Obamacare

CBO's Report on the GOP Obamacare Repeal Bill Offers More Proof That Neither Party Offers Health Care Choices People Want

The GOP's plan to repeal the health law's mandate would lead to 14 million fewer people being covered next year, according to the budget office.

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Jeff Malet Photography/Newscom

Obamacare's individual mandate is forcing millions of people to buy coverage they don't want—but the GOP's replacement plan wouldn't give them desirable insurance options either.

That's one potential conclusion from a report released today by the Congressional Budget Office (CBO) estimating the coverage and budget effects of the American Health Care Act, the House Republican bill to repeal parts of Obamacare and replace it with a new system of subsidies through the tax code. The report contains some questionable assumptions, but overall serves as a useful guide to the failings of both Obamacare and the GOP's replacement plan.

Under the GOP's Obamacare repeal plan, 14 million fewer people would have health insurance coverage in 2018 than under current law, according the CBO. The biggest reason why: "Most of that increase would stem from repealing the penalties associated with the individual mandate."

Part of what's going on in the CBO's scenario is that in some cases, people would forego insurance as a result of insurance premium increases due to changes in the insurance pool. The report projects that without a mandate, younger and healthier people would exit the market, and as a result, premiums would rise in the first several years after the passage of the GOP's repeal bill before declining, relative to our current-law trajectory, in the next decade as a result of a government-funded backstop. (The second stage decline presumes, of course, that the law is implemented as planned over the course of a decade. Pretty much the entirety of our experience so far with Obamacare shows how unlikely that is.)

In any case, it's clear that the CBO is assigning an awful lot of weight to Obamacare's individual mandate—more, it's safe to say, than some experts who believe that the mandate is weak and that the law's subsidies for the purchase of insurance are heavily if not chiefly responsible for Obamacare's individual market coverage numbers.

But let's assume for a moment that the CBO's understand of the mandate is basically correct. If so, what that means is that some large number of people don't want health insurance enough to pay for it, and that in the absence of a tax penalty, many of them wouldn't. As the CBO report puts it, the decline in coverage would happen in part because "some people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties." Emphasis on choose to. That's another way of saying that lots of people are being forced to buy insurance they don't want at the price at which it is offered.

Not all of the projected decline in coverage is in the individual market. Some of the losses are in the employer market as well. And, importantly, some of the projected decline over the next decade is associated with people who do not currently have coverage under Obamacare—but might get it in the future.

Remember, the projected decline is relative to what CBO expects to happen under current law, not to current enrollment. This is important to understand when looking at the CBO's Medicaid enrollment projections.

By 2026, the report estimates that 14 million fewer people will be covered by Medicaid, the joint federal-state program for the poor and disabled that was expanded under Obamacare, than under current law. Currently, the program offers essentially unlimited funds to states on a matching basis. Starting in 2020, however, the AHCA transforms Medicaid into a per-capita block grant program.

Thanks to a 2012 Supreme Court decision, however, the Medicaid expansion is optional for states, and 31 have gone ahead with building out the program. The CBO's estimate is based on the belief that, under current law, additional states would expand Medicaid, resulting in increased Medicaid coverage—but that under the GOP repeal plan, that won't happen. As CBO puts it, some of the decline "would be among people who CBO projects would be made eligible as a result of state actions in the future under current law (that is, from additional states adopting the optional expansion of eligibility authorized by the ACA)." It's not clear exactly how many people the CBO counts in this group.

This is not entirely implausible; after all, under the governorship of Mike Pence, Indiana, a conservative holdout, expanded Medicaid under Obamacare, with a few state-specific carve outs, while claiming to oppose the federal health care law.

Still, this is a political judgment as much as a policy estimate, and it means the CBO's coverage loss estimate is based partly on what you might think of as hypothetically covered individuals­­—not individuals who actually covered now.

Still, it's safe to say that under the GOP's plan, far fewer people would be covered than on our current trajectory. About 52 million Americans would not have health insurance coverage a decade from now, versus about 28 million who would be uninsured under current law, according to the CBO.

