Insurance Subsidies Remain, but So Do Health Law Questions

Jun 26, 2015 · 432 comments
Kerry (Florida)
Even with ACA America has a very serious problem when it comes to health care. To wit: No where else in the world do investors line up to buy stock in companies who gouge the sick (i.e. the insurance companies) to make a buck.

While most civilized countries do all they can to keep medical costs low and their citizens out of the health care system, in America we pay no attention to health and in doing so we line the pockets of investors, not doctors and nurses. And what with so many of us getting older and more frail the money to be made off of people getting sick is staggering.

No other country in the world treats misfortune with such a capitalistic flair. And it is hard for the rest of the world to understand. My buddy from Holland jokes that the next thing we'll do is take bids to put out house fires--or only send cops out to help those who make the highest bid.

Most folks not from here readily agree that there is something sinister about investors making big buck off sick people, but Americans don't mind being billed absolutely to death by a system that places the buck above everything.
Bill (Terrace, BC)
ObamaCare was a RW idea in the first place. The only thing RWers don't like about it is that it is OBAMAcare. When Romney proposed virtually the same idea in MA, RWers loved it. RWers don't want to govern, just to obstruct.
Newman1979 (Florida)
The funding for these lawsuits against the ACA are from the wealthy who pay around 4% more in taxes under the ACA. The Supreme Court essetially said " Do not ever bring the "you did not dot the i" case again. they always raise phoney issues to get slackers to think they are not benifited under the law. Single pay ,in some form, is the best way to get costs under control, including more regulation of pricing (and profits) by the near oligapolistic health insurance industry. Almost all of the industrialized world has already figured that out.
John Townsend (Mexico)
Regardless the inevitable short-comings of extensive legislative change, it is clearly evident now that ACA reforms are empowering patients, driving public & private health insurers to achieve better value, and forcing existing healthcare providers to shape up. Yet the GOP refuses to acknowledge that none of the terrible consequences of the ACA that were supposed to have happened — mass cancellation of existing policies, soaring premiums, job destruction — has actually happened. If the GOP continues its intransigence,
they do so at their political peril.
John Townsend (Mexico)
Re "Single payor - the rest of western societies have figured it out."

And so has the powerful US insurance lobby which has been very active in
hampering ACA evolution. Obama has admitted as much ... and that the ACA is a "work in progress". Recall that the public option (ie essentially a single-payer provision) was dropped in order get the much more urgent pre-conditions provision enacted (we can thank Sen. Leiberman's cheap political grand-standing for making this necessary). Going forward there's no guarantee the obstructionist GOP will let up on its efforts to thwart Obama
governance. But now they know they have a powerful adversary and an election not far off.
Steve Austin (Hopkinsville KY)
This is the difference between the gay marriage case and Obamacare: gay marriage won't kill innocent people. O-care will endanger the health of millions for as long as it exists because there is no way the state death panels will be able to afford it.
This is a prime example of people going into an all-politics-all-the-time mindset and abandoning their innate reason and knowledge of how humanity works.
chcuhog (PA)
I wish the times stopped calling people looking for medical care and/or insurance "consumers". You "consume" when you buy a soda or a shirt, when you are having a heart attack ... well, I guess "consuming" is the last thing on your mind.
John Townsend (Mexico)
The GOP just can't countenance a black man in the White House regardless how competent and capable. These racist bigots have been obsessed with dismantling the ACA (and anything and everything Obama supports) even when it has been proven to be reducing the number of uninsured, bending the healthcare cost curve and reducing the deficit. And there are real people, millions of them, many their own constituents, benefiting from the law. But for the obstructionist GOP this doesn't count for anything. This is the Party of Stupid. It isn't the message, or the messenger or how it is pitched. It's simply ludicrous wrong headed policy that marks the decadent and decaying GOP, no question.
Elias Guerrero (NYC)
Well, of course doubts will remain. Until the polity "gets it" that health care is a right; one borne by all regardless of station the "debate" will continue. Alas, other advanced western democracies have already figured this out, obviously, the U.S. has not.
Realist (Santa Monica, Ca)
I don't understand why they don't to political ads where (sympathetic) people just tell their stories on how the law has helped them. Keep it simple.
John Townsend (Mexico)
Re "I don't understand why they don't to political ads where (sympathetic) people just tell their stories"

Because FOX news will contrive to do the same but with opposite stories.
Even though in the past these have been found to be bogus, the mis-information is out there and the harms been done.
JFMacC (Lafayette, California)
So far the ACA seems to have stymied the opportunities for massive fraud such as Rick Scott's under the systems prior to its becoming a law. Is that what makes certain parties so aggrieved at it?
Ron Cohen (Waltham, MA)
It should also be noted that the subsidies cause resentment among many folks, especially those struggling to pay their premiums. Alone among the so-called entitlements, the ACA is a redistributive program. That is its Achilles heel.

Medicare for all!
Ron Cohen (Waltham, MA)
This is a good, honest report on a thorny and controversial subject.

To the high deductibles, and proposed rate increases for 2016 mentioned in the report, should be added the complaint of many folks who are ineligible for subsidies, that even their current rates are too high, and they struggle to pay them.

It should also be mentioned that Medicaid recipients are less well-served, reportedly, not only as to the quality of care, but also to the availability of doctors who will accept Medicaid.

These are serious flaws. Medicare for all!
JMG (Calif.)
This is not what the Congress originally intended. The legislation was designed to incent the states to establish exchanges so the program did not appear to be "National Health Care"; But that failed and the Court has decided on their own how this law should have been written! So the burden on the federal government has been increased and this issue is still very much alive.
Melanie Harvey (Columbus, OH)
"Many people complain that they must pay several thousand dollars in deductibles before they receive tangible benefits from insurance policies."

Many people are not thinking about what a tangible benefit is. The truth is that being insured vs being uninsured is a huge difference in the price you pay for care. When the ER bills me more than $5000 and my insurance company says No, she only has to pay $2200-- I count that as a tangible benefit worth $3800. It's not just about the high deductible, it's about the price break I get on outrageously overpriced services.
Cassandra (Central Jersey)
Jeb Bush has a plan to replace Obamacare with Republican legislation that would "empower consumers with more choices and control over their health care decisions". Translation: the system we had in 1915. If you get sick, you are on your own.

Next up: replace Social Security with Republican legislation that would "empower consumers with more choices and control over their" retirement income. Translation: the system we had in 1915. If you have no savings in your old age, or they run out, you are on your own.

After Bush does that to us, he will start thinking about how to improve Medicare.

These proposals will save the country a lot of money, so the job creators have more money to create more companies to extract more of your money. Prosperity for all ---- billionaires!
David X (new haven ct)
Obamacare is fundamentally broken...” Mr. Boehner said.

No, you tried, but you didn't succeed in breaking it.
Mr Boehner, unlike the 3 SCOTUS judges, can be voted out of office. All in favor...
Mary Kay Klassen (Mountain Lake, Minnesota)
The problem with healthcare in America is that we should of had a single payer system back when President Richard Nixon floated the idea but the American Medical Association balked at that idea. Since that time, we keep adding more programs where the recipients pay little or nothing for their healthcare premiums or costs but we add more and more bureacracies. We have Medicare, Medicaid, Veterans, current military personnel, current government personnel, Native Americans, and federal prisoners. doe sit make sense to give a veteran who can afford a premium totally free healthcare plus most of them over the age of 62 have Medicare where Part A which is hospital is totally free, I don't think so. I on the other hand had to pay for my premium each month until I could go on Medicare, and pay for Part B. My husband, on the other hand gets all of his care free. There is an illusion that becuase you paid some taxes, mimimal, that were taken out of your check, that somehow you are entitled to totally free care for the next 20 or 30 years. I have never understood that mentality and maybe I never will. I have had a famil that over 3 generations have had over 12 doctors in it and so know healthcare from the inside, and I am 67 so lived through the era where no one had any health insurance, government or private. America is among the unhealthiest in the world becuase of affluence and irresponsibilty. Unlimirted amounts of money to indulge eating, drinking, smoking, etc. is us.
Eleanor (Augusta, Maine)
The word "state" in most dictionaries has multiple meanings. The definition of state as a subdivision of a country usually comes after the definition of state as a nation or country. Just saying. Now, in a rational world, the teaparty/GOP would start looking to help deal with the problems of the ACA but, as usual, they continue to plan to remove it and put in their own health care system-----which they might come up with in a decade or two.
proffexpert (Los Angeles)
I am saddened that only hours after the Supreme Court upheld Obamacare subsidies based on exchanges established by the state, Mr. Drapeau, who suffers from multiple myeloma, is still in fear of losing his access to health care insurance if a Republican President is elected in 2016. It is incredible that the US healthcare system depends on the whims of Republican conservatives and their self-serving funding bosses.
Wally Mc (Jacksonville, Florida)
What role would health insurance companies play in a single payor system?
sleeve (West Chester PA)
Healthcare consolidation has been ongoing for many years, and isn't new or due to the ACA. What insurors ask for in price increases is absolutely not what they get, it is simply the opening salvo until their competition shows up. Weakly supported article.
ALB (Dutchess County NY)
I am sure it can use improvement, but Health Insurance was not very good before. The new plans may not be spectacular, but it sure is better than nothing; that is a very scary place to be especially with children. Personally, I don't think health care should be tied to employment. If you lose your job or change jobs you often have to find new doctors, or go without insurance because COBRA is unbelievably overpriced. ( I still can't figure out WHY employers WANT to pay for insurance.) I think this is the beginning of addressing the issue. More work needs to be done, but it is a start. If It wasn't so lucrative to have a sick population, maybe things would be different.

I think if the "powers" that make these laws started with the basic premise that everyone needs health care and health coverage, and worked together from there it would be a big improvement. I am not entirely sure running healthcare like a "business" is the right way to set it up. (I am not advocating wild irresponsible spending). But we aren't manufacturing widgets here. It's people's lives and health. Everyone is as important as everyone else. And everyone wants their loved one to get the best medicine and care possible. Unfortunately, it's run for huge profits, so you can be tested to death, but it may not actually be the best care. It is also some thing that evolves over time and circumstance. It will never be perfect. Sadly it's a political football, and the real problems and solutions are not addressed.
DSS (Ottawa)
As Americans and as human beings no one should deliberately restrict health care to the sick. And, those in the medical profession should do all that is possible to save lives. However, when money is involved, greed surfaces. Health care, like religion should not be for profit and all Americans and law makers should do whatever is necessary to improve services and the law no matter what the cost. To continue this debate is immoral and un-American.
Brian Hogan (Fontainebleau, France)
There's something else that has left lingering doubts, steadfast resistance, and a movement of true believers: the shape of the earth.
DW (Philly)
Excellent :)

Also the age of the earth ...
Sarah (California)
There will always be those determined to stand athwart the course of history and progress crying "Stop!" In the case of the ACA, such people, one by one, need to be asked, calmly but repeatedly, by news outlets, friends, neighbors, and anyone else who encounters their loud objections to explain specifically and rationally what they propose as an alternative to Obama's health care legislation. They must be pressed - and, in the process, forced to come face to face with the inadequacy of the sorts of ideas they will inevitably propose - to openly articulate a valid reason why America, alone among the civilized nations on the planet, should continue treating access to basic medical care as a privilege rather than a right. They will fail, of course. And, ultimately, they will join the legions of others on history's reject pile. The ACA's haters would have embraced the ACA without questioning had it been proposed by a Republican (never mind that Mitt Romney WAS the original purveyor of the idea); if being honest, these people would also be forced to openly articulate that their objections to the ACA are rooted exclusively in a malign, racist hatred for our president, who is a decent, brilliant, principled man. Get over it, haters. Your attitude and your objections are yesterday's news.
Robert Knox (Mill Valley, CA)
This article gives credence to Republican critics of the A.C.A. that is unjustified. Premiums have NOT increased, as critics warned hysterically would happen. Now the same doomsday prophets are forecasting huge increases for 2016. Enough coverage of these fools! Krugman has the numbers in his columns here in the NYT. And why does the NYT refer to John Boehner as Speaker Boehner and others as Senators, etc., yet refer to our President as Mr. Obama? Could that be part of the institutional, subconscious racism that we need to eradicate? Please show our black President the respect he and his office deserve. He is President Obama.
Emily B. (New York, NY)
The law needs to be revised to not punish people who are attempting to follow it and enroll in health insurance. (Currently, if you misunderestimate your income for the coming year in applying for the subsidies, you can wind up smacked with higher tax penalties than the fine for simply not being insured.)

And as a freelancer, my income simply isn't stable or predictable. I can't just notify the marketplace whenever my income changes, because that is *constantly.* I can't have insurance that makes life harder to have it rather than not have it.
Joe (NYC)
The ironic part of the ACA was that it did not address costs. It merely shifts the costs to other payers. Medicine should NOT be for profit. It is a utility and should be regulated. The ACA has put off the day of collapse, but if the system does not change to a Single Payer system, and regulated as such, the costs will escalate exponentially and ultimately the system will fail.
emm305 (SC)
"Now, he said, he worries that his coverage will be reduced as a result of the 2016 elections."

The question is whether Democrats will do the targeted campaigning to the people who are now insured and will not be and those who will never be with Republicans in WH, House and Senate...but, most of all, will they target the state legislators who have betrayed their states' citizens?

Because, only when those state legislatures have been cleaned out can we prepare for the 2020 census and redistricting to rid ourselves of the 'safe', extreme districts that have given over our governments over to an extreme minority.
John Townsend (Mexico)
Re "will they target the state legislators who have betrayed their states' citizens?"

Case in point ... Gov´t Perry of Texas. He sets the example of remarkably crass politics. His state is ranked first for the number of people with no healthcare coverage at all ... fully a third of its population ... a condition which he has deliberately precipitated by refusing provisions of the ACA.
TheraP (Midwest)
Big jumps in healthcare premiums ca easily be avoided. Let people join Medicare, which costs seniors a bit more than $100/month, a bit more for rapt D, the drug portion (but give Medicare the right to negotiate drugs & that is solved).

If people could join Medicare, those subsidies would fall so much, it would make heads spin!

If republicans do not like high subsidies, remind them, there is a better way.
Jack (Arizona)
My commitment is to Single Payer. I would have little difficulty in living with ACA, however, if instead of the class/wealth plan model currently in place, it were replaced by a single plan, eg., the same plan as those afforded by the Government to our Representatives in Washington.
kkabler (Texas)
Nice article. But the ACA is expensive. For the average America who is too "rich" to receive subsides and in their 40s or 50s, most deductible are extremely high and the monthly cost can be upwards to $1,000 per month. So with $12,000 in premiums plus a huge deductible you find yourself spending a huge amount of money before you really get any benefit. You would be better off negotiating an out of pocket cash plan with your doctors.
Matt (RI)
In plain English, the phrase in question "....exchanges established by the state." is not as ambiguous as some claim, and most certainly does not mean what the plaintiffs claim. The term "state", in it's singular form refers to any and all levels of government, and does not preclude the possibility of federal programs in lieu of state programs. The encouragement of state established exchanges in no way rules out federally managed subsidies. If the authors had intended to limit the establishment of exchanges to only the states, they would have needed to use the plural form of the word, "states", as in "....exchanges established by the states." This case had no merit to begin with.
Eduardo (New Jersey)
Apparently parts of the law need to be changed or fixed which would make it better, Theoretically this is something our lawmakers were hired to do and something that could be accomplished. Remember, good health care for all has already been invented. It's doable.

So who wouldn't want that?

Everyone knows the answer, even the NYT. It's the elephant in the room.

I read yesterday of a couple for whom the law wasn't so good. Very high deductibles and their income was middle class. Take that one thing, fix that, then move on.
I know it's wishful thinking.
Tom (Coombs)
Perhaps the United Stated should tone down it's "Greatest Country in the World" chatter. You have no universal health care.
Bob Garcia (Miami, FL)
Obamacare is a stop gap that keep our medical system from getting worse, but it does nothing for cost containment -- which is why big pharma and the insurance companies have gone along with it.

Universal single-payer coverage, similar to Medicare, but better, is the way to go. However, given that most of our politicians in Washington are bought and paid for by lobbyists, I doubt any of us now alive will ever see single-payer come to pass. After all, we are exceptional!
c harris (Rock Hill SC)
Keeping people from getting Medicaid for political reasons, what a scandal. Of course in the long run these states are going to have to pay for those people's health care much to the discomfort of the state's tax payers. But these politicians are returned to office. Apathy is running this country into decline, as do nothing tax cutting states watch infrastructure, education and health care go to the dogs. Fortunately the ACA provides the insurance exchanges in states that scorched earth die hard anti-Obama politicians would rather "hurt" Obama than help their state's constituents get affordable health insurance.
The merging of health insurance companies so that they can reduce competition is a tried and true American practice to raise prices.
Brown RN (Virgin Islands)
I agree the ACA is not perfect. But don't throw it out. Fix it!
Mary (Atlanta, GA)
While it's been said many times, and ignored by the NYTimes, this was a law for the insurance companies, in part because it was difficult to determine actuaries. That's not the case now, and yet they are asking for 20-25% increases.

In a free market, they would not get away with that. Nor would they get away with the huge deductibles that must be met. Something that didn't even exist 10 years ago; what short memories citizens seem to have.

Insurance companies are thrilled - they make a fortune and can easily hide the 20% profit cap they recieve. The government has no ability to even know. The insurance companies are especially thrilled as they have a guarnteed payment from the Federal government. Ongoing. I'd call it a bail out of a very rich industry; very sad.

Government is thrilled. This guarantees an increase in agencies and Federal staff - by 10s of thousands.

Lastly, it is interesting to see the statistics. So we are comparing 2013 to 2014. Hmmm. In 2010, when the law was signed, <10% of citizens had not insurance. What is the reality? We'll never hear, not part of the story Obama and media want to weeve.

Lastly, my office visits have increased 200 fold in 4 years. My out of pocket has doubled and my deductable increased 50% My meds now cost 3 - 5X what they cost in 2010. And every step is a fight - screening code categorized to diagnostic code (confusion and deliberate attempt by insurance not to cover items like bone density). Worst for all
NovaNicole (No. VA)
Re: the high deductibles. People need to choose plans that are not the cheapest, the "Bronze" level plans in a quest for low monthly premiums, as those plans are cheap because of high deductibles and co payments. Just spend a little more and get better coverage and reasonable deductibles, at least the "Silver" level plans.
Miriam (San Rafael, CA)
Hmmm, clearly it isn't just Republicans who dislike Obamacare. Comments to the NY Times on this article, as usual, ring out with one voice: Single Payer. Since enactment, the favorable view of it has dropped to where 42% dislike it, and 39% approve. Hmmm, if it was working so well, you would think the approval rating would be at least in the 75% range! Yet the Times keeps giving us photos of demonstrators who want ACA, and editorials by Krugman et al singing it's praises.
Could the Times be pro-corporate (insurance industry, pharma....) as usual? In this long article, there are only a few sentences regarding the problems and negative aspects of the ACA. What happened to fair and balanced?
onionbreath (NYC)
Fair and Balanced is Fox News's slogan. Hmmmm....
rip (Pittsburgh)
The Court got it right. Now its time for the American people to get it right and start electing people to serve in Congress who care more about the American people than they do their own personal selfish interests or the interests of their corporate sponsors. The ACA is working, its the law, we need to move on. Politicians who refuse must be voted out of office.
DW (Philly)
Sure, doubts remain - but remember, some of these people with "doubts" were not long ago holding up signs that said, "No to Obamacare! And don't touch my Medicare!" ... they'll get over it.
Don (USA)
The issue isn’t about supporting the healthcare bill or being a Republican or Democrat. It’s about President Obama blatantly lying to us in order to pass the affordable care act.

We then have a supreme court who has twice supported his deception by rewriting the law for political reasons. Our entire constitution and judicial system has been compromised by President Obama to implement his personal ideology.

All Americans should be concerned about the implications for their future and our democracy.
Cedar (Colorado)
I think that what really upsets the Republicans about this is that the AHCA has managed to, in a certain sense, regulate the out of control medical and insurance industries. I have dealt with medical benefits as part of my profession for decades and the AHCA is a good law, with good protections for consumers.
In your list of concerns remaining about the ACA you write, "And rate increases could be coming for consumers in 2016."

