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Obamacare Repeal: Day One & Beyond - What Trump’s Election means for the ACA

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posted on Nov, 10 2016 @ 03:01 PM
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Greetings ATS,

I've been very worried about the healthcare issue, as I have a terrific ACA plan and a very very sick child. I CANNOT lose my health insurance. So after freaking out for a while, I dug in and decided to do some research...

Link



Donald Trump states at his website, “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.” If by Obamacare Trump means the Affordable Care Act in its entirety, this will not happen.

First, any repeal proposal would be subject to a filibuster in the Senate and the Democrats retain more than enough votes to stop a repeal bill.

Second, the Affordable Care Act contains hundreds of provisions affecting Medicare, program integrity, the health care workforce, biosimilars, prevention, and other issues unrelated to what most Americans think of as “Obamacare.”

Immediate repeal of the ACA and presumably restoring the law that preceded it would likely bring the Medicare program, for example, to a halt until new rules could be written. The ACA is inextricably interwoven into our health care system and is not going away immediately.

I called my insurance company today, because in our case, as it is for millions of people, it is imperative that we not lose our healthcare coverage or get caught with a situation where we are suddenly rejected for “pre-existing conditions” or slammed with premiums that are completely unaffordable.

The representative I spoke with was very knowledgable (we have a serious enough issue that our insurance company provided us with personalized service - that is awesome and frightening too, as they only do that for extreme circumstances…). She said that first of all, a “repeal” isn’t going to be able to take effect for at least a year. No matter what they do, the ACA is interwoven into the entire fabric of our healthcare and insurance system, so it can’t be immediately extracted and trashed.

There are several (fairly complicated) things the article I linked detailed as to the specifics of how the ACA could be slowly chipped away at through a combination of Congress using the Budget Reconciliation Process, which cannot be filibustered, but even this won’t eliminate the provisions in the ACA that are NOT budgetary items.



Both houses of Congress passed reconciliation legislation that would have repealed the premium tax credits; the small business tax credit; the individual mandate, the employer mandate; the expansion of Medicaid coverage for adults up to 138 percent of the federal poverty level, presumptive eligibility, maintenance of effort, and benchmark plans for Medicaid; and the ACA’s taxes—the medical device tax, insurer fee, “Cadillac” high cost plan tax, and tax increases imposed on the wealthy—most of the provisions that the public identifies as “Obamacare.”


That of course is a big deal and would mean the “breaking” of the ACA in terms of the financial aspects. Budget Reconciliation isn’t a single “vote.” It is a process by which the Budget is voted on for Reconciliation, then a bunch of committees meet to try and make the budgetary items work.

There are many parts to the law that they can’t “break” within the Budget Reconciliation process:



Importantly, reconciliation legislation could probably not change the insurance reform provisions of the ACA—the ban on preexisting condition exclusions and health status underwriting, caps on annual and lifetime dollar limits, actuarial value requirements, age underwriting restrictions, as they do not affect revenues and outlays.

Okay, so what does all that mean for a family like ours?

It means that through the Budget Reconciliation process, the tax subsidies that make our current insurance affordable, would disappear. For example, our current monthly expense is about $470, (should go up to $525 in 2017). Without subsidies, however, our current plan is $1400 per month.

So at $1400 per month from $470, we’d be in a major crunch, with no option to drop our insurance.

What other options does a family like mine have?

Well, after going to the Trump website and looking under Healthcare, it seems the general idea is to move as many people as possible over to Health Savings Account plans, which have basic out-of-pocket requirements in addition to premiums, and you can invest money in the Health Savings Account to help you meet your deductible. It rolls over every year and can be invested (though in an unhealthy economy, there is greater risk in using that kind of account management).

I don’t know what those plans look like yet and have not researched a quote, so that is a missing piece in terms of specifics.

For our family, though, we would meet the total family deductible and out of pocket with ease. After that, we wouldn’t owe anything for the remainder of the year, including no co-pays (co-insurance) etc.

It does require you to have enough money up front to put into the account, and not everyone has that. With our situation, we can fundraise to help meet our expenses, due to the nature of the illness, if we are unable to meet the requirements.

So - this plan = good for people with money, not so good for people without money.

THAT BEING SAID - guess what? Donald Trump has advocated tax deductions and tax subsidies for health savings accounts (HSAs) to make health insurance more affordable for those who lack it. It might work.

