Flap Your Lips Friday
Posted by Michelle Moquin on January 31st, 2014
Good morning!
Happy Chinese New year!
I realize this write was published before Obama gave the SOTU speech the other night, but do you think that will change anything? This is the repubs latest to repeal Obamacare. Don’t let the word “replace” in the title fool you. The repubs Patient CARE Act would repeal Obamacare in its entirety.
Again, from Think Progress:
The Five Worst Things About The New Republican Proposal To Replace Obamacare
On Monday, a trio Republican senators unveiled an alternative to Obamacare eerily similar to the one that former presidential candidate Mitt Romney proposed in 2012. The plan boils down to a rehash of boilerplate conservative ideas for “market-oriented” and “consumer-driven” health care reform — code words that really mean deregulating the insurance industry and forcing consumers to shoulder a larger burden of their health care costs.
Here are the five most troubling aspects about the new proposal from Sens. Tom Coburn (OK), Orrin Hatch (UT), and Richard Burr (NC), dubbed the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act:
1. It would kick millions of Americans off of their health plans.
Right off the bat, the Patient CARE Act would repeal Obamacare in its entirety, meaning that the three million Americans who have already enrolled in new plans through the law’s state and federal marketplaces and the millions more deemed newly eligible for Medicaid coverage in states that expanded the program would lose their health coverage.
But that’s not the only part of the bill that would take away Americans’ health plans. The CARE Act would also make big changes to the way that Medicaid is funded by imposing a so-called “per capita cap” on it. This cap resembles a block grant and it would push states to cover a highly selective group of people through Medicaid, namely pregnant women, women with children, and the disabled, forcing most of the working poor to pursue more expensive private insurance plans.
2. It dismantles many of Obamacare’s core consumer protections.
Chances are, you’ve benefited from at least one of Obamacare’s consumer protections, like a free checkup, preventive screening for HIV, a mammogram, or no-cost birth control. Millions more will benefit in the coming years, thanks to the law’s requirement that individual policies sold through the marketplaces cover a broad range of “essential health benefits” like maternity care, mental health care, and prescription drug coverage.
Say goodbye to all that under the Patient CARE Act. The bill places no such requirements on insurance companies; in fact, it dismantles Obamacare’s prohibition on gender rating, meaning that women will go back to an era where they are charged $1 billion more for their health care on a national level than men.
3. It does almost nothing for Americans with pre-existing conditions.
Some estimates have shown that as many as half of all Americans have some sort of pre-existing condition. If you’re one of them, good luck getting insurance under the Patient CARE Act.
Under the bill, insurers can still turn away people with pre-existing conditions. The only exception is if you have “continuous coverage,” meaning you’re either already insured or have been able to maintain some form of insurance despite losing the coverage you had through your employer. The thinking behind this idea — which was also proposed by Romney in 2012 — is that insurers will be able to offer cheaper policies at the expense of denying health care to sick people. And while the plan does preserve Obamacare’s ban on lifetime limits on medical benefits, it allows insurers to set annual caps on care.
Coburn et. al. also allude to federal funding for so-called “high-risk pools” for the sickest consumers. But these are plagued with inefficiencies, long waiting periods, and are often prohibitively expensive for both consumers and the government. There’s recent real-world evidence to support those notions — Obamacare’s own temporary high-risk pool program ran out of money despite enrolling far fewer people than originally expected, forcing the government to stop accepting new enrollees.
4. It would make millions pay more for their employer coverage.
The Patient CARE Act would also amount to a tax hike for the more than 150 million Americans who get coverage through their employer. In an effort to encourage Americans to choose skimpier health plans, the bill sets a cap on the federal tax exclusion for employees’ health care.
Currently, workers’ insurance premiums are paid for with pre-tax dollars; under the Coburn-Hatch-Burr proposal, the exclusion would be capped at 65 percent, meaning everyone with an employer plan would have to pay taxes on 35 percent of their premium. If you have a more expensive health plan, your taxes would go up correspondingly. By contrast, Obamacare only imposes a tax on the priciest of health policies — so-called “Cadillac” plans.
5. It provides fewer subsidies to help Americans buy health care.
Coburn-Hatch-Burr does preserve Obamacare’s insurance subsidies in theory. But in practice, the bill pushes more costs onto consumers.
In lieu of Obamacare’s sliding scale insurance subsidies for people between the poverty level and four times the poverty level, the Patient CARE Act provides a flat subsidy that increases with age and is only available to people making up to three times the poverty level. That might work out for someone who is relatively healthy; but if you’re sick and poor, the type of coverage you need could easily be out of reach — particularly since insurers aren’t subject to the benchmark benefits standards of Obamacare.
