# Back in 2009: If you could make 5 changes to ACA, what would they be? **URL:** \ **Category:** Politics & Elections\ **Created:** [November 18, 2014, 1:20am UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926 "2014-11-18T01:20:48Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [November 18, 2014, 6:25pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/21 "2014-11-18T18:25:41Z")
I think mandatory contraception coverage was a mistake as it alienated a huge number of religious conservative Catholics. I think it was a major mistake to take so long to implement the system. While I think one universal system is the best; I think a system where everyone goes into the public system unless they select an alternative individual coverage (like Medicare advantage works) would be OK. I think it is a fundamental mistake to tie health insurance to employment–just like it would be a mistake to tie housing to employment. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [November 18, 2014, 7:44pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/22 "2014-11-18T19:44:04Z")
> [@DigitalC](#): > > You can’t deny coverage for preexisting conditions under ACA, and changing that is not one of your changes. If a patient is uninsured, and breaks his leg, and \*then \*buys insurance, does the insurance company have to pay for the broken leg? Or do they provide coverage, just not for that injury? ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 18, 2014, 8:07pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/23 "2014-11-18T20:07:06Z")
> [@ElvisL1ves](#): > > Missing the point. The ability of insurance companies to deny coverage of pre-existing conditions would often keep people from going to a new employer, or be entrepreneurs, since their or their family member’s conditions would no longer be covered. I think that’s only true for entrepeneurs. Group (employer) plans covered pre-existing conditions before ACA. ACA made the change to individual plans, which did not. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [November 18, 2014, 8:16pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/24 "2014-11-18T20:16:02Z")
> [@ElvisL1ves](#): > > Missing the point. The **ability of insurance companies to deny coverage of pre-existing conditions would often keep people from going to a new employer,** or be entrepreneurs, since their or their family member’s conditions would no longer be covered. Not missing the point. Pre-PPACA, HIPAA already prevented those pre-existing health conditions from being held against you when transferring employers. Portability was not a new idea with the PPACA. The PPACA just handles it in a different manner. The protection could have been increased, sure. As you point out there was no requirement to issue an individual policy allowing a person to strike out on the entrepreneurial path. But there was portability protection from one employer sponsored plan to another so long as nearly continuous coverage was maintained. And my position #4 of my changes covers the portability issue. My idea is that if you lose your job for any reason you get a special enrollment period. As it stands now if you lose your job and begin COBRA payments you do NOT get a special enrollment period (when you can buy any plan without health qualification) if you lose COBRA coverage due to non-payment. You have to exhaust your COBRA coverage first or plea for a special exception. ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [November 18, 2014, 8:29pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/25 "2014-11-18T20:29:01Z")
> [@BobLibDem](#): > > Can’t buy these two. If someone commits medical malpractice you deserve to be compensated fairly as determined by the courts. To permit policies across state borders would mean that all insurers would instantly flock to the state most willing to insist on the lowest level of regulation. No, I do NOT want my health insurance to be regulated by Mississippi. Alas, I am empathetic to limits on damages. I support unlimited actual damages, but see limiting punitive damages as a necessary evil to attempt to restrain the growth in the cost of health care. I grew up in a state border area and for many area residents the closest “good” hospital was just across the state line. I want to be certain that state borders do not artificially cause an unnecessary burden to those on the wrong side of a political boundary. Perhaps there is a better way to do this? And since I wasn’t proposing any substantial changes to coverage, even those policies sold from Mississippi would still have to cover all the same stuff to meet qualifying coverage requirements in states with more tightly regulated markets. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 18, 2014, 9:03pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/26 "2014-11-18T21:03:48Z")
