General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsNews About Obamacare Has Been Bad Lately. How Bad?
Ever since passage of the Affordable Care Act, a fierce debate has been waged over whether the law would work as advertised. While advocates promised that the design of new insurance markets would transform the way consumers buy health insurance, critics warned that the new market would never succeed. Reed Abelson and Margot Sanger-Katz have had front-row seats to the debate, and the two reporters took a few minutes to discuss when and if the market would stabilize.
Margot Sanger-Katz: Every time I write a story about the health law, I get comments and emails from people just above the income cutoff for subsidies. These are the people who have been most hurt by the health law. Plans on the exchanges are just really expensive for them, and often come with big deductibles, too. And if premiums keep rising, theyll keep getting squeezed. Analysts from the Urban Institute have done the math and found that some of them are paying more than 25 percent of their income on health care now. Still, it is awfully hard to imagine Congress approving massive new spending to make Obamacare more generous. Hillary Clinton has some proposals about affordability, but they dont include expanding subsidies.
Reed Abelson: One of the strengths of the law, and its main weakness, is its emphasis on keeping the status quo. While President Obama may have overpromised when he said you can keep your plan if you like it, the insurance isnt radically different. The only way companies can seem to bring down prices is by narrowing networks of hospitals and doctors or hiking deductibles. While Bernie Sanders seems to be offering the most dramatic change by proposing that everyone switch to a government plan like Medicare, Im still looking for a market response some real change in how care is delivered that is much less expensive or at least more effective.
Comment by Don McCanne of PNHP: Six years after the Affordable Care Act was signed into law we hear opinions ranging from what a phenomenal success it has been to what a miserable disaster it is. This brief excerpt from a discussion between two respected journalists who have followed the process closely, and who are well versed on the policy issues, provides us with a perspective on where we actually are on reform.
It is somewhat sobering. There have been some tradeoffs such as expanding nominally the numbers insured but with insurance products that further limit provider choice and shift more costs to the patients. Margot Sanger-Katz says that the health law basically baked in all of the complexity and dysfunction of the pre-existing American health care system.
Most of the system has remained about the same while the deficiencies introduced offset much of the gains. We are still left with tens of millions uninsured, tens of millions more who are underinsured, and costs that continue to increase in spite of the expansion of blunt financial barriers to beneficial health care services. Even employer-sponsored plans are beginning to deteriorate, especially because of higher deductibles and narrower networks.
Reed Abelson says that he is looking for a market response some real change in how care is delivered that is much less expensive or at least more effective. Yet it has been confirmed over the last half century that markets do not work in controlling health care spending. Nothing in the Affordable Care Act will change that in spite of wishes that feeble policy measures such as ACA exchange competition, ACOs, shared shavings, bundling, wellness programs, meaningless rhetoric of quality over quantity, and other ACA concepts would revolutionize health care. The revolution is not happening.
So claims of phenomenal success or miserable disaster can be ignored since we really have not fundamentally changed the infrastructure of our system. But with that background, we actually have failed: We failed to enact an Improved Medicare for All which would have met our goals for reform. We can still do it, you know.
My comment: ACA has helped many, but we have to eventually get to single payer.
KG
(28,751 posts)because, obama!
pampango
(24,692 posts)"Let's vote to repeal it maybe 50 or 100 times."
Bernardo de La Paz
(49,001 posts)Android3.14
(5,402 posts)If a person can't afford the deductible then what you have is a government forcing millions of people to spend thousands of dollars each for a service they still cannot use.
For far too many lower middle class people, the ACA has just been a giveaway to insurance companies. It's one of the reasons Trump's brand of rhetoric is so popular.
Adrahil
(13,340 posts)You ain't gonna get a single payer system, so focus your energy on something that might be acheivable.... Increased subsidies and/or a public option.
Amimnoch
(4,558 posts)Since the Republicans have taken over the house, their only interest is running bill after bill just to remove the ACA with no replacement.
Until we can get Congress back, I just don't see any kind of roll call vote that would pass either option.
I do agree that once we have the numbers a government option will have better chances than single payer. The government option would be the doorway to an eventual single payer system though.
Human101948
(3,457 posts)By the year 2279, we should have national healthcare! Something to look forward to!
Amimnoch
(4,558 posts)One for the upcoming 115th congress?
Feel free to make the most optimistic selections of potential candidates that you'd like. I have. Even with my best picks the numbers aren't there.
Do you suggest there's a way to get single payer or the government option passed without Congressional law? Do tell?
