Bernie Sanders asks questions about those 'concepts'

[mister_coffee]

Trump's approval drops to 31% and doesn't even reach 30% when it comes to the ACA subsidies.
https://crooksandliars.com/2025/12/trum ... 31-economy

And his overall approval rating is at 36 percent with 61 percent disapproval. Probably a bit higher than Gaddafi and Ceaușescu were when they were deposed and killed. But not by much.

[Rideback]

Trump's approval drops to 31% and doesn't even reach 30% when it comes to the ACA subsidies.
https://crooksandliars.com/2025/12/trum ... 31-economy

[Rideback]

yes, I probably shouldn't have referred to the 'market' when it comes to insurance. The whole concept of free markets has become so convoluted with the interjection of subsidies and carve outs that there's little resemblance to the concept our forefathers envisoned.

[mister_coffee]

Almost by definition free markets do not work for health care or health insurance. So I've always felt that trying to use markets to "fix" the problems is kind of silly.

Consumers aren't really able to discriminate on prices or quality of service with respect to health care. One obvious reason is that if you need emergency health care you might not even be conscious. Another obvious reason is that if you live in a place like the Methow you from a practical standpoint don't have many options to choose from.

Further, consumers are given a pretty hopeless task in discerning between different health insurance options. It is especially hard if you are a healthy person who doesn't need or want very much health care in the normal case of things, as it can be impossible to predict your future risk.

[Rideback]

Unfortunately, Jingles the subsidies do go into the pockets of the insurers which is a result of the SCOTUS ruling that spreading the coverage across all the subscribers was a bust, thus one of the basic tenants of insurance structure was tossed to the street and the gap had to be filled by implementing subsidies. The logic of not allowing a market to work is just as nuts as what we're seeing with the Trump subsidies of $12B to farmers, paid out of the tariff accounts Trump implemented which caused the farmers to lose their market in the first place.

Reps have had a decade now where they could have come up with a plan or several plans for that matter. But they haven't. Plain and simple which makes one wonder if they've decided it's more politically beneficial not to stick their necks out and fix things vs keep the ACA in place and just disassemble it piece by piece to make it worse and then call Gotcha when it doesn't work.

[Rideback]

Jingles, yes, however getting the waiver is more than a little problematic:
"For Medical Care (Community Care):
Eligibility: You might get care outside the VA if:
You live in a state without a full-service VA facility (like AK, MT, ND, SD, WY).
Your nearest VA is too far (often the 40-mile rule applies) or can't meet quality/wait time standards.
You and your VA doctor agree non-VA care is medically best.
How it Works: The VA pays for community care if you get authorization before treatment (except emergencies).
Action: Talk to your VA provider or a Veterans Service Officer (VSO) for details on getting approved for community care due to distance or lack of services.
For VA Debts (Financial Waivers):
Waiver Criteria: You can request a waiver for VA debt (like overpaid benefits) if paying would cause financial hardship or be unfair, but you must submit a written request with VA Form 5655 (Financial Status Report).
Distance Doesn't Automatically Grant It: Living far from a VA facility isn't a direct waiver for a debt, but it can be a reason for a waiver if it causes hardship in managing payments or accessing resources.
Action: Apply for a waiver online or via VA Form 5655 (available at VA.gov).
In Summary: For medical needs due to distance, the VA has Community Care programs. For financial issues, you must formally apply for a waiver using specific forms and justification, even if location is a factor."

[Jingles]

And yes, the VA provides good coverage if you can get it. Too often now vets are finding that providers are not accepting new patients so vets are having to travel huge distances to get care. A friend who is a vet recently moved to Oregon where he discovered the closes VA clinic that was accepting new patients was almost 300 miles away.

Rideback you might want to inform your vet friend that if he lives more than 50 miles away from a VA Facility he can get authorization to be seen/ treated at a local medical facility.

As far as the ACA goes and government insurance subsidies goes all it is doing is stuffing the pockets of the insurance companies executives and stock holders

Ken
What you are describing is actually holding folks accountable for their decisions / actions and that is something that is no longer accepted / tolerated in today's society

[mister_coffee]

Maybe federal elected officials should be required to buy their health insurance on the same exchanges we have to use?

[PAL]

Let's not forge from the president on down to the legislators that they get their health insurance paid for...by who, do you think?
But what of people that say, need dialysis for example. Most could not pay out of pocket, so should they just die?