> [@Iggy](#): > > As it stands now if you lose your job and begin COBRA payments you do NOT get a special enrollment period (when you can buy any plan without health qualification) if you lose COBRA coverage due to non-payment. You have to exhaust your COBRA coverage first or plea for a special exception. COBRA cost being exorbitant and virtually unaffordable to all but a few, its details and its portability provisions are largely abstract concepts. In the real world of real family finances for most, yes, changing jobs meant losing coverage. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 18, 2014, 9:11pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/27 "2014-11-18T21:11:13Z")
> [@ElvisL1ves](#): > > COBRA cost being exorbitant and virtually unaffordable to all but a few, its details and its portability provisions are largely abstract concepts. In the real world of real family finances for most, yes, changing jobs meant losing coverage. This is nonsense. The cost of COBRA coverage is set by law, and is the per capita cost to the employer (for their employee plans) plus a 2% load for administrative fees. What may have confused you - assuming you didn’t just make it up out of the whole cloth - is that the cost of COBRA to the employer is thought to be pretty high, since people who elect this coverage tend to be sicker than average, while the employer can only charge based on the average cost of their employees. But a lot of people elect COBRA coverage and the rates they pay are probably lower than what they would pay for plans on the ACA exchanges. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 18, 2014, 9:15pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/28 "2014-11-18T21:15:20Z")
COBRA premiums are on the order of $600 per month per person, or far higher than in a corporate group plan or in an Obamacare plan. That is exorbitant by measures most would consider reasonable, and unaffordable to most, especially the unemployed. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 18, 2014, 9:19pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/29 "2014-11-18T21:19:14Z")
Here’s what the [DOL](http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html) says: > [@](#): > > Your group health plan can require you to pay for COBRA continuation coverage. The amount charged to qualified beneficiaries cannot exceed 102 percent of the cost to the plan for similarly situated individuals covered under the plan who have not incurred a qualifying event. In determining COBRA premiums, the plan can include the costs paid by employees and the employer, plus an additional 2 percent for administrative costs. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [November 18, 2014, 9:19pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/30 "2014-11-18T21:19:27Z")
> [@BobLibDem](#): > > Can’t buy these two. If someone commits medical malpractice you deserve to be compensated fairly as determined by the courts. $50,000 for a broken arm is one thing; $5 million is another. (Hypothetical figures.) ---
**Author:** ![Iggy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iggy/32/3364_2.png) [@Iggy](https://boards.straightdope.com/u/Iggy)\ **Post date:** [November 18, 2014, 10:35pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/31 "2014-11-18T22:35:01Z")
The issue with COBRA coverage is that the former employee now must pay the full cost of the coverage plus the 2% admin fee. Many employers cover a portion of that premium. I pick on COBRA coverage in particular as indeed sicker people tend to keep COBRA, particularly if currently ill. But a person currently losing his job may tend to think he can find a new one quickly and be in for a rude awakening as income drops but health care premiums rise sharply. Don’t bind such a person into potentially 18 months of struggling if they make the mistake of starting COBRA. Let them out have a special enrollment period to buy coverage on a guaranteed issue basis with any subsides he may qualify for. If no special enrollment period is granted he can still but a policy, but it will be subject to medical underwriting. By granting an automatic special enrollment period to the unemployed the insured person can make the decision between COBRA and a market policy then and change to a market policy if it is a better financial decision. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [November 18, 2014, 11:45pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/32 "2014-11-18T23:45:36Z")
> [@Fotheringay-Phipps](#): > > Here’s what the [DOL](http://www.dol.gov/ebsa/faqs/faq-consumer-cobra.html) says: I think you are missing the point that Elvis is making (and for the first time in I think ever, I agree with him :)). When you are using COBRA, that means you are now unemployed. You have no income. So it is no comfort that you can now have coverage for what previously came out of your check PLUS what your employer paid behind the scenes PLUS a 2% administrative fee. You have no paycheck for your previous contributions to come out of, plus are likely scurrying and losing sleep over how to make the mortgage payment next month. To slap a $1600/mo health insurance bill on top of that for your family is absurd. You will do without health insurance unless, as mentioned above, you are very unhealthy, which keeps mostly sick people on the employer’s plan. Show me someone who signed up for COBRA, and I’ll show you a person with health problems. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [November 18, 2014, 11:49pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/33 "2014-11-18T23:49:24Z")
