Here's an UPDATE: the only pol I heard from was GOP Senator, McCormick. I didn't hear from Fetterman (but he did add me to his newsletter mailing lol). Also have not heard from my US Rep, Mary Gay-Scanlon. Fair warning, this will be a long post. I'll share McCormick's response, and my response to that.
"Dear Ms. Dunleavy,
Thank you for sharing your concerns regarding enhanced premium tax credits. Your feedback is essential as we work together to shape policies that benefit Pennsylvania and our country.
The premium tax credit was created under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) to subsidize health insurance for individuals and families who do not qualify for Medicaid and do not receive coverage through an employer. Under the ACA, eligibility for these credits is limited to those with annual incomes between 100% and 400% of the federal poverty level.
The enhanced premium tax credits (PTCs) were introduced through the American Rescue Plan Act of 2021 (ARPA) (P.L. 117-2) as a temporary measure for tax years 2021 and 2022, to make health insurance more affordable during the COVID-19 pandemic.
The enhanced PTCs removed the 400% federal poverty level income cap and were later extended for an additional three years under the Inflation Reduction Act (P.L. 117-169). According to a nonpartisan analysis by the Congressional Budget Office, permanently extending these enhanced PTCs could cost taxpayers approximately $355 billion over ten years.
I believe we must help low-income individuals access affordable health insurance when they truly need it. I also support efforts to minimize waste, fraud, and abuse that place unnecessary burdens on taxpayers and state governments. I will keep your views in mind as Congress considers whether to extend these credits.
It is an honor and a privilege to serve our great Commonwealth in the United States Senate. I appreciate having the benefit of your comments on this important matter. I am always grateful to hear from my constituents.
Sincerely,
Dave McCormick
U.S. Senator"
Here's my reply to Sen. McCormick:
Dear Sen. McCormick,
Thank you for your reply to my message regarding the enormous increase in premiums under the ACA, via Pennie in Pennsylvania. I mentioned in my first message that my premium has gone from approx $65 to $900 per month for an IBX Silver Basic plan. I failed to mention that I have been using ACA subsidies almost since its inception. I believe I joined in the second year.
Because I am self-employed, it is the ACA that has made it possible for me to get health insurance. Without the ACA, I would have never been able to afford it. Healthcare is not a luxury. It's a necessity. I agree with you that "we must help low-income individuals access affordable health insurance" but what do you mean by "when they truly need it"? Are Pennsylvanians not people who need healthcare? The GOP claims that the gig economy is what makes a work force flexible and efficient. But they won't support them with getting healthcare? Honestly, how is a person to live without healthcare? I have Basel cell Carcinoma and must visit my dermatologist every 6 months because I've never made it 5 years without a carcinoma. Literally, how do I live my life without healthcare? Who gets to decide that I "truly need it"?
I really do appreciate you taking the time to reply to my first message, but I must insist that you do more. I need to urge you to be a HERO for me and for other Pennsylvanians. We Pennsylvanians need you to figure out a way for us to get healthcare. We need to be able to go to a doctor, remove a carcinoma, and make sure our hearts are healthy unlike our father and brother who died in their 50s.
I assume you went into the US Senate to do big things, to make a difference. Please realize that THIS IS YOUR MOMENT to do something great for your constituents and for all Americans.
Several Senate Republicans have said they have no intention of revisiting this issue. I’m in the category of people who would qualify for the subsidy but I am considering this to be a dead issue. I’m skeptical Thune would even let it come up for another vote because they have already voted it down once. The House effort is just from a small number of Republican Representatives desperate to try and improve their odds at the midterms by supporting something popular.
The person who actually could make this happen is President Trump, who despises all things “Obamacare.” (Although, I do think we could get him onboard for single payer right now if we were willing to call it Trumpcare.)
The one part of the issue that is true is that these were Covid era subsidies not originally intended to keep going. But the GOP totally botched health care as an issue by whacking other parts of health care in the BBB and not even looking at the issue again until the shutdown.
This defund and destroy playbook is as old as the hills for Republicans. Withhold needed funding causing people to decry how poorly it all works and forcing them to walk away from something that actually worked pretty good, offer no alternative and then watch it all dry up and blow away with the wind as not enough people are in the system to keep the costs down. Congratulations Mike Johnson. You win. There’s a special place in hell for you.
Great article and brings to mind how the discourse can by highjacked by blowhards. The ACA is offers GROUP plans, leveraging buying power, and it offers choice. Dems would do well to make these points more clearly. Also, aside from the moral imperative, every uninsured and under-insured person costs the system (all of us!) more than providing subsidies, as we don't turn away people who turn up at our emergency rooms.
Don't know whether to laugh or cry. As a disabled Veteran, my health care is covered by the VA which good...when you can get it and with cuts and vacancies in the staff, that's a real adventure. Anyhow, back to my point. Indeed, Biden was able to get and extension with retroactive coverages. But, and it's a big but, he had not gutted the agency if people capable of implementing it! Do we still have that capacity? Hey MAGA, when was the "great" you want back, and what did it consist of? Do you honestly believe we're working towards anything that resembles "great"?
Incidentally, comparative-developed-country wise, it can't hurt to remind us here in the U.S. that our problem with fear over health insurance is rather unique.
The YouTube algorithm brought me something from DW (in Germany) where a U.S. expat in Germany says paying for healthcare is just completely different over there vs. here, and people just don't worry much about being unable to pay for it.
To represent the U.S. side in the comparison, we have this Jonathan Cohn post, the comments here, and about half of the other Jonathan Cohn posts, and the comments on those.
Nonetheless, I don't mind beating a dead horse, and being redundant with a sarcastic comment of mine down below:
In the U.S., for many, no matter what happens, and it will be more so if the expanded subsidies are allowed to lapse, or One Big Beautiful Bill (OBBB, Hakeem Jeffries now uses "One Big Ugly Bill") holds:
"I mean, people have access to health care in America. After all, you just go to an emergency room.".
Reminder: The emergency room will treat you to the point of medical-stabilization only, which they have to do because of the Reagan-era EMTALA law. (You are still legally-responsibly for the bills, and many hospitals will collect on that debt.)"
This comment is for an important completeness, and at the risk of distracting us from the current task that the Republicans have brought on us, which is to not go backwards, and have the U.S. health insurance system get worse.
(The current task is to reverse both the expiration of the expanded subsidies, which expanded subsidies included a fix of an initial ACA defect--the 400% of Federal Poverty Level (FPL) "subsidy cliff", and to reverse the provisions of the recent One Big Beautiful Bill (OBBB), which actually is larger in both numbers of people to become uninsured, and number of dollars, than the expiring expanded subsidies, but has been less-clumsily timed by the Republicans to start Jan 1, 2027 instead of Jan 1, 2026.)
