Obamacare / Affordable Care Act : classic or dud?

Classic.

I got a letter saying my current plan won't exist in 2017 and that I'd be auto-enrolled in the nearest equivalent, with a 23% premium hike. I started researching available 2017 plans, intending to drop back to the most basic coverage, and started digging a little deeper into the subsidies and family income reporting. It turns out that I'd mistakenly included my wife's SSDI in the household income last year, and that I had been eligible for a ~$325 subsidy but hadn't taken it. According to the ACA rep (who I got to after being on hold for less than a minute), that subsidy will be applied to my 2016 tax liability and not just vanish in a puff of "oh well."

And since that subsidy still exists for 2017, I've signed up for a silver plan for just over half of what the bronze plan was going to cost me. Deductible drops from $6800 to $1750. PCP visits for a buck, generic drugs for a buck.

Just in time for it to all go away, maybe. Fuck you, Trump.

Trump will have a lot of enthusiastic aiders and abettors in the Republican Congress, who were elected by enthusiastically misinformed voters, whose misinformation and disinformation was funded by greedy, corrupt 1%ers, who will be even more wealthy (they hope) once they kill the ACA -- and probably many thousands of poor and working class people.

well, the wealthy will be wealthier because they will eliminate the extra tax on investment income for wealthy people that goes to funding the ACA. One of the primary changes of Trump's tax plan is reducing taxes on rich people and the types of income they have.

it's a good thing! someday i might be rich and i'll need that tax break .thanks trump

In the last year I finally got a great deal on my health care plan. Made too much for Medicaid, but low income enough to get a $20 a month plan ($500 subsidized). Welp, hopefully I get at least one more year out of it.

Cool dad.

"At some point or another we have to be responsible or have a part of the responsibility of what is going on," Huizenga said. "Way too often, people pull out their insurance card and they say 'I don't know the difference or cost between an X-ray or an MRI or CT Scan.' I might make a little different decision if I did know (what) some of those costs were and those costs came back to me."

The father of five offered a personal example of how this shift might play out. He says his youngest son fell and injured his arm. Not sure if it was sprained or broken, he and his wife decided to wait until the next morning to take the 10-year-old to the doctor's office, instead of going to the emergency room that night. The arm was broken.

"We took every precaution but decided to go in the next morning (because of) the cost difference," Huizenga said. "If he had been more seriously injured, we would have taken him in. ... When it (comes to) those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don't have a cost difference, you'll make different decisions."

http://www.mlive.com/news/grand-rapids/index.ssf/2016/12/sons_broken_arm_bill_huizenga.html

Fast forward ten years, dad's lying in a heap at the bottom of the basement stairs, 'yeah, pop, it looks pretty bad, could be that your spinal column is crushed, but maybe we should sleep on it, don't wanna jump the gun.'

https://www.nytimes.com/2017/01/17/us/politics/congressional-budget-office-affordable-care-act.html

The nonpartisan Congressional Budget Office said on Tuesday that repealing major provisions of the Affordable Care Act, while leaving other parts in place, would cost 18 million people their insurance in the first year and could increase the number of uninsured Americans by 32 million in 10 years, while causing insurance premiums to double over that time.

had a discussion w/ someone yesterday who said we don't need a mandate to offer pre-existing coverage bc once we deregulate insurance industry as well as medical industry prices for insurance will come down enough that low risk consumers will buy insurance in bulk willingly and then from the glut of new customers insurance companies will be motivated to provide insurance for pre-existing high risk consumers as a charitable venture.

i really tried to steelman his pov during the conversation but i think there really is no good argument for this perspective that doesn't just come out and admit that healthcare should be unattainable to some ppl - or put others into lifetime debt.

philip klein apparently agrees:
http://www.washingtonexaminer.com/gop-will-fail-on-obamacare-if-they-cant-admit-a-simple-truth/article/2611075

Republicans are in serious danger of repeating Obama's mistake, because they are having a tough time stating a simple truth, which goes something like this: "We don't believe that it is the job of the federal government to guarantee that everybody has health insurance."

and then from the glut of new customers insurance companies will be motivated to provide insurance for pre-existing high risk consumers as a charitable venture.

...the likelihood of HEALTH INSURANCE COMPANIES, of all the greedy bastards throughout history, to suddenly get a collective social conscience and voluntarily do unprofitable things seems...seems unlikely at best.