Without these tax credits and subsidies (and you thought you were getting away from that - ha!), the HSAs may help some wealthier individuals, but would do little or nothing for the millions of people now receiving tax credits for coverage through the ACA, who often pay little in taxes and receive little benefit from deductions and have little to save in HSAs. With the subsidies, it might actually be a good idea and help more people IF they can come up with the cash for the savings account to work (think good for middle middle class-isa folks, borderline for anyone below that).

Other Republican plans offer fixed dollar tax credits to purchase insurance, which would be of more value to low-income Americans, but would likely fall far short of the cost of coverage now covered by the ACA.


So, what happens if people’s expanded Medicaid suddenly disappears, or your plan becomes entirely unaffordable?

Well, if they remove the pre-existing condition law (which they will most likely have to, because insurance companies are no longer going to be guaranteed the huge amount of new customers that mandates provided), what can people do?

First, if they go back to “the way things were” you will have 63 days to find new insurance if you lose yours. You can also attempt to find a new plan and switch over before yours drops away. You will probably not get the best plans and the consumer protections will be reduced. Use caution in replacing plans - read the fine print - or you could be in trouble if you need an ambulance ride or find out that certain things are not covered at all.

CONTINUED...




posted on Nov, 10 2016 @ 03:04 PM
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CONTINUED

My Advice & Opinion:

First off, it is not as dire of a situation for me personally as I had feared, because we are not on Medicaid expansion, nor are we currently uninsured.

If you DON’T have insurance currently, go get it now. Why? Because if you DON’T have insurance now, and you have a pre-existing condition, you may find yourself UNABLE to get coverage for it, or unable to get coverage at all…

Sign up for an ACA plan to get started, and be prepared to jump ship to something else in the months ahead. Alternatively, go directly to the insurance company (not the market place) and investigate their plans, especially the Healthcare Savings Account plans, if you are able to do that - that is where Trump will put his emphasis. There may be tax credits (Fixed dollar) in the future (not much different than subsidies, just smaller amounts and they would only apply to those who would be paying taxes).

In my opinion, from what I have read, the lower income folks need to make their voices heard during this process, or they may get hit the hardest.

The people who will be happiest are those who already have chunks of money (thousands of dollars) in an investment account that they can just switch over to a Health Savings Account based plan.





So I can relax a little bit, and there is less uncertainty but still a ton of unanswered questions...folks on Medicaid?

Medicaid is a whole other issue, and if they do what they want to and give block grants, it is all up in the air as to how each state would use the funding. It puts MORE burden for Medicaid on the States, which means less people will be served (the waiting list for Medicaid disability waivers in my state for autism is seven years…).

I am out of panic mode and into research mode, so at the very least, things are better...



posted on Nov, 10 2016 @ 03:05 PM
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a reply to: AboveBoard

The goal is to replace the failed Obamacare law with something that benefits all Americans and not just you. Also, requiring a tax to just be alive is regressive as hell. This law is an epic fail that requires revisiting and more than just 'pass it to see what is in it' mentality.



posted on Nov, 10 2016 @ 03:11 PM
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affordable care to me means; if i were a landscaper and your yard looked like crap, i'd give you a discount. my yard isn't that sickly- i can afford to do it.



posted on Nov, 10 2016 @ 03:21 PM
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I really hope Trump can rally both sides to come up with some real healthcare reform that embraces both free markets and ensuring everyone has affordable insurance and healthcare.

There are some very simple things that can be done to help open up the market to bring costs down.

1) Pass a law that preempts state laws so health insurance can be sold nationally across state lines. Right now, insurer's aren't competing at a national level so consumers have no real choice.

2) Decouple insurance from the work place so that individuals buy their own health insurance and it isn't tied in anyway to where you work. Again, this spurs competition and provides more incentive for shopping around by consumers. Any tax benefit that was being provided to the company should be passed on directly to the individual. To put this in perspective, imagine how screwed up your car insurance would be if you had to purchase it through your employer and lost it when you changed jobs.

3) Need simple catastrophic insurance policy. It doesn't cover birth control. It doesn't cover yoga. It doesn't cover whatever other stuff you should be paying for on your own. It is like homeowner's insurance. You carry it in case you break an arm, get cancer, or have some other catastrophic health event. It isn't there to cover your physicals, check ups, or any sniffle you get.



posted on Nov, 10 2016 @ 03:21 PM
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I don't believe Trump intends to eliminate the more popular insurance reforms. He's almost certainly going to defund the Act and certainly IRS enforcement very close to day 1. He will also be pushing Congress to eliminate all roadblock to competition in the insurance world. It is offensive that someone in western PA is paying $175 a month premium for the same benefits as someone in Alaska has to $800 a month for. The only reason it is that way is because PA has competition, AK doesn't.

