A middle-class family's only option: A $43,000 health insurance premium

https://www.washingtonpost.com/health/2025/12/21/obamacare-monopolies-subsidies/

by paulpauper • 7 months ago

42 89 7 months ago

ggm2• 7 months ago

I don't understand how this confers political benefit to the republicans or the white house. Can somebody explain a non conspiracy model how this helps them electorally running into the midterms?

Is there some way aside from the obvious mistruths they can demonstrate its the democrats fault, and achieve some electoral advantage?

Wyoming is extremely "red" according to Web searches (I am not an american)

My default assumption here is, it cannot, and this is going to cost them seats.

undeveloper2• 7 months ago

All indications show that this is absolutely terrible for republicans' self interest, and popularity. trump has gone from winning the popular vote ~~(over 50% voted for him)~~ (a plurality of 49.8% voted for him) to polling at the 30%s. The recent 2025 elections (an off-year, so a variety of smaller elections at the state / city level mostly) have shown democrats are absolutely performing much better right now. This is not contested by either party.

Is there some way aside from the obvious mistruths they can demonstrate its the democrats fault, and achieve some electoral advantage?

You discount the skill republicans have at lying -- regardless, when people are feeling the pinch in their pockets, they will blame whoever is in power. Currently it is the republicans.

sundaeofshock• 7 months ago

<<trump has gone from winning the popular vote (over 50% voted for him)>>

Trump received 49.8% of the popular vote.

kcplate3• 7 months ago

I think you probably need to consider how many and who is affected and where their voting affiliations already lie if they even vote at all.

My guess is this doesn’t help or hurt either party at the voting booth. If you are ACA aligned or participate in that program you probably already vote Dem or not at all.

RickJWagner7• 7 months ago

Meh. Trump is ahead of Obama and Bush, given the same point in the presidency.

The honeymoon is over, but he has not become excessively unpopular.

KPGv22• 7 months ago

they've reached a local maximum and the only simulated annealing in their party (Trump) doesn't care about this issue at all.

fluidcruft3• 7 months ago

Extremely red states don't care. They won't flip at all. And none of the districts are even remotely competitive. Only the primaries matter.

A cursory look says Wyoming has a population of ~580k and ~340k registered voters. The article says Wyoming has 46k people on ACA. Republicans win landslides in Wyoming (40%-50% margins) and 46k people is 12% of voters max (likely closer to ~4% at risk).

ggm2• 7 months ago

Thanks. So, the upside is saving money, at the expense of alienating poorer voters in (this example) a state where their majority is so big they don't care.

gruez2• 7 months ago

Extremely red states don't care.

What about more marginal states? The reduction in subsidies is nationwide, after all.

RickJWagner7• 7 months ago

I’m right-leaning, I agree it does not help Republicans.

Also, propping up ACA ( I say this as an ACA user ) is not the answer, either. The subsidies were temporary, making them permanent only adds to the never ending flood of red ink.

Healthcare needs a complete reboot. As someone on the right, I am open to a reasonable big government solution. ( After all, even Nixon wanted public healthcare. ).

It’s long past the time for patching. We need a reboot.

jmclnx2• 7 months ago

Yes, a "reboot" is needed. A bit of history from what I remember:

Nixon's plan would have passed except for Ted Kennedy, he stopped it in its tracks. Then when the Clintons came in something flipped, the GOP was all against what Hillary was trying to push. I forgot what it was but I think it was some kind of single payer.

So under Obama, the democrats took the Massachusetts plan created by Romney (GOP), which I believe the Heritage Foundation even endorsed, thus created the ACA.

So here we are. Now I think we are in a sad place where for-profit healthcare is entrenched, bribing both side of the aisle to keep their profits high.

_DeadFred_7• 7 months ago

AKA the typical doomer non-solution. 'If we blow it up, somehow a new, better systems will magically emerge'.

If I went to management with the dev plan of 'throw all the source away, start over with a new stack, new devs, from scratch, but also I don't know what the new stack will be, and haven't found new devs' I would be called a moron. But if you are a conservative, it's somehow called rational policy and a plan and it's worth the lifetime lasting damage/potential deaths is will cause a shit ton of people and financial ruin it will cause many.

Edit: Throttled so replying by edit. In the example below, Steve Jobs LITERALLY had a stack in mind, a plan, and people/talent lined up.

tzs• 7 months ago

Also, propping up ACA ( I say this as an ACA user ) is not the answer, either. The subsidies were temporary, making them permanent only adds to the never ending flood of red ink.

It does not add to the red ink, at least according to the accounting rules Republicans used to justify the so-called Big Beautiful Bill's (BBB) costs.

The BBB made many of the 2017 Trump tax cuts, which were temporary and set to expire at the end of 2025 (just like enhanced ACA subsidies), permanent.

Republicans argued that the loss of revenue from making the tax cuts permanent should not count when accessing the effects of the BBB on the deficit because extending something that is expiring doesn't really change anything.

danaris3• 7 months ago

It's not about politics; it's about ideology.