And what if the CBO is wrong? Led by the White House, Republicans spent the weekend blasting the agency, pointing out that its estimates on Obamacare were substantially off the mark—which, as Josh Blackman notes, they very much were. The Trump administration has already dismissed the CBO report as unbelievable.

On a basic level, though, the CBO's Obamacare estimates were directionally correct with respect to coverage. And, importantly, they were closer than most competing estimates, including those produced by the Obama administration, which estimated that individual market coverage under the law would be far higher. One of the values of the CBO is that it acts as a check on overly optimistic estimates from the White House, which has a political motivation to make rosy economic estimates. The CBO's estimates are too often taken as facts rather than as expert-but-not-infallible projections, and this report's estimates are almost certainly off the mark in some form or fashion—perhaps even by a lot. But they outline the type of shifts that are likely to occur under the GOP's plan.

So whatever the actual figure, the CBO's estimate contrasts sharply with the repeated promises from President Trump and senior administration officials that his health care plan would cover everyone. And it does not exactly provide a lot of evidence for the Republican argument that the plan will provide more choices and access for everyone. Presuming the CBO's estimates are basically sound, access to Medicaid would be reduced, and the coverage choices available under the GOP plan would be undesirable to millions of people. And so people would choose to remain uncovered instead.

That's an option people don't have now—at least not without obtaining a waiver or paying a tax penalty—but it speaks to the paucity of other health coverage options that would be available under the GOP plan.

Part of the reason why is that the Republican plan would leave in place much of Obamacare's essential policy scheme, setting up a system of tax credits for people to buy coverage, retaining slightly tweaked versions of Obamacare's preexisting conditions regulations for insurers, and leaving the law's insurance mandates in place (although they could, perhaps, be altered later through the regulatory process). Yes, the law would overhaul Medicaid, but not until the next decade, and there are already legitimate concerns that the timing could result into a system of delays in which the reforms never go into place. The GOP's plan is not an exact replica of Obamacare, but it shares many of Obamacare's assumptions about the role of government in health care. What the CBO's report suggests is that it would bring different problems than the ones we've seen under Obamacare, but not necessarily better ones.

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  1. Why not just do a catastrophic singlepayer for all, and get the govt rest out of healthcare

    Unfortunately the govt is going to pay for some. Too much power to give uo

    1. AS much as i want government out of our lives one could make a reasonable case for government funded “basic” care as in stuff that’s cheap and provides an economic boost.

      Vaccines
      resetting broken bones
      antibiotics

      stuff that if handled at first signs prevents expensive hospitalization and disability. I see it as a means to keep people working and off SSDI.

      I also support government paying for anti-psychotic pills. The reason is many kids are always in juvi because parents can afford the pills. So when the kid is on the pills he is a normal good kid but when he is off the pills he gets into trouble.

      There is a lot of juvi kids that get well in juvi go out and re-offend because they dont have meds. The government pays for the meds when the kid is in jail and a shit ton more stuff. life in prison and sane is a lot more money than meds and a productive member of society.

      Granted gofund me is helping stupid shit like this, which is awesome!

      1. I rather people not have kids that they cant provide for….but we all know retards and retards :/

        But life in prison with meds

        or productive member with meds?

        B is better and cheaper than A…its only logical. Or put the kid and his parents down….sorry. I let the fascist in me slip. 😉

      2. These days some kind of government funded health care must be provided. Society won’t let people just die in the streets. Before Obamacare Hospitals where required to at least provided life saving care. In effect we the tax payer, and those with insurance picked up the bill. In some cases people had insurance but ran into lifetime maximums, again society in some way or form picked up the bill. But at least under Obamacare, people are able to take some of the stress of how to pay for major medical off their mind. Certainly by making sure that people get more than just life saving care, we can in theory reduce costs by treating situation before they are life saving situations.

        As much as I hate Obamacare, that was the Democrats stated goal, and I’d say it has at least moved us in that direction, of getting people care earlier and having to avoid the stress of noting having a way to pay for the care you really need.

