I have an interesting question for those who know about how medical billing works. How is it that, for example, Joe Main Street can go to the ER with a distal fibula fracture (necessitating X-rays and Ortho to cast his leg) and be told "Ok, you don't have insurance, the cost is $15,0000." But the same Joe Main Street can come in with BCBS and get a bill that the hospital agreed to accept $750.

That raises an interesting question for the hospitals. Are you really taking that much a loss on the 90% of your "customers" who have insurance that you have to charge the few who don't 2000% more?

quote:

Originally posted by chellim1:

quote:

Education is a tax expenditure and health care is a private expenditure.

College.... we are talking college tuition. See the graph above. Education is heavily subsidized by government in the form of grants and student loans but most people pay tuition either directly or by borrowing money.
And what has all of that subsidy brought? Beautiful campuses but very high prices.

Yes. I saw that I misread that and was editing while you were writing.

quote:

Originally posted by hile:
I have an interesting question for those who know about how medical billing works. How is it that, for example, Joe Main Street can go to the ER with a distal fibula fracture (necessitating X-rays and Ortho to cast his leg) and be told "Ok, you don't have insurance, the cost is $15,0000." But the same Joe Main Street can come in with BCBS and get a bill that the hospital agreed to accept $750.

That raises an interesting question for the hospitals. Are you really taking that much a loss on the 90% of your "customers" who have insurance that you have to charge the few who don't 2000% more?

I don't have it at the tip of my fingers but there is a case dealing with this issue, holding that such billing is impermissible. It may have been a state case. But, it happens all the time.

I have seen surgeries billed at ~$130,000.00 that were reduced to $35,000.00 because insurance companies will make the hospital limit itself to rates negotiated between the hospital and insurance company.

It is one advantage to insurance.

As you are being wheeled in, you don't have time to negotiate all those things.

I always thought this was fertile ground to drive consumer costs down in any GOP plan going forward.

It's similar to the retail rate vs insurance rate for body shops.

quote:

Originally posted by chellim1:

quote:

Education is a tax expenditure and health care is a private expenditure.

College.... we are talking college tuition. See the graph above. Education is heavily subsidized by government in the form of grants and student loans but most people pay tuition either directly or by borrowing money.
And what has all of that subsidy brought? Beautiful campuses but very high prices.

You are overlooking the fact that employer based insurance is premium deductible by the employer, hence it certainly is government subsidized. I believe employer based insurance is the largest means of insurance in the country.MG

quote:

Originally posted by midwest guy:

quote:

Originally posted by chellim1:

quote:

Education is a tax expenditure and health care is a private expenditure.

College.... we are talking college tuition. See the graph above. Education is heavily subsidized by government in the form of grants and student loans but most people pay tuition either directly or by borrowing money.
And what has all of that subsidy brought? Beautiful campuses but very high prices.

You are overlooking the fact that employer based insurance is premium deductible by the employer, hence it certainly is government subsidized. I believe employer based insurance is the largest means of insurance in the country.MG

Thanks, I realized I misread it and posted this above: "Yes. I saw that I misread that and was editing while you were writing."

quote:

Originally posted by hile:
I have an interesting question for those who know about how medical billing works. How is it that, for example, Joe Main Street can go to the ER with a distal fibula fracture (necessitating X-rays and Ortho to cast his leg) and be told "Ok, you don't have insurance, the cost is $15,0000." But the same Joe Main Street can come in with BCBS and get a bill that the hospital agreed to accept $750.

That raises an interesting question for the hospitals. Are you really taking that much a loss on the 90% of your "customers" who have insurance that you have to charge the few who don't 2000% more?

I asked my wife about this (she works for a hospital). She says that's not the way it is anymore. Now there's a cash discount.

It pays to ask, and to shop around. Read this:

How to Cut Your Health-Care Bill: Pay Cash
Hospitals and other providers increasingly are offering cash prices far below what they charge through insurance....
Paying cash upfront can sometimes mean spending less out of pocket than using insurance.

