Author Topic: 10 years in, is there any evidence the Affordable Care Act improved healthcare?  (Read 2642 times)

Radagast

  • Magnum Stache
  • ******
  • Posts: 2538
  • One Does Not Simply Work Into Mordor
What is the point of the thread? To convince you that the ACA has value?
It's a bit of a "can't see the forest for the trees" argument you've set up. It's obvious that the ACA has provided more health insurance options for more people.
It's also obvious that those with ACA health insurance are still in our crappy health care environment.
I'm scheduled for a hip replacement soon and I'm really glad to have my cheap ACA plan with a low max OOP, oh whoops, that's an anecdote.
But I noticed you were ok with anecdotes when they were your anecdotes.
Feel free to disregard my anecdote as I said. I have not been super impressed, so I look around to see how others are fairing. On the whole they don't seem any better off. Were my expectations too high? I thought we were supposed to get a healthcare system that was actually... better?

Radagast

  • Magnum Stache
  • ******
  • Posts: 2538
  • One Does Not Simply Work Into Mordor
To the OP's question, I have not seen any direct evidence suggesting "improved health care."


But to say it is a failure due to that is a straw man argument.

There is evidence of improved availability of health care coverage for folks who are unable to get it through their employer, and affordability for people would otherwise have been excluded.

It is called the Affordable Health Care Act, not the Improved Health Care Act or Cheap Health Care Act- many people (like myself) who do not have pre-existing conditions and have not been high users may have seen increased cost for premiums- a natural result of adding people to the pool of insured who were previously excluded from coverage.  (Although in the first couple of years when we were low earners it was offset by premiums.) I pay more in premiums now than I did before.  (This may be at least partially to do with the repeal of the individual mandate but not trying to go there).  I also pay taxes for public schools and have no children.  I am ok with both- I would like to live in a civil society that enables all people to have access an education and health care regardless of economic or health background.
Does the below graph show the natural results of greater access to healthcare?

There are plenty of studies out there that show greater access to healthcare since the ACA took effect. I won't bother linking any because you, a self reported non-expert, will draw different conclusions from the experts who compiled the data. If you care to bother, however, you can use google.
So I actually don't care about putatively better access or better insurance because those are second order issues, I care about better results. And I'm not finding them. Is this chart wrong? Am I wrong to be disappointed by this result? What's the whole point of overhauling the public health system if this is what we get?

And the article associated with the image basically describes my position perfectly.

https://alaskapublic.org/2023/03/27/live-free-and-die-the-sad-state-of-u-s-life-expectancy/

Just Joe

  • Walrus Stache
  • *******
  • Posts: 6693
  • Location: In the middle....
  • Teach me something.
What is the point of the thread? To convince you that the ACA has value?
It's a bit of a "can't see the forest for the trees" argument you've set up. It's obvious that the ACA has provided more health insurance options for more people.
It's also obvious that those with ACA health insurance are still in our crappy health care environment.
I'm scheduled for a hip replacement soon and I'm really glad to have my cheap ACA plan with a low max OOP, oh whoops, that's an anecdote.
But I noticed you were ok with anecdotes when they were your anecdotes.
Feel free to disregard my anecdote as I said. I have not been super impressed, so I look around to see how others are fairing. On the whole they don't seem any better off. Were my expectations too high? I thought we were supposed to get a healthcare system that was actually... better?

OP, what should happen then. Should the ACA be ended? What should be done about all the people that would be left uninsurable?

What is the alternative? Letting people suffer long health consequences in silence? The Republicans have an alternative we've all been told. Yet, they have not shared the details. Seem relevant to share them since this is an election year. If they have a better system more people might vote for them.

I'm always open to new ideas. We have countries all over the globe who can be studied for ideas about what works and what doesn't.

I want the best affordable healthcare system for our country. What we have doesn't appear to be the best or the most affordable or the most effective.

Not trying to insult anyone here. Just curious what the best strategies are going forward.

ChpBstrd

  • Walrus Stache
  • *******
  • Posts: 6634
  • Location: A poor and backward Southern state known as minimum wage country
To the OP's question, I have not seen any direct evidence suggesting "improved health care."


But to say it is a failure due to that is a straw man argument.

There is evidence of improved availability of health care coverage for folks who are unable to get it through their employer, and affordability for people would otherwise have been excluded.

It is called the Affordable Health Care Act, not the Improved Health Care Act or Cheap Health Care Act- many people (like myself) who do not have pre-existing conditions and have not been high users may have seen increased cost for premiums- a natural result of adding people to the pool of insured who were previously excluded from coverage.  (Although in the first couple of years when we were low earners it was offset by premiums.) I pay more in premiums now than I did before.  (This may be at least partially to do with the repeal of the individual mandate but not trying to go there).  I also pay taxes for public schools and have no children.  I am ok with both- I would like to live in a civil society that enables all people to have access an education and health care regardless of economic or health background.
Does the below graph show the natural results of greater access to healthcare?

There are plenty of studies out there that show greater access to healthcare since the ACA took effect. I won't bother linking any because you, a self reported non-expert, will draw different conclusions from the experts who compiled the data. If you care to bother, however, you can use google.
So I actually don't care about putatively better access or better insurance because those are second order issues, I care about better results. And I'm not finding them. Is this chart wrong? Am I wrong to be disappointed by this result? What's the whole point of overhauling the public health system if this is what we get?

And the article associated with the image basically describes my position perfectly.

https://alaskapublic.org/2023/03/27/live-free-and-die-the-sad-state-of-u-s-life-expectancy/
The story this 2021 chart tells me is a tale of COVID-19 ravaging through nursing homes in the US while the US political leadership raises conspiracy theories about vaccines and calling masking during a pandemic an infringement upon freedumb. Places like Japan didn't suffer the same drop in life expectancy because they didn't have the same mortality rate. 