        I think we could come up with a better way of achieving that goal, but partisanship as it is today, may mean Obamacare is as good as it may get.

    2. Single-payer CATASTROPHIC coverage is the only way out of this mess (relatively speaking).

      There’s no way a plan that “takes” people’s coverage is going to pass, politically speaking.

      European-style single payer is a joke and a total affront to liberty.

      Singapore does (basically) government-provided catastrophic coverage with the equivalent of HSA’s (tax free medical accounts) for day-to-day medical care. Healthcare costs are very low and quality of care is relatively good.

      A Singapore model is probably the best a libertarian can hope for.

  2. “Presuming the CBO’s estimates are basically sound, access to Medicaid would be reduced, and the coverage choices available under the GOP plan would be undesirable to millions of people. And so people would choose to remain uncovered instead.”

    So we stop forcing people to buy what they obviously don’t want, and we cut some freebies.
    Sounds like a half-way decent start.

    1. Exactly. Any bill passed by Republicans now is bound to be better than any bill proposed by President Warren in 2020 (shudder).

      1. I for one am not going to fall for the fearmongering. Repubs have to be held accountable for their promises. Not be allowed to get away with whatever because”Dems are worse”. Either they stand for something or they don’t.

        1. Stamp your feet. I’m sure someone will care.

        2. Why do the “Republicans” have to held accountable for their health care promises, but Trump does not?

  3. The Trump administration has already dismissed the CBO report as unbelievable.

    EMF’s lawyers have issued a cease and desist order preventing the Trump administration from using that word. The problem here is probably that the GOP is using the same lobbyists to write their law as the Democrats did.

  4. Well, yeah, the problem is what people want is basically impossible.

    “We want everyone covered, no matter how sick! And we want cheaper payments. And a pony, too”

  5. alt-text: “If you think this is a piece of shit, you should see the guy I’m hiding behind it!”

  6. I would take that $50 billion Trump is giving to the military industrial complex and instead give the money to middle class people who currently earn a little too much to qualify for a subsidy.

    1. And I’d throw your commie ass out of a helicopter hovering over the ocean.

      1. That’s not communism dude. I would reduce overall spending but I would prioritize healthcare over warfare. I bet I could kick your ass too. I’m no pussy.

        1. SIV wears women’s undergarments.

    2. Considering that it’s deficit spending, it would be much better for the middle class if the government just didn’t spend it.

    3. “I would take that $50 billion Trump is giving to the military industrial complex and instead give the money to middle class people who currently earn a little too much to qualify for a subsidy.”

      You’re going to give them their money? How about just cutting taxes? They can keep their money.

  7. Glad to see pete back on healthcare articles. he is pretty good here imo.

  8. At this point both D’s and R’s should just come out and say they are in favor of single payer, it would be more honest

    1. pretty much. I wish we could just go back to what it was in the past.

      1. A good 60-70% of the country want govt to be deeply involved in healthcare. The only argument is who gets the bennies. I think a Singapore style system is the best we can hope for.

        1. “I think a Singapore style system is the best we can hope for.”

          Free Slings for everybody.

    2. “At this point both D’s and R’s should just come out and say they are in favor of single payer, it would be more honest”

      As mentioned above, try stamping your feet. Your hyperbole isn’t nearly as effective.

      1. You are the one who wants to let them off the hook, not me

        1. chemjeff|3.13.17 @ 9:57PM|#
          “You are the one who wants to let them off the hook, not me”

          Let’s see that hook you have that I’m proposing to ‘let them off’. I’m sure it’s made of nothing other than your fantasy.
          Yes, I’d love the gov’t totally out of the medical care market, but that ain’t gonna happen regardless of your adolescent tantrums. If we get anywhere, it’s going to take incremental steps.
          Right now, you got nothing, jack, you’re just one more whiny loser. Go stamp your feet elsewhere.