There are other problems with the ACA that also need mending. They are state-specific problems, that is, they depend on how each state implements the details of the ACA, both on its own exchange (if it has one) and at the state Medicaid department (which all states have).
One problem needing to be fixed is that, in many states, there is an estate recovery of expanded Medicaid for people 55 or older when they had the coverage.
A second is that there can be poorly-thought-through administration of the ACA and/or Medicaid and expanded Medicaid, with various problems, including frequent thrashing of people up and down between the ACA on-exchange and expanded Medicaid.
I describe these in more detail here:
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Problem 1) The fixable problems with the current ACA, least discussed in the media, even the New York Times and Washington Post, is that, in some states, ACA expanded Medicaid (and other non-long-term-care Medicaids) can be estate recovered, at least for people who were 55 and over when they had the coverage.
I’ll cut and paste a bulleted item from just a bit of the ways down, which should make the precise issue clear:
“For individuals of any age, medical assistance paid by MassHealth for long-term care in a nursing home, Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID), or an Institution for Mental Disease (IMD). For former MassHealth members with a date of death before August 1, 2024, MassHealth is required to recover the total cost of care it paid for members after they turned 55.”
Within that quoted two sentences, that last sentence is the issue, fairly precisely stated.
In Massachusetts (that’s my state) there was a change, 10 years late (in my opinion) in 2024. They trimmed back the estate recover on Medicaid to the minimum federally required.
But the pre-2024 status in Massachusetts is the issue. (Think of it is that a state now is following the Massachusetts recovery rule, but it’s currently the one that Massachusetts was following between 2014 and 2023).
(Note MassHealth means Medicaid, including ACA expanded Medicaid.)
We don’t know if the state will go after a capitation, or all medical bills paid out. If it’s the latter, the person doesn’t have insurance at all, but rather they have a loan until death for medical expenses.
(In Massachusetts, at the other end of the phone when I had expanded Medicaid, a person told me an insurance company would decide the network and the amount of the bill to pay, but the payment would be made directly by the state. If that's true, then I had no insurance at all, but a loan until death for medical expenses.)
So, this can be fixed by federally prohibiting the estate recovery of non-long-term-care Medicaids.
(I am, frankly, not sure the economists who designed the ACA were aware of this issue, and even are now. I don't know if the two economists who wrote the newsletter post above are aware of the issue, or haven't dismissed it, in my opinion quite erroneously, as unimportant.
One might dismiss it as unimportant by saying, oh, it's only poor people with no assets to lose. But, besides the discounting of the savings of poor people being a problem, it's not just poor people. Expanded Medicaid has no asset test. People with substantial assets frequently wind up on expanded Medicaid. For example, early retired, or while pausing working for a bit. Especially since some Medicaid agencies apparently re-evaluate income frequently, and may use income for a period much shorter than annual.
As well, the notice of the estate recovery can be missing or inadequate. In Massachusetts, it was buried in the middle of a list of 20 items, which all seemed benign--like "we'll check with your employer to make sure you are not cheating...".
In the end, when I finally found out about the estate recovery, I was able to switch to paying full price for on exchange. Because eligibility for expanded Medicaid precludes eligibility for a subsidy on on-exchange. That was OK for me, due to my own finances, and the relatively low raw premiums in Massachusetts, due to the pooling of small-group and on-exchange. But, in some states, it's like $40,000 a year for a couple, and that would be a big problem for many people.)
I do know that in 2014, the Obama administration asked the states not to estate recover expanded Medicaid, but many, including Democratic ones, chose not to comply. (See:
Though, after early coverage in 2014 in some newspapers, leading to many states fixing the problem, many did not, and I believe even some Democratic states, such as NJ and MD, do still recover expanded Medicaid. And Massachusetts took 10 and a half years to fix it! Actually, only by the accident of one state legislator having to leave office because of a sort of a scandal, and another one replaced him, and saw the problem, and worked to get it fixed. (Sen. Comerford, the person replacing the one who had to leave, working with Rep. Barber.)
References on problem (1):
I point to an archived version of the Wikipedia article on Medicaid Estate Recovery, from around 2020, when yours truly (me), put the info in.
(I believe the live article still has the same content. But I gave the archived link just in case.)
(The link may or may not show up at bottom—I don’t know what substack will do)
Note the article is not up to date, so, for example, it is missing the Massachusetts repair in 2024.
(It has those flags in their from one other Wikipedia editor. I had a lot of trouble with Wikipedia from two other "editors" (who knew not a thing about health insurance), and even though a flag on unreliable sources is no longer applicable -- I had had some blog articles giving the flavor from some "The Democrats want to confiscate poor peoples" stuff assets", those are out. But I didn't want to remove the flag on unreliable sources, for fear that the whole article might get pulled from Wikipedia.)
Note that every assertion in the article is supported by references, though you may have to go to the Wayback archive for some of the references, whose live links have disappeared.
(I am allowing long-term care recovery as O.K. because the ACA does not attempt to fix our serious long-term-care financing problem. The ACA has left long-term-care as a problem for another day. But, for other than long-term care, it should be providing (real) health insurance with affordable premiums and copays to everyone. "Real" means not just a loan!)
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Problem (2): Some states, including Massachusetts, seem to thrash people up and down between expanded Medicaid and on-exchange plans, based on the state insisting on income rederminations or FPL adjustments.
This was my experience in Massachusetts, with my 9 years of ACA coverage from 2014 to 2022.
So, for example, one time, in about April, I get about 5 days notice that my on-exchange plan was being terminated, and I would then be on expanded Medicaid. What was the trigger? It took a lot of work to find out, but it was that the number they were using for my income, just a tiny bit over 138% of FPL, had become just a tiny bit below 138% of FPL, owing to changed FPL cutpoints, which changed midyear.
This same thing happened a second time, one year, around Nov 1 at open enrollment time. New income. It was either a quick thrashing up or down between the parts. I forget which. Then, they tell you send in proof of income. They will estimate next year's income however they choose, and they won't tell you in advance how they will estimate it. Another potential thrashing.
(On the Massachusetts ACA site, responsible for both on-exchange and expanded Medicaid enrollment, there is a big notice saying something like "tell us in the future any time your income changes".)
I don't know how often they might redetermine income in Massachusetts. Perhaps, if you had non-steady work, and did what they told you, and told them whenever your income changed, they might thrash you up and down as often as every month. Or even more often. Don't forget: new medical network each time!
