The PPACA - Implementation Phase I

[Rover]

Re: The PPACA - Implementation Phase I

Flaggy and The Fish, none of your comments make sense. It appears to be an effort to find a small portion of the law that got adjusted and then use that to declare victory, pick up your Leggo's and go home.

But, lets take 'em one at a time.

The only way ditching catastrophic insurance coverage, or a medical device tax, would have any significant meaning is if supporters were arguing the law should never evolve once it was passed. That's obviously a strawman argument, right down to it needing a brain (Wizard of Oz reference for the young 'uns). If other funding mechanisms or savings can be found, who exactly is objecting?

Next opinions are like a-holes, as you can find plenty of other people who think its going great so that's irrelevant.

Finally, lets take the knuckledragger theory that the law won't have any of its original provisions left. By my own view, the main provisions were 1) everybody is required to get insurance or pay for not having it, 2) Exchanges will be set up to foster this insurance expansion, 3) Medicaid expansion for participating states. What part of that in your brilliant opinion will be going away, with the obvious disclaimer that you thought it wouldn't pass, the SCOTUS would strike it down, and Obama would lose re-election. Seems like you're 0 for 3 already on this.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

The only way ditching catastrophic insurance coverage [NOTE: the CLASS benefit was a long-term care benefit, not "catastrophic insurance coverage"], or a medical device tax, would have any significant meaning is if supporters were arguing the law should never evolve once it was passed.

Right. You and I are in basic agreement. The law as originally passed needs substantial revision to make it workable. By the time the "revisions" are done (excuse me, I must have meant "by the time the evolution is well along") very little of the original law will remain.

You keep defending the principle and I keep noting that whatever the principle was supposed to be, the actual law fails to deliver. Keep prattling on about how "it's just a minor flesh wound" as it all gets hacked away, if that keeps you happy.

 

[joecct]

Re: The PPACA - Implementation Phase I

Rover, FreshFish et al...

Has anyone figured out how much the PPACA is going to cost the taxpayer?

And can someone please answer my question on States & localities dropping their employee health benefits?

 

[FreshFish]

Re: The PPACA - Implementation Phase I

Has anyone figured out how much the PPACA is going to cost the taxpayer?

based on historical precedent, about ten times as much as the latest CBO estimate.

And can someone please answer my question on States & localities dropping their employee health benefits?

good luck with that. I'm not aware of any such entity that woudn't have to go through collective bargaining with their state / municipal employees' union first. The unions won't even let them adjust retiree health insurance benefits, let alone health insurance benefits for current workers!


if anything, it will be union pressure to preserve the benefits they already have that will become a powerful force in <strike>repealing</strike> "revising" / "evolving" the law.

 

[unofan]

Rover, FreshFish et al...

Has anyone figured out how much the PPACA is going to cost the taxpayer?

And can someone please answer my question on States & localities dropping their employee health benefits?

I don't really understand the question, but the answer in the general sense of whether a state can be compelled by the feds to do sonething is: it depends. I do not believe states pay federal income taxes, for instance, but they obviously pay the employer share of fica and federal gas taxes.

If you're worried about teachers and cops losing their healthcare, I think you don't have to worry about that. No way that happens.

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I don't really understand the question, but the answer in the general sense of whether a state can be compelled by the feds to do sonething is: it depends. I do not believe states pay federal income taxes, for instance, but they obviously pay the employer share of fica and federal gas taxes.

If you're worried about teachers and cops losing their healthcare, I think you don't have to worry about that. No way that happens.

The day NYSUT loses a battle is the day I win the lottery.

 

[joecct]

Re: The PPACA - Implementation Phase I

I don't really understand the question, but the answer in the general sense of whether a state can be compelled by the feds to do sonething is: it depends. I do not believe states pay federal income taxes, for instance, but they obviously pay the employer share of fica and federal gas taxes.

If you're worried about teachers and cops losing their healthcare, I think you don't have to worry about that. No way that happens.

Nobody would "lose" their healthcare. The vehicle on how to get it would (Feds vs. local).

 

[Rover]

Nobody would "lose" their healthcare. The vehicle on how to get it would (Feds vs. local).

