It's already happening. A friend received a letter informing her she'd be dropped by her carrier at year's end. She gets her coverage through NJ's marketplace since she's retired but not yet qualified for Medicare. The "Big Beautiful Bill" strips away incentive $'s previously paid to insurers which made it possible for them to participate in health insurance marketplaces/exchanges in the first place. My friend has no idea what she's going to do & can't afford a pricier policy from a private insurer. This is the real world impact this legislation has set in motion- nothing "Beautiful" for tens of millions of Americans.
That’s awful. These are the stories that need to be shared so people understand what’s really happening out there. Most of America doesn’t view people like your friend as the “welfare cheats” that the bill supporters claim they’re targeting.
The ACA was designed to try to back-load the real costs of the plan onto later years, and to minimize transparency of those costs, so it would be able to pass in Congress. Please reference Jonathan Gruber, the MIT economist who played a large role in the development of the ACA. The ultimate end game was that when ACA failed because it was financially unsustainable in later years (i.e. about where we are right now), the U.S. would then be primed to transition to a single-payer health care system. Regardless of trying to blame everything bad on Trump, the ACA as originally implemented was never going to be sustainable in the long term, because it wasn't meant to be a long term plan--simply an on-ramp to establishing a single-payer health care system in the U.S.A. In fact ACA isn't even "insurance"---it's a subsidy system for young healthy people to subsidize the health care costs of older sicker people.
It’s always good to hear from you. I don't think I blame "every" bad thing on Trump. But he definitely gives me enough material to keep this blog going. So...let me take a minute to respond to a few of your points.
First, while Jonathan Gruber was involved in the development of the Affordable Care Act, he wasn’t its sole architect. As Politico reported, “Gruber depicts himself as the architect, but hundreds of people were involved in the law’s drafting.” The ACA was the product of extensive collaboration among lawmakers, policy experts, and stakeholders. He's entitled to his views and opinions, but they're not widely shared by those involved in the legislation.
Second, the idea that the ACA was designed to fail as an on ramp to a single-payer system is really misleading. The ACA was intentionally built as a middle-ground solution: it preserved the private insurance market, expanded Medicaid only in states that opted in, and created regulated marketplaces for individuals. If the true goal had been to pave the way for a single-payer system, the legislation would have looked very different.
Third, while the ACA isn’t perfect (no major legislation ever is), the evidence doesn’t support the claim that it’s collapsing financially. Enrollment has grown, premiums have stabilized, and insurer participation in the exchanges remains strong. Much of the challenges it has today are not from inherent flaws in the bills design, but from repeated political and legal attempts to weaken it over the past decade.
Finally, I think it's an oversimplification to call the ACA a “subsidy system” where young, healthy people cover the costs of older, sicker ones. In reality, that’s how all insurance works—public or private—through risk pooling. The ACA simply made that structure more transparent by participation mandates and tying any subsidies to income, not age or health.
At its core, the ACA was designed to create a more stable and inclusive health insurance market: one that expanded access, eliminated preexisting condition exclusions, and protected everyone—not just those who could afford to be healthy. And it's done a pretty good job of it.
Really? So when you pay your home owners insurance premium or auto insurance premium or life insurance your family's AGI is an input into the underwriting, your premiums, deductibles, and co-pays? Just like the ACA? I just renewed my auto, homeowners and umbrella insurance. I was not asked what our AGI is and while my premiums may be based on part on my claims history and driving record, funnily enough, and unlike the ACA, apparently my income level was not deemed relevant.
Yup, in those instances your income level is irrelevant. That’s because those products are sold in private markets, where insurers price based on individual risk and profit margins. Health insurance is different—for one critical reason: in America, we’ve decided that access to health care shouldn’t be determined solely by income or health status.
So yes, the ACA treats income as relevant—not for calculating risk, but for determining how much help people need to afford care. It’s a public policy choice, not a pricing algorithm. And one that reflects a belief that access to health care (not guaranteed coverage, just affordable access) shouldn’t just be for the wealthy or the lucky—it should be for everyone.
