What I read, and I did read this online and haven't had the time to look for primary sources so please take with a grain of salt, but worth looking into is this:

pre-existing condition check was a major risk to the insurance industry since nobody knew how much it was going to cost them. So the ACA told insurance companies we'll subsidize some of your costs until things settle down (this is different than subsidizing people's payments). However when it came time for the gov to pay, Republicans blocked most of the subsidy payments to health insurance companies (I think they only received 12% of the expected amount).

And then because insurance companies didn't get that subsidy they obviously passed the cost onto consumers. And I'm sure whatever subsidy was further promised by the Gov they could no longer rely on so they priced that risk in as well.

The GP comment is just another example of how there's a ton of uninformed anger on this issue. People are spitting mad because they're realizing that health care is becoming really expensive, and they think the ACA is to blame because they heard about the ACA last. The amount of actual understanding approaches zero, because few people pay for their own healthcare in the USA.

I kind of want the GOP to just burn everything down and expose everyone to the full pain of this absurd system (in true, "free market" fashion). We'll have a political revolution overnight.

You can argue that cost increases are due to all of those previously uninsured sick people who are now insured and costing the rest of us money, but that's both wrong (costs have been going up faster than inflation for decades), and a pretty awful worldview.

And despite all of that, health care cost growth still dropped

"I decided to leave my job and get an ACA plan for my family, while trying to bootstrap my company."

Before the ACA, because you couldn't have gotten any health care coverage at all. Thus after the ACA, you had an opportunity that would not have been possible (safely) previously.

Married, two kids. Everybody reasonably healthy, have a decent job.

Healthcare costs have become expensive as shit because of the ACA. That's not a partisan talking-point: that's the bottom line in our household budget.

The happy-face anecdotes the ACA's advocates trot out are lovely, but there are far more people in my position.

You say this is like a bad thing. Shouldn't the healthier members of society be happy to contribute to the health of those less fortunate?

Gross to think otherwise.

It really depends on the people you have in your society and what the sick people are contributing.

Getting sick needs to have some kind of downside to it. Else people have no incentive to stay healthy. They can take as many risks as they want to their personal health because it's going to be paid for by other healthy people.

America in particular has a large obese population which is addicted to popping pills and overmedicating in general. If you give people free license to eat whatever they want or take as many drugs as they want without consequence our healthcare costs are going to be unaffordable very soon (they nearly already are)

Once you are in a system where everyone is forced to contribute, one person's actions affect others. If you don't take care of yourself and get sick, others are forced to pay for you. If you have too many people who don't take care of themselves, the healthy people are the ones who get screwed because it's effectively a wealth transfer: They're paying for sick people to have the license to do whatever they want.

The reality is that sick people are a drain on society's resources. Obviously we need a humane solution to treat them but the answer shouldn't just be a blank check. There are sick people who require hundreds of thousands of care YEARLY. They are not temporarily sick, they are permanently sick. I dont' think it's fair that they pay the same rate as healthy people. If you are permanently sick, that sucks but you should pay more of the burden.

Yeah it would suck if illness affected your ability to be physically active, gain and keep employment, be part of a happy relationship, enjoy hobbies, etc.

It's great that you've found a way to punish people financially so those ill freeriders don't get off Scott free.

If you remove any sense of personal responsibility from people's health, they will have no incentive to take care of of themselves. Everything they suffer will be covered by insurance (ie. other healthy people). That's how it is right now. Healthy people are not signing up for these shitty health insurance plans because they are being forced to pay for sick people who eat up 80% ( or some ridiculous number, i don't know what it is) of the actual costs.

It's not about "punishment". it's about people paying their own way. If other people were paying for your car insurance they why not speed, drive drunk, drive recklessly, etc. You are not personally liable for any of your driving consequences.

The reality is that people who are sick are a drain on resources. We have to decide , rationally, how much other people should be forced to pay for these sick people. If you are fine joining a health insurance plan with these people and paying more then fine, all the power to you. So are you doing that?

https://www.washingtonpost.com/news/wonk/wp/2016/09/19/skyro...

> A new analysis from the Urban Institute found that the average unsubsidized premiums in the Affordable Care Act exchanges, commonly known as Obamacare, are actually 10 percent lower than the full premiums in the average employer plan nationally in 2016.

Because I fall well within the middle class, have 2 kids, and am in reasonable health yet am paying far more for poorer health care than I did a decade ago, and beyond the anecdotal evidence that is the same for every family I've spoken to for the last few years it is clear that the ADA is deeply disliked by a vast swath of America for precisely that reason.

The ACA is a shell game that siphoned money from people who had it, dropped it into a big corporate hole, and spat out a bit of it at people who didn't have as much. As a political issue, we are seeing "success stories" trotted out so as to convince the rest of us that gosh, isn't this worth it?

No, it isn't. There has been no net gain with the ACA. It was passed so we could see what was in it, and turns out most of what was in it was a lobbyist Christmas wrapped in a ton of politician incompetence.

It was wealth-destroying political nonsense in the same sense as "cash for clunkers". Feel good, think less.

