Quote from piezoe:
Denner is right. We don't know yet!
The approach taken by the ACA, is based on an idea put forward and promoted some years ago by the Heritage Foundation, and I am guessing that the administration picked up on this because they thought it would therefore be an easier sell to the Republicans, never mind that the complexion of the Republican party is vastly more radical now. Then too, Romney care is based on a nearly identical idea. So again, they must have been hoping to garner broader support than they did. In the end, they got less than zero from the opposition.
The main thrust of the ACA is to make group policy provisions and rates available to everyone. This of course requires a group. The group was to be virtually everyone. The larger the group, and the more its healthy participants, in principle, the lower the rates can be for the sickly and old, compensated by the infinitely higher rates paid by the young and healthy (they previously paid zero because they relied on the tax payer to pay their emergency room cost indirectly through higher insured and Part A Medicare costs. )
No mandate, no young, healthy and poor participants at all. Of course the tax payer still has to pick up the supplement for the poor and the medicaid qualifying. But because you are now including millions who are in the main healthy and they are paying, most of them, something --not zero-- the cost to the taxpayer is less, presumably, even with the supplement, because now their sore throats cost $90 bucks instead of $600. At least that's the "thinking" and those are the kind of numbers the CBO used to score the ACA. There was never an assumption that you could cover 38 million additional with comprehensive coverage and cover the entire cost with savings from emergency room visits not made. Rather the intention was to lower the average cost per person covered. That should be achievable, at least in theory, but it remains to be seen.
I'm not going to defend the ACA, though I understand it. It was dealt a near fatal blow when the public option was removed. That was the single most effective cost control feature, and it was taken out. A second near mortal wound was the Supreme Court decision that permitted States to opt out of medicaid expansion. That was a very key feature in getting the lowest echelon covered and in taking more less automatic care of the problem of confirming income to determine the extent of supplement one qualifies for. Expansion of medicaid would have, and will for the States that expanded, greatly facilitate the implementation. In short, pretty much everything that could be done to wreck the hell out of this ACA legislation has been done; yet the piece of near junk created by the ACA opponents, much to their chagrin lives on.
Now anyone who says, why should I pay for maternity coverage, I'm a single guy, or my wife and I are 72 years old, are calling for the repeal of the ACA. Just the same as those insisting the individual mandate should be dropped. You can't kill those features without killing the ACA. There is no ACA without those features, because again the premise of the ACA is to bring group coverage and group rates to everyone, like it or not. That means everyone has to be in the group!
What can be dropped, and should be, is the employer mandate. It is both useless and unneeded. It is harmful in fact! I understand why it had to be in there to sell the ACA, but now that it is sold it needs to be taken out. It no longer serves a purpose. ACA healthcare policies should be perfectly portable and in no way tied to a particular company.
You could have of course adopted far less broad coverage for the standard and gotten lower rates, but then you are back to indigent pregnant teenagers in the emergency waiting room.
I'm not defending the ACA, I don't much like it. I definitely hated what we had before. Eventually we might get to something tolerable. We've got the ACA, it is not going away, might as well work to make it function the best it can, and keep improving on it. I think attempts to weaken it further to the point of total destruction will fail, because what we had before the ACA was god awful and many want to try something different in the hope it will somehow be better. Maybe the ACA will be even worse, but as denner says, we do not yet know!