As consumers get savvier about shopping for health care, some are finding a curious trend: More hospitals, imaging centers, outpatient surgery centers and pharmacy chains will give them deep discounts if they pay cash instead of using insurance.

When Nancy Surdoval, a retired lawyer, needed a knee X-ray last year, Boulder Community Hospital in Colorado said it would cost her $600, out of pocket, using her high-deductible insurance, or just $70 if she paid cash upfront.

When she needed an MRI to investigate further, she was offered a similar choice—she could pay $1,100, out of pocket, using her insurance, or $600 if she self-paid in cash.

Rather than feel good about the savings, Ms. Surdoval got angry at her carrier, Blue Cross Blue Shield of Arizona. “I’m paying $530 a month in premiums and I get charged more than someone who just walks in off the street?” says Ms. Surdoval, who divides her time between Boulder and Tucson. “I thought insurance companies negotiated good deals for us. Now things are totally upside down.”
Deep discounts

Not long ago, hospitals routinely charged uninsured patients their highest rates, far more than insured patients paid for the same services. Now, in the Alice-in-Wonderland world of health-care prices, the opposite is often true: Patients who pay up front in cash often get better deals than their insurance plans have negotiated for them.

That is partly due to new state and federal rules aimed at protecting uninsured patients from price gouging. (Under the Affordable Care Act, for example, tax-exempt hospitals can’t charge financially strapped patients much more than Medicare pays.) Many hospitals also offer discounts if patients pay in cash on the day of service, because it saves administrative work and collection hassles. Cash prices are officially aimed at the uninsured, but people with coverage aren’t legally required to use it.

Hospitals, meanwhile, have sought ever-higher rates from commercial insurers to make up for losses on other patients. Insurers pass those negotiated rates on to plan members, and given the growth in high-deductible plans, more Americans are paying those rates in full, out of pocket, than ever before.

“When you had just a $20 copay, you didn’t care what rate your insurer negotiated with your doctor. But it only takes one $3,000 MRI bill for people to say, ‘Wait a minute—where did this come from?’ ” says Jeanne Pinder, founder of Clearhealthcosts.com, one of several startups that publish hard-to-find health-care prices for consumers.



ClearHealthCosts has compiled self-pay prices for dozens of tests and procedures in eight cities and found a vast range. In Houston, an MRI for the lower back can cost as little as $750 at an imaging clinic and as much as $1,961 at an academic medical center. A colonoscopy in San Francisco is $600 at one surgical center and $5,500 at another.

Finding the negotiated rates for those same services is tougher, since many insurance contracts bar payers and providers from disclosing them. But individual plan members can see that information on their Explanation of Benefit statements, so ClearHealthCosts has joined with public radio stations in New York, California and Pennsylvania, asking listeners to anonymously post what their health provider charged, what their insurance paid and what they paid out of pocket. Thousands have responded, showing that in many cases, while insurers had negotiated a big discount off the provider’s original charge, the negotiated rates were still higher than the service would have cost in cash at the same place or nearby.

“My favorite was the $5,400 MRI at an academic medical center in California,” Ms. Pinder says. “Insurance paid about $2,900 and the patient paid about $2,500. It looked like he got a great deal—but he could have paid $725 cash down the street.” When people see this data, she says, “they don’t behave the same way in the marketplace again.”

Indeed, the growing price transparency is starting to shake up traditional relationships between payers, providers and patients.

James Lazarus, a vice president of Advisory Board Co., who advises hospitals on self-pay prices, says offering cash rates that are lower than insurance-negotiated rates could violate contract provisions. “If insurers find out that plan members are able to access a cheaper cash rate, they’ll call up the hospital and say, ‘That’s our new contracted rate,’ ” he says.

Some providers do keep their cash rates quiet, in fear of losing negotiating power with insurers. But others are eager to have their low cash prices known—and see them as a way to compete for business and assist patients who might otherwise have to forgo care.

