Checkmate.

Why not just say if someone is carjacking you to shoot them in self-defense and leave it at that? Why talk about the unregistered gun, wiping it clean, and fleeing the seen? All things someone who is doing something illegal would do.

It's not that there's no money, it's that in most areas there is no legal authority to spend any of it. Departments aren't allowed to spend without a signed budget.

IMO, all democrats have to do is make the case to the public on why this new Obamacare is worth having and get public support. I would really be interested in a real debate on what positives instituting this new health care plan would provide vs the potential dangers for people with good existing coverage. Instead, we are back to team sports politics where Obama = always right to one side and always wrong to the other.

The case has already been made. It was a significant subject in the first election and the DOMINANT subject in the 2nd, both of which the Democrats won.

Not only that, but the Democrats won the popular vote AT ALL LEVELS (Presidential & Congressional) in the last one, and the Republican majority in the House only survived because of gerrymandered districts. I'd say it's pretty clear to everyone at this point where the American people stand on the ACA.

Please see: election, 2012: results.

If he would just release his birth certificate, then all questions about his eligibility and legitimacy will go away.

This is the big failing. I posted that Kimmel thing yesterday as a lark, but most people like the ACA. They don't like Obamacare.

http://http://www.latimes.com/business/hiltzik/la-fi-mh-obamacare-20131001,0,4909537.story

At this point, the FUD has become so ingrained, it is nearly impossible to have an honest discussion about 'Obamacare'. Numerous polls have show that provisions, when described as 'Obamacare' score lower approval ratings than the exact same provisions described as 'Affordable Care Act'.

Apparently according to Huffington Post we're only 3 Republicans shy of a Clean CR being able to be passed.

None are from a state south of Virginia. The list includes four from Pennsylvania, four from Virginia, two from New Jersey, two from New York, one from California, and one from Minnesota—but none from states like Alabama, Georgia, Mississippi, Texas, or Louisiana.

Oh. Well, 6 out of 7 is good enough, I guess! :D

Of course it's going to poll badly. Painting with huge generalities here obviously - so no need for everyone to come out and give their own reason why they hate it, but:

• Liberals dislike it because it's mandating business for the insurance companies, and for a subset of them it reminds them that it's not single-payer (Hey - Rome wasn't built in a day)
• Conservatives dislike it because they view it as a "tax" or a "requirement" and they claim to want the freedom to not have health insurance (don't even get me started on the wisdom of that. The one lesson my parents imparted on me was "ALWAYS HAVE HEALTH INSURANCE!").

disclaimer: I'm a "it's not single-payer!" guy myself. But I'm not sure I'd say I disapprove of the individual mandate in a poll.

I'd disapprove of the individual mandate if I didn't think it was the only way we could require coverage of pre-existing conditions.

Right. So the truth is, Americans love Obamacare, as long as it's not called Obamacare, and as long as it doesn't include a key provision of Obamacare. I just think the headline and the message of that article are extremely disingenuous (and I'm a supporter of it).

On the flip side I wondeer what the crosstabs would look like if you explained to survey-takers that the individual mandate was key to being able to provide the provisions that they like - would more of them express at least "okay" with it then? I'd have to imagine so.

Good luck with that.

Interesting

America: a land of liberals, governed by conservatives? | Oliver Burkeman | News | theguardian.com

I don't think you can draw that conclusion. Not liking 1 out of 7 provisions doesn't mean someone would necessarily dislike all 7 provisions put together.

I wasn't trying to draw that conclusion -- I was just summarizing the article's points. The article seems to have brushed aside that part, buried it near the end, said, unfortunately, it's necessary for the other stuff, but that didn't stop them from declaring "Americans love Obamacare."

But this isn't the plan he ran on in the election - it's not even close. It would be like a president running on getting the military out of the middle east and then deciding to pull out of only Abu Dhabi and saying everyone should be excited because that's what they voted him in to do.

