Were you wrong about the Affordable Care Act?

Greenbeard · Mar 16, 2021

Next week we'll hit the eleventh anniversary of the Affordable Care Act becoming law (not bad, given that some didn't think it would survive to its first birthday!). It's fun to think back now to the many predictions, quantitative and otherwise, that were made back then. From John Boehner's warning at the time that its passage would be "Armageddon" and "ruin the country," it was the subject of many outlandish, and frankly deranged, prophecies.

Sarah Palin famously warned that under the ACA her "parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." That turned out not to be a real thing!

Some predicted that private insurance would be made illegal (nope!) or at least that conservatives' then-favorite insurance products, HSAs and high deductible plans, would be outlawed (seems these days like they wish they had been!). Other were less outlandish but still wrong. The ACA would erode employer-based coverage (instead it grew), jeopardize access for seniors (it didn't), destroy Medicare Advantage (it's more popular than ever, and no longer costs more than traditional Medicare), or that projected savings in Medicare were somehow being 'double counted' and would not actually extend the life of the Medicare Trust Fund beyond its expected 2017 exhaustion date (wrong, it did).

Of course, it wasn't just the absurd doom-and-gloomers who were wrong. I thought the first decade of the ACA would mostly be a coverage story, and we wouldn't see much in the way of fruits of its cost containment and care delivery changes until the 2020s. I bought the official prediction that it might push up health spending slightly relative to the baseline over its first decade (instead cumulative costs were $2.7 trillion below the baseline). I underestimated how much GOP political pressures would undermine the law's federalist approach. I thought the individual mandate was a much more important piece of the law's architecture than it seems to have been.

How about you? Has more than a decade of experience with the ACA caused you to update any of your priors?

AGENT J · Mar 16, 2021

Greenbeard said:
Next week we'll hit the eleventh anniversary of the Affordable Care Act becoming law (not bad, given that some didn't think it would survive to its first birthday!). It's fun to think back now to the many predictions, quantitative and otherwise, that were made back then. From John Boehner's warning at the time that its passage would be "Armageddon" and "ruin the country," it was the subject of many outlandish, and frankly deranged, prophecies.

Sarah Palin famously warned that under the ACA her "parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." That turned out not to be a real thing!

Some predicted that private insurance would be made illegal (nope!) or at least that conservatives' then-favorite insurance products, HSAs and high deductible plans, would be outlawed (seems these days like they wish they had been!). Other were less outlandish but still wrong. The ACA would erode employer-based coverage (instead it grew), jeopardize access for seniors (it didn't), destroy Medicare Advantage (it's more popular than ever, and no longer costs more than traditional Medicare), or that projected savings in Medicare were somehow being 'double counted' and would not actually extend the life of the Medicare Trust Fund beyond its expected 2017 exhaustion date (wrong, it did).

Of course, it wasn't just the absurd doom-and-gloomers who were wrong. I thought the first decade of the ACA would mostly be a coverage story, and we wouldn't see much in the way of fruits of its cost containment and care delivery changes until the 2020s. I bought the official prediction that it might push up health spending slightly relative to the baseline over its first decade (instead cumulative costs were $2.7 trillion below the baseline). I underestimated how much GOP political pressures would undermine the law's federalist approach. I thought the individual mandate was a much more important piece of the law's architecture than it seems to have been.

How about you? Has more than a decade of experience with the ACA caused you to update any of your priors?

The ACA was and is not a fix to health care but it is a miracle in many ways simply based on how much it was sabotaged and attacked and its still here benefiting millions

the plan with ANY healthcare system/bill is that it will forever need tweaked and worked on for continued improvement . . to fix parts not working so well, redo parts that failed etc etc

ALiberalModerate · Mar 16, 2021

Turned out as I expected, not a total panacea and not a disaster either.

phoenix2020 · Mar 16, 2021

It's survived a decade of Repeal and Replace (well, more like "Repeal and let's not talk too much about Replace right now") so it's hardy.

Vadinho · Mar 16, 2021

First of all, the ACA was a compromise to get a bi-partisan bill passed that Obama hoped would transform our health care system and move it towards a world class system worthy of the USA. He believed in the better angels of his own party and of the GOP. He was wrong yet he still accomplished an incredible feat by getting it passed. The sabotage of it by the GOP is the only story worth discussing now. No one expected the first cut to be the last cut, it was a step not a destination. If any of you thinks the GOP cares about you, remember what they did to the only real attempt to give every American health care.

swing_voter · Mar 16, 2021

65 million old people are insured by Medicare
73 poor people are insured by Medicaid
About 150 million people are insured by their place of work as a perk

That leaves quite a few without health insurance, mostly small business owners, plumbers, accountants, etc.

