One of the things that has happened in the ACA over the past year is that most of the hard edges were smoothed away. The vegetables got thrown out.
- Individual mandate — gone
- Health insurance premium tax — delayed
- Medical device tax — delayed
- Cadillac tax — delayed
- IPAB — gone
Those were all choices put into the bill and the law to reduce costs or finance coverage expansion. They delivered pain on small, concentrated groups. Now that pain is gone. It makes the ACA less efficient and effective, but there are fewer non-ideological interest groups that want to get a pound of flesh back from the law.
One of the last groups of people who have significant pain points with the ACA are non-subsidized individuals. Some guy writing in the Hill thinks there is a plausible agreement zone to smooth off another rough edge:
Congress should allow any family to receive federal help so that they do not pay more than 10 percent of their income for qualified ACA health insurance. This will make sure that all families will have access to affordable coverage without regard to their health status….
One group of Americans will be hit very hard: middle class families that earn more than 400 percent Federal Poverty Level ($100,400 for a family of four) make too much to qualify for a subsidy and who also have high-cost medical conditions….
As we move back towards a partially bifurcated market where the ACA guaranteed issued, community rated pool partially functions as a high cost risk pool, the moderately well off but sick need a safety net. They don’t have one right now. Opening up subsidies even as underwriting expands provides for a safety net that guarantees at least some access to care without penury.