(For my latter thrashing, I actually had a serious illness, and might have needed to be hospitalized. I didn't appreciate the changed network at all.)
Maybe there is some what to fix this in a changed ACA law, or with regulations and standards?
I've had to add a bit more as reply to this comment, owing to comment length limit.
I have a suspicion, besides that some of the policy people at the top of both designing and maintaining the ACA may not know about these problems (because they are a bit down in the weeds) and may feel it is administrative stuff, a job for people at the state level. Not their job.
No, it is their job. The states, many of them, at least, have, and will continue to screw it up unless you make it damned near impossible to screw up.
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Additional reference about both issues in Massachusetts:
I have kept around a reference to the paper version of the Massachusetts joint on-exchange ACA and expanded Medicaid application for 2019, which is a period when I was using that coverage, and when the estate recovery on expanded Medicaid was in effect.
On adobe pp. 22-23, there is a long list of conditions, that, on the Massachusetts exchange website, popped up on a screen after you put in all of your household information.
So, in that list, way down at items 9 and 10, past other benign-looking items if you're not going to cheat,
"9. To the extent permitted by law, MassHealth may place a lien against any real estate owned by eligible persons or in which eligible persons have a legal interest. If MassHealth puts a lien against such property and it is sold, money from the sale of that property may be used to repay MassHealth for medical services provided.
10. To the extent permitted by law, and unless exceptions apply, for any eligible person age 55 or older, or any eligible person for whom MassHealth helps pay for care in a nursing home, MassHealth will seek money from the eligible person’s estate after death."
So, I think I've made my point about the estate recovery on expanded Medicaid, and other non-long-term-care Medicaids, having been easy to miss.
I might as well add another point: with that "to the extent permitted by law" business, it means after you've gone through putting your information into the exchange website, you have to stop. Find a specialist attorney, and pay them figure out what, exactly, is the extent permitted by law. Before the end of open enrollment.
As well, my other point about the exchange requesting you notify them as soon as there is any change in your income is well made by item 11:
11. "Eligible persons must tell the health care program(s) in which they enroll about any changes in their or their household’s income or employment, household size, health insurance coverage, health insurance premiums, and immigration status, or about changes in any other information on this application and any supplements to it within 10 calendar days of learning of the change. Eligible persons can make changes by calling (800) 841-2900, TTY: (800) 497-4648 for people who are deaf, hard of hearing or speech disabled. A change in information could affect eligibility for such persons or for persons in their household."
By George, with this addition, I think I've done a very good job of documenting the two problems, if I am allowed to say so myself!
I will be happy, of course, to answer any questions posed in the comments.
I look forward to millions of red state Republicans losing access to health care, and even more importantly having to make difficult choices between their health and being able to afford housing and food. I am looking forward to this because I believe in a democracy the people deserve to get what they voted for, and get it good and hard.
I equally look forward to millions of American farmers explaining to their neighbors why they got billions of dollars in subsidy because Trump vaporized their farms profits, but their neighbors lost their healthcare because it was more important to hurt everyone else.
Today was the last day to enroll (or change) for Jan. 1st coverage, and I had to change my plan (in a red state.) Last year the ridiculously high subsidy was $2200, which covered the cost of my "silver" HMO plan. It went up to $3000 for 2026, and my plan went up $1500! So I would have to pay $700 per month for health care!
Wow!
I live on Social Security, a very modest income. No other pensions. So $700/month is a lot.
Fortunately there were two providers with "bronze" plans which came in under the $3000 subsidy. I'm sure I'll be paying a lot more in copays and out-of-pocket expenses, but I'm sure even going without medical insurance, my costs would be less than $700/month.
Welcome to America, where we may have the worst health care system in the developed world, but at least we can take pride in it being the most expensive!
There is something about the culture here in the U.S.. And, for many people, culture and inculcated / indoctrinated ideology over an understanding and rationality is the thing that guides them. (This is a well-known and highly-studied aspect of humanity, and well-understood by politicians over the millenia.) I hate that fact of the human condition. And I am sure there is some bit of that negative property in myself, but I hope not too much.
For people who haven't picked it up from other comments, Frau Katze is actually in Germany, and is one of the few people left from the rest of the world who chimes in comments on our U.S. healthcare system in various places. (Many people from Canada and Europe used to do that say at the NY Times comments sections, a year and more ago, but now, barely a sole from Canada or Europe is to be found. Apparently, they now don't want to help us, but just want us to suffer. I wonder what or who could possibly have caused that?)
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Frau Katze, actually, when she noticed my comment on Krugman's substack about a month ago regarding having my doubts about Dr. Brian Blase and the Paragon Health Institute, directed me to Jonathan Cohn's substack, where Jonathan had mentioned questionable research from Paragon in a post. So I sprung for the bulwark subscription to access Mr. Cohn.
Wait, you say? Why are my comments deleted, appearing blank?
I'll tell you.
I don't know.
For an unknown reason, all of my comments on Krugman were removed, and my commenting privileges stopped for a month!
Most likely, his comment moderator, or his AI, mistook one of my satirical comments as some kind of trolling.
See, the others gone, as well! Some were liked and complimented. People responded with useful information. Genuine high-end discourse. And now they are all gone!
Not only that, but I go way back with Mr. Krugman.
Here I am, back in 2008, about a month before it was announced that Paul Krugman won the Nobel Prize. At this time he is a relatively-obscure NY Times columnist:
tossing in a comment, on a post on the minutiae of health insurance mechanisms with all of about 10 other people. (My topic, BTW, was purchase health-insurance-across-state-lines Republican crap, still coming up in 2025.)
And then, less than, a month later, he wins the Nobel Prize, and everyone and his brother chimes in in his column, in the comments, "Congratulations on your success, Paul". From Paris. From London. From all over the world. Everyone wants to be connected to a Nobel Prize winner. (I declined such a transparent "congratulations" myself.) I recollect about 7,000 "Congratulations, Paul" on that day, and then Prof. Krugman quickly rises to stardom and being a liberal icon.
And my thanks for that being with him when he was just kind of small ! Well, you have seen what my thanks was!
P.S. I'll be O.K. I'm just whining. But, when I do get my comment-posting privileges back on Krugman, which will be in a week or two, he certainly won't be getting any comments that I invest any amount of time to come up with, unless posted elsewhere first!
The subsidies help a lot of people, but they hide the real problem, which is that health insurance should never cost anyone $3,000 a month. As a U.S. citizen living in a country with single-payer, I can tell you that even services paid entirely out of pocket are 60 to 90 percent cheaper than the equivalent in the U.S. There's an "affordability crisis" for you. Maybe the silver lining of the subsidies ending is that things will get so absurdly bad that the U.S. will finally be forced to scrap the system and rebuild it from scratch instead of wallpapering over it every couple of years.
