Ok, lets fix the ACA.

[Eko]

Give some realistic suggestions. I know single payer is probably the most wanted but getting that would be very hard even if we had congress and the presidency. I'm asking for small things that could easily pass that would help a lot of people. Here is one I have. Stop penalizing single parents who don't claim the children as dependents but pay child support. They are using the pay without taking into account how much they pay for child support to determine whether they qualify for subsidies on the ACA or face a fine for not having health care. Hence someone making 40k a year but paying 8400 in child support has to pay 7200 on the ACA roughly for insurance. That puts them down into making 24000 a year. That's pretty unrealistic to expect somebody to sign up for insurance in that instance.
What ideas do you have?

[RandySF]

1. Adjust the subsidy for regional cost of living.

A $45,000 salary may be fine in the South or Midwest, but a waitress but I know a waitress in San Francisco who is having trouble affording her Covered California co-pay after basic expenses.

[Eko]

2. Isnt that already there?

I think it is, if not great idea.

[Sgent]

57. Kinda

the subsidy is based on the local cost of the second least cost silver plan, so regional variations in insurance rates are taken into account for the subsidies. That said, that's only for insurance rates, not co-pays, etc.

[crazylikafox]

3. How about going after the cost of Prescription drugs?

That's not an easy one but you may get bipartisan support for that one. And would help take the cost out of both Obamacare, Medicare & Medicaid.

[Eko]

4. Thats a great idea

but do you have any more specifics on it? How would we do that? Thanks for replying.

[Buzz cook]

7. Currently by law Medicare pays retail for phamaceuticals

We just have to alter the law so that Medicare can use the power of volume buying. It is the same type of powr the veteran's administration has, so the model is right there, no need for fancy new legislation.

[Eko]

13. Bam!

[crazylikafox]

10. Start with letting Medicare negotiate with Drug companies.

Some other initiatives in Congress:

https://democrats-oversight.house.gov/investigations/investigation-of-skyrocketing-prescription-drug-prices

Since we have the highest prescription drug prices in the world, we should also look to other countries that pay less for strategies that work.

[Eko]

12. Awesome.

Agree.

[Bayard]

58. My understanding of our drug prices

Prices are so high in the U.S. because we are funding all the pharmaceutical research for the rest of the world. Other countries will not allow that, so their prices are much lower.

[Buzz cook]

5. A public option

That is the greatest sin of Obamacare. The public option sets a competitive floor for other insurance plans. The expanded pool in Medicare lowers cost per patient and helps shore up that program. With more people on medicare it lowers medicade enrollment and saves funds for that program.

Include part time workers in employer coverage. That has a side benefit of removing the excuse employers have to only employ part time workers.

Remove medicare advantage and reapply the funds to Medicare, closing the gap coverage.

Make a serious effort to make Medicare like a true single payer system.

[pat_k]

6. Absolutely!! Dems need to introduce a bill NOW with Public Option. Change the game.

http://www.democraticunderground.com/?com=view_post&forum=1002&pid=8840730

[Buzz cook]

9. Yes. Democrats should be demanding full loaf legislation.

They really can't afford to "only" be anti-Trump. They need to make real big proposals.

[pangaia]

35. Sounds like a plan.

ATTACK, ATTACK, ATTACK while they are down..

[Adrahil]

15. agree. NT

[Best_man23]

51. I'd buy that

Two words...public option.

[fun n serious]

8. Medicare for all. nt

[Kimchijeon]

16. Agreed, for all!

[superpatriotman]

11. Start revoking insurance company licenses

Unless they fall in line, get in the game and play for our team.

[brush]

56. Yes. Penalize those bastards for too high premiums and for walking away from the plan

[Adrahil]

14. Public option.

That fixes 90% of the problems in the individual market.

[Kablooie]

17. Hey, if Democrats get some practical fixes ready...

When they get in power again they can quickly implement them and show what governing really looks like.

[Kilgore]

18. Serious remodel needed in my opinion

We are a family of three in very rural WA and paid almost $1,400 a month for a bronze plan with a $10,000 deductible last year. We dropped coverage for 2017 and now paying out of pocket, and banking the premium. To add insult to injury, no providers in our county accepts the insurance. Now we pay our local doctor cash and get a great discount.

From where we stand, ACA is broken and both parties need to quit fu*king around, quit the circle jerks and get healthcare fixed.

I know this will offend the ACA puritan cheerleaders, so go ahead and flame me. My asbestos underpants are snugly in place.

[Ms. Toad]

20. I'm surprised you're getting a discount.

Around here, it is the insurance companies that provide access to discounts because they medical entities are required to honor their negoiated rates. I don't recall ever seeing less than a 50% write-off for insurance. For labwork the write-of is between 90 and 95%.

