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Senator Orrin Hatch (R-UT), the co-chair of the Senate Finance Committee, questions witnesses during testimony in Washington May 21, 2013.  A Senate panel will try on Tuesday to pry more details out of current and former officials of the Internal Revenue Service about the agency's targeting of conservative groups for extra scrutiny when they sought tax-exempt status.  REUTERS/Gary Cameron  (UNITED STATES - Tags: POLITICS BUSINESS) - RTXZV77
The favorite Republican attack on President Obama for the last few months has been over the "if you like your health insurance, you can keep it" gaffe. Which makes for some great irony in the Obamacare replacement plan three senators—Orrin Hatch (R-UT), Tom Coburn (R-OK), and Richard Burr (R-NC)—unveiled Monday. Because under this plan, if you like your current insurance, you'd probably have to pay a hell of a lot more for it. And if you just obtained coverage under Obamacare, you might well lose it under the replacement plan. The thing about the replacement plan is that it doesn't just affect people newly covered under Obamacare. Because it limits the tax exemption employers get for providing health insurance, it means that the 85 percent of Americans who have health insurance coverage through their employers would have to pay more for the same coverage. That's absolutely by design.
In essence, the plan attempts to lower health care costs by making people shoulder a greater share of those costs—or "sensitizing" consumers to the actual cost of health care, as Senate aides put it in a meeting with reporters on Monday.

Most people don't recognize how much their employer contributes to their health care plan and don't see the costs the insurance company covers: If people are spending more of their own money, many conservatives argue, they'll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more "skin in the game."

Or, more people will have to penny-pinch when it comes to preventive care—which would no longer be provided without copays under the GOP plan—and will delay care, making costs for treatment higher if they end up getting really sick. Alternatively, they'd only be able to afford junk insurance plans—which would be legal again—and end up bankrupt if serious illness struck. In other words, pretty much just like the pre-Obamacare system, except that even more people could be in danger of losing everything. That's not even considering all those now gaining Medicaid coverage. Under Obamacare's Medicaid expansion, people up to 133 percent of poverty are eligible. The Republican plan would cut that to people at 100 percent of poverty, and provide tax credits to everyone else, up to 300 percent of poverty (under Obamacare, subsidies are available for everyone making up to 400 percent of poverty).
"If they repealed the Medicaid expansion, if they repeal the premium tax credits, people who would be covered by those would probably be terminated," Tim Jost, a health law professor at Washington and Lee University, who supports the ACA, said. "Those people would likely be back uninsured."
In other words, back to pre-Obamacare days for everyone who had been uninsured, and making coverage so expensive that more people are put in jeopardy of losing the coverage they have. And if they have to let their insurance lapse because they can't afford it, and have a pre-existing condition, they'll have to pay even more when trying to buy insurance again, because the Republican plan allows insurance companies to gouge on pre-existing conditions again.

In many ways, the Republican plan is worse than the system before Obamacare came along, because it could hurt the 85 percent of people who have had affordable coverage—made even better under Obamacare—from the employers. But as far as Republicans are concerned, that's just "skin in the game."

Originally posted to Joan McCarter on Tue Jan 28, 2014 at 09:43 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (33+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Tue Jan 28, 2014 at 09:43:59 AM PST

  •  And as usual (6+ / 0-)

    the people writing the bills are not affected by them.

    Bad politicians are sent to Washington by good people who don't vote.

    by Renie57 on Tue Jan 28, 2014 at 04:13:10 PM PST

  •  As has been stated (8+ / 0-)

    The biggest problem with Obamacare is the fact that insurance companies were/are involved.  The employment tied healthcare is a total joke these days with so many people being totally or part time unemployed.  No job, no coverage which makes you more willing to put up with minimal wages for ANY kind of job.  And yes, it doesn't matter to them what happens as long as the peons keep starving and dying.

    ~Arianna_Editrix-- I willingly accept Cassandra’s fate, To speak the truth, altho’ believ’d too late

    by Arianna Editrix on Tue Jan 28, 2014 at 04:20:29 PM PST

    •  Wonder why few (no?) other countries do this? (6+ / 0-)
      The employment tied healthcare is a total joke
      Because it results in the broken system we have today in the US.

