Thread: Trump vows 'insurance for everybody' in replacing Obamacare

Originally Posted by JohnDoe2

Doctors and Nurse Practitioners can see many more patients per day in an office than they can at home because they waste time driving from home to home, finding a parking place and walking up to the house and back to the car.

But you have a great deal more expense with an office, rent, staff and utilities to cite a few. The at home visit is an excellent service and works out very well for doctor and patient. At least it did for us when my Mom needed the service and used such a firm here in North Carolina. They took her insurance for the visits and lab tests, they even had lab companies that came to the house to draw blood and do different things that she needed. Mom's insurance paid for everything after a small annual deductible for office visits she had on her policies.

To improve service and reduce costs is going to take more than what you and MW seem willing to open your minds up to. Americans are very creative when left alone to solve problems in a common sense and pragmatic fashion. Looking back to the way things were done when virtually everyone could afford to see a doctor with or without insurance is a good thing that should be embraced. Our present situation that's breaking the backs and wallets of most Americans has to change in big ways and using ideas that worked well in the past and reviving them is a great step forward.

Republicans, Trump Set for Clash Over Health Care

by Leigh Ann Caldwell
Jan 16 2017, 4:12 pm ET

President-elect Donald Trump is setting the stage for a potential clash with his fellow Republicans when it comes to the repeal and replacement of the Affordable Care Act. Many of his pronouncements in interviews and on Twitter are at odds with long-held Republican orthodoxy on health care.

Trump's plan will provide "insurance for everybody," he told The Washington Post in an article that ran Sunday night. He added that he's going to push for the government to have the ability to negotiate prescription drug prices for Medicare and Medicaid. However, neither of those ideas have been mentioned as possibilities in a Republican replacement plan — and they are both proposals usually opposed by Republicans.

Republicans in Congress have just begun the process of dismantling the Affordable Care Act, also known as Obamacare, a massive health care law that has insured an additional 20 million people and altered the health care industry.

"We're going to have insurance for everybody," Trump told the Post. "There was a philosophy in some circles that if you can't pay for it, you don't get it. That's not going to happen with us."

Trump said people who gained coverage under Obamacare will "be beautifully covered."

Republicans, in the meantime, have not promised universal coverage and have not even promised that the newly insured from the ACA will continue to have insurance.

Rep. Cathy McMorris Rodgers, R-Wash., a member of Republican leadership promises that no one will "have the rug pulled out from under them," but Republicans are resistant to the idea of universal coverage, or even widespread coverage. Instead, House Speaker Paul Ryan last week began using the phrase "universal access" when describing the goals of their health care legislation. Republicans say that cost will be lower, giving people the ability to purchase coverage.

Many of the people who gained coverage under Obamacare did so under an expansion of Medicaid — one that Republicans have been fighting.

As for the negotiation of drug prices, Trump said pharmaceutical companies are currently "politically protected" but added: "not anymore."

Republicans and pharmaceutical companies have long been opposed to the government having the ability to negotiate the cost of prescription drugs. The high cost of drugs for Medicaid and Medicare recipients — although different laws concerning drugs govern each program — are a major expense for the federal government. During the controversial expansion of Medicare to add the Part D program in 2003, Congress instituted a ban on drug price negotiations to garner the support of Republicans who largely opposed the expansion of Medicare.

Trump's position could be explosive on Capitol Hill. Even one of Trump's most ardent supporters, Rep. Chris Collins, R-N.Y., told reporters last week that he doesn't agree with Trump on drug prices.

"We can agree to disagree," Collins said.

Trump has already significantly changed the tenor of Republican efforts to repeal and replace the ACA. After Republican leaders in Congress said that it could take weeks or months after they repeal Obamacare to pass a replacement, Trump said in his first news conference that a replacement bill would come "essentially simultaneously." Republicans have since sped up their timeline, saying that parts of the bill could happen "concurrently" with the repeal.

The House and the Senate passed the first of two steps to repeal Obamacare last week. The second step, which will include the details and scope of the repeal, is likely to come in the next one or two months. Republicans must adhere to strict guidelines on what can be repealed because of their use of a budget gimmick called "reconciliation." Reconciliation only needs the support of a simple majority to pass — allowing the GOP to bypass the need to win support of any Democrats — but only tax and spending provisions can be addressed.