Boulder Community Hospital hasn’t had complaints from insurers, says Chief Financial Officer Bill Munson. “Patients have the right under federal law to request that we not bill their insurance,” he says, “and when they do, they have the right to participate in our self-pay program.”

Regional Medical Imaging of Flint, Mich., says some insurers actually encourage their plan members to take advantage of its low cash prices. (An MRI of the knee there costs cash payers $265, but $510 out of pocket for an Aetna member with a high-deductible plan.) “It’s crazy, I know. But what do the insurance companies care? They’re collecting premiums, and they aren’t having to pay out when patients pay cash instead,” says Amy Davis, the imaging company’s chief operations officer.

Amy Oldenburg, Aetna’s vice president of network and product strategy, says Aetna members who find they can save money by paying cash “should make the best choice based on their needs.” But, she cautions, they could be paying for unnecessary procedures and are missing out on the opportunity to have Aetna coordinate their care.

Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an industry group, says its members haven’t reported many instances of cash prices undercutting their insured rates, but when it occurs, “it’s really a question for providers—why are they accepting lower rates than they could get through insurance?”

The American Hospital Association says its members fear high-deductible plans will increase their bad debt and leave even insured patients unable to afford care. Offering cash discounts helps with both, says Tom Nickels, an AHA executive.

Meanwhile, hospitals have to charge insured patients more to cover losses on Medicare and Medicaid patients, he says. “Health plans have complained about this for years. We have complained along with them. The government doesn’t pay its fair share.”

Patients who encounter big price discrepancies are complaining as well—generally to their insurers. Ms. Surdoval says she called her carrier repeatedly to ask why using her insurance cost more than cash. “The standard response was, ‘We can understand why you might be upset about that.’ It was like they were reading a script.”

Jeff Stelnik, senior vice president of strategy, sales and marketing at Blue Cross Blue Shield of Arizona, says that cases where cash rates are lower than its contracted rates are “very infrequent” and that high-deductible plans “are a great opportunity for consumers to make their own decisions.”
Patient dilemma

Self-pay discounts, however, do present patients with a dilemma: Most insurers won’t count cash payments toward their deductibles. So savvy health-care shoppers have to guess whether they are likely to have a major medical expense during the year, or stay relatively healthy and thus save money by paying cash.

Ms. Surdoval bet she would need knee surgery, so rather than pay $600 for an MRI in Boulder, she went to a doctor at New York’s Hospital for Special Surgery who had treated her before. The MRI there was $2,800, but paying it through her insurance put her over her $3,500 deductible for the year, so the $30,000 she was charged for knee surgery in June was covered in full.

With her out-of-pocket maximum met for the year, Ms. Surdoval says she spent the rest of 2015 getting all the medical care she needed before her deductible rose to $6,000 this year.

https://www.wsj.com/articles/h...-pay-cash-1455592277

quote:

It pays to ask, and to shop around. Read this:

How to Cut Your Health-Care Bill: Pay Cash

It's no secret to me. I've been doing it off an on since the 1990s.

It's also how I know that people who claim that the uninsured can not get treatment or afford care are full of crap.

I have had several health run ins without insurance, and I approached the providers fairly, and in return they were fair with me. This even included a (originally priced) six figure hospital stay.

quote:

Originally posted by Tubetone:
Nice fluffy quotes but philosophy is one thing and practical reality is another.

Actually, these quotes are rooted in both common sense, human nature, and a hundred and fifty year history of US government meddling in private business. They underlie 'reality'. What we have, thanks to government, is a completely distorted reality that, if left to fester and grow, will eventually kill our economy once and for all.

quote:

Please talk of practical solutions if you might. Trust busting resulted from increased prices brought about by monopolistic pure market activities. Many interventions in free market philosophy were and are needed for practical reasons.

I couldn't disagree more with that statement. Why did trust busting become necessary in the past? In almost every case, government colluded with segments of private industry through abusive regulation and taxation that protected and grew the businesses of those who bought themselves politicians. It was a truly unholy union. True free market forces, if left unfettered, would have limited monopolistic business environments, and in the end, served consumers rather than elitist billionaires and their friends. We've seen exactly that situation for the past eight years between the Barry administration and Green Energy cronies.

quote:

My view is that if a man is desperately treading water, he does not seek philosophy.

