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76  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 06, 2017, 01:01:24 am
Quote from: Amendment H7:03 by NC Yankee
b. The formula is as follows: y = 1 - (x - f(t))/2

 where x is the multiple of $12,000 that their annual salary amounts to and f(t) is the formula for determining the max subsidy cutoff as a function of age t. (f(t) = 0.0022*(t-20)^2 - 0.0291*(t-20) +1.66))

Sponsor Feedback: Origination
Status: Representatives have 24 hours to object.
77  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: August 05, 2017, 11:22:22 pm
Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

The CIEP is administered within AtlasCare and this bill does not set any cap.

So effectively any person with a pre-existing condition (since this bill does not contain a community rating provision) will be pushed onto AtlasCare?

Assuming the regions do nothing, yes. But the same goes for every other special group as well, not just those with preexisting conditions. I think it would be hard to do a community rating provision federally, especially since a particular region may just opt for having Atlascare as a single payer provider. Considering also that a particular region has to make the determination regarding the presence of an individual mandate, that pretty much means that future legislating on the manner of those with pre-existing conditions will be dealt with at the regional level.
78  General Politics / U.S. General Discussion / Re: Milestone for Trump: 1 million new jobs in six months on: August 05, 2017, 01:43:40 am
The scary part about reaching the top is that there is only one place left to go.




79  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: Preservation of our Future Act (Debating) on: August 05, 2017, 01:23:57 am
I would think that perhaps an amendment stating that the ultimate enforcement capability is entrusted with a specific agency. And then perhaps that agency or another makes the determination as to what constitutes such byproduct.
80  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 05, 2017, 12:28:32 am
Quote from: Amendment Offered
Section 1: Relationship with the Exchanges

1. AtlasCare shall be a federally administered, market competing public health insurance option, operated by the newly created AtlasCare Office (ACO) within sub-department of H&HS, within the Department of Internal Affairs.

2. AtlasCare shall be automatically provided in all of the Regional Exchanges unless a region opts out of AtlasCare for their Exchange, in which case the mandates in Part I, Section 2.1, shall apply in full to ensure that care remains available, as well as an option for subsidy recipients. AtlasCare will also be available in all regions as an option for active duty military, veteran healthcare and senior healthcare, and the other special groups as detailed in Part III, regardless of a regional opt-out.

3. If at any point a region, which had previously opted out of AtlasCare, fails to provide the regulated options as established in Part 1, Section 2.1, all citizens will be eligible to enroll in AtlasCare until such time as compliance may be obtained.

4. The AtlasCare administration will be tasked with acquiring the most extensive provider network possible while maintaining high quality standards and remaining cost competitive on the Regional Healthcare Exchanges relative to the cost of other providers. It may establish quality standards to ensure the protection of its insured populations. The AtlasCare administration is authorized to negotiate with all medical suppliers and providers to secure lower prices, including but not limited to prescription drug companies.
81  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: August 05, 2017, 12:23:36 am
Quote from: Part II, Section 1, Clause 4 of Current Bill NOT AN AMENDMENT
4. The AtlasCare administration will be tasked with acquiring the most extensive provider network possible while maintaining high quality standards and remaining cost competitive on the Regional Healthcare Exchanges. It may establish quality standards to ensure the protection of its insured populations.  The AtlasCare administration is authorized to negotiate with all medical suppliers and providers to secure lower prices, including but not limited to prescription drug companies.

Quote from: Part II, Section 1, Clause 4 of Current Bill NOT AN AMENDMENT
4. The AtlasCare administration will be tasked with acquiring the most extensive provider network possible while maintaining high quality standards and remaining cost competitive on the Regional Healthcare Exchanges.

Quote from: Part II, Section 1, Clause 4 of Current Bill NOT AN AMENDMENT
4. remaining cost competitive on the Regional Healthcare Exchanges.

Frankly I am of a mind to keep the text as simple as possible for the sake of the game and for the program's efficacy.

