ACA Lives For Another Year

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ACA Lives For Another Year

Postby sardia » Sat Mar 25, 2017 3:41 am UTC

https://fivethirtyeight.com/features/ho ... alth-care/
The House’s failure on Friday to even vote on a Republican bill to repeal The Affordable Care Act — something party leaders promised for seven years and President Trump campaigned on — was a huge defeat for Trump and the GOP, in a number of ways.

It showed that Republicans — now in control of the House, the Senate and the presidency — couldn’t band together on a major priority. It suggests that the divides among Republicans, a theme of the Obama years, remain a problem for the party. In fact, those divides could be even wider in the Trump era: In the health care debate, not only did the deeply conservative House Freedom Caucus break with party leadership, as it often has (arguing the legislation was not conservative enough), but a bloc of more centrist members emerged from the other side of the political spectrum, arguing that the bill was too conservative. And Trump, who has cast himself as a master negotiator, couldn’t get fellow Republicans behind him, making him look ineffectual in comparison to his three predecessors as president, who all got their first legislative priority through Congress in their first year in office.1

I think the GOP and Trump will have a much easier time passing tax reform/tax cuts. Giving away money is much easier than taking away people's stuff. The fact that it'll cause budget problems down the road will be the future Democrat's problem.

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Re: ACA Lives For Another Year

Postby Angua » Sat Mar 25, 2017 9:19 am UTC

http://www.bbc.co.uk/news/world-us-canada-39388815

Trump blames the democrats - they couldn't get 1 democrat to vote for it. Oh dear. Pity about the majority of republicans you had who couldn't have voted as well.

Also, I love this quote
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. Surely this is something you should have figured out (or employed people who already know) before being in charge?
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Re: ACA Lives For Another Year

Postby Liri » Sat Mar 25, 2017 1:04 pm UTC

I like that he takes things so personally. And doesn't quite realize congresspeople aren't his employees.

If there are enough moderate republicans in both chambers, it'll be interesting to see if democrats can get an ACA-touchup bill through. Unfortunately for the less-insured, Trump wasted no time blowing away any notions of "we'll work with him where we can". Who knows.
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And of course we all knew Trump was a bullshit artist, but it's still exasperating that his voters didn't catch on that he had no plans of what to do if he was elected. He essentially promised single-payer, universal coverage during debates
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Re: ACA Lives For Another Year

Postby ObsessoMom » Sat Mar 25, 2017 2:16 pm UTC

Sadly for Trump, Congressmembers' bosses are their constituents, not the President:

Per House members, phone calls on the GOP health bill run 50-to-1 against

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Re: ACA Lives For Another Year

Postby commodorejohn » Sat Mar 25, 2017 3:48 pm UTC

You have to admire Paul Ryan here. It's quite an achievement to spend seven years talking about doing something without ever coming up for a plan to do it, scramble at the last minute to get something together, manage to craft a bill that alienates half of the Republican party by slashing too much of The Affordable Care Act, the other half of the Republican party by not slashing enough of The Affordable Care Act, the entire Democratic party just by existing, and anybody else by not getting rid of odious crap like fines for not having insurance coverage, then go on to publically sulk about it when all your cajoling and outright groveling fails to persuade your fellow Congressmen to vote for what would under any other circumstances be the most obvious "poisoned chalice" bill in recent memory. What a shame for him that American politics doesn't have something akin to the Raspberry Awards; he'd be a shoo-in.
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Re: ACA Lives For Another Year

Postby Liri » Sat Mar 25, 2017 4:33 pm UTC

Paul Krugman regularly mocks Ryan for his undeserved "wonkish, intelligent conservative" reputation. As for the ACA fines, there either has to be a driving force to get healthy people to get insurance, or we move to single-payer.
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Re: ACA Lives For Another Year

Postby Soupspoon » Sat Mar 25, 2017 4:42 pm UTC

commodorejohn wrote:You have to admire Paul Ryan here. It's quite an achievement to spend seven years talking about doing something without ever coming up for a plan to do it, scramble at the last minute to get something together, manage to craft a bill that alienates half of the Republican party by slashing too much of The Affordable Care Act, the other half of the Republican party by not slashing enough of The Affordable Care Act, the entire Democratic party just by existing, and anybody else by not getting rid of odious crap like fines for not having insurance coverage, then go on to publically sulk about it when all your cajoling and outright groveling fails to persuade your fellow Congressmen to vote for what would under any other circumstances be the most obvious "poisoned chalice" bill in recent memory. What a shame for him that American politics doesn't have something akin to the Raspberry Awards; he'd be a shoo-in.


