With Single-Payer dead politically for the time-being, what is next for the ACA?

I’m assuming that Biden will go into the administration and try to unwind any damage that Trump did.

  1. Lengthen the enrollment period
  2. Increase marketing outreach
  3. Increase funding for navigators
  4. Put an end to any talk of Medicaid work requirements
  5. Put an end to any talk of states not using the exchanges
  6. Place more limits on the use of Short-Term, Limited Duration plans (junk plans)

I doubt some things will change, including the individual mandate. I think it’s dead effectively, with a $0 penalty, which I doubt Biden will change. Not sure if Biden will re-authorize the CSR payments that Trump ended, which caused insurers to load up the pricing on their silver plans. He might leave that as-is, since the market has adjusted to it.

I’m wondering if Biden will be able to get McConnell to go along with a re-work of the subsidies that ends the 400% of federal poverty cliff, and maybe higher subsidy %'s for below 400%? I think he might be able to cut a deal with the Republicans where we beef up subsidies in exchange for a tax cut for business somewhere in the tax code.

Finally, I think there are a few more states that will expand Medicaid via referendum, bringing the total to 40-42 out of 50 plus DC.

It’s amazing how well the ACA has withstood the assault of this administration. In the link below, it’s enrolled an estimated 11.3 million people so far this year. It’s not a perfect law by any means, and needs alot more than what I listed above. But politically, there isn’t much wiggle room for Biden right now.

Biden will work toward UHC in a series of baby steps. First- free ACA to the poor. Then lower the Medicare age.

Unless the Dems win the senate (either this session by winning both GA seats or with more gains in the midterms), and nuke the filibuster, nothing is going to happen legislatively.

There are going to be administrative actions like some of the things you mentioned and that’s it.

Why are these hills you want to die on? Sure, you probably are never going to get a Ted Cruz or a Rand Paul to sign on to this plan, but why not try to win the middle? If you expand the open enrollment period, then you are just allowing more people to game the system: to wait and buy insurance once they get sick and destroy the shared cost model. Also, what is wrong with a work requirement? I have to work for my insurance. Why shouldn’t others?

That stuff just seems so extreme. I could see a lot of people saying that they don’t want people to go without heath care, so we provide a system under which able bodies people can work for it. What’s wrong with work?

Some think that people shouldn’t have to make money for somebody else or prove themselves “useful” to somebody else in order to keep living.

Well somebody has to or else there is no free stuff to go around. This is a rather mainstream belief. It is pretty extreme to say that people should get free stuff with no requirement to contribute when you are taking income tax money from people who do contribute and force them to provide for those able bodied people who simply refuse. This type of extremism turns off the middle of the road voter.

UltraVires, you’ve never been laid off? Never had to go find a job and live off of dwindling savings? Still employed during Covid?

Mighty white of you to try stop free loaders in society, and advocate the Sudan version of let the strongest survive.

Or you get laid off because you need to go through chemo for months.

Thank you.

I’m surprised that anyone is surprised that “some people just don’t deserve to live” is a controversial statement.

Put like that it sounds downright awful but everyday economic decisions that take as one of their inputs, at least implicitly, is how much a human life is worth.

A major problem is that a dozen states still do not have expanded Medicaid.

Moderating

This kind of personalization is utterly inappropriate for this forum. Knock it the hell off. You can make your argument effectively without it.

Wait a minute. The majority of America approves of the ACA, and by definition, that would include middle of the road voters.

As for the enrollment period, it currently is 45 days under Trump, and was 90 days under Obama. I think Biden might put it back to the original 90 days, and I don’t think that’s a radical change, to put it back to the original period.

As for Medicaid work requirements, proponents in the past tried to sell it on the idea that it would increase employment without hurting eligibility for Medicaid. But early experiments showed no such thing, as it was problematic in Arkansas when they tried it. And it’s already the case that most Medicaid recipients work.

https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work-what-does-the-data-say/#:~:text=of%20Medicaid%20adults%3F-,Most%20Medicaid%20adults%20are%20already%20working%3B%20among%20those%20who%20are,either%20full%20or%20part-time.

I also have private insurance through my employer. I was lucky enough to not lose my job or get laid off during the pandemic, and I’ve kept my coverage. But there are millions in America who were not so lucky. I don’t think it’s radical to provide a better safety net for such people who fell through the cracks during the pandemic.

This bizarre concern with “freeloaders” destroying the fabric of the country just fills me with despair. [pointstofuckingEurope]

Why should health care require insurance? Why should having a job be intertwined with healthcare?

The thing about Medicaid work requirements is that even if you think they’re a defensible concept, they’re just about impossible to administer in a sensible way. People on Medicaid aren’t living high on the hog, and society still provides a bunch of other incentives to work, so you’re creating this whole huge bureaucracy (or, more likely, giving a huge new task to your existing underfunded bureaucracy) and making every recipient jump through all these extra hoops just so a teeny tiny number of people who would be working but for Medicaid will go back to work (and there’s no evidence it even does that AFAIK). You end up paying more to provide less. It’s a little like whining that the Post Office charges the same to drive a letter across town as it does to fly it to a rural village in Alaska only accessible by sled.

Of course, there’s no reason to assume that level of good faith; states with work requirements are very obviously using the “hoops” to kick people off of Medicaid whether they work or not.

I’m not sure there’s any way to do this given the Medicaid ruling in NFIB v. Sebelius. If anything, there should be a federal expanded-Medicaid system as a companion to the federal exchanges, even if that incentivizes some states to pull out of their own Medicaid expansions; there are some state governments that are just never going to behave and Democrats should stop assuming good faith when they make these programs.

Trump’s CMS approved the State of Georgia exiting healthcare.gov without establishing their own exchange. This is something the Biden administration will have to deal with, or you’ll have more red-states exiting the exchanges altogether and people will be dealing with brokers and likely just dropping coverage altogether without a central exchange to help guide them.

Oh, that sucks, I didn’t even know that was possible.

It doesn’t require insurance. It requires paying a medical provider for his or her services. It requires paying a hospital for the cost of running the facility. It requires paying pharmaceutical and medical supply companies for the cost of developing, producing, and the distribution of their goods.

Additionally, the cost of health care for a given individual is in part due to lifestyle choices. Without some form of penalty for dumb decisions society pays the cost for others’ lack of self concern. Our current system, especially with the politically motivated lack of enforcement of the individual mandate, isn’t great. ‘Free’ everything isn’t great either.