Because clearly no rate increases ever happened before the law was implemented, right?
Bernie (VA)
Two of my friends, married, have 2 children. All are native-born Americans who live in Germany, where they have jobs. They have been contemplating a move to SW Virginia, where the parents were born. They do not expect to earn a high salary and would have to decide looking for jobs before they move. On a recent trip, the wife did research on Obamacare in this state (or commonwealth, as we tend to call it). Choice? Truly an embarrassment of riches--so embarrassing, in fact, that it was mind-boggling. She may have understood it: I could not, and like her I am educated. The most affordable premium for them under the ACA--which, by the way, I endorse--was affordable, but it had a $10,000 deductible. "What happens if my son or daughter falls of a bike and gets hurt? How much are my husband and I liable for?" she asked. The answer she got was: The full amount until you have paid the $10,000 deductible. This is more than they could afford. Although they were hoping to move here this summer, this gave them second thoughts. In Germany, they have single-provider health care (by the state or nation: I'm not sure), for which they pay taxes. which they do not begrudge for they receive value for it. They may still move back to the US, but they are fearful and I cannot blame them. The improvement we need in the ACA is to make it a single-provider plan, in other words an expansion of Medicare.
Walkman666 (Nyc)
As long as a significant number of politicians prioritize profit-making and wealth (i.e. capitalism) over the greater good of public health, then there will be this fight. It is a shame because the republicans then sell it to their electorate inaccurately (yet cleverly) as freedom. Healthcare should not be a profit-based industry. This does not mean that doctors, hospitals, and drug companies cannot generate revenue, but their salaries should be commensurate with a not-for-profit structure. The concept of getting rich off of the well-being of others is why the folks who have $ get great healthcare, and the folks who do not much $ receive spotty healthcare or go to the ER, which drives up costs. This is a philosophical debate and one that should be about decent civilization. Practitioners should not enter the healthcare field if motivated to make millions. The good ones motivated by good deeds are plentiful! What kind of humans are we that we would prioritize who gets healthcare and who doesn't, and that pharma giants can employ executives who get very rich off of potentially helpful (or superfluous) drugs. What is the real purpose of medicine and wellness? Not to get wealthy. The republicans are so fundamentally wrong on this. Selfishness has no place in healthcare.
fitnessgal (new york)
If those of us that are healthy at present are joining a pool for healthcare benefits... should we do this with other forms of good such as pay and earnings too?

why should a sports athlete born with the gift of being 6 foot 10 get to earn all the money himself?
mj (seattle)
"And rate increases could be coming for consumers in 2016. Many insurers have sought increases of 15 percent to 25 percent."

As someone who purchases insurance in the private market and not through an employer, my wife and I experienced such increases in premiums prior to the implementation of Obamacare. Our premiums rose over 100% in 4 years but in 2014 they actually went down. Yes down. The ACA is not driving premiums any higher than they were moving already.

"But the latest poll by the Kaiser Family Foundation found that the public remains deeply divided over all, with 42 percent reporting an unfavorable view of the law and 39 percent reporting a favorable view."

I wonder how many of those who have an unfavorable view of the ACA actually have any direct experience with the law other than the added benefits the ACA provides for all insured. According to the Kaiser Family Foundation, about 48% of Americans get health insurance through their employer. I suspect the vast majority of those in the private market fully support the ACA. It is easy to oppose something that you see as providing little benefit to you.
Mel Vigman (Summit NJ)
As a physician and a taxpayer, it's great to see more people accessing medical care, but not great to see subsidies which come from taxpayers added to Medicare, Medicaid, and other federal medical expenditures. I'm in position to see the waste, abuse and fraud in action, to see the way insurance companies are the real controllers of "Obamacare," with the top priority of medical groups, hospitals, drug companies, etc being for profits, and then more profits (even while telling the public that they are "non profit" and really really are the best companies).
The only answer is to flip the system, put everyone on salary, buy drugs from Canada, get rid of all the non medical care parasites, and copy Germany or Canada or England.
curtis dickinson (Worcester)
It is time for Republicans to move on. SCOTUS has ruled twice. That's enough! SCOTUS is the final determination of constitutional law. Move on, Republicans!
T.E.Duggan (Park City, Utah)
The stated resistance of McConnell, Boehner, Hatch and their acolytes is based on intentional misrepresentations (i.e., lies) about the state of the ACA. It's a strategy which is ultimately bound to fail and, in the meantime, is destructive of the legislative process. That they have gotten away with this for so long is primarily the fault of a feckless and gutless Democratic leadership too uninterested or timid to adopt and execute an "in your face" strategy of confronting the lies with the truth. The truth will prevail but it has to be told loud and clear, with authority.
Speedypete (Augusta GA)
why not replace and then repeal, then we will see the next choice, not just a replace promise.
Blunt (NY)
This is a wonderful outcome. I am very happy for the country. Anything different coming out of the Supreme Court would have been beyond comprehension. This is the wealthiest country in the world. Not having universal healthcare is shameful. ACA is a step in the right direction at best. By the way, the totally wishy-washy coverage ACA received from the New York Times is not impressive to say the least. You really never came out and shouted strongly, without any reservation that the Republicans have been totally wrong. You equivocated and tried to give a "balanced" view. I am sorry but in this case there is no "balanced" view, as much as there is no "balanced" view when it comes to the criminal acts that are direct functions of a lack of gun control legislation.
Fred P (Los Angeles)
The authors of this article state that for 2016 "many insurers have sought increases of 15 percent to 25 percent." How much longer can America allow the medical establishment's greed to take a larger and larger percent of GDP? The Affordable Care Act has had tremendous benefits for many, but unless we take steps to really reduce medical costs we will bankrupt this country.
eusebio vestias (Portugal)
The health can not be a profitable business has to be a good investments well-being of humanity and with better economies and politicians have a moral obligation to protect its citizens because besides the hope must be the change we all have the right to health
ecco (conncecticut)
insurance companies "thriving" can pay X for medicare's 80% of costs coverage and 2X to a company that will pay the remaining 20%.
A teacher (West)
Yesterday, after the Supreme Court decision came out upholding the Affordable Care Act, healthcare stocks--Corporate hospitals, Big Pharma and the like--soared. While the rest of the stock market is trading at about 17x earnings, healthcare stocks have risen in the past two years to 23x earnings. The ACA was written by nearly 400 healthcare lobbyists--is there any doubt who has really benefitted?

Single payer is the only rational way to go.
Thom Boyle (NJ)
Some question may remain, as they should, with any new legislation that is this far reaching. Just imagine though how much better we would all be, overall, if we had spent the last 8 years trying to make it better rather then trying over 50 times to destroy it.
Let's not forget that prior to the 2008 election 75% of Americans listed health care as the most important item on their agenda.
DP (atlanta)
The insurance companies, as the NY Times writers note, have certainly thrived under the ACA . They have cut their costs - not those of consumers - and buttressed their profits. Why wouldn't they? They helped ensure passage of the ACA.

The industry has succeeded in altering the nature of insurance on the individual market, shifting costs to consumers, barring out of network care, and restricting access to doctors and hospitals. All goals attempted in the past but unrealized.

The industry lobbied fiercely on behalf of the Administration to ensure subsidies were available nationwide and the ACA remained intact. In fact, Chief Justice John Roberts cited the insurance industry's amicus brief in his decision.

I realized this morning that the insurance industry is now truly running the show, even more in charge of our healthcare than it was before passage of the ACA. Unless we make major changes, and that means revisiting the ACA, the industry's power over American's healthcare will continue to grow.
David Johnson (Greensboro, NC)
It is laudable that the growth in premiums and medical costs have been slowed but the mergers and consolidation in the industry is a double-edged sword. Efficiency and reduction in care costs are good while a reduction in competition which could lead to price increases is bad. The one remedy for the latter is Medicare for all. We can only hope that the American people will get use to affordable medical care sooner than the capitalist effects that are holding down the increases wear off. If that happens, politicians would be loathed to oppose the universal healthcare fix should it be needed.
James (seattle, wa)
My wife and I are between age 55 and 65 and don't qualify for a subsidy. We have a major medical event this year. Between premiums and maxing out our deductible, with some relief from a health savings account, we'll pay $20k in medical expenses. I think this needs to be fixed. Otherwise, I think the plan does a lot of good.
Jeff (Placerville, California)
How much would you have paid if you did not have insurance?
James (seattle, wa)
Certainly over $100K. I like obamacare, but I think this part is broken.
Murray Veroff, CPA (Fresno, CA)
Everyone continues to use the word "subsidized". Who exactly is doing the subsidizing? Me, for one. And millions more middle class people.
My premium for ONE 59 year old went from just under $ 500 per month to just over $ 900 per month, and I have been advised to look for a double digit increase in 2016. Is that fair?
At least I would like to meet the person whose premium I will be subsidizing for years to come. Quite an expensive gift I am making to someone I don't even know. I don't even get a tax deduction for this monthly gift.
Paul (White Plains)
Proponents of Obamacare will be in for a big shock come 2016. that's when the onerous employer mandates kick in. Lots more costs to employers, lots more bureaucracy, and lots more restrictions on covered services. Watch as more and more doctors decide that Obamacare is just not worth it for them. Watch.
Bob Burns (Oregon's Willamette Valley)
If 17% of private insurance companies' income goes for salaries, advertising, dividends, political influence, etc. that means that only 83 cents of every dollar find their way into actually providing healthcare.

On the other hand, Medicare costs 3% to handle health care claims. No investors, no political lobbyist team, no advertising.

What's wrong with that?

Oh, yeah: "Government takeover of medicine." Americans will go broke lying to themselves about big, bad government and getting medical care for us all.
HL (Arizona)
The ACA in context with what existed before is a huge improvement. Unfortunately the Insurance industry is in the process of gutting both affordability and access for those with pre-conditions.

The Administration and Congress gets a lot of heat for the line that if you like your doctor you can continue to see your doctor. Unfortunately the political solution that got more people coverage with subsidies and denied insurance companies the ability to rate patients based on health didn't regulate insurance companies on who or how small the networks they could contract with to provide services.

The one piece of this legislation that was supported by almost everyone was that sick people couldn't be dropped by their carriers. Instead of dropping them the insurance companies have been allowed to dump many of them into provider networks that small, understaffed and in many cases delivering substandard care.

Everyone must have health insurance, No one should be dropped for being sick and insurance companies as administrators of the US new National Health system must provide access to all providers in return for government subsidies and low cost patients that they are getting as part of the government mandate. The Government needs to address this issue before the employer mandates go in or their will be blood.
Almighty Dollar (Michigan)
After reading this article, why any Republican voters would be against this law is confounding. One can only assume they truly feel the money it costs is not worth it - even though deficits go up without the ACA, or 2) It is an intense dislike/hatred for poor (and mostly black) fellow citizens, or 3) the non existing alternative that they have never put forward under any Republican president is better.

I cannot think of any other reasons. With 40% wanting repeal, it seems the state of our Union is currently not very strong.
bradshj (Chicago IL)
The writer's of this article aren't helping any more than the republican gang (who're just emo that the other gang got one "over" on them) who've thrown roadblock after roadblock in front of it. Even they could benefit from a good primer on the top, as illustrated in the recent non-sensical quips by their leaders.

Instead of rehashing the drama, like so many articles/editorials before, make an effort to educate the readers on the various components of healthcare reform, how each is working together to increase the quality of their lives and what is needed from them to become a better consumer of healthcare. Reform isn't a magic elixir, all have to actively participate to make it work. There is a great deal of consumption of care that is occurring because of other long-term controllable items. 15-20% of the population is doing 75-80% of the consumption at any given time. Many of those have chronic conditions, for which you can't necessarily cure, but only lessen the impact. For the rest, they need to take care of themselves, stay fit, eat healthy and encourage those around them to do the same in order to avoid many of the "poster child" consumers so often high-lighted by articles such as this. Again, as with any large-scale social program, the benefits are realized over years, if not decades. There's no immediate gratification here, Americans need to learn to be patient and stay the course in spite of initial gains not being easily seen....
Annabelle (Huntington Beach, CA)
In my state of California those without health care, including most illegal immigrants, were always treated fully at the taxpayer expense and still are. I didn't know of anyone who was sent away. In the end, this law has been another redistribution of wealth, with the wealthier Americans, like a friend I have, paying over $30K a year for insurance for a family of five (not the Cadillac plan either) to help pay for others with lesser incomes. One way to know it wasn't best for Americans? The medical insurance companies were for it and the Congress and Senate didn't want to participate. And then, there is the IRS handling it? Seriously?
Jeff (Placerville, California)
We in the State of California are paying for indigent medical care through our taxes. Why would private insurance costs be affected by health care costs that the insurance companies are not paying for? I'm on Medicare and my total premiums for Medicare and an AARP supplemental policy cost me about $5500 per year. Your friend is getting off cheaply.

Sounds like you want to blame Obamacare without being hampered by facts.
njglea (Seattle)
Let's calm insurers', Wall Street, "conservative" doubts about health insurance in America by Demanding government-run Single Payer Insurance for All with serious cost controls on providers and insurers. They have stolen enough of OUR money and lives.
AR (Virginia)
Really can't think of anything more nauseating than the sight of Jeb Bush--the dilettante son of privilege and hereditary politician who's never known a moment of financial distress in his life--pledging to repeal the ACA if elected president.
hen3ry (New York)
Although it's politically unpalatable to our elected officials we need a single payer universal access health care system instead of the current fragmented wealth care system we have. Americans are not receiving the care they need. We are getting the care we can afford which is quite a different thing. Even though I had insurance when I fell off my bike, cracked my helmet, bruised and cut myself, I still didn't go to the doctor or the ER because of the costs. I had a concussion and the aftereffects for 4 months. It was cheaper not to go and face the cost of the co-pays, the deductibles, the coinsurance costs, etc. I needed to be checked out but the cost was prohibitive even with insurance.

We do not have a health care system in America. As I've stated in other places, we have a wealth care system. We get the best health care money can buy. Therefore, if I lose my job and cannot pay for health care or insurance, I can walk into any ER, receive care and pay for it. The catch is that I can't. Wealth care is not health care. Health insurance companies, big pharma, hospitals, and even many doctors charge what they can get away with, not what is reasonable. Health insurance is more of a scam since those companies try not to pay for anything. How does this contribute to our well being when we need care?
Marc A (New York)
Doctors charges are limited by what insurance will pay. If a Doctor charges one million dollars for an office visit will the insurance pay one million dollars? A fee schedule exists for every health insurance carrier. If you are paying out of pocket with no insurance then you can always negotiate the cost based on these insurance fee schedules or limiting charges.
Sherr29 (New Jersey)
Jeb Bush ... pledged on Thursday to “work with Congress to repeal and replace this flawed law with conservative reforms that empower consumers with more choices and control over their health care decisions.”
The Republicans have had YEARS including since 2008 when President Obama was elected to come up with a health insurance plan and they haven't. And when Jeb Bush toots his horn about "repealing and replacing" reporters should ask him point blank - with what? Tell us YOUR plan instead of peddling the usual Republican lies and dis-information about the ACA and health insurance in general.
The Republicans have no "plan" other than the failed health insurance/care system that the US has had for years that left millions of people without access to affordable heath insurance which encouraged people to not address health issues when they are more likely to be managed before they become more costly or worse -- deadly.
Walrus (Ice Floe)
I am still trying to figure out why health coverage is so evil. None of the Republicans actually give a reason. They spout about increased premiums, but (1) they never cite any credible studies and (2) premiums were increasing even WITHOUT Obamacare. Take away that argument, and what do you have? Nothing. Rand Paul has philosophical objections, but like both of his namesakes (Rand and Paul), he is a fruitcake.

Taking away healthcare from lower income people is cruel, no matter what justification you offer.
Marc A (New York)
Republicans do not care about low income people.
Nick (Austin)
This article does nothing but provide anecdotal evidence that the law is working.
The main statistics provided are the ones regarding how many more people are now covered, that doesn't equal success. Success would be a revolutionary new healthcare business model, that increased my coverage, gave access to those uninsured, and lowered premiums.

If you're going to play the anecdotal evidence game, you must present both sides. What about those healthy small business employees whose premiums just doubled because their policy now has to accept unemployed sick folks. What happened to choices in this country?
BP (Andover, MA)
The media, especially the New York Times, needs to stop giving Republicans, especially its numerous candidates for the presidency, a pass on providing the specifics for precisely what they would offer the American public in place of the universal health care coverage provided under the Affordable Care Act.

I believe most Americans have grown tired of the empty homilies and vacuous comments being made by Republicans in their attacks on the Affordable Care Act. No American should forget that if Republicans could have their way, they'd eliminate Social Security and Medicare.

The next time a Republican mouths off "repeal and replace", every New York Times reporter should pipe in, "Replace with what? Please be specific Mr./Ms. Republican Candidate. If you are not specific about what your replacement would look like and work, don't expect any reporting of your empty homilies."
Dr Wu (Belmont)
Roberts sticks with the insurance companies and the so-called free market place. As long as insurance companies are doing well he is with ACA. Scalia, on the other hand is bitter. Good to remember that his father was a member of the American fascist party. In this case, the Apple did not roll far from the tree. True, some are helped by the ACA, plus the CEOs of the insurance companies, whose salaries promote out glaring inequalities. Single payer would have been the wiser chioce, but alas, Obama and Roberts went with the free market and its' iniquitous inequalities.
etagluoh (San Luis Obispo, CA)
My niece with a husband and two children is saving about $400 per month on because of Obamacare. She had a pre-existing condition that made health care prohibitive for the family. Republicans have no solution for people like her -- they want to take us back to the pre-Obamacare days. The best solution is to expand Medicare so it covers everyone equally. Let's make access to medical care a right, not a privilege.
Michael J. Gorman (Whitestone, New York)
Chief Justice Roberts came through again on the side of basic fairness and respect for human dignity. The ACA is the best Obama and the Dems could accomplish since a single payer plan would not have been passed. Obama 's legacy is solid. Congrats to President Obams
Barb Campbell (Asheville, NC)
I never thought that I would look forward to turning 65, but I'm counting the months. The Medicare system is in place and operating well; it should be set up to cover all Americans, with higher premiums for those who can afford them.
Mary (Atlanta, GA)
Healthcare is a scam these days. Has been for a while due to insurance. Nothing was done to decrease costs of care. Exactly the opposite has happened since Hillary started getting pieces of her healthcare into non-related legislation through the 90s; it's called pork. This was deliberate and started the double digit increases as you see, it increased the middlemen that provide no care, but make tons of money.

Too many in this country have no idea of the impact of regulations on care. On the impact of government on escalating costs. The only reason that Medicare is working for you now is that it is still primarily the same rules as we had back in the 70s and 80s. Don't worry, that will change as Obama and Congress will continue to cut payments, and therefore care. Followed by insurance companies.

And, oh, maybe you don't know that insurance companies run Medicare. Yup. They are contracted by the government by state. So Medicare is run by insurance, caps for spending are set by government. Lots of employees working in Medicare, but they don't do much.
Jeff (Placerville, California)
I agree! Last year when I reached 65 and enrolled in Medicare, my insurance premiums, with supplemental medical, drug and dental coverage dropped from nearly $800 per month to about $500 per month.
Greg (Austin, Texas)
The disapproval of the Affordable Health Care Act (AHCA) is based in hatred of President Obama, isn't it? And what is the basis of the hatred of him? It is racism. That racist hatred blackens the heart and dulls the mind, doesn't it? Everything the man says and does is hated; that is the blackness of the heart of the hater. And the racist mind cannot acknowledge the rational benefits the ACHA provides to a relative or friend or community.
Another sad part is the haters were hoping that millions of Americans would lose their insurance subsidies and their access to health insurance, weren't they? The racism in America is sickening and unrelenting.
Pottree (Los Angeles)
It is also much more on display in TX than many other parts of the country. In places like TX and OK, hatred of President Obama is almost a religion. The recent bad weather was all his fault, of course.
Craig G (New York, NY)
There are a lot of comments, articles and opinions talking about the number of insured persons. There are very few articles or columns talking about healthcare and if those newly insured are getting healthcare now. Is their healthcare better and are they getting it for less money than they would otherwise be paying if uninsured.
MsPea (Seattle)
I still don't understand the opposition to the ACA. Do the opponents think it's better for people to stay uninsured?

People complain about their tax dollars being spent on the subsidies, but don't they realize that our tax dollars have always paid for coverage for the uninsured? When uninsured people use the emergency room as their family doctor, where do ACA opponents think the payments to doctors and hospitals came from?

Do the people who say they are healthy and resent having to buy coverage, or say they can't afford coverage, think they will never get sick? What dream world do they live in? I'm healthy, but in January I did get sick, finally went to the emergency room and the next day was in surgery. The cost was almost $100,000. Do ACA opponents think it would be better if I was bankrupted by that? Or is it just that the people who complain of taxes and subsidies think they have no obligation to pay anything for coverage and think it should be free? Who pays then?

If the opponents think there's some better way, or have an alternative plan, what is it? Why didn't they come up with an idea in all the years they've been fighting against the law?

The arguments against the law have never persuaded me.
CityBumpkin (Earth)
Despite conservative claims to the contrary, Obamacare is still extremely American. In the name of limiting government, it leaves plenty of room for middlemen to make a tidy profit. In the 21st century, from student loans in education to contractors invfighting wars, giving plenty of room for middlemen to make a tidy profit seems to be the essential component of the American Way.
mc (Nashville TN)
The ACA is flawed and still needs some work. However, most GOP criticisms are based largely on lies, and they need to be called out as such.

"Skyrocketing premiums"? For purchasers of health insurance, premiums have been skyrocketing for decades--which is one of the reasons this legislation was so critically needed. ACA allowed me to ditch my old insurance and its skyrocketing premiums and actually shop for an alternative.

ACA opponents object most strongly to the subsidies--and I have been insulted by GOPers who assume I am getting a subsidy because I bought on the exchanges, and this somehow "punishes" them. Some of us don't qualify for subsidies (not poor) but still need affordable coverage. ACA is not just for the poor and those dark people.