(The multiple comparisons with a certain British process are overwhelming, just to note, except that we're going more slowly, and as yet haven't quite got to the same make-or-break bit where we know where it is actually going, just barely navigated over some speed bumps that might have either absorbed some of the 'rebelliousness' or else prepped them for the later fight when it counts. But, beyond the simple comparison, that's a discussion for the other, more relevant, thread. Which may or may not light up again in a few days time.)

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Re: ACA Lives For Another Year

Postby Thesh » Sat Mar 25, 2017 4:53 pm UTC

Angua wrote:Trump blames the democrats - they couldn't get 1 democrat to vote for it. Oh dear. Pity about the majority of republicans you had who couldn't have voted as well.


That sounds like a stunning endorsement; it was polling at 17% approval before they removed requirements to cover things like emergency care, preventative care and preexisting conditions.
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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 6:01 pm UTC

commodorejohn wrote:You have to admire Paul Ryan here.


Ehhhh, it really was John Bohner who led the House for the past decade. The colossal split in the House was evident years ago when Bohner was ousted and they literally couldn't get anybody to step up to the position of the Speaker of the House. This was a position that nobody wanted, because it was clear that Republicans weren't working together anymore.

Paul Ryan did his best.

---------

You have to remember that the ACA was enacted on March 23, 2010. It took Obama over a year to build support among Democrats (despite a Filibuster-proof super-majority in the Senate) to pass the ACA in the first place. Trump comes in and thinks he can do the same within a month.
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Re: ACA Lives For Another Year

Postby commodorejohn » Sat Mar 25, 2017 6:04 pm UTC

Liri wrote:As for the ACA fines, there either has to be a driving force to get healthy people to get insurance, or we move to single-payer.

As someone who spent a total of about 14 months unemployed a few years back, scraping by on unemployment checks and goodwill from relatives while looking for work, then got a nice chunk taken out of the tax refund that I really, really needed for having the temerity to not pay for health insurance when I barely had the money for housing and food, this argument is cordially invited to shove itself up its ass.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 6:07 pm UTC

I wish I lived in a universe where submitting and supporting a bill that takes away millions of people's medical coverage, allows for denial on the basis of pre-existing conditions, and removes requirements that insurance companies cover things like 'hospitalization' would end your political career in a heartbeat.
commodorejohn wrote:As someone who spent a total of about 14 months unemployed a few years back, scraping by on unemployment checks and goodwill from relatives while looking for work, then got a nice chunk taken out of the tax refund that I really, really needed for having the temerity to not pay for health insurance when I barely had the money for housing and food, this argument is cordially invited to shove itself up its ass.
Right, and I respect your position and the struggle you went through -- but the family of four who just became bankrupt and homeless on account of their youngest having cancer would like to cordially invite you to shut the hell up.

EDIT: That sounds way meaner now I read it again. I didn't mean it that way -- I'm sorry. It sounds like what you went through sucks, and it's not like that isn't important -- I mean, I definitely know what it's like to be unemployed for long stretches of time without enough money to cover stuff like food or rent. But the ACA tried to balance a lot of plates, and the fact is that you need some form of incentive/penalty to get people to support it -- otherwise, lives are going to be destroyed.

Ideally, we'd find a way to balance those plates without screwing people over who need money in their pocket... but keep in mind what the stakes are -- there's a difference between you being out a couple of thousand dollars and somebody being out of a house and home.

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Re: ACA Lives For Another Year

Postby commodorejohn » Sat Mar 25, 2017 6:30 pm UTC

The graciousness of my relatives was the only reason I wasn't out of house and home.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 6:47 pm UTC

commodorejohn wrote:The graciousness of my relatives was the only reason I wasn't out of house and home.
Right, but I mean, there is a big difference between you being out a couple of thousand dollars and someone being out a couple of hundred thousand dollars. On one hand, it's a shitty position to put you in (and ideally we'd find solutions that don't involve putting you in there), but on the other hand, now people who previously weren't at risk of being homeless and destitute are. You're not just devastating families; you're devastating support networks -- like the one you relied on!

