4 ms·

ACA is a federal level law that does several different things. As I understand it, the main points were increased insurance regulation, the individual mandate,

ACA is a federal level law that does several different things. As I understand it, the main points were increased insurance regulation, the individual mandate, and an option for states to expand medicaid [0]. I'm not sure why there is so much state-to-state variance, but afaik the aca wouldn't prevent that. [0]: https://en.wikipedia.org/wiki/Affordable_Care_Act https://en.wikipedia.org/wiki/Affordable_Care_Act

lotsofpulp 5y ago
The main point of ACA was removing the ability for managed care organizations (MCOs, or health insurers) to refuse or price one’s premiums based on the probabilities of their future healthcare costs. This is why I prefer the term MCO, as they are no longer selling just insurance, so the term insurer does not seem apt. ACA introduced rules that effectively make health insurance premiums a tax, where the young and healthy pay for the old and sick (like taxpayer funded healthcare). It did so in a few ways: 1) force MCOs to provide insurance to everyone, by removing pre existing conditions as a criteria for pricing insurance (effectively causing healthy people to subsidize sick people) 2) force everyone to buy insurance (although this got neutered, both by removing individual penalty and allowing employer sponsored plans to continue to exist) 3) pricing is only based on age, location, smoking status 4) pricing is such that highest premium can only be 3x the premium of ages 21 to 24, effectively causing young people to subsidize old people 5) out of pocket maximums for in network providers - this leaves in the true insurance part of the business in that you will not have to pay over a certain amount in a calendar year. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... >I'm not sure why there is so much state-to-state variance, but afaik the aca wouldn't prevent that. Because insurance regulation is still at the state level, and MCOs were allowed to use location as a factor in calculating premiums, so different places in the US have different healthcare costs due to factors such as wages, land costs, liability costs. Although this mostly exists on the state level, I do not think it gets more granular than that.
sidlls 5y ago
The main thing ACA does is help shift even more money from people to health insurance companies. Any other benefits are ancillary or completely accidental.

lotsofpulp 5y ago

The main point of ACA was removing the ability for managed care organizations (MCOs, or health insurers) to refuse or price one’s premiums based on the probabilities of their future healthcare costs. This is why I prefer the term MCO, as they are no longer selling just insurance, so the term insurer does not seem apt. ACA introduced rules that effectively make health insurance premiums a tax, where the young and healthy pay for the old and sick (like taxpayer funded healthcare). It did so in a few ways: 1) force MCOs to provide insurance to everyone, by removing pre existing conditions as a criteria for pricing insurance (effectively causing healthy people to subsidize sick people) 2) force everyone to buy insurance (although this got neutered, both by removing individual penalty and allowing employer sponsored plans to continue to exist) 3) pricing is only based on age, location, smoking status 4) pricing is such that highest premium can only be 3x the premium of ages 21 to 24, effectively causing young people to subsidize old people 5) out of pocket maximums for in network providers - this leaves in the true insurance part of the business in that you will not have to pay over a certain amount in a calendar year. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/ https://www.healthcare.gov/glossary/out-of-pocket-maximum-li... >I'm not sure why there is so much state-to-state variance, but afaik the aca wouldn't prevent that. Because insurance regulation is still at the state level, and MCOs were allowed to use location as a factor in calculating premiums, so different places in the US have different healthcare costs due to factors such as wages, land costs, liability costs. Although this mostly exists on the state level, I do not think it gets more granular than that.

sidlls 5y ago

The main thing ACA does is help shift even more money from people to health insurance companies. Any other benefits are ancillary or completely accidental.