Apparently, that's not a belief that this administration seems to share...
That's not actually true either because ACA does not base premiums, subsidies, co-pays, etc. on net worth. Only on AGI. So for example an early retiree who is not yet taking Social Security or eligible for Medicare but has a substantial portfolio can manage their AGI to get subsidized health insurance via the ACA even if they have substantial assets.
Edited to add: Also, reciting progressive mantras such as "access to health care [affordable access] shouldn't just be for the wealthy or the lucky--it should be for everyone" is a cop out since it doesn't actually accomplish anything except allowing whoever says it to feel self-righteous.
Everyone should have access to all the healthcare they want or need is fine and dandy until it has to be implemented. Allocation of valuable societal resources such as health care implicitly requires a system of rationing for multiple reasons such as 1) there is not an unlimited supply of the valuable assets, in fact to a large degree it is a scarce asset 2) related issues such as moral hazard (if you provide unlimited "free" goods or services which are not actually "free" but paid for by someone else than the recipient, you create huge incentives to waste etc.
So actually Hal in a very fundamental sense universal and unlimited access to any valuable goods or services is bad politics, bad social and economic policy, and basically a pipe dream.
Rationally is economically necessary, and it will occur because it must. The only question is how the rationing occurs--how much will be private action, corporate action, government action, etc.
Using a non-health care hypothetical that might be a bit closer to lived experience, I could just as easily (as you did with health care--as other progressives seem to agree) declare as "axiomatic" the notion that safe, secure and comfortable housing is an absolute human right. And as a corollary to that self-declared axiomatic proposition, further declare that those of us privileged and fortunate to have an abundance of these scarce resources have a legal, ethical, and moral obligation to share said resources with other people who are lacking. And if not willing to share voluntarily, be taxed or otherwise forced to share under threat of government compulsion or penalty.
In fact the Governor of Massachusetts, an extreme progressive, not too far in the past asked more fortunate Massachusetts homeowners to take into their homes and subsidize less fortunate people such as undocumented migrants.
Hal, you just bought a very nice, very large 4 bedroom 4 bath home in Stockbridge. It looks like there is quite a bit of extra room from the pictures.
It seems to me that the progressive logic you have been exclusively promulgating on your blog (and clearly that the governor believes in) almost demands that you seriously consider housing a family of undocumented migrants since you have the extra space. That is simply from a consistency viewpoint.
I am not saying you should. I believe the opposite: Your wonderful 2nd home that you just bought is primarily the fruits of your and your spouse's hard labors over decades of work and you deserve to use or not use those fruits within your and your spouse's sole discretion.
Alan, once again, you've packed a lot into your comment—housing policy, undocumented immigration, personal anecdotes about my home, my professional success, and even moral philosophy. But none of that is really what this post is about.
This piece was about how we, as a country, choose to prioritize our public spending. You talked about the need to ration finite resources. I agree—every budget is about tradeoffs. My point is simply that the “Big Beautiful Bill” makes those tradeoffs in a way that says we can afford to massively expand ICE, increase military spending, and offer tax breaks to people who are already doing just fine—but not maintain healthcare coverage for working-class families and children with disabilities. That’s a values statement, and one I disagree with.
When you say that people with assets can still qualify for coverage based on their AGI, you're right. That’s not a flaw unique to the ACA—it’s consistent with how most need-based programs work. Income is a far more reliable indicator of a person’s ability to pay for ongoing expenses like monthly premiums. The fact that some wealthy early retirees can manipulate AGI to qualify for subsidies is well understood in policy circles. And it almost never happens. Still, it's not a reason to abandon a system that has expanded insurance coverage to over 40 million Americans and drastically reduced the uninsured rate.
