# What is your ongoing opinion of the Affordable Care Act? (Title Edited) **URL:** \ **Category:** Politics & Elections\ **Created:** [January 17, 2013, 11:21pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561 "2013-01-17T23:21:39Z")\ **Posts on this page:** 20\ **Page:** 52
**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:** [January 7, 2014, 11:36am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1022 "2014-01-07T11:36:49Z")
> [@iiandyiiii](#): > > Without the mandate, the unpaid emergency room bills problem continues – **and that’s a really significant part of high insurance rates**. … It isn’t . It really isn’t. It is a popular talking point but the facts do not back up this oft repeated assertion. Emergency Room care is [only about 2% of medical costs](http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/) in the United States. And certainly some of that is payed by insurance and/or cash payment. Such unreimbursed care is a problem for individual physicians working in emergency medicine. [A 2000 study](http://www.acep.org/Content.aspx?id=30308) of emergency physicians indicated that 61% of their bad debt was related to [EMTALA](http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act) provided care. Yet such physicians were less able to shift those losses onto insured patients. The physicians had to eat the loss. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [January 7, 2014, 12:26pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1023 "2014-01-07T12:26:58Z")
> [@Iggy](#): > > It isn’t . It really isn’t. It is a popular talking point but the facts do not back up this oft repeated assertion. > > Emergency Room care is [only about 2% of medical costs](http://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/) in the United States. And certainly some of that is payed by insurance and/or cash payment. > > Such unreimbursed care is a problem for individual physicians working in emergency medicine. [A 2000 study](http://www.acep.org/Content.aspx?id=30308) of emergency physicians indicated that 61% of their bad debt was related to [EMTALA](http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act) provided care. Yet such physicians were less able to shift those losses onto insured patients. The physicians had to eat the loss. Those numbers sound significant to me (and your link discusses other calculations that add up up to 10% of medical care costs), but I’ll change the statement: unpaid medical care (emergency room care and non-emergency care) is a significant part of medical care costs in general. If doctors have to eat their loss, that is bad all around for care, insurance, and costs. ---
**Author:** ![DMC](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dmc/32/18049_2.png) [@DMC](https://boards.straightdope.com/u/DMC)\ **Post date:** [January 7, 2014, 4:56pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1024 "2014-01-07T16:56:07Z")
> [@adaher](#): > > Not enough signups, and the fact that they’ve already had to exempt at least 500,000 from the mandate. > > There’s no way in hell they make 20-30 million people pay the penalty. I hope they do try, though, should create quite the reaction at the polling places. I questioned you about your statement: [QUOTE=adaher] The mandate and the exchanges aren’t looking too viable right now. [/QUOTE] You consider this a response to that? How many signups would be enough, how many are there today? Are you aware of the difference between a delay and an exemption? Are the 500,000 people prevented from getting health care through other sources (just as they have had to in the past), such as insurers, the exchanges, etc. for the year that their employer can push this off? **When all is said and done, do you truly believe that we have fewer uninsured Americans today than we had a year ago? If so, do you have any evidence to back that up?** ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 7, 2014, 7:10pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1025 "2014-01-07T19:10:42Z")
> [@iiandyiiii](#): > > Without the mandate, the unpaid emergency room bills problem continues – and that’s a really significant part of high insurance rates. > > You and I are already paying for the uninsured – they get care, unpaid, at ERs, and our bills go up to pay for it. With the mandate, everyone is chipping in. Under ACA, it continues anyway, it’s just lessened somewhat. The CBO projected that 25 million would be covered by ACA, which leaves nearly half the uninsured population still uninsured. At least in the first year, it looks like we’re going to fall well short of that. Then there are the millions who already are exempt due to hardship. If the mandate was an actual fix, rather than just an alleviation, I could see this draconian measure being useful. However, I don’t think it’s worth it to assault Americans’ freedom in this way just to make a problem slightly less bad. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [January 7, 2014, 7:27pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1026 "2014-01-07T19:27:38Z")
