What effect will the repeal of Obamacare have on our profession?

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The GOP just approved a bill to repeal and replace Obamacare..what are your thoughts?

 

[Abby Atwood]

It will worsen coverage at the community pharmacy counter. More people will have high deductible plans or no coverage. It is going to mean a lot of readmissions for treatable conditions. At the community pharmacy, people are faced with an immediate sticker shock. It is cheaper to pay for prescriptions than to go back to the hospital; but, for someone who can't afford either, there isn't a lot of choice. I work in a relatively wealthy community, but there are still a lot of people who are going to be affected by the Medicaid rollbacks.

Just a series of increased healthcare costs as resources are used to treat preventable conditions without reimbursement 🙁

Maybe the senate will stop it

 

[zelman]

Maybe the senate will stop it

They will. This was just to get Republican reps in pro-Trump regions re-elected.

 

[Sparda29]

They will. This was just to get Republican reps in pro-Trump regions re-elected.

The funny thing is, many of these Pro-Trump areas are the ones that benefit from Obamacare.

There is only one issue I support Trump on, and he can't even get that **** done. (I want to be able to purchase and carry firearms the same way that people in Arizona, Florida, Tennessee, etc are able to. Even though I live in Long Island where I don't need a license to buy a rifle, I cannot buy a rifle that has a collapsible stock, or a pistol grip, or a magazine that can hold more than 10 rounds. It's ****ing ridiculous.)

 

[SouthernDoc2Be]

Not a pharmacy student but..Medicaid Expansion is what allows at least 50% of my state hospital's patient population to seek healthcare. It is a sad day for those who have a pre-existing condition and/or lower income.

 

[Old Timer]

The GOP just approved a bill to repeal and replace Obamacare..what are your thoughts?

It won't pass the Senate, at least as it is now, so right now nothing will happen.....

 

[confettiflyer]

If the Cubs can win the World Series, the senate can pass this bill, lol.

No effect on my end IMO, California won't seek a waiver. We will probably also self-tax to fully fund high risk pools if it comes to that.


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[BMBiology]

Obamacare was going downhill. Not enough money was going to go into the system. This means either we need more taxes, increase healthcare premium or reduce care (probably all).

Nobody likes precondition but what is going to stop me from buying healthcare insurance only after I got into an accident or after my wife got pregnant?

Nobody likes lifetime max but what is going to stop me from getting the most expensive procedure and the most expensive drug therapy unless if they work or not when cost is no longer a factor?

If you work in healthcare, you know there is a lot of waste. Unnecessary cost with no additional benefits.

Let's cover everyone but let's also be realistic. We all need to put more money into the system (yes, this means paying more taxes) while making sure our money is well spent (yes, this means unproven procedures and medications are not going to be covered).

@ least this bill doubled our max HSA contribution (tax saving).


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[Abby Atwood]

Obamacare was going downhill. Not enough money was going to go into the system. This means either we need more taxes, increase healthcare premium or reduce care (probably all).

Nobody likes precondition but what is going to stop me from buying healthcare insurance only after I got into an accident or after my wife got pregnant?

Nobody likes lifetime max but what is going to stop me from getting the most expensive procedure and the most expensive drug therapy unless if they work or not when cost is no longer a factor?

If you work in healthcare, you know there is a lot of waste. Unnecessary cost with no additional benefits.

Let's cover everyone but let's also be realistic. We all need to put more money into the system (yes, this means paying more taxes) while making sure our money is well spent (yes, this means unproven procedures and medications are not going to be covered).

@ least this bill doubled our max HSA contribution (tax saving).

It sounds like a better solution is higher penalties for opting out of health care coverage or possibly no option to opt out. With the new GOP plan, what's to stop someone unable to afford coverage from needing urgent medical care. Hospitals will not be compensated for that urgent care. small health problems will turn into large expensive problems when patients fail to receive early intervention.

 

[BMBiology]

It sounds like a better solution is higher penalties for opting out of health care coverage or possibly no option to opt out. With the new GOP plan, what's to stop someone unable to afford coverage from needing urgent medical care. Hospitals will not be compensated for that urgent care. small health problems will turn into large expensive problems when patients fail to receive early intervention.

They are not going to get very good care at the hospital and most likely, they will die sooner. That is the unfortunate trade off.


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[Dred Pirate]

If the Cubs can win the World Series, the senate can pass this bill, lol.

No effect on my end IMO, California won't seek a waiver. We will probably also self-tax to fully fund high risk pools if it comes to that.


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the only way this is passing the senate is if they change the rules for fillibuster - and the leadership has said they won't do that - but then again....

 

[Old Timer]

the only way this is passing the senate is if they change the rules for fillibuster - and the leadership has said they won't do that - but then again....

