# What Now For the ACA? **URL:** \ **Category:** Great Debates\ **Created:** [November 9, 2016, 3:00pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208 "2016-11-09T15:00:35Z")\ **Posts on this page:** 20\ **Page:** 8
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [November 13, 2016, 6:57pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/141 "2016-11-13T18:57:46Z")
> [@wolfpup](#): > > Back in the early days of the ACA, someone did a survey where it turned out that many voters (typically of the Fox News watching variety) absolutely hated “Obmacare” but were strongly in favor of a different system called the Affordable Care Act whose basic features were described to them, which turned out to be Obamacare. wolfpup, I wish you had a link for that. 🙂 ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 14, 2016, 3:51pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/142 "2016-11-14T15:51:27Z")
> [@adaher](#): > > Yes, there are aspects which are popular, but it’s also pretty expensive and the individual mandate is very unpopular. So it’s going to have to look a lot different once it gets through the GOP shredder and gets rebuilt. I doubt it will look that much different, unless they try they classic GOP approach to reform that **Sam Stone** described. Virtually all of it is popular so long as you don’t call it Obamacare, so it will just be rebranded. ---
**Author:** ![Chetumal](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@Chetumal](https://boards.straightdope.com/u/Chetumal)\ **Post date:** [November 14, 2016, 8:44pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/143 "2016-11-14T20:44:46Z")
[quote=“jasg, post:136, topic:771208”] [li]Mandated insurance too expensive? Allow anyone to buy a barebones, catastrophic policy. If they won’t buy it, apply a tax penalty equal to the barebones premium and throw them in the hell that is Medicaid.[/li][/QUOTE] Um, in what way is Medicaid “hell”? I have received comprehensive and excellent medical care through Medicaid via the expansion in my state. Terrified of losing it. :eek: ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [November 14, 2016, 9:24pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/144 "2016-11-14T21:24:34Z")
> [@Chetumal](#): > > Um, in what way is Medicaid “hell”? I have received comprehensive and excellent medical care through Medicaid via the expansion in my state. Terrified of losing it. :eek: Shh! A bit of strategic/poetic license there - if too many people think it is good then everyone will want it 😃 ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [November 14, 2016, 10:29pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/145 "2016-11-14T22:29:58Z")
> [@Chetumal](#): > > Um, in what way is Medicaid “hell”? I have received comprehensive and excellent medical care through Medicaid via the expansion in my state. Terrified of losing it. :eek: Medicaid is run state-by-state, which means there are SUBSTANTIAL variations from state to state in what is covered and how well it is funded. In Kansas, for example, Medicaid reimbursement rates are low and they are very slow paying, so a lot of doctors don’t want anything to do with it. Finding a primary care physician who will accept new patients on Medicaid can be very challenging, for example, and waiting lists even to have a Medicaid application reviewed, or a procedure pre-approved, are long. [Here’s a recent article talking about provider frustrations](http://cjonline.com/news-legislature/2016-07-26/kancare-providers-vent-frustration-over-state-cuts-forum-federal). ---
**Author:** ![Flying\_Rabbit](https://avatars.discourse-cdn.com/v4/letter/f/858c86/32.png) [@Flying\_Rabbit](https://boards.straightdope.com/u/Flying_Rabbit)\ **Post date:** [November 15, 2016, 10:39am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/146 "2016-11-15T10:39:26Z")
So is there any chance ACA will be repealed and there will be news stories about people losing their coverage, and consequently suffering because of it? Causing such a GREAT BACK LASH against the Republicans that 4 years from now a far left progressive will be elected and we will get a universal healthcare system that works? ---
**Author:** ![Jragon](https://avatars.discourse-cdn.com/v4/letter/j/e19b73/32.png) [@Jragon](https://boards.straightdope.com/u/Jragon)\ **Post date:** [November 15, 2016, 10:42am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/147 "2016-11-15T10:42:32Z")
> [@Flying\_Rabbit](#): > > So is there any chance ACA will be repealed and there will be news stories about people losing their coverage, and consequently suffering because of it? Causing such a GREAT BACK LASH against the Republicans that 4 years from now a far left progressive will be elected and we will get a universal healthcare system that works? Yes, but it’s probably not a great chance. After interviews with Trump (which admittedly don’t count for much given how much his whim changes from day to day), it seems more likely that it will be gutted so that most people don’t directly lose coverage, but rather costs will balloon, but possibly not fast enough for people to really feel it before the next election. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 15, 2016, 10:46am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/148 "2016-11-15T10:46:05Z")