The ACA allows these small business owners to team up and enjoy the savings of group buying power. Ten thousand people can get insurance cheaper than 1 person.

I think the ACA needs work but it's a step in the right direction.

.

Greenbeard · Mar 17, 2021

AGENT J said:
The ACA was and is not a fix to health care but it is a miracle in many ways simply based on how much it was sabotaged and attacked and its still here benefiting millions

the plan with ANY healthcare system/bill is that it will forever need tweaked and worked on for continued improvement . . to fix parts not working so well, redo parts that failed etc etc

There's an odd thing about the ACA where anyone even mildly supportive of it or its achievements feels the need to preface every mention of it with a clarification that it's not perfect, it involves compromises, the work in improving our heath care system will have to continue, etc. All of which are true! But it's also okay to just acknowledge that it's a good thing. For 49 years (until the ACA, actually) Medicaid didn't cover poor adults if they didn't have children, and Medicare even today doesn't cap out-of-pocket spending, leading to a proliferation of supplemental private plans to fill in those gaps. But people don't start every conversation about Medicaid or Medicare with "well, they're not perfect, but...".

I think it's because the GOP was so effective at flooding the zone early on with "bad news," much of it fabricated (see Palin's death panels) or inconsequential. I remember a time when HHS offering 1-year waivers for mini-med plans was the biggest scandal in the rightwing infotainment universe. A decade later does anyone even remember what those were?

Unfortunately, nobody ever counter-flooded the zone with the myriad good news that was actually significant that emerged over the past ten years (record lows in cost growth, people experiencing better health outcomes, health care quality improving, etc, etc). Which has left even many of the ACA's supporters feel like there's something to apologize for.

Greenbeard · Mar 17, 2021

Vadinho said:
The sabotage of it by the GOP is the only story worth discussing now.

I agree it's certainly worth discussing the GOP's sabotage. But saying it's the only story implies there isn't a hugely positive story to tell about the ACA, in spite of the GOP's efforts.

I've long thought there's never been a real reckoning on the right as to how wrong they were, for years, in their predictions about what was going to happen to American health care if the ACA passed. But this thread is reminding me that the right's frame often subconsciously shapes even how the left/center views the law and its performance, too.

Part of the impetus for this thread was to see if anyone's reflected a bit on what they got right and wrong. The eleventh anniversary of passage is as good a time as any!

AGENT J · Mar 17, 2021

Greenbeard said:
There's an odd thing about the ACA where anyone even mildly supportive of it or its achievements feels the need to preface every mention of it with a clarification that it's not perfect, it involves compromises, the work in improving our heath care system will have to continue, etc. All of which are true! But it's also okay to just acknowledge that it's a good thing. For 49 years (until the ACA, actually) Medicaid didn't cover poor adults if they didn't have children, and Medicare even today doesn't cap out-of-pocket spending, leading to a proliferation of supplemental private plans to fill in those gaps. But people don't start every conversation about Medicaid or Medicare with "well, they're not perfect, but...".

I think it's because the GOP was so effective at flooding the zone early on with "bad news," much of it fabricated (see Palin's death panels) or inconsequential. I remember a time when HHS offering 1-year waivers for mini-med plans was the biggest scandal in the rightwing infotainment universe. A decade later does anyone even remember what those were?

Unfortunately, nobody ever counter-flooded the zone with the myriad good news that was actually significant that emerged over the past ten years (record lows in cost growth, people experiencing better health outcomes, health care quality improving, etc, etc). Which has left even many of the ACA's supporters feel like there's something to apologize for.

Its probably a preface because of the loons and snowflakes out there that act like the ACA is the devil and start instantly crying over its praise lol . . so I agree with your assessment.
Yes it has way more pros than cons and I will continue to support it and the bottom line is without it my mom probably dies a lot sooner than she did and Id be currently living in a one-room apartment because i would have sold my house to help her.

SkyChief · Mar 17, 2021

I expected the ACA to be complete disaster, and it is.

"If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor." was a lie, and Obama later admitted it.

Threegoofs · Mar 17, 2021

Greenbeard said:
Next week we'll hit the eleventh anniversary of the Affordable Care Act becoming law (not bad, given that some didn't think it would survive to its first birthday!). It's fun to think back now to the many predictions, quantitative and otherwise, that were made back then. From John Boehner's warning at the time that its passage would be "Armageddon" and "ruin the country," it was the subject of many outlandish, and frankly deranged, prophecies.

