7 ms·

I wonder, how is "obamacare" viewed after those years? Was it a success? Ist there partisan disagreement and a realistic chance that it might get repealed?

fullshark 3y ago
My belief is it was oversold in terms of its transformative impact, both by the advocates and detractors. The major change is no longer refusing insurance for pre-existing conditions, and the various lives that have changed due to having health insurance when in the counterfactual they would not have had it. But there's a reason why all democrats are still running for federal office on a platform of healthcare reform. It won't be repealed after the supreme court upheld it and the republican congress under Trump gave up on trying to repeal it after McCain's no vote on repeal.
- mrguyorama 3y ago
  But Trump and his congress did succeed at repealing some parts of it, like the individual mandate
sidlls 3y ago
It succeeded in getting more people covered by health insurance. It did so by enriching the private insurers who basically run our health care system. Personally I don’t see that as a success, rather it simply made all our health care system problems worse. Access to insurance just isn’t the same as access to health care, because the insurance costs money, and insurers tend to be roadblocks to care. People who tend to need the most care were either already covered (Medicare/Medicaid) or the subsidies under ACA were paltry jokes compared to their needs. There isn’t a realistic chance of repeal. Both of the main political parties here benefit from it too much: the democrats by claiming a health care win, which our latte liberal class eats up, and the republicans by having an additional hot button issue (like abortion and guns) to whip their lunatic fringe up with. Not to mention all the campaign and lobbying money from private insurers who are profiting immensely off of ACA.
- Clubber 3y ago
  >It did so by enriching the private insurers who basically run our health care system. I might add at the expense of the middle class who now have much higher premiums with much higher deductibles.
- tptacek 3y ago
  Private insurers don't run our health care system; provider networks do. When you include fee/service ratios for younger cohorts in the Medicare math, the administrative overhead numbers look a lot less compelling; more importantly, you can zero out administrative overhead from insurers and still only get a grocery store discount on services. The immediate problem with American health care is that providers charge too much for services, and secondarily that Americans access too many services. It's also important to remember --- though I don't think it changes any of the fundamentals of the issue --- that the ordinary "retail" care that we access on a year by year basis, including short hospital stays, isn't where all the cost in the system is.
  - ffgjgf1 3y ago
    However insurance companies have absolutely no incentives for pressuring the providers to reduce prices, the opposite in fact because they get to keep a share of the revenue..
    - tptacek 3y ago
      Medicare also pays unacceptably high rates for services; the idea that Medicare would successfully and meaningfully reduce those rates is more aspirational than empirical. One of the most important bottlenecks in health care affordability (residency funding) is explicitly maintained by Medicare.
    - ativzzz 3y ago
      There are tons of middlemen / services directly in between the consumer and the medicine or doctor the consumer ultimately needs (including insurance). Almost all of those middlemen are trying to maximize their own profits. The industry is complex and our entire society and economic culture is to blame, you really can't single out a single entity
bluGill 3y ago
I hate it just as much. "If you like your insurance you can keep it is true" - but I didn't like my insurance and I'm still forced to keep it. I've long said the big mistake is tying health insurance to employment is the problem (it isn't the only problem, but it is a big one). If I take anything else I turn away more than $1000 in subsidies that my employee currently it putting in, and that means as much as I don't like my insurance I cannot use anything else. Of course since the customer of health insurance isn't me but my employer that means they are not responsive to me and my needs. I'm against socialize health insurance, but what we have today is just as bad though in different ways.
- orangecat 3y ago
  I've long said the big mistake is tying health insurance to employment is the problem (it isn't the only problem, but it is a big one) Yes. This is one of those frustrating areas where economists and experts across the political spectrum are in near-unanimous agreement, but anybody who tries to move the system in a sane direction gets attacked for "taking away your insurance". The ACA doubled down on employer mandates, when it should have used the exchanges as an opportunity to get people off employer-based plans. I'm against socialize health insurance, but what we have today is just as bad As I've often said, we've managed to combine the worst aspects of both markets and central planning with the benefits of neither.
  - selimthegrim 3y ago