*****
Readers: Patient CARE Act – the name in itself is a lie. Many won’t get care if this dismantles Obamacare. Let’s vote those guys out. Blog me.
Peace, Love & Good Health.
Lastly, greed over a great story is surfacing from my “loyal”(?) readers. With all this back and forth about who owns what, that appears on my blog, let me reiterate that all material posted on my blog becomes the sole property of my blog. If you want to reserve any proprietary rights don’t post it to my blog. I will prominently display this caveat on my blog from now on to remind those who may have forgotten this notice.
Gratefully your blog host,
michelle
Aka BABE: We all know what this means by now :)
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January 31st, 2014 at 3:14 pm
Happy Chinese New Year!
I wish you all:
恭喜發財
Gung hei fat choi
龍馬精神
Spirit of dragon and horse
萬事如意
10,000 things according to your will
心想事成
accomplish that in your heart
恭賀新禧
Congratulations on new blessings
大吉大利
Much luck and much prosperity
五福臨門
five happinesses bestowed on your household
出入平安
leave and enter in peace and safety
年年有餘
every year have bounty in excess
招財進寶
seek wealth welcome in the precious
生意興隆
let the business be popular and prosperous
盤滿砵滿
basins full and bowls full (of wealth)
笑口常開
laughing mouths opening frequently
天天向上
daily heading upwards!
Luv, Zen Lill
January 31st, 2014 at 3:16 pm
I saw a combo word that works for me after reading this…
Dipshidiot(s)
The usual MO: f**k everything up and then point at Pres O.
- ZL
February 1st, 2014 at 4:54 am
“Replace!” OMG these Repbublibags just say things without any basis in reality. They’ve not come up with ONE thing to replace it with, and it would cost BILLIONS to do so.
February 1st, 2014 at 4:54 am
Or as Ezra Klein easily argues:
http://www.washingtonpost.com/blogs/wonkblog/wp/20…
February 1st, 2014 at 4:55 am
Most republicans are ideologues, they want big overarching theories that explain everything (ironic, isn’t it,m since they dislike marx), and they prize idea that conform to those theories. therefore the vissicitudes of real people and their lives really don’t come into the equation.
February 1st, 2014 at 4:56 am
Obamacare is the Republican alternative plan to replace Hillarycare in the 1990′s. In the past 20 years the GOP has moved so far right their own plan has become unacceptable to their base. They don’t have a new plan so they should get out of the way and let the adults work.
February 1st, 2014 at 4:56 am
The advantages GOPers have in this area is that universal access to heath care isn’t a goal for them. So they’re free to suggest any policy thingamajiggy they want. Coming up with solutions where you don’t really care about the end results — beyond ‘getting government off our backs’ — is quite a liberating experience.
February 1st, 2014 at 4:57 am
Why do Republicans have such difficulty coming up with an alternative to Obamacare? Because at one point Obamacare was essentially the Republican alternative. It’s pretty much what Republicans offered as an alternative to Clinton’s plan in the 1990s, and it’s pretty much what Romney signed into law in Massachusetts. So it’s no wonder that they haven’t come up with something else that takes us to near-universal coverage.
February 1st, 2014 at 4:58 am
Silvia, they are just as idealistic about some things as democrats are idealistic about some things, but they are less likely to admit it, it seems. At a certain point in life, a person realizes that ideals are not the same as reality. Well, people should realize that, but observing American politics it seems pretty obvious that most people never grow up and a lot of people suffer for it.
February 1st, 2014 at 4:59 am
My take on all of this is that there is a basic choice: reduce costs for those that already have insurance, or try to extend it to everyone. The GOP is more focused on the former, the democrats, the latter.
The perception of the problem is different for the two parties. I would have less trouble with the ACA if its proponents had been a bit more honest – without all the nonsense about how it was going to save money. It isn’t – it was all about universal coverage.
Personally, I think they got the order wrong – reduce costs _first_, _then_ make coverage universal once you have those costs under control. We now have the worst of all worlds – the same incentives for providers and consumers alike, with more consumers and the same number of providers.
It’s going to be a mess.
February 1st, 2014 at 5:01 am
I have now read the source of the GOP’s eight-point plan that is in Ezra’s post (by Ben Domenech, Ricochet website, 7/12/12), the Domenech response to Ezra’s post (Real Clear Politics website, 4/4/13), and Josh Barro’s response to Domenech (Bloomberg website, 4/3/13). Ezra described the 7/12/12 Domenech list as a “plan” but Domenech did not say it was a plan in his 7/12/12 post. What he did say was that Congressional Republicans largely agree with the eight items in the list.
