1) Obviously Medicaid expansion is federally funded (90% after 2020). The question is where does that money come from. For ACA premium subsidies, NPR says they'll introduce taxes, Medicare savings etc. For Medicaid, they'll what?
edit: if you say something like 'from taxes on insurance co' you have to explain how this works, as ACA basically guarantees the insurance co's won't face falling profits due to ACA - they'll be allowed to raise premiums to compensate. Such a solution is nothing but indirect tax on those who pay full premiums.
2) Sure, if you can find a good doctor who takes Medicaid. It would be a choice of last resort for me - fuck HMOs, especially an *HMO known for lowball payments to doctors. ACA is raising Medicaid payments to Medicare levels?
*Note: I'm fine with Medicaid being an HMO - you get what you pay for. (Unless you go to the ER without insurance. Then you get poor service and a bill equivalent to anal rape, since you have no protection from predatory pricing.)
On the funding, the methods are all already demonstrated for everything included in estimates. And note that insurance profits were reduced as a cap, for the future - yes they'll stick to that new reduced cap - but that's gross profit that the cap applies to, not net profit that taxes are taken on.
I'd have to run a ton of hypothetical math, but I can't see where they could pass it off with how its setup.
On Medicaid as a secondary, you clearly don't understand how secondary insurances work - there's ZERO networks with secondaries, if they work with your primary (and all do to my knowledge) then it works ANYWHERE your primary does. Doctor takes Medicare? Then they take Medicare + Medicaid.
And Medicaid pharmacy plans are offered by every pharmacy by law. (Caremark for CVS for example)
Well hey if the law can't actually decrease the number of uninsured, lets just change how we collect and measure the data. *Golf Clap* for liberals everywhere.
I'm sure 2020 when the census is taken next we'll really have no easily visible idea how its doing regardless.
You do realize the census is only tabulated every decade, right? So even if they start this policy tomorrow it wouldn't show results til 2020 - worst way to cook the books ever.
Not to mention conservative leaning tracking polls like Gallup are reporting improved numbers already. But ya know, throw out what you don't want to hear and conspiracy theory up some "unskewing" that's worked out well so far.
1) Yes, I imagine it is a bit complicated. I have two choices here. a) believe that insurance co's won't pass their costs on due to .. what? poor performance of lobbyists, charitable feelings? b) they'll act like any other business and pass their costs on.
For someone like me, not highly qualified in this area, convincing me (a) is correct is a tough sell, if the proof is [complicated math, not shown]. Perhaps someone has done this work for us, and posted the information online? There's so much shit written about ACA its hard to find a good answer to something so technical and specific, and the primary source is a goddamn monster.
2) Yes, you caught me. I didn't read carefully enough(edit: it was actually quite a bad error). Medicaid secondary helps with copays and rx, not so much the payment to the doctor for the office visit or w/e. Got it. Some good info here.
This source may cite NYtimes, but that does not mean all claims made in your link are supported by w/e the NYtimes actually wrote.
Even granting that there is some truth to this for sake of discussion - If shitbag Republicans (not conservatives) are complaining, perhaps it is only because they didn't think of it first.
"Census officials and researchers have long expressed concerns about the old version of insurance questions in the Current Population Survey.
The questionnaire traditionally used by the Census Bureau provides an "inflated estimate of the uninsured" and is prone to "measurement errors," said a working paper by statisticians and demographers at the agency."
Might want to actually read it and the comments first...
For starters the timeframe issue I mentioned, the fact that informally the Census has received direction from the Cabinet for thirty years since it's been established - they just formalized it, and that the old metric was counting people as insured if they had insurance sometime in the previous THIRTY YEARS.
The old figures would count me as being insured from the time I was a gradeschoolerstill based on what the article stastate. Sure, maybe their "last 15 months" new metric is a bit short, but 30 years is ludicrously long. (5 years would be my suggestion personally)
Frk: 1) I'm sure they'll try to, just can't see a way for them to. There does always seem to be a loophole though, so you're probably right in the long run once they find one or create one via lobbying.
Frk: 1) I'm sure they'll try to, just can't see a way for them to. There does always seem to be a loophole though, so you're probably right in the long run once they find one or create one via lobbying.
Let's use this common point of agreement as a starting point. So, in the long run:
1) Premiums go up (insurance co passing on costs to their customers, in the specific context of Medicaid expansion):
a) Those who don't get subsidies pay (middle class and up).. higher premiums
b) more subsidy money is required to cover higher premiums, must increase tax on those who pay for subsidies (e.g. increase tax on $250k or more income, etc), AND/OR
c) the method for deciding who gets what level of subsidy is adjusted, so that some lose the subsidy, and some don't receive as much subsidy
2) My main point all along, here intended in a descriptive sense only, no judgement on wisdom of policy implied (yet):
Funding for ACA funnels money from relatively more to less productive people. The self-made successful entrepreneur (high value work), for example, likely pays extra both in taxes ($250k+) and also his monthly premium in order that a poor laborer (low value work) can receive a subsidy.