    > The ACA doubled down on employer mandates, when it should have used the exchanges as an opportunity to get people off employer-based plans. This was the point of the Cadillac tax
  - spiralx 3y ago
    The ACA included a public option to remove that tie to employers, but it was removed due to the opposition of Joe Liberman and his insurance company backers.
    - HWR_14 3y ago
verall 3y ago
In polling, the "affordable care act" and "ACA" poll better than "obamacare", even though they are the same thing: https://news.gallup.com/opinion/polling-matters/169541/name-affordable-care-act-obamacare.aspx https://news.gallup.com/opinion/polling-matters/169541/name-...
- ceejayoz 3y ago
  And the individual provisions of it tend to poll really well.
  - hotnfresh 3y ago
    This is a typical result in public-opinion poli sci research, at least in the US. The descriptions of what programs do are almost always more popular than programs by name, often by a wide margin. This is how you get weird shit like Trump making vague promises at rallies that sure sound like a call for some kind of stronger ACA or even single-payer healthcare. Many aspects of those things are broadly popular—the propagandized-against labels for them, however, are unpopular in some circles, especially if promoted by a person with the wrong letter next to their name.
  - deleted 3y ago
    [deleted]
- macintux 3y ago
  Obama suggested to Trump that he rename it after himself. https://www.newsweek.com/barack-obama-donald-trump-obamacare-1002240 https://www.newsweek.com/barack-obama-donald-trump-obamacare...
  - pauldenton 3y ago
    Sort of like Obama proposing the same stuff as Mitt Romney did and calling it Obamacare instead of Romneycare
    - macintux 3y ago
_ea1k 3y ago
I've often wondered about this, especially after the repeal of the mandate. It seems like the most useful provision was taken away by that. What are costs like for unsubsidized plans now?
mandevil 3y ago
This is my understanding, as someone married to a healthcare professional and with sick parents I've followed it reasonably well. Before the ACA went into effect, the main focus that everyone talked about was on the individual insurance market: in particular, trying to fix the adverse selection issues that had kept the individual insurance market in a continuous death spiral. ACA tried to fix that with the "Three Legged Stool": guaranteed issuance (no longer could a pre-existing health issue be denied coverage), government subsidies for people who couldn't afford it, and the individual mandate (everyone has to buy insurance or pay a fee) to make sure people didn't free-ride while healthy and only get insurance when they were sick. There was also a side project, which was this was that subsidies for really poor people turned out to be really expensive, so perhaps it would be easier to have everyone below a certain threshold just get Medicaid (government insurance for poor people that for complicated historical reasons is largely federal but partly each individual state funded- this is distinct from Medicare, which is entirely Federal and offers universal coverage to everyone over 65). So everyone can use the exchanges to get insurance, if they don't get insurance they have to pay a fee in their taxes at the end of the year, and Medicaid had expanded eligibility rules to cover more people. Health care wonks largely expected the exchanges to do most of the work, and some of them even envisioned a future where the link between jobs and health care were broken- your job pays you more money and you get insurance on your own through the exchange. But that was a future dream, for the ACA itself the focus was on just getting the exchanges to run. That is what healthcare.gov was all about, matching you to your local exchange and offering you the right plans and subsidy amounts- tying together insurance companies, the IRS for your tax returns, and state IT systems all together. Then the conservative-controlled Supreme Court surprised many, and upheld the ACA exchanges on a 5-4 vote, though they added a random restriction never found before in any Supreme Court ruling that each state would have to accept the Medicaid changes on their own- a rewriting done by the Chief Justice's clerks in haste (after he apparently changed his vote late in the game to allow the rest of the law to stay, the liberal wing joined him immediately, no matter how weird it was, much better than losing the whole thing). Now a decade on, the exchanges have proven to not be very popular- everyone who can still gets their insurance through their company because it is seen as a better deal than going through the exchange (because of corporate consolidation on both the insurance company and medical provider sides there is actually very little competition in the exchanges, so the prices didn't go down as expected). Far more people are covered by insurance than before, but it was almost entirely because of the Medicaid expansion- slowly over time even red states have gotten into it, and now only 10 states are still holding out, even as their rural hospitals are utterly devastated and many are forced to close because they can't get paid for their work (in order to balance the budget within the act, some of