Health insurance

Obamacare Struggles to Survive Its Second Act

Premiums are rising and enrollment is stagnating as the health law heads into its third year.

|

Whitehouse.gov

In a Hollywood screenplay, the second act starts when the protagonist leaves her home and life behind and sets out on the journey that will define the story. Think of Dorothy being swept from her home in Kansas by the tornado in The Wizard of Oz, or Luke Skywalker escaping from Mos Eisley in Star Wars, or Neo choosing to take the red pill in The Matrix. The second act marks the point of no return—and the point at which the real problems begin in earnest.

This is the point at which Obamacare exists today.

As the third annual open enrollment season begins this week, the law is firmly entrenched in American life and politics. Health coverage rates have increased noticeably in the years since the law went into effect, and millions of people rely on it, in some form or fashion, for insurance. Full repeal at this point is at most a distant possibility, one that can only be imagined over the horizon of next year's election, if at all. Some of the law's critics are quietly coming to the conclusion that repeal may now be impossible.

Yet the law is now struggling to stay afloat, to survive and thrive on its terms.

Problem number one for Obamacare is enrollment. The law has consistently undershot its targets. The Department of Health and Human Services (HHS) expects only about 10 million people to sign up for plans the coming year—barely more than the initial expectation for last year, far short of the more than 20 million the Congressional Budget Office (CBO) originally predicted for 2016. It's possible that HHS is lowballing the estimate, yet if sign-ups outpace expectations by a million or more, the tally will still be far lower than the CBO estimated. Even with the help of the law's mandate to buy insurance, the federal government is having a difficult time convincing people to sign up.

Related to this problem is the fact that premiums are on the rise. Stories of Obamacare sticker-shock abound, and even the feds have acknowledged that premiums are on the rise. According to HHS, the average price of a benchmark plan—the second lowest cost option in the "silver" tier of coverage (in which plans must cover an average of 70 percent of health expenses)—is set to rise 7.5 percent this year in federal exchange states.

But that's only one way to look at premiums, and it doesn't provide a complete picture. Silver plans only account for about two thirds of sign-ups, and averages that attempt to capture rate changes across the full spectrum of  plans have found bigger raises. Charles Gaba, an Obamacare supporter who runs the remarkably useful ACA Sign-Ups site, estimated a weighted average increase of 14.4 percent across Obamacare-compliant plans (on and off exchange) in federal exchange states. (A separate estimate which included states running their own exchanges found an average increase of 12-13 percent.) As Gaba cautions, it's not a strict apples-to-apples comparison, but it suggests that the story on premiums is more complicated than the headline HHS estimate.

It's not just how many people are signing up. It's also who is signing up. So far, the people signing up for coverage appear to be sicker than expected, and thus more expensive to cover. Although revenues for health insurers have increased along with the influx of new customers, the expansion of the customer base has not been profitable: According to a recent McKinsey report on health insurance enrollment and revenue, insurers lost a total of $2.5 billion on the individual market—or an average of about $163 per customer.

The unexpectedly high cost of Obamacare's enrollees has contributed to the demise of many of the law's government-backed insurance cooperatives. Of the 23 non-profit insurers started using $2.4 billion in loans provided by the health care law, 10 have already closed or announced plans to shut down, and most of the rest are financially strapped. As a result, hundreds of thousands of customers must switch plans, and average premiums, held down somewhat by the artificially low rates these non-profit plans offered, are on the rise.

(The law's backers have suggested that the failure of these plans is the fault of the law's political opposition, and urged the administration to offer more government support. But these insurers were supposed to be self-sufficient after the initial loans; there is something rather desperate about insisting that these plans, already backed by generous federal loans, and selling heavily subsidized policies at artificially low rates, should require even more government assistance to stay in business.)

These problems build on each other: Low sign-up numbers mean that the people who do enroll tend to be sicker and therefore more expensive to cover, which means that insurers must raise rates in order to compensate, which makes Obamacare even less attractive to the relatively health people who are concerned primarily about affordability, which in turn dampens sign-ups, which makes it harder for insurers to stay in business, which then makes way for competitors to raise rates, and so on and so forth.

Premium subsidies can offset these effects somewhat, blunting the impact of premium increases for many consumers.  But the subsidies are most effective for those at the bottom of the income spectrum, and may not be enough to encourage more middle class customers to buy in.

These problems place Obamacare in an increasingly precarious position, and they are only likely to get worse for now. That's the way things work in second acts, which tend to culminate in a moment of disaster and lost hope. But from that low point comes the eventual solution—ditching the old ways and attacking the problem again with an entirely different approach, one that accounts for the failures of the past. Out of the ashes of the old comes something new and better. For Obamacare, and America's health policy, the third act can't come soon enough.

NEXT: Death Rate for Middle Aged U.S. Whites Anomalously Rising

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. AT this point the Obama administration has ignored and unilaterally changed the law to such an extent that Obamacare is already repealed. The next administration is going to have the authority and circumstances are going to dictate that the law be scrapped no matter who is in office.

