14 years ago, the ACA was signed into law. It was the down payment on a commitment to get everyone insured in the US. And it has cut the uninsurance rate in half with substantial gains after the passage of the American Rescue Plan and the Inflation Reduction Acts.
This BFD is on the ballot in November.
MomSense
I worked my heart out getting this passed and made lifelong friends in the process. I remember so vividy being on the call with OFA the next morning when Obama said (with a very hoarse voice!) that healthcare as a right was now enshrined in law and that we would work to expand and improve it.
Manyakitty
@MomSense: thank you and thank PBO!
Carey
I had retired early and was living off savings – then husband got laid off. ACA was available a few months later.
I remember the application issues, glitchy website and confusing questions… But I didn’t care. I was thankful .
It DID become very expensive. It was my highest bill – higher than my mortgage. I had to take unplanned/ taxable money out of retirement to pay for it which then disqualified me for subsidies… It’s better now and I m still thankful.
RaflW
The indefatigable Charles Gaba of ACA Signups (and blue24 which does a ton of fundraising for Dems up and down ballots and across all 50 states) notes this in his extensive anniversary writeups:
Across coverage groups, a total of 45 million Americans are enrolled in coverage related to the ACA, the highest total on record. This represents 14.1 million more people enrolled than in 2021 (a 46% increase) and 32.5 million more people enrolled than in 2014 (258% increase).
Omnes Omnibus
@MomSense:
I have said since the beginning that this was the greatest accomplishment of the ACA. The details, whether good or could be improved, paled in comparison.
MomSense
@RaflW:
That’s incredible! It’s also worth noting that the ACA expanded patient protections which ended practices like lifetime caps, recission, and denying coverage for preexisting conditions. We also expanded what is covered by Medicare and added contraception and wellness visits to insurance coverage.
My personal favorite is the Medical Loss Ratio!
PST
I was just thinking this morning of how many of us were stuck in jobs we hated or marriages we hated because to leave would be to give up health insurance. Guarantied issue and community rating meant the ACA was liberating even for many middle-class people with good earning capacity.
RaflW
@MomSense: It has been a slog to get GOP states to do the Medicaid expansions that ACA envisioned, but — several times via voter initiatives to force shitty R’s to comply — expansion has continued to roll out over the years.
Thanks for your roll in all this.
The freedom to buy insurance w/o pre-existing condition loopholes or total blocks has meant huge positive changes for me (and BF) personally. We didn’t have to stay chained to jobs/careers we were ready to shift.
Miss Bianca
@PST: Amen to that.
Chris T.
The ACA is the only way I could retire early and still buy health insurance for self and Spousal Unit. It ain’t cheap, but it exists. We’ll be on Medicare soon enough but until then….
Matt McIrvin
@PST: In manager-speak, that translates to “nobody wants to work any more!”
TBone
This could come in handy, too:
https://crooksandliars.com/2024/03/dems-propose-guaranteed-paid-time-all
We must win.
stinger
I’ve always loved that signature. Legible and stylish, like a logo.
Trivia Man
Extended eligibility for children was great peace of mind for me.
I also note the TREMENDOUS opposition that has been a DAILY CONSTANT for all 14 years. And despite the also CONSTANT drumbeat of “we have a BETTER replacement ready to roll out ‘next week’” no better solution is here yet.
President Johnny Gentle (famous crooner)
Aren’t we going to talk about how it clearly appears that Obama left the “O” in his signature incomplete originally and had to use a second pen-stroke to bridge the gap? WHAT ELSE IS HE HIDING?!?!
lowtechcyclist
Same with my kid sister and her husband, who are both in their early 60s. She retired from teaching in 2020; she was ready anyway but the pandemic and the added burden on teachers settled the deal. And her husband has been self-employed for at least a decade – I assume he was on her insurance until she retired. They’ve both been insured through the ACA since then. Otherwise either she’d have had to keep working until 65, or he’d have had to go to work at someplace that had insurance.
lowtechcyclist
@TBone:
This could come in handy, too:
https://crooksandliars.com/2024/03/dems-propose-guaranteed-paid-time-all
This. I’ve been beating the drum for paid vacation and sick leave for years. Everyone should have it.