It seems 1 and 2 say about the same thing (or at least 1 implies 2). Thus, I extrapolate from a point of common agreement to my standing claim.
Previously, Disp provided examples of businesses he is familiar with saving money with ACA in 2014. It could be a counter-example to my claim. But:
They could have been paying too much pre-ACA for a variety of reasons.
ACA is very new, and we're talking long term - the process I have outlined above has not had a chance to take place. Medicaid expansion is in it's first year
I never said that reform wasn't needed, only that ACA is at best band-aid solution, fueled by redistribution from increasingly scarce providers, that leads to more problems and fewer options later, when the situation gets worse. (and can it not, considering ongoing collapse of American middle class?)
__________
You know, fuck this. Shit is complicated; hierarchies, private property, laws. Let's just move to Anarres: The Dispossessed - Wikipedia, the free encyclopedia
Vaclav, if you read fiction, don't miss this one from Le Guin. The opening:
"There was a wall. It did not look important. It was built of uncut rocks roughly mortared. An adult could look right over it, and even a child could climb it. Where it crossed the roadway, instead of having a gate it degenerated into mere geometry, a line, an idea of boundary. But the idea was real. It was important. For seven generations there had been nothing in the world more important than that wall.
Like all walls it was ambiguous, two-faced. What was inside it and what was outside it depended upon which side of it you were on.
Looked at from one side, the wall enclosed a barren sixty-acre field called the Port of Anarres. On the field there were a couple of large gantry cranes, a rocket pad, three warehouses, a truck garage, and a dormitory. The dormitory looked durable, grimy, and mournful; it had no gardens, no children; plainly nobody lived there or was even meant to stay there long. It was in fact a quarantine. The wall shut in not only the landing field but also the ships that came down out of space, and the men that came on the ships, and the worlds they came from, and the rest of the universe. It enclosed the universe, leaving Anarres outside, free.
Looked at from the other side, the wall enclosed Anarres; the whole planet was inside it, a great prison camp, cut off from other worlds and other men, in quarantine.
A number of people were coming alone the road towards the landing field, or standing around where the road cut through the wall ....
Exactly, and those people all paid full (inflated) price of ACA plans vs what was available to healthy people pre-ACA. From the article:
But if they made too much money to qualify for subsidy, he says, he steered them away from HealthCare.gov.
"If you can avoid that whole level of bureaucracy and get a good plan -not necessarily at a good price, but at the same price - and they're not eligible [for a subsidy] ...
But the off-exchange number is just as essential to gauging how well the law is working
Yes, those who signed up off exchange are essential - many had high quality, lower cost health insurance pre-ACA, got canceled, and now pay up to 2x higher premium. They're the suckers who offset insurance co's taking in sick people. (not all - those with pre-existing conditions will be quite happy at the transfer payment they are receiving). If you contest the 2x, I linked information on this in a previous post.
On 1) that's the normal methodology, but since the profits are capped later in the formulae - it would be tricky to balance from what I know of it.
2) Insurance has ALWAYS worked that way, executives have always been part of the same pool as their lower tier staff - the scope is just larger now.
Additionally there was $600 per capita in taxes that used to exist that went towards reimbursing hospitals for defaulted bills from the uninsured that's existed for nearly a century. (which is planned to sunset, since other funding is expected to replace it)
Technically somewhat true - it's a tax on any medical devices that are SHIPPED to or from the US. So for imported and exported units the taxes are only going to be indirectly represented here. It's not just a tax on US held companies or US purchased devices when it comes to those we ship out. In a large amount it's actually getting extra tax dollars for things from companies that have a minimal tax burden here already.
If you're trying to say the tax only applies to items that are imported or exported, you are incorrect. You had me going for a minute, but then I remembered I bought some DME right after the law went into effect and had to pay this tax. I looked at it and it was made in the USA. Unless you plan to claim that the company exported then imported it so I'd have to pay that tax.
You are a US resident, it shipped to you in the US.
But the tax is also paid by international people as well is the point. If it's say $100b of revenue, likely a third or so is coming from the rest of the world, if not more.
Additionally the tax is a noninvoice thing because it's assessed on the shipping company's taxes at the end of the FY according to how the ACA states it's to be assessed... You're likely seeing another tax and getting confused. (i.e. a few states have their own medical device taxes, MRIs have extra Federal ones for about a decade now, etc)
