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[–] AncientArachnid 0 points 3 points (+3|-0) ago  (edited ago)

First off -- the number of people who initially actually needed to buy coverage in the exchanges was, relative to the entire US population, fairly small and should have remained so (I'll come back to that in a minute).

The vast majority of people in the US were covered by an employer's plan, Medicare (65+), or Medicaid (very low income, seniors unable to afford Medicare's small premiums, or those with dependent children).

Obamacare was intended to ensure that people who were not covered by an employer and who did not qualify for Medicare or Medicaid would at least have a hope of a prayer of a chance to access a doctor if they needed one. That imo as a civilized nation is not a bad thing.

The biggest problem was not the individual mandate, although that got a lot of attention (and rightfully so). The biggest problem was the employer mandate that employers with 50 or more employees were required to offer "adequate" coverage to their employees.

What this did was skew and warp our entire employment market, made even worse by the worst recession since the Great Depression. If you were a small business owner, you did everything in your power to cap at 49 employees. People who formerly held 40-hour-a-week jobs were made independent contractors; people's hours were cut to part-time; full-time jobs were cut in two to make two 20-hour-a-week jobs to prevent having to offer insurance. The "gig economy" was already well on its way before the ACA was passed, but the ACA dramatically accelerated it.

So now, all those folks who had been covered by employers, or who might have been able to find full-time benefited work, no longer could and they were forced onto the exchanges, swelling the numbers of those who originally truly needed some way of accessing health care.

Understandably many younger people opted not to buy. This skewed the pool toward older and sicker people, which in turn raises costs, which in turn raises rates => "death spiral". In the meantime, legitimately self-employed people who had been purchasing decent single coverage on the private market saw premiums rise dramatically and unaffordably.

The core issue is not health insurance, coverage, premiums or anything else. The core issue is costs. Health insurance should be available at a reasonable cost for catastrophic events. That's what insurance is.

Health care should be something for which most normal people can pay for the basics themselves. When the cost of simply seeing a doctor for strep throat, a few stitches for a cut, having a mole removed, etc. becomes stratospheric, then people can't take care of even the basic needs themselves. That, though, is a different discussion for a different thread.

Tl;dr: way more people ended up "needing" Obamacare because of how Obamacare twisted the employment market. Catch-22.

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[–] Planet_Terror 0 points 1 point (+1|-0) ago 

I used to work in health-care field, specifically insurance.

The ACA was offered (voluntold) that all people would need to have insurance or pay a fine (tax). The first year I believe the tax was $95 per person, it went up over the years and I think last year it was 2.5% of your total household adjusted gross income, or $695 per adult and $347.50 per child, to a maximum of $2,085 Some people qualify for exemptions under certain circumstances (income being the big one) and do not have to pay the tax.

You said in your post you are 21, I'm assuming you are healthy and probably just go to the doctor for regular check-ups, nothing serious. Insurance generally is all deductible driven (similar to car insurance). You pay the first $X,XXX.XX dollars (typically about $1,500) PLUS your monthly premium and then when you meet the deductible you typically pay 20% of the bill after the deductible is met up to your out of pocket maximum, if you have a max otherwise you keep paying the 20% until your policy renews and then you start all over again. The catch is your doctor needs to be in network otherwise you will pay a lot more because your out of network doctor does not have a contract with your insurance company and can basically charge whatever they see fit.

The reason The ACA failed is most healthy people would rather pay $695 tax and get a regular check-up for about $100 one time a year than pay a monthly premium PLUS deductible and out of pocket maximum considering the costs is probably lower. (I've seen deductibles as high at $10k a year for a certain popular retailer and you know those employees do not make enough to cover that deductible). The tax I would imagine is the lesser of the two choices depending on the coverage you choose via ACA.

So while it was great that everyone could sign up for and have insurance, the only people who did were those who were already sick. That placed the insurance companies in a precarious position as they were loosing money (greedy bastards). They thought that the cost of the insurance for the sick people would be offset by the healthy people signing up who would not use the plan but still pay the premiums.

I'm not a proponent of entitled health-care for everyone, what I am for and what should be done is to regulate the costs of health-care procedures. You can call your insurance company and they can give you an estimate of what a procedure will cost with an in network doctor but it all depends on your doctor and what price they negotiated with the insurance company for each procedure and typically it can be different for each doctor sometimes by thousands of dollars. There needs to be more transparency on the actual cost not the wait and see what I'm being billed approach (hospital stays are a fucking nightmare where billing is concerned).

I also believe that me being older and unable to have kids, not having gender re-assignment surgery or will never need fertility treatments should not have to pay for these services in my premiums but that's a different topic.

To give you an example, I had gamma knife surgery last year when all the bills came in the total racked up was over $100k. It was great that I had insurance and my max out of pocket was $5k due to employer sponsored coverage. However, for the time that surgery took (it was an out patient procedure)3.5 hours for prep and waiting and maybe 30 minutes for the actual radiation treatment, it should never have been that much money. If I did not have insurance I would have been fucked..... Again, I strongly believe we need to regulate the prices and not make everyone have insurance.

