6 ms·

I think this is the greatest obstacle to the "...and Replace" part of Repeal and Replace. The ACA was already the workable compromise.

by Fomite 10y ago

GiorgioG 10y ago
Workable politically, practically it's been completely ineffective in reducing healthcare costs.
- ejstronge 10y ago
  The ACA's goal was not to rein in healthcare spending (this potential shortcoming was discussed before it even passed). While there is funding for experiments aimed at reducing costs, none of the bill's major facets deal with this issue. Here's an article where one of the bill's intellectual architects talks about the topic: http://www.nejm.org/doi/full/10.1056/NEJMp1006571 http://www.nejm.org/doi/full/10.1056/NEJMp1006571
- deleted 10y ago
  [deleted]
- kapauldo 10y ago
  This is factually wrong. I have been providing health care for my employees since 2001. Pre ACA, rates rose 20% per year. Post ACA we've seen 5% raises most years, one year we saw a decrease, and this year, we saw 9%.
  - GiorgioG 10y ago
    Maybe on paper you're factually correct. My rates didn't go up this year ($1800/month) but my benefits went down costing me about $3,000 more than last year.
- jellicle 10y ago
  Actually, it has saved Americans trillions of dollars: http://fortune.com/2016/06/21/us-health-care-costs/ http://fortune.com/2016/06/21/us-health-care-costs/
gozur88 10y ago
Except that it wasn't workable. It was never financially sound and was doomed without additional funding for which the public was never prepared politically. It was rammed through Congress without a single Republican vote using a procedural trick, so politically the best play for the GOP was to let it fail and then hang the failure on the Democrats. I have no idea what Trump's plan is, but I hope whatever it is the Republicans don't play games with the GAO accounting and they also bring Democrats on board so both parties have a political stake in success.
- jljljl 10y ago
  What procedural trick? It received 60 votes in the Senate and a majority in the House.
  - gozur88 10y ago
    The final bill would not have survived a filibuster because the Democrats no longer had 60 votes. From wikipedia: "House Democrats had expected to be able to negotiate changes in a House-Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[165] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.[166][169][170] As per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.[171][172] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats' demands were budgetary: "these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."[169]" Despite the gloss the wiki authors put on it, this is highly irregular. It's within the letter of Senate rules, but if you're expecting to ever get cooperation from the opposition party this is not the sort of stunt you want to pull. I saw a headline that said something along the lines that the Republicans plan to repeal the ACA using reconciliation, which would be poetic if true.
chrisan 10y ago
> The ACA was already the workable compromise. At the time of Republican minority. Power has shifted to the Republicans and there can be a new "compromise"

I think this is the greatest obstacle to the "...and Replace" part of Repeal and Replace. The ACA was already the workable compromise.

by Fomite 10y ago

I think this is the greatest obstacle to the "...and Replace" part of Repeal and Replace. The ACA was already the workable compromise.

GiorgioG 10y ago

Workable politically, practically it's been completely ineffective in reducing healthcare costs.

ejstronge 10y ago
The ACA's goal was not to rein in healthcare spending (this potential shortcoming was discussed before it even passed). While there is funding for experiments aimed at reducing costs, none of the bill's major facets deal with this issue. Here's an article where one of the bill's intellectual architects talks about the topic: http://www.nejm.org/doi/full/10.1056/NEJMp1006571 http://www.nejm.org/doi/full/10.1056/NEJMp1006571
deleted 10y ago
[deleted]
kapauldo 10y ago
This is factually wrong. I have been providing health care for my employees since 2001. Pre ACA, rates rose 20% per year. Post ACA we've seen 5% raises most years, one year we saw a decrease, and this year, we saw 9%.
- GiorgioG 10y ago
  Maybe on paper you're factually correct. My rates didn't go up this year ($1800/month) but my benefits went down costing me about $3,000 more than last year.
jellicle 10y ago
Actually, it has saved Americans trillions of dollars: http://fortune.com/2016/06/21/us-health-care-costs/ http://fortune.com/2016/06/21/us-health-care-costs/

gozur88 10y ago

Except that it wasn't workable. It was never financially sound and was doomed without additional funding for which the public was never prepared politically. It was rammed through Congress without a single Republican vote using a procedural trick, so politically the best play for the GOP was to let it fail and then hang the failure on the Democrats. I have no idea what Trump's plan is, but I hope whatever it is the Republicans don't play games with the GAO accounting and they also bring Democrats on board so both parties have a political stake in success.

jljljl 10y ago
What procedural trick? It received 60 votes in the Senate and a majority in the House.
- gozur88 10y ago
  The final bill would not have survived a filibuster because the Democrats no longer had 60 votes. From wikipedia: "House Democrats had expected to be able to negotiate changes in a House-Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[165] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.[166][169][170] As per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.[171][172] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats' demands were budgetary: "these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."[169]" Despite the gloss the wiki authors put on it, this is highly irregular. It's within the letter of Senate rules, but if you're expecting to ever get cooperation from the opposition party this is not the sort of stunt you want to pull. I saw a headline that said something along the lines that the Republicans plan to repeal the ACA using reconciliation, which would be poetic if true.

chrisan 10y ago

> The ACA was already the workable compromise. At the time of Republican minority. Power has shifted to the Republicans and there can be a new "compromise"