This is what I've found. Tried to get an article that just gave the estimates and not any slant afterward:

CBO: Supreme Court ruling reduces PPACA's costs by $84B

Luke GaleJul 24, 2012



The Congressional Budget Office (CBO) predicted in its July 24 report that the Supreme Court’s decision on the Patient Protection and Affordable Care Act (PPACA), which altered the legislation’s Medicaid expansion provision, will lower the law’s 11-year cost by $84 billion, due to a reduced number of Americans that will be covered under the Act.

To account for the Supreme Court decision that, in effect, gave states the choice to participate in a planned Medicaid expansion that was expected to be mandatory, the CBO and the Joint Committee on Taxation updated PPACA cost estimates published in March and determined that its net cost from 2012 to 2022 will be $1.17 trillion rather than $1.25 trillion.

Since some states are already expected to opt out of Medicaid expansion, the CBO’s most recent cost estimate predicted fewer people would become eligible for and enroll in Medicaid than previous cost estimates. Based on a new prediction with fewer enrollees, the CBO estimated the 11-year cost of Medicaid and CHIP will be $298 billion less than it previously had and the 11-year cost of tax credits and subsidies will be $210 billion more. Less significant changes in the CBO’s new estimate account for the additional $5 billion .

Prior to the Supreme Court's ruling, the office had suggested that new policies established by PPACA would cost federal agencies at least an estimated $115 billion between 2010-2019 to implement, in the form of explicit authorizations for future appropriations for a variety of grant and other program spending.

The CBO's July 24 report detailing its PPACA cost estimates is available here.

http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf

 

[Rover]

Right. You and I are in basic agreement. The law as originally passed needs substantial revision to make it workable. By the time the "revisions" are done (excuse me, I must have meant "by the time the evolution is well along") very little of the original law will remain.

You keep defending the principle and I keep noting that whatever the principle was supposed to be, the actual law fails to deliver. Keep prattling on about how "it's just a minor flesh wound" as it all gets hacked away, if that keeps you happy.

We're not in agreement at all actually, and that's a good thing for me. I do admire your dedication to flailing away long after the issue has been decided. You must have been a hoot on your Little League team, refusing to leave the batter's box after you struck out to end the game until it was time to go to school the next morning. To the rest of us though, you just come off as an idiot. As I've said before, if the Roberts decision so undid PPACA, why are the conservatives so ****ed off? Is it possible you know something the experts on the right don't? Highly unlikely.

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

This is what I've found. Tried to get an article that just gave the estimates and not any slant afterward:

CBO: Supreme Court ruling reduces PPACA's costs by $84B

Luke GaleJul 24, 2012



The Congressional Budget Office (CBO) predicted in its July 24 report that the Supreme Court’s decision on the Patient Protection and Affordable Care Act (PPACA), which altered the legislation’s Medicaid expansion provision, will lower the law’s 11-year cost by $84 billion, due to a reduced number of Americans that will be covered under the Act.

To account for the Supreme Court decision that, in effect, gave states the choice to participate in a planned Medicaid expansion that was expected to be mandatory, the CBO and the Joint Committee on Taxation updated PPACA cost estimates published in March and determined that its net cost from 2012 to 2022 will be $1.17 trillion rather than $1.25 trillion.

Since some states are already expected to opt out of Medicaid expansion, the CBO’s most recent cost estimate predicted fewer people would become eligible for and enroll in Medicaid than previous cost estimates. Based on a new prediction with fewer enrollees, the CBO estimated the 11-year cost of Medicaid and CHIP will be $298 billion less than it previously had and the 11-year cost of tax credits and subsidies will be $210 billion more. Less significant changes in the CBO’s new estimate account for the additional $5 billion .

Prior to the Supreme Court's ruling, the office had suggested that new policies established by PPACA would cost federal agencies at least an estimated $115 billion between 2010-2019 to implement, in the form of explicit authorizations for future appropriations for a variety of grant and other program spending.

The CBO's July 24 report detailing its PPACA cost estimates is available here.

http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf

I would love to know what sorts of assumptions these guys are making in getting these numbers. After, wasn't it fairly recently that it took Senate action to admit to the CBO that a change in tax rates causes behavioral spending/investment/etc. to change?

