WaPo: "Suddenly, Obamacare Is More Unpopular Than Ever"

[angus]

I'm a little surprised.  It made sense to oppose it while it was being written, and even up through 2012 when we had a chance of electing a president and congress who would reverse it, but we're stuck with it now.  Maybe folks are still hoping to undo it in the next congress with a new president.  I just don't think it's possible because it has become too entrenched and too lobby-worthy over the past two years.  Big Pharma CEOs love the benefit to their industry and medical insurers have a captive new audience.  We might be able to tweak it, I really think we're stuck with it.  Might as well learn, if not to like it, at least be "neutral/don't know/don't care" about it. 

[angus]

The only people who support ACA are those who believe it's something other than what it actually is.

I can't escape that conclusion either. 

Still, I think we're stuck with it for the foreseeable future, so I've gone from negative to neutral as a practical matter.  Serenity to accept the things I cannot change, and all that.

[angus]

it's not remotely Socialist or Communist

Agreed.  It's rather the opposite, in fact:  it will funnel trillions of dollars over the coming decade from the people to a few large corporations.  In large part, this is because it focuses on medical insurance, rather than on the underlying causes of medical costs.  Our premium has increased over the past few years, but only slightly and I'm not certain of the relation of the PPACA to those increases.  Still, it is clear that medical costs are not decreasing.  Nor are they projected to decrease.  Estimates are all over the place but it is clear that the percent of GDP in "health care" costs will continue to increase for the foreseeable future.  Some of this is due to an aging population.  Some is due to factors already in place before the PPACA.  Some of it is do to the PPACA itself.

[angus]

it's not remotely Socialist or Communist

Agreed.  It's rather the opposite, in fact:  it will funnel trillions of dollars over the coming decade from the people to a few large corporations.  In large part, this is because it focuses on medical insurance, rather than on the underlying causes of medical costs.  Our premium has increased over the past few years, but only slightly and I'm not certain of the relation of the PPACA to those increases.  Still, it is clear that medical costs are not decreasing.  Nor are they projected to decrease.  Estimates are all over the place but it is clear that the percent of GDP in "health care" costs will continue to increase for the foreseeable future.  Some of this is due to an aging population.  Some is due to factors already in place before the PPACA.  Some of it is do to the PPACA itself.

Cost projections for Medicare have been repeatedly lowered since the PPACA became law and as the growth in Medicare spending has dropped. It's been remarkable good news from an area of federal spending which has previously only provided bad news.

That's because the burden has shifted to the states.  First, there are the administrative costs associated with the mandated expansion of Medicaid eligibility.  Of course, the law promises three years of federal assistance to fully cover the benefit costs, but it does not increase the federal match rates paid to states for associated administrative costs.  So states must pay these added administrative costs beginning on day one of the Medicaid expansion and, even sooner, must shoulder much of the financial burden generated by any work they perform in preparation for the added caseload anticipated in 2014.

The real burden won't show up immediately, because the PPACA promises three years of full federal funding to cover the benefit costs of expansion. Beginning in 2017, however, states are expected to shoulder a progressively larger burden of the benefit costs of new Medicaid beneficiaries.  Something like 10% initially.  By 2020, and for every year after, state taxpayers will have to fund 10% of the benefits for new enrollees.

what's not to like? 

[angus]

What are some of the features that a Gold plan has that a Silver doesn't, or a Silver vs. a Bronze?

I never understood this either.  Are we talking about the olympics or medical insurance.  I get the two confused when folks start with this gibberish.  This is yet another annoying feature of the PPACA.

I assume that "gold" plans cover more stuff and "silver" plans have higher premiums or out-of-pocket expenses, whereas "bronze" plans must be the sort of insurance that paranoid but healthy young adults would have bought even without a mandate, and are just in case of seriously catastrophic events. 

[angus]

It's ... really not that hard. The higher on the list, the more benefits a plan has ...

That's really all healthcare.gov says as well.  

  Bronze: Your health plan pays 60% on average. You pay about 40%.
  Silver: Your health plan pays 70% on average. You pay about 30%.
  Gold: Your health plan pays 80% on average. You pay about 20%.
  Platinum: Your health plan pays 90% on average. You pay about 10%.

Pretty cheesy description.

Based on that description, my own insurance can be described as "platinum" so long as I stay in my "preferred provider" network, "gold" if I go outside the network.  Really, this gold/silver/bronze thing is very helpful when it comes to the olympics, but not so helpful here.  If I wanted to ditch my policy and pick another one, I'd have to read the fine print on both.  The color-coded designations are absolutely unhelpful in this regard.  The government is famous for this.  Remember Bush's security threat levels?  Red, orange, yellow, blue, and green.  (That one was especially irksome because of the weird order.)  Good God!  How unhelpful was that?  And it was over-complicated.  Five colors?!  They should have used two colors only.  One means everything is basically peaceful.  Expect to stand in line an hour or so at the airport.  The other means shit has hit the fan.  Arrive at the airport at least three hours early if you want to make your flight.  All the in-between stuff is just unnecessary.  And this gold/silver/bronze thing is even worse, since it has no analytical value whatsoever.