Perhaps people have jobs and are healthier? Using less health care is a good thing.
@vulcanalex
People aren't using healthcare any less, fewer people HAVE healthcare...big difference.
2
As a MD, the implementation of the ACA led to more confusion, more bureaucracy and made it impossible for patients to navigate let alone struggling medical practices that were already overloaded with paperwork requirements. The only patients of mine who like Obamacare are the ones who get it for free. Imaging a huge monthly premium with a deductible that if you had to use in case of catastrophic event, would bankrupt the average middle class family who was forced on the exchanges and who did not qualify for the medicaid expansion-middle class working people. Imaging this, your Son has acute appendicitis and you are on an ACA plan you barely can afford and he goes to the operating room. Bang, now you will need to pay a 5k deductible as the cost of the operation will be over You are now broke or bankrupt. The undocumented alien who is in the ER with you who needs to procedure gets it for free while and while you are going into bankruptcy while you subsidize the care of the undocumented. This is the reality for my patients and you cannot believe their anger while so many get so much for free. The ACA worked over our most vulnerable class, the middle class. The poor and rich were not all that affected as the rich have no financial concerns about deductibles and the poor get it for free. Our national resources would have been better spent moving towards medicare for all rather than this complex beast that no one can understand and has made care more expensive.
5
@Jim
I agree on deductibles and the ACA. But that is the way the US has chosen to discourage people from getting un-needed care. We add expense on and that includes badly needed care. That existed before the ACA and would exist without the ACA.
2
@Jim - so true. The Blue mid-tier silver plan had $880 mo. premium plus $8800 deductible.
Fine print showed ... wait for it ... 40 percent surgical co-pay. For in-network care.
I walked. Two years was enough.
2
I haven't had insurance since Obamacare because the plans are horrendous.
The mean spirit, dishonesty, and lack of empathy shown by the current administration is beyond belief.. The cruel, tone-deaf remarks of Lara Trump and Wilbur Ross, among others, reveal the contempt the Trump team has for ordinary people not blessed with inherited wealth or sketchy fortunes.
Why do self-designated "Christians" have such undying loyalty to people whose attitudes are more in line with the pagan rulers of the Roman Empire?
Guns in public schools? Walls to keep out immigrants? Control of women's wombs? What makes tens of millions ignore what seems so obvious?
This ex-Republican occasionally loses sleep over it.
4
I see no sense in blaming the Republicans for this mess called the Affordable Care Act...yes, Republican leadership (using the term loosely) is dreadful, but the ACA was passed without a single Republican vote.
Many of us were appalled then, as we are now, with this legislation, even though it did provide ACCESS TO INSURANCE (not necessarily access to healthcare) for many because of subsidies and expansion of Medicaid in some states.
But, here's a little bit of history from TNYT, July, 2017:
When Democrats passed the Affordable Care Act in 2010 without a single Republican vote, they were criticized for being too partisan. In the end, however, the bill included many Republican ideas.
The keystone principle of the act — a mandate that all Americans buy health insurance — is rooted in conservative thinking. Additionally, the Democrat-controlled House and Senate committees adopted nearly 190 Republican amendments while writing the legislation, according to data compiled by The New York Times.
2
@Micki The Republicans were for it before they were against it. This is another rerun. How many times will we watch the Monsters at the Ball play this pattern out?
1
@Micki Yes it included some failed Republican ideas, note the "failed" portion. If you want to improve health care, don't use health insurance to do so. If you want to improve health don't use health care to do so.
@Micki
The Republicans have done all they can to weaken the ACA instead of fixing and improving it. No legislation like the ACA is going to be perfect from the beginning, but that's no excuse to just chuck it out completely...take the time to make it BETTER.
Texas and Tennessee have an interesting agenda: if you are sick, move somewhere else that has medical coverage. The United States version of medical tourism.
In the past for welfare, the scheme of requiring a lengthy residence before getting benefits was ruled unconstitutional; in the present, a shielding scheme could leverage Repuplicancare by requiring residents to buy into a medical plan regardless of income-- even a tiny premium-- and provide no services for 6 months with the enactment day grandfathering anyone who is a resident. No paid plan? Well.. how about a one way bus ticket to Texas! Lots of open land for graves.
1
@MH I live in Tennessee our state spends way too much on Medicaid, and we probably would expand it if the feds did not insist on it staying no matter what might happen in the future.
And there may be the impact of insurers raising deductibles, essentially making health care insurance access meaningless. Without the mandate and reasonable cost to the consumer, many will drop it if healthy.