The point of this post is about national spending priorities. This bill reflects a worldview where expelling longtime law-abiding residents and funding immigration enforcement is more important than keeping cancer patients and medically fragile children covered. I guess I simply believe differently about this than you do. Fair enough....
Hal, I don't think in any of my responses that I've render d judgment one way or the other on any of the specific policy issues you've brought up as inherently "good" or "bad." What I've tried to convey but evidently not clearly enough is that all of the people who voted differently than you would have liked them to on an issue aren't evil, cruel, ignorant or stupid. That's just a consequence of living in a democracy. Just because you don't understand why people might have different opinions than you do, doesn't mean I agree with them or you, and it also doesn't make them wrong, evil, or dumb. Not does it make you wrong evil or dumb. When you criticize your elected representative for voting contrary to your wishes, and therefore the implication is he is being wrong, evil, stupid or bad, you are failing to realize he is voting according to his views of what is best overall for his constituents. Constantly attributing or implying bad motives or stupidity to everyone who disagrees with them politically is a serious failing amongst progressives. And it's not a very effective persuasion technique. You did this with Murkowski too. Responding by saying things implying that people who voted contrary to your wishes want to hurt or deny medical care to all the disabled little children is simply an emotional manipulation tactic. As I tried to point out in a prior response, but you ignored, legislation is all about how society chooses to allocate scarce resources. It's inevitable that choices have to be made but that doesn't mean half the country is evil or stupid for disagreeing with you this time around. And obviously your congress critter voted to increase the SALT tax along with the rest of the bill because that's what his well off but highly taxed constituents wanted him to do. Or at least his best judgment on the issue. If you now believe that a moral issue is implicated, you have the power to exercise your individual judgment contrary to what you seem to believe is the cruelty of all those Maga people that you have othered. You can either choose to simply not take the SALT deduction above $10,000 allowing those excess funds to remit to the government and lessen the national debt. Or you can take that extra tax benefit assuming you are eligible for it and donate those funds directly to a worthy cause of your choosing, including for disabled children. If you accept the benefits of the legislation despite believing that a serious moral imperative is involved, then like many progressives your position will be seen by others as simply a sanctimonious assumption of a mantle of moral superiority that has no actual consequences. And when you say that people who are here in violation of immigration laws are "law abiding citizens," you deny reality. They are at a minimum in violation of immigration laws and regulations. Denying reality in such a brazen manner sends a message that you think other people who favor deporting them are stupid and evil to not believe progressive propaganda and disinformation techniques. And also ignores that it was deliberate Biden administration policy to allow millions to enter or stay over freely, in violation of those laws, and in large measure Trump was reelected in reaction to those Democratic policy abuses. They didn't just drop out of the sky one day through no fault of their own and no fault of Democratic policy choices. People who disagree with you aren't evil, ignorant or stupid because they have decided enough is enough, at least with the most recent election. Not cowardly as you called Murkowski. And again if you think this is all a matter of good and evil not simply a political allocation of scarce resources in a democratic Republic, you still have the available individual choice to do what you seem to believe is the "right thing" morally and ethically and follow Maura Healey's suggestion to Massachusetts homeowners to offer to house an undocumented immigrant or immigrants on an emergency basis to help alleviate some of the severe suffering that is going on up there as apparently Healey has severely cut the governmental resources available to homeless immigrants in the interval since she originally made her suggestion on August 2023. That's not a choice I would personally make even if I had the resources since being responsible for unvetted strangers who I can't even communicate with seems to be fraught with many unknowable risks. In other words it is exactly the sort of idiotic presumptuous policy idea that progressives are fond of because they are trying to appeal to emotions and guilt, but is just so impractical and clueless it turns people off. In any event she walked back a large part of her smug moral progressive superiority on the immigrant housing issue because Massachusetts tax payers have decided they can't afford to be so generous to people who shouldn't even be in this country in the first place and are here illegally. As a wise men said, money talks...well, you know the rest.
