Getting it done: Obama's full-court press on health care

[Malificent]

As someone who has both MS and MD and I'm 43, I'm pretty sure I couldn't get insurance if I had to go back out on the market. And that would mean stopping treatment because the cost of my drugs is equivalent to paying for a luxury car every year.

Fuck the GOP.

[Zarathud]

I hear you. The insulin for my two kids runs $1,000 per month. No doctors visits, no delivery supplies. Stopping their treatment will kill them either quickly or slowly.

My wife was hit by a freight train as a teenager -- and lived which makes for one hell of a pre-existing condition. At 44 working in a high-stress occupation and on a CPAP for hereditary sleep apnea, I'm not likely to be insurable at a reasonable cost. Certainly not with my family.

Fuck the GOP.

[Skinypupy]

Mrs. Skinypupy was born with an extremely rare GI disease called Hirschsprung's Disease. They basically had to remove the bulk of her intestines before she was 1, and she now (obviously) suffers some rather severe GI issues as a result, requiring regular treatments. I'm sure she will be quite uninsurable if we ever need to shop for it ourselves.

Fuck the GOP.

[Chrisoc13]

Is "they aren't going to insure pre-existing conditions!" Going to be the rallying cry of the left this time similar to "death panels"? The hysteria that goes beyond logic for every move the GOP makes on this forum is getting predictable and completely illogical. The forum always assumes the worst with the absolute worst intentions of everything the GOP does. They're politicians. Just like Democrats. Perhaps we can actually find a way to move forward? There won't be much support to pass anything that drops coverage from pre existing conditions so the hysteria is a bit pre-mature. I understand your apprehension, but again... Hysteria. With all things gop related in this forum. Take a step back and breathe. You don't want this to become the lefts death panels.

[RunningMn9]

El Guapo, in your scenario I would point out that individuals paying qualified health insurance premiums also don't pay taxes on the money. So the math doesn't change. If my employer pays me the an extra $10K and I use all of it to pay for qualified health insurance premiums, I don't owe the $2500 in tax either.

But I also have the choice to find a more affordable health plan and to allow health insurers to compete for (and retain) my dollars - which is a more effective way of getting insurers to provide what I need that dealing with my employer.

Keep in mind (others) that I am not an advocate of the GOP plan (outside of breaking up the employer-based insurance system). Opening up the exchanges to foster competition amongst insurers, and having us all shop through it directly would be my next step.

Certainly not repealing the ACA. Fix it.

[RunningMn9]

And Chrisoc13 - I can't speak for anyone else here, but the GOPs obsession with shifting the risk burden onto individuals via health savings accounts is worthy of scorn. From everyone.

[Isgrimnur]

And what group do I get to be a part of to mitigate their risk? Are they going to group me geographically or demographically? Because, as a 40yo guy with elevated blood sugar and a history of asthma, I'm not convinced that there's going to be an affordable solution available to me in an open market.

[Skinypupy]

Is "they aren't going to insure pre-existing conditions!" Going to be the rallying cry of the left this time similar to "death panels"?

Slight difference in that "death panels" was largely exaggerated nonsense, while discontinuing pre-existing condition coverage is exactly what they've stated as their intent.

There won't be much support to pass anything that drops coverage from pre-existing conditions so the hysteria is a bit pre-mature.

And lack of support matters to them because...?

[raydude]

There won't be much support to pass anything that drops coverage from pre existing conditions so the hysteria is a bit pre-mature. I understand your apprehension, but again... Hysteria. With all things gop related in this forum. Take a step back and breathe. You don't want this to become the lefts death panels.

So your position is that we shouldn't freak out until dropping coverage from pre-existing conditions actually comes to pass? Forgive me if I say that's way too late in the game to be concerned.

[Chrisoc13]

I would love to see evidence that their intent is stated to be to drop coverage for pre-existing conditions, any more than death panels was the lefts intent. I mean the GOP intent. Not some idiot congressman quote someone can dreg up.

