The health care act made sense for Massachusetts in 2006, local legislation to meet local needs. But including it as part of federal health care reform and including tax penalties for those who went without? Incredibly controversial.
1
Controversial how? The other 49 states are made up of people just like in Massachusetts, who need health care. Now if they get sick or have an accident, they will have to cover it all out of pocket. Or get emergency Medicaid which is a federal program we all pay for.
2
The SCOTUS decision permitting the ACA to remain and keep the mandate pivoted on the notion that it was a tax that Congress was allowed to impose. So, the mandate removal was another tax cut but it means that those getting the tax cuts along with everyone else will have other out of pocket costs that for most well be much higher than any amount saved on taxes. What matters is the bottom line to individuals and they will not be able to calculate their gains and losses for several years. Overall, the cost of administering the complicated structure of the tax and health coverage will be much greater that simply doing what other advanced democratic countries have done by using the savings from a single payer to pay for care instead of administrative costs. What is not measured is the decrease in anxiety, fear, anger and dread when people don't have to worry about health insurance and access to health care. Just that change alone will make our everyone healthier and wealthier.
2
The party who wants you to believe that government interference in the economy is bad and wrong have done all they could to interfere in the economy to thwart the policies and laws enacted to implement the ACA.
When oh when will republican voters finally understand their political leaders are not trustworthy and lie without conscience? They have been implementing their plans by deception and propaganda since reagan and have become so used to it they now openly operate like the Soviet communist party and none of you seem to notice or care if you do.
The new layout and comments layout is awful. It looks like some kids idea of what a newspaper might have been. Everything about it is annoying and makes it harder to read pay attention and follow.
1
Bernie Sanders is right - pass a universal healthcare system.
Personally I feel that modeling it on the UK's NHS would be the best option. I think that were it properly funded (and right now the Tories in the UK have underfunded it), the NHS could be a superior system to what we have here in Canada.
But the thing is, large numbers of Americans don't have even that. They are about to lose what they do have thanks to the GOP. Even under Obama, it was not perfect. Lots of folks had very pricey monthly premiums and huge deductibles which were only good for catastrophic care. They could not see a doctor regularly due to lack of money.
I don't see any options but universal healthcare at this point to provide coverage for all Americans.
5
"If a mandate was the solution, you could try to end homelessness by mandating that everyone buy a house. They don't have a house because they don't have the money."
- Barack Obama
2
Many people still didn’t buy insurance, it was cheaper to pay the penalty. This tax helped cover the program. It would have been smarter to expand subsidies or in some way help with coverage. Should someone who chooses not to have coverage be turned away?
1
Please consider the history of healthcare when you write important articles such as this. In the late 1980's, HMO's were predominant in the newly minted "healthcare" industry in MA. "Managed Care" by insurance companies demanded approval from the HMO for services of medical and psych treatments, including that of children. 13YO kids were admitted to state hospital wards because HMO's refused inpatient care. There were two inpatient psych hospitals for kids back then: Gaebler Children's (state hospital) and a small psych unit at Children's Hospital. A few private hospitals for kids followed in the next couple of years but failed by the early 1990's when HMO's were most abusive re: approval for treatment. Abuses and denial of care were pro-forma until the Affordable Care Act and the regulation of insurance entities (and the abuses) were curtailed. The ACA has flaws that could and should be fixed. But, it protected the people. Protection of the people was primary by who designed it. But a deal had to be made with some big-board profit-making companies, and the Blue Cross entities across the US. Note those that have pulled out when things got non-profitable in certain states: Anthem BCBS, United Healthcare, Humana. I am not an expert in the US history of for profit "healthcare". But the people at Harvard who developed the ACA are. Please dig deep here. A trove of American history about failed health policies. Care for the people, but not for-profit companies.
4
I think many people will still buy it; Obamacare's existence and knowledge that the insurance is available, provided by the program will be significant in getting people to buy in. There will be people who are addicted to drugs or homeless who 'need insurance' who aren't going to buy it, but the mandate wouldn't affect them anyway.
