What's the future of the ACA?

[jjflyman]

A few weeks ago a Federal judge ruled it unconstitutional. I have not heard another word about it.
Like many here, the ACA will (would have?) play a big part in when we retire if we can take advantage of the subsidies.
Any guesses on what the future of the ACA?

 

[MichaelB]

Thread moved to the Health and ER Forum

 

[ShokWaveRider]

No one Knows?

 

[bingybear]

There was a tread just after that case. I think it was here

 

[Ian S]

The ruling judge has stayed his own decision so ultimately, the Supreme Court will decide it. That will take some time. I'm not sure Roberts wants to have his Court remembered for throwing the healthcare system into chaos so his may wind up being the vote that saves the ACA once again. Keep in mind that everything put in place by the ACA would be eliminated and we would be back to the "good old" days.

If the ACA goes down then I expect to see a successful effort to at some kind of Medicare for All eventually implemented.

 

[GravitySucks]

I think they killed it last year when they got rid of the mandate that everyone have insurance. With out the healthy in the pool the costs will eventually soar to the point it will be unaffordable.
I could work my MAGI to qualify for lower cost than my partially subsidized MegaCorp plan, but I think within another year a subsidized ACA plan will be more than my current and I worry Mega will not let me back on my current plan. My current is expensive, but very inclusive...even has a small dental component which turned out to be better than expected.

 

[marko]

My income makes me ineligible, but I suspect that the demise of ACA, like the demise of SS and Medicare are overstated.

That horse has left the barn. It will survive in some shape or form with the can getting kicked down the road for the next 25 years.

 

[MichaelB]

That horse has left the barn. It will survive in some shape or form with the can getting kicked down the road for the next 25 years.

It is indeed difficult to reverse the ACA. There are many provisions unrelated to insurance that are fully implemented. Many of the regulations affecting insurers are popular and seen by many as necessary.

Much of the disapproval or disagreement with ACA is really an issue with the high cost to insure, and that will not change. This is one reason why it is so difficult to replace. I think this is not so much kicking the can down to road as it is completely ignoring the real underlying issues.

 

[marko]

I think this is not so much kicking the can down to road as it is completely ignoring the real underlying issues.

Right. The same is true of the entire HC system mess overall, IMO.

 

[SecondCor521]

It is indeed difficult to reverse the ACA. There are many provisions unrelated to insurance that are fully implemented. Many of the regulations affecting insurers are popular and seen by many as necessary.

Much of the disapproval or disagreement with ACA is really an issue with the high cost to insure, and that will not change. This is one reason why it is so difficult to replace. I think this is not so much kicking the can down to road as it is completely ignoring the real underlying issues.

Well said, @MichaelB.

From a 50,000 foot point of view, we will get what we collectively decide to do, with all of the multitude of players and incentives and disincentives weighing on those choices.

From an Ultima Thule point of view (heh), we'll probably always have uncertainty about the future and have to deal with it as best we can.

 

[explanade]

When they were trying to repeal it, there were all these CBO projections about tens of millions uninsured if the various repeal measures were enacted.

So the repeal efforts got low approval numbers.

But the activists and donors told Congress they didn't care, they better vote to repeal or else don't bother calling them again for future campaigns.

In any event, there are no alternatives on the horizon. Even Medicare for All gets a lot of talk but there's really no legislative proposal that Congress is ready to vote on.

Sometimes, you will hear people say just go back to the way things were before the ACA but not even the opponents of the ACA seem to be pushing this line of thinking that heavily.

The ACA may have conditioned people to think that govt. needs to try to ensure coverage is more broad or accessible to more people, rather than all individuals having to fend for themselves.

That change in mindset might be the legacy.

 

[Nature Lover]

It is indeed difficult to reverse the ACA. There are many provisions unrelated to insurance that are fully implemented. Many of the regulations affecting insurers are popular and seen by many as necessary.

Much of the disapproval or disagreement with ACA is really an issue with the high cost to insure, and that will not change. This is one reason why it is so difficult to replace. I think this is not so much kicking the can down to road as it is completely ignoring the real underlying issues.

Well said. Addressing the real underlying issues is what's needed. IMHO, it's not going to die, but will continue to evolve. Since we don't appear to have a real national consensus on health care (other than we all want it and don't want to pay exorbitantly for it), it becomes a problem with no clear solution.

Politicians don't normally address issues this large without broad public consensus, so they kick the can down the road until the problem is beyond unmanageable and broader public consensus arrives on options that have a chance of making it better.

