Welcome to the Roller Coaster Ride of the Affordable Care Act

I’m behind in the blog, I admit it. Last week I was planning a blog on all the good news about the Affordable Care Act (ACA), including the 10 million people who signed up; the lower-than-expected premiums; the lower-than-anticipated medical inflation predicted for the coming year, the result of which is due, at least in part, to the ACA.

Then came the ruling from a federal circuit court that the government could not provide subsidies for people to buy health insurance in states that did not set up their own exchanges. The ruling comes from a couple of sentences in the huge bill (about 900 pages) that states that the subsidies are available for people who sign up through state exchanges. Of course, that was when we thought the states would all set up their own exchanges (since the feds were paying for it).

How naïve were we?

Today, just 16 states and the District of Columbia run their own exchanges, with residents of the remaining 34 states buying insurance through the federal exchange. That means that about 5 million people who bought health insurance on the federal exchange and received subsidies may find themselves back where they started – with no access to affordable health insurance and, by definition, health care.

The irony of all this is that the lawsuit that led to the ruling was brought by four people, one of whom, a USA Today columnist noted, is a man who makes $20,000 a year and who would wind up paying just $20 a month for his insurance. These are the kind of people that, as my husband puts it, “should be taken out of the gene pool.” Well, let him go without health insurance and get hurt or sick and that may just be what happens.

The good news is that another panel of judges issued exactly the opposite opinion on a similar lawsuit just a few hours. So, of course, this will wind up in the Supreme Court. . .

As the USA Today columnist (and others) noted, large bills like the ACA always have problems that need fixing; this one is no exception. Usually, Congress just passes some legislation to fix it. There’s just one problem with this scenario: Congress can barely pass gas without threatening a government shut down.

Over health care. In the richest country in the world. Sigh.

Read opinions about Tuesday’s ruling from The New York Times and the Washington Post.



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