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.
schrodingers_cat
Any bipartisan deal with this iteration of Rs on any issue is chasing fool’s gold.
Butch
The healthcare handcuffs are very literally the only thing that’s keeping me in my current corporate job. I have something lined up already for life beyond corporation but the health insurance costs we’ll incur are genuinely frightening.
sheila in nc
There is a lot to like about this proposal, especially because it might be politically feasible. But if this is enacted, the only remaining “pain point” will be on the part of people who are dismayed at the increased pouring of federal dollars into the coffers of insurers, pharma, and medical providers. At what point do we get to propose government price-setting? The direction we are going is not likely to do anything to stop or slow medical inflation.
Elizabelle
“Some guy writing in The Hill…”
LOL. Well done.
Major Major Major Major
Congrats on the Hill placement!
graeme
Please write a series of posts detailing the universal/single payer healthcare plans used in the advanced nations of the world. Maybe your readers would like to know how bad the American non-system is.
Mike in Pasadena
Republicans damaged or eliminated many of the ways the ACA raised revenue, but for Medicare recipients with annual incomes above certain threshholds, IRMMA is still being charged. It makes me ssuspect the Republicans figured out a way to spend the IRMMA revenue on the Pentagon.
stinger
I don’t know who reads The Hill, but I trust that the readership includes lawmakers and policy makers. You lay things out clearly and relatively simply — considering the convoluted health care insurance system we’ve created for ourselves — and I hope others find your proposal persuasive.
Meanwhile, come 2019, I’ll be interested to see if a stool really can stand on two legs! Luckily — selfishly — I’ll be Medicare-eligible by then.
You are much appreciated, David!
StringOnAStick
@Butch: Same for my husband and I. He had planned on becoming a contractor and dropping to 3 days/week with his employer, but then he got diagnosed with a pre-existing condition and my knees qualify for that designation as well. His compromise is going to part time (4 days/week) but we get to keep the health insurance. He was so excited about being able to be a contractor, and then the idiot won*.
* And each and every day we find out that he only won thanks to Putin.
Fair Economist
I’ve always thought, even when Obamacare was still in Congress, that the 10% limit should apply to everyone. Even when policies like the mandates were holding prices down, premiums could be a heavy burden on late middle age people somewhat above median income. The “upper middle class” (which really means working wealthy in our society) and truly rich will never pay 10% for premiums, so those affected by the subsidy cliff are mostly bog-standard middle class folks who are not good targets for special burdens, either morally or politically. On top of that, having the cap be a cliff has really pathological effects because you can have less take-home pay making $55,000 than $45,000. That’s just crazy.
low-tech cyclist
Not yet they haven’t, but wait ’til November 6.
Butch
@StringOnAStick: Yeah, the company I work for was purchased a few years ago and my position transitioned from a “career” that I mostly genuinely enjoyed to a “job” that I can’t stand. I have some things lined up as an independent contractor but until I can get more hours that way the health insurance would be more than I’d be earning. So I find myself just gritting my teeth and putting up with it. Life is too short to be lived this way.
ProfDamatu
@Fair Economist: Absolutely, and I’d go further – I agree with Charles Gaba over at acasignups that the subsidies for folks below 400% FPL should be made more generous. I do have a dog in that fight; I’m at the very bottom of the group expected to pay the highest percentage of income for insurance (just below 10%), and I have to say, it’s definitely painful – I can only imagine how hard it must be for folks in my position who also have, say, large student loans, or who live in a more expensive part of the country!
I’d also like to see cost-sharing addressed too; in my area, the lowest OOP max available for any policy offered on the Exchange this year was about $5,500. In years that I’ve maxed out my cost-sharing, I’m paying 25-30% of my income on medical. And I’m fortunate that I’m not guaranteed to have those expenses every year. That sort of thing just isn’t sustainable long-term for people making below-median income (or lots of others, for that matter!).