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Thread: 2017 American Political Scene

  1. #1261
    Global Moderator Defense Professional JAD_333's Avatar
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    Quote Originally Posted by astralis View Post
    so the new GOP ACA replacement bill is out, and per my earlier discussion with JAD regarding "any possible alternative involves either dropping people, spending more money, or reducing benefits"...the Republicans have chosen an alternative that involves all three.

    truly impressive.
    The plan is stuck between Republican members who want more and those who want less, and compromise doesn't seem hopeful. The committees hope to get it to the floor in a week. This plan has failure written all over it.
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    from Krugman's blog.

    https://krugman.blogs.nytimes.com/

    ====

    So now we know what Republicans have to offer as an Obamacare replacement. Let me try to avoid value judgments for a few minutes, and describe what seems to have happened here.

    The structure of the Affordable Care Act comes out of a straightforward analysis of the logic of coverage. If you want to make health insurance available and affordable for almost everyone, regardless of income or health status, and you want to do this through private insurers rather than simply have single-payer, you have to do three things.

    1.Regulate insurers so they can’t refuse or charge high premiums to people with preexisting conditions
    2.Impose some penalty on people who don’t buy insurance, to induce healthy people to sign up and provide a workable risk pool
    3.Subsidize premiums so that lower-income households can afford insurance

    So that’s Obamacare (and Romneycare before that): regulation, mandates, and subsidies. And the result has been a sharp decline in the number of uninsured, with costs coming in well below expectations. Roughly speaking, 20 million Americans gained coverage at a cost of around 0.6 percent of GDP.

    Republicans have nonetheless denounced the law as a monstrosity, and promised to replace it with something totally different and far better. Which makes what they’ve actually come up … interesting.

    For the GOP proposal basically accepts the logic of Obamacare. It retains insurer regulation to prevent exclusion of people with preexisting conditions. It imposes a penalty on those who don’t buy insurance while healthy. And it offers tax credits to help people buy insurance. Conservatives calling the plan Obamacare 2.0 definitely have a point.

    But a better designation would be Obamacare 0.5, because it’s really about replacing relatively solid pillars with half-measures, severely and probably fatally weakening the whole structure.

    First, the individual mandate – already too weak, so that too many healthy people opt out – is replaced by a penalty imposed if and only if the uninsured decide to enter the market later. This wouldn’t do much.

    Second, the ACA subsidies, which are linked both to income and to the cost of insurance, are replaced by flat tax credits which would be worth much less to lower-income Americans, the very people most likely to need help buying insurance.

    Taken together, these moves would almost surely lead to a death spiral. Healthy individuals, especially low-income households no longer receiving adequate aid, would opt out, worsening the risk pool. Premiums would soar – without the cushion created by the current, price-linked subsidy formula — leading more healthy people to exit. In much of the country, the individual markets would probably collapse.

    The House leadership seems to realize all of this; that’s why it reportedly plans to rush the bill through committee before CBO even gets a chance to score it.

    It’s an amazing spectacle. Obviously, Republicans backed themselves into a corner: after all those years denouncing Obamacare, they felt they had to do something, but in fact had no good ideas about what to offer as a replacement. So they went with really bad ideas instead.
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

  3. #1263
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    Quote Originally Posted by astralis View Post
    from Krugman's blog.

    https://krugman.blogs.nytimes.com/

    ====

    So now we know what Republicans have to offer as an Obamacare replacement. Let me try to avoid value judgments for a few minutes, and describe what seems to have happened here.

    The structure of the Affordable Care Act comes out of a straightforward analysis of the logic of coverage. If you want to make health insurance available and affordable for almost everyone, regardless of income or health status, and you want to do this through private insurers rather than simply have single-payer, you have to do three things.

    1.Regulate insurers so they can’t refuse or charge high premiums to people with preexisting conditions
    2.Impose some penalty on people who don’t buy insurance, to induce healthy people to sign up and provide a workable risk pool
    3.Subsidize premiums so that lower-income households can afford insurance

    So that’s Obamacare (and Romneycare before that): regulation, mandates, and subsidies. And the result has been a sharp decline in the number of uninsured, with costs coming in well below expectations. Roughly speaking, 20 million Americans gained coverage at a cost of around 0.6 percent of GDP.

    Republicans have nonetheless denounced the law as a monstrosity, and promised to replace it with something totally different and far better. Which makes what they’ve actually come up … interesting.

