Some guy at Stat is trying to think about the 2019 Exchanges. Absurd to have long range planning going on.
What do you think?
Despite Republicans’ concerted efforts to repeal and replace the Affordable Care Act, the federal- and state-based exchanges that it created will be in operation at least through 2019. These marketplaces help individuals, families, and small businesses shop for and enroll in affordable medical insurance.
The ACA and its possible replacement, the American Health Care Act, both rely on the same general structure to sell insurance to people who are not covered by insurance through work or other programs. Participants receive income-based subsidies to buy qualified health plans on either a state or federal marketplace (Healthcare.gov). The decisions that will shape the options available in 2019 are now being made by the Centers for Medicare and Medicaid Services.
To ensure that the exchanges function better in 2019 than they have to date, I urge decision makers to consider the four following strategies…..
Cheryl Rofer
Thanks, David. I think it’s utterly essential (and personally theraputic) to think about what the world will look like after we get rid of the Orange Monster and the Republican Party implodes. I’ve been encouraging thinking ahead and trying to do some of it on Twitter.
Lee
I think the Exchanges will exist. I’m not sure they will be as robust.
I have noticed that a very few of my conservative friends on FB have gone from ‘repeal & replace’ to ‘well exactly what should we do to fix the mess of Obamacare?’
schrodingers_cat
@Lee: Conservative and friends does not belong in one sentence. Unless it is
Conservatives are not our friends, to be more specific any R voter is not our friend. They explicitly support policies that will kill us all.
NobodySpecial
Having long range planning in place is preferable to not having anything ready in 2018 given how different things may look. I’d be glad if they had two or three scenarios blocked out.
Feathers
One of the huge problems of the ACA all along has been the media’s “Are you for or against?” framing, without bothering to clarify if the againsters were opposed because it did too little or too much.
Come to think of it, this may be a cause of the Berner problem, in the media there is no reasonable option to the left of the most conservative Democrat.
germy
germy
germy
MomSense
@germy:
I’m sure that 2 million voters purged has nothing to do with our loss there in 2016.
Kelly
Well written and to the point. It’s very familiar to those of us that followed Richard Mahew through the early ACA years. Glad to see you getting a chance to help a larger audience. Now how do we get you on the PBS News Hour?
schrodingers_cat
@Kelly: He needs to be both-sidery and trash the Dems, then he will get an invite to pontificate with Whory Woodruff on the PBS (Pure BullShit) Newshour.
Eric U.
I was feeling gloomy the other day and decided they were going to try to kill the ACA through incompetence and defunding. They are really good at incompetence.
Kelly
@schrodingers_cat: That should work…
Kelly
@Eric U.: Exactly where I was at yesterday afternoon.
germy
@Eric U.:
It’s their best trait.
hovercraft
@MomSense:
You have to remember that Karl Rove’s meltdown in 2012 was because they thought they’d purged enough then to ensure a RMoney win, they thought they had it then. Our side counted on our voters coming out, but we failed to take into account the number of our voters who had been forced out of the pool through a combination of purges, ID laws and restricted voting hours/places. 2016 was the full effect of the 2010 election, gerrymandering, suppression, and all the other myriad ways they shaped the electorate.
germy
@hovercraft:
I spent some time on another progressive blog overrun with “conservative” commenters who argued the biggest problem facing our nation was the number of stupid people allowed to vote. One commenter said (with a straight face) there should be some sort of quiz administered at the polling place before a citizen is allowed to vote.
I pointed out to them the fact that the only way they could hope to win was by voter suppression. They didn’t understand; instead doubled down on “stupid people being allowed to vote.”
I see no point in any outreach to these conservatives.
dr. bloor
@germy: I can’t wait for Gorsuch’s opinion telling disenfranchised Ohio voters that if they want to be allowed to vote, they have to vote for reps who will change the voting laws.
germy
@dr. bloor:
the heritage foundation put his name on their list for precisely that reason.
Bob Hertz
Good ideas in the article, but I would ask:
1. Can the federal government order insurers to pay commissions? or does this have to be from state governments?
2. Increasing subsidies to persons over 400% of poverty is absolutely vital, but would cost at least $15 billion a year.
(see Blumberg and Holohan in 2015) Who will vote to spend the money?
amygdala
Congrats, David! StatNews does a great job of choosing content that appeals to a broad range of biomedical science types, from students and trainees to clinicians to academic and industry scientists to health policy types. Delighted you’ll be getting such a big audience.
TenguPhule
@Cheryl Rofer:
It will be on fire. And we will be spending the rest of our lives trying to put it out.
David Anderson
@amygdala: They are one of the three or four channels that hits the audience that I want to hit on a regular basis. And the process of getting the piece published was extremely professional and straightforward. I enjoyed working with STAT