My view is had that same man not been forced off the deck of the ship by government in the first place (Ex. BarryCare, and before it, government's never ending attempts to meddle and management private industries), he'd be sitting on the deck of the ship enjoying the voyage, rather than being up to his chin in the ocean treading water. But fear not, I'm sure government will be along shortly with a life preserver. Unfortunately, it will likely be made of lead.

It really doesn't have to be as hard and as complicated as Paul Ryan's 3-step Rube Goldberg machine... In fact, it was Speaker Paul Ryan (R-Wis.) himself who said, "We have shown now that there is a clear path to repealing ObamaCare without 60 votes in the Senate. So, next year, if we're sending this bill to a Republican president, it will get signed into law."


The bottom line is, there's still hope and still a viable option. They already have a bill, pending in committee, the same one they previously supported and voted to pass:

Just Pass the Health Care Bill Obama Vetoed

Obamacare escaped assisted suicide at the hands of the so-called "united Republican government" of House speaker Paul Ryan and will now die a lingering and painful death. The American Health Care Act (ACHA), which proves the adage of a camel being a horse designed by a committee, imploded on the launch pad, abandoned by purists left and right, making the perfect the enemy of the good.

Arguing over who now owns this continuing Obamacare train wreck ignores that the American people are still tied to the tracks. While the Democrats celebrate the survival of the health care equivalent of the Hindenburg disaster, the GOP debate whether trying to get what they could through reconciliation was the best strategy.

The Democrats still own it. The Republicans didn't fix or replace Obamacare, but they didn't break it, either. It might have been a better strategy to repeal and replace Obamacare in one bill that would pass the House, leaving the Democrat senators up for re-election in 2018 to either join the replacement effort or filibuster it at their electoral peril.

The bottom line is, there's still hope and still a viable option. Don't go back to the drawing board; rather, simply reintroduce and pass 2015's HR 3762, the Restoring Americans' Healthcare Freedom Reconciliation Act. Introduced by then-Rep. Tom Price, now HHS secretary, the bill passed the House on October 23, 2015 by a vote of 240-189. The Senate, after making changes to make it more robust, passed their version on December 3 by a 52-47 vote. A vote to override President Obama's veto failed on February 2, but the onus was on him and the Democrats. Voters, knowing that a Republican president would have signed the bill, elected one, Donald J. Trump. So what's wrong with reintroducing a bill that passed both the House and the Senate?

Granted, it was not a full repeal and place, but it was a better starting point than the Rube Goldberg legislation that just died in childbirth, doing many of the things everyone, including the Freedom Caucus, said they wanted:

The House version of H.R. 3762 included repealing the individual mandate, the employer mandate, the medical device excise tax, and the "Cadillac tax" on expensive employee health insurance premiums.

It also included a measure to eliminate federal Medicaid funding for Planned Parenthood for one year. But it called for increasing funding for community health centers by $235 million/year for two years (a 6.5 percent increase over the currently scheduled funding).

The House bill also allowed people to use their Health Savings Accounts to buy over-the-counter drugs. Outspoken AHCA opponent Rand Paul voted for the Senate version. Freedom Caucus members Rep. Mark Meadows and Rep. David Brat voted for the House version. Ironically, one of the poison pills in the bill was refundable tax credits, called an "entitlement" by the likes of Meadows today but embraced by GOP AHCA opponents in 2015 as a great conservative idea.

Meadows's hypocrisy as a co-sponsor of Rep. Price's Empowering Patients First Act of 2015 (H.R. 2300) has been duly noted by Quin Hillyer in the Washington Examiner:

The leading double-talker is Rep. Mark Meadows of North Carolina, chair of the House Freedom Caucus – a group even more hard-line than the longstanding conservative caucus called the Republican Study Committee. In multiple interviews, Meadows has repeatedly blasted the refundable credits for somehow amounting to "a new entitlement program."