Just because it's your side doesn't make the response logical. It's sounding equally hysterical as the anti-Obama crowd did.

As to support, I mean Congress won't have the support to remove pre existing conditions. They still have to be elected every couple years. Not to mention trump said he wants to keep it. Do I trust trump? Haha no. The man is unfit to be our president. But I do believe he would actually veto that.

Concern is fine. Expressing concern is great. Getting involved is fantastic. Hysteria is just hysteria. It makes independents and conservatives tune out. It doesn't help anyone. The media still hasn't figured this out. And it's on full display here at oo and elsewhere. While the GOP has been beating the drum of repealing the ACA (or rather beating a dead horse) now that they have the reigns i think we have already seen some recognition from those in power that a replacement plan will be necessary rather than just a repeal plan. To assume a replacement plan won't have pre-existing conditions covered because "hysteria" is jumping the gun a little bit. This is all my opinion of course. None of us truly know what they will attempt to do yet. Which is why now is a great time to bed involved in a non-hysterical way. A way that people might actually listen. Just saying try coming back to earth a bit.

[RunningMn9]

And what group do I get to be a part of to mitigate their risk?

The group of "everyone else that buys the same insurance plan that you do". Isn't that how insurance plans work?

[Skinypupy]

I would love to see evidence that their intent is stated to be to drop coverage for pre-existing conditions, any more than death panels was the lefts intent. I mean the GOP intent. Not some idiot congressman quote someone can dreg up.

Time article from Jan 24

But if the GOP's yet-to-be-unveiled Obamacare replacement plan is anything like what Tom Price -- Trump's nominee to head the Department of Health and Human Services -- has proposed in the past, tens of millions of people could in fact lose their insurance, or pay significantly more for it, because of pre-existing conditions.

Price's plan relies on a "continuous coverage" provision to create waivers for people with pre-existing conditions. An insurer offering coverage in the individual market would not be able to "impose any pre-existing condition exclusion" if the individual has at least 18 months of continuous coverage before enrolling in the new plan.

Translated, that means that if you have a pre-existing condition but haven't had a recent gap in your health coverage, insurers could not discriminate against you.

That provision, however, leaves the door open to policy denials -- or higher charges -- if your coverage lapses. "If you get laid off or lose your job and do have a coverage gap, they would be able to deny you, they would be able to charge more and put limits on your insurance," says Cynthia Cox, associate director of KFF. She notes that the policy does benefit those who can afford coverage, but "doesn't really get at the affordability issue."

If the GOP has something different that they're formulating, then I think we'd all be very relieved to hear it and it would significantly decrease the concern. Unfortunately, they don't seem terribly interested in sharing that information.

In the absence of a new plan, all we really have to go off is what they have previously proposed...which has many of us very worried.

[RunningMn9]

I would love to see evidence that their intent is stated to be to drop coverage for pre-existing conditions, any more than death panels was the lefts intent.

Can we at least agree that their intent is clearly to shift the burden of risk from insurers to individuals?

[Rip]

I would love to see evidence that their intent is stated to be to drop coverage for pre-existing conditions, any more than death panels was the lefts intent.

Can we at least agree that their intent is clearly to shift the burden of risk from insurers to individuals?

Insurers don't get burdened. They just pass it down in premiums. The burden rests with the people same as it always has.

[El Guapo]

I would love to see evidence that their intent is stated to be to drop coverage for pre-existing conditions, any more than death panels was the lefts intent. I mean the GOP intent. Not some idiot congressman quote someone can dreg up.

Just because it's your side doesn't make the response logical. It's sounding equally hysterical as the anti-Obama crowd did.

As to support, I mean Congress won't have the support to remove pre existing conditions. They still have to be elected every couple years. Not to mention trump said he wants to keep it. Do I trust trump? Haha no. The man is unfit to be our president. But I do believe he would actually veto that.