    It would be nice if the media would tell the truth for once and explain that fact to people. It would save us all of the bickering and emotional gnashing of teeth that will come with “repealing hte first black President’s signature achievement”. It already is effectively repealed and the first black President is the one who did it. Progs need to get that fact through their thick skulls. The task now is to clean up the mess. The issue of repeal has been overcome by events.

    1. Funny, back when it was passed I was saying to myself: “What happens if they passed a law and no one followed it.”

      Oddly enough, it wasn’t so much the voter like I thought, but the very administration who tried to implement it.

  2. Just got my increases. 23% increase in premiums and deductible.

    But hey, I don’t need a pre-auth for a sleep study anymore.

    1. Only 23%? I haz a envious.

      1. That compounding effect year-on-year is getting pretty onerous.

        1. But we’re gonna make it up on VOLUME, amirite??!!

    2. 47% this year.

      Oh, and my plan is “no longer available” as of 2016, so I have to switch to one that’s another $500 more a month.

      1. Jesus fucking Christ on a gurney. I was bitching cause mine was *only* 16%.

        Guess I haz a lucky….

        1. I no longer have health insurance. I’m not giving these fucking cunt faggots a penny to support their evil marxist bullshit. Especially not at almost $700 per month for just me. And that doesn’t even take into account price increases for 2016. I will probably of reprice soon for shits and giggles.

          1. Be late on a utility to the point that you receive a shutoff notice. Then you can file for an ACA hardship exemption, whereby you may be given permission to purchase a catastrophic policy. **full disclosure** I filed one year one, was contacted with a request for more information a couple weeks later, then never contacted again (was never denied or granted.)
            I was out of country for 9 months last year and had a mixup with wife over who was paying the electric bill. Was shutoff for 6 days. When I found out, I thought CHA CHING, exemption here I come!

            1. The utility shut-off exemption is only good for a month. But I guess the IRS is a little too busy to investigate these little details.

          2. Heard tell of a lady who saw her premium increases and concluded she was going to go bankrupt even with her subsidies. She decided to bail on insurance altogether, since a medical catastrophe with no insurance and perfect health with insurance were equal financial disasters. The first one she could gamble on avoiding.

      2. Think of it this way, if Chipotle hospitalizes you, then you have a max out-of-pocket now.

    3. The least-expensive HSA PPO in my area is 50% in 2016 higher than what I paid in 2014. (It’s also the least-expensive PPO of any sort.) The maximum out-of-pocket, which is the only number I really care about, is 40% higher than my old policy.

      However, my 60 year-old wife gets free birth control pills.

      Thanks, Obama!

      1. That’s the progressive can-do spirit we need to see more of from you serfs !

        – Proggie

  3. “Hello, I am here to show you your new insurance plan. His name is Roger.”

    “Why do you call an insurance plan Roger, and why is he unzipping his fly…oh…”

  4. For Obamacare, and America’s health policy, the third act can’t come soon enough.

    This may be the most insanely polyannaish thing I will read today. Do you really think the Feds are going to react to its failure sensibly be reducing regulation and increasing freedom in the health insurance and medical sectors of the economy? Or will they just double down and intervene more expansively and draconianly?!?

    1. I think the mandates are going to go down. They have to.

      1. The mandates are the only thing hold it together.

        1. For our betters in government, there is no road so short that a kicked can won’t bounce a little further along.

    2. I can see them cutting back, if an only if the GOP ends up controlling both chambers and the white house. They will likely roll back Ocare to somewhere between what we have now and what we had in 2008. So, no great improvement. But, of course, god only knows what other horrors the GOP will bring down on us if they are essentially unopposed at the federal level…

    3. So like some portion of the populace being forced at gunpoint to practice medicine for minimum wage or are you looking more short term?

  5. “the third act can’t come soon enough”

    I seem to recall that in the truly classic plays, the final act tends to look like this.

      1. There is a great PHD thesis to be written on the mass psychosis that surrounded Obamacare. The entire left half of our political class convinced themselves that the way to reduce medical costs was to make people buy insurance. It boggles the mind how people could be that fucking stupid.

        1. Everyone has long forgotten that it was sold with that promise, too. Now the focus is on how it increased the number of people insured, which, of course, is easy to do if you’re willing to raise costs.

          1. Oh, also, if you bring up medical costs, they’ll just fall back to the old “things would have been even worse” argument.

          2. I am pretty sure requiring people to do something by law, while not completely effective, will increase the number of people doing it.

        2. If only somebody would have warned them. Alas.

        3. I’m sure we could come up with a list of failed Obamacare promises. “Bend the cost curve” comes to mind. And the popular “If you like your plan you can keep it.”

          We – and I mean H&R regulars and other publications – warned of the issues, but we were ignored, or called racist.

          But yet none of the “smart” liberal set has ever admitted to being wrong about this law.

          1. But yet none of the “smart” liberal set has ever admitted to being wrong about this law.

            And never will.

        4. The left half wanted single payer, the (economic) right wanted free markets, it was the fascist center who believed that the third way measure Obamacare represented was ideal. The insurance mandate was intended to prevent the death spiral, which was a right-wing objection to the mandates regarding pre-existing conditions and community rating.