As an aside, sorry about your family's insurance woes... but many of us cannot afford the massive premium increases we were hit with following the ACA going into motion. The costs have tripled and the benefits have been gutted for those of us who had plans before that law was passed. There is no fairness in expecting the "haves" to take it in the shorts to cover the "have nots."



posted on Nov, 10 2016 @ 03:21 PM
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a reply to: AboveBoard

I can't speak for anyone else, but I seriously doubt that "they" will just pull the plug and revert back. That won't work. A new plan and strategy will need to be enacted. It will take some time. (something most people fail to realize)

The old way was great for everyone EXCEPT those with pre-existing conditions. If they can find a way to include that part, then have some competitive companies able to offer services, we might see rates get back to where the super small part of the population that makes between $50 and $80K be able to afford it as well.

But I doubt seriously anything will happen quickly.



posted on Nov, 10 2016 @ 03:29 PM
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a reply to: Metallicus




The goal is to replace the failed Obamacare law with something that benefits all Americans and not just you.


First off, thanks for trying to paint me as a selfish person because I wanted and have affordable health insurance and don't want my kid to die. I really appreciate that. If you actually read the OP, you'll see that I'm not being critical of the Trump plan, but seeing where it might have some holes in it, as well as benefits. In other words, I'm being fair minded, based on my research.

I have been on record here at ATS saying that the ACA should be fixed to be fair for everyone. So keep your insults and baseless assumptions to yourself. (Seriously, can we at least TRY to get past that???)

There are many reasons the ACA didn't work for everyone, and in part it was obstructionism, and concessions that turned it into a behemoth - there were MANY fingers in the ACA pie. The Republicans (or at least a strong segment of them) knew what was in it, as they added in a bunch of stuff themselves - it was a totally transparent process. THEY KNEW. The myth that no one knew what was in it is just political BS. (see evidence below)

Also, it is not "failed" except in your opinion. The US now has the highest number of insured EVER, and that was the main goal of it, that and keeping people from being kicked to the curb for being sick (pre-existing conditions).

If nothing else, Metallicus, the ACA saga brought to light the deep unfairness that existed in our "healthcare system" PRIOR to the ACA, where I know from personal experience, a person who had cancer and lost their insurance couldn't get it back for 10 years - not at all for any reason. Did you know that?

Insurance denials were rampant from crappy plans that people didn't realize weren't covering them in their best interests. There were "Maternity "riders" that required 18 months of pay-in before you could start trying to make your baby or you had to pay out of pocket for the whole thing. Crap like that. (see below)

Don't give me "failed." It succeeded in opening the eyes of even the Republicans to the inherent injustices and lack in in "the way things were." Now they are trying to take on healthcare themselves. It is in their hands. They will own the success or failure of it entirely.

So finally, If Trump and company can come up with something that still fixes all that and is more fair to everyone across the board, then more power to them. I applaud their effort.

:stuff:


Myth of "no one knew what was in it" debunked: LINK



The New Republic: "The Obamacare Debate Was One Of The Most Transparent In Recent Memory." In his article on Gruber's comments, Beutler also explained that Gruber was wrong in his claims that the cost sharing tradeoffs in the ACA weren't publicly discussed. In fact, Beutler asserted that the ACA "actually stands out for how much it was debated, and, for the most part, how transparent that debate was" (emphasis added):

[H]is suggestion that the key cost-sharing tradeoffs weren't widely discussed just isn't true. The idea that healthy people as well as sick people needed to participate in the system was central to the moral argument for the mandate, and figured heavily in the substantive debate over how much more insurers should be able to charge the elderly than the young. The risk-rating tussle is illustrative, because it was the rule, rather than the exception to the long legislative tug-of-war over the broader ACA. Conservatives have always said the health care law wasn't debated, that it was rammed through, nobody read it, etc, etc. But it actually stands out for how much it was debated, and, for the most part, how transparent that debate was. Which in turn explains how difficult it was to pass. [The New Republic, 11/12/14]

Senate Held Years Of Bipartisan Hearings On Health Care Reform Before ACA Passed. Former Senate Finance Committee Chairman Max Baucus (D-MT) posted a timeline of his committee's work on health care reform since 2008, which included more than a dozen hearings through 2008-09 and "31 bipartisan meetings to discuss the development of a health care reform bill" between June and September of 2009. [Senate.gov, accessed 11/12/14]