1
The problem with this entire scenario is people who don't think they "need" insurance. Because they may be healthy at the moment - if they are young, they think themselves invincible - they won't bother getting coverage. They will pay the penalty, especially when it is so minute compared with the premiums. That my friends is a recipe for disaster. I don't think I'll get in an accident this month so why do I need car insurance? In fact why can't I be able to purchase insurance for my car when I get in an accident? Of course that makes no sense, and neither does not requiring someone to be insured. When such an important issue like insurance is left to each individual consumer to decide, you've got - pardon the pun - an accident waiting to happen.
That is why the answer to this conundrum lies with what other First World nations have: universal health care. There are many systems from which to choose, but once a country decides what works for them, then it becomes uniform. Yes, you rugged individualist Americans, we are all in this together. And when you stop thinking like some self-centered spoiled child and instead being part of a diverse Society perhaps then you can see how wrong-headed the Republicans are.
The power and principle of all insurance lies in diversity and the size of the population. Much like those Super Ball lotteries, the more who participate the larger the prize. This is fact. Republicans are lying. That is all you need to know.
DD
Manhattan
5
A mandate is not a nudge.
"The mandate was devised to nudge healthier, less expensive people into the market, lowering the average price of insurance. "
3
The mandate is essential to avoid adverse selection - it's the most basic of insurance principles. Otherwise, only those people who truly NEED insurance will buy it and then premiums don't cover claims and a death spiral occurs, rendering the plan unsustainable.
5
I'd like to implement a nationwide database to record the names and SSNs of all those folks who railed against being forced to buy medical insurance.
They said they "didn't need it" because they were morally superior to those folks who "didn't lead a healthy lifestyle" and why should they have to subsidize those folks?
The database would be available to all hospitals and doctor's offices, and when the time came that those refusers showed up and couldn't pay for their medical care, they would be shown the door. No free riding should apply to them the same way they wanted to block the perceived free riding of others.
6
Trouble is, letting those who are sick to just die in the streets would affect our public health. We would see a return of Cholera and a host of other terrible infections. Americans want a wonderful health care system and they don't want to pay for it. People who choose to go without health insurance are just putting their future health care costs on the rest of us. AND now this hate for the mandate will destroy the ACA.
4
I was being sarcastic to make a point.
Trump and his cadre of Republican government shrinks are determined to rip apart the incremental improvement with the passage of the ACA. Republicans labeled it Obamacare, and then proceeded to condemn it while still in its womb. They wanted to abort Obamacare for no other reason than it would carry the name of a President who Republicans viewed as illegitimate. Republicans succeeded when they did this with HillaryCare. They personalized both plans, then proceeded to demonize Hillary and Obama. Haters of both of them would reject their plans no matter how beneficial they may be. How do we know this? Because when people are asked if they support the ACA versus ObamaCare, the former beats the later by a nautical mile. And until a far more larger percentage of voters get off their duffs and out to the polls and vote Trump and the entire Republican slate out of office only then can we return to some sense of sanity, equality and fairness in our government.
DD
Manhattan
6
The removal of the individual mandate will do nothing to kill the Affordable Care Act, but will increase the cost to Americans who need health insurance. Those who are young and healthy will leave the program; those who are sick or threatened with illness will stay. Insurance companies will act accordingly. You can thank the Republican Party for the suffering they are about to cause to millions of Americans who were young and foolish and did not stay in the insurance program, or the old and infirm who will be punished through vastly higher costs.
2
All the Health care policy analyists disagree with you (myself included). Getting rid of the mandate is the equivalent to telling young workers they no longer have to have Social Security taken out of their checks. When that happens it is "Good-bye Social Security"! and we should be smart enough to realize that the ACA is all but dead now, which means millions of folks will soon no longer have health care. Start crying now baby, the worse is yet to come.
