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

Yeah, but I’m hoping Biden’s administration can reverse that ruling. I think Trump’s view was to kill the ACA using death by a thousand paper cuts. But he’s been unable to kill it. Try as he might, it has stood up. Take a look at the link I sent in the earlier post, where CBPP tracks the sabotage. It’s been relentless.

BTW, I’m a resident of Georgia. This state is one of just 12 that didn’t expand Medicaid. In the South, Georgia used to be seen as more moderate/progressive than other surrounding states. But once Republicans took control of the governorship and legislature, we started acting like Alabama & Mississippi. Hopefully, the election of Biden is the start of a good change for Georgia, and not just a one-off.

This is why I support a mandate. I think adults have a responsibility to get insurance, and if they can’t afford it, society should help them buy it.

A mandate was required. What happened? Just like many other laws it was politically inconvenient to enforce it.

No, what happened is that one party wanted to kill the ACA without repealing it (because they had nothing to replace it with), so they attacked the one thing about the ACA that they hated the most, i.e., the individual mandate. It wasn’t about inconvenience. It was about the destructiveness of one political party.

I wish we would approach the mandate the same way it’s approached in Switzerland. The Swiss will go after anyone that tries to avoid buying insurance. They’ll garnish your wages, and they auto-enroll you in a plan. And because of that, along with some other characteristics of their system, they have UHC in Switzerland.

Didn’t they also try to use the lack of a mandate to try and take down the whole thing using severability or something?

Either way, octopus, your statement is pretty much just wrong.

It was repealed by the Republican controlled Congress in 2017. That in turn became the basis for the lawsuit in which the Fifth Circuit found that without the mandate, the ACA as a whole was unconstitutional:

Politically inconvenient to enforce it?

Or a politically convenient way to attack the ACA, which they could never find the votes to repeal directly?

When 10s of millions are exempted from having to pay the individual mandate it’s pretty much de-facto dead as a provision.

That is not what you wrote. You said it was politically inconvenient to enforce it. In fact, it was set to zero as part of a Republican attack on the ACA.

It seems like you’re not being entirely consistent here. Why not just withdraw your comment or admit error?

Because it WAS politically inconvenient to enforce it. Why else would there have been exemptions that covered 10s of millions of people if it weren’t to curry political favor from those who didn’t want to be forced to pay a mandate?

Ok, I see this won’t be fruitful.

Millions paid the penalty, around 8 million, so it was enforced. Out of 330 million or so Americans, around 12 million filed exemptions, which is a very low %, like around 3 to 4% of the population. It existed, and it was enforced. And it applied to the vast majority of the population. The reason it was eliminated didn’t have anything to do with convenience. It had everything to do with the GOP’s hatred of the ACA, combined with their unwillingness to repeal it.

That’s fair, but I think it’s entirely reasonable to expect a non-disabled adult to pull their own weight and provide for their own food, shelter and anything else they may need. It’s not anyone else’s problem or responsibility to do so. Social safety nets ought to be to catch people who fall, not for slackers to loaf around on like a giant mattress.

That said, I’m a proponent of UHC, if only because it’ll hopefully remove a lot of the price distortion from the healthcare market and make things cheaper for everyone, insurance or not. Right now, the opacity and price distortion introduced and fostered by insurance companies for their own profit is 99% of the reason health care prices are so high in the US. If say… MRI imaging centers had to compete on an open market, or prescription drugs, or simple GP or pediatrician visits did as well, they’d all be significantly cheaper. Insurance negotiated rates and stuff like that screw up the market mechanisms that would otherwise drive down costs.

I’m pretty firmly convinced that if we had actual price competition not screwed up by insurance companies, then a LOT of medical things would be significantly cheaper than they are today. And UHC can help us get there by leveling that playing field.

There is very little “middle” left in the senate. It consists of Mitt Romney, Susan Collins, Lisa Murkowski, and Joe Manchin. That’s it.

If we wanted to appeal to the middle, then we’d re-institute the public option. And if we wanted to make the system work really well, then we’d entirely eliminate the industry built around denying people healthcare. Why do we even have a health-care denial industry to begin with?

We don’t have to “work” to enjoy the protection of the fire department, send our kids to public schools for 12 years, or have the military protect us from foreign invaders. It would be nice if going to the doctor was treated the same way as having the fire department respond.

A government service that everyone receives on an equal basis.

Is was enforced by tax penalty until the mandate was removed.

Is a tax penalty sufficient? No. Well not in the way that it was done in the ACA - a “pay or play” system where you pay a graduated income tax for not having it that buys you into a government plan makes more sense. The US at some point in the future needs to model our system after systems from other countries that effectively result in universal healthcare.

Not to mention if the OP suggestions aren’t “the middle” then I don’t know what is. Those all seem like sensible middle ground positions on the ACA. What would be the middle if those aren’t?

And actually, if we were being transparent about the genesis of the idea of the ACA, it was inspired by RomneyCare in Massachusetts, which was inspired by the Heritage Foundation’s Healthcare Plan published in the late 1980’s. So, the ACA is right-of-center in terms of where the ideas for it came from. What today’s GOP can’t admit is that the ACA was the conservative pathway to UHC, because it kept everything the same in terms of private delivery of healthcare and provided state-based exchanges for people to buy private insurance. Now, to actually get to UHC, the ACA needs alot of work in terms of the level of subsidies and what to do when people refuse to get health insurance (strong mandate penalties, auto-enrollment, and maybe a public option). I’d like to see the US pursue something closer to how the Swiss do it.

To be clear though, the Heritage Foundation’s plan was just the Exchanges. It had nothing for covering Preventive Care at 100%, ending Annual and Lifetime Maximums, ending Pre-existing Condition Exclusions and a whole host of other regulations. Meaning, Heritage is correct in asserting that neither Romneycare (which remember was also negotiated with Democrats in the Massachusetts legislature who overrode Gov Romney on a few things) nor Obamacare are their plan.

I agree that Romneycare and the ACA aren’t exactly the Heritage plan. But that’s picking nits. The Heritage plan had an individual mandate. It had a medicaid expansion. And it had government subsidies. That basic framework was also the guts of Romneycare and the ACA. So, that’s why I say they were inspired by the framework of the Heritage plan.

The fact is that the ACA was a way to get to UHC without ending the existence of private insurance plans. And that framework came originally from the Heritage plan. If the ACA were implemented by President Bush, President McCain, or President Romney, I think the right-wing would be taking credit for it. But it was implemented by a Democrat, and therefore, it had to be destroyed.