THCB

They’re Not Deadlines. They’re Opportunities …

Confusion about Affordable Care Act (ACA) deadlines is rampant. That’s because there are lots of them and they keep changing. The fact is that some of them matter a lot more than others.

In my view, the BIG deadline is:

MARCH 31, 2014: Under the ACA, all Americans must have health insurance, and this is the latest date you can acquire it if you wish to avoid paying a penalty on your 2014 income tax. Some individuals will be exempt from penalties, including, as of last week, people whose policies were canceled because their plans’ benefits did not meet new ACA standards of adequacy.

Another date that has drawn attention but, in my view, doesn’t matter as much:

JANUARY 1, 2014: This is not a deadline so much as an opportunity. It is the first day, when, if you signed up in time (now December 24 for the federal website, but a few states have later deadlines)—and paid your premium in time (at the administration’s urging, many insurers are allowing a grace period through January 10 for the federally run marketplaces and some states have also moved this date)—you could enjoy the subsidized coverage available under the ACA. But if you miss these so-called deadlines, you still have until March 31 to sign up for coverage to avoid a penalty.

For the millions of Americans who are uninsured, or who could have enrolled in improved insurance through a state or federal exchange, missing these deadlines merely means you failed to make yourself better off as soon as you possibly could. BUT YOU WILL BE NO WORSE OFF THAN YOU WERE BEFORE.

There are also some dates that are consequential, but have received less attention, or have receded from the headlines:

NOVEMBER 2014: This is when the Obama administration promises online enrollment for the Small Business Health Options Program (SHOP) in the 34 states where the federal government is operating the small-business marketplaces for companies with fewer than 50 workers. For now, small businesses in these states can apply via paper application or an insurance broker or navigator.

Online access is available already in most of the 17 states and the District of Columbia that are operating their own SHOP exchanges.

JANUARY 1, 2015: The date by which employers with 50 or more employees will become liable for a tax penalty if they are not offering health insurance that meets minimum standards, and an employee becomes eligible for subsidized private coverage through the marketplaces.

The changing dates associated with the ACA are troubling to some, since they suggest confusion and even mismanagement by the Obama administration. It would obviously be reassuring if every declared date were honored and announced rules and intentions never changed.

On the other hand, I’m doing some long-delayed repairs in my home. The contractor said the work would be done by Thanksgiving, but there were unanticipated problems. We’re hoping now for Christmas.  I’ll be happy if it’s done by mid-January, but the key thing is whether, a year from now, I’m satisfied with the result.

Health insurance is obviously way more important to millions of Americans than any home repair project could ever be. But few things in life go exactly as planned, and it would be totally astonishing if the implementation of massive reforms to a sector accounting for 20 percent of our economy rolled out without a bump or a detour.  We should keep that in mind as we think about those changing ACA deadlines.

David Blumenthal, M.D., M.P.P., is president of The Commonwealth Fund, where this post originally appeared.

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54 replies »

  1. Parts of the rock (more like giant boulder) I am attempting to crawl out from include:

    1) Paying a minimum 2.9% (and more) of every dollar I earn for the rest of my life as an ante into a poker game that I and my children will likely never see any potential payoff from since eventually, the game will be raided by the authorities.

    2) Substantial, continued increases in income tax rates to pay towards an $80 trillion plus unfunded Medicare liability.

    http://www.usdebtclock.org/

    3) Having to hear from early entrants in the Medicare Ponzi scheme crow about their good fortune, and worse,

    4) Having to listen to these same “beneficiaries” tell me the answer is Medicare for everyone.

    ACA drives us to Medicaid for almost all with a few fortunate ones still enjoying Medicare for a while. It will not be pretty when providers only ability to cost shift will be from Medicaid to Medicare.

    What the country “decided” in 1965 was not the deal we have now in many of the same ways that what the country “decided” in 2010 is not the deal we have now.

    Delaying the age of full benefits by a year or two will not address the costs of either program increasing by factors of 10 to 100.