[just-jim]

Ken enjoys health insurance, a good part of which is paid for by the taxpayers, at his publicly funded job. He doesn’t think any one else should, I guess.

That’s called hypocrisy. And it is typical MAGA “hooray for me and screw you” bs.

[Rideback]

Ken, do you not include good health maintenance in your criteria of good decision making?

When the ACA was first implemented remember how the doctors' offices found themselves inundated with new patients that they soon realized were people who had never had access to everyday maintenance that most of us take for granted. It's those people who often were ending up having to go to an emergency care after trying to just make do with symptoms until they got too severe to ignore. By giving access to 22+ million people to coverage the overall health of the country improved as did hospitals who had had to bear the economic brunt of providing emergency care without compensation.

And yes, the VA provides good coverage if you can get it. Too often now vets are finding that providers are not accepting new patients so vets are having to travel huge distances to get care. A friend who is a vet recently moved to Oregon where he discovered the closes VA clinic that was accepting new patients was almost 300 miles away.

[tristanbgilb]

I enjoy VA Healthcare and encourage all eligible veterans to use this service.

[dorankj]

Continuing a crap program (ACA, that ISN'T affordable and you DID lose your Dr. and families DID NOT save $2500, all lies to pass it!) that was hugely ramped up during COVID that in no way is still a pandemic is completely idiotic! Somehow we MUST return to insurance being only for unforeseen, unpredictable and true accidents, transferring billions to insurance companies who are ordered to provide tons of health services is horribly inefficient and ridiculously expensive and DOES NOT lead to better outcomes. Individual responsibility to make good decisions (don't smoke, don't be obese and drive safely etc.) and if you choose poorly and the obvious outcomes occur YOU fork over your own money! Socializing Healthcare is a horrible choice. Why doesn't everyone 'deserve' a certain size and quality of housing,or a certain type and speed vehicle or certain quantity and quality of food?

[Rideback]

https://statuskuo.substack.com/p/still- ... irect=true

"Donald Trump famously claimed that he had “concepts of a plan” when it came to healthcare. For once he was actually telling the truth.

Just ask Republicans. The only agreement among them is that there is none. As Rep. Ralph Norman (R-SC) told NBC News yesterday, “The consensus is we need to come up with something.”

Truth bomb moment: Republicans do not, and have never had, a healthcare plan. And now they’re out of time. Senate Majority Leader John Thune promised a vote today on a healthcare plan, in exchange for Democratic votes to reopen the government, to head off the looming crisis from soaring ACA premiums. But the GOP plan is little more than a joke.

Despite efforts by a handful of Republicans to come up with something that would prevent economic catastrophe for tens of millions of Americans come January, the proposal Majority Leader Thune has blessed amounts to a meager cash handout that Republicans know will help no one.

And desperate families shouldn’t look for solutions over in the House either, where there is also nothing to show after years of promises.

The crap plan from Crapo-Cassidy

The Senate will reportedly vote today on two plans.

The Democratic proposal is simple. It would extend ACA premium subsidies cleanly with no conditions for 24 million Americans for another three years.

And the Republican proposal? For some time, it wasn’t clear whether the Republicans were going to even offer one of their own. A compromise plan authored by Sens. Susan Collins (R-ME) and Bernie Moreno (R-OH) would have extended ACA premium subsidies for two years with income limitations and minimum premiums. But it failed to gain traction among the GOP.

Instead, Majority Leader Thune is greenlighting a different Republican proposal from Sens. Mike Crapo (R-ID) and Bill Cassidy (R-LA). That plan would not extend the ACA premium subsidies. Instead it would replace them with modest direct payments to people earning less than a certain maximum amount and who purchase health insurance plans with high deductibles and low premiums. Payments would be deposited into health savings accounts, with $1,000 for those below 50 and $1,500 for those aged 50-64.

This proposal aligns loosely with Trump’s call for people to receive cash to spend as they like instead of handing it to insurance companies. The money could be used on medical services except abortion services or gender affirming care, because of course they exempted those.

But this “fix” is laughable.

As Sen. Bernie Sanders noted, insurance premiums on the ACA marketplace would spike, and families would be required to switch from gold or silver health insurance plans to bronze or catastrophic plans. Under such plans, they would face crushing deductibles of $7,500 and $10,000 for individuals and up to $21,200 for households.