You focus on Hillary, but neither Hillary.. or Bernie has a congress coming up that will help either of them with this highly important issue.
So tell me, Who have you supported, volunteered for, or or worked in some significant way to get elected when it comes to Congress?
These are the people I've chosen to work for, help get elected this cycle. (looks better in the spreadsheet)
State Name Level Office District Status Notes Congressional Primary Date
Alabama Jesse Smith Federal House 3 Candidate 3/1/2016
Arizona Lennie Clark Federal Senate AZ Candidate *Running against John McCain 8/30/2016
Arizona Raúl Grijalva Federal House 3 Serving 8/30/2016
California Preston Picus Federal House 12 Candidate *Progressive Independent 6/7/2016
California Steve Stokes Federal Senate CA Candidate 6/7/2016
California Bao Ngyuen Federal House 46 Candidate *Currently Mayor of the City of Garden Grove, California 6/7/2016
California Wendy Reed Federal House 23 Candidate 6/7/2016
California Bill Ostrander Federal House 24 Candidate 6/7/2016
California Mike Beitiks Federal Senate CA Candidate 6/7/2016
California Joe Williams Federal House 20 Candidate *Peace and Freedom Party 6/7/2016
California Marcus Musante Federal House 44 Candidate 6/7/2016
Colorado Misty Plowright Federal House 5 Candidate 6/28/2016
Colorado Charles "Chuck" Norris Federal House 1 Candidate 6/28/2016
Florida Alina Valdes Federal House 25 Candidate 8/30/2016
Florida Sean Guthrie Federal Senate FL Candidate 8/30/2016
Florida Tim Canova Federal House 23 Candidate *Running against Debbie Wasserman Schultz 8/30/2016
Florida John Xuna Federal House 18 Candidate 8/30/2016
Florida Alan Grayson Federal Senate FL Candidate 8/30/2016
Florida Amanda Kondrat'yev Federal House 1 Candidate 8/30/2016
Hawaii Tulsi Gabbard Federal House 2 Serving *Resigned from the DNC to endorse Bernie 8/13/2016
Hawaii Javier Ocasio Federal House 1 Candidate 8/13/2016
Illinois Marcus Lewis Federal House 2 Candidate Keep FIghting 3/15/2016
Indiana Todd Nightenhelser Federal House 3 Candidate 5/3/2016
Indiana Bruce Peavler Federal House 6 Candidate 5/3/2016
Iowa Gary Kroeger Federal House 1 Candidate 6/7/2016
Iowa Tom Fiegen Federal Senate IA Candidate * Running against Chuck Grassley (R). 6/7/2016
Kansas Mike Pryor Federal House 2 Candidate 8/2/2016
Kentucky Geoff Young Federal House 6 Candidate 5/17/2016
Kentucky Sellus Wilder Federal Senate KY Candidate *In a 7 way primary with fellow Sanders Dems Grant Short and Ron Leach. 5/17/2016
Kentucky Grant Short Federal Senate KY Candidate *In a 7 way primary with fellow Sanders Dems Sellus Wilder and Ron Leach.
Kentucky Ron Leach Federal Senate KY Candidate *In a 7 way primary with fellow Sanders Dems Sellus Wilder and Grant Short.