    3. Hear, hear. Single payer isn’t standard libertarian (although I could make a case that it is the moral equivalent of national defense), but at least it is not a Rube Goldberg crony cock-up like what Dems and Reps have come up with. http://www.PurplePlans.com

      1. aajax|3.14.17 @ 12:01AM|#
        “…(although I could make a case that it is the moral equivalent of national defense),”

        And several idiots might buy your horseshit. Well, maybe one or two, anyhow.

  9. OK, so the local lefty rag takes what is admittedly an estimate and uses the extrapolated numbers:

    “Analysis: GOP health care plan would leave 24 million without coverage”
    http://www.sfgate.com/nation/a…..998712.php

  10. what if the CBO is wrong?

    *Judge*?!

  11. Repealing the mandate without also repealing community rating (ie no denial of coverage for preexisting conditions) would quickly lead to an insurance market death spiral, as people wait until they have a condition before buying insurance.

    1. Simply modify the new coverage premium to be 500% more expensive and not 30% more expensive. Problem solved. $2,500 a month should put the fear of god into their cheating souls.

      1. I think you mean $12,500 a month. $2,500 is what a lot of people are expected to pay now, and they’re already freaking out.

  12. This is total B.S. I paid into risk sharing corporate health care plans for 30 years supporting participants who were older than me and now that I am 62 and suffering from prostate cancer my health care costs are going to balloon to over $20,000 a year? In 30 years I wracked up about $4,000 in health care bills while paying in $80,000 or more dollars in premiums. Now that I am 62 I am going to be scr*wed.

    1. Vote Drumpf

      1. I think not. It would be voting against my own best financial interests. A fact lost on millions of poor Trump voters.

        1. Who should you vote for due to best financial interests?

      2. Damned|3.13.17 @ 11:56PM|#
        “Vote Drumpf”

        And here the hag lost! And you’re still whining about it!
        Loser.

    2. $80,000 doesn’t go very far in the health care biz these days, sorry to say. You should have made sure that you became a multi-millionaire.

      1. I am a multi-millionaire. The prostrate surgery was $32,000 and the radiation was $31,000. Hormone therapy will be $40,000 and advanced genetically engineered medications will be over $100,000 annually. Radiation to kill bone cancer will be $100,000 a year. You begin to see how normal people can quickly go bankrupt from medical therapy in the US. If I was middle class the deductibles would put me in severe financial strain.

        1. Gee, look at all that happy horseshit! How, uh, interesting…

        2. That is the price you pay to live longer….Life is a bitch and living those extra 2-15 years costs a ton of money? Don’t have the money to pay for it? Than die….its how life works

          1. If i ever get cancer i will probably let it kill me so not to drain society. I don’t intend to spend 100s thousands to millions for a few extra years. It is a waste.

          2. you have to wonder how much our life expectancy has been extended just in offering heroic care medical treatments to keep people alive for a few months-years longer. Studies consistently show that the most medical costs occur in the last 2-5 years of a person’s life; a news report I saw a couple years ago had this older guy, about 85 or so, prepping for surgery and told the doctor he wanted life-saving procedures initiated if he went into cardiac arrest, despite the fact that keeping him alive was costing his family thousands of dollars a month even with Medicare. Sorry, but sometimes, “just die” is the appropriate response in this situation because you’re clearly letting fear of your own mortality take precedence over the impact to your loved ones after you pass. It’s one way governments with single-payer systems keep those systems solvent and it’s something these progressive snowflakes won’t realize will be implemented until Great-Grandma June dies while waiting for a stent surgery.

        3. How do you propose paying for these for everyone? You do understand this bill is aca light

  13. Reason’s tiger team of cran-er crack columnists, however, have a plan in the works that everybody would vote for if only they would pay attention to it, dammit.

    1. Anything that comes close to working will look an awful lot like Romneycare. Somehow the GOP cannot stomach that.

      1. N: BaileyCare?

        BaileyCare would enable all Americans to purchase health insurance in a national competitive private market. It would completely eliminate Medicaid and S-CHIP (and possibly even Medicare) and use those funds to provide vouchers to poor Americans helping them to buy private insurance in a competitive market. It also would completely delink insurance from employment; it is a consumer-driven plan that combines high-deductible catastrophic insurance with health savings accounts with the aim of using market competition to rein in health care expenses. Vouchers also mean that there would be no need for tax penalties to force people to buy insurance.

