Scott Walker (R-Wisconsin) released his health insurance “plan” yesterday. Let’s see what is in it.
Fuck that, I have some toe jam to pick out and that is a far better use of my time as I outsource the analysis to Kevin Drum:
It’s the usual conservative mish-mash of HSAs, high-risk pools, tax credits, interstate insurance sales, tort reform, and block-granting of Medicaid….
I figure the net cost, once you account for the end of Obamacare subsidies and other current outlays, is still in the neighborhood of $100 billion or so.1 That’s a lot, so I assume Walker explains pretty carefully how he’s going to pull this off without any new taxes.
Indeed he does. Here’s the answer: “We would simplify and reform how the federal government helps people access health insurance.” Gee, I wonder why no one’s thought of that before….
But there is one other thing I was curious about. It turns out that protecting people with pre-existing conditions is really popular, and this means that Republicans all feel like they have to support the idea. But how?….
We do know a couple of things: (a) if you let your insurance lapse, you’re screwed, and (b) Walker will somehow prevent insurance companies from raising your rates if you maintain continuous coverage. He provides no clue just what kind of insurance regulation would accomplish this, and for a good reason: I doubt there is one. Obamacare accomplishes it via community rating, which requires insurance companies to cover all comers at the same price, but Walker surely rejects this approach. What he replaces it with remains a mystery.
TLDR: My summary of the Price (HR2300) plan applies:
The typical person who benefits from the Price Plan on net are families making more than $200,000 with employer sponsored insurance as they’ll see lower taxes and expanded tax shelter opportunities in the HSA. Additionally, young men with no medical history will see cheaper premiums for equivilant or worse plans. Individuals who are sick, poor, and/or female will be on net worse off.
The only policy space that will be explored on healthcare by Republicans is how they screw sick, poor and female individuals.
La Caterina (Mrs. Johannes)
Since the Walker plan isn’t worth mentioning,let me ask you one of those specific-to-commenter questions that hopefully don’t irritate you too much:
Johannes and I have pretty good (different carriers) plans at our respective jobs. I want to go to a cardiologist who is in network on his plan but out of network on mine. When open enrollment comes around, can we sign up for secondary coverage under each others’ plans and would that expand which providers are in network for us?
Bobby Thomson
Chuck Todd: well, he says it works. It’s not my job to disagree with Republicans. .
Richard Mayhew
@La Caterina (Mrs. Johannes): That is theoretically possible but highly unlikely. Insurers don’t want to play adverse selection games and having the choice to jump networks is a simple adverse selection plat as one insurer will get all of the cheap charges, while the other insurer will get the expensive charges. There is no good way to price a product.
Usually the “solution” is to see if both people can be covered by a single policy offered by a single employer.
I would talk with HR at both companies with the 97% expectation of being shot down about buying what is effectively a supplemental policy.
princess leia
Richard- If you were going to have a major surgery, would you have it under a Covered California Silver plan or wait til you are 65 and covered by a medicare supplemental?
Sherparick
Naturally, Meagan McArdle is having orgasms about both the Walker and Rubio plans. http://www.bloombergview.com/articles/2015-08-18/walker-and-rubio-health-reform-plans-hint-at-gop-direction Unlike Richard or Kevin Drum, she does no real work with figures, but just hand waves that Walker’s and Rubio’s plans help “middle class” people at the expense of the poors, unlike the Muslim Kenyan Usurper’s plan. Now I know that she defines “middle class” as $200,000 and above and kicking the poor and sick to the curb gives our social darwinist, sociopath, “Jane Galt” a thrill.
rikyrah
thank you for this.
of course, it’s a scam and a fraud.
Richard Mayhew
@princess leia: I don’t know. I would have to know the details, I would have to know the networks, I would have to know the personal comfort level, I would have to know the clinical risks, I would have to know the quality of life changes of waiting.
I don’t know.
Omnes Omnibus
@Sherparick:
Not a mental image I want.
japa21
Richard, I just want to say thank you for bringing all of this to us. You have been a godsend for the BJ community, even for those of us in the health insurance industry. I know that sometimes I get so focused on my piece of the pie (network development) that I ignore some of the other aspects.