The last head-to-head comparison did for an office visit, the cash price was $650; the insurance rate for the same visit was $200. (My daughter's insurance had a hiccup & the visit was on a federal holiday so the insurance company was closed & could not verify she was covered, so we asked about the cash price for the visit).

[Kilgore]

21. They do discount

Our local office is a husband and wife operation. A cash office visit is $50 plus any tests or labs.

We are going to approach the Cathloic hospital in the next county and see if we can get set up as a cash customer there.

[Ms. Toad]

22. That is out of the ordinary.

Most medical providers count on cash-pay to supplement the reduced rates they have to give to volume purchasers.

Are you getting at least an 80% reduction on labs? (That's the lowest insurance discount I've found for labs. I.e. if a lab test is billed at $100, the insurance allows them to collect $20. Because I have a 15% copay the insurance company pays $17 and I pay $3 for the labwork. More typically the labwork discount is between 90 & 95%)
)

[pangaia]

38. $650 for an office visit to a doctor?

With Medicare and a gap plan with Excellus Blue Cross/ Blue Shield in Western NY, I think I pay $40 for a PCP visit..

I have Medicare, But before I did and could not afford insurance because of my low income the ER at the nearest hospital gave me a very good discount.. Food poisoning one night...
They do this for everyone, as do many of the local PCPs.

I'm lucky.

[Ms. Toad]

49. Yeah. It's a specialist

My daughter has a rare disease, so this was for a specialist visit - but even so the cash price is exhorbitant to me, and since we've visited doctors in the same practice before I knew the insurance price was around a third of that.

The best they could offer was to sign her up for Medicaid (which she would be eligible for, but for her health insurance). They required her to sign a form stating she didn't have insurance, and since she does - but there was record-keeping glitch - that was an ethical issue - so we asked about the cash price.

Through my insurance, the same doctor is $35 (with an insurance discount to ~$200, so the insurance company pays $165, and the facility writes off the remaining $450)

Through my daughter's insurance, she has to pay the $200, until she meets her deductible for the year, and the facility writes off the remaining $450.

But cash - there's no discount, so the full $650 would have been requried in order to visit the doctor. That's been the case whenever I've had the need to ask about cash prices (and we are very heavy medical consumers, so at least in our area I'm pretty confident that a discount for cash is very rare).

[pangaia]

50. The whole thing is so ridiculous, isn't it.

Do you know about the 'charge master' thing at hospitals?

Google it.. Mind boggling.

Most hospitals have fake inflated prices that virtually nobody pays. Ins companies negotiate a reduced rate. Check out - "charge master".

I mean, if they give hospitals, say, 80% off, why not you? or anybody?

I've been very lucky so far.. I live near Rochester, NY and the U of R runs Strong Memorial Hospital, which is the U or R Medical Center and a teaching hospital. Highland Hospital is associated with it as are quite a few smaller hospitals in the surrounding area. Strong has a very good cancer center of which I availed myself 5 years ago. :&gt )

Also, two of the local insurance companies that offer medicare gap plans are not-for-profit and keep the premiums pretty low. KNOCK ON WOOD, in 2 out of the last 12 years the premium was ZERO! Not any more. though. $66/mo for pretty good coverage AND Part D.

With the fucking christo-facsists in power, I am holding my breath and calling reps..
emailing, etc etc...

[WinkyDink]

24. Better hope nobody in your family needs a serious operation.

[pangaia]

39. Just my thought.

[MontanaMama]

33. We are in a similar place.

Family of 3, in MT, only three plans offered from one company to choose from. We pay $1322 a month for a bronze plan with a $6000 per person deductible. We have yet to take the step of dumping the insurance and banking the premium for fear of something catastrophic happening, but we've talked about it.

While I am grateful for pre-existing conditions protections and no lifetime limits, the ACA needs some tweaking. I'm all for the public option. I'm all for single payer. I have too many friends in Canada and New Zealand that tell me how nutzo we are here in the US and how well they have it.

[grantcart]

37. Not sure I am following you.

More than 85% of the people who use the market place get some subsidy.

Are you saying that your premium was $ 1400 with no subsidy?

By the way if you are self employed or have a business and pay for coverage you can go back and get the subsidy if your income was less than anticipated, understand it doesn't apply to your current situation but might to the previous year.

You can have a family income of $ 90,000 and still get a subsidy:

For plans purchased during the 2017 open enrollment period (November 1, 2016 to January 31, 2017), that upper subsidy threshold is $97,200/year for a family of four; subsidy availability extends well into the middle class.

. . .