  2. @gladd is a shill for the HIT vendors. Obama care will fail as a greater percentage of the GNP will go to health care. Gee, are they excluding the costs EHRs from the health care column? If so, the updated percentages will be false.

  3. No one has EVER claimed that ACA success is founded on HIT. Get serious.

  4. The savings they project from the HIT nirvanna will never materialize. Thus, the financial foundation for the ACA is cracked, and will collapse. There is a premise also that doctors will work for little or nothing paid by Obamacare insurance.

  5. Bobby Gladd:

    I agree with you 100% that it would take 5-10 years to understand if ACA is a success in aggregate and it’s probably closer to 10 than 5; however, the problem is time.

    With ACA one is asking the populace to be guinea pigs during the time it takes to get it right. Outside of aspects of the law not working for people one also has the cost problem. It will be very difficult for many to afford the plans and you have the issue of how it hurts the rest of the economy.

    So the question is during the x year period from now until it’s working reasonably well say 5 years – will the backlash be so great that politicians are forced to repeal it?

    One has to be cognizant of and deal with political and economic reality. Such reality is why the corporate and small business mandates have been pushed past the mid terms.

    My guess is the authors thought they just had to get something passed and then fix/refine it over a several year period and again will they have the political muscle to do so?

    My guess is no. The economic challenge is unemployment is quite high as is the national debt and the economy is not that strong. The closest unemployment # to reality is U-6 = 13.2% an I would hazard full time unemployment is closer to 15/16%.

    The Fed’s bag of tricks is pretty much empty. Quantitative easing will end quite badly at some point. Imagine a 50-60% market correction – very bad for the economy resulting in a lot of layoffs = even harder to afford ACA.

    You also have to look at geopolitics and the weakness of the global economy. The global economy and stability can change for the worse very quickly and if either happens ACA is in trouble.

  6. Probably there is no market to understand unless you are a politician. Medicare beneficiaries would not appreciate the notion they are on the dole. They think they earned it.

  7. Bob —

    One other disadvantage of MA plans is that if you ever want to go back to standard Medicare, you can’t buy a supplemental plan unless you can pass medical underwriting. There is no underwriting requirement if you sign up for standard Medicare when you first become eligible and buy the supplemental plan then.

  8. Bob –

    There are very reasonably priced Medicare Advantage plans in the county where I live as well. The tradeoff, of course, is that you have to accept a limited provider network. For those of us with significant health issues, including myself, we’re better off with standard Medicare because it ensures maximum choice of doctors and hospitals. In my case, my wife and I are also subject to the maximum IRMAA surcharge which we would owe whether we chose standard Medicare or an MA plan. Between that surcharge, the standard Part B premium, our supplemental premium and the cost of a Part D prescription drug plan, we pay over $13,000 per year for our health insurance plus another $3,700 per year for a good long term care insurance policy. The good news is we can afford it.

    Regarding lowering the Medicare eligibility age to 55, the incremental tax burden might seem quite manageable to you but legislators don’t see it that way because most of their constituents don’t see it that way. Just look at all the machinations that took place to get the CBO to score the Affordable Care Act as at least budget neutral. Medicare providers got squeezed. There were new taxes on insurance companies and device manufacturers. High income people were hit with an extra 0.9% Medicare tax on income above $250K for a couple and a new 3.8% tax on investment income above the same total income threshold. Even paying doctors more than the Sustainable Growth Rate (SGR) payment formula calls for (the doc fix) which, until recently, the CBO scored as costing at least $300 billion over ten years was too much for Congress to tackle. Since the CBO recently lowered the estimated cost to $125 billion or so, it’s suddenly a lot more doable.

    We have to work within the system we have. Most people aren’t as willing to pay more in taxes as you are and there aren’t enough high income people to soak. They can’t pay for everyone else by themselves.

  9. Aurthur, what rock are you crawling out from?

    I said i did not understand the Medicare Advantage market. That is not a sin and does not disqualify me from commenting on health reform in general.

