Health Law Tax Penalty? I’ll Take It, Millions Say

http://mobile.nytimes.com/2016/10/27/us/obamacare-affordable-care-act-tax-penalties.html?em_pos=small&emc=edit_dk_20161027&nl=dealbook&nl_art=16&nlid=65508833&ref=headline&te=1&referer=

by JumpCrisscross • 10 years ago

39 115 10 years ago

mobile.nytimes.com

pixl97• 10 years ago

When I can get rent both a house and a car for the same amount health insurance would cost me, the system is totally broke.

HillaryCare isn't working.

https://twitter.com/HillaryClinton/status/697967580770869248

M_Grey12• 10 years ago

You had such a good point, until you scuttled it all by going pointlessly political and partisan. There is a problem here, but it's utterly without a political identity. The bottom line is that we need price controls, and something like an NHS; the current model is just utterly broken. Nothing the R's or D's are saying will change it either, and laying it at one person's feet is pathetic and wrongheaded.

philbarr• 10 years ago

You had kind of a good point until you called someone pathetic and wrongheaded...?

paulddraper2• 10 years ago

Huh?

The article is about Obamacare, aka Hillarycare. Seems on-topic to me.

sharemywin4• 10 years ago

Free market + insurance version of healthcare. How much of my money(my premiums) are you willing to spend to control your diabetes, risk of heart-attack, or cure your cancer? I'll give you a hint, all of it.

rpedela• 10 years ago

The Affordable Care Act is extremely similar to the healthcare plan Hillary championed while she was First Lady.

merpnderp4• 10 years ago

Price controls? We already have doctors willing to pull out of medicaid because it doesn't cover their costs. Price controls just reduce supply and give you situations like in China where medical scalpers sell places in line for doctor visits at up to $500 a pop.

kefka4• 10 years ago

Price controls? How about bloody telling the price for stuff?

"How much is this procedure/appointment?"

And all I get are sneers of derision or confusion. Then I'm told, "The bill will be in the mail." Yeah, well fuck you too.

You want price controls; I want an estimate, and a list of procedures and their costs.

Then again, I'm waiting to sue someone over the lack of informed consent based on financial availability. I'd do it, but I'm not a lawyer.

al3xnull• 10 years ago

I'm in the same boat. To cover my wife and child on top of my employee portion of insurance, I'm at ~$1200 a month. It's more than my car and rent. Going through a long drawn out process of lowering my spending income down ~$15k a year only to move to ~20k with 2017 increases.

I'm with m_gray though. Either party doesn't matter to me. Not a fan of Hillary or Trump. Just want someone to actually make a difference that doesn't include a higher cost to my wallet every time they enact something.

sharemywin4• 10 years ago

Neither is proposing something that could work.

Normalized pricing based on income with transparency on procedures and tests. Deductible + premiums + out of pocket should add up to no more than 8-10% of my income.

And out of pocket should be some fraction of real price based on income. It should always cost 3x to go to a hospital than a doctors office its just the amount should vary based on income.

Let private insurance compete in the supplemental market. And offer public option on exchange.

bonzini• 10 years ago

It would be interesting to know how many of these people are from states that didn't expand Medicaid. Of the two mentioned in the article, one is from Georgia (didn't expand Medicaid) and the other is a customer of someone in DC (could be from DC, Maryland or Virginia; the first two expanded Medicaid, but Virginia didn't).

Amezarak• 10 years ago

Why? If you would have qualified for Medicaid, had it expanded, you don't have to pay the penalty anyway - the government doesn't punish you because your state didn't expand Medicaid.

Only if you qualify for the subsidized private coverage (which poor people do not) do you have to pay a penalty for not getting health insurance. Frankly that part of the law is a little insane, even if it is because it wasn't implemented as intended; if you don't have any income, then you have to pay the full price for coverage on the exchange, no subsidies. Your income has to meet a certain minimum level to qualify for subsidies - the intent was that below that level, you'd get Medicaid.

maxerickson10• 10 years ago

If you qualify for Medicaid based on income, I don't think you can buy from the exchanges (the option is a similar plan off exchange).

bitJericho2• 10 years ago

The public exchanges are a slap in the face. Companies like walmart expect the government to pay for healthcare. The poor wanted socialized healthcare to make WalMart et al pay for it. The poor desire the destruction of the insurance industry, and what they got was what they already had only with IRS penalties.

