(B.C. via GoComics.com)
Happy news, from the Washington Post:
With millions of Americans starting to receive health insurance coverage under the Affordable Care Act on Wednesday, President Obama’s political organization is starting a new campaign to highlight the personal stories of people benefiting under the new law.
Organizing for Action, the non-profit and non-partisan advocacy group that grew out of Obama’s reelection campaign, is launching a new Web site, complete with videos and interactive maps, to showcase personal testimonials from those enrolled in the new health care exchanges…
The site, which will expand in coming days with more personal testimonials and videos, is designed to make sure people see not just the Affordable Care Act enrollment statistics, but also specific ways in which the law is benefiting everyday Americans, an OFA spokeswoman said….
Meanwhile, Some Guy We Hate makes what sound like smart points:
… I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.
Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.
Those who live in red states need the benefit of Medicaid expansion…
In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)
All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier…
*********
Resolutions or otherwise, what’s on the agenda for today?
MikeJ
It’s never time to take a victory lap. Sure things may look good now, but if we just hold out a little longer we can complain about Obummer some more.
Taking a victory lap can help elect more Democrats who are committed to health care reform and actually improves the chances of getting any of the changes Moore claims to want.
BillinGlendaleCA
If things with ACA are going well, take a victory lap. If the administration doesn’t tell the good stories no one will, certainly not the “Liberal Media”.
OzarkHillbilly
This is where I think he gets it wrong. Smart Corporate money will definitely flow to Vermont, but not to crush it, rather to support it and set up business there. CEOs and CFOs should love the public option.
Imagine for a second: An American corporation able to compete with the Japans and Germanys on the world market without the ball and chain of supplying health care for their employees. That too would be a godsend. Of course, this would mean higher taxes for all and the Kocksuckers will hate that and do everything they can to fight it, but if the shareholder really is king of the corporatocracy, the smart money men will line up behind it.
The thing about healthcare is we all pay for it sooner or later, the only question is what is the most efficient way of doing it? I do have hope because as Churchill once said, “Americans always do the right thing, but only after they try everything else.”
Skippy-san
Michael Moore is fat. So is Al Gore.
Never mind that it might actually be helping people, we’ve got well paid hicks on A&E to worry about. Good God man, where are your priorities?!?
As Brother Krugman said in the Good Book: “We’ve even gone beyond selfishness and special interests. At this point we’re talking about a state of mind that takes positive glee in inflicting further suffering on the already miserable.”
OzarkHillbilly
Take note: I did say SMART corporate money. I don’t know, this could go either way really. Too much of the 1% is heavily invested in class warfare and the corner stone of it is to pit the poors and middles against each other. To keep telling us that “If they don’t have health care, it’s because they haven’t EARNED it.”
ie, “They don’t DESERVE health care. But You are BETTER than they.”
geg6
My John’s daughter and her fiancé stopped over yesterday to say happy new year. She signed up for a gold plan for $180 a month. This is the first time she’s had health insurance since college. She’s now 29 years old. She has some health issues for which he’s been paying out of pocket. He’s always been an anti-Obama guy. Not any more!
ETA: I had a couple of I heart Obamacare bumper stickers and she went right outside and stuck one on their SUV!
Schlemizel
Well, you just made me break a resolution I made a decade or two ago to never ever read that dreadful B.C. strip ever again.
@OzarkHillbilly:
“smart corporations” Is that like ‘jumbo shrimp’ and ‘military intelligence’?
Baud
Tales from the front:
Betty Cracker
Moore can be a hysterical jackass sometimes, to the detriment of Democrats and liberal causes, and shortly this thread will be filled with denunciations of his op-ed piece for its failure to clap hard enough for Obamacare. But he makes some great points.
Obamacare is a good start — it was the best we could do given the insane level of GOP obstructionism against President Obama and the Democrats. It’s a half a loaf, which is damn well better than nothing at all, and positive stories about people now receiving coverage and saving money should absolutely be highlighted.
But it’s not going to be convincing if Democrats just engage in happy talk. Most people despise health insurance companies and the process of getting and maintaining insurance, and for damn good reason — it’s a hassle, it’s expensive, and virtually all the companies involved in delivering it are headed up by greedy motherfuckers.