I don't think you're wrong to think of it as bullshit, because -- it kind of is. But I also think you need to keep in mind the scope of the problem it's trying to solve: The number one cause of bankruptcy in America pre-ACA was medical expenses. Near the end of his life, my grandfather -- who, thank goodness, had excellent insurance -- racked up costs in excess of a million dollars over a single year. My family would have lost the house -- and much, much more.

You had relatives who took you in, and that's wonderful -- but now imagine that your relatives don't have a place for you to stay. In fact, they need a place to stay, too, 'cuz they just lost their home on account of insurance refusing to cover their leukemia treatment because they didn't report their pre-existing acne condition. How are you going to help them with that thousand dollars in your pocket? Like, yes -- it is absolute fucking nonsense to demand that people pay money when they can't afford to pay money... and I know very well how a couple of thousand of dollars in your pocket can, under the right circumstances, mean the difference between literal life and death. But let's also keep in mind the stakes we're discussing here -- because they can also be literal life-and-death.

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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 7:28 pm UTC

The Great Hippo wrote:You had relatives who took you in, and that's wonderful -- but now imagine that your relatives don't have a place for you to stay. In fact, they need a place to stay, too, 'cuz they just lost their home on account of insurance refusing to cover their leukemia treatment because they didn't report their pre-existing acne condition. How are you going to help them with that thousand dollars in your pocket? Like, yes -- it is absolute fucking nonsense to demand that people pay money when they can't afford to pay money... and I know very well how a couple of thousand of dollars in your pocket can, under the right circumstances, mean the difference between literal life and death. But let's also keep in mind the stakes we're discussing here -- because they can also be literal life-and-death.


And as heartbreaking as that case is, it isn't commodorejohn's case.

Anyway, this gets a bit personal... but I need more information to fully understand Commodorejohn's case. I know that the ACA was supposed to have provisions to give tax-credits to those who purchase insurance. It sounds like you had some degree of income (since you had a Tax Return). Unlike a "deductable", a tax-credit is basically money, and would basically increase your tax return by the amount associated with the credit. (IE: Mortgage Interest deductable of $4000 effectively only becomes +$1000 on your tax return... assuming an income bracket of 25%.). In contrast, a tax credit of +$800 effectively gives you +$800.

Indeed, its a "refundable" tax credit. Which means that if you owe a total of $500 in taxes, but have $800 in the Premium-Tax-Credit, Uncle Sam gives you $300 (even if you made no contributions last year)

In effect, the ACA was explicitly designed for your case. As long as you made less than 400% of the poverty line, Uncle Sam would have paid some part of your Premiums. More details can be found here.

In short, you needed to make less than 400% the poverty line and also be enrolled in a "marketplace" plan. The specific tax form is the Form 8962. The Premium Tax Credit is based on the cost of the 2nd-lowest cost "Silver" plan in your specific marketplace.

So in effect, the ACA is: force people to pay for insurance. But if they are poor or middle-income (defined as 400% or less of the poverty line), then have Uncle Sam pay for part... or even all (at 133% of the poverty line, you qualify for Medicaid)... of the insurance. The subsidy seems rather drastic, as between 300% and 400% of the Poverty Line gets a 90.31% subsidy.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 7:52 pm UTC

KnightExemplar wrote:And as heartbreaking as that case is, it isn't commodorejohn's case.
I'm aware; that's why I preceded it by saying 'now imagine that', instead of 'in your particular case'.

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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 7:54 pm UTC

The Great Hippo wrote:
KnightExemplar wrote:And as heartbreaking as that case is, it isn't commodorejohn's case.
I'm aware; that's why I preceded it by saying 'now imagine that', instead of 'in your particular case'.


I saw the Dave Chappelle special last night. I believe he called your argument "Comparative Abuse".

I'm hungry and start complaining about it... the last thing a friend is supposed to do is say "Well, there are starving people in Africa". No shit, that sucks for them, but I'm still hungry.