M_Grey12• 10 years ago

The irony is that we're all, WalMart included, going down the same chute into the same incinerator. Between costly wars and wasted money on Insurance and healthcare, we're just killing ourselves as a country.

fowlerpower3• 10 years ago

That's not exactly how our economy works.

Those expensive wars are fought with expensive weapons, which are mostly still made here by American companies. Those soldiers fighting those wars are citizens with full time jobs for many years.

Healthcare is another thing that's made here and someone is getting paid when we pay an efficient amount or simply overpay.

So killing ourselves is all a matter of perspective, some people are doing quite well.

crdoconnor2• 10 years ago

"We"?

Part of the issue is that Americans seem peculiarly unwilling to point their pitchforks in the right direction.

sharemywin4• 10 years ago

poor? I work for a small company that offers horrible insurance because almost everyone 50-60+. We have 4 people in our family and we're about 20k over the median income line. Insurance companies want 15K a year plus 2.5k deductible before they pay dime 1. Exchange, insurance at work doesn't matter both are completely un-affordable.

fowlerpower3• 10 years ago

Blaming the elderly for our problems is a bad move. Simply because the laws of the universe say we will become old too.

Now I agree with you on your other points that the insurance companies took this law and said fuck it we will just raise prices. That is what happens with corporations they want to make money. The fact that the government thought they could just force these folks to do the right thing and cover people with pre-existing conditions and all this other stuff without a single consequence was a really bad oversight.

fowlerpower3• 10 years ago

I think you hit the nail in the head.

Most poor people are worried about making ends meet the very last thing they are thinking about is their taxes and possible IRS penalties. They are expecting a refund and not to get hit with a fine. This is really just another burden on the middle class, it was for sure an unintended side effect by the folks who came up with his law.

merpnderp4• 10 years ago

This law was written with input from the health insurance lobby. There was likely never any doubt how this would play out.

wmccullough• 10 years ago

An example of said burden on the middle class. I make a senior software engineers salary and my wife has Lupus. I'm beginning to have signs of having Lupus and RA myself. Her prescriptions alone barely have any coverage until we meet our out of pocket max, and by then, 10-15% of our income is gone paying just for drugs. This is on top of 25-30% taxes, plus the rising cost of food, and now they are telling me I may need the same drugs as her? So in this new found world, I could potentially lose up to 55% of my income in taxes and health coverage. Oh and for a laugh, Medicare won't cover her because I make too much. This is insane.

Despite this, I'm of the mind that we can't return to the way things were before ACA, and ACA isn't the answer either. Something has to change or we may have to move to another country with better options. People huff about waiting lists, but neglect to realize that waiting lists are often for non-life threatening surgeries. They also forget to tell the part about how routine office visits don't have the same types of waits, and how prescription coverage is still free.

All of my crying aside, I'm left with one thought. How in the actual fuck do poor people afford this shit? I grew up poor and I know what we did--we didn't have insurance and thankfully we were lucky enough not to have any chronic illnesses in my immediate family when I was growing up.

On a lighter note, a small joke: I downloaded the GoodRx and it physically started emitting laughter from the speakers once I typed in the drug names.

patrickg_zill• 10 years ago

Obamacare was expressly designed to fail, it seems.

Take an issue and make it worse, wait for the backlash, then come back to the public and offer a new solution: single payer.

flavor8• 10 years ago

And/or public option. "The insurers can't make this work, so we'll offer a reasonably priced plan."

maxerickson10• 10 years ago

The design included risk corridor payments that aren't being met.

http://www.cnbc.com/2016/05/18/health-insurer-highmark-sues-...

It's also really difficult to say what premiums would have been without the changes the ACA made. Medical inflation has slowed since the law was passed, but again, I think it is difficult to figure out how much of that to attribute to the ACA.

xienze4• 10 years ago

It's also really difficult to say what premiums would have been without the changes the ACA made.

No it's not. Forcing insurers to take people with pre-existing conditions completely screws up risk pools. Anyone could've told you that doing so would make premiums rise much faster than if those customers could be denied.

merpnderp4• 10 years ago

Only if you realize there's likely nothing you can do to ruin your reputation. Usually there are repercussions for failing badly.

xienze4• 10 years ago

Obamacare was expressly designed to fail, it seems.

Of course it was. Anyone with half a brain understands how risk pools work and understands that allowing people to join said pools after developing an expensive, crippling illness will completely wreck everything.

riskable3• 10 years ago

I think we're just experiencing the ultimate end game of the system. The ACA was nothing more than ointment on an infected wound. It worked for a time but it is becoming more and more obvious that this leg our economy needs to be amputated.

