There are serious problems with the information environment, and have been.
There are many who don't realize that the PPACA met paygo rules but that axing it would make things worse because of the cuts to revenue. There are also Republican LEGISLATORS who don't realize the President put chained CPI on the table a looooooong time ago. Heck, the President's most recent budget proposal included means-testing Medicare.
In science writing and medical writing we have been dealing with this for over a decade; it doesn't surprise me to see it spill over into discussions of healthcare, simply because we're talking about how people access medical care and the scientific evidence supporting various forms of care, and that has been problematic for years and years.
With the issues already so complex and so hard to discuss, it drives me crazy that people reach for "they're evil and stupid if they disagree with me." It's absolutely maddening. NO! That's not how you discern truth, by assuming you have nothing to learn from people who disagree with you, and, in fact, they should be stomped out!
It's not that most of us don't *know* that PPACA met Paygo rules, it's that we don't believe (and are, incidentally, correct in that belief), that those rules will ultimately translate to deficit neutral, or ultimate deficit reduction. Here's why
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The employer mandate is fatally flawed. The way it works is that employers who have more than 50 employees must provide "creditable coverage" (i.e., possibly more expensive) health insurance to their employees that does not cost more than (I forget exactly, but something like) 9% of the employee's household income. If the insurance is not at least that generous the employer will get hit with a fine of $2,000 per employee
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I'm not worried at all about people who can make an argument for what's wrong with current law. I am worried about the people who propose that we implement demonstrably worse alternatives, or who quite honestly do not know that PPACA met paygo rules. One disadvantage of having a job communicating science to the public is that you are very rapidly exposed to people who believe that there's a difference between ObamaCare and the PPACA. There are an awful lot of them.
I don't see any way through this other than iterating our way to better laws.
You have way more faith in PayGo rules than I do. I never thought of it as more than a tissue paper construct. And since it's already shredding, well, whatever. The "it'll cost less" idea never made the slightest amount of sense to me. If you start consuming massively more amounts of health care services, guess what? The costs don't go down. It's lovely to be able to do that, it may be morally right to allow that, but it is NOT less expensive.
My thinking is something along the lines of: If the proposal can't even meet paygo, what's the point? Paygo is a floor, not anything more than that
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A couple of things here: the individual coverage they have to offer must meet "creditable coverage" standards, which in practice are more expensive policies than people tended to want to buy for themselves. So they aren't cheap policies, but moderate level
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I think there is something called the IRS "safe harbor" rule which only dings employers if coverage isn't pegged to less than 9.5% of employee wage - not household income. I would think the trick there would be to peg employee rates at 9.45% of wage and then *family* rates at way, way higher - thereby dumping the families onto the exchanges.
Refundable tax credits available in advancegwendallyOctober 4 2013, 02:29:35 UTC
Ah, good find. Yes, I knew they had suspended implementation of the original rules because they were so badly done. (A rule based on employer knowing HOUSEHOLD income should never have passed the first reader's eyes
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Re: Refundable tax credits available in advanceoscarmamaOctober 4 2013, 02:53:13 UTC
I am running into a number of people who don't understand the difference between the tax credits, and the subsidies. As I understand it, the tax credits are pegged to the cost of the second lowest silver plan on the exchange and move stepwise
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In Massachusetts they weren't able to calculate the subsidies - the exchange never started working - so they just told everyone "we'll send an advance on your subsidy straight to the insurance company and you don't have to pay a dime". The insurance companies got paid.
The next shoe to drop is to do their 2014 tax return and determine what subsidy they were ACTUALLY entitled to. Then, presumably, a bunch of them who got too much are going to have to pay it back.
But... the insurance companies got paid. The IMPORTANT thing happened.
There are many who don't realize that the PPACA met paygo rules but that axing it would make things worse because of the cuts to revenue. There are also Republican LEGISLATORS who don't realize the President put chained CPI on the table a looooooong time ago. Heck, the President's most recent budget proposal included means-testing Medicare.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/03/01/what-we-have-here-is-a-failure-to-communicate/
In science writing and medical writing we have been dealing with this for over a decade; it doesn't surprise me to see it spill over into discussions of healthcare, simply because we're talking about how people access medical care and the scientific evidence supporting various forms of care, and that has been problematic for years and years.
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Arrrggh!
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I don't see any way through this other than iterating our way to better laws.
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ETA: like this: http://www.cigna.com/health-care-reform/news/irs-issues-proposed-rules-on-employer-mandate
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The next shoe to drop is to do their 2014 tax return and determine what subsidy they were ACTUALLY entitled to. Then, presumably, a bunch of them who got too much are going to have to pay it back.
But... the insurance companies got paid. The IMPORTANT thing happened.
You may know them by their actions.
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