They want poor(er) people to hurt, so that rich people can have more. It really is as simple as that.

qcnguy6• 7 months ago

It's not about ideology, ffs get a grip.

The US is bleeding out because its government spends so much more than its society can generate via taxes. Its has a debt of 38 trillion dollars. The subsidies were adding to that.

People who say "we'd like to give you free money but can't afford it" aren't motivated by ideology, they're motivated by the money not being there. Borrowing just delays the inevitable and makes it worse - it's literally stealing from children and it doesn't fix anything.

There are ways to fix US healthcare but adding ever more debt won't do it.

gruez2• 7 months ago

They want poor(er) people to hurt, so that rich people can have more. It really is as simple as that.

What about rest of Trump's policies? Are tariffs also a "so that rich people can have more" policy, contrary to the "globalization only benefit the rich" rhetoric of the 2000s?

_DeadFred_7• 7 months ago

From what I'm seeing it's 'Obama and his government intervention broke healthcare, we need the government out so that the system can fix itself'.

maxerickson• 7 months ago

It hasn't been Obamacare at least since the repeal of the individual mandate.

BenFranklin1002• 7 months ago

It’s not pharma that’s driving rising medical costs, it’s hospitals:

https://www.bloomberg.com/features/2025-cancer-drug-markups/

Another contributing factor is that Americans consume a LOT of healthcare, often well past the point of diminishing returns:

“Why conventional wisdom on health care is wrong (a primer)”

https://randomcriticalanalysis.com/why-conventional-wisdom-o...

Finally, basic preventative health care — at least for children — could save more than it costs when we take into account the overall economic effects of poor health outcomes. We should consider making it an entitlement.

Eddy_Viscosity22• 7 months ago

If medical care is a for-profit industry, wouldn't it be in their interest to reduce preventative care, especially for children, so they will have overall greater health care needs (and bills!) later on?

Individual doctors and nurses etc may very well want people to get good treatment, especially children. But they are just the hired labor, the owners of the medical services and insurance industries just want the money and so likely lobby for the worse outcomes. It also has the bonus of further tying people to their employers who offer health plans making them more pliant workers.

qcnguy6• 7 months ago

No, health insurers are motivated to keep their premium payers healthy and have a long track record of funding programmes to improve the health of the population. Think about how insurance works. Where I live they paid for the creation of outdoor gyms.

Individual doctors and nurses etc may very well want people to get good treatment, especially children

It's individual doctors and nurses who are most incentivized to over-treat. They make more money the more healthcare is consumed. It's insurers who have an incentive to keep healthcare costs under control. A big part of the reason US health insurance is so expensive compared to the rest of the world is that Americans stage a massive freakout every time insurers try to control costs. It's a cultural thing and done by both Democrats and Republicans, look at how they call the UK's NICE committee a "death panel".

HDThoreaun3• 7 months ago

Insurers are the only ones trying to control costs in healthcare.

johnwheeler8• 7 months ago

If you're 80 years old, you probably should not receive a subsidized hip replacement.

If you can't afford it on your own, there should just be a palliative care mandate after some age. We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon.

Or, we should pay doctors far less. I don't think they're multi-millionaires in other countries. Not all of them are in America, but many of them are.

analognoise• 7 months ago

This is such a painfully American response.

Nobody can ever imagine a better system, even if it’s used in literally every advanced nation in the world. Nope, instead we have to let Grandpa die painfully to keep those stock prices up.

I’m starting to think Capitalism as it’s practiced here is a death cult of some kind.

johnwheeler8• 7 months ago

Well, I mentioned palliative care, but in general, I agree with you.

I would much rather doctors just get paid less. I took my son to the ER. He had a very high fever. They gave him a child's aspirin and me a $700 bill.

I just don't know what the answer is. And really, if you go into a hospital, you get the sense that there's people basically taking advantage of subsidized health insurance providers and patients both. Health insurance in America is absolutely atrocious. Next to gun fanatics, it's the worst thing about this country.

qcnguy6• 7 months ago

The rest of the world mostly also uses subsidized private healthcare (except for the UK, where healthcare is far worse than in the US).

The US system works well if you can pay the bills. It doesn't have the undercapacity issues the UK has, for example. The unique problem is costs. Controlling costs would mean consumers strongly supporting aggressive action by insurers if they take actions to push costs down. What Americans do is the opposite: they stage protests and demand immediate political retaliation on insurers who try to control costs. Then left wing politicians condemn the insurers, and they fold in the face of public pressure. Medical staff know the public acts this way and so bends insurers over the barrel, knowing people will blame the "capitalists" (who have tiny margins) over the frontline doctors and nurses who are actually taking the money.

https://www.vox.com/policy/390031/anthem-blue-cross-blue-shi...

