Our guest already mentioned that these enhanced subsidies took place with the onset of the American Rescue Plan.
More than 2020 enrollment has doubled.
When it comes to the subsidies, and you said Congress ultimately will decide, I guess it's, I don't know, for every member of Congress, but generally, where is Congress on this idea of continuing the subsidies?
Well, there's a general thought, you know, when President Trump was re-elected and Republicans took control of Congress, the thought was that the subsidies would go away, that they would need that money to extend their tax cuts.
And that indeed may still be the case.
But we're seeing a lot of Republicans, a lot of this expanded coverage, particularly people buying their own coverage, happened in Republican states, particularly in Republican states that didn't expand Medicaid.
So we've seen huge increases in places like Florida and Texas and Georgia.
And some of the senators from those states are a little bit having some second thoughts about whether or not they want to, you know, basically raise people's premiums.
In some cases, premiums could double.
So there's some back and forth about whether or not they're going to let these subsidies expire.
You know, I haven't heard what the White House has said about this because remember, this really is a congressional decision.
They will automatically expire unless Congress extends them.
And of course, then the president would have to sign it.
This is supposed to be part of the one big beautiful bill that the president keeps saying that he wants that would have the tax cuts and more money for immigration enforcement and more money for energy.
This is part of this whole reconciliation process that Congress is about to launch into.
Well, the ACA is an enormous bill that does a lot of things, but the main part of it is to expand coverage, both by giving people who don't have access to workplace coverage through either through Medicaid or through buying it themselves.
There are new rules for insurance companies.
There are a lot of programs that help train future health care workers, health care professionals.
Well, that was one of the big and popular issues in the Affordable Care Act is a requirement that certain types of preventive care be covered with no additional out-of-pocket costs.
So no co-pays or deductibles for certain types of preventive care.
And there are a number of them, but many of them come from something called the U.S. Preventive Services Task Force, which is a quasi-independent agency under the Department of Health and Human Services of experts that basically evaluate preventive services and decide whether or not they're essentially worth the money that they cost.
So they give them grades and anything that the U.S. PSTF grades A or B is required to be covered with no additional out-of-pocket costs by the Affordable Care Act.
Yes, this case says that the U.S. Preventive Services Task Force was not properly established under the Constitution because it's too independent and that they cannot legally, because the members were not appointed by the President and confirmed by the Senate, they are not allowed to make these types of decisions about what should be covered.
Interestingly, well, the Biden administration first started defending this case.
Interestingly, when the Trump administration came in, they continued to defend this case.
So they were at the Supreme Court saying, no, we think that this task force is fine and okay.
And by the way, we exercise enough control over their decisions, or at least whether their decisions are finally implemented, that we think everything is A-OK.
And you don't need to decide that this needs to be completely taken apart and reestablished.
I mean, there isn't always, and you never know for sure, but certainly some of the conservatives that the plaintiffs would need to rule with them, particularly Justice Kavanaugh and Justice Barrett, seemed kind of dubious about these arguments.
And most people who watched the arguments, including me, seemed to feel like it was more likely that the court is going to rule for, in this case, the Trump administration, which was previously the Biden administration, which is against the plaintiffs in this case.
Yeah, well, you know, a lot of people were affected in a lot of different ways.
It may have just been that the group insurance didn't meet the requirements of the law, or it may have just been that the group decided that the insured didn't want to cover them anymore.
And, you know, in many cases, there are a lot of plans that don't meet the needs of people, but that's why there's also a lot of choice.
You know, one of the big complaints, particularly early on, again, was that they had these very narrow networks in some of these plants, and the premiums and the out-of-pocket costs were pretty high.
One of the things that these additional subsidies did was at least make that cheaper, didn't always make the networks broader, but you can usually find a broader network plan.
It's always a trade-off in sort of how much you're going to pay versus, and this is true in group insurance too.
You know, the broader the network, the more you're likely to have to pay for the insurance.
It's always a trade-off with pretty much all kinds of insurance.
I mean, a lot of insurance companies are doing very well.