But I will be offering an amendment to clause one of this particular section in the House and I will repost it here for Scott or someone to offer.
82  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 04, 2017, 11:51:58 pm
I forgot to post this this morning, but "Sponsor has 24 hours (already commenced) and members have an additional 48 hours beyond that offer responses.
83  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 04, 2017, 11:45:55 pm
Quote from: Amendment Offered
b. The formula is as follows: y = 1 - (x - f(t))/2

 where x is the multiple of $12,000 that their annual salary amounts to and f(t) is the formula for determining the max subsidy cutoff as a function of age t. (f(t) = 0.0022*(t-20)^2 - 0.0291*(t-20) +1.66))

Offering this because PiT is absent minded. Tongue
84  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: August 04, 2017, 11:37:41 pm
The AtlasCare portion of this legislation is insufficiently detailed to actually model its impact on coverage, the budget, and the economy. Particularly, the premium structure of the program must be established. If passed as written, there will be no premiums which means there will be no more private insurance. Also, no mechanisms for cost control or consumer discipline.

Beyond that, previous public option proposals scored by the CBO have assumed the public option was designed to financially support itself. If we are financing this with a large new payroll tax increase, then that's different and will need a full and thorough evaluation of its budgetary, health, and economic impact. The question also needs to be asked if our program will more closely resemble FEHB or Medicare.


Atlascare will be charging premiums. It has to compete on the exchanges and there is no other way it could. I am fine with modifying Part 2, Section 1, to make that more clear.

The subsidy and revenues are in Part I and the public option is in Part II for a reason. That is because we are separating the program from money. The AtlasCare program will have to pay for providers at competitive rates and have to compete for customers on the exchanges ( unless a region gives them a monopoly). Eitherway, Atlascare is not getting a dime of this subsidy money directly, the money follows the consumer. Like with Food Stamps. Even when it comes to Seniors, they are not getting the money directly. So the fear that because of this bill, "private insurance" will die if Atlascare doesn't charge premiums, is unfounded. Atlascare will. I am crazy, but I am not stupid. Tongue I don't want any complacency in the healthcare system, I want everyone striving for quality and lower costs. That goes for government just as much as it does for the private sector.

That is because most of the crap score by CBO is made by, for and of centralist loving fixers. Our program is trying to get a good portion of healthcare back to the regions, and encourage regions to come up with diverse alternative insurance arrangements to compete with Atlascare, which in turn acts as a fallback (especially for seniors, vets etc), in case a regions smokes some weed and just chills for the next six months and doesn't do anything.

A lot of funding is being transferred over from existing funding mechanism that is the case for all of the seniors, vets, etc, and the portion of the poor covered by Medicaid/CHIP/etc. Beyond that it inherits prexisting funding streams. I didn't consider 2.5% to be a "substantial" increase from 1.75%, but that being said, I am not thrilled with the payroll tax option, just like I wasn't thrilled with it when we had to fund Fritzcare after the fact, back in 2011, but it was the only option available. We have more flexibility this time, because taxes are not as high and our initial program and implementation creates a program that is less expensive and reduces costs for the regions as well. So I am open to alternative funding options if someone can come up with a plausible that people will support in both chambers.

As for what this "resembles" I don't know what the FEHB is and this is not like Medicare. Once again, the money follows the patients to either Atlascare or another option. With Medicare it goes directly to the program and the program provides the coverage assuming you can find a doctor taking new Medicare patients.

It is also not like Medicaid either, since Medicaid doesn't charge premiums (though it can take your estate if you are on it long enough). And Medicaid has even worse problems with finding a doctor.
85  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: August 04, 2017, 11:06:37 pm
Who is in charge of determining admission to the CIEP? Is there any cap on CIEP funding? I ask because most examples of these kinds of pools eventually failed due to lack of funding, and because I'm concerned about the moral hazard involved with insurers having free license to effectively kick anyone over into the pool.