Concern is fine. Expressing concern is great. Getting involved is fantastic. Hysteria is just hysteria. It makes independents and conservatives tune out. It doesn't help anyone. The media still hasn't figured this out. And it's on full display here at oo and elsewhere. While the GOP has been beating the drum of repealing the ACA (or rather beating a dead horse) now that they have the reigns i think we have already seen some recognition from those in power that a replacement plan will be necessary rather than just a repeal plan. To assume a replacement plan won't have pre-existing conditions covered because "hysteria" is jumping the gun a little bit. This is all my opinion of course. None of us truly know what they will attempt to do yet. Which is why now is a great time to bed involved in a non-hysterical way. A way that people might actually listen. Just saying try coming back to earth a bit.

It's not a speculative worry. Basically, if the GOP does not repeal the requirement to cover pre-existing conditions, then they're not really repealing Obamacare. The core of Obamacare flows as a matter of straightforward logic from that requirement. To start, if you require insurance companies to cover preexisting conditions, then they will offer them coverage but at a completely unaffordable price (basically, they'll offer insurance at the rate that they expect the actual medical care to cost for that condition). You can fix that problem by limiting what insurance companies can charge people with preexisting conditions to what those people can afford. Problem then is that there's no reason for anyone to buy insurance unless and until they are sick. Then the only people with insurance at a given time will be sick people, which will make insurance policies unaffordable to offer. So you fix that by requiring people to buy insurance. And now you have the individual mandate...and essentially the ACA.

Now, Republicans will often say things like "we'll get rid of Obamacare, but keep the good parts like the preexisting condition mandate", but no one really takes that seriously because that just doesn't make any sense. There's no practical way to actually do that. This is why many GOP officials are kind of freaking out (see the secretly recorded discussions on health care) - there's no real way to do what they have been saying that they'll do.

Sometimes they'll try to finesse it by saying something like "insurance companies will have to cover people with preexisting conditions as long as they maintain continuous coverage", which sounds like the same thing but isn't - that's the pre-ACA status quo where a preexisting condition wouldn't stop you from switching insurance companies, but if you lose insurance coverage for even a day all of the insurance companies will deny you coverage on the basis of your preexisting condition.

[Zarathud]

The evidence comes from the Republican Party's track record -- many repeal proposals, no other plan, terrible rhetoric, and general willingness to sacrifice individuals to their corporate constituency. It's a safe bet to take them at their word.

Death panels were an invention for political attacks. Pre-existing conditions are real problems before the politics. Not having access to insurance was a serious issue with my wife before we married. With my kids, it's life threatening. The current Health Savings Account proposal is Pence's Indiana plan and it won't work for my family.

In no reality will I depend on President Donald Trump to be the voice of reason.

[Isgrimnur]

If I end up losing my medical coverage, my new billing address is my Rep's local office.

[El Guapo]

El Guapo, in your scenario I would point out that individuals paying qualified health insurance premiums also don't pay taxes on the money. So the math doesn't change. If my employer pays me the an extra $10K and I use all of it to pay for qualified health insurance premiums, I don't owe the $2500 in tax either.

But I also have the choice to find a more affordable health plan and to allow health insurers to compete for (and retain) my dollars - which is a more effective way of getting insurers to provide what I need that dealing with my employer.

Keep in mind (others) that I am not an advocate of the GOP plan (outside of breaking up the employer-based insurance system). Opening up the exchanges to foster competition amongst insurers, and having us all shop through it directly would be my next step.

Certainly not repealing the ACA. Fix it.

That's true, although it gets into one of the other reasons that we have an employer-based insurance system, which is that employers (and employer-associations) create a natural pooling mechanism. Because employers (and employer associations) are offering a substantial volume of customers, they can generally negotiate a better price than an individual on the market could.

In any event, I don't dispute that you could have a potentially better system where individuals are buying insurance for themselves rather than through employers. The regulated ACA marketplaces could become a vehicle for a functional individual insurance policy marketplace for most people (whereas the pre-ACA individual marketplace was a wasteland of dysfunction and despair).

