# With Single-Payer dead politically for the time-being, what is next for the ACA? **URL:** \ **Category:** Great Debates\ **Created:** [December 26, 2020, 7:41pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978 "2020-12-26T19:41:55Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 26, 2020, 7:41pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/1 "2020-12-26T19:41:55Z")
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. > **[The Graph: 11.34 million QHPs confirmed nationally; you still have time to...](https://acasignups.net/20/12/25/graph-1134-million-qhps-confirmed-nationally-you-still-have-time-getcovered-12-states)** > > Way back in October 2013, I launched the ACA Signups project as a light, nerdy hobby thing which was only supposed to last around six months, through the end of the first ACA Open Enrollment Period (March 31, 2014). Instead...well, let's just say... ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 26, 2020, 8:52pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/2 "2020-12-26T20:52:41Z")
Biden will work toward UHC in a series of baby steps. First- free ACA to the poor. Then lower the Medicare age. ---
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [December 27, 2020, 3:09am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/3 "2020-12-27T03:09:12Z")
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. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 27, 2020, 3:33am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/4 "2020-12-27T03:33:12Z")
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? ---
**Author:** ![Leaper](https://avatars.discourse-cdn.com/v4/letter/l/4bbf92/32.png) [@Leaper](https://boards.straightdope.com/u/Leaper)\ **Post date:** [December 27, 2020, 3:35am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/5 "2020-12-27T03:35:38Z")
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. ---
**Author:** ![UltraVires](https://avatars.discourse-cdn.com/v4/letter/u/ecccb3/32.png) [@UltraVires](https://boards.straightdope.com/u/UltraVires)\ **Post date:** [December 27, 2020, 3:40am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/6 "2020-12-27T03:40:38Z")
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. ---
**Author:** ![China\_Guy](https://avatars.discourse-cdn.com/v4/letter/c/779978/32.png) [@China\_Guy](https://boards.straightdope.com/u/China_Guy)\ **Post date:** [December 27, 2020, 3:46am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/7 "2020-12-27T03:46:40Z")
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. ---
**Author:** ![DeadTreasSecretaries](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/deadtreassecretaries/32/4817_2.png) [@DeadTreasSecretaries](https://boards.straightdope.com/u/DeadTreasSecretaries)\ **Post date:** [December 27, 2020, 3:48am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/8 "2020-12-27T03:48:19Z")
Or you get laid off because you need to go through chemo for months. ---
**Author:** ![Earl\_Grey](https://avatars.discourse-cdn.com/v4/letter/e/d07c76/32.png) [@Earl\_Grey](https://boards.straightdope.com/u/Earl_Grey)\ **Post date:** [December 27, 2020, 3:54am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/9 "2020-12-27T03:54:05Z")
Thank you. ---
**Author:** ![Leaper](https://avatars.discourse-cdn.com/v4/letter/l/4bbf92/32.png) [@Leaper](https://boards.straightdope.com/u/Leaper)\ **Post date:** [December 27, 2020, 4:00am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/10 "2020-12-27T04:00:37Z")
I’m surprised that anyone is surprised that “some people just don’t deserve to live” is a controversial statement. ---
**Author:** ![octopus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/octopus/32/3716_2.png) [@octopus](https://boards.straightdope.com/u/octopus)\ **Post date:** [December 27, 2020, 4:25am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/11 "2020-12-27T04:25:16Z")
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. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [December 27, 2020, 5:49am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/12 "2020-12-27T05:49:43Z")
A major problem is that a dozen states still do not have expanded Medicaid. > **[Status of State Medicaid Expansion Decisions: Interactive Map](https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/)** > > This page displays an interactive map of the current status of state decisions on the Affordable Care Act’s Medicaid expansion. Additional Medicaid expansion resources are listed (with links)… ---
**Author:** ![raventhief](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/raventhief/32/4_2.png) [@raventhief](https://boards.straightdope.com/u/raventhief)\ **Post date:** [December 27, 2020, 7:05am UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/13 "2020-12-27T07:05:31Z")
> [@China\_Guy](#): > > Mighty white of you to try stop free loaders in society, and advocate the Sudan version of let the strongest survive. _ **Moderating** _ This kind of personalization is utterly inappropriate for this forum. Knock it the hell off. You can make your argument effectively without it. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 27, 2020, 2:26pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/14 "2020-12-27T14:26:17Z")
> [@UltraVires](#): > > 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? 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. [Understanding the Intersection of Medicaid & Work: A Look at What the Data Say | KFF](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%2Dtime). 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. ---
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [December 27, 2020, 3:36pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/15 "2020-12-27T15:36:18Z")
This bizarre concern with “freeloaders” destroying the fabric of the country just fills me with despair. [pointstofuckingEurope] ---
**Author:** ![bobot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bobot/32/21622_2.png) [@bobot](https://boards.straightdope.com/u/bobot)\ **Post date:** [December 27, 2020, 3:54pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/16 "2020-12-27T15:54:28Z")
> [@UltraVires](#): > > Also, what is wrong with a work requirement? I have to work for my insurance. Why shouldn’t others? Why should health care require insurance? Why should having a job be intertwined with healthcare? ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [December 27, 2020, 4:07pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/17 "2020-12-27T16:07:12Z")
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_. > [@survinga](#): > > Put an end to any talk of states not using the exchanges 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. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 27, 2020, 4:37pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/18 "2020-12-27T16:37:33Z")
> [@Lord\_Feldon](#): > > 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. > **[Sabotage Watch: Tracking Efforts to Undermine the ACA | Center on Budget and...](https://www.cbpp.org/sabotage-watch)** > > President Trump said that, politically, the best thing to do would be to let the Affordable Care Act (ACA) “explode.” This timeline tracked Trump Administration actions to sabotage the ACA by destabilizing private insurance markets or reversing... Trump’s CMS approved the State of Georgia exiting [healthcare.gov](http://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. ---
**Author:** ![Lord\_Feldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lord_feldon/32/341_2.png) [@Lord\_Feldon](https://boards.straightdope.com/u/Lord_Feldon)\ **Post date:** [December 27, 2020, 4:39pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/19 "2020-12-27T16:39:18Z")
> [@survinga](#): > > Trump’s CMS approved the State of Georgia exiting [healthcare.gov](http://healthcare.gov) without establishing their own exchange. Oh, that sucks, I didn’t even know that was possible. ---
**Author:** ![octopus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/octopus/32/3716_2.png) [@octopus](https://boards.straightdope.com/u/octopus)\ **Post date:** [December 27, 2020, 6:07pm UTC](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978/20 "2020-12-27T18:07:11Z")
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. [Next page](https://boards.straightdope.com/t/with-single-payer-dead-politically-for-the-time-being-what-is-next-for-the-aca/928978.md?page=2)