We need a single payer system or at the very least a single body that negotiates the price of all drugs and health care services on behalf of all Americans. Frankly I'm surprised that the insurance companies aren't lobbying for such a thing as it could be their only hope for continued existence very soon.

The pharmaceutical industry would practically go to war to prevent a single payer or a price-fixed system but they would lose if they're opponent was the insurance industry (and the American people; who have very low esteem for "big pharma").

A most interesting change resulting from an American single payer system would be the increase of drug prices for everyone else (other countries). As it stands right now the only reason drug companies can get away with some of their lower prices in single-payer countries is because the US can and will make up the cost. Lowering the cost of drugs in some countries really does result in higher costs for Americans.

maxerickson10• 10 years ago

We need a single payer system or at the very least a single body that negotiates the price of all drugs and health care services on behalf of all Americans. Frankly I'm surprised that the insurance companies aren't lobbying for such a thing as it could be their only hope for continued existence very soon.

What role do insurance companies have if there is a national body fixing prices?

jefurii2• 10 years ago

Looks like not much of a role at all. After all of my experiences with insurance companies I'm quite okay with that.

A NHS-style system would still need staff in order to function and I expect many rank-and-file insurance people would end up there. The executives can go to hell as far as I'm concerned.

DiabloD3• 10 years ago

None.

Which is America's end game: to end that apparent scam.

This is why I actually had hope for the original draft of Obamacare: he straight up cloned the Netherlands system where insurance companies must insure x% of various classifications of sick people (cancer, AIDS, asthma, heart disease, overweight, etc), where x% approximates the national average...

... and they must spend ridiculous high levels of what they make on actual health care, AND the prices of health care are nationalized.

In the end, they fight over sick people (have a rare sickness? insurance companies will give you a discount to get you, instead of trying to figure out how to lifetime ban you from insurance instead). And what happens if an insurance company can't get enough people to meet the strict guidelines? They're banned from selling insurance in the Netherlands until they do.

This is essentially the original Obamacare, filtered through the American way of doing shit. What we got instead? Half of that, and maybe not even the good half.

We got fucked.

nlodnl• 10 years ago

They'd still be providing insurance. A national body negotiating pricing doesn't necessarily mean any or all forms of healthcare would be affordable.

brightball2• 10 years ago

The ACA was pretty much a terrible proposal from the start.

The logic that lead people from "insurance companies are the problem!" to "force everybody to buy insurance!" required a mind blowing level of cognitive dissonance.

riskable3• 10 years ago

You assume that this current broken state was unintentional. I believe this situation is intentional and was predicted and expected.

Back when Obamacare was being debated I and many others argued that the best it could do would be to slow the meteoric rise of health care costs because it was painfully obvious (to me at least) that it didn't actually solve the problem. I have no doubt that the politicians knew this as well which was why Republicans fought so hard against it and why Democrats wanted it so bad.

I believe they wanted it to come to this. They wanted to demonstrate that even if you force people to get insurance it still wouldn't be enough. It is a real-world application of how, "the compromise" (forcing people to get insurance) doesn't actually impact the price much because health care costs are not controlled by traditional market forces.

What is the price, "the market will bear" when someone will die or suffer immensely without treatment?

kefka4• 10 years ago

I'm also seeing something else here too, with the "screw you, raise price by *1000" executives, schrekli (sic) being one of many.

What many of these comes down to, is they own a right of patent on something that allows them to set the price at will. Or, if they choose, to not license or sell it at all.

Stated differently, why should someone or government tell me how much I should set my price on a patent I own?

An answer, which I am not aware of being used, is eminent domain. We do as such for public good when it comes to roads, buildings, and similar. I know the Supreme Court had to rule back with Wilbur and Orville Wright because they kept avionics back for a decade whilst Europe was booming... because someone wouldn't sell the rights to do aircraft.

Of course, the underlying problem is public institutions pay for the research, and drug companies get access to this and extract. The drug co's aren't researching; the public institutions do; and we do.

jostmey• 10 years ago

Except the drug "schrekli" priced gouged was out of patent. It should have been a commodity, so why weren't any competitors allowed on the marketplace? Take a look at Washington for your answer.

There are lots of amazing companies trying to invent cures that don't otherwise exist, and need compensation for their work. Then you have Epipen and "schrekli" jacking up prices on 30 year old drugs.

msandford2• 10 years ago

We need a single payer system or at the very least a single body that negotiates the price of all drugs and health care services on behalf of all Americans. Frankly I'm surprised that the insurance companies aren't lobbying for such a thing as it could be their only hope for continued existence very soon.

