Author Topic: What comes after the ACA?  (Read 1349001 times)

Exflyboy

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Re: What comes after the ACA?
« Reply #6050 on: July 12, 2020, 02:36:16 PM »
What constitutional rationale do you think SCOTUS would rely on to strike down the ACA?
The case was the Individual Mandate was a mandate and  therefore unconstitutional.  Roberts ruled last time that it wasn't a mandate because the penalty was tied to a tax, therefore no mandate, therefore constitutional.  Since the penalty was set to $0, they argue it is a mandate now, and therefore unconstitutional.  It is an absurdity, a mandate with no legal repercussions is not a mandate, it is a suggestion.  The suit is garbage.
The Congress of 2017 was not bound to abstain from changing the ACA or repealing it entirely.  This Congress had complete, legitimate    power to repeal the ACA when it passed the TCJA that included the provision that  lowered the individual mandate penalty to zero.

That Congress did not exercise its constitutional power to repeal the ACA will hardly be brushed aside by the Court when next term it hears the argument that it should strike down the ACA.
I'm sure that if the GOP had a filibuster-proof majority, they would have repealed it.  Thanks to the filibuster, they settled for setting the penalty to $0.

You mean repealed AND replaced it right?
That was always the mantra, wasn't it?  I don't believe in the caricatures each side projects on the other, so I can't imagine they'd want to go cold turkey.  Even if you think they don't care about those who would lose their insurance (and if you do, you seriously need to meet some people on the other side of the political spectrum and have a good chat), it'd be political suicide.

Well I think thats how they lost the house in 2018 cus they had nothing to replace it with.. Is that your view?

pecunia

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Re: What comes after the ACA?
« Reply #6051 on: July 12, 2020, 03:34:32 PM »
I think we can than the late hero John McCain for maintaining the insurance for millions of people.  He lost his life, but his vote saved many more.

SugarMountain

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Re: What comes after the ACA?
« Reply #6052 on: July 12, 2020, 03:52:16 PM »
What constitutional rationale do you think SCOTUS would rely on to strike down the ACA?
The case was the Individual Mandate was a mandate and  therefore unconstitutional.  Roberts ruled last time that it wasn't a mandate because the penalty was tied to a tax, therefore no mandate, therefore constitutional.  Since the penalty was set to $0, they argue it is a mandate now, and therefore unconstitutional.  It is an absurdity, a mandate with no legal repercussions is not a mandate, it is a suggestion.  The suit is garbage.
The Congress of 2017 was not bound to abstain from changing the ACA or repealing it entirely.  This Congress had complete, legitimate    power to repeal the ACA when it passed the TCJA that included the provision that  lowered the individual mandate penalty to zero.

That Congress did not exercise its constitutional power to repeal the ACA will hardly be brushed aside by the Court when next term it hears the argument that it should strike down the ACA.
I'm sure that if the GOP had a filibuster-proof majority, they would have repealed it.  Thanks to the filibuster, they settled for setting the penalty to $0.

The could have avoided the filibuster and used "reconciliation" to pass the repeal, that's how it was passed in the first place.  This has been one of the big arguments against it, that it was done in by using reconciliation thereby diminishing its authenticity.

The real problem is they had nothing to replace it with because it was basically a Republican plan modeled after the one done by Romney when he was governor of Massachusetts. Pretty much any other plan that requires folks with pre-existing conditions can get insurance are to the left of the ACA on the political spectrum, because those folks aren't profitable and need government involvement either forcing insurance companies to insure them, or through public healthcare of some sort (public option, Medicaid, etc). It's a shame that the insurance lobby owned enough Senators that Obama couldn't get a public option through. Taxes might have ended up slightly higher, but insurance costs would be way lower.

One only need to look at United Healthcare's stock over the last 10 years to see who the big winner is of ridiculous premiums.

sherr

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Re: What comes after the ACA?
« Reply #6053 on: July 12, 2020, 07:50:59 PM »
That was always the mantra, wasn't it?  I don't believe in the caricatures each side projects on the other, so I can't imagine they'd want to go cold turkey.  Even if you think they don't care about those who would lose their insurance (and if you do, you seriously need to meet some people on the other side of the political spectrum and have a good chat), it'd be political suicide.

No it wasn't "always" the mantra, unless you only count what Republicans themselves tell people on TV. The closest they ever came to repealing the ACA was the "repeal and don't replace" plan. That's the one that famously fell one vote short of passing thanks to McCain.

