In case ACA is overturned, then what?

[sol]

I'm still confused when people suggest it's good* to pay the insurance company the ACA subsidized rate

Many of us like the fact that the ACA attempted to fix our broken healthcare insurance market, offering lifesaving medical care to millions of Americans who would otherwise wouldn't have been able to get it.  The ACA means that people are no longer uninsurable.  It also means insurance companies can't drop when you do have an accident and incur expenses, like they could before.  Oh, and it prioritized preventative care that lowers long term healthcare costs for the country, instead of just maximizing private insurance company profits by providing the minimum coverage to healthy people at the minimum cost.

$28,303, when my private plan is only $12,200. (and just as good)

It's definitely not just as good, even if it looks like it to you, because non-ACA plans don't have the same legal protections.  They can have lifetime caps, and they are revocable at any time for any reason.  They are just as good as long as you don't need to use them.

Well, I guess it's good if you can get hardworking tax payers to pay for your health insurance.

Not just yours or mine, everybody's.  That's the point of national healthcare plan, it is designed to keep your country healthy and happy.  We spend money on all kinds of things that are designed to keep people healthy and happy. 

Your argument here could just as easily be applied to medicare.  Why should I pay for an old person's healthcare, must be great to get hardworking tax payers to pay for your grandma's health insurance.  The answer is that because someday you're going to be that old person.  Ditto for things like disability insurance, must be nice to get hardworking taxpayers to pay for your injury rehab or adult home care costs.  Or unemployment, must be nice to get hardworking taxpayers to send you a check each week while you stay home and watch tv.  I think you might be missing the point of these programs.

Instead I had to choose one of the marketplace insurance companies in my area.

You have ALWAYS had to choose one of the plans offered in your area.  The ACA didn't change that.  In fact, the ACA very specifically stayed away from mandating that any company offer any service in any particular place, because that would have been an unjust interference in the free market.  The only thing the ACA did was offer insurance companies more money to expand into more markets, in an attempt to increase competition.

Also the premiums started doubling every year with less competition, more red tape, and massive corruption.

I'm going to ignore your "massive corruption" claim because I think it's pretty rich.  I'm going to ignore your "more red tape" claim because insurance is always about red tape, no matter where you get it.

But on your "premiums started doubling" claim I'm going to push back a little.  Premiums have not doubled in any year, and I think it's pretty well accepted by now that the ACA actually slowed the rate of health insurance premium increases for the country.  Some places and some plans still increased faster than average, and some slower, but the nationwide average rate of increase now is definitely lower than it would have been without the ACA.  So you're either misinformed or just lying.  Given the vitriolic slant of rest of your post, I think I know which it is.

Anyway good riddens to the program and hoping for more variety and free market with healthcare.

You mean like what we had back in 2009?  You seriously want to go back to that?

That's the most extreme opinion about American healthcare I've yet heard expressed on this forum.  We treid "free market healthcare" for decades and it was a disaster, that's why we have this whole mess to begin with.  I've heard people complain about various aspects of the ACA.  Some people don't like specific parts of the law, or think it didn't do enough, or would like to modify it, or even replace it with something similar but better, but you're the first person I've heard openly wish to go back to what we had in 2009.  That was a national crisis, if you remember correctly.  Premiums going up 20% per year, millions of people uninsured, pregnant women getting dropped by their insurance companies at their first prenatal visit, whole states with no non-employer private plans available at all?  You really want to go back to that nonsense?

[mtnrider]

I was in better shape for retirement without the ACA.   There was a lot more companies with plans and more insurance companies fighting for my business.  I remember I could choose between BlueCross & Aetna and 12 others.  Instead after the chance BlueCross & Aetna was no longer offering their insurance in the county that I lived in.  Instead I had to choose one of the marketplace insurance companies in my area.

Also the premiums started doubling every year with less competition, more red tape, and massive corruption.  "Total cost of the HealthCare.gov website had reached $1.7 billion" according to wikipedia.  Anyway good riddens to the program and hoping for more variety and free market with healthcare.

I feel for you that you need to pay more for insurance, and it can be hard to come to terms with the rest of society telling you how to run your finances.  Auto insurance, for example, seems like an heavy lift for teens.  Why should the government require that they purchase expensive insurance?

You haven't provided any actual data, so it's hard to understand what you're getting at.  Did your rates double because you started making more money and no longer qualify for subsidies?  Or did they double because you aged into the next band?  Or did they double because you're comparing 2013 pricing, at your 2013 income, with 2019 pricing at your 2019 income?

I also strongly feel that the ACA is an overwhelming net good for society.  That's not to say that there aren't individual losers.  These cases are the sort of things that government should be looking at.

[des999]

I'm still confused when people suggest it's good* to pay the insurance company the ACA subsidized rate,
$28,303, when my private plan is only $12,200. (and just as good)
See my previous post for details.