> [@jtgain](#): > > I think you are missing the point that Elvis is making (and for the first time in I think ever, I agree with him :)). I _knew_ you could do it. 😉 ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 18, 2014, 11:51pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/34 "2014-11-18T23:51:55Z")
I was responding to Elvis’ claims that the cost were exhorbitant, which was a factually untrue claim. And his claim that it’s “virtually unaffordable to all but a few” is also factually incorrect - there are quite a lot of people who elect COBRA. You’re saying despite the costs not being exhorbitant, it would be hard to afford for someone who lost their job. Agreed. But the costs of exchange plans would also be pretty high for someone who lost their job. The cost of COBRA coverage would not typically be higher than the cost of a comparable plan on the exchange - probably lower, in fact. [I’ll grant that the subsidies for low income people can change things. If the issue is the low income subsidies, that’s a different discussion.] > [@jtgain](#): > > Show me someone who signed up for COBRA, and I’ll show you a person with health problems. FWIW, the typical actuarial assumption is that a person on COBRA costs about 1.5x the cost of an average active employee. ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [November 19, 2014, 12:37pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/35 "2014-11-19T12:37:41Z")
The thing is, when you go to COBRA you’re paying for the entire cost of the insurance when you’ve been used to paying for just the employee’s share, typically less than 10% of the cost. That’s what has been keeping people “trapped” in their jobs, being unable to afford the interim period between losing coverage from job A before coverage begins from job B. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 19, 2014, 2:52pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/36 "2014-11-19T14:52:58Z")
You’re conflating two situations. People are not trapped in their jobs because of COBRA. COBRA is generally not relevant to people who are contemplating switching jobs, because they would typically get coverage at their new job. (And if their new job doesn’t have coverage then they have bigger problems than the cost of COBRA, which is time-limited.) The affordability of COBRA coverage is being discussed in the context of people who _lose_ their jobs - a lot of these people wouldn’t mind being “trapped in their jobs” but were laid off. [BTW, the typical employee cost-share for insurance premiums is between 20% and 30%; 10% would be unusually low.] ---
**Author:** ![BobLibDem](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/boblibdem/32/3149_2.png) [@BobLibDem](https://boards.straightdope.com/u/BobLibDem)\ **Post date:** [November 19, 2014, 3:07pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/37 "2014-11-19T15:07:03Z")
> [@Fotheringay-Phipps](#): > > [BTW, the typical employee cost-share for insurance premiums is between 20% and 30%; 10% would be unusually low.] I’m just one data point but I personally pay 15% of my health care premium. Have no idea if I’m typical. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 19, 2014, 3:25pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/38 "2014-11-19T15:25:02Z")
I do - you’re on the low end. [Not really relevant to the discussion here, but you should know you’re getting a good deal from your employer :)] ---
**Author:** ![Ethilrist](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ethilrist/32/4604_2.png) [@Ethilrist](https://boards.straightdope.com/u/Ethilrist)\ **Post date:** [November 19, 2014, 3:41pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/39 "2014-11-19T15:41:27Z")
Start development on the web page sooner, with greater emphasis on robustness, capacity & bandwidth issues, so it’s ready to go on day one. ---
**Author:** ![Fotheringay-Phipps](https://avatars.discourse-cdn.com/v4/letter/f/d9b06d/32.png) [@Fotheringay-Phipps](https://boards.straightdope.com/u/Fotheringay-Phipps)\ **Post date:** [November 19, 2014, 3:48pm UTC](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926/40 "2014-11-19T15:48:32Z")
> [@Ethilrist](#): > > Start development on the web page sooner, with greater emphasis on robustness, capacity & bandwidth issues, so it’s ready to go on day one. To advocate this, you need to be aware of the considerations involved. Besides being an enormous undertaking in its own right, it was greatly handicapped by the Obama administration’s reluctance to release any regulations before the 2012 elections. Hindsight is 20-20, but knowing then what you knew then, that was a big consideration. [Previous page](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926.md?page=1) [Next page](https://boards.straightdope.com/t/back-in-2009-if-you-could-make-5-changes-to-aca-what-would-they-be/704926.md?page=3)