None of their "and replace" "plans" were popular enough within their own party to get very far. The have no "and replace" ideas. Unless of course you count Trump's "everything will be great and magical, I'll tell you about it after the election" "plan".
« Last Edit: July 12, 2020, 07:56:02 PM by sherr »

Exflyboy

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Re: What comes after the ACA?
« Reply #6054 on: July 13, 2020, 10:12:44 AM »
It would probably make me more money to actually have the ACA repealed.. based on the extra dividends the insurer will pay me through my index funds.

But I am morally outraged that the GOP would happily throw people off their crappy healthcare, so for that reason alone I will be delighted when this bogus lawsuit gets thrown out.. and even happier when (I hope) Trump gets his ass handed to him in November!

Although I'm not counting it.

jim555

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Re: What comes after the ACA?
« Reply #6055 on: July 14, 2020, 05:47:10 PM »
Trump administration asks U.S. Supreme Court to revive Medicaid work requirements
https://www.reuters.com/article/health-medicaid-work/trump-administration-asks-u-s-supreme-court-to-revive-medicaid-work-requirements-idUSL2N2EL24D

When you fail to change the law, have the courts do your dirty work.

Nothing is the law permits work requirements.  Some states have tried to back door a work requirement via a 1115 waiver.  The courts have rightly struck down these attempts as arbitrary and capricious. 

talltexan

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Re: What comes after the ACA?
« Reply #6056 on: July 16, 2020, 04:48:47 PM »
What constitutional rationale do you think SCOTUS would rely on to strike down the ACA?
The case was the Individual Mandate was a mandate and  therefore unconstitutional.  Roberts ruled last time that it wasn't a mandate because the penalty was tied to a tax, therefore no mandate, therefore constitutional.  Since the penalty was set to $0, they argue it is a mandate now, and therefore unconstitutional.  It is an absurdity, a mandate with no legal repercussions is not a mandate, it is a suggestion.  The suit is garbage.
The Congress of 2017 was not bound to abstain from changing the ACA or repealing it entirely.  This Congress had complete, legitimate    power to repeal the ACA when it passed the TCJA that included the provision that  lowered the individual mandate penalty to zero.

That Congress did not exercise its constitutional power to repeal the ACA will hardly be brushed aside by the Court when next term it hears the argument that it should strike down the ACA.
I'm sure that if the GOP had a filibuster-proof majority, they would have repealed it.  Thanks to the filibuster, they settled for setting the penalty to $0.

You mean repealed AND replaced it right?
That was always the mantra, wasn't it?  I don't believe in the caricatures each side projects on the other, so I can't imagine they'd want to go cold turkey.  Even if you think they don't care about those who would lose their insurance (and if you do, you seriously need to meet some people on the other side of the political spectrum and have a good chat), it'd be political suicide.

Well I think thats how they lost the house in 2018 cus they had nothing to replace it with.. Is that your view?

The House passed the American Health Care Act in Spring of 2017. Senate took a series of votes culminating with McCain's famous "no" vote on the "skinny repeal", which would have basically left "replace" for another action of Congress. The Senate was never able to pass anything like AHCA.

pecunia

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Re: What comes after the ACA?
« Reply #6057 on: July 16, 2020, 09:48:40 PM »
I just don't get why they are so opposed to poor folks being able to go to the doctor.  Won't it help the rich people in this country to have a healthy work force to help make money for them?  Seems like a worthwhile investment and rich people have hired a lot of smart people to do their thinking for them.  How come the rich haven't told the GOP to back off a bit?  I mean, Trump is one of their own, a little crazy, but still one of their own.  He was born with a silver spoon in his mouth.

I can sort of understand the race thing.  They don't want healthy minorities, but doesn't the increase of riches even supersede this interest?  There is more money to be made from having people be healthy rather than sick.  Look how much money was made in the cotton fields 150 years ago.  History repeats itself, man.

Maybe, I should write a letter to the Koch brothers and their buds.  They are getting bad advice.

Paul der Krake

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Re: What comes after the ACA?
« Reply #6058 on: July 16, 2020, 11:10:02 PM »
Politics is driven in large part by gut, not rational thought. And deep down, we are all hardwired to distrust people who are too different from us.

If you're a poor American, you might as well be a different species. The American upper middle class has more in common with their international counterparts that live thousands of miles away than with the residents of the low-income neighborhood across the railroad tracks. Sure we come up with explanations like "incentive to work" and "fiscal sustainability", but it's much more primal than this.

pecunia

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Re: What comes after the ACA?
« Reply #6059 on: July 17, 2020, 06:05:21 AM »
I can see no reason as to why you are not correct.  I'd guess most of them will take their dogs to the vet when they are ill.