Insurance companies are legally obligated to pay out 80-90% of their receipts for treatment. Since they can't become more profitable on a percentage basis, they have every economic incentive to drive the cost of medicine up. What's better than making $500/year/customer? Making $1000/year/customer because medicine costs twice as much. You don't even need to get more customers!

There's definitely a whole slew of market failures piled up on top of one another in the healthcare system here in the US.

There are people who are afraid of single payer for silly reasons, but there are also people who are scared of rationing. That's a legitimate fear! And it's not one that can really be assuaged because we've seen that while it's very difficult to get laws passed today, that's nothing compared to rolling them back. So everyone could go into single payer with the best of intentions but it only takes a few changes of administration for things to start to go off the rails, and then it'll be nearly impossible to get the mess sorted out.

I mean, look at the ACA! The whole thing was done with the best of intentions but even before it made it to being a law it got all messed up. And now that it is a law, it's maybe not necessarily having the intended effect.

Couple that with the idea that everyone in the US is about to "make it" or that everyone thinks they're middle class or upper middle class and fears about rationing can seem entirely well founded.

Anecdotally I had a prof who was from Vancouver who had a knee problem and needed an MRI to make sure it wasn't cancerous before they operated. 9 month wait list fo r the MRI or a half day excursion to Seattle and about a grand and he had his imaging. It doesn't prove that everyone in Canada experiences rationing the same way, but it does mean that fears aren't completely unfounded.

mgkimsal5• 10 years ago

" but even before it made it to being a law it got all messed up"

Requiring legislators to read legislation (and maybe even take a test on bills that are larger than 10 pages?) before they vote on it might help. Being told "we have to pass it before we can look inside of it" is... I can't think of anything less sane.

Re: Canada and other countries. I know in the UK you can get private insurance and "go private" for most services, or you can take the public option, which may involve waiting. Why we think here it's going to be 100% one thing... I don't understand. Your canada story already demosntrates that - someone with more money paid for faster service. I have a strong suspicion he could have had that done privately someone in canada for $x, but seattle was closer/easier (?)

unclenoriega• 10 years ago

Healthcare is always rationed, though. It can be rationed by need, ability to pay, or some other way, but there's no system for infinite healthcare yet developed.

rayiner5• 10 years ago

Having a single entity negotiating prices would obviously lower them--it'd establish a monosopny. But would that be a good thing? I mean, we could lower prices for everything that way. Have a single entity negotiate prices for cars, or construction services, for example. That'd lower prices too. Why don't we do that for everything?

mgkimsal5• 10 years ago

arguably not everyone needs everything - many people can get by just fine without a car, or construction services, or other things you might list. Not too many people get by (for long) with poor/ailing health.

Some aspects of health care - basic stuff like getting people insulin they need and whatnot - does that not potentially get justified under "general welfare" clause? Many other countries seem to get by just fine with a baseline "health service" provided to everyone, with "premium" service paid for out of pocket or via private insurance. People should not have to face bankruptcy (or just extreme debt) because they happened to be born with the wrong genes.

mgkimsal5• 10 years ago

"It worked for a time"

It's only been in effect for a few years - what "time" did it "work"?

xienze4• 10 years ago

What, you don't remember those articles immediately after Obamacare went into effect gloating about how everything was going fine?

calvano915• 10 years ago

The big successful aspects of the law remain in my mind: Elimination of lifetime caps, pre-existing conditions. Allowing children to remain on plans until 26. Insuring millions more via expansion of Medicaid or subsidies of premiums with initially more competitive plans.

By and large I think it was a success, albeit a completely temporary bandaid to a system that requires massive re-thinking

neffy• 10 years ago

I agree - a lot of the issue in the US is that there isn´t any effective competition (or control of) the drug companies and price gouging. A single payer will help tackle that. But the key question is, why is American healthcare so expensive, and for such poor outcomes - measured by life expectancy at least? You can lop off a few percent as the cost of running the insurance company infrastructure, but it still doesn´t explain all of it. Nor is it the case that US patients are subsidising other patients drug costs - not all drugs are researched or manufactured by US drug companies.

There is a supply element to all this as well, and it´s not just drugs. Let me give you one example from the UK, since I don´t know the US figures.

One of the problems in the UK is that doctors are very expensive, and there aren´t enough of them - this isn´t because of their student loans, it´s because there´s a shortage of doctors. The NHS imports a lot of doctors from abroad to cover this (causing issues in their home countries), the US does the same. (If you´re a doctor from a country with low cost medical training the markup for working in the US is insane. I digress.)

