ACA Premiums Jump; British Columbia Single-Payer Rates Stay at $75/Month

Yes, insurance premiums on the Affordable Care Act marketplaces are rising by 25%. Subsidies are also increasing, insulating many policy purchasers from this inflation, but we’re still paying that bill collectively.

Senator John Thune has been advising since September that Republicans can win by bashing ObamaCare and its premium increases. But what about the ACA is causing these premium increases, and how do we stanch them?

The ACA imposes two fundamental obligations: insurers have to take all customers, sick or healthy, and citizens have to buy health insurance. As Star Tribune‘s D.J. Tice explains,  insurers can’t get out of the former rule, but citizens can get out of the latter.

The mandate, controversial from the start, may not be working as designed for the simple reason that its penalty is too gentle. For many people, it’s cheaper to pay the “tax” than to buy insurance — and too many young healthy folks are apparently being tempted to defy the law [D.J. Tice, “Rising Health Care Costs: A Race We’re Running Willingly?Minneapolis Star Tribune, 2016.10.21].

Insurers are thus ending up with a sicker, costlier pool of policy buyers without the countervailing revenue of healthier policy buyers. Premiums are rising because a higher percentage of policy holders are actually using their insurance.

How do we fix that imbalance? We can do a Trump repeal and go back to the old system where insurers don’t have to sell their product to the sick people who need it most. Selling insurance only to healthy people means easy profits on low premiums, but it also means taking financial/health security away from millions of Americans. Thanks to the ACA, more Americans have health insurance than ever before. The only way repealing the ACA lowers premiums is if it results in kicking lots of sick people off the insurance rolls.

The problem with the Affordable Care Act is not that it tries to insure too many people. The problem is that it doesn’t insure enough people—i.e., it doesn’t maximize the pool of premium payers to share the burden among sick and healthy (or unlucky and lucky?) alike.

As an alternative, consider British Columbia’s single-payer plan. The Pacific province had planned to increase rates for its Medical Services Plan 4% this year but cancelled that rate hike in September. “The full premium rate for one adult will not increase and will remain at the 2016 [monthly] rate of $75.” B.C. charges no premium for anyone under age 19. B.C. fully subsidizes coverage for residents with adjusted net income (after deductions) of $24,000; subsidies scale down as income rises; folks with net adjusted income over $42,000 pay the full premium: $75 per month for an individual, $150 per month for a couple, nothing extra for kids. That’s for the Medical Services Plan—no deductible, no different levels of coverage, just one plan for everyone.

U.S. Health and Human Services is boasting that “77% of customers will be able to find plans that cost them less than $100 per month, after assistance.” But in British Columbia, under single-payer, 100% of customers get one plan that costs every one of them $75 or less.

If we just want lower premiums and don’t care who has insurance, then sure, fine, vote for Trump and Thune and Noem, repeal ObamaCare, and throw tens of millions back to being one bump or biopsy away from medical bankruptcy. If we want to lower premiums and make sure everyone has insurance, we look to British Columbia, Bernie Sanders, and single-payer.


100 Responses to ACA Premiums Jump; British Columbia Single-Payer Rates Stay at $75/Month

  1. Thune’s argument that the ACA is causing the premiums to skyrocket should be asked why the old plans of Wellmark, as an example, are also increasing. The old, grandfathered plans, do not have the same regulations as the new ACA plans do and they are closed for new applicants.

    “Finally, this is kind of interesting: The filing even shows how enrollment in non-compliant plans has dropped since the ACA went into effect: It hit a peak of 47,000 in 2012, then dropped 20% by the end of 2013, 11% at the end of 2014 and another 9% at the end of 2015 (these numbers don’t match those in the letter, presumably because they’re using an “average enrollment per month” figure).
    Unfortunately, the filing doesn’t break the 30K number out between grandfathered plans (which people can remain in indefinitely, as long as Wellmark continues to offer them) and transitional (which will finally be cut off at the end of 2017, unless there’s yet another extension offered by the HHS Dept.).” http://acasignups.net/16/07/05/2017-rate-request-early-look-south-dakota-grandfatheredtransitional

    What does all of this really mean? It means that there is a reason why Thune and all are getting louder and louder on this issue. In 2017, the transitional plans will end for all. That means that the numbers coming in at that time will be higher than on those plans while being less on the ACA plans by the simple fact of the trading of insureds from old plans to new plans. There is no way the old grandfathered plans can keep going without substantial premium increases as the transitional plans will end.

    Instead of waiting for that to happen by just hoping it will go away, Thune and the rest of Congress need to address this so the bottom does not fall out of the market and cause more pain and loss of coverage to the consumer. Wellmark, as an example, has already shown their willingness to cancel coverage, so Thune is playing with fire by continuing the obstructionism. Go Medicare for all much like the happy folks in British Columbia are doing.

  2. This was a very predictable result with how openly the pre-existing condition was written. The GOP had multiple alternatives which would have remedied this deficiency.

    The other predictable result is how ACA incentivized increasing health care costs vs. putting pressure on costs.

    In the end, it adds up to the President had the votes to pass it without Republican vote and thus could ignore alternatives. You got what you bargained for- Unadulterated ownership of a failed program.

  3. mike from iowa
  4. The old “repeal ObamaCare” and then… (crickets)! Thanks, John! Lotta thought went into that one, or did you get that from Mitch?

  5. Daniel Buresh

    So what do you propose Troy? Letting people die? You guys just want to continue with what you had before….”I gots mine so f— everyone else”…right?

  6. Porter Lansing

    You’re funny when your side’s losing, Troy. The ACA is far from failing and only needs a minor tweak. Republicans are so afraid of helping anyone (for fear of losing a lifetime voter to the party that cares about them) they’ll say and do anything to disparage the fact that millions who couldn’t get insured now do. Medical bankruptcy has almost disappeared.
    How to fix it? Raise the penalty to a level where it’s cheaper to buy a policy then to pay the fine.
    *I have a friend who pays $1700 a year penalty not to buy a policy. When asked if he’d pay a $17,000 a year penalty or buy insurance he said he’d buy insurance. Exit one free rider (who can absolutely afford insurance), mooching off the rest of us and making all our rates rise.

  7. Daniel,

    Nice try. As I said, there were alterrnatives which were ignored.

    Porter,

    The GOP said the fine was insufficient but ignored because a higher penalty caused Dems to not vote for it.

    Just own it. Or join Republicans for an open discussion of repeal and replace.

  8. Daniel Buresh

    What are the alternatives Troy? Let’s hear them and how they would fix the issues.

  9. Porter Lansing

    First you say the ACA is damnable and needs to be repealed, Troy. But now that it’s becoming more and more popular you say the parts that need a tweak are because we didn’t listen to what the Republicans wanted? Glad we agree on the fix of raising the penalty.
    $75 a month for full coverage sounds pretty sweet, though. It’s going to happen, it’s just a matter of how soon. USA pays more than we should for care that’s less then what we deserve.