the US government programs that used to support poor people without insurance were ended- they'll all have Medicaid, so are unnecessary- except then the Supreme Court's rewriting meant that many poor people don't have Medicaid, and the GOP views even attempts to fix things for their own states as a step too far). The individual mandate- which had been viewed as essential to the success of the exchanges- was zeroed out by the Republicans when they took power, that is, the fee for not having insurance was set to 0. And it didn't really have much noticeable effect, because the exchanges didn't make much difference in the end, the power turned out to all be in the Medicaid expansion. This in turn is what has driven the more liberal health care wonks towards single-payer and BernieCare and the like: if the exchanges didn't have much impact and Medicaid did, why not just make Medicaid-for-all?
throw0101b 3y ago
> I wonder, how is "obamacare" viewed after those years? From 2020: > As the Affordable Care Act, or Obamacare, turns 10 years old on Monday, the health care law is as popular as it has ever been, according to new numbers from the latest NBC News/Wall Street Journal national poll.[1] > Forty-two percent of all registered voters believe the law is a good idea, compared to 35 percent who think it's a bad idea, while 23 percent don't have an opinion. * https://www.nbcnews.com/politics/meet-the-press/ten-years-later-obamacare-popular-it-s-ever-been-n1164151 https://www.nbcnews.com/politics/meet-the-press/ten-years-la... On political lines: > Eighty percent of Democratic primary voters, as well as 72 percent of all registered voters who describe themselves as Democrats, say the Affordable Care Act is a good idea. > That's compared to 72 percent of Republican voters in the poll who say it's a bad idea. * Ibid. 2022: > Public opinion of the Affordable Care Act (ACA) has been largely divided along partisan lines since the law was passed in 2010. Following Republican efforts to repeal the ACA in the summer of 2017, KFF Health Tracking Polls found a slight uptick in overall favorability towards the law, and since then a somewhat larger share has held a favorable than an unfavorable view. The most recent KFF Tracking Poll conducted in March 2022 found slightly more than half of the public (55%) hold a favorable opinion of the ACA while about four in ten (42%) hold a negative opinion of the law. Views of the ACA are still largely driven by partisanship: nearly nine in ten Democrats (87%) along with six in ten independents (58%) view the law favorably, while eight in ten Republicans (79%) hold unfavorable views. Explore more demographic breakdowns using our ACA interactive. * https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/ https://www.kff.org/health-reform/poll-finding/5-charts-abou...
hotnfresh 3y ago
Win column: ending “preexisting condition” horror, and prices supposedly have not gone up as much as they were expected to otherwise. Marketplace plans are relatively easy to compare, which is welcome. Loss column: Insurance rate increases still bonkers and unsustainable (IOW at some point, it’ll get high enough to force some kind of big shift or reform, with a lot of suffering and economic damage along the way). No public option. Not all plans are on the exchange (this varies state by state). Even “gold” plans are kinda shit and insurance still tends to cover less each year, even as prices increase. Fewer insurers offering individual plans at all, at least in some states. Healthcare spending in general still stupid-high and getting higher. Whole thing’s still very complicated, adding costs all over the economy and putting a significant time-burden on sick people and families of sick people, all for no reason whatsoever except protecting a bunch (a whole bunch) of middlemen’s jobs.
- js2 3y ago
  Joe Lieberman is the reason for the lack of a public option. https://publicintegrity.org/health/elimination-of-public-option-threw-consumers-to-the-insurance-wolves/ https://publicintegrity.org/health/elimination-of-public-opt... https://slate.com/news-and-politics/2009/10/did-sen-joe-lieberman-just-kill-the-public-option.html https://slate.com/news-and-politics/2009/10/did-sen-joe-lieb...
  - kaibee 3y ago
    This is unfair to all of the Republicans who refused to vote for the plan too.
- jandrewrogers 3y ago
  The ACA increased costs far beyond what they otherwise would have been. It made the cost of good health insurance go up 25% overnight where I lived. The discontinuity in price increases before and after ACA were pretty stark, and not in a good way.
  - tzs 3y ago
    Any mine went down. There are some charts of health insurance costs over time [1] here. These charts look the same pre-ACA and post-ACA. Costs continued to rise at about the same rate has they had before. [1] https://www.kff.org/report-section/ehbs-2023-section-1-cost-of-health-insurance/ https://www.kff.org/report-section/ehbs-2023-section-1-cost-...
Auracle 3y ago