    Secondly, the country decided in 1965 that persons of retirement age would have their health premiums subsidized by other taxpayers. That is because they generally have no employer and because their premiums are the highest.

    We can debate the entry age, maybe 65 is too young, but are you proposing that all subsidies be stopped?

  10. Making a judicious determination of what is “for the good of the nation” is a most agreeable exercise. Finding a majority to support it, though, well. . . .

  11. ” I do not understand this market, but I”… I like pissing in the ocean. Not understanding has not stopped you from “educating” other folks that do understand. Here’s an idea. Why don’t you send another $1,000 a month to the feds to help pay for the rest of your share of the cost of Medicare.

  12. Yes, the big question is what will be most important to Americans going forward; affordability? quality? choice? accessability? What would come with a single payer system?

  13. Let’s say our 58 year old couple, like the majority of their peers, is afforded health care coverage under a plan provided by an employer. They are doubtless unhappy with the cost, to them, of that plan, and of the rising costs of medical care. Are they so unhappy, though, that they could be induced to sacrifice the quality of care they enjoy to further the “greater good” of some sort of “universal single payer” scheme? To give up their provider preferences? Do you suppose they have not heard the tales coming from Canada and the UK about the long delays in seeing specialists and obtaining needed surgery? They would have to be tricked into such a scheme, and are now fully on guard, given the duplicity involved in the ACA (“If you like your. . . ” etc.)

  14. Note to Archon:

    You are a good contributor but I still disagree with you.

    Before the ACA, a Blue Cross policy in MN for a 60 year old and a $5,000 deductible still cost $500 a month. And this was without the ACA mandates. The market is just crappy in those areas, before and after the ACA, in my opinion.

    Note to Barry:

    I am not so sure that even $100 billion a year for the 55-64 year olds is unaffordable today.

    Depends how many are in the program.

    If 15 million baby boomers go into Medicare, and they pay $3000 each, that is $45 billion.

    That leaves the rest of the taxpayers to kick in $55 billion. That is 1% of payroll if you want to go that direction. Not a horrible burden.

    There are also numerous studies on how to pull $55 billion a year out of the defense budget for the next 10 years. Politically hard but numerically rather easy.

    Final note:

    I must be a lucky ducky in Medicare. I joined it recently. I pay $41 a month for a Medicare Advantage plan that covers drugs, plus my monthly part B premium of about $110 a month. I do not understand this market, but I accept my good fortune.

  15. Ahh… The ever-handy “ad hominem” accusation parry / deflection.

    We’re AT LEAST 10 yrs out from knowing whether ACA can be judged an aggregate success. Economically and clinically. I love how y’all just summarily render a verdict of “failure.” And I am not a big ACA fan.

  16. Bob:

    Agreed. My gut though is employees of small and large businesses will get hit as well.

    Small businesses may not have plans compliant with ACA so costs have to go up and I doubt such costs will be fully borne by the small business probably as to bear such costs squeezes their margins too much or makes them unprofitable.

    As for big employers I think they will use ACA to reduce their HC costs. I know two people at large corporations that have already had their plans change – higher premiums and worse coverage.

  17. MD – They’re not that smart and even if they were the bungling of the website wouldn’t be the right way to go about it. It would be better to debt finance it, get everyone sucked in and then reveal the costs.

    My guess is they will now debt finance it and frankly they have to given the delay in the corporate mandate and other delays.

    So ACA will fail, but slowly.

  18. Bobby:

    I disagree with you. Economics is pretty binary in that something works or it doesn’t albeit time horizons and measurements of success can vary. Unfortunately, ACA can’t be considered a success by any measure currently and will get exponentially worse as time passes.

    Your ad hominem attack isn’t helping your argument rather suggests an inability to rebut what I have written.

    The website and the bill are a disaster so exactly who or where are these so called “professionals?”

    There are any number of ways that HC for all could have been done in an economically feasible way, but ACA isn’t one of them. ACA architects failed to anticipate push back from the middle class and the fact that young people wouldn’t be that interested among other things.

