Completely agree. The trick is making sure it's well-executed so that other states can use it as a template. Once one state proves that single-payer can be done well, I suspect it will cascade inevitably.
With 100% seriousness, if the ACA is repealed I will likely be choosing between Massachusetts (where Romneycare would hopefully take priority again) or another country. It's too risky to do otherwise.
My extended and immediate family members have too many horror stories about being denied coverage or it being prohibitively expensive. Like a cousin who had to choose working over being a stay-at-home mom to take care of her kids, since her husband's policy as an entrepreneur wouldn't cover her. She didn't even have any ongoing health problems, just a technical pre-existing condition.
I am unwilling to be stuck in a job or forced to accept unreasonable compensation or a nasty work environment because I have to have health coverage. Which is a decision too many in my family have been forced to make. Many family members (including myself) have far worse chronic illnesses, so it's utterly involuntary -- work or die. And thankfully I have a choice in where to live by virtue of my education and credentials.
I have been blessed so far to not have to deal with it because I've only lived in MA as an adult prior to Obamacare -- where Romneycare was in place by the time I finished undergrad. But I've heard enough first hand accounts and seen the suffering that kind of horrible choice creates. And the absolutely perverse incentives it puts onto the job market, and onto individuals. Health care is not a voluntary market, and treating it like one is bonkers.
Now I'm in California. I seriously doubt I will be able to stay without a guarantee that I can manage medical expenses, and I'm definitively privileged economically compared to the majority of the US population.
Considering the majority in the house and senate, day 1 the ACA is going to get repealed - millions will lose their health coverage, and my employer's profitability is going to tank as a result as an increase of patients coming into the ER can't pay their medical bills and we end up sending them to collections before eventually writing it off.
I'm in a similar boat. I'm a cancer survivor, in my early thirties, and run a technology business. Without government intervention, I can not buy health insurance.
Even if you want to remove the compassion for it, eliminating the ability obtain medical insurance is terrible for the economy. I waited for years to separate from my last employer until I was confident that I could obtain health insurance. There are a ton of risks when starting a new company and the last thing you want to think about is whether or not you can pay medical bills if something were to happen again.
Rather than working on my business, I now need to setup a meeting with the state's high-risk insurance pool to figure out whether they're finally going to eliminate the program and then compare that with the paltry list of plans left on ACA as well as what a broker can find me. To be clear, ACA has massive issues. That said, it meant that I could buy insurance, even if it wasn't the perfect insurance that I wanted.
In 2012 Obama promised premiums would go down, my main point was that health insurance is theoretically no longer tied to employment. (note: I am aware that in practice it is not so simple as Obamacare plans are a small fortune)
Haha... indeed. I meant specifically from the perspective that you were in a situation where leaving your job meant you were now uninsurable (in many states, at least). I have an entirely separate rant on how the ACA stuck people with higher deductible health plans outside of employers (like me and my family) with virtually all of the risk of the formerly uninsurable. It was more politically expedient for the Democratic Congress of ‘09 to not really try to fix the problem.
Obamacare made private medical insurance illegal, so millions of self employed lost coverage from that.
The exchange policies have increased in cost so rapidly they are unaffordable for anyone not getting a massive subsidies. Many self employed are now without insurance because of that.
The danger is that the mandates can be repealed budget reconciliation, but banning denials based on pre-existing conditions can't. So if the mandate gets repealed before Obamacare is replaced the ACA health insurance market will probably collapse.
When I left my last job, I "lived" in Arizona. There was only plan on the Obamacare exchange there, and it was the same price as my employer's plan with much shittier coverage.
ACA is horrendous, unless you're receiving a government subsidy. I'm self-employed and we have one option of insurance provider, and the cheapest plan for my family last year was $18,000 a year with a huge deductible. That's after tax, out of pocket, for a healthy family with no pre-existing. Like all self-employed people I know (who aren't getting government subsidy), I moved my family to Christian Medishare, which is basically catastrophic coverage for about $3,000 year that was grandfathered in when Obamacare was passed. However it isn't truly insurance, it isn't regulated for soundness. I'm seriously considering returning to wage employment for health care benefits.
