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

Obamacare is starting to look a little wobbly. Big insurers are bailing on the public insurance exchanges that were set up under the Affordable Care Act, ostensibly because they can’t figure out how to turn a profit selling coverage through them—which both means shoppers in some states will have fewer options when it comes time to buy their coverage for 2017 and calls into question the long-term stability of the entire massive health care reform. Meanwhile, insurance premiums appear to be headed for a major hike next year.

I mean, it’s not like the SS Obamacare has slammed into an iceberg and water’s gushing into the hull. McKinsey, for instance, has argued that as long as the government keeps offering subsidies, the system should be able to soldier on. Plus, large insurers aren’t giving up on the marketplaces entirely. Take Aetna again. According to its latest Securities and Exchange Commission filing, the 11 states where it’s pulling back from the marketplaces only account for about 20 percent of its Obamacare business. (It had 838,000 exchange customers as of June.) Even in the states from which it’s retreating, the company plans to continue selling coverage off the exchanges, which under the law would allow it to return to the marketplaces in 2018 should it feel so inclined. Meanwhile, Cigna is bucking the trend and plans to expand its marketplace footprint.

And don’t forget: Some insurers are making money on the exchanges. The difference is that companies like Centene and Molina got their starts working with Medicaid patients and have won over low-income Obamacare customers by offering inexpensive plans with narrower doctors’ networks. In a lot of ways, they’re more naturally suited for the exchanges than big names like Aetna and UnitedHealth, which really make their bones selling plush coverage to employers.

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?

It needs to be tweaked, but no, not all. No one wants to go back to having people with pre-existing conditions be essentially uninsurable, no one wants to re-open the doughnut hole, and so on.

On the other hand, if it failed and we went to single payer, I'd be all for that. But I don't see that happening.

My thoughts are it was a horribly planned concept. It is borderline unconstitutional and the minute it was signed premiums jumped up, instead of getting cheaper like promised.

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.

I hope it fails, they need to go back to the drawing board, find a way to do something that does not violate rights with tax hikes, but still affords people the opportunity to have affordable care.

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.

Not only the premiums are rising, but the deductables (paying 'x' amount before insurance kicks in) are getting bigly.

"small tweaks" will not be enough... its going to need a MASSIVE increase to subsidies that covers even the middle class and I seriously doubt the Democrats could pass such a bill now.

And... it will be repealed, even with Clinton at President. However, she'll exact a price since she can be bought after all.

If you're subsidizing it anyway, what's the objection to going to a single payer system?

Herzlos wrote:
If you're subsidizing it anyway, what's the objection to going to a single payer system?

Communism, you hippy!

*The above comment is sarcasm, intended to reflect the general sentiment in the United States that any form of helping people via the state is inherently tyrannical, and therefore Bad .

That said, a lot of people I've noticed generally recognize that a single payer system would be better than the current hybrid system we've been running with (which is probably true).

 LordofHats wrote:

Herzlos wrote:
If you're subsidizing it anyway, what's the objection to going to a single payer system?

Communism, you hippy!

*The above comment is sarcasm, intended to reflect the general sentiment in the United States that any form of helping people via the state is inherently tyrannical, and therefore Bad .

That said, a lot of people I've noticed generally recognize that a single payer system would be better than the current hybrid system we've been running with (which is probably true).

No... because socialism.

Aye, a single-payer, ala Canada, would be better than current system.

Unfortunately, the political will to fix the ACA simply isn't there. The Republicans have spent the last few years making "repeal Obamacare" one of their primary promises. To fix it, rather than repeal it, will be seen as a betrayal of that promise and they risk losing elections for it.

 Tannhauser42 wrote:
Unfortunately, the political will to fix the ACA simply isn't there. The Republicans have spent the last few years making "repeal Obamacare" one of their primary promises. To fix it, rather than repeal it, will be seen as a betrayal of that promise and they risk losing elections for it.

Im pretty sure trump Is doing that for them, they might as well do the right thing.

 whembly wrote:

"small tweaks" will not be enough... its going to need a MASSIVE increase to subsidies that covers even the middle class and I seriously doubt the Democrats could pass such a bill now.

And the GOP won't cut defense spending.

 whembly wrote:

And... it will be repealed, even with Clinton at President. However, she'll exact a price since she can be bought after all.

No, it won't. It will be modified, which is right, and Trey Gowdy will lose all national cred.