Dig into the statistics for medical training in the UK, and it becomes clear that the number of places has been held more or less constant, while the base population has increased significantly, and you can put whatever fudge factor you like on the population needs more healthcare because of obesity/ageing/excessive tea drinking, etc.

http://dera.ioe.ac.uk/16155/1/medical-and-dental-school-inta... (p11)

Finally - this year:

https://www.gov.uk/government/news/up-to-1500-extra-medical-...

Which unfortunately won´t have any real impact for at least 6 years or so.

To solve the american health care problem requires essentially a large scale attack on the cost of the health provisions, and that has to be across the board, and it´s going to take years just because of the lag times involved. Personally I would start with simply doubling the number of medical school places - maintain standards on admission - and work on dropping the salary levels. Provide scholarships so students don´t need big loans. Attack the anti-competitive practices of the drug companies directly, etc.

In other words, remove artificial supply bottlenecks, let the market sort it out... and have some kind of bailout ready for the existing medical professionals, and medical providers, who then can´t repay their loans.

Making the rest of the world pay US prices...isn´t going to happen. Sir Alexander Fleming was Scottish.

maxerickson10• 10 years ago

The market for widely used generic drugs in the US is incredibly competitive. It's niche and patented drugs that see crazy prices.

As far as doctors, the US currently has a surplus of medical school graduates and not enough residency slots to train them. I imagine the most immediate thing the US could do would be to train even more physicians assistants and nurse practitioners and then do a better job of billing less for lower levels of service.

JustSomeNobody2• 10 years ago

Insurance companies have to meet their quarterly earnings goals or investors will punish them. If their lobbying can't get the tax penalty raised, then it will continue to be a better deal for the young and healthy to take the penalty.

raverbashing• 10 years ago

Want to fix healthcare?

- Mandatory price transparency. Health care is procedures and medicines, not a used car. Also all procedures signed off beforehand (with the exception of emergency ones, naturally). If Procedure A costs $100 for Health Insurance A, why should they charge a BS price for someone without Health Insurance?

- Zero drug advertisement (maybe for no-prescription drugs, still)

- Cut on incentives (briberies) by drug-companies

rayiner5• 10 years ago

I'm kind of on board with zero drug advertisements. But what rationale for banning drug advertisements doesn't also apply to banning other kinds of advertisements? I mean, I'd be on board with that too but I'm wondering if you see some distinction.

kasey_junk6• 10 years ago

We do ban other kinds of advertisements already when we deem them against the greater public good.

So I can see how banning drug advertisements falls into the same category as banning cigarette ads, in that it makes for a more healthy public. The same thing can of course be said about just about anything, but sometimes you just have to stand on that slippery slope.

merpnderp4• 10 years ago

Hospitals don't even know how much somethings costs. They just start billing for this that and the other until their bottom line looks decent. This is likely an artifact of our current insurance system where the customer is the insurance company, not the actual patient, and the insurance company can profit at a fixed percentage of costs. So they're fine with spending as much as possible.

jazzyk• 10 years ago

Agree, but you missed one big factor (kind of related to price transparency):

-have individuals/families pay for healthcare, not employers.

Only then people will start caring how much things cost.

teekert• 10 years ago

Here in the Netherlands: You can't pay for health insurance? Here is some subsidy to help you.

In the US: You can't pay for health insurance? Here is a fine of 700$

maxerickson10• 10 years ago

The fine is structured such that only people that can pay for health insurance are hit with it. The various income tests and whatever might not be perfect though.

Here's some numbers.

~8 million people chose the fine[1].

More than 9 million people receive subsidies on the ACA exchanges[2].

About 58 million people receive Medicaid (heavily subsidized insurance)[3].

[1] http://www.cnbc.com/2015/07/20/irs-more-paid-obamacare-fine-...

[2] https://www.healthinsurance.org/obamacare/will-you-receive-a...

[3] https://www.medicaid.gov/medicaid/program-information/downlo...

cmdrfred4• 10 years ago

The fine is structured such that only people that can pay for health insurance are hit with it.The various income tests and whatever might not be perfect though.

That is to say the least. It is all based on the poverty line and that is extremely flawed.