Also of course the $15 minimum wage, and time and a half after 40 hours should be automatic for everyone earning less than $100,000/year, regardless of job classification (professional, supervisor, etc.).
oldster
@Chris T.:
Just out of curiosity, and without going into details, would you mind naming a price-band? Like, “my spouse and I pay $300/$500/$1000/$1500 per month”? My wife and I are considering retirement some day, and I’m curious what we face.
Oh, and maybe you can name your state, since that’s relevant (we’re in NY). Thanks!
laura
I’m also an ACA participant/early retiree. It was the cost higher than our mortgage payment until the Covid subsidies reduced it to a small car payment. Thanks Obama, Momsense and Biden/Harris! In September I’ll transition to my earned benefit of Medicare.
Jackie
@MomSense: I remember when if a woman wasn’t already under a doctor’s care and learned she was pregnant, then sought an OB, pregnancy was considered a “preexisting condition.” Insurance wouldn’t cover the pregnancy.
TBone
@lowtechcyclist: I’m all for all of that when we win! Let the trickle down idgits cry into their microphones while the rest of us live without their bullshit takes. Cry moar is what I’ll say.
Ohio Mom
Yesterday, while bouncing around blogtopia (I don’t remember where), people were swapping pre-ACA horror stories.
Stuff like a husband taking a new job during the wife’s pregnancy, locking her out of maternity coverage, since that was a preexisting condition to the new insurer; people being bounced because they did not report their teenaged acne prescriptions, another preexisting condition snafu; million-dollar lifetime caps; the list went on and on.
It all sounds so ludicrous that I don’t hold it against young people who don’t believe all that was true.
TBone
@oldster: I was paying $750 per month for an ACA bronze plan until Dems (PA Gov. Wolf, et al.) took over, now it’s completely subsidized. I am forever grateful.
TBone
@Jackie: but they still covered boner pills.
StringOnAStick
The ACA let my husband and I retire 2 years early; Covid made me stop working (who wanted to be a dental hygienist when that hit the fan? Not me!), and my husband was so ground down by his job it was just as essential for him. Fortunately his company was trying to reduce payroll in response to Covid impacts so he got a buyout offer. Without the ACA we could not have done that since we both have pre-existing conditions. Everyone I used to work with caught Covid at least twice in the first year. No thanks.
Ours was subsidised because we were no longer employed, but we were willing to pay full cost in order to escape our jobs. We are now enjoying our earned benefit of Medicare.
MomSense
@President Johnny Gentle (famous crooner):
Sooo many people wanted the pen he used to sign it, that he had to stop mid letter with all the letters to switch pens. If you watch the video you can see him realizing he’s running out of letters and still has a bunch more pens he has to use.
Baud
👍
MomSense
@Jackie:
And we all paid out of pocket for birth control pills, IUDs and other contraception (unless your employer self insured and offered contraception coverage) which was really expensive.
My youngest said to me that he thinks we need to expand coverage to include period supplies. Hell yes we should.
Ohio Mom
@President Johnny Gentle (famous crooner): Isn’t that handwriting weirdness because presidents keep switching pens mid-signature so supporters can have souvenirs of the occasion?
it did strike me that it looks like an “O” created by someone with a moment disorder (e.g., tremors, etc.).
ETA: I see MomSense got there first.
marcopolo
@oldster: As someone who has been using the ACA for insurance since roll out (had not been insured for the 5 or 6 years prior) I think the biggest driver for how much you will pay every month is your income level (and you have to have income over the annual poverty line in states w/out Medicaid expansion or over 133% over in states with the expansion). Sort of funny, I had gamed out how much I needed to earn to qualify for the ACA which worked for years, then worked hard to get my state to finally do Medicaid expansion, and when we succeeded I had to redo all my calculations and figure out a way to raise my income. It all worked out and I’ll get to Medicare in a few years but was a small surprise.
