The Obama Administration thread

[GeorgeSteele]

dont quite understand how people can actually believe this plan is going to cut the federal deficit........they must believe in santa clause, the toothe fairy and the easter bunny

Exactly, anyone who would believe the non-partisan CBO over Rush Limbaugh and Glenn Beck probably also believes in Santa Claus and the Tooth Fairy.

and when has any federal program been run efficiently without waiste, corruption, or administrative effectiveness

Like, maybe never!  After we Real Americans rise up and repeal this communist, government takeover of our bodies, let's take down the military, police, blow up a few highways and set fire to our national parks.  Fight for what's right, fight for your LIFE!

if anything, this will cause more job loss among small businesses and have the untended consequenses of causing more people too not be covered

Spot on, the bill might have fancy lingo about exempting small businesses from requiring them to insure their employees and offering significant tax credits if they do offer insurance, but that must have been in the bullshit section of the bill.

hope I'm wrong

I hope so too, then Obama will be re-elected and Democrats will maintain control of Congress... wait... what?

[pilferk]

It is not the medicaid I am referring to.  It as additional program for people who do not qualify for medicaid. It is for people like my brother in law who makes $25k a year with no available insurance.  It is called MN care. They pay into it based on income, they get 100% coverage on everything essentially.  Most private plans in this state are average at best, 80/20 with deductables and copays.  Once the federal bill kicks it, people might pay the same, but who says what insurance plan they will receive? What are the parameters for the level of coverage someone is going to receive once they switch from the state insurance plan to the federal version?  I doubt my coverage will change for the better or worse, but for people who aren't poor enough for medicaid or in a line of work that has health coverage, what is going to happen to their coverage?


MN also has a program GAMC, which is for people who would otherwise qualify for medicaid but they are single...which is on the chopping block, but then those people would go into the MN care program and have to pay a very small premium.

So essentially, I am from a state that already has a "health care bill".

Which, I promise you, is still medicaid.

In CT, we have various title expansions of medicaid (for example, our Husky Program)...but it's all medicaid. Almost ANY state run/administered health care is, by definition, medicaid...because they're funded, at least in part, through federal medicaid dollars, and thus must pass the federal medicaid "litmus".  Ask your local health care provider what they consider that program, in terms of being a "payor" and I PROMISE you they'll tell you medicaid.  It will adhere to all the reimbursement (and by that, I mean to the providers...not the patients) standards and practices of pretty much every medicaid title.  The only other option is if your state is running a non-profit HMO....(GMAC might be that...but it sounds like that program is so overrun that the gov cut funding and they're transferring people back to MinnesotaCares starting in June).

From one of your own State web sites:

MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, federal Medicaid matching funds and enrollee premiums.

The state's control the provisions for participation....it sounds like your state enacted an expanded title to increase coverage, and funded it from state revenue.  The difference, now, is that you'll have increased federal funding, now, for a similar program.  Which SHOULD mean your state tax dollars can either be redirected or your state tax burden can be lowered.  You can STILL keep the title/provisions that expand coverage BEYOND the new federal guidelines (as some states do now) and you'll continue to fund those pieces out of state tax dollars.  But the expansion is going to be a LOT less than it sounds like it is, now.

If you have coverage, currently, you should see NO changes, other than the regulatory ones (pre-existing conditions, keeping your children on your policy, etc).  What you've got is what you'll keep.

If you're above the "133% of the Federal Poverty level" mark, and don't currently have insurance, you'll have 3 choices:  You can aquire insurances (with pretty hefty federal subsidies that go up to, on a graduated scale, families making around 88k a year...which is pretty generous) by yourself or through your employer, you can pay the fines, or you can apply for a federal hardship exemption.

Keep in mind, though, that small businesses are going to see a nice tax break if they offer insurance to their employees: Up to 50% of the TOTAL premium.  LARGE businesses (> 50 employees) have some "incentives" built into the bill via increased taxes to do the same (OK, they're penalties for NOT providing insurance...but I figured you'd all get a laugh from the "talking points" version).

[pilferk]

dont quite understand how people can actually believe this plan is going to cut the federal deficit........they must believe in santa clause, the toothe fairy and the easter bunny

Again, see the CBO analysis.  They basically will not say it will cut the deficit unless their projections at BOTH ends of the range show it will.  In other words, if they saw that worst case scenario is that it INCREASES the deficit...even if the top end is a HUGE deficit reduction...they won't stamp it as a deficit reducer.

So, you can believe the CBO (who are non-partisan, have no agenda, and have no reason to "lie") or you can believe the political rhetoric, which has an agenda.  I'm not 100% convinced, myself.  But I believe it a lot more than I believe the Repubs who are trying not to take a MAJOR policy loss, and who are facing an election cycle.  Because, while it's true that the CBO projections are never dead on, it's also true that I can not find one documented case where they were as far off as the Repubs are saying they are.  What's also funny is that the Repubs, on more than one occasion, have used the CBO projections to either fight against a bill or as a reason to support a bill....when they show numbers that match the Republican's agenda.  So it's hard to take their objections all that seriously, now.

and when has any federal program been run efficiently without waiste, corruption, or administrative effectiveness

The parks service.  I'd argue the Postal Service is pretty darn efficient (if not profitable).  The military is pretty well run.  The Transportation Dept is VERY well run.  They DO exist.

