AFA Rant

[turboguy]

I feel a bit like venting so I will use this post to vent a bit. We are at our renewal time for health insurance. I was under the impression that the past year was the last one we had before being required to be AFA compliant but I guess we have one more year. Last year we had to quit covering families and go to a much worse program to be able to afford coverage at all. This year we just got word that if we want to keep the same coverage our rates would go up 30%. By cutting back from a $ 500.00 deductible to a $ 1000.00 we are able to just have a 3% increase so that is what we are doing.

I am told that to have the same coverage with an AFA compliant program our rates will about double. Our choice for next year may be to go to really crappy coverage and I hate to do that.

I am curious if anyone else is running into this and how you are dealing with it?

[Bobjob]

We have individual plans. It feels ridiculous saying it but, I'm praying my rates only go up 10%, I feel confident it will be more. To me, healthcare seems more tangled than it was before ACA. I'm definitely paying more for less. I wonder how it will pan out or end.

I'm dealing with it the same way you are, ranting about it. There is nothing else I can do.

[nealrm]

The ACA screwed over small businesses and those that have to buy their own insurance. The government did exactly the wrong thing to keep cost down. I thank God that I kept my grandfathered insurance. I had 2 medical issues this year and would have been on the hook for a min of $13,000 if I had switched to a ACA plan. What is really screwy, is that your medical expenses can be as high as $13,000 but your HSA maxes out at $5000.

There is actually a means of using a Doctor were you pay a monthly fee for services in combination with a catastrophic health insurance to ACA coverage guidelines. I'm trying to decide if that saves enough money to make it worth while.

[Brian Altenhofel]

So far, I'm +500% on premium increases after going from a $1K to a $6K deductible and going from $10/$20 (generic/brand) prescription copay to full price with the "Affordable" Care Act. Last year I went the latter 4 months of the year uninsured because the payment processor misapplied my payment resulting in the insurer dropping me for non-payment and being unable to reinstate me because the Affordable Care Act prohibits insurers from reinstating someone who was dropped for non-payment (only one insurance company is approved to provide individual insurance plans here). Technically, I am legally exempt from carrying insurance, but I do it for karma - I hear plenty from my friends in the medical field about how bad Indian Health Services is at paying even after they approve the care. I used to live in an area where many of the non-chain pharmacies would sell medications for what they would normally get compensated from insurance if you didn't use insurance, but I haven't found a pharmacy around here that isn't affiliated with a chain.

[Harold Mansfield]

Interesting.

I'm paying pretty much the same thing for the same coverage, and there is no maxing out of my coverage. As opposed to what I had before the ACA which was nothing because I couldn't swing the $1200 mo. payments for crap limited coverage.

Not sure why my experience is so different from everyone elses, but without the ACA I'd have no heath insurance.

[Fulcrum]

Not sure why my experience is so different from everyone elses, but without the ACA I'd have no heath insurance.

Don't worry Harold - they're coming for you soon.

[nealrm]

Interesting.

I'm paying pretty much the same thing for the same coverage, and there is no maxing out of my coverage. As opposed to what I had before the ACA which was nothing because I couldn't swing the $1200 mo. payments for crap limited coverage.

Not sure why my experience is so different from everyone elses, but without the ACA I'd have no heath insurance.

I don't understand. If you had nothing before, how can you be paying the same now? Or are you saying you were paying $1200 before and are paying that under ACA?

[Harold Mansfield]

Don't worry Harold - they're coming for you soon.

I'm more worried about a Trump presidency, and Republican Congress that repeals the ACA and things go back to the way they were. No insurance, no options, and insurance companies having absolutely no regulations what so ever that they have to actually provide service.

The ACA can be improved. Starting over would be catastrophic and the insurance companies are going to go on an all out money grab that will send us back to worse than it was before.

[Harold Mansfield]

I don't understand. If you had nothing before, how can you be paying the same now? Or are you saying you were paying $1200 before and are paying that under ACA?

No, I'm saying before the ACA I had nothing. Since the ACA I have insurance and I haven't seen any significant rate increase much different from any other insurance or service that I pay for.

[Brian Altenhofel]

The premiums are determined by age, health, and income. In some areas, there is only one company allowed to offer individual insurance plans - basically a government-sponsored monopoly. That's all the "Affordable" Care Act was about. There's a good reason why the insurance companies and pharmaceutical companies were the biggest lobbies for it.

[nealrm]

No, I'm saying before the ACA I had nothing. Since the ACA I have insurance and I haven't seen any significant rate increase much different from any other insurance or service that I pay for.

The premiums for ACA is capped by income. So if your income hasn't risen over the last few years the only thing that would happen is the subsidy would increase.

[turboguy]

I think for a few who have had serious health issues it has been a wonderful thing but for the majority who don't have serious problems and particularly for employers it has been a nightmare.

[Harold Mansfield]

I didn't say my premiums haven't risen. I'm just not seeing the outrages increases by 20%, 30%, and 50% that people keep saying. I've heard people tell me their premiums have doubled. I'm just not seeing it. Rates are only income based if you qualify for subsidies. Other than that you pay for it just like any other insurance and it costs what it costs depending on what you purchase.

One of my buddy's swears his rates have risen 500% (Which of course I don't believe, and before the ACA he had NO insurance), but also neglects to mention that in the last 3 years he got married, now has 2 step children, and has a different job and income than he had 3 years ago. But to hear him tell it his rates just increased for no reason and nothing in his life has changed and no one got any older.

Look, I obviously don't know everyone's specific situation, what state they're in, how old they are and so on. I'm just saying for me, I have no complaints. That doesn't mean you don't have something to complain about. That's personal to you.

I will say this, in all my years on this earth I don't remember any time when people weren't complaining about their insurance. I don't remember the years when everyone said it was great, coverage was 100%, insurance companies weren't screwing them over, they weren't constantly fighting with them over coverage, there were no horror stories of people dying because companies wouldn't pay for treatment, and premiums never rose. I just don't remember what decade that was because I never saw it.

What I do remember is the insurance industry being so bad and so corrupt that Hollywood made movie after movie about it. So I don't think people are remembering reality when they say it was better before. People are also comparing rates today to when they were 20 and single.

Most of those things are against the law now. So trade the dying for not being covered complaint with complaints about cost. Nothing is going to make everyone happy. But we can improve what we have if we work together.

[turboguy]

Up until the AFA we really were happy with our insurance and although it was a big expense we had great coverage, could afford to cover our employees families and really were fine with it.

Now just every year we seem to have more issues and have to cut back to afford it at all. We are paying the same money now as we did before but now everyone has to pay a lot more out of their own pocket.