Anyway, the most I’ve ever paid monthly, earning about the bare minimum to participate, was ~$200/month for a silver plan (this has included a hefty subsidy from the gov’t of anywhere from ~$700-~$900/month over the years). With the changes made under the Biden admin my payment is now about $90/month. Also, a few years ago my insurer screwed up so badly that when they had to refund excess charges I basically didn’t have to pay anything for a year my credit was so big. I had to call them up when I didn’t get charged that Jan and ask if I was insured or if I had made a mistake and wasn’t. That was different.
The other driver of cost is, of course, the plan you choose. I have friends who really wanted to stay with their current PCP and when they went on the ACA this past year only one plan (the most expensive one) had their doctors in network. They now have some regrets for while their PCP was in network, other MDs they use are not and it’s just overall more expensive. Once again, understanding the income restrictions (and other financial details like co-pays and deductibles) would have helped them a lot. They’d been on Medicaid (which they really liked) but were kicked off because they earned a little over the line which forced them to make a rushed decision. If I’d had a chance to talk with them ahead of time I think they’d have taken a different route, though I understand the desire to want to stay with a doc you’ve been seeing for a while and like. So yeah, navigating the income situation (at the low end plus in states with Medicaid expansion) has been the biggest issue for folks I know.
But, very very happy for the ACA to exist. I worked 50-60 hours/week to get Obama elected in 2008 (was a neighborhood team leader where I live) and it has been a BFD for me and hell, just about everyone when you take into account all the aspects of it (pre-existing conditions, extended to 25 child coverage, etc…).
Kay
@marcopolo:
The best kept secret in the US is how much people like Medicaid. “Oh, that’s okay! I’ll stay on Medicaid, thanks” :)
I remember during the Obamacare fight Lefties were furious about Medicaid rather than Medicare – Medicaid was the lesser, supposedly. I don’t think they know anyone on Medicaid. People really like it.
Kay
@Ohio Mom:
We saw the liftetime caps in action a lot. I recall Indiana had a special program for pediatric patients with serious illness because they would reach the cap so quickly. I once had a mother come to me with 3 million in unpaid meds, above her million cap. Her teenage son had passed away with the blood cancer he was being treated for, and she was nearly catatonic with grief and dealing with collections calling her. Just a brutal system.
marcopolo
@Kay: Yeah, if I were in a blue state Medicaid would be great. It pretty much worked like Medicare for my friends–they could almost go anywhere for what they needed. But where I live the state legislature had to be forced to pay for it (and this was after we put in the constitution through a ballot initiative), they still try to fuck around with it every year, and the state level administration is awful. A lot of folks dropped off after the Covid restriction requiring states to keep folks on the rolls ended just because of crappy administrative issues. And the transition between Medicaid & ACA coverage when your income is bouncing around is anything but seamless
Edited to add: I guess there is maybe a poverty shaming aspect to Medicaid that taints it for some; but if you get into the details it is the state level administration of it (in red states) that is the real issue with which folks should be concerned.
UncleEbeneezer
On the one hand we have a President who will continue protect/improve Obamacare. On the other, a Fascist who is still promising to destroy it (and Democracy).
But is it really worth voting for Biden? ¯\_(ツ)_/¯
oldster
Thanks, Tbone! Thanks, marcopolo!
Looks like I need to do more research, but what you are describing sounds pretty good.
Another Scott
@MomSense: +1
Lots of presidents used multiple pens to sign important legislation, to be able to give them out to those who helped make it possible. Obama continued that tradition.
TIFG, of course, didn’t, but just did his black sharpie scrawl as only his action mattered. But he didn’t have anything important to claim except for the tax scam, so there’s that, also too.
Cheers,
Scott.
Parfigliano
Notice how the usual suspects dont call it Obama Care anymore. DEMs should always call it Obama Care. Remind normie voters what a DEM Congrees and President can do for them.
wjca
I agree that Obamacare was a great thing for America. And am appalled that troglodytes in a few red states still refuse to let their residents in on the benefits.
And yet, I recall my best friend. She had (for personal family reasons) a severe allergy to the very idea of marriage. But she also had medical issues, and her boyfriend with whom she was living convinced her to marry him so as to get access to his health insurance. It took her decades before she was able to admit, even to me, that they were married. But here they are, nearly 4 decades later, still married and happy as clams. And I wonder if, had ACA been available, it would have happened.