But honestly, most private industry faces the same issues, FYI.  Big business is RIFE with it, but the motivation for profit just bends where and how it manifests.  But I assume your point is that it seems to occur more often in the government, where profit isn't the litmus test for success. 

Which is why this program works out well.  Because, contrary to what the Repubs are telling you...this is NOT a government take over of healthcare.  THEY won't be running day to day operations.  They're regulating and enforcing.  The ONLY thing the fed will run, and it's short term, are the insurance exchanges...which will eventually be spun off as (or to an existing) non-profit corporation.

And using your logic, we should just close down the federal government and let the State's become their own countries.  Because the fed can't function, right?

It's funny how the Repubs decry the inefficiency of the federal government ONLY when we're talking about programs they don't like.  Never when it's something they're pushing for....I mean, under Bush, the government EXPLODED with new programs and agencies.  Yet...I never heard the objection you're making, above.

if anything, this will cause more job loss among small businesses and have the untended consequenses of causing more people too not be covered

That's a nice talking point...but there's not all that much behind it.  Why do you think the above?

First off, I can't see HOW it would effect small businesses.  They're unlikely to be making more than 250k a year in profit (and if they are, they're not so small).  There is no employer mandate, so they don't have to provide coverage to their employees....AND they don't have to pay the penalties levied against larger businesses with more than 50 employees (I know, I know...if there's no mandate, then how can there be "fines"....it's a fine line they're walking, but it does exist).  In fact, the only place you see small businesses effected, really, is that they'll get a tax break (up to 50% of the TOTAL premiums) IF they CHOOSE to provide health insurance for their employees.  But they don't have to....

If ANYTHING, it can actually help the small business compete for labor....because they will now better be able to provide a benefit pretty much exclusively in the realm of larger businesses.  Granted, right NOW, that's not a factor because the demand FOR jobs is outstripping the NEED for labor.

And how can it cause more people NOT to be covered?  There's no logic behind that, at all.

hope I'm wrong but it sure seems to me that this will bankrupt the company and add to our deficit

That's largely because you're listening to talking points, rather than both familiarizing yourself with what's actually IN the bill (and not what you're being told is in it), how it will ACTUALLY function (and not how you're being told it will function), and what the projections on costs ACTUALLY say (and not what the Repubs tell you they think they'll be).

Which is fine....but that's why you're going to disconnect from a whole bunch of people who think otherwise.

[sandman]

anyone see the PAINFUL exchange between O'Reilly and Weiner last night? here it is...

http://nymag.com/daily/intel/2010/03/anthony_weiner_to_oreilly_you.html

anyone know the answer to Bill's question?

[JuicySwoos]

It is not the medicaid I am referring to.  It as additional program for people who do not qualify for medicaid. It is for people like my brother in law who makes $25k a year with no available insurance.  It is called MN care. They pay into it based on income, they get 100% coverage on everything essentially.  Most private plans in this state are average at best, 80/20 with deductables and copays.  Once the federal bill kicks it, people might pay the same, but who says what insurance plan they will receive? What are the parameters for the level of coverage someone is going to receive once they switch from the state insurance plan to the federal version?  I doubt my coverage will change for the better or worse, but for people who aren't poor enough for medicaid or in a line of work that has health coverage, what is going to happen to their coverage?


MN also has a program GAMC, which is for people who would otherwise qualify for medicaid but they are single...which is on the chopping block, but then those people would go into the MN care program and have to pay a very small premium.

So essentially, I am from a state that already has a "health care bill".

If you're above the "133% of the Federal Poverty level" mark, and don't currently have insurance, you'll have 3 choices:  You can aquire insurances (with pretty hefty federal subsidies that go up to, on a graduated scale, families making around 88k a year...which is pretty generous) by yourself or through your employer, you can pay the fines, or you can apply for a federal hardship exemption.

These are the people who would be in the MN care program right now......these are the folks who are most hurt by lack of insurance...they don't get the full blown medicaid, have lower income levels, etc.  It sounds like they will then be forced into a private plan.  Even is the state gets more funds, how can it be for a similar program when those people are out of the program because are forced to buy private insurance?  And even if it does lower the tax burden, how is that going to help these people who don't pay taxes anyway? Where in the bill does it state these folks are guaranteed to keep their current level of coverage once they switch to a private plan?

Moreover, one of the biggest issues of our health system is even people with a good job, decent pay, and health insurance, it still costs an arm and a leg after the fact.  For instance, I had an HMO when my first son was board and it didn't cost me one dime out of pocket.  My second son, my employer had switched to some cheaper stank PPO, which was essentially an 80/20, and his birth cost me over $2500 out of pocket, and unlike my first son, it was a "natural" birth vs a C-section.  I can only imagine how much it would of cost me if we had to do another C-Section.  For me personally, it is what it is, least I have insurance, I make good money, so not the end of the world.

But, if people in MN Care are forced into a private plan similar to mine, they are going to be SOL, and this bill will hurt these folks in my state.  Which makes no sense because these are the folks who need this bill the most.  Poor people get medicaid, rich people are rich, upper middle class have health care and a means to pay, middle to lower middle class people get screwed.