No, they can pass this with 51 votes under the arcane rules of reconciliation. That's why this what a normal bill that had committee hearings and the like

 

[npage148]

Not sure about the industry but I've decided that if I need expensive medical care I'll have no qualms about declaring bankruptcy after transferring all asserts to my family. I'll skip out on a 300k bill and tell the hosp to send it to washington to get paid

 

[BMBiology]

Not sure about the industry but I've decided that if I need expensive medical care I'll have no qualms about declaring bankruptcy after transferring all asserts to my family. I'll skip out on a 300k bill and tell the hosp to send it to washington to get paid

Even if your hospital debt is forgiven, the IRS will send you a huge tax bill. And yes, the IRS can go after your retirement funds (401 k). You can't transfer that.


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[Dred Pirate]

No, they can pass this with 51 votes under the arcane rules of reconciliation. That's why this what a normal bill that had committee hearings and the like

can't you filibuster reconciliation thou? But even if you can't I see at least 3 moderate GOPers telling Trump and Ryan to f off and not voting for this - especially if they are up for election in 2018

 

[lord999]

Not sure about the industry but I've decided that if I need expensive medical care I'll have no qualms about declaring bankruptcy after transferring all asserts to my family. I'll skip out on a 300k bill and tell the hosp to send it to washington to get paid

As above, hope you don't have assets.

As for the legislation, here's the thing. The debate has never been on access to healthcare, but on financing. What everyone is deeply worried about in DC is the reactions of hospitals that close their ERs (as they have become more or less primary care) due to EMTALA requirements sinking the hospital budget.

We're not politically willing to let people die due to lack of coverage (yet), but we can't get people to pay into insurance pools such that everyone balances out. We're not willing to force the matter as a tax (it really isn't that yet), but we're not willing to change the way we pay ourselves as practitioners.

I think we're going to have a Raw Deal passed someday that:
1. Basically doesn't give a flip about long-term elder care (so Alzheimer's, dementia, and long-term care patients will die like they did pre-1968)
2. Takes the tax benefit away from businesses to provide health coverage (as they do now) forcing everyone to buy insurance at individual and not community rates.
3. Becomes risk based (at IBW, -$50, at 1.2 IBW +$150, more than 2X IBW +$400, unmarried +$300) for premium determination
4. Promotes "faith-based initiatives" returning us to the days where you had to join a church because that was your only welfare plan option (welfare existed long before the government got involved)

Whether we go a government route to insure everyone or an individual route to insure no one, there will always be organizations to take care of the ill. It's just that it'd be a very different proposition to practice without government support.

States like CA, MN, and MA can tax their residents sufficiently to fund their own plans, so I'm not particularly worried about the situation even if I were to participate in the local market. Rural places like Iowa, well, Darwinism at work.

 

[lord999]

can't you filibuster reconciliation thou? But even if you can't I see at least 3 moderate GOPers telling Trump and Ryan to f off and not voting for this - especially if they are up for election in 2018

Byrd Rule - Wikipedia

No, there are sufficient votes to override the filibuster and the caucus has made it clear the penalties for going maverick on filibusters (also, your own party can invoke cloture on you). The other parliamentary procedure is that the party Whip has to approve your floor time. Bills are not an open debate once it leaves the committee, and supply bills specifically have rules against same party sabotage. MacDonough has made it ($#*ing clear that the Senate shall not follow the House in terms of breaching the peace on this.

 

[Dred Pirate]

Byrd Rule - Wikipedia

No, there are sufficient votes to override the filibuster and the caucus has made it clear the penalties for going maverick on filibusters (also, your own party can invoke cloture on you). The other parliamentary procedure is that the party Whip has to approve your floor time. Bills are not an open debate once it leaves the committee, and supply bills specifically have rules against same party sabotage. MacDonough has made it ($#*ing clear that the Senate shall not follow the House in terms of breaching the peace on this.

What I meant about the GOP telling trump to eff off - is that if 3 of them (in addition to the Dem's) won't vote for it- it is DOA. I don't see there being enough votes - you can't satisfy the moderates and the extremists. I may be wrong, but I sure the hell hope not

 

[lord999]

What I meant about the GOP telling trump to eff off - is that if 3 of them (in addition to the Dem's) won't vote for it- it is DOA. I don't see there being enough votes - you can't satisfy the moderates and the extremists. I may be wrong, but I sure the hell hope not

Not really as the House bill is not even going to the floor. The Senate intends to pass their own version, and the Parliamentarians and the overworked Congressional Staff will have to write an omnibus bill reconciling the two and re-approaching both chambers for passage.

We have five factions in the Senate:
True Blue Democrats - Your stereotypical Democrat
Blue Dog Democrats - Democrats with specific issues that they are guaranteed to vote against the party on
True Red Republicans - Your stereotypical Republican and the most numerous
Freedom Caucus Republican - Antifederal or possibly antistate (in the sense of "State" being Government) Republican
Blow#(% Legislators (there is a less family friendly term than that) - Legislators that you have to give a certain sort of ... in order for them to vote your way. If Larry Craig or Ted Kennedy were still Senators, then possibly a literal one.

You need two of the five factions for majority (50) and three of the five for substantive (60) votes in the Senate.

 

[Kobethegoat24]

Highly doubt it passes the senate but I am concerned about how it affects older people if it passes. CBO estimated that the first bill proposed would cost older Americans more and younger Americans would benefit


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