        So why did I offer BaileyCare as an alternative to what eventually evolved into the economically and medically absurd mishmash that is Obama’s Affordable Care Act? As I wrote:

        I want to stress that mandatory health insurance is a second-best proposal. A totally free market system would be preferable; it’s just not likely politically. Mandatory health insurance is a way to stop creeping socialization and preserve private medicine.

        I should add that with vouchers, a mandate is unnecessary since folks would generally have the wherewithal to buy insurance.

        1. You have completely bought into the Paul Ryan kook-aid. So sorry guy. There may be no way back.

        2. High deductible is no good for poor people, because if they can’t afford the deductible, they never get the benefit of the insurance coverage.

          How does BaileyCare compare to Kotlikoff’s purple plan?

          1. Poor people currently get Medicaid. It has a $0 dollar deductible. What happens to them under the Ryan plan?

          2. You don;t need high deductible if what is covered is minimal stuff. If you nix all the mental health, chiro, weird alt medicine and the likes. The actual cost of insurance is not very high.

          3. a: The HSAs aim to cover the high deductibles – voucher recipients can/will put some of that cash into HSAs for that purpose.

          4. High deductible is no good for poor people, because if they can’t afford the deductible, they never get the benefit of the insurance coverage.

            Price transparency and enforcement of current anti-monopoly and anti-price discrimination laws would effectively lower costs across the board due to competition for customers, while insurance would be re-aligned mostly for catastrophic, emergency events only–the way insurance is actually supposed to work. In that instance, the high deductible becomes moot as insurance companies can lower the deductible since they’re no longer covering every fucking doctor visit under the sun. if you want a comprehensive plan, the insurance companies can offer that too–but you’re going to pay out the ass for it in monthly premiums because you’re using more of the insurance company’s money pool.

        3. “I want to stress that mandatory health insurance is a second-best proposal. A totally free market system would be preferable; it’s just not likely politically. Mandatory health insurance is a way to stop creeping socialization and preserve private medicine.”

          We’ve sunk low enough to require people to buy what they don’t want?
          Ron, it could be true, but what a horrible alternative to consider.

          1. And every other First World country uses single payer medical insurance. And none of their insurance rates even approach what we pay in the US. What have you to say about that?

            1. NorEastern|3.14.17 @ 12:41AM|#
              “And every other First World country uses single payer medical insurance. And none of their insurance rates even approach what we pay in the US. What have you to say about that?”

              Well, for starters I have to say you’re a slaver. Further, you’re an ignoramus for making that claim. And then you really ought to be embarrassed for such stupidity.
              What do you have to say about that?

            2. Their healtchare providers get paid way less and america subsidies their drugs? They also ration heavily

  14. That’s one way to put it.
    If you want to blame both sides for the GOP plan that was rushed through, and voted in committee before there was a score. Without any input from the other side

    Makes reason.com appear neutral for those who like to be libertarians but are Republicans

    1. Current day Republicans are so far right they fell off the Earth. And it is a sphere.

  15. Here’s how you can assure that the CBO correctly estimates how many people will have coverage: Cover everybody

    Here’s how you can guarantee that the cost to taxpayers will be controlled: Peg the total premium coverage to 12% of GDP (health care is now about 18% overall, but the government would not have to cover 100%), paid for with a corresponding increase in income taxes.

    Here’s how you can guarantee that all individuals will be attractive to competing insurers: Provide individualized vouchers in an amount that reflects actuarial estimates of health cost risk of each individual based on their health markers (e.g., history, blood pressure, blood sugar levels, cognitive function, body mass index, etc.)

    If someone can afford cadillac coverage, let them buy it out of their own pocket.