What I don't believe is that healthcare costs have gotten more expensive FASTER THAN THEY ALREADY WERE because of the ACA, any more than I think that my cat died in 2012 because of the ACA ("Gee, Thanks Obama!") which I'm sure some people would also argue.

So in your comment, I absolutely believe

> Healthcare costs have become expensive as shit

But I think you're trying to assign blame where it's not due with

> because of the ACA.

The ACA introduced no cost controls and just shifted the costs around from 1 demographic to another (mostly to the lower-middle and middle class healthy people, who don't actually use much health care).

So obviously for every sob story of a saved life, there's at least 2-3 stories of relatively young (26-30) healthy people whose deductibles and premiums have gone through the roof.

That's why people on the internet can't ever agree whether the ACA was a good thing, because there's plenty of anecdata from both sides.

I think we, as a population have to accept that Americans, in general, are very unhealthy people. It's quite obvious with ~35% obesity and the #1 killer being heart disease. Naturally, mitigation health care is an order of magnitude more expensive than preventive care. Hence the rising costs of health care (for everyone, even though some people don't feel the pain of costs, whether by being subsidized or being rich)

In a lot of ways that's exactly what insurance is. It's pooling resources to cover expenses for the people who need it. In any given time period most people won't need it, or won't need it to an extent higher than their contributions, but it's there just in case. There's variation in premium amounts to account for the difference in likelihood of need (so those younger generally-healthier people pay lower premiums), but a very important part of making it work is having a large enough pool that only a limited percentage needs to use it each year.

There are also measures that were taken to try to reduce costs, but how effective they were may be up in the air. The only one I can name offhand was the requirement that insurance companies spend at least 80-85% of revenue on medical expenses. At least one person noted that might also lead to higher costs (via overpaying to let that overhead grow), though I think that that's the kind of problem that market factors would actually address - if you're overpaying, that money has to come from somewhere so you're also charging higher premiums and will shed customers as they seek cheaper insurance.

Other cost-cutting measures have been killed off through effective lobbying (e.g. Medicare being barred by law from negotiating drug prices, introduced back with Medicare Part D and the Donut Hole).

And yes, the general fitness level of Americans is pretty poor. Unfortunately, addressing that is more of a public health matter, and since the onset of modern medicine public health has been more and more relegated to a secondary role. Interestingly, some insurance companies seem to be trying to revive non-medical measures to improve the health of their customers through things like discounts for fitness assessments, fitness programs, etc. The assessments and advice resulting from them may make a difference, but even just the embarrassment factor of being unfit and going for one may help change behaviors.

I'll just note that in general, obesity is different from anorexia - fat people realize they're fat, are often concerned or embarrassed about it, and a large percentage of them would like to be be if not thin at least a lot less fat.

1. Rate Review & the 80:20 rule: http://obamacarefacts.com/obamacare-rate-review-80-20-rule/

2. IBAP or "death panels" if you're a halfwit politician from Alaska: https://en.wikipedia.org/wiki/Independent_Payment_Advisory_B...

3. Readmission Reductions Program where hospitals won't be reimbursed if patients come back with the same issues: https://www.cms.gov/medicare/medicare-fee-for-service-paymen...

4. The HCFAC was given an extra $350M to combat fraud and absuse: https://oig.hhs.gov/reports-and-publications/hcfac/index.asp

5. The ACA authorized CMS to run background checks and site visits (which were previously forbidden) on providers to ensure they're legitimate.

6. The ACA authorized CMS to withhold payments if fraud is suspected -- Previously they were required to pay, then try to get the money back.

7. The ACA greatly expanded the Recovery Audit Contractor program to Medicare C and D, mandating post-billing audits of Medicare providers.

8. The ACA gave the OIG the ability to levy large fines ($50,000/false statement) on providers who defraud health programs.

9. The ACA created a centralized databank to share claims information between Medicare/Medicaid/CHIP/VA/DOD/SSDI.

10. There are a litany of provisions about home health care, hospice, nursing homes, and other areas that were formerly high-risk fraud areas. New penalties, restrictions, enforcement mechanisms, etc.

11. The ACA reduces payments to hospitals that have high incidence of hospital-acquired infections in their patients.

12. The ACA greatly expanded competitive bidding for durable medical equipment ensuring that nearly all categories now will have a proper bidding process and regular price updates.

13. The ACA expanded the prescription drug rebate program: https://www.medicaid.gov/medicaid/prescription-drugs/medicai...

14. The ACA established the Center for Medicare/Medicaid Innovation which research and perform trials of new care delivery models with a focus on lower-cost, higher-quality service.

15. The Bundled Payments for Care Improvement changes the focus of hospitals by providing a target cost for an admission instead of paying for each service the patient receives. So if you go to the hospital with a kidney infection, instead of performing every test in the world on you to run up their reimbursement rate, the hospital is now focused on the lowest cost care that will prevent readmission: https://innovation.cms.gov/initiatives/bundled-payments/

I mean.. there are literally hundreds of cost-control provisions..

In addition while this is a contentious subject telling people to "reconsider your certainty [...] if you don't know basic facts" is needlessly confrontational.

Obviously, I don't think you're obligated to offer any details you don't want to.

I guess I assumed you had a point and weren't just firing off scary sounding exaggerated anecdotes.