In defense of the ACA, partly the $3,000 a month cost for an older individual or couple (under 65) is from "adverse selection", because not everyone chooses to get the coverage if there is a fee to pay for it (which most people have), and if they feel they are probably not going to get sick. So the people who wind up picking up coverage tend to be a bit less healthy than average compared to others their age.
As well, here in the U.S., we tend to do a lot of hidden cost-shifting, so that people on Medicaid and expanded Medicaid these programs are for lower-income groups) get their services charged at maybe 30% of what people on employer plans or ACA on-exchange plans pay. Our Medicare (people 65+) tends to pay about 60% rather than 30%. So, the costs before any subsidy on the ACA reflect much cost for other people being shifted to it.
(Many people in the U.S. just hate subsidies because of right-wing rhetoric and perhaps an added puerility. So they tend to have to be hidden.)
But your point, that wherever in the world you are now, the U.S. pays about 18% of GDP for healthcare, and you pay 9%-15%, for similar or lower life expectancies here, makes your point. (Those numbers being a well-known statistic. Some point out that we have more death by violence and obesity then elsewhere, so some of the lower life expectancy is from that, but it can't be that much.)
It's true. We need a complete overhaul of the healthcare system. The ACA was never a perfect plan. What would happen in a sane, serious country woild be something like temporarily extend the subsidies while a bi-partisan committee would work on a robust remaining of the whole sysrem. What passes for a healthcare system now is a travesty.
1000%. The truth is that the insurance industry has been profiteering from the ACA, and the enhanced subsidies. We have to see that. The R's are not wrong in that assessment. And I agree, it may take this crisis to understand the fundamental problem. We have to come to terms sooner or later that healthcare should not be a profit making industry. Once we've finally swallowed that concept, the rest may be relatively smooth sailing. But too many are choking on the entire notion of healthcare for all, as a human right. That's the thing we just cannot agree on.
I'm going to insert disagreement. In Massachusetts, where I live, I think most or all of the insurers are structured as non-profit. (Hospitals as well.)
Out healthcare costs are still quite high.
(Not to dispute that single-payer, being maybe analogous to standard Medicare for older people, has about a 98% payout ratio of bills paid to premium, whereas the ACA only requires 80%. As well, a fair amount of medical resource as services from physicians is eaten up by them having to monkey around and getting approvals from 500 different insurance companies, not all of which can be passed off to medical assistants. So, less total care is available with all of the insurers, not-for-profit or for-profit.)
This is the whole reason that the insurance industry bribed Manchin, Biden and others to deep six the public option in the ACA. The point of the public option was that it would ensure that the insurance companies couldn't simply profiteer off of the ACA, and Biden killed it. Which is why you don't let the old white guy from Delaware negotiate your signature legislative achievement after he bailed out the banks and left the rest of the country to lose their houses.
I heard Washington state Rep Adam Smith who seemed to have a good idea an interview: health insurance is fine, but cannot be a for-profit industry. That sounds reasonable. But how to thread that needle may be a challenge, since it strikes me there could be some creative get-arounds for the companies.
Its important to remember that from at least the 1800s until the early 1980s (thanks Ronnie) it was illegal to be a for profit insurance company. Not just health insurance, ANY INSURANCE. The only reason that ceased to be is because of Republicans lobbied by, surprise surprise, the insurance industry.
It was illegal because In jolly olde Englande at one point the insurers all colluded at one point and ran a scam not unlike the one insurers are running now and nearly bankrupt the crown, and the crown made it clear at the time that they could keep thier wealth or thier lives, but not both.
Its absolutely easy to return to that state and put the genie back in the bottle, all it takes is a handful of people willing to tell the wealthy that the gravy train is over. If our society cant manage that, then it probably doesnt deserve to exist.
St. Luigi has shown us the way forward, we all but have to follow in his righteous example.
👏 Love that: Keep your profits or your life. But you can't keep both. Yes, and I think hospitals were all once run mostly as not-for- profits, in the first half of the 20th century. Gradually, that changed. Now they're gorgons.
This should be a major problem for Massachusetts. Everyone must be enrolled in a plan, and proof of insurance is required with tax returns. A lot of people are going to take the lowest plan, which the state offsets with Medicaid money. Insuring all these people will be a massive drain on the stat’s budget.
Here's an UPDATE: the only pol I heard from was GOP Senator, McCormick. I didn't hear from Fetterman (but he did add me to his newsletter mailing lol). Also have not heard from my US Rep, Mary Gay-Scanlon. Fair warning, this will be a long post. I'll share McCormick's response, and my response to that.
"Dear Ms. Dunleavy,
Thank you for sharing your concerns regarding enhanced premium tax credits. Your feedback is essential as we work together to shape policies that benefit Pennsylvania and our country.
The premium tax credit was created under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) to subsidize health insurance for individuals and families who do not qualify for Medicaid and do not receive coverage through an employer. Under the ACA, eligibility for these credits is limited to those with annual incomes between 100% and 400% of the federal poverty level.
The enhanced premium tax credits (PTCs) were introduced through the American Rescue Plan Act of 2021 (ARPA) (P.L. 117-2) as a temporary measure for tax years 2021 and 2022, to make health insurance more affordable during the COVID-19 pandemic.
The enhanced PTCs removed the 400% federal poverty level income cap and were later extended for an additional three years under the Inflation Reduction Act (P.L. 117-169). According to a nonpartisan analysis by the Congressional Budget Office, permanently extending these enhanced PTCs could cost taxpayers approximately $355 billion over ten years.
I believe we must help low-income individuals access affordable health insurance when they truly need it. I also support efforts to minimize waste, fraud, and abuse that place unnecessary burdens on taxpayers and state governments. I will keep your views in mind as Congress considers whether to extend these credits.
It is an honor and a privilege to serve our great Commonwealth in the United States Senate. I appreciate having the benefit of your comments on this important matter. I am always grateful to hear from my constituents.
Sincerely,
Dave McCormick
U.S. Senator"
Here's my reply to Sen. McCormick:
Dear Sen. McCormick,
Thank you for your reply to my message regarding the enormous increase in premiums under the ACA, via Pennie in Pennsylvania. I mentioned in my first message that my premium has gone from approx $65 to $900 per month for an IBX Silver Basic plan. I failed to mention that I have been using ACA subsidies almost since its inception. I believe I joined in the second year.