*Well, I guess it's good if you can get hardworking tax payers to pay for your health insurance.

hey, look at me, I'm young and healthy, my insurance should be cheaper than everyone else.  I'm not paying for old people, sick people, sick kids, etc..  That's all easy to say when you and your family are healthy.  I'd like to hear this same argument from someone that has a child born with some medical condition that the old system would have told to fly a kite/we can't insure you. 

It's not all old people or people that don't take care of their health.   I know that is a convenient excuse, but we have to choose to either help others or not, remembering that someday we may need that same help.

[Larsg]

Follow the China Study Diet to the letter - 100% Vegan with no Vegan junk, limited sugar and oil, etc. It can be done if you learn how to cook like a vegan chef and not getting enough protein is a complete Myth. Only vitamin you need is Vitamin B12 and you CAN EAT UNLIMITED GOOD CARBS. If you have a weight problem or diabetes, the weight falls off, you don't have to watch your calories as you are eating low calorie and or high density nutrient foods and carbs - potatoes, fantastic and you can have as much as you want less the Oil, Butter, Creams, and then very limited high quality salt....same with high quality breads with limited ingredients...fills you up, weight falls off if you are overweight...maintains if under. The key doctors in this movement are:

Dr's Collin and Thomas Cambell; Dr Caldwell Esselstyn; Dr Barnard; and Dr McDougle, and Dr Michael Klapper. With the exception of Dr Barnard, these are all pretty old, fit geezers, upright, sharp minded, no heart disease, no cancer geezers who are a delight to watch on youtube. Each of them has a website with cook books and or cooking webinars. It will change your life and you will worry about all this stuff so much less with the exception of emergencies which can be a different kind of insurance all together....this is insurance all In itself where you can live longer healthfully and then die quickly usually of natural causes.

Before making judgements, check them out on youtube. Start with Dr Benard as he grew up on a Cattle Ranch, his dad did too and they both went into medicine. On youtube, they break down all the statistics, all the reversal of diseases they have seen following the diet, etc.

By contrast, The guy who created the Atkins diet died overweight of coronary artery disease...that is no joke, you can look it up.

Bernard covers how the food industry gets you hooked on Dairy that is like an opiate (built in by nature) but is one of the leading causes of cancer as it pumps hormones all through your body as that's what it was meant for, to grow baby calves into huge cows - he has all the status on this - Casein is the milk is deadly to humans...causes prostate, breast, and all other types of cancers.

Calcium and protein and very easy to get in a vegan diet w/out much effort - again, they can walk you through it.

My family and I have been Vegan for about 15 years...most amazing thing we ever did...cut out the weight, the joint pain, lifted energy, increased mental cognition, no longer can take a nap even if I wanted to as I have so much energy. Fixed mood issues and so many other things as well as being much kinder to the planet.

Good luck and here is one video to start

https://www.youtube.com/watch?v=xdToIu_ydpA

[SugarMountain]

Really not worth fretting about. You have money, money buys options.

If it does disappear, it's not going to be gone overnight with millions of people suddenly without coverage one morning. You will get months, if not years, of advance notice.

Every time a door closes, another window opens. Something will be there.

This is just such an optimistic take that ignores a lot of realities.  It's certainly possible that the ACA does get over turned.  Justice Roberts has saved it twice, but might not a 3rd time. (Let's be clear, this current lawsuit is going to end up in front of the Supreme Court.)  And if it does get over turned the first thing insurance companies are going to do is drop coverage for those with pre-existing conditions.  Those folks just are not profitable.  All kinds of stuff like high blood pressure, high cholesterol, diabetes, heart issues, allergies, skin cancer (had a mole removed? fuck right off), or as one previous poster mentioned tourets.  It does not take a major health issue to be categorized as having a pre-existing condition that could get you denied coverage. Millions of have people have them, some estimates as high as 100 million. Pretty much anybody 60+ has had something.  And if you missed something on your application, you could later be denied coverage despite having paid premiums for years.

Sure, the guaranteed coverage for those with pre-existing conditions is the single most liked aspect of the ACA, but without the mandate which has already been removed, it all falls apart.  The ACA is basically a 3 legged stool:
1) Everyone is guaranteed coverage, regardless of health. (And a certain level of coverage, which is one of the reasons ACA is more expensive than prior policies - it covers a lot more).
2) Every has to get coverage.  This prevents people from just waiting until they get sick to buy insurance.  This enlarges the pool to make #1 possible.
3) Those who can't afford it get subsidies to enable #2.

We've eliminated #2 and you can already see the consequences of this in that many areas have only one provider available and costs have gone up significantly.  This makes sense, with a smaller pool and the pool is comprised of fewer younger healthy people, costs will go up.  This is causing more people to drop out.  Will we get into a death spiral?  That remains to be seen, but it certainly seems like it is very possible.

So what happens if either the current court case is upheld and ACA is just outright killed or it goes into a death spiral?  Nobody knows.  None of the smart people on here really know.  The optimistic view is there will be a soft landing and ultimately something better will be done. Medicare for all? A public option for those who are uninsured?  True nationalized healthcare?  States implementing solutions?  Or do we just return to the wild west where insurers insure who they want and everyone else can pound sand? 