      "Ridicule is the only weapon which can be used against unintelligible propositions." - Thomas Jefferson

      by rfall on Tue Jan 28, 2014 at 04:25:47 PM PST

      [ Parent ]

      •  Jobs and health care are not directly tied (3+ / 0-)
        Recommended by:
        high uintas, NoMoreLies, jim bow

        …in other nations -- however, employers pay a general per-employee tax into a government fund used for health care. And everyone pays an income tax, part of which flows into that fund, as well.

        “The Internet is the first thing that humanity has built that humanity doesn't understand, the largest experiment in anarchy that we have ever had.” ― Eric Schmidt

        by Pluto on Tue Jan 28, 2014 at 04:49:47 PM PST

        [ Parent ]

        •  Well, that's fine. (1+ / 0-)
          Recommended by:

          That's just another form of "everyone pays, spread the risk."

          What the other systems don't do is tie your health insurance to your specific job, which eliminates the problem that Arianna noted.

          "A standing military force, with an overgrown Executive will not long be safe companions to liberty. The means of defence agst. foreign danger, have been always the instruments of tyranny at home." - James Madison

          by gharlane on Tue Jan 28, 2014 at 07:21:00 PM PST

          [ Parent ]

    •  Yes, that is a "problem with Obamacare" (4+ / 0-)

      but given this type of proposal, we should thank our lucky stars we got as much as we did. These people are truly cruel and without compassion for anyone.

      The real problem is not with Obamacare but with slime like these Senators.

      Ed FitzGerald for governor Of Ohio. Women's lives depend on it.

      by anastasia p on Tue Jan 28, 2014 at 04:46:36 PM PST

      [ Parent ]

    •  Except to fix this problem ... (0+ / 0-)

      ... we'd have take everyone off their employer-based coverage either through (1) a single-payer system or (2) replacing the employer tax-exclusion with a sliding scale refundable tax credit to purchase health insurance on the exchange.  (2) would also require eliminating the age and smoker ratings and probably eliminating the bronze and silver tiers -- or at least the bronze tier.  In other words, a lot greater number of people will be better/worse off.  Both (1) and (2) are pretty much political non-starters.  Obamacare was proposed because it was the least disruptive proposal and thus the most politically feasible.

      I'm not saying I disagree with your thoughts on the employer-based insurance system being inefficient.  I just question the political feasibility of your ideas, though I would love to see them enshrined into our nation's social fabric.

  •  How does this work if I've already been skinned? (7+ / 0-)
    Overall costs will come down, the argument goes, if consumers have more "skin in the game."
    This is a favorite, bullshit line of thinking used by conservatives and libertarians.  Such a "driving force" is only in operation, however, for those goods and services which are not essential, and for those consumers who have the money to use for "the game".

    A category into which healthcare should not fall.

    "Ridicule is the only weapon which can be used against unintelligible propositions." - Thomas Jefferson

    by rfall on Tue Jan 28, 2014 at 04:24:20 PM PST

    •  It IS bullshit in so many ways (3+ / 0-)
      Recommended by:
      high uintas, OregonWetDog, JerryNA

      This presumes a lot of things. It presumes you have access to compare costs, that costs are all totally transparent (ha!) It presumes you have the time to do so. It presumes you have a deep understanding of what you need and what you are buying. And it presumes that when your child wakes up in the middle of the night in pain with a high fever, you are calm enough to go online and research what might be wrong and the costs of various treatment alternatives.

      It presumes a whole steaming pile of bullshit.

      Ed FitzGerald for governor Of Ohio. Women's lives depend on it.

      by anastasia p on Tue Jan 28, 2014 at 04:48:40 PM PST

      [ Parent ]

      •  They think we are malingerers with Munchhausen's (2+ / 0-)
        Recommended by:
        JerryNA, NoMoreLies

        Syndrome -- where people get their jollies from unnecessary medical procedures.  It makes no sense -- a smart insurance company or doctor will detect those cases and not treat them needlessly, except perhaps for the mental illness Munchhausen's Syndrome.  

        The lie is obvious to anyone with a brain.  However, the public stenography service that passes as the mainstream press treats it as a good argument, since both parties are assumed to have an equal claim on the truth, facts be damned.