    For the GOP proposal basically accepts the logic of Obamacare. It retains insurer regulation to prevent exclusion of people with preexisting conditions. It imposes a penalty on those who don’t buy insurance while healthy. And it offers tax credits to help people buy insurance. Conservatives calling the plan Obamacare 2.0 definitely have a point.

    But a better designation would be Obamacare 0.5, because it’s really about replacing relatively solid pillars with half-measures, severely and probably fatally weakening the whole structure.

    First, the individual mandate – already too weak, so that too many healthy people opt out – is replaced by a penalty imposed if and only if the uninsured decide to enter the market later. This wouldn’t do much.

    Second, the ACA subsidies, which are linked both to income and to the cost of insurance, are replaced by flat tax credits which would be worth much less to lower-income Americans, the very people most likely to need help buying insurance.

    Taken together, these moves would almost surely lead to a death spiral. Healthy individuals, especially low-income households no longer receiving adequate aid, would opt out, worsening the risk pool. Premiums would soar – without the cushion created by the current, price-linked subsidy formula — leading more healthy people to exit. In much of the country, the individual markets would probably collapse.

    The House leadership seems to realize all of this; that’s why it reportedly plans to rush the bill through committee before CBO even gets a chance to score it.

    It’s an amazing spectacle. Obviously, Republicans backed themselves into a corner: after all those years denouncing Obamacare, they felt they had to do something, but in fact had no good ideas about what to offer as a replacement. So they went with really bad ideas instead.
    As if the ACA was a great idea to begin with, fulfilling all it was promised to. Instead, premiums have been soaring while coverage shrinks, and people lost those plans they were promised they wouldn't lose, insurance companies are getting out of the market, and the bulk of new enrollments came from the expansion of medicaid. It is a monstrosity that is already collapsing.

    http://money.cnn.com/2017/02/15/news...-death-spiral/

  4. #1264
    Senior Contributor Doktor's Avatar
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    Asty, JAD, anyone else willing to give an insight,

    How is DOS doing these days? Over here, we are very confused.

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  5. #1265
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    Wooglin,

    As if the ACA was a great idea to begin with, fulfilling all it was promised to. Instead, premiums have been soaring while coverage shrinks, and people lost those plans they were promised they wouldn't lose, insurance companies are getting out of the market, and the bulk of new enrollments came from the expansion of medicaid. It is a monstrosity that is already collapsing.
    lol, the ACA has been "already collapsing" since its creation, what is new?

    if the ACA were in such utter disrepair as you describe, it is funny how it is now the most popular it has been since it first started, and how enrollments hit a near record for 2017.

    and if all of this is fake news, then the GOP would simply need to just wait until the entire market collapses and then come in with their own plan.

    as it is, the GOP plan is essentially Obamacare-lite: it is the same structure, just with fewer benefits covering less people... -AND- significantly fewer cost controls. so tell me, how does the GOP plan solve the shortfalls of the ACA?
    Last edited by astralis; 07 Mar 17, at 22:34. Reason: changed source for ACA signups
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

  6. #1266
    Senior Contributor DOR's Avatar
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    Quote Originally Posted by Wooglin View Post
    As if the ACA was a great idea to begin with, fulfilling all it was promised to. Instead, premiums have been soaring while coverage shrinks, and people lost those plans they were promised they wouldn't lose, insurance companies are getting out of the market, and the bulk of new enrollments came from the expansion of medicaid. It is a monstrosity that is already collapsing.

    http://money.cnn.com/2017/02/15/news...-death-spiral/

    Wooglin,

    You might want to keep a tighter leash on that attitude toward Obamacare, just for safe keeping. There’s a bunch of nasty old facts around here that could chew it up real bad.


