CMS released a big slug of enrollment numbers for Obamacare last week and we now have a pretty good idea of how enrollment is going to turn out for 2025:
Enrollment in the Obamacare marketplace has doubled during Joe Biden's term in office. Part of this is due to more aggressive recruiting and part to the increased subsidies in the Inflation Reduction Act. Total Obamacare enrollment, including Medicaid expansion, is 43.6 million.
The average Obamacare premium is up a hair compared to last year:
Why? Just why? TBH, who fucking cares? The president-elect is tweeting a Bond villain monologue and we're posting about ACA enrollment? What fucking world is this?
Nobody gives a crap about what the president elect tweets. Nobody.
it's just Trump being Trump.
But people do expect health insurance that they can afford and that covers enough of their costs that they are not bankrupt by it.
But nobody care what Trump tweets. If they did, he wouldn't be the president elect.
My point was more that these kinds of things are unimportant compared to resisting authoritarianism, and unimportant compared to resisting the inevitable attempts to repeal the ACA. Not a peep here about that, though.
This is the worst approach, it's exactly what Trump wants.
Not caring about actual, real-world, important things like healthcare coverage because we are too busy focusing on the Trump drama of the day is what Trump wants.
This is exactly what the Trump marketing team has been working on for 8+ years. Reject everything else, focus all your attention on Donald. Donald is the main character in every story, every day. There is nothing else.
Don't fall for this. Don't be a sucker.
Maintaining societal norms, including health care coverage for self-employed people seems like a pretty good way to resist authoritarianism.
If, as my conservative neighbors keep telling me, it's just Trump being Trump, let's see if we can maintain those norms and have his antics be performative instead of administrative.
I fucking care. It would be nice to live in a first world country with first world health insurance. Obamacare was a step in that direction, and it took huge Democratic majorities to get it through. Biden has strengthened it despite intense republican opposition.
A rare victory for Democrats. And people like cmayo don't care that these gains are now in grave danger?
What are the odds Republicans underfund or completely defund the ACA and use people's rising costs in the marketplace to claim that the program was flawed and needs to be dismantled, and as they do so, they eliminate all of the provisions including children allowed to stay on their parents until age 26, no premiums for pre-existing conditions, etc.?
I think very high.
When the subsidies end at the end of 2025, I will face an extra $16k/yr costs in premiums. It is likely that my wife and I will drop insurance completely for a while, or at best drop back to the cheapest bronze plan but that will still likely cost more than we're willing to pay.
IIRC there's a piece of Obamacare funding—part of one of Bidens's big bills (I think the American Rescue Plan but don't quote me)—that significantly enhances premiums affordability. Democrats being the idiots they are, wrote an expiration date for 2025 into that part of the legislation.
So, unless Democrats can figure out some legislative jiujitsu, ACA enrollment numbers, I fear, are going to drop by a lot during Trump's second term even if he doesn't succeed in major sabotage or repeal.
I'm not sure if that's a bad thing. Make the Republicans responsible for millions of Americans losing their health insurance. It might not change minds, but then again it might change enough of them to help the Democrats in the midterms. People who voted for Trump deserve what they get. I just hope the rest of us can survive the worst of his bullshit.
The big thing that was done for my perspective is that the subsidies for premiums used to end at 400% of federal poverty line. Now they do not, and premiums are capped at (to put it as simply as possible) 8.3% of your AGI (less if you earn less).
This is:
A. GREAT! I sort of get first world health insurance in the low end of the range for health insurance costs in the first world (which are 8-14% of some rough equivalent of "AGI").
B. TERRIBLE! It has allowed insurance companies to basically whatever the hell they want (subject to other ACA provisions); customers (like me) don't see the actual cost; the government picks up the difference.
When the subsidy limit is reimposed, I will face an extra $16k/yr in premium costs if we remain on the same plan, and we are unlikely to remain enrolled.
The ACA with the subsidy limit is pretty sucky for upper middle class self-employed folks like me.
Biden promised to make Obamacare more affordable, and he did. But we all know that Harris lost because Democrats don't care about economics or the working class, only woke, so there.
JohnH - for those who enroll, its a fair guess that most find the premiums are affordable: the article shows the deep discounts or free insurance most receive on the ACA. However, the fact that the US still has about 30 million uninsured Americans, post ACA, also tells you something: they do not find the ACA appealing (affordable, maybe easy to enroll, who knows...).
Most people are not aware of the subsidies that are available to make actual monthly costs lower than the nominal plan premiums. This is spectacularly true for low-income-but-not-medicaid-eligible folks.
I found this in a conversation the other day.
With a medical provider.
She did not realize that a silver plan would probably cost them less than a bronze, high-deductible plan.
(My physical therapist in an independent office, not affiliated with a major hospital network.)
It's amazing how much Leon doesn't understand the MAGA movement. It's not an eye opener if he had been paying attention to the MAGA movement for the past eight years. Or to Trumps life at all.
This doesn't belong here. ugh!
1.) The ACA was a huge fight, and yet, the legislation has a reasonably small impact. The ACA enrollment is about 10% of the US population.
2.) Almost everyone on the ACA gets free, or materially reduced, premiums. Thus, the unfilled demand for market rate insurance is very low.
1) Obviously the impact is significant for people who get their insurance through ACA.
Sixty percent of Americans under 65 have employer-sponsored health insurance; over-65’s are covered by Medicare; many veterans have VA or TRICARE. ACA was designed to fill in the gaps in this mixed environment. Many universal-coverage systems, for example most of those in the Germanic countries, combine employer-provided and government-paid insurance.
KenSchulz - fair insight on the people who benefit from the ACA. Rather, my point was, relative to the size of the US market, the fight was far greater than the legislations actual impact.
40 million people is a lot of people. This is more people and a larger % of the population than was covered by Medicare in the first decade+ of Medicare .
The total impact also influenced private coverage and healthcare providers.
Many people have ACA coverage at some point and cycle off to other private coverage due to job or income changes....so 40 million understates the impact as it's just this moment in time.
Harder to calculate the value of this, but this coverage also provides a floor or a known backup option if your job coverage goes awry. Fear of losing work coverage was pretty intense for a lot of people. This fear is now much less intense.
So....the actual impact is quite large. It's a big f&#$ing deal.
The ACA created changes throughout the medical system that have had a profound impact on delivery of medical care; from standardized on-line medical records to analysis of outcomes for treatments across a broad spectrum.
That you don't know about these changes does not change them nor their impact -- both good and bad -- on health-care delivery in the US.
The biggest impact of Obamacare was the Medicaid expansion, and it’s huge. Talking about Obamacare as if it’s only the exchanges is very misleading. The regulation changes, particularly getting rid of denials for pre-existing conditions, was also huge.
As someone who purchased private insurance before Obamacare and since, I think there's one major accomplishment you all fail to comprehend.
Before Obamacare, there were 50 different sets of rules, and any national discussion about health insurance got bogged down in the differences between those rules. I remember, in McArdle's Atlantic Days, watching the discussions devolve due to those differences and people talking past each other.
Today, when we address the problems, they are mostly all the same across the nation; we are having a single dialogue and not talking past each other so much. The problems of the system are mover obvious because we all have the same problems, not 50 variations of problems that vary by state.
And of course, there's that whole no pre-existing condition coverage. . . the #1 thing that will be on the insurers chopping block.