Hacker News Reader

Comment by refurb | Hacker News Reader

The increase in costs were most certainly driven in part by the ACA changes. No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs. Require a bunch of things be added to mandatory preventive visits? Those have to be paid for as well.

That said, I agree the costs would have continued to go up, but to say there is no evidence that the ACA contributed to it is just ignoring the math.

View on HN

I had the same experience where as a sole proprietor health insurance for a family of 5 is now $2,000/month. $24k/year not for great healthcare, but for the privilege of paying a "discounted rate" on "select services" when you actually need healthcare.

We haven't needed the coverage for two years but when we did, what we needed wasn't covered so we paid full price anyway including $80 for a bottle of Ibuprofen that was casually offered to us. The markups are almost criminal.

For a $1M home you can find insurance for $1,500 per year. It's exponentially less expensive.

ACA was the worst possible compromise to a serious problem. A public option, universal healthcare or deregulation all would have been better options.

It'd be much nicer to be able pay a doctor to make house calls as needed and waive your right to a malpractice lawsuit than to pay to support this insurance/legal/government system we have now.

> No longer allowed to deny based on pre-existing conditions? Insurers need higher rates to cover those costs.

Is there any alternative though? We're going to pay those costs one way or another: either the government pays for all the unprofitable patients' healthcare (the wet dream of health insurers), or we tell those people to go fuck themselves.

And now we have the worst of both worlds:

Those patients have no coverage so get Emergency treatment for acute symptoms of their issues that rarely fix the underlying problem, and beyond that we also tell them to go fuck themselves.

You are "most certain" about something that empirical data refutes. Health care costs grew more slowly after the ACA than before it and, in particular, at no point subsequent to the passage of the ACA have health costs grown more than they did during the Bush era.

There are all sorts of things that should have (and perhaps even did) impact prices after the ACA. Not just coverage requirements (which, again: most employer-provided health plans --- which is what we're talking about here --- already complied with), but, more importantly: unprecedented instability in the insurance markets during the almost decade-long concerted effort by the GOP to hamstring and ultimately repeal the bill. And yet, the numbers are right there: health care costs are growing, but they are not growing more than they were prior to the ACA.

I think we’re arguing different things.

Sure, costs went up less after ACA.

However, the ACA directly added costs to insurance that weren’t there previously.

I don't understand this argument. The ACA changed a bunch of things about the health care system. It reduced some costs and increased others. The point is to reduce the total cost (or, in this case, the total rate of increase in health care costs).

It reduced some costs

What were those?

P4P, bundled care, reference pricing, the IPAB-based spending controls, reduced hospital readmissions, the premium rate review process.

Can you help me understand the argument you were trying to make above? I continue not to grok the point you were trying to make.

The government subsidizes ACA plans for many participants. That was partly meant to soften the impact of requiring coverage for pre-existing conditions. And then there is/was the individual mandate, to get everyone to contribute even if they were currently healthy. The ACA also imposed a tax on high earners (IIRC, >=200K, not sure if it is inflation adjusted) to fund the subsidies, and it cut spending on Medicare Advantage, which costs the government more than the other medicare plans.

That being said, I'm not disagreeing that costs went up after the ACA more than they would have, but, IMO that was just insurers/providers raising prices because they could.

There's no evidence that costs went up after the ACA more than they would have, and, in particular, costs grew significantly faster under Bush than they have at any point after the ACA. I'm not sure I understand why we're supposed to give credence to HN-style first-principles analysis of why insurance costs should have increased; in particular, most employer-provided health plans already complied with the ACA's coverage requirements. The data simply doesn't back these arguments up.

My companies insurance premiums were going up 10-15% a year for years before the ACA.

Ours were going up sharply before too, at Matasano (2005-) and before we started Matasano, our health insurance at my previous employer also got slashed (2001-).

Reply on news.ycombinator.com