This is the same Meadows who just two years ago signed on as a co-sponsor of the Empowering Patients First Act of 2015, authored by then-Rep. Tom Price, who now is secretary of health and human services. The official summary for that bill starts with one sentence saying it would replace Obamacare; then the very next sentence – the first sentence explaining the actual substance of the act – reads as follows (my emphasis added): "The bill provides for refundable tax credits for health insurance coverage and health savings account (HSA) contributions." ...

If the tax credits are such an obvious betrayal, why have solid conservatives supported them for so long? The House Freedom Caucus has yelled loudly against the leadership's replacement bill, but among the other caucus members who signed onto Price's tax credit bill two years ago were Reps. Jeff Duncan, Scott Perry, Trent Franks, Scott DesJarlais, Steve Pearce, Ted Yoho, Randy Weber, and Mark Amodei – along with noted budget hawk Mick Mulvaney, who now heads the new administration's Office of Management and Budget.

FreedomWorks' Jason Pye has recommended that the GOP in fact consider resurrecting the Restoring Americans' Health Care Freedom Reconciliation Act and sent a letter to Congress endorsing the idea:

FreedomWorks has long opposed ObamaCare and supported the effort to repeal the 2010 law, which is why we key voted in favor of the Restoring Americans' Healthcare Freedom Reconciliation Act, H.R. 3762, in the 114th Congress. This bill repealed ObamaCare's tax and cost-sharing subsidies, most of the law's taxes, and Medicaid expansion within two years. It also zeroed out the individual and employer mandates.

The Restoring Americans' Healthcare Freedom Reconciliation Act passed both chambers of Congress with overwhelming Republican support. In fact, only five members–three in the House and two in the Senate–voted against it. All but three House Republicans voted to override President Barack Obama's veto of the Restoring Americans' Healthcare Freedom Reconciliation Act in February 2016.

After President Obama's veto of Restoring Americans' Healthcare Freedom Reconciliation Act, Speaker Paul Ryan (R-Wis.) said, "We have shown now that there is a clear path to repealing ObamaCare without 60 votes in the Senate. So, next year, if we're sending this bill to a Republican president, it will get signed into law."

The Heritage Foundation, which had grave reservations about the AHCA, urged after Trump's election the re-passage of the 2015 legislation, suggesting that based on past support, it could have been on Trump's desk for him to sign on day one:

There are no more excuses to be had. The Republican-controlled Congress has every tool that it needs to overcome any and all obstacles that stand in the way of fully repealing Obamacare. Now that voters have given Republicans control of the House, Senate, and the White House, this campaign promise can and must quickly become reality and the American people should hold them, and President-elect Trump, accountable for delivering on that promise.

In fact, it is entirely possible for the Republican Congress to have a bill fully repealing Obamacare on President-elect Trump's desk by the time he takes office on January 20. This memo outlines the path that Congress can take over the next two months to ensure a bill repealing Obamacare is the first thing President Trump signs – and that he signs it on Inauguration Day. ...

In 2015 the House and Senate passed a reconciliation package (H.R. 3762) that repealed most, but not all, of Obamacare. During the process, Heritage Action argued that: "Using reconciliation this year is important because it should be a trial run for 2017, when we will hopefully have a President willing to sign a full repeal bill. If we are short of 60 votes in 2017, then we will need to use the reconciliation process to accomplish this. If we do it now and do it right, we can ensure full repeal is a fait accompli in 2017." While the initial, House-passed version of H.R. 3762 in 2015 fell far short of true repeal, the Senate amended the bill to make it a more robust repeal package.

Indeed , there are no more excuses to be had. I advise the GOP to learn from history and, in this case, try to repeat it. There is a Plan B waiting to be passed. Pass it.