ANd those subsidies are keeping some of the neighbors alive. The sort of evil mentality that sees this as punishment should be called out too--shame on them.

You cannot fail to carry health insurance and remain middle class in this country. Even a minor illness can bankrupt you. Access to healthcare is not a luxury.

I could go on about the outright lies told about the ACA but we've all heard them. We need to decide policies such as this on FACTS not lies.
DRS (New York, NY)
It's easy for the poor and young to hold placards praising their subsidies (who doesn't like free stuff after all?) but why are the subsidies paid for only by the well-to-do? Why aren't average Americans asked to chip in, like they are for Medicare and Social Security, in the form of a payroll tax? If they are not willing to, I think it proves just how shallow and hypocritical the moral basis for universal health insurance really is. Put up or shut up. It's easy to spend other people's money, and frankly offensive for those of us who have to pay for it through tax surcharges.
Gene Horn (Atlanta)
Read the numbers carefully

Kaiser - 6 in 10 previously uninsured. That means that 4 in ten were previously insured.

There ar 7 M in the federal programs. The state programs are about the same. This means that of the supposed 14 M on subsidy, 5.6 M previously had insurance.

Medicaid and children's health added 12.3 M. That means the total added were 14 M plus 12.3 M less 5.6 M or 20.7 M. Wait, we started with 50 M uninsured and still have 36 million uninsured.

40% of those subsidized make less than 1.5 times the eligible poverty level. The level is $23,500 times 1.5 for a single and 1.5 times $30,800 for a family of 4 That means that 60% make more than $34,250 if single and more than $45,350 if a married family of 4.

The average subsidy (per person) is $3,264 which covers 3/4ths of the premium. That makes the average premium $4,351. Medicaid for an adult costs on average $4,500. The Silver Obamacare program costs $5,500 on average. Lizzie's policy is cheaper but has high deductibles and copay.

Assume the Medicaid 12.3 M are adults and cost $4,500 X 90% =$49.8 Billion and the 14 M subsidized cost $3,264 = $45.7B. That is a total of $95.5 B. The fiscal 2014 actual federal expense was over $200 B. Over half did not go to the insured.

Got the picture yet?
KarlosTJ (Bostonia)
"Good Health" is a result of the effort I expend to achieve a goal. It involves solving problems such as what to consume, how to exercise, etc. It also involves solving problems such as accidents: viruses, allergic reactions, broken bones, diseased organs, cancer, etc.

Solving such problems either requires or is enhanced by products and services such as exercise equipment, nutritional plans, surgery, pharmaceuticals, medical expertise. All of these products and services require trading cash that I earn (by producing my own products or services) for these products and services created by others.

Obamacare and its Progressive lackeys ignore these facts. Instead, Obamacare proclaims that you can get something for nothing - that all these products and services are to be handed over to you without your having to earn them.

There is no "right to healthcare". Such a "right" is a diktat: it requires someone else to create the products and services that the "right" encompasses. This is perverse and evil. It is the Way of the Thief. It is literally "From each according to his ability, to each according to his need." Everyone in favor of this is as Marxist as it is possible to be.
smlynch (NJ)
Nonsense. I speak as a public health scholar. Much of your health is determined by your genes and your upbringing prior to your making any conscious decisions about your health. Everyone gets sick. Everyone dies. Accidents happen beyond our control. It does not matter how much effort you put into it, you will require health care. And any society which promises the right to life, liberty, and the pursuit of happiness must therefore put health care as a basic right as well, because without your health, you have none of these, including the ability to earn the money to buy additional products and services to maximize your health within biological constraints. If you want to call providing a health care safety net "Marxist," then you can count me as one. And what I'll call you is "thoughtless and ignorant" of the way health care fundamentally differs from other commodities.
Mr. Robin P Little (Conway, SC)

It was President Obama's thankless task to put together an unwieldy combination of public and private insurance plans with a mandate to buy coverage as part of the process of nationalizing healthcare that earned him so much enmity. Due to a rump element in the Republican party, variously identified as Tea Party members and libertarians, but really belonging to the paranoid, racist, far-right which goes back to the John Birch Society of the late 1950s, he ran headlong into a firestorm which caused those who opposed him to say they would do everything possible to dismantle so-called Obamacare.

Forcing Americans to buy coverage, or face fines, is still the central feature many despise, an act which led to him being called 'imperious'. Add in the fact of his skin color, and his fate was sealed. This far-right element will never like him, or his Presidency, no matter what happens to prove them wrong. He can safely ignore these critics, but the enmity they bring to their political opposition is toxic to the Republican party. Moving away from it is their best strategy.
Steve Hunter (Seattle)
How so many people could be so opposed to the goal of affordable health care for all Americans, not just the privileged is unAmerican.What does this say about us as a nation, not much.
Mr Magoo 5 (NC)
It seems to me that the president has the American people supporting and serving health care providers, drug companies and insurance corporations, rather than the other way around.

The 1776 American Revolution was as much about freeing colonies from the powerful English corporations as anything else. English companies were given a mission to exploit the peoples wealth as a public service for the realm.

In our early American history the state legislators and shareholders had complete control over the corporations. Company officers could be terminated for charter violations or lack of serving the public's well being.

The Supreme Court rulings has reversed roles and we now serve corporations by making it mandatory to have or pay for health care to corporations.
rjs7777 (NK)
We live in a country whose government already pays as much money per person for health care as Canada and Germany. We are paying for universal health care, today. I have what is considered really good private insurance, on top of that. And I still don't have realistic access to health care. I turn appointments down, because Id have to pay for tests in cash.

The medical system as it exists today is evil. It needs to be completely destroyed and replaced by a humane, low cost, high effectiveness program, one that does not focus on the final 6 months of life, but instead focuses on the first 83 years of life. It should be funded solely from existing government health care budgets.
Pottree (Los Angeles)
Don't be foolish: the purpose of health care is not HEALTH... it is a business opportunity all about MONEY. The poor - okay, the not rich - don't really deserve health care because they don't have any money to milk out of them in the fake name of health care. They are, in that sense, worthless to the GOP. In their fantasy world, EVERYTHING is about money; they've even figured useful ways to monetize racism.
The Poet McTeagle (California)
A lot of opposition may well be due simply to hatred of Obama. Racism is alive and well. Once he is off the stage, combined with the power of the health insurance lobby, surely the GOP attacks on the middle class and poor will move to other fronts.
Matt (New York, NY)
Doubts, shmouts. It will take time for the public to come around, but come around they will! The Republicans are committing political suicide over an issue they cannot possibly win. Universal health insurance is good for the country and it is the law of the land. Is it really worth losing the presidency over an unwinnable issue now that it has been settled by the highest court in the land (and a historically conservative court at that). Amazingly, there are still a lot of people who continue to believe that Obama was not born in the U.S. Shades of Trump! I mean, come on. Haven't we moved past the issue of Obama's birthplace already? The rest of the country is moving forward. The Republicans better get in line or be prepared to lose.
kg (new york city)
At the end of the day, the debate on the ACA boils down the fact that there is a significant segment of our population who believe that we do not have a shared responsibility to ensure that all -- and, especially, the poorest of us -- have access to good, affordable health care. As a society, we all pitch in for other shared services like police, transportation, and the like. Why not health care? Why are we so selfish with each other on the one thing that is necessary for everybody?

So much for E pluribus unum.
Mike Frederick (Charleston, SC)
Republicans need to stop trying to repeal the Affordable Care Act and propose ways to fix it. They look stupid to anyone who's watching. There are serious problems with the ACA but it's here to stay. Costs of the Act seriously understated and the deferred cost have yet to been seen.
Pottree (Los Angeles)
It is part of their program to look stupid: this appeals to the base, mainly in former slave states, that weigh two or three times what they should and live in trailers, yet vote like they're on the board of the country club.
Chaz1954 (London)
Odd how the posts here from libs are so, how do I say it, Hillary-esque! From our dinner table, the conversations center around the numbers of people that we know who have lost their insurance/Doctor (17) and the number of people that our brother-in-law (owner of a steel fabrication co.) has had to lay off due to costs (11 or 22% of his staff).
This debacle will really raise its ugly head in about 5-7 yrs as the true costs hit and youth (21-30yrs old) who voted in the man in our WH who signed this (though I am sure never read it) will be wondering why their paychecks (if they have jobs) are being hit by higher taxes.
jb (binghamton, n.y.)
Problems with health care in America are not new. Ronald Reagan made an unfortunate effort to improve Americas poor but expensive health care system, and made it far worse in the process. When, against the advice of most experts, he chose the insurance industry to "manage" American health care costs shot up, quality declined, and millions were shut out of care entirely. The health care industry power and profits soared. There was no way out of the miasma created by Reagans historic blunder.

The Affordable Care Act can't fix the unfixable. Legislation had to work with the mandate given the insurance industry and build around that messy center. There was no possibility of a simple system once a system of endless rules had been entrenched. Only more rules could follow. There was, however, an opportunity to redress the worst of the Reagan plan and to provide almost all Americans with decent health care. That's what the Care
Act did. It also will slow the escalating costs in a number of ways.

The Affordable Care Act may never be perfect. It's much better than we had and the best that could be made of someone else's mess.
newton (fiji)
Yes, Congress ! Lets have a few more votes to repeal it (300 sounds like a nice round number and a doable goal) and plenty more hours "debating" how its ruining America. Its not like there are any other problems left to solve....
Christine McMorrow (Waltham, MA)
"Many people complain that they must pay several thousand dollars in deductibles before they receive tangible benefits from insurance policies. Many others assert that the law has encouraged insurers to narrow their networks of health care providers, limiting the selection of doctors and hospitals available to some consumers."

So how is this different from health insurance BEFORE the ACA? Self-employed people were subject to all the above and more. In the years prior to Medicare, I had to purchase private plans that routinely increased premiums by 20% or so each year, even for high-deductible plans.

The Republicans may scream, but their solution of "more choices and control over the healthcare" means a return to rapacious insurers and an open market where only those with significant means can afford their plans. Vouchers, privatization, whatever they call it---it means, you have choices if you are willing to pay for them.

Our healthcare system is just so complex, so convoluted, so full of inconsistencies, duplications, and waste, that there is no way to fix it other than to enact national health insurance with uniform rules and options across all states.

But the main reason the GOP so hates the ACA is that its core beneficiaries are the poor. By their reckoning, the poor should remain uninsured, and better yet, hidden away from view. Don't they realize that uninsured citizens are walking time bombs of high costs that get spread around to all of us?
TBBAC50 (Indianapolis, IN)
Has Dennis Hastert weighed in on this?
jwp-nyc (new york)
Everyone we know who had been paying for health insurance pre-ACA agrees that they are paying between 10-33% less for the same or equivalent package of benefits. Prior to this legislation coming into gradual effect we all coped with year over year increases that were obviously 'jiggery' by the insurance industry with no competition or oversight in a system where, in effect health insurance was being used as a 'protection racket' to ensure primary health care and even consideration for hospital admittance.

Should we have national health insurance? Let's call it Universal Medicare. Would it offset what we are currently paying for health insurance? Yes. Would it be less anxiety and confusion producing? Yes. Would it profit the health insurance industry. No. They would need to find another line of work. Would doctors like it? No. Doctors want to get rich and still feel like the origin of moral rectitude and self-righteous self-regard while 'doing good.' The AMA is one of the major reasons that broader health care took so long in coming. They started fighting the notion nearly a century ago. We seem to have addressed that by importing about half our doctors from abroad.
William Case (Texas)
It will take years to know whether ACA subsidies are a success. It will depend on the ACA impact on insurance premiums. Many insurances providers are already asking for substantial increases. If premiums level off at acceptable levels, ACA will be a success. If premiums climb to high, young people, who subsidize older people, will drop out, preferring to pay the fines rather than the premiums.
Karen L. (Illinois)
Insurance companies must be taken out of the equation with regard to health care. Even on Medicare, I still must buy supplemental insurance to ensure that I won't go bankrupt paying the 20% that Medicare doesn't cover. That supplemental policy is not cheap and goes up every year, at a greater percentage than my social security check.

Yes, some people run to the doctor or ER for every little thing. But having paid for my own health insurance for over 30 years (no golden group policy) with high deductibles, I'm not in that habit. What is needed for the senior population and probably for every generation is more general medicine practitioners who deliver regular preventative medical care to avoid the high cost of emergency or pseudo-emergency care. And they should be compensated accordingly.

Currently, not enough medical students go into general medicine or pediatrics because the specialties pay so much more. And with high medical school debt, it is no wonder. This is another area of our health care delivery system that needs reform.
Shoshanna (Southern USA)
it will never be fully implemented, and will collapse as it will never be enough free stuff, subsidies won't cover the entire cost, deductibles too high, etc.
Patrick (New Jersey)
It truly doesn't matter what the politicians legislate. Insurers will increase premiums no matter what. If it wasn't the cost of claims, it would be something else. Until the law finds a way to make insurance companies easier to deal with, until it finds a way to stop them from denying claims as an automatic first step, until the average person doesn't need a Ph.D. in economics to understand the billing process and policies, our health care system will remain a mess.
recharge (Vail, AZ)
Yesterday the airways were jammed full by Republican pundits, presidential aspirants and party leaders in what can only be characterized as sour grapes and denial. Their reliance on tired old sound bites and "medical experts" to denounce the SCOTUS ruling is truly amazing - the once rational Republican party has embarked on a race to irrelevance.
Michael F (Yonkers, NY)
According to the CBO the ACA will cost 170 billion a year. Obama said it wouldn't cost more than 100 million a year. Since the ACA my insurance has gone up almost 20 percent. My copays have tripled and I had to find a new doctor. I couldn't keep the one I had. The CBO also says that some 30 million will still be uninsured. So lets see. It doesn't reduce cost and it doesn't cover that many more people. Oh and it will result in a great expansion of the federal bureaucracy. So just what about it do you like?
Diana Moses (Arlington, Mass.)
It was clear from the moment that the Supreme Court released its decision that made the Medicaid expansion voluntary that the ACA as written is part of a a work-in-progress of improving how we pay for health care in this country. Beyond that gaping hole is what I consider to be an important problem, namely how complicated our health insurance system is. I have spent weeks and months of my life, and I am sure I am not alone in this, trying to figure out what a family member needs to do in order to transition from one insurance situation to another or to coordinate benefits between systems. These transitions have come up because of a move from one state to another or reaching age 26 or being offered Medicare while still eligible for private insurance as a child under 26. Make the wrong choice and the costs can become prohibitive. I have a lot of education and know how to work the phone, but even the legal experts I ended up consulting commented on how complex the situations were -- they, too, found them difficult to navigate. We need a system that is less byzantine, we need a simpler system, one with fewer pitfalls. Providers and their billing offices often have difficulty navigating the system themselves -- I have had to try to bring provider billing office, Medicare, and private insurer together on the phone in order to get everyone on the same page about how to bill a claim so that the insurance arrangement the patient has is honored. I think we need single payer.
RDG (Cincinnati)
In 1968 Richard Nixon said he had a "plan" to bring the Vietnam War to an end. He had no such plan.

Today we hear Republican candidates again telling the American people that they will replace ACA with "choice", "free market competitiveness" and the like while reining in health care costs (despite what my fellow Southern Ohioan, John Boehner, claims in the article).

Well, GOPs, let us see your repeal-and-replace plans. Let health care experts, accountants, economists and the average jamoke vet these offerings, getting down to the deviled details sans the rhetoric.

Or, rather than wrecking uber alles, you can take what appears to be something of a success and work with the President in remedying ACA's more glaring flaws to make it even more cost effective and inclusive. Sadly, I'm not holding my breath on that one.
B (Minneapolis)
"The subsidies also appear to have drawn substantial numbers of younger, healthier Americans into the new insurance markets, stabilizing premiums even for people who pay the full cost themselves."
So much for the "death spiral"
But that won't stop fanatical opponents from shouting false claims - death panels, Congress is exempt from the law, death spiral, job killer, budget buster, can't keep your doctor, premium skyrocketed, deductibles unaffordable, etc., etc., etc.,
And it won't stop them from making claims about things that can't be proven or disproven due to lack of sufficient experience, such as the impact of the law on Americans' health.
But, lest they be reduced like McConnell and Boehner to shouting meaningless characterizations, such as "spectacular flop" or "law is broken" , Republicans will have to pass a law that changes some aspect of Obamacare. Otherwise, their 2016 campaign assault on Obamacare will not be based upon anything other than general statements that will have less and less credibility no matter how many times they are repeated.
cmsvmom (Florida)
Note the age of the man in the example pictured. 63. Too young for Medicare. Too sick and old for much else. The previous system told boomers like him to hurry up and die unless charity stepped in to provide medical care at the level of quality available to those who are covered by insurance, Medicare, or private payment.

That is but one of the cavernous gaps that must be closed and repaired by any attempt in 2016 to repeal or amend the existing law.

The "choices" for consumers like this 63 year old man are simple. Life or death.
CALynn (Scootchus)
This is all smoke and mirrors. The plaintiff in the case didn't even have standing. He was a Vietnam Veteran who did not purchase on the market because his health care is free at the (socialized) VA. Additionally, 100%/of my tax clients this year who purchased on the market and received a subsidy, had to pay all of part of it back. The effect on employer provided insurance is devastating. Deductibles have doubled and triped as ACA works as a bottom feeder, bringing DOWN the quality and equitable use of insurance. But hey, the stock market did well yesterday trading those health care stocks.
anthony weishar (Fairview Park, OH)
Health care premiums were a scam until the Affordable Care Act. I carried my daughter on my employer subsidized Blue Cross policy until she was 26. It cost me an extra $300 a month, and my employer even more. Under ACA, she pays $40 a month for the same coverage, same carrier.
Marc A (New York)
Are you sure the coverage is identical? Deductibles, copays, out of pocket costs all the same? I would verify that.
Pops (South Carolina)
Saying the subsidies are paid for by the government is an intentional obfuscation intended to hide the fact that costs have risen substantially for those not receiving subsidies. Clearly, it is not convenient for the NYT to say that the subsidies are paid for by charging most people higher premiums and by those people who actually pay taxes in this country. The government merely is the instrument by which this enormous transfer of money from the middle class to the poor is accomplished. It has made health care less affordable for the majority and more profitable for the insurance companies. And it is making the quality of care poorer, especially for older people.
AnnS (MI)

(1) Premiums increases have slowed dramatically since the ACA

(2) the majority get their coverage from their employer, Medicare or Medicaid.

(3) The ACA has ZERO impact on the Medicare and the quality of care for the over-65. It has nothing to do with Medicare (except for ending subsidies to private insurers that sell Medicare Advantage plans and thus makes them compete on a level field with standard Medicare.)

(4) THe transfer is from the upper income and rich to the MIDDLE CLASS

Poor for 1 person = around $11770 a year or less and for Medicaid the cutoff is around $16000+/-

Poor for 2 people = around $15930 a year or less and the Medicaid cutoff is around $21,000+/-.

The median worker makes around $26700 a year (annual Soc Sec wage report) (50% make more and 50% make less)

That person qualifies for subsidies with an income for 1 person that is 226% of Federal Poverty Level (NOT poor!)

The median household income is around $50,000.

A household of 3 with up to an of $60000 qualifies for subsidies - and are in the top 43% of all households in income.

A household of 4 with an income of $72000+ qualifies for subsidies - and are in the top 35%

The REAL middle class has an income of $30000 (25th percentile) to $99,000 (75th percentile.)

These people are NOT "poor".

It is that health insurance is so obscenely expensive that the REAL middle class - can not afford it.

You seem to think that the bottom 65-70% of the US is "poor"
Fawles Rowke (KY)
I am all for universal coverage, but not in a system that is profit-driven and provides inferior care for up to three times the $ other developed nations spend on health coverage (not insurance!).

I am in my high 50s. If I get sick, which happens once every five years, I go to a walk-in clinic, pay $100 and never look back. If I needed surgery after an accident, I would have to file bankruptcy, but I simply cannot afford to pay $3.8k/yr and come up with the $7k/yr as my co-payment out of $33k/yr, out of which $20k/yr goes towards car and house payments and $4k/yr to my children in Europe, the latter of which is not even tax deductible. Tell me how I could pay $340/mo out of nothing. And I am not collecting any benefits. The banks that destroyed our previous standard of living do not even reschedule my loans, which can easily force me into Chapter 7 (maybe some of the loans need to disappear so that the Fed can print new $). The IRS cannot enforce the penalty after I pay the rest of my taxes (that is the law).
Robert (Out West)
How? easy.

1. You're in Kentucky, where KYnect works great. Call 'em up and ask for help.

2. if you only make $33 grand a year, you're entitled to a subsidy that would get your costs down.

