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Arguments against ACA: - It cost me money - It's not perfect Arguments in favor of ACA: - It literally saved my life Regarding increasing premiums, the com

• enraged_camel 10y ago
  >>Furthermore, premiums have gone up year-over-year every year almost every year since I've been paying for my own insurance -- and that's well before ACA. Not only that, but they were increasing at a much faster rate before the ACA. Of course, most people didn't notice, because those who were employed were covered by their employer, and the unemployed were uninsured.
  • kmkemp 10y ago
    And also, it was very easy for insurance companies to drop a few expensive procedures in the small print to maintain the same premiums. Then, when customers actually had to use their insurance, they get screwed.
• ErikVandeWater 10y ago
  > - It literally saved my life Could you expand on this?
  • nilkn 10y ago
    The poster is probably referring to folks with pre-existing conditions who couldn't get insurance either affordably or at all prior to the ACA and who would've faced utterly insurmountable treatment bills without insurance.
  • the_gastropod 10y ago
    Read through the article here. There's a collection of quotes from YCombinator startup founders about how the ACA helped them. Several founders were uninsurable without the ACA.
    • thebent 10y ago
      Yep, you nailed it. Had it not been for ACA, making the career leap to co-founder would have been incredibly difficult. Two years later, it's a honor to be able to provide insurance to our employees.
      • rootusrootus 10y ago
        My wife works for a very small business -- five people, to be exact. They get group insurance through the company providing their payroll processing. Not by going directly to the exchange. It seems like that should be an option any founder of a small business could take advantage of?
        • thebent 10y ago
          Yes, the group insurance through a payroll processor is a great solution. That's what we do now. The caveat is that it only works if you're collecting a paycheck, but not if you're bootstrapping from savings.
    • cderwin 10y ago
• vmarsy 10y ago
  As a non US Citizen, I have a question: If Obamacare is repelled at the Federal level, could a state just implement its local ACA? what prevents California for instance of giving health coverage for its residents? California is a good example since it "the world's sixth-largest economy" (If California was a country) I'm sure healthcare companies wouldn't want to cut themselves out of this market? This would give California and SV an even bigger advantage regarding what is described in Sam's post.
  • acchow 10y ago
    > This would give California and SV an even bigger advantage regarding what is described in Sam's post. Btw, San Francisco has essentially had universal health care since 2007 (via Healthy San Francisco), though it doesn't cover non-residents on I-94. It would be interesting to see if citizens and permanent residents represented a high proportion of founders in SF than, say, Silicon Valley.
    • elastic_church 10y ago
      > The program is open to city residents, ages 18 and up, whose incomes and net worth are low but who do not qualify for other public coverage, and who have had no insurance for at least 90 days. Ah the classic "if you are middle class F U" program
  • Judson 10y ago
    Yes. https://en.wikipedia.org/wiki/Massachusetts_health_care_reform https://en.wikipedia.org/wiki/Massachusetts_health_care_refo...
  • cderwin 10y ago
    It certainly could, and in fact Massachusetts implemented a similar program in the mid 2000s
  • dragonwriter 10y ago
    > If Obamacare is repelled at the Federal level, could a state just implement its local ACA? Some parts of the ACA could be implemented in state law, some would be either illegal or impractical at the state level. It's also likely that a repeal would be accompanied or followed by federal policies which would make state-specified versions of the ACA less practical than they are now. > what prevents California for instance of giving health coverage for its residents? California already provides state-run send healthcare beyond the requirements of the federal programs it participates in.
• cderwin 10y ago
  Obviously there's a non-zero chance it will blow up, but isn't that risk worth it if reform would: * Preserve some form of protection for people with pre-existing conditions (this covers the "save my life" part) * Lower costs of health insurance for both individuals and the public (perhaps dramatically) * Actually address the underlying healthcare issues directly, i.e. implement policies that will reduce the cost of healthcare itself, not just the cost of insurance In particular, the risk of losing some important things (like coverage of preexisting conditions) seems extraordinarily low.