    “Trump said that “Obamacare premiums nationwide have increased by double and triple digits,” giving the average 116 percent increase in Arizona as an example. But that state was the only one to have a “triple digit” average increase in premiums on the ACA exchange, for individuals who buy their own insurance. As we’ve written before, the average nationwide change was a 25 percent increase from 2016 to 2017 among the 38 HealthCare.gov states. Ten of those states had single-digit increases or a decrease in the average second lowest-cost silver plan. And it’s worth noting that 84 percent of the 10.4 million Americans with marketplace coverage in the first half of 2016 received tax credits that limit the amount those individuals have to pay toward premiums.,” FactCheck.org, March 1, 2017. http://www.factcheck.org/2017/03/tru...s-to-congress/



    Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too,” NPR, October 24, 2016.
    http://www.npr.org/sections/health-s...o-do-subsidies

    The truth about those rising health insurance premiums”, CNN October 25, 2016
    http://edition.cnn.com/2016/10/25/op...premiums-jost/

    Key point: increases in premiums this year are because plans were under priced in 2014-16, and the increase merely brings prices up to where they were expected to be back when ACA was being shouted down, I mean “debated” in Congress.
    According to the report, Congressional Budget Office projections from 2009 suggested average 2017 premiums of $5,538; HHS is projecting average premiums of $5,586. Indeed, premiums in many states are still below the cost of employer coverage.


    and,


    Slower Premium Growth Under Obama,” FactCheck.org, February 6, 2015
    http://www.factcheck.org/2015/02/slo...h-under-obama/

    Like I said, very nasty things those facts.
    Very nasty.

  7. #1267
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    Quote Originally Posted by DOR View Post
    Massachusetts is a blue state because of how it votes in presidential elections; that doesn’t mean it is California blue, where every state official comes from the Democratic Party.
    California state senate 27 Democrats 13 Republicans Massachusetts state senate 34 Democrats 6 Republicans In the California State Assembly 55 Democrats 25 Republicans Massachusetts House of Representatives 126 Democrats 34 Republicans. California US House Representatives 29 Democrats 14 Republican Massachusetts US House Representatives 9 Democrats 0 Republicans. In Massachusetts Democrat voters out number Republicans nearly 3 to 1 in Califronia it's 1.5 Dems to 1 Republican. The Cook Partisan Voting Index has Massachusetts bluer than California.

    DOR simple yes or no is California bluer than Massachusetts in elective representation in non presidential elections?

    You are right the Republican Gov and the Republican Lt Gov of Massachusetts were elected by the majority vote in despite all 9 state districts being democratic controlled. How did REDMAP, ALEC and CrossCheck and gerrymandering make this possible?

    Quote Originally Posted by DOR View Post
    Charlie Baker, the GOPer Governor, ran as a social liberal and a fiscal conservative, sort of like me. Sort of like a whole lot of people who are so disgusted at the GOP that they don’t think it can be salvaged.
    Gov. Charlie Baker emphasizes bipartisanship and compromise comes across as non partisan and non didactic. He is not disgusted by the GOP and believes it can be salvaged You are only as good as the people around you. Treat them as less they act accordingly.

    Quote Originally Posted by DOR View Post
    Nevada turns blue after holding its breath for too long. The state voted for every successful presidential candidate for nearly 100 years, with very few (2? 3?) exceptions. That’s a bunch of Dems and a slew of GOPers. Governor Brian Sandoval, ex-Gaming Commission Chair, is Hispanic. He ran against None of These, the top vote-getter in the Democratic Primary (30%). Well, actually it was Bob Goodman, with 25%.
    The state of Nevada experiences oxygen deprivation and politically becomes blue and the Republican Governor wins the majority votes because of his ethnic origins and not his abilities. What the term? Dog whistle.

    Quote Originally Posted by DOR View Post
    Then again, did you read up on REDMAP, ALEC and CrossCheck?
    I didn’t think so.
    DOR I read them. REDMAP by my favorite science writer Elizabeth Kolbert. Her stuff on extinctions, global warming and ocean acidification excellent but her take on REDMAP not so much. I aspire to the view of Real Clear Politics on this matter. http://www.realclearpolitics.com/art...s__124626.html

    "These statehouse wins were not solely a byproduct of Southern partisan realignment -- Republicans also took active, strategic measures to win at the state level across the country. Since the 2004 election, the Republican State Leadership Committee has raised over $140 million to help accomplish this. The Democratic Legislative Campaign Committee, the RSLC’s counterpart, raised less than half that amount in the same period. While other groups also contributed significant amounts to these races, these numbers highlight the emphasis the GOP has put on state legislature elections in recent years.

    Republicans also spent money on the right races at the right moment. In 2010, they funneled over $30 million into the Redistricting Majority Project, also known as REDMAP. REDMAP funds helped the party candidates win a majority in Ohio, Pennsylvania, North Carolina and elsewhere, giving the GOP greater control over the decennial congressional and state-level redistricting process."