The CIEP is a program within Atlascare itself. So the Atlascare office would be in charge of it.
86  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: August 04, 2017, 06:17:45 am
I will also note once again that once we reform the public health care, it will be necessary to then pursue with reforms to other aspects of health care including but not limited to:

1. Delivery
2. Medical Records
3. Technology
4. Tuition Inflation
5. Malpractice Liability
6. Drugs
7. Mental Health

These will best be handled in subsequent bills and if attempted here would make this bill too large and complex.
87  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Health care... (Debating) on: August 04, 2017, 06:17:03 am
I will also note once again that once we reform the public health care, it will be necessary to then pursue with reforms to other aspects of health care including but not limited to:

1. Delivery
2. Medical Records
3. Technology
4. Tuition Inflation
5. Malpractice Liability
6. Drugs
7. Mental Health

These will best be handled in subsequent bills and if attempted here would make this bill too large and complex.
88  Atlas Fantasy Elections / Atlas Fantasy Elections / Re: Single Payer Now on: August 04, 2017, 05:59:56 am
Would it really be Atlasian healthcare reform without walls of text?

Been trying to minimize that throughout this project, with mixed results Tongue

I support this. As a citizen I wouldn't want to deal with something other than single payer. 

x Poirot



Of what benefit is there to the game for such a policy that provides no reoccurring playability, when there is a path that has the potential to enrich the game as well as to be a good policy decision. 
89  Atlas Fantasy Elections / Atlas Fantasy Elections / Re: Single Payer Now on: August 04, 2017, 05:56:11 am
Deeply concerning that your much-vaunted healthcare reform plan has not determined the status of Atlasia's single largest insurer.
Well I think that considering how important it is, that we don't just dump seniors into a new program without concern for how they will be effected by it or what not. We have been focusing on the core of the program, it makes no sense to arrange a process to integrate seniors into a program where the core portion of it still needs improvement.
This bill's been in the process since December. No plan for whether or how your plan will interact with the largest single group of policyholders—especially the ones that account for the largest share of healthcare costs—seems to me like a pretty grave oversight.

Scott's bill hit the floor in December, yes. But our group discussion and the present project didn't really start until Feb/March. That is when I created the google Doc we have been working off of.

And no it was not an oversight. We were debating whether or not the game could handle a discussion of a healthcare plan complex to the point that Medicare was included, or kept separate and only changed minimally. The final decision was made at the end of June and the text for it composed in July.

And yes we all would have preferred it been finished two/three months ago. Scott, PiT and I have RL obligations and especially in the case of PiT and myself made us all getting together rather difficult. So determinations on how to handle certain items took weeks longer than expected.

I don't believe in monopolies be they gov't or privately owned. I prefer people to have options, because if don't it is a license to being treated like crap, with low quality and higher prices.
That's why I support single-payer, which would allow any individual to freely choose among any participating provider.

Assuming there are multiple participating providers, which is not a certainty. And if there isn't, you are a screwed.

They don't "disappear." They are mitigated. Only a universal system can entirely eliminate the cost of uncovered care, by ensuring that all people have coverage. By making coverage cheaper, you reduce that burden—but only single-payer eliminates it.

We provide a sliding scale subsidy to those who cannot afford it and to the middle class. If a region wants to, it can pass a mandate that people have to buy Atlascare in their region, but even without that, you seem to think our proposal is AHCA or some other crapsh**t from the RL Republicans. Do you honestly think Scott would support a program like that? It has a public option and a generous subsidy.

The sliding scale subsidy we had in the 2014 bill covered people 100% of premiums up to 150% of the poverty line and slowly tapered downward from there. The reason it is taking so long now, is because we are trying to factor age into the subsidy.

The gap between "universal access to purchase health insurance on a sliding scale" and what I want is pretty significant.

Then by all means, push your region's legislature to supplement the sliding scale to 100% at all income levels and only allow AtlasCare on the exchange.

ok, these are all great things that don't conflict with single-payer at all.
But Single payer does not address them, but yet forces the healthcare system to eat the cost of them with no reimbursement. And I have seen this game, passing education reform is hella difficult and no I don't think that Senate bill is going to do much to address tuition inflation either.
Sure, but that's no change from the status quo, and failing to improve the material circumstances of millions of people because the Senate is dysfunctional is a poor reason to vote against something—particularly when the leadership of both chambers is involved in this process.

