Right, but as I said healthcare is not really a “market” anyway. There is no “price discovery” if you get cancer or suffer a heart attack. So what is the way to address this? Let the poor die? Give them care, but take their house after the fact to pay for it? Or is it to give the middle and upper middle classes a free ride more akin to the poor? His post also ignores the elephant in the room, and that’s the fact people are living way longer and yes the government (through Medicare) is subsidizing that extended life. This is actually also what eats up a disproportionate share of healthcare resources, not some number of lower-ish middle class who sign up for ACA subsidies (I’m fairly certain the truly poor would be on Medicaid or Medicare and have nothing to do with the ACA discussion anyway). There is a way to “unwind” all that and have 100% free market healthcare, but the side that wants to do that isn’t honest about what it would actually mean to remove the subsidies that support life. Instead, I recall most of their arguments to reign in the costs of healthcare plans were social warrior nonsense like not forcing everyone to pay for contraceptives through health plans or exclude tranny care. Laughably irrelevant stuff in terms of % of spending.
Your link doesn't give a straight metric on the increased premiums, but does say the average lowest silver plan jumped almost 30% in 2018. While other years have seen small drops or increases according to the article, that's still a substantial uptick overall. Here's another source showing the continued rise. Add this rise to the lagging wage rate increase and a much larger portion of family income is going to just health insurance.
None of that directly addresses his point, though, which (as far as I can tell) was regarding the escalation of insurance premiums - for seemingly worsening coverage - that many middle class Americans experienced in the aftermath of ACA. As with a lot of major legislation, the main focuses and impacts are felt at the low-income and/or high income level while the middle class gets what feels like a Stealer's Wheel shaft. Personally, I think the trends on rising premiums/deductibles with lowering coverages would have happened without the ACA, as well, as the major insurance companies' business model is to collect more premiums and pay out less in benefits. They were going down this path irrespective of Obamacare. But much like "inflation!" over the last 2 years, companies used the ACA as their boogeyman for rate hikes.
My point of saying the rich don't care is because their health insurance costs are a much smaller fraction of their income. If their premium goes up $2,000 a year it doesn't affect their household budget. And the poor have subsidizes healthcare, so again, they don't really care if the costs of health insurance go up, they don't feel that either. So as health insurance costs continue to rise well above wages, the squeeze gets put on the middle class as their spending power goes down. Health insurance costs are a large portion of their budget every year. I've always said it's straddling the middle of public and private heath insurance that is our issue. Either go 100% free market (which I don't think is realistic) or 100% public options.
Your assessment that it universally screws the middle class is at best uninformed. It is true, for some people, probably younger, who were otherwise healthy, it did increase their premiums. The main reason it increased premiums is that policies now are required to cover things like mental illness, drug addiction, and maternity related costs. So if you were young, healthy, no pre existing conditions, not mentally ill, not drug addicted and not a woman having a baby, yeah your premium went up. However for lots of others in all income classes it helped as follows: - parents can add kids up to 26 on a policy. - you can’t be booted due to preexisting conditions - mental health, substance rebab and maternity coverage - subsidies for coverage, even for middle class Also, while health care has continued to increase, the trajectory of increase has decreased. The total amount of federal government spending on medical care has increased much less than expected before ACA, even with the addition of ACA subsidies and Medicaid expansion. So your assessment was grossly incomplete.
If we're all in relative agreement that premiums have gone up, especially relative to wage growth, I'm not sure I understand the argument. This shifts the financial burden to the middle class the further and further you get removed from subsidy levels. It's a bell curve at some point if you get far enough away from subsidy level, but we're probably talking 200+k households at that point? Just a guess Removing the "Subsidy Cliff" at $49k ( I think it was) helped, but still
So what are you defining as middle class? Sure there are probably some people who make six figures or more that are paying more for health insurance. But at the same time they have expanded and better coverage.
That is a straight line meaning that there was no impact from the ACA…but you know what it does show? Companies transfering costs to employees under the cover of aca increases.
A straight line rising showing the burden on the middle class as percent of income. Median income. That's been my point.
I'm not arguing that healthcare isnt debilitating to families. I agree with that. I just dont think that it is directly connected to ACA since it looks the same before and after. Its more related to a highly regulated industry with no transparency, lack of competition, a growth in corporate profits in the industry and a burden shift in premiums from company to individual.
Looking just at premiums is an incomplete picture. For the overwhelming majority of middle class, they are the part of this graph that took on a much heavier burden. They also, overwhelmingly saw a massive increase in their out of pocket expenses as many had to transfer to high deductible plans. This transfer to was in effect mandated by the ACA via the Cadillac Tax on very good HMO/PPO plans that many companies had been providing. City’s assertion that companies were transferring costs onto employees is at best disingenuous. Companies has to transfer costs or they would have had to pay the 40% Cadillac Tax. Again, Obamacare has been a disaster. No way to put lipstick on this pig. The good things that the ACA did provide could have been provided in a much less expensive manner that screwing the working, middle, and upper middle class population.
I dont think you understand the ACA at all. I mean you are blaming a provision that was never implemented, delayed twice, and then repealed, which does exactly the opposite of what you suggest. Other than that. Spot on analysis as always. Not sure if ignorance or disingenuity is appropriate here but one of them is.
You’re Monday morning quarterbacking. Companies started implementing policies and providing plans to comply with the Cadillac Tax well before the delays in payments of the tax. The net result of the implementation of compliant plans is exactly what Channing and I are talking about; Premiums AND out of pocket expenses have BOTH increased substantially.
A rare glimpse of truth so bright it burns the retina. Well done. (...as I choke down the bitter taste of bile in my mouth over same...).
The % share was spiking before ACA on this very chart. Hard to say ACA was a negative based only on this chart. Although it doesn’t really say anything in support of ACA either. Might be correlated to something else, the period where the curve flattens is during the RE bubble when there was probably some “false income” in the economy and then the financial crisis happened. After that it resumed its uptrend as far as eating a greater % share of income, albeit at a slower rate than the early 2000’s.
Only one of us has been a decision maker at large corporations over the last 20 years. No one was planning for that. First, we negotiate our plans in 1 or 2 year increments so anyone telling you it impacted negotiations is a straight up liar. That is why the delays were always 3+ years out. Second, it wouldnt have impacted most plans back then, just the high end ones typically for executives once it ever arrived. Third, our consultants were very clear that it was never going to be in place because costs were rising faster than the CPI adjustment and that it was impractical to implement.
Please tell me, specifically, the simple way to cover low income people and those with pre-existing conditions. I've noticed that these arguments tend to make the claim that such a plan is out there, but they never say what that plan is, specifically.
I think you can stretch an argument that the ACA lowered overall costs since the increase in rate stayed consistent to pre-ACA with more people covered with better coverage (ie pre-existing) including more at risk folks. But it does continue to eat up more and more of a family's income which will only stop when people refuse to pay it.
