When I wrote Monday that we could expect a firehose of misinformation about the Affordable Care Act in the coming months, it didn’t occur to me that some of that misinformation would show up in the comments section of this newsletter. HEALTH CARE un-covered is a reader-supported publication.
The ACA plans are expensive plans most often highly subsidized by the federal government. Cost to government is likely greater than Medicaid or Medicare. Costs are far greater than employer costs. For a family not meeting income requirements for subsidization, plan premium could be $15,000 annually with an $18,900 annual deductible. Note, when subsidized the government picks up these costs.
Is this really cost effective coverage or simply another way of padding the pockets of payors and the legislators they support.
then are you a Medicare for anyone who wants it? that was the original proposal under Clinton that republicans torpedoed. Even Trump, before he drank the republican line stated "why don't we just give Medicare to everyone". that would cut the costs for anyone who wants to have government healthcare. I am on COBRA and the exchanges are crazy expensive but we all now pay the cost for GLPs, life saving biologics and other treatements where $750K is the cost.........We have to have the what will we pay for conversation as a country. ANd the subsidies are cheaper than paying the full cost of Medicare.
I am not a Medicare for all as I do not want a total government run system. The ACA is a further demonstration of poor government intervention. Government can pay for things but they shouldn’t be the sole party arranging things. Let the private sector build the models and compete for service and volume. Medicare Advantage is a good example.
An excellent summary. Do you think the Cadillac tax should have taken effect? It seems like large employers and unions provide generous benefits to avoid income tax, and that excess benefit should be taxed.
What is the current cap in who can receive a subsidy? Did Congress get rid of the 400% FPL cap? Is it now a percentage of income? I had heard that families making $250k could receive government subsidies.
“Enhanced” subsidies were passed to help during the Covid emergency? Why have and should the enhanced subsides be extended? Our federal government cannot afford it.
Our family of 4 pays $25,000/per year with $3000/person in network deductibles, $7000 out of network. The subsidization by the government drives up prices for the rest of us.
Thank you for your summary, Wendell. Folks forget or "misremember" as you said, how we got to a watershed point in 2008-2010 in the first place. Cost increases of health services and therefore health insurance was outstripping our GDP gains. It was unsustainable.
The ACA established baseline benefits and community rating to prevent the insurance atrocities seen in the 70s, 80s, and 90s. Additionally, it provided a mechanism for hospitals and physicians to get reimbursed for services to patients, who the previous year had no way to pay.
The ACA plans are expensive plans most often highly subsidized by the federal government. Cost to government is likely greater than Medicaid or Medicare. Costs are far greater than employer costs. For a family not meeting income requirements for subsidization, plan premium could be $15,000 annually with an $18,900 annual deductible. Note, when subsidized the government picks up these costs.
Is this really cost effective coverage or simply another way of padding the pockets of payors and the legislators they support.
Frankly, it’s ridiculous.
then are you a Medicare for anyone who wants it? that was the original proposal under Clinton that republicans torpedoed. Even Trump, before he drank the republican line stated "why don't we just give Medicare to everyone". that would cut the costs for anyone who wants to have government healthcare. I am on COBRA and the exchanges are crazy expensive but we all now pay the cost for GLPs, life saving biologics and other treatements where $750K is the cost.........We have to have the what will we pay for conversation as a country. ANd the subsidies are cheaper than paying the full cost of Medicare.
I am not a Medicare for all as I do not want a total government run system. The ACA is a further demonstration of poor government intervention. Government can pay for things but they shouldn’t be the sole party arranging things. Let the private sector build the models and compete for service and volume. Medicare Advantage is a good example.
So true, the ACA was good for a small subset of people with preexisting conditions (and the payors and their lobbyists) and bad for everyone else.
Thank you
An excellent summary. Do you think the Cadillac tax should have taken effect? It seems like large employers and unions provide generous benefits to avoid income tax, and that excess benefit should be taxed.
What is the current cap in who can receive a subsidy? Did Congress get rid of the 400% FPL cap? Is it now a percentage of income? I had heard that families making $250k could receive government subsidies.
“Enhanced” subsidies were passed to help during the Covid emergency? Why have and should the enhanced subsides be extended? Our federal government cannot afford it.
Our family of 4 pays $25,000/per year with $3000/person in network deductibles, $7000 out of network. The subsidization by the government drives up prices for the rest of us.
Thank you for your summary, Wendell. Folks forget or "misremember" as you said, how we got to a watershed point in 2008-2010 in the first place. Cost increases of health services and therefore health insurance was outstripping our GDP gains. It was unsustainable.
The ACA established baseline benefits and community rating to prevent the insurance atrocities seen in the 70s, 80s, and 90s. Additionally, it provided a mechanism for hospitals and physicians to get reimbursed for services to patients, who the previous year had no way to pay.
Thank you for doing this follow-up!