          1. It’s pretty difficult to get people to ignore their own self interest and sacrifice to serve the misfortunes of others without enslaving them at gunpoint – that’s why there are mandates.

  6. SLANDER AGAINST THE GREATEST FREE MARKET REFORM EVAH!

    /Derp

    1. I blame it on (circle all that apply: Bush, obstructionist House Republicans, corporate greed, the rain that was fallin’ fallin’).

      1. Does Obamacare cover earworm infections?

        1. Oh, yeaaaahhhhhhhh, sorrrrrry – that’s one of the few things that’s NOT covered. Yeah……sorrry….:(

        2. Of course; someone will be over to your place shortly with the earwig. Oh, you meant does it cover the treatment costs? No, but rest assured, the earwig is free.

      2. You forgot Global Warming.

    2. *dysconjugate gaze*

  7. The eternal optimist in me hopes the next administration will comes to its senses and dump government control of health care insurance all the way, including repealing employer premiums tax exemption. The realist in me doubts this.

    But it can’t continue. Something’s got to give, and it will, sooner rather than later. The thing is just too damned expensive and unwieldy. It can no more continue along its current path than Hitler’s invasion of the USSR could succeed, or the Japanese expansion into Southeast Asia and the South Pacific.

    What form that will take, I do not know. But it won’t continue for long, even if they resort to hyper inflation.

    1. Two things make me an optimist; the continued increase in technology and the rise of pay per service medical providers. Technology is making more and more aspects of medical care cheap enough and easy enough for small clinics to provide on a fee for service basis. Those things are operating outside of this mess and will provide a safety net when this entire thing collapses.

      1. My worry is that statists will continue to save the mess from collapse by one last minute hack after another, until they’ve built up an incredible spaghetti mess of intertwined bureaucracy, and it will never quite collapse, but just remain in place while technology gradually makes it irrelevant. But it will stay in place as a bureaucratic survivor.

        Sort of like the railroad union oversight body; they reacted so late to getting rid of firemen and brakeman and cabooses that they very nearly turned railroads into dinosaurs.

      2. One thing makes me a pessimist: the gratuitous and costly regulations that are ubiquitous in both medical research and provision of care are hear to stay at best, and getting worse at worst; and as long as production and provision of a service or product is so unprofitable and inefficient, no real private market can emerge to produce and provide to satisfy demand. As such, more and more state control is ‘needed’ down the line to keep things going.

        I’m convinced certain root problems would (but won’t) need to be solved to make reducing government control politically possible: FDA and other regulations on bringing drugs to market need to be decimated; barriers to entry into the medical field need to be rolled back; in short, the factors that are directly driving up costs of products and personnel need to remedied as a prerequisite. Of course you need the government to prop of every domino down the line until it stops tipping over the first domino.

  8. I would be curious to know, dollar for dollar, whether coverage has really increased since passage. Certainly, more people are enrolled, but if they’re struggling to meet the copays or deductibles are too high to make coverage meaningful, then it’s a wash or worse.

    1. You mean you want to know if anyone is getting any more or any better health care as a result of this? You just don’t understand. It is all about “coverage”. Only a simpleton would not understand that “coverage” is the end good in any health care system.

      I am being sarcastic of course but the people who came up with this thing really are that stupid.

      1. I get the notion that people aren’t as quote-unquote screwed if they get pregnant hit by a bus since there’s an upper ceiling on what they’re expected to pay (not, by and large, that they were expected to pay for it, anyway), but putting a cap on life-changing medical expenses could have been achieved much more affordably with catastrophic insurance.

        Instead, Obama & co wanted to micromanage the industry and all the particulars of health plans like the cretinous power-hungry bureaucrats they are. So it should be relatively straightforward arithmetic to determine whether, even absent the premium costs a family is required to pay, they’re any better covered for day-to-day care than they were winging it and paying out of pocket with a cheap HDHP to cover the really bad shit.

        1. upper ceiling limit

          me edit gud

          1. I liked “ceiling” better since it’s clearer that it’s an upper limit.

        2. They were not screwed before. Remember, hospitals have to give you care regardless of your ability to pay and you can write off medical debts in bankruptcy.

          1. Right. Lefties seem to be misremembering having to step over the piles of corpses of people who couldn’t afford healthcare.

          2. But isn’t that emergency care only ? I have heard of patients being transfered to county or charity hospitals. If you need some type of procedure they don’t necessarily have to give it without payment.

            1. If you have a $5,000 deductible, and you don’t have $5,000, then there’s no difference. In fact, it’s worse because you’re also out the premiums you paid to get the policy.

              1. But that cuts down on the number of insurance claims that have to be paid. It’s probably considered a feature rather than a bug.

    2. My costs for insurance have basically doubled (deductibles and premiums). I find that prices from doctors and hospitals have climbed significantly as well. Since that comes out of my deductible, I’m bearing that,

      A recent trip to dermatologist should exemplify how ridiculous it is. I had a bump removed and checked, it was 5 minute procedure along with lab testing. $450 total. Meanwhile, a full face and neck laser treatment for age spots, etc… would have cost me under $200. Difference? Insured procedure vs non-insured.