Ezra’s post analyzes the eight items in his usual thoughtful manner and Domenech’s 4/4/13 response includes many insightfully substantive ideas, which I hope the good folks at Wonklog will follow up on.
Domenech does himself no good with his snarky comments but, at least he begins to explain to the masses (such as myself) what Conservatives have in mind concerning health care. I do mean Conservatives, not Republicans, because Domenech does not speak for any Republicans in Congress that I am aware of, but his ideas probably do represent Conservative thought on health care.
If Ezra and others have ever said in the past that the Republicans have no plan to replace Obamacare, it is because Republicans don’t have a plan to do so and Domenech’s 4/4/13 post does not constitute a Republican plan.
All I have ever seen or read from Republicans about a plan to replace Obamacare, reform healthcare, etc., are unsubstantiated claims about a plan followed by political attacks on Obamacare to, as best as I can determine, increase the political power of the Republican Party.
I have an idea. Why don’t Republicans in Congress study the Domenech 4/4/13 post, prepare a real plan for replacing Obamacare or reforming health care, and release to the public so that they can find out what the Republicans have in store for them. So far, all that I have seen from Republicans in Congress are political attacks and shameless exploitation (e.g., “death panels).
February 1st, 2014 at 5:13 am
Ira#10, why would you think that the GOP is focused on reducing costs for those who already have insurance when the majority of their proposals increase those costs, and in fact, their entire approach is premised on the idea that if you make people responsible for more of their own costs, free market competition will reduce costs overall?
And as for the ACA, it’s *already* slowing the growth of costs (no one claimed it was going to reduce costs, just bring down growth from its current way-above-inflation levels.) Universal coverage *does* reduce the growth rate, by, among other things, encouraging treatment of health problems in the early stages, when it’s cheaper.
To deny that, you’d have to ignore the experience of every other industrialized country in the world. And beyond that, the ACA doesn’t just do one thing, so it’s actually “nonsense” to insist that it was “all about universal coverage.” It has numerous provisions to push practices that everyone knows will reduce costs in the long run, but haven’t been adopted because the up-front costs mean that the “free market” punishes early adopters, and to encourage experimenting with different models for treatment and efficiency by rewarding the ones that succeed.
We don’t have “the same incentives” because the ACA changes them.
The fact is that we have been trying the “reduce costs first” approach for decades (HMOs, HSAs, etc.) and the result has been spiraling costs. We already had a mess, and now we’re going to get as close as our powerful insurance industry will let our political system get to the systems in other countries produce better outcomes at much lower costs.
February 1st, 2014 at 5:16 am
Republics have come up with plans in congress – just look at Rep. Paul Broun’s plan to COMPLETELY REPLACE obamacare. (see H.R. 4224).
February 1st, 2014 at 5:18 am
Jimmy#12, “And as for the ACA, it’s *already* slowing the growth of costs”
Slowing the rate of growth of costs is not the same thing as reducing costs. All I know is that my health care took its biggest cost jump ever this year (I live in CA) and I am getting less for it.
But hey, who knows what it would have been like without the ACA?
February 1st, 2014 at 5:22 am
I know, it’s sickening. I think people have short memories, so rises in insurance premiums just keep happening, but people act like it’s new. Insurance premiums have been going up a lot every year for quite some time now. I’ve read horror stories about how it’s the hospitals’ fault, and I believe the stories, but good Lord, why is THAT happening?
What is behind hospitals constantly trying to get away with charging astronomical fees? Is it because all their emergency rooms are in the hole? I want to see REAL info on why costs are so high, and I sure don’t trust insurance companies for that info, either. They are such hypocrites.
I couldn’t get covered by Kaiser as an individual, but now am on my husband’s Kaiser policy. They REALLY need to stop the commercials about thriving and how much they care and all – they only care if you’re healthy, as an individual, or if you belong to some group defined by someone . . .
Groups can be anything, and to help people, if they really cared, they’d simply make up their own groups. Ha ha, I think I’ll post this as an individual comment now that I’ve gone on for so long.
February 1st, 2014 at 5:23 am
Larry#13;
My point was for Republicans to propose a plan, not merely one Republican Congressman.
February 1st, 2014 at 5:26 am
Phil, I read Ezra’s posts to. Excellent job, but let me offer a couple of comments:
(1) Using segregated state pools for preexisting condition people would, by definition, mean that the highest cost highest risk people would be placed in one pool.