3. Stop using Urgent Care. For one thing, no, you're not gettting out of a walk-in office for only $100.

4. Please stop expecting the rrst of us to pick up the tab for you, if you get really sick or injured.
Fawles Rowke (KY)
Thank you for your well-meaning response. However, my monthly payment would be $340 which, of course, I could not afford based on the fact that I would have $5k/yr to live on, which would include real estate tax and car insurance ($1.5k/yr). I could not afford a penny towards the $7k/yr deductible either. Urgent Care is the only thing I can afford, and I'm happy I hardly ever need it. In order to put your mind to rest, I have been driving for 33 years and I have never been in an accident.
ClimateChange (Maryland)
The President stated that some states have not taken up the opportunity to expand Medicaid "despite the fact the federal government is picking up the tab". He is wrong. Some taxpayers are picking up the tab for others in society. That is what bothers some taxpayers. The federal government has no money to spend, it must take it from others to spend it. Of course it can print money it chooses not to take from others.
Robert (Out West)
And who pays for the willfully uninsured when they get sick? Elves?
Jordan Davies (Huntington, Vermont)
"Under the Affordable Care Act, the federal government pays all costs for newly eligible Medicaid beneficiaries through 2016, and after that, the federal share never goes below 90 percent."

So why I ask myself do the governors of those states noted not accept Medicaid? Give me a reason, an intelligent one.
Michael F (Yonkers, NY)
Here is an intelligent. The 90% that the federal government is paying is still coming from the taxpayers of those states or do you believe that the federal government has its own money?
Fawles Rowke (KY)
My $340/mo prospective premium is already high, but if I need coverage, I'll have to cough up my first $7k every year; not an appealing option, because out of $33k a year, $20 go towards car and house payments and $4k to my children who live abroad, so child support is not even tax deductible. Of course, I can't afford coverage. The ACA has increased costs for people like me, so many of us can't afford coverage; the ACA left in the middlemen (insurance companies) and added a Byzantine government system (aka. cronies). I would gladly pay 7% of my income for truly affordable coverage; yes, the rich would pay more than the poor, but even the poor would be mandated. At the same time, I would not allow corporations to hire people for so little that the taxpayer has to subsidize the poor.

The price of health coverage is not going to go down as long as medical establishments can bill; their best interest in the current system is to get as much out of everybody's insurance as possible; then you are advised to "pull the plug" or are offered an experimental drug like a lab rat. Doctors working for salaries with a set number of patients would be actually motivated to heal, not to treat. Prescription drugs actually kill more people than car accidents do. The IRS can't enforce the penalty, so I am happy without health insurance, esp. working with doctors for several years; they know so little that I'm sorry for them. They don't even have time for reading up on new findings in Medicine.
curtis dickinson (Worcester)
It won't be long before Canadians won't bother crossing the border into America for it's fine medical treatment. Because it'll be no better than what they now have.
Barbara (Los Angeles)
If Congress would stop trying to repeal the entire law and instead focus on improving the things that are troublesome, perhaps approval of the law would increase. It is a big, complex change to what was business as usual in healthcare. Let's try to make it better. Keep the good parts such as the previously outlandish caps, the denial of coverage for all pre-existing conditions, the many, many uninsured. Tackle now the insurance industry carte blanch on premiums, an expansion of easier ways to sign up or compare plans, perhaps gap plans for the big deductibles (like Medigap coverages), and an ability for negotiations with drug companies that are currently, stupidly, outlawed. Social Security and Medicare have been modified and tweaked many times. Why no ACA?
Lynn (New York)
"with 42 percent reporting an unfavorable view of the law "
If you ask the, about " Obamacare" they respond with the negative view based upon uninformative coverage in the press, which gives inaccurate attacks as much weight as accurate information.
However, if you ask them about actual provisions in the law, one by one, they overwhelmingly favor them.
In other words, if you poll on the actual law, rather than its reputation, there is strong support.
Christine McMorrow (Waltham, MA)
We have Michelle Bachman to thank for the law's nickname. It was coined in derision-- and even though the President laughingly said, "I like that name," it has come to represent the full shrill and vitriolic hatred his opponents have for him and anything he touches.

Even (especially, I should say) a law that that has helped so many low-income people and achieved many of its intended cost and quality control measures.
Ron Goodman (Menands, NY)
They hardly ever split the "unfavorable" opinion out to distinguish between those who want the law repealed, as opposed to those who don't like it because it doesn't go far enough. If you add that second group to those who favor the law, those wanting it repealed suddenly command a much less commanding position.
Anne-Marie Hislop (Chicago)
Who are all those 40%+ who dislike the law? Many of them likely are comfortable in employer provided insurance or on Medicare. Others are likely the very well off resenting an additional payment. Many likely believe the GOP's nonsense that the law is 1) a failure; 2) driving up healthcare costs; 3) not acceptable because it limits consumers' "right" to widely chose doctors and hospitals. That last is an illusion. I have had employer provided insurance for years. I have had to pick docs from lists of those who took my plan. I have had to switch dentists when I got insurance; I've had to find another med when one I took was suddenly dropped from the formulary.

If those who naively believe that the law is awful and the GOP will do better put a republican in the White House, they will find themselves again needing to keep a certain job in order to have coverage. There will again be thousands of folks who are uninsured and depending on so-called 'charity care' at the ER (which costs all of us $) - oh, and the well-off will again get to keep their extra cash. So, glad we could help them with that.
Anne-Marie Hislop:

"Many of them likely are comfortable in employer provided insurance"

You should familiarize yourself with the real employer health insurance market. Maybe then you might have a greater appreciation for the difficulties people are facing.

Multiple studies show that 80% of workers are enrolled in plans with deductibles, they are paying higher deductibles than ever, and that significant numbers (20%-30%) are likely to skip care because they cannot afford it.
Fawles Rowke (KY)
I am one of the ones who loathes the new system, because now we also have to pay for government cronies' Byzantine systems and pay benefits for those whose employers refuse to provide coverage or pay a living wages. Instead of a profit-driven system, I would prefer universal coverage in a single-payer system.
Julia Holcomb (Leesburg)
I don't like it, much. The fact that it is better than what the nation had before just speaks to how bad what we had before was. Deductibles are huge: mine eats almost all of my tax credits. But the preventive care is excellent. It gets boring reminding providers that they have charged me in error for procedures I do not have a copay for. I'm educated, and I'm privileged, and I get those charges removed, eventually.
I wish I knew if the providers who issue bills for well-woman care, routine checkups, that expensive colonoscopy, are cheats, or just inadequately briefed on how ACA works. And I often wonder how many people are paying bills that, like the ones I have to argue and fight back against, they shouldn't be paying at all.
Bos (Boston)
The Republicans need to get a grip and stop toeing the extremists' line. 67 attempts - and counting - to repeal is down right embarrassing. If they want to enhance it, fine. This slogan of repeal and replace is so idiotic. Some of them were scare stiff fearing SCOTUS might actually lose its collective head and repeal it. If so, there would be a guaranteed sea of blue in 2016. Instead of trying to appeal to the extremists, who would oppose President Obama even if he supposed something very Republican, moderate Republicans, an endangered species if still in existence, should think about their own legacy. Stop being the laughing stock!
Chaz1954 (London)
We will stop when we hit 2x the count. This is a costly awful bill that impacts negatively more 'citizens' than it helps.
SBK (California)
I have been buying my own heath insurance since my early 20's. I am now over 60. My premiums have not gone up significantly under the ACA. I am not a rich person. I am a children's art teacher. The health insurance premium is the first bill I pay every month. I am proud and honored that the money I put into the health system may benefit Mr. Drapaeu and others like we share expense and risk across our communities. He could be the wise teacher who inspired my children, the bus driver who picked up my niece when she was crying, or countless others who contribute acts of kindness and invention every day, in every field.
Steve Austin (Hopkinsville KY)
You need to understand the thousands of different stories, like that of Barbara Wager of Springfield, Oregon. That state's Death Panel has advised her that it won't buy her the cancer drug she needs but it WILL provide assisted suicide At No Cost.
DR (New England)
Thank you. You said everything I've been feeling and you said it better than I ever could.

It makes my day to know there are good people like you in the world.
Craig M. Oliner (Merion Station, PA)
Charles R. Drapeau, 63, of East Waterboro, Me., who bought insurance through the federal exchange, said he was “ecstatic and extremely relieved” at the ruling.

"Mr. Drapeau has multiple myeloma, a blood cancer, and takes a drug that costs more than $10,000 a month. A federal subsidy covers nearly half of the $1,600 monthly premium for a policy covering him and his wife. Now, he said, he worries that his coverage will be reduced as a result of the 2016 elections."

Dear Mr. Drapeau: vote Democratic.
Steve Mumford (NYC)
My sense is that Obamacare has made healthcare significantly more expensive and cumbersome for the middle class, who are subsidizing the poor who did not previously have health insurance.

Is this a good thing, overall for the country? Perhaps.
But there's no doubt in my mind that this is a program exclusively for the poor that the rest of us are paying for.
AnnS (MI)

You have a VERY odd idea of "poor"

Poor for 1 person = around $11770 a year or less and for Medicaid the cutoff is around $16000+/-

Poor for 2 people = around $15930 a year or less and the Medicaid cutoff is around $21,000+/-.

The median worker makes around $26700 a year (annual Soc Sec wage report) (50% make more and 50% make less)

That person qualifies for subsidies with an income for 1 person that is 226% of Federal Poverty Level (NOT poor!)

The median household income is around $50,000.

A household of 3 with up to an of $60000 qualifies for subsidies - and are in the top 43% of all households in income.

A household of 4 with an income of $72000+ qualifies for subsidies - and are in the top 35%

The REAL middle class has an income of $30000 (25th percentile) to $99,000 (75th percentile.)

These people are NOT "poor".

It is that health insurance is so obscenely expensive that the REAL middle class - can not afford it.

You seem to think that the bottom 65-70% of the US is "poor"

How arrogant - and how utterly uninformed you must be in your little bubble of the top incomes in the US
curtis dickinson (Worcester)
We have welfare which offers so many subsidies; food, education, housing, and medical. And for each baby the benefits are increased. There is no reason for these recipients of welfare to ever get a tax producing job to help replenish the federal trough.. And now it just got better for them, we give them health insurance too!.
M (New York)

Your figures are way off base. A person making 11000 a year isn't poor, but destitute!
demilicious (Sunnyland)
Very very happy for Mr. Drapeau and all like him..whew!
eric key (milwaukee)
If you want to have insurance, you cannot complain about paying the premium and then not using it. Unless and until we all get that through our heads we will be stuck with the ACA and its pernicious predecessors. Sooner or later this country will wake up and take one step closer to the civilized world by providing health coverage to all its citizens with no out of pocket costs and no health insurers skimming of the premiums to line the pockets of their shareholders.
MsPea (Seattle)
And, who will pay for such a wonderful system?
Jonathan (NYC)
Here are the simple reforms that are needed:

1. "Networks" are out. All doctors and hospitals must declare whether they accept ACA patients or not. If they do, then they must accept all patients with ACA policies.

2. The prices for each service and procedure will be uniform for all ACA patients. That doesn't mean they'll be the same in every location, as regional adjustments for high local costs will be required. An MRI might cost $350 in Alabama and $650 in NYC.

3. There will be no deductibles, but there will be a set co-payment for each procedure and service, with an annual cap.

4. The coverage needs to be somewhat reduced. There will still be no overall dollar cap, but many excessive offerings will be pruned. If you want them, you can pay yourself at a set price.

5. Insurance companies will compete on price within these parameters. Since all the policies offer exactly the same thing, it will be much easier to compare prices.
You are removing all negotiating leverage between hospitals, doctors, insurers, etc.? Probably a good thing as few understand them, including Obama. He claimed insurers would have to compete when they were actually beholden to hospitals in certain areas. A complete misreading of the many dynamics at work.
Bill Michtom (Portland, Ore.)
"Without subsidies, many would be unable to buy insurance."

This sentence speaks to the central problem with Obamacare: it doesn't provide care, merely access to insurance. Getting insurance, as Romneycare veterans in Massachusetts were telling us at the time, does NOT mean one can afford actual care or medicines or prosthetics, or any medical procedure.

For instance, as a medicare patient, I still must pay $175 for a CT scan, something that I couldn't afford on Social Security alone.

The Affordable Care Act should properly be called the Mostly Affordable Insurance Purchasing Act.
Jeff (Placerville, California)
Without Obamacare and its subsidies, those same people would not be able to buy any form of medical insurance at all. So, it seems to me your attitude is that if one is stupid enough to be poor or gravely ill, they should just suffer.
Emily B. (New York, NY)
Yup. The bronze-level plans, the ones I could consistently afford, would not give me access to actual care (beyond preventative care), because I'd be subject to $3000 or more in deductibles before any help from insurance.

I need relatively minor but chronic issues looked marketplace plan that I could actually afford would let me do that.
Eleanor (Augusta, Maine)
Universal health care.
Robert (Minneapolis)
Anyway you cut it, we still need to deal with the cost of medicine in the U.S. This is what holds down participation and puts U.S. businesses at a disadvantage. I do not pretend to have the answer to this. A few thoughts are as follows: more medical school slots, malpractice reform, the ability for the government to negotiate better prescription pricing, and more centers of excellence so each hospital isn't trying to do everything. I am sure that people in the health business have more ideas. This is where the discussion needs to go. I pay 25k a year, or so, for medical care for me and my family. I am lucky, I can pay, but for the population as a whole, it is not sustainable. Medical costs are going to cause other necessary government programs to be slashed and pit the young vs. the old.
Bob Krantz (Houston)
Agreed, Robert, and I do not have the answer either. But the total cost of medicine also includes the frequency (and timing) of expensive drugs and procedures. When stats show a large portion of spending driven by heroic efforts in the last months of life, and even more spending due to health problems self-induced by poor life-style choices, we need to address the other part of the cost equation.
Ann (new york)
In answer to Robert.
First and foremost get Health insurance companies out of the business on Wall street. It forces them allegiance to its stockholders first and patients last.
Second: Have Doctors, Insurance companies, Pharmaceutical companies sit down yearly to come up with the cost of procedures and drugs. Demand that Congress, the majority in the pockets of big Insurance and Pharmaceutical corporations and Wall Street, stay out of the business of health care. And that they too should have the same options as the rest of us. No special treatments for them. This is done in many other western countries and it works. Pharmaceutical Co.with the blessing of our congress bared Hospitals and Insurance companies from negotiating prices.
Marc A (New York)
I also pay $25,000+ per year for medical care/ins. for my family. This is money that could be put toward college expenses and retirement.
JB (Park City, Utah)
As we assess the strengths and weaknesses of the ACA, recall that every large, complex program needs constant assessment and revision to fix the problems. But Republicans refuse to fix the problems because failures fit their political agenda.

This will not be a sustainable agenda now that it is clear that the ACA is here to stay.
John Jordan (houston, tx)
What I find is that it is unreasonable for these people to think they can get healthcare for free. What the subsidies do is similar to what goes on in the workplace. The employer pays part of the cost. I am covered under a very good HMO plan, but I have family members who have coverage under Obamacare. Comparing the cost of Obamacare to what I would pay with my trade union, Obamacare comes at about half the cost with the subsidies. Nothing is free and the one thing that it has done and that is to bring people into the system to be healthier and in the long run cost less. Some cost in the form of co pays does have the effect of making people use their insurance in a more responsible manner.
tennvol30736 (GA)
From those I know that have obamacare, their policies contain copays and deductibles.
Bill Michtom (Portland, Ore.)
Your understanding of real health care, the kind actual advanced countries like Europe, Japan, Australia and some others have, is sorely lacking. Universal single payer insurance, paid through government taxation not only is free at the point of service, it cost about half as much as the US system and has much better health outcomes.

Check out
Julia Holcomb (Leesburg)
My copay for seeing a specialist is $75. My deductible is $4K. You're right, nothing is free. Wonder where you got the impression those on the exchanges don't pay for their care?
Doug (Boston)
Is the law a success? Sure, if the measure is the number of people covered by insurance. Absolutely not if the measure is "value". Of course, if you are ideologically predisposed to the notion that everyone is entitled to care, paid by people based on their ability to pay, then you are thrilled with this thing. However, the ever increasing cost is unsustainable. Thus, those in the health care sector will be enjoying the transfer of wealth from those not in the business. Another case of big government failure. Nice job, Democrats.
SeenItAll (TN)
Health costs were ever increasing before Obamacare, and at double digit percentages. Forget that did you?
Steve Ross (Denver, Colorado)
Are you conversely ideologically predisposed to say that people are only entitled to the care they can pay for based on their savings and credit?
So a young person in an entry-level job that doesn't provide insurance, who has the misfortune of developing cancer, should forgo life-saving cancer treatment since it's unaffordable? For the benefit of U.S. economic efficiency?
john (pa)
Health Care should be considered a right and pretty much like everything else should be paid for based on your ability to pay. You know, like highways. We all share the cost, some use them more than others, and the more you make the more you pay. I wonder why more don't complain about that inequity? Unless of course you are also opposed to the graduated income tax, a cornerstone of our nation for decades.

So far it looks as if ACA will slow down the rise in costs. But we don't know yet. But ACA is saving American lives. It is a known fact that having insurance is good for your health. And I don't know why anyone would be opposed to saving lives...
Alex B (Oregon)
Lest we forget, the theory underlying the ACA was a conservative, free-market alternative to a single-payer system originally favored by Democrats. It was the brainchild of the Heritage Foundation, who ran in fear from its own ideas when they became politically controversial.
Michael Bertaut (Prairieville, LA)
Is this what we have come to? Measuring our success by how efficacious our efforts are when we attempt to convince someone that they should accept an incredibly valuable resource (access to a 3rd party payer for healthcare) with a guaranteed offer of coverage at a substantial discount subsidized with federal dollars? THAT is a measure of success?

If we created a program to essentially hire folks to stand on the street corner and hand out $100 bills, would our measure of success then be how fast passers-by accepted that largesse?

PLEASE tell me we are going to go deeper than that! PLEASE tell me there will be, at some point in time, at least a modicum of analysis to indicate whether or not these showers of federal dollars actually improved people's lives.

And can we get really crazy here, and actually analyze whether it improved their lives in the most cost effective way possible? Oh no, I'm clearly dreaming now.

How can we ever expect the hard working, tax paying middle class to support any expansion of government when we give them the policy equivalent of "social promotion" in moving them to the next grade?

I fear such soft expectations will add even more to the Gridlock in DC, approved by a populace tired of getting so little back for their hard work.

Sherry Jones (Washington)
One study shows giving free medical care to poor children (Medicaid) is actually repaid to the government in terms of the increased taxes they will pay over their lifetime. And that's not counting the economic benefits of the better, higher-paying work itself, or the non-economic benefits of well-being and health. No doubt insurance subsidies will have similar results. Insurance subsidies are an investment in human capital, like education, not just a hand-out. Healthier workers make a stronger America, and that might be considered a success. Of course, subsidies also achieve a fairer healthcare system in which everyone contributes a little bit so that the poor and elderly don't have to suffer, a kind of moral success. But I'm guessing you're stuck in your position and not really curious at all about why subsidies for low-income Americans might be a success.
Michael Bertaut (Prairieville, LA)
Actually, I would be thrilled to see data that supports PPACA's methodology and some common-sense measure of success that indicate this is money well spent. Within the next few years, the total will exceed $80B a year, bigger than the budget of almost every single state in the nation, so there is a lot at stake here.

But stuck? Not a bit. The investment is a done deal, I WANT it to work now, I just want the program held to standards that make sense.

But thanks for playing!
Great American (Florida)
Government subsidized private health insurance is a Ponzi scheme which Madoff look like mother Theresa.

Madoff took cash from customers and gave them worthless paper. Private health insurance companies take cash from the government and their insured customers , remove 30% of all health care dollars from health care, and give them a worthless piece of paper (an insurance card) in return.

Obama enabled this scam by telling the American people that if they had an insurance card they'd have access to quality affordable health care. The insurance companies and their bondholders, shareholders, executives, bureaucrats and patron politicians are laughing all the way to the Hamptons with their dividend distributions away from doctors and patients.

Isn't it time to cut out the middlemen insurance companies and move onto a single payer national or regional health insurance much like our utility co's with limited profitability and safe afforable quality product for all?

Someone tell Obama
landrum13 (New York)
I agree with your second to last paragraph, but I fear we are a long way from that in this country. Still ACA has been valuable to insuring millions of more people, including those with preexisting conditions.
SeenItAll (TN)
Before Obamacare, if you came down with a really serious, and expensive, disease, insurance companies were guilty of trying to find a typo or error in your application and then cancelling your policy, i.e. your insurance card was worthless.
john (pa)
I think most people know which party is the reason we don't have a single payer system. But don't worry, I'm sure we will soon.
Sherry Jones (Washington)
If Senator Orrin Hatch is concerned about the cost of insurance, let him schedule a hearing on hospital pricing. Hospitals charge ten times actual cost, according to a recent NYT article, and nonprofits and community hospitals do, too. Hospitals say their high prices make up for Medicaid reimbursement rates, but Medicare rates are set at actual cost, including overhead, etc. We need to get to the bottom of this. These are unconscionable contracts -- it's your money or your life -- and price-gouging should be outlawed.
Great American (Florida)
The Affordable Care Act ISN'T!!

Obama changed the focus of health in America from the importance of access to quality affordable care to 'being insured'. The holding an insurance card and access to quality affordable care aren't the same.

What Americans with and without ACA insurance now recognize is that holding a health insurance card in America does not guarantee access to safe quality affordable health care.