      1. I know multiple people who got totally fucked by the “Cadillac insurance tax”. Not only did they jack up the rates, they changed the tax code to insure that people who had good insurance no longer did.

        This thing basically fucked over everyone in the entire country. I know there are supposed to be all of these people getting free shit, but I have never seen them. Even the people getting Obamacare subsidies are getting subsidies to buy overpriced insurance that is a rip off even after the subsidies.

        1. And everybody forgets that states can recoup long-term care costs of people on Medicaid from their estate. It’s not a widespread practice yet, but it will be.

          1. They already do for medicare. And if you try and hide your assets, they can send you to jail.

          2. Medicare, not Medicaid, and I totally support them doing this.

            1. I support it as well, however the tendency is for people to act like Medicaid is a blank check and argue for the expansion of the program.

          3. “It’s not a widespread practice yet, but it will be.”

            It’s pretty widespread. We had to cash out my grandmothers estate, down to selling off her vehicle and cleaning out all her accounts. Then we had to certify that the estate had no remaining assets. After that Medicare covered her nursing home care. And that was in the late 1980’s.

            1. We had to do this too for my grandma, around 2008. Both medicare and medicaid were involved. They actually let her remain in her home until she died but once she was gone they had dibs on all her assets. We got about 14k from her entire estate when all was said and done, the state got about 170k.

        2. “I know multiple people who got totally fucked by the “Cadillac insurance tax”.”

          You can count me among them. The tax amounts to 3.33% of my annual income. I am in the lower 50% of income nationally, and otherwise barely pay federal taxes.

    3. I got really sick in October. I mean at one point wondering if my life was in danger sick.

      Three times I even went to the ER. What was amazing was seeing doctors treating patients in hallways. One time I was one of those patients. They told me that they didn’t have any room, so they were going to do some admin fiddle where I was seen but not seen formally in the ER. So I sat on a gurney in a hallway while a very nice, elderly Pakistani doctor with a massive gut, looked me over and checked my vitals old-school.

      I took the opportunity to ask the front desk about how busy they were. They said this year had been the busiest they ever had. My estimate is that they had 1 patient in the hallway for every 1.667 rooms.

      It appears that in the case of the hospital I went to, the most important part of Obamacare, reducing ER visits, has utterly failed.

      1. Of course it did. Forcing people to buy insurance just got them to over use the system more. Hell, they are paying for it, so why not use it? And the insurance networks were overloaded. Yes, you have insurance but can’t get a doctor to take you as a patient. That leaves going to the ER.

        Obamacare has not accomplished a single thing it claimed to do.

        1. Disagree; it gave Dems a highly-visible achievement, even if they *did* end up running from it in 2012 and 2014.

          1. Had they not passed Obamacare, I bet they would still have the Senate and might still have the House. It was a political disaster.

            1. Also, who knows what else Obama would have chosen to use his political capital on. Maybe criminal justice reform, or ending the war on drugs? Haha, jk. He would have just invaded Sudan and Syria instead.

          2. I think this is true, and it isn’t necessarily inconsistent with it having a negative effect in the short term on dem electability.

            Obamacare will end up being much like the New Deal: Posterity will almost universally praise it as a miracle (with the exception of ‘a few irascible economists’) while in fact, its positive impact is not only objectively questionable, but it was actually far less popular among those who lived through it than it is today. In the late ’40s and early ’50s, the leading Democrats (including ‘liberal’ ones like JFK) almost unanimously supported rolling back the New Deal almost immediately after the War; even many Dems saw it as a failure. It was only decades of forgetting that lead people to remember it as fondly as most Americans do today.

            The ACA will be similar I think, only it will never get rolled back. “All the good it’s done” will just get beaten into our heads so much over the coming years that eventually any alternative (or its relative merits) will become unthinkable, much like criticizing the New Deal is a form of blasphemy these days in polite circles.

        2. “Obamacare has not accomplished a single thing it claimed to do.”

          I’m pretty sure that Democrat pols intended for ObamaCare to create several new, dependable Democrat voting blocs in the “free shit brigade” and new donor groups in medical services and Big Pharma industries. I think ObamaCare did accomplish that. Hillary is the top recipient of industry cash in the current cycle, and the Dems generally get a much larger share of the industry’s cash than in years past according to Open Secrets.

          ObamaCare did accomplish one thing: it enabled affluent people who were previously unable to purchase insurance due to pre-existing conditions to purchase insurance … for the time being.

      2. “They told me that they didn’t have any room”

        Part of this is the literal problem of constructing facilities. I don’t know where you live, but in CA it is now nearly impossible, and unbelievably expensive, to build and license a hospital building. Even when they have the staff for the ER, they often literally don’t have enough rooms and beds.

        1. Maybe Kevin Erdmann (writer of the Idiosyncratic Whisk blog) is right and local regulatory housing supply constraints are, in fact, the cause of all the world’s problems?

  9. “It’s not just how many people are signing up. It’s also who is signing up. So far, the people signing up for coverage appear to be sicker than expected, and thus more expensive to cover.”

    Than WHO expected? We all knew that was going to happen. Every Republican who spoke out is on record as predicting this. In addition to the premium increases, and the fact that far fewer people signed up than was predicted by the Dems.

