sort of, there were some changes to MA care post Obama care as outlined in this article in the globe, which increased enrollment even further.
https://www.bostonglobe.com/magazin...ssachusetts/4lMPvCS2fIDbInyhLBxxpL/story.html
But wouldn't those changes be minor compared to a state with little or no previous mechanisms for insuring those who can't afford insurance but are above Medicaid level? The reason I'm shocked is because although wait times increased everywhere - unavoidable when there is a large influx of new demand into a system capable of only slowly increasing supply - nothing I've seen has been anything like that, even in states where previously large segments of the population had access to only emergency care.
One bizarre thing about Massachusetts is that the initial increase in patient waiting times when Romneycare went into effect never really subsided. That makes me think that there are some unique Massachusetts factors (maybe weakness in the better-paying specialist field, maybe higher taxes overall that make becoming a Massachusetts general practitioner unattractive) which is exerting a larger influence than is Obamacare. Also, it's worth noting that the ACA recognized this effect (increased waiting times due to sudden higher demand) and includes some steps to mediate it, such as funding for training and subsidizing general practitioners and nurses. Perhaps these need to be increased, perhaps these need to be better divided between states (i.e. the same pay in rural North Dakota would provide a much better standard of living that in urban Massachusetts), or perhaps there is some other ACA factor that needs to be addressed/adjusted.
It's also worth pointing out that while the initial flood of insured generates more Stage 2 or higher cancers or similar problems, over time that should reverse as more cancers are found earlier, in more easily (and cheaply) treated stages.
No. It's what happens when human beings undertake complex tasks in a short period of time.
The people who actually write things, are people. They are not infallible.
All this case was about was, some very clever people spent a lot of time looking for ways to undo the law, and they came across this apparent contradiction, and ran with it.
No one with any sense could possibly believe that Congress intended that the mechanism they created for letting people apply for subsidies, when a state did not set up it's own exchange, would then deny all applicants.
No. What happened was that the architect and perhaps his immediate backers had one vision, whereas the main body of the supporters had a different vision. Gruber is on record multiple times explicitly pointing this out as the intent and he was THE architect. However he appears to have been leading the only force with that intent - thus the lack of dissent from Democrat Representatives who would be expected to catch holy Hell if their red state constituencies were excluded from benefits others receive (assuming THAT would pass SCOTUS's review, which I doubt) and the other sections which imply that the federal exchange is a substitute in every way for a state exchange. Which it should be - not every state has the money or the population to justify setting up an exchange, and some states will fail spectacularly, so the federal exchange needs to be available as a backstop rather than penalizing citizens as a means of pressuring politicians. (Shades of Christie!)
Its going to death spiral anyway.
<-- This is me not caring since I now have employer insurance. But let me tell you... the individual market is basically dead.
And for all the older people with nice plans who think they did a good thing supporting obamacare... wait for the cadillac tax
.
The ACA is not one size fits all. Guess who it fucks over? Hmm lets see. Temp workers. New college grads. Older Atypical college students who try to work while in college. People going back to college. People changing careers. etc. etc.
The ACA was never meant to be our forever system; Obama himself is on audio tape stating that he can't go to a fully socialized single payer system immediately, but he can move us toward that. Instead it was designed to seize control of health care for the federal government. As support for a single payer system grows, more onerous burdens can be placed on insurance companies, which will generate more support for a single payer system. Until that time, Obamacare can easily delay, modify and shift around as needed to continue as long as it needs to continue.
As for the individual market, it's hardly dead. Many if not most states are seeing very large increases requested this year, but that's to be expected as the system shakes down and insurers get better handles on cost. Probably be modest decreases next year as the flood of first-timers' health issues are handled and insurers develop better models and better mechanisms for handling the individual policy market. If not, the bureaucracy can mandate changes to shift some of that individual policy cost to group policy costs. Either way, I doubt the ACA will collapse before we have single payer.
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