"Let me tell you about the very rich. They are different from you and me. They possess and enjoy early, and it does something to them, makes them soft, where we are hard, cynical where we are trustful, in a way that, unless you were born rich, it is very difficult to understand." - F. Scott Fitzgerald

talltexan

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Re: What comes after the ACA?
« Reply #6060 on: July 17, 2020, 07:21:14 AM »
I just don't get why they are so opposed to poor folks being able to go to the doctor.  Won't it help the rich people in this country to have a healthy work force to help make money for them?  Seems like a worthwhile investment and rich people have hired a lot of smart people to do their thinking for them.  How come the rich haven't told the GOP to back off a bit?  I mean, Trump is one of their own, a little crazy, but still one of their own.  He was born with a silver spoon in his mouth.

I can sort of understand the race thing.  They don't want healthy minorities, but doesn't the increase of riches even supersede this interest?  There is more money to be made from having people be healthy rather than sick.  Look how much money was made in the cotton fields 150 years ago.  History repeats itself, man.

Maybe, I should write a letter to the Koch brothers and their buds.  They are getting bad advice.

Part of it is that ACA was basically a heritage foundation plan, with many details worked out by MIT economics professors (who used to be pretty dang conservative Pre-Trump); these were the same MIT professors who'd helped Gov. Romney with the Massachusetts plan. Part of the indignity was that Obama essentially stole the clothes of conservatives to get it done because no more liberal plan could have passed Congress even with 59 Democrats in the Senate. So he left almost no way for a productive backlash to happen. The surest sign of this was in the structure of the American Health Care Act passed in 2017, which basically accepted the logic of Obamacare in having almost the same structure.

sherr

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Re: What comes after the ACA?
« Reply #6061 on: July 17, 2020, 07:31:57 AM »
Part of it is that ACA was basically a heritage foundation plan, with many details worked out by MIT economics professors (who used to be pretty dang conservative Pre-Trump); these were the same MIT professors who'd helped Gov. Romney with the Massachusetts plan. Part of the indignity was that Obama essentially stole the clothes of conservatives to get it done because no more liberal plan could have passed Congress even with 59 Democrats in the Senate. So he left almost no way for a productive backlash to happen. The surest sign of this was in the structure of the American Health Care Act passed in 2017, which basically accepted the logic of Obamacare in having almost the same structure.

Democrats passing a largely conservative healthcare reform = "the unreasonability of the backlash is Obama's fault because he left no path for reasonable backlash".

This is not even close to the first time you've used similar logic to blame Democrats for Republican's failings. I know you're no fan of Trump, but this seems to be a pretty obvious bias. Aren't Republicans supposed to be the party of personal responsibility? Why does that not extend to them taking responsibility for their own actions?

talltexan

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Re: What comes after the ACA?
« Reply #6062 on: July 17, 2020, 08:35:32 AM »
@sherr, thanks for responding: I've seen enough of your posts to know that you are thoughtful, so I will attempt to be sincere here, when I often fall short of that standard. Maybe "blaming" isn't the impression I want to give. Rather that there isn't a productive policy direction conservatives can go, so they just angrily grabbed the steering wheel of the country away from Democrats.

I think the ACA was reasonable, as it was a way to make some progress at all, when many Democrats still had a bitter taste from the failure of reform in 1993-1994 (and even though that reform failed, they lost the House for twelve years). Obama pragmatically opted for that over a symbolic push for M4All, which Liebermann made clear he would block. He should not be held responsible for Boehner witholding republican votes at the last minute.

sherr

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Re: What comes after the ACA?
« Reply #6063 on: July 17, 2020, 09:29:13 AM »
@sherr, thanks for responding: I've seen enough of your posts to know that you are thoughtful, so I will attempt to be sincere here, when I often fall short of that standard. Maybe "blaming" isn't the impression I want to give. Rather that there isn't a productive policy direction conservatives can go, so they just angrily grabbed the steering wheel of the country away from Democrats.

I think the ACA was reasonable, as it was a way to make some progress at all, when many Democrats still had a bitter taste from the failure of reform in 1993-1994 (and even though that reform failed, they lost the House for twelve years). Obama pragmatically opted for that over a symbolic push for M4All, which Liebermann made clear he would block. He should not be held responsible for Boehner witholding republican votes at the last minute.