Because I am self-employed, it is the ACA that has made it possible for me to get health insurance. Without the ACA, I would have never been able to afford it. Healthcare is not a luxury. It's a necessity. I agree with you that "we must help low-income individuals access affordable health insurance" but what do you mean by "when they truly need it"? Are Pennsylvanians not people who need healthcare? The GOP claims that the gig economy is what makes a work force flexible and efficient. But they won't support them with getting healthcare? Honestly, how is a person to live without healthcare? I have Basel cell Carcinoma and must visit my dermatologist every 6 months because I've never made it 5 years without a carcinoma. Literally, how do I live my life without healthcare? Who gets to decide that I "truly need it"?
I really do appreciate you taking the time to reply to my first message, but I must insist that you do more. I need to urge you to be a HERO for me and for other Pennsylvanians. We Pennsylvanians need you to figure out a way for us to get healthcare. We need to be able to go to a doctor, remove a carcinoma, and make sure our hearts are healthy unlike our father and brother who died in their 50s.
I assume you went into the US Senate to do big things, to make a difference. Please realize that THIS IS YOUR MOMENT to do something great for your constituents and for all Americans.
Yours truly - your constituent Jackie Dunleavy
Several Senate Republicans have said they have no intention of revisiting this issue. I’m in the category of people who would qualify for the subsidy but I am considering this to be a dead issue. I’m skeptical Thune would even let it come up for another vote because they have already voted it down once. The House effort is just from a small number of Republican Representatives desperate to try and improve their odds at the midterms by supporting something popular.
The person who actually could make this happen is President Trump, who despises all things “Obamacare.” (Although, I do think we could get him onboard for single payer right now if we were willing to call it Trumpcare.)
The one part of the issue that is true is that these were Covid era subsidies not originally intended to keep going. But the GOP totally botched health care as an issue by whacking other parts of health care in the BBB and not even looking at the issue again until the shutdown.
⭐ Pre-Existing Means Excluded
We remember a law that said, “You belong,”
If you’re sick or you’re well, you still can be strong.
Pre-existing? No problem.
You’re covered. You’re in.
Healthcare was human—not profit, not spin.
But Congress chopped coverage and pulled out the thread,
Now pre-existing means denied instead.
Cancer? Diabetes? Asthma too?
Sorry, dear neighbor—not covered for you.
Then came the chatter on Fox every night:
“Just buy it at Costco! It’s cheap! It’s all right!”
Rand Paul waved charts with a confident grin,
But group plans don’t work when you’re already sick within.
Costco plans? They’re not magic.
They’re not ACA law.
They can screen you and drop you—
That’s legally raw.
No subsidies. No guarantees.
No rule saying insurers must say “yes, please.”
Just old-school denial with shiny new names,
A rerun of history’s cruelest games.
So grandparents speak up, steady and true,
Cutting through noise that’s meant to confuse.
Because freedom means care when your health’s on the line—
Not disinformation dressed up as fine.
And we ask it out loud, for the people to see:
If pre-existing means excluded again…
Who is healthcare really for—
You and me?
#ResharingBrigade #GrandparentsForTruth #IndyMedia #ProDemocracy #SupportUkraine #SupportPalestine #SupportAfghanVets
This defund and destroy playbook is as old as the hills for Republicans. Withhold needed funding causing people to decry how poorly it all works and forcing them to walk away from something that actually worked pretty good, offer no alternative and then watch it all dry up and blow away with the wind as not enough people are in the system to keep the costs down. Congratulations Mike Johnson. You win. There’s a special place in hell for you.
They could.
But they won’t. There’s on what 2,3 working days Congress has left? And they get to come back in January and somehow get a budget or CR passed.
Well, Speaker Johnson said there's not going to be a vote - "It just wasn't meant to be."
So...
Great article and brings to mind how the discourse can by highjacked by blowhards. The ACA is offers GROUP plans, leveraging buying power, and it offers choice. Dems would do well to make these points more clearly. Also, aside from the moral imperative, every uninsured and under-insured person costs the system (all of us!) more than providing subsidies, as we don't turn away people who turn up at our emergency rooms.
Don't know whether to laugh or cry. As a disabled Veteran, my health care is covered by the VA which good...when you can get it and with cuts and vacancies in the staff, that's a real adventure. Anyhow, back to my point. Indeed, Biden was able to get and extension with retroactive coverages. But, and it's a big but, he had not gutted the agency if people capable of implementing it! Do we still have that capacity? Hey MAGA, when was the "great" you want back, and what did it consist of? Do you honestly believe we're working towards anything that resembles "great"?
Incidentally, comparative-developed-country wise, it can't hurt to remind us here in the U.S. that our problem with fear over health insurance is rather unique.
The YouTube algorithm brought me something from DW (in Germany) where a U.S. expat in Germany says paying for healthcare is just completely different over there vs. here, and people just don't worry much about being unable to pay for it.
That's here:
https://www.youtube.com/watch?v=MNzJkMUowsI
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To represent the U.S. side in the comparison, we have this Jonathan Cohn post, the comments here, and about half of the other Jonathan Cohn posts, and the comments on those.
Nonetheless, I don't mind beating a dead horse, and being redundant with a sarcastic comment of mine down below:
In the U.S., for many, no matter what happens, and it will be more so if the expanded subsidies are allowed to lapse, or One Big Beautiful Bill (OBBB, Hakeem Jeffries now uses "One Big Ugly Bill") holds:
"I mean, people have access to health care in America. After all, you just go to an emergency room.".
-George W. Bush, 7/10/07 ' ,
"(From here: https://web.archive.org/web/20100423045051/https://georgewbush-whitehouse.archives.gov/news/releases/2007/07/20070710-6.html
At about the 17th paragraph.)
Reminder: The emergency room will treat you to the point of medical-stabilization only, which they have to do because of the Reagan-era EMTALA law. (You are still legally-responsibly for the bills, and many hospitals will collect on that debt.)"
This comment is for an important completeness, and at the risk of distracting us from the current task that the Republicans have brought on us, which is to not go backwards, and have the U.S. health insurance system get worse.
(The current task is to reverse both the expiration of the expanded subsidies, which expanded subsidies included a fix of an initial ACA defect--the 400% of Federal Poverty Level (FPL) "subsidy cliff", and to reverse the provisions of the recent One Big Beautiful Bill (OBBB), which actually is larger in both numbers of people to become uninsured, and number of dollars, than the expiring expanded subsidies, but has been less-clumsily timed by the Republicans to start Jan 1, 2027 instead of Jan 1, 2026.)