2
It’s a sad state of affairs when a Republican idea is rejected because a Democrat has his name on it. Partisanship has become more important than mental acuity, and we think we are a world leader.
6
You missed the upshot, Upshot.
This law makes health insurance reliant on consumers to not game the system.
The requirement to insure people with pre-existing conditions goes hand in hand with the mandate. Now healthy people can cancel their insurance, and wait to get sick to buy insurance. There is no reason for healthy people to have insurance, if they can wait until they are sick to buy it. Theoretically every healthy person, based on their self interest, should be canceling their insurance.
People with insurance from their employer probably won't, but employers might do it for them.
The upshot is that this canceling of the mandate is a completely irresponsible attack on health insurance. Beyond gutting the basic compromise that underlies the ACA, health insurance itself is undermined, because insurance relies on spreading the risk to healthy people so costs are not born only by the sick. You cannot have insurance if The risk pool only contains people with 100% risk.
Right now insurance companies are predicting how many people will drop insurance based on this and week raise premiums on everyone else.
Republicans, you broke it. You own it.
9
The individual mandate has been a discriminatory tax. Imagine having to pay for something you chose not to buy! A tax which buyers don't pay.
That Obamacare required it shows what a faulty program it was, overall. Whole things needs an intelligent re-doing -- & that may be a while yet.
2
Imagine having to pay for astronomical emergency room care for those who won't get insurance and then have an expensive accident. They should have also repealed the law that requires emergency rooms to treat societal freeloaders, which make MY premiums go up.
12
That's the argument of a free-rider. People who don't buy insurance "until they need it" often don't or can't buy it at all. Insurers aren't in the habit of picking up new customers just after their cancer diagnosis, or while they're in the ER following a catastrophic car accident. The rest of us pay for your stinginess. You're welcome.
7
As long as the individual mandate was associated with Barack Obama, it never stood a chance. The irony of it is that the Obama Administration loaded it with so many exemptions and caveats that it really didn't achieve what was intended: to broaden the overall risk pool to include the healthy young.
I detest Trump and all he stands for, but in the case of the mandate, he was simply following the wishes of most Americans, who thought the mandate was unreasonable and unfair.
2
As long as people who choose not to buy insurance do not show up in the ER expecting care when they become ill injured.
This is the end of the ACA. Getting rid of the health care mandate is equivilent to telling young workers they no longer have to pay for their future social security AND expecting it will be there when they need it. What will those so called "Young and Healthy" adults do when they get really, really sick? Answer: they will expect their country (as in tax payers) to pay their bill.
6
I never saw any reports on IRS enforcement of the penalty for failing to obtain insurance under the Affordable Care Act. My impression was that Obama was not eager to give the Republicans the weapon of IRS prosecutions of people who disregarded the law and failed to pay the penalty. I thus won't be surprised if the repeal of the individual mandate doesn't impact signups much, esp if, at the same time, states succeed in restricting Medicaid coverage.
2
If you underpay your taxes, the IRS will contact you, usually one to three years later, and let you know how much you owe (with penalties and interest). If you don't pay up right away, they begin their very hard-nosed collection procedures.
There is no separate payment or collection of the tax penalty for not having insurance. Why would you expect enforcement of that one part of the tax code to get different treatment than others?
2
A Plan for Universal Health Coverage through Private Insurance:
Under this Plan, everybody will have health insurance from a private insurer. The amount of coverage provided by the private insurer will be up to a certain basic limit usually spend by most people in a year. Any expenses over that limit will be covered by a Pool created for that purpose (Pool Coverage). My preferred choice is a limit of $50,000 (can be flexible). This limit can include dental and vision cares as well. This limit will be covered with no deductible and co-pay to encourage people to have annual checkup and to participate in wellness programs. High deductibles and co-payments will be applicable to expenses over the basic limit to discourage unnecessary spending.
