The Problem With The ACA That Needs To Be Fixed

And I don’t think a market-based approach will do it. It’s certainly not getting the job done right now:


As Dylan Scott notes (boldface mine):

Just a decade ago, the average American with employer-sponsored coverage had a deductible of $303. Flash forward just one decade, and that number now sits at $1,350.

What this means is that Americans who do need medical care are being asked to spend significantly more to get it. There is a growing number of Americans who have to spend more than $1,000 on medical bills before their health insurance coverage kicks in

As deductibles rise, patients are increasingly finding themselves on the hook for the actual price of medical care. This includes patients like Bradley Sroka, who I wrote about earlier this year after his daughter’s short visit to the emergency room where she received antibiotic ointment left the family with a $937 bill. The family was on the hook for the entire bill because they were still within their insurance plan’s deductible.

When expanding Romneycare nationally was first proposed (what would be the ACA or ‘Obamacare’), I noted that many people would hate the deductibles. If you’re not in a really good plan with low deductibles, many people would end up paying a lot for medical care. That doesn’t mean it didn’t do some very good things, such as ending denials due to pre-existing conditions or preventing massive amounts of medical debt. But when 40% of Americans can’t meet a $400 emergency expense, a couple thousand dollars of medical bills still means they are going into debt–or not receiving medical treatment. This isn’t working, and this is not having nice things.

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4 Responses to The Problem With The ACA That Needs To Be Fixed

  1. Kathryn Acosta says:

    So people are paying hundreds of dollars a month in premium charges (required by law) for health insurance they cannot use because they can’t afford the deductible. How is that not theft? How is that not extortion by the health insurance companies sanctioned by our government? Time to eliminate the health insurance cartel. No more selective health care. Single-payer for everyone now!

    • zero says:

      Millions of jobs in insurance and medical admin will evaporate when that happens, which is one of many arrows in the quivers of extractionists.

      Start with a universal basic income sufficient to live without a job. (That’s housing, utilities, food, transportation; basically pay everyone as if they had a reasonable job for their area.) Apply cost of living adjustments by census tract and inflation adjustments by CPI. This program will replace the federal minimum wage as well as most forms of federal benefits like social security / disability.
      Add free state college tuition, allowing anyone to pursue a degree or trade certification without taking on debt.
      Now you’re free to go single-payer and end the medical insurance industry. Any employees who lose their job will keep their house and can retrain into another industry for free if they want.

      Who pays? The people who benefit from predatory management practices. People with offshore accounts. Corporations who move money to jurisdictions of convenience. (This would be a great opportunity to implement mandatory labor representation on corporate boards and a 30% federal nonvoting stock ownership of all companies in lieu of taxes.) If they don’t have enough to pay for it all then we take what we can safely take and print the rest while the economy reconfigures.

      • Kathryn Acosta says:

        I agree that perhaps millions of jobs will disappear. However we disagree on the solution. IMO a federal job guarantee – providing a job to anyone who wants it that is federally paid for and locally run – would provide needed stability to the economy. Of course we could combine a FJG with a UBI for those who can’t or don’t want to work. As to who pays for it – the government should pay for it. We live in a monetary sovereign nation that issues free floating fiat currency. The government can never run out of the money that it issues at little or no cost. The fear of inflation that has been so ingrained into our psychic has been proven false. The US has not seen a rise in inflation since the 1970’s. Our understanding of what causes inflation has grown over the years and we now know that inflation is caused by too many dollars chasing too few goods. As Alan Greenspan once said, the issue is not producing the dollars, it is whether or not you have something to spend the dollars on. The government can easily provide tuition free education as well. We can have all three programs: Medicare For All, Federal Job Guarantee, and tuition free education. How to pay for it is not the issue. Having the will to do it is.

  2. A in Ca says:

    For those with an income near or just above the level for subsidies, it is bad too.
    I and family have a ‘Bronze’ plan, with a $6,500.- deductible per person, $13,000 for the family;
    premium per month is ~ $1275.- . (This is for wife, in 50ies, and 2 kids in college, early 20ies.
    I am on Medicare). The next better ‘Silver’ plan, with only a ~ $2,000 (or 2,500?) deductible, would have been ~ 1,000 more premium per month, so I gambled, hoping nobody would get sick. Unfortunately, last two years, there were accidents, and each year I did have to shell out the full deductible + some other fees, for about ~$8000 deductible + copay/year.
    The irony then is, to pay for it all, I have to take money out of a 401(k), which is counted as income, putting our income well above the level for any Obamacare subsidy. (we also live in a high-rent area, northern California, so some income level is needed to keep a roof over our heads).
    Then, Medical expense above 10% [7.5% for >65] is deductible from income for income tax, withdrawing money to pay bills again makes that income level go up, so you also get less of this tax benefit. Oh well.

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