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For one thing, as I understand it, the ACA was pretty effectively sabotaged by removing the mandate, which destroys the math that makes insurance work. Because
by wrs 11mo ago
For one thing, as I understand it, the ACA was pretty effectively sabotaged by removing the mandate, which destroys the math that makes insurance work.
Because pre-existing conditions have to be covered, you're free to wait until you have a serious (expensive) condition, then sign up for an ACA plan. And there's no mandate that spreads that risk around to healthy people, so the population is severely skewed.
I have no definitive data on this, but it seems self-evident that the system can't work well.
- mindslight 11mo agoEven with the individual mandate, it seems self evident that incentives are for private insurance companies to happily take in the extra premiums from healthy people, and then drop or have prohibitively high premiums after people get sick. The medical loss ratio tries to mitigate this, but just kicks the can down the road where the incentive becomes to dump the money into administrative overhead and self-dealing with providers/pharmacies run by affiliated companies.
- scottjg 11mo agothis is mostly right, but it's not true that you can just sign up at any time. there's an open enrollment period for the aca marketplace and if you miss it, you won't have the opportunity to buy health insurance until next year.
- inferiorhuman 11mo agoThe individual mandate merely guaranteed a captive audience for health insurance companies. That doesn't do anything for cost. What drives cost is the ACA limiting profits based on the cost of care, thus more expensive care equals more profits. Can you see where this is going? Five states plus DC still have an individual mandate (ugh), and yes health insurance premiums are spiking there too. A large part of that is due to the tax credits (generously labeled subsidies) expiring – even with an individual mandate health insurance is prohibitively expensive.