But beyond that, I have enjoyed what I can only describe as the loosening up of Richard over the past couple months. Yes, still wonky, but with a little more passion and non-wonkiness thrown in. The toe jam line is precious and appropriate.
japa21
@rikyrah: Of course it is a scam and a fraud. It is from (name any Republican) and therefore by definition is a scam and a fraud.
princess leia
@Richard Mayhew: Me, neither!! That is what makes all this stuff so hard to negotiate. I am trying to be prudent and protect my old age as, like many, I don’t have much. A wrong decision could be devastating. Totally insane- and yet so much better than what we had just a few years before.
D58826
That is the beginning and the end of the GOP philosophy. If you can’t screw those groups then it isn’t worth doing.
OzarkHillbilly
All Republican health care plans can be summed up in 2 words:
You’re fvcked.
Richard Mayhew
@OzarkHillbilly: No, the two words are “Fuck you” with anger and spite
PurpleGirl
@OzarkHillbilly: Nit Pick: That is 3 words. (But I agree with the sentiment.)
WereBear
Gee, it’s almost like it’s on purpose or something!
MattF
@OzarkHillbilly: Also, “Die sooner.”
It should be noted that Walker is the posterboy for professional politicians who tend the needs of the 0.001%. Says here that he’s trying to attract the Trump voters by being a ‘real’ conservative, but I’m feeling doubful about whether that’s gonna work.
Jeffro
So here are some choice quotes from McMegan’s screed:
What am I missing here? She’s not a fan of “third-party-payer”…so wouldn’t single-payer be more efficient? And why would consolidation make innovation in payment systems even harder – with fewer providers and insurers, wouldn’t there be fewer payment systems that have to “talk” to each other?
I am translating this to mean, “I understand that doing my way would mean yanking coverage from millions, and I’m not willing to do that unless we could do it sneakily, so that Republicans don’t pay a price at the voting booth.” Sound about right?
So much wrong here. I guess she is ignoring the effect Obamacare had on getting rid of expensive policies that didn’t cover much?
So much more wrong here. The Walker plan benefits those at the very top, correct Richard? You’d have to make more than $200k/year.
Anytime Republicans talk about personal savings accounts and HSAs, Democrats should be prepared, in plain language, to talk about how this subsidizes & further enriches those already best equipped to save…because they. have. all. the. money. Whether it is Social Security, Medicare, Medicaid, Obamacare, any & all of it: they always want to help those who are already doing well and pretend that these accounts are just as available to the poor (if they’d, you know, just step their game up and take advantage of them).
WereBear
@princess leia: As someone who has been thoroughly crushed by the previous American healthcare system, (not once but twice!) let me share my viewpoint:
Health is far more important than money.
I’m not just paying lip service to a common saying. I’m pointing out that at these stakes, money is meaningless; you have to look at it in a plutocrat form.
If there’s no downside to waiting, then wait. But if waiting is dangerous and acting now costs money, spend the money. Declare bankruptcy if need be, or drive down the cost of credit card interest rates with debt consolidation.
Yes, it’s not how we were raised to think and that’s how we get crushed. I’ve come to not care because our financial overlords don’t care.
Heck, if they can play with monopoly money and nearly bring down the world’s financial system, if they can blithely destroy lives and economic infrastructures and world relations, take your life in your own hands and do what you must.
Ruckus
@WereBear:
This.
Either play their game, like they do, or don’t play at all.
dedc79
@Jeffro: how about the line at thd very end when she claims the ACA steals from the middle class to cover the poor?
shell
Wow, Walker didn’t break much of a sweat with that cut-and-paste ‘Health Plan’. Tho he forgot to add the ol’ ‘You can always get health care by going to an emergency room!’
boatboy_srq
@Jeffro: Considering that the pre-ACA health insurance market seemed tailored to move the older/sicker middle class out amongst The Poors, then grind them under the Medicaid boot, it’s hardly surprising that the GOTea would be unhappy about that pattern changing. Spot-on translations BTW.
D58826
@dedc79: Much better to steal from the poor to give to the middle/ and esp.upper class. The only question I have is how do you get blood out of a stone or more to the point money out of the poor.?
dedc79
@D58826: Yeah, she writes “It will redistribute money upward” as if this is a rational proposal that reasonable people can disagree about.
