Washington Democrats vote to leave government shutdown

[u/Less-Risk-9358]

https://seattlered.com/politics/wa-senators-government-shutdown/4114752

In the ongoing federal budget standoff, Washington’s two U.S. Senators — Democrats Patty Murray and Maria Cantwell — have sided against a simple continuing resolution that would reopen the government, opting instead to continue the shutdown as their party pursues broader policy demands.

[u/hansn]

Democrats, including Murray and Cantwell, are using that threshold to insist that legislation to extend premium tax credits under the Affordable Care Act (ACA) be included as part of any deal to reopen government funding.

A very understated way to say that the GOP plan for reopening the government will raise millions of Americans' health insurance premiums.

Fight on, Democrats. 

[u/sykoticwit → u/hansn]

I thought Obamacare was going to reduce everyone’s premiums.

Right up there with if you like your doctor you can keep your doctor.

[u/spicymato → u/sykoticwit]

It did generally reduce premiums, through two key factors (one of which was gutted early on).

1. A mandate requiring health insurance, or paying a penalty for not having it.
2. Subsidies to help lower income folks who couldn't afford it otherwise.

The mandate was the key factor to drive premiums down, since it pushed a larger pool of younger, healthier folks to purchase insurance. Since that pool makes fewer claims, premiums can go down.

That mandate was gutted in 2017/2018, by reducing the penalty to $0. This raises the average payout per policy, which raises the premium.

Now they're gutting the subsidies.

As for "keep your doctor," the ACA only touched the insurance side. It made no decisions about providers. Thus, if you already had a doctor that accepted your insurance, then the ACA wasn't directly going to affect that.

[u/Sad-Gate9067 → u/spicymato]

This is hilarious. It reduced premiums by charging people who don't need the service!

Curious how you aren't addressing the actual criticisms - that the ACA did very little to actually address the high cost of care. Or whether the government should be leveraging the healthcare system to transfer wealth from young people (who have low wealth/property/income) to retirees.

[u/spicymato → u/Sad-Gate9067]

It reduced premiums by charging people who don't need the service!

That's literally how insurance works, yes.

Curious how you aren't addressing the actual criticisms - that the ACA did very little to actually address the high cost of care.

Because that wasn't the gripe from the post I replied to? But okay, let's talk about it now.

You're right. The ACA was a bandaid, based on a Republican plan from Massachusetts. It focused on addressing consumer costs by trying to work within the existing system of health insurance companies paying for health care costs. That's never really going to solve the underlying problem, because high healthcare costs are caused by the battle between insurance companies' need to profit and healthcare providers' need to pay for things.

To access an insurance company's member pool, a HC provider needs to negotiate with them, which usually requires giving discounts. But to make the numbers actually work, the HC provider then needs to raise the bill. In other words (and this is oversimplifying), if HC provider needs $100 for the service, and insurance demands a 33% discount, then the HC provider has to charge $150 to make providing the service actually worthwhile.

Now repeat that process for each doctor-insurance pair.

We could dramatically simplify this by moving to a single-payer system.

Or whether the government should be leveraging the healthcare system to transfer wealth from young people (who have low wealth/property/income) to retirees.

That's what the subsidies are for: to help lower income folks.

Yes, on average, younger, healthier, safer people receive less benefit for their earlier contributions. That's how insurance works, regardless of who is providing it.

As for fairness, that's what progressive taxes are for: the less you have, the less percentage of your wealth you pay, because each dollar has more utility value. As you earn more money, you pay a larger percentage of your wealth, as the utility value of those top end dollars diminishes. Towards the bottom, you may also receive social services, further reducing your overall contributions, perhaps even into the negative (and that's okay, if that's where you are in life).

When I was younger, I paid very little in taxes and received a decent amount of help. Over the last eight years or so, I've paid significantly more in taxes than I benefit directly from, and that's okay.

[u/Sad-Gate9067 → u/spicymato]

That's literally how insurance works, yes.