The most "controversial" aspect of this bill is the only thing I have seen that can address the true problem (IMO) of health care.  COSTS.  Making everyone who can pay, pay for something, in theory will lower everyones insurance costs, but that is coverage costs....What about direct costs? Ever actually read an itemized medical bill? $8 for an ibuprofen, $90 for some shrink to come in for once second and ask how you feel, it is a joke.  What is this bill doing to address this type of nonsense?

Again, from my prism, I don't see how this bill is going to help me, or anyone who actually needs help in my state.   

[pilferk]

These are the people who would be in the MN care program right now......these are the folks who are most hurt by lack of insurance...they don't get the full blown medicaid, have lower income levels, etc.  It sounds like they will then be forced into a private plan.  Even is the state gets more funds, how can it be for a similar program when those people are out of the program because are forced to buy private insurance?  And even if it does lower the tax burden, how is that going to help these people who don't pay taxes anyway? Where in the bill does it state these folks are guaranteed to keep their current level of coverage once they switch to a private plan?

You're misunderstanding.  With MinnesotaCare, the only requirement seems to be financial (which is different than most other states)...and it's the same financial requirement that exists currently.  So if you're on MinnesotaCare (which is an expanded version of Medicaid, without the secondary requirement), you'll stay there.  So, for Minnesota, you won't see an expansion of Medicaid ELIGIBLE patients (you won't see a reduction, either). But you WILL see more federal dollars to cover those people.  No one will be forced to leave the program and buy private insurance.

But those who are ABOVE the "medicaid eligible" financial threshhold will have the above listed choices.

Moreover, one of the biggest issues of our health system is even people with a good job, decent pay, and health insurance, it still costs an arm and a leg after the fact.  For instance, I had an HMO when my first son was board and it didn't cost me one dime out of pocket.  My second son, my employer had switched to some cheaper stank PPO, which was essentially an 80/20, and his birth cost me over $2500 out of pocket, and unlike my first son, it was a "natural" birth vs a C-section.  I can only imagine how much it would of cost me if we had to do another C-Section.  For me personally, it is what it is, least I have insurance, I make good money, so not the end of the world.

Your current coverage is your current coverage.  However, the thought process is that, with increased roles (and an increased pool) your PROVIDER will charge you less (because you don't have to pass on the costs of unpaid care to other patients).  That SHOULD help reduce your "20%" amount.

AND, if the competition they are projecting actually bears out (and on this, I have my doubts), most plans will...you'd think...create better provisions for their customers so they don't change plans.  We'll see. 

But, if people in MN Care are forced into a private plan similar to mine, they are going to be SOL, and this bill will hurt these folks in my state.  Which makes no sense because these are the folks who need this bill the most.  Poor people get medicaid, rich people are rich, upper middle class have health care and a means to pay, middle to lower middle class people get screwed.

They won't be forced into a private plan.  See above explanation.

The most "controversial" aspect of this bill is the only thing I have seen that can address the true problem (IMO) of health care.  COSTS.  Making everyone who can pay, pay for something, in theory will lower everyones insurance costs, but that is coverage costs....What about direct costs? Ever actually read an itemized medical bill? $8 for an ibuprofen, $90 for some shrink to come in for once second and ask how you feel, it is a joke.  What is this bill doing to address this type of nonsense?

Read 'em?  I've helped generate them.   I've helped develop RVU's and whole sements of our costs vs charge tables.  The wonders of working in Finance at a world class (and, FYI, a non-profit) healthcare institution.

PART of the reason those direct costs are so high is that the providers have to cover the costs they CAN'T get back from those that simply can't pay their bills.   SOMEONE has to pay for the materials, overhead and labor "consumed" by those patients, and it means they have to charge more for things to do that.  Most institutions have things like free bedcare funds, grants, and indigent patient programs..but that money is limited. 
There are OTHER factors:  Some this bill addresses, some it doesn't.  But this will help, a lot. 

Anecdotally about 7% to 8% of our patients each year are uncompensated (well over 30k patients) care....that's directly passed on to everyone else with higher direct costs, because it has to be, or we'd have to shut our doors.

Again, from my prism, I don't see how this bill is going to help me, or anyone who actually needs help in my state.   

Part of that is I don't think you exactly understand the bill.  Which is fine and why the type of dialogue we're having is so good.

I think the benefits for your state are LESS than those in other states, without the type of Medicaid expansion you have.  But they're certainly there.  The regulations, like being able to keep your kids on your insurance til they're 26, the "no pre-existing condition" rules, etc. will still apply, too.

[pilferk]

anyone see the PAINFUL exchange between O'Reilly and Weiner last night? here it is...

http://nymag.com/daily/intel/2010/03/anthony_weiner_to_oreilly_you.html

anyone know the answer to Bill's question?

I'm not SURE, but given the way it works with minor cases of Medicare or Medicaid fraud (by the patient), it would be the Federal or State courts (and, thus, law enforcement)...rather than like tax fraud (who's proceedings are kicked off by the IRS).    It's like being issued a traffic ticket, to some extent, though.  You just get a bill in the mail.

UNLESS it's systemic, premeditated, and exceeds a certain amount of money....then it's a criminal offense (again, for Medicare/Medicaid).  Doesn't look like there's any provision for that type of enforcement, in this bill, though.