Cranky

  • Magnum Stache
  • ******
  • Posts: 3837
I think you have to define why “better healthcare” = “living longer”, as I think that living longer probably has an awful lot of factors beyond access to the medical system, starting with prenatal nutrition. Life expectancy isn’t declining because people don’t see doctors, but because a million people died of Covid and quite a lot of people have died from addiction.

And while we have improved healthcare access (which is not synonymous with “healthcare system”) we haven’t made that universal. If your deductible is $5k, plenty of people still can’t afford to go to the doctor.

lhamo

  • Magnum Stache
  • ******
  • Posts: 3073
  • Location: Seattle
YOu know what probably would have resulted in a better/more functional system overall?   A single-payer national health system like what most developed countries have.  But NOOOO -- that was too much socialism for the conservatives and the hedge funds all invested in insurance companies and for-profit hospitals.  So we got the crappy inherited mess that still allows all kinds of people to take their cut out of a multi-billion dollar sector.

partgypsy

  • Walrus Stache
  • *******
  • Posts: 5196
YOu know what probably would have resulted in a better/more functional system overall?   A single-payer national health system like what most developed countries have.  But NOOOO -- that was too much socialism for the conservatives and the hedge funds all invested in insurance companies and for-profit hospitals.  So we got the crappy inherited mess that still allows all kinds of people to take their cut out of a multi-billion dollar sector.
yes this. We should of had the courage to move to a single payer healthcare system. But health insurance companies have the money, to block this. Single payer and if people want fancier cutting edge care they can get additional coverage. Study after study have shown that single payer increases health care access AND decreased costs per person. And for those who say it can't work in the US, the VA is, a single payer system that on many metrics, is rated the same ir better (outcomes, safety, even patient satisfaction) than private insurance. Despite the fact veteran population has a far higher percentage of what are called medically complex patients. We do need to do something. Our current system is overtaxed. Healthcare professionals, esp in private care where there are quotas and high case loads, are stressed, burned out, and for some roles not being replaced as fast as people are leaving the profession. As far as life expectancy, it is my prediction that US life expectancy has reached its peak, and will either stay the same ir trend downward. Everything from lack of prenatal and postnatal medical care and taking away family planning from the mother, vaccination rates, preventative care, quality of diet, exposure to plastics and other environmental pollution, are all going to negatively impact qol and life expectancy going forward. Some of those can be legislatively addressed, IF we had the will to do so. Instead we are arguing about trans using bathrooms.
« Last Edit: March 11, 2024, 11:48:40 AM by partgypsy »

swashbucklinstache

  • Pencil Stache
  • ****
  • Posts: 622
  • Location: Midwest U.S.
I think you have to define why “better healthcare” = “living longer”, as I think that living longer probably has an awful lot of factors beyond access to the medical system, starting with prenatal nutrition. Life expectancy isn’t declining because people don’t see doctors, but because a million people died of Covid and quite a lot of people have died from addiction.

And while we have improved healthcare access (which is not synonymous with “healthcare system”) we haven’t made that universal. If your deductible is $5k, plenty of people still can’t afford to go to the doctor.
OP, I'll take this a bit further even. Healthcare policy reform is focused on increasing value, defined as the intersection between cost and quality. By everyone in the field.

You're free to select solely life expectancy of a developed nation as your quality metric. Please note that the experts in the field (I have 10+ years of experience in this field) don't ever select one single metric and this metric is not a good one for broad inference. Notably, this metric is moderately resistant to insurance-based changes for developed nations . Many of the known changes for those that work were implemented by ACA. To throw a grenade, what do you think the life expectancy of children who would've been aborted pre-overturn is, knowing what we know about the socioeconomic status of such children?

I know you said you wanted to hand-wave away 5-6% decreases in cost but let's be clear about this number. That's 240 billion dollars a year and a decrease of 4% of all government spending. Here are the categories you can pick one from to now get for free:

Veterans Benefits and Services
Education, Training, Employment, and Social Services
Commerce and Housing Credit
Transportation
Other, as in everything not listed above or in the big 6, two of which are health and a third is debt service.

By the way, health costs have an interesting distribution. Chronic conditions and inpatient care have a gigantic share of costs that are mostly invisible to you unless you have them. This makes discourse hard and it's hard to understand the impact of preventative policy, floor setting, and access to care. The example I usually use is I'd happily pay a homeless person $100 to go to the doctor once a year, plus transportation costs, and $5 to take free insulin instead of paying 250k for their leg to be amputated emergently.


It's healthy to have this discussion but even a cursory review of the data shows ACA has significantly impacted costs positively and has increased quality modestly. Not to pick on you, but look again at the Alaska article and listen to the experts in it...

Quote
Quote
It’s just the NIH and the CDC
This is near the end but it highlights the authors point succinctly, that the fault is not with the ACA or it's oversight. Explicitly, the experts in this field highlighting the same metric as you are not aiming their ire at the ACA at all.

Quote
Then, last week, more bad news: Maternal mortality in the U.S. reached a high in 2021. Also, a paper in the Journal of the American Medical Association found rising mortality rates among U.S. children and adolescents....A big part of the difference between life and death in the U.S. and its peer countries is people dying or being killed before age 50. The “Shorter Lives” report specifically points to factors like teen pregnancy, drug overdoses, HIV, fatal car crashes, injuries, and violence....Two years difference in life expectancy probably comes from the fact that firearms are so available in the United States,” Crimmins says. “There’s the opioid epidemic, which is clearly ours – that was our drug companies and other countries didn’t have that because those drugs were more controlled. Some of the difference comes from the fact that we are more likely to drive more miles. We have more cars,” and ultimately, more fatal crashes. The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income
We know life expectancy is dominated by young deaths. The old people things that are going well are exactly what was incentivized by the ACA. Teen pregnancy and firearms? Increases in the former are caused by horrifically performing abstinence-only education, lack of access to contraceptives, overturning roe, poverty, and violence in video games (jk). Read their emphasis on non-insurance factors here and think what kinds of policies make this better and what kinds make it worse.

