Letter: This is why Republicans can't find a replacement for Obamacare

[oncemoreuntothejimbreech]

(01-23-2017, 11:04 PM)Rotobeast Wrote: Oh, gee...... “price transparency”.

Wasn't that one of the main things that goof Gary Johnson was pushing for ?

Oh gawd . . . Now you're triggering my other case of PTSD. You're on a roll tonight. I had shoulder surgery last year and it's turned into a lawsuit. Not to bore you with too much detail, but I asked for my total out of pocket expense before I agreed and was told $1054. Afterwards, I received two seperate bills for ~$3600 each (which doesn't include the other bills.) I called and they told me I should have contacted my insurance company to know my total cost. She said they don't always know what the doctor is going to do so they can't give me a price. I asked how can I ask my insurance for a price when you can't tell me what the doctor is going to do so I can ask my insurance for a price. 

[Rotobeast]

(01-24-2017, 12:21 AM)oncemoreuntothejimbreech Wrote: Oh gawd . . . Now you're triggering my other case of PTSD. You're on a roll tonight. I had shoulder surgery last year and it's turned into a lawsuit. Not to bore you with too much detail, but I asked for my total out of pocket expense before I agreed and was told $1054. Afterwards, I received two seperate bills for ~$3600 each (which doesn't include the other bills.) I called and they told me I should have contacted my insurance company to know my total cost. She said they don't always know what the doctor is going to do so they can't give me a price. I asked how can I ask my insurance for a price when you can't tell me what the doctor is going to do so I can ask my insurance for a price. 

It's always the ones we love, who aggravate us the most.


Anyway.... yeah, that shit is crazy.
Gary suggested that it should be like a grocery store, where EVERYTHING is marked with a price.
Imagine going to a grocery where nothing was marked. 

[Benton]

(01-24-2017, 12:36 AM)Rotobeast Wrote: It's always the ones we love, who aggravate us the most.


Anyway.... yeah, that shit is crazy.
Gary suggested that it should be like a grocery store, where EVERYTHING is marked with a price.
Imagine going to a grocery where nothing was marked. 

That's one of my biggest HCR issues. You get your spleen out in a large metro hospital, it's one price; your wife gets hers out in a small rural hospital with a different insurance company, she pays a different price. 

And you'll never get a straight answer from a doctor on what something is going to cost. It's always "well, we'll have to bill your insurance." It should be: "I'm charging to X. You can call your insurance and find out how much they'll cover."

[*wildcats forever*]

Drug pricing is another area that needs addressed. One of the reasons countries like Canada have lower prices is their single-payer system, which allows the government to negotiate directly with manufacturers. The US has banned Medicare from doing this, plus banned citizens from buying outside of the country. So the prices go up at alarming rates, while wages are stagnant at best, along with some of the workforce losing hours because of AHA's stringency. Republicans would win over millions of people if they corrected this problem.

[GMDino]

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html

Quote:U.S. judge finds that Aetna deceived the public about its reasons for quitting Obamacare


Aetna's about-face on the ACA came less than a month after the Justice Department sued to block the company's $37-billion purchase of Humana. (Jan. 23, 2017)

Aetna claimed this summer that it was pulling out of all but four of the 15 states where it was providing Obamacare individual insurance because of a business decision — it was simply losing too much money on the Obamacare exchanges.

Now a federal judge has ruled that that was a rank falsehood. In fact, says Judge John D. Bates, Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $37-billion merger with Humana. Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued Monday blocking the merger.


Aetna executives had moved heaven and earth to conceal their decision-making process from the court, in part by discussing the matter on the phone rather than in emails, and by shielding what did get put in writing with the cloak of attorney-client privilege, a practice Bates found came close to “malfeasance.”

Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger.— U.S. District Judge John D. Bates

The judge’s conclusions about Aetna’s real reasons for pulling out of Obamacare — as opposed to the rationalization the company made in public — are crucial for the debate over the fate of the Affordable Care Act. That’s because the company’s withdrawal has been exploited by Republicans to justify repealing the act. Just last week, House Speaker Paul Ryan (R-Wis.) cited Aetna’s action on the “Charlie Rose” show, saying that it proved how shaky the exchanges were. 


Bates found that this rationalization was largely untrue. In fact, he noted, Aetna pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations. Bates’ analysis relies in part on a “smoking gun” letter to the Justice Department in which Chief Executive Mark Bertolini explicitly ties Aetna’s participation in Obamacare to the DOJ’s actions on the merger, which we reported in August. But it goes much further.