Had we stayed with the same coverage our increases would have been 27% followed by 65% followed by 30%

They are telling us right now that next year we will be facing a real disaster unless we force some of our employees off the system who don't want to go off the system since they do qualify for medicare. If we don't do that we will be looking at an 80% increase.

[nealrm]

Why does everyone keep writing AFA instead of ACA?

The program does have it's good points. The clauses providing drop protection and elimination of pre-existing conditions are 2 of those most positive aspects. Those with big medical issues did see benefits from those under this program.

However, it has fundamental problems. The subsidies will cause prices to increase, subsidies always cause prices to increase. The way the system is setup, the amount the public pays will increase until a majority of the population pays the max amount allowed by the cap. The total cost (subsidies + user payment), will continue to increase after that. That is the nature of government subsudies.

There are enough other flaws in the program that the difference between improving and replacing is a matter of interpretation. But whatever you choose to call it, the current system shouldn't be allow to continue.

[turboguy]

You are correct and that was my mistake. It is the ACA. When I posted I had just had a long talk with my office people about how to deal with next years increase and was a little distracted. Either that or I was upset enough that I felt like swearing and thought of it as the Affordable F Act. :-)

[Brian Altenhofel]

drop protection

But if you are dropped for an allowed reason, you cannot be reinstated, even if the cause was a third party's error.

[nealrm]

But if you are dropped for an allowed reason, you cannot be reinstated, even if the cause was a third party's error.

yep - Like I said a lot of issues.

[Freelancier]

Since ACA, my rate increases have been -1%, 3%, 1%, 10% and I have basically the same coverage as before (in some instances much better, in some instances slightly worse). Before ACA, every year like clockwork, it was an 8-12% increase, year after year after year.

What changed? Insurance companies MUST spend 85% of their policy revenues on care or refund the money.

Who sets the rates? Not ACA. That's your state's insurance commissioner who is approving the rate increases and deciding which insurance companies can play in your market. If your state has few competitors in the market, that's up to your insurance commissioner to correct it. My state's commissioner is corrupt and a buffoon, but we had competition before he arrived, so he hasn't screwed it up too bad yet.

The reality is that low density population areas are going to have few choices, for the same reason you have few choices for grocery stores. Businesses go where they can find the most customers. And building out a health network of doctors in rural areas is not cheap or easy.

I'm still for single payer for a basic "bankruptcy insurance" health policy and then letting people buy supplemental policies to cover things over and above that. But our dysfunctional weirdos in Washington think that's "socialism". Sigh.

[nealrm]

Georgia rates have not increase as much as many other states. Interesting that Georgia has done everything they could do to not be part of Obamacare. However, 2017 looks to change that.


Four of the nine carriers that currently offer exchange plans in Georgia will exit the exchange at the end of 2016: UnitedHealthcare, Cigna, Aetna, and Harken (more details below).For the remaining exchange carriers, the following are the average rate increases that were requested (https://ratereview.healthcare.gov/#urrresults?U2FsdGVkX18d0K9TYWjsxmnvnfe3wZBhVobZ%2 Bc4g%2Bm4GVVnnyNS5lW4XJXAy7e91pVqA7yBDnWs2Gb4j1hIm lIXE9zrUjr8N5IYdPYMue1slIQyedHpfODXk1567pahk) and approved (http://www.myajc.com/news/news/obamacare-insurance-to-jump-by-double-digits-in-ge/nsLXm/) for Georgia’s exchange carriers:


Blue Cross Blue Shield of Georgia: Initially proposed 15.1 percent, but with Aetna’s exit, and the assumption that many of Aetna’s current enrollees will switch to BCBSGA, the carrier said they were reconsidering their rate proposal, and the possibility of filing a new proposal (http://www.northwestgeorgianews.com/rome/news/local/blue-cross-may-bump-up-rates-on-georgia-insurance-exchange/article_ef8d37d2-6634-11e6-98bc-ab5bc2ba87c1.html). Their new rate filing had an average rate increase of 21.4 percent (https://ratereview.healthcare.gov/#urrdetails?U2FsdGVkX1%2FlETFCp2COKhvJnUBz1N03fRsa c24pemk7IxPgB5XUh85KxySzrTSdHVsFVpda8uAu9spIFp6oCu LXm0gc01s9s%2FlX71aCguwX%2B5ZbGDJ1xkQH6H6qzYIxXhXm TEjqMv78jI6b%2BWi9GonTDdj31gwdx8DwV6k%2F8U0VdmKuw7 hwr1SmlxWvgxUPvVwO9q%2FKFvuw9ta1T6G8kWkTvQ%2F8SClq bYl6%2BkuEEh0VPZsci15BOd3xM0pnD0Q9), which was approved by regulators.
Humana: 67.5 percent (coverage area will be reduced (http://www.georgiahealthnews.com/2016/05/rates-insurance-exchange-soar-2017/) to Atlanta, Columbus, Macon, and Savannah areas); approved as requested, at 67.5 percent.
Kaiser Permanente: 18 percent requested; approved average rate increase is 17.6 percent
Ambetter from Peach State Health Plan: 7.4 percent to 8.3 percent requested, depending on whether dental/vision included; approved average increase is 13.7 percent.
Alliant: 18 percent (https://ratereview.healthcare.gov/#urrdetails?U2FsdGVkX1%2FAfLNTVKhbuqCRJiS1%2F%2Fpf iQXEIajXlPD5UDSIcrawVR5YTobdVtZTeg8cHUsWYaVe3u8Yqj Ycf3SZg%2FQ%2BqxkmfUvR2iirZ4DGmCA4JkEQQL4iO5tNzp08 %2FIiLO4sGRr3Et1xZr%2BGlI9zxlLNpdXUMURBHPBdL7UOZrQ %2BlP3R%2FUe0gNxaQtNaY3FgJu7Idez2grvpEqSs0AxHxKeBN LZ8BiGiWf1c9M0XKp8J6OT%2Bb67jLk6CtCyTM) requested; approved average rate increase is 21 percent

Source: https://www.healthinsurance.org/georgia-state-health-insurance-exchange/

[nealrm]

Who sets the rates? Not ACA. That's your state's insurance commissioner who is approving the rate increases and deciding which insurance companies can play in your market. If your state has few competitors in the market, that's up to your insurance commissioner to correct it.

Only partially correct. The ACA does have caps on amount a family can pay based on income. That is what the subsidies are for, to keep the payment down for a portion of the population.

Also the state insurance commissioner is not as powerful as you imply. There is a trade off between lower rates and the number of companies offering services. A free market is the best means of balancing that trade-off, but there hasn't been a free market in health insurance in decades.

