Is Obamacare Doomed?

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**d-usa**

Jihadin wrote:
d-usa wrote:
redleger wrote:
Civilian workforce filling in roles Soldiers can do kills our budget.

Why use soldiers for any job a civilian can do?

Because civilians doing the job are paid way more.

Are they paid more?

And even if they are paid more, the question to ask should be: do they cost more?

A soldier might get less pay, but there are additional costs to having a soldier do the job:

- Cost of training (basic and specialization)
- Tricare for soldier and dependents
- Education for dependents
- Subsidized groceries
- Retirement pay
- Separation pay
- Veterans benefits
- base operations

A good look at the question of civilian vs soldier: http://www.rand.org/content/dam/rand/pubs/monographs/2007/RAND_MG598.pdf

**Jihadin**

Most of the DoD employee's are former military D-USA

Edit

I'm paid about the same as a E5 starting off in the Government.
Yet. Yes...there's a yet
I draw 90% Disability
I draw Retirement
On top of my pay with a Locality Adjustment

Free Medical to Service Connected Injuries.

Veteran Affair is not part of the Defense Budget so Vet Beanies out
Separation Pay is a one shot deal if one RCP out (Retention Control Point)
Retired Vets can shop in the PX/Commisary so IIRC groceries and merchandise is not subject to state taxes.
Tricare IIRC the S/M pays into it for his/her dependents

**redleger**

djones520 wrote:
redleger wrote:

It was so horribly thought out that military were gonna have to buy their own insurance on top of the insurance they already have because it was written so poorly.

What?

I know of absolutely zero service members who have had to do this.

I'm not at all a fan of ACA, but lets not just make gak up about it.

Djones, it was immediately fixed once it was reported, prior to implementation. But quick google will show it to be true. Tricare was not covered in the initial ACA. Im on a government computer on Staff Duty right now is not allowing me to click on the pages. Net nanny here is ridiculous.

**d-usa**

Jihadin wrote:
Most of the DoD employee's are former military D-USA

Which just goes back to "why have a soldier do a job a civilian can do".

**redleger**

https://www.congress.gov/bill/111th-congress/house-bill/4887/text

Here is the amendment to fix the fact that Tricare was not covered under the ACA which would have caused us to have to get additional pooled coverage.

**Prestor Jon**

Vaktathi wrote:
CptJake wrote:
Vaktathi wrote:
redleger wrote:
And I am currently active duty so I do have first hand experience over what the budget cuts are doing to us
Perhaps thats an issue with resource allocation rather than actual funding problems?

If the US military cant do its job while matching the rest of the planet combined dollar for dollar on spending, then its not a funding problem, its a problem with where that funding is going.

Even if the money was being spent 'correctly' (however you want to define it) it would not solve the issue. The 'job' the military is doing/being asked to do/is being told it must be able to do in the future is expensive.

If you REALLY want to cut down the military budget, you must redefine what you expect the military to do and then resource it at the level required for it to do so. If you want the military to be able to handle 'near peer' bad guys in the near to mid future, you have to fund the force structure and capabilities required to do. If you want the military to be able to deploy X force structure in Y time, you have to fund the required capability.

There is a lot of waste, and I know for a fact a lot of effort going into limiting at least some of. But war is inherently wasteful, and maintaining the force structure and capability set to ensure the military can meet the 'job' POTUS and the congress critters expect it to do now and in the future is not cheap.

We may spend more than other countries, but we currently DO a lot more with our military AND have levied some pretty hefty 'Be Prepared To' requirements on them as well.
I get all that, and in many respects there are good arguments for reducing the scope of the mission requirements of the US military. However, when we're dealing with hilariously mismanaged programs like the F35 with an eventual expected total program cost exceeding that of the GDP of the Russian Federation, or decisions to pay contractors 10x to do what soldiers (often the very same people) used to do, or "patriotism for pay" scandals at sporting events, and all the previously aforementioned issues, there are tens if not hundreds of billions of dollars not being put towards fulfilling those mission requirements, and that makes it hard to feel terrible about military budget cuts.