  10. Roger Cornelius

    Here’s how we know how bad Obamacare is, Donald Trump said today, “that ALL his employees are having tremendous problems with Obamacare”.
    Now we know how rich he got, the SOB doesn’t pay for his employees healthcare.

  11. Daniel,

    There were several alternatives on how to handle pre-existing coverage. Never had a debate on it.

    There were several alternatives on cost containment. Never had a debate on it.

    There were several alternatives on recession and keeping rates down. Never had a debate on it.

    If you expect me to take hours to go through them all, you are going to be disappointed. Do your own research. A few months ago, the GOP and Speaker Ryan presented a broad consensus plan on various items for which we can have a debate. The biggest problem with Obamacare is there was a rush to pass anything without regard to its realistic workability or alternative ideas to reach the same goals.

  12. Mr. Buresh, good question. Even one alternative would be interesting to hear about because they do not exist. After all of these years Troy and his gang have not come up with one alternative that would not leave the sick behind.

  13. mike from iowa

    http://www.modernhealthcare.com/article/20160624/BLOG/160629939

    Here is the wingnut plan for people with pre-existing conditions.

    There were at least 5 plans set out this year alone, but none was actual legisdlation. Just wingnut thoughts.

  14. Roger Cornelius

    For the past 6 years of the Obama presidency the republicans had majorities in both the House and Senate. During that period all we heard was “repeal Obamacare” 66 or 67 times.
    Not once do I recall republicans coming forward to make the points Troy has made, they were too busy with their obstructionists ways.
    Has the republican leadership ever approached the Democratic leadership with with new or better reforms to Obamacare?
    Like others have asked here numerous times throughout the years, where is the republican plan and if they have one, why won’t they reveal it?

  15. Here is the alternative plan that Troy speaks of “So the Republicans have a backup plan, in case you do get sick. If you get sick in America, this is what the Republicans want you to do. If you get sick, America, the Republican health care plan is this: “Die quickly.” That’s right. The Republicans want you to die quickly if you get sick.”” From Representative Alan Grayson of Florida.

  16. I’m disappointed in you Troy. You usually have some substance in your answers.
    I’ve never heard any alternatives to fixing Obamacare either form the Pubs, just that it’s horrible and bad.
    Meanwhile in MN, Gov Dayton is extending the olive branch to ‘pubs to work with the DFL to fix the increasing MNSURE premiums.
    Don’t say Dems haven’t tried.

  17. Troy I’m open to ideas on how to improve the ACA. However thus far the GOP is only interested in repealing it which is why they have attempted to repeal it or defund it more than 60 times in recent years.

    I’ll admit I don’t follow each and every bill that works its way through Congress, but I don’t recall hearing about any significant bills that are targeted at improving the ACA. If there are tweaks that need to be made then by all means we should do it – but if this constant desire to repeal it in order to go back to the broken system we had before isn’t going to work.

    My hope now is that with President Clinton in office and with a Democratic majority in the Senate that maybe we can make some headway with single payer universal coverage. Take the for profit insurance companies out of it because the billions they collect in profit does absolutely nothing to improve health or reduce healthcare costs. In fact there is evidence to suggest insurance actually raises overall healthcare costs.

    One way or another, our nation is paying for the healthcare of those who can least afford it. If someone has no insurance, we subsidize them when they can’t pay the ER bill. The only way around this is to lump everyone into a pool and start working towards preventative medicine. Vaccinations, medications for ongoing conditions, birth control – these are things that cost little but save a lot.

    It is long past time that we take action. If the Republicans have a plan that can improve upon our current system and if they actually present the plan then I’m on board… but thus far I can’t say as I’ve seen anything of substance. It seems they would rather spend their energy on repealing it without an immediate plan to replace it, and that isn’t because they honestly care about the rising costs of healthcare, but it appears it be due to the fact that they fear what the ACA will lead to and that they don’t want Obama’s name associated with anything that is ever considered a success.

  18. Canadians really do have it good, I know for a fact that Mayo Clinic accepts the Canadian Single Payer. I know you would all be surprised to know that Mayo Clinic does not get a lot of Canadians coming for healthcare though. They are satisfied with what they have, and they live longer and are not as fat.

  19. In the end, we all know that the current health system will not sustain itself. Big insurance knows this and I just think they are trying to get every last greedy penny they can from working Americans before expanding Medicare to all finally happens.

  20. Daniel Buresh

    Troy, you just want to go back to what you had before with less people covered and bankruptcy for those who can’t provide for themselves. I don’t see anything good in that. Sure the ACA wasn’t 100% correct but it was a step in the right direction. I am republican but this is the one thing I disagree with our party on. I will not sit by and let people die if I can pay more in taxes to insure the health and well-being of my fellow man. We need to get profit out of healthcare and move towards single payer. If that means i have to wait a little longer for care…fine. If that means we have to put in so-called “death panels” so that people who have lived a decent life don’t get the heart transplant at age 60 just because they are filthy rich….fine. I won’t sit by and allow these horrible things to continue because you were content with letting the lesser individuals in our society die. My mentor said one thing that stuck with me, “for those who have the ability to do something to help others, it is their responsibility to do so”. I will die knowing I did what I could and I won’t continue to follow the selfish attitudes of my party on this topic. It all boils down to are you willing to let people die, and people like you along with the rest of the grey hairs in our party, they are more than willing to do that and they are too afraid to say it. Now, go to your church every week and sit in your castle looking down at all peons. Your god will be very impressed when you get to meet him if you don’t find yourself burning in hell. I’m not a christian, but I know what is right and what is wrong, and the republican motto of survival of the fittest is wrong on so many moral, ethical, and christian levels. Greed is one of the 7 deadly sins for a reason and you are showing your true colors.

  21. mike from iowa

    You need to go all the way back to June of 2016 to find any so-called alternatives to the ACA. They all are based on the preposition of repealing the ACA and start from scratch with insurance companies involvement.

  22. Pope Francis respectfully pleads for single payor and for the US to get it done. He knows what is the right thing to do and is so rightfully abiding by the Catholic Golden Rule of taking care of the sick and poor.

  23. Yes Jenny and the reason that Canadians are much less likely to be fat is that to them, 6 hot dogs are what pulls a sled, whereas here, that is an in between meal.

  24. Daniel Buresh

    Catholics only are willing to care for those they deem worthy of such help. Drunk, drug abuser, whore, atheist, homosexual, transgender….they’d let them all die in the street if they could. They are the most judgemental people I have ever had to be around for such a long time in my life.