[Brian Altenhofel]

Also the state insurance commissioner is not as powerful as you imply.

This.

Before ACA, insurance companies could use their entire national pool of insured to mitigate risks. After, they are limited to only using the pool within the state. That's why some insurance companies have been pulling out of lower population states.

The 85% rule is a joke. If I go to a larger population state, the price the insurance companies have negotiated with the pharmaceutical companies for my medications is often significantly lower. The 85% rule is also why some small independent pharmacies will sell medications to those who don't have or don't run insurance for only what they receive for the prescription (which, in my case, was often about the same as the copay). As an example, I can buy my asthma medication for $24 without insurance. With insurance, I have to pay a $20 copay and I get a statement in the mail later that say I received $237 in benefits.

[Brian Altenhofel]

Got my notice of a 75% increase as well as most area providers being out-of-network now, including trauma centers. Out-of-network services are not covered under out-of-pocket limits, by the way.

Like most Democratic Party policies, the "Affordable" Care Act is designed to benefit a few big corporations who are large party donors and hurt the working class.

[Harold Mansfield]

Got my notice of a 75% increase as well as most area providers being out-of-network now, including trauma centers. Out-of-network services are not covered under out-of-pocket limits, by the way.

Like most Democratic Party policies, the "Affordable" Care Act is designed to benefit a few big corporations who are large party donors and hurt the working class.

Is it true that Blue Cross is the only insurer in the state where you can purchase plans from the federal exchange? If so, that sounds less like Democratic Party polices and more like your state kind of sucks. How are you supposed to choose a plan from competitors when there are none?

In my state there's competition. What's up with OK?

And is this more than 10% of your income? If it is, that's also not right or legal. You're supposed to qualify for subsidies to keep your cost under 10%.
I'm less concerned with the price as I am the promise that this should not cost more than 10% of your income. There was never a promise that rates would never go up ever. That's unrealistic.

[turboguy]

From what I hear on the news the average increase for next year is 27%. It is renewal time for us. Our increase is about in that range. Overall our insurance premium was scheduled to go from $ 77,000.00 to $ 104,000.00. That is I believe 9 single coverage and two family, total 11 people. We are cutting our coverage again to keep the rates not too much more than last year.

[Brian Altenhofel]

Is it true that Blue Cross is the only insurer in the state where you can purchase plans from the federal exchange? If so, that sounds less like Democratic Party polices and more like your state kind of sucks. How are you supposed to choose a plan from competitors when there are none?

In my state there's competition. What's up with OK?

And is this more than 10% of your income? If it is, that's also not right or legal. You're supposed to qualify for subsidies to keep your cost under 10%.
I'm less concerned with the price as I am the promise that this should not cost more than 10% of your income. There was never a promise that rates would never go up ever. That's unrealistic.

They are the only insurer providing individual plans. There were more than five eight years ago. Because they cannot draw from the national pool like they could before, insurers have pulled out one-by-one. There were 3 left in 2014, and 2 left in 2015, but the second one shouldn't count (identical plans were 3x the BCBS rate - they were basically listing them to say they offered them). Low population and mostly rural makes the state rather high risk.

The ACA is working as designed. Create blessed monopolies, penalize those who work for a living.

Of course it's not more than 10% of my income for premiums. But before Obamacare, my total out-of-pocket (including premiums) would have amounted to ~4% of my income. Now I spend more than that on premiums with significantly less coverage and fewer "approved" medical service providers (doctors, hospitals, ambulances, pharmacies, etc). I had a hard cap on my out-of-pocket expenses before. Technically, I don't now.

[Freelancier]

I had a hard cap on my out-of-pocket expenses before.
You also had a system where the insurer could cancel you for any reason... like if you got sick and needed to use the policy more than they felt they wanted to spend. And then, because you were sick, no other insurer would touch you for any amount of money. Fun times!

[nealrm]

You also had a system where the insurer could cancel you for any reason... like if you got sick and needed to use the policy more than they felt they wanted to spend. And then, because you were sick, no other insurer would touch you for any amount of money. Fun times!

Safeguards preventing that are two of the good things that came out of the ACA. However, they could have easily been enacted, and likely with bi-partisan support, by themselves. As for the 10% limit, that is a joke. All it means is the premiums that are above 10% of your income are paid by the government using taxes paid by the people. Based on our current inability to pass a balanced budget, we might as well just pass a law say the all children are required to pay for health insurance for their parents.

Government subsidies always increase prices. It part of the supply and demand curve. Subsidies increase demand, which increase prices.

[Freelancier]

However, they could have easily been enacted, and likely with bi-partisan support, by themselves.
Sounds so simple, so please tell us the magic solution that does that without adding to the complaints that rates keep going up...?

[nealrm]

Sounds so simple, so please tell us the magic solution that does that without adding to the complaints that rates keep going up...?

Let see, you add in those protections and remove the garbage requiring coverage that many don't want or need. You allow selling across state lines and generally allow the free market to work. Something that hasn't been allowed in health insurance for decades. (No the prior system wasn't free market, it was no where even close). In addition, you up the contribution limits for HSA to the point that having only catastrophic insurance is an option.

There are already doctors and medical services that will accept lower cash payment in place of having to deal with insurance or medicare. That's true for even smaller communities like mine. Work to encourage those type of practices.

To help the working poor, add in a pre-withholding tax break to help pay for insurance with a check at filing to verify insurance was purchased.

[Brian Altenhofel]

You also had a system where the insurer could cancel you for any reason...

You can still get dropped (I was last year). And if an insurer drops you, they are not allowed to do business with you the rest of that year.

[Brian Altenhofel]

There are already doctors and medical services that will accept lower cash payment in place of having to deal with insurance or medicare.

Unfortunately, it's becoming an either accept insurance or don't environment for providers. Costs of compliance are forcing many providers who would often offer a "cash discount" into affiliation groups that require that cash rates be what the insurance companies negotiated as the market rate (even if providers never see the proceeds of most of that market rate).

[Harold Mansfield]

They are the only insurer providing individual plans. There were more than five eight years ago. Because they cannot draw from the national pool like they could before, insurers have pulled out one-by-one. There were 3 left in 2014, and 2 left in 2015, but the second one shouldn't count (identical plans were 3x the BCBS rate - they were basically listing them to say they offered them). Low population and mostly rural makes the state rather high risk.

This part needs to be fixed, and we can fix it. All it would take is for Congress to pay it some attention. They could lift this restriction by the end of the week.


Of course it's not more than 10% of my income for premiums. But before Obamacare, my total out-of-pocket (including premiums) would have amounted to ~4% of my income. Now I spend more than that on premiums with significantly less coverage and fewer "approved" medical service providers (doctors, hospitals, ambulances, pharmacies, etc). I had a hard cap on my out-of-pocket expenses before. Technically, I don't now.