There are other problems with the ACA that also need mending. They are state-specific problems, that is, they depend on how each state implements the details of the ACA, both on its own exchange (if it has one) and at the state Medicaid department (which all states have).
One problem needing to be fixed is that, in many states, there is an estate recovery of expanded Medicaid for people 55 or older when they had the coverage.
A second is that there can be poorly-thought-through administration of the ACA and/or Medicaid and expanded Medicaid, with various problems, including frequent thrashing of people up and down between the ACA on-exchange and expanded Medicaid.
I describe these in more detail here:
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Problem 1) The fixable problems with the current ACA, least discussed in the media, even the New York Times and Washington Post, is that, in some states, ACA expanded Medicaid (and other non-long-term-care Medicaids) can be estate recovered, at least for people who were 55 and over when they had the coverage.
In case you or readers are not familiar with the issue, I link to the Massachusetts estate recovery page https://www.mass.gov/info-details/massachusetts-medicaid-estate-recovery
I’ll cut and paste a bulleted item from just a bit of the ways down, which should make the precise issue clear:
“For individuals of any age, medical assistance paid by MassHealth for long-term care in a nursing home, Intermediate Care Facility for Persons with Intellectual Disability (ICF/ID), or an Institution for Mental Disease (IMD). For former MassHealth members with a date of death before August 1, 2024, MassHealth is required to recover the total cost of care it paid for members after they turned 55.”
Within that quoted two sentences, that last sentence is the issue, fairly precisely stated.
In Massachusetts (that’s my state) there was a change, 10 years late (in my opinion) in 2024. They trimmed back the estate recover on Medicaid to the minimum federally required.
But the pre-2024 status in Massachusetts is the issue. (Think of it is that a state now is following the Massachusetts recovery rule, but it’s currently the one that Massachusetts was following between 2014 and 2023).
(Note MassHealth means Medicaid, including ACA expanded Medicaid.)
We don’t know if the state will go after a capitation, or all medical bills paid out. If it’s the latter, the person doesn’t have insurance at all, but rather they have a loan until death for medical expenses.
(In Massachusetts, at the other end of the phone when I had expanded Medicaid, a person told me an insurance company would decide the network and the amount of the bill to pay, but the payment would be made directly by the state. If that's true, then I had no insurance at all, but a loan until death for medical expenses.)
So, this can be fixed by federally prohibiting the estate recovery of non-long-term-care Medicaids.
(I am, frankly, not sure the economists who designed the ACA were aware of this issue, and even are now. I don't know if the two economists who wrote the newsletter post above are aware of the issue, or haven't dismissed it, in my opinion quite erroneously, as unimportant.
One might dismiss it as unimportant by saying, oh, it's only poor people with no assets to lose. But, besides the discounting of the savings of poor people being a problem, it's not just poor people. Expanded Medicaid has no asset test. People with substantial assets frequently wind up on expanded Medicaid. For example, early retired, or while pausing working for a bit. Especially since some Medicaid agencies apparently re-evaluate income frequently, and may use income for a period much shorter than annual.
As well, the notice of the estate recovery can be missing or inadequate. In Massachusetts, it was buried in the middle of a list of 20 items, which all seemed benign--like "we'll check with your employer to make sure you are not cheating...".
In the end, when I finally found out about the estate recovery, I was able to switch to paying full price for on exchange. Because eligibility for expanded Medicaid precludes eligibility for a subsidy on on-exchange. That was OK for me, due to my own finances, and the relatively low raw premiums in Massachusetts, due to the pooling of small-group and on-exchange. But, in some states, it's like $40,000 a year for a couple, and that would be a big problem for many people.)
I do know that in 2014, the Obama administration asked the states not to estate recover expanded Medicaid, but many, including Democratic ones, chose not to comply. (See:
https://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-14-001.pdf and
https://www.healthaffairs.org/content/forefront/implementing-health-reform-medicaid-asset-rules-and-affordable-care-act )
As well, it was caught by Andrew Sprung a few times relatively recently, such as:
https://xpostfactoid.blogspot.com/2021/01/the-117th-congress-should-end-medicaid.html
Though, after early coverage in 2014 in some newspapers, leading to many states fixing the problem, many did not, and I believe even some Democratic states, such as NJ and MD, do still recover expanded Medicaid. And Massachusetts took 10 and a half years to fix it! Actually, only by the accident of one state legislator having to leave office because of a sort of a scandal, and another one replaced him, and saw the problem, and worked to get it fixed. (Sen. Comerford, the person replacing the one who had to leave, working with Rep. Barber.)
References on problem (1):
I point to an archived version of the Wikipedia article on Medicaid Estate Recovery, from around 2020, when yours truly (me), put the info in.
https://web.archive.org/web/20250824223703/https://en.wikipedia.org/wiki/Medicaid_estate_recovery
(I believe the live article still has the same content. But I gave the archived link just in case.)
(The link may or may not show up at bottom—I don’t know what substack will do)
Note the article is not up to date, so, for example, it is missing the Massachusetts repair in 2024.
(It has those flags in their from one other Wikipedia editor. I had a lot of trouble with Wikipedia from two other "editors" (who knew not a thing about health insurance), and even though a flag on unreliable sources is no longer applicable -- I had had some blog articles giving the flavor from some "The Democrats want to confiscate poor peoples" stuff assets", those are out. But I didn't want to remove the flag on unreliable sources, for fear that the whole article might get pulled from Wikipedia.)
Note that every assertion in the article is supported by references, though you may have to go to the Wayback archive for some of the references, whose live links have disappeared.
(I am allowing long-term care recovery as O.K. because the ACA does not attempt to fix our serious long-term-care financing problem. The ACA has left long-term-care as a problem for another day. But, for other than long-term care, it should be providing (real) health insurance with affordable premiums and copays to everyone. "Real" means not just a loan!)
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Problem (2): Some states, including Massachusetts, seem to thrash people up and down between expanded Medicaid and on-exchange plans, based on the state insisting on income rederminations or FPL adjustments.
This was my experience in Massachusetts, with my 9 years of ACA coverage from 2014 to 2022.
So, for example, one time, in about April, I get about 5 days notice that my on-exchange plan was being terminated, and I would then be on expanded Medicaid. What was the trigger? It took a lot of work to find out, but it was that the number they were using for my income, just a tiny bit over 138% of FPL, had become just a tiny bit below 138% of FPL, owing to changed FPL cutpoints, which changed midyear.
This same thing happened a second time, one year, around Nov 1 at open enrollment time. New income. It was either a quick thrashing up or down between the parts. I forget which. Then, they tell you send in proof of income. They will estimate next year's income however they choose, and they won't tell you in advance how they will estimate it. Another potential thrashing.