Those provisions that could be repealed include a tax on families making more than $250,000 per year, a tax on tanning machines, a tax on the most expensive health care plans, a tax on the insurance industry and a tax penalty on employers who don't provide health insurance for their employees and a tax penalty on people who don't purchase it.

Trump said that he would present a plan for health care repeal after his nominee to be Health and Human Services Secretary, Rep. Tom Price of Georgia, is confirmed.

http://www.nbcnews.com/politics/cong...h-care-n707496

• Joseph Antos@joeantos

February 26, 2016 3:48 pm | AEIdeas

The pros and cons of selling health insurance across state lines

Obamacare has not done much to slow the growth of health care costs. Government actuaries project that health spending will grow 5.8% a year over the next decade — substantially faster than growth in the economy. Could Republican proposals to sell health insurance across state lines bend the cost curve and make premiums more affordable?

The idea seems simple enough. Right now, if you are buying your own health insurance, that coverage must be sold by an insurer regulated in your state.

Instead of a national market, health insurance is sold in 51 state markets (including D.C.) with differing regulations.

According to proponents, insurers should be allowed to sell health insurance according to the rules of a single state of their choosing, regardless of where their customers live. That would promote “regulatory competition” among the states, who would have an incentive to attract insurers by reducing unnecessary regulation. Insurance costs would decline as plans become tailored to the demands of consumers, rather than continuing to provide a list of benefits that increase costs but do not provide value for major segments of the market.

Twenty20.

That was a better argument prior to Obamacare. Highly regulated states, such as New Jersey or the District of Columbia, imposed costly mandated benefits on the individual market. Less regulated states, such as Kentucky, allowed insurers to tailor their plans to the demands of consumers, resulting in lower premiums and less coverage for things like acupuncture and fertility treatments.

Today, the federal government has taken control from the states over what health insurers may sell.

“Essential health benefits” have largely supplanted state benefit mandates, and other Obamacare rules limit the terms under which health plans operate.

State regulation has taken a backseat, resulting in greater uniformity of insurance across states. There are more insurers offering coverage in the individual market — attracted by billions in new subsidies — but the scope of competition is restricted and premiums show no sign of declining.

It is clear that regulatory competition can’t work if the federal government is the primary regulator. That is why Republicans also support returning regulatory authority to the states as part of a broader reform of the health system. But even in that context, one should not expect interstate sales to significantly reduce the cost of health insurance.

A health plan offered in New York City will charge a higher premium than the identical plan offered in rural Colorado because of differences in those markets other than regulations. New York City has higher costs for housing, food, and other consumer purchases, and those costs are built into the prices of medical services. New York has an older, less healthy population that uses more medical services. In addition, New York has more local physicians and greater access to expensive medical technologies, which also drives up the cost of coverage. Just because good coverage is affordable in one state does not mean that the same plan will be available at a comparable price somewhere else.

Learn more:

• Improving health and health care: An agenda for reform

One other fact that is often overlooked in the debate over interstate competition: we already have it for most consumers. Employer-sponsored health plans account for more than 60% of Americans with health insurance. Most of those plans are “self-insured” and exempted from state regulation through the federal Employee Retirement Income Security Act. A market-based reform would help slow the growth of premiums for those plans, but an across-state-lines policy would affect individuals and some small employers and would not have an impact on larger firms.

Supporters of allowing insurers to sell across state lines are making an important policy point. Health insurance in this country is overly burdened by regulations that raise costs without providing value for many consumers. Even with substantial subsidies, enrollment in exchange plans has fallen well below what was expected when Obamacare was enacted.

Reforms are needed to make the individual insurance market more responsive to consumers and taxpayers.

Regulatory competition is one tool in establishing a balance between cost and consumer protection in health insurance, but it must be part of a broader reform agenda to be effective.

http://www.aei.org/publication/the-p...s-state-lines/

Nothing prevents companies from selling across state lines today. They choose to operate in a single state through multiple state companies in order to avoid federal regulation and the Sherman Anti-Trust Act that prevents monopolies, price-fixing, collusion and other non-competition behavior. The McCarran-Ferguson Act of 1945 exempted the insurance industry from the Sherman Anti-Trust Act if regulated by a state. That's why they don't sell across state lines and confine each of their "state" companies to operate only within that state because by doing so they evade Sherman Anti-Trust laws and regulations. And it's not just health insurance companies, it's any and all insurance companies.