Are you mixing up 2012 and 2008? This is most certainly the plan he ran on in the 2012 election.

This.

There's no free lunch.

Yes. There was a whole election, it was on TV and everything, after the ACA was passed and signed.

Really? Because the House Republicans wouldn't pass his "ideal vision" he shouldn't have compromised?

Now we can all argue (and I still will to this day) that he caved too much too fast, but that's a different point.

The bill was signed in 2010 and is nothing like what he promised in 2008. The only thing he's promised since 2008 is that the average family would save $2500 a year on Obamacare - which is not even close to true in the foreseeable future for this version of it.

This current form of Obamacare appears to do little to pair down the actual cost of heath care for most people. In fact, if you have a decent employer-offered plan right now, there are three results for you from this plan:

1. Your premiums will stay roughly the same and your employer will continue coverage (more likely for larger companies).
2. Your employer may decide to drop coverage kick you to the exchanges if it saves them money (more likely for smaller companies). At which point your premiums will go up and you will have lesser overall coverage.
3. Your employer may decide to dodge the system and move you to a part time employee - at which point you lose all your benefits and need to go on an exchange like option 2 (already happening at some fast food/lower income jobs).

So, again, for the 60-70% of families with solid employer-paid health care face only negatives with this plan. And that's not to mention the potential damage this could do to unions who would now be forced to pay for more coverage at a higher rate while private non-union contractors won't face any increase.

I'm honestly fairly shocked that anyone is in favor of this plan. I fail to see more than 5 or 10% of the population who would benefit from this. And, most of them are already on publicly subsidized plans like Access here in Arizona. Some very small business owners (less than 25 employees) may see a slight decrease in their premiums from their current Co-OP to the exchange, but there's no guarantee that they can see their same doc or have similar levels of coverage.

Then don't do anything. I would honestly rather have a more aggressive and well-thought out plan to move people completely off employer-paid health plans. Then, the government could essentially subsidize the individual to go out and get the same plans companies currently do. Just scale the subsidy by income level to where most people pay a similar premium and have the option to join all the companies for a given state (ie, United Healthcare of AZ or Blue Cross Blue shield of AZ). Essentially, the individual is getting the subsidy over the current company they work for.

That would have been a much better first step than this half ass plan that doesn't really help anyone. These exchanges are basically going to end up being more expensive and less coverage than existing company-based coverage. How does that help people?

Except for the examples of where the exchanges are cheaper and provide equivalent levels of coverage.

You are having a massive reading comprehension fail. JPhillips and I are talking about the 2012 election. You are aware that an election happened in 2012, right? And that the 2012 election took place after Obamacare was passed?

As of 2012, 256 million people have health insurance and 45 million do not. 5 million of those have pre-existing conditions that prevent them from gaining non-employer coverage because of cost. 27 million make under 45K and most of those people qualify for lower income plans in most states (like Access) but just don't sign up for them. Another 10 million or so are not citizens and wouldn't really be helped by Obamacare anyway.

So, why not focus on the 5 mil with pre-existing conditions and ensuring the 27 million who make under 45K have a decent option and understand how to sign up? Why do we need to potentially F-up coverage for 20-30 million (12-15%) of the 170 million with coverage to essentially help between 15 and 25 million who need it?

The individual mandate was put in place in 1986. The costs were just messily passed through to you by hospitals. All this did was eliminate that mess and make it more straightforward.

Now you're moving the goalposts. You initially said the problem was that the ACA hasn't been discussed enough. Now you're just anti-ACA.

You leave out a lot of benefits in the ACA.

Families now know their children can be insured to age 26 even if they don't get hired immediately after college.

No more worries about pre-existing conditions. If you lose your job and can't afford or run out of COBRA you can still get a decent policy.

Measures that will tie reimbursements to outcomes rather than number of procedures, which will likely slow the rate of medical inflation.

Hell, medical inflation is already slowing and while the data isn't conclusive, most experts believe the ACA is playing a part.