    Translation inspiration Democrats should pay attention to key races and come up with a strategy. You can always try a https://en.wikipedia.org/wiki/Califo...tion_14_(2010)
    Last edited by Dazed; 08 Mar 17, at 08:53.

  8. #1268
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    Quote Originally Posted by DOR View Post
    Wooglin,

    You might want to keep a tighter leash on that attitude toward Obamacare, just for safe keeping. There’s a bunch of nasty old facts around here that could chew it up real bad.


    “Trump said that “Obamacare premiums nationwide have increased by double and triple digits,” giving the average 116 percent increase in Arizona as an example. But that state was the only one to have a “triple digit” average increase in premiums on the ACA exchange, for individuals who buy their own insurance. As we’ve written before, the average nationwide change was a 25 percent increase from 2016 to 2017 among the 38 HealthCare.gov states. Ten of those states had single-digit increases or a decrease in the average second lowest-cost silver plan. And it’s worth noting that 84 percent of the 10.4 million Americans with marketplace coverage in the first half of 2016 received tax credits that limit the amount those individuals have to pay toward premiums.,” FactCheck.org, March 1, 2017. http://www.factcheck.org/2017/03/tru...s-to-congress/





    Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too,” NPR, October 24, 2016.
    http://www.npr.org/sections/health-s...o-do-subsidies

    The truth about those rising health insurance premiums”, CNN October 25, 2016
    http://edition.cnn.com/2016/10/25/op...premiums-jost/

    Key point: increases in premiums this year are because plans were under priced in 2014-16, and the increase merely brings prices up to where they were expected to be back when ACA was being shouted down, I mean “debated” in Congress.
    According to the report, Congressional Budget Office projections from 2009 suggested average 2017 premiums of $5,538; HHS is projecting average premiums of $5,586. Indeed, premiums in many states are still below the cost of employer coverage.


    and,


    Slower Premium Growth Under Obama,” FactCheck.org, February 6, 2015
    http://www.factcheck.org/2015/02/slo...h-under-obama/

    Like I said, very nasty things those facts.
    Very nasty.
    Yes, nasty. Such as the fact that none of your post actually refutes what I said.

    Here's another nasty fact... those guys campaigning on getting rid of obamacare won overwhelmingly in 2016, at all levels. Chew on that a bit.

  9. #1269
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    Quote Originally Posted by astralis View Post
    Wooglin,



    lol, the ACA has been "already collapsing" since its creation, what is new?

    if the ACA were in such utter disrepair as you describe, it is funny how it is now the most popular it has been since it first started, and how enrollments hit a near record for 2017.

    and if all of this is fake news, then the GOP would simply need to just wait until the entire market collapses and then come in with their own plan.

    as it is, the GOP plan is essentially Obamacare-lite: it is the same structure, just with fewer benefits covering less people... -AND- significantly fewer cost controls. so tell me, how does the GOP plan solve the shortfalls of the ACA?
    Oh good! Vox and more polls. When will you ever learn?

  10. #1270
    Senior Contributor GVChamp's Avatar
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    Quote Originally Posted by astralis View Post
    Wooglin,



    lol, the ACA has been "already collapsing" since its creation, what is new?

    if the ACA were in such utter disrepair as you describe, it is funny how it is now the most popular it has been since it first started, and how enrollments hit a near record for 2017.

    and if all of this is fake news, then the GOP would simply need to just wait until the entire market collapses and then come in with their own plan.

    as it is, the GOP plan is essentially Obamacare-lite: it is the same structure, just with fewer benefits covering less people... -AND- significantly fewer cost controls. so tell me, how does the GOP plan solve the shortfalls of the ACA?
    Rise in Obama-care popularity=status quo bias

    Republican plan is a non-plan, has zero possibility of getting passed. Still better than ACA in that it doesn't continuously shovel money into a black hole, but it doesn't do anything to arrest the ongoing death of the individual market (it just speeds them up).

    Which means in the long-term MORE reforms needed for the individual markets and more money shoved in there somewhere, because the failure of individual markets is not an option (either politically or policy).
    Last edited by GVChamp; 08 Mar 17, at 14:22.
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  11. #1271
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    GVChamp,

    Rise in Obama-care popularity=status quo bias
    of course there's going to be a status quo bias. but if Obamacare is in the death-spiral that Wooglin asserts it to be, that status quo bias would be overwhelmed.