Quote
Yes, Americans eat more calories and lack universal access to health care. But there’s also higher child poverty, racial segregation, social isolation, and more. Even the way cities are designed makes access to good food more difficult.
Socioeconomic problems are more important than ACA. Poverty reduction and anti-racism investments are part of access to care as the term is used in policy research, and ACA funds experiments in this through CMMI. That is, some of the increase in costs due to the ACA are aimed directly at these problems.

Quote
American life expectancy is lower than that of Cuba, Lebanon and the Czech Republic......fact that living in America is worse for your health and makes you more likely to die younger than if you lived in another rich country like the U.K., Switzerland or Japan......The NIH should undertake a “thorough examination of the policies and approaches that countries with better health outcomes have found useful and that may have application, with adaptations, in the United States,” the authors wrote.....the focus should instead be on the fact that every other rich country has been able to figure out how to help people live longer, healthier lives.....England, France, Italy...Some of the policies he’s identified as helpful include universal, better coordinated health care, strong health and safety protections, broad access to education, and more investments to help kids get off to a healthy start. These policies are “paying off for them,” he says, and could for Americans, too.
A homework problem to show you're invested in this convo not just doing a democrat bad drive by on RomneyCare: tell us, for each of those countries, if they are more like pre-ACA America or like we didn't go far enough on the ACA. Tell us if you think these authors think the ACA was an improvement or not.

It's totally fine to think we could have done better than the ACA. But we should get the facts right and be careful about throwing out bipartisan bathwater lest we resign ourselves to getting our time machines out and play the blame game. I'll start by acknowledging it was unfair of me to act you linked this article for anything other than the headline image, which was very understandable to do. I couldn't resist since it's essentially experts begging people to support social welfare policy and go even further than the ACA :). I'll also commend you for seeking out data.
« Last Edit: March 11, 2024, 01:13:14 PM by swashbucklinstache »

wenchsenior

  • Magnum Stache
  • ******
  • Posts: 3779
What is the point of the thread? To convince you that the ACA has value?
It's a bit of a "can't see the forest for the trees" argument you've set up. It's obvious that the ACA has provided more health insurance options for more people.
It's also obvious that those with ACA health insurance are still in our crappy health care environment.
I'm scheduled for a hip replacement soon and I'm really glad to have my cheap ACA plan with a low max OOP, oh whoops, that's an anecdote.
But I noticed you were ok with anecdotes when they were your anecdotes.
Feel free to disregard my anecdote as I said. I have not been super impressed, so I look around to see how others are fairing. On the whole they don't seem any better off. Were my expectations too high? I thought we were supposed to get a healthcare system that was actually... better?

Depends on how you define better? Our two closest 'couple friends' had their lives functionally saved by the ACA being put in place just a couple years prior to serious permanent health challenges developing. Both couples would have been completely bankrupted by medical bills without the ACA caps on out of pocket payments; and both of the people in question would most likely be dead now, since their care required ongoing intervention with drugs and treatments that are completely unaffordable out of pocket except for billionaires.

NOTE: Anecdotal, obviously, but pretty huge effect on MY life, as their friend, as well as theirs.

Telecaster

  • Magnum Stache
  • ******
  • Posts: 3543
  • Location: Seattle, WA
Posting to follow.  I've got some thoughts on this, but I don't have time right now. 


partgypsy

  • Walrus Stache
  • *******
  • Posts: 5196
What is the point of the thread? To convince you that the ACA has value?
It's a bit of a "can't see the forest for the trees" argument you've set up. It's obvious that the ACA has provided more health insurance options for more people.
It's also obvious that those with ACA health insurance are still in our crappy health care environment.
I'm scheduled for a hip replacement soon and I'm really glad to have my cheap ACA plan with a low max OOP, oh whoops, that's an anecdote.
But I noticed you were ok with anecdotes when they were your anecdotes.
Feel free to disregard my anecdote as I said. I have not been super impressed, so I look around to see how others are fairing. On the whole they don't seem any better off. Were my expectations too high? I thought we were supposed to get a healthcare system that was actually... better?

Depends on how you define better? Our two closest 'couple friends' had their lives functionally saved by the ACA being put in place just a couple years prior to serious permanent health challenges developing. Both couples would have been completely bankrupted by medical bills without the ACA caps on out of pocket payments; and both of the people in question would most likely be dead now, since their care required ongoing intervention with drugs and treatments that are completely unaffordable out of pocket except for billionaires.

NOTE: Anecdotal, obviously, but pretty huge effect on MY life, as their friend, as well as theirs.
it is true my mom prob would have been dead as if today, without aca. She would sign up for health insurance, and after paying for 11 months, right when pre existing conditions would be covered,  would be canceled. Yes, she has a pre existing condition  eta 11 months, not 1 month
« Last Edit: March 16, 2024, 10:06:08 AM by partgypsy »

wenchsenior

  • Magnum Stache
  • ******
  • Posts: 3779
What is the point of the thread? To convince you that the ACA has value?
It's a bit of a "can't see the forest for the trees" argument you've set up. It's obvious that the ACA has provided more health insurance options for more people.
It's also obvious that those with ACA health insurance are still in our crappy health care environment.
I'm scheduled for a hip replacement soon and I'm really glad to have my cheap ACA plan with a low max OOP, oh whoops, that's an anecdote.
But I noticed you were ok with anecdotes when they were your anecdotes.
Feel free to disregard my anecdote as I said. I have not been super impressed, so I look around to see how others are fairing. On the whole they don't seem any better off. Were my expectations too high? I thought we were supposed to get a healthcare system that was actually... better?

