It’s hard to find objective infirmation on the ACA. I’ve heard what medical colleagues think about it, what American politicians say and have read books from both sides. I know what many Canadians think. I am an emergency physician, trained in family medicine and have dipped my toes into a lot of other areas.
Most Canadians support public care with government as the single payer. Canadians generally pay nothing out of pocket for emergencies, basic care, deliveries, surgeries and specialists. Dental care, medicines, optometry and psychologists are not always covered by public plans. Taxes are significantly higher, of course. Overall, the system was generally adequate before Covid. Canadian surgeons, in particular, often disagree. Other Canadians often thought Obamacare should go further. It was much weakened when made optional at the State level since a few people require a lot of care. The people requiring little care balance costs out. The focus is still largely on treatment and not prevention.
The Republicans obviously did not come up with a focused plan for all their criticism - having the House and Senate but not doing much. And many think the Democrats lacked courage and added too much water to the original to respect current stakeholders.
So, since information is hard to come by from unbiased sources, I ask you:
Overall, how would you rate the ACA?
For you, what have been strengths and weaknesses?
What should be done next?
(Since this is an Internet forum you are encouraged to keep private matters private.)
Before Obamacare I was denied single coverage due to pre-existing conditions. My current employer does not have a group health plan because it’s only 5 people and all of the rest have other sources of insurance (spouse, Medicare), so I would still be without insurance if there was no marketplace where the insurers can’t look at your pre-existing conditions before offering coverage. My employer is able to pay for my marketplace coverage through a small employer health reimbursement arrangement so I don’t pay income tax on it and no one pays payroll tax on it, just like would be the case for a group health plan.
As far as I can tell, the system works absolutely perfectly. Premiums did go up a lot while I was still unemployed and surviving off my mother, but they’ve plateaued since I’ve found work and have been paying for my insurance through my labor. 2020 was less than 2019 and I even got some of my premium back from 2019 because they didn’t spend enough. If it keeps up I might not even qualify for the full reimbursement amount.
I’ve had a standard corporate job all through this time, so for me there was never any question about having some kind of health plan. However, Obamacare improved the variety of plans available to me. In particular, they started offering a high-deductible plan coupled with an HSA, which is ideal for my personal circumstances.
I think the US should have some form of universal health care, probably single-payer, so in that sense Obamacare didn’t go nearly far enough. But for me it has been a win.
Worked great for me. As I understand it, and I could be wrong, NY Marketplace is not exactly Obamacare, but meets the requirement of it, so sort of it by exceeding it. I now have real coverage that actually covers stuff and though I have had medical expenses there was no charge to me I felt was high, previous I had what turned out to be a sketchy private insurer that, thinking I had good insurance, cost me about $10K out of pocket for a 12K bill.
it was a mash up of private industry and public provision. It took the worst of both worlds and exluded the good (mostly, what little good there was, namely the pre-existing conditions rule, was very good) I got punished for not paying for something I couldn’t afford, I got punished for living somewhere that refused to expand medicaid, which I made too much money to qualify for, I got punished for refusing to play into the scam that it worked out to be. Obamacare was either too much or not enough, it amounts to the same thing in the end. A good idea butchered and destroyed and perverted into worse than nothing.
To clarify here, because I scared myself for a minute on this: I received less back as a rebate from my premium than I spent on health care expenses over and above the amount my employer reimbursed me tax free, as I always have hit the cap for these plans.
I got laid off from my old job at the beginning of 2015, and wound up working as a freelancer for 2 1/2 years, before getting another full-time gig which offered health insurance. I kept my old insurance from the old job through COBRA through the end of 2015, and then bought an ACA policy which I carried for 2016, and the first half of 2017, until I was covered by my new employer.
I have type 2 diabetes, and had the ACA (and its provision preventing insurers from denying coverage due to pre-existing conditions) not been in effect, I would almost undoubtedly not have been able to get health insurance once I could no longer be covered under my old employer’s policy via COBRA (which would have occurred in mid-2016, as I understand it).
I like the slowish expansion idea. Biden talked about getting Medicare down to age 60. That is a good step. Find other ways to expand coverage. Keep improving it.
Also, I forgot to mention that I save a ton of money on prescriptions just from being a Blue Cross policy holder. Blue Cross doesn’t pay the pharmacy a dime, but still allows me to pay 1/5 of what the pharmacy would charge someone who didn’t have any kind of insurance. I (paid by my mother) had to pay those prices for at least a year (I forget because it was an absolutely awful period of my life) just to survive before the Marketplace opened. I don’t cost Blue Cross anything at all beyond any other member who never makes a claim, yet I receive a huge benefit in exchange for my premium.
I don’t think people give enough credit to the ACA for requiring that insurance policies cover annual physicals, vaccinations such as flu shots, birth control methods. I have friends who say things like, “Aw, she lost her job? She should go on Obamacare!” as though the subsidies were the whole point.
Personally, I have employer-paid insurance, and my husband and daughter have individual plans. In purchasing those plans, even though we don’t qualify for subsidies, we did benefit from the ease of shopping on the Marketplace.
I’m a sole proprietor of a business with no employees. I lost my traditional (stupid employer-sponsored) health insurance when my husband died unexpectedly 13 years ago. It was great insurance, but the costs to COBRA after my husband’s death were shocking. Still, I used it for the allowable 3 years. They made some good money off me for those years, I can tell you.