    It was the architects’ extreme arrogance that blinded them to reality and such arrogance may serve to destroy the progressive movement something quite dear to their hearts.

    How exactly does the household/CEO analogy fail?

    As for mortgages, people were quite blind – even Goldman. You just have to look at the issue with a longer time horizon to understand this. What need will the world have for investment banks after global economic collapse?

  19. Bob –

    Since the 55-64 age group are all part of the baby boomer generation, there were approximately 40 million births in that cohort. Probably 15% of them have died by now which still leaves 34 million. I don’t think employers would selectively be able to dump those still working into Medicare but they probably could and would once they retired. However, the employer could decline to cover spouses as many do especially smaller employers.

    The actuarial value of Medicare breaks down roughly into $5,500 for Part A, $5,000 for Part B and $1,500 for Part D. Part B has a beneficiary premium of $104.90 per month which covers 25% of its costs. A stand-alone Part D plan would have to be purchased for somewhere between $15 and $50 per month, maybe more unless the beneficiary chooses a Medicare Advantage plan that includes prescription drugs. For standard Medicare, a supplemental plan is needed and usually purchased for $165-$225 per month or so. The bottom line is that many seniors are spending $300-$350 per month for Medicare premiums and supplemental plans despite low incomes in many cases though there are 9 million seniors that are eligible for both Medicare and Medicaid.

    If Medicare were opened up to people between 55 and 64 years old, it could easily wind up costing taxpayers $100 billion per year if the beneficiary contribution were capped at 10% of income. With the trust fund unable to support the existing program on a long term basis, I don’t think it could pass the Congress even if Democrats had complete control of both houses plus the presidency.

  20. No, it was not the same, because prior to the ACA, our couple could have purchased a policy of their choice, instead of one loaded with benefits mandated by the Progressive Elite.

    You speak much of increased taxation. Too much.

  21. I would not expect the 55 year olds to have to pay full freight to buy into Medicare. They would subsidized by overall tax revenues in the same way that Part B of Medicare is subsidized today.

    Just for fun (well, fun for healthcare students), let’s say that anyone over 55 with no employer coverage could buy into Medicare for 10% of their income.

    Say that this opened up Medicare to 5 million persons ages 55-65.

    They each made $30,000 a year on average and thus contributed $3,000 a year.

    Their actual costs in Medicare might be $9,000 a year apiece.

    Therefore the hit to general revenue would be 5 million times $6,000.

    This is $30 billion a year.

    Congress spends that much before breakfast some days, but to speak more maturely, $30 billion a year can be covered by fairly minute changes to income and/or payroll taxes.

    I realize there would be a problem of ’employer dumping’, and we could soon have 15 million in this program rather than just 5 million.

    I still like it.

  22. Bob –

    One of the problems with trying to get / force people, even young people, to buy health insurance for the first time or buy significantly better and more comprehensive coverage than they had before is that it is so disruptive to their budgets even with subsidies in many cases. The problem is especially acute for the over 55 crowd with rules that allow 3 to 1 age rating. With pure community rating, though, insurance would be ludicrously expensive for young people.

    Most people, including myself, are not aware of how low the taxes were that originally financed social security and Medicare so I looked it up. It turns out that the original social security tax which began in 1937 was 1% on the first $3,000 of wages or $30.00 per year paid by both the employee and the employer. Today, it’s 6.2% on a wage base of $113,000 $7,006 each. The Medicare tax started out in 1966 at 0.35% of the first $6,600 in wages or $23.10 for the employee and employer. The wage base increased only 50% in the first eight years but the tax rate tripled to about 1%. It reached its current level of 1.45% in 1986. The wage base reached $135,000 in 1993 and then the cap was removed entirely the following year. By the way, annual Medicare spending today averages a bit under $12,000 per covered life or $24,000 for a couple with about 12% of that paid by beneficiary premiums. Not many 55 and over folks could afford to buy into that even if they were allowed to. The subsidies would have to be huge if we limited the individual’s premium to 9.5% or 10% of income.

