deregulate companies like crazy to milk local economic benefits. Like what happened with credit card companies leading to, among other things, usurious rates.
B) The VA is not single payer. The latter uses private providers - the gov't foots the bill. The VA is owned and run by Uncle Sam and most providers are gov't employees. (It's also unbelievably overwhelmed, but that's another discussion).
I am not a single payer advocate, but it's useful for the non-lazy among us to get their facts straight lest they diminish the conversation with red herrings & erroneous information.
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BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
Like car insurance and homeowner's insurance?
I don't have either of those and I've never been fined or taxed for them.
Glibness is excusable...no one knows everything. I did try to correct your false information.
But you seemingly don't even want to learn which portends badly for your ability to transcend intellectual darkness.
...will lead to a death spiral to the insurance exchanges.
Any other questions?
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SO you say
Glibness is excusable...no one knows everything. I did try to correct your false information.
But you seemingly don't even want to learn which portends badly for your ability to transcend intellectual darkness.
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The insurance companies make their money from all the twenty somethings who are forced to get coverage. Get rid of the mandate and a lot of young people will risk going without insurance. That will jack rates even higher for everyone else.
The mandate was the plum that was dangled in front of the insurance industry to get them on board with the Affordable Care Act. Get rid of that and the whole thing will go down the tubes.
Not taking a position on whether that is good or bad. Just pointing out what the real strategy is.
It was already going down the shitter. Insurance companies have been pulling out of the exchanges for the last two years.
Beer Man... why do you think the insurance companies were fleeing?
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As to the other question, eliminating the mandate doesn't eliminate the exchanges, it just means people don't pay a tax if they don't have insurance.
Yes, though the exchanges might functionally cease to exist. With fewer healthy people in the pool, whatever insurers remain in the exchange may jack prices up to a level that no one can afford. Or all insurers might leave some markets altogether, leaving no individual insurance option.
E.X.A.C.T.L.Y
...here's the analogy that refutes your threads.
Imagine an auto insurance exchange in which the safest drivers did not have to get insurance.
Your premiums would go through the roof.
The entire conceptual framework of insurance... be it health, auto, whatever is the diversification of the risk pool. The majority will always subsidize the minority. That's how insurance works.
...make that the healthiest and safest driver will always subsidize the less healthy and unsafe drivers!
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fIn comment 13693160 Vanzetti said:
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The insurance companies make their money from all the twenty somethings who are forced to get coverage. Get rid of the mandate and a lot of young people will risk going without insurance. That will jack rates even higher for everyone else.
The mandate was the plum that was dangled in front of the insurance industry to get them on board with the Affordable Care Act. Get rid of that and the whole thing will go down the tubes.
Not taking a position on whether that is good or bad. Just pointing out what the real strategy is.
It was already going down the shitter. Insurance companies have been pulling out of the exchanges for the last two years.
Beer Man... why do you think the insurance companies were fleeing?
Well, that's the thing....are you really being forced, as in a mandate? Not really....you can opt out.
To me a mandate would be something like you don't sign up, you can't go to a doctor or the ER (okay, obviously that's exaggerated).
But look at in these terms, to drive you are forced to buy car insurance.......you may not want it (to pay for it) or ever need it (no car insurance) but it's against the law to drive and not have it.
A few of things..
1. you are required to buy the insurance or you have to pay a penalty.
2. It is nothing like automobile insurance but it should be. First, in this case you are asking people to buy healthcare insurance even if they dont need it. So, your auto insurance example would be like being forced to buy it even if you dont own a car or a divers license.
3. One of the other huge flaws in the whole healthcare insurance thing is that the costs to insure people absolutely should be far different from one another based upon your lifestyle and health (NOT AGE). So, if you are a smoker and are 50lbs over weight, then you should be paying a lot more than someone who stays in shape. This would be one way to help with the obesity issues. Giving people even more of an incentive. This also drives up the overall costs.
You don't have a body?
Because poor people tend to be the least healthy, the risk pool in the individual insurance market became unbalanced, causing some of these insurance providers to lose money. In that environment, leaving the exchanges made sense financially for those companies.
There are also a few cases where insurance companies, typically larger ones, are leaving the exchanges even though they are not losing money. Most of that is due to the perceived instability of the current law caused by things like the Cost Sharing Reduction being revoked by the House, along with several attempts to repeal the ACA. The calculation by these companies is that in the long run money will be saved should the ACA become permanently broken, while in the short term the losses from not participating in the exchanges are minimal.
Long story short, if the ACA was fully embraced at the outset, with all of the states expanding Medicaid and the Congress making sincere efforts to keep it functional, we would have seen even better results than what we do now across the board.
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So, your auto insurance example would be like being forced to buy it even if you dont own a car or a divers license.
You don't have a body?
Heh!
To be fair, only live bodies are required to have insurance. Zombies get a waiver.
