Today, the ACA turns 12.
It is still a Big Fucking Deal.
It has mostly succeeded in the drafters’ intent to reduce but not eliminate uninsurance in the United States. The pathways to get there are different as Medicaid has done more work than the Marketplaces. But at this point, the law is part of the fabric of American society even as there is intense policy and political opposition to the law.
Much like many tweens, it is a little bit ackward, a little bit gangly and occassionally its voice will crack mid-sentence. The ACA still needs a significant technical correction update to adjust for the realities as they turned out instead of how they were hoped to be. But the law stands and it mostly does what it intended to do.
It is still a Big Fucking Deal.
Baud
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Matt McIrvin
And it is still in perpetual danger of repeal or nullification. One difference today is that the political blowback from that would be high.
Ohio Mom
As far as I can tell, two things make it hard to repeal: allowing adult children to stay on parents’ plans those extra years until age 26, and protecting coverage for pre-existing conditions.
Those things mean a lot to middle-class voters, who might not otherwise care about people with limited financial resources.
It’s a bit of a Rube Goldberg of a program but it works. Who knows how long we will have to wait until the next incremental change? (Answer, a long time).
Benw
2 ways the ACA has impacted my life: no pre-existing conditions clause means I’m more secure with my cancer treatment, and second my kids’ well care is fully covered. Covering those well visits is such a huge deal, but it doesn’t get much attention in the press, but it’s a BFD
SiubhanDuinne
Thank you, David. This is a welcome and necessary reminder. Much appreciated.
JPL
I still wear my BFD t-shirt with pride.
p.a.
@Matt McIrvin: Hell they still try to blow up Social Security & Medicare, but at least now it’s mostly by back-door sabotage. They never quit. It’s fucking exhausting.
stinger
I haven’t directly benefited from the ACA myself, having gone from employer coverage straight to Medicare, but I’m very glad this law was passed and remains (largely) in effect. Surely the pandemic has shown that it is better for society as a whole for people to have health care!
Great reminder, David.
Happy birthday, Patient Protection and Affordable Care Act, and thanks, Obama!
Bruce K in ATH-GR
I can say unequivocally that without the requirements imposed by the ACA on the for-profit healthcare industry, I’d be uninsurable and facing a looming bankruptcy-or-death decision.
narya
I love the ACA. I remember my PANIC trying to get insurance when I worked at the bakery, and only being able to find expensive coverage that EXCLUDED care for the one thing I was most likely to have to deal with (but luckily did not). That was 15 years ago, and it still gives me shivers.
Ella in New Mexico
ACA really is a BFD but we need to do some legislative work fast to keep it from turning completely back into pre-ACA days.
Insurance companies are doing everything they can to deny patient care that they think is costly. More and more essential medications to treat conditions like diabetes, hypertension, COPD, mood disorders, even common antibiotics for infections are being taken off formularies or having co-pays increase to levels many of my patients can’t afford.
Ordering a simple medication for COPD or asthma has become a frigging nightmare. Last week one of my patients had been on a very common and inexpensive asthma medication for almost 10 years that was just declined a prior authorization by his new Medicaid Expansion Insurer and he was basically offered medication that never did and never will control his disease or “Why don’t you try one of the onliine discount programs like GoodRX”? They asked me, his provider, to call a hotline to appeal and I basically spent 30 precious clinic minutes I don’t really have to lose to sit on hold to be told “no, we won’t be paying for that drug”.
And forget what they are doing with diabetes meds it’s a whole diatribe worth of angry.
So yeah, for it’s skeletal safeguards like keeping kids on their parents insurance and a few still guaranteed annual screenings it’s great, but Corporate is trying like hell to destroy its actual benefits at the point of care.
Elizabelle
I appreciate Obamacare. And I appreciate the courageous Democrats who enacted and protect it. Never forget.
Ruckus
@Ohio Mom:
Given the political realities in this country how could it be anything but a Rube Goldberg situation?
The political reality is that approximately half of our federal legislative government is insane and growing more so by the minute. They are fighting a losing battle but it’s some days (like the senate “hearings” currently underway) that are especially strange, idiotic, asinine and bizarre because they show how far the right has gone with all their insanity and total lack of integrity, honesty. realism and their bullshit.
bbleh
@Matt McIrvin: @p.a.: @Bruce K in ATH-GR: As a prime example of government working to help ordinary people, it is a PRIORITY for Republicans to sabotage, dismantle, &/or repeal it. Can’t have that sort of thing! Sends the Wrong Message!