An extreme exception, I’ll grant. But one I inevitably think of in the context of stories like this.
Ruckus
All of you that retired early! I started working at 12 and had a job for all but one year till I was 72. Sixty years. Sure it started out with a paper route and working with dad, but 60 yrs, with only one year of not having a job. The only positive thing I can think of for that is my SS is actually not all that bad. This fall I will have been retired 3 yrs. And every job I’ve had has been physical, not a desk jobs. Which does have it’s benefits.
We all have a lifetime, some good, some great, some not so much. Or so long, one cousin only lived 6 months. It’s life. It can be good or even great. It can be so short that really there is no experience. It can be over a century or at least close. This year I hit 3/4 of a century and can I tell you, it is a different world than it was. And yet it still has a beginning, a middle and an end. Some spend a lifetime worrying about what comes next, if anything, some live as if it will all end tomorrow – which for them it really might because of how they live, and most of us put one foot after the other, experience it, enjoy it, sometimes not. It is what it is, good, bad and not so much. Look around, see what you have, what you have to lose, to gain, to enjoy, to not so much. It’s life.
Live every day like there is no tomorrow, because one day there won’t be.
Live every day like there is tomorrow, because you never know till the sun comes up, or doesn’t.
PaulB
Add me to the list of people who were able to retire early because of the ACA. Work had grown untenable and I was miserable. Without the ACA, I would have been stuck, as getting another job in the high-tech industry when you’re over 60 years old is basically impossible. COBRA would have covered me for 18 months, but that wouldn’t have been enough to get me to age 65 and Medicare. After that, I’d have been screwed.
The ACA premium was 25% less than the equivalent COBRA premium would have been. And it got even better a year later when Democrats passed the bill providing additional subsidies for people like me who formerly did not qualify. The ACA and the enhanced subsidies were, for me, a BFD.
Alas, without Congress taking action, those enhanced subsidies will expire next year. Another reason to do our best to get a Democratic trifecta.
persistentillusion
@Kay: I was on Medicaid when my breast cancer was discovered after a mammogram. Total cost to me for intake, surgery and radiation? $50.
Loved Medicaid to pieces.
Mike in NC
Before ACA, I got laid off and had to sign up for COBRA for continued medical care. That really sucked.
lowtechcyclist
@MomSense:
I don’t remember that part, but it’s been a few years! But I was watching it all live, including when Obama and Biden were walking towards where the signing ceremony was being held, and the mics picked up the now famous moment where Biden said to Obama that this was a “big fucking deal. :-D
Brachiator
A few years ago, I was in the hospital waiting to get a medical procedure done. I still remember a guy a few medical bays away telling a nurse that he would be dead if he didn’t have Obamacare. I think he said that he did craft work in the film industry, but previously wasn’t able to get health insurance.
lowtechcyclist
@UncleEbeneezer:
But he hasn’t earned my vote! /s/s/s/s/s
Ruckus
Two good things about being in the military.
First, it’s a course on humanity. One gets to see that no matter how you feel about your life up till then, not everyone has the same life. Some better, some not even close to good. Appreciation for life, good and bad is a good thing, and not everyone gets there. Some of the reasons one way or the other are asinine, some are valuable lessons in growing up.
Second, it provides the VA. Earned healthcare. Can’t say it’s always great, but can say it isn’t often less than good enough. (A side note. Remember Gray’s Anatomy? The “hospital” was a VA clinic, one that I used for a number of years. They did a good job of not making it obvious, it took me a while to see it but the cables that ran alongside the building for some time gave it away.) Anyway, one doesn’t get to choose their doctors and rarely that can be an issue, but overall it is pretty good. I have some really good docs and the crappy ones don’t seem to stay long. So thanks everyone for my healthcare, even if I did earn it.
Fake Irishman
@marcopolo:
this is a good comment. Another unappreciated part of Obamacare was that it not only expanded Medicaid eligibility, but also mandated states streamline and simplify application and other bureaucratic procedures to make it easier for beneficiaries.
mrmoshpotato
@Matt McIrvin:
Ugh! I remember hearing that bullshit back in 2020.