Daniel John Sobieski is a freelance writer whose pieces have appeared in Investor's Business Daily
http://www.americanthinker.com...ll_obama_vetoed.html

this article pretty much expresses my view on Ryan's disaster:

https://townhall.com/columnist...g-things-up-n2304530

Paul Ryan should walk around Congress for the next couple of weeks wearing a sign around his neck that reads, “I am a failure.”

the big news this week isn’t the first quarter Obamacare repeal festival of ineptitude – it’s that Neil Gorsuch is going to sail through to confirmation, leaving the burning wreckage of the SCOTUS filibuster in his wake. That’s the money right there, a win guaranteeing that the future confirmation of RBG’s replacement – who I hope is so conservative he eats raw meat off the bone – will be just a mere 51-vote technicality.

And there’s other stuff too: laying the Keystone pipe, rolling back regulations, ICE booting out aspiring Democrats, and Trump wrangling new jobs. Even the fact that Team Trump was wiretapped was reaffirmed despite the NYT denying that when it reported that Team Trump was wiretapped it really meant that Team Trump was wiretapped.

Slowly but surely, small win after small win – we’re moving toward victory. But thanks to kongressional klutzes like Ryan, a war of attrition is how it’s going to have to be.

We know the strategy – grind out win after win, big and small, over time until the liberals are broken. It’s the tactics that Ryan has botched; he’s shown no aptitude for the basic blocking and tackling of legislating and consistently falls back on the errors of the past.

Here’s how healthcare should have gone. Paully, starting the morning of November 9th, you should have orchestrated an inclusive effort to create a bill based on a consensus that incorporated every stakeholder with the ability to icepick it (the transition team, the Freedom Caucus, the squishes, the think tanks, and most vitally, the Senate). Once you had something everyone agreed on – and 216 sure votes in the House and 51 in the Senate – you all appear with the Prez in front of the cameras to announce it before you actually put out the document, thereby cementing in the narrative about why the people should dig it before the haters can hate it into little pieces. Then you pass it and win.

Seven years in and Ryan wasn’t ready.

Ryan is still making tactical errors. Instead of saying, “Tomorrow, I am calling together all the stakeholders and we are getting right back to work on fixing this,” it was, “Well, that was sad. Let’s forget about repealing Obamacare for a while and work on tax reform"

Obamacare’s getting repealed, just not today. Nor next month apparently, since the 438 members of the House can’t seem to do more than one thing at once. Of course, if Ryan didn’t have them working just eight days in April – yeah, you heard me right – maybe they could accomplish something besides managing to look both inept and lazy

quote:

Tomorrow, I am calling together all the stakeholders and we are getting right back to work on fixing this,”

Yep... that's what he should have done.
But it's not too late...

Another Perspective:
Enough With the Recriminations, Go Back to Work

March 27, 2017

Yes, Ryancare was a bad idea and yes, failing to pass it will be sold as a defeat for Trump. So what?

What’s the old quote? God helps invalids, small children, and the United States of America?

There’s another one, which came courtesy of Winston Churchill: “You can always count on Americans to do the right thing — after they’ve tried everything else.”

Somewhere between those two old chestnuts is where we are in the aftermath of the American Health Care Act — otherwise known as Ryancare — being pulled by House Speaker Paul Ryan when it was clear there simply wouldn’t be enough votes to pull it to passage.

That failure has already been thrown around as a major blow to the Donald Trump administration, and Trump validated this critique over the weekend with an ill-advised tweet: “Democrats are smiling in DC that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood and Ocare!”

If anybody in Trump’s White House suggested such a tweet (there were rumors it was Reince Priebus’s work), a firing is warranted. Because those Republicans in the Freedom Caucus and the conservative organizations undergirding them who killed the AHCA have done Trump, the GOP, even Ryan and the House GOP leadership and the country at large a favor. We can now start over and get back to first principles where health care is concerned.

This was, for some reason, not possible a month ago.

Let’s remember that in 2015 not only did the House pass but the Senate also passed an Obamacare repeal bill. It went all the way to President Obama’s desk, before Obama vetoed it.