My main point when we were getting into this is just that it sounds like Republicans (or at least, one prominent GOP plan) involves tackling the employer-based insurance market at the same time as they repeal (and theoretically replace) Obamacare. Which politically, seems like invading Russia before you have defeated England.

[Fireball]

Is "they aren't going to insure pre-existing conditions!" Going to be the rallying cry of the left this time similar to "death panels"? The hysteria that goes beyond logic for every move the GOP makes on this forum is getting predictable and completely illogical. The forum always assumes the worst with the absolute worst intentions of everything the GOP does. They're politicians. Just like Democrats. Perhaps we can actually find a way to move forward? There won't be much support to pass anything that drops coverage from pre existing conditions so the hysteria is a bit pre-mature. I understand your apprehension, but again... Hysteria. With all things gop related in this forum. Take a step back and breathe. You don't want this to become the lefts death panels.

Read their policy proposals. None of them — none of them — guarantee the issuance of insurance to people with pre-existing conditions at community rate. None.

[El Guapo]

The evidence comes from the Republican Party's track record -- many repeal proposals, no other plan, terrible rhetoric, and general willingness to sacrifice individuals to their corporate constituency. It's a safe bet to take them at their word.

It's more than just the GOP track record, though - they're at war with the fundamental logic of health care markets. Most health care expenditures are made by a minority of people with expensive conditions. So it's just an unavoidable reality that in order to have or to a least approach universal coverage or universal access to medical care, you have to shift costs from the old and sick to the young and healthy.

You can do that through a regulated private market (which would by logic as I say above wind up looking at least somewhat like the ACA). You can do that through the government (single payer, or higher taxes and direct and heavy individual subsidies). Neither of those is consistent with GOP political constraints.

[Fireball]

I would love to see evidence that their intent is stated to be to drop coverage for pre-existing conditions, any more than death panels was the lefts intent. I mean the GOP intent. Not some idiot congressman quote someone can dreg up.

Tom Price, the HHS secretary, has outlined his vision for health care reform, which specifically does not guarantee the issuance of health insurance to people with pre-existing conditions. The few Republican plans that do address pre-existing conditions do so in a completely inadequate way, such as Paul Ryan's "Better Way" plan that does not require the issuance of insurance but which creates a "high risk pool" that would provide coverage for people with certain pre-existing conditions — but which funds that "high risk pool" at 1/3 the amount that independent estimates calculate would be necessary to provide adequate coverage. Donald Trump's "plan" from the campaign, if you can call it that, requires insurance companies to sell insurance to people regardless of pre-existing conditions, but does not require them to do so at the "community rate," which means the insurance company could charge you $400 a month for a policy while charging someone with a pre-existing condition $15,000 a month for the same policy, effectively denying coverage through another means.

Just because you are unaware of these facts does not mean that those of us who are sounding the alarm about them are hysterical.

[ImLawBoy]

Personally, I think one side calling the other "hysterical" while the other side calls the first side "ignorant" will really help to build a productive discussion.

[Smoove_B]

It's more than just the GOP track record, though - they're at war with the fundamental logic of health care markets.

It's not just health care but a general political / social /moral philosophy on what it means to be part of society. There's a strong undercurrent of "I'm not paying for other people's problems" in just about every area. Pregnant? You're carrying that baby to term but don't expect Medicaid or SNAP benefits after that child is born. Insurance? I'm not paying more per month in my premiums so sick people can take advantage of my ability to pay more. Unemployment? Why are you taking money from my paycheck to give to illegals that are sitting around collecting benefits? In a neighboring town they're currently arguing over the installation of a sewer system. It was voted down because the sewer system only impacts a few dozen or so businesses on main street and a few dozen homes in the surrounding area. Never mind the harm to the environment or that Main Street is in a death spiral because no one wants to move into a buildings with 50+ year old cesspits, I'm not paying pennies on the dollar for my property taxes to increase because it's not something that instantly and immediately benefits me directly.