A lot of insurance companies are doing very well in the ACA market.
Some of them came in, maybe bid off more than they could chew, and then left.
But the market's been relatively stable for the last couple of years.
And as I said, we've doubled the number of people in these ACA plans.
And as the costs have gone down, the satisfaction has gone up.
There are still a number of issues.
Some the Biden administration was addressing.
There was sort of an unfortunate incentive for rogue brokers to shift people around between plans, even if they didn't want to change plans because the brokers got paid additional money.
That's something that they were trying to address.
Now we're seeing the Trump administration cutting back on some of the staff who helps people who run into problems with their ACA plans, which could be another issue.
So it's not, you know, it isn't perfect.
Nobody ever suggested it was, but it is, you know, now, excuse me, 15 years sort of into this, it is a relatively stable way that a lot of people get their health insurance.
I suppose that in the lead up to the passage of the ACA, you heard from critics and supporters alike that it would change the way that doctors practice.
It would change the way that hospitals do their business.
Well, we've seen a lot of other changes in the health care system.
I mean, one of the things we're seeing a lot of is private equity coming in because we spend so much money on health care, and that's had, I would say, a bigger impact on how the provision of health care has changed than the Affordable Care Act, which remember, yes, yes, it's between the Medicaid expansion and the people on the marketplace coverage, it's 40 million people, but we have, you know, 330 million Americans now, because of the law, most of whom have some kind of health insurance.
So it's not necessarily from the law that has changed the health care system.
The health care system has, I mean, the healthcare system has changed and the law along with it.
I just want to say I've had ACA care for a few years now, and it helps me when I go to get my testing done, you know, my cholesterol, colonoscopies, all kinds of stuff.
I don't find the deductible absorbent.
And if it wasn't for that, you know, I wouldn't have good care.
It's not much good for, you know, if you're sick and need to go in for that.
I mean, all insurance, you have to meet your deductible.
And that's pretty typical of employer plans these days, too, is $500 or even $1,000.
I mean, there are a lot of ACA plans.
And again, there's a choice of plans.
If you want to pay lower premiums, you're going to have higher deductible.
It's just like car insurance.
So there are people with multi-thousand dollar deductibles who are basically crossing their fingers and hoping that they don't get sick and need expensive care.
But as Coller said, and as we were talking about this, preventive care comes without any additional out-of-pocket costs because they want to incentivize people to get preventive care so they don't get sick.
So they don't need to go into the hospital or have some kind of procedure where they would have to pay their deductible, but also the insurance would have to kick in a lot more money.
I'm a federal retiree, and so I opt to, although I qualify for Medicare, I keep my federal insurance at a cost of about $250 a month, just fearing a Republican administration, what they might do.
If I don't renew it, I lose it for the rest of my life.
So that's my plan.
And also, I would like to say that it's preventive, not preventative.
From Michigan, Ron is next, receiver of private insurance.
unidentified
Hi.
Hi, I got private insurance.
I don't seem to have any problems with my insurance except the proscene from the medical field.
Seems like they overcharge the insurance companies.
They probably give them a kickback, too.
It's like a big scam between the hospitals and the insurance companies and the government and stuff, mostly just the insurance companies in the hospitals.
And to that guy that was talking about the deadly wound, that's talking about baptism that was changed in 325 AD by the church.
That was a deadly wound when they changed baptism from Jesus' name to Father Son.
To the point of how hospitals practice their care, Julie Robner, what are the discussions going into the ACA is monitoring how much it costs for a hospital to provide services and what could be done about those costs?
More recently, there have been efforts, both Republican and Democratic efforts, to increase transparency in pricing, both from the insurance side and from the provider side, from the hospital side.
They've been met with different levels of success.
It's still a work in progress.
But, you know, there's the hope that if people have a better idea of what things actually cost, that they might be able to do better job comparison shopping.
Perhaps prices could be a little bit better controlled.
As I say, that is something that the Affordable Care Act kind of sidestepped and that other legislation has addressed since then.
You're supposed to be able to get an estimate from your provider, and you're supposed to be able to get an estimate from your insurer about how much they will pay.
