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Posted on 11/16/2025 11:16:23 AM PST by E. Pluribus Unum
Lawmakers are racing toward a mid-December deadline, with Republicans hoping to present side-by-side legislation with Democrats’ plan to extend ACA subsidies.
President Donald Trump has again promised a “far better and far less expensive” alternative to the Affordable Care Act, and Republicans are rushing — again — to deliver one.
For weeks throughout the longest government shutdown in history, Trump avoided negotiating with Democrats on the health care concerns fueling their standoff. Now lawmakers on both sides of the aisle are speeding toward a self-imposed deadline of mid-December to hold dueling health care votes.
Democrats maintain the simplest and most popular option is to extend ACA subsidies set to expire next month. Analysts say millions of people — many in states that supported Trump — will forgo health insurance if the program ends. The president’s own pollster has warned that not extending the subsidies would pose a major political risk for the GOP in the midterms.
But rather than sign on to Democrats’ proposal, the president has argued instead that billions of dollars in ACA subsidy money should be redirected away from health insurers and toward the general public, potentially in the form of untaxed health-savings accounts.
Many health economists have panned Trump’s plan, saying it is likely to create a “death spiral” in the ACA marketplaces. Healthy people would be prone to drop coverage, using the subsidies to pay out of pocket for whatever limited health care they need, leaving sick people behind and causing premiums to skyrocket.
The scenario smacks of déjà vu — with lawmakers and experts acknowledging the seemingly interminable battle around the 15-year-old health law, Republicans’ long struggle to deliver an ACA alternative that can pass Congress, and the return of a dynamic from Trump’s first term that repeatedly ended in failure.
(Excerpt) Read more at washingtonpost.com ...
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Only thing is unless medical providers are deregulated along with the healthcare insurers there can be no free market where the supply and demand curve is efficient in setting price. However, would anyone really want a colonoscopy by Dr. Nick performed in Scopes Are Us RV parked at the TA truck stop on the frontage road?
I am on Medicare now, I have my previous healthcare coverage as my supplement (Anthem BCBS), and I also have access to VA healthcare. I should be ok, but as with anything else in this world, nothing is a certainty.
SUBSIDES from TAXPAYERS are NOT savings.
It is additional burden on productive citizens with incomes.
I am 85.5 years old and now have no medical expenses. I maintain great health with good diet and daily exercise. I Cured my border line diabetic condition, high blood pressures, knee & hip joint pain, panic attacks, irregular heart beats by changing lifestyle.
Add to that high blood pressure, type 2 diabetes, joint pains, liver damage, bowel issues, stomach & duodenum ulcers. I had all above maladies in my mid 50’s. Cured them all through serious lifestyle change. Now in mid 80’s have no medical expense!!
That’s quite impressive. To what specific actions do you attribute your success?
Specifically, the RSC Health Care Plan will:
PROTECT Americans with pre-existing conditions
Extend HIPAA portability and pre-existing condition protections that have long benefited Americans with employer-sponsored insurance to people moving into the individual marketplace.
Establish federally-funded, state-administered Guaranteed Coverage Pools to ensure individuals with high-cost illnesses have access to quality and affordable coverage.
Repackage existing funding for ACA premium subsidies and Medicaid expansion to fund state-administered flex-grants to subsidize health insurance for low-income individuals.
Reduce regulatory barriers to give Americans access to quality care.
EMPOWER Americans with greater control over their health care decisions and dollars
Reform the tax code to provide equal tax treatment in the employer and individual health insurance markets.
Unleash Health Savings Accounts (HSAs) by empowering Americans to use their money – tax-free – to cover more health-related expenses including insurance premiums, direct primary care service fees, and health sharing ministry dues.
Increase allowable, pre-tax contributions to HSAs from $3,500 to $9,000 for individuals and from $7,000 to $18,000 for families.
PERSONALIZE health care to meet individual needs
Eliminate ACA mandates forcing Americans to pay more for coverage they do not want or need.
Enhance HSAs in a way that allow for individuals to effectively own their personalized health care plans so they can take their plan from job to job.
Embrace and remove barriers on innovative health care solutions such as telemedicine, direct primary care, association health plans, and health sharing ministries.
https://rsc-pfluger.house.gov/framework-for-personalized-affordable-care
That’s probably the best official Republican plan I’ve seen.
My long-term plan is to bring on market force:
1. Break most hospitals into two highly competitive entities
2. Convert other hospitals into real estate leasing entities with competing surgical suites and nursing wings
3. Separate out drug coverage so hospital systems can run care coverage systems and cut out insurance company overhead and meddlers....
4. Create interstate drug plans that don’t have to cover every drug....Group and exchange plans to offer vouchers at plan set amounts for out-of-formulary drugs. Plans without minimums (or vouchers) could be vended directly to individuals and families.
5. These plans would be all the doctors (and AI) prescribe for formulary drugs with co-pays equal to manufacturing cost
....
8. reform medical education, breaking down medicine and dentistry into simpler chunks and start it in the first year of college
9. replace most primary care doctoring with AI
(human doctor would confirm AI diagnosis, orders for expensive tests[MRI, genetic], prescribe radiation imaging/treatment, and voucher/government co-pay drugs)
To replace it with “the free market” would mean ending and eliminating the health insurance market as it is currently set up.
[My plan for 2026]
[I’m not sure this is entirely correct as it is complex.]
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.
If the plan is provided by or through a health care providing system, the percentages shall be reduced by 1/20th.
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 three-bedroom apartment if the household has an adult and at least two children over age 3,
for a two-bedroom apartment if the household has an adult and a child over age 2 but doesn’t have at least two children over age 3,
for a one-bedroom apartment otherwise,
plus government-funded help for the rent,
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 child care expenses not paid for or reimburseable by others,
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 when at least one has not received government-funded assistance for child daycare,
of the:
1. 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 unless mainly supported by government disability pension income.
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.
Never ever miss 30 minutes mild aerobic exercise every day.
That I’m my opinion is 75% responsible for improving my health. The other 25% is from a diet without pasta or white bread, half calories from fresh fruits & veggies. Other half calories from meat & dairy & 2 toasts of whole grain bread.
You’re an inspiration. Keep posting!
Yep, we need a "hard reset" with the health insurance system going back to 50's/60's era traditional group health insurance...get the government out...no govt. mandates on what coverage you have to purchase i.e. restore true high deductible policies like a $5K or $7.5K deductible policy for catastrophic accidents/illnesses. That is what the wife and I had before the "ACA"/Obamacare and it was affordable (<$300./mo)(now banned under the ACA as "inadequate coverage"). Also get the government out of the health care coverage/reimbursement industry, their "20 cents on the dollar" reimbursement rates for Medicaid/Medicare caused hospital and doctor prices to skyrocket (to compensate).
Unfortunately none of this will happen...the "Free Stuff Army" is too strong along with the politician vote buying power schemes/hand outs.
More likely the ACA will achieve it's goal of completing the transition to single-payer socialized medicine (we are 1/2 way there...the Feds/states are paying over 50% of health care/insurance costs already).
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