ok, so first and foremost, don't go partisan in discussing it, but....
What is the essence of the affordable care act?
As best this poor soul can figure out, there are two basics:
you must have insurance. if you're poor enough, the gov't will subsidize it. if you're not poor enough, the gov't will penalize you for not having it.
the act makes it easy for your work place to not cover you when you retire. It may just be coincidence, but starting in 2015, almost everywhere, when you retire, you're on your own.
So, all you believers, convince me. What else did the affordable care act do to make the health care business more affordable.
I really hope this isn't political, but it's something I've been thinking about, and most of what I'm thinking is I must be missing something. Tell me what I'm missing.
everyone focuses on the must buy insurance
and everyone jokes that noone read the bill well that was because
it was a big bill for a reason
there are real cost cutting measures in ACA
What you need to know about Obamacare’s cost-cutting measures - ( New Window )
my insurance went from a nice HMO to a high deductible plan (which sucks, but I don't know as it had anything to do with the ACA. it was coming. the company didn't want to pay what it would take to keep me in a good insurance plan, so they downgraded. was going to happen one way or another)
Holy crap! You up until recently still had an HMO? That amazes me.
I guess I don't understand the complaints about cost going up and plans being suckier, because since ~2003/2004, my health insurance has been doing exactly that. Long before the ACA came around. I've been on a high deductible plan for 8 or so years.
Currently my family deductible is $6500/yr. Luckily to help a bit with that, I have an HSA that as long as I let them suck some blood once a year so that they can justify charging more because of all of the fatties, that my company inputs $500 and then matches up to $1500/yr.
What's hilarious, is that currently I'm going to end up paying almost exactly the same out of pocket for the upcoming birth of my child that I would be paying if I had no insurance and just paid the hospital up front (~$2400). The only real savings I have using the insurance is something that's not even required- the company seed money in my HSA.
This current form of PPO that I have now hasn't changed for 5 or so years- it was a little different at first (8 or so years ago)- basically with a lower deductible and more seed money.
Anyway- the point is that higher costs and shittier plans were already coming. Don't fool yourself into thinking that without the ACA your costs weren't going to go up or your coverage wasn't going to go down. That's just silly.
As far as providing insurance after retirement? 20yrs ago my company provided that...but you had to pay in full the entire cost- which with the HMO we had back then was around $900/mo. I can't think of many employers that were going to provide the exact same coverage for retirees as for current employees- someone correct me if I'm wrong, but basically the perk of insurance for retirees was that you stayed in the group insurance and hence were paying the group rate that's a significantly lower rate than just buying your own- especially if you're in a large group.
They did away with the retirement insurance benefit back in 2001. So again- don't fool yourself into thinking the ACA was the driving force...that was pretty much coming already- with the costs skyrocketing, there's no way companies could keep offering that benefit.
I would like to see less of the burden on the middle class- and I'd also like to see more of a single payer system- so please don't take this post as me being a fan of the ACA at all- I'm not. I just want to clear up the really silly myths about how it's raised the cost for everyone. The cost was going up anyway- at least now there are people that previously didn't have insurance (which we were already paying for when they went to the emergency room) who have it.
My $.02
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All's it takes is a little congressional action.
Seriously?
Cobra-like insurance could bridge the gap for people losing coverage if King v. Burwell goes the GOP’s way.
So within a week I will introduce legislation that uses the 1985 “Cobra” law as a temporary model to protect those harmed by ObamaCare. Cobra offers workers who have lost their jobs the option to keep their health coverage for 18 months—so Congress should offer individuals losing insurance the ability to keep the coverage they picked, with financial assistance, for 18 transitional months. This would simultaneously avert the full-scale implementation of ObamaCare in these 37 suddenly desperate states. It would also help protect suffering patients entangled in the court’s decision to strike down illegal subsidy payments.
Link - ( New Window )
Thankfully, I don't see a majority of SCOTUS justices ruling in the plaintiffs favor. Obamacare survives.
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That's possible, but Chait may not be factoring in the power of Republican anti-Obamacare ideology. Some Republican states have expanded Medicaid because it makes economic and humanitarian sense; but many others still hew to GOP orthodoxy that such a step is a capitulation to evil Obamacare. Ideology might yet prevent the Republican Congress and Republican statehouses from acting rationally to ameliorate the effects of a Supreme Court ruling.
So, ctc, are you really confident that the most conservative component of the House is going to let Boehner pass a fix that is fairly simnilar to the ACA itself in terms of its impact? Really?
And then, ctc there is this, also from your link:
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In fact, every objective analysis has shown that the ACA has brought down the rate of healthcare cost increases and materially lowered the nation's uninsurance rate. If the GOP analysis of the state of America's healthcare is as off-base as Sasse's, the party has no chance of designing a reasonable plan of its own.
It's always fun when scomeomeone with an opposing view makes your strongest arguments for you. Thanks.