    If we could magically start with a clean sheet of paper and people knew as soon as they started their first job that 10% or 12% of their pay would be withheld for health insurance coverage, they could budget for it. Rents and homes available for purchase would cost less than they do now or wages would be higher to accommodate the health insurance tax burden and they would be built into the prices of everything else we buy.

    If we ever went to complete taxpayer financing for health insurance, it would probably have to be via something like Ezekiel Emanuel’s idea of a dedicated VAT but the tax rate would likely have to be in the 15%-20% range as opposed to the 10% rate that he proposed in his book, “Healthcare Guaranteed.” That would be pretty disruptive too, however.

  23. The bungled rollout could easily be a calculated maneuver to blunt everyone’s realization that this thing is going to cost them a fortune for far less coverage. They have been unable to buy it. Dilutes the sticker shock.

    Watch the cash price for care climb like a homesick angel. The emergency departments will be backed up for days, not hours.

  24. Note to Archon:

    Having sold health insurance in MN, I would say that the situation described for a California couple is about the same after the ACA as it was before the ACA.

    The individual market has long been a very expensive place for persons over 55 without employer assistance.

    Since the subsidies run out over about $62000 in income for a couple, and since age rating is still present albeit moderated, and since insurers still have to cover cancer and heart disease……..then costs are still very high for this group.

    Private insurance does not work well for everyone. At older ages, we should either increase the subsidies, or allow persons over 55 to join Medicare for an income-adjusted premium.

    Bob Hertz, The Health Care Crusade

  25. “Covered California’s shop and compare tool shows that a 58-year-old couple in Los Angeles County with $65,000 in income buying a bronze plan would have to spend $19,400, including $9,400 in premiums and a $10,000 deductible [before deductible is exhausted and ObamaCare’s benefits kick in.] (ObamaCare: Older Workers Could Pay 25% of Income, Investor’s Business Daily, 12-26-13.)

  26. I get a sense the blog authors here do not like links in the comments, but after reading this tonight, it only adds to my sincere disgust with the agenda by the Democraps behind it.

    The link is from Hot Air, but motivated by a story at USA Today about even more hidden fees:

    http://hotair.com/archives/2013/12/26/coming-up-next-obamacare-taxes-and-fees/

    I hope the blog authors allow the link, I think it applicable to the post and thread here. Really, this wonderful law and man behind it, helping the middle class exactly how, what , becoming extinct!?

  27. One factor not discussed here so far is what happens to healthcare costs. Healthcare costs have come in below initial estimates for four straight years now. In fiscal 2013, per capita Medicare spending was flat vs. 2012 resulting in no increase in Part B premiums for 2014. Nobody understands exactly what is driving this but getting ready for the ACA is probably part of it. Hospitals, for example, are focusing more aggressively on reducing hospital acquired infections and preventable readmissions.

    In the private sector, we are likely to see explosive growth over the next several years in private exchanges, especially for retirees. Many employers are anxious to shift to a defined contribution model for active employees as well. Both single carrier and multiple carrier private exchanges can help them do this. In the current labor market, it should be easier for employers to pull this off than it would have been in the 1990’s when the economy was much stronger and employers were less willing to risk upsetting employees.

    I think the recent website glitches are relatively small beer in the longer term scheme of things as far as the ACA is concerned. Adverse selection was always the potential Achilles heel of the ACA and it’s possible that premiums could be higher than expected going forward requiring larger subsidies as well. At the same time, economic activity appears to be strengthening and the federal deficit was well below initial expectations in fiscal 2013 thanks to slower than expected growth in Medicare and Medicaid, lower spending for defense and unemployment benefits and significant contributions to the Treasury from large profits again earned by Fannie Mae and Freddie Mac.

    There are a lot of moving parts here. The bottom line as it relates to health insurance is that millions of people are going to be better off than they were before the ACA took effect. Lower income people will gain access to Medicaid and somewhat higher income folks will get decent private health insurance, many for the first time. Subsidies will help them to pay the premium.