> [@adaher](#): > > Under ACA, it continues anyway, it’s just lessened somewhat. The CBO projected that 25 million would be covered by ACA, which leaves nearly half the uninsured population still uninsured. At least in the first year, it looks like we’re going to fall well short of that. > > Then there are the millions who already are exempt due to hardship. It’s not perfect. Supporters like me believe that the health care system is significantly improved under the ACA, even though many problems still remain. > [@](#): > > If the mandate was an actual fix, rather than just an alleviation, I could see this draconian measure being useful. However, I don’t think it’s worth it to assault Americans’ freedom in this way just to make a problem slightly less bad. Hyperbole. And supporters do believe that this is a significant improvement, and therefore worth the possibility of greater costs to relatively small numbers of people. For the vast majority who will end up paying more under the ACA (and most will pay less), they will be getting superior coverage for their higher payments. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 7, 2014, 7:32pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1027 "2014-01-07T19:32:14Z")
You could be right about most of that, but it does seem to me that the mandate is proving it’s lack of necessity. There are already many checks in the law that prevent a death spiral from occurring. That makes the mandate unnecessary. There’s very little evidence that the mandate is actually getting people to buy health insurance who otherwise wouldn’t. Finally, the mandate is virtually uncollectable. The IRS has been denied most of the usual tools to collect tax debt. Congress recognized that the mandate was a draconian measure, and thus gave it all the force of a Security Council Resolution. If the President scraps the mandate for this year, or millions don’t pay it and the sky doesn’t fall, just get rid of the damn thing. ---
**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:** [January 7, 2014, 7:54pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1028 "2014-01-07T19:54:03Z")
> [@iiandyiiii](#): > > … If doctors have to eat their loss, that is bad all around for care, insurance, and costs. Well, as has been said… a billion here, a billion there, and pretty soon you’re talking about real money. Senator Dirksen is attributed as having made that famous quote… back in the late 1960’s. And there is certainly an element of truth that a 1% slice of the health care pie (which itself is around 18% of the federal budget) is sizeable. You’re just not going to save health care on that. So whether unreimbursed emergency room care is “significant” is largely a matter of semantics. It is a huge number. But it is but a tiny sliver of a gargantuan pie. As to doctors eating a loss… PPACA takes future cuts from Medicare. Care to guess where that money is supposed to come from? The plan is to squeeze it right from the provider’s pockets. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [January 7, 2014, 7:59pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1029 "2014-01-07T19:59:31Z")
> [@adaher](#): > > If the mandate was an actual fix, rather than just an alleviation, I could see this draconian measure being useful. However, I don’t think it’s worth it to assault Americans’ freedom in this way just to make a problem slightly less bad. So long as it confers more freedom that it assaults, most Americans will support it. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [January 7, 2014, 8:43pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1030 "2014-01-07T20:43:41Z")
> [@adaher](#): > > You could be right about most of that, but it does seem to me that the mandate is proving it’s lack of necessity. There are already many checks in the law that prevent a death spiral from occurring. That makes the mandate unnecessary. What are the checks that prevent a death spiral? Gotta cite? ---
**Author:** ![Terr](https://avatars.discourse-cdn.com/v4/letter/t/839c29/32.png) [@Terr](https://boards.straightdope.com/u/Terr)\ **Post date:** [January 7, 2014, 8:47pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1031 "2014-01-07T20:47:15Z")
> [@jasg](#): > > What are the checks that prevent a death spiral? Gotta cite? Google “ACA corridors”. Fun stuff. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [January 7, 2014, 10:58pm UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1032 "2014-01-07T22:58:21Z")