The ACA is a watered down stopgap. It clearly has problems, and that was evident to everyone from the outset. It's better than what we were dealing with before (and is the primary reason a friend of mine is still alive, he'd have been dead without the coverage extension to 26 because he would not have been able to afford treatment), but its far from perfect. Nobody expects that the ACA will be the final word on healthcare, it had to be dramatically changed, neutered and hamfisted in order to get passed given the exisitng political climate.

 dogma wrote:

 whembly wrote:

"small tweaks" will not be enough... its going to need a MASSIVE increase to subsidies that covers even the middle class and I seriously doubt the Democrats could pass such a bill now.

And the GOP won't cut defense spending.

 whembly wrote:

And... it will be repealed, even with Clinton at President. However, she'll exact a price since she can be bought after all.

No, it won't. It will be modified, which is right, and Trey Gowdy will lose all national cred.

Im pretty sure if they cut defense spending any more, we would be down to 1 full division with broken equipment and 1 plane to ferry the entire Army around, while the navy is getting new ships. Defense spending at some point has to quit being cut. there are other ways to fix the money sink, but its not proper to discuss it here.

I don't care about a politicians credibility. The moment they run for office, they are scum until they prove otherwise. I am rarely proven wrong.

US defense spending could live with very large cuts and not radically weaken actual combat capabilities. We might have to live with fewer cool toys and expensive research projects (and no longer being able to fly literal pallete loads of cash around and conventiently lose them, or pay 7 digits for a gas station in Afghanistan), but US defense spending still matches nearly the rest of the planet *combined*, we're not in any danger of beind reduced to "1 full division with broken equipment and 1 plane to ferry the entire Army".

The US defense budget has been massively bloated and poorly overseen for decades. It could live with cuts and still remain effective. Hell, the army was forced to spend untold millions buying new tanks it said it didnt want to need because the Congress decided they wanted to keep buying them. The DoD was the worlds largest purchaser of Kalashnikov pattern rifles for many years and kept zero records on where the rifles were going and handing them out like candy (while Department of State tried to meekly destroy as many as they could, which wasnt many, as the arms were seized...often they very same ones we bought). Which illustrates the problem nicely.

 redleger wrote:
Im pretty sure if they cut defense spending any more, we would be down to 1 full division with broken equipment and 1 plane to ferry the entire Army around

Actually if they cut defense spending we'd still probably be the most expensive and well funded military in the world.

 Tannhauser42 wrote:
Unfortunately, the political will to fix the ACA simply isn't there. The Republicans have spent the last few years making "repeal Obamacare" one of their primary promises. To fix it, rather than repeal it, will be seen as a betrayal of that promise and they risk losing elections for it.

I said at the time that the actions of the GOP were one of the most disappointing things about Obamacare, because healthcare is something that affects every American at one time or another, and thus, should be above party politics.

The GOP of yesteryear would probably have worked constructively on this with the D's, with measured criticism etc etc and proposed sensible alternatives, thus filling the role of opposition and appearing statesmanlike.

Instead, we got mass hysteria, the British health care system being grossly slandered by ignorant right-wingers and the GOP convincing people who would have benefited the most from better healthcare (the poor), from voting against their own interests

To answer the OP's question, I think it will carry on under Clinton.


Automatically Appended Next Post:

 redleger wrote:

 dogma wrote:

 whembly wrote:

"small tweaks" will not be enough... its going to need a MASSIVE increase to subsidies that covers even the middle class and I seriously doubt the Democrats could pass such a bill now.

And the GOP won't cut defense spending.

 whembly wrote:

And... it will be repealed, even with Clinton at President. However, she'll exact a price since she can be bought after all.

No, it won't. It will be modified, which is right, and Trey Gowdy will lose all national cred.

Im pretty sure if they cut defense spending any more, we would be down to 1 full division with broken equipment and 1 plane to ferry the entire Army around, while the navy is getting new ships. Defense spending at some point has to quit being cut. there are other ways to fix the money sink, but its not proper to discuss it here.

I don't care about a politicians credibility. The moment they run for office, they are scum until they prove otherwise. I am rarely proven wrong.

I don't know if you're a US military veteran or not, so forgive me if I'm preaching to the converted, but from my knowledge, a US army division, or a Marine Division, is a pretty formidable fighting unit. The amount of fire power it can churn out is astonishing.

