Corky,

I liked nave better.

Donner,

"Gee thanks Captain Obvious."

It took me a few hours to research info and get the post how I wanted it.

Then came you.

Such an intelligent thoughtful post (shot out your butt)

Sandwich sales will be going up.

Protestors will be tossing sandwiches now..

Corky,

Just because he hasn't revealed anything, doesn't mean nothing exists.

The smart thing to do is not give his enemies ammo to use against him until we get past this current hurdle.

(continued from above)

When the ACA was written, it said subsidies were for exchanges "established by the State." That made sense when everyone thought states would cooperate but many didn't. So opponents sued, complaining that people who bought insurance through the federal exchange weren't allowed to get those tax credits. The case, King v. Burwell (2015), went all the way to the Supreme Court.

The Court ruled that Congress meant for subsidies to apply nationwide, whether a state or the federal government ran the exchange. That ruling saved the ACA, but it exposed how fragile it really was. One poorly worded sentence, "established by the State.", nearly destroyed the entire law. Another wrench in the grand plan.

Then came yet another one. The individual mandate penalty for not buying insurance was repealed, thus depriving the grand plan of much needed revenue.

Things haven't worked out the way the architects promised. Yes...some lower income Americans gained coverage, but employer group plans have continued climbing. Self-insured have been squeezed. A huge problem was that cost controls were largely ignored. Furthermore, Congress never allowed cross-state competition, which could have lowered costs by putting pressure on insurance providers. ACA would have never passed if they had.

That brick wall for businesses is still there. Employees covered by employer plans are generally ineligible for subsidized exchange coverage, as are their spouses if the employer's plan meets ACA affordability rules.

Something is still broken in the system. Hospitals, pharmaceuticals, administration, and government regulation continue driving up costs and no one has the backbone to fix them.

Democrats won't touch their signature program, and Republicans still haven't offered a serious, workable alternative.

So here we are, decades later, staring at the same brick wall I saw coming forty years ago.

Then came Trump.

Dan,

"I knew. Forty years ago."

As did I.

My accounting career, going back to the 80s, started with automating businesses that were still doing manual accounting. Novell servers, workstations, and local area networks were coming into use. I set up automated accounting systems using provided trial balances and subledgers. I usually worked alone, getting small and mid-sized companies up and running and then trained their employees.

Over the years, I talked with many owners and accounting managers, and something I saw was alarming. Over and over again, every company I worked with had one thing in common. When their annual group health insurance renewal arrived, the premium had typically increased five to ten percent, in that ballpark.

Year after year, those rate hikes outpaced inflation and consumed a bigger share (percent) of sales revenue than nearly every other expense on their books.

That spelled trouble for companies that had, for years, just absorbed the increases while still offering free health insurance for employees. I even knew one company that provided free family coverage until the late 80s.

At that rate, a brick wall was inevitable. It was just a matter of time. Something was wrong then, and it's still wrong now.

The government eventually stepped in with a grand plan called the Affordable Care Act (ACA) or Obamacare which was supposed to fix the system by spreading out risk and making insurance affordable for everyone. It offered federal premium tax credits (subsidies) for people who bought coverage on new state-run insurance exchanges, along with a mandate requiring everyone to have and pay for health insurance. The idea was simple. Healthy young people who often skipped insurance would now pay in, spreading and balancing costs for everyone else.

But there was a problem. Many states refused to create their own exchanges or expand Medicaid. That forced Washington to step in and build a massive federal exchange what we now know as Healthcare.gov (as a backup). It was never supposed to be the main system, but suddenly it was. That was the first wrench in the grand plan.

Then came another one, even bigger.

(continued)