I'm not questioning your cost because of course, how would I know. But I'm sure you weren't getting free preventative check ups, the protection of not maxing out your coverage, the protection of not being denied for pre-existing conditions, and your insurance company wasn't required to spend 80% on care. Those are new laws.

Look, just like every other thing in life we need to work on and fine tune the law. But before the law insurance companies were completely unregulated, people had no options to do anything about it, and people just died.

If you're still young or have never been seriously ill, that doesn't seem like a big deal yet. But for many people who's loved ones died because an insurance company dropped them when they needed them most, it is a big deal.

We need to fix what's wrong and keep what's good. Just like anything else.

[Brian Altenhofel]

the protection of not being denied for pre-existing conditions

I have a pre-existing condition. My pre-Obamacare plan had a rider for that condition (asthma). Medications were covered, and I rarely paid more than $10 for an inhaler (basically when I lost too many in too short of time). I had no limits on the number of refills for my nebulizer treatments or my rescue inhaler as long as they were prescribed. Now I have to get approval on some refills, and part of that is also determining whether the copay applies or if I have to pay full retail. That rider was the first thing to go away because offered plans had to be uniform under the law.

My plan then also covered all ambulance services, including air. Now, none are covered. Most area hospitals are out-of-network. Before, I had a plan where I had a 99% chance of a provider being in-network if I just walked in the door. Now it's down to around 15% (and those aren't taking new patients).

What good are free preventative checkups on a plan if there are no providers who can give the free preventative checkups? That "free" only applies in-network.

You can still max out Obamacare. The law doesn't say "no limits", it says "no unreasonable limits".

Unlike most of Congress, I did read the bill in it's entirety, including translating it's amending language into what the final codified law would be.

[Harold Mansfield]

I have a pre-existing condition. My pre-Obamacare plan had a rider for that condition (asthma). Medications were covered, and I rarely paid more than $10 for an inhaler (basically when I lost too many in too short of time). I had no limits on the number of refills for my nebulizer treatments or my rescue inhaler as long as they were prescribed. Now I have to get approval on some refills, and part of that is also determining whether the copay applies or if I have to pay full retail. That rider was the first thing to go away because offered plans had to be uniform under the law.

My plan then also covered all ambulance services, including air. Now, none are covered. Most area hospitals are out-of-network. Before, I had a plan where I had a 99% chance of a provider being in-network if I just walked in the door. Now it's down to around 15% (and those aren't taking new patients).

What good are free preventative checkups on a plan if there are no providers who can give the free preventative checkups? That "free" only applies in-network.

You can still max out Obamacare. The law doesn't say "no limits", it says "no unreasonable limits".

Unlike most of Congress, I did read the bill in it's entirety, including translating it's amending language into what the final codified law would be.

So is your position to go repeal the entire thing and go back to the way it was for EVERYONE because you personally liked what you had before?
Or is it that we can fix the parts that need it and keep the things that are good?

I'm all for ideas, but so far no one who is against the law in it's entirety has any. For 6 years I've been hearing "repeal and replace" but no one has even tired to come up with an actual solution to replace it with. Until there's something else to even suggest, you won't be able to just repeal it and leave millions of people hanging.

So I hear the complaints. Many are valid. I want things to work for everyone.
So, what's the solution?

[turboguy]

I don't think we can go back to what we had before but what we have now isn't working either.

Personally I think they need to attack the underlying problems.

One is the cost of healthcare which has become ridiculous.

Part of that is that Americans have become sue crazy. Juries feel like it is the evil insurance companies money and have no hesitation spending it. One lawyer I was talking to about doing some paperwork for me had to wait for a big trial. It was a case where a woman in Home Depot had a pipe fall on her foot. He ended up getting her 6 million dollars. I don't know what the state of her foot was but 6 million sounds ridiculous. His share would have been nearly 2 million. I question how much pain and suffering he had for his 2 million.

I have read that for each doctor who spends a few minutes chatting with you it takes 3 support people, mostly for the paperwork. If we made this all simple costs could be a lot lower. When I was 5, while learning to ride a bike i hit some gravel and fell and had blood gushing from my head. My dad called the Dr, and rushed me over and he put a staple in my head and charged us 10 bucks. Three years ago I was on the side of a trailer and fell over backwards with my head hitting a piece of gravel and blood was gushing and I went to the ER and they put a staple in my head and charged the insurance company $ 3,500.00. That doctor who put the staple in when I was a kid had no support people at all. There really wasn't much insurance available in those days. You just went to his office and waited your turn and the fees were low enough that no one thought much about it yet he still could afford the biggest house in town and vacations most of us could only dream about.

Why are many procedures 1/4 of the cost in other countries using the same equipment and US trained doctors. The problem may only in part be the ACA it could also be some of the underlying problems. Part of our problems might be that the majority of our politicians are lawyers.

[Harold Mansfield]

I don't know how we're going to cut the prices of things. Pharmaceutical companies are out of control. What can we do about that?
Legally restrict them? Is that fair? However is it fair that they charge us, in this country, more than the rest of the world?
I'm torn on that one.

And why can't medicare/medicaid negotiate the same as the VA?
Doctors were billing medicare for whatever. We got that down, but then people are complaining about that because less doctors want to service people with medicaid or ACA plans.

If we lower our costs by force ( law), the medical profession turns on us and moves on to better paying patients and insurance companies.

It's a catch 22 either way we turn and I don't have an answer for it.
Someone has to get screwed for us to get everything we want.

Who should it be?

[nealrm]

I'm all for ideas, but so far no one who is against the law in it's entirety has any.

I believe I did post a solution, one based on the free market but with some protection in place. As for the bit about people die, they still are. That hasn't changed. The out of pocket expense is now at $14,000 for a family. For the people you are talking about that is not any different than a million

I know that I am extremely glad I kept my non-obama insurance. I had my appendix out and a back issue, under Obamacare I would have been out $13,700 and the government would have been out over $12,000 for the subsidy. Of course I would have saved a full 1,200 over the year in premiums. Cost wise, the number are not working out.

[nealrm]

I don't know how we're going to cut the prices of things. Pharmaceutical companies are out of control. What can we do about that?
Legally restrict them? Is that fair? However is it fair that they charge us, in this country, more than the rest of the world?
I'm torn on that one.

Part of the problem, is that the US is subsidizing the rest of the worlds pharmaceutical research. Other countries have laws in place preventing the companies from passing the research cost onto the consumer. We need to stop that. My suggestion is that we place a tariff on all medicines going to countries with those laws. That tariff could then be used to provide care within the US or lower tax rates.