We can't solve all problems, but lets start by solving specific problems of the people we're directly talking with. Besides, the ACA provisions, in theory, are supposed to handle commodorejohn's case. It was my understanding that the law was supposed to benefit the unemployed and whatnot. So I'm curious why it wasn't working in this case. My understanding of the law could be wrong, or perhaps there's a corner case that really does demonstrate a weakness in the current law.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 8:06 pm UTC

KnightExemplar wrote:I'm hungry and start complaining about it... the last thing a friend is supposed to do is say "Well, there are starving people in Africa". No shit, that sucks for them, but I'm still hungry.
"I'm hungry..." -- "Well, yeah, but that's because we've been using this food to feed people who are literally starving right now. I recognize it sucks that you're hungry, and we should find a better solution that doesn't leave you hungry, because that's unfair and kind of fucked up -- but I hope you at least understand why we're doing this with our food."

Yeah, you're right, that's totally the same thing.

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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 8:09 pm UTC

The Great Hippo wrote:
KnightExemplar wrote:I'm hungry and start complaining about it... the last thing a friend is supposed to do is say "Well, there are starving people in Africa". No shit, that sucks for them, but I'm still hungry.
"I'm hungry..." -- "Well, yeah, but that's because we've been using this food to feed people who are literally starving people.


That's clearly not this case.

commodorejohn alleges that he was unemployed for 14 months and then further penalized by the ACA's individual mandate. However, the ACA was supposed to have given him a tax-credit to assist him in paying for insurance.

Lets stick with the facts we have at hand here. Again, I'm not claiming I know everything, but this is my understanding of how things should have worked. Commodorejohn likely has more actual personal experience in this subject area than the rest of us do, so... this is probably a time where we shut up and ask him questions.

We don't have to necessarily agree with him after he explains his viewpoint. But now is not the time to criticize his conclusion.
Last edited by KnightExemplar on Sat Mar 25, 2017 8:12 pm UTC, edited 1 time in total.
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Re: ACA Lives For Another Year

Postby Thesh » Sat Mar 25, 2017 8:11 pm UTC

KnightExemplar wrote:commodorejohn alleges that he was unemployed for 14 months and then further penalized by the ACA's individual mandate. However, the ACA was supposed to have given him a tax-credit to assist him in paying for insurance.


But he also says that we shouldn't discuss why the mandate exists or what the alternatives are, so I'm not sure what you are expecting in response?
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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 8:13 pm UTC

Thesh wrote:
KnightExemplar wrote:commodorejohn alleges that he was unemployed for 14 months and then further penalized by the ACA's individual mandate. However, the ACA was supposed to have given him a tax-credit to assist him in paying for insurance.


But he also says that we shouldn't discuss why the mandate exists or what the alternatives are, so I'm not sure what you are expecting in response?


I'm mostly just expecting us to be decent to someone who is sharing us a personal story. Fuck, Democrats are supposed to care for the unemployed.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 8:18 pm UTC

KnightExemplar wrote:That's clearly not this case.

commodorejohn alleges that he was unemployed for 14 months and then further penalized by the ACA's individual mandate. However, the ACA was supposed to have given him a tax-credit to assist him in paying for insurance.
Okay. That's not what I was discussing with commodorejohn, though; I was discussing commodorejohn's obvious displeasure with the ACA's insurance mandate, and trying to get them to empathize with why that mandate, while kind of sucky, is probably still better than the alternative (a world where the ACA doesn't work at all, and millions of Americans lose their homes).

Whether or not commodorejohn is the victim of mismanagement or bureaucratic malfeasance -- and is actually owed tax credits they did not receive -- is a separate point, and not one I was discussing. You're more than welcome to discuss it with them (and it might very well be to their benefit!), but don't drag my unrelated points into it.
KnightExemplar wrote:I'm mostly just expecting us to be decent to someone who is sharing us a personal story. Fuck, Democrats are supposed to care for the unemployed.
I'm not a democrat, but -- outside of my first comment, which I immediately apologized for (I didn't realize how insulting it sounded until I read it a second time), I'd like to know exactly what in my previous posts gave you the impression that I wasn't sympathetic to their plight.

Was it the part where I mentioned that I knew what it was like to be unemployed and with no money for food or lodgings?

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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 8:23 pm UTC

The Great Hippo wrote:Okay. That's not what I was discussing with commodorejohn, though; I was discussing commodorejohn's obvious displeasure with the ACA's insurance mandate, and trying to get them to empathize with why that mandate, while kind of sucky, is probably still better than the alternative (a world where the ACA doesn't work at all, and millions of Americans lose their homes).

