Require states to accept Medicaid expansion (I have no idea of the mechanics to do that). Make it so every warm body in the country has either Medicaid, ACA or Medicare (VA & retiree plans count). Universal coverage between the 3.
Thank you for such an informative, concise synopsis.
+1. I haven’t seen such a concise and balanced summary. Thanks.
That was in the original ACA, and was struck down by SCOTUS.
Not yet. SCOTUS is hearing arguments about it this fall with a decision to come in 2021.
And of course on the original 2012 case, Justice Roberts saved the individual mandate.
ACA was more negative than positive for me. Positives, it made me sign up again for health insurance and I went to the doctor for a checkup for the first time in a couple decades. Negatives, premiums went sharply up each year, and I very much don’t appreciate being compelled by my country to give my money to a corporation.
My insurance was $75 per month 2 years before ACA. It went up sharply every year of ACA, at ~$400 per month or so I canceled. It’s not wise to go without the safety net, but for all practical purposes it’s just a huge amount of wasted money for me since I never go to the doctor.
Top to bottom disaster for me - I paid more to get less coverage when I was a W2 employee and during times when I was an independent contractor it was 10x as bad. I pay more in premiums now than I paid in rent at the time when I first moved out of my family house and began paying my own bills, for a plan that covers almost nothing. The gross financial impact is the main reason that ACA has been such a disaster for the responsible class (people who made sure to pay their own bills through employment income and carried insurance even when it was not mandatory to do so) but there 's all sorts of little annoyances too - the fact that there is one magic month per year when you are allowed to shop for plans, the pointless documentation requirements like getting a nonexistent form that shows you lost your job because you have to “prove you are eligible” to give thousands of dollars a year to a company that you are legally required to buy from before you can do so, etc. The fact that more thought was put into the Pajama Boy campaign to have uninformed people whose parents still pay their bills yell at their relatives who actually have to deal with the program about how great ACA is than into the details of the program itself, the disastrous website launch that almost led to a bunch of the most insane Republicans winning office in 2013, the constant appeal to alleged “subsidies” that no one can actually qualify for unless they were in the Medicaid group to begin with - it’s a giant screw-you to middle class earners who are putting 10% or far more of their income into health insurance premiums. Indirectly I also blame the ACA for all of the damage that the Trump administration has done to America, which presumably I don’t need to specifically list here - there’s simply no way we would have a Republican White House and Senate without the voter backlash from people harmed by the ACA. As I stated in another thread, as a strategic political move, the content and implementation of the ACA is probably the stupidest major initiative from a U.S. party in the last 50 years.
I would love to go back to the plan I had at my first full-time job when I paid $120 a month pre-tax for 100% coverage of routine and preventative care, including 2 dental cleanings and a pair of glasses a year, 85% coverage of prescriptions, and significant coverage of other types of medical expenses. I did not have a problem with “affordable care” that needed to be solved, and I am now paying exponentially more for nothing in return, in order to subsidize other people in a way that is probably less efficient than doing so through some Canadian-like system. The millions of people like me will continue to be disturbed by that no matter how many times party lobbyists tell us that we are not allowed to notice it, or that the purpose of the “Affordable Care Act” was never to make “care” “affordable” but rather to expand insurance coverage to as many people as possible at any cost, or that we are horribly selfish for not wanting to pay for the lifestyles of a dependent, workshy class that was covered as well as it ever was going to be by Medicaid before all of this happened, or that a tiny sliver of “responsible people with pre-existing conditions” is where all this money is going when we all know it’s going to insurance executives and people who refuse to pay their own bills.
The “dependent, workshy class” are still covered by Medicaid. It’s the working class who have been screwed by decades of wage stagnation who needed the help.
It’s more than that. It made Medicaid purely dependent on your taxable income. Pre-Obamacare, and still today in non-expansion states, most people are just flat-out ineligible regardless of their income, because they don’t fall into one of the eligibility categories (such as being elderly, disabled, or a child or pregnant woman).
The problem (political problem, I mean) with a public option is that a good public option will destroy large parts of the employer-sponsored insurance system and throw people’s coverage into real or perceived chaos, while a public option that leaves employer insurance in place will cover very few people because the only reason employer insurance works is that it’s a financial trap (most employer plans are paid for with thousands of dollars in company scrip that can only be used on the employer’s chosen plan). To get out of that trap, a public option that was aimed at people who don’t like their employer’s plan would have to be funded by a fairly hefty payroll tax, to replace the lost money from their employer’s contribution. And if employers can just pay a payroll tax to get employees coverage, without having to administer those benefits, a lot of them are just going to stop offering insurance altogether, and now we’re in the “if you like your plan, you can keep your plan” trap from Obamacare. I think the Biden plan errs on the side of giving very little choice to people on employer plans, though there’s only so much value in evaluating a presidential candidate’s ideas on this kind of thing (Obama ran on opposition to an individual mandate after all).
*Right now, most employers pay thousands of dollars per employee for healthcare. Employees who opt out do not get that money given back to them, they just lose compensation. Any public option that allows people a fair choice of the public option will
I don’t think any of what you’re describing is a trap. I agree that markets have built around the current system and changing it would be disruptive and cause a short-term political price to be paid, I don’t agree that transitioning into a world with the public option it is insurmountable. It’s probably less of a disruption than putting in the ACA was.
It screwed us. For over 25 years we have depended on my husband’s employer subsidized health insurance which was very good. I work for a small company that does not offer health insurance. It would be too expensive. We are both healthy and no have no kids at home. So we just held our breaths having no insurance and hoping my husband would be back to work soon. Then came Obamacare and we were required to have insurance. While my husband wasn’t working we qualified for an insurance plan with $0 premium but a $3000/ea deductible. We took it because we couldn’t afford any of the other plans. Throughout that year, my husband was able to pick up some temp jobs here and there. When I did our income taxes for that year, we ended up owing $13,000!!! His little bit of income made it so we were not eligible for the $0 premium package so we then owed the $1000+/month premiums. When he did get a temp job, I would go back to the insurance website and make changes to our income. But I couldn’t ever predict what it would be in any given month. I was so stressed out. I thought maybe I had done something wrong with our taxes, so I took them to the accountant that we use at my job. He came up with the same number. He told me if I had $4500 to put into an IRA immediately, the $13,000 would go away. LUCKILY, I had stashed away some emergency funds.
I thank the Lord every day that he is back to work with an employer that offers amazing benefits.
Isn’t the tax code fun?
I’m just glad that the loophole existed. We could never have paid a $13,000 tax bill.