That said it's also not like healthcare doesnt also have any of its own very real equivalent issues too

Because Congress controls the purse strings every federal dollar spent is politicized so Congress determines how to fund the military in whatever manner helps powerful members of Congress get re-elected instead of authorizing military spending in a pragmatic manner to help military do its job the best it can. Things like how many tanks the army needs is determined more by how many need to be built to keep the factories in congressional districts open with no layoffs than how many the army actually needs to be mission capable. Civilian oversight of the military is a good thing but it's always screwed with the budget really hard.

**Jihadin**

Woops. There's actual General Schedule workers and then there's Contractors. I think we're lumping those together
GS pay chart
and
Military Paychart

**redleger**

I wasn't. I was talking about both, lol. Although contractors tend to make a bit more.

**Jihadin**

They make much more. Depending on location.

Here's a GS Scale Pay Chart
http://www.federaljobs.net/salarybase.htm#General_Schedule_(GS)

2016 Military Pay Scale
http://militarybenefits.info/2016-military-pay-charts/

**redleger**

Oh I know those charts like the back of my hand. Initially as a GS9 instructor, Ill actually be taking a bit of a cut. But hey gotta pay the bills.

**Prestor Jon**

Easy E wrote:
http://www.slate.com/articles/business/moneybox/2016/08/is_obamacare_doomed_all_your_questions_answered.html

Right now, Obamacare seems to be working much better in some states than others. In California, more than three-quarters of providers managed to squeeze out a profit in 2014, and residents have a whole slew of carriers to choose from. In rural states and the South, where populations are sparser and the residents often unhealthier, things have gone far less smoothly.

Some states may be suffering from a bit of self-sabotage. As Charles Gaba notes, insurance companies have tended to ask for higher premium increases in states where lawmakers (irrationally) declined to expand Medicaid under the Affordable Care Act, because they just hated Barack Hussein Obama that much. Their obstinance probably pushed a lot of low-income, not-particularly-healthy patients into the Obamacare exchanges, where they could get highly subsidized coverage. Some states also allowed residents to retain old plans that didn’t meet the Affordable Care Act’s standards through 2017, which kept those customers off the exchanges. They’ve also seen insurers ask for bigger hikes.

In the end, though, the Affordable Care Act is a national law that needs to work everywhere. And it doesn’t yet.

So, the states that chose to embrace the new law are doing poorly with their exchanges, while states that embraced the law are not. Okay then. Color me shocked! Therefore, Obamacare is failing since nationally it is not working everywhere the same way.

The danger of Death Spiral is a real threat to Obamacare's continues existence.

Your thoughts?

That's a really partisan take from Slate regarding the states that chose not to expand Medicaid. The ACA's Medicaid expansion puts additional financial burdens on state to help cover the cost of new enrollees on top of covering half the cost of current enrollees and states have to come up with the funding while still balancing their budgets each year.

http://kff.org/medicaid/issue-brief/medicaid-financing-how-does-it-work-and-what-are-the-implications/

States generally are required to balance budgets, creating tension across programs. Unlike at the federal level, states are required to balance their budgets. State lawmakers must therefore balance competing spending priorities (K-12 education, Medicaid, transportation, etc.) as well as make decisions about the amount of revenue to collect. Balancing these competing priorities creates an ever present tension. Increases in Medicaid spending are driven largely by enrollment growth but also reflect states need to respond to rising health care costs. While ever present, the ever present tension of balancing spending across programs is particularly acute during economic downturns, when state revenues decline and Medicaid enrollment increases as people lose jobs and income at the same time as demand for other programs increases. Although the guaranteed federal match reduces the need for increased Medicaid spending from state sources, states still must increase the amount of non-federal dollars spent on the program in order to access those federal funds. States sometimes turn to provider tax revenues, inter-governmental transfers and other non-federal revenue sources to help fund the state share of Medicaid spending during such periods.

http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx

Provisions of the Affordable Care Act would have expanded Medicaid to all Americans under age 65 whose family income is at or below 133 percent of federal poverty guidelines by Jan. 1, 2014. With the ACA's "income disregard" provisions (known as modified adjusted gross income, or MAGI), the effective income threshold for Medicaid eligibility is 138 percent of federal poverty guidelines (or $16,394 for an individual in 2016). As passed by Congress, states failing to participate in this expansion would have risked losing their entire federal Medicaid allotment. The Medicaid expansion provision of the law led to challenges that rose to the U.S. Supreme Court - on June 28, 2012 the court ruled that Congress may not make a state’s existing Medicaid funds contingent upon compliance with Medicaid expansion. In practice, this ruling makes Medicaid expansion a voluntary action by states.