Smoking gun? Aetna threatened to quit Obamacare if the government blocked its Humana merger

Among the locations where Aetna withdrew were 17 counties in three states where the Department of Justice asserted that the merger would produce unlawfully low levels  of competition on the individual exchanges. By pulling out, Aetna could say that it wasn’t competing in those counties’ exchanges anyway, rendering the government’s point moot: “The evidence provides persuasive support for the conclusion that Aetna withdrew from the on-exchange markets in the 17 complaint counties to improve its litigation position,” Bates wrote. “The Court does not credit the minimal efforts of Aetna executives to claim otherwise.”

Indeed, he wrote, Aetna’s decision to pull out of the exchange business in Florida was “so far outside of normal business practice” that it perplexed the company’s top executive in Florida, who was not in the decision loop.

“I just can’t make sense out of the Florida dec[ision],” the executive, Christopher Ciano, wrote to Jonathan Mayhew, the head of Aetna’s national exchange business. “Based on the latest run rate data . . . we are making money from the on-exchange business. Was Florida’s performance ever debated?” Mayhew told him to discuss the matter by phone, not email, “to avoid leaving a paper trail,” Bates found. As it happens, Bates found reason to believe that Aetna soon will be selling exchange plans in Florida again.

Mergers in the healthcare sector: why you'll pay more

As for Aetna’s claimed rationale for withdrawing from all but four states, Bates accepted that the company could credibly call it a “business decision,” since the overall exchange business was losing money; he just didn’t buy that that was its sole reason. He observed that the failings in the marketplace existed before Aetna decided to withdraw, but that as late as July 19, the company was still planning to expand its footprint to as many as 20 states. In April, top executives had told investors that Aetna had a “solid cost structure” in Florida and Georgia, two states it dropped.

While the Department of Justice was conducting its investigation of the merger plans but before the DOJ lawsuit was filed, “Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger,” Bates observed. During a May 11 deposition of Bertolini, an Aetna lawyer said that if the company “was not ‘happy’ with the results of an upcoming meeting regarding the merger, ‘we’re just going to pull out of all the exchanges.’”

Smoking gun? On July 5, Aetna CEO Bertolini warned the DOJ what would happen if it sued to block the Humana merger. After the DOJ sued, Aetna followed through on its threat.

In private talks with the DOJ, Aetna executives continually linked the two issues, even while they were telling Wall Street that the merger was “a separate conversation” from the exchange business. Bertolini seemed almost to take the DOJ’s hostility to the merger personally: “Our feeling was that we were doing good things for the administration and the administration is suing us,” he said in a deposition. 

Bates found “persuasive evidence that when Aetna later withdrew from the 17 counties, it did not do so for business reasons, but instead to follow through on the threat that it made earlier.”

The threat certainly was effective in terms of its impact on the Affordable Care Act, since Aetna’s withdrawal has become part of the Republican brief against the law. That it says so much more about Aetna executives’ honesty and integrity probably won’t get cited much by GOP functionaries trying to repeal the law. Aetna is at least partially responsible for placing the health coverage of more than 20 million Americans in jeopardy; that it did so at least partially to promote a merger that would bring few benefits, if any, to its customers is an additional black mark. 

If there’s a saving grace in this episode, it’s that the company’s goal to protect the merger hasn’t worked, so far. The DOJ brought suit, and Bates has now thrown a wrench into the plan. Aetna has said it’s considering an appeal, but the merger is plainly in trouble, as it should be.

[oncemoreuntothejimbreech]

A corporation lied IOT make money? There's a real shocker.

[Mike M (the other one)]

(01-25-2017, 02:53 PM)oncemoreuntothejimbreech Wrote: A corporation lied IOT make money? There's a real shocker.

No shit, This is just another perfect example of why we need to switch to a Universal Healthcare Plan in order to stop this type of BS.
I am not a fan of big government, but I believe that healthcare and education should be fundamental rights of all USC's.

[oncemoreuntothejimbreech]

(01-25-2017, 07:53 PM)Mike M (the other one) Wrote: No shit, This is just another perfect example of why we need to switch to a Universal Healthcare Plan in order to stop this type of BS.
I am not a fan of big government, but I believe that healthcare and education should be fundamental rights of all USC's.

I think I would stop just short of a fundamental right, but a highly encouraged privilege.  Unlike some, I don't think it should be provided free of charge.  I think the individuals need to have some skin in the game to cut down on some of the abuse.  There will always be abuse, though.  

[GMDino]

http://reason.com/blog/2017/01/25/sen-rand-paul-introduces-replacement-for

S

Quote:en. Rand Paul Introduces Replacement for Obamacare

Paul's bill equalizes tax deductibility on insurance whether obtained through employer or not, makes creating private group insurance easier, relies on Health Savings Accounts.