I’ve advocated for Obamacare among people I know, and I’ve found that the most productive approach is to be honest about its shortcomings and the atmosphere in which it was conceived while also talking about its benefits. It’s important to point out that programs evolve and get better over time as well, like Social Security, and that Obamacare in its current incarnation is just a start.
Will Moore’s piece give ammo to RedState? Sure, but the people who read RedState are completely untethered from reality anyway — they are dumb enough to believe that a watered down, corporate-friendly compromise like Obamacare is “the Crown Jewel of Socialism.”
They’re not the people we need to convince — it’s the undecideds and the persuadables we have to reach. And for them, honesty is more convincing than happy talk, in my opinion.
Comrade Javamanphil
@OzarkHillbilly: I suspect you are both wrong and corporations will continue to (mostly) ignore Vermont. Our tax rates are pretty steep, labor pool pretty small and infrastructure can be a challenge. Not to mention Act 250 which makes the permitting process here longer than in other places. However, the bellwether to watch for development is probably the Northeast Kingdom.
All that said, not quite sure which legislators the corporations would plan to buy or how. Big money campaigns just can’t get much purchase here. In fact, ignoring Vermont would probably be the smartest course of action and just right us off as those crazy hippies again. Ground zero will be someplace else.
EriktheRed
But Mr. Moore, what these private companies do is in line with conservatives’ wishes for us to have a new Randian feudalism governing our lives. Having any kind of government entity doing these things will lead to the gulag, dontcha know.
Baud
@Betty Cracker:
I didn’t read Moore’s piece so I’m not going to comment on it. But you and I have been talking lately about how the rhetoric used sometimes may not match the intent or help produce the desired outcome. (I wish we could do that when I didn’t have to get ready for work because it’s an interesting topic to me).
I don’t disagree with your point about being honest and upfront about Obamacare and its imperfections. But it does seem to me that it’s possible to use rhetoric that accomplishes that without having the distraction of people on your side debating whether you kneecapped them.
p.a.
@MikeJ: absolutely. The retaliban NEVER gives up. They’re still trying on Social Sec!
OzarkHillbilly
@Schlemizel:
Dog! Let’s hope not!
@Comrade Javamanphil:
You got room for me there?
OzarkHillbilly
@Betty Cracker:
Personally, I think the people who need to be convinced are the 85% who already get their healthcare through their employer. They need to be shown how they personally benefit from the PPACA. (I for one hate calling it “Obamacare”. I feel that that word alone is a surrender to the forces of darkness who seek to disparage the very idea of healthcare for all by attaching the name of the “Chosen One” to it) A few weeks back my wife and I were having half a conversation (she was conversing, I was acknowledging) that went something like,
“Our health insurance now covers this.”
“You can thank Obama for that.”
“Our health insurance now covers that.”
“You can thank Obama for that.”
“It now covers this, that, and whateveritscalled.”
“You can thank Obama for that.”
We didn’t get to the end of lifetime limits as she hates politics and I was getting dagger eyes.
Betty Cracker
@Baud: I think it’s an interesting topic too. I’m convinced that the way the debate plays out among Democrats is crucial to how issues are perceived by less committed partisans. Kneecapping your own side isn’t okay, but neither is squelching internal dissent by shouting down anyone who criticizes a strategy or policy.
Ronald Reagan was president and the Berlin Wall had yet to fall when I was in high school (I’m old!). I remember thinking the messages they were peddling back then about pot (gateway drug! one toke and you’ll end up choking on your own vomit in a gutter!) and commies (they’ll burn the whole world down to enslave us!) were 100% bullshit because it was straight-up propaganda with zero nuance.
@OzarkHillbilly:
Agreed — the persuadable subset of them, anyway. The RedStaters among them (wingnut blog, not political map) are a lost cause and a waste of time.
OzarkHillbilly
@Betty Cracker:
You young pup you! Your still wet behind the ears, I’ll bet!
Funny phrase that 2nd one. I wonder what it’s origins are?
