SB 2016-047 - Universal Healthcare and Affordability Act (Debating)

[Bleach Blonde Bad Built Butch Bodies for Biden]

As I've stated before, this bill is very much incomplete and there are lingering cost-related issues that exist within our healthcare system that still need to be addressed, particularly those which arise from shortages, logistical issues, liability costs, etc.  The bill in its current form provides a blueprint for how to guarantee coverage with a mix of private and public options, while allowing the regions to design their own programs and set their own regulations.

Originally I'd considered throwing out the ACA and starting from scratch, but I think we can keep the federal exchanges provided that we work out the necessary cost adjustments.

Unfortunately, I'm a little unsure how to drive down the costs that exist in the current system.  I would encourage Yankee and anyone else to submit some proposals that would achieve this.  One idea I had in mind was incentivizing hospitals and doctors to take a "less is more" approach to providing care; Germany (whose system is what inspired the framework of this bill) has a system which penalizes over-utilization of care on the part of doctors, but I'm not sure if or how that would work for a country like ours which bears the bulk of the medical and technological innovations that come out each year.  That, I think, is the major challenge we have to address.

[Bleach Blonde Bad Built Butch Bodies for Biden]

When it comes to the Medicare buy-in, am I to assume there will be premiums attached especially to the higher ends of that $90,000 spectrum?

I'd think there would be.  That will probably need to be clarified in future amendments to the bill.  In essence, Medicare parts A, B, C and D are scrapped as all Medicare recipients are covered for the same services (which are drawn from Fritzcare).

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If the federal government is going to offer public plans to most people on a means basis, why would we need to maintain two different single-payer systems?

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The public plans won't make services free of charge.  I would be fully on board with incentivizing preventative care.

If we want all Medicare plans to cover the same things as Fritzcare (we can consider whether to offer specialized plans instead, of course), then a sliding scale premium could work here.  Do you remember the formula shua had written up in 2014 or where he posted it?

[Bleach Blonde Bad Built Butch Bodies for Biden]

Sorry - I haven't been avoiding this (well, not entirely, anyway ).  I just wasn't sure where to begin in redrafting the current bill and I got pretty confused doing so at certain points, so here's the new part of the law which addresses the government system:

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Under the formula, y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).[/quote]

This isn't being offered as an amendment yet.  In essence, Medicare plans are transferred over to the new AtlasCare program by default and Medicaid recipients take subsidies if they choose to look for private plans.  Like Medicare, AtlasCare plans are sold individually and in parts.

My main concern is that I don't want AtlasCare to run into the same problems that Medicare has had, so this is where funding and cost reductions come into question.  I decided we should address those next if we're okay with this model.

[Bleach Blonde Bad Built Butch Bodies for Biden]

As someone who's never had to use any form of US healthcare my knowledge is very much weighted towards outcomes rather than the actual process of getting healthcare.

So under the current plan you could have a private insurance plan, yet sign on for Atlascare part D to get your medication? 

Well, in America, you need to be enrolled in either Medicare Part A, Part B, or both, in order to qualify for prescription drug benefits.  I'll add that to the draft.

[Bleach Blonde Bad Built Butch Bodies for Biden]

It's not an amendment yet.

The bill requires foreign nationals to have insurance prior to admittance into the country, not into hospice care, but I'll submit an amendment later on to clarify.

I think the GM will have to give us a final cost analysis before the bill goes to a final vote.

[Bleach Blonde Bad Built Butch Bodies for Biden]

I actually think that having separate healthcare bills would be a lot more convenient for us, and certainly less confusing, instead of having a grand debate about the healthcare system over one bill.  I'm going to amend the bill we have now with the changes that were proposed.

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Under the formula, y is the subsidy (measured in terms of full cost of public option coverage) and x is defined as household income (measured in terms of poverty line).

SECTION 6. TAX SUBSIDIES FOR PRESCRIPTION DRUGS

Individuals and families that are covered by private insurance or HICs shall be eligible for an annual tax credit not exceeding $5,000 to offset "out-of-pocket" prescription drug costs that exceed 5% of their annual income.

SECTION 7. FOREIGN NATIONALS

Foreign nationals visiting the Republic of Atlasia via visa must provide proof of insurance coverage prior to admittance into the country.  Permanent residents shall be eligible for private, non-profit, or public insurance.
[/quote]

If this is the model we're going with, it might be appropriate to ask the GM for a cost and budgetary analysis (unless the House makes changes, in which case we might want a budget analysis afterwards).

[Bleach Blonde Bad Built Butch Bodies for Biden]

I have PMed GM Kalwejt and asked him to give us a budgetary analysis.

[Bleach Blonde Bad Built Butch Bodies for Biden]

I have PMed GM Kalwejt and asked him to give us a budgetary analysis.

Did he say how long it would take to provide such analysis?

He didn't get back to me at all, and now he's on leave from the GM office, apparently.

Ugh...

[Bleach Blonde Bad Built Butch Bodies for Biden]

I have PMed GM Kalwejt and asked him to give us a budgetary analysis.

Did he say how long it would take to provide such analysis?

He didn't get back to me at all, and now he's on leave from the GM office, apparently.

Ugh...

     Well this might take a while. I'll get the hot chocolate going.

Hey so instead of waiting on budgetary analysis, if the sponsor wants to come up with his own budgetary proposal and gives sources and calculations to GM Kal, then Kal can agree or veto the cost. I wouldn't mind helping do it at all, either. Just so we can get the ball rolling on such an important issue.

I honestly don't know anything about budgeting and haven't even helped write a budget since I was Northeast Governor some years ago.  Believe me when I say that math is not my strong suit.  I don't even know how to begin with this.