> [@jasg](#): > > What are the checks that prevent a death spiral? Gotta cite? > [@Terr](#): > > Google “ACA corridors”. Fun stuff. I fail to see how a temporary risk and revenue sharing provision will block death spirals in the long term. In addition, it seems predicated on some insurers having lower risk profiles that others - but what if every insurer ends up with a high risk scenario? The only sharing that happens then is to share higher premiums with customers. Step one into a spiral… Worse yet, what if insurers just decide to check out of a market? I watched that happen here in WA State in the 90’s when the insurance reform did not include a [mandate](http://www.washingtonpost.com/blogs/wonkblog/post/health-reform-without-a-mandate-lessons-from-washington-state/2012/06/16/gJQAosKghV_blog.html). Not pretty. Also, if it is such a good alternative to a mandate for avoiding a death spiral, why are Rubio and the Cato Institute so keen to eliminate it? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 8, 2014, 12:13am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1033 "2014-01-08T00:13:47Z")
> [@Fear\_Itself](#): > > So long as it confers more freedom that it assaults, most Americans will support it. As of right now, the mandate is deeply unpopular, even though only a small number of Americans are subject to it. Plus there’s just this idea of our government purporting to order us around. Democrats obviously don’t know Americans, a lot of us will not carry insurance just because they tried to make us. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 8, 2014, 12:16am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1034 "2014-01-08T00:16:08Z")
> [@jasg](#): > > I fail to see how a temporary risk and revenue sharing provision will block death spirals in the long term. In addition, it seems predicated on some insurers having lower risk profiles that others - but what if every insurer ends up with a high risk scenario? The only sharing that happens then is to share higher premiums with customers. Step one into a spiral… > > Worse yet, what if insurers just decide to check out of a market? I watched that happen here in WA State in the 90’s when the insurance reform did not include a [mandate](http://www.washingtonpost.com/blogs/wonkblog/post/health-reform-without-a-mandate-lessons-from-washington-state/2012/06/16/gJQAosKghV_blog.html). Not pretty. > > Also, if it is such a good alternative to a mandate for avoiding a death spiral, why are Rubio and the Cato Institute so keen to eliminate it? Actually, it’s primarily liberal wonk blogs saying a death spiral is impossible. Mainly because they have to say that since people aren’t signing up in large enough numbers. But I think they are right anyway. Here’s Sarah Kliff: [http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/17/why-obamacare-wont-spiral-into-fiery-actuarial-doom/](http://www.washingtonpost.com/blogs/wonkblog/wp/2013/12/17/why-obamacare-wont-spiral-into-fiery-actuarial-doom/) > [@](#): > > So say Larry Levitt, Gary Claxton and Anthony Damico, experts at the Kaiser Family Foundation who have put together a new brief analyzing what would happen if young adults snubbed the Affordable Care Act. Even if young people sign up at half the rate the administration hopes for, it would nudge premiums up only by a few percentage points, their report says. > > “When you do the math, it matters, but not nearly as much as the conventional wisdom suggests,” Levitt says > > The worry tends to go something like this: If young adults don’t sign up for insurance coverage through the exchange, then the market loses a wide swath of very healthy enrollees – and wouldn’t have enough people to help pay the claims of the sicker, older subscribers. Without enough young people to subsidize the costs of older enrollees, insurers would instead raise premiums to cover the higher costs. And that would make coverage less desirable to young shoppers in 2015. > > * * * > > But to see what would happen if this trend continued, the trio used data on typical health care costs for older and younger people to figure out how bad that would be for the exchange. > > If young adults (those under 35) were 25 percent less likely than the rest of the population to sign up for Obamacare, they would represent 33 percent of exchange enrollees – rather than 40 percent. This means there would be fewer young people to subsidize older insurance subscribers. To make up that difference, the experts estimated, insurers would need to increase premiums by a terrifying … 1 percent. Yes, exactly 1 percent. > > Levitt, Claxton and Damico also tested a scenario where young adults are half as likely as older shoppers to enroll. In that case, the younger enrollees would make up only a quarter of the exchange market. Premiums would fall 2.5 percent short of covering subscribers > > “I had a general sense it wouldn’t be giant, but this was even smaller than we expected,” Levitt says. “It’s not a terrifying number.” ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [January 8, 2014, 12:17am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1035 "2014-01-08T00:17:22Z")
