Affordable Health Care Law under review by SCOTUS

[baldgriff]

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edit: dental services are covered for those on social assistance.

This is absolutely silly also. So the poorest of the poor get to have braces and perfect teeth - buy my niece doesnt because my brother makes just a bit more than is allowable.... gotta be on the government teat in order to get full coverage.....

[TranaGreg]

Now this is silly -
why would we not cover birth control pills and yet cover abortions? Isnt one of these more preventative than the other (and probably cheaper?)

yeah, there's not exactly a universal position on it up here; obviously there never will be ... and I'm not going to go down that rabbit hole, it's where we've landed ... if you get to a point where you have consensus on all other matters let me know, I'll dig into it a bit more then ...

[TranaGreg]

This is absolutely silly also. So the poorest of the poor get to have braces and perfect teeth - buy my niece doesnt because my brother makes just a bit more than is allowable.... gotta be on the government teat in order to get full coverage.....

you're making assumptions about what dental services are included & which aren't ... you might want to look into what dental services are provided as opposed to judging the position based on a one-liner

[OaklandA's]

If you are equating Massachusetts with ACA, it's an apple brandy and orange TicTacs comparison. They are not very similar.

J

As usual, your answers are brief and evidence-free. Both Romneycare and the ACA included:
1) Government-based exchanges
2) Guaranteed Issue (No one can be denied)
3) Subsidies for lower income households
4) Individual Mandate (or face a financial penalty)
5) Business Mandate (Mass has it for companies with 10+ employees; ACA for 50+)
6) Medicaid Expansion (Mass had it for low income children, parents, pregnant women, long-term unemployed; ACA allowed states to offer it to any low income individual or family)

Romneycare and ACA are basically the same.

[baldgriff]

you're making assumptions about what dental services are included & which aren't ... you might want to look into what dental services are provided as opposed to judging the position based on a one-liner

Have we define dental coverage here in this conversation?? Under most dental care you can get braces with some insurance coverage. Seems reasonable to assume that braces would be a covered item.... just using my real world experience and applying it to trying to understand what will be covered and wont be. So then in your version braces are not covered - ok.

What is covered - I assume 6 month office visits. What about cavities full coverage? What type of filling is available? Do we cover TMJ, or retainers for teeth grinders?

Much of this is pretty standard in dental coverage - with the customer paying their portion of course. So again I ask - what is covered?

Im not trying to be a dick here - Im just trying to point out that even on something as "simple" as dental coverage - you have to define the coverages and you have to draw the hard line.

[TranaGreg]

Have we define dental coverage here in this conversation?? Under most dental care you can get braces with some insurance coverage. Seems reasonable to assume that braces would be a covered item.... just using my real world experience and applying it to trying to understand what will be covered and wont be. So then in your version braces are not covered - ok.

What is covered - I assume 6 month office visits. What about cavities full coverage? What type of filling is available? Do we cover TMJ, or retainers for teeth grinders?

Much of this is pretty standard in dental coverage - with the customer paying their portion of course. So again I ask - what is covered?

Im not trying to be a dick here - Im just trying to point out that even on something as "simple" as dental coverage - you have to define the coverages and you have to draw the hard line.

your reference to those on social assistance as being on the government teat belies this

I think everyone knows that you have to define what is in & what is out

[Redbirds Fan]

Have we define dental coverage here in this conversation?? Under most dental care you can get braces with some insurance coverage. Seems reasonable to assume that braces would be a covered item.... just using my real world experience and applying it to trying to understand what will be covered and wont be. So then in your version braces are not covered - ok.

What is covered - I assume 6 month office visits. What about cavities full coverage? What type of filling is available? Do we cover TMJ, or retainers for teeth grinders?

Much of this is pretty standard in dental coverage - with the customer paying their portion of course. So again I ask - what is covered?

Im not trying to be a dick here - Im just trying to point out that even on something as "simple" as dental coverage - you have to define the coverages and you have to draw the hard line.

This is exactly right.

Dental coverage, even with the best private health insurance, means different things. Braces, for example, may be covered at only 50%. Dental services which are necessitated by injury or disease may be covered at 100%. Annual checkups and cleanings (preventative care) may be covered at 100% as an incentive to better dental health. Other items may be covered at 80% or so, after a significant deductible. In fact, I think this is exactly what my wife's employer provides.

So, as bg says, the question isn't just coverage or no coverage, but what type of coverage.

Same with reproductive health. Even if you don't want to provide birth control pills, you have to look at the number of women who need some type of birth control measures as a medical necessity.

EDIT: Well, not exactly right. I missed the part about dental coverage being standard. In my experience it varies wildly.

I want to make clear that there should be dental coverage for purely dental issues, with recognition that dental services will be always be available when necessitated by medical conditions. For example, TMJ is a medical condition...treatment would be available regardless of whether there was dental coverage.

[onejayhawk]

Therein is the problem. The moment you start to define coverage you enter expressio unius territory, ie adding one thing excludes all others. So, ACA didn't define coverage. It mandated very broad minimum coverage and left the rest to the Secretary of HHS, Sylvia Burwell. She took an expansive approach, which has led to many exchanges going bankrupt and insurers to stop writing coverage.