@Ohio Mom: @stinger: It really is important to remember that not only has it got, what, over 30 million now (?) people insured who otherwise would not have been, it has also improved the situation dramatically for very many — I would estimate far more — who would have had insurance in any case, but who have gone from crappy expensive insurance to something of reasonable quality and affordability, myself among them.
Ohio Mom
@Ruckus: For hearings, I rely on Aaron Rupar’s Twitter. He’s really good at excerpting videos of the highlights/low points.
Yes, the questions the Republicans have been asking are gobsmackingly strange, idiotic, asinine and bizarre. As well as glaringly off-topic.
Aaron made a point that he was not posting the more graphic questions about child pornography. They must have been really ugly.
scribbler
@Ohio Mom: Agree so much with this comment. As self-employed people, we struggled for years with securing affordable health insurance, and every time we switched companies, we worried about how many things would be added to the “pre-conditions” (and therefore, not covered) list. ACA has been a godsend.
ETA: While not necessarily inexpensive for us, it’s better than what we had in the past.
kindness
I get that Congressional Republicans will still say bad stuff about the ACA and vow to kill it. They are just serving their masters (yea, they are all bought, paid for and owned and they know it) but I don’t get the yokels back home, most of whom have someone on Medicare & Medicaid in their family and yet they still support the yowling hyenas that play out on Fox News. It’s not Stockholm Syndrome but close. Tribal shit I can’t figure out #1001.
debg
Thanks, Obama. I mean it. And Joe Biden. And all the other Democrats who got this thing done. And all the journalists and bloggers who helped them do it.
The ACA makes life better for people in an appreciable way. That is what government is supposed to do IMHO.
catclub
@p.a.:
But this happened a few weeks ago. I think that 75 year retirement mandate was done in 2006 by the outgoing GOP congress.
topclimber
Thanks for the reminder of the good things Dems do.
Do you know if ACA is still threatened by legal challenges? I remember some Tex-ass judge claiming the whole program was illegal because the penalty tax for not signing up has been repealed. Are the Dems doing anything to address that (e.g. $1 penalty) as well as other tech issues? It seems like they could do that in reconciliation because our two resident DINOs have not attacked it (to my knowledge).
ETA technical not tech issues that frustrate Congressional intent.
catothedog
Obamacare Is Boosting Economic Health
The 12 states holding out against Medicaid expansion are laggards in job-market strength and income growth. Even the ones that signed up late are doing better.
…A decade’s worth of data has now rendered a partial verdict: States that have fully embraced the Affordable Care Act are enjoying healthier labor markets and stronger income growth than those that haven’t….
Eljai
I obtained coverage through the ACA this year. I left a full-time job and moved across the country so I could spend more time with my family. I’m currently free-lancing. As someone over the age of 50, but not yet eligible for Medicare, it’s definitely a BFD to me!
Brantl
Does ackward mean it’s prone to “©ackne”?
Wvng
When people talk about how politicians don’t have the courage to take risks and do the right thing when it can hurt them, I bring up the ACA. Many Democrats KNEW that voting for this could cost them their seats. The Dem caucus KNEW it could cost them the house. They did it anyway, because it was the right thing to do. Very few in the GQP have such courage, as we see daily.
The Other Bob
@Elizabelle: I ran into a former Congressman a few weeks ago that had only one term in office due to his vote for ACA. I thanked him profusely because it has helped my sister and parents so much. He said it was the more important thing he ever did in his political career.
The Other Bob
@Eljai: We don’t hear enough about how much the ACA Marketplaces helps entrepreneurs. A friend of mine has her own business and loves the price and coverage she gets for her kids.
KrackenJack
Hear, hear.
Unfortunately, current events will totally overwhelm the ACA anniversary. It would be nice if Biden and the Dems could reinforce the benefits, but alas that is not the world we live in.
Fake Irishman
@The Other Bob:
I got an opportunity to do this with Mark Schauer of Michigan a few years back. His response: “I sleep soundly at night.”