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So, your auto insurance example would be like being forced to buy it even if you dont own a car or a divers license.
You don't have a body?
Funny... I think you know what I mean. I forgot my 5th point..
5. I would design the plan this way....
A. You are not required to buy healthcare insurance
B. Premiums vary not only based upon what level of insurance you want, but also based upon your health.
C. You can opt to not purchase healthcare insurance, but if you do, you are on the hook for all costs should you need emergency care at a hospital. In the event that you are unable to pay, then the balance is transferred to the IRS and will be added as a tax obligation that you are on the hook for. Not necessarily something you need to pay in full in April. You could be on a payment plan but this is an obligation that you would need to repay. By doing this, you would probably scare enough people into buying some level of insurance.
People don't want to be forced to purchase coverage and contribute to the system, but when they need it expect it be there. Rather selfish, I'd say.
It is a system like many others that requires everyone to support it and be there for others and have it there for you in case you need it.
In comment 13693292 EricJ said:
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Because there will be few healthy people in the pool.
you think people are signing up to avoid a penalty? That penalty is cheaper than the healthcare premiums. So... people are just paying the fine since they are healthy and most likely will not need to dip into the insurance.
BTW, am I the only one who thinks it is fucked up to force the American public to purchase something that they may not want or need?
In comment 13693214 Overseer said:
Everyone buys their plan directly with pre-tax income, businesses (especially smaller businesses) are unburdened from massive premiums - often bolstering salaries as a result - individuals have freedom of movement without "job lock", and the risk pools per state become exponentially larger, dropping costs.
Companies flush with cash (big tech, etc) will likely still offer health plans, or perhaps supplemental Cadillac level benefits, but they'll have to do so on an even playing field tax-wise with those buying their own.
The exchanges will cease to be the red headed stepchild of the insurance market(s) as they become the marquee event. Watch how fast they work (relatively speaking...this is the insurance industry, after all) then.
The mandate is a key component. If one doesn't understand why after 8 years of this debate (it should have been obvious even before then), it will be difficult to explain.
This approach would require true bipartisan leadership so it won't happen but it's vastly superior to the current system, the sociopathic previous one, or pie in the sky and flawed in its own right Single Payer.
In comment 13693374 Overseer said:
A) the relative judiciousness of "sell across state lines" has been exposed time and time again and it's largely cited by those unable or unwilling to grasp the intricacies wedded to something as complicated as our system of insurance.
It could theoretically work with extremely stringent federal guidlines, but we know that is despised by a powerful group. As it stands, it is guaranteed to be a race to the bottom as states deregulate companies like crazy to milk local economic benefits. Like what happened with credit card companies leading to, among other things, usurious rates.
B) The VA is not single payer. The latter uses private providers - the gov't foots the bill. The VA is owned and run by Uncle Sam and most providers are gov't employees. (It's also unbelievably overwhelmed, but that's another discussion).
I am not a single payer advocate, but it's useful for the non-lazy among us to get their facts straight lest they diminish the conversation with red herrings & erroneous information.
Funny... I think you know what I mean. I forgot my 5th point..
5. I would design the plan this way....
A. You are not required to buy healthcare insurance
B. Premiums vary not only based upon what level of insurance you want, but also based upon your health.
C. You can opt to not purchase healthcare insurance, but if you do, you are on the hook for all costs should you need emergency care at a hospital. In the event that you are unable to pay, then the balance is transferred to the IRS and will be added as a tax obligation that you are on the hook for. Not necessarily something you need to pay in full in April. You could be on a payment plan but this is an obligation that you would need to repay. By doing this, you would probably scare enough people into buying some level of insurance.
That describes the U.S. healthcare system pre-Obamacare. The only difference is the IRS would be empowered to be bill collectors for the healthcare industry. Mostly to collect from the working poor who can’t afford to buy insurance.
And why stop there? Why not let any company with a claimed unpaid debt present it to the IRS to collect for them?
Because poor people tend to be the least healthy, the risk pool in the individual insurance market became unbalanced, causing some of these insurance providers to lose money. In that environment, leaving the exchanges made sense financially for those companies.
There are also a few cases where insurance companies, typically larger ones, are leaving the exchanges even though they are not losing money. Most of that is due to the perceived instability of the current law caused by things like the Cost Sharing Reduction being revoked by the House, along with several attempts to repeal the ACA. The calculation by these companies is that in the long run money will be saved should the ACA become permanently broken, while in the short term the losses from not participating in the exchanges are minimal.
Long story short, if the ACA was fully embraced at the outset, with all of the states expanding Medicaid and the Congress making sincere efforts to keep it functional, we would have seen even better results than what we do now across the board.
The three states that have counties with zero Obamacare insurance plans are Washington, Ohio and MIssouri. The first two expanded Medicaid, soo......