I also question your assumptions, but we won't know until data starts coming in.

I'm skeptical about a lot of parts of it. Especially the empowering and subsidizing of insurance companies, which seems to represent a huge step AWAY from where some proponents claim the plan is taking us. But the fact that some Republicans are so terrified of it being implemented also seems to be a tell that they think the plan will work pretty well. If they were so sure it was going to be an unpopular disaster, then you'd think they'd want to give it chance, because it's something that the Democratic party can be judged by. Of course, on the other hand, before this phase of the opposition heated up, some Democrats here couldn't distance themselves fast enough from ACA ("this wasn't what we wanted so don't judge us by it"), and if it turned out to be unpopular, it would just be spun as being the Republicans' fault anyway since they "obstructed" (i.e., were more effective politicians), and kept the the Dems from what REALLY wanted.

I think it's true that America is much more liberal than the Congressional representative breakdown would suggest, or than conservative representatives think, and that on the whole, they're more than ready for something like ACA, but is the point of that that Republicans should voluntarily cede more power, or is that Democrats are just really terrible at politics? I wonder if there was a way they could have attempted to tackle the debt issues before the nutjobs did. There had to be common ground at least there. Instead it was just something that had to be fought over, the Dems tried to frame it as a weird, fringe issue that we shouldn't care about it, next thing you know, you have an environment where the tea party abomination could flourish.

And it kind of sucks that even with 10% Congressional approval ratings, people seem to be digging their heels in, rallying around their party more strongly than ever. I guess that's unavoidable, but I kind of preferred the last few months, where Dems were pissed off at the administration over NSA stuff. Even though I personally didn't care about that issue as much as health care, it really felt like the kind of environment that could be conducive to real change and upheaval and backlash in terms of what the parties stand for. I want to see people angry at their own parties, that's the only way to fix Congress. Regular Republicans could reasonably be that kind of angry right now, but it doesn't seem like that's going to happen. (though I guess I'm doing my part, I have voted Republican a good amount, but would never be a party member as long as either the tea party or the religious fundamentalists have so much power, and would certainly not vote for any Republican candidate who either supported or were silently complicit in this shutdown approach - which I think is almost all of them.)

As for this whole thing, I'm just ready for the trillion dollar coin - when can we break that out?

Of those 256 million who currently have coverage, how many have pre-existing conditions that might cause them to enter the pool of non-coverage due to the loss of employment or some other factor that causes them to lose coverage? That is one of the things that is addressed as well that your scenario ignores.

And those numbers aren't static. How many people lose coverage or have pre-existing conditions over a ten or twenty year span?

That election wasn't on Obamacare, it was on the economy. Almost 50% cited the economy in exit polls, with Healthcare around 15% and foreign policy 7-8%.

But, again, no one understands what Obamacare currently is. We were told one thing in 2008, nothing in 2012 and now have a system that does nothing to help a vast majority of the working public.

They did but it was rejected early on as a non-starter in negotiations.

This is one of the things that baffles me as well, as many parts of the ACA have roots that can be traced back to the Nixon/Ford administrations in the 70s, and the Heritage Foundation in the 90s. Large swaths of the bill are things Republicans have been advocating for nearly 40 years.

Does that mean that Dems have been opposing this kind of plan for 40 years? What's different now, if that's the case (Edit: I really don't know the history of it, but if Republicans supported it, and we didn't have it, I imagine there was opposition)?

Democrats had been pushing for a single-payer system. The single-payer vs. mandate battle is what killed HillaryCare back in the 90s. What changed was a willingness to embrace the mandate.

The mandate was originally a GOP idea that demanded participation of all who would in future receive benefits. It was a way of making everyone pay rather than get a free lunch.

The 5 million number is fluid as some people will get hired and others lose their job and face extremely expensive non-employer options. But, Again, come up with a plan that covers the following:

1. 5 million uninsured due to pre-existing conditions (and people who might become uninsured due to pre-existing conditions)
2. The very few people between the ages of 18 and 24 who have families and aren't currently covered (nearly all with families qualify for some form of existing public plan like Access).
3. People who make under $45K and don't have insurance.