 

[Cessna152]

The ruling judge has stayed his own decision so ultimately, the Supreme Court will decide it. That will take some time. I'm not sure Roberts wants to have his Court remembered for throwing the healthcare system into chaos so his may wind up being the vote that saves the ACA once again. Keep in mind that everything put in place by the ACA would be eliminated and we would be back to the "good old" days.

If the ACA goes down then I expect to see a successful effort to at some kind of Medicare for All eventually implemented.

The case first has to survive the Fifth Circuit Court of Appeals before it can advance to the Supreme Court. I've seen an argument that made a compelling case that the appeals court might reject the case on the basis that the plaintiffs have no standing to sue in the first place. And if it managed to make it to the Supreme Court, they might also reject it due to plaintiffs not having standing. The argument, very briefly, goes like this:

In order for a plaintiff to show standing, they have to show some form of harm. With the mandate tax/penalty at zero, they can show no harm and therefore have no standing. A longer version of the argument can be found at https://reason.com/volokh/2018/12/21/why-no-one-has-standing-to-challenge-the

 

[SecondCor521]

The case first has to survive the Fifth Circuit Court of Appeals before it can advance to the Supreme Court. I've seen an argument that made a compelling case that the appeals court might reject the case on the basis that the plaintiffs have no standing to sue in the first place. And if it managed to make it to the Supreme Court, they might also reject it due to plaintiffs not having standing. The argument, very briefly, goes like this:

In order for a plaintiff to show standing, they have to show some form of harm. With the mandate tax/penalty at zero, they can show no harm and therefore have no standing. A longer version of the argument can be found at https://reason.com/volokh/2018/12/21/why-no-one-has-standing-to-challenge-the

I googled and I think I found the text of the complaint in the Texas ACA case here:

https://www.texasattorneygeneral.go..._v._U.S._et_al_-_ACA_Complaint_(02-26-18).pdf

The argument by the States that they have been harmed start on page 16 of the PDF. Four specific harms are listed.

I did not read thoroughly the reason.com article you cite, but in scanning it I am confused because the Texas case was brought by a number of States, and most of the counterarguments in the article seem to focus on individuals. I am not sure what to make of that - on the face of it it seems to be a red herring.

 

[Cessna152]

I googled and I think I found the text of the complaint in the Texas ACA case here:

https://www.texasattorneygeneral.go..._v._U.S._et_al_-_ACA_Complaint_(02-26-18).pdf

The argument by the States that they have been harmed start on page 16 of the PDF. Four specific harms are listed.

I did not read thoroughly the reason.com article you cite, but in scanning it I am confused because the Texas case was brought by a number of States, and most of the counterarguments in the article seem to focus on individuals. I am not sure what to make of that - on the face of it it seems to be a red herring.

The document you found was the original complaint. Later on two individuals were added as plaintiffs. Later still, California and some other states had themselves added as defendants so that they would have standing to appeal any adverse decision. If they hadn't added themselves, the Trump administration would not be expected to appeal an adverse decision (since that is what they presumably desire) and ACA would die in that court - the case never making it to the appeals or supreme court since the only defendant having standing to appeal would have declined. Hence the desire of California and pro-ACA states to get themselves named as defendants so they could appeal (and this is what actually has happened - California and others are appealing the decision, not the Trump administration.)

The following web site appears to list all the motions and other documents filed in the case:
https://www.courtlistener.com/docket/6321938/texas-v-united-states-of-america/

 

[joeea]

A few weeks ago a Federal judge ruled it unconstitutional. I have not heard another word about it.
Like many here, the ACA will (would have?) play a big part in when we retire if we can take advantage of the subsidies.
Any guesses on what the future of the ACA?

- The Texas court ruling will be overturned
- The ACA will stay pretty much as it until the next election
- Premiums will rise less than many folks anticipate

I believe we aren't supposed to discuss politics, so I'll leave it at that.

 

[VanWinkle]

- The Texas court ruling will be overturned
- The ACA will stay pretty much as it until the next election
- Premiums will rise less than many folks anticipate

I believe we aren't supposed to discuss politics, so I'll leave it at that.

I hope your crystal ball has a clear picture because that sounds like
the best outcome for me.

VW

 

[GTFan]

- The Texas court ruling will be overturned
- The ACA will stay pretty much as it until the next election
- Premiums will rise less than many folks anticipate

I believe we aren't supposed to discuss politics, so I'll leave it at that.