Sarah Palin famously warned that under the ACA her "parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." That turned out not to be a real thing!

Some predicted that private insurance would be made illegal (nope!) or at least that conservatives' then-favorite insurance products, HSAs and high deductible plans, would be outlawed (seems these days like they wish they had been!). Other were less outlandish but still wrong. The ACA would erode employer-based coverage (instead it grew), jeopardize access for seniors (it didn't), destroy Medicare Advantage (it's more popular than ever, and no longer costs more than traditional Medicare), or that projected savings in Medicare were somehow being 'double counted' and would not actually extend the life of the Medicare Trust Fund beyond its expected 2017 exhaustion date (wrong, it did).

Of course, it wasn't just the absurd doom-and-gloomers who were wrong. I thought the first decade of the ACA would mostly be a coverage story, and we wouldn't see much in the way of fruits of its cost containment and care delivery changes until the 2020s. I bought the official prediction that it might push up health spending slightly relative to the baseline over its first decade (instead cumulative costs were $2.7 trillion below the baseline). I underestimated how much GOP political pressures would undermine the law's federalist approach. I thought the individual mandate was a much more important piece of the law's architecture than it seems to have been.

How about you? Has more than a decade of experience with the ACA caused you to update any of your priors?

Unsure. I had higher hopes initially, but it was watered down and the Medicaid portion was not adopted by many states. But its made a great dent in uninsured and has helped decouple health care from employers.

But my expectations changed so much between 2009 and now, I cant tell you if its 'better' or 'worse'. Its unquestionably good though, but it could be so much better....

rickc · Mar 17, 2021

It could have been much better If the democrats didn't compromise in the spirit of bipartisanship. As usual Republicans are willing to negotiate. They will let you compromise your position. Then they all vote against it anyway.

Remarkable it survived all these years with Republicans claiming to repeal and replace continuously.

Too bad there isn't bipartisanship. ACA needs a tuneup. It could be made much better.

upsideguy · Mar 17, 2021

SkyChief said:
I expected the ACA to be complete disaster, and it is.

"If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor." was a lie, and Obama later admitted it.

How is it a complete disaster? Please elaborate and document.

SNOWFLAKE · Mar 17, 2021

SkyChief said:
I expected the ACA to be complete disaster, and it is.

"If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor." was a lie, and Obama later admitted it.

so never mind the millions who have benefitted, you have a grievance about something that was said at the time, and are still carrying that grievance??

Montgomery · Mar 17, 2021

I had to choose an answer to see the results of the poll. I chose 'I don't know' but I would have chosen 'I don't care' had that been one of the options.

To Canadians and the rest of the world's modern democracies, it's a joke topic!

It's hard to feel pity for a people who are dying for lack of high quality and affordable health care, especially when many of them have made their own beds.

It's hard even though they can make their point by referring to their 1st. amendment rights as the valid reason for why they and their loved ones must die.

craig · Mar 17, 2021

Greenbeard said:
Next week we'll hit the eleventh anniversary of the Affordable Care Act becoming law (not bad, given that some didn't think it would survive to its first birthday!). It's fun to think back now to the many predictions, quantitative and otherwise, that were made back then. From John Boehner's warning at the time that its passage would be "Armageddon" and "ruin the country," it was the subject of many outlandish, and frankly deranged, prophecies.

Sarah Palin famously warned that under the ACA her "parents or my baby with Down Syndrome will have to stand in front of Obama's 'death panel' so his bureaucrats can decide, based on a subjective judgment of their 'level of productivity in society,' whether they are worthy of health care." That turned out not to be a real thing!

Some predicted that private insurance would be made illegal (nope!) or at least that conservatives' then-favorite insurance products, HSAs and high deductible plans, would be outlawed (seems these days like they wish they had been!). Other were less outlandish but still wrong. The ACA would erode employer-based coverage (instead it grew), jeopardize access for seniors (it didn't), destroy Medicare Advantage (it's more popular than ever, and no longer costs more than traditional Medicare), or that projected savings in Medicare were somehow being 'double counted' and would not actually extend the life of the Medicare Trust Fund beyond its expected 2017 exhaustion date (wrong, it did).