[D]

Had a patient today who is in the Army and she said pretty much if the govt runs the program like they do her medical, we are pretty much fucked. LOL



saw this on Facebook and it gave me a good laugh!

A health care plan written by a committee whose chairman says he doesn't understand it; passed by a Congress that hasn't read it, but EXEMPTS themselves from it; signed by a President that also hasn't read it and who smokes; funding administered by a treasury chief who didn't pay his taxes; to be overseen by a surgeon... general who's obese; financed by a country that's broke. ~ What could possibly go wrong?"

[Smoking Guns]

D, I think even Pilferk would agree the members of both parties in congress, but especially the democratic, seem so unable to do something right that America (a large portion) just assume they will eff this up as well.  Reid and Pelosi are tow of the biggest jokes ever.  So even if they have a good idea, you really have to question it, because its almost unbelivable that they would even have one.

[pilferk]

Had a patient today who is in the Army and she said pretty much if the govt runs the program like they do her medical, we are pretty much fucked. LOL

The VA is basically single payor.

This system is not single payor.

The vets, actually, would probably benefit MORE from getting THIS system, than they do sticking with the one they've got....which, admittedly, sucks donkey balls.

[pilferk]

D, I think even Pilferk would agree the members of both parties in congress, but especially the democratic, seem so unable to do something right that America (a large portion) just assume they will eff this up as well.  Reid and Pelosi are tow of the biggest jokes ever.  So even if they have a good idea, you really have to question it, because its almost unbelivable that they would even have one.

No, not really.  Especially not with the partisan parts of the comments, above.  In fact, I don't think the dems are any worse (or any better) than the Repubs at all this...and history sort of bears that out.

I think Congress has issues, on both sides of the aisle, but I do think they get it right more often than not.  The problem is they're about 50/50 on the "big stuff" (again, including BOTH parties, here), which is what American's tend to remember, and much better at the smaller stuff.  That shouldn't surprise or discourage anyone because, lets face it, the small stuff is easy and the big stuff is hard.

But then, if you look at the non partisan evaluations (stuff like the CBO's evaluation), they usually tell you when/how Congress is going to "fuck up".  They're not saying stuff like that about this bill.  Again, they're not going to be balls on accurate...their projection are ranges and they give a conservative midpoint.  But what they're saying is compelling enough to make me think they've got a better chance at being RIGHT this time than they are wrong.

I don't KNOW this bill is going to work.  But I know that what we've got ISN'T.  This actually maintains the market and just regulates the industry (contrary to the popular "government takeover" crap), which I actually think might work. MY biggest worry is that the insurance companies will still operate in an insular market and not compete, especially with some of the anti-trust exemptions.  It's actually somewhat amusing to listen to the Repubs get all whipped up into a lather because, honestly, this bill is a hell of a lot more centrist than the Repubs had any right to expect given the majorities the Dems have in Congress. 

Ultimately, time will tell.

As an aside...Reid is underwhelming as the Senate Majority Leader.  He's sort of a wet blanket. But you can't sit there an tell me that Pelosi is an idiot.  Far from it.  That 70 year old woman is sharp as a tack, and has proven to be a STRONG speaker.  You might not agree with her on policy, and that's fine...but the reason you dislike her is precisely why she's such a good speaker.  She's good at whipping up the Dems and getting them to vote for policy you disagree with (as a more conservative person).   Dems said largely the same thing about Newt (and still do, I guess, when he does his talk show rounds) for the same reasons.

 

[sandman]

pilferk - i didn't realize Pelosi was 70. damn! she looks young for her age.

i disagree with you on the insurer anti-trust exceptions. they are pretty much a non-issue. it sounds bad in theory but it has little effect on competition or pricing. the primary way the exemption is used is to share claims data so insurers can more accuratley predict losses (and better price their products). but that is primarily in property/casualty insurance. the exemptions barely benefit health insurers becuase they tend to not share claims data as much.

but i agree. this bill is not extreme. and it looks like it will be paid for. the republicans are just acting like 4-year-olds, and the extreme BS needs to stop. the only real criticisms they can have are:

- tax increase: goes against republican principles. i'm not a fan of tax increases, but we're in desperate time so i'm ok with that. although i really don't like CG tax increases.
- CBO projections: you can argue that the data given to them is faulty and/or unrealistic. and/or they could argue that the assumptions will not actually happen (Congress approving huge Medicare cuts is really tough to envision).

i can't really think of anything else they can complain about, which is why they are acting like children.

[pilferk]

pilferk - i didn't realize Pelosi was 70. damn! she looks young for her age.

Her birthday is actually today.....which I knew only because I heard it all over the news yesterday.  I wouldn't have pegged her as that old, either.

i disagree with you on the insurer anti-trust exceptions. they are pretty much a non-issue. it sounds bad in theory but it has little effect on competition or pricing. the primary way the exemption is used is to share claims data so insurers can more accuratley predict losses (and better price their products). but that is primarily in property/casualty insurance. the exemptions barely benefit health insurers becuase they tend to not share claims data as much.