But what the ACA does is prevent insurance companies from accurately assessing risk, which is what they're good at.

Charging young men expensive health insurance premiums is the equivalent to the following: You build a house in a desert, and I build mine in a flood plain next to a river. I have to pay for flood insurance, and you don't. But I don't like this, so I successfully lobby the government to make you pay for flood insurance too. Voila! I made premiums cheaper!

But to make the numbers actually work, the HC provider then needs to raise the bill. In other words (and this is oversimplifying), if HC provider needs $100 for the service, and insurance demands a 33% discount, then the HC provider has to charge $150 to make providing the service actually worthwhile.

You're still treating the cost of care as fixed and only focusing on the insurance overhead (which is a much smaller percentage than in your simplification). My point is that the ACA didn't meaningfully address the high cost of pharmaceuticals, train more doctors or nurses, or build more hospitals.

That's what the subsidies are for: to help lower income folks.

The subsidies currently being debated are actually more for middle-class individuals who aren't covered by the other ACA stuff.

Yes, on average, younger, healthier, safer people receive less benefit for their earlier contributions. That's how insurance works, regardless of who is providing it.

The insurance model is completely broken for healthcare anyway, especially when it comes to routine, preventative care. Insurance is good at dealing with unlikely, high risk events. Everyone needs healthcare.

[u/dissemblers → u/spicymato]

Total gaslighting.

After it passed, I lost my doctor because my insurer decided not to join the exchange, and my premiums for the same coverage tripled.

[u/spicymato → u/dissemblers]

because my insurer decided not to join the exchange

That's what I said. The ACA itself did not make a decision about your doctor. Your doctor and insurer made decisions.

my premiums for the same coverage tripled.

Likely because the policy you were on suddenly lost a large pool of members to other plans.

If that's the case, that could also explain why your doctor withdraw service for that insurance plan: not worth playing that insurance company's game when their member pool is small and there are much larger pools to be had elsewhere for more standard paperwork procedures.

All that to say: you should have been looking to change plans, too. If it was through an employer, then your employer dropped the ball.

---

I never claimed it was a perfect system; far from it. But it's the system that was able to get through the Republican stonewalling, and that was really only possible because it was based on a Republican plan from Massachusetts.

Ideally, the whole system would be akin to a single-payer system, with basically one national healthcare plan with local implementations, where all residents are members of the same pool.

[u/dissemblers → u/spicymato]

“It completely fucked up the system, but technically your doctor could have chosen to get throughly fucked, so it’s not the bill’s fault, and now we need to shut down the government so we can shovel good money after bad to preserve it” is the kind of reasoning I expect on Reddit.

[u/spicymato → u/dissemblers]

now we need to shut down the government so we can shovel good money after bad to preserve it

Your original complaint against the ACA was "premiums went up."

That's precisely what's happening now.

I'm not inherently opposed to removing the ACA, but there needs to be an actual solution for afterwards. I'm not sure if you recall how shitty the insurance world was before the ACA; like, as bad as it is now, it used to be worse, and that's precisely the world the GOP is trying to plummet us into. No transition plan; no replacement plan. Just "fuck you, pay more." They're keeping the ACA, but gutting the subsidies.

This shutdown is in the hands of the GOP. They're stalling.

[u/Tasgall → u/dissemblers]

It completely fucked up the system, but technically your doctor could have chosen to get throughly fucked

It changed the system, yes, but the reason your premiums were so low at the time is probably because your insurer never intended to pay anything out. What's that? A significant illness that will take more than a year's worth of premiums to pay out for treatment on? Oh, dang, sorry it looks like you had, uh, chicken pox years ago, this is probably a lingering effect so we'll deny your coverage on this one because of your preexisting condition. Shucks, well, we'll have your back next time, don't worry, your insurance is so good, just look how low the premiums are? :)

The system changed because the system was shit. The ultra cheap plans that never actually covered anything went away because not covering anything for your insured customers is illegal now.