"The current federal poverty level is $23,550 a year for a family of four and $19,530 for a family of three. But this measure is based on a methodology developed in the 1960s and now widely recognized as outdated. One major criticism is that the official poverty level is too low. Current research suggests that, on average, families need an income of about twice the federal poverty level just to afford basic expenses. Moreover, although the cost of living varies significantly within and across states, the federal poverty level is the same across the continental U.S."

http://www.nccp.org/topics/measuringpoverty.html

drakonandor3• 10 years ago

The solution seems obvious. Instead of fining (those who can afford it), use that money to pay for their Medicaid/Medicare.

That way they have insurance, which was the goal of this program, no?

kasey_junk6• 10 years ago

I see a lot of value in a single payer system as health care system as I fundamentally believe healthcare spending does not conform to the same rules as other parts of the economy and thus might make all of our (basic) understanding about economics moot.

That said, single payer does not solve the single biggest classic problem with the current healthcare system in the US and that is the agency issue. Right now I cannot make informed choices as a consumer in this market. Prices are not transparent and the people negotiating the prices are not the people receiving the care.

Further, we've coupled insurance to employment which is just insane.

Oddly McCain's health plan from a few elections back would have at least dealt with the last point. I wonder if the exchanges would be more successful if the entire population was buying insurance through them.

alistairSH• 10 years ago

Yeah, I do wish we'd figure out a way to decouple insurance from employment. Right now, I have two choices... one from my employer, and one from my wife's employer. One is terrible ($12k/year OOP max), the other is better (but still worse on cost and benefits than the typical PPO from 15-20 years ago).

maxerickson10• 10 years ago

It should have been done as part of the ACA. Remove the tax incentive and encourage all those people to go to the exchanges. It would probably have to have been done in a staged manner.

After that, eliminate Medicaid in favor of fully priced exchange subsidies (I say "fully priced" because as far as I can tell, much of the funding for Medicaid comes from jacking up prices that other people pay for care, creating a tax that gets hidden in insurance premiums and deductibles).

Instead the ACA placed more requirements on employers and expanded Medicaid.

bnolsen• 10 years ago

I see no value in turning a whole industry into defacto civil servants. Doctors and nurses are people too who need to be able to choose themselves. I don't give a rip about insurance. Getting access to health care is what matters. Doctor/patient relationship is what matters. I see no need for government to get involved other than stopping ethical type (illegal) abuses.

kasey_junk6• 10 years ago

Getting access to health care is what matters

And how do you provide access to extremely expensive health care without insurance or government? Risk sharing is the issue and in this case it seems fraught with moral hazards regardless of how it is done.

tptacek2• 10 years ago

If you don't give a rip about insurance, you should be especially irritated at ACA and the ACA status quo ante, because the insurance companies and hospital chains quietly negotiate the prices for health care services, collude to establish favorable prices for the insurers, and lock individual consumers out of those prices.

A fun experiment I've had the pleasure of running: try to get an MRI done outside of your insurance policy --- that is, try to pay the rack rate for an MRI, out of pocket.

0xcde4c3db2• 10 years ago

It has not worked all that well, and that is at least partly to blame for soaring premiums next year on some of the health law’s insurance exchanges.

People love to blame any post-2010 health insurance problem on Obamacare, but what's the evidence that rate hikes are actually significantly influenced by PPACA?

mgkimsal5• 10 years ago

but what's the evidence that rate hikes are actually significantly influenced by PPACA?

For 4 years before "mandatory purchase" was in effect, I saw annual 3-5% increases in premiums. In 4 years since, I've seen ~20% increases each year (last year was 'only' 11% increase - I'm bracing for much more).

The 'evidence' is insurance companies bringing in more people who previously didn't have insurance - generally, they either needed or used more services than whatever the premiums (+ subsidies) they were paying covered, and insurance companies lose money because of this. In NC, BCBS lost ~$400million last year (or so the claim goes). They can't sustain those losses indefinitely.

forgotAgain• 10 years ago

Twenty to fifty years from now historians are going to reference the ACA as a case study of early 21st century American government:

1) hyper partisan political process

2) special interest control of the content of laws

3) release of information by the government used as a method to manage the electorate rather than inform

4) front loaded benefits with back-ended payments

5) political class taking credit for the good stuff and leaving if for others to clean up the mess

Generally speaking, all aspects of American government in this place and time are reflected in the ACA. All aspects share the same sustainability issues.

falcolas• 10 years ago

I will always support the ACA, for one big reason: friends and coworkers of mine who were denied insurance before can now get insurance.

I am more than willing to pay higher premiums (or tax penalties) if it means that people who need treatments can now have access to those treatments without going bankrupt.

Health Law Tax Penalty? I’ll Take It, Millions Say

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