Whether or not commodorejohn is the victim of mismanagement or bureaucratic malfeasance -- and is actually owed tax credits they did not receive -- is a separate point, and not one I was discussing. You're more than welcome to discuss it with them (and it might very well be to their benefit!), but don't drag my unrelated points into it.


It has everything to do with the situation however. The Premium Tax Credit, under the ACA, was explicitly designed to make the individual mandate more affordable to low-income people.

Because we shouldn't be forcing poor people to buy things they can't afford. That's fucked up. I think we all can agree on that point, yes? Or do you seriously think that the only way to write the ACA is to force poor people to buy things they can't afford? I'm not necessarily asking commodorejohn to share explicit numbers with us btw, because personal finances are always a personal matter.

But I'd like to get an overall idea of how things were working for him (or not working for him)

KnightExemplar wrote:I'm mostly just expecting us to be decent to someone who is sharing us a personal story. Fuck, Democrats are supposed to care for the unemployed.
I'm not a democrat, but -- outside of my first comment, which I immediately apologized for (I didn't realize how insulting it sounded until I read it a second time), I'd like to know exactly what in my previous posts gave you the impression that I wasn't sympathetic to their plight.


Said quote was aimed at Thesh and not you. However, talking about hypothetical and imaginary cases when we have a real situation under discussion is callous IMO.
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Re: ACA Lives For Another Year

Postby Thesh » Sat Mar 25, 2017 8:28 pm UTC

KnightExemplar wrote:I'm mostly just expecting us to be decent to someone who is sharing us a personal story. Fuck, Democrats are supposed to care for the unemployed.


Yes, of course, if only I had asked a concern troll before! Whenever someone has a personal story, we should never question the point they are making with it, or else that means we don't care.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 8:34 pm UTC

KnightExemplar wrote:It has everything to do with the situation however. The Premium Tax Credit, under the ACA, was explicitly designed to make the individual mandate more affordable to low-income people.

Because we shouldn't be forcing poor people to buy things they can't afford. That's fucked up. I think we all can agree on that point, yes?
Yes. However, I was addressing commodorejohn's disgust with the very concept of the mandate, not the actuality of it.
KnightExemplar wrote:Said quote was aimed at Thesh and not you.
Okay. I don't know if Thesh is a democrat, but I'd like to know exactly what in their previous post gave you the impression that they weren't sympathetic to their plight?

If not Thesh, can you please tell me which democrat in this thread has shown that they don't care for the unemployed?

Or are you just complaining that democrats around the country didn't run to the forums, register in mass, and start flooding this thread with sympathetic comments the instant a poster here mentioned they'd once struggled with unemployment?

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Re: ACA Lives For Another Year

Postby KnightExemplar » Sat Mar 25, 2017 8:37 pm UTC

The Great Hippo wrote:
KnightExemplar wrote:It has everything to do with the situation however. The Premium Tax Credit, under the ACA, was explicitly designed to make the individual mandate more affordable to low-income people.

Because we shouldn't be forcing poor people to buy things they can't afford. That's fucked up. I think we all can agree on that point, yes?
Yes. However, I was addressing commodorejohn's disgust with the very concept of the mandate, not the actuality of it.


It seems like he dealt with the actuality of it when his tax return was penalized.

At the end of the day, we cannot deny that reality hit his checkbook and it has caused suffering for him. Accepting his disgust (even if we disagree with it) is the least we can do. I don't think any of us can change his story or the past in which he was penalized under The Affordable Care Act.

The only thing we can do is understand his story, and then incorporate it into our arguments.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 8:48 pm UTC

KnightExemplar wrote:At the end of the day, we cannot deny that reality hit his checkbook and it has caused suffering for him. Accepting his disgust (even if we disagree with it) is the least we can do.
What, you mean like this?
The Great Hippo wrote:I don't think you're wrong to think of it as bullshit
Since you seemed to miss that bit, I'll go ahead and clarify:

Yes, KnightExemplar. I accept their disgust, even if I don't agree with it; I also sympathize with their situation.

Would you like Thesh to say it, too? Should we stop and get everyone in this thread to say it? Maybe only the people who are registered democrats? Would that make you feel better?