Maryland Terence Strait Federal House 4 Candidate 4/26/2016
Maryland Tony Puca Federal House 6 Candidate 4/26/2016
Michigan Paul Clements Federal House 6 Candidate 8/2/2016
Minnesota Keith Ellison Federal House 5 Serving 8/9/2016
Minnesota Rick Nolan Federal House 8 Serving/Re-Election *Superdelegate 8/9/2016
Missouri Cori Bush Federal Senate MO Candidate 8/2/2016
Nevada Alex Singer Federal House 3 Candidate 6/14/2016
Nevada Jesse Sabaih Federal House 3 Candidate 6/14/2016
Nevada Dan Rolle Federal House 4 Candidate *Running against fellow Sanders Dem Lucy Flores 6/14/2016
New Hampshire Shawn O'Connor Federal House 1 Candidate 9/13/2016
New Jersey Alex Law Federal House 1 Candidate 6/7/2016
New Jersey Eloy Delgado Federal House 8 Candidate 6/7/2016
New Jersey Peter Jacob Federal House 7 Candidate 6/7/2016
New Jersey Richard McFarlane Federal House 11 Candidate 6/7/2016
New Jersey Eric Beechwood Federal House 2 Candidate 6/7/2016
New Jersey Jim Keady Federal House 3 Candidate
New York Bill Perkins Federal House 13 Candidate *Currently in New York Senate 6/28/2016
New York Eric Kinson Federal House 24 Candidate 6/28/2016
New York Zephyr Teachout Federal House 19 Candidate 6/28/2016
New York Diana Hird Federal House 18 Candidate 6/28/2016
New York Jonathan Clarke Federal House 3 Candidate 6/28/2016
New York Ali Mirza Federal House 5 Candidate 6/28/2016
New York Noah Sargent Federal House 25 Candidate 6/28/2016
New York Jeff Kurzon Federal House 7 Candidate 6/28/2016
North Carolina John McNeil Federal House 2 Candidate 3/15/2016 - Senate 6/7/2016 - House
North Carolina Peter Noris Federal House 104 Candidate 3/15/2016 - Senate 6/7/2016 - House
North Carolina Kevin Griffin Federal Senate NC Candidate Keep Fighting 3/15/2016 - Senate 6/7/2016 - House
North Carolina Chris Rey Federal Senate NC Candidate *Currently Mayor of Spring Lake **Keep Fighting 3/15/2016 - Senate 6/7/2016 - House
North Dakota Cory McGarvey Federal House ND Candidate 6/14/2016
Ohio Janet Garrett Federal House 4 Candidate 3/15/2016
Ohio Keith Mundy Federal House 16 Candidate 3/15/2016
Ohio Kelli Prather Federal Senate OH Candidate Keep Fighting 3/15/2016
Ohio Marcy Kaptur Federal House 9 Serving 3/15/2016
Oklahoma Tom Guild Federal House 5 Candidate 6/28/2016
Oregon Kevin Stine Federal Senate OR Candidate 5/17/2016
Oregon Dave McTeague Federal House 5 Candidate 5/17/2016
Oregon Jeff Merkley Federal Senate OR Serving 5/17/2016
Pennsylvania John Fetterman Federal Senate PA Candidate *Currently Mayor of Braddock, PA 4/26/2016
Pennsylvania Kerith Strano Taylor Federal House 5 Candidate 4/26/2016
South Carolina Dimitri Cherny Federal House 1 Candidate *Running against Mark Sanford 6/14/2016
South Carolina Arik Bjorn Federal House 2 Candidate 6/14/2016
Texas Tom Wakely Federal House 21 Candidate 3/1/2016
Utah Destiny Clifford Federal House 4 Candidate 6/28/2016
Vermont Peter Welch Federal House VT Serving 8/9/2016
Virginia Bill Bunch Federal House 9 Candidate 6/14/2016
Washington Angela Marx Federal House 3 Candidate #StrongerTogether for a better future for OUR posterity 8/2/2016
Washington Phil Cornell Federal Senate 1 Candidate 8/2/2016
Washington David McDevitt Federal House 3 Candidate 8/2/2016
Washington Mike Lapointe Federal House 2 Candidate 8/2/2016
Washington Minh Tran Federal Senate WA Candidate 8/2/2016
West Virginia Mike Manypenny Federal House 1 Candidate 5/10/2016
Wisconsin Tom Breu Federal House 1 Candidate *Running against Paul Ryan 8/9/2016
Wisconsin Wendy Gribben Federal House 8 Candidate 8/9/2016
Wisconsin Myron Buchholz Federal House 3 Candidate 8/9/2016
Or, do you just prefer generic snark without action?
Human101948
(3,457 posts)anything to get rid of Republican lovin' DWS. (Unfortunately I cannot work there in person.)
If you're working for each and every one of those listed, you must be from Krypton.
Seriously would love to help everyone with donations but I am not Warren Buffet or David Koch--so tell me how.
Amimnoch
(4,558 posts)I generally dedicate 4-6 hours for phone banking on Saturdays and Sundays (occasionally take one off). Sometimes for a couple of hours in the evening during the week when I get a list.
I tweet to get their names out there.
I don't help every one every day, but i do cycle and as primary contests come up, I focus whatever phone banking time I can afford to help the ones that are closest to primary day out.
Having been in the Navy, and having a job that works with people from all over the country, I also use my facebook contacts, and some of my linked in contacts to help get the word out on these lesser known names that in the in are the key to making a real difference. Some take it up and spread the word themselves.. others disagree with my choices.. C'est la vie.