That will cost a fraction of this effort and leave all of us with good coverage without the specter of being dropped by our employer coverage. Now, if you want to move to a pure "public" system where no one gets employer coverage and completely change the system - that's a whole different argument and one that I think could be done in the right manner. But this current plan is going to cause a lot of angst for people in small-to-medium sized companies who can now justify dropping coverage because of the existence of these exchanges. And, given my company pays over 60% of my monthly healthcare premium right now, I doubt that me dropping to an exchange is going to end up with me having the same coverage for the same out of pocket cost I have.

Then I completely disagree with the people that rejected that (part aside - I really don't care).

This is another issue that could really hurt lower income people. Some unions may also need to go to similar tactics over time:

US employers slashing worker hours to avoid Obamacare insurance mandate | World news | theguardian.com

In addition, that number of uninsured is only going to grow. My family has qualified for the state health care here for a number of years but are being dropped this year. States are being forced to lower the line at which they accept individuals and families because the system is so expensive. We're certainly not the biggest state but I know here a large percentage of people are no longer eligible for that state plan as of this year. I'm sure this isn't the only state that's finding it can't afford the current system.

Also, the idea is to create a system which begins to push costs down. The costs aren't going to be different day one, but the ACA contains provisions to try to trend downward. It's not a magic bullet and maybe it's not enough, but it's something to address families like mine.

So let's get this straight. If the companies are cutting hours to avoid the mandate, that means they're already not providing health benefits. Otherwise, the mandate wouldn't affect them. So the only way to claim they're paying more for healthcare is if a private plan was cheaper than an ACA exchange plan. And that has been shown not to be the case even before subsidies (which most part time employees would qualify for) are applied.

If I had the choice between 32 hours a week with private health care that won't cover any pre-existing conditions and 28 hours a week with a cheaper exchange plan that will cover pre-existing conditions, then I definitely pick the latter.

I don't think you will be able to push costs down without drastically changing the system. However, I do think that provisions should be made to specifically handle people with coverage issues that are prevalent (pre-existing conditions, low income, ...).

My fear here is a bit of "throwing the baby out with the bath water". While it's clear the ACA will help a certain number of people, it may also have some unintended consequences and hurt many more with insurance or that see their hours cut to fall into compliance.

In the end, I just feel that there is a better way to handle these holes in existing coverage without subjecting everyone with current coverage to this risk.

OK. How would you solve pre-existing condition issues?

Not true. Many companies (like Home Depot) currently offer health insurance options that are more bare bones (ie, higher deductible) for current part time workers in the 25-35 hour range. They have now said they are pulling this and cutting non-full time hours to below 29. So, if you were a part time employee for home depot working 35 hours and getting their low end health car coverage. Now, you will have your hours cut to 29 and have to pay more in the exchange for a new health care plan.

That's great if you have pre-existing conditions - but only around 2-3% of potential workers have those. For the remaining 97%, this sucks. Again, baby with the bath water. Why not just come up with a plan for the current exclusions and leave everyone else with what they have? Maybe someone who was working part time at Home Depot might like to decline their coverage and hop on a public plan because they make less than 45K - great. But don't set up a system to where they are forced to.

This is the point of the government - safety net options. If someone has pre-existing conditions and can't get coverage, have a government subsidized public option they can use. We do that with lower income families (ACCESS in AZ), younger kids and disabled on a state level already. I can't imagine it would be that much harder to come up with a plan that also covers the 2-3% of the population that has pre-existing conditions that prevent them for being covered traditionally.

Coverage of pre-existing conditions (without realistically punitive rates) defies the very use of the word "insurance". It's the equivalent of guaranteeing coverage for the world's worst (or unluckiest) driver.

It might be the single most offensively stupid element of the entire boondoggle afaic.