  25. While many of the goals were good (portability, preexisting conditions, lifetime benefits, repricing after catastrophic experience, increased access), ACA was fundamentally flawed from the beginning as an insurance program and worsened health care costs (vs. contained them) and the implosion is the logical consequence. You passed it without our input. Own it.

    Its a lemon. One doesn’t fix a lemon car. One scraps it and buys another. Solving the above requires a full repeal and starting over. I do not support putting bandaids on this piece of crap. If you want GOP support, come to the table open to a full and complete repeal and replacement.

  26. Porter Lansing

    A quick GOOGLE of the question, “Are health insurance companies diversifying?” brings up page after page of scholarly articles on their mass move to get out before their gravy train comes off the rails. Most are moving to technology implements. This is the same move made years ago by Big Tobacco when the campaign donations they were giving to Republicans to cover up the truth about their product stopped working.
    Q~ If you could buy a Medicare policy for an affordable price would you do it?

  27. Actually Daniel, you just named a large portion of the Catholic church – its priests. You should take a walk down the darkest streets in the heart of Hennepin County some night. There you will find what the Catholic church has tried to hide – pedophile HIV infected priests, homosexual priests – all sad souls living a double life.

  28. Porter Lansing

    Troy … There’s a good chance the ACA will be replaced. But you’re not going to like the replacement anymore then you like Obamacare. Democrats are the party of helping people. Republicans are the party of profit. Expanding Medicare and selling policies to anyone that wants one isn’t a big profit item for anyone and thus won’t get Republican approval. But we can live with that because your party dislikes anything that helps the people. People vote for the party that helps them and that drives Republicans crazy.
    Now you’ll ask the tired question, “Who’s going to pay for this?” Seeing how we liberals in our liberal states reach into our paychecks every month and send money to South Dakota and many other Republican states, I guess we liberals are going to pay for it. (Don’t claim the money goes to the reservations because there’s proof it goes mostly to your roads, schools and programs for the poor just like it does in every state. You could start paying more of your own bills, you know.)

  29. Daniel Buresh

    Jenny, I disagree. I have met some of those you speak of but it is still a very small percentage. There are some very good priests and nuns who I have met in my life who do not act like the followers they teach. The problem is the church doesn’t want to acknowledge those sins at all so that is why they live such hidden lives. They know what is right, and many are willing to continue serving in spite of that. Sexual repression can make really good people fall into really bad things. When it comes to being judgemental, I will generalize a majority of catholics because I have sat at the table with many and listened to the vitrol they spew. There is a reason why christianity is dieing and there is a reason why younger generations are saying “No” to the older generations in the Republican party. We want it to evolve or it will never last. This is why I support young, moderate republicans. They are the only hope we have left against the aging populations too stubborn to understand the wrong in their ways.

  30. John Kennedy Claussen, Sr.

    ACA is nothing but a political football for the GOP. If the GOP really wanted to help make health care for all Americans more affordable and available, then would do more than just make the health care debate another instrument of their “scorched earth” obstructionist politics.

    Back in the day, Democrats offered “HillaryCare,” and the GOP responded with a Heritage Foundation idea, which later became known as “RomneyCare” and “ObamaCare.” But when the Democrats offered “ObamaCare” the Republicans responded by moving even further to the right and thus, opposing their own Heritage concept in the name of obstructionism.

    Let us face it, the GOP’s current concerns for the ACA are mere crocodile tears at best, when you consider that absence their once embracing of the ACA idea the only other policies ideas that they have brought to the table over the past 25 years concerning health care reform were health savings accounts and tort law reform. Two policy ideas that are completely disingenuous in dealing with the health care issues of our time. Because HSA enhancement assumes you already have the money to pay for health care (So what’s the problem?) and the tort reform is merely at best a transfer of wealth from the lawyers to the doctors with the consumers experiencing no true or guaranteed savings….

  31. Well, since you don’t have the capacity to accept the reality ACA is imploding nor the capacity to discuss alternatives, you own it.

  32. Porter Lansing

    Damn right we own it. We built it. We’ll tweak it, too. What have Republicans ever built besides war debt?

  33. Troy, what are you so upset about the ACA for, have your premiums skyrocketed?
    Now you know how most middle class Americans have felt for years with double digit increases year after year.
    Have you been personally affected by not being able to afford health insurance? Are you having to stay working just to be able to be on the Company insurance? Have you had to scrape by to be able to even afford insurance. Well, welcome to how most of America has lived decades before the ACA came around.

  34. Pubs really do take after their main man, Donald Trump, whine if you don’t get your way and offer no help to get it fixed.

    Oh, and threaten to sue.

  35. Troy agrees completely with the ACA! His own words ” While many of the goals were good (portability, preexisting conditions, lifetime benefits, repricing after catastrophic experience, increased access), ACA was fundamentally flawed from the beginning as an insurance program and worsened health care costs (vs. contained them) and the implosion is the logical consequence. You passed it without our input. Own it.” That description in a nutshell, is the ACA Obamacare, RomneyCare. So again Troy, exactly what was the flaw, with the exception of not having a big enough penalty for not having it?

  36. Porter Lansing

    Good one, Jenny.

  37. The ACA premium increases are driven by the Free Market. How’s that workin’ out for ya’ Pubs. A public govt option is lookin’ good about now isn’t it? Pubs made sure to kill that.

  38. mike from iowa

    Famous last words from Troy the Comedian- If you want GOP support, come to the table open to a full and complete repeal and replacement.

    From the part of obstructionism with zero credibility and no bargaining power.

    First we want you to repeal the ACA and defund Planned Parenthood and outlaw all abortions and provide amnesty for all wingut traitors who engaged Iran in foreign policy and a permanent Supreme Court seat for Antonin the dead guy and all Dems must kiss Saint Ronnie Raygun’s wrinkly ass before we will deal with you.

  39. mike from iowa

    Wingnuts plan says if you don’t like getting gouged on your premiums and change plans, you will lose your pre-existing condition coverage. That is a large incentive for prices to go up.

  40. What kind of thought process goes into what health insurance actually does. It is supposed to take care of the medical bills which is why you pay premiums. Same thing with auto and home, you pay premiums so that at claim, it is paid.

    The ACA is different from auto and home because with those two, if you have to much risk, they will not put the paper on you. That is why we have the ACA so that the paper is spread. The reason that health care costs are high is because we are sick, that should be the wake up call on the need. It is not because of the Black Dude wanting to do anything but help his fellow Americans with all the protection the government can provide. We are the government so this should be simple stuff. Until we get the idea that we are all one bump on the melon or one car accident away from a catastrophic sickness or injury that will put us and our families in need of healthcare that will cover us immediately when we loose that job that we can no longer work at, all is crap. Troy knows this because he knows families that this is exactly what has happened. We all know someone close that is dependent on the goods and services of the ACA, including Troy.