Fake Irishman
@topclimber: That legal challenge got kicked last year by a 7-2 vote at the Supreme Court stating [correctly] the plaintiffs didn’t have standing. There are some cases in the lower courts that could limit essential coverage provisions, but that wouldn’t blow up the law.
Fake Irishman
@stinger:
you actually have directly benefited in subtle ways. The ACA also reinforced and increased standards for employer coverage and improved Medicare part D coverage. But it’s still says something good about you as a person that you support this because it’s good for the community without necessarily seeing the benefits for yourself.
topclimber
@Fake Irishman: Thanks, I missed that.
StringOnAStick
Without the ACA I would have had to work in a job with huge exposure to Covid; I retired instead. Without the ACA, my husband’s diagnosis with a long term chronic blood cancer (that remains subclinical and this needs no treatment currently and may never) would have made him uninsurable, and at age 64 we would both be uninsurable in a pre ADS world.
Getting/keeping a job after age 50 has become increasingly difficult in the US as companies sought to get rid of higher insurance costs, I wonder if the current strong job market has ameliorated this any? I did read yesterday that Wal-Mart employees are the single largest user group for Medicaid among the working poor, so that’s working out well for that very profitable company.
Ruckus
@Ohio Mom:
And through it all she has remained delightful and composed and so far smarter than all of her opposition added together that they should all apply for a cage at the zoo, as laughing hyenas. Of course the real hyenas would protest their being described as rethuglicans because they are actually far, far better…..
Ruckus
@catothedog:
Well who wants to live in a state that is trying to kill their citizens?
Especially when one doesn’t have to.
Ruckus
@StringOnAStick:
I retired last year. At 72 yrs old. I got my first job at 12 yrs old. 60 yrs of doing stuff for money. Often not a lot of money, I was in the navy for 3 1/2 yrs. (They gave me an early out – I had no idea till the ship’s clerk showed me the radiogram – I broke eardrums for about 5 minutes. And the order on a Tuesday read discharge before noon on that Friday. I stepped off the gangplank for the very last time at 11:59am.) My last job paid well and while retirement won’t be spent on the Riviera on my yacht – because I don’t have one, I’m OK. That can not be said about a lot of people and that’s mostly because of the conservative rethuglican party. Look back and see when we’ve had recessions/depressions.
StringOnAStick
@Ruckus: So many people a decade to two younger than us have gotten creamed over and over in the stock market (all bad market years directly attributable to R’s), because companies figured out how to drop all retirement risk onto employees via 401k’s, etc. And they got nailed at the early and mid points of their working lives, where the “magic” of compounding breaks both ways. Now the youngest can’t get far enough out from under college debt to buy homes or start families. Every bit of this can be laid at the feet of R economic policies and doctrine, so of course their next act is to go after Medicare and SS. My dad the 90 yo ultra right winger asked me a few years ago why more people didn’t just go on Medicare and was surprised to hear that you have to be 65 and older to do so. If it wasn’t for his lifetime corporate pension, SS and Medicare, he’d be broke and would have died decades ago, but he still will vote straight ticket R until he dies. I wonder how his decades of reflexive anti Russian hate is faring these days? Actually I don’t wonder since all he does is watch FOX. I can only communicate with him via email since he is in a constant state of anger from watching FOX so all he does on the phone is try to start fights and yell.
Ruckus
@StringOnAStick:
I am rather lucky that my parents were Democrats – liberals.
My grandparents really had no input/say in my parents political views and passed very long ago, last one was 1974, first to pass was in 1936.
I worked till 72 because that’s how long it took me to get to a reasonable SS monthly payment. And when I say reasonable I am being very generous. Many people really can not reasonably survive on SS. And it won’t get any better any time soon. In fact, as you wrote, it is actually more difficult than what I faced, for those not all that much younger.
PaulB
Without the ACA, I could not have retired in 2020 but would instead have had to continue working until I hit age 65 and was eligible for Medicare. Not the end of the world if I had had to stay but the ACA allowed me to leave a job and a manager that were becoming almost unbearable.
The added benefit in the relief bill in 2021, restricting total premium cost to 8.5% of my income, is saving me around $4,000 a year, changing health insurance from an expensive “pay-for-this-instead-of-taking-a-vacation” necessity to an affordable necessity.
Yes, it’s a Big Fucking Deal.