Who the fukk can afford ACA?

[Savvir]

Democrat and Republican politicians sabotage the healthcare system in general in this country because both parties are bought and paid for by health insurance companies.

Breh.

You do not follow politics.

You just parrot talking points .

I'm speaking on actual legislation

You are just saying generic phrases that are popular to repeat.

Stop quoting me, and go study on why states have implemented aca differently

 

[FAH1223]

A Six-Point Plan for States Who Want Free Obamacare
Jon Walker April 13, 2018

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Carl Lender / Flickr

States could theoretically game the complex design of the Affordable Care Act (ACA) to get the federal government to pay for free, state-run health insurance for basically everyone in their state making less than 400 percent of the FPL (just under $100,000 for a family of four). Ironically, such a scheme is only possible because of efforts by conservative Democrats to make the ACA friendlier for private insurers and thanks to President Donald Trump’s bungled attempt to sabotage the ACA by ending payment of the cost-sharing reductions (CSR).

The complex way the advance premium tax credits are calculated under the Affordable Care Act has created several bizarre incentives and outcomes. One of the most glaring is that an individual making below 400 percent of the federal poverty level (FPL) ends up paying more for insurance if their state has a competitive exchange market and much less if they have a “dysfunctional” exchange with only one insurer. While this dynamic existed before, it has been made worse by Trump’s ending of the CSR, which caused total subsidies to increase. The result is that in many red states with badly functioning exchanges, individuals qualify for free bronze insurance plans.

In theory, there is nothing stopping a state from exploiting this dynamic to make the federal government pay for free public health insurance for their residents. They just need to follow this six-step plan:

1. Create a new government-run health insurance company to sell insurance on their state ACA exchange. There is nothing the federal government could do to stop this. It is long established in our legal tradition that state and local governments can create and operate government-run companies. Los Angeles County already has a county government-run insurance company (LA Care) that sells insurance plans on the California exchange.
   
   
2. Require that all insurance be sold at pure community rating, one price for all ages. Vermont and New York State already have this requirement. Under the ACA, insurance companies can set premiums for older people three times higher than for younger people, which was done to encourage young people to buy insurance. Yet due to the design of the ACA subsidies, this has paradoxically resulted in younger people who qualify for subsidies actually needing to pay more to get insurance than older people, undermining the entire point of this rule. This disparity needs to be removed to make sure everyone gets free insurance.
   
   
3. Drive all private insurance off the state exchange, leaving its public insurance company as a monopoly. The McCarran–Ferguson Act leaves regulation of individual and small group markets primarily up to states, and the ACA maintained this legal dynamic. That means there are several ways states could try to achieve this goal. A) The state could give its public insurance company such an overwhelming market advantage with negotiating provider rates that after a few years all other insurance companies are out of the ACA exchange business. The dynamics of the ACA have already resulted in large parts of the country with only one insurer, so it is easy to see how a public insurer with a special advantage could quickly gain a monopoly via market forces. B) The state could adopt new insurance taxes and regulations on network size, CEO compensation, MLR, transparency, etc… so that no private insurer would want to operate in the state. C) According to the ACA, for an insurer to sell on an exchange it needs to be “licensed and in good standing” in the state, so the state could refuse to license any private insurer or create rules such that no insurer would be considered in good standing. D) The state could choose to have an “active purchaser” exchange and simply refuse to allow any plan but the public insurance plan on their exchange. California’s active purchaser exchange rejected roughly half the private insurers that wanted to be on it originally.
   
   
4. Have the public insurance company create just one Bronze plan, one Gold plan, one normal Silver plan, and one super-expensive Silver plan to sell on the exchange. The ACA subsidies are calculated based on the second-lowest cost Silver plan (SLCSP). Now that the public insurance company is guaranteed to have the SLCSP, the goal is to make it as expensive as possible to maximize the size of the federal subsidies. A few federal requirements likely limit the premium amount a state could charge for the “super-expensive Silver,” but based on current prices from some monopoly insurers we know it is clearly possible to make the SLCSP $200-400 more a month than the cheapest Silver. I suspect a public insurance company with an explicit goal of exploiting the system could go even further. Including in the plan every single provider in the country, fully reimbursed at their absurd list price without any negotiated discount, could cause the SLCSP be $1,000 a month or more expensive than the normal Silver plan.
   
   
5. Set the actuarial value of the Silver plans as close to 72 percent as possible to further maximize subsidies. California wisely already does this.
   