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Re: ACA Lives For Another Year

Postby Thesh » Sat Mar 25, 2017 8:53 pm UTC

I'm unaffiliated, so I don't think that would help.
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Re: ACA Lives For Another Year

Postby The Great Hippo » Sat Mar 25, 2017 9:01 pm UTC

Oh. Huh.

Well, if you're not the snooty democrat being indecent to commodorejohn, and I'm not the snooty democrat being indecent to commodorejohn, I guess... the snooty democrat must be invisible? Or a metaphor.

Nah, I'm going with invisible.

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Re: ACA Lives For Another Year

Postby sardia » Sat Mar 25, 2017 9:34 pm UTC

commodorejohn wrote:
Liri wrote:As for the ACA fines, there either has to be a driving force to get healthy people to get insurance, or we move to single-payer.

As someone who spent a total of about 14 months unemployed a few years back, scraping by on unemployment checks and goodwill from relatives while looking for work, then got a nice chunk taken out of the tax refund that I really, really needed for having the temerity to not pay for health insurance when I barely had the money for housing and food, this argument is cordially invited to shove itself up its ass.

Do you live in a state that didn't expand Medicare? Or were you in a complicated scenario where you had income but your expenses were so high, you were poor.

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Re: ACA Lives For Another Year

Postby morriswalters » Sat Mar 25, 2017 9:53 pm UTC

I'm sorry for the pain it cost him. But no system can be totally fair to everyone. There are tons of sad stories on both sides. The Republicans dug in their heels and opted out of making realistic changes that might have improved the Act. And now they can't repeal and replace. Just what can they do?

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Re: ACA Lives For Another Year

Postby sardia » Sat Mar 25, 2017 10:01 pm UTC

morriswalters wrote:I'm sorry for the pain it cost him. But no system can be totally fair to everyone. There are tons of sad stories on both sides. The Republicans dug in their heels and opted out of making realistic changes that might have improved the Act. And now they can't repeal and replace. Just what can they do?

One of the options is to undermine the bill through regulatory means. Not sure what the end game is besides making the exchanges collapse for supposed political gains.
https://fivethirtyeight.com/features/th ... mps-hands/
Spoiler:
Trump could use HHS to alter or undermine the law

There are 1,442 citations in #ACA where it says “The Secretary shall…” or “The Secretary may…” @HHSGov, we’ll look at every single one.

— Tom Price, M.D. (@SecPriceMD) March 17, 2017

While Congress writes the bills, a lot of their interpretation and implementation is up to federal agencies. In the case of health care, that task falls on the Department of Health and Human Services, whose new secretary, Tom Price, has been a fervent opponent of the ACA. And while the law has been heavily criticized as government overreach, there’s quite a bit of flexibility written into it.

HHS has already made some moves that could affect the insurance marketplaces in the future. The final days of the open enrollment period for the insurance marketplaces set up by the ACA coincided with Trump’s inauguration. HHS and the Trump administration quickly pulled advertisements promoting enrollment, ads that had been effective in previous years at getting young adults to sign up for coverage. The move appeared to dampen enrollment among this group, a typically healthier set that is key to balancing out the insurance rolls and keeping costs down. HHS could also change requirements for health insurance coverage. Plans sold on the insurance marketplaces are required to cover a list of 10 services, known as essential health benefits, broad categories that include mental health, pregnancy care and prescription drugs. HHS was left to define what must be covered within those categories. Insurers must cover mental health, but must they pay for behavioral therapy for children with autism? They must provide women’s health care, but do they have to provide contraception for all women, free of co-pays? The more plans have to cover, the more they cost. The less they cover, the less useful they are to some of the people who buy them. The Obama administration largely let states decide what those essential benefits would be, but Price could make those decisions at the federal level, requiring insurers to cover fewer services.

But Price could do two things now that would have huge effects on the marketplaces: He could drop a court case left over from the Obama administration, a move that would cut some subsidies to more than half of marketplace enrollees, and he could loosen the most hated part of the law, a mandate requiring most people to have coverage or pay a penalty at tax time. More than 6 million people who get insurance through the marketplaces get help paying for deductibles and co-pays, in addition to the federal help they get to pay for health insurance premiums. A federal judge determined that the subsidies were an illegal appropriation of funds. The Obama administration was fighting the ruling; if Trump’s government lets it stand, it will cost insurers millions and could upend the market.