But you can also pay full price throughout the year for a plan through the exchange, and then claim your subsidy as a lump sum when you file your taxes. (Subsidy reconciliation is completed when you file taxes, using form 8962. If the subsidy you receive during the year is too high, you’ll pay back some or all of it when you file taxes; if it was too low – or if you didn’t receive an advance subsidy at all during the year – you’ll get the balance of the tax credit when your return is processed).

Source: https://www.healthinsurance.org/obamacare/will-you-receive-an-obamacare-premium-subsidy/
Follow us: @EyeOnInsurance on Twitter | healthinsurance.org on Facebook

We are a middle income couple with about the same premium but get a significant subsidy.

[pangaia]

41. I agree the premiums and deductible are insane but..

with no insurance, what happens if, heaven forbid, you are driving home one night on a 2-lane highway and the driver of that semi- coming at you falls asleep and crushes your car?

[Lurker Deluxe]

46. What happens?

First thing is you get taken to the hospital and fixed, to the best of their abilities.

Second thing is you get billed for that service, which will be astronomical.

Third thing that happens is they set you up on a payment plan that will last the rest of your lifetime. That payment plan is based on your income, they do not want you to 13 them.

Fourth thing that happens is you sue the fuck out of the driver, who is insured for such things.

Once you start talking about $10K+ a year for something that if you have to use it will cost you $10K+ if that scenario comes to pass the option of banking that money and taking the risk becomes an option. Five years in you are $50K up and would be able to cover most emergencies.

A friend did not have health insurance and had a GI bleed. He went to the emergency room and they fixed him ... for $25K. But it is not like they turned him away because he was uninsured. His payment is $450 a month for five years .. still cheaper than what insurance would cost him.

Certainly there are things that can happen that would run into the $100K+ problem, but those things will more than likely bankrupt you anyways unless you have a really good job with excellent benefits. After you get crushed by the 18 wheeler how long does your employer keep paying you? Certainly not the years it will take to heal. You may never be able to work again.

[joshcryer]

19. Public option, prescription drug negotion. Simple.

[WinkyDink]

23. What's WRONG is the inclusion of for-profit insurance companies that can raise premiums!

[Eliot Rosewater]

27. WE have 2 phrases here that are uncommon elsewhere, popular vote and health insurance

[MontanaMama]

36. Yep.

Insurance is organized crime. Fuckers need to go down.

[mackdaddy]

25. At least drop the Medicare age to 60.

This would take a lot of the high dollar people out of the insurance market. I have heard that this was originally intended anyhow when the program was started.

Even put a timed drop in the enrollment age to 55 then 50 in coming years. We may not be able to get a public option through but this might get there incrementally.

[Eliot Rosewater]

26. Reverse Roberts erroneous ruling about states opting out of Medicaid expansion

and fund the risk corridors as originally intended.

Do people here know about Rubio and the risk corridors?

[The Wielding Truth]

54. Absolutely correct. These Republican changes have damaged the ACA.

[matt819]

28. At the moment

I think it's probably best to revel in their failure and put modifications of the ACA aside.

I think it could use some improvements, not least of which is negotiations with insurance companies to bring premium increases under control. But all in good time.

[Ilsa]

29. Offer Medicare to people 50 and older.

Takes a hunk of risk pool away from insurance companies. Eventually they'll be almost useless for anything but Supplemental policies without the high premiums. They'll make plenty off money.

Treat maternity, neonatal, all pediatrics as public health issues, covered 100% by a form of medicare.

Student debt jubilee to doctors, nurses, other Allied Health. Bonuses to those who serve in underserved areas.

[mvd]

30. While I do think we would have a chance to enact single payer if we get the Presidency and Congress.

..it may take a while. So the premise of your thread is a good one.

My first concern is lowering the outrageous drug prices. Let the government negotiate so both the old and young get lower prices.

Hillary had other ideas here:

https://www.hillaryclinton.com/briefing/factsheets/2015/09/21/hillary-clinton-plan-for-lowering-prescription-drug-costs/

Secondly, we should expand subsidies so that there isn't such a sharp cutoff with who gets help.

Thirdly, introduce a public option.

[Eko]

31. All great ideas from everybody!

Thanks!

[MichMan]

32. Raise the fines for not participating

I will get attacked for this I have no doubts, but IMO this was a big issue with the current law

One major premise of the ACA was that everyone would buy in thus spreading the risk. This would ensure everyone had coverage and avoid people going to the ER for routine care. This was intended to ensure that a lot of healthy young people would be buying insurance that had not had it previously.

Instead a certain number of people have decided to pay the fine and go without since it is cheaper than buying insurance. Since the only enforcement method is losing your tax refund, it isn't that hard to make sure you aren't going to have much of one by altering your withholding. Of course, now if they need care, they still go to the ER same as before.