  •  This is SO true . . . (9+ / 0-)
    If people are spending more of their own money, many conservatives argue, they'll be smarter consumers. Overall costs will come down, the argument goes, if consumers have more "skin in the game."
    the last time I needed neurosurgery when I was between insurance and had to pay for the procedure out of pocket, I got it performed by an automobile mechanic who learned the craft off the internet - and she only charged me the going rate for fixing cars - about $95 per hour plus a set shop fee of $22.

    Overall I saved over $37,887 off the price quoted to me by the county hospital.

    And I am confident that the quality of thinking that shines through in my posts is convincing that the savings were well worth it (the point being, the cut rate neurosurgeon didn't (all that badly) damage my brain).

    •  Right! (1+ / 0-)
      Recommended by:
      Roadbed Guy

      I needed neurosurgery also and like you between insurance jobs and I was. Pocket.  Auto mechanic internet guy saved money me lots like many thousands and did the operation and now I'm quite sure my brain wasn't mmmbnnbngm gggmrdajfdk fdwa.enf adf e/  iewpapfpeaef.  at all.

      "A standing military force, with an overgrown Executive will not long be safe companions to liberty. The means of defence agst. foreign danger, have been always the instruments of tyranny at home." - James Madison

      by gharlane on Tue Jan 28, 2014 at 07:26:05 PM PST

      [ Parent ]

      •  Meh - I've taken my car to lower quality (0+ / 0-)

        service providers, too.

        looks like that might have happened to you brain-wise, this time around.

        but don't be discouraged, stick with it, you'll eventually find an honest / competent auto mechanic / brain surgeon!

        •  brain? what is..... brain? eom (0+ / 0-)

          "A standing military force, with an overgrown Executive will not long be safe companions to liberty. The means of defence agst. foreign danger, have been always the instruments of tyranny at home." - James Madison

          by gharlane on Thu Jan 30, 2014 at 03:11:57 PM PST

          [ Parent ]

  •  "Consumers???" (6+ / 0-)

    That's what's so fucking wrong with this whole line of thought: health care is just another market commodity.

    I hope some Democrat will stand up and flame them to hell and back for treating access to health as a fucking "market good" like, say, widgets.

    The most violent element in society is ignorance.

    by Mr MadAsHell on Tue Jan 28, 2014 at 04:27:01 PM PST

  •  Will someone, for God's sake, please unplug Hatch? (6+ / 0-)

    That photo makes it clear that he is well-past his "sell by" date.

    "Ridicule is the only weapon which can be used against unintelligible propositions." - Thomas Jefferson

    by rfall on Tue Jan 28, 2014 at 04:27:11 PM PST

    •  Would love to (0+ / 0-)

      I fear we might get another Mike Lee, however. I've been thinking that maybe Matheson may run to replace Lee who is not very popular here due to his obvious Ted Cruz crush. Who knows?

      I find it ironic that Hatch is there given the fact that our Governor turned from not wanting to embrace Medicaid expansion to going for it. That didn't happen in a vacuum, the people want health care.

      And daddy won't you take me back to Muhlenberg County Down by the Green River where Paradise lay. Well, I'm sorry my son, but you're too late in asking Mister Peabody's coal train has hauled it away. John Prine

      by high uintas on Tue Jan 28, 2014 at 05:00:12 PM PST

      [ Parent ]

  •  Just ask Georgia teachers and state employees (1+ / 0-)
    Recommended by:

    if that rationale sounds vaguely familiar. Go to Facebook and look up information on T.R.A.G.I.C. - a group formed to fight insurance changes for the state of Georgia plan for teachers and other state employees. The group is 11,000 strong in less than a month due to "skin in the game" type policies that were threatening to bankrupt people. Due to the huge outcry, the governor listened and changes have been made. However, this is an election year for the governor and he has competition in the primary and in the other party. Allowing a group as large as the state employees to be energized was not a good move on his part.

  •  As with everything with these people (1+ / 0-)
    Recommended by:

    unless you're doing more and more, you're no good and get nothing.