The government subsidized private health insurance industry is a ponzi scam. While the health insurance industry removes 30% of every health care dollar from those with insurance cards, and pays big dividends to its shareholders, bondholders, executives, bureaucrats and patron politicians, Americans are sick and dying. There's no difference between what Madoff did to his investors, and what government subsidized private health incs are doing to their customers.

Health insurance needs to guarantee access to safe quality affordable health care, not just the ability to hold an insurance card. Someone tell Obama.
Randall Frank (Ann Arbor MI)
Sen Hatch: give me a break. The main reason why premiums continue to escalate at many multiples of the cost of living is that Republicans in congress refuse to allow the federal government to do anything to control costs. We are the only country in the developed world that allows unfettered increases in things like prescription drug prices to go unchallenged. While I have no problems with highly discounting drugs to developing countries, Americans subsidize costs for the rest of the developed world. Britain, Germany, Japan, etc. all get their drug costs subsidized by Americans (as do Iran, Russia, and many countries we don't consider to be our friends), all because we are the only country in the world that allows drug companies to charge ten or even hundreds of thousands of dollars for prescriptions. Yes, there needs to be reasonable profits to allow for drug research, buy why should those costs be shouldered primarily by Americans? If Republicans in congress allowed for the federal government to negotiate for drug prices, this would force the costs to be spread more fairly around the developed world. The buying of politicians by the drug companies is probably the most profitable investment the drug companies make. And drug costs are only the tip of the iceberg.
The Scold (Oregon)
Many insurers have sought rate increases of more than 15 percent for 2016.

Wait a minute Mr. Pear, isn't this average or less than the annual increase over the last ten years?

And as the neo-liberal corporatist in both parties are beholden to Big Pharma Americans pay far more for medication than anywhere else in the world. If we had price controls on drugs the entire situation would look much different. My monthly medication cost are my greatest expense far and away.
Mark (Rocky River, OH)
The whole health insurance industry is a dead man walking. We all see the ER someday and we need to agree that catastrophic care is a basic human right. Every other industrialized nation can deliver care to its citizens at a fraction of what we collectively pay. In the next decade we will see a single payer system for catastrophic care and the marketplace will drive down the costs of routine care that you will shop for ( check ups, flu shots, skin rash) at CVS, WalMart etc. We will eliminate the middlemen black mail and reduce costs. Then we will need to tackle the ridiculous end of life costs eating up Medicare dollars and be honest about the fact that we will all day one day. Let's focus on quality of life and being moral.
Mark (Rocky River, OH)
I mean "die one day",.... keyboard fever.
Kristine (Illinois)
Not sure if Sen. Hatch was paying attention before Obamacare but I recall my health insurance premiums increasing dramatically from 1998 to 2008 -- and my coverage was less and less each year. Is the rate of increasing premiums higher than usual?
Swatter (Washington DC)
FYI: healthcare systems in five capitalist democracies around the world that work at least as well as here at lower cost, some single payer and some not:
James Starr (Birmingham, Michigan)
I'm looking forward to "ClintonCare". Single payer health insurance for all. Everyone deserves access to the best health care in the world, regardless of income. It's time for the republicans to wise up, and stop paying homage to the insurance lobby.
Swatter (Washington DC)
I'll say what I've said many many times before: to the degree that the ACA has only addressed access and not costs or quality, republicans had the opportunity to push the ACA to address these other aspects but instead chose to have it address them less by shouting out some of the few provisions that addressed cost (e.g., having medicare pay for the patient initiated conversation with their doctor regarding end of life decisions (living will) to avoid having Terri Schiavo situations) and pretending what had initially been conservative proposals (heritage 1989, 1992, 1994; Nickles' bills in the 1990s; Romneycare early 2000s; support for Wyden bills 2007, 2009) were suddenly socialist and unconstitutional when Obama proposed similar measures. Yes, the ACA is flawed, but conservatives have very much to do with that. Let's fix it instead of continuing this pretend fight. The Supreme court's decision is now in and in support of the subsidies, so lets cut the crap and fix what's wrong with the ACA.
pkbormes (Brookline, MA)
This is an example of how racism effects the political and economic issues of the nation, according to one of Dr. Paul Krugman's recent pieces in the Times.

He points out that it is a majority of former slave holding states that have rejected the subsidy.

The Right has convinced angry poor White people that any subsidies would go to "those people". Poor Whites assume wrongly that it would be they who would be paying for the medical costs of sick people of color as they go without.

This Supreme Court case is connected to last week's killing of 9 people in a S.C. church.

Thank God the Court has just ruled in favor of the ACA.

Apparently we are making incremental progress towards racial justice. It matters not whether or not the S.C. made the right decision for the right reasons (doing what is right for all the American people). Hopefully the decision was not made because of pressure from a Republican Party that is clearly in trouble these days as its racism is becoming easier and easier for all to see.
ks turner (upstae ny)
Justice is blind not stupid but once again they show their true colors as a wise man once said you can educate ignorance and you can medicate crazy but there is no cure for stupid.
B (Minneapolis)
Some who have commented on this article and many who have commented on other articles about Obamacare complain about their hard-earned tax dollars being used to pay subsidies. The only taxes on individuals supporting Obamacare are on people filing singly with capital gains, dividends, etc. more than $200,000 per year or $250,000 per year filing taxes jointly. Such a tiny fraction of the population has such high "unearned Income" it is hard to believe that most such comments are from people actually subject to the tax. So, they probably aren't subsidizing coverage for the formerly uninsured.
Pete (Los Angeles)
Please cite a source for your allegation that this one small tax on a very small base is covering all subsidy costs. Every source I have found indicates it is a minor source and the vast majority of the subsidies are paid for by general income tax revenues and more borrowing from China.
Jonathan (NYC)
Actually, when my company kicked me out after 29 years, I was paid one year's severance as a lump sum in September. You can achieve the same thing by selling a house you've had for a long time - it doesn't really take much to get over $200K if you're in the NY metro area and have a decentish sort of job.
B (Minneapolis)
Pete: I didn't say that one small tax is covering all subsidy costs. I said such a small portion of taxpayers have investment incomes greater than $200,000/$250,000 I find it hard to believe that most people complaining about individual taxes supporting Obamacare actually pay such taxes.
Now look at Table 4 in the lastest CBO report. It shows that tax and penalty revenues to support Obamacare will be $1.174 trillion over the next 10 years. And that does not include some major cost reductions also supporting the law, such as a $715 billion reduction in hospital payments (see the 2nd column of page 10).
In Table 4 you will also see high income tax surcharges of $346 million equal about half the cost of the subsidies ($712 million). So, they are significant.
As to your last point, no other general income taxes pay for the subsidies or other parts of Obamacare (see again Table 4). And Obamacare will reduce the deficit by $353 billion, so we will be borrowing less, not more as you say, as a result of Obamacare. See "Net Effect on the Deficit" row in Table 4.
Greg (Long Island)
Senator Hatch had plenty of time to fix the health care system and as far as I know he, nor his party, did anything while they were in charge and costs, premiums, etc. grew at a much faster pace than under Obamacare. Nothing man makes is perfect. Perhaps he should just propose incremental improvements. What are his suggestions?
pk (germany)
You are spot on
Michael (CT)
Right. He is personally responsible for the crises in American Healthcare. THe other 99 senators in congress are innocent bystanders
Steve Austin (Hopkinsville KY)
America's suggestion? That 80% of the country was SATISFIED with the system in place before this unworkable mess was hatched. The fact that it has needed dozens of politically required fixes should tell you something.

We could have taken JUST the $2 billion wasted on the O-care website and put a fantastic hospital in 2 or 3 or 4 cities. Setting up charity hospitals will prove to be FAR less wasteful than this ACA where the death panels are already denying cancer treatments to people but offering to assist their suicide for free.
At least THAT's free.
But if we keep blowing billions a day that we don't have, the final assisted suicide will be for the federal government and the dollar.
But I am sure our wise liberal statists have a plan for after the dollar is worthless.
Howard64 (New Jersey)
This is simply a political and hatred of Obama issue. The only net gain of killing ACA is the possibility of less democratic voters in the future, because they will die as a result of less health care.
BR (Times Square)
That's one small step of sanity.

Now for the other 1,000 steps we need to reach single payer universal healthcare.
Warren (Shelton, Connecticut)
Orrin Hatch knows (or should know) that premiums are not rising as quickly as they used to. Remember, he stifled insurance competition by not coming out in favor of a public option.

The ACA was primarily about coverage. Its pursuit of lower overall health care costs are tied to evidence-based care guidelines - use the most practical procedures and drugs, and be rewarded for keeping costs down. Republicans demonized the palliative portion of that work as "death panels".

Republicans really don't have a leg to stand on. They could have improved ACA, they instead choose to keep poking at it until it breaks. Alternatives? Zero. We all pay and suffer so that they can score political points.
Andrew (Yarmouth)
Subsidies upheld - Linda Greenhouse called it! "Read the briefs," she said, and fortunately she did.
Carole A. Dunn (Ocean Springs, Miss.)
Millions of people cry about the cost of medical care getting higher. It's true that it is, but no one is pointing out one of the biggest reasons for that. Since the advent of managed care administrative costs for doctors and hospitals and other healthcare entities have gone up by billions of dollars. I had no coverage before Medicare, and a doctor who charged me only 1/3 of the cost of a procedure told me that without the costs of managed care, that was all he would have to charge anyone. He went on to say that before all the hundreds of different plans under managed care he only needed one bookkeeper in his office. Now he needed nine. Couple that with the billions of dollars insurance companies spend on litigation to get out of paying doctors and hospitals and the additional billions spent by medical practitioners to litigate for their money, a very high percentage of our healthcare dollars is spent before anyone even gets an aspirin.
Robert (Out West)
Your doc lied to you.
Mellow (Maine coast)
"Lizzie Perez Jimenez, 22, of Tampa, Fla. ... earns $1,300 a month and is not offered insurance. Her premium is $200 a month. She pays $50 and receives a tax credit of $150. 'Without the tax credit, I probably would not have insurance,'” said Ms. Jimenez, who has asthma. 'It’s way too expensive for me.'”


And without that insurance, buffered by a subsidy, Ms. Jiminez could pass along to the rest of us a virus, a bacterial infection, and any other countless pathogens as we stand in line next to her at the bank, the movie theatre, the checkout line.

If we want a society in which we are protected from what other people could unwittingly transfer onto us, we must pay for it. If we're going to complicate the matter by voting for politicians who strive to suppress wages and to send good-paying jobs overseas, yet still demand the constant of a healthy society, well, we'll have to pay for subsidies for those caught up in those employment-related complications.

Why can't the GOP figure that out for itself?

But I just saw that the breaking news that the SCOTUS will allow the subsidies.

FXQ (Cincinnati)
Obesity, diabetes, peripheral vascular disease, hypertension, strokes, COPD, emphysema, asthma, heart disease are all the leading causes of the soaring cost of health care, and almost all self-inflicted due to the consumption of tobacco, alcohol, fat and sugar. Tax these products to the fullest extent to pay for these problems.
jb (ok)
They are not "almost all self-inflicted". I'm sorry to bear the news, but people get sick and die, no matter whether they smoke or drink or not. And stripping them of money will do nothing good for them or you. If you're a very health-conscious person, if you exercise and watch your diet, you may have a long life with health problems only at the end, and maybe brief health problems then. Or you may have a stroke, you may have atrial fibrillation, you may have cancer (as did my now-deceased healthy-living 52-year-old sister did, whom you would suppose smoked, I am sure, but never did). So do be careful of how you plan to punish the sick, even supposing that they are not already punished enough.
Sharon (Miami Beach)
Completely false....while it is true that many chronic diseases in this country are lifestyle related, many of them are not. My best friend's husband died age 36 after 6 years spent battling cancer... not a drinker, not a smoker, regular exerciser. Cost to treat him - $2 million. His widow is fortunate that he had excellent insurance.

And don't forget about car accidents, occupational accidents and hazards, type 1 diabetes, etc, etc...
Concerned Citizen (Anywheresville)
Diabetes is a highly heritable disease -- my great aunt had this for 30 years, but was always slender, athletic and fit. So what exactly was her "lifestyle fault"? how did she "self-inflict this"? BTW: she never smoked....ate a strict diabetic diet with little fat and no sugar.

At the end of her life, she had Alzheimer's, requiring very costly care. Please tell me again, how this was her "fault" for her "lifestyle choice".
Jack M (NY)
Obama was outmaneuvered by the insurance companies during healthcare negotiations. Obama was outmaneuvered by Maliki negotiating the withdrawal conditions from Iraq. Obama has been outmaneuvered by Putin in Ukraine. And Obama is about to be outmaneuvered by Iran. Basically, whenever he goes to bat with the big boys who use hardcore tactics he is clearly out of his league. He's not a tough negotiator on that level. Period. Especially when they dangle some phony transient "win-win" political gain in front of him.
Big Chien (NY)
Wins on Health Care! No American soldiers dying in Iraq! Russia's economy tanking! Obama outmaneuvered? I'll take my chances relying on his talents; you can have Trump!
velocity (Chicago)
Administration wins 6-3 with Chief Roberts, Kennedy, Ginsburg, Breyer, Sotomayor, and Kagan
pkbormes (Brookline, MA)
Why is it always about the money?
What about the well-being of the American people?
pk (germany)
on america we do care about the poor money talks poor people have no money hence they do not talk
Mark (Rocky River, OH)
Because eventually you run out of "other peoples money." We can make care available to all at much lower costs when we get to single payer. We can all save and all share.
Auster (New York, NY)
You write that: "Although they reduce the direct cost of buying insurance for many consumers, the subsidies do not by themselves hold down the overall cost of insurance, which is driven in part by health care costs."

John F. Holahan of the Urban Institute, who you quote, recently published a study which found that the US is spending $2 trillion less on healthcare than it would have pre-Obamacare. Although the insurance companies will always try to get large premium increases to improve their profits, the historically low health care inflation means they don't have facts to support their argument.
AC (California)
I can't help but look at the dark purple in the state of Florida on this map, with nearly 10% of its under-65 population covered by a federally-run exchange. The current governor, Rick Scott, was CEO of the Health Corporation of America (a telling term), when it was systematically defrauding the federal government of billions of dollars; it eventually settled federal, state, and private lawsuits alleging fraud for over $2 billion. Yet he has the audacity to call the federal exchanges and Obamacare "overreach."

The Rick Scotts of the world are the disease making America sick; I thought Obamacare was the cure in 2010, but now I see that it just treated the symptoms. Single-payer healthcare is the only way to get to the root of this cancer that is killing America.
Ed (Arizona)
Now that they've lost again I'm waiting for the GOP to float legislation ofr subsidies for gun owners.
Jeffrey (California)
I imagine there will be a short rise in medical costs since many of those new to insurance have had longstanding issues they couldn't afford to address. After those are addressed, the costs should go down.
MIMA (heartsny)
How many ways can we put it?

The person who sued, Mr. King, can receive health care from the Veterans Administration. The taxpayers are paying for his health care essentially.

He was willing by pursuing this lawsuit, to take away health care from his fellow Americans. He found a way to potentially do that by objecting to a snag in the wording of the law, "state", and thus, carried his plan through.

It is unimaginable that a fellow American can have the desire to leave other Americans without cures for cancer, heart surgeries and respiratory care so they can breathe and move without despair, care (including surgery) for eyes so people can see, orthopedic assistance so they can retain or obtain mobility, and so many other conditions.

We all are faced with larger deductions and premiums these days it seems (except maybe our Congressional "leaders" who are very very well taken care of). However, those deductibles and premiums are nothing compared to a very acute change in a life threatening health condition. I know, I was an RN Case Manager for years, and also a person who indeed did need a life threatening and life saving surgery and saw my own personal bills.

As a health care provider, as an American, as a human being, I hope with all my heart the Supreme Court does not negate the ability for many Americans to get the most basic and decent service of humanity - health care.

We cannot allow Mr. King's greedy thinking to be our national mandate.
Robert (Detroit)
According to statements made by that person, he was told that the Republicans would create work-arounds to help those who would lose insurance. This shows that his selfishness was coupled with a frightening gullibility. Could be a FOX news watcher?
john (pa)
Sitting here in limbo in Pennsylvania wondering how much longer I'll have health insurance. I'm 63 so in 2 years I'll qualify for Medicare. I remember the stress when you don't have insurance.

And when the supreme court takes away the subsidies millions lose their insurance and the cost to those with insurance will skyrocket as only the sick continue to purchase.

I wonder if the supreme court will state that their decision in this case shouldn't be used as a precedent like they did with Bush v. Gore.
Kalidan (NY)
The intense desire to maintain status quo, the fear of the future, and the irrational concern that change will help the wrong people is getting the way of fresh thinking about innovative healthcare solutions. This debate and legal wrangling serves as Exhibit 1 in validating this inference. For instance, if we implemented what we know today about prevention, and taking care of the final six months of American lives, we would come out ahead. But complete silliness gets in the way.

The outcomes of legal wranglings may matter less in the long run; the trajectory has been set, and we will land somewhere in the single payer, European/Canadian style healthcare ballpark regardless.

If 1915-2015 is any indicator of the evolution in healthcare in America, it is not too far fetched to estimate that by 2115, 60%-80% of all Americans will be working in healthcare-related fields (just like in 1970s, 20% of us worked in auto-related businesses), all businesses will be primarily engaged in taking care of their employees' health and well being, and run a side business of products and services to support this initiative. Many businesses, including the US Military, are already there. Quite a bit of their money goes to just creating jobs for their own sake, providing benefits to current employees and retirees (vets).

We are called to evolve, innovate, and change. And so we must. Resistance (legal wrangling) is futile.

pk (germany)
remember republicans do not believe in evolution hence we have de-evolution
Ben Graham's Ghost (Southwest)
If forced to bet, I think SCOTUS will leave the Affordable Care Act alone by a vote of either 5-4 or 6-3. Either Roberts, Kennedy or both will not want to be responsible for the chaos that would result by striking the ACAs chief provision. I think the other three conservatives could care less and will interpret the words of the ACA with little contemplation of context, intent or what is humane. May these three spend their final days without any health insurance.
Cheryl (<br/>)
You nailed it.
James (Atlanta)
The problem with this discussion and the fallacy on which the premium structure was based is that healthy young people would sign up, pay premiums but not use much in the way of services, has turned out to be (predictably) wrong. Healthy young folks are simply not signing up, or paying for health insurance. Premiums for folks who do buy insurance will rise dramatically this year and in the coming years as the well understood but intentionally ignored reality makes itself evident that a big part of who was supposed to pay for all this, healthy young people, aren't.
Mitch Jones (New York)
I do think that our healthcare suffers a lot. Many people don`t get what they deserve. Obamacare and Medicaid proved their ineffieciency and it`s time for officials to make real changes but not to endlessly talk about it.
DB (Charlottesville, Virginia)
Why cannot the U.S. institute a single payer system as have almost every other western industrialized nation? One reason only: The political obstructionism of the GOP who swore, even before Obama was elected, to bring him down.

How can France, a much smaller country, afford to have a successful single payer system with a much better outcome that the U.S.? Simply because they care about their fellow citizens.
jb (ok)
Of course health insurance costs aren't going down. There's profit in it. It would have taken a public option or other restraints on the corporations to prevent it. As it is, it's all a great gift to them, and we are left watching as the prices spiral far beyond our means.

Cutting subsidies will merely make that far worse. Demands that people buy insurance that they have no way to buy will be met with failure and anger. And the distrust and dislike of Americans from left to right for the government that seems incapable of serving us and all too "efficient" at serving the wealth elite will increase by similar measure.
anr (Chicago, IL)
Single Payer. Use Canada as a model.
E.H.L. (Colorado, United States)
We benefit from the subsidies. A little under 1/3 of our premium is covered by a tax subsidy. The deductibles are higher than I'd like. But, that was true in my pre ObamaCare plan, as well. The coverage is much better and the premium, with subsidy, is slightly lower than what we paid before. Still, I would have preferred Medicare for all.
AC (California)
Sometimes America just seems like a giant prison run for the interests of the wealthy and powerful elite. Oh wait, no it doesn't, because prisoners get free healthcare.
Kevin Cahill (Albuquerque)
The Supreme Court will lose all credibility if it sinks the ACA.
Suhas Vaze (Columbus, OH)
Dear NY Times,
I want to come at this in a slightly different way. I want to hazard a guess at the Supreme Court's imminent decision.

During the last challenge to the ACA, Justice Roberts broke the tie and the Court ruled 5-4. I remember reading at least part of the text of the ruling and the Court's message was, "Hey Congress, don't ask the Court to fix what you had a chance to legislate and debate".