Depends on how you define better? Our two closest 'couple friends' had their lives functionally saved by the ACA being put in place just a couple years prior to serious permanent health challenges developing. Both couples would have been completely bankrupted by medical bills without the ACA caps on out of pocket payments; and both of the people in question would most likely be dead now, since their care required ongoing intervention with drugs and treatments that are completely unaffordable out of pocket except for billionaires.

NOTE: Anecdotal, obviously, but pretty huge effect on MY life, as their friend, as well as theirs.
it is true my mom prob would have been dead as if today, without aca. She would sign up for health insurance, and after paying for 1 months, right when pre existing conditions would be covered,  would be canceled. Yes, she has a pre existing condition

My mom (working poor/uninsured) almost died of a very treatable illness pre ACA (only didn't b/c I forced her to the doctor and offered to pay for the visit/labs).  One of my aunts might have died anyway (lung cancer), but she was in the same situation and so couldn't afford to go to get testing that might have caught the cancer early enough to treat.

Not that having the ACA in place covers everyone, nor is affordable for everyone. But it does prevent fear of utter bankruptcy as a result of a serious health condition. And people are more likely to go to the doctor if they aren't dreading the possibility that discovery of something will get them booted from insurance (if they even have it), or that their expenses will be a manageable limit if they are sick. Both my aunt and mother 'didn't want to know' b/c they knew if it was serious, they would simply never be able to afford it. As it turned out, my Mom's condition WAS very treatable with minimal expense. My aunt's was the worst case scenario, and even if she'd gotten care in time it would have bankrupted her.

Radagast

  • Magnum Stache
  • ******
  • Posts: 2538
  • One Does Not Simply Work Into Mordor
I guess now is a good time for a segue into my take on why there isn't any big sign of improvement. When I first found MMM the ACA was a hot and recent topic. It coincided with my learning about the existence of investing. One book I read was "Unconventional Success" by David Swenson, in which he suggests what asset classes are appropriate to invest in and why. I applied his investing framework to healthcare and got the following ranking of who has the most interest in good healthcare:
1. You have your own best interest in mind, like always
2. The government wants good taxpayers, soldiers, bureaucrats, and employees for its campaign donors and oligarchs, plus a general interest in placating the plebes. And they want it at a good price, and have power to get it. The government's interest is very closely aligned to yours, and given their better data and resources and ability to use statistics most people would be if anything better off if the government managed their care.
3. Healthcare industry. They want maximum money which is opposite of your interest, but they can also get it through other ways such as improving efficiency or thinking of profitable new methods.
4. Health insurance companies. Adversarial zero sum party. They take money out of the system, and the net result is less money. They have no incentive to improve your health in any way. Like a 1% financial advisor who puts you in loaded funds.

The problem with insurance obviously is that it's like a casino: most people lose, and a handful win big. Insurance is a great thing for rich people to dabble in. Sure on average most of them lose money, but it can offset some deep risks. The problem with applying it to an entire nation is that then the average outcome for the whole nation is financially losing. The losses go to the health insurance company profits, and money goes to the employees of the insurance companies who handle all aspects of the business. More losses are caused by healthcare employees who need to deal with the more complicated billing, and the unseen time of people trying to work through the complexities of the system. Another way it's like a casino is that although most people lose, the winners are very vocal.

The other problem is that insurance has deductibles. These encourage people to delay care until the situation is dire, then rack up as many bills as possible. The effects of this have been known for centuries: "an ounce of prevention is worth a pound of cure." Not only does that make everything more expensive, but it also results in worse outcomes because loads of things are best caught early. In fact an efficient healthcare system would look like the opposite of insurance: instead of a $5,000 deductible where people spend nothing for years at a time until they are deathly sick, you'd want them to have a $5,000 credit and they are desperate to nip issues in the bud while minor cheap and easy to solve.

By mandating insurance we are encouraging:
Maximum amount of money to be directed away from the system
Minimum incentive to improve health outcomes
Maximum reporting of miracle cures
If you wanted a system to maximize profits, maximize reporting of good outcomes, and minimize actual effort directed to good outcomes this would be it.

So that's been my hypothesis for eight years or so. What would disprove my hypothesis? Costs and outcomes converging on those of first world countries.

Radagast

  • Magnum Stache
  • ******
  • Posts: 2538
  • One Does Not Simply Work Into Mordor
And then I feel like I'm going crazy. There's not even a plausible method by which insurance would improve outcomes at the national level, and nobody mentions it. Not MMMers who are otherwise astute to insurance, not government health agencies. The portion of the population covered by insurance is more accurate as a measure of policy failure than policy success. Or am I missing something?

shuffler

  • Pencil Stache
  • ****
  • Posts: 571
And then I feel like I'm going crazy.
I don't know that I'd say crazy, but your thoughts & presentation certainly are jumbled.
I wrote a longer reply with lots of quotes, but deleted it in favor of something more succinct.

Your main thesis seems to be (not a direct quote) that health insurance is bad because it (a) has overhead administration costs, and (b) provides profits (another cost) to health insurance companies. These costs are carried by the consumer.

Fair summary?

You claim that health insurance companies "have no incentive to improve your health in any way".  I believe this is factually untrue.  If an insurance company had perfectly healthy subscribers, they'd pay (nearly) zero administrative cost, thereby maximizing their profit at a fixed (read: mandated by the ACA) medical loss ratio.  This is borne out by many insurance plans (especially corporate, in my own personal experience) providing incentive plans (like gift-cards and such) for subscribers receiving routine diagnostic and preventive services, or for specific actions like quitting smoking or losing weight. Perhaps you'd argue that insurance companies don't have enough incentive to improve our health ... which is a fine statement to make, but how much incentive would be the right amount of incentive?  How would it work?