> [@Flying\_Rabbit](#): > > So is there any chance ACA will be repealed and there will be news stories about people losing their coverage, and consequently suffering because of it? Causing such a GREAT BACK LASH against the Republicans that 4 years from now a far left progressive will be elected and we will get a universal healthcare system that works? There won’t be much of a backlash because the people who benefit from ACA are neither donors nor reliable voters. It’s possible they might come out just this once because they are angry, but Democrats aren’t stupid enough to try to do the health care thing again this soon after the last disastrous attempt. That would just return Republicans to power again. ---
**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:** [November 15, 2016, 11:37am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/149 "2016-11-15T11:37:11Z")
> [@Jragon](#): > > Yes, but it’s probably not a great chance. After interviews with Trump (which admittedly don’t count for much given how much his whim changes from day to day), it seems more likely that it will be gutted so that most people don’t directly lose coverage, but rather costs will balloon, but possibly not fast enough for people to really feel it before the next election. If premiums balloon, it means the end for free market health insurance companies. The faster that prices rise, the more people leave the system. It is an unsustainable market, and it will bring about universal health care sooner than later. Getting rid of the mandate but keeping the good bits only hastens the end. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 15, 2016, 1:31pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/150 "2016-11-15T13:31:00Z")
I don’t think prices will boom. Get rid of the coverage mandates and that will bring costs down immediately. In the short term that might bring more people into the market. Democrats demanding comprehensive coverage with some things even being free may have been good HEALTH policy, but worked against their desire to make health insurance cheaper. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [November 15, 2016, 4:04pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/151 "2016-11-15T16:04:33Z")
> [@adaher](#): > > I don’t think prices will boom. Get rid of the coverage mandates and that will bring costs down immediately. In the short term that might bring more people into the market. What specific mandates are really adding all that much to the cost of health insurance? Health care spending is highly concentrated: the bottom half of the population (ranked by total health care expenditures) accounted for a whopping 2.7 percent of spending in 2012. ([cite](https://meps.ahrq.gov/data_files/publications/st455/stat455.pdf)) The people whose main health care needs are the “free” annual physical, Pap smear/mammogram or prostate exam, periodic tetanus shots, and the like are not the ones driving the cost curve. Meanwhile, five percent of the population accounts for more than half of all health care spending, with the biggies being cancer, heart disease, COPD/asthma, trauma, and mental illness. What coverage mandates can be eliminated here that will drastically reduce costs? (The mandate to cover mental health care is the only big one I see, and the costs of untreated mental illness are pretty high too.) ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [November 15, 2016, 4:53pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/152 "2016-11-15T16:53:51Z")
> [@adaher](#): > > I don’t think prices will boom. Get rid of the coverage mandates and that will bring costs down immediately. In the short term that might bring more people into the market. Do you have a cite for this? ---
**Author:** ![tim-n-va](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tim-n-va/32/3001_2.png) [@tim-n-va](https://boards.straightdope.com/u/tim-n-va)\ **Post date:** [November 15, 2016, 4:54pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/153 "2016-11-15T16:54:30Z")
The one counter argument that I heard was that it is easy to vote for something that will kick millions off of their health insurance when you know the President will veto it. It is a lot harder to make that vote when it is real and not symbolic. ---
**Author:** ![tim-n-va](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/tim-n-va/32/3001_2.png) [@tim-n-va](https://boards.straightdope.com/u/tim-n-va)\ **Post date:** [November 15, 2016, 4:59pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/154 "2016-11-15T16:59:34Z")
The mandated coverage is just one more step in the necessary trade offs. You want to eliminate per-existing conditions, you have to require everyone buy insurance. If you want everyone to buy insurance, you have to somehow define a minimum level of coverage to be considered insured. Otherwise there would soon be very cheap “health insurance” plans that only provide trivial coverage. Some mandated coverage probably can be adjusted but they are just as crucial to the whole things as the mandate to have insurance. ---
