The problem field is slighty different: if your income is constrained and you are generally in good health you are going to choose a low premium plan with consequent higher deductible. When it's your turn to end up in hospital you get to pay up to the (substantial for you) out-of-pocket limit, even though you belong to the demographic that cannot afford it and Obamacare was sold to you as making healthcare affordable and accessible.

Obama was a sellout.

All of this was true pre-ACA, but worse (in my family's case, much worse; we went bankrupt over $90k in medical bills back in the 2000s). As it was, the thing barely passed.

Ezekiel 4:12-15 applies:

’Eat the food as you would a loaf of barley bread; bake it in the sight of the people, using human excrement for fuel.’ ... I said, ‘Not so, Sovereign Lord! I have never defiled myself.’ ‘Very well,’ he said, ‘I will let you bake your bread over cow dung instead of human excrement.’

We could be dealing with worse shit, however shit remains shit.

Isn’t this a take on fuels for the sacrificial/temple fire?

No, it's not. The prophet is with the Jewish exiles in Babylon and is enacting the siege of Jerusalem. Food, water and fuel are running short in Jerusalem, and he plays out what it looks like.

Cow dung is actually a great biofuel.

> All of this was true pre-ACA, but worse (in my family's case, much worse; we went bankrupt over $90k in medical bills back in the 2000s). As it was, the thing barely passed.

Sorry to hear that.

One of the massive negative side-effects of ACA will come to the national forefront in a few years. We now have tens of millions of people enrolled in Medicaid. What most don't understand is that, after 55 years of age, this isn't insurance at all, it's a loan you are required, by law, to repay.

Don't take it from me, here's a summary directly from the Medicaid website:

https://www.medicaid.gov/medicaid/eligibility/estate-recover...

I looked into this a while back. The State can place liens on your estate and your children could be stuck with a bill because of that. For example, if you have a home it is very likely that 100% of the value of your home will be consumed by your healthcare bills if you needed what I am going to call a normal level of care for that age group from 55 onwards.

In other words:

People were told they they were getting health insurance through Obamacare. In reality, they agreed to receive a credit card using their estate as collateral. If this isn't fraud, I just don't know what is.

Obamacare might just be the largest private-property grab by any government in the history of this nation, if not humanity. I wonder how many people actually understand they will not be able to leave anything to their children. Or worse, leave them a huge bill owed to the State.

These are the things that really rattle me: Politicians selling pushing programs in the most dishonest ways possible. How many people would have supported ACA had they were told they would have to sign-over their estate to pay for their after-55 medical bills? Very few, if any.

What really sucks about this is it affects the low to middle class portion of the population in a disproportionate manner. They are the ones who end-up on a Medicaid plan, not people who can afford to pay for something else. Once again, politicians claim to be for the little guy and, instead, they royally shaft them every time they are able to. All they care about is their votes.

I'd rather have to do a little estate planning in my 50s than not make it there because I was uninsured in my 30s. The nursing home thing is very, very well known, you can plan ahead to avoid it, and most of the folks poor enough to benefit from Medicaid expansion weren't going to pass down much anyways.

Medicaid expansion is also just one portion of the ACA.

No, Joe Lieberman was a sellout, and Senate Dems refused to kill the filibuster, so we got the best we could get at the time. And even those insufficient changes were considered such an affront to "personal liberty" or whatever that it resulted in a historic midterm "shellacking."

Adding up the premiums plus the out-or-pocket max for the plan options that had my providers on my exchange, the low premium option was the least expensive, despite its higher deductable.

The low premium option is the least cost option if you don't use much healthcare, or if you use a lot; but there's a range somewhere in there where the higher premium plan may lower your total costs. Of course, if you're getting a premium subsidy, the calculation changes.

But yeah, Obama promised access to healthcare and delivered access to healthcare insurance. It's not unuseful, but it's not really enough.

If it were up to me, I'd lower the medicare eligibility age every year, and gradually grow the system, a couple decades later we'd have Medicare for All (ish, not all seniors are eligible).

The problem is that incidence for individuals is 100 %, and someone who gets to pay the full yearly deductible is likely so sick that he can't work. Lovely. Not only do you get to pay the hospital, now you are missing a chunk of income, too, when you can least afford it!

An Obamacare Bronze plan is like the bank extending credit - they carry the umbrella after you when the sun is shining, but at the first drop of rain they disappear.

My point is the Platinum or whatever plan isn't any better. It's probably worse for most people. Total out of pocket is going to be higher because out ot pocket max + premiums is worse than the Bronze.

Of course, paying the hospital is usually sort of optional. They're most often happy to bill you later and send you to collections, and you can let it accrue. It's not great, but if you're so sick you can't work, what are you going to do about a debt you can't afford to pay? Better to not pay it.

The issue is that deductibles used to be 1/10 as much before the ACA. And you had the option to buy "emergency only" coverage, which had a high deductible, but a much cheaper premium.

These days, because of the ACA all plans are "emergency only", except without the lower premium.

> The issue is that deductibles used to be 1/10 as much before the ACA. And you had the option to buy "emergency only" coverage, which had a high deductible, but a much cheaper premium.

They were cheap for a reason. They're back in force, if you want to grab one. I don't advise it. https://www.propublica.org/article/junk-insurance

Do people not remember how insurance was like before the ACA? You actually could get less expensive insurance that actually covered things. Not this junk insurance you're linking to me, which only exists because of the ACA.

These days all coverage is emergency only coverage, because of the insanely high deductibles. Except without the benefits of lower premiums.

I am aware that some things improved, but not for the average low risk person.

> Do people not remember how insurance was like before the ACA?

I do. My wife and I went bankrupt with it, via $90k in copays and coinsurance.

We had good insurance, but back then insurance could have uncapped costs of this kind. As a bonus, they could a) set a maximum annual and lifetime amount they'd pay and b) decline to renew our coverage, leaving only high-risk pools (4-5x as expensive for premiums) available.

I have a zero-deductible ACA plan. There are plenty of them.

> I have a zero-deductible ACA plan. There are plenty of them.

How much does that cost? And which state?