And it did..... And it does.... And it will....
Posted on 11/15/2025 6:20:35 AM PST by MtnClimber
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That’s absolutely right.
Big time.
And it did..... And it does.... And it will....
[I’m not sure this is entirely correct as it is complex.]
This is a possible reinsurance model PPACA replacement scheme:
US citizens and lawfully present persons of a US resident household shall be eligible for coverage as per the PPACA.
The federally subsidy eligible expenses of each eligible issued policy shall be:
1. 85% of Medicare Part A scope coverage provider payouts,
2. 80% of Medicare Part B scope coverage provider payouts, plus
3. 80% of prescription drug coverage provider payouts on a policy.
Uncle Sam shall pay a share of the federally subsidy eligible expenses of each eligible policy equal to 30%,
plus 1/6th of each policyholders’ household premium calculation percentage below 400% of FPL that is above 40%.
[The 30% is to mainly cover the costs of chronic condition people.]
A policyholders’ premium calculation percentage shall be the lesser of 100% or 25 times:
their statutorily expected household monthly income,
less the HUD fair market rent for a two-bedroom apartment,
less vehicle loan obligations when computed on a monthly or 30-day basis,
less vehicle insurance obligations when computed on a monthly or 30-day basis,
less court-ordered obligations due, including child support, fines and costs, when computed on a 28-day, 30-day or monthly basis,
less expected student loan repayment expenses when computed on a monthly or 30-day basis,
less other amounts the coverage issuer justly deems reasonable and specific for college attendance when averaged to a proper extent by the month over an appropriate time period,
less other monthly or corresponding amounts the coverage issuer reasonably deems to be mandatory,
divided by 1/12th the annual FPL amount for the covered household size.
The statutorily expected household monthly income shall be the sum,
for each person of the household at least 19 years of age,
excluding the primary caregiver in the household for the under full-time school age children of the household,
the:
1. the hourly computational wage rate for the household’s state*100[what can be expected from working retail],
reduced by two-thirds if a full-time college student
and a photocopy of the student’s college ID or proof of tuition payment is on file with the coverage issuer,
2. if higher, the person’s income last stated by the policy purchaser, or person,
3. if lower, the person’s net income stated reasonably accurately not more than 70 days ago by the policy purchaser, or person,
for no more than four months of the policy year.
Hourly computational wage rates for 2026 shall be assumed to be as follows:
1. AK, HI, WA, CA, OR, NJ, NY, MD, MA, RI, DC - $16/hour
2. CO, AZ, IL, NB - $15/hour
3. ME, VT, VA, UT, FL - $14/hour
4. GA, MI - $13/hour
5. NM - $12/hour
6. AL, MS - $10/hour
7. other states $11/hour.
[States with severe winter weather may be given a lower rate than their statutory minimum wage rate.]
Extractable profit to not exceed:
1. 1% of the Medicare amount, plus $100, for each inpatient episode paid within 30 days of initial correct provider billing and within 60 days of initial provider billing,
2. 1% of the Medicare amount, plus $8, for each other provider bill paid to the contracted amount within 30 days of initial correct provider billing and within 60 days of initial provider billing,
3. $1 for each off-patent drug prescription paid for, $3 if for 90 days,
4. $5 for each patented drug prescription paid for within 30 days of the policy year, $15 if for 90 days, and
5. $20 for each recombinant drug provision paid for within 30 days of the policy year.
Administrative related and in-house care costs shall not exceed the extractable profit limit, any applicable reasonable state law limit, or any policy limit. All issued policies shall have a reasonable percentage of premium limit stated within the first 1000 characters of any initial normal course of access policy specific marketing page.
Insurers may, with reasonable 30-days online posted notice, raise premiums of a PPACA policy type to reasonably expect to reach the extractable profit level based on actual and reasonably forecast expenses during the calendar year, subject to a 5% monthly premium rise cap.
Any funds left over after claims on PPACA policies have been paid for the calendar year and profit extracted shall be paid over to Uncle Sam.
There shall be a customer premium payment grace period, to 11:59PM of the third Friday of each month, for the third and fourth full coverage months of the policy.