  41. Roger Cornelius

    Just wondering if Troy and his Donald Trump republicans are willing to tell 12 million plus on Obamacare that we repealed the whole thing and you’ll have to wait in the wings until we come up with something better.

  42. mike from iowa

    http://www.huffingtonpost.com/2013/08/05/kathleen-sebelius-obamacare_n_3708198.html

    Wingnuts urge young people not to sign up for Obamacare hoping to make the insurance too expensive by not spreading risk pool around.

  43. Jerry,

    The flaws are fundamental as they depended on one over-riding principle: Coersion via the mandate.

    Jenny,

    Desiring the goals of ACA and accepting a poorly designed attempt bound to fail are not the same thing. From the beginning, I tried to discuss the flaws and the response was I was anti-poor etc. Well, since passage health insurance costs have doubled, you can’t keep your doctor, and deductibles have increased. It was predicted but any warning was ignored. You own it. When you are ready to engage in an open dialogue, honest and respectful, let us know.

  44. Oops: “and not accepting”

  45. Porter Lansing

    Troy … Your facts used to be pretty accurate but since Trump started leading republicans you’ve become a misinformation machine.
    1. Health insurance costs haven’t doubled.
    2. I’ve had the same doctor for years.
    3. Deductables have only gone up if you chose to buy a policy with higher deductables.
    You want to help make things better? Sorry, can’t trust ‘ya. PS … What does coersion vs mandate mean?

  46. Troy, okay then, using your logic, what say you about the Medicare Part D? You say Coercion via the mandate directed at those under 65, I say so what. The unfunded mandated law, driven through by President George Bush mandated that those who receive Medicare Parts A and B, must by law, purchase a prescription drug plan. It was a failure. Simple as that. Democrats took it up and worked with Republicans to make it work. They did not like it, but they worked with Republicans to make it work for the good of the country. BTW, the penalty devised for that unfunded mandate is much more severe than the one imposed by the ACA. So come on down from that high horse of indignation and remember the recent past. I realize that you are kind of a party hack on these matters, but at least let your historical mind go back to 2003, not so far, and see that there was a coercion via the mandate done then to seniors that was much more severe than what the ACA imposed on the under 65 crowd. Facts are facts. Without a mandate, you cannot make it work. Check out the mandate for car insurance, don’t have it, go to court until you do. Try telling you mortgage holder that you just don’t feel like paying for insurance. Back to the drafting board for you sir, you have not made your case.

  47. John Kennedy Claussen, Sr.

    In my earlier comments, I forgot to mention a third part of the GOPs panacea approach to fixing our health care system, and that is their continual obsession with allowing insurance companies to sell health insurance policies across state lines. Some how they think this is the missing link to health care solvency. A course, it is classic GOP where they give total control and faith in the market system to solve a problem. Never mind the fact, that this problem in its greater entirety is the result of a free market system relative to other countries over the years to begin with….

    The problem with this selling across state lines idea is that we do not a have federal insurance commissioner, unless the GOP is now suggesting we need one, which I would think would go against classic GOP faith in decentralization and the 10th Amendment. So what we would then have is insurance companies selling all over the country with no federal policing, thus leaving it to the 50 individual states to police and enforce insurance laws, which would cause insurance companies overtime to gravitate towards those states with less regulatory history from which to work from, which would be very analogous to what happen with the credit card industry for 30 years until the Feds finally stepped in and placed greater control over that industry with the ’09 Credit Card Reform Act.

  48. Porter Lansing

    Well thought out, JKC. ??

  49. Darin Larson

    Troy, you seem to forget what was happening in the private health insurance markets before Obamacare. Premiums were rising 10-30% each year. Medical bankruptcies were rampant and if you had a preexisting condition you better keep your job or you were screwed.

    Obamacare was a compromise with many good things that you listed. Unfortunately, the votes were not there for single payer and the cost control that it could have brought about. No one thought that Obamacare was the be all and end all. It was a good start. Republicans have vowed in bad faith to never let it succeed for political reasons.

    How many years have gone by and the Republicans still don’t have a plan to replace Obamacare? Their only plan is to repeal it. That is no plan at all. Republicans have controlled both houses of Congress and they have not passed any plan to replace Obamacare. They have just conducted meaningless, symbolic votes to repeal. Democrats own Obamacare; Republicans own obstructionism along with a complete lack of fresh ideas. “No” is not a plan.

  50. Porter Lansing

    Good one, Darin but you’re talking to a stone wall. He’s only posting here because Power’s site is like a cemetery at midnight. No one around …

  51. Darin Larson

    I hear ya Porter, but one of my hobbies is asking Republicans to explain their nonexistent plans to improve our country. :) It is cathartic!

  52. John Kennedy Claussen, Sr.

    Speaking of the DWC, there are so many “anonymous” commentators over there, that you have to wonder if maybe just one commentator is constantly having a conversation with him or herself…. Any suggestions as to who that might be?….;-)

  53. Porter Lansing

    JKC … As Dr. Newquist pointed out it’s pretty easy to recognize a persons writing and there’s a software app that can identify an anonymous post by comparing it with other posts anywhere on the internet. A person only knows so many words and only a psychopath genius can disguise their writing style.
    I know for a fact that Pat Powers posts under different names and we know that Lynn is the one behind District 3 Dems Against Cory. I suppose if I was as selfish and bigoted as most on DWC I’d hide my name from neighbors, too.

  54. The ACA provides an interesting paradox of something that on one hand was bound to fail, but is also on the other hand serves a huge purpose. We now have publicly documented evidence of what insurance companies are going to do when they are faced with the challenge of a few common sense rules that would make healthcare applicable for everyone. When Hillary is president and we hopefully pivot to pushing for a single payer system or possibly even better an offering of a public healthcare policy, the ground work is done. And there’s no whining from the insurance industry that “We could have agreed to those terms”.

    Another thing… Christian Healthcare Ministries has been offering a program for years that already complies with the guidelines of the ACA and you don’t see them complaining or jacking their rates. I understand a slightly different beast, but it still serves the same purpose at a fraction of the cost. This is what we need to model our health insurance industry after. Not the for profit system that we are all too familiar with.

  55. John Kennedy Claussen, Sr.

    Porter, thank you, that is interesting…. Based on what you have told me, they are not at least “psychopath geniuse)” over there on the other side…. Well, at least not geniuses……;-)

  56. I don’t have time to address everything but I will say one thing.

    Porter is a flat out liar- Pat Powers is not posting as anonymous. He has also made the same false accusation against me. The fact he lies about this which isn’t really relevant to anything (unless he wants to engage in the logic fallacies vs. making intellectual arguments) makes him wonder when he says the truth, if ever.