Financing: The basic limit and Pool Coverages are financed by individuals by paying a certain percentage of their income to the Pool. For basic limit, everybody will pay 10% of their income (can be flexible) up to the basic limit to the Pool. For the Pool Coverage, the payment will be from incomes over $50,000 based on progressive or flat rate as needed.
The Pool can collect money through pay roll and tax forms as employers are doing currently. As the coverage provided by insurance companies are capped, insurers can develop actuarially sound rates.
This is a unique American plan, but all the details are not given here due to space limit.
3
Obamacare will live on as what it had devolved into anyway: subsidized insurance for the fourth quintile of earners without employer coverage. The uncertainty about how all this will work out is an excellent illustration of the wisdom of that old dead constitution that would leave such matters to the states where these experiments could be run on a smaller scale.
1
Perhaps you missed the incentives the Obama administration gave states to pilot new ways of improving our medical industry. The small incubator model was a feature of the ACA.
2
Let's not whitewash the fact that the Kochs and Friends put tens of millions into a media blitz to get people, especially young people, to opt out of Obamacare.
Remember the creepy Uncle Sam ads? Those were just one of their ways of misinforming the public, in that case lying that the ACA would put the government in your examination room.
There was sabotage at every turn by the GOP because they couldn't abide a successful black man in the White House.
22
Most people assume foreclosures no longer happen in our country. They still do and over 95% of all Foreclosures occur due to an inability to pay a health care bill. Kinda makes you wonder if thats why the very wealthy support getting rid of the mandate and dismantling the ACA.
2
The American Academy of Actuaries wrote a letter to Congress on 12/12/2017 urging them NOT to eliminate the mandate. These are professionals who deal in risk management and believe the mandate a very necessary tool. It speaks for itself.
http://www.actuary.org/files/publications/Tax_Reform_Conf_Comm_Individua...
10
Yes. I think we've gotten inadequate coverage of the ways torpedoing the individual mandate will dismantle significant parts of our medical delivery systems.
1
My wife and I are self-employed and both own small businesses. Prior to enrolling in ACA we were paying $1900 per month for our health insurance. After finding a new plan through the ACA, we are now paying $900 for a BETTER plan. The ACA might not be perfect, but it is saving millions of people far more than this petty tax break the GOP just rolled out.
Shame on you Ryan, McConnell, and Trump. All three of you are an embarrassment to this country and a disgrace to the offices you hold. Especially Ryan, who thinks the rest of us shouldn't have the same benefits extended to him when his family needed it, repugnant!
27
Your example is contradicted by mine. Fortunately, I have a grandfathered plan which started around $378 for a family of 5 when ACA was enacted and now is about $550. Meanwhile, the cheapest ACA bronze plan with similar deductibles and co-pays is $1100...much more expensive.
Maybe you are getting a subsidy which is why your plan is cheaper now. That just means the taxpayers are paying for you.
I thought Susan Collins was going to fix all this. I also believe in the tooth fairy.
6
Mandate or no mandate, the Affordable Care Act's math simply does not work without the Cadillac Tax, which was delayed indefinitely in order not to harm Hillary Clinton's chances of being elected President in 2016. There just aren't enough of us healthy self-employed folks to hold down the price of insurance on the exchanges.
Time for all you folks getting tax-free employer paid insurance benefits to quit lecturing us about how wonderful the "Affordable" Care Act is and put your money where your mouths are!
6
Finally!
Now let's get rid of the seatbelt law, the drinking age, and all road signs -- especially those onerous speed limits.
signed,
the ER and ICU worker unions
12
Sorry, but we Americans are a free people. We don't do well will ''Thou shalts'' coming down from a single political junta or party drunk with power.
The power and control freaks in the rest of the world demanding obedience were what our families LEFT to come here.
Folks in our country like to debate. We are looking for the best solutions to our individual problems and the problems we share as citizens of our country. It is a process and we are proud of it. Many people new to our country did not grow up with the same freedoms and expectations that US Citizens have. We all have a right to our opinions and a right to express them. You may have left a difficult world, but most folks are shocked when they find out how expensive things are here. We do not have universal health care here. One way or another we all have to pay for health care.