It's the biggest scamola. Self employed people on he individual market are the ones bearing the brunt of Obamacare. No tax deduction for premiums either.
I don't believe 20M more people have medical coverage because of Obamacare, that's a lagging indicator that's likely dead wrong. If you are self employed it made medical insurance unaffordable. Before Obamacare I paid $400 a month for a $5k deductible plan for my family. Post Obamacare I paid $1,100/month, then $1,400/month and quit when it went to $1,800 a month.
So my family has no long term medical insurance and no one is counting our dropping medical insurance in any statistic.
Obama care made health insurance a lot more expensive for me. I used to pay $66 a month for a high deductible PPO plan now I have to pay triple that for an HMO with a similarly high deductible. In other words it made following an entrepreneurial path more expensive.
Obamacare created new gaps that absolutely sucked - made over 58k and self employed? No subsidies for you and paying a skyrocketing premium higher than any reasonable home mortgage with a 10k deductible. Completely unrealistic. And then the IRS hit you for thousands in penalties via the individual mandate.
I lived through that, uninsured, for five years or so as a business owner - to “rich” to get subsidies, too poor to afford 20k+ per year for nothing except a theoretical out-of-pocket max (I say theoretical because there are many exceptions, loopholes, and the annual reset). Being hammered by the IRS for this was.. just.. swell.
So for me Obamacare sucked because it made the cost of individual market plans completely unaffordable and then taxed me for not being able to afford it. As a business owner responsible for employing others, it seemed especially ridiculous because here was a strong disincentive for me to continue on, which would mean a negative ripple effect beyond just me, i.e. layoffs, if I shuttered the operation.
Once the individual mandate went away, and some new options for employer cost sharing like QSEHRA/ICHRA came about, it has gotten a bit more manageable, but most small business owners I know still struggle with healthcare. Cost sharing programs like CHM are about the only workable alternative but they don’t offer the kind of bankruptcy protection a solid insurance premium would cover, and they are religious by nature. Alternatively, DNR and a term life insurance policy.
Best option is to be married, have spouse work for the man to get into corporate group plan for family, while you grow your business enough to sustain an insurance scheme.
But it sucks out there on the individual market - the raw actuarial numbers to insure you are bad - and subsidies disappear quickly with any amount of AGI. Since the vast majority of Americans are on employer-paid healthcare plans, this is a view into it that most don’t see. The cynical side of me (as a small business owner) says this is by design to keep you working for corporate America - consolidation of labor, consolidation of the profits. For me, Obamacare further entrenched this aspect of the system, which has become more terrible, not less.
I comment rarely, but had to chime in as the ACA was very important to me in terms of starting a company.
The ACA also allowed me to pursue founding a company. 6 months before the ACA kicked in, I left my job to start a robotics company. As I was only 29 years old, I did not think it would be a problem getting individual health insurance -- I had done it in the past when attempting my first venture.
What ended up happening was that every health insurance company rejected me for having the pre-existing condition of asthma! It made no sense as I was very healthy and my asthma under control as long as I took a control inhaler everyday. The cost of my medicine would be way less than the premiums I paid -- but some actuary somewhere decided I was too high risk!
For 6 months, I was scared of getting sick or injured -- to the point where I was considering giving up to get a job just for health insurance. That thought to me was just so ridiculous and heartbreaking that I couldn't do it --I just kept telling myself that I had to make it to Jan 1.
I was overjoyed the day I got my insurance card -- it was a huge sense of relief. What brought me even more joy was knowing all my fellow Americans whom also could not get or afford insurance could finally receive it.
Today I no longer need the ACA -- our company is doing great, we're well-capitalized, and provide excellent health insurance to all of our employees. Without the ACA, this dream would not have been possible. We were able to create wealth and jobs because of the ACA -- it makes no sense to repeal it.
Even before I needed the ACA -- I had enough empathy to know that every person has the right to health care and one of the biggest reasons I voted for President Obama. When it affected me personally, it obviously hit even harder. The GOP's lack of empathy as well as a real solution to the problem are just infuriating -- it is absolutely shameful and disgusting how they are attempting to repeal this law.
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