We need to repeal immediately the anti-competition McCarran-Ferguson Act of 1945 for the benefit of all insured people and companies.

Originally Posted by JohnDoe2

Doctors and Nurse Practitioners can see many more patients per day in an office than they can at home because they waste time driving from home to home, finding a parking place and walking up to the house and back to the car.

Exactly, that's why I say it probably wouldn't be feasible in heavily populated areas (cities). Also, I would probably question the quality of healthcare being received from a doctor that has the free time to make house calls and is limited to what he can carry in his little black bag. The day of Doc Adams' house calls on the Kansas prairie are long past.

Plans to Sell Health Insurance Across State Lines. At the Fox News Republican debate last month, Donald Trump offered a way to lower health care costs: allow insurers to sell their policies across state lines. “What I'd like to see is a private system without the artificial lines around every state,” he said.Aug 31, 2015

The Problem With G.O.P. Plans to Sell Health Insurance Across State Lines
https://www.nytimes.com/.../the-problem-with-gop-plans-to-sell-health-insurance-across-...

The Problem With G.O.P. Plans to Sell Health Insurance Across State Lines

Margot Sanger-Katz

@sangerkatz

AUG. 31, 2015


At the Fox News Republican debate last month, Donald Trump offered a way to lower health care costs: allow insurers to sell their policies across state lines.

“What I’d like to see is a private system without the artificial lines around every state,” he said. “I have a big company with thousands and thousands of employees. And if I’m negotiating in New York or in New Jersey or in California, I have like one bidder. Nobody can bid.” Erasing those lines, he said, would result in “great plans.”

The idea of developing a more national market for health insurance has become a major part of Republican health reform orthodoxy. A bill to allow interstate insurance sales was introduced in Congress in 2005, and, since then, has been a part of the platform of every Republican presidential nominee. Mr. Trump is not alone in his view: Scott Walker, Marco Rubio, Ted Cruz, Rand Paul, Rick Santorum and Bobby Jindal have all endorsed it. Aside from repealing the Affordable Care Act, allowing insurers to sell their products across state lines appears to be the most popular health policy idea among the G.O.P. candidates.

It’s such a perennial suggestion that when Len Nichols, a health policy professor at George Mason University and the author of a 2009 paper on the subject, was asked for comment, he said: “Are you kidding me? We’ve been through this about 30 decades ago.”

The idea is that by eliminating the red tape associated with state insurance regulation, insurers will be able to offer national plans with lower administrative costs. That would expand consumers’ choices and reduce the price of insurance.

The proposals also all assume that, in place of expensive regulations in some states, insurers would have the option of choosing to base their companies in a state with fewer rules.

In some versions of the plan, they would have to comply only with basic federal requirements that would apply everywhere.

“You would have a lot more people coming into the market,” said Brittany La Couture, a health policy counsel at the conservative American Action Forum, who has written about the idea in a largely positive light. A national market would “give people options, help them choose the best plan for them,” she said.

Both critics and enthusiasts of the idea agree that this could be true. Some states require much more of insurers than others, and following the many and varied state rules may drive up the cost of insurance in some markets. Customers in a state requiring insurance to pay for chiropractic care or infertility treatments, for example, might prefer to buy a cheaper policy in a state that doesn’t require such benefits.

The trouble is that varying or numerous state regulations aren’t the main reason insurance markets tend to be uncompetitive. Selling insurance in a new region or state takes more than just getting a license and including all the locally required benefits. It also involves setting up favorable contracts with doctors and hospitals so that customers will be able to get access to health care. Establishing those networks of health care providers can be hard for new market entrants.

“The barriers to entry are not truly regulatory, they are financial and they are network,” said Sabrina Corlette, the director of the Georgetown University Health Policy Institute.