There is no mention in this article of the legislation Senator Susan Collins of Maine has proposed to soften the impact of the mandate’s demise. One bill (Collins-Nelson) would provide seed money for states and authorize high-risk pools. The other (Alexander-Murray) would reinstate the cost-sharing reductions that help low-income people with their co-pays, which might encourage insurers to stay in the market. At first Senator Collins said that the bills would become law this year, based on promises from the President, Mitch McConnell, and Paul Ryan. This week she said that action on the bills would wait until next year, prompting a storm of derision.
Does the author of this article have an opinion on whether Collins’s bills are likely to pass, and whether they would really do what she claims they will do?
The whole point of insurance is to have one giant pool. The more you slice and dice the pools, the higher the risk in each pool.
Of course the actual risk to the insurance company is spread across all of the pools, but they like making a lot of little pools as an excuse to raise premiums.
Since the best pool would be one big pool, spreading the risk across the whole population, and since Medicare (with 3% overhead) is more efficient than private insurers (who average 14% overhead), and because the whole problem with which provider accepts what insurance would go away, the logical way to do health insurance is Medicare for all.
But Democrats blew that twice.
Hopefully with Republicans attacking ACA (you broke it you own it) the next health reform will be for real.
11
The problem with the mandate is that it was, in effect, a wealth transfer from the healthy to the sick. Rather then from the healthy to the sick, wealth should be transferred from the affluent to the needy. No wonder it failed the test of politics.
4
That is the whole point of health insurance, a wealth transfer from the healthy to the sick.
Everyone pays in when they are healthy and then when you get sick, everyone is paying for you.
Should only people with burning houses buy fire insurances? Should we buy auto insurance after the accident?
Republicans seem to have no understanding of the meaning of insurance at all.
9
Those who consider themselves "healthy" have the crazy belief that they will NEVER get sick. And, when they do get sick, they want EVERYONE ELSE TO PAY FOR WHAT THEY NEED. Really? Shame on anyone who does not carry comprehensive health insurance. Until we have universal health care paid by all (which is the only way we can do this fairly) not having health insurance is immoral.
4
Any state is free to put a heath insurance mandate into their state income tax to match what the ACA has done.
This is actually better for a state than what ACA provides to a state:
1) the state keeps 100% of the tax penalty, under ACA it get 0%. The state can spend the resulting tax revenue however it sees fit.
2) if a person qualifies for a subsidy, the Federal government pays, not the state.
3
If the insurance companies want to keep markets stable, which is in their long-term interests, how about an advertising campaign that shows how inexpensive coverage can be for younger, healthier participants.
The ACA subsidies and the extensive Medicaid expansion make it easy to afford coverage.
Spend anywhere from $1 to $100 per month and you should be able to have health insurance.
Who's spreading that information?
8
With the individual mandate gone, the insurance companies will raise rates to account for the departure of healthy people from the pool of insured.
Thus will the nominal 2000 dollar per year tax cut for the middle class be negated by a 10 or 20 percent rise in monthly insurance premiums.
11
I think the demise of the individual mandate might end up being a positive development.
The mandate was the most hated feature of ObamaCare. Many hated it for ideological reasons, others felt forced into a feature they did not want to pay for, while still others could barely afford the payments.
The mandate probably lowered prices for some people, but left many struggling.
With the mandate gone, I feel the popularity of the ACA will increase significantly.
Those who qualify for a subsidy will still benefit from the program, as will all those that have been included in the Medicaid expansion.
As I said, with the most objectionable feature removed, Obamacare might flourish and serve as a model for a better solution in the future; something based on a more generous expansion of Medicaid or lower age criteria for Medicare.
2
You mean the subsidy that has been removed by the Republicans? Customers can rely on that for another year, at most.
The mandate was the most hated feature, because thosee people don't want to pay. Guess what, health care is expensive. Who is suppose to pay for that?