Even though I support Hillary, Tim's on my list of support as well. I've donated $20. I volunteered to bank for him, but haven't been listed yet (I think he's getting a lot of support there anyway due to the race against DWS)
Also, even as a Hillary supporter, I'm sooooo hoping the "feel the bern" movement at some point spreads and really tackles congress. To be honest, there's been several times this season I've given serious consideration to switching for the POTUS run. If I'd seen this movement turning into an intelligent version of the Teaparty movement, and going after the Congressional landscape, I can say with certainty that I'd have switched over.
Human101948
(3,457 posts)Thanks for the insight.
scscholar
(2,902 posts)is why our rulers supported such a horrific plan. We need to push for what is right instead of what is less worse.
SammyWinstonJack
(44,130 posts)Demsrule86
(68,556 posts)It works great. Her deductible is way lower than mine...I have workplace insurance which we pay 500 a month for and we have an 8000 out of pocket...we get nothing paid for until we hit 6000 ...nothing...not even a prescription. That is the reality of insurance obamacare or otherwise...and most people I know have the same sort of insurance. Last year with two serious illness in our kids, we spent over 10,000 on medical...our plan did not cover wheelchairs and some other stuff.
EdwardBernays
(3,343 posts)Forcing people to buy a product is a nonsense. Especially if the people that can't afford the product are punished with no access to healthcare.
And if the solution is, "we'll gradually make it better for some people - or at least we'll try" then you're not really understanding the problem.
scscholar
(2,902 posts)be able to afford more subsidizes. Just be patient.
Skink
(10,122 posts)50 dollar Doctor visits. A30 day supply of the meds I take would be about 1200. The ACA plan takes that down to about 40. There are other benefits. Blood work 95 percent discount. What is the problem. There is no problem.
magical thyme
(14,881 posts)And the # of insured does not equal the # with access to healthcare.
Bernardo de La Paz
(49,001 posts)magical thyme
(14,881 posts)Bernardo de La Paz
(49,001 posts)Objects in the vacuum of space aren't sucked into anything because there is no air pressure behind them to push them.
Without a mass, there is no gravitational field. The concentration and distribution of the mass controls the shape and strength of the gravitational field.
Technically, you are correct that the gravity doesn't suck, the mass sucks objects toward it by the intermediation of the gravity field.
Human101948
(3,457 posts)magical thyme
(14,881 posts)Donald Ian Rankin
(13,598 posts)Enthusiast
(50,983 posts)Mbrow
(1,090 posts)My insurance thru my union has been screwed over and over by the insurance companies since this started, the best plan we can get now is costing me and the other people 5x as much in deductibles and cost of care no longer covered. I understand what happened but compromise doesn't always work. and with the asshole re-thugs pushing back, well we know how that's working. we need to elect Bernie and keep going right on down the road. If Bernie is not elected we still need to keep going and force the issues from the bottom up. These assholes can't run this country with out us helping them to run it and if we convince enough people to join us we can win.
strategery blunder
(4,225 posts)I'm talking about ~150% FPL, which is about where I'm at.
The first year I was on ACA, my total monthly premium was about $280, my subsidy was about $210, leaving me with $70. (Fortunately I was able to find a plan on the exchange with a much more feasible $600 out of pocket maximum--adding another zero to OOPM makes the policy worthless to someone of this income).
That was manageable, and sure I made some sacrifices elsewhere to be able to re-enter the healthcare system after years of doing without, but those sacrifices were worth it.
A few months ago, it came time to renew. (Technically I had to switch to the next most similar plan as the one I had was discontinued, but the coverage is very similar.) My subsidy remained the same, but the premium went up to about $310...leaving me with $100 out of pocket premium.
The insurance company will say that my premium "only" went up 10%. But from my perspective--going from $70 to $100--it went up almost 50%!
I can probably absorb that for a year or two, but there will come a point, probably before the next presidency ends, where it becomes more economically sensible for me to cancel the policy, pay the tax penalty, and use the savings of not paying a premium to fund my $70/month prescription (that I currently pay $10 copay for) and the associated ARNP appointments to get said prescription renewed.
ACA was pretty much a one-time-lowering of costs to get people into the system who could not afford medical care before, but it came up short in long term cost containment. In ten or twenty years, we'll see large swaths of society who are right back where they started before ACA.
Yo_Mama
(8,303 posts)That's a provision in the law that few know about, but what it says is that subsidy increase is limited to GDP growth.
The theory was that this law would lower the actual COST of health insurance, but instead it has greatly increased it, and the increases show no signs of slowing down.
