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The ACA is better than what we had, which was nothing but a broken system that was spiraling downward. Insurance premiums were skyrocketing to the point where many employers could no longer afford health insurance as an employee benefit, and more and more people were getting priced out of the system. And this was taking a toll on everyone else, because uninsured people had no choice but to let health conditions that could be managed through regular doctor visits and proper medication go ignored until they became an emergent situation. Which resulted in ER care (the most expensive kind of care available), and an exorbitant bill that the patient could not pay. And we paid for that, through taxpayer funded uncompensated care funds and higher insurance premiums.

The ACA gave subsidies to insurers if they participated in the exchanges, giving people a choice of insurance. It provided subsidies to people who could not otherwise afford insurance, resulting in millions of people getting health insurance that was unavailable to them before. It required people to have insurance (except in extreme hardship cases), so that healthy people in the pool kept costs down for all. It taxed the very rich by a small percentage, to offset the costs of the subsidies. And it expanded Medicaid, so that the working poor (people whose income was just a little too high for regular Medicaid, but not high enough to afford insurance) had a chance of getting healthcare.

And it worked, for the most part. Until Republican-controlled states decided they wanted no part of the Medicaid expansion. Until subsidies were cut way back for insurers, leading many of them to pull out of the exchanges. Until advertising for the enrollment period was stopped, resulting in many people who would otherwise sign up not knowing about the sign-up period. Until enforcement of the mandate was stopped, resulting in healthy people deciding not to get insurance at all, which meant that only sick people were signing up, causing premiums to go way up. Republicans were the ones who caused all of these things, not the ACA. This is like burning down a house and then proclaiming, “see, that house was defective!”

The ACA would have been better with a public option. A non-profit basic insurance plan offered by the government at cost to anyone who wanted it. It would compete with private insurers and force them to compete with it by lowering their prices and working to keep costs down. That didn’t happen because the private insurers didn’t want to see their gravy train interrupted. But even without the public option, the ACA was far better than the broken system we had before.

Now, the AHCA is returning us back to the days before the ACA. Gone is the tax on the rich to help offset the cost of subsidies. Gone are the subsidies for insurers, so there’s no incentive for them to participate in exchanges. Gone is the insurance mandate that would draw healthy people into the insurance pool to help keep costs down. Subsidies for people needing help affording insurance will be gone as we know it, reduced from what they were. Gone is the expanded Medicaid, which will leave millions without insurance — people who need it most. And Medicaid itself will be gutted, with nothing to replace it for the poor.

Doctors and hospitals have already raised hell over the AHCA, as this means a return to the days when an increasing number of patients every year cannot pay their medical bills. And when that happens, prices have to be hiked higher or hospitals have to close their doors. You think costs are high now? Wait.

The ACA wasn’t perfect. But it was the best thing that was possible in the political climate at the time. And it allowed millions of people to be insured. People who will lose that insurance if the AHCA atrocity passes.

Just out of idle curiosity, what advice do you have for someone who can’t afford health insurance, because premiums would cost three quarters of their income without some kind of help? “Don’t get sick”?

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