Obamacare just raised your health care premium by $63

“We have to pass the bill, to see what is in it!” – Nancy Pelosi

So lib#2 thinks it’s ok to take food or medicine out of the mouths of others when it deems the cause worthy enough.

What I find to be very interesting is the petulance of conservative governors, such as Rick Perry, who are now exhibiting abject stupidity in cutting off their noses to spite their faces, to the delight of the most progressive ObamaCare supporters who are now in the process of getting what they wanted in the first place.

I saw this one coming from a mile away.

I could explain it myself, but here’s a short and very cogent explanation, from today’s “JAMA Forum,” where “JAMA” is the Journal of the American Medical Association.

news@JAMA
December 12, 2012
JAMA Forum: States Wrangle Over Obamacare’s Health Insurance Exchanges
Filed under: Caring for the Uninsured and Underinsured,Health Policy,The JAMA Forum — Aaron Carroll, MD, MS @ 10:07 am
Tags: The JAMA Forum

By Aaron E. Carroll, MD, MS

The JAMA ForumWay, way back in the long ago, when Obamacare was just a bill and not yet a law, a robust debate was conducted on how the health insurance exchanges should be set up. Most people who supported the bill in one form or another agreed that we needed the exchanges. They would provide the marketplace where we could pool people who were not receiving insurance through their employers. These types of collectives were common in countries that rely on private insurance companies to achieve universal coverage, and they are exemplified by the Massachusetts Health Connector, where individuals buy insurance in that state if they don’t get it through their jobs.

The 3 general rules of an exchange are clear. Insurance companies must offer policies to everyone, whether they have chronic conditions or not, a policy called “guaranteed issue.” They have to offer policies at similar prices regardless of chronic conditions, sex, or race, a policy called “community ratings.” If people earn too little to afford insurance, they are provided tax credits—subsidies—to offset the costs of premiums. On these 3 rules, general agreement has existed among those who supported reform efforts, even from the start.

Sure, there were some differences in the details. Some people wanted the subsidies to go to people making up to 400% of the federal poverty line. Others wanted the cap to be lower. Some wanted to place everyone making more than 100% of the poverty line in the exchanges and enroll those lower than that in Medicaid. Others wanted that minimum to be set at 133% of the poverty line. There were lots of arguments over whether the exchanges should offer a “public option,” a government-administered health insurance plan.

But the biggest and most technical disagreement on the exchanges had to do with their general setup. Should there be 1 national exchange or many more state-based or regional exchanges?

Some people, especially those who leaned towards the progressive side, argued that a national exchange made more sense. They believed that pooling all uninsured individuals into 1 group would make insurance a less risky enterprise and reduce the cost of premiums. They thought it would eliminate redundancies in the system and allow for economies of scale to lower the cost of reform. They also thought that removing control from individual states, some of which opposed health care reform, and centralizing it under the federal government’s auspices, would increase the chances of the law succeeding.

Many people in the Senate, especially those from more conservative states, felt different. They were skeptical about allowing insurance, something that has usually been regulated at the state level, to be suddenly given over to the federal government. They argued that even at the state level, pools would be more than large enough to remain stable. They also felt that states would be best equipped at a local level to innovate and take advantage of regional differences to improve the marketplace.

In the end, the progressives in the House lost. The Senate plan for state-based exchanges prevailed, especially after the election of Scott Brown to the Senate removed the 60th Democratic vote there. That outcome froze in place the Senate bill that would eventually, with minor modifications, become law. Exchanges would be located in the states, unless they could not or chose not to create them. In such cases, the federal government would take over.

As long as the survival of the law appeared fragile, many states decided to gamble on not setting up exchanges. Hoping that the law might be struck down last spring by the Supreme Court or its repeal made possible by the recent election, conservative governors dragged their feet in setting up exchanges, making it less likely that they would be able to retain control if Obamacare survived. The last year has shown us that it will almost certainly be here to stay.

But today, an odd turn of events has unfolded in the world of exchanges. It’s the liberal states that have chosen to create their own insurance exchanges. Most states run by conservative governors have chosen not to create exchanges and have left them up to the federal government. Some have done this out of protest against the law in general, often in its entirety; they have resolved not to appear to be supporting its enactment in any way. Others have decided that the local exchanges are an unfunded mandate that they don’t want to pay for and would rather the expense be borne by the federal government.

