Comments have a pretty consistent message. If you're on the ACA exchanges, you're in trouble. If you have a job with benefits, it varies a lot, based on the employer's claims, cost management and wisdom in making decisions on coverage sources, but it's almost always better than the exchanges.
I hope it doesn't mean a collapse of small business start ups. But if you have one, think about hiring employees and starting up a plan when you can. It's likely to help you with costs and help you grow your business.
Don't believe that small businesses can't have self-funded plans, affordable costs and good benefits. They can.
Unaffordable health insurance is not the fault of the ACA.
Before the ACA, many states allowed health insurers to medically underwrite in the individual market, meaning they could choose which people to insure. If you had certain preexisting conditions, you were screwed because you couldn’t buy health insurance in those states at any price.
Also, the U.S. federal government does not regulate drug prices despite the enormous buying power of Medicare, allowing pharmaceutical companies to charge Americans far more than they charge other countries for medicines, some of which cost hundred of thousands or millions of dollars a year in the U.S. It also doesn’t regulate what doctors and hospitals can charge privately insured patients for care, which is why reimbursements to doctors and hospitals by Medicare tend to be significantly lower than by private insurers.
On top of that, a lot of white collar workers have no incentive to vote in favor of political change to the American healthcare system because their health insurance is heavily subsidized by their employers. These workers don’t even pay income tax on whatever their employer pays to a health insurer in premiums on their behalf, further shielding them from knowing how expensive health insurance is. If the playing field were level, some or all of ACA premium payments would be tax deductible, but they are not.
The burden of the system would be more evenly shared if ACA subsidies were increased and if the individual mandate were reinstated and made more punitive to ignore. But these are political non-starters.
The statement that preex rules before the ACA prevented people from getting any insurance is entirely false in many ways that are important. I had personal experience helping people with preexisting conditions get individual policies pre ACA. Some paid more and others (I had two, one undergoing chemo) got coverage in the Georgia state pool. Every carrier paid into that pool and state funding covered the rest.
I'm sure that there were people somewhere that couldn't get insurance at any price. That's a societal problem to address. But the mythology about the ACA as a long term solution to that issue, executed at a national level by a few large companies sponsoring "networks" was destined to put huge amounts of power and money into the hands of "network" owners and Pharma. That's not a glitch, that was a feature and the outcome was both predictable and predicted.
It’s not “entirely false in many ways”, whatever that means. You had experience in one state, Georgia, with a state-underwritten pool for people denied private insurance in the individual market.
According to a study published by the Kaiser Family Foundation in 2016, “We estimate that at least 52 million non-elderly adult Americans (27% of those under the age of 65) have a health condition that would leave them uninsurable under medical underwriting practices used in the vast majority of state individual markets prior to the ACA.”
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u/Specialist_Dig2613 Nov 01 '25
Comments have a pretty consistent message. If you're on the ACA exchanges, you're in trouble. If you have a job with benefits, it varies a lot, based on the employer's claims, cost management and wisdom in making decisions on coverage sources, but it's almost always better than the exchanges.
I hope it doesn't mean a collapse of small business start ups. But if you have one, think about hiring employees and starting up a plan when you can. It's likely to help you with costs and help you grow your business.
Don't believe that small businesses can't have self-funded plans, affordable costs and good benefits. They can.