Pittsburgh Mike
@MomSense: Absolutely right that the ACA’s ban on lifetime caps, its treatment of pre-existing conditions, ban on recission, etc made individual insurance an actual viable choice for the first time ever.
It can still be improved — right now subsidies have been increased temporarily and those increases should be made permanent. And we should drop the Medicare eligibility age, which would take the most costly patients off of the ACA roles.
But the ACA is by far the best health care reform I can remember.
Starfish
@PST: People were marrying their friends just to get them some health insurance!
Ruckus
@Kay:
Our economic/governmental system has positives and negatives. Somedays just trying to understand it is a major pain in the ass and others it’s a life saver. Sort of like life/humanity. The concept is good, but sometimes the actual operation has holes the size of craters on the moon. Those often get filled, but sometimes it takes a while and has opposition, mostly from people that want to protect their positive sides by taking those away from others. Humanity – who knew?
stacib
@oldster: I’m dealing with this now with my 93-year-old mother. She was in the hospital due to asthma, and the inhaler her pulmonologist prescribed is almost $500 through her Managed Advantage Plan administered by United Healthcare. I was advised to drop the MAP, convert to straight Medicare A & B and add Medicaid. Not only would the monthly premium for United Healthcare go away ($180 per month), her inhalers and any medical devices would then be fully covered. Unfortunately, it’s not a choice because of asset levels, but damnit, I sure wanted to change over. Co-pays are bankrupting me.
JPL
Wow! My BFD t-shirt is fourteen years old.
billcoop4
@oldster: ACA and New York
You may already know this, but the NY Exchange is available at this link. You should be able to explore options there.
I’ve been on it since 2018; policy is $450ish per month with about a 1/3 subsidy.
BC
dnfree
@Jackie: In 1973 I was pregnant when I was laid off from my job. I went on my husband’s insurance, but it not only would not cover the pregnancy and delivery, it would not cover that baby until (she) was 15 days old. My insurance covered nothing, and we’re very lucky the baby was healthy. We got audited that year by the IRS for high medical expenses.
Juju
@oldster: This Obamacare subsidy calculator may help you. It’s what I use to figure out what my subsidy will be.
https://www.healthinsurance.org/obamacare/subsidy-calculator/
dnfree
@wjca: In contrast to someone getting married who otherwise might not have, I’ll give you my son-in law’s brother, who died at 23 in 2005 of leukemia because he didn’t have insurance. (He worked waiting tables.) He’d go to the hospital, they’d give him a transfusion and send him home—every two weeks. They didn’t diagnose the leukemia, just gave him blood to solve the immediate problem, and he couldn’t get on the state emergency medical coverage because he didn’t have a diagnosis. By the time he got a diagnosis it was too late. (Sadly, his family was not knowledgeable about how to navigate the multiple systems involved.)
People used to say it was okay if you didn’t have insurance because the hospital had to treat you. Sure they do, if you have something obvious like a broken arm. They don’t have to diagnose your expensive disease and treat it.
Kay
Juju
cain
@dnfree: why do people look back in the past and think it was all great with experiences like these?
Ruckus
@lowtechcyclist:
I’ve owned 2 businesses and one of them I was the only person working there. The other had employees. Paychecks/payroll taxes/insurance – workers comp and healthcare. The work required to run the place, properly, reasonably was almost as much as actually producing the products. But it is also a really good course in humanity, both learning about it and having some. The work required skills and expertise to accomplish and it costs money to hire reasonable, trained, willing human beings. Some of them will have character and some will be characters. Most often both….
So I’ve been in the military, had jobs, owned 2 companies, had employees and not and can honestly say that one of the hardest parts wasn’t the physical work but the humans involved. We are all (ok most of us) humans, with all the good – and the bad parts and some are more on the good side but some are not, and it’s life. We provided health insurance because it’s important. I was amazed at how many didn’t actually use/need it but humanity requires it because very few of us stay healthy 100% of the time.
cain
@TBone:
It’s makes great economic sense as well. Giving people time off like the weekends means that they will spend money. It’s great for small businesses and so on.