You claim that insurance is bad because it has deductibles.  But it's hard to understand what you're comparing against.  Insurance vs. No-Insurance, or pre-ACA vs. post-ACA, or then you provide some other hypothetical of subscribers receiving credits to spend on preventative healthcare.  Surely a deductible is better than paying full-freight in a no-insurance world.  And the ACA has done well to eliminate the deductible/cost-sharing on many preventative services -- which has the same net effect of $0 cost to the consumer as your "credits" proposal, for those services.  I suppose deductibles are bad compared to a world where, as you suggest, everyone gets "credits" and never has to pay the full-freight cost ... but is that realistic proposal?

And that's kind of the problem with your argument.  It's totally unclear what your basis of comparison is (no-insurance, pre-ACA, post-ACA, or something else).

If my summary above is accurate, then I suspect you're actually working your way towards making an argument for single-payer/nationalized healthcare, in order to reduce the administrative costs and eliminate the profit-costs.
Hey, welcome to the club!  MMMers and government agencies/pundits do talk about this all the time!  It's just kind of weird to see someone go the route of bashing the ACA first, before then arriving at single-payer.

Or if that's not the case, then what are you comparing our current post-ACA situation against?  Rather than railing against insurance in the abstract, how about proposing or pointing to a system that works better?

--------------

As an aside:
What would disprove my hypothesis? Costs and outcomes converging on those of first world countries.
I mean, there's a whole lot else wrapped up in there.  We could have the same/similar structure to our healthcare system as some other first world country, but we should expect to continue seeing worse results as long as we keep denying women their bodily autonomy and refusing to vaccinate ourselves & our children.

Cranky

  • Magnum Stache
  • ******
  • Posts: 3837
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.

dandarc

  • Walrus Stache
  • *******
  • Posts: 5433
  • Age: 41
  • Pronouns: he/him/his
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.
« Last Edit: March 14, 2024, 01:00:18 PM by dandarc »

farmecologist

  • Pencil Stache
  • ****
  • Posts: 597
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.

And remember...many who went through the onerous application process pre-ACA were rejected.  And yes, that fact is totally lost on people today.  Folks have very short memories on nearly everything it seems.

The ACA has also allowed many to be able to start businesses, retire early, etc... Before the ACA, many were working a corporate job, etc... solely for the healthcare because the knew they would likely be rejected in the private market, etc...

As far as the single payer aspect, that certainly was on the table.  However, a certain political party was adamantly against single payer, and the law wouldn't have passed congress with it in place.


the_hobbitish

  • Handlebar Stache
  • *****
  • Posts: 1384
Maybe I'm missing something because I have never been in the weed on this issue... I didn't ever think ACA was supposed to improve healthcare outcomes across the board. I thought it was meant to provide access to healthcare to those who didn't have employer coverage. If you have millions of more people with access to healthcare which improves the lives of those people what is the downside?

Yes, healthcare outcomes in the US are still very much a problem that needs to be addressed, but isn't that a separate issue?




ChpBstrd

  • Walrus Stache
  • *******
  • Posts: 6634
  • Location: A poor and backward Southern state known as minimum wage country
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.

And remember...many who went through the onerous application process pre-ACA were rejected.  And yes, that fact is totally lost on people today.  Folks have very short memories on nearly everything it seems.

The ACA has also allowed many to be able to start businesses, retire early, etc... Before the ACA, many were working a corporate job, etc... solely for the healthcare because the knew they would likely be rejected in the private market, etc...

As far as the single payer aspect, that certainly was on the table.  However, a certain political party was adamantly against single payer, and the law wouldn't have passed congress with it in place.
A certain political party negotiated to water down the ACA and remove a government insurance option, then reneged and voted against the watered down bill. Of course, the ACA had may Democrats who voted against it as well, so unilateral passage of a single payer bill was not assured. Presumably the whips counted up the votes and buried that option.

Cranky

  • Magnum Stache
  • ******
  • Posts: 3837
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.

Public Option - there was supposed to be one, right? I’ll have to poke around and see what happened to that. Gosh, it seems like that was a long time ago…

farmecologist

  • Pencil Stache
  • ****
  • Posts: 597
Maybe I'm missing something because I have never been in the weed on this issue... I didn't ever think ACA was supposed to improve healthcare outcomes across the board. I thought it was meant to provide access to healthcare to those who didn't have employer coverage. If you have millions of more people with access to healthcare which improves the lives of those people what is the downside?

Yes, healthcare outcomes in the US are still very much a problem that needs to be addressed, but isn't that a separate issue?

Absolutely.  The ACA improves healthcare access.  What folks do with that healthcare access is up to them.  I suspect some have a low-end ACA plan, but don't use it frequently because of high out of pocket costs, which can likely lead to poor outcomes in these cases.



dandarc

  • Walrus Stache
  • *******
  • Posts: 5433
  • Age: 41
  • Pronouns: he/him/his
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.

Public Option - there was supposed to be one, right? I’ll have to poke around and see what happened to that. Gosh, it seems like that was a long time ago…
If your income is low enough and you're in an expansion state, you have a public option - called Medicaid or whatever your state has branded Medicaid as (MediCal in California, for example).

If you are in a non-expansion state and you're low income and you don't have kids / disability / whatever other criteria your state has other than income, then your state's REPUBLICAN legislature has failed you big time - get on them or at least vote blue no matter who or get involved with a voter initiative to bypass the legislature.

Because in expansion states there is no coverage gap - you either qualify for medicaid, or have affordable insurance through your employer, or you can buy affordable insurance on your state's exchange. A lot of people are still effed in the non-expansion states - Republican's playing culture wars vs. actually serving their constituents at its peak awfulness.

ETA - Medicaid expansion by state - only 10 states have yet to expand: https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/
« Last Edit: March 15, 2024, 09:33:22 AM by dandarc »

ChpBstrd

  • Walrus Stache
  • *******
  • Posts: 6634
  • Location: A poor and backward Southern state known as minimum wage country
Actually Wikipedia has a long list of answers to the OP's question, with research citations. E.g.