In this equation I am not the one failing to improve the material circumstances of millions of people. The one pushing a system that will be forced to amputate arms and limbs to contend with costs of an entirely different industry is. Those arms and limbs will come in the form of denied coverage or reduced quality of care.

So you are going to reduce costs by having one consumer of healthcare (thus maximum negotiating power to dictate price), but the number of doctors won't decline?

Studies have estimated a decline in GDP that is going to healthcare from 17% to 12% or 13%. That is not chump change my friend, that is hundreds of billions of dollars and that is far more than "Insurance company profits". Where is that money coming from? Or where do you think it is going to now? Lets say 20% is profits, the rest is going to paychecks, and/or cost of doing business from the cost of supplies to the cost of liability insurance to the cost of rising tuition.

Single payer takes a sledge hammer to the healthcare delivery and provider system, which is already struggling to cope with demand, to drastically reduce costs. It is the only way it can possibly achieve the kind of cost cutting you envision from Single Payer.
It's not "insurance company profits," it's insurance companies themselves, and all the paperwork and layers of administration that come with the system we have now. Physicians in ambulatory care, for instance, spend nearly twice as much of their time doing paperwork as they do actually meeting with patients. The vast reduction in paperwork alone would create substantial cost and time savings—around $371 billion.

Another significant portion of cost savings would come through eliminating unnecessary treatment by catching illnesses earlier. An increase in preventive care, per estimates, could result in net savings of up to 40%. By expanding access to preventive care, you create significant cost savings by reducing long-term spending on other forms of healthcare. I doubt it'll reach that 40% number, but that's still hundreds of billions more on top of the hundreds of billions you already saved through reducing bureaucracy.

Still eliminating a lot of jobs and that "saved time" will be cashed in by bureaucrats in the form of reducing the number of ambulatory care providers, since they will be desperate to make up the immense sea of red ink. And the single payer system will itself inundate providers with paperwork, so that too is going to be no change from the current system.

Oh I fully agree with preventative care. That is why we went to great lengths to ensure access to preventative care and one of the few mandates on that regions is they must maintain an preventative care provider on their exchange at all times. It is also covered in AtlasCare itself.

And once again, I will never vote for any bill that condemns people to any sort of monopoly of any form be it public or private. Be it healthcare, banking, power, or anything else. Monopolies turn customers into enslaved consumers of an entity that has no need to take responsibility and a large pool of money to buy and corrupt gov't officials.
And I won't vote for any bill that fails to guarantee to all people, regardless of their socioeconomic status, their fundamental right to healthcare.
[/quote]

I think we should focus our limited resources on helping those who need it most rather than wasting resources offering free care to Donald Trump and Bill Gates.
90  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HR 1133 - Joint Resolution Commemorating Southern Heritage (Final Vote) on: August 04, 2017, 04:23:45 am
AYE
91  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HB 1135 - Prescription Drug Transparency Act (Final Vote) on: August 04, 2017, 04:23:21 am
AYE
92  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Currency of Atlasia Act (At Final Vote) on: August 04, 2017, 04:21:27 am
A final vote is now open on this legislation, Representatives, please vote Aye, Nay or Abstain.
93  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: Atlasian Aid Protection Act (At Final Vote) on: August 04, 2017, 04:19:05 am
AYE
94  Atlas Fantasy Elections / Atlas Fantasy Elections / Re: Candidate Declaration Thread on: August 04, 2017, 04:17:19 am
I am filing to run for reelection to the Atlasian People's House of Representatives
95  Atlas Fantasy Elections / Atlas Fantasy Government / Re: SB 2016-047 - Universal Healthcare and Affordability Act (Debating) on: August 04, 2017, 03:52:03 am
Reposting this here.

So before people go crazy let me state clearly what does this.