Matt McIrvin
@Schlemizel: Johnny Hart died and took his increasingly wingnutty religious and political obsessions with him. The relative of his who took “B.C.” over seems to have taken it back to its roots as an occasionally amusing gag strip, at least part of the time.
dmsilev
@OzarkHillbilly: Consulting The Google, the consensus answer appears to be “From the drying of amniotic fluid on a baby after birth, specifically a new-born farm animal, which last dries behind the ears (partly because licked dry by mother everywhere else).[2][3] German variants (still wet behind the ears, not yet dry behind the ears, green behind the ears) also borrowed.[1]”
( from Wiki)
danielx
One of my oldest and best friends has been waiting with bated breath for January 1 to roll around so he can sign up…he’s uninsurable in conventional insurance terms due to various injuries, mishaps and whatnot. Hell, let’s just say you would hesitate to sit next to the guy in a bar for fear lightning would hit, because you know exactly where the ten ring would be. In any case, he can now get a pretty decent plan for around 500 a month, which is not a stretch for him – no tax credits, but he says it beats being uninsured by miles. So good on it, says I – ACA is a long way from perfect, or even good, but it was at least achievable, which single payer wasn’t.
As to today’s agenda, it will involve snow. Of which we have about five inches right now with another 2-3 on the way. Combined with 19 degrees and 20 mph wind, it’s going to be just an absolutely wonderful day. On the other hand, there is firewood on the back porch, gas in the snowblower and the Outback with 108k is running like a Rolex. (Have wondered why Subaru doesn’t put out commercials showing a blizzard with an Outback plowing through it and then an Outback parked on a beach with the sunroof open and surfboard strapped on top with the slogan “it’s always Subaru weather”.)
WereBear
Fresh from the baptismal font. Still an infant, in other words.
Comrade Javamanphil
@OzarkHillbilly: Possibly. Can you use right/write correctly? If so, looks like I would have to cede my space.
-8 this morning, btw.
OzarkHillbilly
@dmsilev: THX! I though about googling it but it is so much more fun when others do it for me! ;-)@danielx:
That would take some of that “smart corporate money” we were discussing before.
danielx
@OzarkHillbilly:
Could it be I have a future in advertising? Move over, Don Draper!
J.D. Rhoades
@OzarkHillbilly:
“They don’t DESERVE health care. But You are BETTER than they.”
“Because YOU know you’re lucky that we’ll give you a job so you’ll work 12 hours a day, come in on nights and weekends, and not fuss about getting overtime.”
OzarkHillbilly
@danielx: I don’t know. I have the ***perfect ad campaign*** for beer but I’m not there yet.
I would tell you how it goes but I’d have to kill you. I will say this tho, it involves Scarlett Johansson in a bikini, John Goodman in a tutu, Philip Seymour Hoffman and Al Pacino as a couple of dorky fisherman and Francis McDormand as one of the long suffering wives.
It would sell millions! MILLIONS I tell you!!!
Poopyman
@OzarkHillbilly: I’m pretty sure good beer already sells millions without much advertising. I assume you’re targeting the Anheuser-Busch or Coors crowd, then?
Southern Beale
Good piece from Al Jazeera: the “other” NRA, or, how the restaurant lobby works to keep restaurant worker wages down.
OzarkHillbilly
@Poopyman: Or Miller. It works for all of them but I would be hard pressed to allow a non/anti-union shop like Coors get their greedy hands on my goldmine.
Bill Arnold
@Comrade Javamanphil:
Also, Montpelier is a nice small town (fewer than 8000). There are a few decent restaurants but it is not built for hordes of lobbyists and protestors. (Not a resident; I visit maybe once a year.)
gene108
@Betty Cracker:
It is not ammo to Red State that’s a problem. It is the casual info gathering, who skims headlines that will think Obamacare sucks, Obama sucks, QED I won’t vote or I’ll vote Republican.
We are in an all out war against Republicans, who will look for any opening to attack. Publicly stating “hey, our lines have a weak point here” is just an invitation to lose.