> [@adaher](#): > > As of right now, the mandate is deeply unpopular, even though only a small number of Americans are subject to it. > > Plus there’s just this idea of our government purporting to order us around. Democrats obviously don’t know Americans, a lot of us will not carry insurance just because they tried to make us. Do you get these talking points straight from the RNC, or do they just sink in subconsciously from repeated Fox News viewings? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 8, 2014, 12:25am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1036 "2014-01-08T00:25:02Z")
THat one came from Howard Dean. 🙂 [http://newsok.com/howard-dean-individual-mandate-in-obamacare-wasnt-necessary-washington-times/article/3919075](http://newsok.com/howard-dean-individual-mandate-in-obamacare-wasnt-necessary-washington-times/article/3919075) ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 8, 2014, 12:27am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1037 "2014-01-08T00:27:27Z")
> **[Howard Dean: Obamacare Individual Mandate ‘Wasn’t Necessary’](https://talkingpointsmemo.com/livewire/howard-dean-obamacare-individual-mandate)** > > Former Democratic presidential candidate Howard Dean said Monday that Obamacare's individual mandate "wasn't necessary" and would damage Democrats during the 2014 election. “The individual mandate was… Former Democratic presidential candidate Howard Dean said Monday that Obamacare’s individual mandate “wasn’t necessary” and would damage Democrats during the 2014 election. “The individual mandate was not necessary and it’s probably a big political thing, and that is going to hurt the Democrats because people don’t like to be told what to do by the government no matter what party they’re in,” Dean said on CNBC. ---
**Author:** ![Fear\_Itself](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fear_itself/32/19637_2.png) [@Fear\_Itself](https://boards.straightdope.com/u/Fear_Itself)\ **Post date:** [January 8, 2014, 12:27am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1038 "2014-01-08T00:27:40Z")
> [@adaher](#): > > As of right now, the mandate is deeply unpopular, even though only a small number of Americans are subject to it. Which is pretty irrelevant with regard to the assault on freedom, right? “I hate the individual mandate, because it doesn’t affect me at all!” is not a very persuasive battle cry. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [January 8, 2014, 12:36am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1039 "2014-01-08T00:36:46Z")
How many people does a war against obscenity affect? Freedom matters to people in this country as a general principle. Yes, I know it’s a pain in the ass for progressives. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [January 8, 2014, 12:36am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1040 "2014-01-08T00:36:48Z")
> [@adaher](#): > > [Howard Dean: Obamacare Individual Mandate ‘Wasn’t Necessary’ - TPM – Talking Points Memo](http://talkingpointsmemo.com/livewire/howard-dean-obamacare-individual-mandate) > > Former Democratic presidential candidate Howard Dean said Monday that Obamacare’s individual mandate “wasn’t necessary” and would damage Democrats during the 2014 election. > > “The individual mandate was not necessary and it’s probably a big political thing, and that is going to hurt the Democrats because people don’t like to be told what to do by the government no matter what party they’re in,” Dean said on CNBC. from your own cite : > [@](#): > > “New York is like the poster child for why you need an individual mandate,” Sabrina Corlette, a research professor at Georgetown University, told KHN. “They implemented all the reforms without the individual mandate, and premiums just went through the roof.” Also, please read my “[mandate](http://www.washingtonpost.com/blogs/wonkblog/post/health-reform-without-a-mandate-lessons-from-washington-state/2012/06/16/gJQAosKghV_blog.html)” link from above for another real life example of why the mandate is needed. I watched that happen and saw what it did to friends on the individual market. Not pretty when a mandate is repealed but pre-existing conditions must be covered. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [January 8, 2014, 12:39am UTC](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561/1041 "2014-01-08T00:39:41Z")
> [@adaher](#): > > How many people does a war against obscenity affect? Freedom matters to people in this country as a general principle. Yes, I know it’s a pain in the ass for progressives. Boy do you not understand progressives. [Previous page](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561.md?page=51) [Next page](https://boards.straightdope.com/t/what-is-your-ongoing-opinion-of-the-affordable-care-act-title-edited/647561.md?page=53)