I accept your objections to the ACA, and disagree with most of them.  They are very well stated, however, and consistent with your conservative philosophies.

 

I do have a decent pair of reading glasses, got them out, and read this again.  You made 2 statements here:

 

1) That these patients were pushed to a Medicaid instead of a commercial plan.  I'll take that at face value.

2) Medicaid care is of significantly lower quality.  When my mother reached retirement age, she qualified for Medicare, including part D.  She is satisfied with both.  She did not have to change providers.

 

What am I missing?

 

Thanks, it's cool to disagree without being disagreeable!

 

1. One of the hallmarks of the ACA is the enhancement of the state level Medicaid programs for the poor. The changes the ACA made increased the floor income requirements for enrolling in Medicaid meaning that more people qualify for the program, so instead of getting a commercial plan from an insurance company they go on the state dole. The ACA provides federal money to the states to help pay for these additional subscribers, but that subsidy begins to decrease after a few years. That was the topic of all the talk about Rick Scott and other governors refusing the federal money last year.

 

2. Medicaid is not Medicare. Since Medicaid is a state level program it is chronically underfunded. As a result, reimbursements in Medicaid are frequently 50% of the Medicare allowable or less. So Medicare (the federal program) has a large rate of participation among providers and a happy patient panel, but Medicaid (the state program) has significantly fewer doctors with corresponding dissatisfaction in the patients. This becomes more of a problem when all these new subscribers were added to the program. Here's the trick: the ACA has language that requires the states to increase the Medicaid reimbursement to the Medicare level to entice more physicians to participate, but as before, the subsidy to pay for all that additional outlay will only be here for a few years, then the states have to figure out a way to pay out twice the Medicaid dollars that they were before. It's a budgetary time bomb just waiting to explode around 2018.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Thanks, it's cool to disagree without being disagreeable!

 

1. One of the hallmarks of the ACA is the enhancement of the state level Medicaid programs for the poor. The changes the ACA made increased the floor income requirements for enrolling in Medicaid meaning that more people qualify for the program, so instead of getting a commercial plan from an insurance company they go on the state dole. The ACA provides federal money to the states to help pay for these additional subscribers, but that subsidy begins to decrease after a few years. That was the topic of all the talk about Rick Scott and other governors refusing the federal money last year.

 

2. Medicaid is not Medicare. Since Medicaid is a state level program it is chronically underfunded. As a result, reimbursements in Medicaid are frequently 50% of the Medicare allowable or less. So Medicare (the federal program) has a large rate of participation among providers and a happy patient panel, but Medicaid (the state program) has significantly fewer doctors with corresponding dissatisfaction in the patients. This becomes more of a problem when all these new subscribers were added to the program. Here's the trick: the ACA has language that requires the states to increase the Medicaid reimbursement to the Medicare level to entice more physicians to participate, but as before, the subsidy to pay for all that additional outlay will only be here for a few years, then the states have to figure out a way to pay out twice the Medicaid dollars that they were before. It's a budgetary time bomb just waiting to explode around 2018.

 

I had Medicare and Medicaid confused.  Thanks for the clarification.

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Because the industry hasn't been regulated for the last century? The government did so well with it already we should give them more power, never mind that the local, state and federal governments have had their disruptive paws all over the it and total screwed it up. That's the mindset that Conservatives and Libertarians just can't accept. And I had my appendix out in 1985, my God do I wish they had laproscopic surgery back then, I wouldn't have this 6 inch scar in my gut.
But hey,it's clearly not worth paying for all these swell advances we've given the world. 



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We? The first laparoscopic surgery on humans was performed in Sweden, and the first laparoscopic appendectomy was performed in Germany. Much of the research on this type of procedure was done as much outside the U.S. as in.

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If something can corrupt you, you're corrupted already.
- Bob Marley


 

Here's the trick: the ACA has language that requires the states to increase the Medicaid reimbursement to the Medicare level to entice more physicians to participate, but as before, the subsidy to pay for all that additional outlay will only be here for a few years, then the states have to figure out a way to pay out twice the Medicaid dollars that they were before. It's a budgetary time bomb just waiting to explode around 2018.

 

Isn't the federal subsidy 100% for three years then gradually decreasing to a floor of 90% in 2020?

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If something can corrupt you, you're corrupted already.
- Bob Marley


 

We? The first laparoscopic surgery on humans was performed in Sweden, and the first laparoscopic appendectomy was performed in Germany. Much of the research on this type of procedure was done as much outside the U.S. as in.

 

Perhaps you're correct, I was using it more as an easily understood generalization.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Isn't the federal subsidy 100% for three years then gradually decreasing to a floor of 90% in 2020?

 

Then there's another scheduled decrease for 2022, though as far as I know that percentage hasn't been decided yet. The increase in panel size coupled with the required increase in reimbursement to Medicaid providers is what creates the issue for state budgets starting in 2018.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Now this is...interesting. What could possibly drive the Obama admin to hide the 2015 plan rates until the middle of November? What could possibly be happening, gosh, even today, that would make them put a 45 day hold on the release of the price increases?

 

http://www.usatoday.com/story/opinion/20.../16933173/

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Perhaps you're correct, I was using it more as an easily understood generalization.

 

I am correct, and my point is your generalization is based on a flawed assumption.

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If something can corrupt you, you're corrupted already.
- Bob Marley


 

I am correct, and my point is your generalization is based on a flawed assumption.

 

Fine, I had an MRI (Goldsmith, State U of New York, 1977) a month ago. Better? 

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Fine, I had an MRI (Goldsmith, State U of New York, 1977) a month ago. Better? 

 

I guess, but the first patent application for an MRI device was filed by a Russian doctor. I just don't know why this part of what you posted is relevant to your point.

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If something can corrupt you, you're corrupted already.
- Bob Marley


 

We've already done price controls in this country, they don't work.

so you are fine with thousand(s) of percent markup on products...Not me...that's not fair to the consumer...If businesses could be trusted to sell their products at a reasonable markup, we wouldn't need anyone to watch out for them...I have stated repeatedly I really don't like more regulation, but I like being fleeced even less

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so you are fine with thousand(s) of percent markup on products...Not me...that's not fair to the consumer...If businesses could be trusted to sell their products at a reasonable markup, we wouldn't need anyone to watch out for them...I have stated repeatedly I really don't like more regulation, but I like being fleeced even less

 

Yes, I'm fine with the mark up on this one particular instance that you've harped on for three days because I understand economics in a way that you apparently can't comprehend even after our rather lengthy discussion.

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“An empty vessel makes the loudest sound, so they that have the least wit are the greatest babblers.”. - Plato

Now this is...interesting. What could possibly drive the Obama admin to hide the 2015 plan rates until the middle of November? What could possibly be happening, gosh, even today, that would make them put a 45 day hold on the release of the price increases?

 

http://www.usatoday.com/story/opinion/20.../16933173/

They don't want to piss off their voters by showing them ahead of time how badly we're all getting screwed over by this. So they wait until after the elections. I think the GOP is going to take the Senate. I know our race here in NC is pretty neck and neck. Voters are just tired of the nonsense on both sides and I think many Dems are voting anything other than Democrat trying to find the lesser of 2-3 evils and hoping it turns the government around.

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