My concern isn't ONLY with the anti-trust exemptions.  It's that they're trying to spur on competition AND allowing the anti-trust exemptions.  That seems counterproductive, to me.  I agree, they might not matter all that much....but if the incentives and provisions of this law (I keep having to correct myself from typing "bill") don't work, they're going to have to fall back to something to get them to compete.  Maybe this will be a wakeup call to the insurance industry that Congress CAN pass meaningful healthcare reform, and it'll scare them straight so as to avoid the possibility of a public option or a huge outcry for single payor.  That, I think, is one of the things Congress is banking on.

[sandman]

here is the republican talking points and "potential" strategy going forward, from everyone's favorite political commentator...

By KARL ROVE
Democrats are celebrating victory. The public outcry against what they've done doesn't seem to bother them. They take it as validation that they are succeeding at transforming America.
But we've seen this movie before and it won't end happily for Democrats. Their morale rose when the stimulus passed in February 2009. The press hailed it as a popular answer to joblessness and a sluggish economy. At the time, Democrats thought it brightened their chances in the 2009 gubernatorial elections.
But a flawed bill, bumbling implementation, and unfulfilled expectations turned the stimulus into a big drag on Democrats in Virginia and New Jersey. A CBS News/New York Times poll recently reported that only 6% of Americans believe the stimulus package created jobs.
Democratic hopes that passing health-care reform will help them politically will be unfulfilled because ObamaCare only benefits a small number of people in the short run. Until the massive subsidies to insurance companies fully ramp up in 2017, this bill will be more pain than gain for most Americans.
For example, changes in insurance regulations in 2011 and two new mandates in 2014 that force everyone to buy insurance and require everyone to be charged a similar price regardless of age or health will cause insurance premiums to rise more than they would have otherwise. The 10 million people who have a health savings account will also be hurt starting in 2011. With each passing year after that, they will be able to put less away tax free for medical expenses.
ObamaCare cuts $1.8 billion in support for Medicare Advantage this October, another $5.8 billion in October 2011, and an additional $9.2 billion right before the 2012 presidential election. This will increase premiums and reduce benefits for the 4.5 million people in the program.
Drug companies will start raising prices to pay billions in new taxes they will have to pay starting next year. New taxes on medical devices and insurance companies will show up in higher prices and premiums before long.
Polls may show a temporary increase in the president's popularity, but underlying public opinion about this law is not likely to change just because the president hits the trail to sell it. After all, he made 58 speeches before the measure passed, including two in prime time.
Before that string of speeches the public was in favor of the concept of health-care reform by a ratio of 2 to 1. Afterward, about 60% of the public was opposed to the president's plan. Those who strongly opposed outnumbered those strongly in favor by 2 to 1 or better in most polls.
Tens of millions of ordinary people watched the deliberations, studied the proposals, and made up their minds. Their concerns about spending, deficits and growing government power are not going away.
Nor is their opposition to ObamaCare. According to a new CNN poll, majorities of Americans believe that they will pay more for medical care, the federal deficit will increase, and that government will be too involved in health care under the president's plan.
Democrats claim they've rallied their left-wing base. But that base isn't big enough to carry the fall elections, particularly after the party alienated independents and seniors. The only way Democrats win a base election this year will be if opponents of this law stay home.
To keep that from happening, Republican candidates must focus on ObamaCare's weaknesses. It will cost $2.6 trillion in its first decade of operation and is built on Madoff-style financing. For example, it double counts Social Security payroll taxes, long-term care premiums, and Medicare savings in order to make it appear more fiscally responsible. In reality, ObamaCare isn't $143 billion in the black, as Democrats have claimed, but $618 billion in the red. And giving the IRS $10 billion to hire about 16,000 agents to enforce the new taxes and fees in ObamaCare will drive small business owners crazy.
Republicans have a powerful rallying cry in "repeal, replace and reform." Few voters will want to keep onerous mandates that hit individuals and taxes that hobble economic growth. Rather than spending a trillion dollars on subsidies for insurance companies and Medicaid expansion, as ObamaCare does, Republicans should push for giving individuals the same health-insurance tax break businesses get, which would cost less.
Republicans must also continue to press for curbing junk lawsuits, enabling people to buy insurance across state lines, increasing the amount of money they can sock away tax free for medical expenses, and permitting small businesses to pool risk.
Opponents of ObamaCare have decisively won the battle for public opinion. As voters start to feel the pain of this new program, Republicans will be in a stronger position if they stay in the fight, make a principled case, and lay out a competing vision.
Mr. Rove, the former senior adviser and deputy chief of staff to President George W. Bush, is the author of "Courage and Consequence," published this month by Threshold Editions.

[JuicySwoos]

These are the people who would be in the MN care program right now......these are the folks who are most hurt by lack of insurance...they don't get the full blown medicaid, have lower income levels, etc.  It sounds like they will then be forced into a private plan.  Even is the state gets more funds, how can it be for a similar program when those people are out of the program because are forced to buy private insurance?  And even if it does lower the tax burden, how is that going to help these people who don't pay taxes anyway? Where in the bill does it state these folks are guaranteed to keep their current level of coverage once they switch to a private plan?

You're misunderstanding.  With MinnesotaCare, the only requirement seems to be financial (which is different than most other states)...and it's the same financial requirement that exists currently.  So if you're on MinnesotaCare (which is an expanded version of Medicaid, without the secondary requirement), you'll stay there.  So, for Minnesota, you won't see an expansion of Medicaid ELIGIBLE patients (you won't see a reduction, either). But you WILL see more federal dollars to cover those people.  No one will be forced to leave the program and buy private insurance.