1. Expands Regional Involvement in Healthcare.

- It is easy to write up and bill and have Nyman make all decisions and both Conservatives and Liberals have presented plans that do just that. Aside from the subsidy, a few minimal regulations and public option (which I will explain later, so please hold off the guillotine), most every major decision regarding the nature of the healthcare system will and can be determined by the Regional Governments. This will therefore stimulate discussion and activity and regional elections by having elections of real consequence at that level. This will include but is not limited to the decision of whether or not to have single payer/individual mandate. With the passage of this bill, that will become a regional decision.

It is important to consider healthcare as an issue, but it is also important to remember that this is a game and the things we do policy wise should stimulate the game and the regions, not shut them down.

2. Yes there is a public option in this bill. But guess what, we already have public Option(s) and the "s" is important. Depending on which special group you are, you have your own little siloed public option. This bill takes all those public options and consolidates them into one federal public option, and paves the way (if a regional opts for such) for everyone to have alternatives. This means that seniors, vets, the poor, will now have greater access to choice and quality healthcare, will preserving the important promises we have made to our seniors etc.

3. Replacing the multitude of public options with one public options enables us to eliminate a metric f@$kton of government programs and offices that will now longer be necessary, or to trim down others that will remain with a smaller objective.

4. This is the Middle Ground on healthcare between a one sized fits all, top down program, and the real life healthcare situation which I think everyone agrees is a mess. It borrows from non-single payer systems that still ensure universal access like Germany, expands the degree of local control and expands the competition and choice to greatest number of healthcare consumers. In the process of doing so, it consolidates the roll that Nyman plays in healthcare, bringing simplicity, lower cost and higher quality to those who currently depend on Medicare, Medicaid, the VA, etc.

5. This was a massive bipartisan effort and there are elements that all sides can get behind. I am especially grateful for the hard work and patience (especially patience) of Senator Scott, as well as the contributions of Senator PiT (whose math skills were invaluable), President Dfw, Vice President Goldwater and numerous, numerous others. I also want to do like wise for former and hopefully soon to be Representative Potus, who while probably not thrilled with the overall proposal, some of his recommendations from his proposal this spring are present or shaped similarly to those he proposed, including untaxed HSA's and the incorporation of age into the formula was inspired by his use of age along with income in his tax credit proposal.

96  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 04, 2017, 03:48:36 am
So before people go crazy let me state clearly what does this.

1. Expands Regional Involvement in Healthcare.

- It is easy to write up and bill and have Nyman make all decisions and both Conservatives and Liberals have presented plans that do just that. Aside from the subsidy, a few minimal regulations and public option (which I will explain later, so please hold off the guillotine), most every major decision regarding the nature of the healthcare system will and can be determined by the Regional Governments. This will therefore stimulate discussion and activity and regional elections by having elections of real consequence at that level. This will include but is not limited to the decision of whether or not to have single payer/individual mandate. With the passage of this bill, that will become a regional decision.

It is important to consider healthcare as an issue, but it is also important to remember that this is a game and the things we do policy wise should stimulate the game and the regions, not shut them down.

2. Yes there is a public option in this bill. But guess what, we already have public Option(s) and the "s" is important. Depending on which special group you are, you have your own little siloed public option. This bill takes all those public options and consolidates them into one federal public option, and paves the way (if a regional opts for such) for everyone to have alternatives. This means that seniors, vets, the poor, will now have greater access to choice and quality healthcare, will preserving the important promises we have made to our seniors etc.

3. Replacing the multitude of public options with one public options enables us to eliminate a metric f@$kton of government programs and offices that will now longer be necessary, or to trim down others that will remain with a smaller objective.

4. This is the Middle Ground on healthcare between a one sized fits all, top down program, and the real life healthcare situation which I think everyone agrees is a mess. It borrows from non-single payer systems that still ensure universal access like Germany, expands the degree of local control and expands the competition and choice to greatest number of healthcare consumers. In the process of doing so, it consolidates the roll that Nyman plays in healthcare, bringing simplicity, lower cost and higher quality to those who currently depend on Medicare, Medicaid, the VA, etc.