GHayduke (formerly lojasmo)
It’s going to be -30F in southeast MN on Monday. This is not windchill, but rather ambient temp. -50 windchill temp.
Fuck. Moderation?
Paul in KY
Question from someone who watched way too many football games over last few days:
Can someone explain the Taco Ball commercial where the kid takes off running with (I presume) his father running after him. Why is the kid running after the parents came home early? Doesn’t he have to go back there sometime?
estamm
Forgot Hart died. I used to live in his hometown (Binghamton/Triple Cities in NY), and his cartoons were everywhere. But then he devolved into this hate-filled winger, and I grew to despise him. Some of his cartoons were on par with Mallard Fillmore. I haven’t read BC or Id in probably 30 years.
Kay
@Betty Cracker:
I don’t think it’s a good piece, though. The Montana system isn’t “exactly like” the clinics at corporations. The clinics at corporations are for-profits, so they don’t have “patients as the only goal”.
Vermont probably isn’t a good example of single payer. Vermont had a public and non-profit health care system in place when they went to single payer. That’s why they can do it. Vermont also has to institute cost controls, and cost controls are a real political sticking point, because people immediately freak out about rationing. They hope to accomplish cost controls with incentives for good care (as opposed to expensive care), but that’s really difficult to do.
They already have a problem with out of state companies who offer health insurance to in-state people as compensation. The Vermont system seeks to do away with employer-provided health insurance. They have to compensate those people for the “pay” they lose, or exempt them.
IMO, this:
Applies also to Democrats who are gliding over how complicated this is when advocating for expansion.
I don’t even know what he wants. He starts with a public option, then single payer health insurance, and he never reaches the COST of health care, which is the hardest issue of all.
I love the Vermont plan, but the key to the whole thing is they have the basic outline of a non profit provider scheme (community hospitals and health centers). Moore never addresses this, or anything else that makes it really difficult to “reform” health care both substantively and politically.
Bottom line, I don’t know that people can “keep” the health care delivery we have now AND have a health care payment mechanism like Vermont’s. I think he has to address that, or at least mention it. His advocacy is, to me, too easy. It’s happy talk.
SiubhanDuinne
@Betty Cracker:
Dwight Eisenhower was president and the Berlin Wall had yet to be built when I was in high school (I’m older!)
Kay
@Betty Cracker:
The really hard question that we avoided with health insurance changes (rather than health care changes) is what cost controls would people be willing to accept in a single payer system?
Would they be okay with community health centers for ordinary care, for example, or are they going to object to that if they’re accustomed to a “private doctor”?
I think the Big Hard Question is can we keep the health care we have and just change the payment mechanism, or do we also have to change health care? Because a lot of people (who have insurance) are happy with the health care we have.
I think a public option is a great idea, and the one and only reason we don’t have one is for-profits lobbied against it. But that’s much different than single payer. Single payer is much more difficult, because you probably have to reach health care with single payer, and that’s when people will go absolutely nuts with anxiety. They went nuts with just health INSURANCE reform, and we never really reached health care.
Betty Cracker
@Kay: Good point about Moore’s advocacy — he’s way too simplistic, and you’re right, that is another form of happy talk. Not surprising coming from Moore, who is more propagandist than documentarian anyway.
Dave
@Paul in KY:
The man is the father of the girl he was visiting.
Ben Franklin
http://www.theguardian.com/world/2014/jan/01/snowden-affair-case-for-pardon-editorial
.
The usual suspects are talking out both sphincters on this issue.
Hayden while before Congress said ‘He started a valuable conversation, but we don’t want more Snowdens” OWTTE
Ben Franklin
@Betty Cracker:
Funny thing is, they are assisting us toward our goal. Single-payer is one-stop convenience store shopping, compared to the inordinately complex system known as ACA
Kay
@Betty Cracker:
The problem for me is, it isn’t just insurance companies. I know why advocates focus there, everyone hates insurance companies, and I have no problem with advocacy tactics like that. I think it makes political sense to focus on insurance companies and I think an advocate can use that frame, all’s fair in love and war, etc.