Kind of ironic, since it was a Republican idea to begin with, courtesy of the right wing Heritage Foundation and the right-leaning health insurance industry chieftains. But this was never about ideoogy. It's about punishing the middle class and poor for not being rich. Even the Republicans' theology tells us that. If you are not rich, God does not love you.
14
If Obama had tried to pass single payer universal healthcare, the Republican counter offer would have been Romney Care, the ACA. Then Obama could have negotiated from a position of strength, and could have accepted Romney Care with a public option as the compromise and the Republicans would have owned half of it.
The centrist Democrat strategy of beginning negotiations with the desired compromised has failed repeatedly.
8
I will gladly pay more taxes for universal coverage. Insurance is expensive and co-pays and deductibles make actual health care out of reach for millions of Americans. We need another option besides cobbling together a terrible for-profit scaffold cooked up by conservatives leaving most of us at risk and many dying without care. Absolutely shameful for the “richest country in the world”.
16
I didn't know the individual mandate had been the Heritage Foundation's idea. It just shows you how weird politics can be. The individual mandate turned out to be toothless, and I personally knew several people (all younger men) who chose to forgo having insurance and paid the penalty. A lot of guys who are younger don't get annual check-ups or preventive care. Women generally get annual gynecological exams at least, so they can get a birth control prescription. I think the GOP Congress really failed on this one. If more people drop out of the insurance market, it will become a nightmare for any individual trying to purchase insurance. The costs will go up even higher -- and they're already high. It's time to put politics aside (you too, Democrats) and come up with a solution.
5
Good riddance to Obamacare.
Even Bill Clinton saw that families were paying over $25K a year in premiums and deductibles before getting even a dollar's worth of healthcare.
The very rich and everyone getting a subsidy didn't care, but all of the working people were pillaged. Once you're okay with watching someone else get pillaged no matter who else benefits, there's something wrong with you.
6
Pillaged?
So did you pay more in taxes because of the ACA?
Of course not.
4
If you felt pillaged before, wait until the rates increase 10% a year and the essential benefits are stripped out of plans because insurance companies are no longer required to cover them. Good times ahead.
1
Honeybee, who is paying for your health care?
Gutting only the mandate but leaving the remaining ACA regulations in place is essentially health care populism. For some people it will feel good in the short term, like taking a shot of morphine for a gushing wound. But over time it has the potential to severely wound the marketplaces and broader health system. Congress has at its disposal a myriad number of evidence-based, bipartisan solutions for sustainably reducing costs and expanding coverage. This is not one of them.
4
I am very concerned about what will happen to the individual markets in general. I live in one of the nation's largest cities, and we have only two options for individual insurance coverage. Both went way up in price from last year. If there are evidence-based, bipartisan solutions, let's hear them already! I just want basic coverage and protection at a price I can afford.
2
One party has no interest in evidence. They told the Centers for Disease Control, to stop using the phrase "evidence based."
If you want a solution to be evidence based, you will have to go to the left base, build power and force Republicans to compromise.
Large premium increases are directly resulting from the unpredictability the dotard sewed into the medical system with his constant contradictory messaging (because he doesn't understand the issues). Now that insurance companies know they won't have the healthy members brought in by the mandate, prices will rise even more.
Let's be clear. Far from being some sort of "experiment," we know full well that a "mandate" is essential to the efficient working of a national healthcare system. Every advanced nation on the planet requires every resident to have health insurance, and to pay into health insurance. It is that universality that permits those nations to offer affordable healthcare to all. Without it, the young and healthy opt out, and that dramatically raises the cost to the elderly and those afflicted with serious injuries or illnesses.
It's no mystery. And we know, as the Congressional Budget Office pointed out, that without it, millions of Americans will either lose or forgo insurance. And that will be a disaster.