But those who are ABOVE the "medicaid eligible" financial threshhold will have the above listed choices.

Moreover, one of the biggest issues of our health system is even people with a good job, decent pay, and health insurance, it still costs an arm and a leg after the fact.  For instance, I had an HMO when my first son was board and it didn't cost me one dime out of pocket.  My second son, my employer had switched to some cheaper stank PPO, which was essentially an 80/20, and his birth cost me over $2500 out of pocket, and unlike my first son, it was a "natural" birth vs a C-section.  I can only imagine how much it would of cost me if we had to do another C-Section.  For me personally, it is what it is, least I have insurance, I make good money, so not the end of the world.

Your current coverage is your current coverage.  However, the thought process is that, with increased roles (and an increased pool) your PROVIDER will charge you less (because you don't have to pass on the costs of unpaid care to other patients).  That SHOULD help reduce your "20%" amount.

AND, if the competition they are projecting actually bears out (and on this, I have my doubts), most plans will...you'd think...create better provisions for their customers so they don't change plans.  We'll see. 

But, if people in MN Care are forced into a private plan similar to mine, they are going to be SOL, and this bill will hurt these folks in my state.  Which makes no sense because these are the folks who need this bill the most.  Poor people get medicaid, rich people are rich, upper middle class have health care and a means to pay, middle to lower middle class people get screwed.

They won't be forced into a private plan.  See above explanation.

The most "controversial" aspect of this bill is the only thing I have seen that can address the true problem (IMO) of health care.  COSTS.  Making everyone who can pay, pay for something, in theory will lower everyones insurance costs, but that is coverage costs....What about direct costs? Ever actually read an itemized medical bill? $8 for an ibuprofen, $90 for some shrink to come in for once second and ask how you feel, it is a joke.  What is this bill doing to address this type of nonsense?

Read 'em?  I've helped generate them.   I've helped develop RVU's and whole sements of our costs vs charge tables.  The wonders of working in Finance at a world class (and, FYI, a non-profit) healthcare institution.

PART of the reason those direct costs are so high is that the providers have to cover the costs they CAN'T get back from those that simply can't pay their bills.   SOMEONE has to pay for the materials, overhead and labor "consumed" by those patients, and it means they have to charge more for things to do that.  Most institutions have things like free bedcare funds, grants, and indigent patient programs..but that money is limited. 
There are OTHER factors:  Some this bill addresses, some it doesn't.  But this will help, a lot. 

Anecdotally about 7% to 8% of our patients each year are uncompensated (well over 30k patients) care....that's directly passed on to everyone else with higher direct costs, because it has to be, or we'd have to shut our doors.

Again, from my prism, I don't see how this bill is going to help me, or anyone who actually needs help in my state.   

Part of that is I don't think you exactly understand the bill.  Which is fine and why the type of dialogue we're having is so good.

I think the benefits for your state are LESS than those in other states, without the type of Medicaid expansion you have.  But they're certainly there.  The regulations, like being able to keep your kids on your insurance til they're 26, the "no pre-existing condition" rules, etc. will still apply, too.

 Now I understand what you are saying, people who don't fit the federal requirements for medicaid but meet the state requirements for a state run version of medicaid, can stay on medicaid? Correct?

Then it comes to the question is who exactly are these uncovered people driving up the costs?  Who are those 7% to 8% you are speaking of?  

I don't think it is just uncovered people driving up the costs, what percentage of covered people can't pay the deductable and/or the 20%?  Rack up huge medical bills, can't work as a result, can't pay as a result. You would think that is a very high cost sent on to the rest. That is not going to change under this bill if people's coverage does not improve.  Sorry to say I am skeptical that a for profit insurance company is going to pass any savings onto us, there is no reason to because there is no competition under the current system.  Also, if people with pre-existing consitions have to be covered, won't that effectively offset cost savings by a bigger pool?


I am not claiming this bill should cure all the ills of healthcare, there is no such sytem in reality.  I am just trying to figure out, based on the purported costs, and the reaching of the feds onto the states, the whole cost benefit thing to see if I am for or against it.  I am just not seeing much of a change right now to justify the costs (not just money, the whole feds making people buy a private product is very scary imo).  

Unlike many who either support or are against the bill, I want to know as much as I can about it before I have a strong opinion on it. You are helping a great deal, but I know you're a bit bias so I will also get some info from the other side of the political spectrum as well.

 I used to be a "principals" voter, meaning I voted for ideas that would not be benefit me much, if any, but I thought were the best for the country overall.  Now I think I am reaching the "abundance to selfishness" step on the fall of a great nation scale, and I am now a "what's in it for me" voter.

[pilferk]

Now I understand what you are saying, people who don't fit the federal requirements for medicaid but meet the state requirements for a state run version of medicaid, can stay on medicaid? Correct?

More or less.  The federal program doesn't force anyone off the current program they're on, if they're on one.  That's probably the simplest way to explain it.  The complexities of the bill go into a lot more detail, but suffice to say if your state law is broader in it's permissiveness to the medicaid rolls, the Fed isn't going to make them find something else.