I had insurance purchased through the exchange for a few years after. It was just for me, a healthy(ish) man in my 20s. The year was $200 a month. The next year was $300 a month. The next year was $450 a month. It had some good in it, such as not denying people based on pre-existing conditions (along with the limited period you can get insurance). Capping how much insurance companies can make as a percentage of revenue was a real poison pill that only served to make costs balloon. They have no reason to be more efficient, or to try to clamp down on healthcare costs. The more we all pay, the more they make, and it's their only path to do so apart from taking marketshare from a competitor. I think we'll probably end up with single-payer sometime, which will be a real mess and a huge amount of money will be wasted for decades. We could fix the insurance system, but it'd be politically unpopular: Everyone's insurance is insurance again. By that, I mean it doesn't cover routine care (apart from a yearly physical, just to encourage that), medications, etc. It's all very high deductible, possibly with some sort of low income subsidy (that still shouldn't go too far). Providers need to publicly list prices, or give good faith estimates for things that aren't routine. Cap medication prices to an average of...Canada, UK, Germany, and Japan - or some other list. This wouldn't be needed for cheaper drugs but for the ridiculously expensive ones that'd normally eat up your high deductible in a month. Bam. Done. There'd be a few years of pain, but you'd quickly see healthcare prices drop off a cliff as consumers would suddenly care that their clinic's sleep study costs $7,000 when the place an hour away only charges $1,500, or that they can do testosterone injections for $20 a month instead of taking a pill that costs $500 a month.
- ffgjgf1 3y ago
  Or just copy the Swiss system (which is entirely privatized, more so than in the US) if you want to maintain a high degree of direct government involvement in healthcare which exists know you could also copy one of the functioning mixed public/private systems (like the one in the Netherlands). Why try and reinvent the wheel?
  - hotnfresh 3y ago
    Just need price controls (at least limited ones, and the credible threat of more) plus a good public fall-back option, and strong standards for what health insurance has to cover. That seems to be the minimum (Singapore model). Those elements seem to be the common factors in basically all OECD healthcare systems outside the US. Taking it farther can work, and may even help, but those seem to be the things you have to have (though price controls can also be implicit, via monopsony). “Credible threat of more” for the price controls may not work in places less authoritarian than Singapore, so you may have to swing closer to the price-book model of places like Japan, if not just go single-payer.
fullstop 3y ago
I had a conversation with my neighbor, a staunch Republican, about eye exams after she had taken both of her kids to get checked and was dismayed over the cost of the exams. She seemed surprised when I mentioned that nearly all insurance plans are required to cover vision tests for children due to provisions in the ACA. She didn't know what the ACA was, which kind of surprised me, but she definitely knew what "ObamaCare" was and changed the subject after realizing that she had wasted money on screenings because she assumed that she had no vision coverage. It astounded me how many people hated "ObamaCare" but had positive views of the Affordable Care Act. Even today I think that it would be political suicide to repeal the ACA.
- wolverine876 3y ago
  The GOP does many things that would be political suicide, but the Democrats never make them pay a price, never even try. How are the Dems using the Speaker of the House debacle? They should be all over the place talking about GOP incompetence, and here's what you'll get if you elect them.
  - the_sleaze9 3y ago
    Are they not? I believe they voting mccarthy out in the first place was only possible because of the dems' votes
    - wolverine876 3y ago
      I mean, the Dems don't make them pay a price in public opinion or at the ballot box.
RheingoldRiver 3y ago
I've been a contractor my entire career thus far, and I'm not married. Obamacare is the only reason this has been possible.
- ejb999 3y ago
  I have been a contractor for more than 30 years - well before Obamacare existed - and I always had insurance, why was it not possible for you before Obamacare?
  - RheingoldRiver 3y ago
    Preexisting conditions wouldn't have been covered (at least, that's my understanding)
HWR_14 3y ago
There is no realistic chance it will get repealed if the democrats control either branch of congress or the presidency. I think it was a success. It might not be as good for people who were getting excellent healthcare through work, but tens of millions of people have insurance who didn't before.
ericmcer 3y ago
Probably based on peoples lives: Poor? It is awesome, your healthcare might be ~$40/mo Work for a huge company? you're indifferent to it. Self-employed? It is terrible, your rates skyrocketed. Trash bronze plans can cost you >$500/mo and barely cover anything. Good plans will be closer to $1000.
- deepsun 3y ago
  Except for the first category, I believe it was the same thing before the obamacare. I paid $380/mo as self-employed plan, but it was like 10 years ago. And employers paid even more for their employees.