But at some point we have to talk about health care. What it costs. Can we do what we’re doing now in health care AND have universal single payer? I don’t think we can. Even the smallest efforts to cut health care costs in our existing single payer system (Medicare) are nearly impossible to put in. The fight to kill the Medicare advisory board that is part of the PPACA was absolutely ferocious. It was “rationing”. They’re STILL trying to kill it.
Paul in KY
@Dave: Where is the girl!! Certainly that is the most logical explanation, but they need to either show a glimpse of her or say those are “Sara’s” parents.
Grumble, grumble…
Thank you for answering & Happy New Year!
Dave
@Paul in KY: They do actually say “Let’s say her parents came home early…”
Ad here
Happy new year to you as well, and let’s hope you aren’t ever stuck eating Taco Bell, whether running away or not.
Steeplejack
@Paul in KY:
I had trouble replying on the tablet earlier, but I see Dave has beaten me to it. The ad—which is a sinkhole of humor fail—makes sense if it’s the girlfriend’s father chasing him. Although I would think most dads would be glad to come home and interrupt the kids eating Taco Bell instead of doing other things.
Paul in KY
@Dave: Man, I was hearing the voice over as ‘let’s say YOUR parents came home…’
I need to clean my ears out, LOL!
On a related note, I saw ‘Portugal the Man’ at Bonnaroo. Great band, highly recommend them & their new album.
Thanks to you & Steeplejack.
Gloryb
@Baud: With “Ashokan Farewell” playing in the background, just like Stephanie Miller’s reports from the mall from the war on Xmas.
catclub
@Steeplejack: “glad to come home and interrupt the kids eating Taco Bell instead of doing other things.”
This. If they are just eating – at a table – no need to run away.
feebog
@Kay:
I think we can. But not on a state by state basis. A Public Option plan, offered and run by the Federal Government is really nothing more than Medicare with higher premiums. The question is whether such a plan would be competitive in the evolving environment that the PPACA creates over the next few years. An alternative would be to start lowering the eligibility age for Medicare over the next twenty years while maintaining the status quo in terms of coverage for young and middle aged folks.
Kay
@feebog:
That’s the payment mechanism. It’s not what I’m asking.
We spend too much on health care. That’s why Vermont had to wrestle with cost controls before they guaranteed (public) payment.
Can we “keep” our current for-profit health care system and combine that with guaranteed public payment? Or will we also have to put in some cost controls that may be unpopular or contentious or at the very least new and unfamiliar?
Vermont is actually wrestling with this, and that’s different and more difficult than just addressing the payment mechanism and stopping there. Vermont has a huge advantage in health care (not insurance, but health care) because they already have a system of community, non profit health care providers.
rikyrah
1. NONE of this ‘ whistleblower’ shyt. It would have been labeled TREASON from DAY ONE.
2. They woulda gotten all into the fake educational credentials.
3. They would have trotted out every WHITE MAN ever turned down for a job with Booz Allen, complaining how this UNQUALIFIED BLACK MAN got a job over them.
4. If Snowden’s Black Daddy got on tv talking the bullshyt that White Snowden’s father did…they would have gotten his ass fired from his job too.
do I need to go on?
Elie
People forget that the cost of healthcare in this country reflects the fact that people make livings, sometimes very generous livings and profits from it. We can all superficially agree that this is “bad” but the reality is that decreasing the incomes and profits from this has to be done carefully and over a little time. You can’t whack 18% of GNP and the livings that represents “just like that”. It is not a matter of just will — it would definitely impact the overall economy until alternative work/livings/revenues can be found in other sectors for at least some off the folks living off of the current bloated hog. Its already starting to happen and there is a lot of anxiety in health care corporate and consulting circles.
Everyone wants complex/difficult change to happen quickly and to be pain free and perfect. I just shake my head and thank the Lord that as many people get it as do… people you think would be relatively smart about implementing large scale complex change sometimes seem to lose all their ability to think through what this means and all the steps that need to happen…
Mnemosyne
@Kay:
We cannot keep our current for-profit health care system. It will have to change to being a nonprofit one, and I think most of PPACA is set up to pressure for-profit health insurance companies out of the marketplace.