14
I wonder if people like me are included in those counts of predicted people losing coverage: I'm on COBRA now and likely will be unable to find new coverage on the individual market when that runs out, due to pre-existing conditions. It's not the just mandate being carved out of the ACA, it's also the essential benefits.
The Democrats adopted the mandate, a Republican idea, because the Democrats are closer, ideologically, to the Republicans than they are to the public who overwhelmingly support single payer.
Do you think the Russians are subverting our "democracy"? Corporate America bought most of the politicians long ago thereby turning us into an oligarchy, so I say, "what democracy"?
10
The mandate DID NOT WORK 10,000,000 people pay for coverage though the exchange (8,400,000 subsidized premiums, 1,600,000 full price) & another 5,500,000+/- people buy off the exchange. About 7,400,000 people in all pay full price.
More people opted to pay the fine (or are exempt typically because of cost) than actually pay for coverage in the individual market. Based upon the most recent data, 6,700,000+ tax-filing households (or estimated 17,286,000 with 2.58 people per household per US census) have opted to pay the fine.
92% of those who choose the fine had household incomes under $75000; just under 80% had household incomes under $50,000 & over 37% had incomes under $25,000 https://www.nytimes.com/interactive/2017/11/28/us/politics/obamacare-ind...
You explain to a couple making $42000 how much better off they would to have to spend more money (prem +ded) just to get antibiotics because insurance will protect them from huge medical bills they couldn’t pay when just hitting the annual ACA out-of-pocket max of $14700 put them into bankruptcy
Hospitals provide charity care for the uninsured. If the person is insured, even if they can never pay the out-of-pocket share, then no charity care.
The numbers – premiums + out-of-pockets versus no premiums & paying out of pocket for the office visit and antibiotics do not work for all of these households in the bottom 50-65% of the US & they do not have assets to protect from creditors.
9
Requiem - a mass for the souls of the dead - is an apt title for this article. For surely thousands of Americans will die prematurely due to loss of insurance and millions more will be hurt by loss of coverage and higher premiums.
Republican Senators and Congressional Representatives killed the mandate for the most venal of reasons - to transfer the tax savings to wealthy individuals who do not need tax cuts.
8
People want insurance when they have assets to protect. Therein lies the real problem. A lot of younger Americans and some older (and sicker) don’t have any assets – all they have are bills. So, they look at medical insurance as a bet. If I don’t have insurance then I save all that money. To make matters worse, everyone has a hedge on that bet in that federal law requires all medical care providers who take any form of government money to provide care to anyone, regardless of their ability to pay. So, the bet to not have insurance, particularly when you are asset-free, is a sure thing. If all you have is a stack of bills, adding one more to the stack and keeping what you would have paid for insurance, is a win-win. The fact that everyone around you winds up paying off your debt doesn’t bother you at all because all you care about is yourself. Back in the day, the RNC called these folks “Deadbeats” now they are Patriots because they tend to vote Republican.
15
I have substantial agreement with you, that for people without assets to protect, it can tend to be a good bet to go without health insurance.
I do want to clarify that the care that providers are required to provide regardless of ability to pay in under the EMTALA law, and is only emergency care to the point of stabilization. (In certain locations, hospitals and charities may provide more, but there's no guarantee.)
8
And is this going to be the model to destroy Medicare and Social Security, HUD housing and food stamps? Kill the programs by abandoning their funding sources, and when the costs rise, vote in the middle of the night to sicken the poor and the powerless?
To be a Republican today is to be just another Putin stooge, an adherent to the oligarch model of governance and economics. Steal from the poor, kill the independent press, hide your evil behind smarmy state press.
I wonder how many will die so the evil of the Trump family can strut about. Complicit really doesn't describe the crime being committed by the Trump family and Congressional Republicans, perhaps UnAmerican does.
9
" .. The mandate’s first big moment in the spotlight came in 2006, when it became part of a Massachusetts .."
.. which is 80% Boston .. Harvard .. M.I.T. Not the USA. Someone please tell Bernie Sanders that. Thanks.