    1. LOOK!!! OVER THERE!!! The Rethugs can’t deal with CNBC, but they expect us to elect them to deal with Putin! HAHAHAHAHAHAHAHAHAHA!

      /Obamabot

      1. You forgot :”Its the law and you are just going to have to get over it”.

        1. Thus sayeth John Roberts!

          1. Fuck John Roberts, the dishonorable son-of-a-bitch.

    2. Really … “adverse selection” has been a well understood concept in the insurance industry for something like 200 years.

  10. Is the employer mandate in effect yet ? That should be the third act.

    1. partially. but the bulk of it goes into effect 2016

      1. Thanks NoVAHockey.

      2. Obama wants to have one foot out the door when that thing hits.

        1. One mans Legacy is another mans suffering.

        2. That way it’ll be president Trump’s fault.

  11. Our plan consultant let me know a month ago that in 2016 we’ll need to be OCare compliant, about 15% cost increases, plus must start covering employee’s “kids” up to age 26. I started informing employees today that I’m closing the plan instead. Make it tough for me to offer employee benefits? OK, fewer benefits.

    1. Ok. I asked too soon. Thank for answering my question netizen.

  12. I WAS TOLD THERE ARE NO SECOND ACTS IN AMERICA!!!

    FRAAAUUUUUUUUUD!!!

  13. Here is another final act, courtesy of Hector Berlioz.

    1. The Damnation of Faust has a spoiler right in the title – it’s as bad as Le Morte d’Arthur.

      Thanks for keeping up the dramatic suspense, guys!

  14. In a horror flick, the second act usually starts when either the first person dies, or the last means of escape has been severed.

    1. And by “the first person”, you mean “the black guy”.

      Cause – fact.

      1. What about Night of the Living Dead?

        1. The original PC movie

          1. Really? Because I detected a lot of bigotry toward the anthropophagous and differently-alive communities.

      2. Black, for maybe a mulatto marxist……….

  15. The government mandates you buy a product. The government prints money. The government sets interest rates. The government sets minimums wages, etc., etc. And, they still have the nerve to call the USA a free market economy.

    “To be GOVERNED is to be: inspected, spied upon, directed, law-driven, numbered, regulated, enrolled, indoctrinated, preached at, controlled, checked, registered, counted, taxed, licensed, authorized, admonished, forbidden, punished, extorted from, squeezed, hoaxed, robbed; then, at the slightest resistance, fined, vilified, harassed, hunted down, abused, clubbed, disarmed, bound, choked, imprisoned, condemned, shot, and to crown all, mocked, ridiculed, derided, outraged, dishonored. That is government; that is its justice; that is its morality.”? Pierre-Joseph Proudhon (1851)

  16. When I was in college I was a part of a student organization that was filled with touchy, feely education majors (and the same ilk). I remember how naive and stupid they were and thought that they were in for a shock once they got into the “real world”. I was a business major, particularly accounting, which is about determining equity to whom it belongs – presumably a very necessary vocation in the world. So I thought I knew at least something about how the world worked. This was 30 years ago. Little did I realize that THEY were going to take over. THEY are now running the government. And I mean “Republicans” too. Just a mass of career politicians and hangers-on who don’t know shit from shinola. The make bad laws and unleash them on the people. They refuse to make decisions and dump the consequences on others. They are children. Obamacare is essentially a thoughtless mass of juvenile hopes and dreams of “adults” who have not progressed beyond the skills and emotions of eighth graders. They MIGHT gain some polish and a form of erudition – but they are stunted people with power meant for real adults.

    Oh well.

    1. It’s kind of ironic toolkien. When you were in college. I was one of those people on staff that cooked for you that did know shit from shinola. You remind me of some of the student employee’s I used to work with.

      Here is a funny. =)

      https://www.youtube.com/watch?v=YTHL0y6xvLE

      1. You are one of the good ones toolkien. =)

    2. Obama’s trademark “Hope’n’Change” was all about exploiting the childishness of a very large fraction of American voters.

  17. Think of Dorothy being swept from her home in Kansas by the tornado in The Wizard of Oz, or Luke Skywalker escaping from Mos Eisley in Star Wars, or Neo choosing to take the red pill in The Matrix.

    Or in Downfall, Hitler getting that T.O. jersey thinking the Cowboys were sure to make it to the Super Bowl.

    1. I don’t understand why he chose adventure movies for examples. PPACA is more along the lines of Deep Impact. Even if we avoid total destruction, we’ll still be in pretty bad shape.

    2. Or Jennifer Connelly thinking she’s finally turned her life around, in Requiem for a Dream.

      1. Or Donald Sutherland realizing that earth is being invaded and deciding to alert the authorities.

        1. Or when Ned Stark sets out for King’s Landing.

          If that was act 2, then what act are we on now? Forty-something?

        2. Donald Sutherland is a vile communist traitor who played an important role in radicalizing Jane Fonda. I hope he dies slowly, screaming in agony, from stomach cancer.

    3. Or when the asteroid decides to fly toward Earth in Armageddon.

  18. I skimmed this, but is anyone tracking dropouts? As the premiums for the bronze plans rise eleventy billion percent, people gon’ drop out.

