I don't understand what is being required as coverage under the ACA that people oppose and think is too fancy.
Someone mentioned mammograms. Is it because they are a man? Do they think I should get a discount since I don't need prostrate checks? Do they think prostrate exams are cheaper, and thus men should pay less? Should we divide out all gender-specific medical costs and charge different premiums based on gender?
The logic boggles me.
Someone could oppose the mandate based on the minimum actuarial value rather than the required covered benefits.
Perhaps this person is wealthy and healthy and carries only a critical illness indemnity plan or some other stop loss kind of product. They pay for what little regular health care they receive out of pocket and if something really bad happens, insurance covers it.
If that person wanted to do the same strategy under ACA, they'd have to pay the tax.
I would consider this to be a legitimate gripe with ACA.
Of course, I don't know how many people this actually describes vs. people who don't carry insurance b/c they think they're invincible but in reality they're a $10K bill away from medical bankruptcy.
You think someone wealthy enough to legitimately use that strategy cares at all about a $700 fine? Please. It's extremely unlikely they would be paying it anyway because nobody in that situation is getting a tax refund.
Well, no but I think there might be just a basic philosophical difference in the point of insurance.
When I was a kid (back in the dark ages), we didn't have insurance for much of the time. However, it was expected that you paid for your doctors and dentist appointments. Now the good and bad on that:
Good: you budgeted for this. Paying for your own medical care came before cable TV, eating out, computers, new clothing, vacations, etc. (some of these items were just coming out when I was growing up)
Bad: during lean times, you went to the dentist every 2-3 years and the doctor less frequently than that. Teeth are very important and dental hygiene is really important to health.
So it was expected that you covered the basics, and insurance (if you had it), covered the big stuff. (I had to have surgery twice when I was 12, no insurance, my parents paid that off for 5 years).
Now, other philosophy: an ounce of prevention is worth a pound of cure.
For whatever reason, people don't go to the doctor when they are ailing. For some (even people my age), they would get mad at a copay for an annual exam. The whole cost sharing thing was an affront, and these are upper middle class people.
For others, they just can't afford it. A $25 copay? No money for that. So the problems are left to get worse. Infections. Bad teeth. High cholesterol. Pre-diabetes. Wait long enough and you have very very expensive, bad problems.
The good thing about the ACA is that preventive things are fully covered. So if it really does result in people going to the doctor, getting diagnosed, and fixing things before they get worse, then it is worth it in the long run.
For me, I fall in a gray area. I totally understand the point of expecting people to use insurance for catastrophic things only. On the other hand, insurance companies suck and deny deny deny - I really don't think people should die because they cannot afford insurance and treatment, and I also don't think people should be bankrupted due to health / medical issues (I also believe we spend too much on treatment.)