It's already happening. A friend received a letter informing her she'd be dropped by her carrier at year's end. She gets her coverage through NJ's marketplace since she's retired but not yet qualified for Medicare. The "Big Beautiful Bill" strips away incentive $'s previously paid to insurers which made it possible for them to participate in health insurance marketplaces/exchanges in the first place. My friend has no idea what she's going to do & can't afford a pricier policy from a private insurer. This is the real world impact this legislation has set in motion- nothing "Beautiful" for tens of millions of Americans.
That’s awful. These are the stories that need to be shared so people understand what’s really happening out there. Most of America doesn’t view people like your friend as the “welfare cheats” that the bill supporters claim they’re targeting.
The ACA was designed to try to back-load the real costs of the plan onto later years, and to minimize transparency of those costs, so it would be able to pass in Congress. Please reference Jonathan Gruber, the MIT economist who played a large role in the development of the ACA. The ultimate end game was that when ACA failed because it was financially unsustainable in later years (i.e. about where we are right now), the U.S. would then be primed to transition to a single-payer health care system. Regardless of trying to blame everything bad on Trump, the ACA as originally implemented was never going to be sustainable in the long term, because it wasn't meant to be a long term plan--simply an on-ramp to establishing a single-payer health care system in the U.S.A. In fact ACA isn't even "insurance"---it's a subsidy system for young healthy people to subsidize the health care costs of older sicker people.
Hi Alan,
It’s always good to hear from you. I don't think I blame "every" bad thing on Trump. But he definitely gives me enough material to keep this blog going. So...let me take a minute to respond to a few of your points.
First, while Jonathan Gruber was involved in the development of the Affordable Care Act, he wasn’t its sole architect. As Politico reported, “Gruber depicts himself as the architect, but hundreds of people were involved in the law’s drafting.” The ACA was the product of extensive collaboration among lawmakers, policy experts, and stakeholders. He's entitled to his views and opinions, but they're not widely shared by those involved in the legislation.
Second, the idea that the ACA was designed to fail as an on ramp to a single-payer system is really misleading. The ACA was intentionally built as a middle-ground solution: it preserved the private insurance market, expanded Medicaid only in states that opted in, and created regulated marketplaces for individuals. If the true goal had been to pave the way for a single-payer system, the legislation would have looked very different.
Third, while the ACA isn’t perfect (no major legislation ever is), the evidence doesn’t support the claim that it’s collapsing financially. Enrollment has grown, premiums have stabilized, and insurer participation in the exchanges remains strong. Much of the challenges it has today are not from inherent flaws in the bills design, but from repeated political and legal attempts to weaken it over the past decade.
Finally, I think it's an oversimplification to call the ACA a “subsidy system” where young, healthy people cover the costs of older, sicker ones. In reality, that’s how all insurance works—public or private—through risk pooling. The ACA simply made that structure more transparent by participation mandates and tying any subsidies to income, not age or health.
At its core, the ACA was designed to create a more stable and inclusive health insurance market: one that expanded access, eliminated preexisting condition exclusions, and protected everyone—not just those who could afford to be healthy. And it's done a pretty good job of it.
Really? So when you pay your home owners insurance premium or auto insurance premium or life insurance your family's AGI is an input into the underwriting, your premiums, deductibles, and co-pays? Just like the ACA? I just renewed my auto, homeowners and umbrella insurance. I was not asked what our AGI is and while my premiums may be based on part on my claims history and driving record, funnily enough, and unlike the ACA, apparently my income level was not deemed relevant.
Yup, in those instances your income level is irrelevant. That’s because those products are sold in private markets, where insurers price based on individual risk and profit margins. Health insurance is different—for one critical reason: in America, we’ve decided that access to health care shouldn’t be determined solely by income or health status.
