I'm in a similar boat. I'm a cancer survivor, in my early thirties, and run a technology business. Without government intervention, I can not buy health insurance.

Even if you want to remove the compassion for it, eliminating the ability obtain medical insurance is terrible for the economy. I waited for years to separate from my last employer until I was confident that I could obtain health insurance. There are a ton of risks when starting a new company and the last thing you want to think about is whether or not you can pay medical bills if something were to happen again.

Rather than working on my business, I now need to setup a meeting with the state's high-risk insurance pool to figure out whether they're finally going to eliminate the program and then compare that with the paltry list of plans left on ACA as well as what a broker can find me. To be clear, ACA has massive issues. That said, it meant that I could buy insurance, even if it wasn't the perfect insurance that I wanted.

What would you say to thousands of people with decent health whose premiums and deductibles have gone up and who are forced to keep paying it to avoid the penalty?

While it seems fair to subsidize the costs of your particular problem, does it also seem fair to ask of them to subsidize the costs associated with obesity and palliative care of the old?

These people do not have software developer salaries either. The income cut-off for being offered some sort of a discount on the plans is rather low, so it really eats into the budgets of their families.

Prior to ACA, people who were old or obese could still buy insurance. Prior to ACA, people like me who were cancer survivors could not, in any way shape or form, buy health insurance outside of government programs. If you are asking whether or not I believe it to be fair that premiums have gone up because in order to cover the uninsurable, absolutely.

And, to be clear, even now health insurance is not cheap for me. I did better in my business than I ever did before and I still budget for and spend 9% of my gross income on healthcare, which is split between premiums and my out of pocket max.

ACA is absolutely, positively not a perfect law. However, ACA has allowed me to start a business. ACA has given me the possibility of starting a family. I am not alone. If the cost of that is the requirement that I muster enough compassion to cover the costs associated with subsidizing the obese and old, then that is absolutely worth it.

I think it is fair to ask healthy people to subsidize health care for unhealthy people.

I think the best means of structuring society's relationship to medical care is to make it available to everyone within that society, spreading the costs across all parts of society.

That, to me, is the most sensible approach, even when some people pay more than they use, or some people use more than they pay for.

Pooled costs and guaranteed access to shared resources is one of the things that society is/does. Medical care doesn't seem different from roads, schools, police, the FCC, whatever.

Whether the ACA does a good job spreading the costs around or getting people access to medical care, that's a separate discussion. But whether it should at all, not a question for me. It should.

I feel for you. Working in the medical industry I feel the ACA is one of the most important (if not what many of us would have wanted) steps towards providing care to everyone we have taken, the fact that it's going to end up vanishing is going to have a huge impact - one that unfortunately is likely to only be felt years from when it happens.

Without the Medicaid expansion, they likely won't be able to afford any private insurance as well. The ultimate outcome is going to be uninsured people flooding the ER, who by law has to stabilize them. But maintenance drugs will be out of reach of many.

It's the loss of access to maintenance drugs that's going to shorten the lives of some folks I know.

God help us if any of us get cancer.

Aaaand, just learned that a buddy of mine was diagnosed with liver cancer.

Shit.

Repeal and replace. I'm sure Trump's solution will not leave you in the cold. It would be wreckless to repeal without ensuring people like you keep your insurance.

Would you trust your health or your life to "repeal and replace"?

Because that is what has been asked of me and some folks I know.

Serious question. Are you in a position where your access to health care rests on "repeal and replace" working out?

Replace with what, exactly?

A few years ago I read an article in the online version of some magazine -- Fortune, maybe -- that was attempting to rebut the argument that the GOP opposed the ACA but had never offered a coherent counterproposal. The author listed maybe a dozen plans that had been put forth by various Republican legislators.

I commented on the piece that a dozen plans is no plan. The GOP needed, I argued, to settle on a single plan to go to the voters with and say, "Here, this is what we should do instead of the ACA." Nothing like that has ever happened.

Well, now they'll have their chance to repeal the ACA with or without a replacement in hand. I won't be surprised at all if they don't replace it with anything, and we'll be back to where we were. -- Which will really put a damper on people over 45 or so quitting their jobs to do startups.

> I'm sure Trump's solution will not leave you in the cold.

I hope you're right, but I don't know how you can possibly be sure.

The current insurance market is not a permanent thing. If you look at the ACA marketplace, the list of plans changes year by year and that's the same thing that happens on the private market. In that context, what does keep your insurance even mean? Yes, I highly doubt we'll get dropped from our insurance plans in the middle of the year, but those of us on the independent market almost always have to buy a new plan every year. As such, the question of whether or not we can obtain a new plan is extremely important.