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In comment 13693318 Beer Man said:
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fIn comment 13693160 Vanzetti said:
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The insurance companies make their money from all the twenty somethings who are forced to get coverage. Get rid of the mandate and a lot of young people will risk going without insurance. That will jack rates even higher for everyone else.
The mandate was the plum that was dangled in front of the insurance industry to get them on board with the Affordable Care Act. Get rid of that and the whole thing will go down the tubes.
Not taking a position on whether that is good or bad. Just pointing out what the real strategy is.
It was already going down the shitter. Insurance companies have been pulling out of the exchanges for the last two years.
Beer Man... why do you think the insurance companies were fleeing?
I believe they are trying to circumvent the law. The AFA does not allow them to deny insurance based on preexisting conditions. Currently, they are losing money in exchanges while finding that the personal and corporate sponsored plans are bringing a much more profitable cliental. The exchanges are bringing in people who are more in need of healthcare, while the ones that were supposed to fund the excahnges (the young and healthy) are opting out and paying the fine. By leaving the exchanges, they are in a sense making themselves unavailable to many of the more needy, and propping up their bottom line.
Beer Man... if your explanation has any credibility, it is overwhelmed by a much simpler and direct fact of life -- the current administration created a tremendous amount of uncertainty about ACA which led to insurance companies jacking up rates, not to mention scaring several of them to leave the marketplace altogether.
Because poor people tend to be the least healthy, the risk pool in the individual insurance market became unbalanced, causing some of these insurance providers to lose money. In that environment, leaving the exchanges made sense financially for those companies.
There are also a few cases where insurance companies, typically larger ones, are leaving the exchanges even though they are not losing money. Most of that is due to the perceived instability of the current law caused by things like the Cost Sharing Reduction being revoked by the House, along with several attempts to repeal the ACA. The calculation by these companies is that in the long run money will be saved should the ACA become permanently broken, while in the short term the losses from not participating in the exchanges are minimal.
Long story short, if the ACA was fully embraced at the outset, with all of the states expanding Medicaid and the Congress making sincere efforts to keep it functional, we would have seen even better results than what we do now across the board.
Well played, Sir!
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Funny... I think you know what I mean. I forgot my 5th point..
5. I would design the plan this way....
A. You are not required to buy healthcare insurance
B. Premiums vary not only based upon what level of insurance you want, but also based upon your health.
C. You can opt to not purchase healthcare insurance, but if you do, you are on the hook for all costs should you need emergency care at a hospital. In the event that you are unable to pay, then the balance is transferred to the IRS and will be added as a tax obligation that you are on the hook for. Not necessarily something you need to pay in full in April. You could be on a payment plan but this is an obligation that you would need to repay. By doing this, you would probably scare enough people into buying some level of insurance.
That describes the U.S. healthcare system pre-Obamacare. The only difference is the IRS would be empowered to be bill collectors for the healthcare industry. Mostly to collect from the working poor who can’t afford to buy insurance.
And why stop there? Why not let any company with a claimed unpaid debt present it to the IRS to collect for them?
IRS collecting? Well the ACA broke that cherry with it's penalty collections so it's already happening. The real problem with this, however, is the bills sent out by hospitals to those who are uninsured and are (and I'm being charitable) exorbitant. They're usually negotiated down (hey, if you're going to put a millionaire into bankruptcy you kind of have to) but I don't see how this plan creates the necessary mechanism.
IRS collecting? Well the ACA broke that cherry with it's penalty collections so it's already happening. The real problem with this, however, is the bills sent out by hospitals to those who are uninsured and are (and I'm being charitable) exorbitant. They're usually negotiated down (hey, if you're going to put a millionaire into bankruptcy you kind of have to) but I don't see how this plan creates the necessary mechanism.
Whether anyone likes or dislikes the idea of the ACA penalty for non-insurance, the fact is it’s a tax and thus is in the purview of the IRS to collect. Empowering the IRS to collect private debts on the say-so of private companies is a dangerous road to head down,
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IRS collecting? Well the ACA broke that cherry with it's penalty collections so it's already happening. The real problem with this, however, is the bills sent out by hospitals to those who are uninsured and are (and I'm being charitable) exorbitant. They're usually negotiated down (hey, if you're going to put a millionaire into bankruptcy you kind of have to) but I don't see how this plan creates the necessary mechanism.
Whether anyone likes or dislikes the idea of the ACA penalty for non-insurance, the fact is it’s a tax and thus is in the purview of the IRS to collect. Empowering the IRS to collect private debts on the say-so of private companies is a dangerous road to head down,
Of course the irony is thick that to get it passed it was sworn that it wasn't a tax, only to be upheld by the USSC BECAUSE it was a tax.