fullshark 3y ago

My belief is it was oversold in terms of its transformative impact, both by the advocates and detractors. The major change is no longer refusing insurance for pre-existing conditions, and the various lives that have changed due to having health insurance when in the counterfactual they would not have had it. But there's a reason why all democrats are still running for federal office on a platform of healthcare reform. It won't be repealed after the supreme court upheld it and the republican congress under Trump gave up on trying to repeal it after McCain's no vote on repeal.

mrguyorama 3y ago
But Trump and his congress did succeed at repealing some parts of it, like the individual mandate

sidlls 3y ago

It succeeded in getting more people covered by health insurance. It did so by enriching the private insurers who basically run our health care system. Personally I don’t see that as a success, rather it simply made all our health care system problems worse. Access to insurance just isn’t the same as access to health care, because the insurance costs money, and insurers tend to be roadblocks to care. People who tend to need the most care were either already covered (Medicare/Medicaid) or the subsidies under ACA were paltry jokes compared to their needs. There isn’t a realistic chance of repeal. Both of the main political parties here benefit from it too much: the democrats by claiming a health care win, which our latte liberal class eats up, and the republicans by having an additional hot button issue (like abortion and guns) to whip their lunatic fringe up with. Not to mention all the campaign and lobbying money from private insurers who are profiting immensely off of ACA.

Clubber 3y ago
>It did so by enriching the private insurers who basically run our health care system. I might add at the expense of the middle class who now have much higher premiums with much higher deductibles.
tptacek 3y ago
Private insurers don't run our health care system; provider networks do. When you include fee/service ratios for younger cohorts in the Medicare math, the administrative overhead numbers look a lot less compelling; more importantly, you can zero out administrative overhead from insurers and still only get a grocery store discount on services. The immediate problem with American health care is that providers charge too much for services, and secondarily that Americans access too many services. It's also important to remember --- though I don't think it changes any of the fundamentals of the issue --- that the ordinary "retail" care that we access on a year by year basis, including short hospital stays, isn't where all the cost in the system is.
- ffgjgf1 3y ago
  However insurance companies have absolutely no incentives for pressuring the providers to reduce prices, the opposite in fact because they get to keep a share of the revenue..
  - tptacek 3y ago
    Medicare also pays unacceptably high rates for services; the idea that Medicare would successfully and meaningfully reduce those rates is more aspirational than empirical. One of the most important bottlenecks in health care affordability (residency funding) is explicitly maintained by Medicare.
  - ativzzz 3y ago
    There are tons of middlemen / services directly in between the consumer and the medicine or doctor the consumer ultimately needs (including insurance). Almost all of those middlemen are trying to maximize their own profits. The industry is complex and our entire society and economic culture is to blame, you really can't single out a single entity

bluGill 3y ago

I hate it just as much. "If you like your insurance you can keep it is true" - but I didn't like my insurance and I'm still forced to keep it. I've long said the big mistake is tying health insurance to employment is the problem (it isn't the only problem, but it is a big one). If I take anything else I turn away more than $1000 in subsidies that my employee currently it putting in, and that means as much as I don't like my insurance I cannot use anything else. Of course since the customer of health insurance isn't me but my employer that means they are not responsive to me and my needs. I'm against socialize health insurance, but what we have today is just as bad though in different ways.

orangecat 3y ago
I've long said the big mistake is tying health insurance to employment is the problem (it isn't the only problem, but it is a big one) Yes. This is one of those frustrating areas where economists and experts across the political spectrum are in near-unanimous agreement, but anybody who tries to move the system in a sane direction gets attacked for "taking away your insurance". The ACA doubled down on employer mandates, when it should have used the exchanges as an opportunity to get people off employer-based plans. I'm against socialize health insurance, but what we have today is just as bad As I've often said, we've managed to combine the worst aspects of both markets and central planning with the benefits of neither.
- selimthegrim 3y ago
  > The ACA doubled down on employer mandates, when it should have used the exchanges as an opportunity to get people off employer-based plans. This was the point of the Cadillac tax
- spiralx 3y ago
  The ACA included a public option to remove that tie to employers, but it was removed due to the opposition of Joe Liberman and his insurance company backers.
  - HWR_14 3y ago

verall 3y ago

In polling, the "affordable care act" and "ACA" poll better than "obamacare", even though they are the same thing: https://news.gallup.com/opinion/polling-matters/169541/name-affordable-care-act-obamacare.aspx https://news.gallup.com/opinion/polling-matters/169541/name-...