That has created the problem that without an influx of young healthy people enrolled in the exchanges, they have had to raise the premiums higher and higher for those that did enroll.

Many of the other industrialized countries that offer universal care fund it with a VAT. This ensures that everyone pays into the system. No politician in this country is going to suggest that as an option

[taught_me_patience]

43. I agree with this

I think at some point, higher fines won't work. However, I do think that the combination of the penalty AND the continuous coverage provision of the Republican plan would be more incentive for younger people to join.

[briv1016]

34. 19 states have yet to expand Medicaid.

[moose65]

40. Come at it from both sides

We should expand Medicare to cover everyone from birth to age 18, and then age 60 and over (to start). Young adults age 18 - 25 can join their parents' plans. Also, work toward making Medicare a true single payer plan, with no copayments or deductibles. And we absolutely must do something about the cost of prescription drugs. Allow Medicare to negotiate with the drug companies.

[taught_me_patience]

42. I have numerous ideas and most wouldn't be popular here

1) increase the cost ratio from 3-1 to 4-1 to lower costs for younger people to get into the system
2) increase the penalties to be that it is automatically taken from the paycheck and you get a refund when you file your tax return if you prove you've had insurance for 12 consecutive months
3) provide an option for a high deductable savings account with a tax credit applied to the HSA AND insurance premium subsidies if the individual qualifies
4) allow states to form state-level co-ops to expand offerings across state lines in a pool of states
5) implement the continuous coverage provision to make the penalty for not having insurance even more painful

[MichMan]

47. Dont like #2

Since I have had coverage for decades, I will not support a plan that makes me pay double every single month with the assurance that I will get it back eventually

[TexasBushwhacker]

55. Young people don't want to pay ANYTHING for insurance

because they think they are immortal, so I don't see #1 working.

[nikibatts]

44. Put those Public Health Service docs sitting behind desks in DC out in the rural areas

to make up the for docs who refuse to serve Medicaid or the poor. Let the PHS docs be the gap providers. They are already earning a government salary and active duty military benefits. Make them earn it. Then offer payment for medical school debt to new docs who will work in those underserved areas for two years with basic salary and benefits and housing expenses. Let the Fed gov be their insurance coverage until their service terms are completed. let them work side by side with seasoned PHS Corp medical and mental health physicians.

That should address on part of the problems of docs and insurers refusing to service ACA patients.

[Sgent]

59. A huge number

of PHS docs are in the rural areas serving patients -- and you wouldn't even know they are PHS.

A family member of mine was a PHS doc in a rural area earlier in her career, had a military ID card, a rank of 0-4, no uniform, and no idea how to salute.

Most uniformed PHS docs you see are either deployed with the coast guard (they provide CG medical care) or are the supervisors.

[Eko]

60. I like this one

Nice!

[phleshdef]

45. The ACA is mostly fine, the problem is the costs of treatment and the price of drugs.

An MRI should never cost something at one hospital and twice as much at another, for example. And we need to open up the market to cheaper, imported medicine. Just following those 2 concepts alone would go a long way.

And of course a public option available to anyone that doesn't have employer provided healthcare would be fantastic.

We all know that some form of a robust single payer program is the best way to go, but I think doing the above would put us in line to have a really good healthcare system from front to back.

[stopbush]

48. My wife and I are on an ACA plan through Covered CA.

Kaiser Permanente.

We got it for catastrophic insurance. We pay only $128 per month with the subsidy. Our deductible is $4500 each per year. Sounds bad.

However, I stopped by my local KP office today as I got a call that I was due for a retinal scan. Just wanted to see how much it would be. Well, it was free as it was a preventative procedure. I had the scan done. While there, I asked about charges under my plan. Found out an office visit would cost me $60. I had 3 labs scheduled - 2 blood tests and a urine sample. My cost is a copay of $10 per lab, or $30.

Hmm, that's not expensive at all.

As far as my meds, I get them at Costco in 90-day supplies. One of them costs $10, another is $30. I have no idea what they would cost thru KP as they are prescriptions I got when I had UHC benefits through my job at the time.

[Hoyt]

52. I had a Kaiser Medicare Advantage Plan for a few years, before going back to work. I liked it a lot

Of course, I'm not one that has to search out their own doctor for every specialty care needed. Just give me a primary care doc who listens, and tell me where to go when it is time. Kaiser does a good job with that and they truly care about keeping you healthy for them and you. If people would accept a Kaiser type non-profit plan, we'd save some real money.

[RandySF]

53. There may be a silver lining today.

We're finally talking about improving it instead of fighting. It was just a year ago a lot of people on this board wanted to see it crash and burn in hopes of replacing it with single-payer.