On the individual mandate, Price could weaken enforcement or redefine who is exempt, though there are some legal limitations to how far he could take those changes. Either way, the net effect would be fewer signups, particularly among young and healthy people who have less incentive to get coverage. “That’s the kind of hole you could drive a truck through,” Levitt said.
So less enrollment, more exemptions for enrollment, and less coverage. All those raises rates or makes the bill worse. The winners would be the healthy people who get exempted and don't get sick.

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Re: ACA Lives For Another Year

Postby commodorejohn » Sat Mar 25, 2017 10:22 pm UTC

KnightExemplar wrote:commodorejohn alleges that he was unemployed for 14 months and then further penalized by the ACA's individual mandate. However, the ACA was supposed to have given him a tax-credit to assist him in paying for insurance.

Unfortunately I don't recall all the details as this was ~2-3 years ago (fortunately, I've since found work again and not had to deal with it.) My guess would be that it was due to my 14 months of unemployment being broken up by a brief stint back at my old job before getting laid off a second time, during which I was making enough that I was above the "poverty line" but not by enough to save any serious amount of money for further unemployment. In any case, I know that according to the tax-prep service I used, I was not eligible for any such credits, and it would've been pretty much irrelevant in any case because there's no way I could've spared the money for insurance even with a few hundred bucks in tax credit. So...yeah.

Thesh wrote:But he also says that we shouldn't discuss why the mandate exists or what the alternatives are, so I'm not sure what you are expecting in response?

I'm not telling anyone anything about what they can and can't discuss. I'm just saying that, as someone who got the shit end of that stick, I reject that particular argument.
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Re: ACA Lives For Another Year

Postby Thesh » Sat Mar 25, 2017 10:48 pm UTC

I didn't really see it as an argument, just a statement of the situation: either you need to make sure everyone buys insurance or the individual market collapses (google "three legged stool ACA") or you go single payer. What alternative is there besides letting millions go uninsured?
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Re: ACA Lives For Another Year

Postby Dark567 » Sat Mar 25, 2017 11:08 pm UTC

The Great Hippo wrote:I don't think you're wrong to think of it as bullshit, because -- it kind of is. But I also think you need to keep in mind the scope of the problem it's trying to solve: The number one cause of bankruptcy in America pre-ACA was medical expenses. Near the end of his life, my grandfather -- who, thank goodness, had excellent insurance -- racked up costs in excess of a million dollars over a single year. My family would have lost the house -- and much, much more.

I'm going to be a complete ass here, and I know I am making assumptions and not being as empathetic as I could....I'm going to make a point that is very clinical and economical. Please feel free to disregard if it will be upsetting.
Spoiler:
Millions spent on end of life care in that situation doesn't sound like a good use of resources. Considering the situation sounded bleak(again, this could be wrong, I am inferring from the above), if he didn't have insurance would you really have spent millions to extend his life for a short time? Is that really worth going bankrupt? And at some point, it isn't possible for the government or insurance companies to pay for that care for everyone who needs EOL care to add a few more years. This is why for example, NHS sets cost effectiveness measures weighted against current expected life expectancy and sometimes won't fund procedures. The 2015 NICE amount seems to £30,000 per quality adjusted life year, so the expected treatment would have to yield a couple decades longer life span for the NHS to have funded it across the pond(granted the cost of this treatment would be less, probably in half). In the US insurance/medicare seems to be willing to pay about $200,000-$300,000 per quality-adjusted year which doesn't really sound like a sustainable amount(although importantly, US has explicitly legislated against ever using cost-effectiveness for quality-adjusted years to make medical decisions). I guess my point is, that as US government gets more involved it will likely have to make some of the same choices(especially under single payer) and in those scenarios, you'd have to pay for separate insurance or out of pocket as well for an elderly person's very expensive treatment.
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Re: ACA Lives For Another Year

Postby LaserGuy » Sun Mar 26, 2017 8:35 am UTC

Dark567 wrote:
The Great Hippo wrote:I don't think you're wrong to think of it as bullshit, because -- it kind of is. But I also think you need to keep in mind the scope of the problem it's trying to solve: The number one cause of bankruptcy in America pre-ACA was medical expenses. Near the end of his life, my grandfather -- who, thank goodness, had excellent insurance -- racked up costs in excess of a million dollars over a single year. My family would have lost the house -- and much, much more.