8
@JP You get insurance to pay for risks that you can't afford to take. If you are healthy why would you need or want health insurance? If you are hurt in several ways other insurance takes care of you.
The only reason we saw an increase in people with health coverage after the ACA was implemented was two - fold. 1) The law mandated you buy insurance or pay a 'fee.' That fee was made minuscule so as to avoid criticism of the new law. It was supposed to increase, but that didn't happen. For the same reason. 2) expansion of Medicaid was more than significant - and it was the reason we had many insurance companies drop out of the exchanges over time, when their subsidies started to decrease. The NYTimes will never admit it, but this law was very poorly designed, contained too many subsidies to sustain it for the long term, and basically forced those NOT subsidized or eligible for Medicaid to pretty much see their costs double. It did NOT improve care. It turned healthcare into a bureaucratic mess that is driving the actual providers out of the profession. Ask any doctor or nurse; it more than doubled their paperwork due to the complexities in reporting and documentation instituted by HHS under the guise of 'improved access and care' while they 'cut the cost of care.' All they did was deny reimbursement; again, over time. Incompetent bureacrats and insurance mogels are now in control of care as a result. And the majority of every dollar spent on healthcare goes to non-providers. No matter how much one liked Obama or democrats; we have to face the fact that the ACA was terrible, had many unintended consequences and needs major tweaking.
9
Everyone agrees that health care is too expensive in the U.S. but no one seems willing to sit down and make the necessary changes to Obamacare. It was not perfect, but it was a beginning. All of the following items could be fixed.
The high cost of insurance is part of the problem. Funding the program by requiring younger, healthier people to buy insurance was a requirement if it were to succeed. High cost of drugs is another problem. Ridiculously expensive medical malpractice insurance needs capping, as do lawsuits for events like spilling hot coffee in your lap. Another item that is rarely mentioned is the cost of treatment in hospitals for undocumented individuals. The following is from Forbes.
"All told, Americans cross-subsidize health care for unauthorized immigrants to the tune of $18.5 billion a year . Of this total, federal taxpayers provided $11.2 billion in subsidized care to unauthorized immigrants in 2016."
A serious group of lawmakers would have sat down during the last two years and fixed Obamacare instead of grumbling about dumping it.
8
@Daphne You are confused, insurance is not care.
The Republicancare health care plan...stay well, or die quickly.
5
Where is the fantastic, best, beautiful healthcare bill trump and the Republicans were going to give the country? Why are not We The People AND the press hounding trumpity with that question? Seems Mitch McConnell has been hiding a lot these days. That man doesn't want to answer ANY questions about ANYTHING.
4
Well considering that the cost these days of a single insured policy is the same as a family before Obamacare it's very easy to see why.
5
See, the thing that amazes me is that for such a wealthy country the US has poorer health outcomes than Australia, while spending close to twice as much as Australia does per capita on health care.
Actually, that doesn't amaze me. If anything I'm amazed at how the Republicans have succeeded so well in encouraging the lower and middle classes to vote for a party that peddles policies that are not merely against, but absolutely hostile to their interests.
From afar, it looks like a kind of like a consensual Jonestown, but on a national scale.
6
I am 63 years old. My insurance rose to almost $1000 a month with a $3000 deductible & no prescription coverage. I have opted to drop it. What a fantastic country we live in. Insurance for some, the fortunate, but the rest of us...not so much. I am desperately hoping that Medicare will still be around to cover me in a year and half.
7
My family is covered by Kaiser Permanente, a nonprofit. Premiums are affordable, and in my experience, the care is excellent.
2
So once again, America is showing the way. There are to many issues to discuss. Suffice it to say, the GOP has given the Democrats an issue that just won't go away. Just wait for the hearings on Medicare for all. The republicans won't know where to hide.
1
I work with patients who have Obama plans (for lack of a better name for them). They are very expensive, still have very high co-pays and deductibles, have limited coverage for many things and have limited networks. So most people, besides paying enormous premiums, are also paying thousands out of pocket. And then they still don’t have all services covered. So, is it any wonder why they drop the plans? Plus, many plans have gone out of business and those members did not seek a new plan. Our family policy with a very good Blue Cross plan through my husband’s employer is also very expensive. But the network and benefits are broader. We are all in a similar boat. My daughter had an ER visit and it was still 2000$ out of pocket. Most people can not afford that. What we need is major insurance reform. Healthcare is way too expensive. It is outrageous. This goes way beyond politics. Plus the insurance companies are still making huge profits. And at our expense.