Inevitably, it will be a costly (to buyers) failure. i’d give the Republicans much more credit if they simply said “No insurance for pre-existing condition patients, too bad you lost the genetic lottery.”
(2) Selling insurance across state lines — the states, not the feds, decide if insurance can be sold within a state. So a state can permit any insurance from anywhere to be sold within the state at any time — nobody is stopping them.
With so many states now under GOP control, how many GOP-controlled states have chosen to permit the selling of policies across its line? None that I’ve heard of, though I could be wrong. If some have done so, are they in fact shining examples of lower insurance policy prices?
Signed Former Republican who still believes in logic and evidence.
February 1st, 2014 at 5:27 am
Phil#16, there have been a few other plans proposed by other republicans in congress – I just gave you one example.
One has to just look them up, instead of just parroting the standard progressive line that there are no plans from the republicans….
February 1st, 2014 at 5:28 am
C’mon Ezra, what he meant by “comprehensive health insurance” is not really insurance. It is a prepayment plan, and it is guaranteed to drive health care spending through the roof.
February 1st, 2014 at 5:29 am
Once again, Klein is dumber than a box of rocks. Replacing the employer-paid loophole is quite easy — unless you’d rather do partisan attacks,
1) Make it taxable income
2) Increase the standard deduction to offset it.
3) This would allow every one of us to pocket every penny we save, but still have the same tax deduction.
Any questions?
Somebody explain to Ezra why we seek the lowest-possible deductible in healthcare, but the highest affordable deductible in both auto and home insurance. He hasn’t been paying attention to the issue.
For example, consider the insane mandate to include birth control pills. The most common pills cost $9-$10 per month. Processing the claim will cost twice as much. duh. Insuring rarely used but much higher-cost birth control would make sense, but would not include ant costly pandering for votes,
The free market hasn’t failed, We don’t have one. The illusion of free healthcare has failed. We can’t afford it.
February 1st, 2014 at 5:30 am
Ezra Klein does an excellent job of exposing the hollow nature of most of the Republican proposals . I’ll pile-on a bit:
1) “Reduce tax giveaway for employer-sponsored health insurance.” Duh. Everybody agrees that the tax incentives are the root of much evil. Saying you want to do away with subsidized employer insurance is like taking a position against waste, fraud and abuse in government. That’s not a political strategy. The drafters of Obamacare made a valiant and brave effort to at least cap the tax incentives. The lobbying pushback was withering, the caps got delayed and weakened. Face it, people love their juicy tax breaks. Conservatives should have applauded Obamacare attempt to make some progress; but of course they sat –back and cynically accused Obamacare of undermining employer-provided insurance.
3) “Insure across state lines.” Ezra describes the consequences of simply steamrolling state regulation. The practical way to implement more interstate activity is through the insurance exchanges, which will work to standardize state-level regulation. Again, conservatives should be applauding the Obamacare exchanges, especially because exchanges were their idea in the first place!
4) “Handle the uninsurable through high risk pools.” This non-idea is so stupid that it pains me. High Risk Pools have been tried for 40 years, the track record is dismal, they help only a small, wealthier slice of people with pre-existing conditions. HRP are a rhetorical way to pretend to care about the uninsurable, then sweep the problem under the rug.
I’ve run out of hot air. As to the other proposals – what Ezra said.
February 1st, 2014 at 5:31 am
Grace, “Insurance” *IS* a prepayment plan, by definition.
In the case of a state-administered health insurance plan, everyone pre-pays but some “redeem” more of what they paid in than others. Some (those with serious illness(es) will draw more than they put in, but this difference is made up by the amounts put in by those who drew less than what they put in because they’re healthy, either by lifestyle choice, luck, or (as it usually is ) both.
If you don’t like the concept of pooled risk, that’s fine, but that is in essence what insurance is.
February 1st, 2014 at 5:33 am
Larry#18, We’re in a continuous loop. No matter how many individual Republican members of Congress have proposed health care reform programs or replacements of Obamacare, they don’t amount to a plan from Republicans in Congress. I didn’t parrot any standard progressive lines in my original post.
February 1st, 2014 at 5:35 am
More Doctors in Texas After Malpractice Caps
http://www.nytimes.com/2007/10/05/us/05doctors.htm…
February 1st, 2014 at 5:39 am
Good lord, Dennis#24. If you remove the ability of patients to sue doctors, of course it become more profitable to be a doctor. The fact that doctors migrate to more profitable geographical regions is of zero benefit to the country as a whole.