Chris
@D58826:
“Squeeze blood from a stone” is increasingly their entire economic model. Redistributing money upwards probably made some sense when they started it in the Thatcherite/Reaganite era, when there was still enough of a middle and working class for there to be money there. Nowadays they’re both barely scraping by, but the 1% are getting more and more frantic that there must be some money somewhere lying around that they can get their hands on.
This from the people who normally scoff at any kind of wealth redistribution when we’re talking about the rich, saying that that’s not sustainable and that “the problem with socialism is that you eventually run out of other people’s money.”
Jeffro
@dedc79:
I guess with her kind of mindset, once you’re in you’ve got to be all in. How she sleeps at night I’ll never know (actually I can guess: I’m sure she sleeps like a baby)
Why is it only “stealing” when money is moving down the income ladder?
Why is it only “class warfare” when the 99% do it?
These people drive me crazy…
Laura
Out of state sales AND tort reform.
I can’t wait to purchase that Arkansas plan for coverage in California which promises medical care and doesn’t deliver, and be barred from seeking redress in a court of competent jurisdiction.
Or I could just run out and burn some cash in the gutter.
Kropadope
@dedc79:
This might be true if you define “middle class” as people on the lower end of a six figure income and “poor” as anyone making from (I’m spitballing) 30-80 grand.
Seanly
Well, that’s only about 80% of the population…
TXkid
@Richard Mayhew:
Do you have any advice with regards to health insurance for someone who will be quitting their job (and losing their health insurance) and then moving out of state a month later? Cobra vs some short term health plan? Thanks!
Chris
@Richard Mayhew:
@TXkid:
I’ll second this question, actually. It’s not me yet, but come January it’s probably going to be. (Moving from a state without Medicaid expansion to a state with it, if that matters any).
Miki
Minnesota Public radio did a little compare piece this morning: Walker’s “plan” vs. How it Works in Minnesota.
What a weaselly little turd …..
Davis X. Machina
@Chris:
Social Security. All that money. Collected by compulsory process. Sitting there — unmanaged, generating no fees, no commissions — it’s no wonder it drives some people mad.
Kropadope
@Kropadope: She gets most of her news from Fox, so I have no idea.
Karen
Richard, I know it’s OT but I’m going crazy and my stomach has been in knots so hopefully you can please, please help me. On November 1, I’ll have been on Disability for two years, although it was retroactive from April 2014. In January of 2014, I started on Medicaid, under MD Medicaid expansion act, where they didn’t count my Disability check as income. In July I got a letter and a Medicare number explaining that I was automatically enrolled in Medicare part A and had until November to decline Medicare part B (which I have no intent of doing).
Here is my question. I’ve been told that Medicare is my primary but Medicaid could be my secondary. Since I got Medicaid under the new rules, do I get to keep it as a secondary or does the criteria suddenly change? With Medicaid as a secondary it would pay for what Medicare won’t and between 2014 and 2015 I’ve had breast cancer, double mastectomy, DVT, mini-stroke, three stents in rehab for Rheumatoid Arthritis related PT and OT and kidney stone surgeries. If all I can get is Medicare with no secondary, I’ll go bankrupt. I also get an aide thanks to Medicaid and mental health services. If you can’t answer the question, could you please maybe give me an idea of where I need to go next? I called the MD health connection, the exchange where I got Medicaid and they said the criteria should be the same BUT that they don’t know when it comes to Medicare. I called Medicare and they said they don’t know when it comes to Maryland Medicaid. Help?
Richard Mayhew
@Karen:
This is WAY past my knowledge base. My best bet is to talk to a social worker or a case worker that manages your Medicaid claim. The state wants to get to the point where Medicaid is the secondary payer as they will eventually be on the hook for 10% of the Medicaid claim value, but 0% of the Medicare claim value. They should know the process of getting you off to Medicare.
The Exchange will be useless, they deal mostly with commercial insurance not government programs.
Best bet is to call the Medicaid office as they want to help you get off of their program.
Richard Mayhew
@Chris: @TXkid: Let me get a longer response to both these related questions tomorrow.
Short answer, COBRA is often a bad deal in the PPACA world with a few notable rare exceptions. Long answer will lay out the decision tree.
Thoughtful Today
And again :)
BERNIE SANDERS supports my values on health care:
http://feelthebern.org/bernie-sanders-on-healthcare
“Medicare for All” / Single-payer health-care system for every American.