15
This is a great topic to cover. As the behavior of different States diverge, we have an opportunity to study different approaches. This subject is a great example of why looking at averages (America's uninsured) is misleading. Let's see and study the impacts of those states that both broaden and narrow access to affordable health insurance. Surely the nation can learn from this.
2
Oh, and they took out fining people that don't sign up. So people are rolling the dice, once again. And the rest of us are covering their costs when they need insurance. Yes, insurance is unaffordable, but more so when folks don't buy coverage and drive up costs when they use emergency rooms, etc.
11
I'm part of the uptick. I just can't afford it anymore. The insurance on the New York State of Health website is so expensive and the deductibles are so high. Yeah - I know the commercials keep saying insurance is available at low cost. What a joke. In 2018 I had to pay 15-20 of my pretax income towards insuance premiums and health care before the insurance company had to kick in a single penny. That doesn't even count prescriptions or the dentist or the eye doctor. NOT affordable. If I could get insurance (premiums + deductibles) for less than 10 percent of my income - or better yet 10 percent of my ACTUAL post tax income - THAT would be affordable.
12
@anae So President Obama compromised to get a (any) health care act started. Once in place, hopefully, modifications and adjustments would take place.
But his compromises were not compromises, they were place holders that the GOP would slash at causing insurance raises and loss of control until it could be eradicated. Unless a strong movement to FIX a good start in health care for all is begun, the US regains its unique place in the world; no health care as a national standard.
8
@rixax
Remember, Pelosi said “Don’t read it, just pass” and her party did that with penalty taxes for so called “ Cadillac Plans” that the liberal legislators assumed were all in the private sector— but than a funny thing happened as all the public unions ( teachers, policeman, fireman, state and local government workers) complained that it was their members ( Read “ loyal Democrats”) that had Cadillac Plans, not the private sector employees and when Barack figures out that he had skewered his voting base he used executive orders to defer the Cadillac plan penalties TWICE because he couldn’t risk alienating public unions.... so please check your facts before blaming the Republicabs
2
Every uninsured person is problem. They will possibly leave the healthcare system with debts they can’t pay, spreading the costs to those who do. They will end up with unpaid debts ruining their credit and they are likely to put off basic care and show up only when the pain is too bad and they are much more expensive to treat.
As much as believe access to care is a right, the economic argument for ensuring ALL people are covered,and pay if they can, is strong and should appeal to everyone along the left-right spectrum. EVERY OTHER developed country understands this and insists that all citizens are covered
16
Wrong to drop insurance, emergency rooms cannot handle the overflow.
Yes when you're young you are strong, but be careful.
Don't drop your insurance.
4
If you are in your 50s, the cost of insurance for a family of two the out-of-pocket maximum is something like half of the median income. If a serious illness will bankrupt you, why bother with insurance?
8
Article VII.
Government is instituted for the common good; for the protection, safety, prosperity and happiness of the people; and not for the profit, honor, or private interest of any one man, family, or class of men: Therefore the people alone have an incontestable, unalienable, and indefeasible right to institute government; and to reform, alter, or totally change the same, when their protection, safety, prosperity and happiness require it.
---From the Constitution of Massachusetts written entirely by John Adams prior to the Federal Constitution.
8
Nobody should be surprised about what states have caused Medicaid roles to shrink. they are the same states that have little or no State taxes which can be sued to help pay for unnecessary things like public education, infrastructure, healthcare, etc; You know, all the "little things". It is also not surprising that these are the same states whose Republican Senators voted for the moronic tax cut that favored the very wealthy in our country. They hate the "blue" states who have high taxes for some of the above items and who, previously, were allowed to take an IRS deduction for helping the state move forward. Red versus Blue - the Civil War part Two. When the people in those Red states finally wake up and see what they have wrought, bye bye GOP.
3
Imagine if all health care premiums and costs were instantly reduced 50-60%. That's what would happen if we got rid of insurance companies and health 'insurance' and instituted a system of health CARE instead. Health care could be fully funded via taxes on cigarettes, alcohol, pot, and luxury items, a 4% employer tax, additional taxes on the 1% and corporations who aren't paying anything right now. Doctors remain independent and all billing is centralized through government. Some version of this works in single payer countries....and it works well. HALF of our health care costs go to running health insurance companies and providing their leadership with outrageous salaries and benefits, and incredible shareholder profits. Get rid of that and we can all have effective and affordable health care like most of the developed world.