   
6. Automatically enroll everyone who qualifies for tax credits into free coverage and make them keep it.

This strategy should more than double the amount of federal affordability subsidies going to a state each year, hundreds of millions or billions depending on the size of the state. It would make basically everyone in the state under the 200% FPL eligible for a free enhanced Silver plan, which they should be selecting to get the cost-sharing reduction. Everyone making 200% to roughly 300% FPL would qualify for a free Gold plan, and everyone from 300-400% FPL would qualify for at least a free Bronze or potentially a free Gold (if the super-expensive Silver Plan can be pushed high enough). People making over 400% FPL would still not get subsidies, but making coverage free for basically all lower income people and automatically signing them up should significantly reduce the premiums for the unsubsidized population.

Undoubtedly if this plan were tried, it would face lawsuits and opposition from health insurers and the Trump administration, but there is likely not much they can do if mechanisms to drive out all private insurers and drive up the price of the super-expensive Silver plan are carefully crafted. Nothing in this plan depends on requesting federal waivers.

It made sense that blue states tried to make the ACA exchanges work like intended when they had a federal partner. But if this administration doesn’t care about making the law work as designed, neither should states. The question is, are any states willing to stop trying to make the ACA work as designed and instead exploit the ACA to best help their people?

 

[ROFLOCO]

Breh.

You do not follow politics.

You just parrot talking points .

I'm speaking on actual legislation

You are just saying generic phrases that are popular to repeat.

Stop quoting me, and go study on why states have implemented aca differently

i understand the politics behind states that didn't optin for medicaid expansion after the ACA was implemented (mostly red conservative states). But none of this solves the real problems with the healthcare industry in this country.

there's built in profits/incentives in the healthcare industry to deny as much treatment as possible which is why our healthcare system ranks dead last relative to other wealthy nations. our healthcare system is also the leading cause of bankruptcy in this country (even for those who are insured). It's also responsible for 40+ thousand lives per year due to lack of access.

beyond just wanting states to opt in for medicaid expansion what people should be *fighting for* is a single payer/free at the point of service healthcare system which gets the profit-motive out of the healthcare industry entirely

right now the USA is the only country in the first world that doesn't have some version of single payer healthcare (where the government as a service to its people is the single payer/insurer and not aetna or bluecross or united or any of these other shady health insurance companies).

 

[Savvir]

You are preaching points that have nothing to do with the post I was replying to.

In a thread about helping people understand their insurancesoptions that CURRENTLY EXIST you are trying to preach about changes in the structure of healthcare itself that won't even be able to take affect for YEARS even if we had the political push to make it a reality .

Please save these posts for your activist Twitter account .

 

[ROFLOCO]

This is the political forum is it not ? The title said "who can afford ACA"? I responded that healthcare industry is a much bigger problem. then you called me out for talking about things i didn't know about. which is why i responded to your post and then elaborated on the original point i was making.

 

[Savvir]

People in here are having different experiences with their aca eligibility. I point out that the GOP sabotaged it's rollout in certain states. You came with the crusty "both sides are the same" argument and I shyt on you. Save your posts for Twitter or just don't quote me when your response isn't relevant to what I'm saying

 

[ROFLOCO]

People in here are having different experiences with their aca eligibility. I point out that the GOP sabotaged it's rollout in certain states. You came with the crusty "both sides are the same" argument and I shyt on you. Save your posts for Twitter or just don't quote me when your response isn't relevant to what I'm saying

both sides are the same (for the most part), you never disputed that, but instead you resorted to name calling and other pointless bullshyt. if you can't handle the heat get out of the kitchen bra

 

[Savvir]

Bro what the fukk are you talking about. Both sides are not the same . The discrepancies between ACA coverage clearly shown by the posts in this thread are a testament to the difference .

 

[DEAD7]

I still don’t understand how passing such a deeply flawed reform knowing full well the other side of the isle could and intended to ruin it was seen as a win.
I’m convinced now that the aca was just a shytty step towards single payer.

 

[Saysumthinfunnymike]

I applied for AZs state insurance when my job wasn’t giving me insurance and they said I didn’t qualify

So I should have tried to get a subsidy at that point?

I hate that more people don't realize how all this works.. it's unfortunate. When you attempt to purchase a plan through the ACA they simultaneously will have you apply to see if you qualify for state insurance. If you are denied state insurance because you make too much then yeah you are going to qualify for some portion of a subsidy unless you make too much and in that case you'd have a job where you are offered insurance or you'd be wealthy enough to buy it without a subsidy.

 

[Saysumthinfunnymike]

and at "both sides are the same." "Obamacare" works fine if it's not gutted. Obama put in place a system that put millions more on affordable insurance. It was designed to assist the working poor and middle class and it did just that. People living in poverty already had the option of state aide.

Obama wanted people to have health coverage. GOP doesn't give a shyt if anyone has coverage. How is that "the same"? Some of u been hanging out in TLR too long