I think the fundamentals we need to look at are a) how much AtlasCare will cost in total, b) the Medicare savings gained from people opting for AtlasCare plans, c) the costs and savings associated with what is essentially transforming Medicaid into a voucher program that will likely be phased out in the near future as people shop around for better plans, and d) the prescription drug tax benefit for private customers.

Anyway, I haven't slept a wink for the last day and a half, so now definitely isn't the time for me to jump into all of this.  If anyone knows someone in this game with actuarial expertise, I suggest you ring them up ASAP.

[Bleach Blonde Bad Built Butch Bodies for Biden]

My main suggestion is to have costs slashed for those making $90,000-$150,000 if possible, alongside special discounts for individuals or families with at least one member serving in the military(reserves and coast guard included) for more than four years.

I don't think that's completely necessary as we're going to have lateral competition across all income groups.  And I would think that families would already be covered under the plans of service members who choose to go with AtlasCare.

[Bleach Blonde Bad Built Butch Bodies for Biden]

NeverAgain is working on a budget analysis currently, so I'll pick this back up when he's done.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Don't worry, I haven't forgotten about this or anything.  I just PMed NeverAgain for an update.

[Bleach Blonde Bad Built Butch Bodies for Biden]

The program doesn't just inherit the costs of Medicare and Medicaid, though.  Remember that one program's recipients are being automatically transferred into a bigger program and the other is being phased out in favor of a voucher system for current recipients to help them transition.  That's a huge difference between what this bill does, and Obamacare.

So one of the questions we're trying to address is if the program lowers budgetary costs in the long run via Medicaid phaseout or increases them by the introduction of a public option + startup funds for co-ops.  I'm inclined to believe this lowers costs, but overhauls of this degree shouldn't be passed without a price tag.  And we're limited in terms of what current healthcare figures can tell us in determining that.

[Bleach Blonde Bad Built Butch Bodies for Biden]

See, this is why I asked for a volunteer to crunch the numbers for us, because I'm terrible at math in general and have only a vague idea of what we're drawing these figures from.

So, we take $200-300 billion to pay for the subsidies and subtract the remaining Medicaid costs after a set period of time?  Can we undo the Medicaid expansion in the states that signed up for it with the ACA?

[Bleach Blonde Bad Built Butch Bodies for Biden]

All right, then.  If that makes it easier to measure the cost and impact of this bill, I'll amend the text so that the public option is standalone.

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[Bleach Blonde Bad Built Butch Bodies for Biden]

Yeah, Kalwejt's gone and NeverAgain has ignored my multiple reminders about the analysis.  Oh well.  Guess we'll have to wait before the new GM is confirmed.

[Bleach Blonde Bad Built Butch Bodies for Biden]

This has been submitted to the new GM.

(I want to get this thing off the floor already, too.  Believe me. )

[Bleach Blonde Bad Built Butch Bodies for Biden]

Oh, excellent.  Thanks for catching that, 1184AZ.

With the information provided, I'll amend the bill so that this program is appropriately funded.

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With that, I'll stress that these figures are subject to change as both the public and private costs are contingent upon future changes to our healthcare system, including federally-funded programs like Medicare and Medicaid.  Some changes that would have otherwise been authorized by this bill were removed at the request of Representative Potus and Speaker Yankee for simplicity sake, but I do intend to bring back those reforms in the near future among others that haven't been considered yet.

I'd like to give the Senate and Yankee some more time to look at this bill in its current form, after which we can proceed to a final vote if no one wants any changes.

Thanks again to GM Dkrol for a very thorough review of this bill and cost projection.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Sorry, I don't know why I just noticed this but this would have to be the most expensive bill ever passed in the history of the republic if these numbers were accurate.  The United States spent $2.9 trillion total on healthcare in 2013 which is about $9,255 per person.  There is no way these numbers are anything close to accurate; either Dkrol added several too many zeros or something went completely wrong in his calculations.

I'll seek to have this revised.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Sorry, I don't know why I just noticed this but this would have to be the most expensive bill ever passed in the history of the republic if these numbers were accurate.  The United States spent $2.9 trillion total on healthcare in 2013 which is about $9,255 per person.  There is no way these numbers are anything close to accurate; either Dkrol added several too many zeros or something went completely wrong in his calculations.

I'll seek to have this revised.

Actually I don't think it is wrong.

Historical NHE, 2015: NHE grew 5.8% to $3.2 trillion in 2015, or $9,990 per person, and accounted for 17.8% of Gross Domestic Product (GDP). Medicare spending grew 4.5% to $646.2 billion in 2015, or 20 percent of total NHE. Medicaid spending grew 9.7% to $545.1 billion in 2015, or 17 percent of total NHE.Dec 2, 2016

Medicare+Medicaid is 1.1 Trillion.

800 billion might actually be low balling the cost.

Ugh, sorry, I read it right the first time... scratch that.

So the analysis is sound, all things considered?  This is before we change Medicare and Medicaid.

[Bleach Blonde Bad Built Butch Bodies for Biden]

After some discussion with the President and members of Congress, I am motioning to suspend the rules and end debate on this legislation for an indefinite period.

[Bleach Blonde Bad Built Butch Bodies for Biden]

After some discussion with the President and members of Congress, I am motioning to suspend the rules and end debate on this legislation for an indefinite period.

Why?

Long story short: a second health care bill is in the works that the authors want to pass first, and then return to this one.  I'm not withdrawing this bill; it's just getting put on the back burner for a little while.

[Bleach Blonde Bad Built Butch Bodies for Biden]

Can my motion get a second, please?

[Bleach Blonde Bad Built Butch Bodies for Biden]

I'm going to lift the motion to suspend debate.  (Technically such a motion is not provided for in the Senate rules anyway, but alas.)

More to come.

[Bleach Blonde Bad Built Butch Bodies for Biden]

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