I say that the Court follows the exact logic/approach. They will not issue a decision based on a "technicality". They'll look at Congress's intent and find the Federal Exchanges constitutional.
Jeff (Evanston, IL)
If readers want to know how ACA is working, read Paul Krugman's column on a regular basis and check out his blog, Conscience of a Liberal. ACA has succeeded on every count. No one ever said that it would keep health care costs from rising. Its goal was to bend the curve in costs, and that it has done extremely well. The Orin Hatch quote is typical Republican propaganda.
arish sahani (usa)
Only insurance is bad thing for a nation. People should have many options pay as you use is good idea. Local dr should have rate chart to deal with patients not billed after the treatments with surprises.
W.R. (Houston)
While this is probably not something that can be done, I'd like to know the ethnic, racial breakdown of the people receiving subsidies. I speculate that It is perceived that the majority of people receiving subsidies are minorities; however I suspect that low income whites receive the majority of the subsidies. If I am correct, this information has the potential to change attitudes about subsidies In our highly racist society. It could also inform low income whites that this is a great program for them.
I Love Dobby (Seattle)
I'm not saying this affordable care act is a panacea for the ills of our system but critics who claim it isn't lowering cost oppose measures to limit costs by setting up such straw men as "death panels", "rationing", "socialist healthcare", and supporting legislation such as GWB's Medicare prescription drug benefit which didn't allow the government to negotiate drug prices. I want mine but you can't have yours!
jerry lee (rochester)
Reality check ceo,s of these health care companys making 4200 dallors an hour at expense of people who cant afford health coverage we all know who supreme court will decide in favor of monay . Doesn't matter that's wrong they find way making wrong right
Look Ahead (WA)
“The creation of an almost trillion-dollar federal government subsidy program has done little to mask the impact of Obamacare’s biggest failure — skyrocketing premiums,” said Senator Orrin G. Hatch, Republican of Utah and chairman of the Finance Committee.

The article says the 6.4 million nationwide receive subsidies that average $3,264 per year. That is $21 billion, which is only 2% of a trillion. I would guess that expanded Medicaid added a similar amount, so still under 5% of a trillion. The annual Defense Budget is at least 30 times that much, not including the $4 trillion we blew in Iraq and Afghanistan. The Joint Strike Fighter program costs $400 billion (and counting).

Politicians like Orrin Hatch and Rand Paul make crazy assertions with impunity and journalists print them without challenge or qualification. That's too bad.

Why does the GOP hate Obamacare so much? Because much of the premium subsidy comes from a 3.6% tax on households earning over $250,000 a year, those poor suffering souls who receive a disproportionate share of tax subsidies on mortgage interest, retirement savings, investment income and other goodies.

And that's the group who funds GOP political campaigns.
Kelly (New Jersey)
Insurance exists to protect assets. It is not used to provide access to a service. You don't "insure" your car for oil changes, or repairs in general- you insure it against catastrophic loss; a crash or storm damage. Access, for example moving low income patients out of emergency rooms and into a doctor's office through "coverage," could lead to substantial reductions in the overall cost of delivering care. This is accepted fact. Using for profit insurance companies with a system of subsidies, is not an efficient or effective way to achieve that goal. Other countries have figured this out, though few use a true single payer system.

The ACA, left unscathed by the Supreme Court, needs work. We could start by eliminating for profit insurance companies from the provision of access to care. We might then provide basic no frills universal access to all with a graduated employee/employer deduction and allow non-profit insurance to augment basic coverage for deductibles. Medicaid could be expanded for those who are temporarily out of work. We could leave elective Botox and ankle shaving to the for profit insurance market.

Whether this or a better alternative is conceived, one thing is certain. Until we remove share holder interests from access to health care, our health care will cost too much, fail too many and continue to provide fodder to the political bonfire that warms no one.
Concerned Citizen (Anywheresville)
You are correct as to car insurance or homeowners insurance. Those exist to protect your asset (a house or car). Car insurance does not cover routine maintenance, or even serious repairs -- it only covers ACCIDENTS. Ditto for homeowners insurance: nobody expects it to pay for ordinary repairs and maintenance.

But health insurance should not even be called insurance, really. Or only the catastrophic kind should be! We expect health insurance to pay for preventive services, for contraception, for pregnancies both planned and unplanned -- for ordinary colds and flu, for vaccines, for well baby care.

That is not strictly speaking "insurance". Its' health CARE. The ACA is a great failure because all it does is provide INSURANCE, often at a very high cost due to deductibles, and it reduces ACCESS, because to get insurance to so many people (many of whom are "undesirable" from the POV of having pre-existing conditions), it must reduce networks, doctors and hospitals.

A few people have benefitted, but mostly those with huge subsidies (subject to change, even during a calendar year!) and those who got to go on 100% free Medicaid welfare....which is vastly superior to any paid insurance, as it has no premiums, no copays, no deductibles AND covers dental/vision care at zero cost. That's a few million people. To benefit those few, tens of millions of others suffer higher costs and reduced coverage.
Glen (Texas)
The cost of health care, across the board, is untenable, but in some areas it is downright criminal. Drugs and medical devices, particularly those surgically implanted, are typically the most egregious examples. Laboratory testing is hot on their heels, neck and neck with monitoring charges for things like blood oxygen saturation percentage.

To perform the latter a small transducer is placed over the tip of a finger and a digital display provides the pulse rate and the oxygen level in about 5-10 seconds. The retail cost of a pulse oximeter, available to anyone with no prescription necessary, runs from $15 (junk) to as much as $400 for a quality device. Hospitals bill "by the use" for this monitoring, that is, every time one is placed on a finger and the result is recorded in a chart, a charge is generated. This charge is not inconsequential, unless you can walk by a $50 bill lying on the sidewalk and not be bothered to reach down and put such a paltry sum in your pocket.

$10,000 for one pill!! That's not even the most expensive drug out there, people. Cardiac pacemakers can and do run more than a Porsche 911 and the garage to park it in. And that's if you just buy it and toss it in the dresser drawer. If you need to use it, installation is extra. Oh, and you might die as a result of the procedure or from postoperative complications.

Joking about the cost of health care is easy. Solving the problem is as serious as a heart attack.

Universal. Single-payer.

Concerned Citizen (Anywheresville)
Unfortunately for this discussion, you (and many other lefties) continually confuse UNIVERSAL coverage with SINGLE PAYER. Only 3 nations have single payer. France, which is widely considered to have the best and most comprehensive national health care, does NOT have single payer. In fact, no nation in Europe has single payer.
Leigh (Georgia)
So true! My father had his shoulder replaced the same year his beloved dog has one of his hips replaced, so it was easy to compare the costs. What stunned me the most was the cost differential of the actual, chunk-of-metal replacement joint. For his medium-large dog: $1500. For my medium father: $35,000. When considering economies of scale, the human joint should be significantly cheaper than the canine one, since many, many more human shoulders than dog hips are replaced every year. That sort of price gouging is evil.
Glen (Texas)
So, CC, you are for universal healthcare but would rather have multiple conduits to receive payment. Is that correct? Fine, no problem for me.

BTW, you know my given name, what I looked like 66 years ago, and that I live in Texas. Why use an alias if you're proud of your philosophical stance?
Roger Faires (Portland, Oregon)
Universal healthcare and getting rid of the profit mongers is the only solution. This system we have now will be looked at by generations much further into the future as something akin to slavery; private companies holding the rank and file citizens hostage while reaping money from both those citizens and the federal government.

We can easily have single payer by reducing defense spending and tax subsidies for massively weathy companies and increasing education which will in turn foster a smarter and healthier populous.
Taoshum (Taos, NM)
Subsidies? If they are not allowed for something as fundamental as health care, then how could they be allowed for crop support, transportation, housing, energy, education, law enforcement, trade, commerce, R&D and on and on...? Many of these are implemented via the tax code so at a fundamental level, little difference exists between them.
TyroneShoelaces (Hillsboro, Oregon)
Anyone with their head screwed even half way on knows that the single payer approach is only way national health insurance will work and work effectively. That this was never more than a passing thought in the collective consciousness of our bought and paid for congress is but another indication of how seriously messed up our political system has become.
robert conger (mi)
600 billion to police and terrorize the world. American citizen waiting for a court to decide whether they can afford to live or not .Something seems wrong.
John F. (Reading, PA)
American voters seem to be victims of narrow ideology that keeps pumping fear and misinformation to them. I know my Republican Congressman Patrick Meehan uses the misleading talking points all the time to justify keeping his constituents from getting health insurance. I hope a younger generation will be smarter in selecting representatives.
jck (nj)
Measuring the success of a program based on how many individuals accept a subsidy paid for by others is nonsense.
MetroJournalist (NY Metro Area)
One of the many problems with both Romneycare and Obamacare is that neither ever addressed the rising costs of providing health care. Yes, advances have helped drive up cost, but the real culprit is -- dare I say it? -- corporate greed.
Mark (Northern Virginia)
The greater issue is whether Judge Roberts, who promised to "call balls and strikes," give proper respect to judicial precedent, and who was nominated by a president who declared, more times than any I ever heard, "no legislation from the bench," has made the United States Supreme Court a partisan shopping bazaar.
mHealthTalk (Austin, TX)
Utah Senator Orrin Hatch needs a spanking for his lies to the public about "skyrocketing premiums." While not perfect, the ACA has slowed the rise in healthcare spending, flat-lined the overall costs, and introduced more competition into the insurance market through the exchanges. One thing it failed to do was to control drug prices.

Most of the complaints about higher insurance premiums have come from people who once had low-end policies that lacked provisions required by the new law, like annual preventative exams and eliminating the ability to cut off coverage from people once their care needs got expensive. Replacing those bad policies with better ones can surely affect premiums, but that does not justify this Republican's false and inflammatory claims.
ACJ (Chicago, IL)
This court, and the political party they represent, often talks of the past transgressions of activists courts, yet this court does not think twice of sticking it's judicial nose into our bedrooms and our health needs. Instead of calling balls and strikes, the Roberts court has erected its own judicial stadium to play their own version of judicial baseball.
Dmj (Maine)
Missing from this discussion are the four most important features of the ACA:
1) insurance companies can no longer drop you for being sick
2) there are no longer fixed amount caps on what is paid out if you get sick
3) everyone pays the same rate for their chosen level of coverage
4) you cannot be disqualified for pre-existing conditions.
This has completely revolutionized the way my family receives health care, and we receive no subsidies.
This insurance is vastly superior than my prior insurance.
Orin Hatch is disingenuous in his statement, because health care was being paid for by outrageous charges in emergency rooms and outpatient clinics.
I pay about the same as I did before, but for quality and complete coverage, rather than the junk policy (and the fact is most insurance prior to ACA was junk) I had before.
My view is that ALL of SCOTUS should be recused from deciding this case simply because of the gold-plated spoon-fed Cadillac health care policies the justices receive paid for by MY tax dollars. No one getting government subsidies NOT subject to revision by this law should have the power to shoot it down unless they are willing to have their own health care shot down.
Cowboy Marine (Colorado Trails)
Multiple myeloma is a pretty common disease treated by taking a pill. Only in America would a month's worth of those pills cost $10,000. That's downright evil.
Joey (TX)
"In states that have not expanded their Medicaid programs, Americans earning less than the poverty level are ineligible for subsidies and generally cannot afford insurance."

For example- Texas.

Rick Perry "The way we keep score, is tort reform to make it harder to sue doctors and health care providers. "

Presumably, Rick Perry argues merely addressing the lawsuit excuse will keep
health care cost down. I think the real reason he refused to expand Medicare was he didn't want the nation to know, statistically, what a failure Texas's economic policy has been for lower income workers.
Dan in Phoenix (Arizona)
Mergers among health insurers will kill any hope of affordable care.
The ACA has been a tremendous success for the uninsurable to procure health insurance, however my employer has notified me that as a result of the ACA the only insurance available in 2016 will be a high deductible health savings account with a $5,500 deductible and a $11,000 out-of-pocket maximum. in addition to the the monthly premiums.
So in effect and my spouse with breast cancer and I will be essentially uninsured.
Thank you Mr. "If you like your health insurance you can keep your health insurance", President. you've been real helpful.
Gregg (North Carolina)
Same here. Premiums AND deductibles have gone up over the last couple of years. I'm happy that many who were previously uninsured now are, but now THEY are saddled with high deductibles. So...what was the point of the ACA?
Dougl1000 (NV)
What insurance did you have before that would not have excluded you on the basis of preexisting condition? If it was group insurance,why did your employer drop it?
Jeffrey (California)
Are you sure you shouldn't be saying, "Thank you, greedy employer for using the ACA as an excuse to reduce my benefits"?
dre (NYC)
Thanks to republicans - who have no health care plan different from what existed in the 1950s - when it comes to health care and most anything that benefits the average person, the policies in this country are insane and reflect a wild west mentality that everyone should be independent and not reliant on anyone, and if you get sick or need help, take an aspirin, hope that helps.

Low income people need subsidies at the least. The country of course really needs universal coverage for everyone. Heaven help us, it doesn't look good.
Garak (Tampa, FL)
Senator Hatch (R-Heartless) whines that the ACA has resulted in “[t]he creation of an almost trillion-dollar federal government subsidy program has done little to mask the impact of Obamacare’s biggest failure — skyrocketing premiums.”

Earth to Orrin, reality calling. The tax subsidy for employer-provided health insurance costs almost 5 times as much as the ACA subsidies. And that tax subsidy is a major factor in skyrocketing premiums. So where is Sen. Hatch (R-Die Quickly) on that massive tax subsidy? Is he going to push for having the premiums paid by employers show up on the W-2 forms of the employee? Of course not. They are his supporters. They are special. The rest of America is not.

And there you have the conservative position on health care. Another in a long line of cases of flip-flopping conservative moral relativism.
Tom (NYC)
Nice try. Its union workers who oppose the tax. Why didn;t the dems change this when they passed the law? They had 60 senators.
Yeah, whatever.... (New York, NY)
The pain that will be inflicted on those most in need is disgraceful. The Republican party and it's fringe supporters such as the Tea party, are shameful and selfish.
Medicare for all is the only answer.
HEP (Austin,TX)
The ruling will be an interesting indication as to whether our judicial system is intact or whether it has become an entity controlled by a conservative activist court. The case before the Supreme Court was brought by people who scoured the country looking for individuals who would have standing in the case; they found people who are not going to be hurt by the ruling regardless of how the Court rules. In other words, the entire case is based on a lie; the plaintiffs do not have legitimate standing and yet the Court took the case. It is time for a change in this country. Time to kick the reactionary elements out of Congress and time to keep them out of the White House.
Great American (Florida)
ACA is a scam. Obama changed the focus of health in America from the importance of access to quality affordable care to 'being insured'.

What Americans with and without ACA insurance now recognize is that holding a health insurance card in America does not guarantee access to safe quality affordable health care.

That is the scam. While the health insurance industry removes 30% of every health care dollar from those with insurance cards, and pays big dividends to its shareholders, bondholders, executives, bureaucrats and patron politicians, Americans are sick and dying.

Health insurance needs to guarantee access to safe quality affordable health care, not just the ability to hold a card. Someone tell Obama.
john (redondo beach)

the health care act is not a scam. it definitely has serious problems, but is a good thing for our country, in my opinion.

the PRESIDENT, it is a respected elected office by the way (i suggest you address it as such) has said that the health care plan he implemented is just a start.

president obama has mentioned many many times that it is far far from perfect. that is has several 'problems.'

the biggest is money of course. greed. on all sides. including some of the very programs/policies that the president endorses.

the good;

ALL americans are eligible for insurance. especially the americans who need the health care the most; the ill.

read that again.

this is revolutionary in our history. our founding fathers even wrote a document about the sick. it is part of the foundation of our country; to include. not exclude. especially the poor, the sick, the minority, etc.

the current health care act is simply a start. visit some other countries to see how health care is handled. for such a wealthy nation it is an embarrassment how we treat ill americans. the bottom line is much more important than lives to the many that make the decisions sometimes about these things.

there are many problems with the presidents program. to start chipping away at what he started is wrong in my opinion.

continued good health to you great american.
Chris (Missouri)
Healthcare is an industry that - in a moral society - should have no profit motive.

The return on investment should be the well being of humanity.
Pops (South Carolina)
I suggest you go to work for ANY health care company, then, and forego your salary. By Your logic, there should be no profit motive and salary while not profit for the company, is profit for the compny's workers who make any more than what is necessary for purchasing life's basic necessities. Movie money is profit. Money for TV is profit. Money for ice cream and potato chips is profit.
Ann (new york)
Why is heath care allowed to be bought and sold on the stock market? This is the real problem. Reading that insurance companies are looking to buy and sell will only increase the cost to the consumer. Each time, each year the stockholders demand profits, profits that are made by increasing monthly premiums to the patients. Health insurance companies will become large corporations buying and selling each. Overtime time the real winner once again are the super wealthy stock holders Health care should never have been allowed to be a commodity for the stock holders to make a profit from the citizens. "Shame on America" Our Congress should demand health insurance companies to be taken out of this gambling on WALL STREET, where hedge fund managers are already licking their chops. No other western society allows this shameful game playing with the health of its citizens. Our health should never have been allowed on Wall street.
Goodguy6410 (Virginia)
You're absolutely right: healthcare SHOULD have NO profit motive.

However, that's just not how the world or humans in particular operate. Will you provide me something just to further humanity's well being? Seriously, would you?
Every socialist health program we can think of involves long, long waits and rationing. A profit motive, like it or not, gives pharmaceutical companies, durable medical equipment makers and other innovators an INCENTIVE to constantly develop new drugs and tools. Do we see this innovation anywhere else? Of course not. When the very rich of other countries get very sick, where do they always come? To America, where the profit motive has been alive and well.
Ed James (Kings Co.)
1) One has to be VERY dubious about figures emanating from a source - the Fed. govt - with one heck of a lot of skin in the game. That is, EVERYBODY knows that "lies" can be told using numbers, and once there's motivation to lie or exaggerate, AND the facts are murky, one should be very dubious about a "fact-based approach." IS IT REALLY that?

I'd take the "plaudits" at the top of this article with a grain of salt.

1a) NOT THAT THE opponents of Obamacare are any less likely to lie/exaggerate. It's kind of rich for Oren Hatch to say that Obamacare hasn't put the brakes on premium "creep." (Obviously "gallop" is more like it.)

This preceded the intro of Obamacare and - while the Times knows when a horse is dead and doesn't try to resurrect it - I think it's safe to say that just as Medicare's rates go up more slowly than the Medicare supplement plans, had we gone with single-payer, MEDICAL COSTS would have experienced at least a modestly more potent push-back.

2) The article really falls down on the job - or the methodology behind it does - when they trumpet "We got lots of healthy young people in" and don't talk about the "dark side" of the coin: LOTS OF very sick people did, too! AND THAT, I suspect, is what's driving hefty premium increases. Since the Republican alternative seems to be "Some poor people will die - that's capitalism for you," it's really not just about numbers, but making good policy in an area as tough as healthcare requires OPEN EYES and relevant facts.
soxared04/07/13 (Crete, Illinois)
If the Supreme Court grants a victory to King et al., there will be jubilation in every (red) state which has spurned Medicaid expansion. Until low-income whites show up at the emergency rooms because they need service. Or when they receive in the mail the inevitable news that their insurance premiums are (a) being cancelled or (b) being increased. Who will these people blame? President Obama?
Mark (Tucson, AZ)
The gift of the Bush presidents keeps on giving! They appointed the worst Supreme Court justices in the history of the court! I would not vote for Jeb! (remember he is so scared that a voter will associate him with his loser brother that he will not state his last name) just for this reason alone! The SCOTUS represents the best philosophy of their party, Greed Over the People (GOP)!
A (Bangkok)
America is in a state of denial about the ill health of the population at large.

No insurance program - single-payer or other - is viable when the country's people are sick and getting sicker.

Imagine a community of smoldering households, that are about to combust. What do you think the fire insurance premiums would be on households in that community?

That is America now vis a vis health insurance.
Steve Bolger (New York City)
Mental health is every bit as spotty as physical health in the US.
Christine McMorrow (Waltham, MA)
“The creation of an almost trillion-dollar federal government subsidy program has done little to mask the impact of Obamacare’s biggest failure — skyrocketing premiums,” said Senator Orrin G. Hatch, Republican of Utah and chairman of the Finance Committee."

Well, before the ACA, premiums were skyrocketing also, and if SCOTUS rules for the plaintiffs (who, in this trumped up "wrongful" suit ironically haven't suffered anything and indeed, are either receiving or close to receiving Medicare), just wait.

Healthcare costs are exploding, as they've always done, because nobody is reining the hospitals, drug companies, medical device companies, and other armaments from the great healthcare arms race. A race where major cities like Boston, have multiple teaching hospitals and multiple transplant programs, for example, that are duplicative.

Whether you repeal the ACA and start all over with the GOP plan of vouchers and privatization. costs will continue to rise unless some form of price equalization or regulatory caps are enacted. And if you think the GOP will put the brakes on big pharma and big medicine, you're sadly mistaken.

Healthcare is broken in America. The country should emulate all industrialized nations and pass universal healthcare.
Concerned Citizen (Anywheresville)
You are correct in that before enacting things like subsidies or exchanges, the ACA should have addressed COSTS -- which are utterly out of control. We need non-profit insurers, and we need price caps, especially on medication -- and we need to be able to negotiate drug prices, whether for Medicare, Medicaid, the VA or any other health insurance plan.