Yes there is. They could have been happy that they got what they wanted out of health care reform, and moved on to other issues and/or worked to improve the ACA as problems arose. You know, like you yourself sound like you want.

I agree with you on everything else, that the ACA was reasonable, that nothing closer to M4All could have passed at the time, etc. And I also think that you are a pretty thoughtful poster.

My point though is that the right assumes that Republicans always have to "yank the steering wheel to the right" on every issue. Which is not true. And when they do, and we find ourselves in crazyland as a result, a right-leaning tendency is to assign blame to both sides - to the Republicans for getting us here, but also to the Democrats for not giving them "space" to "correct" things to without ending up in crazyland. That it's really the Democrat's fault because they're too reasonable and too centrist that they've allowed the knee-jerk-to-the-right Republican party to shift the Overton window too much.

It's the Republican party's fault that the Overton Window is this far right, no one else's. It's the Republican party's fault that they "had" to make the ACA a partisan issue and obstruct-everything for 8 years and steal a Supreme Court appointee from Obama. And that's been an effective strategy, I'm not denying that. But the blame for the Republican's unreasonable reaction to the ACA lies solely on the Republican party, not on the Democrats for being "too centrist". If the Democrats propose a reasonable compromise (like the ACA) then the Republicans should join them and work with them, and if they don't they have no one but themselves to blame.

talltexan

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Re: What comes after the ACA?
« Reply #6064 on: July 17, 2020, 09:35:51 AM »
Indeed the Republicans don't work with the Democrats because they see their mission as preventing change. No progress is what they're trying to maintain. As long as reform is thwarted, they feel like they've served their voters.

And as long as they maintain power, there's not even that much danger of progress. So Republicans have successfully created a culture where they can properly weaponize fear of that progress to maintain their own power.

rmorris50

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Re: What comes after the ACA?
« Reply #6065 on: July 17, 2020, 05:01:42 PM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.


sherr

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Re: What comes after the ACA?
« Reply #6066 on: July 17, 2020, 07:30:22 PM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.

I don't know if anyone has statistics, but I think there's a ton of boomers who are in that situation right now actually. And probably me as well.

pecunia

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Re: What comes after the ACA?
« Reply #6067 on: July 17, 2020, 10:06:53 PM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.

I don't know if anyone has statistics, but I think there's a ton of boomers who are in that situation right now actually. And probably me as well.

I was doing it until quite recently and have known other for whom this situation was their reality.

How many businesses are not being started because people are hampered by this health care thing?  How many good ideas are stifled?  If someone could put cash aside and freely take six months or a year off to pursue some sort of new gadget, well, we'd have that new gadget.  Man, we could have the flux capacitor!

How many existing businesses are not doing as well as they could be doing because you've got people whose heart and soul are not in their vocation, but only plod along day after day to maintain their healthcare?

The GOP has always claimed to be the party of business.  They should get behind some sort of universal healthcare thing to stay aligned with their core values.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #6068 on: July 18, 2020, 06:14:28 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

American GenX

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Re: What comes after the ACA?
« Reply #6069 on: July 18, 2020, 07:25:37 AM »
I was going to FIRE in the spring of 2019.  I put that off a year at first and now until at least the spring of 2021 due to the ruling by the federal judge in Texas back in Dec 2018 and continued uncertainty as the case plays out and is to be heard by SCOTUS.

But I would never state that I'm working just for health care benefits.  If I wasn't getting paid as well, I would quit.

pecunia

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Re: What comes after the ACA?
« Reply #6070 on: July 18, 2020, 07:57:20 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

Mr nonunion hardhat I just don't think it is the same.  You can save to cover the food.  You can save to cover the housing.  However, healthcare costs can destroy your life.  It is true ruination both physically and financially.  I am sure you already know this.  Bucky, it just ain't the same.

It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it.  I don't see people getting stirred up about free food or housing. 

Paul der Krake

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Re: What comes after the ACA?
« Reply #6071 on: July 18, 2020, 09:08:16 AM »
Meh, if that were true, you'd see a much higher labor participation rate than in the rest of developed countries that do have universal coverage. But that's not the case.

rmorris50

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Re: What comes after the ACA?
« Reply #6072 on: July 18, 2020, 09:46:28 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

Mr nonunion hardhat I just don't think it is the same.  You can save to cover the food.  You can save to cover the housing.  However, healthcare costs can destroy your life.  It is true ruination both physically and financially.  I am sure you already know this.  Bucky, it just ain't the same.