FYI - Cost control laws general don't work. The one that do, are extremely specific and limited scope. Even in those cause they work poorly at best. In this case, we would end up with a black market medical economy or people would just leave and get the better service in other countries.

[Fulcrum]

Welcome to government subsidized healthcare. We've got it up here and it has both its pros and cons. Ours isn't treated as insurance so the actual costs are harder to pin down yet annual budgets have healthcare as one of the top 2 expenses (education is second and both combined are over half of the budget).

As Ray pointed out, lawsuits and exorbitant costs are part of the problem, yet not the only problem. CEO's raising prices by 7000% because they can and then laughing at congress when questioned about it. Money managers and pension funds looking for guaranteed returns buying controlling interests and then raising rates to improve their balance sheet. Not to mention the cross-company ownership that has created ownership structures and congregations that anti-trust laws were created for.

I think Nealrm has one of the best solutions. Allow the free market to remain free and just have the government enforce some of the laws that are already on the books. I have no problem when those who truly need help receive it, but when that help becomes the standard for everyone than I start to ask questions that no one wants to answer.

[Bobjob]

To add to y'alls list of the issues I believe the tens of millions of illegal immigrants to this country over just the past 20 years has probably had a negative affect on the US's healthcare system.

[Brian Altenhofel]

Got my finalized premium. It's actually an 87% increase instead of 75%. I'm going uninsured. I would be paying more for insurance than I made as a department manager at Walmart 10 years ago.

If you want to reduce the cost of insurance, let consumers purchase insurance across state lines. Let the states establish and expand their own safety nets for those with low incomes.

One of the reasons for the higher increases in some states (like Oklahoma) is not expanding Medicaid within the state. Because of that, BCBS is having to also take on people who would be on Medicaid. But there's another side to the refusal to expand Medicaid here: we already have two programs funded by an endowment trust that have the funding available to expand to cover the new ACA classes. Because those classes could also be covered under Medicaid, USDHHS has to grant permission to cover those classes with a non-Medicaid program, and they refuse to grant that permission. Expanding Medicaid would require significant state revenue increases to fund, while covering those classes with already existing programs would not require revenue increases.

An option some people take is getting a non-compliant plan. In some cases, buying a non-compliant plan and paying the fine costs less than an ACA-compliant plan and provides better benefits.

I know many people who are having to come out of retirement to pay for health insurance. Before the ACA, they had plans that either had guaranteed flat premiums or guaranteed premium increase rates (similar to how term life insurance premiums work). After the ACA, those plans were considered non-compliant.

[Bobjob]

We received our new premiums, a 40% increase for the wife and a 27% for me. We are paying slightly over $1000 a month. Wish I could just put that money in some kinda health savings account. Then I could at least borrow against it if I needed to.

[nealrm]

I don't know if my insurance will continue on next year. The company is pulling out of the state, but I haven't received any formal notice.

I looks at the SH__care plans. For 25% more I can get less than half the coverage, none of my doctors are in the plans, the only company available is not one I would want to do business with and I lose my HSA. The partisanship of those supporting this joke is beyond belief to me. How you can take a problem, implement a "solution" that didn't resolve the base issue, caused a majority of the population problems, and still get the unconditional support of from some is what I just can't understand. Has logical thought and reason completely left the country?

[turboguy]

The other thing that is sort of frustrating is not only do I have to pay more for insurance but have to pay for my own health care basically. I just had my semi-annual physical and got the first of the probably 4 bills I will get. The bloodwork testing that used to be paid in full is now costing me $ 275.00 out of my own pocket. The one that was a bit ridiculous was the last time I went they gave me one printed sheet with about 12 questions where you check a box asking if I was depressed. Things like did I ever think I would be better off dead? The doctor looked at my negative responses for about 20 seconds and I got a bill for interpreting that questionnaire for $ 250.00 +/-. The bill for the same questionnaire last week is yet to come. My guess is my semi annual physical will cost me $ 1000.00 out of pocket for 15 minutes with the doc or less.

[nealrm]

I hear you. If I am forced to go with poorcare, I will probably set up a separate regular saving account the premiums and the $13,000 out of pocket expenses should I need it. I only hope that I can save that up before I need to use it...

[Freelancier]

Renewal just showed up. 2% increase. Last 3 years was +1%, -1%, +10%. Prior to 2013 when the law went into effect, it was 10-15% increase every year like clockwork.

It helps not to live in the middle of nowhere.

[Brian Altenhofel]

Renewal just showed up. 2% increase. Last 3 years was +1%, -1%, +10%. Prior to 2013 when the law went into effect, it was 10-15% increase every year like clockwork.

It helps not to live in the middle of nowhere.

OKC isn't exactly the middle of nowhere.

Before the ACA was passed, 3-4%/yr were my usual increases.

The ACA went into effect in 2010, by the way. Not all provisions have been implemented yet.

[nealrm]

These are the increases the were just improved in Georgia:
Alliant, 21 percent
Ambetter (Peach State), 13.7 percent
Harken Health, 51 percent
Humana, 67.5 percent
Kaiser Permanente, 17.6 percent.
Blue Cross / Blue Shield 21 percent

Why is your only 2%???? I checked those numbers again several sources, and they are being consistently reported. The reports do all carry a note similar to this however "Georgians whose incomes don’t change much could see their subsidies, or discounts, on exchange plans rise significantly, so the impact of higher rates may be softened, experts say."

Also - I'm less than a hour outside of the St. Louis metro hour, clearly not the middle of nowhere. Heck, except for some of the prairie states and Alaska, it's hard to find large area that would qualify as the middle of nowhere.

[Freelancier]

You might be looking at one particular type of plan's increases. We have high end insurance, so we're not paying $400 a year for it for a family of 4, our costs are closer to $1700 per month already and I'm happy to pay that considering the doctor costs we've run up in the past several years using the plan that the insurance company paid out on our behalf. So... 2%.

[nealrm]

The number were what the Georgia insurance board approved as an average premium increase. So I am guessing that some of the plans saw more than others. But since you saw 2% someone else would have to see a 40% increase to get a 20% average.

$1700 per month, wow. We are $600 under that with a grandfathered, non-Obamacare plan (family of 4). I'm glad that my plan has a HSA, it helps me save the deducible for when it is needed. I really wish that the HSA were pushed much, much harder. They would resolve a great many issues.