(On the Massachusetts ACA site, responsible for both on-exchange and expanded Medicaid enrollment, there is a big notice saying something like "tell us in the future any time your income changes".)
I don't know how often they might redetermine income in Massachusetts. Perhaps, if you had non-steady work, and did what they told you, and told them whenever your income changed, they might thrash you up and down as often as every month. Or even more often. Don't forget: new medical network each time!
(For my latter thrashing, I actually had a serious illness, and might have needed to be hospitalized. I didn't appreciate the changed network at all.)
Maybe there is some what to fix this in a changed ACA law, or with regulations and standards?
I've had to add a bit more as reply to this comment, owing to comment length limit.
(Continuation)
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I have a suspicion, besides that some of the policy people at the top of both designing and maintaining the ACA may not know about these problems (because they are a bit down in the weeds) and may feel it is administrative stuff, a job for people at the state level. Not their job.
No, it is their job. The states, many of them, at least, have, and will continue to screw it up unless you make it damned near impossible to screw up.
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Additional reference about both issues in Massachusetts:
I have kept around a reference to the paper version of the Massachusetts joint on-exchange ACA and expanded Medicaid application for 2019, which is a period when I was using that coverage, and when the estate recovery on expanded Medicaid was in effect.
That's here:
https://web.archive.org/web/20220814230835/https://www.bmc.org/sites/default/files/Programs___Services/Services/aca-3-english-3-21-19.pdf
On adobe pp. 22-23, there is a long list of conditions, that, on the Massachusetts exchange website, popped up on a screen after you put in all of your household information.
So, in that list, way down at items 9 and 10, past other benign-looking items if you're not going to cheat,
"9. To the extent permitted by law, MassHealth may place a lien against any real estate owned by eligible persons or in which eligible persons have a legal interest. If MassHealth puts a lien against such property and it is sold, money from the sale of that property may be used to repay MassHealth for medical services provided.
10. To the extent permitted by law, and unless exceptions apply, for any eligible person age 55 or older, or any eligible person for whom MassHealth helps pay for care in a nursing home, MassHealth will seek money from the eligible person’s estate after death."
So, I think I've made my point about the estate recovery on expanded Medicaid, and other non-long-term-care Medicaids, having been easy to miss.
I might as well add another point: with that "to the extent permitted by law" business, it means after you've gone through putting your information into the exchange website, you have to stop. Find a specialist attorney, and pay them figure out what, exactly, is the extent permitted by law. Before the end of open enrollment.
As well, my other point about the exchange requesting you notify them as soon as there is any change in your income is well made by item 11:
11. "Eligible persons must tell the health care program(s) in which they enroll about any changes in their or their household’s income or employment, household size, health insurance coverage, health insurance premiums, and immigration status, or about changes in any other information on this application and any supplements to it within 10 calendar days of learning of the change. Eligible persons can make changes by calling (800) 841-2900, TTY: (800) 497-4648 for people who are deaf, hard of hearing or speech disabled. A change in information could affect eligibility for such persons or for persons in their household."
By George, with this addition, I think I've done a very good job of documenting the two problems, if I am allowed to say so myself!
I will be happy, of course, to answer any questions posed in the comments.
I look forward to millions of red state Republicans losing access to health care, and even more importantly having to make difficult choices between their health and being able to afford housing and food. I am looking forward to this because I believe in a democracy the people deserve to get what they voted for, and get it good and hard.
I equally look forward to millions of American farmers explaining to their neighbors why they got billions of dollars in subsidy because Trump vaporized their farms profits, but their neighbors lost their healthcare because it was more important to hurt everyone else.
Today was the last day to enroll (or change) for Jan. 1st coverage, and I had to change my plan (in a red state.) Last year the ridiculously high subsidy was $2200, which covered the cost of my "silver" HMO plan. It went up to $3000 for 2026, and my plan went up $1500! So I would have to pay $700 per month for health care!
Wow!
I live on Social Security, a very modest income. No other pensions. So $700/month is a lot.
Fortunately there were two providers with "bronze" plans which came in under the $3000 subsidy. I'm sure I'll be paying a lot more in copays and out-of-pocket expenses, but I'm sure even going without medical insurance, my costs would be less than $700/month.
Welcome to America, where we may have the worst health care system in the developed world, but at least we can take pride in it being the most expensive!
I’m being assailed in the comments at the WSJ where I defended Canada’s single payer system. They have these Fox News talking points.
Oh, Frau Katze. Nice to see you here!
There is something about the culture here in the U.S.. And, for many people, culture and inculcated / indoctrinated ideology over an understanding and rationality is the thing that guides them. (This is a well-known and highly-studied aspect of humanity, and well-understood by politicians over the millenia.) I hate that fact of the human condition. And I am sure there is some bit of that negative property in myself, but I hope not too much.
For people who haven't picked it up from other comments, Frau Katze is actually in Germany, and is one of the few people left from the rest of the world who chimes in comments on our U.S. healthcare system in various places. (Many people from Canada and Europe used to do that say at the NY Times comments sections, a year and more ago, but now, barely a sole from Canada or Europe is to be found. Apparently, they now don't want to help us, but just want us to suffer. I wonder what or who could possibly have caused that?)
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Frau Katze, actually, when she noticed my comment on Krugman's substack about a month ago regarding having my doubts about Dr. Brian Blase and the Paragon Health Institute, directed me to Jonathan Cohn's substack, where Jonathan had mentioned questionable research from Paragon in a post. So I sprung for the bulwark subscription to access Mr. Cohn.
That interplay of comments is here:
https://paulkrugman.substack.com/p/vibecessions-part-ii/comment/180320182
Wait, you say? Why are my comments deleted, appearing blank?
I'll tell you.
I don't know.
For an unknown reason, all of my comments on Krugman were removed, and my commenting privileges stopped for a month!
Most likely, his comment moderator, or his AI, mistook one of my satirical comments as some kind of trolling.
See, the others gone, as well! Some were liked and complimented. People responded with useful information. Genuine high-end discourse. And now they are all gone!
https://paulkrugman.substack.com/p/hard-landings/comment/179644750
https://paulkrugman.substack.com/p/the-vibecession-deepens/comment/179254062
https://paulkrugman.substack.com/p/doge-was-a-harbinger-of-trumps-assault/comment/181002566
(Many of my comments found useful by others, and the last one useful to me, referring me to Jonathan Cohn's substack.)
Like the empty frames at the Isabella Stewart Gardner museum, where paintings stolen in a giant heist a few decades ago once were. ( https://www.gardnermuseum.org/blog/five-frames-left-behind ) !