Given this choice, many states have been weighing the costs and savings associated with expanding Medicaid to cover people under the age of 65 with incomes at or below 138 percent of the federal poverty level. Even with the federal government paying for a significant portion of the cost of coverage for the newly eligible—100 percent in 2014 through 2016, decreasing to 97 percent in 2017 and eventually 90 percent in 2020 and thereafter—fiscal uncertainties remain.

**Ahtman**

redleger wrote:
False. That is not what I said, I said we would be down to one brigade, and that was being slightly fesicious.

Of course it isn't the literal words you used or I would have just quoted it and not had used the word 'essentially'. Anyone can see the original post that others saw as problematic as well. You complain about things being facetious but use what is at best a pedantic argument after moving the goal posts.

**redleger**

Why can't anyone walk the middle anymore. Why must there always be a left and right? /sigh\

OK, so its would not be the end of the world, I am not crying doom. That one Division would be the best division in the world, but its one division, and can't do everything that would be asked of it. See posts above by CPTJake, no need to repeat why here.

I am currently experiencing the pains of cutbacks. Cutbacks are not being done at the levels they should be, instead they are taking away benefits, maintenance capabilities, while still funding R and D. The policies on spending have not changed, so therefore everything else will get stripped away except what we call "readiness"

If the spending policies were changed, and money was left to the discretion of a commander, and incentives were put in place to not spend every dime, then at the troop level, you would not feel the pain the way we do now, and the budget could be cut further without hurting benefits or readiness. It is actually a lot more complicated than that, but that is the simple version.

**Easy E**

redleger wrote:

If the spending policies were changed, and money was left to the discretion of a commander, and incentives were put in place to not spend every dime, then at the troop level, you would not feel the pain the way we do now, and the budget could be cut further without hurting benefits or readiness. It is actually a lot more complicated than that, but that is the simple version.

Welcome to life in any bureaucratic organization. The public sector is no different.

Automatically Appended Next Post:

Prestor Jon wrote:

That's a really partisan take from Slate regarding the states that chose not to expand Medicaid. The ACA's Medicaid expansion puts additional financial burdens on state to help cover the cost of new enrollees on top of covering half the cost of current enrollees and states have to come up with the funding while still balancing their budgets each year.

Good stuff as always Prestor. However, are you arguing that the states that dragged their feet on ACA did not do so for ideological reasons?

**Prestor Jon**

Easy E wrote:

Prestor Jon wrote:

That's a really partisan take from Slate regarding the states that chose not to expand Medicaid. The ACA's Medicaid expansion puts additional financial burdens on state to help cover the cost of new enrollees on top of covering half the cost of current enrollees and states have to come up with the funding while still balancing their budgets each year.

Good stuff as always Prestor. However, are you arguing that the states that dragged their feet on ACA did not do so for ideological reasons?

**whembly**

Easy E wrote:

Automatically Appended Next Post:

Prestor Jon wrote:

That's a really partisan take from Slate regarding the states that chose not to expand Medicaid. The ACA's Medicaid expansion puts additional financial burdens on state to help cover the cost of new enrollees on top of covering half the cost of current enrollees and states have to come up with the funding while still balancing their budgets each year.

Good stuff as always Prestor. However, are you arguing that the states that dragged their feet on ACA did not do so for ideological reasons?

I'm sure there were some ideological reasons E... just as some of the state who has chosen to expand may have done so as well.

But, the state knew they would have to come up with additional fundings, so for some state, the only pragmatic choice may have been to NOT expand.

EDIT: ninja'ed by Prestor's even better reply.