Sen. Angus King (I-ME): "There Was Long Debate About It On Both Sides." Responding to Gruber's comments, Sen. Angus King emphasized that there was much debate before the health care reform law passed:

"I certainly don't endorse those kind of comments. But I can recall that debate. I wasn't in office. [I]t was a very vigorous debate," King said when asked about Gruber's comments. "Everybody knew that there were going to be additional taxes required to support the support for premiums under the Affordable Care Act. I don't see it as any deep, dark conspiracy. There were all kinds of -- there was long debate about it on both sides." [The Washington Post, Post Politics, 11/11/14]



posted on Nov, 10 2016 @ 03:29 PM
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a reply to: AboveBoard

Love bless you, AB, for all your work on this topic! It is excellent and should be read by all to understand more what repeal and replace means.

Another main focus of replace is allowing health insurance to be bought "across state lines". That is the Republican Party focus, a Libertarian approach (via the Koch Bros ideological push into the party). But that does not mean that a company will sell you a policy you might want. Nor does it mean that health care costs would be lowered or contained.

An article
An Obamacare Provision Even Republicans Can Love



posted on Nov, 10 2016 @ 03:32 PM
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originally posted by: network dude
a reply to: AboveBoard

I can't speak for anyone else, but I seriously doubt that "they" will just pull the plug and revert back. That won't work. A new plan and strategy will need to be enacted. It will take some time. (something most people fail to realize)

The old way was great for everyone EXCEPT those with pre-existing conditions. If they can find a way to include that part, then have some competitive companies able to offer services, we might see rates get back to where the super small part of the population that makes between $50 and $80K be able to afford it as well.

But I doubt seriously anything will happen quickly.


I agree.

It was also not great for women who wanted pregnancy covered, and not great for people who had cheaper plans they THOUGHT were good, only to find out they were screwed (the ACA put in place national standards of coverage so that wouldn't happen - thus the people pissed off that they couldn't keep their plan - the insurance business alters and changes plans obsessively, however, so their plan would most likely have changed at some point anyway...)

I sincerely hope they will make the effort to keep in the things that protect people, in which case, I have no problem with it. I honestly hope it will be a step-up, and more fair for everyone (though apparently some people here don't understand that and think I'm some sort of selfish ass...sigh. - Not directed at you, btw.)



posted on Nov, 10 2016 @ 03:37 PM
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originally posted by: burdman30ott6
I don't believe Trump intends to eliminate the more popular insurance reforms. He's almost certainly going to defund the Act and certainly IRS enforcement very close to day 1. He will also be pushing Congress to eliminate all roadblock to competition in the insurance world. It is offensive that someone in western PA is paying $175 a month premium for the same benefits as someone in Alaska has to $800 a month for. The only reason it is that way is because PA has competition, AK doesn't.

As an aside, sorry about your family's insurance woes... but many of us cannot afford the massive premium increases we were hit with following the ACA going into motion. The costs have tripled and the benefits have been gutted for those of us who had plans before that law was passed. There is no fairness in expecting the "haves" to take it in the shorts to cover the "have nots."


First, thank you for your kindness. It has been rough.

Secondly, I totally hear you. I agree with you.

I advocate for protecting people at a base-line, including pregnancy and such, and pre-existing conditions as well. Part of why I come to ATS is to get out of the echo-chamber tendency we can fall into - only listening to our own "side." I have been saying for the past couple of years that the ACA needed some serious fixing if it were to continue, in order to be fair and truly affordable. As it seems it will be eliminated, I hope and pray that the GOOD things will be kept "sacrosanct" and the fairness issue fixed on all income levels.

There may be some "holes" in this for lower middle class folks, unless the tax credits and subsidies Trump is talking about can fill them.




posted on Nov, 10 2016 @ 03:38 PM
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I'm interested in what this new health care system will look like. Reading up on the thread I see that Obamacare (ACA) helps out many people who would be screwed over by the insurance companies otherwise. That would make the prices go up. I heard that Obama had plans to address some of the issues in an extension of the bill, but I also heard that Trump was going to repeal the act.
edit on 10pmThu, 10 Nov 2016 15:44:46 -0600kbpmkAmerica/Chicago by darkbake because: (no reason given)



posted on Nov, 10 2016 @ 03:41 PM
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a reply to: darkbake

I think they will start the "ending" process fairly immediately. That is why I started researching, so I could figure out how to continue having it...




posted on Nov, 10 2016 @ 03:46 PM
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a reply to: AboveBoard

I don't know much about healthcare, but it sounds like they are going to repeal the Obamacare act and leave it up to private insurance companies? What kind of oversight and regulations are there in place currently?



posted on Nov, 10 2016 @ 03:47 PM
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From American Enterprise Instiutute, a conservative think tank


But even in that context, one should not expect interstate sales to significantly reduce the cost of health insurance.