Belly bassist Gail Greenwood talks about her endometrial cancer and the ACA: http://bellyofficial.com/2017/01/17/personal-note-gail/

They'll repeal ACA and kick the responsibility down to the state level in the form of block grants, and it'll be a mess and everyone will get to keep running in perpetuity on ineffiecicient government.

to a certain extent a lot of responsibility is already at state level -- the Medicaid expansion -- the states that didn't comply ended up fucking over a bunch of people, but what were the fucked over people going to do? Move to another state?

http://www.motherjones.com/kevin-drum/2017/06/if-obamacare-dies-national-health-care-will-take-its-place/

“We’re not seeing any evidence of a death spiral or a market collapse,” said Cynthia Cox, Kaiser’s associate director of health reform and private insurance. "Rather, what it looks like is insurers are on track to have their best year since the [Affordable Care Act] began.”

http://www.politico.com/story/2017/07/13/obamacare-markets-health-care-240487

never mind all that though. the gap between the rich and the poor is way too narrow in the US. cut those taxes!

tax cuts here we come!

http://www.politico.com/story/2017/09/15/bill-cassidy-obamacare-repeal-bill-242770

^ this isn't being played up in the press, in large part because the chances of its failure are too real and why chance another high-profile failure? if the trumpets start to blow fanfares for this coming to the floor, then they probably have 50 votes nailed down, with Pence to break the tie.

With Paul already against, Murkowski and Collins can block it. I don't see how it can pass. It's a slightly clever thing, to slide some money around between the states to cushion the blow of the cuts from senators that matter, but not clever enough, what with Kentucky and Nevada probably taking a beating.

If they just wrote a plan that said 'defund health care in California and New York, give half the money to red states, half the money to the rich', that would probably pass...

Obamacare is finished. It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore.

He's right, it's dead and gone. Only thing left is the rotting husk known as Trumpcare. Enjoying owning it.

It's not dead and gone and it's still torturing me and my family.

which means it's doing exactly what it was designed to do--bring on single payer.

I was worried I wouldn't qualify for a tax credit since I had an income bump last year, but it worked out ok. My copays and generic drug costs are jumping next year, but they were amazingly low this year so I'm not surprised.

But yeah, bring on single payer. Year to year stress and uncertainty is no way to live.

I'm interested - how much do you guys have to pay monthly on average for health insurance (British-Australian here, never paid a penny/cent for private health insurance, although I pay a tax levy of about $1500 yearly for national health system coverage)

medicaid, so $0.00

I have three kids and a wife, and the cheapest Obamacare I can find for 2018 (this will be the third plan since Obamacare began, because my plans keep getting killed off) will cost me $1,750 per month for a bronze plan. A silver plan would cost me $2,200 per month and they don't even offer gold plans anymore in my state. It's an increase of 35% from last year, and my annual deductible is going up about 25%. There are now only two companies left in my state offering insurance on the exchange. And I don't get to keep my doctors, which is going to cause a great deal of problems and more expense to transfer the volume of records.

If your employer doesn't pay your health insurance, if you're not rich and not poor, then you're fucked.

Wow. That's absolutely massive. Like more than 12 times what I pay, which indexed to taxable income anyway, so the less you earn the less you pay. Healthcare would be the number one reason why I don't think I could live in the US.

I am not going to lie, it's fucking terrifying.

If your employer doesn't pay your health insurance, if you're not rich and not poor, then you're fucked.

― Randall Jarrell (dandydonweiner), Sunday, November 12, 2017 7:09 PM (fourteen minutes ago) Bookmark Flag Post Permalink

otm

i have employer provided health insurance

Mine is for me only.

This year: $485 premium - $250 tax credit = $235 monthly premium out of my pocket
(I qualified for $329 tax credit but only used $250 so I'll get the other $948 applied to my tax bill in the spring)

Next year: $745 premium - $578 tax credit = $167 monthly premium out of pocket
(my deductible is going from $1750 to $5000, generic drugs from $1 to $15, primary care copay from $1 to $25, so despite a lower premium my monthly health care costs are going to be a bit higher, because I take 8 drugs and have to go to my PCP 4x/year)

Terrifying is right. Fuck a Republican who wants to make America more "free" and less safe.

I have paid for my own insurance and healthcare out of pocket for 10 years now. The amount of fuckery in the system is much, much worse EXCEPT for the fact that you can't get denied coverage and you can't get booted for a preexisting condition. And those two items are a life saver and bankruptcy protector for thousands (if not millions) of people, so I'm glad to pay to address that moral/financial lapse of the past...until of course, I can't afford it anymore.

Obamacare was a baseball bat to the hornet's nest of healthcare.

Really makes me wonder how anyone who isn't rich could ever vote Republican.