ceejayoz 3y ago
And the individual provisions of it tend to poll really well.
- hotnfresh 3y ago
  This is a typical result in public-opinion poli sci research, at least in the US. The descriptions of what programs do are almost always more popular than programs by name, often by a wide margin. This is how you get weird shit like Trump making vague promises at rallies that sure sound like a call for some kind of stronger ACA or even single-payer healthcare. Many aspects of those things are broadly popular—the propagandized-against labels for them, however, are unpopular in some circles, especially if promoted by a person with the wrong letter next to their name.
- deleted 3y ago
  [deleted]
macintux 3y ago
Obama suggested to Trump that he rename it after himself. https://www.newsweek.com/barack-obama-donald-trump-obamacare-1002240 https://www.newsweek.com/barack-obama-donald-trump-obamacare...
- pauldenton 3y ago
  Sort of like Obama proposing the same stuff as Mitt Romney did and calling it Obamacare instead of Romneycare
  - macintux 3y ago

_ea1k 3y ago

I've often wondered about this, especially after the repeal of the mandate. It seems like the most useful provision was taken away by that. What are costs like for unsubsidized plans now?

mandevil 3y ago

This is my understanding, as someone married to a healthcare professional and with sick parents I've followed it reasonably well. Before the ACA went into effect, the main focus that everyone talked about was on the individual insurance market: in particular, trying to fix the adverse selection issues that had kept the individual insurance market in a continuous death spiral. ACA tried to fix that with the "Three Legged Stool": guaranteed issuance (no longer could a pre-existing health issue be denied coverage), government subsidies for people who couldn't afford it, and the individual mandate (everyone has to buy insurance or pay a fee) to make sure people didn't free-ride while healthy and only get insurance when they were sick. There was also a side project, which was this was that subsidies for really poor people turned out to be really expensive, so perhaps it would be easier to have everyone below a certain threshold just get Medicaid (government insurance for poor people that for complicated historical reasons is largely federal but partly each individual state funded- this is distinct from Medicare, which is entirely Federal and offers universal coverage to everyone over 65). So everyone can use the exchanges to get insurance, if they don't get insurance they have to pay a fee in their taxes at the end of the year, and Medicaid had expanded eligibility rules to cover more people. Health care wonks largely expected the exchanges to do most of the work, and some of them even envisioned a future where the link between jobs and health care were broken- your job pays you more money and you get insurance on your own through the exchange. But that was a future dream, for the ACA itself the focus was on just getting the exchanges to run. That is what healthcare.gov was all about, matching you to your local exchange and offering you the right plans and subsidy amounts- tying together insurance companies, the IRS for your tax returns, and state IT systems all together. Then the conservative-controlled Supreme Court surprised many, and upheld the ACA exchanges on a 5-4 vote, though they added a random restriction never found before in any Supreme Court ruling that each state would have to accept the Medicaid changes on their own- a rewriting done by the Chief Justice's clerks in haste (after he apparently changed his vote late in the game to allow the rest of the law to stay, the liberal wing joined him immediately, no matter how weird it was, much better than losing the whole thing). Now a decade on, the exchanges have proven to not be very popular- everyone who can still gets their insurance through their company because it is seen as a better deal than going through the exchange (because of corporate consolidation on both the insurance company and medical provider sides there is actually very little competition in the exchanges, so the prices didn't go down as expected). Far more people are covered by insurance than before, but it was almost entirely because of the Medicaid expansion- slowly over time even red states have gotten into it, and now only 10 states are still holding out, even as their rural hospitals are utterly devastated and many are forced to close because they can't get paid for their work (in order to balance the budget within the act, some of the US government programs that used to support poor people without insurance were ended- they'll all have Medicaid, so are unnecessary- except then the Supreme Court's rewriting meant that many poor people don't have Medicaid, and the GOP views even attempts to fix things for their own states as a step too far). The individual mandate- which had been viewed as essential to the success of the exchanges- was zeroed out by the Republicans when they took power, that is, the fee for not having insurance was set to 0. And it didn't really have much noticeable effect, because the exchanges didn't make much difference in the end, the power turned out to all be in the Medicaid expansion. This in turn is what has driven the more liberal health care wonks towards single-payer and BernieCare and the like: if the exchanges didn't have much impact and Medicaid did, why not just make Medicaid-for-all?