  • analog31 10y ago
    The reason why ACA was passed in the first place, was that it didn't attack the insurance industry. ACA was about access, not cost. Maintaining the insurance industry will limit the possibility of reducing costs, but the industry is too powerful to simply give up without a fight.
    • redler 10y ago
      Right. The political power of the insurance companies ensured it was framed as "access to insurance" instead of access to health care itself. Health care is a general ledger category under "loss control". Likewise, the ACA repeal efforts are disingenuously framed as "enhancing access to insurance".
  • scarmig 10y ago
    Those are all admirable goals. But it's difficult to imagine a repeal and replace that accomplishes these. Why? It's all about the pre-existing conditions. If insurance companies have to take all comers, that makes the system easy to game: don't get insurance until you're sick, and then jump onto the system. This would essentially destroy insurance markets. What's the obvious solution? Mandate everyone sign up for insurance, at risk of facing penalty fees. Then you're always paying into the insurance industry, and insurance companies can survive and provide value to the healthy and the sick. But this is tough: not everyone can afford health insurance. So, you provide subsidies to those who can't. So, if you start from the 2008 status quo and want to add protections for pre-existing conditions, that game plan is pretty much set in stone. But the issue is that that essentially is the ACA. There are other aspects, but that's the core mechanic. It's pretty much impossible to build a system from 2008 to cover pre-existing conditions without re-implementing the ACA. You can play with how high fees should be and how high subsidies should be, but that's pretty much it. And most of the Republican "alternatives" (insofar as they exist at all) work by putting a ton of loopholes in the pre-existing conditions protections, a strategy widely regarded as revolting and that only works because people are being bamboozled about what protections they would actually receive.
• marknutter 10y ago
  "It literally saved my life" is an argument that could justify anything you want it to, no matter how bad it actually is. It'd be a little like saying nobody should ever leave their house because you never left your house and avoided any number of catastrophes that could have killed you. If preventing people from dying is the only metric by which a health care system is judged then pretty much anything can be justified at the detriment of other less tangible benefits, like insanely high prices, non-coverage of therapies used to treat non-life threatening conditions, no provisions for birth control, etc. Health care isn't simply about keeping people alive - it's about helping them live a high quality of life.
• hiram112 10y ago
  Here's my anecdote: Before ACA, as a full-time worker at decent companies I paid maybe $50 a month for my insurance, my employer picked up the rest. When I went to the doctor, filled a prescription, or anything else routine, it was $10-$20 max. In the one year where I had a lot of care (broken wrist), I think I paid my out-of-pocket max of about $750 and that was it. After ACA: Catastrophic plan at pretty much every company I work for now (same for many of my friends in non government jobs). Minimum deductible of $1500-$2000 as a single guy. Probably 5x that for someone with a child and wife. When I go to the doctor, I pay for everything out of pocket at full price: $300 for a prescription (in the US they push up the drug prices to astronomical levels - we cannot buy from foreign sources), $200 for a simple doctor's visit. I have never hit my deductible which would then pay 80% of my costs. Oh and I can't actually just go and get things like a hearing test or sleep study - I first need a referral from my primary physician at $200 / visit. In exchange, I get to put $100 away each month tax-free into a 'FSA' account. It is mostly use-it-or-lost-it by the end of the year, and will go back to my employer (i.e. a perk for them, not for me). At the end of this year, it basically turned into a $200 gift from me to my employer.
  • vpeters25 10y ago
    I think you hit the nail on the actual issue with health care in the USA. The problem is not as much insurance companies but medical providers' price-gouging. Edit: sometimes it's a good idea to call ahead and ask for "uninsured quote", you would be surprised your $200/visit physician might only charge $50 to someone without insurance.
    • nodamage 10y ago
      It's an unfortunate feedback cycle. Medical providers charge high numbers because they know insurance companies will only pay out a percentage of the billed amount.