We now have ample reason to suspect that the decision not to revisit that 2015 legislation came, as Hot Air’s Taylor Millard suggested, from the fact that the leadership never wanted to repeal Obamacare — or, perhaps more to the point, were terrified of the political ramifications of doing so.

But with the AHCA now on the scrap-heap, those fears and that conventional wisdom can be cast aside.

The way is clear for the Republican leadership now to do what they promised and repeal Obamacare. Replace it? What for?

The idea that Congress will design a Washington-centric health care system with a prayer of effectiveness runs counter to not only conservative principles but our national experience — and that’s putting it mildly. The Washington-centric health-care systems we already have are the cause of the dislocation in our health-care markets, and between them — the VA, Medicare, and Medicaid — they’ve proven government healthcare sucks in America every bit as much as it does in Venezuela, the U.K., and Red China.

If you’re a conservative, you’re supposed to be against such ideas. Taking on the charge to build a better Rube Goldberg contraption for 320 million people than the Democrats did won’t fit in that box.

Ryan said when the CBO panned his plan by claiming it would put 24 million Americans off the insurance rolls that the verdict was better than expected. Nobody in the leadership team bothered to drive home the point that the vast majority of those 24 million people would be uninsured because they’d prefer to be uninsured than waste money on bad products the government currently sees fit to force them to buy. Why? Who knows. Perhaps out of fear.

Well, Speaker Ryan and President Trump and whoever else might be listening, your worst fears have come true — you can’t get a majority for passing a Republican redesign of Obamacare the CBO projects won’t be substantially more popular than the original recipe. So, what now?

Perhaps just repeal the damn thing, with an effective date a year and a half (or so) away to give the market an opportunity to prepare, and announce that from now on you’re out of the business of running the medical system from Washington. Tell the folks from now on you will only pass bills on health care containing specific tweaks to the system to free the market — allowing people to buy group insurance outside of their employment, for example, or facilitating an interstate health market, or promoting health savings accounts, especially for young people, or doing something to equalize tax treatment between individual purchasers of health insurance and the employer-based market. Pass those or something like them INDIVIDUALLY. Stop trying to change the world all at once.

And once you repeal the damn thing, you will likely be shocked at the votes you shake loose on the other side.

There were never going to be any Democrats supporting the AHCA. Democrats like Obamacare, and thus their default position is going to be a status quo position. You don’t need Democrats to repeal Obamacare; you proved that in 2015. So repeal it and change the status quo back to something that looks like the system pre-Obamacare which 85 percent of the country thought was fine. Democrats didn’t think it was fine, though — present them with specific improvements to be weighed against a status quo of which they don’t approve, and some of them will find value in them.

The failure of the AHCA doesn’t kill the GOP, and it doesn’t kill Trump, and it doesn’t kill Ryan. Obamacare will fail, just as Trump predicted, and it is not Trump’s, Ryan’s, or the GOP’s fault when it does. That was true before Ryancare was cooked up and presented to an unwilling Congress, and it’s still true. The mistakes that have been made in the past few weeks are only fatal, if they’re allowed to be.

Get up, dust yourself off, and do better. Focus on the promises which got you where you are, and fulfill those. And then stop, and for the most part, get out of the way. You’ll be shocked at how much better that works for you than trying to put the federal government in charge.

https://spectator.org/enough-w...ons-go-back-to-work/

The republicans NEEDED for this to happen. They will regroup, come up with a strategy, and get something done.

quote:

Originally posted by hile:
I have an interesting question for those who know about how medical billing works. How is it that, for example, Joe Main Street can go to the ER with a distal fibula fracture (necessitating X-rays and Ortho to cast his leg) and be told "Ok, you don't have insurance, the cost is $15,0000." But the same Joe Main Street can come in with BCBS and get a bill that the hospital agreed to accept $750.

That raises an interesting question for the hospitals. Are you really taking that much a loss on the 90% of your "customers" who have insurance that you have to charge the few who don't 2000% more?