  57. Well then, that is how Troy rolls. Typical. Instead of addressing the questions, he accuses the questionnaires as a liars. Troy, ya got nothing man. Your argument is as shallow as your attempt at being clever. Your party has no plans for replacement of the ACA and for that matter, no plans whatsoever on any matter relating to healthcare other than to take it back where it was. One thing that your party has done and continues to do with consistency is to obstruct progress. Your boy Thune has a video out that says he understands gridlock, damn right he does, he is a major player in not getting anything done. The only thing your gang has done is to vote 60 some times to kill the ACA, not change it, kill it. Many great points have been brought into this conversation by observations of the facts, none from you though. Not only have you failed to make intellectual arguments, you have failed to make any arguments other than to hold your breath and stomp your feet. Troy, you have become the poster boy of what is wrong with your party. Why don’t you compromise with yourself and argue intellectually for the good of the country as a whole rather than the continued path you are taking that the party is the country. The ACA is the beginning of a way to make government an important part of our lives by providing the protection of the right of healthcare. In the big scheme of things, it is much like the defense argument of keeping us safe as well. We pay our taxes for those kinds of protections not to pay insurance companies to attack us.

  58. Porter Lansing

    I don’t need to defend myself, Mr. Jones. It’s obvious by personal phrases, timing of the response to my post, personal knowledge of the subject and choice of adjectives, adverbs and prepositions not used in conjunction by anyone else, that posts made under anonymous and made under Pat Powers name are too similar too often to be from someone else. There is, however software that can verify this but it’s not free and exposing something, as you say, which isn’t really relevant isn’t worth the bucks.

  59. We all know Cory’s political blog is the most popular in SD.

  60. Porter,

    So now you admit you don’t know it as a fact but it is your deduction based on your study of Pat’s phraseology. That makes your first statement an admitted lie. If you think you don’t have to defend a personal attack, it speaks to your character.

  61. And away we go! Let me see if I can get this straight, Pat’s phraseology means as much as a bucket of spit and especially regarding the ACA. Ya got nothing Troy, ya got nothing. Single payer is the only way to solve the issues of fairness regarding healthcare for all. Medicare has already proven itself and does so even further each day with more and more enrolled. That is the platform that already exists, be a good lad and ask your parents about how happy they are with their Medicare.

  62. Daniel Buresh

    Troy,
    At least Powers lets you comment. That coward is too afraid to allow anything of mine through, even when I agree with him. That is pretty telling but we already knew he was a shill unwilling to even criticize his own party leaders. If you can’t criticize them all, you are a lemming. Even our guys screw up and they need to be held accountable.

  63. So Troy how do you know Pat Powers doesn’t post under other names? You claim he doesn’t, but don’t you have to admit you really can’t be 100% sure? Doesn’t that also make your statement a lie?

    You guys can debate who posts under various names, but it seems like a waste of time and a distraction doesn’t it? Who really cares – some people use sockpuppets and some people have thin skin. So be it – that is the nature of the Internet.

    Now as to the ACA:

    Troy: “Its a lemon. One doesn’t fix a lemon car. One scraps it and buys another.”

    I disagree. If you have a car that flashes the check engine light a couple of times, the radiator starts leaking, and the starter goes out making you late for work one day you don’t scrap it. You make it work. Not only can most people not afford to scrap and replace something, but it isn’t practical. A lot of people label cars as lemons when reality they just need some maintenance. Few cars actually qualify as being lemons, and even those that do are often refurbished and sent back out there.

    So when we look at Obamacare what the primary issue is surrounds costs and insurance companies dropping their plans. However as you said the ACA has a lot of good in it such as portability, covering preexisting conditions, increased access, a focus on preventative medicine etc. These aren’t things we can walk back from.

    If the ACA is repealed, how does the GOP plan to address the financial challenges facing Medicare? As we know, the ACA actually prolonged the solvency of Medicare and improved the financial situation, so if you repeal the ACA you would by default create greater problems with Medicare. I haven’t heard anything on this topic from the GOP in all of their many attempts to repeal.

    http://www.cbpp.org/research/health/medicare-is-not-bankrupt

    Troy: “I do not support putting bandaids on this piece of crap. If you want GOP support, come to the table open to a full and complete repeal and replacement.”

    Of course you don’t want to fix it, because fixing it would allow the ACA to continue and it will forever be known as Obamacare, which gives Obama a checkmark in the win column… and we can’t have that can we?

    The vast majority of the concern coming from the right isn’t really about Obamacare or increased costs. It isn’t about helping people but instead it is about politics. This is why they are quick to say we need to kill the ACA and repeal it and why they have spent so much time and energy trying to defund it or trying to attach riders to other bills to kill it without offering a comprehensive replacement as a solution.

    They don’t need the Democrats to come to the table to develop their own solution – but they aren’t interested in solutions. They are only interested in playing politics and trying to prevent a Democratic President from being successful.

    How do we know this? Well first we know it because the GOP hasn’t proposed any meaningful reforms that would address actual healthcare costs. They haven’t offered any ideas on how to control increasing insurance costs outside of the ACA where premiums continue to rise at double-digit percentages annually in many areas. It seems the only solution the GOP has is to repeal Obamacare and return to what we had before. They want to let the insurance companies solve the problem on their own – but we tried that and it failed.

    It is easy to state that the only solution is to repeal, but until the GOP has an actual replacement ready to go, repealing is short-sighted. This just shows they haven’t bothered to think it through and just want to kill it before the Democrats are able to transform it into something more. Republicans are already upset that Roosevelt is forever associated with Social Security – the last thing they want is for Obama to forever be associated with what is eventually a single payer system that the public would overwhelmingly support.

  64. Porter Lansing

    Well asserted, Craig. And, as you say it’s not just Pat and Troy posting under anonymous, it’s also using various nicknames to hide an identity. Any teacher will tell you it’s not hard to spot plagiarism because it just isn’t the way a student writes. Same goes in the inverse. When you’ve read 90% of the posts on DWC and DFP for the last seven years it’s not hard to spot common phraseology.
    ~ And just a humorous aside, how do like being treated the way you and the Anti-Clinton zealots have treated Secretary Clinton for thirty years of her exemplary service to USA? Accusations seem to be acceptable for her so how about for you?

  65. @Craig, there is a reason you do not hear about what will happen with Medicare if Troy gets his way to kill the ACA, the killing walks hand in hand. You would then see the privatization of Medicare with vouchers. That is something that has been discussed in great lengths by the “Cat Food Commission” https://www.laprogressive.com/catfood-commission/ By killing the ACA the republicans would get a twofer.

