Well since the individual mandate is gone, there is no reason to sign up for health care without getting a penalty.
Universal health care is here to stay. The next Dem administration will be able to expand subsidies, implement medicare buy in, implement public option and put in more regulation to create a true national market for insurance and full coverage.
At this point in the game, no one cares about the penalty. It never mattered, really.
Has Comrade Cockholster tweeted about this “victory” yet?
I know many heathy young adults (friends of my sons) who recently went through the process of acquiring healthcare at age 26 when they could no longer be covered by their parents. In informal discussions with them, they’ve all come to realize that it makes sense to have insurance. Their reasons are varied - one realized how much his routine prescriptions would have cost without coverage, another broke his leg in a bicycle accident and saw in print what he would have paid without insurance, etc. They aren’t going to be quick to give up their insurance and losing the mandate isn’t going to have a large impact. I do worry that rising premiums might make it unaffordable for some who are carrying student loan debt and working in some fields (humanities, arts, public policy) where starting salaries are low.
In fact, the GOP is relying on the mandate repeal to dissuade so many people from buying insurance that they think they’ll net $300bn in subsidies to stem their budget losses.
They gave up the cash from the penalty and swore tons of subsidised citizens wouldn’t carry insurance without the penalty. Nuts. Or lying.
I hope that’s true, at least that it no longer matters, now that the ACA has gained traction. (Not sure we can ever know for sure what would have happened if the ACA had been launched with no mandate).
We’ll find out over the next year or so.
Well they put off the penalty for the start of ACA, and I’m not even sure when they turned it on. And it’s also tied to tax rebates, that not everyone gets, or looks at as regular money. It was a weird, halfassed penalty, that needed to change, one way or another.
I think we needed something to help inscos buy in, but this was some pretty weak sauce.
But it’s not like they could deny people emergency coverage without insurance. That would have been another tack, one that would have raised some eyebrows though, and likely appealed to republicans.
It seems like the people most likely to do that would be the ones with incomes toward the top of the ACA’s sliding scale, where they receive only modest subsidies, or no subsidies.
The GOP is counting on increasing premiums (and the lack of subsidies to cover those at the higher income levels), now combined with the lack of a penalty for not having coverage, to persuade millions of Americans to dump their ACA coverage (or not seek it in the first place, if they are a young person just entering the market).
And honestly I woudn’t be surprised if a few million do. These would probably be folks who are some combination of stretched thin financially, relatively young and in relatively good health, and folks who could probably afford the premiums but are just short-sighted and willing to take the gamble of going uninsured in order to save some bucks in the short term.
The question is whether the loss of those folks from the risk pool will be enough to cause the premiums to rise so sharply that millions more will be forced to drop their coverage, which in turn will cause premiums to rise more, causing more defections, and so on in a positive feedback loop, which in turn could cause more insurers to drop out of the ACA market – the “ACA implosion” scenario that Democrats and health insurance experts have been worried about. Hopefully not.
I agree. The stick was only “needed” (if indeed it was) because the subsidies get skimpy toward the top of the ACA sliding scale (which covers up to around the lower end of the middle class).
The simple solution (if money wasn’t an issue) would be more substantial subsidies, reaching higher into the income scale. With a big enough carrot, who needs a stick? The relatively small number of morons who would turn down the opportunity for truly affordable insurance probably wouldn’t be enough to harm the overall risk pool. So beefing up the subsidies would be an obvious first step in any constructive ACA “repair” effort.
Unfortunately, any constructive ACA repair effort will probably have to wait until after 2019, and with Trump’s veto pen in the equation, perhaps until after 2021. For now, the system is probably going to have to limp along as is – at best some version of the cost-sharing subsidies might be reinstituted. If it isn’t, we’ll likely see sharp premium increases next year…which threatens to set off the “implosion” scenario.
Overall, I’d say the ACA is turning out to be more durable than I dared to hope even a few months ago. But we’re not nearly out of the woods yet. The full damage from the combination of sabotage and neglect is not yet clear.
I found this theory about the mandate going away interesting:
Ya! This:
“It is very possible — maybe even highly likely — that ObamaCare successfully enrolled millions more Americans in health insurance by expanding Medicaid and offering subsidies (carrots!) and not by demanding that people buy insurance (stick!).”
In which case, the purported savings to the GOP budget will be much lower than they calculated.
which then means (to the GOP mindset) that Medicare and Social Security will have to be dramatically cut. I get sick just thinking about that possibility.
You do realize, of course, because you’re not stupid, that the market needs younger participants to succeed.
I think, for some reason, that this feels like the Civil War. And these early skirmishes are bold and bad, but they’ve pissed off people with far greater numbers and resources. The backlash on this will be mighty.
In the end, we will be different, but OK, and Ken Burns will tie it all together for us, in 9,000 hours of fundraising earnestness. There will be Emmys.
The medical profession and hospitals will be thrilled! Um, no.
Edit: There are hospitals in small cities and rural areas that have closed or are closing.
Wrong. The market does not need healthy young adults, although it will get plenty. It only needs lots of healthy (young) people to keep premiums down. But so long as the ACA’s basic premium subsidies remain (which they will) in the law, it makes no difference to 80-90% of ACA marketplace participants what the higher rack rate premiums are, because they don’t pay the rack rate. Rather they only pay an affordable rate based on their income irrespective of the rack rate. The law should be amended to deal with the 10-20% who are higher earners and don’t get subsidies. But since a lot of these folks are high income Republicans, I suggest they pick up their phones and explain it to their Republican Congressman.