    • cmiles74 10y ago
      Hospitals and insurance companies are co-dependent. In my experience, hospitals price everything high so that they have more room when they negotiate with the various insurance companies. No one is meant to pay these prices. Hospital billing is also pretty awful. I've seen them place every possible reimbursable item on every bill, full well knowing that some insurance companies would cover some items and others different things. This resulted in inflated bills that were never paid in full regardless of a person's insurance coverage. Many hospitals will negotiate with the uninsured but it's rare for them to make this easy to do. This article is pretty weak, but the best I could find on this relatively arcane subject: http://truecostofhealthcare.net/hospitalization/ http://truecostofhealthcare.net/hospitalization/
• yellow_postit 10y ago
  Reinventing American Health Care (https://www.amazon.com/Reinventing-American-Health-Care-Outrageously/dp/1610395425/ https://www.amazon.com/Reinventing-American-Health-Care-Outr...) is a great read on the history of health care in America and how we arrived at the ACA. It also highlights known issues that the author somewhat over optimistically expected congress to try and address.
• hellcow 10y ago
  As just one anecdote for rebuttal, my insurance premium increased by 20% this year--not even mentioning the additional deductibles they hid in the renewal options. I, for one, am very much looking forward to purchasing insurance from the best provider in any of the 50 states, not just the few available to me in CA.
  • SomeCollegeBro 10y ago
    I agree that opening up across state lines is a very good thing. However, if the marketplace goes away and there's not a good way to force companies to be competitive, we're really not in a better place either. Hopefully we can have the best of both worlds.
    • ceejayoz 10y ago
      > I agree that opening up across state lines is a very good thing. When this was done with credit card companies, they all moved to the state with the least regulation and started instituting consumer-hostile stuff like mandatory arbitration. I'd really rather not have this happen with my health insurance.
  • jasonmp85 10y ago
    Obviously 20% seems high, but they'd be higher without it, crazily: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamacare-premiums-20160726-snap-story.html http://www.latimes.com/business/hiltzik/la-fi-hiltzik-obamac...
  • willholloway 10y ago
    The idea that the lack of competition between states is the reason for high health insurance premiums is a red herring. The reason premiums are high is that costs are high, and our population is obese, disease prone and litigious. If we want to contain costs we have some options: 1) Public option/Medicare for all could save us 10-20% in parasitical insurance company costs/administrative overhead. 2) We find solutions for obesity. Obesity is the #1 driver of increased health costs in America. 3) We stop holding doctors/pharma financially responsible for bad outcomes outside of their control through the legal system.
• importantbrian 10y ago
  The part I don't like about ACA is the mandate. I really don't think the government should be mandating people purchase a product from a private company. There is a simple solution to this though. Just expand Medicare and make everyone in the country eligible for it. No one is forced to participate in Medicare, but if you delay your enrollment you have to pay penalties when you join. This is a simple way to handle the healthy people won't join until they need it problem. Most people will join to avoid paying the penalties. Medicare is one of the most popular government programs. I don't understand how this isn't being talked about as a solution.
  • tunesmith 10y ago
    It is being talked about, and has been talked about for years. But the reality is that to expand Medicare, you need around 65 Democratic Senators, a comfortable Democratic majority in the House, and a Democratic President.
  • acbabis 10y ago
    What happens when someone puts it off their whole life and doesn't have money when they need to enroll?
    • pavel_lishin 10y ago
      Is that a different case than someone putting off enrolling in health insurance today, with or without the ACA?
    • importantbrian 10y ago
      I think that's on you. The purpose of the government is not to protect you from making monumentally bad life choices. If the government doesn't bail those people out then that will just strengthen the incentive to sign up when you become eligible.
  • harryh 10y ago
    I don't understand how this isn't being talked about as a solution. It is being talked about but there is significant opposition from those that don't want to raises taxes to the level that would be required to finance such a proposal.