Quote
The CDC reported that the percentage of people without health insurance fell from 16.0% in 2010 to 8.9% from January to June 2016.[201] The uninsured rate dropped in every congressional district in the U.S. from 2013 to 2015.[202]
Quote
States that expanded Medicaid had a 7.3% uninsured rate on average in the first quarter of 2016, while those that did not had a 14.1% uninsured rate, among adults aged 18–64.[204] As of December 2016 32 states (including Washington DC) had adopted the Medicaid extension.[205]
Quote
A 2017 study found that the ACA reduced socioeconomic disparities in health care access.[206]
Quote
Ten years after its enactment studies showed that the ACA also had a positive effect on health and caused a reduction in mortality.[208]
Quote
A 2016 study found that residents of Kentucky and Arkansas, which both expanded Medicaid, were more likely to receive health care services and less likely to incur emergency room costs or have trouble paying their medical bills. Residents of Texas, which did not accept the Medicaid expansion, did not see a similar improvement during the same period.[227][228]
Quote
A study using national data from the Health Reform Monitoring Survey determined that unmet need due to cost and inability to pay medical bills significantly decreased among low-income (up to 138% FPL) and moderate-income (139-199% FPL) adults, with unmet need due to cost decreasing by approximately 11 percentage points among low-income adults by the second enrollment period.[232] Importantly, issues with cost-related unmet medical needs, skipped medications, paying medical bills, and annual out-of-pocket spending have been significantly reduced among low-income adults in Medicaid expansion states compared to non-expansion states.[232]

As well, expanded Medicaid has led to a 6.6% increase in physician visits by low-income adults, as well as increased usage of preventative care such as dental visits and cancer screenings among childless, low-income adults.[232] Improved health care coverage due to Medicaid expansion has been found in a variety of patient populations, such as adults with mental and substance use disorders, trauma patients, cancer patients, and people living with HIV.[233][234][235][236]
Quote
Following Medicaid expansion and dependent coverage expansion, young adults hospitalized for acute traumatic injury in Maryland experienced a 60% increase in rehabilitation, 25% reduction in mortality, and a 29.8% reduction in failure-to-rescue.[238] Medicaid expansion's swift impact on cancer patients was demonstrated in a study using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program that evaluated more than 850,000 patients diagnosed with breast, lung, colorectal, prostate cancer, or thyroid cancer from 2010 to 2014. The study found that a cancer diagnosis in 2014 was associated with a 1.9 percentage-point absolute and 33.5% relative decrease in uninsured rates compared to a diagnosis made between 2010 and 2013.[235] Another study, using Surveillance, Epidemiology, and End Results (SEER) Program data from 2010 to 2014, found that Medicaid expansion was associated with a 6.4% net increase in early stage (in situ, local, or regional) diagnoses of all cancers combined.[239]

Anyway... it goes on and on like this with 515 references cited.

Morning Glory

  • Magnum Stache
  • ******
  • Posts: 4863
  • Location: The Garden Path
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.

Public Option - there was supposed to be one, right? I’ll have to poke around and see what happened to that. Gosh, it seems like that was a long time ago…
If your income is low enough and you're in an expansion state, you have a public option - called Medicaid or whatever your state has branded Medicaid as (MediCal in California, for example).

If you are in a non-expansion state and you're low income and you don't have kids / disability / whatever other criteria your state has other than income, then your state's REPUBLICAN legislature has failed you big time - get on them or at least vote blue no matter who or get involved with a voter initiative to bypass the legislature.

Because in expansion states there is no coverage gap - you either qualify for medicaid, or have affordable insurance through your employer, or you can buy affordable insurance on your state's exchange. A lot of people are still effed in the non-expansion states - Republican's playing culture wars vs. actually serving their constituents at its peak awfulness.

ETA - Medicaid expansion by state - only 10 states have yet to expand: https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

We just got Medicaid expansion in North Carolina,  despite a Republican-controlled legislature. Some of them (at least in this very narrow instance) are looking at the needs of their constituents instead of the party platform. 

My guess is that Wisconsin will be next as they finally got rid of the awful gerrymandered district maps.
« Last Edit: March 15, 2024, 09:56:41 AM by Morning Glory »

dandarc

  • Walrus Stache
  • *******
  • Posts: 5433
  • Age: 41
  • Pronouns: he/him/his
Right - but that is the most recent state to do so and implementation turned out to be 10 full years later than it could have been . So yeah, good for NC for finally doing the right thing, but I'd suspect the state turning more blue is what really drove this happening there - for example the NC governor who signed the legislation is a Democrat.  NC's legislature also dragged its feet on passing a budget for almost 3 months in 2023, further delaying implementation of Medicaid expansion.

I currently live in Florida where it will take a citizen initiative for this to happen because this is ground-zero for the culture wars. Actually, I have to check and see if the organizing committee for that has it on the 2024 ballot (I'd think that it needs to be a presidential election year here to have any hope, but then Trump so who knows). Might convince me to delay relocation until after November. SC is the most likely destination for us for proximity to family reasons, but NC is still on the list - and Medicaid expansion / other political aspects are one reason why we might choose NC over SC.

Edit: looks like the relevant group is targeting 2026 for medicaid expansion in Florida. Interesting choice as the last attempt was 2020, but ultimately decided to delay. Takes a lot of work to get the number of signatures required for this here. But if I'm remembering correctly, an increase in the super-majority requirements failed in 2022 at least once things do make it to the ballot.
« Last Edit: March 15, 2024, 10:20:42 AM by dandarc »

farmecologist

  • Pencil Stache
  • ****
  • Posts: 597
Originally, the ACA was supposed to include some kind of policy offered by the government wasnt it? And the courts kicked that out? It was my understanding that this was meant as a back door run to single payer. I agree that as it stands it has been a gift to the insurance industry.
There was supposed to be a penalty for not having insurance at all that the courts threw out. Changes the risk calculous a bit, but the proposed additional tax for going without any insurance wasn't that big.