11
If you qualify for Medicaid, then sign up for it; people may not be aware that they qualify. The larger issue, indeed, is price, which makes the question of insurance one of whether you’re better off with it than without. I’d say you’re better off with insurance, even if it’s basically a catastrophic plan—no use for regular use, which is what Obamacare plans often amount to, but then you should look it at it as bankruptcy protection. Of course, this held true long before the ACA.
3
This must please the Republican members of Congress. The GOP would rather give tax money (entitlements) to oil, gas, farms, Pharma, foreign governments, and tax cuts for the rich.
6
Meanwhile the mayor of NYC taxes legal New Yorkers to pay for the health care bills of illegals. Americans come last with both parties.
16
@Right Here
Is this true?
@Right Here
I think you are looking at this the wrong way. Whether they are illegals or not, they are living amongst us in NYC. If they get sick, and depending on the type of illness they have, they could be a public health danger. You don't want someone who has multiple drug resistant TB on your subway car, do you? Regardless of whether they are legal or not legal, they are human beings who should be treated with dignity and respect. Deport them if you want but don't deny them care. it's not a good human quality.
8
@Carol - take a look:
De Blasio Unveils Health Care Plan for Undocumented and Low-Income New Yorkers
www.nytimes.com/2019/01/08/nyregion/de-blasio-health-care-plan.html
1
The bad news is that Republican governors & legislatures are doing everything they can to restrict Medicaid.
The good news is that those are the states that Trump won, and his supporters will at last learn to be careful what you wish for.
7
@camorrista Maybe. I don't think most Trump supporters did not vote for him expecting economic benefits. What they expected was support for their racism & anti- immigrant rants.
5
This isn't rocket science. Whatever the flaws of the ACA, its policy purpose was to establish American coverage for health care. Other western democracies have managed to meet this collective social challenge more effectively, efficiently and economically than we.
Notwithstanding their election-year hype, the GOP, especially but hardly limited to President Trump, despises American public investment in national health, leaving no leaf unturned, legislative or judicial, to destroy whatever progress is made while Republicans are out of power.
9
I have been self-employed since 2003 and live and work in the state of Connecticut where we have some of the highest health insurance premiums in the United States. I have been consistently priced out of the market since the inception of the ACA. CT is a high cost of living state as well.
Each year I research all the options. There are only two health insurance providers in CT so the choices are limited. I am not eligible for a subsidy.
In Dec 2018, there were eight total options. Here are the three lowest cost options available to me (1 person plan):
#1 - $13,424 paid out of pocket before coverage applies. Emergency/hospital care not covered. ($577.00/mo + $6,500.00 deductible, then 80/20 split: insurer covers 20%)
#2 - $16,076 paid out of pocket before coverage applies. 50/50 thereafter but only at provider operated facilities in the state (five locations, total in the state). No coverage for other facilities or healthcare providers. ($798/mo + $6,500 deductible).
#3 - $20,900 paid out of pocket before coverage applies
($1,200/mo + $6,500.00 deductible) with a 50/50 split. I would be able to see healthcare providers in the network, but not outside of the network. This plan did cover hospital emergency room visits.
None of these plans make any sense (especially 1 & 2: why would anyone pay for basically no coverage?). My major costs are (high to low): Taxes, College (1 son), Housing, Utilities, Transportation, Food.
31
@Susan Rubinsky
Not so fast. Whether willfully or naively, you're ignoring the fact that, as a policyholder, you are billed at the contract rate, starting with dollar one. Depending on the policy, and barring catastrophic illness, this may be the biggest financial benefit that most policyholders reap. I routinely see provider billing reduced by 50%-90%, and in some cases disallowed altogether, all per contract, which is a big part of what your premium pays for. So "no coverage" is a fiction. If you think it's tough being insured, try going without and see what life is like when you get charged the inflated "retail" prices for your medical services.
2
After the GOP's mindless, relentless war on health insurance--replete with lies, fearmongering, and sabotage--why should this be surprising?
8
Health insurance has gotten ridiculously expensive. My COBRA is ending, and I was *shocked* at the rates to get insurance that had lower coverage. And I'm very healthy. Ridiculous.
We definitely need Medicare for all. And don't tell me how much other countries pay in taxes. Between my current taxes and what the insurance companies want for a high-deductible policy I'm already paying 50+% in taxes.
20
I made the decision to pay almost $1100 a month out of fear that at 64 I could easily have a huge medical bill for even a minor illness or injury. This is basically a catastrophic plan requiring a $7500 deductible. However, a total out of pocket of $20000 (including the premium) is less than even 1 emergency. It's a big chunk out of my retirement, but better than losing everything. It was a very tough choice. I have another year before I am eligible for Medicare.
