Comment by biggermike | Hacker News Reader

Comment by biggermike | Hacker News Reader

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It's very rare to have direct proof of the effect of an economic/regulatory intervention, but luckily, in this case, we do. We've had a decade a survey data that indicates exactly what the effect the ACA had on employer provided healthcare was.

See here for one such example: https://pnhp.org/news/impact-of-aca-on-employers-and-their-e...

Some relevant highlights: * More than one-third of organizations now have increased out-of-pocket limits, in-network deductibles and/or participants’ share of premium costs in response to ACA. More than one in five organizations have increased copayments or coinsurance for primary care, increased participants’ share of prescription drug costs and/or increased the employee proportion of dependent coverage cost. * The excise tax on high-cost group health plans (a.k.a. Cadillac tax) is considered the top ACA cost driver beyond 2015. Since 2011, a steadily increasing percentage of organizations has taken action to avoid triggering the excise tax — a trend likely to continue. More than one in ten organizations already have adopted changes to prevent them from triggering the tax, 21% are working on changes and 28% plan to act sometime prior to 2018. Only one-quarter said changes were not necessary either because they have no high-cost plans (23%) or because they plan to pay the tax (2%).

That being said, the year following the passage of the ACA saw a large anomalous spike in employer healthcare costs that wasn't present in Medicaid/Medicare. It's almost undeniable that this was due to the ACA.

That’s what happens when poorer people who tend to work for employers that don’t offer benefits such as health insurance start getting healthcare.

Someone has to pay for it, and it shows up as increased premiums/deductibles/employer share of premium, but in exchange, we get rid of pre existing condition exclusions, we get in network out of pocket maximums, and older people don’t get hit so hard because younger people have to subsidize their healthcare.

Growth in healthcare costs also slowed in the years after ACA was passed as the various provisions were phased in:

https://www.statista.com/statistics/720767/medical-cost-tren...

This isn't an argument over the merits of the ACA. Many of are fine with Universal Healthcare but not with deluding ourselves into thinking that it's a free lunch. It's a statement of fact intended to address the false premise that we don't know the causal effect of the ACA on various healthcare costs.

We know exactly what it was as we have direct evidence as to what actions employers took in response to it e.g. increased premiums, increased out of pocket minimums, reductions in coverage, etc. The result is that, pound for pound, the same healthcare is more expensive.

> Growth in healthcare costs also slowed in the years after ACA was passed as the various provisions were phased in:

This is unsupported by the chart. In fact, it shows the opposite: the largest decreases in healthcare spending growth occurred before the passage of the ACA. That aside, the parent comment is seeking the causal effect of the ACA on healthcare costs, not a low correlating trend.

But old people have Medicare. Health insurance for old people hasn't been the problem.

65+ has Medicare. Health problems start in your 40s, and greatly accelerate in 50s. Most Americans have clogged arteries, diabetes, or hypertension and need treatment many years before getting to Medicare age.

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