**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:** [November 15, 2016, 5:14pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/155 "2016-11-15T17:14:09Z")
> [@adaher](#): > > I don’t think prices will boom. Get rid of the coverage mandates and that will bring costs down immediately. I don’t see how that could could be even remotely possible. No mandate means fewer healthy subscribers, which means higher premiums to cover the cost of unhealthy subscribers. There is no positive outcome to getting rid of the mandate while keeping pre-existing condition coverage, full stop. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 16, 2016, 7:15am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/156 "2016-11-16T07:15:49Z")
By the coverage mandates I mean things like free preventive care. Sure, you want insurance to cover certain things, but mandating what the price of such things shall be is going beyond the government’s sensible use of its powers. and even fairly cheap things can add to your premiums and other co-pays, because you’re taking a medical procedure or device or prescription that would either have a co-pay or not be covered at all until one met their deductible, and making it free. That money has to come from somewhere and it will be reflected in higher co-pays for other things and higher premiums. So just get rid of those free items and let them be covered the same way other services are covered, and that will lower co-pays and premiums. There is no rational reason to prioritize birth control over cancer treatment. ---
**Author:** ![Clothahump](https://avatars.discourse-cdn.com/v4/letter/c/51bf81/32.png) [@Clothahump](https://boards.straightdope.com/u/Clothahump)\ **Post date:** [November 16, 2016, 1:18pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/157 "2016-11-16T13:18:09Z")
> [@RickJay](#): > > ACA is dead; it’ll be repealed within six months of Trump taking office, adding on time if the Democrats filibuster it. > > A lot of Trump’s promises are crazy or impossible, but not that one. It is something that is both Constitutional and politically possible. He has both a Senate and House that will probably put it in front of him as quickly as they can. And with any luck, it will happen sooner rather than later. ACA should never have existed. I honestly can’t think of a worse piece of legislation that has been passed in my lifetime. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [November 16, 2016, 1:20pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/158 "2016-11-16T13:20:44Z")
> [@Fear\_Itself](#): > > I don’t see how that could could be even remotely possible. It’s not. Just as it’s impossible that the ACA is bankrupting Medicare (it helps Medicare), or that the ACA did nothing to contain costs. ---
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [November 16, 2016, 1:27pm UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/159 "2016-11-16T13:27:38Z")
> [@adaher](#): > > By the coverage mandates I mean things like free preventive care. Sure, you want insurance to cover certain things, but mandating what the price of such things shall be is going beyond the government’s sensible use of its powers. and even fairly cheap things can add to your premiums and other co-pays, because you’re taking a medical procedure or device or prescription that would either have a co-pay or not be covered at all until one met their deductible, and making it free. That money has to come from somewhere and it will be reflected in higher co-pays for other things and higher premiums. So just get rid of those free items and let them be covered the same way other services are covered, and that will lower co-pays and premiums. There is no rational reason to prioritize birth control over cancer treatment. Considering that most of the preventive care is stuff like vaccines and wellness check that cost negligible amounts, but prevent issues, which left untreated, I think that in the long term (meaning beyond a year or so), you are going to find your pennies saved on vaccines lost in the thousands of dollars spent on treating people after they get sick from something that could have been prevented. Birth control, also, not a high price, and saves quite a bit on labor and delivery costs. Most insurance companies covered BC for free before the ACA for this reason. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 17, 2016, 5:12am UTC](https://boards.straightdope.com/t/what-now-for-the-aca/771208/160 "2016-11-17T05:12:29Z")
And they are more qualified to make that determination than even the smartest government experts. They actually have skin in the game. Plus government experts are influenced by politics and what was decided must be free had more to do with winning female voters than health policy. [Previous page](https://boards.straightdope.com/t/what-now-for-the-aca/771208.md?page=7) [Next page](https://boards.straightdope.com/t/what-now-for-the-aca/771208.md?page=9)