“ACA-I: The Obama Care Hope”, subtitled: “Just enough to get America hooked” has been the law for about 6 years now. Nearly all of the provisions are in place, and now we are seeing results! About 2/3 of the people who were previously uninsured are now insured, and lots of people have better insurance for less money. On the other hand, there is a hole in the marketplace plan that does not supplement some people enough, there are a number of states that do not have enough insurers to provide competition, and there are other issues that have prevented the remaining ~10 million from getting insurance.
Six years into this, most people are at least OK with ACA-I, and at the same time we’ve seen where it has weaknesses. What would you suggest for improvements that will go into the sequel: “ACA-II: Hilary Care strikes back!”, subtitled “even better in the 21st century”
Some things I would like to see:
An option to buy into Medicare through the marketplace.
Fix the supplement hole in the marketplace.
Remove the ceiling on Medicare taxes (SS tax too, but that is a different thread)
Apply Medicare (and SS) taxes to investment income and some other unearned income.
Extend Medicare to kids up to at least age 18, preferably 26. Long term: all people get Medicare. Employers or individuals could then buy supplemental insurance from the private market to reduce co-pays or to get premium service.
In 8 years we can look forward to “ACA-III: Return of the ???”
I wish they had chosen the Medicare for all option. And why they do not let Medicare bargain with the drug companies is mind-boggling. There’s only one way to make it so Republicans work with Democrats to fix it right- formally rename it “ReaganCare”. Do that and Republican obstruction melts.
I agree with this completely, but ideally I’d prefer we do something similar to the estate tax where X dollar amount is tax free, but beyond that there is a tax.
I’m not sure what the level ought to be, but say something like anything over 10% of 100k per year investment returns gets taxed. At some point investments become your “job” and such people ought not have their income privileged over people who are actually earning an income with their labor.
Even if calling it ReaganCare would help push it through, I refuse to tolerate having that name attached to ANOTHER thing he had nothing to do with.
As for a public option… Yes, we should have it, and I have ZERO hope of us getting it until at least over a decade. We had one shot to get it done earlier, and we failed. The house across the nation is too influenced by gerrymandered districts and until we REMOVE republican control (I have zero hope they will get their anti government in nearly all things shit together, the dogma is too strong) I see no chance a public option will ever make it through.
We have to wait for millennials and others to get older and make up a higher percentage of the electorate, and for the older population to die off. This can only happen one funeral at a time, and that takes time.
With the notable exception of the Medicaid expansion, aka “public option for a lot more poor people than before.” (Offer not valid if your state legislature/governor are craven and/or heartless and/or clueless - thanks, Justices.)
(Also, I think that the new regulations on insurers make the ACA a pretty lean cut of pork altogether, but that’s a weedier topic.)
Eliminating the middleman, for one. Why should the government pay insurance companies to pay health care bills rather than just paying the healthcare bills directly?
Busting regional insurance monopolies is another bonus. Plus it’s step one on the path to UHC. Also, it changes “make them buy health insurance” into less of a “let them eat cake” scenario. If you’re going to mandate that people buy health insurance, you need to actually make it available and affordable to them, or else it’s nothing but a $700 tax on poor people. The government can do that, but it can’t force insurance companies to.
The OP seems to be using the amount of people who have insurance as the benchmark … “[T]here are other issues that have prevented the remaining ~10 million from getting insurance.” … That’s only about 3% the population and it’s not hard to imagine these folks just not wanting insurance … as long as the fines are substantially less than the performance, then we’ll always see a small group of people just paying the fines … it’s a $50 fee for the permit to block a city sidewalk with a concrete boom, but a $10 fine if they catch us without a permit … the good money is just not getting the permit …
The flaw with the ACA is that it only deals with the costs of insurance … expecting the insurance companies to compete for better profit … except the insurance companies have their profits guarantied by the re-insurance program … they don’t have a financial motivation to control the costs of the actual health care … in fact even with the same margin, insurance companies have higher profits with the higher costs of health care … 40% of $2 million is twice as much as 40% of $1 million … [ka’ching] …
It’s about trade-offs … we can substantially reduce health care costs (and the insurance) if we socialize the industry … in Japan, only the doctors who are practicing their medicine in a clinic are allowed to own shares of stock in that clinic; hospitals have no stock, they are non-profit … the downside is that raising capital to build a new hospital would almost have to be appropriated through Congress, and that could take decades …
When will we be able to tell the 12-year-old child that they can’t have a double lung, heart, kidney and liver transplant?
It would be fun to see a public option set up with benefits so good in such a way that private insurance companies would be barely, but only barely, be able to match. Challenge them to step up their game.
Take a look at the lavish headquarters and huge CEO salaries of the insurance behemoths. All that money comes from premiums that isn’t going to provide health care. Moreover, they all have staff whose jobs depend on finding ways to deny claims. Replace them with civil servants whose loyalty is to the public.
Right, sheds the fears of Big Gu’mit as well. On an even playing field (no preexisting condition refusals, no border limitations on service) I think the government can do a better job, if someone doesn’t believe that they still have no reason to refuse putting them both to the free market test. What are they afraid of? People wanting to pay more for worse care?
Businesses are rightly afraid of competing with taxpayer-subsidized, no-profit-motive government services. In most cases I agree the government should stay out of the market. But in the case of healthcare I say let the insurance companies burn.
That’s not the argument though. Is government run healthcare solvent.? That question stands on it’s own. If it is, I don’t care if insurance companies exist as long as there is a Public Option. If it is not, I and the rest of America would reevaluate the Public Option even being a goal.
Public Option or Medicare available to all, and allow negotiating with Pharmaceutical companies for volume discounts on their products, as is done in other civilized countries. That ability was stripped-out of Medicare Part D when is was implemented 10 years ago by, you guessed it, legislators in the pocket of Pharma.
The subsidization objection is valid, IMO, if you want a measure of the actual costs. Which isn’t to say that it is a reason to avoid the public option, but subsidizing something doesn’t make it more efficient.
The profit motive argument, OTOH, is nuts. There’s nothing in the free market theory that says that non-profit entities, government or not, cannot compete with private business on a level playing field. If it’s revenue neutral and provides more health care to more people for less total cost, it’s a success.