5. This was a massive bipartisan effort and there are elements that all sides can get behind. I am especially grateful for the hard work and patience (especially patience) of Senator Scott, as well as the contributions of Senator PiT (whose math skills were invaluable), President Dfw, Vice President Goldwater and numerous, numerous others. I also want to do like wise for former and hopefully soon to be Representative Potus, who while probably not thrilled with the overall proposal, some of his recommendations from his proposal this spring are present or shaped similarly to those he proposed, including untaxed HSA's and the incorporation of age into the formula was inspired by his use of age along with income in his tax credit proposal.
97  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 04, 2017, 03:30:32 am
Quote from: R&RPHA Continued
Quote
Part III: Transition Periods and Coverage for Special Populations

Section 1: Transition for Medicare and Medicaid[/b]

1. Recipients of Medicaid and the Children’s Health Insurance Program will be transitioned over in an orderly fashion, administered by the H&HS Sub-Department, into AtlasCare program, with their premiums, co-pays and deductibles subsidized 100%, under the premium subsidy established and paid for in Part 1, Section 2.3. All those who were eligible for the expansion of these programs under the ACA, will be eligible for this provision regardless of whether the state or Region took the voluntary expansions or not.

2. Medicare Recipients will be transitioned over in an orderly fashion, administered by the H&HS Sub-Department to the equivalent parts of Atlascare, from the equivalent parts of Medicare that they are presently enrolled.

3. All Federal government employees will be transitioned to AtlasCare by January 1, 2018, including members of Congress and the President. With the present healthcare programs for said people abolished under the oversight of the Department of Internal Affairs.

4. The Department of Internal Affairs will be responsible for directing, supervising and effecting this transition by the date of January 1, 2018. The Department shall work with its subordinates and regional authorities to ensure coordination and ensure that there are no lapses in services for the recipients of Medicare, Medicaid and similar programs.

5. Once the transition has been completed, the Department of Internal Affairs, shall direct for the elimination of unnecessary administrations, offices, and sub departments that are no longer required subsequent to this transition.

Section 2: Coverage for Special Populations

1. All active duty military personnel shall be eligible for full coverage under AtlasCare, fully paid for by the Defense Health Agency, of the Sub-Department of Defense, within the Department of State, with no premiums, co-pays or deductibles.

2. All Veterans shall be eligible for full coverage under AtlasCare, with no co-pays or deductibles, with subsidies for premiums as described in Part 1, Section 3 of this Act.  Cost normally associated with co-pays and deductibles shall be covered by the government through the Veterans Benefits Administration.
  
3. A “veteran” is defined for the purpose of this section as any person who served on active duty in the armed forces of Atlasia and received an honorable or general discharge.

4. Upon the completion of this transition of Veterans and Activity Duty Military to the Atlas Care program, with AtlasCare expenses covered by the VBA and Defense Health Administration, the Department of State shall subsequently review and direct the elimination of unnecessary administrations, offices and sub-departments that are no longer required subsequent to the transition.

Section 3: Pre-existing Conditions and High Risk Populations

1. A Comprehensive Insurance Equality Pool (CIEP) shall be established within AtlasCare so that those with pre-existing conditions can receive affordable care without discrimination.  Those with pre-existing conditions or other factors such as age or gender which may increase risk to health or risk of health related cost shall be covered under AtlasCare at the same cost to the consumer as those without these conditions.

2. The CIEP shall be subsidized out of funds derived from the same revenue provided for the health subsidy in Part I, Section 2.3, clause e, to the extent necessary to achieve cost parity to the consumer.

3. The CIEP shall have open enrollment periods determined by the AtlasCare Health Directorate.  Those with changes in condition or subject to increased premium cost at their current insurance provider may enroll in the high risk pool program through special enrollment so long as they have maintained coverage through AtlasCare or another insurer prior to such change in condition.

4. A Risk Adjustment Program will be established to involve private providers with annual net income greater than $50 million. Plans with lower actuarial risk will make payments to plans with higher actuarial risk to adjust for variation in distribution of high risk patients. This program will be administered by the Health Resources & Services Administration.