[RunningMn9]

That's true, although it gets into one of the other reasons that we have an employer-based insurance system, which is that employers (and employer-associations) create a natural pooling mechanism. Because employers (and employer associations) are offering a substantial volume of customers, they can generally negotiate a better price than an individual on the market could.

That's certainly true in the current model, where employer-sponsored health plans are the vast majority. Somehow this isn't an issue when I shop for car insurance. I don't require my employer to shop for me (using his criteria, not mine), and somehow not only can I find affordable insurance in NJ, I have a variety of insurance companies constantly trying to get me to switch to them (by offering better service and/or lower rates).

I understand that there are real differences between car and health insurance - but I genuinely believe that the true application of market forces - when applied to health *insurance* (not healthcare, or at least not certain types of healthcare), will result in more affordable policies than what is available on the open market now. Whether they will ever compete with employer-sponsored plans is a hard comparison to make because it's likely that I wouldn't choose the same plan that my employer chose for me, since we have different criteria that we are using to make the selection.

In any event, I don't dispute that you could have a potentially better system where individuals are buying insurance for themselves rather than through employers. The regulated ACA marketplaces could become a vehicle for a functional individual insurance policy marketplace for most people (whereas the pre-ACA individual marketplace was a wasteland of dysfunction and despair).

Agreed. The ACA health insurance exchanges would have been a natural vehicle for this. Even if we modified the system so that my employer still paid the tab (or a portion of the tab) under existing tax rules, but individuals have the option to choose the best plan for their needs.

I don't believe the system can work properly until the insurance providers are directly competing for the business and dollars of the people actually consuming the product.

My main point when we were getting into this is just that it sounds like Republicans (or at least, one prominent GOP plan) involves tackling the employer-based insurance market at the same time as they repeal (and theoretically replace) Obamacare. Which politically, seems like invading Russia before you have defeated England.

I think that we are in total agreement that whatever path the GOP takes forward, they will completely cock up the situation. This is easy to see based on the fact that here we are, 7 goddamn years after they started the "Repeal Obamacare!!" crusade, and we now know that they didn't spend even a fucking second of that time figuring out what their alternative was.

Likely because their primary aversion to the ACA is politically-based, rather than policy-based (since it's by and large the plan they wanted to go with in the early 1990s, and which many libertarian groups supported prior to Obama co-opting it).

[Jeff V]

I'm not paying pennies on the dollar for my property taxes to increase because it's not something that instantly and immediately benefits me directly.

A former colleague and unabashed acolyte of the Orange God tried to get me to take action against AT&T because they recently announced they will be dropping POTS service in the state.

I informed him I have not personally used an AT&T service in many years; this affects me not at all. Presumably he understands the sentiment.

[Fireball]

That's true, although it gets into one of the other reasons that we have an employer-based insurance system, which is that employers (and employer-associations) create a natural pooling mechanism. Because employers (and employer associations) are offering a substantial volume of customers, they can generally negotiate a better price than an individual on the market could.

That's certainly true in the current model, where employer-sponsored health plans are the vast majority. Somehow this isn't an issue when I shop for car insurance. I don't require my employer to shop for me (using his criteria, not mine), and somehow not only can I find affordable insurance in NJ, I have a variety of insurance companies constantly trying to get me to switch to them (by offering better service and/or lower rates).

Part of the difference there is that all clients of an auto insurer are treated as being part of the same giant pool, whereas (for bad, legacy reasons) different workplaces and even different counties in the individual markets are all treated as separate pools. One of the best ways to "enhance" the ACA would be to require all insurers to treat *everyone* covered by *any* of their insurance products to be in the same risk pool, thus equalizing premium costs across all policyholders, in my opinion.

Agreed. The ACA health insurance exchanges would have been a natural vehicle for this. Even if we modified the system so that my employer still paid the tab (or a portion of the tab) under existing tax rules, but individuals have the option to choose the best plan for their needs.