 

[FreshFish]

Re: The PPACA - Implementation Phase I

This is intriguing...

new findings from one of the most important public-policy experiments since the 1970s.

A team of varsity health economists, mostly at Harvard and MIT, is studying the relationship between health outcomes and health insurance delivered by Medicaid. In 2008, Oregon's Medicaid program conducted a lottery to enroll a limited number of low-income adults, and the economists are comparing over time the winners who gained coverage with those who applied but remain on a waiting list. Such experiments with large randomized trials are rare.

On Wednesday the New England Journal published the results from year two of the Oregon project, which "showed that Medicaid coverage generated no significant improvements in measured physical health outcomes" versus being uninsured....

The Medicaid group used about 35% more health services, but they showed no clinical differences from the identical uninsured group across basic health measures like blood pressure, blood sugar and cholesterol levels that can be improved with the right treatment. The same was true comparing subgroups such as people with chronic diseases like diabetes. Health spending was higher among the Medicaid group, despite claims that using more preventative care and less emergency room will lower costs.

The study did go on to find one significant area in which Medicaid did make a difference, but only for 5.5% of the non-Medicaid participants in the study, and that is in the area of catastrophic health costs.

Now sensible economists have been saying for years that if you are going to provide healthcare assistance, a high-deductible plan (i.e., catastrophic coverage) is the best way to get value for the dollar, and this study confirms that finding.

Which goes to the heart of one of the greatest flaws in PPACA: it tries to micro-manage way too much. If they had said something like "we want to backstop everyone by making available a subsidized stripped down barebones plan with a $10,000 deductible, the purists on the right would have mumbled their "slippery slope" mantras and "toe in the door" doomsday scenarios, but most reasonable people would find a way to compromise on that concept. But to force everyone in the entire country into a rigid plan with extensive details? not smart.

 

[unofan]

Re: The PPACA - Implementation Phase I

Now sensible economists have been saying for years

Ah yes, the "no true Scotsman" fallacy. With one word you acknowledge that other economists hold differing views, but they can be summarily ignored since they aren't "sensible." That way you never have to challenge your own view on things, since clearly the sensible people agree with you.

 

[Rover]

Re: The PPACA - Implementation Phase I

I'm all for experiments and testing to improve the service, but I'm not sure I'd draw definitive conclusions from one survey. For example did this study review mental health or just blood pressure/cholesterol? Also, what were the differences in medical bills between the two, as people can run up devastating expenses even with one significant illness. Finally, I'm also curious if the good people of Oregon, much like Colorado folks, tend to be a bit healthier than the population of the country at large.

This does bring up a bigger point though. I'm all for conservatives running on an end-Medicare/Medicaid platform. Surely you jest, you say. Not at all. All those poor rural folk in places such as Kansas, Nebraska, WVA, Kentucky, Alabama, etc need to realize what exactly they're voting for, and this proposal ought to bring that concept home loud and clear.

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

I'm all for experiments and testing to improve the service, but I'm not sure I'd draw definitive conclusions from one survey. For example did this study review mental health or just blood pressure/cholesterol? Also, what were the differences in medical bills between the two, as people can run up devastating expenses even with one significant illness. Finally, I'm also curious if the good people of Oregon, much like Colorado folks, tend to be a bit healthier than the population of the country at large.

This does bring up a bigger point though. I'm all for conservatives running on an end-Medicare/Medicaid platform. Surely you jest, you say. Not at all. All those poor rural folk in places such as Kansas, Nebraska, WVA, Kentucky, Alabama, etc need to realize what exactly they're voting for, and this proposal ought to bring that concept home loud and clear.

Actually, the legislators did shoot themselves in the foot a bit. Do you know why they need to set up state-run exchanges, or why states have to be the ones to sponsor Medicare or Medicaid? It's because they kept one of the Glass-Steagall laws where you're not allowed to purchase insurance across state lines. That way, if a state chooses not to set up a state-run exchange that is compatible with PPACA, the PPACA is effectively unenforceable.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

Does anyone else find it amusing that the Feds have to prescribe exactly how to set up an insurance exchange?

We've already had one for decades. They call it "the market."