Then it comes to the question is who exactly are these uncovered people driving up the costs?  Who are those 7% to 8% you are speaking of?  

In YOUR state?  Your Self pays may be less than ours...because you have expanded state coverage.  CT doesn't have that expansion (ours deal specifically with children), nor do most states. They pretty much stick with the stated federal guidelines, which means poverty AND another of the conditions be met.  That leaves out a whole bunch of people.

In addition, you have people living, in those states without broader medicaid coverage, above the 133% of Federal Poverty who can't afford insurance AND don't qualify for Medicaid.  There's another large chunk of folks.

And remember, the Fed isn't saying they're going to cover all of them via Medicare.  Some of those folks will buy insurance from a private company with a federal subsidy. Some will get insurance through work with either a Fed subsidy, a significant employer contribution, or both.  Those options are going to be available in MN as much as in CT, NY, CA, or anywhere else.

I don't think it is just uncovered people driving up the costs, what percentage of covered people can't pay the deductable and/or the 20%?  Rack up huge medical bills, can't work as a result, can't pay as a result. You would think that is a very high cost sent on to the rest. That is not going to change under this bill if people's coverage does not improve.  Sorry to say I am skeptical that a for profit insurance company is going to pass any savings onto us, there is no reason to because there is no competition under the current system.  Also, if people with pre-existing consitions have to be covered, won't that effectively offset cost savings by a bigger pool?

In looking at our financials, unpayed/Self pay patients are a much higher contributor toward uncompenated care vs those unable to pay their deductible, their co-pay, or their 20%.  We do see a DELAY in getting back that money, sometimes...but the hospital can work out reasonable payment structures for those people who have hardships (at least ours does).

Trust me when I tell you, as a member of finance (and I've moved on and up from there in recent years, but things haven't changed), we analyzed this 6 different ways from Sunday.  The two leading causes of increased costs FOR US was having to cover the shortfall in uncompensated care and undercompensated care (which, FYI, was about Medicaid reimbursement rates, which go UP under this law...not exhorbitently, but enough to cover more/most of the shortfall in that area).  What we got from the HMO's/PPO's, Commercial payors, and workman's comp were all fine...as was our ability to collect the patient's obligations AFTER insurance.  We heard the same thing from other institutions in our area, and around the country. 

And again, if OVERALL costs to the patient go down, so to does their 20%.  If they had to charge 2000 before, and you were liable for $800 of it then, if they now have to charge $1800, your 20% is only $720.  That gap only gets bigger, the larger your bill is, and the more the institutions can reduce charges.

Remember, it's not the INSURANCE companies that charge for things.  It's the health care institutions.  We're talking about patient care costs...or at least I am.  Not insurance premiums. Having said that, though, what you would expec is this:

Health care costs come down, so the insurance companies will be paying out less money.

There will be a whole bunch of new people looking to buy insurance.

Each company is going to want that business (because it means profit), and given the federal guidelines about required coverage...they're not going to be able to compete all that much on plan features.  I suppose they could TRY to compete on service level..but that's unlikely.  So they're likely going to engage in a price war.

If they do, those with existing plans are going to see lower premiums to be had and either abandon their current plans, or put a whole lot of pressure on their companies HR departments to do something to get commesurate premiums.

And thus, your premiums could come down.

Now, I'm not going to sit here and tell you that's what WILL happen.  I think I've made clear my reservations on whether or not the insurance companies will come join us in the pool or not.  But, the logic seems pretty sound, to me.  And what's so amusing is it's based on a good chunk of Republican sensibility:  That the market will act, react, and correct itself around the consumer.

As for the pre-existing part, there's 2 things to remember:  MOST people not currently with a plan don't have them, and if you ask any actuary, they'll tell you that those people with pre-existing conditions will be "buried" in the pool.  What that means is:  Their costs aren't so much that they are outweighed by the increased premiums payed by the sum total of the new additions.  Again, if anything, it tilts things the other way.  The complications from those with pre-existing conditions are MORE than covered by the increased premiums coming into the system.

I am not claiming this bill should cure all the ills of healthcare, there is no such sytem in reality.  I am just trying to figure out, based on the purported costs, and the reaching of the feds onto the states, the whole cost benefit thing to see if I am for or against it.  I am just not seeing much of a change right now to justify the costs (not just money, the whole feds making people buy a private product is very scary imo).

Again, for your state, the reform piece of the bill, and the increased medicaid funding, are probably going to be the big ticket items. You may also see increased coverage of your population (increasing the pool and spreading the "insurance company" costs amongst a larger pool), better reimbursement rates from medicaid to the provider (which would reduce overall PROVIDER costs),  and other ancillary benefits.  But it sounds like you guys already have a pretty liberal medicaid program in your state (MA has a similar program, too, I think).   So you might not get the same mileage as someone in CT or NY or CA is going to get.  But it doesn't HURT you, in your state, by the looks of things, either.

Unlike many who either support or are against the bill, I want to know as much as I can about it before I have a strong opinion on it. You are helping a great deal, but I know you're a bit bias so I will also get some info from the other side of the political spectrum as well.