    :) the above thoughts come from a crazy mind. ;)

    by Shreve on Tue Jan 28, 2014 at 04:33:05 PM PST

  •  It'a kind of hard to believe (1+ / 0-)
    Recommended by:
    high uintas

    …the Republicans would advance a plan like this. It has no positives.

    Would preexisting condition coverage have any meaning if risk-based pricing is used?

    One thing is for sure, the Health Care investment sector will not go for it.

    Not now that they are this close to achieving a steady big-ticket money pump directly from the US Treasury -- just like the cash pump that keeps the defense contractors flush with dough.

    “The Internet is the first thing that humanity has built that humanity doesn't understand, the largest experiment in anarchy that we have ever had.” ― Eric Schmidt

    by Pluto on Tue Jan 28, 2014 at 04:39:25 PM PST

    •  It's the worst of both worlds. (2+ / 0-)
      Recommended by:
      JerryNA, Pluto

      Capping the employer tax exclusion still means employers -- not employees, as would be the case if you entirely eliminated the employer tax exclusion, and used the funds for subsidies to purchase health insurance on the Exchange (assuming no age or smoker rating) -- choose their health plans, and continue to hide the true cost of health insurance.  Even worse, those with older, sicker workforces will suffer from capping the employer tax exclusion as their plans are more expensive the way they wouldn't if you just started all over.

  •  The Cadillac Tax does the same thing, by design (0+ / 0-)

    It is designed to make good coverage more expensive for employers, so they cut back on policies, throw more of the cost onto workers.  Also giving workers more "skin in the game" so they control costs, by design.

    But vague language was thrown in about how the Cadillac tax will help subsidize other policies, so of course it's all good, and doesn't at all put anyone's healthcare in jeopardy.  Those spoiled overpaid workers can just go on the exchange and get a new policy.

  •  Turn all those ads around from 2010 and 2012 (0+ / 0-)

    "Senator Toomey/Portman/Johnson/Kirk voted to cut Medicaid."

    "What do you mean "conspiracy"? Does that mean it's someone's imaginings and that the actual polls hovered right around the result?" - petral

    by conspiracy on Tue Jan 28, 2014 at 04:43:51 PM PST

  •  Give me an example (3+ / 0-)
    Recommended by:
    high uintas, JerryNA, ruellia

    "If people are spending more of their own money, many conservatives argue, they'll be smarter consumers."

    I want an example in a private-insurance based system of healthcare delivery and with drugs only approved (and thus only covered by insurance) for a specific indication, how this would drive costs down.  Yes many "smart consumers" try to buy their drugs from Canada, but pharma companies generally try to shut that down.

    Let's say I have cancer (and I did, in fact). Tell me what different decisions I would have made under this new plan than I did under my employer-based insurance?  Like the article's author said, about the only change is that people won't bother with preventive care or even for care when they are sick, but perhaps not sick enough. But I fail to see how that will cut costs, especially if the condition worsens and they end up in the ER.

    •  Most likely, that would be the decision of (1+ / 0-)
      Recommended by:

      whether or not you should blow your own brains out rather than seek cancer treatment.  Yes, that is exactly how these people think.

      You have watched Faux News, now lose 2d10 SAN.

      by Throw The Bums Out on Tue Jan 28, 2014 at 05:20:08 PM PST

      [ Parent ]

    •  DIE FASTER. (0+ / 0-)

      They expect you to decide that since you can't afford treatment, you'll just decide not to do it and die faster.  

      Grayson wasn't kidding or grandstanding.  It IS what they want you to do.

      America, where a rising tide lifts all boats! Unless you don't have a boat...uh...then it lifts all who can swim! Er, if you can't swim? SHAME ON YOU!

      by Back In Blue on Wed Jan 29, 2014 at 01:44:19 AM PST

      [ Parent ]

  •  The GOP has a pre-existing condition .. (3+ / 0-)

    Symptoms include:

    ignoring all evidence to the contrary ...

    -- Every OECD country of note, except one, us, has a functioning nationalized healthcare system.

    -- Each one structures the system such that people don't actually have to consider they have "skin in the game"

    Because they have learned that it is better to have everyone not give a second thought to getting early treatment, with no questioning needed, and minimized delay.