Of course, it wasn't just the absurd doom-and-gloomers who were wrong. I thought the first decade of the ACA would mostly be a coverage story, and we wouldn't see much in the way of fruits of its cost containment and care delivery changes until the 2020s. I bought the official prediction that it might push up health spending slightly relative to the baseline over its first decade (instead cumulative costs were $2.7 trillion below the baseline). I underestimated how much GOP political pressures would undermine the law's federalist approach. I thought the individual mandate was a much more important piece of the law's architecture than it seems to have been.

How about you? Has more than a decade of experience with the ACA caused you to update any of your priors?

I apposed it when it became obvious what a huge totally unmanageable hodgepodge it had become. The Democrats caved when they did not expand Medicare (which was working well and popular at the time), and phase into a Medicare for all option to private insurance.

Montgomery · Mar 17, 2021

upsideguy said:
How is it a complete disaster? Please elaborate and document.

SkyChief said:
I expected the ACA to be complete disaster, and it is.

"If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor." was a lie, and Obama later admitted it.

Here's an example of how we Canadians see it sometimes:

The scenario: Your wife is lying on the ground bleeding to death and you refuse her help because it would be an acknowledgment of the ACA making help affordable.
You are a strong and righteous American who will never compromise his 1st. amendment rights for short term gratification.

Gawwwwd bless you for your strength and determination!

SNOWFLAKE · Mar 17, 2021

my taxes, when I worked, was slightly higher, and I DO MEAN, slightly higher, than people with similar incomes in the US.
for that, when I developed a melanoma, I had it removed, the hole grafted, the site dressed by nurses at a local clinic as well as the donor site, ALL without a penny out of my pocket.
a close friend needed both his knees replaced, same thing, he had the surgery and his rehabilitation as well was completely paid for.
granted, our health care doesn't cover prescription drugs, but considering what you all down there pay, we pay a pittance in comparison.

the canard about people here going to the states is just that, a canard. oh yeah, some rich folks who don't want to wait a couple of months for surgery go to the states to jump the queue but that is all that is.

NOT ONE PERSON, not my dad when got bone cancer, or my mother, or my brother, or myself, or any of my friends EVER had a reason to cross the border.

NO NEED to worry about going bankrupt paying medical bills or paying huge sums a month for "insurance".

What is not covered, like dental, we can still purchase on a monthly plan that is far less than any of you pay.

YET, we hear about our system being socialism, when in fact our system as guaranteed a lower infant mortality rate, longer life, less obesity, and LESS needless surgeries since our doctors can't bleed us dry.

Obamacare is better than nothing, but you all need to start pushing hard for universal health care, EVERY other civilized nation in the world has it.

But you know ........ "death panels" and such

SILVER SURFER · Mar 17, 2021

Greenbeard said:
...Medicare Advantage (it's more popular than ever, and no longer costs more than traditional Medicare)...

I don't disagree with your OP and don't mean to nitpick, but the quoted part is not entirely correct. Some Medicare Advantage plans do cost more than traditional Medicare, although they often provide better coverage.

Greenbeard · Mar 17, 2021

SkyChief said:
I expected the ACA to be complete disaster, and it is.

"If you like your plan, you can keep your plan. If you like your doctor, you can keep your doctor." was a lie, and Obama later admitted it.

If you liked your plan when the ACA passed, you could keep it (provided your insurer also liked your plan and continued to offer it). And the participation of doctors in any particular plan's network is determined by contract negotiations between doctors and health plans; the ACA doesn't insert the government into those private contract negotiations.

That's the "complete disaster"? That the ACA didn't commandeer the business operations of insurers and health care providers? The convergence of critiques from the left and right is another fascinating trend that emerged after the ACA passed, and I'm still not entirely sure what to make of it.

Montgomery · Mar 17, 2021

SNOWFLAKE said:
my taxes, when I worked, was slightly higher, and I DO MEAN, slightly higher, than people with similar incomes in the US.
for that, when I developed a melanoma, I had it removed, the hole grafted, the site dressed by nurses at a local clinic as well as the donor site, ALL without a penny out of my pocket.
a close friend needed both his knees replaced, same thing, he had the surgery and his rehabilitation as well was completely paid for.
granted, our health care doesn't cover prescription drugs, but considering what you all down there pay, we pay a pittance in comparison.

the canard about people here going to the states is just that, a canard. oh yeah, some rich folks who don't want to wait a couple of months for surgery go to the states to jump the queue but that is all that is.

NOT ONE PERSON, not my dad when got bone cancer, or my mother, or my brother, or myself, or any of my friends EVER had a reason to cross the border.

NO NEED to worry about going bankrupt paying medical bills or paying huge sums a month for "insurance".