Insurance is math driven. If you can specify the outer limits of of potential liability and the nature of the covered group, you can come up with a fair price. In the real world, fair often does not equate with affordable. In order to bring the price down, you can limit coverage and/or improve the covered pool. These steps are crux of the debate. Democrats want to expand coverage and improve the pool by including healthy people, by force if necessary. Republicans want to allow for companies to create a variety of coverages, priced differently.

J

[baldgriff]

your reference to those on social assistance as being on the government teat belies this

I think everyone knows that you have to define what is in & what is out

My reference to the government teat doesnt make me a dick - it just makes it simpler to get across that if you give people better coverage as a poor person than they will get by earning a living and affording better coverage than you provide a situation (generally) where it is more advantageous to suckle the teat of the breast that is feeding you.

[In the Corn]

If I were in charge, and I'm not (anywhere)

There is easily a place to draw some lines as to where the basic health care starts and everyone should pay in and these should be free or a minimal co-pay:

- Vaccinations
- Annual Physical
- Anything "Minute Clinic" related type appointment
- Two Dental Cleaning/Year
- Eye Exam and Basic Glasses (adds on like tinting, glare-resistance are out of pocket)
- General Practitioner Diagnostic
- 3-4 Mental Health Visits (after that additional co-pay)
- Prescription Drugs (with co-pay)
- I'm sure I'm missing some things here...I don't want to debate contraception, although, I would be in favor of it being covered.

After these things, you would need a secondary insurance to cover something the rest.

Just my thoughts.

[baldgriff]

Do we cover chemo under our "plan"?

Do we cover drug rehabilitation?

Do we cover open heart surgeries or transplants?

What drugs are covered and are generics allowed (does it matter?)


Again - we can sit here all day espousing and lauding the holy single payer system, but until you define what it actually is - it is just speculation and farts in the wind.

We all know the ACA sucks - it seems that some people want everything covered and some only want basic medical coverage (yet wont define basic).

and I agree on the separate observation that our military budget is way over blown.

[swampdragon]

If I were in charge, and I'm not (anywhere)

There is easily a place to draw some lines as to where the basic health care starts and everyone should pay in and these should be free or a minimal co-pay:

- Vaccinations
- Annual Physical
- Anything "Minute Clinic" related type appointment
- Two Dental Cleaning/Year
- Eye Exam and Basic Glasses (adds on like tinting, glare-resistance are out of pocket)
- General Practitioner Diagnostic
- 3-4 Mental Health Visits (after that additional co-pay)
- Prescription Drugs (with co-pay)
- I'm sure I'm missing some things here...I don't want to debate contraception, although, I would be in favor of it being covered.

After these things, you would need a secondary insurance to cover something the rest.

Just my thoughts.

hospitalization?
emergency care?
surgeries?
catastrophic illnesses?

where do these go?

[baldgriff]

Does the government pay for the delivery of babies and the hospital stay?
If they are paying for the birth control or the abortion shouldnt they pay for the delivery?

What about the handicapped? What of there coverage is considered "basic"? Do all wheelchair bound people now get motorized chairs? Which ones do or dont?

[senorsheep]

This "untested, partisan" plan had actually been tested successfully in the state of Massachusetts by a Republican governor.

Massachusetts was a good basic functional test for how to make health exchanges work across a small, relatively homogeneous population. I don't know that it was a sufficient test for rolling out the national model, due to a few key differences:

1) Size: 6.5 million people vs. 300+ million.
2) Scope: The uninsured rate in MA was about half that of the national rate; the national plan had much broader (and costlier) objectives - wellness and nutrition programs, community health centers, etc.
3) Costs: The MA plan allowed for more cost-sharing (co-pays); the national plan's primary cost control mechanism - single payer - was politically unachievable.

So, as a functional experiment, MA was solid first step, but it couldn't really address how to roll it out nationally across ideologically and economically diverse populations with wildly different resources, levels of need, and desire to commit to the model.

Seeing it work in California would have satisfied my "size and scope" concerns. I would have also liked to have seen how exchanges would have worked in red and purple states.

The real challenge was/is political - how to sell the exchange model to conservatives. Romneycare was instructive in that regard. Romney sold his vision to conservatives as a business-friendly, market-driven model whose primary goals were to 1) require the uninsured to take responsibility for their own health care expenses, and 2) to forestall costlier, government-driven solutions being proposed by Democrats. He brought a lot of cost-conscious conservatives on board by balancing the state budget before implementing the law, and carefully controlling the costs afterwards (I think I read somewhere that Romneycare added only 1% to the MA state budget). Most importantly, by all accounts, he worked like a madman to build consensus across party lines and competing special interest blocs, making it a true bipartisan plan in his state.

[TranaGreg]

Does the government pay for the delivery of babies and the hospital stay?
If they are paying for the birth control or the abortion shouldnt they pay for the delivery?

What about the handicapped? What of there coverage is considered "basic"? Do all wheelchair bound people now get motorized chairs? Which ones do or dont?

my point was simply that it's better to try to come up with a model knowing that you'll get some things wrong, than it is to throw your hands up in the air & say it's not worth it.