    Over the last 20 years, I’ve faced some significant health challenges and medical expenses. I always had comprehensive health insurance available to pay most of the bills. I wouldn’t have wanted to face those bills without good health insurance and I don’t think anyone else should have to either. My federal income taxes will go up to help pay for the ACA subsidies but now that I’m retired, I no longer pay FICA taxes on my income which consists mainly of social security benefits and investment income. The one area that I worry about, though, is inadequate income verification for those applying for subsidies. While I’m willing to pay my share in taxes, I’m not willing to pay for fraud in this or any other government program. I expect maximum effort to minimize fraud losses.

  28. MD as Hell, you could have referred to Mr Gladd too, I frankly have zero clue to what he is thinking that adds anything viable to these threads most of the time! He is a living example of the Saul Alinsky mentality that drives the Democrap machine. Insult people and then give this false and lame defense of being a victim.

    Gets old! Oh, but maybe I do have a clue what he thinks after all!

  29. Was this post’s author one of the losers standing behind Obama when he gave the press conference saying how the medical community was in favor of this legislative assault on America?

    Anyone aware of a site that does name all those “doctors”standing behind Obummer at that press conference? I would like to read it if it exists.

  30. I’d say that your “understanding” of ECON is that those who agree with your opinions are the people who “understand” ECON.

    It’s like the 50 blind men describing an elephant through touching parts of it and recounting what they feel.

    The household budget analogy fails utterly, as does the CEO one.

    All we have is amateurs — beyond the actual professionals who you claim don’t count.

    The mortgage bubble was Gresham’s Dynamic run amuck. Moral Hazard writ large. There was nothing “blind” about it; it was fully knowing and willful. I used to work in subprime risk modeling and management. My knowledge is anything but academic with respect to that.

    See my “Tranche Warfare” at http://bgladd.blogspot.com/2008/12/tranche-warfare.html

    and its follow-on “The Dukes of Moral Hazard.”

  31. Note to BC:

    You are right that many persons above the subsidy line will find ACA insurance unaffordable.

    The basic reason is this:

    they have to buy a policy which has the normal protections of grouo insurance — but without any employer subsidy!!

    The lack of employer money in the individual market is the absolute dominant factor. With subsidies to some, the government is attempting to be kind of a surrogate employer.

  32. Agreed. The flawed website and shifting of timelines hasn’t made it easier.

    As per the contractor, the homeowner would fire the guy without question.

  33. Right Bob, and therein lies the problem. The patient has no idea what treatments and diagnostics cost. Everyone’s happy to get “free” preventive care, but it’s not really free is it?

  34. Come now, we must take the broader view, and contemplate the situation from the perspective of those who are differently situated. To those who are to benefit from the subsidies funded by the taxpayer or the premiums of others, the ACA makes perfect ecnonomic and political sense.

  35. BC:

    Let me endorse your point about tenured profs and CEO’s not understanding the real world of insurance.

    But I will be more specific. When a generous employer plan adds benefits, as plans have been doing for the last 20 years, the insured participant sees little or no increase in their share of the premium. This leads to the illusion that better coverage is basically free.

    We saw this kind of thought pattern on a small scale when the supporters of a contraceptive mandate just said that “insurance should cover this,” tacitly assuming that there would be no charge to employees.

  36. You may well be correct in the time frame BC, I was merely re-iterating
    Dr. Blumenthal’s statement. My concern is that while huge projects may be expected to have setbacks, the unfortunate website rollout and the constant shifting of timelines do not portend well for this particular project. If your contractor had mangled your house in the initial stages of remodeling, would you trust him to finish the job as promised? Not only that, what if he did not draw up or review the project blueprints before starting?

  37. Mr. BLUMENTHAL. If your home repair contractor lied to you repeatedly about what you were getting and ends up with cost overruns two or three times what was promised, and later you find out all the plans and costs were merely a boondoggled ruse to distract and demoralize and the contractor actually knew your house was going to burn down because that was his plan all along so he could replace your house with a prison, would you reward this same contractor with the contract to build and run the prison (or should I say the opportunity to build and run the prison)?