So yes, the ACA treats income as relevant—not for calculating risk, but for determining how much help people need to afford care. It’s a public policy choice, not a pricing algorithm. And one that reflects a belief that access to health care (not guaranteed coverage, just affordable access) shouldn’t just be for the wealthy or the lucky—it should be for everyone.
Apparently, that's not a belief that this administration seems to share...
That's not actually true either because ACA does not base premiums, subsidies, co-pays, etc. on net worth. Only on AGI. So for example an early retiree who is not yet taking Social Security or eligible for Medicare but has a substantial portfolio can manage their AGI to get subsidized health insurance via the ACA even if they have substantial assets.
Edited to add: Also, reciting progressive mantras such as "access to health care [affordable access] shouldn't just be for the wealthy or the lucky--it should be for everyone" is a cop out since it doesn't actually accomplish anything except allowing whoever says it to feel self-righteous.
Everyone should have access to all the healthcare they want or need is fine and dandy until it has to be implemented. Allocation of valuable societal resources such as health care implicitly requires a system of rationing for multiple reasons such as 1) there is not an unlimited supply of the valuable assets, in fact to a large degree it is a scarce asset 2) related issues such as moral hazard (if you provide unlimited "free" goods or services which are not actually "free" but paid for by someone else than the recipient, you create huge incentives to waste etc.
So actually Hal in a very fundamental sense universal and unlimited access to any valuable goods or services is bad politics, bad social and economic policy, and basically a pipe dream.
Rationally is economically necessary, and it will occur because it must. The only question is how the rationing occurs--how much will be private action, corporate action, government action, etc.
Using a non-health care hypothetical that might be a bit closer to lived experience, I could just as easily (as you did with health care--as other progressives seem to agree) declare as "axiomatic" the notion that safe, secure and comfortable housing is an absolute human right. And as a corollary to that self-declared axiomatic proposition, further declare that those of us privileged and fortunate to have an abundance of these scarce resources have a legal, ethical, and moral obligation to share said resources with other people who are lacking. And if not willing to share voluntarily, be taxed or otherwise forced to share under threat of government compulsion or penalty.
In fact the Governor of Massachusetts, an extreme progressive, not too far in the past asked more fortunate Massachusetts homeowners to take into their homes and subsidize less fortunate people such as undocumented migrants.
Hal, you just bought a very nice, very large 4 bedroom 4 bath home in Stockbridge. It looks like there is quite a bit of extra room from the pictures.
It seems to me that the progressive logic you have been exclusively promulgating on your blog (and clearly that the governor believes in) almost demands that you seriously consider housing a family of undocumented migrants since you have the extra space. That is simply from a consistency viewpoint.
I am not saying you should. I believe the opposite: Your wonderful 2nd home that you just bought is primarily the fruits of your and your spouse's hard labors over decades of work and you deserve to use or not use those fruits within your and your spouse's sole discretion.
Alan, once again, you've packed a lot into your comment—housing policy, undocumented immigration, personal anecdotes about my home, my professional success, and even moral philosophy. But none of that is really what this post is about.
This piece was about how we, as a country, choose to prioritize our public spending. You talked about the need to ration finite resources. I agree—every budget is about tradeoffs. My point is simply that the “Big Beautiful Bill” makes those tradeoffs in a way that says we can afford to massively expand ICE, increase military spending, and offer tax breaks to people who are already doing just fine—but not maintain healthcare coverage for working-class families and children with disabilities. That’s a values statement, and one I disagree with.
When you say that people with assets can still qualify for coverage based on their AGI, you're right. That’s not a flaw unique to the ACA—it’s consistent with how most need-based programs work. Income is a far more reliable indicator of a person’s ability to pay for ongoing expenses like monthly premiums. The fact that some wealthy early retirees can manipulate AGI to qualify for subsidies is well understood in policy circles. And it almost never happens. Still, it's not a reason to abandon a system that has expanded insurance coverage to over 40 million Americans and drastically reduced the uninsured rate.