There shall be a customer premium payment grace period, to 11:59PM of the fourth Friday of each month, for the remaining months of a policy.
Great post (the good news first).
Are you planning to repeal EMTALA, and pass a Federal law to prevent enforcement of existing State laws which forbid denial of care for nonpayment?
Great post (now the bad news).
The insurance model can’t be fixed.
The guy who wrote it admitted right after Roberts re-wrote it, that it was DESIGNED to make health care so laborious that the NPC’s would vote for gov’mt healthcare.
THAT WAS THE ENTIRE GOAL. Just make another program like Brit’s NHS — and skim it like all the $$ siphoned off to Ukraine.
An operation takes place in a room.
There is a surgeon. He has gown on. He will refer to an imaging display device.
This is a nurse with a gown on and a cart with a set of scalpels, some hand tools such as clamps, some suture material and sometimes a stapling device and staples. She also has a suctioning device.
There is an anesthesiologist. He has an anesthesia machine, a heart monitoring machine, some gas tanks and tubing, and a mask. He will also have a syringe and a tube with a pre-induction drug. He will have a few other syringes and off-patent drugs in case there is a problem.
Sometimes, there will be a heart bypass machine and a nurse to man it.
The patient is placed on a bed and draped.
It might take about 15 manhours for these people to do their work on the patient, on average.
The patient might have worked 80,000 manhours.
The greater the damage in the eyes of conservatives, the greater the victory in the eyes of the Left.
“Are you planning to repeal EMTALA, and pass a Federal law to prevent enforcement of existing State laws which forbid denial of care for nonpayment?”
My Latest Suggested EMTALA (and Medicaid ER) Reform
FOR CARESEEKERS
To get care under the EMTALA or Medicaid for yourself or custodial child, the hospital might require you to
1. pay $100 in cash or by financial organization card accepted at the emergency care facility,
2. hand over your valid SNAP card and tender a matching valid domestic governmental picture ID,
3. hand over your valid domestic driver’s license,
4. hand over your valid US passport,
5. hand over your operable Apple or Samsung cellphone model listed by a current regulation issued by a Secretary of HHS, or
6. hand over a valid domestic governmental picture ID of yours and
a tender matching financial institution statement less than 70 days old showing a domestic governmental or employer direct deposit of at least $150, both for hospital photocopying and recordkeeping.
States might be allowed to authorize emergency care facilities to contemporaneously debit SNAP cards for EMTALA incidents.
Items handed over may be retained by the emergency care facility until retrieved within one month by the responsible party by paying $100, or more, for the care, plus a retrieval fee not exceeding $20 in a manner the facility accepts. Items not timely retrieved may be disposed of in a legally allowable manner.
NOTE: People can get the care they need, but only by paying $100, forfeiting an expensive cellphone, or going through the hassle of replacing a SNAP card or government picture ID.
FOR HOSPITALS
I would allow hospitals collect up to $1,000 per incident of EMTALA service from employers, with payment not in excess of $50 per week per employee concerned being due to any and all EMTALA providers and not for more than 100 weeks after service. Such payments on behalf of an employee would be considered to be a debt of the employee to the employer. Employers could collect back from employees and ex-employees (and require EMTALA incident employees to participate in an employer plan).
The bigger issue is it was unconstitutional on its face.
Hospital costs can be reduced by splitting most hospitals 50/50 between two companies.
Bkmk
How so?
But no ID to vote, right???🤬🤬🤬
Actually, the ACA did exactly what the hard left wanted… screw over the American people.
“How so?”
Private sale within a set timeframe, or auction sale by government agent.
Hospital has 100,000 sq. ft. over six buildings.
Half the buildings or 45% of the square footage has to be sold off to a competitor.
.
“no ID to vote”
That would violate the due process rights of candidates IMO.
Voting should have strict due process requirements.
There is a war in Ukraine because election results in 2014 weren’t trustworthy. About 200,000 people are dead as a result.
Nothing stops this train
America’s entitlement debt-bubble will grow until it explodes and collapses.
At that point, we will be in full Latin American economic and dictatorship mode.
Study Brazil, Argentina, Venezuela, Bolivia to know our future.
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