Bill Arnold
@oldster:
I’ve been using a NYS ACA personal plan (gold level) for about 5 years now. It’s a name brand plan (there are cheaper; I go for stability and wide network), and about $1079 per month this year. Work has been a couple of contract (tech/research) positions (quite happy with the current one). Making too much for subsidies.
It is functionally indistinguishable (from personal observations only) from the Fortune 500 corporate health care plans that I had previously. That is my general impression; that the ACA plans are as good as employer-subsidized plans (sometimes better), though it sucks that the employer isn’t subsidizing them. (It is wise to set up auto-pay.)
Bill Arnold
@Parfigliano:
I call it ACA in personal interactions, and when people say “what?” I say , you know Obamacare.
cain
@TBone: 750? Damn that gotta hurt. You saved 10k a year woo !
dirge
In the early 2000’s, our neighborhood bar held a fundraiser for a regular with breast cancer. A lot of people pitched in what they could, but nobody had the kind of money that would make a difference. It was a pretty grim, hopeless affair.
When Republicans talk about healthcare, what I hear is a plan to murder my wife, and millions like her.
Matt McIrvin
@wjca: When same-sex marriage became legal in New Hampshire, a family member’s girlfriend’s employer immediately dropped their same-sex domestic-partner benefits in the state, said “get married like everyone else”. So they did. Though I suspect they would have sooner or later anyway.
Ruckus
@marcopolo:
I use VA healthcare and so my docs are who they are. Crappy ones no one likes do not stay long. But no one gets to choose their docs. Fortunately most full time docs are pretty good. Sure there is always the chance you won’t like them but as above, if they are assholes, they do not stay long. I have for decades decided that if I didn’t like one – leave and find someone else, do not hang around waiting for them to learn human, if they don’t know by the time they’ve been to college, med school, internship, residency, they never will. They are shit humans and always will be, unless they have a come to whomever/whatever moment. Which is sometimes/occasionally forced upon humans who think their shit doesn’t stink and their lives are far more valuable than yours. It isn’t pretty, does not happen as often as is necessary but that wake the hell up moment usually gets their attention. BTW It is a fun thing to deliver. Have had to do it once. The VA is not a place for over confidant, overly pompous assholes because at least 95% of the vets have seen at least one pompous asshole above them (and likely far more) and tolerated that ONLY because they had to. I left the XO of my last ship speechless, after he signed my discharge paper (last in the chain that had to sign – and I had it in my hand) and proceeded to chastise me for my attitude about the navy. I no longer had to tolerate his or his bosses bullshit. I was actually not inflammatory or rude, but I was no longer under his or his boss’s thumb and he found out that I fully understood that. Leadership does not come from stars or stripes, nor does it require them. And having stars or stripes does not mean one is a leader, it only means that some will have to follow them. BTW that captain had been in charge of 10 ships on the east coast and the one I had been on for 2 yrs was one of them. He wanted to go to the pentagon, that funny building with one extra side, but no one wanted him there – I think they fully knew what size asshole he was.
rikyrah
Obamacare IS A BFD.
THANK YOU, NANCY PELOSI.
She got into the weeds and pulled it over the finish line.
Chris T.
@oldster:
WA state; it was about $2200/mo originally (2020) and is now up to $2700/mo, but I bought pretty good coverage. COBRA in California (until we moved up here) was similar. I’m on Kaiser but others were in the same price range for this kind of coverage.
Lower-end bronze was about $500 less, I think, when I looked at the prices in December, but I’m on expen$ive meds (familial diabetes and heart issues).
Chris T.
@cain:
You think that hurts, try over $30k/yr. I “make” too much (from retirement withdrawals) for subsidies, except for one year when we put all expenses off and qualified for Medicaid, which was actually better than the high end plan I’m buying and cost $0. Here in WA state there’s a very sharp cliff between “qualify for Medicaid” and then suddenly “no subsidy”.
(No need to cry for us; I had a very good tech job and I saved a lot. Barring catastrophes like the volcanoes in WA going off, we should be fine.)