Then there was supposed to be funding for insurers to off-set their costs associated with the cost-sharing-reductions. Courts (or maybe it was a Republican congress?) blocked that, but insurance companies figured out how to stay profitable via silver-loading in spite of that decision.

Despite the challenges and far from perfect situation today, at the end of the day, millions more people have better health coverage than was the case under the pre-ACA rules. And wow is it simpler to obtain individual insurance than it used to be - I feel like that aspect is completely lost on anyone who didn't have reason to try to buy individual insurance both pre and post ACA. That was quite the onerous application process when I did it back in 2009 or so - and I was reasonably young and healthy, can't imagine how much more time just filling out the paperwork I'd have had if I had any pre-existing conditions. I think in the US, the ACA is likely a necessary step if there's ever going to be a single-payer system here - just too many cultural and political factors working against just getting that done in relatively short order here.

Public Option - there was supposed to be one, right? I’ll have to poke around and see what happened to that. Gosh, it seems like that was a long time ago…
If your income is low enough and you're in an expansion state, you have a public option - called Medicaid or whatever your state has branded Medicaid as (MediCal in California, for example).

If you are in a non-expansion state and you're low income and you don't have kids / disability / whatever other criteria your state has other than income, then your state's REPUBLICAN legislature has failed you big time - get on them or at least vote blue no matter who or get involved with a voter initiative to bypass the legislature.

Because in expansion states there is no coverage gap - you either qualify for medicaid, or have affordable insurance through your employer, or you can buy affordable insurance on your state's exchange. A lot of people are still effed in the non-expansion states - Republican's playing culture wars vs. actually serving their constituents at its peak awfulness.

ETA - Medicaid expansion by state - only 10 states have yet to expand: https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/

We just got Medicaid expansion in North Carolina,  despite a Republican-controlled legislature. Some of them (at least in this very narrow instance) are looking at the needs of their constituents instead of the party platform. 

My guess is that Wisconsin will be next as they finally got rid of the awful gerrymandered district maps.

Being from Minnesota, a state that actually seems to care about it's citizens, we have had expansion since day 1.

However, our daughter has been attending grad school in North Carolina for a couple years now and boy...you don't realize how good you have it until you don't have it anymore.  I couldn't believe they hadn't expanded Medicaid in NC...but as you said, they finally did it as of 12/1/2023.   NC government services in general are much worse than MN as well.  I was kind of disgusted at how long it took our daughter to even get an appointment at the DMV in NC, etc...  MN also has programs such as a renters property tax rebate ( https://www.revenue.state.mn.us/renters-property-tax-refund ), among others.

As for Wisconsin, boy...they have really sunk low form what they once were.  Shows what happens when you let the conservatives rule...hint: not good for the average citizen.  Getting fair election maps back in Wisconsin is a huge win for the public.  It will take a long time to claw back what was lost though...sad stuff.




« Last Edit: March 15, 2024, 10:21:16 AM by farmecologist »

Samuel

  • Pencil Stache
  • ****
  • Posts: 770
  • Location: the slippery slope
The ACA has also allowed many to be able to start businesses, retire early, etc... Before the ACA, many were working a corporate job, etc... solely for the healthcare because the knew they would likely be rejected in the private market, etc...

The ACA was great for early retirees who engineered their finances to have incomes low enough to get subsidies but I'm not so sure about it being good for the more Fat FIRE folks or people looking to start businesses. As I understand it the single biggest losers, fiscally speaking, of the ACA are people on the individual market who don't qualify for subsidies. Prices on the individual markets are much higher now and markets have a lot fewer plan options than pre-ACA. Prices for individual plans have climbed much higher than the prices for employer sponsored plans have over the last 10 years. A decent number of middle class people not on employer plans are now opting out of health insurance because the prices have spiked so much.

As far as the single payer aspect, that certainly was on the table.  However, a certain political party was adamantly against single payer, and the law wouldn't have passed congress with it in place.

The ACA passed by the skin of it's teeth on a purely party line vote. No Republicans voted for it (and 39 Democratic representatives voted against it). So Republicans didn't scuttle a single payer or public option plan, the conservative wing of the Democratic party did.

dandarc

  • Walrus Stache
  • *******
  • Posts: 5433
  • Age: 41
  • Pronouns: he/him/his
I don't think that's actually true about individual vs. group insurance cost - what the ACA did primarily was to more or less equalize the unsubsidized costs from a situation where individual insurance IF you could get it was cheaper. But the reason individual insurance was so cheap was that insurers largely did not have to write a policy, or cover as broadly as typical group insurance did. Individual health insurance in many states could discriminate against those with pre-existing conditions, group insurance generally speaking could not do that.

Then you add in that a lot of group policies have always sheltered the individual employees from a large portion of either the premium, the risk, and often both and people pre-ACA had a lot less knowledge of how much health insurance really costs. ACA kind of takes the cover off of that to an extent.
« Last Edit: March 15, 2024, 11:53:14 AM by dandarc »

bluecollarmusician

  • Pencil Stache
  • ****
  • Posts: 605
  • You call this a Fi(re)?
Maybe I'm missing something because I have never been in the weed on this issue... I didn't ever think ACA was supposed to improve healthcare outcomes across the board. I thought it was meant to provide access to healthcare to those who didn't have employer coverage. If you have millions of more people with access to healthcare which improves the lives of those people what is the downside?

Yes, healthcare outcomes in the US are still very much a problem that needs to be addressed, but isn't that a separate issue?

Yes, this has been stated multiple times in this thread.  OP considers this a second order effect (? I don't understand why?) IMHO the health care being provided has not changed, so why would the outcomes change?  More people just have access to it without being bankrupted, which IS borne out by the data. 