I predict the latter, at least for a while.  The political situation being what it is in this country, it is going to be a while before the side who feels the government should have a role in this is going to have the Presidency, both houses of Congress, and judges who agree.  Like probably not until I get to Medicare.  The Republicans had majorities + the Presidency for two years and passed no actual replacement legislation after spending 6 years post the passage of ACA doing every thing they could to prevent any improvements and claiming they would would "repeal & replace".

So, much like the original poster, the healthcare situation is probably my biggest FIRE worry.  Our backup plans include buying property in Spain or Portugal (500k Euros for a property and you can get a "golden visa" and access to their healthcare system), business investment visas in various countries, or buying a business with enough employees to get some group coverage. Or even alternating getting jobs that get benefits, working for a while and then doing COBRA.  I'm almost 52, so if I retire now and take COBRA for 18 months, then DW gets a job for a year and we take COBRA, then I do it, etc, we'd each have to work a couple of years out of the next 13. 

We're rich, so we'll be fine, but the healthcare situation in the US is a disaster and believing that magic will happen and everyone will be taken care of is just dreaming.  If presented the option to write a check for $500k to have 100% coverage for the rest of our lives, I'd likely do it.

[Mr. Green]

It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.

[bacchi]

It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.

Isn't that the crux of the current ACA case making its way up? "A tax is not a tax if it's $0."

[SugarMountain]

It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.

Being a felon still has negative consequences external to jail time, whereas breaking the "mandate" has none.  Is a mandate with no penalty really a mandate?  Seems more like a suggestion at that point.

[Paul der Krake]

We're rich, so we'll be fine, but the healthcare situation in the US is a disaster and believing that magic will happen and everyone will be taken care of is just dreaming.  If presented the option to write a check for $500k to have 100% coverage for the rest of our lives, I'd likely do it.

Read my post more carefully, I never said everyone will be fine. I said "money buys options", including moving to another country.

I think we're completely in agreement here. You and I and virtually everyone reading this will be fine. Others, maybe, maybe not.

[bmjohnson35]

Unfortunately, the lobbyists for the healthcare industry, pharmaceutical companies and insurance companies have too much influence over our elected officials.  I agree that the ACA is a very flawed solution, but it's the only real solution that fit my needs as an early retiree.  If you have pre-existing conditions and are unemployed, ACA is the only reasonable option in the US.  I am relying on our elected officials to continue their foolishness and be unable to kill it anytime soon.  If they do, I hope they produce some reasonable alternative.  Otherwise, I will have to consider going back to work or leaving the country.

The truth is, if we don't get a handle on this issue as a nation, the existing setup will likely fail. Healthcare costs can't continue to increase at it's present rate when personal incomes aren't even keeping pace with moderate inflation for many citizens.

BJ
 

[DaMa]

Here's another thought...a lot of things have changed since 2014.  In Michigan, Blue Cross Blue Shield of Michigan was the insurer of last resort as it was not allowed to deny coverage to anyone.  That changed after ACA, and BCBSM is now a mutual company.  If the ACA is gone, people who used to be able to get coverage in Michigan won't be able to.  I'm sure there are similar situations in other parts of the country.

My point is that it will be worse than it was before.  We will not be going back to where we were before the ACA.

[Mr. Green]

It's super frustrating every time I hear someone say the individual mandate has been removed because that is technically incorrect. This just tells you that the current administration has done a great job of spinning it that way. The penalty for not having health insurance is still there, they just lowered it to $0. If I changed the penalty for a felony conviction to no consequence, you're still a felon. It's pure gamesmanship.

Being a felon still has negative consequences external to jail time, whereas breaking the "mandate" has none.  Is a mandate with no penalty really a mandate?  Seems more like a suggestion at that point.

But the mandate is still the law, just gaming the system to $0 doesn't change that. The next budget bill could change it back to >$0.

[FIRE 20/20]

We're rich, so we'll be fine, but the healthcare situation in the US is a disaster and believing that magic will happen and everyone will be taken care of is just dreaming.  If presented the option to write a check for $500k to have 100% coverage for the rest of our lives, I'd likely do it.

Read my post more carefully, I never said everyone will be fine. I said "money buys options", including moving to another country.

I think we're completely in agreement here. You and I and virtually everyone reading this will be fine. Others, maybe, maybe not.

It depends on what you define as "fine".  I am very healthy and have healthy family members, but I do have a couple of pre-existing conditions that completely prevent me from getting insurance without the ACA or something similar.  I don't have any way to get citizenship in another country with decent health care, and an extended emergency room visit or cancer treatment could cost hundreds of thousands of dollars.  I agree that having more than enough money to FIRE puts me in a relatively great position, but without the ACA or something similar I'll be in a really tough position if something severe happens.  Medical tourism only works if you can actually travel to wherever you're going to get care, and after an accident or dealing with a long-term condition doesn't always make travel possible. 
With that said I generally take your point - people here will generally be in a vastly better situation that other people if the ACA disappears, but I think that "fine" probably isn't accurate if they're dealing with or get hit with a serious and expensive condition.