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madronedorf856 karma

Below are Cohn's answer to questions that were asked earlier.

Who will benefit the most and who will receive the least with Obamacare?

Great question! You can't make policy without winners and losers and Obamacare is no exception. Some people will be better off, some will be worse, some won't see most change. The goal, I always say, is to maximize the number of winners, minimize the number of losers, and make sure the losers -- I hate that word, but for this instance I"ll use it -- aren't really put into bad shape. I think Obamacare meets this standard, and does so easily. The biggest winners are the people who suffer in the system today -- the uninsured, who will get coverage; the under-insured, or people with lousy coverage, who will have solid benefits. That's the obvious part. But it goes beyond that. A ton of lower- and middle-income people are going to get financial assistance, sometimes thousands of dollars a year, that will help them pay for their insurance. Many others will benefit, too, but those are the most obvious ones. As for who will benefit the least/lose the most? I'd start with the people who benefit most from the existing dysfunction in the system. That means, among others, young and healthy men who are reasonably well off. Today, the insurance industry charges them very low rates, because they tend not to have big medical bills. And they tend to be content with very skimpy insurance policies, basically for the same reason -- they figure they're unlikely to get sick. The new law prohibits insurers from charging sick people more than healthy people, but that also means -- by definition-- insurers can't charge healthy people less. THeir premiums will go up. And while subsidies and other Obamacare policies -- like making Medicaid more widely available -- will mitigate or eliminate the increases for many, many others will end up paying more. This is the "rate shock" you've heard so much about.

whats going to happen in all the states that didn't expand medicaid?

A lot of low-income people very much in need of help aren't going to get it. It's really that simple -- and it's not going to change until the conservative lawmakers blocking their states from joining the Medicaid expansion change their minds. The good news is that some have. In Arizona, Michigan, Ohio, and Pennsylvania, Republican governors have embraced the Medicaid expansion, even though they're not big fans of Obamacare. They think it's a great financial deal for their states (it is!) and that their residents will benefit (they will!). Of course, in Ohio the governor is still fighting with Republicans in the legislature over this and we'll have to see what happens in Pennsylvania.

And that's not to mention the many other states where Republican governors and state legislatures aren't budging at all.

If my employer offers overpriced, underwhelming insurance, can I get Obamacare instead?

Short answer: Yes Not short answer: As you may know, Obamacare is designed to keep the existing employer-based insurance in place. So if you have coverage on the job, the assumption is you'll keep it. The law sets up new marketplaces -- they used to be called "exchanges" -- where anybody can get a policy, regardless of pre-existing condition. But it's mainly for people who don't have coverage from an employer. As a result, you can't take advantage of the subsidies there (which are worth as much as thousands of dollars a year) if your employer is offering coverage. But if the coverage your employer is really expensive, then the law makes an exception. In that case, you can buy a policy on the exchanges AND qualify for those federal subsides. The law defines "really expensive" as any policy in which the premiums would cost more than 9.5 percent of your income. Naturally, the law itself doesn't say "really expensive." That's my language.

madronedorf30 karma

Obama can't kick people off independent commissions.

madronedorf25 karma

Reposting my question!

Could you explain more about payment models (fee for service, capitation, bundled payment), how it exists in the pre-ACA healthcare world, and what, if anything ACA does to [possibly] change this arrangement?

madronedorf8 karma

Q1: What is the advantage of Title 2 over Section 706. What lead the President to support one approach over the other?

Q2: Could you explain the forbearance process? Specifically, does it work? Does the request to forbear have to come from a regulated entity, or can the FCC unilaterally do so? How permanent is the process?

Q3: There is often confusion around the term paid prioritization, what it includes, and what it doesn't. How do you/the President understand the term? What does it include, and what does it NOT include?

Q4. How effective would using Title 2 be? As I understand, Title 2 doesn't in itself ban paid prioritization, but only bans "unjust or unreasonable" discrimination. Assumedly, broadband firms would say it is not unjust, or unreasonable to ask certain companies to pay more if they use more.

Q5: What took so long? This may be related to Q1, but Obama originally came out in favor of net neutrality in 2007. That was seven years ago. Why now, with this approach?

madronedorf2 karma

A strong message from the President is doing what he just did. If people think demotion in an independent agency is apt to make someone change their mind, they just really are not terribly in tune with how people live in the real world.