13
The most basic rates for me and my husband are almost $2000 per month with a $12,000 /year family deductible. We have insurance, but what's affordable about that?
18
So you take away the penalty for not buying insurance and some people opt out of buying it? Sounds reasonable to me. If your "choice" is an insurance plan with $300-1500/month premium, a deductible of $2000-5000 and co-payments of $30-150/visit, it's not rocket science why some people decide NOT to buy it.
19
I have no problem with health insurance rates falling as long as the uninsured are receiving healthcare some way when needed. Forcing everyone in a free country to carry unaffordable health insurance premiums and deductibles by making it a priority over affording healthy living, timely immunizations and balanced nutrition or pay a penalty to the IRS was draconian.
5
This entire country is sick, in more ways than one.
11
ACA might be expensive for some that have higher incomes but you better consider what the price of a sudden onset disease might cost. And let me tell you one thing, these occur to people who are young still. A new MS diagnosis for someone at age 40, leukemia for another person, these are not one time doctor office visits. Trump has sabotaged health care for Americans!
11
It’s time for some numbers. I am solidly behind those who advocate for universal health care. However, even I need to be convinced we can pay for expanded care. And how can we win over doubters without specific plans on funding?
Much as the Democrats have campaigned on this issue, I have yet to see figures on how to make this work. I have friends who’ve spent the past two decades on health care for all; when I press for costs and sources of funding, I get vague, general promises that tell me my friends haven’t even begun to grapple with the issue.
Medicare is now my primary medical insurance; it is wonderful and I wish it on everyone. How about a NYT analysis on how to roll back the age eligibility by five years every, say five years. My first choice for expanded funding would be curtailing tax rates and tax dodges for the wealthy. Just how much is the recent Trump/Republican tax plan costing us ordinary citizens? In this still very wealthy country, I know we can afford universal coverage, but I want to see a plan. For the fierce political battles from here until November 2020, let’s have plans of implementation for every politician’s promises. No more sweet talk and no more dreams without plans.
8
@citizen vox Other counties make universal health care work. You just have to think of it as a necessity, rather than a possibility, & viola! it works.
3
Difficult to understand how The Upshot could publish an article on health insurance under Trump and the Republican congress without using the most telling word of all: "Sabotage."
The Trump administration has been sabotaging the ACA, with the connivance of Congressional Republicans. And as a result, millions of Americans are suffering.
That's what needs to be said.
28
@Sean The ACA is good for some folks, bad for others. What we need is national health insurance.
5
One issue that needs addressing is that the same insurers who participate in the "exchange" don't pay docs well. In Westchester, NY a majority of doctors don't take "from the exchange". The practice consultants who advise doctors have a list....and in Westchester, most private docs won't take ACA care ... you are a cash customer. Why bother ?
8
We need Improved Medicare for All. No CDs (co-pays, deductibles), Yes DVDs (Drugs, Vision, Dental)!
5
What happened to the " better, cheaper healthcare " Trump promised?
He did say that and as we know, he never lies.
6
The ACA definitely is not affordable and at least in my state practically a fraud. If you are "not poor", something very easy to accomplish, you have to pay the full unsubsidized rate, deductibles, etc. And after paying thousands of dollars in monthly payments, you have to meet a horrendous deductible, and even then, the insurer graciously will pay only 50% if you use the "in network" services, however, in a "network" hospital, not everybody is "in-network", half might be "out of network", and that means you have to pay 100% of that. And lets not talk about the horrible and incompetent service you get.
So, in conclusion, if you can schedule an operation, do it somewhere else except here in the US, better service, and better prices, even with the "deductible" for those who have insurance.
7
$1577 a month.
For four people.
That's what I pay Providence here in Oregon for health insurance each month. PLUS, I have a $7300 deductible. So they won't pay ANYTHING, unless I have something catastrophic happen.
I don't blame families for not buying health insurance. My husband and I both work, both self-employed, both working for decades, and this hits us hard.
For a family with an average income, for a family just starting out, this would be impossible to pay. Of course you'd drop it in favor of paying the rent or mortgage.
The Republicans had a chance - in control of the house, senate, and White House to make Obamacare better. Or, to find another program that would HELP Americans. They refused to. They tried to dismantle and/or get rid of Obamacare repeatedly.
Their goal was not to help Americans obtain affordable healthcare, affordable insurance.
Their goal was to take away one of Obama's signature accomplishments. Their goal was his defeat. Make him invisible in the history books.