There is actually a mechanism for businesses to do this through the ACA, using the "small business exchanges" to provide a broad selection of plans, with the employer then paying a portion of the premium selected by the insurance holder. This is how Congressional staff and members of Congress purchase their health insurance through the exchanges.

Likely because their primary aversion to the ACA is politically-based, rather than policy-based (since it's by and large the plan they wanted to go with in the early 1990s, and which many libertarian groups supported prior to Obama co-opting it).

Yup. If you want a market-based path to near-universal health insurance coverage, it's going to be broadly indistinguishable from the ACA. The best possibility for these "repeal and replace" efforts, if they were to pass, would be that the pieces of the ACA are torn down, relabeled, and put back together in a slightly different pattern.

[LordMortis]

That's certainly true in the current model, where employer-sponsored health plans are the vast majority. Somehow this isn't an issue when I shop for car insurance. I don't require my employer to shop for me (using his criteria, not mine), and somehow not only can I find affordable insurance in NJ, I have a variety of insurance companies constantly trying to get me to switch to them (by offering better service and/or lower rates).

Are you a high risk driver? It's the closest I can think of to someone with an existing condition.

Part of the difference there is that all clients of an auto insurer are treated as being part of the same giant pool,

I don't think that is the case. I think auto insurance pools are by state and then if you are lucky by some sort of discounter, like a credit union. Then your just an actuary science of risk, which I believe is the same thing they do health insurance, ranging from your 11 digit zip code to your credit score, in addition to things like your record and car safety. We'd need Cortillian or someone more knowledgeable to really talk about it.

[RunningMn9]

That's certainly true in the current model, where employer-sponsored health plans are the vast majority. Somehow this isn't an issue when I shop for car insurance. I don't require my employer to shop for me (using his criteria, not mine), and somehow not only can I find affordable insurance in NJ, I have a variety of insurance companies constantly trying to get me to switch to them (by offering better service and/or lower rates).

Are you a high risk driver? It's the closest I can think of to someone with an existing condition.

The comment you are referencing of mine has nothing to do with pre-existing conditions. It simply had to do with employers getting employees a bulk discount.

[LordMortis]

That's certainly true in the current model, where employer-sponsored health plans are the vast majority. Somehow this isn't an issue when I shop for car insurance. I don't require my employer to shop for me (using his criteria, not mine), and somehow not only can I find affordable insurance in NJ, I have a variety of insurance companies constantly trying to get me to switch to them (by offering better service and/or lower rates).

Are you a high risk driver? It's the closest I can think of to someone with an existing condition.

The comment you are referencing of mine has nothing to do with pre-existing conditions. It simply had to do with employers getting employees a bulk discount.

I'm really confused then because I thought it has everything to do with pre existing conditions. Even before the ACA if you were the picture of health and never used your health insurance, you could shop for health insurance and find it at rates and tax subsidies comparable or much lower than what employers pay. Essentially, as long as you've never needed insurance, and weren't high risk, then health insurance was cheap.

http://www.consumerreports.org/content/ ... 202008.pdf

From 2008

If you go to the eHealthInsurance.com
W
eb site, which links to hundreds of in-
surance plans across the country, you will
find many policies offered at seemingly
affordable prices. A recent search found
policies available for a 25-year-old man in
Evergreen, Colo., for as little as $45 a
month. But unless you are also 25 years
old and in perfect health don’t bet on get-
ting such a policy.
“It’s true that the advertised prices for
many individual policies in many states
are eye-poppingly low,” says Karen Pollitz,
a research professor who heads projects
on individual health insurance at the
Georgetown University Health Policy
Institute. “The policies often cover very
little: $5,000 deductibles, four doctor visits
a year, no drugs.”
Our survey found that the median out-
of-pocket medical expenses for the past
12 months were $2,264 for those with in-
dividual insurance vs. $973 for people
with employer-based plans.
And anyone with a pre-existing condi-
tion who has individual insurance must
pay whatever rate the company charges.
Although it is illegal in all states to kick
people out of insurance plans if they be-
come ill, in most states insurance compa-
nies are allowed to increase rates as much
as they need to cover the plan’s medical
costs, plus a reasonable profit.