    1. Yes, to tracking dropouts.. But mostly to support the case for more next year. Next year’s net total forecast was cut sharply.
      The biggest hoax is still missed by rightwing media and think tanks. Before Obamacare expansion, Medicaid eligibles had a HIGHER uninsured rate than in the private market! Too many doctors refuse Medicaid, especially in inner cities, where there aren’t enough privately insured to offset losses on as little as $17 per visit from Medicaid.
      There was a TEMPORARY increase in Medicare reimbursements, but that’s expired. Medicaid is free, so no need to “unregister.” Eventually, “free market” wizards MAY start looking to see how many have coverage, but no treatment. This MAY be why emergency room usage INCREASES, in the only study of Medicaid expansion (Oregon).
      Listen closely when the GOP Health Taliban (including Rand Paul) claim public health providers can provide Medicaid treatment now provided by Planned Parenthood. They admit no private providers will touch it (duh), and assume public centers can quickly add the staffing needed for a half billion of added care. Right.
      As they pander for votes and dollars, have you seen news reports that it’s illegal to defund ANY provide for Medicaid. For obvious reasons. Changing the Medicaid law will be a further government intrusion over consumer choice, by free marketers, right?

      1. “health Taliban…”
        Huh? In what way is limited government intrusion in health care analogous to the Taliban? Where are you getting these things?
        “They admit no private providers will touch it..”
        And why is that?

        “it’s illegal to defund ANY provide for Medicaid…”
        ‘Provide’ is not a noun. Please attempt to be at least remotely grammatically coherent so I don’t get a brain aneurysm from reading your comments.

        1. “health Taliban…”

          Huh? In what way is limited government intrusion in health care analogous to the Taliban? Where are you getting these things?

          Taliban Is theocratic, with contempt for woman’s r equality.
          I get these things by being well-informed.

          “They admit no private providers will touch it..”

          And why is that?

          Law protects choice of providers. Medicaid pays less than Medicare, as liittle as $17 per visit. Like Medicare, providers offset losses by overcharging insurance companies. But PP uses abortion profits to subsidize their losses in inner-cities.

          Many inner cities have no physicians at all. (No private insured patients to screw). So PP is the sole provider for millions of inner-city women . But they’re only black.

          So punishing Planned Parenthood, for a constitutionally protected procedure, paid with private dollars won’t prevent a single abortion. But deprive millions of women of their only provider.

          Hence, Taiiban. Deny millions of women a choice of providers,a blatant abuse of free markets. But they’re only black.

          “it’s illegal to defund ANY provide for Medicaid…”

          ‘Provide’ is not a noun. Please attempt to be at least remotely grammatically coherent so I don’t get a brain aneurysm

          If your brain is is that fragile,confusing typos with grammar, these facts may give you a stroke. Lay down, breathe deeply.

  19. For Obamacare, and America’s health policy, the third act can’t come soon enough.

    Doesn’t everyone die in the third act?

    1. Just the kulaks, wreckers and hoarders. You’re not one of them are you?

  20. The law’s backers have suggested that the failure of these plans is the fault of the law’s political opposition, and urged the administration to offer more government support. But these insurers were supposed to be self-sufficient after the initial loans; there is something rather desperate about insisting that these plans, already backed by generous federal loans, and selling heavily subsidized policies at artificially low rates, should require even more government assistance to stay in business.

    Welcome to government where that which is failing is called “underutilized”.

    1. That’s depressing. Suggests that Reason doesn’t know the original co-op, which would have been cheaper than any government plan on earth. With more consumer choice and power than possible in any public or private on the table in the US. It was even endorsed and defended on the uber-left website, Daily Kos. Even the New York Times.

      Reason, good as they are on so ma

      1. Hmm, I got a screen refresh before finishing. This belongs at the end,

        Reason, good as they are on so many topics, has never been a good source for healthcare.

      2. What are you even talking about? You are referencing some healthcare panacea that would provide “more consumer choice and power than possible in any public or private [noun missing] n the table in the US” and ” cheaper than any government plan on earth.”

        Do elaborate:what in holy hell are you talking about? “Even the Daily Kos endorses…” That’s about as encouraging as the “even coma patients endorse…” “Even Lenin supports the New Economic Policy.” Well, if even Lenin isn’t too socialist for it, then it must be great.

        I’m beginning to wonder if you know what ‘even’ means.

        1. MarkLastnamem, ready?

          The ORIGINAL co-op proposal was a co-op HMO,, patterned after Seattle’s Group Health Co-Op, where I was a member for 17 years. Over 600,000 owner/members.

          Doctors are salaried employees of their patients. They run their own hospitals and own their own pharmacy. Pick up your prescription on your way out of the clinic or hospital. Think hard on their overhead costs for claims processing.

          Not a penny. (gasp)! THAT is why it’s cheaper than any plan on earth.
          More consumer control, because consumers own and/or employ their entire healthcare. (Except for rare specialist needs,)
          There are two competing HMO co-ops in Seattle, so … MORE CONSUMER CHOICE!