So unless you're poor, or illegal (See the amount of money that DeBlasio is providing for free healthcare for illegal immigrants) you're paying an outlandish sum in premium unless you're covered at work.
This is a terrible, and scary time for healthcare in America. Our president doesn't care about Americans, and neither do his weak, pathetic followers in the house and Senate.
Why should THEY care anyhow? They have TAX PAYER funded health insurance.
Let us eat cake.
17
Medicare for All is the solution.
7
@Zejee You realize Medicare is not free? That people on it paid into it all their working lives? But now you want the rest of the country on it for paying nothing?
5
@Laxmom If you like, we won't call it 'medicare'. We'll call it National Health Insurance. Happy now?
3
@Laxmom
That is only one of Medicare's funding sources. https://www.medicare.gov/about-us/how-is-medicare-funded
1
In the fall of 2016, Donald Trump promised "better and cheaper health insurance for everyone".
Along with a wall that Mexico would fund, this was obvious nonsense from a blathering demagogue.
We are in for a rough ride.
7
Ok, the next democratic nominee for president, if you want the best chances to win, do these three things first.
1-Make ACA or an even better plan your #1 priority and don't run on an identity obsessed, elect me because I am a man, black or female like Hillary did.
2-3- Repeat #1.
7
The ACA is a U.S. law. The president of the U.S. took an oath to "faithfully execute" the laws. Individual-1 has violated that oath and needs to be impeached and removed from office.
6
Note to the Prez: Increasing the number of people without health insurance is NOT how you MAGA. Covering everyone like in single payer is how you MAGA.
9
The Republicans are winning!
That’s not surprising
You are a ‘less developed’ country. A bit more everyday.
6
@Dorado
That hurts, and it's true.
1
The GOP believes that health insurance is exactly what it says it is: Insurance for healthy people. If you're not healthy, you don't deserve insurance or care.
3
This confirms my belief that the ACA promoted and increased the ranks of Medicaid. Having medicaid is to be underinsured. But this also confirms my belief that health care “systems” make too much money and all healthcare non-profits are a farce.
2
Now that's an absolute shocker. That 6 years of Republican campaigning on "repeal and replace"was nothing more than mumblings of scared conservatives terrified the Democrats would prove, once again, they could do that which the GOP on their best day cannot? There's a reason Democrats are responsible for EVERY social program in this countries history - because they identify a need and fix it. All the while Republicans fuss and complain, but not before taking full advantage of the rights borne by committed Democrats.
6
For the first time in my life (I'm 64) I have no health insurance. My ex employer does have a retiree program which has just one insurer United Healthcare, which has gone up in cost each
year, currently for 2019, $1,156/month. $13,872/year with $3 ,500 deductible - $25 & $35 co-pay, for an individual policy.
Nixon made healthcare for profit & current republicans couldn't care less care
5
Who pays for the uninsured? The taxpayers or those of us with insurance. Our local hospital saw a 40% decline in unrecoverable expenses the first 5 years after the inception of the aca. Now they are rising again. In the same time our premium for our employer provided health insurance went up half as fast as the 5 years prior to the aca and we had two years where the premium did not change. Under trump they have started rising again
12
@tom - There's another casualty of lack of insurance, especially lack of Medicaid. My state's legislature voted to expand Medicaid under the ACA. The rightwing extremist governor vetoed it. As a result, for several years our rural and small-town hospitals have been under increasing stress because so many of their patients are poor and uninsured. We've seen hospital closures every year in those small towns - 15 in 2018 alone. And some of the closed hospitals were regional hubs for dozens of smaller towns that had no hospitals at all.
8
The GOP has tried to sell Medicaid as a form of welfare. That it is money spent on the undeserving poor. Many of them want to turn Medicaid into a state funded program. What you see is an effort to demoralize the ACA. To what end? Certainly not to provide better health care to Americans. Certainly not to reign in health care costs.
8
Hedge fund billionaire Ken Griffin just closed on his latest residence (he has at least 7 by most counts) in NYC.
The cost? $238 million.
Thankfully Trump and a Republican Congress gave him a massive tax cut so he won't really miss this almost quarter of a billion.
Why do we put up with it all?
35
The reason for the decrease is that many who are intelligent realize that having insurance is not worth it. Health care should not be a profit-driven enterprise. It is a basic human need. For many, not having insurance is much cheaper. Paying for medical care out of pocket is much more affordable. The only ones who benefit from insurance are those with medical conditions that require expensive treatment, and the insurance companies. Medicare is not affordable, either. If we saved the money we pay for insurance, including Medicare, we would have more than we need for our care. Instead, we are giving away our money to those who need it for expensive care, and worse, to insurance corporations who are only interested in profits.