• nodesocket 10y ago
  I posted a ASK HN[1] a few days ago related to signing up for health care through CoveredCA as a single bootstrapped founder. If you're self employed and make over $50,000 a year no matter where in California you live, you'll have to pay full retail premium prices without any discount. My company as a whole makes over 50k a year, but less than 100k a year (still getting off the ground). Thus a monthly premium of $460 a month for a standard decent PPO plan puts a large burden on me. Additionally, if I don't get health coverage I'll have to pay a heavy tax penalty at the end of the year. Essentially as a bootstrapped small business owner, health insurance is a large burden of cost and I was forgotten in the Affordable Care Act. Instead my cost to purchase a plan skyrocketed as I subsidy other people's care. That is not fair, everybody is not paying their fair share. Middle class self employed are the one's who got hurt the most. Finally go compare CoveredCA.com and then go use https://www.blueshieldca.com https://www.blueshieldca.com. CoveredCA literally is one of the worst designed and functioning apps I've ever seen. It constantly errors and doesn't keep state that I am logged in. The UI/UX is terrible. I'm guessing CoveredCA was outsourced to a non-technically competent contractor overseas. Compare that to BlueOfCalifornia which is a great site, beautifully designed, and functions as it should. This is why government can't have nice things. [1] - https://news.ycombinator.com/item?id=13353755 https://news.ycombinator.com/item?id=13353755
  • skizm 10y ago
    Wait, why would they count your company's total revenue as your income? Is there no legal entity between you and your company? (LLC, C-corp, etc.)
    • nodesocket 10y ago
      I'm a single founder 100% owner LLC, personal and business income is combined. Plus on CoveregedCA they ask for personal income and self employed income when seeing if you qualify for discounts. Finally, dealing with sending them tax and finance documents to get the discounts would be a huge hassle and I'm almost certain a hair-pulling frustrating experience. By the time that is all done, I'll probably be out of their discount bracket anyway.
• jnwatson 10y ago
  2015-2016 rate increase was muted due to insurers still trying to price the market. Rates for 2017 increased significantly, from -3% to 116% depending on the state: http://www.thefiscaltimes.com/2016/11/01/Here-s-How-Much-Obamacare-Premiums-Are-Rising-All-50-States http://www.thefiscaltimes.com/2016/11/01/Here-s-How-Much-Oba... I think the ACA was responsible for temporarily suppressing rates. Now that the costs are better understood, we're back to around where we would have been without it.
  • devsquid 10y ago
    The fact my nation is as wealthy as it is but it does not want to invest in the health of its people is insanity to me. Health insurance is essentially a bet that someone's health cost will be less than their monthly premium. Why would my country not take on that bet? It seems like something that would be way more effective if it was orchestrated on a national level. (ノಥ,_｣ಥ)ノ彡┻━┻
    • brianwawok 10y ago
      Considering every single TV spot is selling us things to make us Fat or die sooner, I would not want to take the otherside of the bet against people getting sick. Americans, we are all about freedom. Freedom to kill ourselves and eat twinkies. But we expect help when we are sick. One side or the other has to budge a little. Do we give up being able to get the same insurance despite unhealthy habbits? Do we give up helping the poor and the sick?
      • cmurf 10y ago
        This is why we need fact based research to understand these costs, and use a direct tax on those items to recoup those costs from those who engage in those risks. Go skiing? Well there's a higher tax for the ticket because you have X% higher risk of breaking a leg. Twinkies right now are a grocery food so in fact it has less tax, where it probably should be taxed like booze or cigarettes (in effect a sin tax). Of course sin taxes get abused, where the money goes to the general fund rather than going to mitigation for the undesirable behavior.
• mgkimsal 10y ago
  > Furthermore, premiums have gone up year-over-year every year almost every year since I've been paying for my own insurance -- and that's well before ACA. I've been paying my own premiums for 9 years. Before ACA, premiums went up ~5% per year - 8% one year, perhaps. Since ACA, I've seen increases of 25%, 20%, 20%, 25%, then 11% then 13%. OK, yes, it's anecdotal. But "it goes up every year regardless" is missing data there - pre-ACA there were inflationary increases - post-ACA there are increases to cover millions of people who weren't included before.
• itbeho 10y ago
  You can add the following against it in my case: - not able to keep my existing health plan. I had a great low-ish deductible plan with good benefits cancelled due to ACA. - not able to continue seeing my family doctor (that my folks and sister still see). I'm pretty sure the current doctor I have hates all his patients and staff. And yes, it costs a lot more in terms of premiums, deductibles and prescription meds. But also in travel time because the other physicians in my town that accept CoveredCA stopped accepting new patients.