    But, just as they do with their perverse and impractical focus on "Lower taxes lead to jobs!!" they thump the table, pronounce a problem soluble by the least effective of methods - and decry any effort to make matters better.

    Purely pathological behavior.

  •  "Smarter consumers?" (2+ / 0-)
    Recommended by:
    high uintas, JerryNA

    If you live in a town or small city with ONE hospital, how, exactly, are you supposed to be a "smarter consumer"? Travel a hundred miles to another town to comparison shop while your appendix is bursting?

    These are moronic ideas pushed by greedy sadists and supported by fools.

  •  ARRRGGGHHH!!! (1+ / 0-)
    Recommended by:

    So how can I be a "smarter consumer" of health care????  I guess I just stop getting sick, or only go to the emergency room when that weird lump gets REALLY big.

    What is wrong with these fucking people??????  Health care is not like buying a goddamned TV!!!!

    "Mediocrity cannot know excellence." -- Sherlock Holmes

    by La Gitane on Tue Jan 28, 2014 at 05:18:19 PM PST

  •  Forgot to mention (1+ / 0-)
    Recommended by:

    People with preexisting conditions are back to being screwed over...

  •  The day the Republicans offer something good... (1+ / 0-)
    Recommended by:

    ...on healthcare will be the day they take governing seriously, start to compromise, help design ungerrymandered congressional districts, strengthen social security, pay for wars, cut the military budget, re-enact the voting rights act, and.....

    oh nevermind. It's amazing to me that they take themselves seriously. Maybe they don't. I don't imagine even Republicans believe Orrin Hatch has anything positive to offer.  

    I'm from the Elizabeth Warren wing of the Democratic Party

    by voicemail on Tue Jan 28, 2014 at 05:45:30 PM PST

  •  In truth (2+ / 0-)
    Recommended by:
    JerryNA, skepticalcitizen

    The bronze -- and even silver -- Exchange tier plans, are pretty much "skin the game."  That we can call a 60 percent actuarial value policy "insurance" is kind of "skin the game" in my book.

    And the 3:1 age and (1.5:1) smoker rating still doesn't make insurance affordable enough for those 55-64.

    Sad as it is, the Hatch/Coburn/Burr bill exacerbates both of these problems by eliminating the minimum benefit package, widening the age rating to 5:1, and basing decreased subsidies on both income and age (making it impossible for states with to tighten their community rating as insurance will be unaffordable to the young).

  •  This is such bullshit! (0+ / 0-)

    Who is buying this rhetoric?  Certainly not the schlubs like me who are paying through the nose for an employer sponsored program that still requires blood, sweat and tears.  My first procedure with my new policy is going to be paid in full by ME - $589 straight out of my pocket for a damn CT scan of my head.  (Deductibles, you know).  My doctor said it would probably cost me $100.  It's such a
    shitshow.  We're getting screwed on the high premiums that don't really buy anything.  I'm old, I'm angry, and soon to be even more broke.  "Health care?"  AYFKM?

  •  Plus 'pre-existing condition' rejections again (1+ / 0-)
    Recommended by:

    Once more, insurance companies would be free to reject people for coverage due to any and all pre-existing conditions.

    And as I've pointed out in other comments, the insurance company's definition of disallowed pre-existing conditions became so broad since the 1990s as to include virtually anything that might cause someone to see a doctor.

    Get migraines or hay-fever allergies, and need a prescription now and then? Then you join me and the reason I didn't have insurance for most of a decade.

    Diabetes, asthma, or arthritis? If you've seen a doctor for any of those, you're uninsurable. Same thing if you're a woman and are pregnant.

    Hell, insurance companies were rejecting newborn babies simply because they weren't born perfect and without any complications whatsoever.

    I've often complained how the PPACA was entirely too much of a giveaway to the insurance companies and Big Med -- and it still is. But the GOP's counter is an abomination.

    "Don't ride in anything with a Capissen 38 engine. They fall right out of the sky." -- Kaywinnit Lee Frye

    by Technowitch on Tue Jan 28, 2014 at 07:19:17 PM PST

  •  I wish (0+ / 0-)

    I had insurance, but I have been unemployed for 19 months, so I roll the dice every month,

  •  LMAO at these buffoons n/t (0+ / 0-)

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