[Freelancier]

I have different motivations in my purchase of health insurance than many. I want as much as possible to be deductible on my taxes. Insurance co-pays and deductibles are not a tax deduction; premiums are. So I happily pay more for insurance premiums. A few years back, we could have a health reimbursement plan to move more of those expenses over to deductions, but the IRS changed the rules for a while. It's possible that might finally be back in play for my business, not sure until after my accountant gives me the "ok" next year, in which case, I'll change back to a high deductible plan and get the rest under an 100% reimbursement plan.

[nealrm]

Interesting, I will have to do some math and see if that works out better than using an HSA. HSA contributions are tax deductions and can be used for co-pays, deductibles and other non-covered medical expenses (vision, dental). Unfortunately, it can no longer be used for OTC medicines.

[Bobjob]

Has logical thought and reason completely left the country?

In my personal opinion you couldn't be more correct. Introducing emotion to decisions that should be made logically is what ruins everything.

[nealrm]

In my personal opinion you couldn't be more correct. Introducing emotion to decisions that should be made logically is what ruins everything.

If we could just figure out how to move people away from the extremes and make it so that comprimes isn't a bad word in politics. Maybe we should force the Congress and Senate to seat members by either state or last name and not by party. Then at least they would be forced to interact at some level.

In many ways, Obamacare is no longer about insuring that individuals get health care. It is more about who is right, with right being defined as either keeping or scrapping it. Really I don't care if they scrap it or just rewrite it so it works. We just need a system in place that encourages personal responsibility, provides a safety net for those that need it, has some protections in place for coverage and generally allows market forces to reduce cost to a minimum.

[Harold Mansfield]

Well, this was a great discussion but none of you will have to worry about it much longer. Trump and McConnell promise that fully repealing the ACA is the FIRST thing on the agenda. I'm sure things will be MUCH better and more affordable as soon as insurance companies can go back to maximizing profits and over providing actual coverage and care. Back to what we had. Not sure it's going to be as wonderful as everyone selectively remembers.

Next stop, privatizing social security.

[nealrm]

Interesting thing about companies maximizing profits over service, it's only possible when the government steps in and prevents competition. Completion does an extremely good job at keeping prices down and forcing companies to meet the needs of their customers.

[Harold Mansfield]

Interesting thing about companies maximizing profits over service, it's only possible when the government steps in and prevents competition. Completion does an extremely good job at keeping prices down and forcing companies to meet the needs of their customers.
Unfortunately that's not the way it was before. Time will tell. We won't have to wait long to see it things were as great as everyone remembers with all of this awesome competition and competitive pricing.

A few things that also get whacked as the ACA is repealed.

1. Protection against being denied because of a pre existing condition
2. Protection against coverage maximums
3. Requiring employers to provide insurance for full time hourly workers.
4. Free check ups
5. 24 million people will be instantly uninsured. That's 24 million less policies getting paid. Not sure how that makes it easier for companies to offer lower rates, but we'll see.
6. Hospitals will lose the funding that the ACA provided.
7. Insurance companies no longer required to spend 80% on care.

And that's not dramatics, those are things that exist now, that will cease to exist. But that's the way Americans voted, so nothing for me to do except ride the same bus as everyone else. Good or bad.

Before you call me an apologist and Liberal sheep, I'm not. I'm a fan of working together and fixing things that are repairable rather than tossing out all of the progress, when there is no plan in place going forward.

The ACA has a lot of good things that it's detractors benefit from everyday that I don't think are realizing they are going to lose with a full repeal. If not for them directly for someone in their family, their spouse with the pre existing condition, their kids.

Personally I have friends in the medical profession and one that sells to hospitals The thought of their hospitals losing funding is real and if so they're assed out. My good friend is disabled. The ACA has been a God send to help him literally survive. He's already living as lean as he can. If his benefits are changed...he now has to pay higher deductibles, prescriptions aren't covered anymore, and all of the things that the ACA provided that makes it possible for him to actually live and get care...he literally will not be able to survive here. He's eye balling Mexico and Canada as we speak just to stay alive.

These are real things and real people. Not politics and partisan trash talk.

It's like the old Seinfeld joke: No one ever remembers how hungry they were after they've eaten. I just don't remember the good old days of 7 years ago the way some people claim happened. I remember 30 years of people screaming for the government to do something because insurance companies were raking them over the coals. Hollywood made movies about people dying because insurance companies dropped them when they got sick. It was real. This was happening. I'm amazed how many people think going back to that is better.

Well, strap in cause they're about to get exactly what they asked for.

[nealrm]

Before we didn't have an open market for health insurance. The federal and state government actively prevented an open market and the competition that it would have allowed. I hope what ever replaces the ACA will avoid that and allow for a more open market. I also like very much that one of the focuses of the new bill is to be HSAs.

The ACA does have it's good points and it's repeal doesn't mean those will all go away. I expect that many of them will be incorporated into the next bill. However, many will disagree with several of the items you call "Good" point. Most would be better controlled by a free market, and one is nor related to the ACA.

I only hope that we get input from both sides and work out a compromise for this new bill. I will be very disappointed in the Republicans if they do the same thing the Democrats did with the ACA.

[Harold Mansfield]

Understand I'm not arguing with you, nor have any animosity or political statements. Just making points in the discussion.


Before we didn't have an open market for health insurance. The federal and state government actively prevented an open market and the competition that it would have allowed. I hope what ever replaces the ACA will avoid that and allow for a more open market. I also like very much that one of the focuses of the new bill is to be HSAs.

The ACA does have it's good points and it's repeal doesn't mean those will all go away.
Repeal means exactly that. Those things go away as soon as the repeal takes affect. The day of. And I'm confident that they will move swiftly on it to end as quick as possible. They've been waiting 7 years to do this. They're so obsessed over it that they ceremonially repeated 70+ votes to repeal it just so that they could keep dreaming about it.


I expect that many of them will be incorporated into the next bill. However, many will disagree with several of the items you call "Good" point. Most would be better controlled by a free market, and one is nor related to the ACA.

But you're hoping. There is no plan in place. Not even any suggestions. I've been hearing replace for over 5 years. Not one idea has surfaced yet of what to replace it with. We are literally throwing out the baby with the bathwater for "something" to be determined later.

History has shown us all that once it's gone, replacing will no longer be a priority. It took 25+ years to get the ACA passed. Orrin Hatch (R-UT), Charles Grassley (R-IA), Robert Bennett (R-UT), and Christopher Bond (R-MO). were trying to get it to the floor of the Senate back in 1993. ( Of course they went on to oppose it after Obama passed it). But people were talking about it for 20 years before that.

As slow as Washington moves, are you really confident that there will be a replacement quickly when there isn't one word on paper, not one idea, not even one agreed upon direction to even start with? Of course not. Once it's gone, it will cease to be a priority. Mission accomplished.