          Yes, EVEN the New York Times and Daily Kos endorsed this PRIVATE healthcare, with LOWER COSTS than any government plan, and MORE CONSUMER CHOICE than any government OR private plan …wait for it … as an alternative to a government plan.

          Nobody knows, but since all the advantages cannot be touched by ANY public or private plan, I assume it was likely buried by both parties, It disappeared around the time they were cutting the deal for the votes of hardcore progressives (led on this by Jay Rockefeller). If I wanted government-only healthcare. I’d have killed it too.

  21. I think I can take one, or maybe two hits on my income tax return’s before I have to comply with the individual mandate. I was in a position to invest in a catastrophic plan before Obamacare. Now even with the subsidy not so much.

    GAH !!!! You people don’t need to hear about my Woe’s.

    Drink you silly bastards. =D

    https://www.youtube.com/watch?v=f55CqLc6IR0

    1. There are certain life events that make one exempt from Obamacare. Getting a disconnect notice from your electric company is one of those and easy to get. Simply delay payment until you get notice , pay the bill and then show the notice to your tax preparer.

    2. There are certain life events that make one exempt from Obamacare. Getting a disconnect notice from your electric company is one of those and easy to get. Simply delay payment until you get notice , pay the bill and then show the notice to your tax preparer.

      1. Thanks OneOut for the advice. I am one of those people who always pays their bills though. To detriment. I can be honest to a fault. Though I would have no problem dealing in illegal antibiotics.

    3. “I think I can take one, or maybe two hits on my income tax return’s before I have to comply with the individual mandate.”

      I thought collection is still legally limited to your Federal Tax return. If your withholding is set so that you are close to Zero, what does the IRS do? Do they treat it as Taxes owed with penalties and interest? Or does it just sit there, to be paid sometime in the future?

      1. Related article: http://www.dailyfinance.com/20…..e-penalty/

        1. If the Penalty Tax exceeds your Income tax return then you pay in. This is the reality of not being able to afford, or resisting the cost of Obamacare.

          1. You are squeezed between having to pay all of your disposable income on health insurance, or losing your disposable income on your income tax refund. Some of us like to invest our disposable income on family, or you know invest it in things like Health Care.

            1. At this point in my life I would rather have my own choice in how I spend, or invest my own Capital.

              1. Racist !!!!11!!1

    4. I won’t pay them a fucking penny for that.

      1. You have no choice, because GOVERNMENT.

      2. Here’s your pill: you have the freedom to swallow it, or the freedom to get strapped to a table while we shove it up your ass.

  22. What’s the saying?

    The best remedy for a bad law is vigorous enforcement?

    1. It worked with the Nuremberg laws.

      Didn’t it?

  23. Shreik the least hardest hit.

  24. Repeal is indeed impossible. A repacement would be fine, if any dumbasses on the right had one — to show voters.

    For example, Ryan and Cato (among others) keep chanting in unison that Medicare Vouchers will increase competition … among insurance carriers? WTF? Can we control automobile costs with more competition between Allstate and GEICO?

    So the self-proclaimed champions of free markets … are looking at the wrong fucking market!

    There has ALWAYS been competition in Medicare. Consumers shop for and select many of their own providers, but … wait for it … have no skin in the game.

    Crazy, eh? We’ve been talking about consumers with skin in the game for 50 years … until it counts.

    Anyone with half a brain … after a few moment’s thought … or asking an accountant … would see that Medicare vouchers do not reduce government by one penny. They simply add a costly new middleman between the government and the providers! But they SOUND anti-gummint to the goobers. There is no better proof of the moral and intellectual bankruptcy of anti-gummint libertarianism (as opposed to the original pro-liberty version).

    Sorry, Peter, your efforts are totally wasted. Big government is winning by default. No viable challengers.
    Of thee I sing.

    And why is it ME getting this into Reason? Hmmm.

    1. So you are admitting then that government regulation of medical research and care provision is the core problem? Ok, thanks, now explain to me what prefrontal stroke led you to the belief that this reinforces your “pro-government libertarianism.”

      It has been explained innumerable times how vouchers would reduce costs. For starters, all the administrative costs associated with the ACA. Then there’s the advantage of consumer freedom, as opposed to letting asshat bureaucrats dictate which plans are acceptable and which are verboten. You might be familiar with some of the literature on the matter if your spine weren’t irreparably bent in such a way as to leave your head physically irremovable from your anus.

      1. So you are admitting then that government regulation of medical research and care provision is the core problem?

        WHERE? I ain’t that dumb.

        what prefrontal stroke led you to the belief that this reinforces your “pro-government libertarianism.”

        Pro-government? (lol)

        It has been explained innumerable times how vouchers would reduce costs.

        Can we reduce car prices with more competition between Alllstate and GEICO?

        all the administrative costs associated with the ACA.

        Medicare is not ACA

        Then there’s the advantage of consumer freedom,

        In the wrong market Insurance is not healthcare. Skin in the game THERE.

        asshat bureaucrats dictate which plans are acceptable and which are verboten.

        Has nothing to do with vouchers

        if your spine weren’t irreparably bent in such a way as to leave your head physically irremovable from your anus

        You haven’t saved a dime. You’re in the wrong market. Medicare is not ACA . You don’t know what “skin in the game” is.