    Republicans will have to get over their aversion to higher taxes and single payer, Democrats will have to get over their aversion to vouchers.

    1. aajax|3.14.17 @ 12:25AM|#
      “…Republicans will have to get over their aversion to higher taxes and single payer, Democrats will have to get over their aversion to vouchers.”

      Fuck off, slaver. YOU pay for the entire thing.

      1. Boy, there is a whole pack of retards here tonight.

        1. Slavers will just have to get over their aversion to self ownership.

    2. Just go single payer. Because of rewards to stockholders and bloated administrative costs even decent private health care coverage is 15% more expensive than Medicare.

      The CBO report is probably accurate within +/- 30%. That has been the historical average. Not a bad crystal ball for forecasting the future. Not a bad record for a modern crystal ball forecasting the future. We all can run the probable numbers of new uninsured Americans under Ryan’s bill.

      1. NorEastern|3.14.17 @ 12:38AM|#
        “Just go single payer.”

        Fuck off, slaver. YOU pay for the entire thing.

      2. The CBO report is probably accurate within +/- 30%. That has been the historical average. Not a bad crystal ball for forecasting the future. Not a bad record for a modern crystal ball forecasting the future. We all can run the probable numbers of new uninsured Americans under Ryan’s bill.

        That is either some pure comedic gold right there or tragically misplaced optimism right there. Are we talking about how things might be in some alternate parallel universe where aren’t bankrupt and one can kick from the end of the road? Also +/- 30%??. Can anyone name one Govt program that has ever been on the minus side of +/-? Ever? Even +30% doesn’t seem realistic unless you accidentally left off an extra zero somewhere in your math. This is why we have a “preview” button down below, right next to the one that says “submit”.

      3. Insurance isnt the reason healthcare costs so much. If that was true why not pay out of pocket?

  16. Turns out that you can’t cure all the world’s problems with legislation.

    Having health insurance doesn’t stop disease. Cancer still kills you and fighting it is expensive. People like to think that health insurance companies are magic pi?ata that can give you unlimited money until you are all better. That’s not really the way it works.

    In real life you get sick and there is a great deal of money and effort in treating you sometimes. If we want to throw endless money at every person in hopes we can all become immortal it’s going to get very expensive very fast.

    1. Yea thats the issue. People are like i want to survive this disease! The technology exists! Everyone should be able to beat it!….Everyone should drive a fucking tesla….the tech exists but the resources dont. Jesus. People fail basic math.

  17. Medical and Health care is technology. Which for almost everything means it gets cheaper, better and more abundant as time goes on. With the exception of anything remotely connected to the medical field. This continues to grow more costly with each passing year in spite of the increases in knowledge and technology that should provide the exact opposite economic effect. It also gets more regulated every year. For our own good of course. Self Ownership? Of your own body? That is just crazy. Because if anyone could just pay anyone else who offered to provide these particular goods and services to them, regardless of legal certification everyone might end up getting substandard quality or paying quacks and scammers. So instead of a free market system where there might be risks we will just force everyone into a highly regulated, inefficient regulatory scheme with massive dead weight losses and unreasonably high costs, that no one but the extremely wealthy can afford to pay out of pocket. This is presumably less risky and better for everyone in the long run. Even if the result of this is that the majority may have to go without medical and dental care. Or at least anything they can afford without leaving the country.

    1. Technological advancements do result in cheaper healthcare services, the same as in all other areas of technology, but the reason it keeps getting more expensive are government meddling (as you already noted) and the fact that, unlike it other areas of technology, everyone wants (and many feel entitled to) cutting edge medicine. If everyone wanted cutting edge computers, personal computers would still be seen as expensive (~$4,000), but since people settle for last year’s technology computers on average are inexpensive (~$500). If everyone demanded the latest cars they would be expensive (~$50,000), but since people settle for last year’s model of last century’s technology cars are relatively inexpensive (~$8,000). The same pattern is true in medicine, that what was previously cutting edge has come down in price to affordable levels while still retaining its effectiveness, the difficulty is that people don’t settle for decent, affordable healthcare, they demand the best.

