
Trump Wants to Keep Parts of ACA: Pre-Existing Conditions and Coverage to Age 27 - liberatus
http://www.wsj.com/articles/donald-trump-willing-to-keep-parts-of-health-law-1478895339
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davidf18
A major problem is that Congress mandated the medical ration between young
adults and the elderly to be 1:3 instead of 1:6 which better reflects the true
costs of care meaning the young would be paying 75% more than they should for
their age category. Many have complained that young, healthy people are not
signing up for health plans but this is the reason why. The youth are paying
75% more than they should in an efficient market. Fix the medical ratio to be
1:6 and there will probably be a lot more healthy young people signing up for
insurance.

Much of the health care costs of the elderly are from chronic disease which
itself is from smoking and obesity among other causes.

Other countries such as the UK, France, and Canada have tobacco taxes at least
$5 to $7 per pack. The high cost of tobacco has more than half the effect to
help people to quit and helps to ensure the young never start smoking. The
tobacco taxes can also be used to pay for the higher health care costs that
smokers have thus helping to reduce the subsidy in health care that non-
smokers pays for smokers.

When the ACA was put into place, they should have raised the Federal tobacco
tax to be $5 to $7 per pack (today it is about $1).

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bubinubn
Although there are plenty of studies to suggest otherwise, at least one study:
[http://journals.plos.org/plosmedicine/article?id=10.1371/jou...](http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050029)
suggests that smokers have a lifetime healthcare cost that is lower for the
simple reason that they die earlier, and dying is cheap.

full disclosure: I smoke, and am thus not impartial when it comes to higher
cigarette taxes.

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davidf18
Very sorry you're a smoker. Even if one is a smoker, one should want tobacco
taxes to increase because 1) it is the single best intervention to help others
to quit and for youth to never start and 2) today there are negative
externalities for government (employees, Medicaid, Medicare, VA, Army) and
firms that hire smokers because the health insurance costs are higher than
normal. That means tax money that should be going towards other things are
going towards tobacco related healthcare Instead. Taxing tobacco ensures that
there is not so much of a subsidy of non-smokers for smokers.

Whether overall there is health savings for smokers, while the smokers are
being covered by insurance they cost substantially more money than non-
smokers.

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jrnichols
Anyone that looked at his campaign site would have known that he was going to
keep parts of it. Instead we have scare tactic headlines all over Facebook
about how he's just going to terminate medical coverage for 20 million people.

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cloudjacker
but then his "extremist site" would have been in their browser history

Even in the debates it was obvious both candidates were talking about keeping
the act. I thought it was bizarre they didn't acknowledge that to each other.

"Fix it"

"Repeal it and replace it with more competitive state exchanges" so like fix
it?

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davidf18
The solution is to address the health problems structurally -- it is not going
to be addressed by competitive health insurance marketplaces.

Rather, most of health care costs are from chronic disease from mostly tobacco
use and obesity. Obesity is largely caused by sugar sweetened beverages
(SSBs). Taxing tobacco and SSBs will dramatically reduce the chronic disease
costs from smoking and obesity.

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deskamess
I hope he challenges Republicans and tells them they can create something
better than ACA/Obamacare. Get them on board with that. Then challenge them to
send him something better than ACA that genuinely takes care of people.
Replace ACA - don't gut it without replacement. If he can do this it could
humanize him, the Republican party and do the country good. The problem is
'social' and Republicans don't go together... but perhaps Trump is not all
that Republican. Perhaps we need an egomaniac to get things moving. Fuelled by
the party hate to get anything Obama related erased.

I know, I ask and hope too much.

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setpatchaddress
Yeah, good luck with that. So far, it looks like it's going to be W.'s third
term, in practice. But with more racism, xenophobia, and general gloom.

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nugget
Everyone knows what the solution is. One way or another, the Feds need to
provide broader subsidies and some form of reinsurance to the ACA market, the
same way they already do to the medicaid market via those states who have
expanded medicaid. The question isn't what do to, but rather who pays for it,
and how. Since the Republicans are historically the party of fiscal
constraint, Trump should have much more flexibility to deficit spend than a
Democratic President would have. The debt to GDP % will likely increase but we
have a couple decades before we find out if that matters or not.