Government interference in the operation of the market made health care more expensive and more inefficient. and of course the solution is even more government interference.

and because the interference became so great, we needed an even more drastic overhaul.

and part of the overhaul is to set up an insurance exchange.

why?

in an attempt to use market forces to improve pricing and options!

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Does anyone else find it amusing that the Feds have to prescribe exactly how to set up an insurance exchange?

We've already had one for decades. They call it "the market."

Government interference in the operation of the market made health care more expensive and more inefficient. and of course the solution is even more government interference.

and because the interference became so great, we needed an even more drastic overhaul.

and part of the overhaul is to set up an insurance exchange.

why?

in an attempt to use market forces to improve pricing and options!

Communism at its finest.

 

[unofan]

Does anyone else find it amusing that the Feds have to prescribe exactly how to set up an insurance exchange?

Are you bi-polar? You've gone from "very, very concerned" to "amused" in the span of what, 12 hours?

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Are you bi-polar? You've gone from "very, very concerned" to "amused" in the span of what, 12 hours?

Amusement in something that is typically of no laughing matter can be a cause for concern.

 

[Rover]

Actually, the legislators did shoot themselves in the foot a bit. Do you know why they need to set up state-run exchanges, or why states have to be the ones to sponsor Medicare or Medicaid? It's because they kept one of the Glass-Steagall laws where you're not allowed to purchase insurance across state lines. That way, if a state chooses not to set up a state-run exchange that is compatible with PPACA, the PPACA is effectively unenforceable.

Focusing on this one issue, I never understood why people think being able to purchase insurance across state lines is some sort of great untapped health care savings that the gubmint is preventing. If you live in NYC and purchase North Dakota insurance, your insurer isn't going to get to pay North Dakota doctor prices to a provider in Manhatten.

Its similar to how Minny based Geico doesn't charge you according to the going rate in Duluth if you drive in SF or LA or Boston. They charge you what it costs to fix the car where you live.

Lastly, the logistical nightmare that would happen if everyone has access to 1000 different policies would most likely cost more than any savings you'd get for as of now undefined reasons. How would you handle the different laws each state has, even before you get to controversial stuff like abortion or same sex couple coverage?

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Focusing on this one issue, I never understood why people think being able to purchase insurance across state lines is some sort of great untapped health care savings that the gubmint is preventing. If you live in NYC and purchase North Dakota insurance, your insurer isn't going to get to pay North Dakota doctor prices to a provider in Manhatten.

Its similar to how Minny based Geico doesn't charge you according to the going rate in Duluth if you drive in SF or LA or Boston. They charge you what it costs to fix the car where you live.

Lastly, the logistical nightmare that would happen if everyone has access to 1000 different policies would most likely cost more than any savings you'd get for as of now undefined reasons. How would you handle the different laws each state has, even before you get to controversial stuff like abortion or same sex couple coverage?

Something makes me wonder if the same arguments were trying to be made when they were talking about allowing banking to happen across state lines. I do think you're also making an assumption that insurance companies are not going to put forth a behavioral pricing scheme into place, which would include physician costs. The biggest point behind this, however, is that this is what a federally-run exchange would need in order to be set up and effectively enforce the law. In addition, you talk about 1000 different policies. At the time of the start of the enforcement of Glass-Steagall, there were 15,000 different brands of banks. Do you honestly believe there's anything even close to that today? If insurance were allowed to be purchased state lines, would we still have 1000 brands of insurance each trying to put out a policy? Whether or not this creates a too-big-to-fail scenario and the cycle just starts all over again, I don't know if it will happen, but it's certainly a possibility. My point is, though, if you're going to create a federal tax rebate system such as PPACA, it needs to be made federally available in order to be effective.

As for your concern about state laws, I don't see how anything of that sort would change. Just because a policy allows for the coverage of something doesn't automatically mean that it would be taken. As an example, my bank gives me rewards for buying $7 worth of food at Chik-Fil-A. But what do you know? There isn't one close to me. I'd have to go to another state in order to use that. My health insurance could cover me for mammograms as part of a bundle deal in order to get me a lower price, but how much use is that to a guy? What if I want to buy fireworks? I have to go to Pennsylvania for that. Not much different when it comes to health products that aren't available in a state for one reason or another. That's the chance you take.