Gov. Scott Walker of Wisconsin and Donald Trump at the Republican presidential primary debate on Aug. 6. They are among several candidates who have embraced the idea of a national market for health insurance.CreditMandel Ngan/Agence France-Presse — Getty Images

n 2012, Ms. Corlette and co-authors completed a study of a number of states that passed laws to allow out-of-state insurance sales. Not a single out-of-state insurer had taken them up on the offer. As Ms. Corlette’s paper highlighted, there is no federal impediment to across-state-lines arrangements. The main difficulty is that most states want to regulate local products themselves. The Affordable Care Act actually has a few provisions to encourage more regional and national sales of insurance, but they have not proved popular.

Insurers have been muted in their enthusiasm for G.O.P. across-state-lines plans. Neither America’s Health Insurance Plans, the lobbying group for most private insurers, nor the Blue Cross Blue Shield Association have endorsed such a plan when it has come before Congress.

There’s a part of the health insurance market where regulations are largely identical around the country: the one for private Medicare Advantage plans. If uniform rules alone could ensure a broad array of competitors, you might expect to see many insurers participating. But that does not seem to be the case.

A recent report found that, in 97 percent of counties, the market for Medicare Advantage plans was “highly concentrated,” meaning very limited choices.

Beyond regulations and doctors, demographics help explain why insurance is cheaper in some places than others.

Insurance tends to be less expensive in states like Utah and Colorado, where more people are young and healthy. If customers in New York wanted to start buying Utah plans, they might face two surprises: fewer local doctors and higher costs related to the health of the local population.

“I’ve tried for 10 years to explain this to Republicans; it is a big problem,” said Merrill Matthews, a resident scholar at the Institute for Policy Innovation, which focuses on free-market solutions to policy problems. “Just because a good affordable policy is available in another state doesn’t mean that I would be able to get the network of physicians and the good prices that are available in that other state.”

For that reason, even enthusiasts for interstate insurance sales say the plan is “not a panacea” or “not a silver bullet.”

Critics of the across-state-lines plan worry about negative consequences of letting insurers shop for the state regulator of their choice. Just as many businesses tend to incorporate in Delaware, or credit card companies have headquarters in South Dakota, insurers may end up congregating in whatever state offers the most lenient regulations. That could mean that customers who get sick could be harmed because there are few comprehensive policies available, or because consumer protections are weak when things go wrong.

Right now, the Affordable Care Act sets up some minimum standards for insurance plans sold everywhere, but since the Republican proposals include repealing the law, those limitations would presumably disappear.

There’s one other problem with Mr. Trump’s statement: The across-state-lines issue affects only individuals and small businesses, and rarely matters for large companies like his Trump Organization. His campaign wouldn’t confirm the company’s insurance arrangement, but nearly every large American company is what’s called self-insured. That means it is not subject to state insurance regulation.

Truly national health insurance companies are still rare, in part because building a national provider network is so difficult. The limited choices Mr. Trump faced were most likely those of the national market and not the result of varying state regulation.

Plans to Sell Health Insurance Across State Lines. At the Fox News Republican debate last month, Donald Trump offered a way to lower health care costs: allow insurers to sell their policies across state lines. “What I'd like to see is a private system without the artificial lines around every state,” he said.Aug 31, 2015 The Problem With G.O.P. Plans to Sell Health Insurance Across State ...

https://www.nytimes.com/.../the-problem-with-gop-plans-to-sell-health-insurance-across-...

The idea is that by eliminating the red tape associated with state insurance regulation, insurers will be able to offer national plans with lower administrative costs. That would expand consumers’ choices and reduce the price of insurance.

No, the "idea" is to restore competition in the industry by subjecting the companies to Federal Fair Trade Laws and Sherman Anti-Trust Act laws. Presently, all these companies operate in a "state" with individual "state" companies that are regulated by the State Insurance Commission. No anti-trust, no fair trade laws. They are free to collude, price-fix and create monopolies through anti-competition behavior. The McCarran-Ferguson Act of 1945 was passed by Democrats in Congress and signed into law by Harry Truman to bypass a US Supreme Court Ruling on the subject of the insurance industry and the Sherman Anti-Trust Act. The McCarran-Ferguson Act exempts the insurance industry from the Sherman Anti-Trust Act, if regulated by a state.

It's a strange phenomena that people write articles on a subject they appear to know nothing about. Of course they could just be Democrats trying to protect their insurance monopolies.