And it failed because BHO, a U.S. senator for 153 days, refused to call the PPACA what it was -- a tax increase. Which caused 80% of the litigation.
Now, time for the experienced to fix this mess.
4
I live in MA, and I point out that we still have our old mandate (double penalty for not carrying coverage--Federal and State--while the Federal is in place).
The Globe confirmed yesterday that the state penalty for not carrying coverage will remain. (Fortunately.)
5
Too bad experience is the one thing this administration does not have.
I am the middle class that has received no assistance, no subsidy for my health insurance premium. . I am self employed and buy my medical insurance on the individual market.
In 2015 there were four companies to choose from and my $6500 deductible no frills Bronze plan was in the mid $500s.
2016 the individual market was down to two companies and that same no frills plan was $770 a month.
Come Jan 1 I will have only one company to buy my insurance from and my no frills Bronze Plan will now be $1050 per month!!!
No one in the middle class who buys on the individual market has wage growth to adjust for the astronomical rate increases in their medical insurance premiums.
My options; go without insurance and risk losing all I have worked hard for, my home and my personal savings. Continue to pay the high rates and hope that the state I live in, California, will work on a plan. Cut my billable hours and reduce my income so I can qualify for a subsidy. This is assuming Washington does not succeed in completely dismantling the ACA.
For many of us what small tax relief the Tax Reform bill will send our way will be more then deleted by rising health insurance costs.
32
get an insurance for catastrophic events and save some money to go for elective treatment to Thailand or India.
1
Thank the GOP.
This is the fruit of their attempts to destroy Obamacare.
3
Strange that Americans do not balk at the requirement to have car insurance in order to drive a car or to have homeowner's coverage as a prerequisite for a home mortgage, and home ownership. However, when it comes to health care, it is fine to "go bare" and to expect that other privately insured patients will cover one's health costs if one cannot afford them.
Another key point is that ACA coverage offers free preventive services and access to large group prices for health care providers. These deep discounts to large insurers from the hospitals' "list price" can range to 80%.
If there is any sliver lining, perhaps the resultant chaos of the ACA market collapse, for both patients and providers (which have become quite content with escalating cost shifting to private payers and raising private prices exorbitantly as they merge into unregulated cartels) will result in the only solution to cost control---- provider price controls, as competitive market forces diminish.
3
The mandatory part of car insurance doesn't protect YOU against loss, it only protects those you collide with. You're perfectly free to find your own level of risk tolerance.
4
But the public doesn’t foot the bill for losses to uninsured drivers like it does for emergency room treatment of people who don’t buy health insurance.
Mandating people buy a product has caused insurance costs to skyrocket and insurance stocks to boom. A large majority, including most Bernie voters, are happy for the mandate's demise. Makes Medicare for All much easier to pass.
6
Michael, You are Wrong and Wrong
Requiring the young and healthy to be in the insurance pool brings down average premium costs.
I am not, and I doubt most other Bernie supporters, are happy that millions will lose coverage and everyone who needs private insurance will pay higher premiums due to the Republican vote to end the mandate. Republicans will block universal health insurance for years to come. Are you really willing to throw all of those people under the bus for the distant possibility of passing "Medicare for All"?
8
Bottom line assuming the mandate is not brought back if there is a democratic wave election in 2018 or 2020, these are some of the main effects.
1-Millions of free loaders who don't want to pay into it, will get free medical since they are judgement proof. The general population will be paying for it.
2-Low income people will be protected assuming the assistance they are getting under ACA in paying the premiums continue.
3-The real victims are the middle class people under ACA who do not get assistance in paying. Their premiums will sky rocket.
24
Yes. On your item (2), total post-subsidy premiums for people in the up-to 400% of Federal Poverty Level people are capped at around 8% of income, and substantially less for people well below 400% of Federal Poverty Level.
The loss of mandate, (as well as Trump's elimination of cost-sharing subsidies by executive order) hit that same >400% of FPL group.
1