What we really need is strongly regulated nonprofit insurance companies like they have in places like Switzerland, but good luck convincing Americans that government regulation is good.
CaseyL
Controlling healthcare costs is going to be a hard sell, because controlling costs means having to say that some medical procedures will not be performed in certain cases.
IIRC, statistically speaking, the last weeks of life are the biggest dollar-sink for healthcare. People who are dying, after a critical injury or illness, or of old age, rack up the biggest costs. How much of that is palliative care, and how much of it is additional treatment with a slim-to-nil chance of success?
There’s a term of art in medicine, “poor prognosis.” Poor prognosis means a specific current condition is so bad the known treatment regimes have a slim-to-nil chance of success. I don’t know whether “poor prognosis” is used to deny care, or if it’s a single factor providers may use to determine a treatment regime, or if it’s a factor providers may use to authorize unorthodox or experimental treatments not otherwise covered by an insurance policy.
But soldiering on in the face of “poor prognosis” is a major cost-curve issue. If one of the aims of single payer is to bend that curve downwards, anything that addresses “poor prognosis” will start the death panel shriek-fest all over again – and more justifiably, at that.
Advocates of single payer should maybe start working with the medical community to figure out how to talk about this issue, and how to deal with it. One suggestion: change the way research is done, so that patients can more easily get unorthodox or experimental treatments, and change the extrapolative models accordingly to factor out, or account for, the higher failure rate.
flukebucket
Mossberg and Duck Dynasty teaming up to come out with a new line of guns. PRAISE GOD!
Kay
@Elie:
Absolutely agree. The fact that these are middle class incomes doesn’t get enough play either. Health care spending holds up a huge group of employees, and most of them are middle class.
In fact, people here were told to “re-train” from manufacturing TO health care in the 1990’s. If we’re going to wind that down, it can’t come overnight.
Paul in KY
@CaseyL:
Under ‘single payer’, the 1st major cost savings would be when you remove the profit from the system. Less overhead too.
Paul in KY
@Kay: IMO, the ‘whacking’ comes at the level of those who make salaries of > $500,000
Elie
@Paul in KY:
I disagree. Those at the upper end tend to protect themselves pretty well until the very last dog dies. Who gets whacked early are the middle managers and worker bees who make 40 – 90K/year. Most of the consulting and insurance companies are already stripping down their staffing, making it very difficult to execute many necessary projects, etc.
Elie
@Paul in KY:
The other thing that will also happen is the shrinkage of salaries in the healthcare sector –. All the incentives are going to line up to put a stop on exorbitant salaries and more in house projects instead of expensive consultant fees. All of this sounds good but remember that what is getting shrunk is your and my friends middle class salaries and buying power. Yes, there will be winners in this, but I don’t think right now that it is clear who those folks will be…
Monala
@OzarkHillbilly: Yeah. I got into a Facebook debate with someone who claimed that Obamacare was screwing people over because when he looked on the exchange web site, he couldn’t find anything that was as good financially for his family as his employer-based insurance. I pointed out that it wasn’t meant to be as good as employer-based insurance, just much better than what had been available on the individual market previously.
I also noted that when we purchased my husband’s plan on the exchanges, we bought through the same insurance company I have through my job. The rates aren’t as good, but they’re pretty close. We both have $20 copays for office visits and $10 copays for generic meds. I get 4 free visits before a deductible of $500 kicks in; he gets 3 free visits before his deductible of $1250 kicks in.
I also pointed out the ways that everyone benefits from the ACA: no lifetime caps, no pre-existing conditions exclusions, etc. He said that’s great, but doesn’t make up for the higher costs on the exchanges. So I asked why he was concerned, since he wrote that he has employer insurance – unless that had changed? He never responded to the question.
LAC
@Betty Cracker: I did not read his op-ed but if he is positive about ACA, good on him. Now does that mean that he feels better about voting for “that kind of black guy”? Because that is where he and the rest of “how black are thou, Obama?” crew can frig off
JustRuss
I wish Obama could run for a third term, just to watch the Republicans and pundits complain about how unseemly it is of him to politicize health care by mentioning the success of the ACA.