Manh
They have no choice. We are to far into it to start from scratch. If you read my first post on this thread. I stated the ACA is what it is. I'm talking reality for the situation that is today. You can't change the past, you can only move forward. Those who live in the past are doomed to failure. That's about how political I'll get on this board.
The whole point of obamacare was to get as many people covered as possible. Get the poor out of the emergency room and in to a doctors office. It would bring down costs.
The whole point of obamacare was to get as many people covered as possible. Get the poor out of the emergency room and in to a doctors office. It would bring down costs.
Which states are those?
Actually that is what the SCOTUS heard arguments about yesterday. The question is will the poor LOSE coverage due to subsides being cut to those states that didn't setup exchanges.
Those federal subsidies appear, maybe, possibly, the way the law is written, will only be available to states that set up their own exchanges.
As far as emergency room usage. read the thread. A lot of good insight on here.
I don't remember what states. Mostly down south i believe.
I don't remember what states. Mostly down south i believe.
That's a different discussion and will turn too political for this board. IMHO
It seems the ACA has caused companies to hire part-timers instead of full-timers who would otherwise cost more under ACA. This appears to me with the large retail stores in my area and really impacts the quality of service due to the many people being hired having no interest in actually working.
Second, it appears that the ACA is tax regressive. I think that MIT professor was right after all; it is a tax. However, the tax is on the lower-middle classes! Good job leaders! So it is good for me but does not appear to be better for the folks working part-time at Whole Foods and the few nannies I run accross who want and have paid for healthcare complain about "Obamacare" inecessantly as their costs went up!
That is all anectdotal but down here in the trenches, working for the man, that is what is being seen. I presume that some economist (maybe the MIT guy) will jump in and claim the old system was not tenable so a change had to happen. Well, it did, tax the loweer classes and let the corporations effected do a work-around.
My answer to that is that the complexity of the ACA has created many messes like the one you list here. My answer to it is that given time, that will go away.
No country with universal access and any public component has not instituted, recently, significant reform to their own systems in the 2000's. Germany, France, UK, the Scandinavian countries.
But, even more importantly, cost cutting has got to be one of the most boneheaded goals of a public insurance plan.
It's not even clear that cost cutting is inherently desirable. It's also not clear that cost cutting procedures will work, given that all the countries face annual price increases in healthcare that are similar to the U.S.
Lastly, public cost cutting initiatives (like global budgeting in France, for instance) always have very bad perverse side effects, such as a reduction in technology (look at MRI's per capita in France). And, of course, they don't solve any of the significant inequities found in healthcare (LE in France/UK between professional workers and laborers).
Businesses facing tremendous uncertainty don't start cutting en masse; they wait.
There has been some evidence that part-time jobs are not falling after the recession, which (in part) can be attributed to the ACA:
But it's far too early to tell.
Similarly, we should expect to see continued wage declines after the recession, as firms compensate workers with more benefits and lower wages.
This graph below can again, in part, be contributed to the ACA:
It does not mean that it is significant nor long lasting. There are effects, but claiming that something has or has not happened is moronic.
Can we blame that on the ACA too?
And as far as stagnating median income, a growing proportion of economists believe that accelerating technological change is playing an increasing role, one which will only increase over time. I guess we can blame the ACA for that, as well.
I was in retail management back in the 60s and 70s. We started going to the part time model back then because it was realized that stores are busier at certain hours of certain days and floor coverage (customer service) could be vastly improved with the flexibility. We found many capable and willing workers, who wanted part time jobs to fit their schedules ... moms with kids in school, college students ... etc). Of course there still has to be a backbone of full timers working towards advancement but part time employees is, and has been, the way to go to a large retail environment for many, many years.
Can we blame that on the ACA too?
And as far as stagnating median income, a growing proportion of economists believe that accelerating technological change is playing an increasing role, one which will only increase over time. I guess we can blame the ACA for that, as well.
Question, Manh -- Hasn't median income been stagnating for quite some time? Just asking for clarification. Also, the point about the rest of the world still being in more dire economic straits that the U.S. is a telling one. I guess they shouldn't have adopted the ACA, eh?
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It seems the ACA has caused companies to hire part-timers instead of full-timers who would otherwise cost more under ACA. This appears to me with the large retail stores in my area and really impacts the quality of service due to the many people being hired having no interest in actually working.
I was in retail management back in the 60s and 70s. We started going to the part time model back then because it was realized that stores are busier at certain hours of certain days and floor coverage (customer service) could be vastly improved with the flexibility. We found many capable and willing workers, who wanted part time jobs to fit their schedules ... moms with kids in school, college students ... etc). Of course there still has to be a backbone of full timers working towards advancement but part time employees is, and has been, the way to go to a large retail environment for many, many years.
Sphinx
Wasn't that the Sears model that didn't workout too well for them at the time,but the model everyone changed to?
Trying to remember ancient management 101.