throw0101b 3y ago

> I wonder, how is "obamacare" viewed after those years? From 2020: > As the Affordable Care Act, or Obamacare, turns 10 years old on Monday, the health care law is as popular as it has ever been, according to new numbers from the latest NBC News/Wall Street Journal national poll.[1] > Forty-two percent of all registered voters believe the law is a good idea, compared to 35 percent who think it's a bad idea, while 23 percent don't have an opinion. * https://www.nbcnews.com/politics/meet-the-press/ten-years-later-obamacare-popular-it-s-ever-been-n1164151 https://www.nbcnews.com/politics/meet-the-press/ten-years-la... On political lines: > Eighty percent of Democratic primary voters, as well as 72 percent of all registered voters who describe themselves as Democrats, say the Affordable Care Act is a good idea. > That's compared to 72 percent of Republican voters in the poll who say it's a bad idea. * Ibid. 2022: > Public opinion of the Affordable Care Act (ACA) has been largely divided along partisan lines since the law was passed in 2010. Following Republican efforts to repeal the ACA in the summer of 2017, KFF Health Tracking Polls found a slight uptick in overall favorability towards the law, and since then a somewhat larger share has held a favorable than an unfavorable view. The most recent KFF Tracking Poll conducted in March 2022 found slightly more than half of the public (55%) hold a favorable opinion of the ACA while about four in ten (42%) hold a negative opinion of the law. Views of the ACA are still largely driven by partisanship: nearly nine in ten Democrats (87%) along with six in ten independents (58%) view the law favorably, while eight in ten Republicans (79%) hold unfavorable views. Explore more demographic breakdowns using our ACA interactive. * https://www.kff.org/health-reform/poll-finding/5-charts-about-public-opinion-on-the-affordable-care-act-and-the-supreme-court/ https://www.kff.org/health-reform/poll-finding/5-charts-abou...

hotnfresh 3y ago

Win column: ending “preexisting condition” horror, and prices supposedly have not gone up as much as they were expected to otherwise. Marketplace plans are relatively easy to compare, which is welcome. Loss column: Insurance rate increases still bonkers and unsustainable (IOW at some point, it’ll get high enough to force some kind of big shift or reform, with a lot of suffering and economic damage along the way). No public option. Not all plans are on the exchange (this varies state by state). Even “gold” plans are kinda shit and insurance still tends to cover less each year, even as prices increase. Fewer insurers offering individual plans at all, at least in some states. Healthcare spending in general still stupid-high and getting higher. Whole thing’s still very complicated, adding costs all over the economy and putting a significant time-burden on sick people and families of sick people, all for no reason whatsoever except protecting a bunch (a whole bunch) of middlemen’s jobs.

js2 3y ago
Joe Lieberman is the reason for the lack of a public option. https://publicintegrity.org/health/elimination-of-public-option-threw-consumers-to-the-insurance-wolves/ https://publicintegrity.org/health/elimination-of-public-opt... https://slate.com/news-and-politics/2009/10/did-sen-joe-lieberman-just-kill-the-public-option.html https://slate.com/news-and-politics/2009/10/did-sen-joe-lieb...
- kaibee 3y ago
  This is unfair to all of the Republicans who refused to vote for the plan too.
jandrewrogers 3y ago
The ACA increased costs far beyond what they otherwise would have been. It made the cost of good health insurance go up 25% overnight where I lived. The discontinuity in price increases before and after ACA were pretty stark, and not in a good way.
- tzs 3y ago
  Any mine went down. There are some charts of health insurance costs over time [1] here. These charts look the same pre-ACA and post-ACA. Costs continued to rise at about the same rate has they had before. [1] https://www.kff.org/report-section/ehbs-2023-section-1-cost-of-health-insurance/ https://www.kff.org/report-section/ehbs-2023-section-1-cost-...