This is much more than a medical billing question.

quote:

Originally posted by showpro:
I don't think you can just straight-up repeal the bill. I mean, how would that work? It took years to put all these mechanisms in place. Lawyers, accountants, corporations, state governments, regulators...the list goes on...what would they do when it was repealed? What would the insurance companies sell?

The turmoil would be epic.

If you want the president and the Congress to look completely incompetent, a straight up repeal would be an excellent way to do that.

I believe, based on 30+ years experience in most facets of the health insurance industry, that it could be done in under a year. Many States use Deemer Provisions. A carrier submits contracts and pricing, if the Insurance Commish doesn't reply in 30 days, its deemed approved for sale.Products that predate ObamaCare might not even need refiling for approval. They are sitting on the shelf. Its the IT work to the Claims Systems and the CS staff and sales Reps retraining that is time consuming.

Half of this isn't needed for self funded group plans.

You always have the option to continue to sell what you have. Bet on the price going up if there have been losses in the past two years. With Med Loss Ratios no longer gov't dictated, companies will err in their own favor to the extent competition will let them.

quote:

Originally posted by bubbatime:
The republicans NEEDED for this to happen. They will regroup, come up with a strategy, and get something done.

One can only hope. I think the biggest problem is attempting to put into a bill all the things different groups want in it. Just repeal the ACA entirely, and then pick up a few minor pieces to make sure that indigent folks aren't left in the ditch (maybe beef up Medicaid and put in place strong rules of eligibility). If folks want their 26-year-old "children" to be covered by their policy, some vendor will create a policy that does that; if people need coverage for existing conditions, policies will be developed to do that, too (they will be more expensive, and should be). Let the market work out what policies are needed and what they have to cost.

flashguy

quote:

Originally posted by Redford1970:

quote:

Originally posted by showpro:
I don't think you can just straight-up repeal the bill. I mean, how would that work? It took years to put all these mechanisms in place. Lawyers, accountants, corporations, state governments, regulators...the list goes on...what would they do when it was repealed? What would the insurance companies sell?

The turmoil would be epic.

If you want the president and the Congress to look completely incompetent, a straight up repeal would be an excellent way to do that.

I believe, based on 30+ years experience in most facets of the health insurance industry, that it could be done in under a year. Many States use Deemer Provisions. A carrier submits contracts and pricing, if the Insurance Commish doesn't reply in 30 days, its deemed approved for sale.Products that predate ObamaCare might not even need refiling for approval. They are sitting on the shelf. Its the IT work to the Claims Systems and the CS staff and sales Reps retraining that is time consuming.

Half of this isn't needed for self funded group plans.

You always have the option to continue to sell what you have. Bet on the price going up if there have been losses in the past two years. With Med Loss Ratios no longer gov't dictated, companies will err in their own favor to the extent competition will let them.

Great info. Thanks!

Most of the people in government looking to repeal were looking for a phase out, not a straight up, instant repeal.

quote:

Most of the people in government looking to repeal were looking for a phase out, not a straight up, instant repeal.

Should that be reassuring? Most of the people in government wouldn't know their butts from the proverbial hole in the ground, and even when they can ascertain such a difference the likelihood that what they want is some combination of right, sensible, good for the country and their constituents, or even just a good idea is infrequent at best.

Stopped clocks and all that.

quote:

Originally posted by 46and2:

quote:

Most of the people in government looking to repeal were looking for a phase out, not a straight up, instant repeal.

Should that be reassuring? Most of the people in government wouldn't know their butts from the proverbial hole in the ground, and even when they can ascertain such a difference the likelihood that what they want is some combination of right, sensible, good for the country and their constituents, or even just a good idea is infrequent at best.

Stopped clocks and all that.

What he said.

Plus the just means the "deal" that needs to be brokered is between conservatives and moderates. It can only get better for the taxpayer AND individual at this point.

I was all wrapped up in being pissed it didn't get repealed. After a few days to think about it. It's a win, the final plan will be more conservative and better for America.