Sponsor: NC Yankee
Co-Sponsors: Fhtagn and JGibson
House Designation: HB 1140 I think
98  Atlas Fantasy Elections / Atlas Fantasy Government / HOUSE BILL: The Reforming and Regionalizing Public Healthcare... (Debating) on: August 04, 2017, 03:28:48 am
Quote
House Bill
To reform and regionalize the public healthcare system by creating a uniform public healthcare option, while devolving major regulatory authority to regions and ensuring universal access to healthcare regardless of income or age.


Be it enacted in both Houses of Congress Assembled,
Quote
This Bill is to be Entitled: The Reforming and Regionalizing Public Healthcare Act of 2017

Part I: Health Care Marketplace

Section 1: Regionalization


1. All present healthcare exchanges are abolished as of January 1, 2018.

2. Three new exchanges will be created and administered by the Health & Human Services (H&HS) Sub-Department, within the Department of Internal Affairs, with jurisdictions matching those of the three Regions. The H&HS Sub-Department will coordinate with regional officials during the setup and implementation process, and hand over administration and regulation of the new exchanges on January 1, 2018, to the respective Regional Government

3. All Federal restrictions on the access to these markets will be abolished as of January 1, 2018, including but not limited to the sale of insurance across regional lines.

4. On that date, the Regions will become the primary regulator of access onto their market and responsible for determining the nature and structure of healthcare providers allowed onto the exchange to compete, provided all terms of this act and federal law are complied with.

5. Should a region’s legislature fail to act by the above date, the H&HS Sub-Department will continue to administer the exchange until such time as the Regional Government is able to assume control.

Section 2: Coverage
1. Minimum Coverage Requirements


a. Preventative Care: Every exchange must offer at least one provider that covers preventative care, be it in the form of a private insurer, co-op or public health care benefit. Preventive care shall be defined as care related to disease prevention, early diagnosis and health maintenance, including clinical examinations, immunization, prenatal care and medically indicated screenings.

b. Each exchange will be required to have at least one provider that covers catastrophic and emergency room care.

c. AtlasCare must be available to all populations mentioned in Part III of this Act.

d. All other mandates on either citizens or healthcare providers will be the responsibility of the regions.

2. Health Care Savings Accounts

a. Individuals and Households may establish Healthcare Savings Accounts (HSA) with unlimited tax free contributions. Employers may also set up these accounts for their employees, with any matching contributions also tax free.

b. The money in these HSAs must be used for healthcare and healthcare related expenditures. No prohibitions will exist on the use of this money for any healthcare or healthcare related expense, including insurance premiums. The money will also be carried over from year to year.

c. The money in these accounts will be invested as a reasonable, sustainable rate of growth and insured in its full amount, by the Federal Government, under the FDIC.

d. All contributions by an individual to their HSA, made during the course of the year will be tax deductible.

3. Subsidized Health Care Coverage

a. Healthcare Insurance will be subsidized in accordance with a sliding scale subsidy based on age and income in relation to a maximum of $12,000 annually, indexed to Health care inflation.

b. The formula is as follows: y = 1 - (x - f(t))/2

where x is the multiple of $12,000 that their annual salary amounts to and f(t) is the formula for determining the max subsidy cutoff as a function of age t.

c. The formula will be applied towards the premiums, co-pays and deductibles of  qualifying providers, as determined by those who comply with all provisions of Federal and applying regional regulations, on the exchanges, as established in Section 1.

d. Anyone who doesn’t have a qualifying insurance program for any period of time, will have the subsidy distributed to a Health Savings Account, as established in Section 2, Part 1, subject to further regulation by the regions.

e. The subsidy will be paid for using the existing revenues for the Affordable Care Act, Medicaid and Medicare. The Medicare Payroll Tax will be renamed the Health Care Payroll Tax and increased from 1.45% to 2.50% on employees and employers, for a total of 5%.  

f. The subsidy shall be administered with the H&HS Sub-Department by the newly created Healthcare Subsidy Office (HSO).

4. Prescription Drug Out-of-Pocket Monthly Cap

a. Each family or individual who legally resides in the Republic of Atlasia shall receive a tax credit for full compensation of any monthly amount for which prescription drugs exceeded $250 in out-of-pocket costs.

b. These tax credits will be paid for using the existing revenues for the Affordable Care Act, Medicaid, and Medicare.