Regardless, some people are portraying every state’s refusal to set up an exchange as a blow to the law. I’m not so sure. It’s true that the federal government is playing catch-up in setting up the regulations for a national exchange. It’s also true that there are some very real issues involving the subsidies and national exchanges that must be resolved in the coming year.

The arguments for and against the national exchange still hold, though. There were good reasons to prefer one before, and the fact that states have switched sides for political reasons doesn’t change those rationales. The media may like to portray a preference for a federal exchange rather than a state-based one as a blow to progressives and their hopes for the law. But progressives may just be getting what they had wanted in the first place.

***

Aaron Carroll, MD, MS (Image: Ted Grudzinski/AMA)About the author: Aaron E. Carroll, MD, MS, is a health services researcher and the Vice Chair for Health Policy and Outcomes Research in the Department of Pediatrics at Indiana University School of Medicine. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

About The JAMA Forum: JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.

Or, to state it another way:

Oh, please, PLEASE, don’t throw me into the briar patch.

– Larry Weisenthal/Huntington Beach CA

@openid.aol.com/runnswim:

The 3 general rules of an exchange are clear. Insurance companies must offer policies to everyone, whether they have chronic conditions or not, a policy called “guaranteed issue.” They have to offer policies at similar prices regardless of chronic conditions, sex, or race, a policy called “community ratings.” If people earn too little to afford insurance, they are provided tax credits—subsidies—to offset the costs of premiums. On these 3 rules, general agreement has existed among those who supported reform efforts, even from the start.

There is nothing clear about any of it. The rules are still being written as I write this. As for the States, they have no idea what the costs will be, what controls will be put in place, or what regulatory conditions will exist and how they are subject to change. So, they are supposed to just take ownership of a program controlled by HHS? Maybe they should just pass it blindly like the Congress so they can see what’s in it.

Sebelius clarified, ” The [ObamaCare] law allows your state to expand your Medicaid program and the federal government will pay 100 percent of the cost of all newly eligible residents in Medicaid for three years, beginning in 2014.”

Now. wait a minute!
The feds can PRINT their money.
So, when they say they will pay for all these poor people to be insured for three years it means the value of everyone’s dollars will be that much cheaper…..
THEN…..
It falls to each state.
And STATES cannot print their own money!
States must balance their budgets by cutting back elsewhere or raising taxes.

Talk about a set up!

So, add another state to the long list of states just saying NO!
Pennsylvania will not set up its own health care exchange under the federal Affordable Care Act
Gov. Tom Corbett faulted federal authorities for what he called inadequate answers to his questions about cost and other issues.
He added: “It would be irresponsible to put Pennsylvanians on the hook for an unknown amount of money to operate a system under rules that have not been fully written.”

The rules have not even been fully written yet!
And some slobbering Obamites can’t wait to sink their own states!
States that want to run their own exchanges had until Friday to submit plan.

@openid.aol.com/runnswim:

Imagine some GS guy from NY with a degree from Harvard running the exchange in Texas and Gov. Perry calls and the director can simply say take a message. Poor Perry’s head will explode.

That’s hilarious! Poor Rick Perry, he would be powerless. Wait, no he wouldn’t. He could just have the whole agency removed from his State. As a matter of fact, he could just request the State Legislature to propose an order of nullification for the whole law, and refuse to collect the taxes. Whose head would explode then?

@openid.aol.com/runnswim:

State governments can’t nullify federal laws.

41 States have implemented Real ID, the remaining States passed laws to nullify it. It’s a pretty good law, but it is an unfunded mandate, much like Obamacare.
Colorado and Washington State have legalized marijuana. That’s nullification.
Alabama passed Amendment 6 freeing all Alabama residents from participating in Obamacare or any other compulsory healtcare program. Wyoming passed a similar law.

Efforts at this point to resist are truly futile and will only hurt the economies of the states which fail to get on board.

So we’re one big collective now, huh? Just like the Borg, we will be assimilated? I wouldn’t count on it.

By the way, I just read an article which supports another argument I’ve been making on this blog for years: high tax rates actually have a net positive effect on job growth.