Not only that, I was a paying subscriber!
Not only that, but I go way back with Mr. Krugman.
Here I am, back in 2008, about a month before it was announced that Paul Krugman won the Nobel Prize. At this time he is a relatively-obscure NY Times columnist:
https://archive.nytimes.com/krugman.blogs.nytimes.com/2008/09/19/mccain-on-banking-and-health/
tossing in a comment, on a post on the minutiae of health insurance mechanisms with all of about 10 other people. (My topic, BTW, was purchase health-insurance-across-state-lines Republican crap, still coming up in 2025.)
And then, less than, a month later, he wins the Nobel Prize, and everyone and his brother chimes in in his column, in the comments, "Congratulations on your success, Paul". From Paris. From London. From all over the world. Everyone wants to be connected to a Nobel Prize winner. (I declined such a transparent "congratulations" myself.) I recollect about 7,000 "Congratulations, Paul" on that day, and then Prof. Krugman quickly rises to stardom and being a liberal icon.
And my thanks for that being with him when he was just kind of small ! Well, you have seen what my thanks was!
P.S. I'll be O.K. I'm just whining. But, when I do get my comment-posting privileges back on Krugman, which will be in a week or two, he certainly won't be getting any comments that I invest any amount of time to come up with, unless posted elsewhere first!
That’s weird. I notice Krugman’s comments are more policed than other Substacks.
The subsidies help a lot of people, but they hide the real problem, which is that health insurance should never cost anyone $3,000 a month. As a U.S. citizen living in a country with single-payer, I can tell you that even services paid entirely out of pocket are 60 to 90 percent cheaper than the equivalent in the U.S. There's an "affordability crisis" for you. Maybe the silver lining of the subsidies ending is that things will get so absurdly bad that the U.S. will finally be forced to scrap the system and rebuild it from scratch instead of wallpapering over it every couple of years.
In defense of the ACA, partly the $3,000 a month cost for an older individual or couple (under 65) is from "adverse selection", because not everyone chooses to get the coverage if there is a fee to pay for it (which most people have), and if they feel they are probably not going to get sick. So the people who wind up picking up coverage tend to be a bit less healthy than average compared to others their age.
As well, here in the U.S., we tend to do a lot of hidden cost-shifting, so that people on Medicaid and expanded Medicaid these programs are for lower-income groups) get their services charged at maybe 30% of what people on employer plans or ACA on-exchange plans pay. Our Medicare (people 65+) tends to pay about 60% rather than 30%. So, the costs before any subsidy on the ACA reflect much cost for other people being shifted to it.
(Many people in the U.S. just hate subsidies because of right-wing rhetoric and perhaps an added puerility. So they tend to have to be hidden.)
But your point, that wherever in the world you are now, the U.S. pays about 18% of GDP for healthcare, and you pay 9%-15%, for similar or lower life expectancies here, makes your point. (Those numbers being a well-known statistic. Some point out that we have more death by violence and obesity then elsewhere, so some of the lower life expectancy is from that, but it can't be that much.)
It's true. We need a complete overhaul of the healthcare system. The ACA was never a perfect plan. What would happen in a sane, serious country woild be something like temporarily extend the subsidies while a bi-partisan committee would work on a robust remaining of the whole sysrem. What passes for a healthcare system now is a travesty.
You will get no argument from me on the overall problem — ie, underlying cost of American health care
The international comparisons are also important
Stay tuned for more on this very topic!
I have a saying, and you are welcome to use it (but you read it here first!)
We may have the worst health care in the developed world, but at least it's the most expensive!
1000%. The truth is that the insurance industry has been profiteering from the ACA, and the enhanced subsidies. We have to see that. The R's are not wrong in that assessment. And I agree, it may take this crisis to understand the fundamental problem. We have to come to terms sooner or later that healthcare should not be a profit making industry. Once we've finally swallowed that concept, the rest may be relatively smooth sailing. But too many are choking on the entire notion of healthcare for all, as a human right. That's the thing we just cannot agree on.
I'm going to insert disagreement. In Massachusetts, where I live, I think most or all of the insurers are structured as non-profit. (Hospitals as well.)
Out healthcare costs are still quite high.
(Not to dispute that single-payer, being maybe analogous to standard Medicare for older people, has about a 98% payout ratio of bills paid to premium, whereas the ACA only requires 80%. As well, a fair amount of medical resource as services from physicians is eaten up by them having to monkey around and getting approvals from 500 different insurance companies, not all of which can be passed off to medical assistants. So, less total care is available with all of the insurers, not-for-profit or for-profit.)
This is the whole reason that the insurance industry bribed Manchin, Biden and others to deep six the public option in the ACA. The point of the public option was that it would ensure that the insurance companies couldn't simply profiteer off of the ACA, and Biden killed it. Which is why you don't let the old white guy from Delaware negotiate your signature legislative achievement after he bailed out the banks and left the rest of the country to lose their houses.
I heard Washington state Rep Adam Smith who seemed to have a good idea an interview: health insurance is fine, but cannot be a for-profit industry. That sounds reasonable. But how to thread that needle may be a challenge, since it strikes me there could be some creative get-arounds for the companies.
Its important to remember that from at least the 1800s until the early 1980s (thanks Ronnie) it was illegal to be a for profit insurance company. Not just health insurance, ANY INSURANCE. The only reason that ceased to be is because of Republicans lobbied by, surprise surprise, the insurance industry.
It was illegal because In jolly olde Englande at one point the insurers all colluded at one point and ran a scam not unlike the one insurers are running now and nearly bankrupt the crown, and the crown made it clear at the time that they could keep thier wealth or thier lives, but not both.
Its absolutely easy to return to that state and put the genie back in the bottle, all it takes is a handful of people willing to tell the wealthy that the gravy train is over. If our society cant manage that, then it probably doesnt deserve to exist.
St. Luigi has shown us the way forward, we all but have to follow in his righteous example.
👏 Love that: Keep your profits or your life. But you can't keep both. Yes, and I think hospitals were all once run mostly as not-for- profits, in the first half of the 20th century. Gradually, that changed. Now they're gorgons.
Knock it off with what the Dems should do. ALL CONGRESS SHOULD DO WHAT IS RIGHT
This should be a major problem for Massachusetts. Everyone must be enrolled in a plan, and proof of insurance is required with tax returns. A lot of people are going to take the lowest plan, which the state offsets with Medicaid money. Insuring all these people will be a massive drain on the stat’s budget.
Let the Trump voters feel the pain. Yeah, sucks for the normies, but they have to experience the consequences of their actions someday.