The ACA was great for early retirees who engineered their finances to have incomes low enough to get subsidies but I'm not so sure about it being good for the more Fat FIRE folks or people looking to start businesses.

@Samuel Are they losers because they don't get a subsidy?  What about the folks who would like to Fat FIRE or start a business who have pre-existing conditions, or conditions that require ongoing expensive care?  Maybe we could say the people who have no insurance through work, have no health issues (i.e. low users) and make a (relatively speaking) lot of money will pay more for health insurance than when the insurance companies could restrict and limit their coverage whenever they needed it? To put it another way people who are healthy and rich and don't need to work for anyone else might pay more for their health insurance than they did when people who were poor and had health issues were excluded from the marketplace.  . I am totally ok with that.

I mean, it can't cost that much more- it is capped at 8.5% of your income.  People who think that is "expensive" are paying orders of magnitude higher for lots of other items in their life (or else they would have plenty of money to pay it based on their income.) 

In many ways, I think that it just makes sense to think of your ACA premiums as a secondary tax.  People don't like to talk about "taxes" but essentially that's how it operates.  It's not unaffordable- people just don't prioritize it above their iphones, their new tesla or their 5th bedroom... or whatever.  We won't qualify for subsidies this year, and we are very low users.  So according to your calculus we are the (fiscally speaking) losers- however I don't feel that way at all about it.  I actually have insurance that I can count on if we find out tomorrow that I have rare brain cancer like one of my uncles did, or if I my wife has an accident I know that we will be able to afford to have her taken care of - and without jeapordizing our FI...!!!  So it's a GREAT thing for FAT Fire and people who want to start a business.  Did I have a cheaper "oh shit" HSA super high deductible plan 15 years ago.  Yes.  Would it have been worth a damn in a really band emergency give the plan caps, limitations-?  Would I have felt comfortable retiring with that plan?  Heck no....
« Last Edit: March 15, 2024, 12:30:40 PM by bluecollarmusician »

Samuel

  • Pencil Stache
  • ****
  • Posts: 770
  • Location: the slippery slope

Are they losers because they don't get a subsidy?  What about the folks who would like to Fat FIRE or start a business who have pre-existing conditions, or conditions that require ongoing expensive care?  Maybe we could say the people who have no insurance through work, have no health issues (i.e. low users) and make a (relatively speaking) lot of money will pay more for health insurance than when the insurance companies could restrict and limit their coverage whenever they needed it? To put it another way people who are healthy and rich and don't need to work for anyone else might pay more for their health insurance than they did when people who were poor and had health issues were excluded from the marketplace.  . I am totally ok with that.

I mean, it can't cost that much more- it is capped at 8.5% of your income.  People who think that is "expensive" are paying orders of magnitude higher for lots of other items in their life (or else they would have plenty of money to pay it based on their income.) 

I just meant that the people hit most by increased health insurance costs post ACA are people on the individual market who don't get subsidies. Those plans are much more expensive than before and the rise in costs has outpaced the rise in costs in employer sponsored plans by quite a lot.

The 8.5% cap is a very recent (and as of now temporary) fix for this very problem, but until it was introduced in 2021 people in this position were getting hit harder than any other group by cost increases.

I actually have insurance that I can count on if we find out tomorrow that I have rare brain cancer like one of my uncles did, or if I my wife has an accident I know that we will be able to afford to have her taken care of - and without jeapordizing our FI...!!!  So it's a GREAT thing for FAT Fire and people who want to start a business.  Did I have a cheaper "oh shit" HSA super high deductible plan 15 years ago.  Yes.  Would it have been worth a damn in a really band emergency give the plan caps, limitations-?  Would I have felt comfortable retiring with that plan?  Heck no....

That's a fair point. It's not an apples to apples comparison between pre and post ACA plans with regards to reliability.


sonofsven

  • Handlebar Stache
  • *****
  • Posts: 2013
My experience buying my own sole policy from 1995 on was that the price rose fairly consistently and the  coverage became more limited every year, similar to car or homeowners insurance. The deductible also increased.
I think most of the opposition is political. Critics I've talked to personally often have no experience buying their own policies before the ACA and don't realize that costs have steadily risen. Many pre ACA policies were complete garbage and would never pay out. Of course they were cheaper. Kind of like the health sharing ministries of today.
So get your free colonoscopy when you turn fifty and thank the ACA.
It's not perfect, but it's better than what we had before.

RetiredAt63

  • CMTO 2023 Attendees
  • Senior Mustachian
  • *
  • Posts: 20709
  • Location: Eastern Ontario, Canada
Reading all this, isn't an equally appropriate question

Did the ACA decrease the rate of medical bankruptcies?

dandarc

  • Walrus Stache
  • *******
  • Posts: 5433
  • Age: 41
  • Pronouns: he/him/his
Reading all this, isn't an equally appropriate question

Did the ACA decrease the rate of medical bankruptcies?
Data seems to say yes - at least there was a correlation form 2010 to 2016 to a significantly lower level of personal bankruptcy filings.

https://www.consumerreports.org/personal-bankruptcy/how-the-aca-drove-down-personal-bankruptcy/

Of course there's so much going on that can impact this - 2022 was the lowest level of bankruptcy filings in many years, but of course that might be attributed to the pandemic and the various relief programs there were. 2023 ticked up significantly on this metric, but still very far below 2019's level of filings.

And interesting that bankruptcies in the US were pretty much flat 2016 to 2019 before going way down for pandemic. This makes me think that the main thing driving bankruptcy filing is government policy - sometimes more or less voluntary from congress (ACA maybe?), sometimes conditions force it (financial crisis, pandemic). Just speculating obviously.

https://www.debt.org/bankruptcy/statistics/
« Last Edit: March 16, 2024, 09:20:10 AM by dandarc »

 

Wow, a phone plan for fifteen bucks!