I'm now in HR and it is an absolute headache to process the forms for all employees not to mention the calculation to figure out if an employee should be offered coverage if they don't work XX amount of hours... again another topic.

TLDR: Mandatory insurance is not the answer, regulating pricing on procedures, office visits, and medication is what is needed.

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[–] AncientArachnid 0 points 1 point (+1|-0) ago 

Excellent comment, thank you.

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[–] Malthrax 0 points 1 point (+1|-0) ago 

I agree with most everything you said, except "regulating pricing on procedures ..." because government price-fixing DOES NOT WORK, because the people who would be setting those prices are too easily influenced by lobbyists.

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[–] AncientArachnid 0 points 1 point (+1|-0) ago 

Industry lobbyists are a big part of the reason prices are so high now.

What do we do? Serious question.

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[–] Planet_Terror ago 

Thanks, I should have been more clear on the definition of regulating but my post was already long. I agree the government should be left out of regulating the prices with those damn lobbyists. One idea is the insurance companies can definitely provide an average of costs for each procedure as we already know it's different from doctor to doctor and state to state. That could be used to set pricing. Perhaps have a percentage increase every 3-5 years or so so long as incomes do not remain stagnant.

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[–] MarcusA 0 points 1 point (+1|-0) ago 

The program that passed as Obamacare was not what it started out as. After obstinant Republicans got done with it, it became this Marketplace system. 2hrs of googling will get you up to spped on that part.

Anyway, the issue now is that the program relies on a marketplace of insurance companies who are forced to ensure everyone. They dont want to do this naturally, so there were huge subsidies from Federal GVT to prop up the program. However, Ins companies are not mandated to engage in the program if they dont want too.

Now, with Republicans in power, the subaidies are being cut off and Ind companies are walking away. The Marketplace is running out of vendors. In state after state, the program is collaping under its own weight.

This is largely because nothing was ever done to actually reduce the cost of healthcare in the country, only shift a chunk of the bills to taxpayers. Yet another program to steal from the populous.

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[–] The_Lurkster 0 points 1 point (+1|-0) ago 

I don't understand how we would have 20 million less people with health insurance considering Obamacare is nose diving as we speak, and eventually there won't be any providers left in the program anyway. As to your question, the less govt involvement, the better. Prices and quality will be better for people who WORK and don't expect free shit for doing nothing.

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[–] Demwitsarestupid 0 points 1 point (+1|-0) ago 

The 20 million figure is a total lie. Not one person will lose health insurance. I'll tell you where the 20 million figure comes from. There may well be 20 million people who are currently being forced to by insurance who will choose to spend their money on other things.

[–] [deleted] 0 points 1 point (+1|-0) ago 

[Deleted]

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[–] 9273428? 0 points 1 point (+1|-0) ago 

But it doesn't even help in a catastrophe! Say you get a million dollar medical bill. You pay the deductible, and then your shitty bronze plan covers 60%. You're still left with a hospital bill of 400,000. Might as well still be a million.

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[–] Maxwellbegun ago 

You have a lot of great answers here, but I'd like to sum it up in brief: 20 million people will no longer be forced to buy a product that they don't want.

That's all.

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[–] crankypants15 ago  (edited ago)

It's a big deal to the left because:

  1. Because Obamacare represents the left's socialist efforts and is a step towards socialism and gov't control of everything (which is called communism).
  2. Because the left has no idea how a free market actually works. They truly believe in this scam called Obamacare.
  3. After Obamacare was passed my employer couldn't afford so many full-time employees AND pay them require health care so we had to lay them off, and rehire them as contractors, responsible for their own health care. Obamacare fed the contractor surge since it was passed. Not that many people could actually get a subsidy for, nor afford Obamacare. Plans they could afford had deductibles of $5000-10000, and they didn't have the money for the premiums OR deductibles.
  4. Numbers quoted on "Obamacare users", I'm sure is just the number of users on the Obamacare websites, not the actual people who have an Obamacare policy.

Obamacare repeal is having problems because just enough Republicans are RINOs. Paul Ryan especially is being paid off by some Democratic interest. Follow the money.

and what are the alternatives that are hoped for?

  1. Obamacare limited healthcare exchanges to within one state. Trump wants to make exchanges allowed to have healthcare provided for by any company in any state. This increases competition and brings down premiums. There will also be a larger variety of health care plans.
  2. Put down the fork, exercise regularly, take personal responsibility, and be healthy.

Now are those 20 million people a hefty percent illegal immigrants?

Very likely. Because the illegal immigrants get welfare and can vote, that doesn't mean they actually got Obamacare in every state.

Other alternatives

Make people responsible for their own health. And enforce it.

In Michigan they are considering a bill to prevent people from buying soda using food stamps (we also call it SNAP or the "bridge card" because a debit card is used with a pic of the Mackinac bridge). But this has to be enforced at the retailer, and retailers rarely enforce current food stamp provisions anyway. Even if it passed, it is unlikely to make a difference unless Michigan inspectors do some sting operations.

This bill won't prevent people from buying sugary tea, sports drinks, or high-sugar "juices" though. So it's another dead-out-the-door from clueless Michigan legislators.

This bill is from the same culture that arrests men when their wives beat them bruised and bloody. Thanks Michigan!

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