  66. Troy is just defending his business interests and his party brand, as can be expected.

  67. I don’t know how one can be a practicing Catholic and not follow their Golden Rule. SD Catholics need to brush up on their Catholic history. As an ex-Catholic, I can never stress enough how prominent the social teachings of taking care of the poor and vulnerable is in the Church. American Catholics have moved away from that and are just obsessed with abortion.
    Protecting wealthy business interests is so, so against what the REAL teachings of the Church are all about.
    Take a class on the history of the Social Doctrines of your Church, all you right wing South Dakota Catholics. You’re not following it.

  68. Craig,

    I have log in privileges at SDWC so I can post threads. This gives me the ability to review IP addresses. I’m sure. I just reviewed the three IP addresses used by “Pat Powers”). Not once was there a post from those addresses not identified as Pat in the first 100 posts. I didn’t go further only for time. But, the FACT remains there wasn’t one in 300 posts. How is that for assurance?

    I do not intentionally ever post anonymously. I’ve done it occassionally as I forget to log-in and I correct it when noticed (usually immediately when my post ends up being anonymous unless I leave my desk as soon as I hit “post”). I intend to put my name behind everything I say.

    I agree it is a distraction to throw rocks like this but it starts with Porter making a false charge. People here disagree with Pat and many don’t like him. I get that. But, to charge him (or me) with something blatantly false.

  69. Okay then, so the issue is moot with Pat Powers. What about the alternatives you claim would solve the whole shebang? No more distractions, just the alternatives.

  70. So THIS is what McCarthyism is like in practice.

    MAYBE I’M PAT!

  71. Troy not that it is really substantive, but if I post one comment from my work PC on a VPN, another from my home PC, a third from my phone, and a fourth from my tablet logged into the free wifi offered at McDonalds they will each have unique IP addresses. That in itself doesn’t really tell us much.

    In fact, another political blog in our great state that I used to frequent had an issue with sockpuppets. One poster saved his login info on his laptop under one name, and used different credentials from his phone. The blog owner knew they were unique IPs, but the guy posting forgot which name he was using and let the cat out of the bag. Eventually I started keeping track and found a few of the regulars each had four or more names they posted under.

    So it happens. I can’t say that I know it happens at DWC because honestly I’m not a regular there and have no idea what their posting standards are. I just know it happens elsewhere often enough that believing it happens there wouldn’t be a stretch.

    That said – who really cares. It is a distraction.

  72. Jerry,

    There were multiple options to address each of the goals I listed above. Representative Ryan announced a few months ago a white paper on the Obamacare replacement. You can read it.

    I don’t agree with all of them but that is what debate and discussion is all about and concede I could change my mind with the discussion, debate and discussion which didn’t happen with the passage of Obamacare.

    In particular, I think portability/pre-existing conditions/lifetime payments can be better handled and more comprehensively via a re-insurance vehicle similar to how property and casualty insurance firms protect themselves from concentrated risk (ala a hurricane in Florida). Explanation of it requires much information more than what can be done in a blog. If you want to educate yourself on it, I would suggest you study how P&C reinsurance works. Maybe a simpler comparison (but less exactly comparable but might help with grasping concepts) would be to study the concepts of how mortgage insurance works in combo with what I’ll call CONCEPTUALLY similar to a “strip” of term life insurance that runs until one is eligible for Medicare.

    What I like about this is it allows people to seamlessly change jobs without any consideration to pre-existing conditions and the impact on the new employer is the actuarial risk of a person of their age while the pre-existing risk becomes the obligation of the re-insurer. This will allow employers to offer (and unions negotiate) the extent of coverage/deductible etc. without paying the “Cadillac tax.”

    If you desire single payer and believe the goal of Obamacare was to be a trojan horse to single payer, you may not be interested in examining any alternatives.

    Insurance is really a subset of high level math called actuarial science whereby it is not only a pooling of risk (which defuses the impact of catastrophic events across all insured) AND anticipates behavior based on incentives/disincentives (the latter of which Obamacare ignored to large measure and why it is imploding).

  73. Porter Lansing

    Right, Dicta. WE’RE ALL PAT … hands up, don’t shoot

  74. Darin Larson

    Troy, Reinsurance is your big idea to replace Obamacare? Reinsurance works fine in a property and casualty setting where unforeseen losses due to natural disasters can be spread across a much larger group of insurance providers. Healthcare costs are rising nationwide and there is little to be gained by pooling if you don’t get healthy young people signed up to spread the risk. Reinsurance does not address this. In fact, it just adds another layer of administration and inefficiency potentially, especially when compared to single payer systems.

    And the white paper from Paul Ryan and his buddies that you say is the replacement for Obamacare has not even been put into bill form and no one can fully evaluate its effect on cost or coverage:

    “The plan will not be put into legislative text, however, meaning it will be less specific and the cost and effect on coverage levels will be harder to assess. Instead, the plan will be a “white paper,” according to Rep. Joe Pitts (R-Pa.).
    The proposal will include a version of Speaker Paul Ryan’s (R-Wis.) long-standing proposal to make Medicare more market-based, giving seniors a kind of voucher to use for private insurance, according to two Republican lawmakers who attended the meeting.”

    http://thehill.com/policy/healthcare/279755-gop-closes-in-on-obamacare-alternative

    When you have a bill with a plan let us know, would ya? I’m not holding my breath.

  75. We just keep trying to put lipstick on a pig. The pig is not Obamacare. The pig is the US healthcare system. We’re suffering from market failure in the US healthcare system, and nobody wants to deal with it. If the market were working, people would be able to determine in advance what healthcare providers charge and shop around like they do for everything else. Until we reform our healthcare marketplace and bring it up to 21st century standards of transparency and competition, we are never going to be able to restrain cost increases. Congress hasn’t drilled deep enough into the problem because that would make the people that fund their campaigns uncomfortable, and because they are fundamentally lazy and can get away with doing nothing and get re-elected anyway. Just look at how many years the GOP Party majority has bashed Obamacare without offering up any solution to its problems. Lazy!

  76. mike from iowa

    How does it help to talk youngsters into signing up for healthcare when wingnuts are telling them not to?

    Whose side are wingnuts on? Not the American people’s side. They put more restrictions on people’s freedoms and then lie through their teeth about to stay in office. ACA needs all those young people in the risk pools. Treacherous, traitorious wingnuts deserve the firing squad. They are not the loyal opposition. They sold out.

  77. Darin,

    This is a complex matter. I was only giving an example/component to address what I thought was Jerry’s question. You can’t really expect me to lay out an entire viable plan on a blog.

    And, to explain briefly is impossible, the concept as laid out does induce the healthy to get insurance because of the effect on current rates of the young plus they only have assurance of access to future insurance if they get insured now. Unlike Obamacare’s guaranteed future coverage, there is a perverse incentive to be uninsured until they need it.