BTW - I could be wrong, but can't tax refunds be confiscated by IRS if the taxpayer has unpaid child support or alimony outstanding? Not sure about that.
every county in US in 2018 has an Obamacare insurer
Paulding County, Ohio, The last empty Obamacare county, where 380 customers on the individual marketplaces Had an insurance provider fill in gap.
This interesting discussion -
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In comment 13693246 Jim in Fairfax said:
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In comment 13693240 njm said:
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Thanks. If they repeal the mandate these plans make a lot of sense and it wouldn't affect the deficit so it could be included. But I doubt anyone down there is thinking about such things.
Allowing non-compliant plans would mean reapealing the entire ACA.
OK. Another result of Justice Roberts defining the penalty as a tax. Who knew?
I'm guessing someone has some compromising videos of Judge Roberts (;>
the rumor was the he had adopted daughter that interestingly somehow was unlawful and someone got to him and wanted to make it public. Who knows, but an interesting explanation even if fiction.
the rumor was the he had adopted daughter that interestingly somehow was unlawful and someone got to him and wanted to make it public. Who knows, but an interesting explanation even if fiction.
Really? Keep the stupid debunked conspiracy theories out of this please.
Just got a bill from the hospital for my wife. $98,000.
One page, bill doesn't tell you crap. We'll end up paying give or take under $4,000 out of pocked for the whole thing including Drs. yet to come in as it is end of year so deductibles have been being paid.
That describes the U.S. healthcare system pre-Obamacare. The only difference is the IRS would be empowered to be bill collectors for the healthcare industry. Mostly to collect from the working poor who can’t afford to buy insurance.
But under Obamacare, we are forcing them to buy insurance. It is not affordable either.
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That describes the U.S. healthcare system pre-Obamacare. The only difference is the IRS would be empowered to be bill collectors for the healthcare industry. Mostly to collect from the working poor who can’t afford to buy insurance.
But under Obamacare, we are forcing them to buy insurance. It is not affordable either.
The tax penalty was put in to place to encourage people who are healthy, and are actually able to afford insurance, to go ahead and purchase it. No one is "forced" to do anything.
Yes, Obamacare sucks. But that’s because at the core it’s the same crummy system we’ve always had. The ACA has the virtue of making healthcare available to millions that didn’t have it before. But it provides it to them via the same shitty, expensive and inefficient system we’ve always had.
Unless the population of this country can agree to the massive changes that would be needed to fix it, it’s not going to get any better. I doubt it will happen.
But our system is dysfunctional
we actually have 4 systems
Employer provided Private Insurance
Medicaid and CHIP for poor
Medicare for Elderly
Obamacare private insurance markets for everyone else
the only thing these different systems have in common is tax payers subsidized them in one form or another.
It seemed like Obamacare was first step in rationalizing our healthcare system but I think now that a catastrophic collapse is the only way our healthcare system will truly be reformed
which is our VA system for Veterans
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The tax penalty was put in to place to encourage people who are healthy, and are actually able to afford insurance, to go ahead and purchase it. No one is "forced" to do anything.
No they are not forced, just taxed by the IRS, which if you refuse to pay puts you in jail...
Think about it, $3600 for insurance with a $7000 deductible. That is fair?
The people hurt the most are the uninsured with high medical bills. I find it strange that uninsured pay more for treatment than those with insurance. My wife had surgery and the insurance reduced the bill from $50k to $12k, they paid 90% of that. So how is it that the hospital accepts 25% of the billed amount when insurance pays, but they want 100% when there is no insurance company/assignment? That is what is wrong with the system. That is what is not fair.
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In comment 13694443 EricJ said:
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The tax penalty was put in to place to encourage people who are healthy, and are actually able to afford insurance, to go ahead and purchase it. No one is "forced" to do anything.
No they are not forced, just taxed by the IRS, which if you refuse to pay puts you in jail...
Think about it, $3600 for insurance with a $7000 deductible. That is fair?
$3600. You must be relatively young.
That is because insurance companies negotiate a fee schedule to include the healthcare provider, in your case a hospital, in their network. With no negotiated fee schedule, the uninsured get charged as much as possible, though most providers negotiate the fee down when they realize that putting someone into bankruptcy does them no good. Basically they are trying to recoup the losses from the unprofitable services they provide to Medicaid and (to a lesser extent) Medicare.
The people hurt the most are the uninsured with high medical bills. I find it strange that uninsured pay more for treatment than those with insurance. My wife had surgery and the insurance reduced the bill from $50k to $12k, they paid 90% of that. So how is it that the hospital accepts 25% of the billed amount when insurance pays, but they want 100% when there is no insurance company/assignment? That is what is wrong with the system. That is what is not fair.
It’s a free market system; it’s not required to be fair. You could call up providers and negotiate better rates for yourself. I doubt you’d get far with most, but with enough work you might find good prices some places.
Of course if you’re having a heart attack or you suffered a traumatic injury that’s difficult to do. But no one is forcing you to get treatment.