I only hope that we get input from both sides and work out a compromise for this new bill. I will be very disappointed in the Republicans if they do the same thing the Democrats did with the ACA.

I like hope, and maybe I've spent too much time in Vegas, but I put my money on logical probabilities based in facts, and history. I take one long shot a year, that there will a safety in the Superbowl, and I make that bet expecting to lose. Not hoping everything will magically go exactly as I need it to.

[Freelancier]

I think one of the issues is that people really really (I could repeat that a few more times to get the point across) do not understand the health insurance market and how it works.

Start with something as simple a concept to most people as "in-network doctors". They're cheaper because the doctors have contracts with the insurance company defining how much they get paid for different activities. Just try to imagine how much effort is involved in building and maintaining these yearly contracts with the doctors necessary to properly service a city of 1 million, 5 million people. We're talking hundreds and hundreds and hundreds of doctors and contracts. The contracts control how the doctor gets paid, how much, which plans the doctor can see as "in network", which plans are considered "out of network". There's a HUGE amount of effort involved in finding doctors in smaller towns who will take the insurance so that the insurance company can even start to sell plans to people near those small towns. That costs lots of money and effort. I know about this through a guy who actually has that job, finding the doctors and negotiating contracts with them.

So take the really cool mythical idea that an insurance company in Utah can sell across state lines to someone in Nevada. Do they have any doctors in Nevada that are "in network"? If not, higher co-pays and deductibles, making the sale much harder, meaning the insurance company won't stay in the market. The company might as well buy an insurance company who already has an established doctor network in Nevada, right? That's what they do now when they want to move into a new state. Just ask Anthem or Aetna or any of the conglomerates.

What about removing all "regulations" so they can sell whatever they want? So they can do things like not cover wellness visits, flu shots, colonoscopies, mammograms, exactly what they used to do before ACA. That leads to more sick people and higher costs for everyone. Oh, you want to have those things covered? That's a regulation, which is just a scary word for "rule". You don't want them covered but you want to keep everyone's costs low? Won't work, sicker people are more costly to cover, catching problems early through wellness visits saves lots of money overall.

I really really want Democrats to get out of the way of any attempt at "repeal" just so Republicans can own the ensuing mess and people can understand that their complaints were based on stupidity instead of reality and beg for a solution like they did in 2007-2008. A lot of thought and political horse trading went into ACA, even if you weren't in the room to see it happen. They didn't end up with the best possible outcome -- political compromise rarely turns out the absolute "best" result -- but they ended up ensuring 20 million more people than before ACA and that's no small feat. AND it ended up reducing costs to the government, also not a small feat.

I've written elsewhere I think we need to just increase the Medicare tax by 2% and use that to make sure everyone is covered with what would now be a "bronze" policy with a $5K deduction. Use Medicaid to close the deductibles and co-pay gap for poorer people, but everyone is covered from birth until death. If they want a different network or better coverage, they can buy it on the secondary market (like people who buy Aflac coverage). But that'll put three or four HUGE insurance companies out of businses and Congress won't do that so easily.

[nealrm]

Start with something as simple a concept to most people as "in-network doctors". They're cheaper because the doctors have contracts with the insurance company defining how much they get paid for different activities. Just try to imagine how much effort is involved in building and maintaining these yearly contracts with the doctors necessary to properly service a city of 1 million, 5 million people. We're talking hundreds and hundreds and hundreds of doctors and contracts. The contracts control how the doctor gets paid, how much, which plans the doctor can see as "in network", which plans are considered "out of network". There's a HUGE amount of effort involved in finding doctors in smaller towns who will take the insurance so that the insurance company can even start to sell plans to people near those small towns. That costs lots of money and effort. I know about this through a guy who actually has that job, finding the doctors and negotiating contracts with them.
Yet businesses somehow managed to do similarly complex things every day. Cable companies some how manage to run terms of millions of miles of cables so you can watch TV. There are thousands of phones towers in a city so you can get good phone reception, each of those with a contract. Feed miles, slaughterhouses, restaurant chains all require dealing with millions of people.


So take the really cool mythical idea that an insurance company in Utah can sell across state lines to someone in Nevada. Do they have any doctors in Nevada that are "in network"? If not, higher co-pays and deductibles, making the sale much harder, meaning the insurance company won't stay in the market. The company might as well buy an insurance company who already has an established doctor network in Nevada, right? That's what they do now when they want to move into a new state. Just ask Anthem or Aetna or any of the conglomerates. yet some how businesses manage to work across state lines. Is it really more difficult to service Kansas city Mo and Kansas city ks, than it is to service KCMO and St. Louis MO? Does it make any sense in some areas you can only select medical service on the right side of the street?


What about removing all "regulations" so they can sell whatever they want? So they can do things like not cover wellness visits, flu shots, colonoscopies, mammograms, exactly what they used to do before ACA.
All the plans I had before the ACA covered those and we're cheaper than the current ACA plans. So how did the ACA improve anything in that respect.


I really really want Democrats to get out of the way of any attempt at "repeal" just so Republicans can own the ensuing mess and people can understand that their complaints were based on stupidity instead of reality and beg for a solution like they did in 2007-2008. A lot of thought and political horse trading went into ACA, even if you weren't in the room to see it happen. They didn't end up with the best possible outcome -- political compromise rarely turns out the absolute "best" result -- but they ended up ensuring 20 million more people than before ACA and that's no small feat. AND it ended up reducing costs to the government, also not a small feat.

The problem is that the only compromise that occurred was within a group that generally shared the same ideas. Those with other ideas were excluded.

Until we stop this foolishness of not working towards a solution in the hope the other side will look bad, we will keep failing. The last election had 2 more people per thousand vote for Clinton over Trump. Neither side had a majority. Both sides need to remember that.

[Freelancier]

Cable companies some how manage to run terms of millions of miles of cables so you can watch TV.
Maybe you weren't around for all the cable company mergers that happened throughout the 80's and 90's and even now? Comcast was a small Philly cable operator back at the beginning, they didn't lay all that cable in Atlanta... they bought others who already set up systems.


Is it really more difficult to service Kansas city Mo and Kansas city ks, than it is to service KCMO and St. Louis MO?
You took a low density state example and turned it into a contiguous city example and expect me to respond?


All the plans I had before the ACA covered those
They did not. I paid a co-pay and deductibles for my wellness visit, had to pay $25 for a flu shot, had to pay for colonoscopy, etc. I never even saw a bill this time for my colonoscopy.


The problem is that the only compromise that occurred was within a group that generally shared the same ideas.
If that was true, why did it take over a year to happen? You might not have noticed that part with all the yelling going on.

