SENATE BILL: Reforming Atlasian Public Health Act of 2014 (Debating)

[🐒Gods of Prosperity🔱🐲💸]

NAY

We tried this before, it was expensive, we'd need to raise taxes again.

[🐒Gods of Prosperity🔱🐲💸]

We have already fixed sixth in thep resent text

I just found something else:

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Is this bold meant to be a limit on the reintroduced co-pays?

That is how I have always understood it.

[🐒Gods of Prosperity🔱🐲💸]

All that I'll say is that it'd be very strange for most people to buy insurance when we have a public option that - at least on paper - provides a better quality of care at a lower cost than most health insurance plans did prior to Fritzcare's enactment.

Maybe these benefits are not actually what they appear to be, and maybe providers are skirting the law and discriminating in favor of patients with private insurance. But if Fritzcare is working in the way that it's intended to work, few people would have any reason to seek out private insurance.

Moreover you'd expect massive adverse selection problems in the private market because the people who find purchasing additional insurance worthwhile are probably using a lot more health care than those who do not. If we haven't wiped out the private health insurance industry completely, the prices that the remaining firms charge will be extremely high.

I'm not especially sympathetic to the insurance industry. But we need to understand how Fritzcare is working if we're going to have this single payer vs. reformed Fritzcare debate. Yankee is correct insofar as a generous, free, and universally available public option is almost functionally indistinguishable from true single payer. The primary difference is that we haven't actually banned private insurance, but as we've likely driven most or all insurance companies out of business, the distinction is mostly a matter of principle.

The consequence of this is that single payer advocates are arguing for reforms that would be less drastic in their effects than the reforms that would be necessary to make Fritzcare compatible with a thriving private insurance market. There isn't really any viable ground between the two.

There is a reason for many people to purchase private insurance in the current set-up, which is that above a certain income level, the government benefits leave a whole lot left to pay.  You are correct though that this provides an adverse selection problem.  You may be right that creating a subsidized private option as I have suggested is a more radical change at this point than moving to full single-payer, though that's not enough to stop me from wanting to try to do it.  It seems like some sort of sliding-scale premium is being put forward as the middle ground - whether or not that's viable I don't know.

[🐒Gods of Prosperity🔱🐲💸]

Just throwing stuff down here, I would have the following in Section 1.

- Establish a system of exchanges with one in each region. ANHC has to be offered in each.
- You then have a set of regulations establishing any limits on co-pays, deductibles or mandated coverage like preventative care (or you could just give everyone ANHC coverage for the preventative side, whatever works best)
- Any other regulations deemed necessary
- Subsidization Scheme

If I am not mixing up what people have proposed here, I would like to see what shua had it mind in terms of the numbers on the last part.

My thought was to make the subsidy whatever ANHC costs for a person up to 150% of the poverty line, and then a sliding scale from there, but I hadn't figured out precise figures.

[🐒Gods of Prosperity🔱🐲💸]

Would you be willing to formulate a scale that would be acceptable to you?

I can give it a try.

[🐒Gods of Prosperity🔱🐲💸]

here's a possible formula:

x = household income  (measured in terms of poverty line)
y = subsidy (measured in terms of full cost of public option coverage)

y= 1 when x <= 1.5 (150% of poverty line)
y= -.4(x - 4) when x >= 1.5



changes may be considered more gradual than appears in this graph, for ex.:
for a family of 4, household income of $36000 (150%), subsidy is 100% of public option rate
for that family with household income of $48000 (200%), subsidy is 80% of rate, etc.

[🐒Gods of Prosperity🔱🐲💸]

I think this would be good for now (we can amend it later if need be):

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where 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]

I'm thinking we may need to amend the actual ANH Act itself, given we are redefining it as a public option that may be purchased with a subsidy alongside other plans. 

[🐒Gods of Prosperity🔱🐲💸]

Are the MediSave accounts supposed to be instead of the payroll tax?

[🐒Gods of Prosperity🔱🐲💸]

Healthcare Payroll Tax and a tax on Health Insurance.

The former of which is the vast majority.  How does MediSave fit into this?  Having mandatory accounts on top the payroll tax just adds to the financial burden.

[🐒Gods of Prosperity🔱🐲💸]

Wait, what just happened?  Did we just change the entire text of this bill into an amendment to the Healthcare Modernization Act

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[🐒Gods of Prosperity🔱🐲💸]

If the sponsor would like, we can hold off on that amendment.   It is crucial to me though that that language in the Healthcare Modernization Act not be changed in the final bill.

[🐒Gods of Prosperity🔱🐲💸]

Would you mind explaining me the CIEP? :/

Are you familiar with the concept of a "high risk pool"?  That's what this is.  It is a subsidized program to make sure that those with preexisting conditions have a good option for affordable insurance.

[🐒Gods of Prosperity🔱🐲💸]

Would you mind explaining me the CIEP? :/

Are you familiar with the concept of a "high risk pool"?  That's what this is.  It is a subsidized program to make sure that those with preexisting conditions have a good option for affordable insurance.

At least in Obamacare, High Risk Pools are inside the Exchange thing, aren't them?

Obamacare (ACA) doesn't have high risk pools. In the US, where they exist they are creations of the various states. The way ACA is set up it is actually likely to reduce usage of high risk pools.  What we are doing here is a focus on assurance of coverage through a nondiscriminatory public option rather than a focus on mandates as in the ACA, and so a high risk pool plays a role here to make sure the public option can function while providing affordable coverage.

[🐒Gods of Prosperity🔱🐲💸]

I don't know but aren't HRP more expensive than having a mandate?

I don't believe so, at least not the way we are doing it.

AYE

[🐒Gods of Prosperity🔱🐲💸]

Great job on making sense of all of this and coming up with a reform, but I'm curious as to what the point of the CIEP is. Why is that necessary when the ANHC plan presumably already provides coverage to those with pre-existing conditions?

It may be important so that the general ANHC plan can be priced at an affordable rate to the consumer, to separate out those with high-risk conditions into a parallel program that offers the same benefits.  Whether it turns out to be necessary, or if there is a better solution, we can see upon further study.

[🐒Gods of Prosperity🔱🐲💸]

Good question bore.  The New Atlasian Healthcare Act is replaced by this.

I see for some reason we ended up leaving out the medicare/medicaid/tricare phase-out from the administration section.    That may need to be corrected.

[🐒Gods of Prosperity🔱🐲💸]

So has the tricare transition been completed already?