    Republican plan is a non-plan, has zero possibility of getting passed.
    likely, seeing as how the GOP is embroiled in a mini civil-war on the subject.

    Still better than ACA in that it doesn't continuously shovel money into a black hole, but it doesn't do anything to arrest the ongoing death of the individual market (it just speeds them up).
    i don't see where this new bill stops "continuously shoveling money". essentially, this new bill takes the cost controls of the ACA and eliminates them for the wealthy. the elimination of the individual mandate is meant to do the same for everyone else, but in reality as you said it will lead to the speedy death of the individual market.

    so in essence you would see an initial decline in people on health insurance as the new system is implemented, and then another wave when the market declines or collapses.

    if the goal of the GOP was to create a new conservative healthcare system, that is curious because they took the old structure of the ACA. if the goal is to reduce taxes on the wealthy, the GOP would have done better to not touch the ACA and just propose a new tax cut for the wealthy to counteract the effects of the ACA.

    good luck with that deficit though.
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

  12. #1272
    Senior Contributor GVChamp's Avatar
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    Private money getting shoved into pointless healthcare is not a government problem. The ACA and current healthcare is a continuous outflow of government spending. My understanding is that the new GOP plan is effectively capping the Medicaid spending and the refundable tax credits. So the Federal Government isn't exposing itself to effectively unlimited losses.

    Projected outwards, it's less fiscally dangerous than the ACA.

    Politically, projecting outwards, the death of the individual markets guarantees single payer.

    There only way to get to a conservative health insurance policy market at this point is to strip down the mandates on the health insurance plans and impose mandatory savings for first-dollar coverage, and backstop insurer losses for the sickest patients. That's the only way to get there from here.
    Last edited by GVChamp; 08 Mar 17, at 15:41.
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  13. #1273
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    GVChamp,

    My understanding is that the new GOP plan is effectively capping the Medicaid spending and the refundable tax credits. So the Federal Government isn't exposing itself to effectively unlimited losses.
    which effectively means premiums go up even faster. it might not be a government problem from your POV, but it certainly will be a political problem for the people signing off on it...:-)

    remember, Republicans promised a system where premiums would go down, everyone will have coverage and nothing is mandatory. they're just missing a pony and a chicken in every pot.

    Projected outwards, it's less fiscally dangerous than the ACA.
    we'll need to wait for the CBO read on that, but I can't imagine this to be the case. even leaving aside the long-term health aspects, the collapse of the individual markets would cause significant economic loss.

    even if you were to replace the ACA or the AHCA with a single-payer health system (which from my POV would be good in the long-term), in the short-term you'd suffer a significant amount of disruption in the healthcare and insurance industries.

    There only way to get to a conservative health insurance policy market at this point is to strip down the mandates on the health insurance plans and impose mandatory savings for first-dollar coverage, and backstop insurer losses for the sickest patients. That's the only way to get there from here.
    not sure how different "impose mandatory savings for first-dollar coverage" is from "mandatory health insurance". same thing with "backstop insurer losses", that would still represent your continuous outflow of government spending (and would actually get closer to the idea of 'death panels' than the actual ACA, lol).
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

  14. #1274
    Senior Contributor GVChamp's Avatar
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    Right, any of the feasible solutions are political fire-bombs. Mandatory savings is an even bigger problem than the mandate and the backstopped losses are a huge liability equivalent to our current program.

    But the Republicans need to suck that up and get over it if they want a conservative health financing system, and set up mechanisms to limit the losses. There's not really a way around it (except, of course, just killing the individual insurance market totally).

    Them's the way the cookie crumbles.
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    GVChamp,

    i don't get it, though. what is it about mandatory savings/backstopped losses that would make it a conservative health financing system? we seem to be saying the same thing, that in concept both ideas are pretty similar to what already exists in the ACA. which shouldn't be a surprise to anyone because the ACA -is- the conservative position on healthcare, as JAD pointed out earlier.

    in any case that's not what is up for discussion, and if this plan really is dead in the water i'm not sure what alternatives conservatives have. no one will go for the Freedom Caucus plan, which is essentially to undo the ACA and hope for the best.

    as it is, this is becoming quite amusing for me to watch because this ACA 0.5 will ensure that the GOP eats an enormous public backlash over what is essentially a relatively small $600 billion tax cut for the wealthy-- and making singlepayer that much more likely.
    There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov

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