[Chrisoc13]

Personally, I think one side calling the other "hysterical" while the other side calls the first side "ignorant" will really help to build a productive discussion.

I'm not really the other side though. Republicans don't represent me. I may be conservative but Republicans no longer represent me. I'm for fixing ACA, not repealing it. The Republican obsession with repealing it is beyond me. It's become a strange rallying cry. And I still think they will keep large chunks of it if they ever do anything with it.

Even though I'm not Republican and I don't support our current president doesn't change the fact that the "f&@$ the GOP" posts make me tune out anything those people are saying. And I'm not alone. The media is doing similar things with trump right now. Fear mongering in the opposite direction. Both sides are playing with fear and moderates are left to simply not trust either side. In my experience at least. Playing into his hand. Silence the moderates and leave the extremes to run the show. There are lots of legitimate concerns to be raised, but if every concern is looked at as the worst possible scenario and sold as gospel... Moderates step away.

Anyways I won't pretend to be as knowledgeable on actual plans floating around as fireball, I don't have time to be. But I still think plans without pre-existing conditions being covered won't fly well anymore. They may be floating around but until one actually gains any sort of traction it's just someone's dream.

[RunningMn9]

I'm really confused then because I thought it has everything to do with pre existing conditions.

Perhaps it would help to put my comment in the context of the comment it was addressing?

That's true, although it gets into one of the other reasons that we have an employer-based insurance system, which is that employers (and employer-associations) create a natural pooling mechanism. Because employers (and employer associations) are offering a substantial volume of customers, they can generally negotiate a better price than an individual on the market could.

That's certainly true in the current model, where employer-sponsored health plans are the vast majority. Somehow this isn't an issue when I shop for car insurance. I don't require my employer to shop for me (using his criteria, not mine), and somehow not only can I find affordable insurance in NJ, I have a variety of insurance companies constantly trying to get me to switch to them (by offering better service and/or lower rates).

I was responding to El Guapo's comment about one of the reasons we have an employer-based system being that they offer a substantial volume of customers, thus negotiating a better price than an individual could.

My comment had nothing to do with pre-existing conditions.

[Zarathud]

The Republican Party has been purging its moderates for two decades. Obama tried to negotiate and received nothing but grief in return.

Who is left to persuade or negotiate in the party?

[stessier]

Wow, this sounds like a way to bankrupt everyone.

WASHINGTON — House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.

[Combustible Lemur]

Personally, I think one side calling the other "hysterical" while the other side calls the first side "ignorant" will really help to build a productive discussion.

I'm not really the other side though. Republicans don't represent me. I may be conservative but Republicans no longer represent me. I'm for fixing ACA, not repealing it. The Republican obsession with repealing it is beyond me. It's become a strange rallying cry. And I still think they will keep large chunks of it if they ever do anything with it.

Even though I'm not Republican and I don't support our current president doesn't change the fact that the "f&@$ the GOP" posts make me tune out anything those people are saying. And I'm not alone. The media is doing similar things with trump right now. Fear mongering in the opposite direction. Both sides are playing with fear and moderates are left to simply not trust either side. In my experience at least. Playing into his hand. Silence the moderates and leave the extremes to run the show. There are lots of legitimate concerns to be raised, but if every concern is looked at as the worst possible scenario and sold as gospel... Moderates step away.

Anyways I won't pretend to be as knowledgeable on actual plans floating around as fireball, I don't have time to be. But I still think plans without pre-existing conditions being covered won't fly well anymore. They may be floating around but until one actually gains any sort of traction it's just someone's dream.

But what you're missing is that due to due gerrymandering the GOP no longer has to play to the majority, they only have to supply the feedback loop of information in strong districts. Of course losing preexisting coverage won't fly, except that there is a built in buffer that protects the GOP from unpopularity.