**skyth**

Please...they opted out because Obama wanted them to opt in.

Anything else is an excuse to try to hide the real reason.

**whembly**

skyth wrote:
Please...they opted out because Obama wanted them to opt in.

Anything else is an excuse to try to hide the real reason.

What real reason is that skyth?

**dogma**

Prestor Jon wrote:
Congress can change that extra generous rate of reimbursement to a lower rate anytime there's no guarantee that it lasts.

There is no guarantee that anything lasts. Why would you think otherwise?

Prestor Jon wrote:

The ACA Medicaid expansion requires states to find funding to cover their share of the cost and that means state politicians have to redistribute their budgets or raise taxes and that might not be politically or fiscally viable for every state. There states that are in poor fiscal shape and they'd have weigh the facts of how many new people would qualify for Medicaid, how much it would cost and what they had to spend.

States should be forced to raise taxes, as they are artificially low; the work of State politicians.

**sebster**

whembly wrote:
The laws like 'can't prohibit pre-existing conditions' and 'can't have lifetime maximum coverage' is going to stay, even if ACA is repealed.

Can't have the law removing denial for a pre-existing condition, without also having the mandate and the subsidies. If people can just sign up once they're sick, then they have no incentive to sign up before they're sick. And that's would give the death spiral everyone talks about. And of course, if people are mandated to get insurance, then you need the subsidies to make sure everyone can afford coverage.

Like it or not, without a single national carrier then the basic ACA structure is what you have to have.

And no, a single national is not going to happen. ACA just tried to stop insurance companies from being able to deny coverage to people, and in response the insurers created such a political furor that people got death threats, and they created a whole new conservative movement. The idea that there could be laws passed that actually got rid of the national insurers is a pipe dream.

Wow, flashbacks to 2009 there.

**whembly**

sebster wrote:
whembly wrote:
The laws like 'can't prohibit pre-existing conditions' and 'can't have lifetime maximum coverage' is going to stay, even if ACA is repealed.

Can't have the law removing denial for a pre-existing condition, without also having the mandate and the subsidies.

Sure you can. No need to have the exchange... just let the various insurance co. compete for your business.

If people can just sign up once they're sick, then they have no incentive to sign up before they're sick.

That's. Happening. Now.

And that's would give the death spiral everyone talks about.

Death Spiral has begun Seb. It'll be accelerated when the Cadillac Tax kicks in.

And of course, if people are mandated to get insurance, then you need the subsidies to make sure everyone can afford coverage.

Sure. Then, make the baseline requirements really cheap.

Like, basic Primary Care visits + Catestrophic coverage.

Like it or not, unless you want a single national healthcare system, the basic ACA structure is what you have to have.

I want single payer... not NHS.

Wow, flashbacks to 2009 there.

Yup. And the critics are proven right so far...

**dogma**

whembly wrote:

Sure you can. No need to have the exchange... just let the various insurance co. compete for your business.

What about people that frequently move between States?

**whembly**

dogma wrote:
whembly wrote:

Sure you can. No need to have the exchange... just let the various insurance co. compete for your business.

What about people that frequently move between States?

Reapply?

Just like how you have to relicense you car, get new drivers license, etc...

**dogma**

whembly wrote:

I want single payer... not NHS.

NHS is single payer.

whembly wrote:

Reapply?

Just like how you have to relicense you car, get new drivers license, etc...

I didn't have to re-license my car when I moved to Minnesota, or get a new driver's license, and I certainly don't need to do either of those things when I commute to Wisconsin or Indiana.

**whembly**

dogma wrote:
whembly wrote:

I want single payer... not NHS.

NHS is single payer.

As far as I know, NHS also includes the providers, whom are government operated.

The Canadian model, most providers are still privately operated and competes for those block grants from Canada Medicare.

Automatically Appended Next Post:

dogma wrote:

I didn't have to re-license my car when I moved to Minnesota, or get a new driver's license, and I certainly don't need to do either of those things when I commute to Wisconsin or Indiana.

So?

Why are you bringing commutes into this discussion?

As to re-license car/drivers license... some states allow you to do that.