    The whole point of Ryan’s paper is to have a full and transparent discussion of the concepts. Obamacare was written in the dark without transparency or independent review of both intended consequences and unintended consequences. Social Security, Medicare, Medicaid, etc. were drafted and discussed in the open whereby it got both bi-partisan support but also consent of the governed. Obamacare has never had either.

    Rors point is legitimate. In addition to having a workable health insurance plan, we do have to address cost-containment (which Obamacare made worse despite promises otherwise). And, I agree with Ror that it must include consumer involvement and competition. I also agree with Ror “Congress hasn’t drilled deep enough” but I don’t agree it is just Republicans in Congress who have failed us. Democrats and the President (Obama and those before him) have failed us. And, the Governor’s and various state legislatures. I also don’t agree it was laziness or nefarious motives of anyone on either side.

    I think it is a failure to actually discuss the problem and explore solutions with an attitude which respects all perspectives. Might some components require more government involvement? Yes. Might some components require less government involvement? Yes. On one side, there are those who say only full government control (single payer) will work. On the other side, there are those who say no or minimal government involvement will work. So, what we get is a bastard fundamentally flawed hybrid of semi government control because the people are unwilling to go with either extreme.

    We can do better. On the GOP end, they have to come to the table committed to find solutions. On the Democrat end, they have to come to the table committed to throw out everything that is not working.

    Sidenote: One of the popular components of Obamacare is kids staying on their parents plan until they are 26. Sounds great. In fact, I have a daughter who has enjoyed this benefit since she graduated from college and went to work. She even got married and stayed on our plan. But, as Darin said, one of the big problems is there is insufficient young people getting coverage. Well, duh. I’m not saying this has to go or be rolled back but people have to understand the impact it has and determine whether it is appropriate.

  78. Porter Lansing

    It’s not complex and making it so is just stalling, looking for some angle to make a profit. It’s like before we were born, when people weren’t taking care of the seniors even though they knew it was necessary. Young males, before marriage, know they need to buy a health policy but they’re not doing it. Thus came the solution. Our government took care of the seniors (Social Security) and took a deduction from your paycheck to pay for it. You can extrapolate what’s going to happen with healthcare. It’s on the ballot in CO and it’s been implemented worldwide. It’s hard for Republicans to believe but a working person who’s payroll taxes go up by 20% monthly but no longer has a monthly health insurance payment will have more spending money at the end of the month. USA healthcare costs will be purchased as a group and will become stabilized. It works all over the world and denying it and looking to make a buck off sick people is how we got in this mess. (“I’m from the gov’t and I’m here to help you.” ~ Ron Reagan made it into a joke but it’s cheaper to buy things we all need as a group. Think COSTCO.)

  79. Porter, if ACA and a health insurance plan wasn’t complex, why did Obama need 3,000 pages for the law (single biggest in history)? Are you saying Obama took something simple and made it complex?

  80. Porter Lansing

    Troy Jones … C’mon, man. It took 3,000 pages because Republicans obstructed Medicare Part E. E is for everyone. Obamacare is complex. The tweak and the replacement are simple. Either jack up the penalty for not following the law and buying a policy or start Medicare for all.
    *Thread Is Dead ?Last Word Is Yours

  81. Craig, Darin, Jerry and others,

    Sorry the dialogue has to stop. Porter has declared the thread dead.

  82. Roger Cornelius

    Speaker Ryan’s “white paper” may not matter at all come election day, he is in trouble on multiple fronts.
    If Trump wins the White House and Congress stays republican the alt-right will oust him. Trump will surely support a move to oust Ryan.
    If Hillary wins, the alt-right will still wants Ryan out for his lukewarm support of Trump.

  83. Troy, In a nutshell, here is the wonk Ryan’s white paper “It proposes putting $25 billion behind high-risk pools for people with pre-existing conditions and for others, and transforming the federal-state Medicaid program for the poor by turning it into state block grants or individual per-capita allotments to hold down spending.” http://fortune.com/2016/06/22/republicans-obamacare-paul-ryan/
    In my household, we have a name for some like Ryan’s white paper, we call it toilet paper for obvious reasons.

    I did notice one thing though that I kind of thought was interesting. This is regarding group health insurance. In that pool, the employer would pay a portion of the insurance, usually half or more and the employee would pay the other half. Where the expense would come in would be for the dependents as they were not underwritten and did not have pre-existing conditions. Those premiums for the entire family would be somewhere north of $1,500.00 per month to some that were over $2,000.00 per month. Counties were usually the ones that had the sick people insured because that was the only place many of them could get insurance so they took jobs there that did not pay very much just so they could get a family member covered. It was a mess and that is exactly what you and Ryan are proposing to take us back to. Property taxes would have to raise in order to offset the premium increases and we all know what happens then, once the tax has been levied, it ain’t gonna go down even if the sick people on the group die. The maximum the insurance company could charge was a 67% rate increase per year and they did it. The only way to fix this entire matter would be to go to a Medicare for all.

  84. Richard Schriever

    All Republican plans (whether complex or simple) are focused on one target; Assuring someone not directly engaged in providing actual health care PROFITS from it. They are all about profiting from peoples’ illness, without getting their hands “dirty”.

  85. Darin Larson

    Troy, I’m not sure where you are getting the idea that Obamacare was supposed to hold down healthcare costs. That was never one of the primary focuses of ACA. Getting 20 million people health insurance was a primary goal and doing away with preexisting condition restrictions and the epidemic of medical bankruptcies.

    I’m also not sure where you are getting the idea that Republicans had no clue what was going on when Obamacare legislation was considered and passed. The Republicans knew what was going on and offered no constructive criticisms, changes or proposals to make the law better. They simply said no. You can also tell that they were never serious about making healthcare accessible to most Americans because they to this day do not have a bill to replace Obamacare. They have also not considered one bill to strengthen or change the ACA besides complete repeal. We still do not know what repeal would mean if Republicans had their way other than 20 million folks would return to having no health insurance.

    The law has largely been a success in spite of SCOTUS and the Republican Congress trying to undermine it at every turn. We need to make it better and Republicans need to get on board with constructive improvements rather than being the party of no–no health insurance, no healthcare access, no ideas.

  86. Troy, the Republican Congress under President Bush passed needed approvals for RomneyCare in Massachusetts. RomneyCare also had the coercion via the mandate and you all loved you some RomneyCare. Now add a couple of years and boom, you have the Black Dude as the president. Not to hard to take a look to the north and see the state that already put this in motion. Put the same process out and it should pass the republican muster as they were so familiar with it. But no, suddenly it is like the most dangerous thing to America since Teletubbies, oh the horror. https://en.wikipedia.org/wiki/Massachusetts_health_care_reform

  87. Porter Lansing

    Oh, I get it now. It’s coercion via the mandate not coercion vs the mandate. My bad. I suppose that means forcing everyone to have affordable health insurance.