        We already have competition in the CORRECT market, insurance.
        Seniors shop and choose many of of their providers, but have no skin in the game.
        Vouchers create competition in the wrong market.

        (boldface in defense from aggression)

  25. Obamacare was always meant to fail. It is nothing more than a stepping stone to single payer. Obama hopes that there is an FDR to his Wilson, only without a gap in between. When the Senate majority leader says openly that its a path to single payer publicly, it’s not a conspiracy theory anymore.

    The only question I have is how and why the insurance companies were so stupid to go along. I’m guessing because they are full of a lot of dupes like most of the country.

    1. The only question I have is how and why the insurance companies were so stupid to go along I’m guessing because they are full of a lot of dupes like most of the country.

      Guess again. Insurers forced it before Obamacare took office, accepting re-existing conditions, IF there was a universal mandate (so the healthy would enroll)

      But Obamcare forces younger, poorer Americans to subsidize lower premiums for older, wealthier ones. Guess who has more votes? Don’t blame the dupes; it was the entire GOP, which never had a credible alternative — still don’t – – only free-market slogans — still do.

      Then the right went ape-shit crazy, screeching that Congress voted itself a “special exemption” from Obamacare .. which was actually the identical “employer contribution” approved by law ? and never repealed. Oops.

      They also claimed a bullshit subsidy to insurers. which was designed to balance the risk of setting rates BEFORE knowing where the high-risks would enroll, just as they did with Medicare Prescriptions under Bush. The losing insurers (too many high-risks) would be compensated by the winning insurers (fewer high-risks) with government managing it. It too exploded when healthy folks stayed out. No subsidy. Not one Republican saw the potential risk, so they are culpable. But still expert at inventing excuses for their base.

      1. Considering that the Republicans never pushed Obamacare and most of would surely vote repeal the whole thing if they had sufficient dem votes, I’m not sure how I’m supposed to find them “culpable”.

        It’s true that republicans don’t have (or at least announce) a credible alternative but….. why is that? Because most of the public would reject it if they heard it. I’ve seen what’s proposed by Cato and Reason and it’s the left would almost certainly attack it as “right wing”. Even the tea party is reluctant to cut medicare.

        You’re an articulate guy, but also a bit of an ass. You’re having a good laugh at the expense of the bumbling Republicans, but the truth is, most of the country (effectively) believes healthcare is a right or should be a responsibility of the government. It’s not about messaging or presentation. Why don’t you pitch your ideas to some lower class immigrants and see how they take it?

        The republicans never had a chance of repealing subsidies, for obvious reasons. That part of Obamacare was and is quite popular. It would have been great for them to act on principle and risk their political careers, but it wasn’t going to happen. They’re still feeling the sting from the government shutdown.

        I’m on expanded medicaid. I don’t pay into any pools. If the republicans came to medicaid beneficiaries and insisted “no more free stuff for you, it’s market solution time”, you think any of them will listen?

        1. You’re an articulate guy, but also a bit of an ass.

          ME?

          You’re having a good laugh at the expense of the bumbling Republicans,

          Not laughter. I’m pissed. But I’m laughing at you.

          but the truth is, most of the country (effectitevely) believes healthcare is a right or should be a responsibility of the government.

          That’s WHY they need a credible alternative. DUH

          Yes, what Cato proposes is dumbfuck stupid. I’ve don’t recall any policy from Reason.

          It’s not about messaging or presentation

          IT TAKES A CREDIBLE PLAN.

          .. “no more free stuff for you, it’s market solution time”, you think any of them will listen?

          Why should they? Free market jargon has never done a thing. “Geit gummint oUt” is not policy. And nobody proposed what you said.

          . Why don’t you pitch your ideas to some lower class immigrants?

          That makes no sense , and you obviously have no fucking clue what my ideas are.

          The republicans never had a chance of repealing subsidies?

          Ummm, they should never have existed. Back then, what if they showed that Medicaid had a higher rate of uninsured (18,8%),than the private market? (16.6) Oh wait, they don’t know THAT! Here’s documentation.

          http://libertyissues.com/Medicaid-Private/

          But I’m only an ass. Do you have ANYTHING relevant to contribute?

  26. In other words, things are going according to plan.

  27. My obamacare plan is $1040/month with about $13.5K/year deductibles. Open market I can find a plan for about $958 up from $745.
    So if I follow the rules I can be out about $25k on cost next year. $1000/month is more than my house note.
    Is there a way to buy true catastrophic insurance for something truly bad (cancer, accident, etc)? I look at year to date doc and rx expenses my family spent about $1700.

    Am I missing something?

  28. Start working at home with Google! It’s by-far the best job I’ve had. Last Wednesday I got a brand new BMW since getting a check for $6474 this – 4 weeks past. I began this 8-months ago and immediately was bringing home at least $77 per hour. I work through this link, go? to tech tab for work detail,,,,,,,

    ———- http://www.4cyberworks.com

  29. Pass a law that violates citizens’ rights – problem solved. Oh, wait. Problem still not solved. Some people never learn.

Please to post comments

Comments are closed.