Ditto for me, we're only 2 years away from the next election and nothing serious will happen until after that (if that). There's no way the decision would wind its way through all the appeals that quickly anyway.

2 more years of status quo, barring some unforseen additional sabotage that would probably also be tied up in the courts.

 

[scrabbler1]

- The Texas court ruling will be overturned
- The ACA will stay pretty much as it until the next election
- Premiums will rise less than many folks anticipate

I believe we aren't supposed to discuss politics, so I'll leave it at that.

I agree with your first 2 points, but disagree with the third one. In my state (NY), I have had 2 big rate increases in 2018 and 2019, each in the 14-18% range, now paying $647 per month for a Silver plan (no subsidy because I went over the cliff in 2017 and 2018; maybe I don't go over in 2019?). Before 2018, the rate increases had always been under 10%. At this rate, in 3 years I will be paying around $1,000 a month.

 

[ivinsfan]

Did anybody notice that yesterday with the Dems in control of the house they announced they intended to start hearings about the possible cost/implementation of Medicare for all? Fasten your seat belts..it could happen as soon as 2020 if certain things happen in the next election.

People are going to be surprised at what that costs them it won't be free. I feel to get the insurance companies and such on board they will use the Medicare type plan where all people pay the same monthly and then shop for add on plans to cover OOP and drugs.

 

[Rianne]

Did anybody notice that yesterday with the Dems in control of the house they announced they intended to start hearings about the possible cost/implementation of Medicare for all? Fasten your seat belts..it could happen as soon as 2020 if certain things happen in the next election.

People are going to be surprised at what that costs them it won't be free. I feel to get the insurance companies and such on board they will use the Medicare type plan where all people pay the same monthly and then shop for add on plans to cover OOP and drugs.

Hopefully, govt. will negotiate prices and pharma will come down to reality as to the cost of prescription drugs. And procedures will be better understood from hospital to hospital. We cannot continue in the dark about these costs.
I, thankfully, don't use expensive prescriptions. If that ever happens, I would gladly increase my monthly premiums to a few hundred $$. DH/me waiting at Walgreens for a flu shot in late Sept. There was a long line. Two separate gentlemen up to counter to get meds. We overheard $250 for a 30/day supply. One man responded with much anxiety, I gave you a coupon when I submitted this. They declined and suggested he go back to insurance or manufacturer and check. He walked away without prescription. Similar happened with next man. His cost was considerably higher. The cost of insulin (or should I say they're charging $500/month). A diabetic cannot live without insulin.

 

[ivinsfan]

Hopefully, govt. will negotiate prices and pharma will come down to reality as to the cost of prescription drugs. And procedures will be better understood from hospital to hospital. We cannot continue in the dark about these costs.

That will be the mother of all fights get some popcorn ready..Pharma will not go down without a fight. I've seen my DH EOBs from Medicare and if the hospitals got that little amount of money from everyone they'd go broke.

I personally believe the Medicare Advantage plans will be the blueprint for Medicare for all and it's the reason the marketing for Advantage has been so aggressive.

 

[easysurfer]

Did anybody notice that yesterday with the Dems in control of the house they announced they intended to start hearings about the possible cost/implementation of Medicare for all? Fasten your seat belts..it could happen as soon as 2020 if certain things happen in the next election.

People are going to be surprised at what that costs them it won't be free. I feel to get the insurance companies and such on board they will use the Medicare type plan where all people pay the same monthly and then shop for add on plans to cover OOP and drugs.

What happens to the ACA in the future is anyone's guess.

IMO, Medicare for all may be too extreme, but wouldn't mind Medicare for 50+ .

 

[Dtail]

That will be the mother of all fights get some popcorn ready..Pharma will not go down without a fight. I've seen my DH EOBs from Medicare and if the hospitals got that little amount of money from everyone they'd go broke.

I personally believe the Medicare Advantage plans will be the blueprint for Medicare for all and it's the reason the marketing for Advantage has been so aggressive.

+1
My household is the example.
DGF is on Medicare Advantage. I am on ACA.
We both had to see a Cardiologist. $35 co pay for her and $5 co pay for me.
I can see my internist for free 3x a year.

 

[sheehs1]

It is indeed difficult to reverse the ACA. There are many provisions unrelated to insurance that are fully implemented. Many of the regulations affecting insurers are popular and seen by many as necessary.

Much of the disapproval or disagreement with ACA is really an issue with the high cost to insure, and that will not change. This is one reason why it is so difficult to replace. I think this is not so much kicking the can down to road as it is completely ignoring the real underlying issues.

+100 !