Missouri isn't one of those. (particularly because we have that yearly road tax).

**dogma**

whembly wrote:

As far as I know, NHS also includes the providers, whom are government operated.

So...single-payer.

whembly wrote:

The Canadian model, most providers are still privately operated and competes for those block grants from Canada Medicare.

A mixed system.

whembly wrote:

Why are you bringing commutes into this discussion?

Because it is relevant to inter-State politics, and commerce.

whembly wrote:

As to re-license car/drivers license... some states allow you to do that.

Missouri isn't one of those. (particularly because we have that yearly road tax).

My license was recognized in St. Louis.

**whembly**

dogma wrote:
whembly wrote:

As far as I know, NHS also includes the providers, whom are government operated.

So...single-payer.

I stand corrected.

whembly wrote:

The Canadian model, most providers are still privately operated and competes for those block grants from Canada Medicare.

A mixed system.

Yep. My preference.

whembly wrote:

Why are you bringing commutes into this discussion?

Because it is relevant to inter-State politics.

How so?

whembly wrote:

As to re-license car/drivers license... some states allow you to do that.

Missouri isn't one of those. (particularly because we have that yearly road tax).

My license was recognized in St. Louis.

I wasn't talking about recognition. You asked what happens if you moved.

**dogma**

whembly wrote:

I wasn't talking about recognition. You asked what happens if you moved.

So an Illinois license would not be recognized in Missouri if the person moved, but it would be fine if that person was a tourist or a commuter?

**sebster**

Prestor Jon wrote:
I'm saying that blaming anti Obama partisanship for states not expanding Medicaid is a half truth at best.

Okey dokey, let's go through the states that haven't expanded medicaid and see if we can find a common denominator.

Florida: Rejected by Republican Governor Rick Scott.
Georgia: Republican Governor Nathan Deal will not support Medicaid expansion.
Idaho: Republican Governor Butch Otter confirmed in his state-of-the-state address that Idaho would not expand Medicaid.
Kansas: Republican Governor Sam Brownback is leaving it up to state legislature, which is controlled by Republicans who haven't passed any motion accepting expansion.
Maine: Republican Governor Paul LePage has vetoed a bill expanding Medicaid.
Mississippi: Republicans in the legislature blocked plans to expand Medicaid in June 2013.
Missouri: In February 2014 the Republican controlled state Senate defeated an effort to expand Medicaid in Missouri. The Democratic governor is on record for expanding Medicaid.
Nebraska: In May 2013 Republicans in the Legislature filibustered the Medicaid expansion, which was also opposed by Republican Governor Dave Heineman.
North Carolina: In 2013 the Republican controlled General Assembly passed a bill banning Medicaid expansion. The Republican governor Pat McCrory is actually in favour of expansion.
Oklahoma: Republican Governor Mary Fallin rejected the Medicaid expansion in November 2012.
South Carolina: The state House Republican majority rejected an expansion of Medicaid on March 12, 2013. Republican Governor Nikki Haley announced in July 2012 that she opposes expansion.
Tennessee: Republican Governor Bill Haslam has rejected medicaid expansion. To his credit he's working on an alternative that would take some federal funds and use that to help low income people to purchase insurance through their employers. However the deal was rejected by a senate committee, with the Republican committee members shooting it down.
Texas: Republican Governor Rick Perry and the Republican majority in the state Legislature have unanimously rejected the Medicaid expansion. There is legislation introduced by Democrats that would expand medicaid, but that's not going anywhere because Republicans control the senate and governorship.
Utah: Republican Governor put forward a plan to expand medicaid with the federal funding, but a Republican controlled Utah House committee rejected it. He has tried a new model that puts any shortfall in federal funding on to hospitals and other parts of the health industry, but Republicans in the House are on record as rejecting this proposal.
Virginia: Democratic Governor Terry McAuliffe is in favour of Medicaid expansion, but the Republican controlled Virginia Legislature has kept the expansion out of its budget, and they are not expected to entertain McAuliffe's budget proposals to accept expansion.
Wisconsin: Republican Scott Walker has rejected Medicaid expansion, but is looking at other possible strategies.
Wyoming: The Republican Governor has supported an alternative medicaid expansion scheme, however the Republican controlled state Senate and House in February 2015 voted against the expansion plan.