The point of this post is about national spending priorities. This bill reflects a worldview where expelling longtime law-abiding residents and funding immigration enforcement is more important than keeping cancer patients and medically fragile children covered. I guess I simply believe differently about this than you do. Fair enough....
Hal, I don't think in any of my responses that I've render d judgment one way or the other on any of the specific policy issues you've brought up as inherently "good" or "bad." What I've tried to convey but evidently not clearly enough is that all of the people who voted differently than you would have liked them to on an issue aren't evil, cruel, ignorant or stupid. That's just a consequence of living in a democracy. Just because you don't understand why people might have different opinions than you do, doesn't mean I agree with them or you, and it also doesn't make them wrong, evil, or dumb. Not does it make you wrong evil or dumb. When you criticize your elected representative for voting contrary to your wishes, and therefore the implication is he is being wrong, evil, stupid or bad, you are failing to realize he is voting according to his views of what is best overall for his constituents. Constantly attributing or implying bad motives or stupidity to everyone who disagrees with them politically is a serious failing amongst progressives. And it's not a very effective persuasion technique. You did this with Murkowski too. Responding by saying things implying that people who voted contrary to your wishes want to hurt or deny medical care to all the disabled little children is simply an emotional manipulation tactic. As I tried to point out in a prior response, but you ignored, legislation is all about how society chooses to allocate scarce resources. It's inevitable that choices have to be made but that doesn't mean half the country is evil or stupid for disagreeing with you this time around. And obviously your congress critter voted to increase the SALT tax along with the rest of the bill because that's what his well off but highly taxed constituents wanted him to do. Or at least his best judgment on the issue. If you now believe that a moral issue is implicated, you have the power to exercise your individual judgment contrary to what you seem to believe is the cruelty of all those Maga people that you have othered. You can either choose to simply not take the SALT deduction above $10,000 allowing those excess funds to remit to the government and lessen the national debt. Or you can take that extra tax benefit assuming you are eligible for it and donate those funds directly to a worthy cause of your choosing, including for disabled children. If you accept the benefits of the legislation despite believing that a serious moral imperative is involved, then like many progressives your position will be seen by others as simply a sanctimonious assumption of a mantle of moral superiority that has no actual consequences. And when you say that people who are here in violation of immigration laws are "law abiding citizens," you deny reality. They are at a minimum in violation of immigration laws and regulations. Denying reality in such a brazen manner sends a message that you think other people who favor deporting them are stupid and evil to not believe progressive propaganda and disinformation techniques. And also ignores that it was deliberate Biden administration policy to allow millions to enter or stay over freely, in violation of those laws, and in large measure Trump was reelected in reaction to those Democratic policy abuses. They didn't just drop out of the sky one day through no fault of their own and no fault of Democratic policy choices. People who disagree with you aren't evil, ignorant or stupid because they have decided enough is enough, at least with the most recent election. Not cowardly as you called Murkowski. And again if you think this is all a matter of good and evil not simply a political allocation of scarce resources in a democratic Republic, you still have the available individual choice to do what you seem to believe is the "right thing" morally and ethically and follow Maura Healey's suggestion to Massachusetts homeowners to offer to house an undocumented immigrant or immigrants on an emergency basis to help alleviate some of the severe suffering that is going on up there as apparently Healey has severely cut the governmental resources available to homeless immigrants in the interval since she originally made her suggestion on August 2023. That's not a choice I would personally make even if I had the resources since being responsible for unvetted strangers who I can't even communicate with seems to be fraught with many unknowable risks. In other words it is exactly the sort of idiotic presumptuous policy idea that progressives are fond of because they are trying to appeal to emotions and guilt, but is just so impractical and clueless it turns people off. In any event she walked back a large part of her smug moral progressive superiority on the immigrant housing issue because Massachusetts tax payers have decided they can't afford to be so generous to people who shouldn't even be in this country in the first place and are here illegally. As a wise men said, money talks...well, you know the rest.