A few things that could be fixed:
- Get rid of tobacco rating and only rate on age and geographic location. I'm as anti-tobacco as it comes, but it's awfully arbitrary to single out smokers when there's so many bad habits out there for people to choose. Smokers under the age of 65 generally only have around 10% higher claim costs anyway, and yet the ACA allows insurers to charge smokers up to 150% more. It's not until people reach Medicare age that smokers really pull away on costs
- Allow subsidies for people who make above 400% of FPL and buy insurance on the Exchanges. The people at 401% are the biggest losers of the ACA. I believe a person making 400% of FPL has their premiums capped at 9% of their income. Just do that for everyone who buys it on the Exchanges. The subsidies won't be extended too much further than that anyway, just because the rates aren't so high that a person making 800% of FPL will have to spend more than 9% for a silver plan. But if he does somehow, he should get a subsidy too.
- Somehow require all states to accept the Medicaid Expansion. Maybe as a compromise, the Feds could cover at 100% permanently (then you could legally justify forcing states to accept, probably), although that will cost more.
- Maybe get rid of the employer mandate and funnel more people onto the Exchanges. Or change accounting laws to make it so that large businesses can just help people pay for individual insurance on the Exchanges (post-subsidy) and come out ahead or equal money-wise.
Interesting fact: Before the ACA, the U.S. was only ranked a few spots behind Canada in the WHO list of best health care systems. I imagine we'll pass Canada pretty soon. Single payer, at least in the Canadian sense, is not the answer for the USA, and while the British system is objectively superior, there's just no way it's ever going to happen here.
How many people at >400% of poverty don't receive subsidized insurance through their jobs? I make less than that and I get my insurance through my employer.
