Affordable Care Act update

Today is the deadline to begin signing up for health insurance under the Affordable Care Act. Not unexpectedly, there has been a surge in enrollments in the days leading up to it and it seems possible that the enrollment target of 7 million, that had been seen as unreachable after the disastrous rollout, may actually be within sight.

I have said that the people who opposed the ACA to such an extent that they actively sought to sabotage its implementation and even dissuade people from signing up were truly evil, because they were risking the lives and health of ordinary people in order to pursue their anti-Obama agenda.

About 36% of Americans without insurance have decided to pay the fine rather that buy insurance. Some are doing so because they cannot (or have been misled to think they cannot) afford it. What I find inexplicable are those people who can afford it but refuse to sign up for health insurance because they oppose the plan. The radio program Here and Now had an interview with ac accountant in Colorado who said that he was not signing up because he opposed the plan on principle and was willing to pay about $250 for emergency room visits once or twice a year if he needed to see a doctor. When asked what he would do if he had an accident or developed a serious illness, he started regurgitating the well-worn talking points put out by the opponents and did not address the question that his emergency room treatments would be paid for by others.

You can listen to him.

This guy seems like a classic case of someone cutting off his nose to spite his face.


  1. raven says

    We won’t know the final March 31 tally for days, possibly weeks, but that indispensable enrollment tracker Charles Gaba is projecting 6.78 million exchange enrollments, with a chance of topping 7 million.

    That figure covers enrollments in private healthcare plans via and the individual websites offered by 14 states and the District of Columbia. As my colleague Noam Levey is reporting, the Rand Corp. estimates that another 4.5 million previously uninsured adults have signed up for Medicaid in states that expanded that program under the ACA. And about 3 million young adults have obtained coverage through an ACA provision allowing them to stay on their parents’ employer plans until age 26.

    http:// www.,0,4488747.story#ixzz2xa1TJCaM

    The actual numbers are 7 million for private insurance, 4.5 million Medicaid expansion, and 3 million young adults on the parents policies. Total 14.5 milllion.

    Oddly enough, Republican enrollment is not much different from Democratic enrollment. They can babble on endlessly about “socialism” but never turn down Social Security and Medicare. Bunch of hypocrites.

    I expect those numbers to rise in the coming years. Rollouts for these sorts of programs always start slow and are backloaded.

  2. rpjohnston says

    $250 for an emergency room visit? It was like $3k when I had kidney stones, and all I had was some painkillers and a prescription for water. Plus about an hour of standing in the lobby waiting for them to get around to processing my paperwork, and then another half an hour to complete that, get basic tests, and finally GET the painkillers. That was fun.

    I guess I’m part of the statistic of “recently enrolled”; I got a plan, and my dad is paying for about 2/5 of it. Post-tax, that is, he cut me a check for 2/5 the yearly cost, and I pay the actual bill. It’s extremely unpleasent to still be leeching off him but that’s a big fraction of my income.

  3. AnotherAnonymouse says

    In contrast to the ACA, here’s the medical plan my company provides (and we finally got cards for last week): costs $1,000/month with a $4,000 deductible. I take a medication for a chronic illness; the insurance will cover $5/month of the generic (leaving me $70) but nothing if I have to take the name-brand, and the $5 doesn’t kick in until after I’ve met my deductible.

    Next year I’m shopping the ACA; none of those deals are as bad.

  4. says

    As a graduate student with a very small stipend, I don’t meet the minimum income. My state, luckily, just passed the medicaid expansion, but I haven’t gotten any details about that, yet.

    When I’m done with grad school, in the unlikely event ecologists start getting paid higher end salaries, I’ll gladly pay more taxes to help people stuck at my current income level. This sucks, and nobody deserves it, even if they are lazy.

  5. says

    When asked what he would do if he had an accident or developed a serious illness, he started regurgitating the well-worn talking points put out by the opponents and did not address the question that his emergency room treatments would be paid for by others.

    I wonder what he will do if his local hospital ER says, “Sorry, only people with coverage get treatment here. ACA or private insurers. Find another hospital to take him.”

    No, that’s not callousness or wishing ill on him. That’s already happened at some US hospitals where poor people have been sent to other hospitals (or worse, dumped on the street and left to die) because they had no private insurance coverage.

    Of course if it did happen to someone like him. gainsayers would try to blame ACA instead of the hospital administrators who made the decision. Funny how they don’t blame the administrators or the HMOs running hospitals that kill people by neglect.

  6. lorn says

    rpjohnston @ #2 – Exactly.

    Last I saw an ER charge it came to close to $500 for just the privilege of sitting in their ER, it didn’t include examination or treatment, and that was most of a decade ago. I suspect it is something closer to $1000 by now. Use an ambulance, a good idea for prompt service, and just the ride alone runs north of $500 on the low end.

    I used to work in a hospital and used to understand the billing system where every little thing gets billed separately. The ride to the ER is a bill, the ER visit is another charge, and each doctor, and every little thing they do is another line on the bill. I learned this when, while working for the hospital, sprained my ankle as part of a larger on-site accident. The hospital emergency response team trotted to the scene in their flight suits carrying their medical gear in backpacks.

    I asked about who was going to pay and the director of the department showed me the bill where the emergency department billed our department for response and transport within the hospital. I was rolled in a wheel chair to the ER, got a few X-rays, had my ankle lovingly wrapped in an Ace bandage by a pretty nurse (the high point of my day), and was issued crutches. Total cost to my department ran almost $2000. They were nice about it. I was credited with a full eight hours even though I was on the clock for less than four.

  7. hannahs dad says

    Hey you.
    Yeah, you, c’mon here.
    Have a listen.
    Boy have I got somethin’ you want.
    Very cheap.
    And its the best there is – really good.

    It’s called – ‘The Public Health System” here in Australia.
    Its a public health system whereby anyone can go to a public hospital [there are stacks of them in every city and in most regional centres] and get whatever health care they need.
    Wanna hear that again?
    “anyone can go to a public hospital and get whatever health cart they need.
    For nothing.
    You know – no cost.
    Taxes pay for it.
    And the tax rate for health is far less than the cost of health insurance in your country.
    And its a top notch health system, one of the best from a medical POV in the world.


    You too can have it, after all we pinched the idea from the poms er Brits to you, from their National Health Service.
    Its not perfect, what is, but its better than what the conservatives claim and a helluva lot better than the system you got.

  8. Mano Singham says

    @hannahs dad,

    I agree. I have been advocating something along the lines that you describe for ages. The US system is crazy.

  9. Guess Who? says

    @Lorn: 18 years ago, I was rushed to the local hospital in an ambulance, unconscious and seizing. Upon examination, they determined my medical issue was far too complicated for them to manage, and sent me by ambulance to a national-level hospital 45 minutes away. I was billed $1500 for the first ambulance, which the insurance declined to pay because I wasn’t admitted *at that hospital*. My bill was turned over to a collections agency while I lay in a coma in the second hospital and legal proceedings were started against me while I was in the CCU, still in a coma (and apparently quite the scofflaw!). The American system is crazy.

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