  38. Perry:

    Absolutely, but I’d say that you’d have to see what the satisfaction is 2-5 years out. One year is too soon. Over 2-5 years one will see the economic effect that ACA has on the economy, which I think will be quite negative unless debt financed.

    Debt financing it is another problem. Outside of the economic effect, 2-5 years will also give people a sense of whether they like their quality of HC or not.

    Time will tell.

  39. Not true. There are a great many people in this country that understand economics they just tend not to be tenured professorial types.

    Anyone that successfully runs a household budget understands economics as do most business owners and CEOs.

    Emotions blind clear thought. The tenured bunch tends not to understand economics well in general largely due to the fact that they get paid regardless of what they do. To the extent that they do then they often are blinded by their idealism, ego or greed. Such blindness applies to most of Congress as well and many captains of industry in verticals like HC, finance and defense.

    There is zero room for amateur day when one is talking about radically altering 1/6th of the economy. The reason is over 300 million people depend on it to meet basic necessities. Furthermore, what the US does affects the global economy or in other words a great deal of the global population.

    A good example of such global effect is the Arab Spring, which was caused by QE2 resulting in commodity inflation. All of this gets back to the blindness that permitted the mortgage bubble.

    Bottom line – with a great deal of power comes a great deal of responsibility. When one intends to do something “big” there is an onus upon one to really think it through whether this is changing HC, starting a war or other.

  40. ” but the key thing is whether, a year from now, I’m satisfied with the result.”

    That’s the real question, isn’t it?

  41. All the brouhaha over the rollout and changing deadlines have served as a nice distraction from the issues to come. Not as many people are signing up as had been anticipated, many of those that are (over 60%) are being added to medicaid’s rolls, and there is a real possibility that the age and illness distribution among those paying premiums will be skewed. This will of course lead to higher premiums in the years to come, and thus the subsidies will have to be increased beyond the “funding mechanisms” in the original bill. And I’m sure you realize that subsidies really come out of the general fund, i.e. from taxes. (Many patients mistakenly believe the unsubsidized premiums of the “rich” pay the subsidy for the poor). One would truly have to have a progressive mental illness not to at least see the potential for significant economic damage from this legislation.

  42. “It’s pretty clear that the architects of the bill do not understand economics.”
    __

    NO ONE understands economics, least of all those purporting to instruct the rest of us on the subject.

  43. Can hardly wait for your comments…

    This commentator clearly thinks there is a pony here somewhere.

  44. “BUT YOU WILL BE NO WORSE OFF THAN YOU WERE BEFORE.” That’s not factually correct, is it? But those who find that their premiums and deductibles have been jacked up under the ACA can congratulate themselves for having furthered the redistribution of health care.

  45. I agree that when you change 1/6th of the economy there will be bumps.

    Missed/confusing deadlines, the website not being ready on time, etc. are growing pains that can be fixed or just dealt with over time. Put simply the short-term headaches aren’t the problem other than providing the opposition with the outrage du jour.

    The problem is ACA is structurally unsound and once one gets past the short term problems one is still faced with an unworkable bill.

    Narrow plans, losing one’s doctor and the like are all things that are and will continue to make the plan politically indefensible, but the thing that kills it is cost.

    A lot of people above the subsidy line simply can’t afford it and a great many with higher incomes above this group can’t afford it without radically changing their fixed monthly outflows. So what does this second group do? Sell their house and get a cheaper mortgage, put the kids in a cheaper school, break their auto lease and drive a jalopy?

    Add to this the bill will suck a lot of money out of all other vertical sectors leading to higher joblessness and therefore more will need subsidies.

    So defend the bill all you want, but flogging a dead horse is flogging a dead horse – it will never get up.

    It’s pretty clear that the architects of the bill do not understand economics.

  46. And, let the hateful Mad-as-Hell-at-Everything comments ensue in 3,… 2,… 1…

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