In other countries the public doesn't act this way and costs are more reasonable. Sometimes insurance premiums even fall. Switzerland has a two tier system with basic mandatory health insurance that's basically controlled by the government (private firms provide it but there are price controls and they can't refuse customers). And it has supplementary insurance for higher quality care that's almost free market. This year basic premiums went up 5% and supplemental premiums fell 0.9%

https://www.bfs.admin.ch/bfs/de/home/aktuell/neue-veroeffent...

Cost control requires private sector discipline without people like Kathy Hochul getting involved, but healthcare even in the USA does not have that.

vinyl7• 7 months ago

Something changed in the US in the last 15 or so years that caused our whole country to become a death cult. All I see in the economics is a bunch of looting and pillaging before the music stops

HDThoreaun3• 7 months ago

The better system that the rest of the world uses is letting grandpa have a bad hip. Absolutely insane that you take a huge part of what makes other systems cheaper and claim other systems would never do that and capitalism is to blame for everything bad.

KPGv22• 7 months ago

If you go to a hospital in the United States, it's a lot of old people getting expensive care.

You think hospitals aren't full of old people getting care in other countries? And do you think it's possible that young people in the US don't go to the hospital because they can't afford to?

johnwheeler8• 7 months ago

I took that out because I didn't think it was relevant. And yes, that is my point. Young people can't afford insurance in America. It's terrible. I think the GLP-1s are going to make things better. A huge problem, as everybody knows in America, is obesity. That's also a major tax on the system.

TimorousBestie5• 7 months ago

We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon.

Easy enough for someone who thinks they have a “long time horizon” to say.

mgh955• 7 months ago

What other choice is there? About 10% of all US healthcare spending is on end-of-life care [1]. It's not pleasant to talk about, but it is a discussion that needs to take place.

[1] https://www.wrvo.org/health/2019-09-30/ten-percent-of-all-he...

johnwheeler8• 7 months ago

I'm middle-aged so I don't really have a long time horizon but I do have expensive insurance. If you have employer-covered insurance, you don't know what the hell you're talking about. So it's easy for you to say.

jrjrjfhgggg• 7 months ago

I think you need some empathy and life experience.

ProfessorLayton• 7 months ago

It's worth pointing out that it's generally older people voting in other older people into power to deny younger people universal healthcare.

(This isn't a free pass to younger people either, they don't vote as much as they should)

UncleMeat3• 7 months ago

The article does not list the people's ages. But we can be confident that they are not 80.

They are on an ACA plan, whereas an 80-year-old would be on medicare. They are also photographed in the article and.... obviously are not 80.

What does the medical expenses of 80-year-olds have to do with the situation described in the article?

johnwheeler8• 7 months ago

The subsidies are being given to the elderly in much greater proportion (free) and not the young

Eddy_Viscosity22• 7 months ago

We shouldn't save the soon-to-be-dead at the expense of the people with a long time horizon.

Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth?

salawat• 7 months ago

Perhaps we could just have a 'poor people incinerator' for those whose expected medical expenses exceed their net worth?

Thanks for putting that out there. Give it 10 years, and I'm thinking we'll see the first "bio-repurposing vats". Never mention crap like that on HN. Too many closet psychopaths looking for a big break.

Understand the attempt at shaming. But there are likely a non-trivial number of readers here with such Methuselan inclinations.

tim333• 7 months ago

I don't agree about hips but if they let anyone competent become a doctor the supply would go up and the wages become more normal.

johnwheeler8• 7 months ago

Sure, that sounds fine. Something like that. Something, damn it.

silverquiet• 7 months ago

The hip seems like such a bad example to me. First of all, who do you think needs hip replacements? It's not young people; surgeons don't even like to do them on young people (and to a joint replacement surgeon, "young" is under 60) since there's a good chance they'll outlive the joint itself. And it's a one-time cost for a surgery that increases an old person's independence vs an ongoing cost of palliative care (whatever that means) and having to provide more care for someone who has a potentially treatable disability. Hip replacement is considered "the surgery of the century" - the 20th century that is, because it is one of the most successful in terms of function and satisfaction provided to patients.

k310• 7 months ago

It's all about promises made to the industry, privatization of everything.

Politics? We don't need no stinking politics because there are already US troops deployed in this country, and do you for one minute think that immigrants and non-white citizens are going to go through checkpoints at voting lines without harrassment or detention or arrest on Trumped up charges? Few states have vote by mail.

Courts have not taken action to defend the constitution. In one particular case, quite the opposite.

jmclnx2• 7 months ago

It is a shame for them, but this was predicated by my Father and Uncles in the late sixties when they were talking about a for-profit hospital operating somewhere in far from us. I overheard them talking in the kitchen when I was a kid. I never forgot.

So here we are, yet the idiot US politicians still do not want real health care support for their constituents because they will lose their bribes.

Edit: Now I am wondering if they were talking about Nixon's proposed plan. I had forgotten all about that plan until I saw a comment about it.

franktankbank• 7 months ago

Nixon's proposed plan

I've got a suspicious feeling Nixon WAS in fact a crook.

A middle-class family's only option: A $43,000 health insurance premium

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