[nealrm]

Maybe you weren't around for all the cable company mergers that happened throughout the 80's and 90's and even now? Comcast was a small Philly cable operator back at the beginning, they didn't lay all that cable in Atlanta... they bought others who already set up systems.
You missed the forest because of the trees. The point was that businesses already servicing large populations of customers. The logistics of serving large populations of customers is always complex, and overwhelming when viewed in it's entirety. However, business do it and do do it generally well.



You took a low density state example and turned it into a contiguous city example and expect me to respond?
Missouri is not a low density state. It is a good example because it falls almost dead center average. But if you want a high density example how about New York and Newark versus New York and Buffalo?



They did not. I paid a co-pay and deductibles for my wellness visit, had to pay $25 for a flu shot, had to pay for colonoscopy, etc. I never even saw a bill this time for my colonoscopy. Just because your plan didn't cover those doesn't mean the all plans didn't cover them. Mine did. Nor are those item's free today, all we did was change who pays the bill. Before you paid some upfront, now you pay more but do it via taxes.



If that was true, why did it take over a year to happen? You might not have noticed that part with all the yelling going on.
The ACA was proposed in July 2009 and signed by Obama in March 2010, 8 months. That is a lightning pace for a bill of that magnitude to get through congress. I realize that most liberals believe that there was compromise, but rejecting every single suggestion that came from the other side is not comprise.

[Freelancier]

You missed the forest because of the trees.
I specifically thought of cable companies when I made my first explanation, because how they have grown so huge mirrors almost exactly how insurance companies have gotten so large. You either buy the assets of a failing franchise or you buy the cash flow of a successful one; you don't start from scratch if you can help it, because it's a huge money suck for a few years until you build out the infrastructure. Maybe I'm just looking at the forest.


Missouri is not a low density state.
Your example was KC, KS + KC, MO. Not Missouri vs Kansas. So you've changed the example yet again, but still not addressing my explanation at all. As for different cities, right now if you want to be a "winning" health insurer in a state, you work as hard as you can to cover the entire state, so that you can get the lucrative corporate health buyers.


Nor are those item's free today, all we did was change who pays the bill. Before you paid some upfront, now you pay more but do it via taxes.
I don't know where you figure that taxes pay for my corporate insurance, but whatevs...


I realize that most liberals believe that there was compromise, but rejecting every single suggestion that came from the other side is not comprise.
Like Orrin Hatch's amendment to the bill in committee that all states starting with the letter "U" would be exempt? You know that was a thing, right? That's a serious suggestion?

I'm done. When someone starts bringing up "libruls", it's time to find something more productive to do.

[nealrm]

Clearly we are not going to agree on this. Once a conversation degrades to false accusations, it is time to close it out. This isn't yahoo.com, this is a civil forum.

[turboguy]

For those who really benefited from the ACA and are concerned about losing their coverage today Trump said one of the priorities of the new plan is insuring that those who could not get coverage before the ACA are still able to get coverage. Hopefully that won't change and you won't have anything to worry about.

[Brian Altenhofel]

Start with something as simple a concept to most people as "in-network doctors". They're cheaper because the doctors have contracts with the insurance company defining how much they get paid for different activities.

Several hospitals and other services have been dropped because the rate reductions the insurance company wanted after increasing premiums on consumers would have required more than 1/3 of staff to be laid off.

[Harold Mansfield]

The ACA was proposed in July 2009 and signed by Obama in March 2010, 8 months. That is a lightning pace for a bill of that magnitude to get through congress. I realize that most liberals believe that there was compromise, but rejecting every single suggestion that came from the other side is not comprise.

Actually the ACA is mostly based on legislation that Republicans were trying get passed back in the 90's.

In 1993, Republicans twice introduced health care bills that contained an individual health insurance mandate. Advocates for those bills included prominent Republicans who today oppose the mandate including Orrin Hatch (R-UT), Charles Grassley (R-IA), Robert Bennett (R-UT), and Christopher Bond (R-MO). In 2007, Democrats and Republicans introduced a bi-partisan bill containing the mandate.

Versions of the bill, supported by members of both parties failed to get a vote for years. There are 2 versions of it in 1993 that had 24 Republican co- sponsors. No Democrats.

In 2007 they tried again co sponsored by 7 Democrats and 9 Republicans. It failed to make it to vote again.

Here are the previous versions of the bill
2003- Consumer Choice Health Security Act (http://healthcarereform.procon.org/sourcefiles/senate_bill_1743_1993.pdf) (SB 1743)
2003 - Health Equity and Access Reform Today Act (http://healthcarereform.procon.org/sourcefiles/senate_bill_1770_1993.pdf) (SB 1770)
2007- Healthy Americans Act (http://healthcarereform.procon.org/sourcefiles/senate_bill_334_2007.pdf) (SB 334)
2009- Healthy Americans Act (http://healthcarereform.procon.org/sourcefiles/senate_bill_391_2009.pdf) (SB 391)
2009 ( the one that passed) Patient Protection and Affordable Care Act (http://healthcarereform.procon.org/sourcefiles/HR3590.pdf) (HR 3590) (

As Governor Mitt Romney instituted it in Massachusetts, it was passed in that state in 2006. At the time pretty much every Republican Governor and Representative traveled to MA to praise Mitt and how well it was working out for their state.

So this wasn't some new thing that was sprung on people. It was the product of Conservative think tank the Heritage Foundation, it was tested by a Republican governor at the state level and praised by all sides.

Now with that said, what were these suggestions that came from the other side that were rejected? And who suggested them? Maybe I'm remembering 7 years ago differently than you, but what I remember is the "other side" refusing to come to the table on it because they were confident they could defeat it because they had already promised to stop this President from doing anything what so ever. That's documented. McConnell said it on video.

When it passed is when I started hearing a bunch of whining from the same guys who supported it before about how they didn't have time to read it, and then started promising to repeal it. Since it passed they have refused to come to the table to update or fine tune it, and with EVERY budget have tried to defund it or kill aspects of it. They even went to court to try and kill it and the Supreme Court ruled 6-3 in 2015 that it was lawful.

Over the Past 7 years, Congress didn't vote 70 times trying to change any part of it, improve it, or implement their ideas. They voted 70 times to repeal it completely. Even with the 5 years of calls to "Repeal and Replace" I've still never seen ANY mention or ideas or action to replace it with what? Who's working on it? Is there a draft? Is anything written down what so ever?

So whatever ideas they claim they had, their actions don't say that they had any intention of implementing them..and they've had the Congress, the time and the votes to do it.

Like I said, maybe I'm remembering the last 8 years differently than you so I'm open and listening. If there's good ideas out there that the "Liberals" shot down that I somehow haven't heard about, I'd like to hear them.