And example: A colleague was bragging to me about a trip he and his family were going to take to Las Vegas. This trip was being all paid for as a Christmas bonus to his wife who was a nurse that worked at an insurance company. I was turned off and told him I did not think it was something to brag about considering how many die in this country because they cannot afford medical care. Premiums and deductibles are extremely high for the benefit of those seeking profits and high salaries to enjoy luxuries at the expense of humanity.
7
@ART - Only someone who has never had a major illness can write so confidently about doing without insurance and paying out of pocket. Our friend's unexpected cancer diagnosis and subsequent 2 years of cancer surgeries and chemo came with a bill of $2 million. He was fortunate to have had a low 6-figure income, savings and investments, plus excellent health insurance. Nevertheless, with all the attendant expenses, he ended up remortgaging his house, spending all his savings, and had he lived, he'd have had to start over with lingering health problems and no money.
8
@MegWright
It's unfortunate about your friend. However, he had the money to pay for expensive insurance and resources to pay for what it wouldn't cover. Think about those who cannot even afford Obamacare, which by the way, it's not affordable, has very high deductibles and limited doctors. Many cannot afford even that. Your friend is obviously rich. Those that aren't have to pay insurance to cover the expenses of those who have money. When they get sick, they cannot afford care at all, not even with the insurance they pay for.
4
@ART
Do you have any idea how much having a baby costs?
Or having critical (not chronic) treatment in an ICU?
3
Our health insurance premium went up $247 this year and now costs $1,841.14 per month for the 2 of us, both in our 50s. Thanks Repulicans.
36
@Johnny PP why are you blaming the Republicans for the price increase? Blame the insurance companies.
3
I was homeless for a bit. I came to view healthcare as a luxury. When I broke my arm, all the staff knew there was no way I could get surgery, so they sighed and wished me well. I'm not complaining, but there is this feeling that the only way a person can retaliate is inflicting pain on themselves by refusing care. The only way to make a statement is through self harm. And ultimately that doesn't mean anything either. But all you can do for your dignity is pointless defiance.
3
Perhaps there were to many people obtaining Medicaid that shouldn’t have? The new requirements of showing more documentation or having to work if they are to receive the benefits, have knocked some people out of Medicaid that perhaps shouldn’t have been receiving it all along. Just wondering.
13
@Letmeknow - Do some research on the results of these new requirements that any "able-bodied' Medicaid recipient prove they're working. The current application form in my state is 13 pages long, and requires extensive documentation and proof. Add to that the requirement to report your hours worked online monthly, a website that's deliberately down for most of the day (and night), the fact that employees don't control the hours they work, their employer does, and the fact that many people needing Medicaid don't have computer access, and you have a recipe guaranteed, as it's intended, to make it nearly impossible to comply.
9
@Letmeknow The idea that people have to work to get medical care is abhorrent to me. I live in a country where everyone has medical care, regardless of whether you are working or not. You get sick whether you are working or not. And if people get sicker, they certainly are not going to be able to work, so how does that help get people into the work force? Try a little compassion.
8
@Letmeknow
Work requirements are one reason why more people are claiming disability status under Social Security than filing for Medicare. Apparently it's what you do out in Trump country, without feeling shame about it.
3
A very important article, for sure. Our health insurance situation is in grave danger and only getting worse daily. But as a physical therapist, what is that man doing in the picture? He has 2 different types and sizes of cane. That would make you so much more likely to fall, just look at him. He's going to need very good insurance for the broken hip he's about to get.
15
@Bridget & besides, how long can her & his female companion live without head?
I'm sorry, but in states that failed to expand Medicaid, Obamacare is not really improving the situation because a certain segment is not eligible for subsidies. God help if an economic downtown increases the uninsured rate even further.
11
@NotKafka
Medicare for all!
3
The question for the "larger number of people living without health insurance" is: How well are they living, and for how long? The uninsured fall into two groups, one that would like to have insurance but cannot or believes they can't afford it, and those who are, right now, young and healthy, and believe that they won't need it anytime soon. For the latter, a word of caution: stuff happens, and it's not that predictable. If you're healthy, health insurance is like a parachute: it's comforting to know it's there if you need it. That peace of mind is worth something, too!
23
@Pete in Downtown
But increasingly, it has become very difficult to find work that is not temporary or full-time. Why? Companies and universities do not want to pay benefits that include insurance.