The rejection of medicaid expansion by Republicans and only Republicans is not a half truth. It is an absolute truth.

You are right that the medicaid expansion isn't just free money to the states, that the rate of Federal funding is already set for reduction, and there's nothing stopping future reductions. But to reject healthcare coverage for your state's low income residences because the government won't pay 100% of the cost forever is ridiculous, and nothing no state would do in ordinary political climes.

**whembly**

dogma wrote:
whembly wrote:

I wasn't talking about recognition. You asked what happens if you moved.

So an Illinois license would not be recognized in Missouri if the person moved, but it would be fine if that person was a tourist or a commuter?

Just stop. Not what I said.

Automatically Appended Next Post:

sebster wrote:
Prestor Jon wrote:
I'm saying that blaming anti Obama partisanship for states not expanding Medicaid is a half truth at best.

Okey dokey, let's go through the states that haven't expanded medicaid and see if we can find a common denominator.

Florida: Rejected by Republican Governor Rick Scott.
Georgia: Republican Governor Nathan Deal will not support Medicaid expansion.
Idaho: Republican Governor Butch Otter confirmed in his state-of-the-state address that Idaho would not expand Medicaid.
Kansas: Republican Governor Sam Brownback is leaving it up to state legislature, which is controlled by Republicans who haven't passed any motion accepting expansion.
Maine: Republican Governor Paul LePage has vetoed a bill expanding Medicaid.
Mississippi: Republicans in the legislature blocked plans to expand Medicaid in June 2013.
Missouri: In February 2014 the Republican controlled state Senate defeated an effort to expand Medicaid in Missouri. The Democratic governor is on record for expanding Medicaid.
Nebraska: In May 2013 Republicans in the Legislature filibustered the Medicaid expansion, which was also opposed by Republican Governor Dave Heineman.
North Carolina: In 2013 the Republican controlled General Assembly passed a bill banning Medicaid expansion. The Republican governor Pat McCrory is actually in favour of expansion.
Oklahoma: Republican Governor Mary Fallin rejected the Medicaid expansion in November 2012.
South Carolina: The state House Republican majority rejected an expansion of Medicaid on March 12, 2013. Republican Governor Nikki Haley announced in July 2012 that she opposes expansion.
Tennessee: Republican Governor Bill Haslam has rejected medicaid expansion. To his credit he's working on an alternative that would take some federal funds and use that to help low income people to purchase insurance through their employers. However the deal was rejected by a senate committee, with the Republican committee members shooting it down.
Texas: Republican Governor Rick Perry and the Republican majority in the state Legislature have unanimously rejected the Medicaid expansion. There is legislation introduced by Democrats that would expand medicaid, but that's not going anywhere because Republicans control the senate and governorship.
Utah: Republican Governor put forward a plan to expand medicaid with the federal funding, but a Republican controlled Utah House committee rejected it. He has tried a new model that puts any shortfall in federal funding on to hospitals and other parts of the health industry, but Republicans in the House are on record as rejecting this proposal.
Virginia: Democratic Governor Terry McAuliffe is in favour of Medicaid expansion, but the Republican controlled Virginia Legislature has kept the expansion out of its budget, and they are not expected to entertain McAuliffe's budget proposals to accept expansion.
Wisconsin: Republican Scott Walker has rejected Medicaid expansion, but is looking at other possible strategies.
Wyoming: The Republican Governor has supported an alternative medicaid expansion scheme, however the Republican controlled state Senate and House in February 2015 voted against the expansion plan.

The rejection of medicaid expansion by Republicans and only Republicans is not a half truth. It is an absolute truth.

You are right that the medicaid expansion isn't just free money to the states, that the rate of Federal funding is already set for reduction, and there's nothing stopping future reductions. But to reject healthcare coverage for your state's low income residences because the government won't pay 100% of the cost forever is ridiculous, and nothing no state would do in ordinary political climes.

Because it's a GAK.LAW. Not because it was pushed by Obama.