  18. The whole notion of the government some how fixing things by making more regulations and forcing everyone to purchase something that the market can never provide in the current regulatory system is beyond absurd. It is worse then them breaking our legs and then offering to give us a free crutch. Which we soon discover is not free at all but absurdly overpriced. And almost completely useless as a crutch as well.

    1. D: Excellent point – given tech progress and market competition all areas except for those in which there is massive government interference – medicine, public education, and defense – get cheaper and more productive over time.

  19. I’m honestly a little surprised people around here aren’t coming to the bill’s defense a bit more.

    – 800B over ten years cut from Medicaid, and setting the program on a track of withering away entirely
    – 10% reduction in premiums once the plan fully settles in

    And this is on top of a massive tax cut and repeal of the individual mandate. Realistically speaking, this is about as good a bill as someone who’d like to see free market health care could expect as a way to bridge the gulf between what we have now and an actual free market system. It seems to take steps in that direction at least.

  20. CBO? How can you respect a ten year estimate in a four year election cycle? It cannot ever be accurate.
    Last I looked, it has to follow some of the assumptions baked into the legislation, so the numbers start out tweaked.
    And it has to compare to the existing fantasies, not the real world.
    This whole mess caused by combining the availability/use of health care AND health insurance is phony anyway.
    Access to health insurance is one thing; access to healthcare is another thing.
    The current law was designed to fail; however, they expected it to fail under Democratic political control, and be replaced with single payer as “the only thing we can do”.
    There is a built in impossibility in requiring the purchase of insurance, and requiring coverage of pre-existing conditions. Not to mention forcing providers to provide “free” care to those who cannot pay. (slavery?)
    The main point to hammer, is that of choice. Does the new law increase of reduce choice for an individual?

  21. Unfortunately, many of the most vocal in the debate on Obamacare/Trumpcare/Anycare have not been in a position where they had to purchase health insurance out of their own pocket. Prior to Obamacare, a private payer was faced with two choices – pay an large amount for a basic HMO (roughly $1K/mo, +/- depending your state) or jump through an insane amount of hoops to become a sole proprietorship or corporation to get your cost in the $500/mo ish range. Even then, there was no assurance your coverage would continue, especially if you incorporated (too few on the policy!), and that omits the question of whether $500/mo is itself excessive for the average worker.

    Coverage for pre-existing conditions (possibly covered earlier by another policy) was difficult, if not impossible. So called “catostrophic” plans, when looked at closely, were/are a waste of money as they covered only a very small portion of surgery and a hospital stay, let alone non-hospital treatments (ask them what will be covered if you need bypass surgery for a heart attack, then have one.)

    The cost of healthcare in the US is a mess for many reasons. Obamacare is far from perfect, but it has addressed problems like the above that affected millions of people. How to fix it without throwing out its positive aspects will be very difficult in a crony capitalist federal/state environment.

  22. Everyone wants great medical care at cheap prices for their ‘tribe’. Their tribe may be just their family, or family and friends, or family, friends and their local community, or may even include their skin color or tax bracket. It seems all ‘tribes’ are at best indifferent, or at worst murderous of other tribes for a number of rational and irrational reasons. A few labels for other tribes come to mind. One tribe may label any or all other tribes as enemies by using various labels. Liberals, Conservatives, socialists, capitalists, poor, rich, bleeding hearts, greedy heartless, etc… Of course neither political party can reach a consensus. Regulations, or as sometimes known, laws, will have to be passed to the detriment of some group of tribes. The only question is which tribes loose and which tribes win.

  23. It seems that the CBO Report on the AHCA has done more to destroy the CBO than ObamaCare Repeal.

  24. Considering that it’s deficit spending, it would be much better for the middle class if the government just didn’t spend it. iMessage on PC and iMessage for PC

  25. It seems all ‘tribes’ are at best indifferent, or at worst murderous of other tribes for a number of rational and irrational reasons.Zapya for PC and Zapya for windows

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