Also the false equivalency between the hysteria of the left and right is how Clinton's suspect emails lost an election to the top to bottom corruption of Trump's campaign.

[Kraken]

Personally, I think one side calling the other "hysterical" while the other side calls the first side "ignorant" will really help to build a productive discussion.

I'm holding my fire on this topic until there's an actual plan to criticize, because I'm skeptical that any such plan will emerge. The GOP is divided on not just details, but basic philosophy as well, and their president is a wildcard, and the public is not on their side. When you look at what Obama went through to pass the ACA (remember that full-court press?), the thought that a fractious GOP will have an easier time of it is dubious. I don't think they honestly care about healthcare, but they've painted themselves into a corner with their repeal promises.

Yup. If you want a market-based path to near-universal health insurance coverage, it's going to be broadly indistinguishable from the ACA. The best possibility for these "repeal and replace" efforts, if they were to pass, would be that the pieces of the ACA are torn down, relabeled, and put back together in a slightly different pattern.

Agreed. That's why my panties aren't in a bunch yet.

[El Guapo]

Personally, I think one side calling the other "hysterical" while the other side calls the first side "ignorant" will really help to build a productive discussion.

I'm not really the other side though. Republicans don't represent me. I may be conservative but Republicans no longer represent me. I'm for fixing ACA, not repealing it. The Republican obsession with repealing it is beyond me. It's become a strange rallying cry. And I still think they will keep large chunks of it if they ever do anything with it.

Even though I'm not Republican and I don't support our current president doesn't change the fact that the "f&@$ the GOP" posts make me tune out anything those people are saying. And I'm not alone. The media is doing similar things with trump right now. Fear mongering in the opposite direction. Both sides are playing with fear and moderates are left to simply not trust either side. In my experience at least. Playing into his hand. Silence the moderates and leave the extremes to run the show. There are lots of legitimate concerns to be raised, but if every concern is looked at as the worst possible scenario and sold as gospel... Moderates step away.

Anyways I won't pretend to be as knowledgeable on actual plans floating around as fireball, I don't have time to be. But I still think plans without pre-existing conditions being covered won't fly well anymore. They may be floating around but until one actually gains any sort of traction it's just someone's dream.

I don't disagree that "fuck the GOP" isn't going to persuade many people on the fence. But they're all posts by people whose families are exposed to potentially real harm if the ACA is repealed, so I understand the anger.

But your last paragraph here shows the bind that the GOP is now in on health care. Your understanding is probably shared by most Americans. And yet, Republicans have been campaigning for 6+ years on repealing Obamacare. If they keep the preexisting conditions ban, that essentially requires keeping Obamacare (perhaps with some minor changes and rebranding). The base will be furious if they do that after presenting the ACA as the root of liberal evil for years. If they don't keep the preexisting conditions ban, then the public response could be politically catastrophic for them.

[stessier]

But your last paragraph here shows the bind that the GOP is now in on health care. Your understanding is probably shared by most Americans. And yet, Republicans have been campaigning for 6+ years on repealing Obamacare. If they keep the preexisting conditions ban, that essentially requires keeping Obamacare (perhaps with some minor changes and rebranding). The base will be furious if they do that after presenting the ACA as the root of liberal evil for years. If they don't keep the preexisting conditions ban, then the public response could be politically catastrophic for them.

I think that really depends on how it is packaged. With the divide in "real" news these days, it's likely they wouldn't have to change anything and could still sell their base that they fixed it as their base is only listening to a very narrow set our sources.

[LawBeefaroni]

And what group do I get to be a part of to mitigate their risk?

The group of "everyone else that buys the same insurance plan that you do". Isn't that how insurance plans work?

Which comes first, the group or the plan?

Premiums and benefits will dictate which plan an individual will choose, not the cohort. A plan with horrible benefits for a diabetic probably won't have diabetics clamoring to join. It will also probably have lower premiums.