For frame of reference, I'm a registered independant who's socially liberal and fiscally conservative (I think this might be the first time in recent memory we've discussed anything related to finance, though!!).  That's why, right from the get go, my biggest concern with this process was cost and whether "we" (meaning the counry) could pay for it all.  If we hadn't been able to....I would have been a whole lot less interested in this bill.  I likely would have been OK with it, because we need SOMETHING at this point, but I would have probably been wavering between "OK" and "annoyed but neutral".

But this bill?  It fits right in my sensibilities. 

I used to be a "principals" voter, meaning I voted for ideas that would not be benefit me much, if any, but I thought were the best for the country overall.  Now I think I am reaching the "abundance to selfishness" step on the fall of a great nation scale, and I am now a "what's in it for me" voter.

I'm closer to your ideology than you might think.  I might lean a little further left on social policy and "good for the country", sometimes...but not much.

I've never voted for a Dem in a local election.  I've never voted for a Dem for Governor of our state.  I've only voted for a Dem Representative once (maybe twice...when did Nancy Johnson leave the House?),and only then because the Repub candidate that year was HORRIBLE.  Since '92, in the presidentials, I've voted Repub once (in '92), Indie once ('00), and Dem three times ('96, '04, and '08).  I know that many people here think that, no matter what I say to the contrary, that I'm a lever pushing Dem....but that's not quite true.  If a Repub ran for the White House on a strong "Regan era Repub" platform, and promised a balanced budget, I'd vote for them again.  For a long time I actually thought McCain might do that...then he buckled to the social neo-con "base" that formed during GW's presidency.

[Smoking Guns]

pilferk - i didn't realize Pelosi was 70. damn! she looks young for her age.

You do realize she has spent a ton of money on cosmetic surgery don't you?

[pilferk]

pilferk - i didn't realize Pelosi was 70. damn! she looks young for her age.

You do realize she has spent a ton of money on cosmetic surgery don't you?

She's got a REALLY good surgeon, then.  Maybe a bit too pulled back (musta been a West Coaster), but still.

[JuicySwoos]

I'm closer to your ideology than you might think.  I might lean a little further left on social policy and "good for the country", sometimes...but not much.

I've never voted for a Dem in a local election.  I've never voted for a Dem for Governor of our state.  I've only voted for a Dem Representative once (maybe twice...when did Nancy Johnson leave the House?),and only then because the Repub candidate that year was HORRIBLE.  Since '92, in the presidentials, I've voted Repub once (in '92), Indie once ('00), and Dem three times ('96, '04, and '08).  I know that many people here think that, no matter what I say to the contrary, that I'm a lever pushing Dem....but that's not quite true.  If a Repub ran for the White House on a strong "Regan era Repub" platform, and promised a balanced budget, I'd vote for them again.  For a long time I actually thought McCain might do that...then he buckled to the social neo-con "base" that formed during GW's presidency.

Wow, we are closer....I was a "Regan Republican", although morso because of Reagan "the myth" and not Reagan "the man". I was a Poli Sci/ History double major, in College Republicans, a coolaide drinking partisan all the way...all the way up to the 04 election.  I lived in urban St Paul, had big ole "W" posters all over just to piss off my neighbors, drove a big gas guzzling Land Rover, was living the "Republican" life.  I was so excited when Bush got control of the congress, something Reagan never had.  Bush had a chance to do what Reagan couldn't as a result.  I thought Bush could have been the next Reagan without the charisma and/or speaking ability.  Boy was I wrong, NEO con all the way.  Run on fringe right wing social issues, spend like Democrats.  I used to watch Fox news 24/7...haven't watched that station for more than 2 minutes going on 3+ years. To paraphrase Reagan, I did not leave the Republican party, the Republican Party left me.


For me, I seperate "conservative/liberal/moderate" in two ways.  I first decipher if it is something better left to the states.  When I think it is up to the states, it will depend.  On the state level, I am moderate fiscally and liberal socially.   If I lived in ND, that would maybe change.  On the federal level, fiscally conservative, socially statist (meaning it should be a question for the state).  People ask me if I am pro-choice or pro-life, I say I am pro-choice but I think Rowe V Wade should be overturned....people ask me how that is possible?  I think it should be a state issue much like the death penalty.  But I am pro-choice in the sense that reasonable people can disagree on the subject, therefore it is a moral issue, and government should stay out if possible.  Gay marriage?  Against it nationally, support it on the state level.  Pot? Drugs? Same thing.   

The problem with being fiscally conservative and socially liberal is figuring out which ideal is most important.  Most social issues have a price tag, so which viepoint trumps the other?

But all of the above was what was. This is the first time I have discussed anything in depth on this board in this section.   Now that I am married, traded in the Rover for a Honda, have two kids, a mortgage, etc...my passion for political theory has been destroyed by the self serving politicians in Washington.  So now I have to look at it as "what's in it for me".  I have also come to the conclusion is I am not going to change anyone's mind, and I doubt anyone is going to change mine, so why bicker over whether Obama is the ant-christ or whether Bush is the next hitler.

In terms of this bill, you are lucky in the sense you have first hand knowledge because you're in that business.  Now, if anyone wants to talk about Obama's mortgage plan.....that would be my area of expertise...

[Smoking Guns]

There is some talk of a value added tax...  Please, someone tell me that will not be on the table as an option....