Even 1 US division is nothing to sneeze at.

 redleger wrote:
Im pretty sure if they cut defense spending any more, we would be down to 1 full division with broken equipment and 1 plane to ferry the entire Army around

If you cut your defense spending in half you would still spend more than China and Russia put together. =)

I am not saying you should - halving it overnight might actually do more harm than good - but your military is certainly not underfunded.

It appears to have shifted money around rather than making healthcare actually cheaper for all. As usual the middle class is paying the bill.

 Do_I_Not_Like_That wrote:

 Tannhauser42 wrote:
Unfortunately, the political will to fix the ACA simply isn't there. The Republicans have spent the last few years making "repeal Obamacare" one of their primary promises. To fix it, rather than repeal it, will be seen as a betrayal of that promise and they risk losing elections for it.

I said at the time that the actions of the GOP were one of the most disappointing things about Obamacare, because healthcare is something that affects every American at one time or another, and thus, should be above party politics.

The GOP of yesteryear would probably have worked constructively on this with the D's, with measured criticism etc etc and proposed sensible alternatives, thus filling the role of opposition and appearing statesmanlike.

Instead, we got mass hysteria, the British health care system being grossly slandered by ignorant right-wingers and the GOP convincing people who would have benefited the most from better healthcare (the poor), from voting against their own interests

To answer the OP's question, I think it will carry on under Clinton.


Automatically Appended Next Post:

 redleger wrote:

 dogma wrote:

 whembly wrote:

"small tweaks" will not be enough... its going to need a MASSIVE increase to subsidies that covers even the middle class and I seriously doubt the Democrats could pass such a bill now.

And the GOP won't cut defense spending.

 whembly wrote:

And... it will be repealed, even with Clinton at President. However, she'll exact a price since she can be bought after all.

No, it won't. It will be modified, which is right, and Trey Gowdy will lose all national cred.

Im pretty sure if they cut defense spending any more, we would be down to 1 full division with broken equipment and 1 plane to ferry the entire Army around, while the navy is getting new ships. Defense spending at some point has to quit being cut. there are other ways to fix the money sink, but its not proper to discuss it here.

I don't care about a politicians credibility. The moment they run for office, they are scum until they prove otherwise. I am rarely proven wrong.

I don't know if you're a US military veteran or not, so forgive me if I'm preaching to the converted, but from my knowledge, a US army division, or a Marine Division, is a pretty formidable fighting unit. The amount of fire power it can churn out is astonishing.

Even 1 US division is nothing to sneeze at.

1 military division is not enough to do everything the US and the rest of the world wants us to do. It could barely stop an invasion on American soil if we were hit hard. And I am currently active duty so I do have first hand experience over what the budget cuts are doing to us.


Automatically Appended Next Post:

 Ashiraya wrote:

 redleger wrote:
Im pretty sure if they cut defense spending any more, we would be down to 1 full division with broken equipment and 1 plane to ferry the entire Army around

If you cut your defense spending in half you would still spend more than China and Russia put together. =)

I am not saying you should - halving it overnight might actually do more harm than good - but your military is certainly not underfunded.

No I would not say it is, but the rules on how the money is appropriated and spent are whats killing us. But totally off topic.

The ACA did nothing for the people who were already paying for insurance other than make them choose between hiked up premiums and paying a tax penalty at end of year, which in some cases ended up being less than the insurance. So yea, its horrible. So like I said, horribly thought out, horribly implemented, and not a good deal for most Americans.

 Ahtman wrote:
Actually if they cut defense spending we'd still probably be the most expensive and well funded military in the world.

Not if you ask the Pentagon and Congress. Even a penny less threatens the entire foundation of American security and safety.

 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.

The ACA did nothing for the people who were already paying for insurance other than make them choose between hiked up premiums and paying a tax penalty at end of year, which in some cases ended up being less than the insurance. So yea, its horrible. So like I said, horribly thought out, horribly implemented, and not a good deal for most Americans.

The ACA didnt radically increase costs for the overwhelmingly vast majority of the already insured. One also has to realize that for the cost increases that did happen, much of that was because coverage also expanded. People couldnt be turned down for pre-existing conditions anymore and could be covered by parents longer. Stuff like that, which was definitely a plus, and without which there are many people who would now be dead or insanely in debt.

 JohnHwangDD wrote:

 Ahtman wrote:
Actually if they cut defense spending we'd still probably be the most expensive and well funded military in the world.