A health plan offered in New York City will charge a higher premium than the identical plan offered in rural Colorado because of differences in those markets other than regulations. New York City has higher costs for housing, food, and other consumer purchases, and those costs are built into the prices of medical services. New York has an older, less healthy population that uses more medical services. In addition, New York has more local physicians and greater access to expensive medical technologies, which also drives up the cost of coverage. Just because good coverage is affordable in one state does not mean that the same plan will be available at a comparable price somewhere else.


I think that Americans get the idea that "across state lines" means they can buy a cheaper policy from another state, but that would not necessarily be true.
edit on 10-11-2016 by desert because: add bold



posted on Nov, 10 2016 @ 03:54 PM
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originally posted by: darkbake
a reply to: AboveBoard

I don't know much about healthcare, but it sounds like they are going to repeal the Obamacare act and leave it up to private insurance companies? What kind of oversight and regulations are there in place currently?


Those are great questions! (I don't have all the answers - so if others do, please help me...)

There is more oversight now with the ACA. There are "national standards of care" that make sure a plan covers an ambulance ride or other transportation, that wellness checks for kids are covered, maternity is covered, etc. There are tons of "insurance regulations" in place that are very "read the fine print" and designed to protect the consumer. The biggest regulation change was that people could not be excluded on the basis of "pre-existing conditions" which meant more financial risk for the insurer.

They are trying to come up with something different - a hybrid of ideas, I think - based on private insurance. I don't know the entirety of their plans. I do think they will have subsidies and tax credits in place, and will encourage people who can to used Health Savings Accounts.

- AB



posted on Nov, 10 2016 @ 03:58 PM
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a reply to: desert

Hey desert! Thank you for your replies and additions.

The "across state lines" idea for inducing competition has been held up a lot - it will be interesting to see if that does anything. I'm thinking it will increase monopolies, due to the fact that the more people are in an insurance pool, the cheaper the insurance can be.

Also - the article mentioned for those who got caught with pre-existing conditions after the ACA had been repealed (which implies they WON'T hold on to this very popular provision) will be put into "high risk pools." Now these have been tried and have failed due to lack of funding in the past. I don't know what they plan to do differently to make them work...

Thanks also, for the encouragement!!!


- AB



posted on Nov, 10 2016 @ 04:02 PM
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Since Obamacare is private insurance based, my friend who uses it recently needed to shop around for a new plan. She had to call several insurers, then had to contact her doctors to find out if they would take this or that insurance. This took several hours. Buying across state lines would not relieve any of that.

Another thing, I had an insurance plan once that wouldn't cover me if I were taking a vacation in another state. Read the fine print!

There are even some occasions when traveling 200 miles away from home a policy holder could not use the insurance, because no doctor out of the home area took it. Read the fine print!

Read the fine print! Insurance companies are out to make a profit, and any way they can deny payment, they will, even with Obamacare.

And, yes, AB, you are correct that special savings accounts are good IF YOU HAVE THE MONEY to begin with.... or end with in some cases, too.



posted on Nov, 10 2016 @ 04:02 PM
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originally posted by: Metallicus
a reply to: AboveBoard

The goal is to replace the failed Obamacare law with something that benefits all Americans and not just you. Also, requiring a tax to just be alive is regressive as hell. This law is an epic fail that requires revisiting and more than just 'pass it to see what is in it' mentality.


You know, this is a bit off topic, but it really disturbs me that you come into this thread and take an angry swipe at me and get 10 thousand stars for it, when all I'm doing, honestly, is being helpful and researching this topic. People aren't even reading the OP, it seems, before giving you the "high five" for "getting me."

I didn't put it in the mudpit for a reason. I wanted to present facts and my opinion of them, not take swipes at people. It doesn't entirely surprise me, but it is disheartening.



- AB



posted on Nov, 10 2016 @ 04:15 PM
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a reply to: AboveBoard

You are welcome!

I wish I knew what was going to happen. I have no problem now, as I have an excellent insurance plan and will switch to Medicare in a couple years. If Medicare is "privatized", then I will need to "shop around", too. Which is a pain for the elderly to do, as we will have different healthcare needs, with higher payments with less income.



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