I think this is the real win here. Like most legislation ACA is a complex combination of good and pad parts, but the fact that people with pre-existing conditions or terminal illnesses can still get health insurance for treatment is a huge step forward for our society as a whole.

Like the report said, there's still progress to be made.

I still contend that the availability/unavailability of health insurance was not the problem that needed solving. Instead, it's one of many symptoms that can be attributed to the unreasonable cost of healthcare, which has escalated in part because of the disassociation between the actual billing and payment. Insurance is similar in concept to chips as a casino in this -- by creating distance from the actual cash transaction, people are less likely to question the cost of something because it doesn't have a direct impact on their wallet.

> I still contend that the availability/unavailability of health insurance was not the problem that needed solving. Instead, it's one of many symptoms that can be attributed to the unreasonable cost of healthcare, which has escalated in part because of the disassociation between the actual billing and payment.

The rate of increase in per-capita costs has decreased under the ACA. So, while it perhaps hasn't yet solved the problem, its certainly hard to argue that its been thing worse than the system in place before it was adopted.

We need a period of time that isn't coincident with a huge recession before we celebrate this too much.

> We need a period of time that isn't coincident with a huge recession before we celebrate this too much.

The most recent recession ended the same year the ACA was passed, the annual average cost growth rates, for private insurance and both major public programs, after the ACA are lower than the 5 year period containing that recession and the passage of the ACA, and even moreso lower than the 5 year period before that (during which there was no "huge recession".) [0]

[0] Figure 4 in TFA.

It also allows us to pool money and average it in case unknown and expensive procedures are required. We also want to encourage people to get cheaper preventative care instead of avoiding it due to short-term costs. Insurance programs benefit from incentivizing that behavior as much as ordinary people do.

"People are less likely to question..." seems to be placing the blame at least one notch too far down. Try asking how much something will cost and no-one can tell you—insurance or provider. Medical billing at all levels is batshit insane, and it's not the fault of "consumers" (patients) that they can't figure it out. Even trying is mostly pointless.

Which is why insurance, unlike casino chips, has cash deductibles.

The uninsured rate has decreased from 16% to 9%, so there are now a significant more number of people insured that were not before.

The good parts and the bad parts are related. The ACA effectively forces rates to go up for people who can afford it to increase or extend benefits to people who can.

There was a slight increase in 2010, but (overall) not a significant change to the growth in premium contributions made by single workers and families between 2005 and 2015 - http://i.imgur.com/KCiwoEJ.png

Same here, my parents were in the "make too much to receive government assistance but not enough to pay for private insurance healthcare" group, now with the ACA they finally have health insurance after nearly a decade of going without it.

And in response to the parent, are there problems with the ACA? Of course, but let's iterate on it, instead of dismissing it completely because you happen to be one of the few who doesn't benefit from it.

Prior to the ACA, many states offered High Risk Pools to cover people in your situation. Were these not applicable in your case?

The only way to get into the pool in my state was to be without insurance for 6 months and provide proof of denial or exclusion of a condition. That was untenable when I was going to follow up visits every 3 months and CT scans every six months.

You say that like the ACA was the only way to get that outcome...that somehow more insurance was the solution rather than the problem. The fact of the matter was that with a democratic president and the largest democratic majority in generations, voted in on a platform of "just fucking fix healthcare already", we still couldn't even see a single payer proposal make it to the floor for a vote.

Not only did we not get the healthcare that we voted for, we got mandated insurance based healthcare at even higher prices, with even more bureaucracy, and huge tech boondoggles as the icing on the cake. Sold to the public as not a tax, but then justified at the Supreme Court as a tax. 5% of the population comes out ahead and everybody else behind.

The 111th congress will go down in history as the most cowardly and counter effective we will ever see. That Obama is whitewashing and patting himself on the back like this is bordering on insanity.

> we still couldn't even see a single payer proposal make it to the floor for a vote.

> Not only did we not get the healthcare that we voted for

Three of the Democratic candidates in that election campaigned on something very similar to what the ACA delivered, including both of the top two -- Clinton and Obama.

None of them campaigned on single payer, so its not surprising that what was delivered looked like what was successfully campaigned on. Inasmuch as anything can be said to be the "healthcare we voted for", the ACA is more like that than single-payer would have been.

> It has allowed me the luxury of being able to purchase individual insurance

You could do that before ACA.

> instead of being chained to a 8-5 corporate job

What does this lifestyle choice have to do with ACA? ACA doesn't somehow give you free time or extra money. Unless you are getting your insurance for free (which was possible before ACA, mind you). ACA often does not offer the cheapest plans either...

> You could do that before ACA.

The GP said he was a cancer survivor. I've talked with several people with serious past or pre-existing conditions, including past occurrences of cancer, who could not find anyone willing to sell them an individual health insurance plan at any price prior to the ACA -- the only way they could get insurance was to be in a job where a group plan was offered.

> What does this lifestyle choice have to do with ACA?

It creates health insurance exchanges on which people can by individual insurance without being denied for pre-existing conditions, meaning they don't need to be in a job offering a group plan in order to get insurance.

> ACA often does not offer the cheapest plans either...

ACA has made it possible for people to buy individual plans who were not able to buy them, at any price, before (the rules that do that, such as the rule against pre-existing condition exclusions, are the reason for the cost increases for individual insurance for people who were insurable prior to the ACA.)

> It creates health insurance exchanges on which people can by individual insurance without being denied for pre-existing conditions

One could (and can) do this without the exchanges.

Yes, before ACA some pre-existing conditions would deny access to some policies from some insurers. This was to prevent a career smoker at age 75 from signing up for a new very large policy, and immediately get the benefits they haven't paid for.

We didn't need all of the baggage that came with ACA to accomplish this.

> meaning they don't need to be in a job offering a group plan in order to get insurance

> ACA has made it possible for people to buy individual plans who were not able to buy them

Before ACA, you did not need to belong to a group plan to get insurance. And to that endeavor, private individual insurance policies are about the same price now as they were then...

~~~~

Meanwhile... ACA didn't touch pharmaceutical companies - the true reason healthcare is so expensive ($700 salt water IV's anyone?).

> private individual insurance policies are about the same price

Not for `zrail: pre-ACA, insurers charged high-risk buyers like him/her much higher-than-average premiums based on their medical history. Now that's not allowed.

The entire point is that healthcare is no longer coupled to a specific employer.

> The entire point is that healthcare is no longer coupled to a specific employer.

It never was. You could always get an individual plan.