7
@Pete in Downtown I didn't have health insurance til it was time for medicare. Admittedly, I didn't have a devastating chronic illness, & didn't think of the horrific possibilities. I figure that's true of most young & middle aged people, - or has America become the most fearful nation on earth?
4
It’s the people who’ve never been sick, that are/were against the Affordable Care Act. Those voters that elected Republican representatives against the ACA, will have to discover the hard way why the key provisions of the law were so important. Those that come to mind are no lifetime caps on coverage, no pre-existing condition clauses and coverage for your children until 26 years old.
Unfortunately, in order to pay for those subsidies that many people required to pay for health insurance, also required that people who chose to opt out of insurance needed to pay penalties to the IRS. Now that the Trump administration refuses to apply that provision, as well as shortening the time people have to sign up for insurance, inevitably uninsured numbers have gone up. Apparently the same is true of some states’ insurance rates.
You don’t get something for nothing.
20
@Jane K Health INSURANCE isn't getting anything. The insurance adds nothing health care. Lets end health care insurance!
2
The article is correct that individual buyers are being priced out of the market. I would suggest the more appropriate wording is that unsubsidized buyers are being priced out. This was inherent in the original ACA design, which lumped non-subsidized buyers into a single risk pool with the much more numerous and less healthy group of subsidized buyers, as well as with those whose medical problems kept them from buying insurance pre-ACA. This was done on the erroneous assumption that the premiums paid by the healthy group would help subsidize the premiums paid by the other two groups. This objective has failed, as there are no subsidies flowing from potential buyers who have dropped out. The result is a loss of coverage for millions of people with no offsetting benefit. The situation could be corrected by changing the risk pool rules.
32
@james lowe
This comment is spot on. A small group of non-subsidized individuals who were thrown into the ACA pool are the victims. Business partnerships have become ineligible for small group insurance, people 30 and older can no longer buy catastrophic insurance -- all to boost the size of the ACA pool. The cynical design of the ACA relied on those without the bargaining power of large employers being forced into the individual market.
7
@Kathy Anderson - The ACA is NOT the individual market. It formed a large pool of enrollees which automatically makes insurance cheaper than it is if you purchase it as an individual.
4
@james lowe
You have hit the main flaw in the ACA, in the head. The subsidies have a dead stop number. For singles, it's around $48-49 thousand. For a married couple it's near $63,500. If you make $1.00 over that amount, you are cut off! The dollar amounts need to be phased in.
8
The ACA was a good idea. It needed to be tweaked and some incentives provided to keep the insurance affordable. Now, with Trump and the GOP ruining things, it's time to re-examine single payor. The increasing cost of health insurance with the high deductibles, high co-pays, narrow selection of doctors and hospitals, etc., along with the constant battles patients and their families have with insurance and the bills, ought to be a thing of the past. Instead we, the patients, are dinged and dinged, and dinged. We're stressed by being ill, losing jobs, and being unable to pay for care we need. Or we're stressed by chronic illnesses that require medication(s) that insurance companies decide not to cover and we have to pester our physicians for a new prescription.
How is it that in the EU and other, less developed countries, health care is a right? How is it that we're told we have the best health care in the world but we aren't able to receive it when and where we need it without worrying about going bankrupt? Why are we the exception? Next to paying for a college education and house, medical costs, including insurance, deductibles, co-pays, and other associated costs, are one of the biggest outlays of cash Americans face and not because we have a choice.
If our elected officials had to deal with the problems we deal with for health care it wouldn't stay this way. Most of us do not buy the plan that will serve us best: we buy what we can afford and pray.
85
@hen3ry
A German PhD scientist told me that when the German government tried to impose a "small" fee for their college education, students were demonstrating in the streets, and the government backed down. He couldn't understand why American students put up with it.
I think it's because our Democratic "leaders" are like Tony Blair, who said that he would rather lose an election than go back to the old Labour activism. Chuck Schumer said that by moving to the right, they would lose working-class Philadelphia, but they would make it up in the suburbs. You saw how well that worked out.
They're shamelessly raising money, including personal speaking fees, from the same special interests that they've favored in office.
Obama had a billion-dollar campaign. He rejected offers by McCain to control campaign spending. Hillary Clinton raised millions in personal speaking fees from the very corporations she was supposed to be overseeing.
Bernie Sanders was unique in his independence from corporate interests, and his policies reflected that. I don't see anybody else like that running for president.
16
@hen3ry Single payer in the US will never work due to the way our populations eating and exercise habits. The reason why those safety nets work so well in Europe is due to the healthy population.
1
@hen3ry
Amen my brother.
1