Part II: AtlasCare

Section 1: Relationship with the Exchanges

1. AtlasCare shall be a federally administered public health insurance option, operated by the newly created AtlasCare Office (ACO) within sub-department of H&HS, within the Department of Internal Affairs.

2. AtlasCare shall be automatically provided in all of the Regional Exchanges unless a region opts out of AtlasCare for their Exchange, in which case the mandates in Part I, Section 2.1, shall apply in full to ensure that care remains available, as well as an option for subsidy recipients. AtlasCare will also be available in all regions as an option for active duty military, veteran healthcare and senior healthcare, and the other special groups as detailed in Part III, regardless of a regional opt-out.

3. If at any point a region, which had previously opted out of AtlasCare, fails to provide the regulated options as established in Part 1, Section 2.1, all citizens will be eligible to enroll in AtlasCare until such time as compliance may be obtained.

4. The AtlasCare administration will be tasked with acquiring the most extensive provider network possible while maintaining high quality standards and remaining cost competitive on the Regional Healthcare Exchanges. It may establish quality standards to ensure the protection of its insured populations.  The AtlasCare administration is authorized to negotiate with all medical suppliers and providers to secure lower prices, including but not limited to prescription drug companies.

Section 2: Components of AtlasCare
1. Eligibility and Benefits


a. All Atlasian citizens are eligible for coverage under AtlasCare, entitling them to public, quality standard of care.

b. The health care benefits under AtlasCare cover all medically necessary services, including at least the following:

  • Primary care and prevention.
  • Inpatient care.
  • Outpatient care.
  • Emergency care.
  • Prescription drugs.
  • Durable medical equipment.
  • Long-term care.
  • Palliative care.
  • Mental health services.
  • The full scope of dental services (other than cosmetic dentistry).
  • Substance abuse treatment services.
  • Chiropractic services.
  • Basic vision care and vision correction (other than laser vision correction for cosmetic purposes).
  • Hearing services, including coverage of hearing aids.
  • Podiatric care.
  • Contraceptive services.
  • End of Life Care - Shall be limited in hospital settings up to the cost of such care when attained through a hospice setting.

2. Parts of AtlasCare

a. Benefits covered by AtlasCare plans shall be purchased individually, with recipients being covered under the following parts:

AtlasCare Part A provides benefits and coverage for

  • Inpatient hospital stays and care
  • Hospice and home health services

AtlasCare Part B provides benefits and coverage for

  • Doctor and clinical lab services
  • Outpatient and preventive care
  • Screenings, surgical fees and supplies
  • Physical and occupational therapy

b. AtlasCare Part C provides benefits and coverage for all services covered under AtlasCare parts A and B.  Recipients must apply for Parts A and B in order to qualify.

c. AtlasCare Part D provides coverage for prescription drugs.  Every AtlasCare Prescription Drug Plan has a formulary that lists drugs covered by the plan.  Only those enrolled in at least one of AtlasCare Part A or AtlasCare Part B may qualify for prescription drug benefits.

To be continued
99  Atlas Fantasy Elections / Atlas Fantasy Government / Re: HOUSE BILL: Northern Separatist Act (At Final Vote) on: August 04, 2017, 02:56:23 am
AYE
100  Atlas Fantasy Elections / Atlas Fantasy Elections / Re: Federalist Main Street Partnership (v2.0) on: August 02, 2017, 03:19:10 am
I don't think single payer is a good idea, maybe universal healthcare as a whole but single payer is likely too far left for the platform.

Do you still have that map handy. 


Speaking from a real life perspective, I found it very informative. Most countries have a form of national healthcare, but only the Commonwealth realms + Japan have Single Payer.

All the others have some form of mixed system. Though this gets lost in the political debate because in an us versus them sense we have no universal system of any kind, while every other nation has something pretty much, and that/plus our close proximity to Canada and close political influence on and from the UK, pushes that in a single payer direction, when it is not even a system that most European Countries have.

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