Not if you ask the Pentagon and Congress. Even a penny less threatens the entire foundation of American security and safety.

You have to look at how the money is spent, based on laws. R and D alone kills our budget. Civilian workforce filling in roles Soldiers can do kills our budget. Separate accounts that can not be used for one thing, but ok for another, and oh BTW you have to spend it all, or you get nothing next time. I saw a lot of wasteful spending, because money had to be spent to get money. Instead of promoting saving, it promotes wastefulness. So when the budget is cut, the needed equipment, housing, healthcare and essentials, the reasons most of us joined, are what suffer. Therefore cutting the budget effects not the fighting ability, nor the civilian workforce as a whole, but the individual warfighter. And that is the problem, Stop cutting the budget until the issues with spending are fixed.

edit for typo

Well now you are changing what you said from, essentially, "if the budget is cut we're all gonna die!" to "well the money isn't spent well".

No one said the money was used efficiently or even very well and in fact Vaktathi pointed out the problems and bloat in the budget.

 redleger wrote:
Civilian workforce filling in roles Soldiers can do kills our budget.

Why use soldiers for any job a civilian can do?

 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.

 CptJake wrote:
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 fore structure and capabilities required to do.

Except, there are NO "near peer" bad guys out there. The stuff that's pushed right now assumes that Russia *and* China both go on the march to conquer all of the Europe and Asia Pacific simultaneously, using Gen+1 equipment that they clearly don't (and won't) have, under a political and economic engine that they don't (and won't) ever have. It's a future reality that's literally beyond anything any tinfoil beanie-wearing nut has ever dreamed up.

 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.
Why are we acting shock on Defense Budget? We have had this discussion numerous times. Current US Military Doctrine is enough force to sustain a two front theater. Granted that got bent all the Hell on OIF/OEF due to sustain operations but US Military is downsizing as of now.

 JohnHwangDD wrote:

 CptJake wrote:
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 fore structure and capabilities required to do.

Except, there are NO "near peer" bad guys out there. The stuff that's pushed right now assumes that Russia *and* China both go on the march to conquer all of the Europe and Asia Pacific simultaneously, using Gen+1 equipment that they clearly don't (and won't) have, under a political and economic engine that they don't (and won't) ever have. It's a future reality that's literally beyond anything any tinfoil beanie-wearing nut has ever dreamed up.

Not really accurate at all. China has invested (very smartly) in a set of capabilities designed to counter our ops in that theater, and has fielded some damned good stuff as a result. Their access denial capabilites are pretty damned impressive and cover several aspects of warfare that are new and emerging (from cyber to space for example). Same with the Russians. Putin's ongoing 'shape the area of operations' phases in the Ukraine and nearby is very informative. The combined asymmetrical capabilities and conventional capabilities are actually pretty scary and certain areas way past what we can do.


Is the US in danger of being invaded by either? Not even close, because neither are investing in what they would need to do so. But if we expect PACOM to do what POTUS and congress tell them they need to be able to do, it has a bog cost. In Europe, again, if we expect the DoD to do what they have been directed to be able to do, there is cost.

Ahtman wrote:Well now you are changing what you said from, essentially, "if the budget is cut we're all gonna die!" to "well the money isn't spent well".

No one said the money was used efficiently or even very well and in fact Vaktathi pointed out the problems and bloat in the budget.

False. That is not what I said, I said we would be down to one brigade, and that was being slightly fesicious. However what would happen is Soldier benefits would continue to drop, there would be no annual raises to match inflation or the civilian work force, and equipment would fall apart. I know. I came in during the Clinton years, and vehicles stayed broken.

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 they cost less, work more hours, and usually care more about helping each other. Why pay someone 15 an hour to process my pay, when a Private being paid 8 dollars an hour can push the same paperwork. That's budget issue number one right there. As much as I want this job im hoping for when I retire, it could be done more cost effectively by another active duty instructor. Its the same job Im doing now, but I would be getting paid more as a civilian. You have to understand how a budget cut effects the force. They reduce personnel, but not the mission. We are at 50% strength, and expected to operate at 100% which results in morale issues, suicide is up as well as depression and Soldiers getting into trouble in off duty time, as little as it is. I just left doing that job because im retiring very soon. So as someone who obviously really doesn't understand the question they are asking, civilian workers get paid more, work less and therefore add those 2 together and then think about that.

 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.

 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