Hacker News Reader

Comment by lapcat | Hacker News Reader

> Now a decade on, the exchanges have proven to not be very popular- everyone who can still gets their insurance through their company because it is seen as a better deal than going through the exchange

This is a rather strange interpretation, because the marketplace was never intended to compete with or replace employer provided insurance. In fact, the ACA has an employer health insurance mandate for companies with at least 50 employees. The marketplace is primarily for people who aren't otherwise covered by employer health insurance or Medicaid, such as the self-employed, and I suspect that the marketplace is used by most of those people, especially because of the income-based subsidies.

View on HN

Like I said, a lot of health care policy wonks in 2010 were definitely expecting the exchanges to be where the action was, and were talking about future changes that would allow employer subsidies onto the exchange or for higher wages in exchange for breaking the link totally (health care wonks have long hated the link between employment and health insurance- it's a weird legacy of WW2 that doesn't make sense). This is why Congress and their legislative staffers are the only people who do have employer subsidies on the exchange- the GOP offered a poison pill to force Congress to only be offered insurance through the DC exchange, but the Dems gladly accepted the pill because they thought it would mark the way to the future. This did require a lot of extra rule-making and pipe-fitting such that the (quite poorly paid) staffers didn't get screwed too badly on the deal, which took an extra year, but since 2015 Congress has only been offered health insurance through the DC Exchange, the same as anyone else who lives in DC. Because the GOP thought it would embarrass the Dem's and the Dems thought it would instead mark the way that everyone would go.

> a lot of health care policy wonks in 2010 were definitely expecting the exchanges to be where the action was, and were talking about future changes

Ok, but... how are the dreams of "policy wonks" relevant? What we got is what Congress passed, and what Congress passed preserved and enshrined the role of employers in providing health insurance. Thus, the fact that people who have employer-provided health insurance are not on the exchanges doesn't seem interesting, given the actual laws in place (as opposed to some imagined future alternative).

And I think you're underestimating the number of people who don't have employer-provided health care and who do use the exchanges, especially with the so-called "gig economy".

> This is why Congress and their legislative staffers are the only people who do have employer subsidies on the exchange

Congress granting itself an exception is just par for the course.

You have to remember that originally those exchanges would also have had a public option available to compete with private plans.

Reply on news.ycombinator.com