Perhaps you can instruct these betters to give you a reading lesson.
You were complaining about people lamenting the extreme negative effects of the ACA (the short-run) and I was calling them dolts, not you.
This is an internet bulletin board, so you may not get the respect you're accustomed to, but that should be a challenge to you, not an insult.
Couldn't give 2 shits if internet strangers respect me. Plenty of people that matter do, and that's enough, whether its warranted or not.
These problems will be solved - and I will suggest to you that they are already - but I'm a dolt...
On Long Island, thru the late 50s stores were closed on Sundays and only open one or two evenings a week, usually Monday and Friday. Almost all the employees were full time. Scheduling was easy. Then when the stores started opening on Sundays and every evening Mon thru Sat scheduling became more of a challenge. At first more full timers were hired but it was slowly learned that wasn't the way to go because the schedule was too rigid. Little by little when a full timer left he/she was replaced by two or three, maybe even four, part timers. My point was necessity brought part time workers into retail decades ago, blaming the ACA is ridiculous.
These problems will be solved - and I will suggest to you that they are already - but I'm a dolt...
Yes, you are, especially if you believe that these problems are already solved.
Interesting; the rest of the developed world hasn't solved any of these issues, but the U.S. did in one fell swoop...
And yeah, I think the problem of not reading is more of a lack of intellectual challenge on your part, but hey, wallow away.
I absolutely believe that the ACA is having some material effect on the pt/ft ratio. It would be fairly absurd for some lower wage employers to not factor this in.
But is the ACA suppressing wages (not sure if kicker argues this)? That's a tougher sell. Wage stagnation (or worse) seems to exist, but the attribute it to the ACA and not the worst recession in 75 years leading to a particularly abnormal oversupply of labor (people who would take a job in their industry at any wage still not having jobs), the increased ability to offshore production and work (b/c of IT, lower shipping costs etc), productivity gains, and a host of other reasons (shareholder activism/private equity) seems too selective. How do you prove that the ACA contributed in any way to a lack of wage growth? Also, do health benefits count as wages? If I make $10 in year 1 and 2, but get more fringe benefits in year 2, do you say my wages stagnated?
It's another topic, but it's technological change and other forms of bureaucratic creep, as well as some notable labor market issues.
I think that the ACA may play a contributory role in wage stagnation, but is not the primary driver. I also think that it will be pointed to as the cause because of the false correlation, but it would be wrong.
Benefits count towards broader measures of "wages" like total compensation. Common datasets impute a monetary value for health insurance and the like. So, with your statement, total wages stagnated, but total compensation did not. But, you have to remember that part of the wage decreases may be, in fact, due to increases in non-wage fringe benefits.
It's what happened with mandated maternity coverage.
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So why don't you challenge yourself, rather than say stupid things like I should "read more about how experts say it's a no-go"?
These problems will be solved - and I will suggest to you that they are already - but I'm a dolt...
Yes, you are, especially if you believe that these problems are already solved.
Interesting; the rest of the developed world hasn't solved any of these issues, but the U.S. did in one fell swoop...
And yeah, I think the problem of not reading is more of a lack of intellectual challenge on your part, but hey, wallow away.
I don't believe anything. You know that. And yes, the majority of the most enterprising solutions to the worlds problems starts in the US.
I was agreeing with you. That the model was studies in 1980's management 101 kind of enforces that.
The only impact that the ACA could possibly have is reducing the number of part time hours available to work for part timers by reducing the full time work week to 30 hours.
I don't know if there is any data available one way or the other or if there is a big concern about it in that work force.
Yes, we'll have to do it again sometime. :-)
This is a big reason I am so thankful I have been working for the city for the last 4 years. I get free healthcare (for now anyway) for me and my family. If I stay here through retirement, I will continue to receive my healthcare. That, plus the pension are enough of golden handcuffs for me. I get a little frustrated about salary in the short term, but realize for the long term someone would have to blow me away with an offer to get me to leave. Last Fall I got an offer for about 10K more. But, with the cost for their health plan and added commuting costs, I would have ended up bringing home less.
Also, and I forget the exact circumstances, but the "refund" businesses receive for spending a certain percentage on health care. The "refund" is supposed to be used to further support their employees. However, there is very little in terms of regulations on how this needs to be spent. Some 9very few) companies have given that money directly back to employees either in the form of payment or a reduction in their employee contribution to health care coverage. But, a lot simply put it back in their operating budget to be used as general funds, which was not the intended (on paper) nature of the refund.
This case has one similarity in that the legal precedent does allow the case to go either way based on the scope of the ruling, but it differs in that the politics have changed; the non-compliant red states would suffer if its overturned.
There's a clear disconnect here.
Regardless, as my initially point stated, I do support the idea of providing care to those who otherwise couldn't afford it. When I say "not at the expense of others" I am saying it shouldn't come at the expense of reducing services and increasing costs for others. Find the funding for this program.