I'm going to be a complete ass here, and I know I am making assumptions and not being as empathetic as I could....I'm going to make a point that is very clinical and economical. Please feel free to disregard if it will be upsetting.
Spoiler:
Millions spent on end of life care in that situation doesn't sound like a good use of resources. Considering the situation sounded bleak(again, this could be wrong, I am inferring from the above), if he didn't have insurance would you really have spent millions to extend his life for a short time? Is that really worth going bankrupt? And at some point, it isn't possible for the government or insurance companies to pay for that care for everyone who needs EOL care to add a few more years. This is why for example, NHS sets cost effectiveness measures weighted against current expected life expectancy and sometimes won't fund procedures. The 2015 NICE amount seems to £30,000 per quality adjusted life year, so the expected treatment would have to yield a couple decades longer life span for the NHS to have funded it across the pond(granted the cost of this treatment would be less, probably in half). In the US insurance/medicare seems to be willing to pay about $200,000-$300,000 per quality-adjusted year which doesn't really sound like a sustainable amount(although importantly, US has explicitly legislated against ever using cost-effectiveness for quality-adjusted years to make medical decisions). I guess my point is, that as US government gets more involved it will likely have to make some of the same choices(especially under single payer) and in those scenarios, you'd have to pay for separate insurance or out of pocket as well for an elderly person's very expensive treatment.


It doesn't need to be end of life care for treatment costs to get enormously expensive. When I had cancer a few years back, the treatment cost for diagnosis, a short hospital stay, chemo, medication, a couple of PET scans, ended up in the $200,000-$300,000 range in six months, and that's for a treatment course that was fairly uncomplicated as far as such things go, on a young (30s), otherwise healthy patient. Obviously I didn't have to pay that because I live in a sane country, though I did have to fork out some cash for fucking filgrastim, with retails for $1000/week--had I needed its more expensive alternative, pegfilgrastim, it would have been closer to $10000/week. Had I needed more extensive hospital stays or surgeries, it could have been close to a million dollars worth of treatment easily.

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Re: ACA Lives For Another Year

Postby The Great Hippo » Sun Mar 26, 2017 9:35 am UTC

The screwed up part is that it's not as if the cost of medical care actually correlates with the difficulty of providing it. Trying to perform moral calculations based on cost-of-care means your moral calculations are now based on whatever price-tag suppliers have decided to set.

It's not as if there's some sort of critical shortage re: cancer treatment; someone getting chemo doesn't mean someone else can't. That's why it seems kind of fucked up to me to talk about this in terms of how much we're willing to spend to save a life -- the only reason we're even having that conversation is because somebody decided it's okay to charge hundreds of thousands of dollars for cancer treatment.

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Re: ACA Lives For Another Year

Postby elasto » Sun Mar 26, 2017 10:28 am UTC

But they would say that that's because they have to cover the cost of developing the treatment - including all the attempts at treatment that didn't succeed - and all the costly trials therein.

About the best you could do is ban marketing spending by drugs companies, but that would only be a small percentage of any 100k price tag.

This is what you get as a society if you decide you want to extend life at any cost. The more pragmatic and utilitarian an approach you take the more you get accused of having 'death panels' who 'choose who lives and who dies'...

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Re: ACA Lives For Another Year

Postby The Great Hippo » Sun Mar 26, 2017 10:44 am UTC

elasto wrote:But they would say that that's because they have to cover the cost of developing the treatment - including all the attempts at treatment that didn't succeed - and all the costly trials therein.
And they'd be lying.

Just compare costs in the states to anywhere else.

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Re: ACA Lives For Another Year

Postby Angua » Sun Mar 26, 2017 11:25 am UTC

NICE still approves recommended treatments using QALYs in the UK.
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Re: ACA Lives For Another Year

Postby Sableagle » Sun Mar 26, 2017 11:39 am UTC

KnightExemplar wrote:I'm hungry and start complaining about it... the last thing a friend is supposed to do is say "Well, there are starving people in Africa". No shit, that sucks for them, but I'm still hungry.

We can't solve all problems, but lets start by solving specific problems of the people we're directly talking with.
You missed the word "unrelated" in there, didn't you?

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