The promoters of tort reform claimed that it would lower “defensive medicine”, leading to lower costs to the consumer. The experiment has been run in Texas, the results are in : Texas doctors are prescribing medicine at the same rate as elsewhere because they have the same profit motives.
Consumers are not benefiting a bit; on the contrary, they have been harmed because now it is nearly impossible to seek redress for legitimate malpractice.
Maybe it is a good thing that doctors have fatter pay checks. But the theory that they will pass on their windfall to consumers has now been thoroughly debunked by the Texas experiment.
February 1st, 2014 at 5:39 am
The goal of the republican plan is NOT universal coverage. It is greater freedom.
A young healthy male has an expectation cost of actual healthcare consumed of about $300 per year. If is simply a bad bet to insure against those costs for over $3000. Why would he want to purchase maternity coverage? It would be like mandating that people who without cars purchase auto insurance. He wouldn’t, but Obamacare mandates it. And there are a zillion other coverage mandates that drive up costs in Obamacare.
A wise plan would allow Americans the FREEDOM (what this county is all about, or so I heard) to purchase the coverage that suits them. Or not, if that suits them.
To solve the free rider problem, simply make medical debts non-dischargable with bankruptcy. Or we could make the provision unpaid medical care deductible for the providers and a taxable benefit to the recipient of the care (taxed at a separate rate that is open to negotiation). There are plenty of creative solutions that do not require us to abandon the CORE PRINCIPLE of FREEDOM as does Obamacare.
To directly respond to Mr. Klein, the Democrat vision is that everyone should have to purchase government approved levels of health insurance (whether they want it or not) and the Republican vision is that everyone should be free to decide for themselves how much, if any, health insurance is right for themselves.
February 1st, 2014 at 5:41 am
Hubert#25, Same results in Colorado.
February 1st, 2014 at 5:43 am
Oh, and to fix the problems caused by EMTALA, don’t create a rash of other govt regulations.
Fix or end EMTALA.
February 1st, 2014 at 5:54 am
Sunnu#26, Health insurance is not like broccoli. You need to join Judge Scalia in a remedial class on the nature of health insurance. We inherently are not isolated from each others decisions to purchase health insurance.
As to universal coverage: there are many conservative pundits who recognize the value of universal coverage. They will be the ones who participate in reforming and improving Obamacare. Neandrathals conservatives will be left on the scrap heap of history.
And as to your tirade on EMTALA, what specifically do you want to fix? And how are you going to fix it without gov regulations? Are you suggesting that emergency rooms not be required to treat injured people?
From http://www.emtala.com/faq.htm
“The essential provisions of the statute are as follows:
Any patient who comes to the emergency department requesting examination or treatment for a medical condition must be provided with an appropriate medical screening examination to determine if he is suffering from an emergency medical condition.
If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute’s directives.”
February 1st, 2014 at 5:55 am
I have no problem if the GOP wants more freedom, not comprehensive coverage. But just admit it and admit the reality that some people will go without. Then let the people judge.
February 1st, 2014 at 5:57 am
C’mon, Republitrolls! You may not LIKE Ezra, but in your heart (and in your posts), you KNOW he’s right! ACA tries to nudge us toward a system where most American citizens (non-citizens — or at least people who aren’t legal residents — are NOT eligible for ACA coverage) have insurance coverage for their serious health care expenses.
NOTHING Republicans have proposed would do that! NOTHING the GOP has proposed is INTENDED to do that! And your posts indicate that YOU don’t WANT to do that!
There are TWO problems with pretending we can have a decent health care system for rich people and the top half of the middle class and nothing at all for “the 47%.”
ONE we’ve experienced for 30 or 40 years now: doctors and hospitals WILL provide at least SOME care for the people YOU don’t care about, and WILL raise YOUR insurance costs to pick up at least SOME reimbursement for that “free” care.
But the SECOND problem — the epidemiological problem — is MUCH more serious. Despite all we do to construct “bubbles,” we share the same country — and streets and schools and malls and movie theaters and fast-food joints and airports and playgrounds and even places of worship.
So you can PRETEND that it doesn’t matter to “productive” Americans whether “unproductive” Americans have ACCESS to at least a minimal level of health care….until the day your child or grandchild contracts an illness or infection by coming into contact with “those people” or something “those people” touched!
You CAN’T really live in a bubble, and whining about the cost of caring for your fellow citizens guarantees that your OWN loved ones are going to suffer the medical consequences of your selfishness!