It makes total sense. Take money out of the economy, give it to a vast central power that has no idea how to manage or spend it, and watch the country grow. Instead of people keeping more of their money, we should definitely do more of this:

$30 million to spur mango production and sales in Pakistan
$1 million to get people to visit government websites
$916,567 to underwrite horse-drawn carriage exhibits and survey shipwrecks in Wisconsin
Half million dollars to study whether people trust Tweets from Twitter
$207 million on a duplicative second engine design for the F-35 fighter
$55,382 to study hookah smoking in Jordan
$300,000 to developing a dance program to illustrate the origins of matter
$425,642 to study information dissemination and Indian politicians
$592,527 to study why chimpanzees throw objects
$338,998 for researchers to study the impact of women on the Icelandic textile industry

Let’s be honest, people could keep more of the money they earn or the government can take it to make sure these and many other great programs like it are fully funded. Tough choice, I’ll have to get back with you.

@openid.aol.com/runnswim:

The Alabama and Wyoming laws are just for show. They have no force of law whatsoever, if the Obama justice department chooses to enforce federal law, which it certainly will, in the case of ObamaCare. SCOTUS has repeatedly found that, when Federal law conflicts with state law, the Federal law trumps state law.

Really. So what are Obama and Holder going to do? They going to come down to Alabama and arrest the governor and the legislature. I have to tell you, I’d pay to see that.
I was thinking about this last night. When they passed the law changing the drinking age to 21, several States said no. Louisiana flat out refused. They finally gave in because the federal overlords threatened to withhold highway money. That’s about all the enforcement the feds have over the States. And the States can just threaten to not collect taxes. The States have power Larry, whether you want to admit it or not. We do not have kings and lords, as much as the left would like for it to be so.

With regard to your examples of seemingly silly federal wastes of money, number one, you don’t know nor cite the details of those studies. You don’t know why the studies were approved and what was the rational and knowledge felt worthy of being studied/gained. And, anyway, stuff like that is a drop in the bucket

“Just a drop in the bucket.” Always an easy thing to say when it’s not your money. I have a lot of respect for you Larry; you’re very smart and you have very good analytical skills. You know I put those numbers up there for more than just the programs. It is part of a greater problem, baseline budgeting. All federal departments get an increase in the amount of money they get each year. Every single year they get more than they got the year before. Within those departments are other departments. They also get more money each year than they got the year before, with one exception. If you do not spend all the money you were given by the end of the year, your budget for the next year is reduced. This creates waste in every department, including defense. I have posted many times that I believe the defense department waste more money than just about everyone. The thing is, defense is the only program the federal government is mandated to take care of in the Constitution. Even so, I think the waste should be dealt with in defense, just as it should in every department. Let’s look at just one of these budget items. You said:

You don’t know why the studies were approved and what was the rational and knowledge felt worthy of being studied/gained.

What about this budget item:

$300,000 to developing a dance program to illustrate the origins of matter

I don’t pay $300,000 in taxes every year. I would imagine if you took every person that posted to this thread and combined their income taxes paid each year, we would have a problem coming up with $300,000. So instead of providing for the common defense, or helping any of our fellow citizens that actually needed a hand, our money went to a dance program illustrating the origins of matter.

Anyway, we are talking health care here: government run health care (i.e. Medicare) has been documented to (1) cost less, (2) produce higher consumer satisfaction, (3) produce fewer personal health care-related bankruptcies, and (4) produce unsurpassed health care outcomes. ObamaCare will ultimately produce the same benefits, once the kinks have been worked out.

Doctors are dropping medicare left and right. This article list six reasons doctors are dropping out:
http://www.physicianspractice.com/six-main-reasons-physicians-are-dropping-medicare-patients
With Obamacare, everything will be medicare (government-thug) style tactics. If there is no more incentive to become a doctor, there will be less doctors. There are some medical magazines saying we are already in a physician shortage:
http://www.healthleadersmedia.com/content/MAG-92871/Will-There-Be-Enough-Doctors
http://usatoday30.usatoday.com/news/health/2009-08-17-doctor-gp-shortage_N.htm?imw=Y
And primary care doctors are already in major demand:
http://www.npr.org/2012/08/07/158370069/the-prognosis-for-the-shortage-in-primary-care
And you have faith that a bunch of people in Washington that can’t even agree on the color of grass to fix it?