You blame the GOP, however, when the Democrats are equally complicit in letting prices spiral out of control -- because both parties are beholden to big contributors, of which BIG INSURANCE and BIG PHARMA are huge players.
Bill Appledorf (British Columbia)
The premiums reported in this article are ridiculous. Medicare's premium is about $80/month for an individual. Canadian medicare is about half that. What wonderful contribution does a corporation make to society by ripping millions of people off for as much as they possibly can in order to make a few individuals obscenely rich? Privatization is the cruelest joke this planet's greediest actors play on the human race.
Concerned Citizen (Anywheresville)
Medicare premium is $104, not $80. So I have to doubt your figures on British Columbian provincial health insurance. I believe in Canada it is a progressive tax, so YOU may be paying $40 a month (plus a VAT on everything, plus very high income taxes) but I think the average Canadian workers pays about $92 a month.
Seldoc (Rhode Island)
Senator Hatch's assertions that the cost of health insurance are skyrocketing and that the ACA is the cost are both belied by the facts. It's unfortunate that at this point, many politicians still refuse to make an honest assessment of the program. Instead they make politically charged statements loaded with incendiary language. With this kind of leadership how will we ever be able to deal with the problems presented a healthcare system that consumes and ever growing percentage of our economy.
JRMW (Minneapolis)
I've noticed something that has gotten lost in this debate. The various news agencies make it seem as though a vote against the ACA by the SCOTUS will leave millions of people without insurance *forever*

This is not true. If the SCOTUS votes against the ACA then states without their own exchange will lose out initially, but those states can then set up their exchange at any time in the future.

So if the good people of Maine (or Wisconsin, or any other affected state) are saddened by the loss of subsidies, they need merely convey their concerns with their local governmental officials who can set up an exchange.

If their State chooses not to set up an exchange they can either decide to stay in the state and do whatever it is they will do, or they can move to a state with an exchange.

I'd be interested to know how the Drapeaus voted over the last 40 years.
Did they consistently vote Republican? Or Democratic?

There's about a 50% chance that Mr. Drapeau is getting exactly what he voted for: Death.

voting does really matter.
CPBrown (Baltimore, MD)
Of course, when the government initiates a large new subsidy system, there will be beneficiaries who can be found for this new largess. The real question is - was this the best, and most efficient way of responding to problematic health care needs in the country.

We must acknowledge that not having health insurance does not invariably mean not getting health care itself. Which was/is the original goal. Also, achieving higher levels of subsidies may not necessarily mean success for the program.

And another way of looking at the data from the Kaiser Foundation is that nearly 50% of those getting insurance through the exchanges - already had coverage. Was funneling them through the exchanges truly necessary ? And, if people with higher incomes don't see a benefit of the exchanges, why is that a problem ?

It might have been better to directly address those with no insurance, rather than disrupt many more people, who had already found ways to cover their own health care needs.
Marc A (New York)
This whole plan is ridiculously complicated. Many people do not even understand what a deductible is. Of course people will understate their income to pay out less money for insurance. They may have to pay it back later but many are desperate for insurance NOW!
$10,000/month for life saving medication? Ludicrous! Get the pharmaceutical industry out of the political lobbying business.
This whole mess is very easy to clean up. MEDICARE FOR ALL!!!!!!!!!
AG (Wilmette)
There is one part of this article that needs urgent clarification and/or elaboration.

' “The creation of an almost trillion-dollar federal government subsidy program has done little to mask the impact of Obamacare’s biggest failure — skyrocketing premiums,” said Senator Orrin G. Hatch, Republican of Utah and chairman of the Finance Committee.'

A trillion dollars is an enormous sum (even today). Multiplying the average annual subsidy (S) by the number of people subsidized (N) should give us the total annual subsidy (T). If T is $1 trillion, and S is $3,264 as per the article, then N is more than 300 million, which is way too large. So either the annual subsidy is not 1 trillion, or 1 trillion is the subsidy over something like 10 years or more.

Perhaps my arithmetic or my logic is flawed, but it would also not be surprising if Hatch was playing with the numbers with intent to mislead. Could the NYT please explain what is going on.
Lynn (New York)
Yes, and ask Hatch how much the Iraq invasion he voted for has cost over that same period of time.
jutland (western NY state)
Good question here. Hey, NY Times, how about addressing what AG has written here.
Paul Wilczynski (Asheville, NC)
I wouldn't be surprised if the trillion dollar reference was for a period of 10 years.
Sharon (Miami Beach)
I am self-insured in a high deductible health plan that I purchased OFF of the marketplace. Not a single one of my doctors will accept an insurance policy that was purchased through the marketplace. So, how is this progress? Yes, more people are insured, but if one cannot actually USE the insurance, how is it beneficial?

Jon Davis (NM)
In a capitalist health care system where the only goal of health care is to increase profits of the corporations, costs will never been held down.
John Smith (NY)
All the subsidies have done is to shift the burden of paying for healthcare from individuals to taxpayers. So instead of low-income individuals self-sacrificing in order to afford healthcare such as giving up Smoking, Alcohol, latest Electronics they now can indulge in their vices content in the fact the the taxpayers have their back. Prime example is Mr. Drapeau who has a beautiful kitchen in probably a beautiful home yet wants us to pay for his medication. While sympathetic to his fighting cancer I'm sure that on his income he can pay for his medical insurance without a subsidy if he cut back expenses.
And we will see how taxpayers react when Medicaid costs squeeze out the public services we are paying taxes for.
Josh (Grand Rapids, MI)
Lots of blame being thrown in the wrong direction. You want someone to blame for the situation we're in, look to those who wrote the bill. It's a mess - a mess now waiting for its 3rd ruling from the Supreme Court.
Ben Graham's Ghost (Southwest)
Messy it may be, but at least no one will go bankrupt under the ACA.
Concerned Citizen (Anywheresville)
@Ben: with a $6300 yearly deductible under a Bronze policy, many people WILL go bankrupt. You may not realize it, but $6300 (plus your premiums and copays) per year is a bankrupting expense to many working class families.
iborek (new jersey)
Once again the one percent is being favored and the impoverished, chronically ill or terminally ill are being shafted and deprived of necessary medical insurance and ongoing medical treatment. What's wrong with those state governments who fail to recognize the need for subsidies to insure good health coverage and continued good health for the others?
Panthiest (Texas)
Tax credits for health care are wrong?
What about for private jets and race horses?
Give me a break.
Jim L (Durham, NC)
And what critical points are you referring to? Higher premiums, higher medical costs or smaller tax refunds?
Wack (chicago)
Purpose of ACA was to cover as many people as possible.

To bring down costs, we need real free market reforms - 1) let medicare negotiate prices; 2) let people pay medicare prices + some % for non covered items from HSA account; 3) allow more foreign doctors/healthcare professionals who can pass our board exams (without lengthy residency because that just protects income of incumbents). look at pharmacists - they were allowing foreign graduates to apply for board certificates till 2005. And then they just forced everyone to take pharm D here again- there have been no complaints of those foreign medical grads - this is just protecting income of existing pharmacists. 4) allow specialized short term certificates for generalists to perform certain tasks (like dentists doing gum surgery - dont tell me that we need 3 yr program for general dentist to learn gum surgery!!!).

In short open the healthcare field to providers of entire world and prices will come down. As long as we restrict that competition, we will not achieve any real cost savings.
Panthiest (Texas)
The laws related to health care in this country are made by elected officials who get rich from the lobbyists and industries prospering under our current system.
Our road to universal healthcare is blocked by this reality. I would say shame on all of them, but they wouldn't care.
Christian Haesemeyer (Los Angeles)
Why is Orin Hatch quoted saying the ACA has led to "skyrocketing premiums" without pointing out that premiums are not, in fact, doing any such thing? That the opposite is in fact true - premium growth is lower than it was before the ACA went into effect?
DB (Charlottesville, Virginia)
Mr. Hatch is doing so solely because he is a far right Republican and benefits if the rates go up. He is following the GOP "scare them" line. His approach is that it won't affect him since he has a Premium policy provided him as a senator - meaning he doesn't have to pay for it since it is a benefit of his position.
Coolhunter (New Jersey)
So much for the 'past it to find out what is in it'. It provides a lesson for the ability to pass major legislation without taking sufficient time to have it reviewed. Haste makes waste. Soon that will replay in TPP, when the final bill is presented in a short thirty day review. Since it is all about up or down, it would be better to have 90 days to pick it over. Anything less will be repeat of O care rush to disaster.
Hozeking (Indianapolis/Phoenix)
Let's just call subsidies what they are. It's just another giveback or freebie paid by the hard working, successful taxpayers.
Philip (Boston)
we are all americans
gdk (rhode island)
Bernie Sanders "Medicare for all"
Coolhunter (New Jersey)
Would not a subsidy for any and everything be a good idea? So, to ask if health care subsidies have succeeded is the wrong question. The question should be at what cost to our health care system in both terms of quality, accessibility and outcomes is the question. To talk about one without the other is dishonest. It fails on all counts. My premium did not go down $2500 per year as promised, it went up $4000. So, I am paying for someone else' s care. If that fair? Of course not. Maybe we should be talking about the penalties O care has inflected on the other 95% of Americans.
mario (New York, NY)
Game of Thrones had it right - kill the insurance man!
Old School (NM)
Obama care is a failure, perhaps a step in the wrong direction as this was has been well understood by those who are not duped by politics and media hype. In a capitalists country where money is an incentive you cannot cover more people with the same number of health care providers.
Wrighter (Brooklyn)
My father is a hard-working blue collar man who lives below the poverty line and would never have been able to afford his health insurance, which he desperately needs, without the ACA. Like many others, I am very nervous about this decision and it's potential fallout..hoping the Justices do the right thing.

Is the ACA perfect? Not by a long shot, but it's a foot-in-the-door that may one day eventually lead to a sensible and humane healthcare system (single payer). If there isn't a plan in place to counter the affects of the millions of people finding themselves without health insurance again, the Right might as well hand 2016 over since they have been the loudest and fervent opponents of it since day 1 and it won't be hard to connect the dots, even for their supporters in the South where ACA fallout will be the largest.
John from Westport (Connecticut)
A huge albatross around the necks of businesses is the overhead in managing healthcare for employees. If businesses were freed from this expense, and a viable single payer system available, businesses could focus on doing their business, not spend billions in managing employee health coverage and employees could move easily based on market conditions. Surely the business loving GOP could see that the employer-based health insurance model is bad for businesses in the US.
Andy (California)
Your going to get it. Just be patient. But when you do, don't complain about how much worse it is, because it will be, with the federal government entirely in charge. There will be no more market and service and innovation will decline while costs go up even more. Enjoy socialized healthcare.
Art (Colorado)
Is Orrin Hatch a health care expert? Why is he quoted in this article? He makes a bald assertion that the ACA has resulted in "skyrocketing premiums". Where are the facts that support this ideologically motivated assertion?
Wayne A. Spitzer (Faywood, NM)
If you believe that prompt and preventative healthcare costs less than delayed and emergency healthcare, then you can only conclude that ACA has reduced the countries over all healthcare bill.
Joe (NYC)
Orrin Hatch's statement on premium increases is patently false. Why does the Times not rebut this? The main problem with Obamacare is the continuing stream of lies that Republicans spew out in its opposition.
G. Sears (Johnson City, Tenn.)
Rube Goldberg could not have concocted anything as convoluted and complex as the ACA.

Healthcare in the U.S. remains the most expensive and least responsive to the health needs of its citizens in the First World.

King v. Burwell would have been moot had the Republicans been anything but insurgents bent on sabotaging the product of Obama’s dogged push for healthcare reform no matter how divisive, costly, complex, and ineffective the outcome might be.

At its core this is mostly about American politics and governance at its worst. Republicans and Democrats are equally culpable.

Changing one sentence in the law would avert the looming crisis of a partisan SCOTUS decision, but it would not stop the train wreck that will be the eventual outcome of ACA carried forward without substantive bipartisan efforts to take healthcare in America out of the junkyard.
Steve Bolger (New York City)
If I were a state governor I would recommend adopting the federal exchange system rather than waste taxpayer money to rewrite the same code 50 different ways. This case is stupid from a to z and the Court was stupid to grant it a hearing.
R. R. (NY, USA)
Oc fourse the ACA has not, and will not, hold down costs. No entitlement ever does this. Other health care reform measures would have been, and could be, much better.

The true cost of the ACA is revealed in the painfully slow recovery from the Great Recession. This cost is now abundantly clear throughout the US.

Obama was told his priority was to fix the economy, but instead he saddled the economy with this.
chsat103 (Detroit)
How dare Obama saddle us with Stock Exchanges at all-time highs and the lowest unemployment rates since the recession!
rudy whitcomb (los angeles)
Theres no instead. He DID fix the economy. And as far as saddling the economy, something had to be done about healthcare and for years the GOP simply refused to do anything that would be of help to Americans
ScottW (Chapel Hill, NC)
We must never forget the ACA, with some of its beneficial points, is a plan created by the conservative Heritage think tank that was first implemented by a Republican governor in Mass. It is not aimed at providing affordable healthcare to ALL citizens, but is merely a mechanism for further entrenching us in the awful private health insurance industry.

In a real, compassionate society, like almost every other industrialized society, all citizens are covered at about half the cost of what we pay. Without profit and greed ruling our legislators we would have single payer. But in America, if you can't make a buck off the misery of others you just aren't doing it right.
Nick Metrowsky (Longmont, Colorado)
As health insurers continue to buy each other out; we may end up with a single payer; single payer for profit. The latest was Ciigna turning down a buyout from Anthem (the Blue Cross people). Also, if people think premiums are rising now, wait to 2017, when you will pay more, for less coverage.

Those who like Obamacare never see the true cost of the premiums; those who do not receive subsidies, or are on employer plans, do.

I just checked Ohio, Colorado and Wyoming for a plan fro a 60 year old. The premiums ranged from $850 to $1100 per month; on a silver plan. It was marginally better for bronze. Throw in $5000 to $7000 deductibles. Imagine paying that with no subsidy; it was more than my mortgage payment. Oh yeah, add about 15%,, to the premiums, by the time one is 64.

The ACA was a gift to the health care industry. The good people can get insured no matter what and no lifetime caps are great. But, insurers continue to decrease one's network, so out of pocket continues to rise. In a few years, greed will make the ACA no different than what we had before; but, with less choices and options.

So, the Supreme Court will do the nation a favor to find for the plaintiff. This will force Congress to do the job right. And that job, is Medicare for all. Want more coverage? By a Medigap Policy (which Mr. Obama just got rid of in 2020, so seniors "have more skin in the game"). They will have a choice eat, have a roof over their heads ore get sick.
Abe Levy (Bonita Springs FL)
We waited decades for the Godot of a single payer system. It would not be smart to go backwards to that wait.
Garak (Tampa, FL)
Those who benefit from the tax subsidy for employer-paid health insurance never see the true cost of those premiums. They do not appear on their W-2 forms. Nor do they see the higher taxes everyone else pays to cover the $250 BILLION annual cost of that tax subsidy. Those lucky duckies see only the small part of the premiums that they pay.
David L, Jr. (Jackson, MS)
Wait a second. People losing ACA subsidies, and thus their insurance, is going to force a GOP-controlled Congress to enact Medicare-for-All? Anything else you want for Christmas? Lagniappe: partridge in a pear tree.
rfsBiocombust2022 (Charlottesville)
I encourage people to write to their state insurance commissioner and ask how they are performing audits on insurers in the state to enforce the Medical Loss Ratio (MLR) provision of the ACA. This provision alone should help drive down premium increases but only IF audits are performed.
Bruxelles (northern VA)
Only a progressive would suggest that transferring wealth from one group to another in the form of healthcare subsidies is a success. Why don't you get serious about tort reform and the actual costs of healthcare and stop the redistribution of wealth. Or you could just pay my bills for a change!
Rita (California)
Agreed. People need to get serious about the actual costs (and quality) of health care. Let's start by eliminating slogans and sound bites that obscure rather than illuminate.
David (California)
Insurance almost by definition involves redistribution of wealth. Very few people ever have their house burn down. Most of what they pay in homeowners premiums is "redistributed" to the few people who have a catastrophic loss.
Almighty Dollar (Michigan)
Lawsuits are a minuscule cost according to many studies, less than 5%. has loads of data on this points.
Steve Projan (<br/>)
Let's face it the ACA is a kluge, i.e. a bunch of ill-fitting parts that was cobbled together to deal with multiple interest groups ranging from the insurance companies to the hospitals to the docs and, oh yeah, the patients with the uninsured getting the shortest shrift. The Republicans hate it,even though the main parts are their idea!! Because, it makes Obama look good. There is one simple solution, Medicare for everyone.
Susan (New York, NY)
The last I heard France is NUMBER ONE in healthcare. The US is NUMBER THIRTY-SEVEN. Medicare for all. It's a no-brainer. If we could get rid of the lobbyists, this could be accomplished.
Abe Levy (Bonita Springs FL)
You are quoting the WHO 2000 report which also states about French health insurance: "Most citizens receive their insurance through their employer and almost everyone has supplemental private insurance."

There are also many objective criticisms of this report. The judgments in it are not "facts" and not as generally accepted as you would think.

Read more:
HANK (Newark, DE)
And that number probably includes Medicare as part of healthcare delivery in the United States. Can you imagine what the number would be without it?
HANK (Newark, DE)
Abe, I don't need anybody's report to tell me a healthcare system with wealth based access would be nowhere near the top. All you need to do is walk into any ER and observe just who is there. After you remove those who might be illegal aliens, you are left with the desperately poor and victims of Republican based obstruction to the ACA. What country with "socialized medicine" would you see that in?
jb (binghamton, n.y.)
Significant cost savings will accrue as participants enjoy better health later in life. That takes time and Americans don't have the patience to consider the future.

While a single payer system would be better in some aspects it would also be worse for some. This system may not seem elegant but it is, like democracy itself, better than any known alternative.
rdg (OH)
HOW would it be worse for others, pray tell?????
Roger Faires (Portland, Oregon)
Please show us where single payer would be negative( other than for the profit mongers in the healthcare business). As someone stated above, France is single payer and they have the number 1 rated health care system in the world. And for France's size of land versus their population, they actually have far more people in their country.
Concerned Citizen (Anywheresville)
Roger: France is absolutely NOT single payer insurance -- no nation in Europe has single payer.

If you understand single payer that poorly, you really should not be advocating it.
Michael Piscopiello (Higgganum Ct)
It's not to hard to imagine that in the near future, health care costs will overrun the subsidies and place a huge burden on families making $25 -100K. In many ways, the ACA subsidy structure is like our federal welfare programs, once you reach a certain income threshold, you're new found wealth will be eaten up by the benefits/subsidies you lose, putting you in a more precarious economic position. Worse now, is that you will be forced to purchase that health insurance or be penalized.
Byron Jones (Memphis, Tennessee)
"... putting you in a more precarious economic position. "

Worse than before ACA? Tell that to my relative who lost her insurance after being diagnosed with cancer. You do have some imagination.
Michael Piscopiello (Higgganum Ct)
Byron, I am only talking about he economics of ACA, I fully endorse and support the ACA as a step in the right direction for US health care. If rising costs out strip the subsidies and people end up with deductibles that wipe out savings, then yes, it will be as bad as before the ACA. Not to be snarky as well, but think it through, you don't need that much imagination to see it happening
Mark Krieger (Cleveland, Ohio)
This is a big one. A progressive law passed by congress, obstruction, mendaciousness and sabotage by the disgruntled opposition, a frivolous legal case that reaches the court, and SCOTUS decides...what? Beyond this case, they are giving an indication of the continuing effectiveness, in an increasingly complex an interconnected world, of our way of governing going forward. If the United States is to be taken seriously as a world leader, this is a watershed moment.
Byron Jones (Memphis, Tennessee)
If SCOTUS finds for the plaintiff, that should be a call to arms (ballots?) to send the GOP back to the 12th Century, where it belongs.
John (Texas)
It seems absurd to me that medical care is almost entirely funded through insurance. Insurance makes sense when risk is low, but consequences are catastrophic. When insurance becomes a ubiquitous middleman, basic care like asthma medication become absurdly expensive.

The ACA is never going to lower costs. Being written almost entirely by health insurance lawyers, I doubt it was that was ever truly the intention. All the ACA did was shift costs, as evidenced in this article's 33(!) uses of the word subsidy.

IMO, the way to fix healthcare is to get rid of the insurance middle man for basic care, standardize healthcare bookkeeping to make the market more fluid, strip corporate giveaways like the patent extension in the TPP to encourage generics and competition, stop supporting employment-sponsored healthcare, have insurance history follow a person throughout life so more years of contribution equal lower rates and lastly only subsidize healthcare for people in serious need... like Mr. Drapeau. Make sure people realize that the safety net is a horrible, but humane place to wind up.
Byron Jones (Memphis, Tennessee)
You mean, kind of like what is done in France?
Robert E. Johnson (Randolph, NJ)
Is it not reasonable that costs would rise before leveling, then drop as the previously uninsured with preexisting conditions regain their health? I would expect a downward trend after the pre existing conditions are resolved.
Todd Fox (Earth)
No. It isn't reasonable. Pre-existing conditions often require continual and expensive care. They don't resolve with treatment.
Todd Fox (Earth)
No. It isn't reasonable.
Socrates (Verona, N.J.)
To summarize, the ACA is working pretty well, but it could use some stronger cost controls like those in Medicare and in single payer systems from Europe that minimize medical and pharmaceutical extortion.