Therefore, in a few more years it is possible that those with subsidies will be paying ever larger portions of their income for health insurance premiums, and it is very hard to see that as substainable.
Here's a CBO write-up of that provision:
http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/121xx/doc12188/05-12-subsidies_in_exchanges.pdf
Exactly how and when that will kick off is uncertain, because it depends on GDP growth and how many persons are receiving subsidies. The limit is about 1/2 a percent of gross GDP.
Thus, if the economy is doing poorly, subsidized individuals and families would have to pick up more of the premium cost than if the economy is doing well.
There's a lot of uncertainty in this, but the point is that those subsidies are not going to stay equivalent to those we now have for another decade:
http://kff.org/health-reform/fact-sheet/analysis-of-2016-premium-changes-in-the-affordable-care-acts-health-insurance-marketplaces/
Scuba
(53,475 posts)And yes, we can afford it.
Umbral18
(105 posts)Who am i kidding, I'm already shopping for urns.
Scuba
(53,475 posts)yourpaljoey
(2,166 posts)Warren Stupidity
(48,181 posts)that could negotiate prices for services in the public interest and remove profit entirely from the health insurance industry. Just an idea.
karynnj
(59,503 posts)for medical services. Long ago, I saw a film created by doctors that advocated for different ways that insurance companies (including Medicare) could remunerate doctors for their work. It argued that the existing fee for service had a problem as it led to incentives that would increase pay, but not improve results. A main complaint of the doctors was that they did not become doctors to spend hours (or staff hours) negotiating with insurance company people.
Here is an article from earlier this month, of one such study. Note that Medicare is doing the study and even in a Medicare for all world, the idea is that it could lead to better medical care possibly (but not necessarily) at a lower cost.
http://www.npr.org/sections/health-shots/2016/04/11/473802292/medicare-seeks-savings-and-innovation-with-a-switch-in-doctors-pay
WDIM
(1,662 posts)bought from billionaire private insurance companies. It does nothing but suck the wealth from the many and give it to the few.
tularetom
(23,664 posts)But it it has made it less affordable for a larger number of people.
People who could not even get insurance can now get it but at a cost beyond their ability to pay.
As the subsidies disappear, more and more Americans will simply walk away from Obamacare and the health care funding situation will simply revert to the status quo ante.
In five years, maybe a couple more, it will be like Obamacare never happened. And the country will have pissed away ten years on a failed half assed solution to the health care crisis.
Kip Humphrey
(4,753 posts)We did get a note from ACA excusing us from the tax fine though!
hfojvt
(37,573 posts)Is that written into the law? Or is that Republican push back?
Obamacare has certainly made care more affordable for me. I am saving about $3,000 this year in insurance costs, maybe more, depending on where my income shakes out.
A friend, OTOH, has said that he is paying a $150 fine and that the options he got were not very affordable, which seems strange, considering his income is about as low as mine.
tularetom
(23,664 posts)The subsidies were to be phased out after some limited period of time.
hfojvt
(37,573 posts)I would be surprised if that was written in.
Searching for phase out only brings me to stories of how they phase out by income level. Like who knows, if I make another $100 in annual income, I may lose $2 a month in subsidies and some wanted to "boo hoo" about marginal tax rates because of that.
If subsidies do phase out that would really suck. I am still wondering if I can still get a subsidy if I retire early.
Dems to Win
(2,161 posts)I'm voting for Bernie in hope that my brother, a WalMart employee, can finally get health care. WalMart now gives him a 'health insurance' policy with a $5500 deductible -- for a $10/hr employee! He still can't afford to go to the doctor when he gets sick.
The ACA was passed solely by Democrats, not a single Repub vote. So why did the Dems pass a Republican plan? Nancy Pelosi bragged that the ACA included 200 Republican amendments.
I'm furious that Democrats passed a 'health care reform' that leaves out the working poor. If the ACA is the best we can expect from incremental Dems, then the hell with them. We need drastic change.
hfojvt
(37,573 posts)the co pay for a doctor visit is probably only $20. If he needs to go to the hospital, to save his life or something. Well, it is better to owe $5,000 than $25,000. $5,000 is only $20 a week for the next five years.
Dems to Win
(2,161 posts)He has to pay out $5500 for health care before the 'insurance' will pay a dime.
hfojvt
(37,573 posts)they hear from people who want to complain.
For my part, it seems to be saving me, personally, a whole bunch of money. It would be working much better if so many states had NOT opted out of the medicare expansion.