When my access to COBRAed health insurance expired, I found out I had a preexisting condition I didn’t even realize I had. I’d seen an orthopedic surgeon about intermittent numbness in my hands a couple years before my husband died. His told me I had mild spinal stenosis and that at some point, I’d probably have to undergo surgery – but to postpone that surgery for as long as possible. I promptly forgot about this medical appointment until I applied for regular insurance 1 month before the 5-year limitation for reporting the appointment expired. Due to this “preexisting condition,” the only insurance company that serviced my area for sole proprietors deemed me “high risk.” At that point, I was priced right out of the market.
I limped along until Obamacare was enacted with a catastrophic-coverage-only high deductible plan. (Incidentally, if Obamacare hadn’t been enacted and I ever needed richer coverage, I was precluded from purchasing it for a 2-year period because of using a high deductible catastrophic care plan.)
Thankfully, Obamacare was enacted and I was able to obtain regular coverage at a reasonable cost. Because the Sword of Damocles sways above the full ACA, I have not wished to disclose any information to a physician that might constitute a new “preexisting condition” until I qualify for Medicare. So now, my situation is reduced to seeing a doctor who wants to provide good care but cannot, because I cannot be completely honest with her about all my medical concerns. Great system we’ve got.
I still haven’t had the surgery to fix my spinal stenosis. The problem hasn’t worsened. Other than routine preventive care, I haven’t used my medical insurance. If the Supreme Court does away with the ACA, I’ll probably go back on a catastrophic care plan until I reach Medicare age. I spend a lot of time making sure I don’t take a bad fall.
I rate the ACA as very poor.
I lost my doctor, I lost my allergist, I lost the great healthcare I had from my employer because they had to meet ACA. My deductible went from $200 to $3,000, and my prescription coverage went from $20 to $250. I, a single male, now have to be on a plan that gives me pregnancy coverage.
What should be done next? Scrap the damn thing, and go back to the original plan.
It hurt me very slightly. My now wife (at the time fiancee) had to pay more for insurance because her previous plan didn’t cover pregnancy and the new one that did cost more (pregnancy is actuarily expensive). It wasn’t for that long (we got married and my employer’s coverage started covering her), so total extra cost to us was in the hundreds of dollars.
Overall, I’d rate the ACA as middling. It’s a complex hodge-podge of a law that ended up passed not-quite-fully-baked after the Democrats lost their 60th Senate vote and I’m concerned that the unexpected consequences of it will be large and possibly negative. I think it’s an improvement over the previous system, but I worry that by further entrenching private insurance companies and not getting rid of the employer/healthcare link it’ll be harder to get to an actually good healthcare system, instead of just a less horrible one.
I think that the path to a healthier population is mostly through things that aren’t part of the “healthcare” system.
It’s always kind of crazy to me that dentistry is often not covered under employer/government health care. The cost of prophylactic dental care is absurdly cheap compared to expensive later interventions, and basically everyone needs it. Lots and lots of people would be totally fine if they skipped going to the doctor for a decade. Skip going to the dentist and they’d have major problems down the line.
The Canadian government, according to my paper today, priced the cost of covering dental care at $1.5 billion (many have private coverage). If true, that seems a remarkable bargain to me compared to many government expenses and should be pursued.
My health insurance costs increased significantly the first enrollment period after the ACA was enacted, and increased every year after that. Furthermore, things that used to be at least partially covered (with copay) got lumped into the annual deductible, which also increased significantly.
When I lost my employer-backed health insurance, the zeroing of the individual mandate was helpful, when it came to tax time. I found I could not afford health insurance at all on my own and am without health insurance at this time.
Was forced out of my job in 2013, and spent the rest of that year looking for work, unsuccessfully. In the fall of 2013, I was able to buy insurance through the marketplace with subsidies, which made insurance affordable for us to buy (we had been paying through the nose for a bare-bones plan from the time I became unemployed). Then on January 1, 2014, we finally had pretty damn good insurance again, and it was at a price we could afford. This also allowed me to slowly grow our family business, without worrying about working a full-time jobs somewhere just to have insurance.
For the past seven years, we’ve had affordable insurance that wasn’t tied to an employer. For the past three years, I’ve worked full time at the business my wife and I started. In short, without the ACA, we wouldn’t be working for ourselves right now, and if the ACA goes away, likely so does our business.
I give the ACA a high B+.
Strength: We’ve been able to have good affordable insurance. My wife and I have had a couple surgeries in the past three years that haven’t ruined us financially. Weakness: The amount of subsidy is entirely tied to income. As self-employed people, when we’re applying for coverage each year, we have no idea how much we’re going to make. We’re also in that strange income place where our kids still qualify for the MI-KIDS insurance, so they can’t get on our plan, and it becomes harder to find offices that take both our insurance and our kids. Also, we continue to pay much more in premiums as we make more money (less in subsidies)-- the amount of increase in premiums seems to be higher than the amount of increase in our income, but maybe that’s my imagination.
What should be done next? I don’t know, this kind of stuff is above my pay grade. I’d ultimately love something that doesn’t tie your insurance costs to your income. Is that even possible? Oh and less billing. I had hernia surgery and got invoices and bills from like five different entities. Luckily the insurance paid the bulk, but still…
When I was unemployed I tried to apply, only to be told I made too much in UI each month to qualify for medicaid but too little each year to qualify for an ACA subsidy. So I got nothing. Some people benefit from it, but if your work is seasonal or your income changes month to month its pretty much useless.
Overall the law is fairly poor and compromised too much. It should be replaced with something like ‘medicare extra for all’ (which is more feasible than medicare for all) which auto enrolls the uninsured in a public option type plan and uses a wide range of cost saving measures to reduce medical expenses.