What is not covered, like dental, we can still purchase on a monthly plan that is far less than any of you pay.

YET, we hear about our system being socialism, when in fact our system as guaranteed a lower infant mortality rate, longer life, less obesity, and LESS needless surgeries since our doctors can't bleed us dry.

Obamacare is better than nothing, but you all need to start pushing hard for universal health care, EVERY other civilized nation in the world has it.

But you know ........ "death panels" and such

Good one!
Here's a bit of meat to go along with your facts. Roughly 2 1/2 times more Americans travel out of country for health care than do Canadians. Some of them come to Canada and some go to Mexico.

edit: Oh, and some of the more wealthy ones who can afford the air fare, go to the world's leading countries on health care! They get a free vacation in Europe and come home healthier and richer for the experience.

They can spend years lazing about on the shores of the Mediterranian for the same price as a tonsillectomy in America!

Montgomery · Mar 17, 2021

IN fairness to Americans, they have a (??) 1st., 2nd. 3rd., whatever right to provide their insurance company billionaires with huge profits. It's the insurance company's money, not other people money! OPM.

Greenbeard · Mar 17, 2021

CHuDWah said:
I don't disagree with your OP and don't mean to nitpick, but the quoted part is not entirely correct. Some Medicare Advantage plans do cost more than traditional Medicare, although they often provide better coverage.

Fair point, I should have been clearer: Medicare Advantage no longer costs the government more than traditional Medicare.

Before the ACA, it was a boondoggle that paid more public funds to private insurers for a patient than it would for a patient in traditional Medicare. From 2009:

In 2009, payments to MA plans continue to exceed what Medicare would spend for similar beneficiaries in FFS. MA payments per enrollee are projected to be 114 percent of comparable FFS spending for 2009, compared with 113 percent in 2008. This added cost contributes to the worsening long-range financial sustainability of the Medicare program.

The ACA set out to fix that, reducing government payments to Medicare Advantage to bring it in line with the traditional program. And it did! From 2020:

We estimate that total Medicare payments to MA plans will average about 100 percent of FFS spending in 2020.

Ten years ago, the right hysterically predicted that stopping the overpayments to private insurers under Medicare would destroy Medicare Advantage. In reality, ten years later the program is thriving despite the drop in payments. Did any of the folks making those predictions adjust their priors when they turned out to be totally wrong? Where is Paul Ryan these days anyway.

Montgomery · Mar 17, 2021

Greenbeard said:
If you liked your plan when the ACA passed, you could keep it (provided your insurer also liked your plan and continued to offer it). And the participation of doctors in any particular plan's network is determined by contract negotiations between doctors and health plans; the ACA doesn't insert the government into those private contract negotiations.

That's the "complete disaster"? That the ACA didn't commandeer the business operations of insurers and health care providers? The convergence of critiques from the left and right is another fascinating trend that emerged after the ACA passed, and I'm still not entirely sure what to make of it.

There's a much more effective argument for Skychief and his fellow health care haters. It goes like this:

LOL, hahahahahaha!

They 'get it' a lot quicker and then stew in their own juices, rather than screech out their facts and figures that prove the rest of the world is wrong, wrong, wrong!

GummyVitamins · Mar 17, 2021

Greenbeard said:
If you liked your plan when the ACA passed, you could keep it (provided your insurer also liked your plan and continued to offer it). And the participation of doctors in any particular plan's network is determined by contract negotiations between doctors and health plans; the ACA doesn't insert the government into those private contract negotiations.

This isn't even close to being an accurate representation of what was promised and the end result. PoliFact, who generally bends over backwards to help Democrats, called this the "lie of the year."

Lie of the Year: 'If you like your health care plan, you can keep it'

It was a catchy political pitch and a chance to calm nerves about his dramatic and complicated plan to bring historic ch

www.politifact.com

He also got "Pants on Fire" ratings when he tried to walk it back.

Barack Obama says that what he'd said was you could keep your plan 'if it hasn’t changed since the law passed'

President Barack Obama’s attempt at explanation has only fanned the flames of controversy over his campaign line, "If yo

www.politifact.com

All of your excuses were said by his administration and they were all deemed untrue.

Valerie Jarrett says 'nothing in Obamacare forces people out of their health plans.'

The White House has been on the defensive recently over its claim, repeated numerous times over the years, that under Pr

www.politifact.com

Were you wrong about the Affordable Care Act?

Were you wrong about the Affordable Care Act?

Yes, it turned out better than I expected

Yes, it turned out worse than I expected

No, it turned out as I expected

I'm not sure

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