Sanders’s office provided three examples of how this would play out for different insured individuals and families:

A 62-year-old couple in Miami, Florida, making $85,000 would be forced to pay $21,654 more in premiums than they do today and see their deductible go from $0 to $7,700.

A family of four living in Kansas making $45,000 could be forced to pay $4,500 more for surgery after a heart attack than under current law.

A 46-year-old living in New Orleans, Louisiana, making $32,000 could pay $2,560 more for breast cancer treatment and premiums than under current law.

These cost increases are not doable for any of these people.

Sanders noted that the Cassidy-Crapo plan “would make an already broken and outrageously expensive health care system even worse.” Premiums would go up two to four times for millions of Americans. The plan would not address rising costs of prescription drugs. And it would do nothing to make it easier for Americans to see a doctor.

Sanders concluded, “The Cassidy-Crapo bill would lead to more medical bankruptcies, more unaffordable care and more Americans going without the health care they desperately need. That would be absolutely unacceptable.”

Yet this is the only plan the Senate GOP intends to advance at this time.

Bullet points are not a plan

The healthcare plan situation in the House is no better. It’s hard to fathom, but as of yesterday, when Speaker Mike Johnson called his conference to a meeting, he offered them only healthcare plan bullet points. Per Politico,

Speaker Mike Johnson presented attendees of a closed-door conference meeting with [a] list of 10 possible policies that could get votes in the coming weeks or months, according to five Republicans in the room.




These points are so broad as to be meaningless. “Innovation” is just a concept, not a plan. And notably, as with the Crapo-Cassidy plan, the ideas did not include an extension of the existing ACA premium subsidies, the very crisis driving the urgency to act.

The continued lack of any actual GOP healthcare plan is causing considerable consternation among Republican House members who will have to face angry voters next fall. They expressed frustration at how poorly the whole topic has been handled.

“There was a general uneasiness because nothing is coming together,” said a House Republican to Politico.

“We wasted so much time,” one conservative Republican declared, lamenting that there was no unified GOP plan with just seven session days left in the year. Recall that Johnson sent his conference home for most of the last few months when they could have been working on a healthcare plan.

A bipartisan group of “moderate” House members, including Republicans in vulnerable swing districts, is hoping to force a vote on the House floor to extend the ACA premium subsidies via a discharge petition. But that effort seems stalled, and there isn’t time under the rules to succeed before the clock runs out on 2025.

So where does this leave us?

Without 60 votes for either proposal in the Senate, and with no viable House plan to address the looming healthcare affordability crisis, the ACA premium subsidies will expire and millions of Americans will face not only sticker shock but a Hobson’s choice: 1) going without health insurance or a plan with inadequate coverage, or 2) shelling out two to four times as much for an ACA plan with worse coverage and very high deductibles.

The hard truth is this: Republicans are fully prepared to let the ACA subsidies expire and send healthcare soaring for everyone. Why? A solid number of them absolutely hate Obamacare, and they believe that making it unaffordable will ultimately kill it.

Democratic Whip Katherine Clark said it best. “The GOP health care plan has been the same for 15 years. Repeal the ACA and return to when millions were denied coverage for pre-existing conditions.”

There is a terrible irony at work here. One group most vulnerable to a healthcare system that excludes or prices out those with pre-existing conditions is Trump’s own voter base in deep red states. Per a report by KFF, the share of adults with “declinable pre-existing conditions” exceeds one-third of all adults under age 65 in states like West Virginia (37%), Arkansas (34%), Kentucky (34%), and Mississippi (34%).

Without the protections of Obamacare, these Republican voters would be shifted into different “risk pools” with higher premiums, or they might not be insurable at all.

Extending the ACA premium subsidies is a costly proposition, and it admittedly doesn’t fix the underlying causes of rising healthcare costs. We still need to move toward universal healthcare coverage, perhaps under some kind of single payer plan that cuts out the insurance companies. But the idea that we will suddenly throw millions off their health insurance by ending the subsidies on January 1 is both morally reprehensible and economically foolish. And it is a move the Republicans, who control government, will own.

The only silver lining is that millions of Republican voters will soon experience what the rest of us have been warning about. Along with Democrats and independents, their wrath might finally be directed where it belongs: at the party that took away their insurance, their Medicaid and their food security, all to fund tax breaks for their super wealthy donors."