I'm currently in Australia - the health system is far from perfect, and if you need elective surgery and don't have private health insurance you can wait a long time for it... but in general I have no complaints with the way it's treated me or my family. And that's included some surgery and a couple of hospital stays. And I never, ever have to worry about how I'm going to pay for my healthcare. That's a burden I really wouldn't want in life.

And I can only imagine funding healthcare through tax revenue is way more efficient anyway.

which means it's doing exactly what it was designed to do--bring on single payer.

You may or may not recall that all the basic ideas incorporated in the ACA were proposed by the conservative Heritage Foundation and first implemented under Mitt Romney in Massachusetts, where it worked more or less reasonably.

Far from being designed to bring on single payer, it was democrats from conservative-leaning states like Montana who ensured that the ACA did not have a government-run option, but required citizens to seek their insurance from the private sector.

Lastly, the rises in premiums we've experienced under the ACA are largely due to sabotage by the republican congress, which could not repeal the ACA due to lack of votes, but who were able to throw a monkey wrench into the works by failing to fund the subsidies to insurance companies written into the original law, that should have buffered the market from the lag between when the sickest people signed up and when the healthy laggards were persuaded to sign up, via slowly escalating penalties for not participating.

You have the history and facts of the matter wrong, or else the facts are in your possession, but you are drawing a stupid conclusion entirely unwarranted by them.

thank u aimless

which means it's doing exactly what it was designed to do--bring on single payer.

There were many in Congress/Senate/elsewhere in the Obama Adminstration (whose goal was a single payer system) who had their hands all over the writing and execution of the ACA. The basic tenets ACA were borrowed from Romneycare, sure. But as you note, the weak execution of the ACA allowed the Republican Congress (and Republican leadership in general) to fuck with it, including a challenge in the Supreme Court. During the writing and passage of the bill (and after it was passed, and after the Court made its landmark ruling), these weaknesses (particularly in the funding mechanisms) were discussed and if you didn't see the many comments about how it would lead to single payer, then I guess you missed it. But thanks Aimless, I appreciate your comments and I'll try not to make a stupid comment next time.

I don't believe there were too many in Congress/Senate/Administration whose goal was a single-payer system and I don't recall any of them publicly saying they were creating this too FAIL to lead to single payer (and I find it hard to imagine any of them would be playing such a long game as that anyway). I do agree that it's a Frankenstein's monster of a bill and that it's complexity has lent itself to sabotage (which the Republicans are happy to do) but I don't think that was the intent (rather to upset the existing the system as little as possible was).

Lastly, the rises in premiums we've experienced under the ACA are largely due to sabotage by the republican congress

I don't know the size of the effect on premiums relative to Repub sabotage, but lower-than-expected number of young and healthy people buying ACA policies is the other big factor.

the weak execution of the ACA allowed the Republican Congress (and Republican leadership in general) to fuck with it

This is true. But your suggestion would require that the Democrats designed the ACA in order to purposely lose control of the House and Senate in the next election. Yeah. Right. Very cunning of them, I'm sure.

im having a real hard time imagining they ever wanted single payer. more like furthering the entrenched industry deathgrip.

the Obama Adminstration (whose goal was a single payer system)

in the same way that his goal *wink wink* was also shutting down gitmo

i hope the republicans throw 13,000,000 lazy bum americans off health care to cut taxes on the hardworking and virtuous wealthy. #mrga

BARBARA EHRENREICH: WHY I’M GIVING UP ON PREVENTATIVE CARE

The piece itself belies the headline a bit.

But still.

I have been more intimate with the current medical system than I ever would have chosen and I agreed with the major thrust of that piece. Health and illness are extremely personal, science is extremely impersonal, and capitalism is extremely greedy and uncaring, and physicians are pushed around chaotically by all these influences, so medical practice is caught in a maelstrom of irreconcilable conflict. This doesn't conduce to the reinforcement of reasonable and caring medical practice.

TEN BUCKS HUH

The beauty of this system is that the mega-rich and their servants feel unashamed about rubbing your nose in their shit. Like they're doing you a favor. And sadly, too many people love it and ask for more. https://t.co/iDtEizfziB

— Dennis Perrin (@DennisThePerrin) December 10, 2019

Still amazed by how many people know jack shit about this law. See stuff like "Trump didn't get rid of Obamacare but at least he made it so ppl aren't forced to buy Obamacare, they can now buy thru private insurers". Just change the name of this country to Dunning-Krugerstan already.

and of course Trump obv doesn't understand it at all