tag:blogger.com,1999:blog-8512362.post2608165639928558422..comments2024-03-10T13:59:19.230-04:00Comments on xpostfactoid: The ACA's uncertain shield against underinsurance: A CSR compendiumAndrew Sprunghttp://www.blogger.com/profile/17601269968798865106noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-8512362.post-82775014172254070592015-09-10T09:00:41.684-04:002015-09-10T09:00:41.684-04:00There is not much writing about the CSR on the net...There is not much writing about the CSR on the net (many of the best articles and interviews are from you)...........<br /><br />So I have a few questions:<br /><br />a. Who thought up the CSR idea?<br /><br />b. What were the cost estimates (I have seen estimates of $17 billion a year, which seems very high)<br /><br />c. Why were CSR's cut back at about $18,000 of income for a single person?<br /><br />It feels like CSR's were a backdoor federal expansion of Medicaid. If numerous darn states are holding Medicaid at 100% of poverty (or less), then let's smuggle something close to Medicaid into a federal program that states need not improve.<br /><br />As a result, CSR's have the virtue of Medicaid -- helping those in need -- but also the terrible vice of Medicaid, which is the harsh 'cliffs' where the benefit disappears, and the pulling back of benefits if one's income goes up very slightly.<br /><br />The obsessive need to tie benefits to exact income is what caused the ACA to have terrible website performance in the first place. Now we have the obsessive pullback of benefits if a tax return does not equal projected income.<br /><br />Universal programs are far more desirable than need-based programs. The ACA is just one more reminder of this, not that we needed another reminder.<br /><br />Incidentally, a few of the Republican alternatives to the ACA have flat universal tax credits that might be based on age, or are just plain flat.<br />Even a broken clock is right twice a day, and these reforms make initial sense to me!bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-90067156374437199242015-09-06T09:42:18.145-04:002015-09-06T09:42:18.145-04:00Thanks as always for your excellent detail work.
I...Thanks as always for your excellent detail work.<br />I just cannot get my eyes off that figure of 200% of poverty as the cutoff for CSR benefits. If I remember correctly, that corresponds to an annual income of about $22,000 for a single person.<br />If Obama had stood up in 2009 and said, "We have a health insurance reform that will give comprehensive insurance to persons under $22,000, either through Medicaid expansion or the back-door subsidies of tax credits and the CSR," there would have been polite response from the left and probably not much more.<br />Instead, the millions of workers who make over $22,000 and do not have a generous employer had some hope that the ACA would help them too.<br />But they lost out when the deficit hawks in both parties held the ACA to a relatively low budget target.<br />Obama figured that half a loaf was better than none at all, and history may in fact prove him right.<br />I wish that Sanders and Clinton would state far more directly that they want to expand the CSR's.bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.com