Auracle 3y ago

I had insurance purchased through the exchange for a few years after. It was just for me, a healthy(ish) man in my 20s. The year was $200 a month. The next year was $300 a month. The next year was $450 a month. It had some good in it, such as not denying people based on pre-existing conditions (along with the limited period you can get insurance). Capping how much insurance companies can make as a percentage of revenue was a real poison pill that only served to make costs balloon. They have no reason to be more efficient, or to try to clamp down on healthcare costs. The more we all pay, the more they make, and it's their only path to do so apart from taking marketshare from a competitor. I think we'll probably end up with single-payer sometime, which will be a real mess and a huge amount of money will be wasted for decades. We could fix the insurance system, but it'd be politically unpopular: Everyone's insurance is insurance again. By that, I mean it doesn't cover routine care (apart from a yearly physical, just to encourage that), medications, etc. It's all very high deductible, possibly with some sort of low income subsidy (that still shouldn't go too far). Providers need to publicly list prices, or give good faith estimates for things that aren't routine. Cap medication prices to an average of...Canada, UK, Germany, and Japan - or some other list. This wouldn't be needed for cheaper drugs but for the ridiculously expensive ones that'd normally eat up your high deductible in a month. Bam. Done. There'd be a few years of pain, but you'd quickly see healthcare prices drop off a cliff as consumers would suddenly care that their clinic's sleep study costs $7,000 when the place an hour away only charges $1,500, or that they can do testosterone injections for $20 a month instead of taking a pill that costs $500 a month.

ffgjgf1 3y ago
Or just copy the Swiss system (which is entirely privatized, more so than in the US) if you want to maintain a high degree of direct government involvement in healthcare which exists know you could also copy one of the functioning mixed public/private systems (like the one in the Netherlands). Why try and reinvent the wheel?
- hotnfresh 3y ago
  Just need price controls (at least limited ones, and the credible threat of more) plus a good public fall-back option, and strong standards for what health insurance has to cover. That seems to be the minimum (Singapore model). Those elements seem to be the common factors in basically all OECD healthcare systems outside the US. Taking it farther can work, and may even help, but those seem to be the things you have to have (though price controls can also be implicit, via monopsony). “Credible threat of more” for the price controls may not work in places less authoritarian than Singapore, so you may have to swing closer to the price-book model of places like Japan, if not just go single-payer.

fullstop 3y ago

I had a conversation with my neighbor, a staunch Republican, about eye exams after she had taken both of her kids to get checked and was dismayed over the cost of the exams. She seemed surprised when I mentioned that nearly all insurance plans are required to cover vision tests for children due to provisions in the ACA. She didn't know what the ACA was, which kind of surprised me, but she definitely knew what "ObamaCare" was and changed the subject after realizing that she had wasted money on screenings because she assumed that she had no vision coverage. It astounded me how many people hated "ObamaCare" but had positive views of the Affordable Care Act. Even today I think that it would be political suicide to repeal the ACA.

wolverine876 3y ago
The GOP does many things that would be political suicide, but the Democrats never make them pay a price, never even try. How are the Dems using the Speaker of the House debacle? They should be all over the place talking about GOP incompetence, and here's what you'll get if you elect them.
- the_sleaze9 3y ago
  Are they not? I believe they voting mccarthy out in the first place was only possible because of the dems' votes
  - wolverine876 3y ago
    I mean, the Dems don't make them pay a price in public opinion or at the ballot box.

RheingoldRiver 3y ago

I've been a contractor my entire career thus far, and I'm not married. Obamacare is the only reason this has been possible.

ejb999 3y ago
I have been a contractor for more than 30 years - well before Obamacare existed - and I always had insurance, why was it not possible for you before Obamacare?
- RheingoldRiver 3y ago
  Preexisting conditions wouldn't have been covered (at least, that's my understanding)

HWR_14 3y ago

There is no realistic chance it will get repealed if the democrats control either branch of congress or the presidency. I think it was a success. It might not be as good for people who were getting excellent healthcare through work, but tens of millions of people have insurance who didn't before.

ericmcer 3y ago

Probably based on peoples lives: Poor? It is awesome, your healthcare might be ~$40/mo Work for a huge company? you're indifferent to it. Self-employed? It is terrible, your rates skyrocketed. Trash bronze plans can cost you >$500/mo and barely cover anything. Good plans will be closer to $1000.

deepsun 3y ago
Except for the first category, I believe it was the same thing before the obamacare. I paid $380/mo as self-employed plan, but it was like 10 years ago. And employers paid even more for their employees.