And I just feel that the private sector insurance is just way too much.
I had tried that, and the copay was just staggering.
And I had to sign up for the Affordable Care Act for the services that I needed, my back surgery, my knee surgery.
The copay was staggering.
The Affordable Care Act put me in a position to be able to have these necessary surges that I needed.
I just feel the government is in such a strong financial position.
It's confusing that we proclaim a title of the wealthiest and the rich, but you have other nations or countries, and correct me if I'm wrong, that provides that for the citizens in their country.
Why we don't have something being able to on both sides balance this out?
This is a concern every day for the average American citizen that need medical care, that cannot walk into a facility to be able to medically get treated because they are definitely feeling the responsibility of a massive debt that they cannot get out of under the provision of what insurance carries that you have or if it's private.
But I just feel it has to be a better way.
It should be a better way because I should not have to have shoes off of private insurance and then it was better with affordable care.
Well, this is a hundred years debate now about how the U.S. should provide health services and health insurance to the population.
We've never been able to agree on, you know, the Affordable Care Act was a very hard, hard-fought battle over not just the sort of the two years that it took Congress to do it, but the preceding six or seven.
And, you know, we saw another, we saw fights in the 1940s.
We saw fights in the 1960s that gave us Medicare and Medicaid.
We saw fights in the 1970s and the 1980s.
You know, we were going to, we're going to continue.
It's a work in progress.
Nobody, I think it's fair to say, is very satisfied with the way our health system is working.
But at least I think the consensus is it's better than it was.
Yes, as I said, already the Trump administration has vowed to cut the outreach and to, again, shorten the sign-up period for the Affordable Care Act.
That was something that the first Trump administration did.
We're seeing these offices laid off these caseworkers who help people who run into problems with their plans.
As we know, it's not a completely smooth running system.
So, and of course, depending on what Congress does, if they cut back on the Medicaid expansion that was in the law, that could affect as many as 20 million people.
And whether or not they extend these additional subsidies or let them expire, that's another 20 million people.
I went through, I have a disability, got into an accident.
And, you know, it surprises me when I got this insurance that I could just walk in and get my insurance, you know, get whatever I needed taken care of, whatever ailment, walk out, spend very little on, you know, my prescriptions and the bill and everything.
And I think with all that we've paid into our system and with having friends benefits in the past way before my time, the insurance would be a priority because it is known that we're all going to get sick at some point.
That's a fact.
Everyone in this country is going to get sick at one point.
And with all that we've put into it and all the progress that we've made, I would hate to see anything like this go away.
I think we need more.
I think we need to go towards more of a, even more universal health care because this relieves the stress of a lot of Americans, you know, and that in itself makes life a lot easier.
And I would like to push to see it go even further and even more affordable.
That's just me, but I enjoy.
I enjoy being taken care of and paying what little bit of taxes I have into it, and I'm okay with it.
Yeah, there's no doubt that there is vast overcharging.
There are a lot of people who are in the, a lot of people in the healthcare industry who are making a lot of money.
And basically, it's an arms race between insurers and payers and providers.
And hospitals need to keep their doors open 24-7 and have staff available 24-7.
Insurers want to pay, don't want to overpay because they want to be able to charge as low premiums as they can.
So it is just sort of the constant back and forth.
But there are, as I said, there's a lot of now, there's a lot of private equity coming in that wants to basically take as much profit as they can out of what's a very profitable sector.
I mean, one of the things that we're seeing is that private equity is buying up hospital chains, basically selling out, you know, taking it apart for parts, selling the real estate and having the hospitals then pay rent because they don't own their land anymore.
And then some of the hospitals have ended up in bankruptcy and ended up closing.
It's been a real problem, sort of the things that private equity has come in and done to basically make profits for the private equity shareholders.
It's not a really sort of, it's not the best model for how private equity should work, which is not to say that private equity isn't useful often.
You know, it comes in and provides capital for things that are absolutely necessary.
It's just when private equity comes in and takes apart something that's already existent.