It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it.  I don't see people getting stirred up about free food or housing.

Agreed. Another difference is the cost of health insurance can be substantially cheaper from an employer vs the individual market. Food and housing costs the same whether you're employed or not.

John Galt incarnate!

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Re: What comes after the ACA?
« Reply #6073 on: July 18, 2020, 10:22:15 AM »


It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it. 

That's the reason this  thread has 1,343,156 views.

People fear the unknown of the upper limit of the range of future healthcare costs.

« Last Edit: July 18, 2020, 10:41:09 AM by John Galt incarnate! »

zolotiyeruki

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Re: What comes after the ACA?
« Reply #6074 on: July 18, 2020, 11:11:03 AM »
How many people work just for the health benefits, and how many people would stop working/retire if there was universal healthcare. I have no idea, but I wonder if that's the dirty little secret that never gets talked about. Republicans feel people have all the more incentive to work if families' healthcare depends on it, and thus keep the economic engine going.
I don't think it's logical to think of healthcare as unique here.  Or, put another way, "How many people just work so they can put food on the table," or "How many people work just so they can have a place to live?...Republicans feel people have all the more incentive to work if their housing depends on it...."  Healthcare costs money.  Of course more people will retire if you make it cheaper by making workers pay for it!

Having health insurance tied to employment is certainly an obstacle to be overcome, though.  Employers don't typically pay for their employees' mortgages (or a portion thereof), or pay for their groceries.

Mr nonunion hardhat I just don't think it is the same.  You can save to cover the food.  You can save to cover the housing.  However, healthcare costs can destroy your life.  It is true ruination both physically and financially.  I am sure you already know this.  Bucky, it just ain't the same.

It is a unique thing.  I guess if it wasn't people wouldn't be all stirred up about it.  I don't see people getting stirred up about free food or housing.
There's a distinction here that I didn't explicitly point out, that you're missing.  I'm talking about health insurance, not healthcare.  Employers sponsor health insurance, which costs a usually-predictable amount each month, similar to housing and food costs.

Agreed. Another difference is the cost of health insurance can be substantially cheaper from an employer vs the individual market. Food and housing costs the same whether you're employed or not.
That's true, in large part because in the individual market, you're evaluated on your individual risk profile.  And part of the issue with insurance is that some risk factors are things you can control (smoking, weight, etc), and others you can't (family history, accidents, etc).

seattlecyclone

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Re: What comes after the ACA?
« Reply #6075 on: July 18, 2020, 11:32:40 AM »
I think if people learned more about the ACA and trusted that it, or something better, would exist until they become eligible for Medicare, they wouldn't be so afraid of leaving their employer health insurance behind.

That said, health insurance isn't quite the same as food or other necessities that people buy with their paychecks. Employers buy the insurance for their employees, usually at a very significant discount, and often a better quality than is available through the ACA exchanges.

I know the employer-based coverage I left last year had a lower deductible than all but a few of the gold plans on my local exchange, a lower out-of-pocket maximum than any of them, and there were no premiums for employee-only coverage. If those were the only material differences, all you need to do is save up some cash and the ACA will work fine for you. Health insurance is expensive and people who are used to heavily subsidized coverage from their employers often don't realize how expensive it is, but saving up for it on your own is possible even if you have a spendypants retirement with no premium subsidies.

There is one more wrinkle though. The coverage I had through my former employer would pay for routine care across the US. None of the ACA plans available in my area will do that. They all have networks narrowly confined to within the state of Washington and some have little to no coverage outside the Seattle metro area. They'll all pay for "emergency" care anywhere because the ACA makes them, but you can expect them to try and argue against anything borderline being an "emergency" at all. Of the six companies offering coverage in my area, only one (Kaiser Permanente) will even cover urgent care out of network. None of the companies covers non-urgent visits. That's not a big deal for me and my healthy family, but could be a major source of concern if you have a condition that requires occasional routine services and you want to do any sort of extended travel ever.

Bringing it back to the food analogy, it's not just that your employer is giving you a discount on fancy meals, it's that the meals they're giving you aren't available at any price if you go it alone. Whether the less-fancy stuff will provide adequate nourishment depends a lot on the individual.

jim555

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Re: What comes after the ACA?
« Reply #6076 on: August 03, 2020, 08:27:29 AM »
Missouri will vote on Medicaid expansion through a ballot measure tomorrow.

pecunia

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Re: What comes after the ACA?
« Reply #6077 on: August 03, 2020, 09:41:10 AM »