The Democratic question is how to we improve the ACA.

The Republican question is how do we expand the GOP Death Panels.

D to go forward ; R to drop dead.
troublemaker (new york, ny usa)
Or like a car: D for Drive (forward) and R for Reverse.
Chris (Arizona)
We really should have Medicare for all instead of just those 65+, but Obamacare offered a lot of good for those who couldn't get private health insurance due to cost or pre-existing conditions.

But conservatives couldn't say enough bad about it and didn't want it. If it does end up going away, I wonder how many conservatives will realize how stupid they were.
vlad blinkin (singapore)
Iam an American citizen who is presently living in Singapore, though I will return to the US shortly and continue my career as a teacher. I would just like to share some observations about the two health care systems. First about the US. I have checked the premiums that I and my family would pay for Insurance. They are around $1000 a month even with subsidies, expensive for a teacher. As the articles states, premiums are rising due to rising Health care costs. Lets look at Singapore. Every citizen here has lifetime health insurance with very reasonable premiums that they also must pay. ( Singapore believes in a controlled market place, so no free lunch or health care). So the question is why can Singapore provide universal health care at a reasonable cost and the US struggles mighty . to do the same? One reason is simply price controls that the Government imposes on public health providers.For example, emergency room visits are capped at around $100, and lower than that for poor people. I think in the US a visit is at least $1000 dollars and higher. Also, drugs have price controls as well. It seems to me that reasonable price controls might be one solution to ever rising health inflation in the US.
Concerned Citizen (Anywheresville)
The ACA was DESIGNED not to have any price controls, so that Big Insurance would be happy -- remember, an executive from Big Insurance actually WROTE THE ACA.
Frank (Johnstown, NY)
Single payer,, Medicare for all - that would have been the easier, most efficient and most cost-effective way to go.
Abe Levy (Bonita Springs FL)
This case is not about a typographical error in the writing of a major law. It is about whether the Supreme Court has any sense of decency.
Byron Jones (Memphis, Tennessee)
Decency? I'd settle for pragmatism.
toom (germany)
As far as I can find, the cost increases after passage and implementation of the ACA are somewhat lower than before. Was the goal of the ACA to eliminate cost increases in medical care? I thought its purpose was to eliminate some restrictions on those seeking insurance and to enlarge the pool of insured.
Todd Fox (Earth)
The cost increases of health insurance have been astronomical however, at approximately 14% a year.
Howie Lisnoff (Massachusetts)
Even a moderate improvement in how a human service is provided for those in need is met grudgingly by the forces of reaction in this political and economic system.
abo (Paris)
Only in the U.S. would a plan of this complexity be considered an advance. I feel sorry for all those caught up in such an inhuman system.
The complexity of health insurance is an invitation to the insurance industry to create an unecessary infrastructure that increases cost, promotes fraud, allows cherry picken' and lessens participation. The actuarial mathematics of insurance to spread the risk over large pools is defeated in a blur of rules and exceptions that doesn't cure one illness. Insurance has been enabled to spend more money to NOT pay the bill rather than to efficiently process claims.

Single payor - the rest of western societies have figured it out.
Susan (New York, NY)
Bingo! We have a winner!!!
Lindah (TX)
I have to disagree with your last statement. Single payer does not equal universal healthcare. See Germany, Belgium, Switzerland, et al. It isn't just a matter of semantics.
David H. Eisenberg (Smithtown, NY)
But do the rest of them pay to defend the rest of the world and are the reason the world is not largely fascist or communist? Did they help resurrect Europe after WWII? Are they highly diverse immigrant societies or largely homogenous societies that have opened their doors to virtually everyone? And do they provide not only the degree of freedom that we do to their citizens, the opportunities and quality of life? And have they really figured it out, or are the attempts at doing so fraught with difficulties too? Because every one I look into seems to have great problems either in providing services or costs to the society - and sometimes both. It would be great if no one had to worry about healthcare. I don't see how we can afford it (nor, watching a congressional hearing yesterday, do the "experts" know. And the current plan has made it worse. It should fail or be greatly modified. Paraphrasing Obama on with Iraq, we should get out of it as carefully as we got into it carelessly.
VJBortolot (Guilford CT)
We await the Supreme Court decision on the ACA subsidies. Some see the court saying that the subsidies in the present law are illegal but all can be remedied by Congress simply altering a single sentence.

But in a dissenting opinion on the recent decision in the Spder-man toy patent case ,Justice Alito said he held out little hope that Congress would effectively overrule the Brulotte decision. “Passing legislation,” he wrote, “is no easy task.” So any legislative repair to the ACA is very unlikely.

It would be cynical and disingenuous for the court to decide the case in this manner.
mB (Commonwealth of Virginia)
States that run their own insurance could be directly affected. In fact, subsidies available in them could be held unconstitutional. As one amicus recently observed . . .

At oral argument Scalia insinuated that the tax-credit statute clearly denies tax credits to individuals enrolled in healthcare plans through federally-facilitated Exchanges. And if this is so, then so be it, even if this means the remaining tax credits available for insureds in state Exchanges would be rendered unconstitutionally coercive. Scalia suggested if a statute is not ambiguous the Court should not interpret the statute (in his words, “rewrite it”) to avoid a constitutional question. The words of the statute are controlling, no matter what the consequences.

What was Justice Scalia's point and to what end?

Perhaps he was suggesting that the Court should declare that the tax-credit statute, as written, applies only to state Exchanges and, because it does, it is coercive in an unconstitutional way. Consequently, the whole statute must be struck down and no tax subsidies can be permitted under the Act regardless of whether an Exchange is state- or federally-operated. Justice Kennedy's remarks at oral argument could be read as consistent with this view as well.
John (London)
Looks like the Republicans are digging their own grave with this issue. You can fool some of the people some of the time....
David Henry (Walden Pond.)
Expect the GOP sociopaths on the court to hurt as many as possible.
Eddy L. (Bella Vista, AR)
I'm nervous about the decision. Before we enrolled in the federal health insurance plan, my wife and I (both 63) paid app. $575.00/month to Blue Cross. We signed up and our monthly rate is now $301/month. But, Blue Cross raised our premium to app. $1300/month at the time we joined the govt. plan.
So the govt is paying a subsidy of $1000./month for us. If Affordable Health Care goes away, we assume we will then have to pay the full $1300 instead of our original $575.00. I am under treatment for cancer so we are very concerned about this Supreme Court decision. We have never understood how Blue Cross was able to jack up the rate so high when we were accepted into the subsidy.
Todd Fox (Earth)
It's because you have a different plan now. For one thing it covers birth control and maternity care, now universal requirements. You probably didn't have those benefits before.
J (US of A)
Stop calling them subsidies and start calling them Government Hand Outs on the backs of tax payers.

You ask in essence has giving poor people more of tax payers money made them less poor. What a surprise..yes! What an amazing program!

What you ignore is why does the darn medicine cost $10,000 a month !!!

Because the pharmaceutical industry made out like bandits with this law and are bleeding this country dry.

Obamacare is just a huge handout and did nothing to address the main drivers of costs which is not the doctors. But since our lobbying is nonexistent and we don have shareholders we were ignored.

Since the writers of the law have said that the words that were written were what they wanted it to say there is only one sensible outcome. Do you thing SCOTUS...kill it.
Kay Sieverding (Belmont Ma)
Romney Care has been successful in Massachusetts since 2006. The economy is good, no one complains, and beggars in Boston/ Cambridge appear to be mostly claimed homeless vets.
David H. Eisenberg (Smithtown, NY)
If you think it has, Kay, suggesting you read up on it. There's a reason other states haven't followed it. It ceased to exist in essence years ago.
former MA teacher (Boston)
Just give the man the medicine--why not?:

Charles R. Drapeau, 63, and his wife, Diane, 62, of East Waterboro, Me., have insurance purchased through the federal exchange. Mr. Drapeau has multiple myeloma, a blood cancer, and takes a drug that costs more than $10,000 a month. The premium for the couple’s insurance is $1,600 a month. The subsidy is $755, and the amount the couple pays is $845.
mario (New York, NY)
Why on earth would any drug "cost" $10,000 a month? Who manufactures this drug? This drug should be free!
vulcanalex (Tennessee)
Of course nothing is going to drive down the actual cost of care, and when those costs go up the cost of insurance has to go up as well. Look at the total system costs and it becomes simple. We have more costs in the exchanges, more tests for those sick who now have coverage and more yearly physicals for those who are healthy. More drugs for newly covered conditions, and more testing to find other conditions that doctors will be looking for. Simple!!!
Brice C. Showell (Philadelphia)
I assume the justices will not be reading about possible horrors of their decision.
Hozeking (Indianapolis/Phoenix)
I hope not. I'd rather have the justices spend their time reading the constition and how this law complies or not.
JPM08 (SWOhio)
The picture on the front of the lead web page tells it all, Republicans have instilled fear into many citizens over their endless battle with Obamacare, and now with a possible program ending decision coming from the SCOTUS, they have nothing to replace it, in fact are proud of themselves for fighting the urge to help fellow citizens, keep the cause of drowning the government in a bathtub.

All to reap benefits for themselves and spite the POTUS...

What a screwed up mess of a country
Chris Gibbs (Fanwood, NJ)
The Court believes there is no more racial prejudice in the US. They believe money is speech and corporations are people. Perhaps they will announce that disease has been cured, all of it, so health insurance is no longer necessary.
swm (providence)
Why is the government making this so difficult? Everyone gets sick. Everyone needs medical care. This is not an entitlement, it's a basic human need that many other nations have managed to work into their system.

The government offers health insurance to various groups - veterans, the elderly, the very young - it could be scaled to universal coverage. The corporate interests of health insurers pales in comparison to the millions of people who just want to be able to go to a doctor if they get sick.

On this single issue, how anyone could vote for the Republican deniers of access to health insurance is beyond me. What is in it for a person to make it impossible to get health insurance?
troublemaker (new york, ny usa)
Population control of certain demographics, for starters...
Jim (North Carolina)
So, Obamacare is good but not as good as it could or should be because it does not control rising insurance premiums. This was not only predictable but predicted. This was why many wanted and still want a single payer or at least a government choice to put real pressure on insurance companies and medical providers. I vote for single payer. It works in more advanced countries such as in Scandinavia.
Concerned Citizen (Anywheresville)
No nation in Scandinavia (or Europe!) has single payer.

You undermine your argument when you clearly do not know what "single payer" even means. Only 3 nations have single payer. You are likely thinking of Canada -- the other two single payer nations are in Asia.
mB (Commonwealth of Virginia)
Subsidies have held down the costs of health insurance for those who need them.
Dtngai (NY)
It is ridiculous that the people filing the suit are not even getting insurance thru the exchange.

It's funny that the representatives of people in the red states, who are benefiting the most from this, are trying to kill Obamacare.
Gabbyboy (Colorado)
I agree. The most ridiculous part of this case is that the plaintiffs HAVE NOT BEEN HARMED. Why the court decided to take this case when the plaintiffs have no standing is so riduculous it defies understanding...politics as usual now firmly entrenched in the halls of justice.
Beantownah (Boston MA)
Whatever the Supreme Court decision, this case does not cast the Affordable Care Act in a flattering light. The argument in favor of upholding the ACA is embarrassing to its supporters: That in a frantic partisan rush to pass the bill, no one bothered to read it, allowing a consequential typo to become passed as a law. The counter argument suggests this law is such a stitched together series of compromises (dozens of private insurance companies serving as a national health insurance plan surrogate; state's rights balanced against the power of central government) it will eventually collapse under its own confusing weight. Either way, not encouraging. And meanwhile, the the ACA is pushing insurance premiums for middle class working families ever higher.
klm (atlanta)
No matter how they rule, the Justices will still have government provided health insurance. Ironic, no?
Marc A (New York)
They all have "Cadillac" plans. The best of the best!!!!!
America the beautiful!
Matt (RI)
So do Mr. Boehner and his pals.
Save the Farms (Illinois)
The Census Departments shows that the percentage uninsured from 2008 to 2013 decreased by 0.2% (from 14.7% to 14.5% - Figure 2).

Costs have skyrocketed because insurers figured out quickly that they could use the yearly 9.5% on total costs as what they would charge. Monthly rates, especially subsidized ones, are competitive, but deductibles and co-pays are not ($6,600 for the individual, $13,200 for a family). At every level, Obamacare is largely catastrophic insurance as people mostly pay out of pocket, thus avoid the Doctor, until they meet the yearly limits.

It appears the only beneficiaries are those at the very bottom receiving Medicaid, at the expense of those receiving Medicare because of the transfer, and a narrow sliver of people with expensive or chronic conditions that do not have employer-based insurance and do not qualify for Medicare or Medicaid. The young and healthy within the program benefit the least because they pay up to three times the yearly rates they might otherwise as a subsidy to the older and potentially sicker people within the program.

The ACA has failed - it did not cut the rate of uninsured and did not lower costs. We need to abandon it and have have a social discussion on what should replace it.
Mr. Blandings (New York)
ACA was put into full force in 2014. You quote numbers for the period prior to its coming into force. You arguments simply don't hold water.
Marc A (New York)
We cannot simply abandon it at this point. It must be modified, yes.
Medicare for all would solve this problem.
R. Williams (Athens, GA)
Very strange. You claim the percentage of uninsured has not declined based on data that only goes through 2013, before the insurance mandate kicked in. You conveniently avoid the data for 2014 and 2015 that show the opposite of what you claim.
Jack (Eastern PA)
Another biased Robert Pear article, with misleading and unsupported assertions. THE FACT IS that the ACA (Obamacare) has slowed the rate of increase in both the cost os medicine and of insurance - contrary to what this article asserts.

Mr Pear and the GOP better beware of what they wish for - Without the ACA, the medical system in the US will collapse. Shrinking the pool of insured people will do nothing to reduce the cost of medicine or of insurance - but it will drive millions back to hospital ER for basic care, bankrupt thousands of hospitals and millions of families, while delivering ever declining levels of care.

The very wealthy don't need insurance - and they don't give a damn about anyone else
PW (White Plains, NY)
Thank you, Jack, for calling the co-author of this piece on his bias. And kudos to the NYT for its unusual decision to publish his comment. My past occasional comments regarding writers have been uniformly ignored, which I took to be a reflexively thin-skinned reaction on the Times' part to (what I believed to be) thoughtful critiques.

Yes, it is demonstrably true that Mr. Pear and his frequent co-author Michael Shear have often seemed to have particular difficulty giving credit where credit is due when it comes to Mr. Obama. And appropriate editorial oversight too often appears to be lacking
DW (Philly)
I haven't read most of the comments so I hope I am not stating something that's been said repeatedly, but:

Isn't it short sighted to decide this soon whether the program will bring down costs? If you bring disproportionately young people into the system, yes, naturally, if they pay high deductibles there's going to be a lot of cases where it superficially "doesn't seem worth it" if you measure it after just a few months or years - because nothing much was medically wrong with these people.

The value of routine access to health care is largely PREVENTIVE - meaning that the actual savings cannot be calculated till years down the road, when the generation of young people who came into the system in the early 2010's, are at an age where preventive health care earlier may have caught early cancers, helped stave off heart disease, etc. Isn't that when you say, "Let's see what this saved us." And isn't it a pretty good bet the savings will be substantial?

What am I missing?
Neweryorker (Brooklyn)
You make a great point about the long term effects of healthcare. To your message, though, you're probably missing the fact that the ACA has exorbitant deductibles meaning people are paying monthly bills but can't afford to get treatment because they can't cover the deductibles. More directly, in 2015, insurance companies are asking for substantial rate increases, such as 16, 30, even 85%.
Miriam (San Rafael, CA)
Uh, what exactly in western medicine staves off heart disease? And as many articles in the Times note, early diagnosis of cancer is misleading and not particularly beneficial.
Matthew Carnicelli (Brooklyn, New York)
"Although they reduce the direct cost of buying insurance for many consumers, the subsidies do not by themselves hold down the overall cost of insurance, which is driven in part by health care costs."

Only Federal Government involvement, via either single-payer or a robust public option, coupled to transformational changes in how doctors pay for medical school and malpractice insurance, what pharmaceutical companies are allowed to charge for drugs, and what hospitals charge for services, could have realistically held down the rise in health care costs.

The private sector is unable to regulate itself - and there are simply too many ways at current to game the system.

All of our advanced industrial competitors provide universal medical coverage while paying as little 8-11% of GDP in comparison to our 17-18%. While individual lifestyle choices do factor into this equation, their impact is assuredly far more modest than conservatives contend - unless they are prepared to conclude that "godless, hedonistic" Europeans live healthier lives!

As it is, merger mania is overtaking the American insurance industry, as companies recognize the ACA as the boon to business that it is:

"Based on the high-flying stock prices of the big health insurers right now, investors must be convinced that bigger profits are in the offing. The chief executives are also expecting big paydays."
Charles W. (NJ)
"The private sector is unable to regulate itself "

So of course the liberal progressive answer is to add even more useless, self-serving, parasitic government bureaucrats to the public payroll. Even the government loving NYTs, that never saw a tax that it did not want to impose or increase, has said on many many occasions that government is always inefficient and often corrupt.
Adam (Baltimore)
This is a really important article and one that needs to be shared with anyone who still is still vitriolic towards the ACA for all of its faults. It is still a step in the right direction and eventually, hopefully, will lead to a nationalized, single payer system.

Hopefully these critical points were articulated during the court hearings to make the case clear that millions of Americans have indeed benefited from receiving subsidized coverage due to severely low incomes. Even younger people are now in the pools even if costs are slightly higher.

It's sad that this case even made its way to the SCOTUS' doorstep, but I have faith that this law will be upheld because if not, Congress, especially the GOP, will pay dearly.
Francis (Florida)
obamacare increased everyone's premiums, lot more unhappy people in non-subsidised insurance market
Steve Austin (Hopkinsville KY)
Perhaps this case made it to SCOTUS just so the last few liberals who weren't sure of one man would now understand: how hard Chief Justice Roberts wants you to like him. He really wants you to like him! With apologies to Sally Field.

Who knew SCOTUS needed a public relations professional.
John (Harvard, MA)
The rancorous debate and various court challenges over the ACA's individual and employer mandates, Medicaid expansion, tax subsidies, contraception coverage, Origination Clause, among other aspects of the ACA all serve to highlight (1) the complexity of the nation's dysfunctional health care financing system (or, non-system) and (2) demonstrate the willingness (indeed, gleefulness) of many politicians to use the ACA and health care as a political football. Whatever the result in the King case, these two facts of American health care won't change any time soon.
winchestereast (usa)
May we parse this differently ? The top insurers' stocks ran new highs in the first quarter of 2015. CEO compensation ran from $10 million for Humana's Bruce Broussard, $13.5 million at Anthem where Joseph Swedish sits as CEO, $14.9 million for United HealthCare's Stephen Helmsley and $15 million for Aetna's Mark Bertolini (SEC filings), $14.5 million at Cigna where David Cordani sits. This is a for-profit industry where those with influence take home the $, whether market-based or subsidized by the rest of us. CEO compensation is just a single line in a deep layer of highly paid individuals.
Health care isn't really so expensive. Our current for-profit system is. Just watch as UHCare and Anthem jockey for control in this heady arena. They'll claim the data mining etc is in the name of quality care, cost control....If they wanted to control cost they'd lower rates and run lean.
Madeline Conant (Midwest)
For anyone who has any doubt where the unnecessary expense of America's health care system goes, please read and recommend the post above by winchestereast. Look at how much, for example, is going directly into the pockets of the CEOs of Big Insurance. Think of those guys when you pay your monthly premium. We could have single payer instead of this obscenity.
Francis (Florida)
Obamacare is like a lottery to health insurance companies
Doug (Boston)
to blame the for profit sector is to completely miss what is really going on. All you have to do is look at that the not for profit sector of healthcare to see the real abuse. There is no shortage of multimillion dollar CEO's leading teaching hospitals and non-profit healthplans. And, by the way, because they are "non-profit", they do not pay taxes. At least the for profit companies actually finance the system, to some degree, through their federal, state and local taxes. In fact, it should be noted that the state of California recently rescinded the tax exemption of Blue Shield of California because: 1) they make too much money, 2) they have too much money and 3) they pay too much to their executives.

It's always appealing to the left to get the pitchforks out for the public company CEOs (who pay taxes), try looking at the non-profit ones for a change. You'll be enlightened.
Carolyn Egeli (Valley Lee, Md)
Nothing works as well as a public option. That's the only thing that would make this system truly fair.
Denise (Chicago)
The white elderly that have the public option of Medicare vote against others having this public option.
Francis (Florida)
My Health Insurance Premium and out of pocket expense went sky high after obamacare, look what happenned to college fees, any kind of subsidy kills market place, there should be a better way!
Carolyn Egeli (Valley Lee, Md)
Healthcare is best done the same way as Medicare.
See also