  88. Yes, Mr. Lansing, for what its worth, it is gotten now. Not such a bad thing when Republicans do it, but the end of the world when Democrats do it. Meanwhile, the republican base says hands off my Medicare as if they all are not interconnected.

    We taxpayers have paid each of our congress folks a to staff their offices in Washington with professionals who read and vet the laws being presented for approvals on the various floors of congress. When the ACA was being debated for more than 2 years, there was ample time for staffers to read, vet and make presentations to their bosses. To say that they were not informed of a couple thousand double spaced pages of a bill, is a big fat lie.

  89. Mitt Romney proved that Republicans and Democrats could work together and pass a bi partisan healthcare bill that is the mirror of the ACA Obamacare. There is a key word here though and it is work. Republicans in Massachusetts know what the word means. Democrats in 2003 understood what the word work meant as well and did a great job of working together with Republicans to fix the Medicare Part D mandated drug plan. The only noticeable thing missing from both of these fixes for the public was President Obama. Republican have endangered all that is dear to our democracy with their racial hatred for the president and we see it today with the amazing comparison of health insurance costs between British Columbia and here. Those folks up there pay for their healthcare and we should do the same, only realistically. Stop the republican obstructionism and fix the problems.

  90. Porter is a flat out liar–troy, I thought u had more class than this. ever since republicans shouted “You Lie!!” during Obama’s 1st state of the nation, I think, republicans have been unwinding any semblance of parliamentary skill in congress. taking civility down like this before the nation was the precursor for things like thune and 46 other senators’ letter to iran that it should pay no attention to the president. wow. you guys started the republican party unravel, and now it may be slipping out so fast no one will be able to stop it. I welcome it as consequences to such obsequious behavior that is now par for the course from republicans. is it racism or stupidity? and on your part is it just personal unravel under the present extraordinary, infamous performance of your candidate?

  91. saying “liar” probably deserves a punch in the mouth as such fighting words have long been recognized as. anybody called a liar to his/her face has every right or duty to take it as a deliberate deep insult.

    “liar or crooked Hillary” is the new low of the republican party as it campaign slogan. it is not normal in our society to debase anyone like this. especially if you have any higher education.

  92. perhaps more important than short term premium growth, is growth of Antarctic ice melt, the real long term elephant in the living room:

    Khazendar’s study, which was published Oct. 25, 2016, in the journal Nature Communications, revealed dramatic losses of ice from the ocean sides of the glaciers’ grounding lines. The fastest-melting glacier, Smith, lost between 984 and 1,607 feet of ice thickness between 2002 and 2009.

    That pace is nearly six times faster than a previous estimate.

    The study relied on radar- and laser-based measurements, and both confirmed the glaciers’ ice loss.
    ”If I had been using data from only one instrument, I wouldn’t have believed what I was looking at, because the thinning was so large,” Khazendar said in the statement. http://www.huffingtonpost.com/entry/glaciers-rapid-retreat-should-be-alarm-bell-to-everyones-ears_us_580fb20ae4b08582f88c6624

  93. Daniel Buresh

    Troy,
    Your entire position reminds me of Republicans when it came to the teacher pay raise legislation. You kicked the can down the road for 10+ years and then when something is proposed by the other side, you scream that you weren’t given a chance and are forced to pass something you don’t like. That is called reaping what you sow. Instead of providing actual solutions, you just avoid addressing the problem and then scream when someone does your job for you. That isn’t called leadership. That’s called being a toddler. Either get on board or get out of the way. You have screwed this country up enough along with all your selfish grey haired friends.

  94. bearcreekbat

    J.B. Silver’s analysis of the ACA and potential fixes is interesting and seems to address many of the issues this thread has been flirting with, but in a little more straightforward language.

    http://www.salon.com/2016/10/27/obamacare-is-not-doomed-how-the-next-president-can-save-the-affordable-care-act/?source=newsletter

    One point is that

    In reality, the ACA consists of four major parts:

    1. Expansion of Medicaid for low-income working poor, with mostly federal financing.

    2. Research on alternative ways to treat conditions to inform physician practice.

    3. Tests of innovative ways to organize and deliver health care for better value that can be quickly implemented across the system.

    4. The exchanges, for purchasing subsidized individual policies from private insurance companies.

    While the exchanges seem to be getting the most public attention and criticism, the other three parts are extremely important.

    Silver also points out a flaw in Troy’s argument that the ACA did not adequately address cost containment. The ACA was designed appropriately but Congress then dropped the ball:

    The problems of the individual insurance exchanges come from many directions. Besides insurance company pricing errors compounded by their natural risk avoidance, the government changed the rules midstream and limited the range of premiums insurers can charge, which forced the young to pay too much or the old too little.

    This was compounded by a huge failure of Congress to hold up their end of the bargain in supporting the transitional support promised by the law to companies willing to take the plunge into the unknown of the exchanges, as I wrote about in The Conversation in August. When only 12 percent of the support promised to companies with higher than expected costs was paid, the higher risk and big losses drove many out of the markets. Thus, many of the problems of the exchanges lie directly at the feet of Congress.

    And we all know which party has controlled both Houses of Congress for the last 6 years, right Troy? Given that little detail, which party “owns” the cost containment problem?

  95. In the meantime, how are things going with hospitals. Well then, here is a very significant expansion of Rapid City Regional Hospital in Rapid City http://www.regionalhealth.com/Newsroom/News/2016/Regional-Health-unveils-plans-for-major-expansio.aspx

    Then Custer, South Dakota comes along http://rapidcityjournal.com/news/local/custer-regional-health-partnering-to-build-new-million-hospital/article_87d95fb6-aae6-571d-a0fe-9ba7cfc60fa0.html

    Sturgis, South Dakota says what the hell and now will build this http://www.regionalhealth.com/Newsroom/News/2016/Regional-Health-breaks-ground-on-new-clinic-in-S.aspx

    Even given the obstructionist republican congress and lackeys that support them, we are still able to claw our way to progress without the anvil of Troy and his do nothings. Now, if the dummies in the legislature would realize the importance of economic development, other than finding corrupt vehicles like EB5, we could have Medicaid Expansion. This would not only cover the health of the working poor, it would also lessen the pressure on middle class folks that are getting hit hard with premium increases or lack of “promises” from Wellmark.

  96. @leslie, The Department of the Interior just announced that 79,000 acres of off shore sea land would be auctioned for lease for the installation of wind chargers. This president Obama, is helping to lead the way to save this planet from itself. Sure will miss the Black Dude. Thinks about healthcare for the people and gets it done. Thinks about the planet and does something about it. In the meantime, republicans continue with their view of their belly buttons while vacationing to think of more ways to obstruct. They are very very professional on not doing any kind of work whatsoever.