[*]Sen. Rand Paul (R-Ky.) today introduced his comprehensive plan to replace Obamacare after the Republicans, as they claim they intend to, fully repeal it.



[*]
Paul calls it the "Obamacare Replacement Act" (S. 222), naturally. Among its key provisions:

Quote:• Provides a two-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage.
• Restores HIPAA pre-existing conditions protections. Prior to Obamacare, HIPAA guaranteed those within the group market could obtain continuous health coverage regardless of preexisting conditions.

[*]

That's to cover those who worry about mass insurance deprivation without Obamacare. But interesting market innovations are in the bill to change the game as well:

Quote:• Replaces the existing open-ended tax exclusion for employer-provided health insurance with a universal deduction on both income and payroll taxes that would provide the same level of benefit regardless of how an individual obtains their health insurance.

[*]
Paul lamented in a conference call for media introducing the bill this afternoon that some were interpreting this as eliminating the employee tax deduction; it is not, merely extending it to individuals paying for their own as individuals or in a market-formed group.
The bill will also give "individuals the option of a tax credit of up to $5,000 per taxpayer for contributions to an HSA.... Removes the maximum allowable annual contribution, so that individuals may make unlimited contributions to an HSA....[and] Eliminates the requirement that a participant in an HSA be enrolled in a high deductible health care plan."

The full bill has many other details on the HSA plan, who can use it and how and for what, and its tax treatment.

Paul's bill also wants to make it easier for individuals "to pool together for the purposes of purchasing insurance" and thus "Amends the Public Health Service Act (PHSA) to allow individuals to pool together to provide for health benefits coverage through Individual Health Pools (IHPs). These can include nonprofit organizations (including churches, alumni associations, trade associations, other civic groups, or entities formed strictly for establishing an IHP) so long as the organization does not condition membership on any health status-related factor."

Paul's plan also "Increases access to individual health coverage by allowing insurers licensed to sell policies in one state to offer them to residents of any other state" with certain wrinkles explained at length in the full bill.

The bill also rejiggers the law surrounding:

Quote:Association Health Plans (AHPs) [which] allow small businesses to pool together across state lines through their membership in a trade or professional association to purchase health coverage for their employees and their families. AHPs increase the bargaining power, leverage discounts, and provide administrative efficiencies to small businesses while freeing them from state benefit mandates.

While AHPs currently exist, strict Department of Labor standards exist regarding the types of organizations that may qualify as a single large-group health plan under ERISA. The standard stipulates that the association must be a group of employers bound together by a commonality of interest (aside from providing a health plan) with vested control of the association to such an extent that they effectively operate as one employer. This is considered a difficult standard for most associations to meet.

[So Paul's bill] Amends ERISA to define AHPs and allow for their treatment as if they were large group single employer health plans. This definition would allow a dues-collecting organization maintained in good faith for a purpose other than providing health insurance to benefit from the insurance regulation exclusions currently afforded to large-group health plans under ERISA.

[*]
Paul also wants through the bill to "give new flexibilities to states in their Medicaid plan design, through existing waiver authority in current law....[to] allow states to make changes to their Medicaid plans without interference from Washington."

In a conference call this afternoon to introduce the bill, Paul said he believes that at least generically he's got Speaker of the House Paul Ryan (R-Wisc.) and Senate majority leader Mitch McConnell (R-Ky.) on board on the notion that a full replacement must happen simultaneous with repeal.

He believes his plan has "consensus ideas that 100 percent of Republicans in the House and Senate can embrace" and that they then can "take to Democrats to see if Democrats in favor of trying to replace a broken system" will also hop on board.

Paul says he finds an alternate replacement bill from Sens. Collins (Maine) and Cassidy (La.) lacking, mostly because it allows too much of Obamacare to potentially survive on the state level. He says he believes ultimately the best way to deal with very sick people with pre-existing conditions will lie with Medicaid and the states who can "look for innovative ways" to provide necessary care without bankrupting the system.

As far as the process goes, Paul says he does not expect a real repeal vote for at least two weeks. In the meantime, he says he is "pushing hard" his bill, which he's "sent to leaders in the House working on the issue, discussed it with leaders in the Senate."

He's "trying to emphasize that this bill has the potential to insure millions at cheaper cost than under Obamacare and has great ability to straighten out the mess in the individual markets."

Other media noting this announcement today include Business Insider and Rare.

Peter Suderman reported earlier this month on Paul's reluctance to repeal without a comprehensive replacement plan ready

[*]
Based on my limited understanding it seems okay.  Will the GOP back a plan that involves taxing though?